Review Questions
Because school-age children have developed increased muscular coordination and can apply cognitive ability to their behavior, the number of injuries in middle childhood is diminished compared to early childhood. Even so, injuries still occur near home and school. The most effective means of prevention is education regarding the hazards of risk-taking and the improper use of equipment. Please match the developmental ability of the school-age child with the injury for which he or she is at risk: 1. Is apt to overdo 2. Confidence exceeds physical ability 3. Is excited by speed and motion 4. Enjoys trying new things 5. Easily influenced by peers A. Motor Vehicle Accidents B. Drowning C. Burns D. Poisoning E. Bodily damage
1; B 2; E 3; A 4; C 5; D or C
A nurse is providing discharge teaching to the parent of an 18 month old toddler who has dehydration as a result of acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? A. "I will monitor my child's number of wet diapers" B. "I will offer my child small amounts of fruit juice frequently" C. "I will give my child polyethylene glycol daily for 7 days" D. "I will avoid giving my child solid foods until his diarrhea has stopped."
A. "I will monitor my child's number of wet diapers"
The patient is ordered daily divided doses of gentamycin. The patient completed an intravenous dose of gentamycin at 4:00 PM. When should the nurse obtain the peak level? A. 4:30 PM B. 5:00 PM C. 5:30 PM D. 6:00 PM
A. 4:30 PM
The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often, because they are so effective. The nurse will offer which information that is true for children? A. Chronic oral steroid use can inhibit growth. B. Frequent use of this drug may lead to a decreased response. C. A hypersensitivity reaction to this drug may occur. D. Systemic steroids are more toxic in children.
A. Chronic oral steroid use can inhibit growth.
What is the overriding goal of atraumatic care? a. Prevent or minimize the child's separation from family b. Do no harm c. Promote a sense of self control d. Prevent or minimize bodily injury and pain
B. Do no harm
A patient is prescribed vancomycin orally for antibiotic-associated pseudomembranous colitis. The nurse will monitor the patient for what? a. Leukopenia b. Red man syndrome c. Liver impairment d. Ototoxicity
D.
The nurse is caring for a patient receiving intravenous gentamicin for a severe bacterial infection. Which assessment finding by the nurse indicates the patient is experiencing an adverse effect of gentamycin therapy? A. Blurred vision B. Hand tremors C. Urinary frequency D. Tinnitus
D. Tinnitus
The major goals of therapy for children with cerebral palsy include: A. reversing degenerative processes that have occurred. B. curing underlying defect causing the disorder. C. preventing spread to individuals in close contact with the child. D. recognizing the disorder early and promoting optimal development.
D. recognizing the disorder early and promoting optimal development.
Which heart defect and hemodynamic change pairing is correct? a. Aortic stenosis and obstruction to blood flow out of the heart b. VSD and decreased pulmonary blood flow c. Tricuspid atresia and increased pulmonary blood flow d. AV canal and mixed blood flow
a. Aortic stenosis and obstruction to blood flow out of the heart
You are admitting a patient and note the presence of exopathlamos, weight loss, and increased pulse. You recognize this group of symptoms as __________ and a nursing intervention as ________________________. a. Graves' disease: encourage rest and increase calorie intake b. Diabetes Insipidus: replace ADH (antidiuretic hormone) c. Congenital adrenal hyperplasia: supplement cortisol d. Hashimoto's disease, replace thyroid hormone
a. Graves' disease: encourage rest and increase calorie intake
A nurse is caring for a 8 year old child who has acute glomerulonephritis. Which of the following findings should the nurse expect? a. Periorbital edema b. Stomatitis c. Hypotension d. Bloody diarrhea
a. Periorbital edema
Which statement by the parent of an uncircumcised male infant would indicate the need for further teaching? a. "I should avoid using harsh soaps when cleaning my baby" b. "I should forcibly retract the foreskin of the penis once a day" c. "Once the foreskin is retractable, it should be returned to its normal position after cleaning" d. "Frequent diaper changes are important"
b. "I should forcibly retract the foreskin of the penis once a day"
The nurse is ready to assess an eight month old who is sitting quietly on his mother's lap chewing on a toy. Which should the nurse do first? a. Elicit reflexes b. Auscultate heart and lungs c. Examine eyes, ears, and mouth d. Examine the head, moving toward the feet
b. Auscultate heart and lungs
A child just returned from surgery in a hip spica cast. The PRIORITY nursing intervention is to: a. elevate the head of the bed. b. Check circulation c. turn the child to the right side d. offer sips of water
b. Check circulation
Which of the following is NOT a symptom of Kawasaki's Disease? a. Strawberry tongue b. Koplik spots on the buccal mucosa c. Edematous, peeling hands and feet d. Red conjunctiva without drainage e. Fever > 38C for greater than 5 days
b. Koplik spots on the buccal mucosa this is a symptom of measles
Which behavior suggests appropriate psychosocial development in the adolescent? a. The adolescent seeks validation for socially acceptable behavior from older adults b. The adolescent is self-absorbed and self-centered and has sudden mood swings. c. Adolescents move from peers and enjoy spending time with family members d. Conformity with the peer group increases in late adolescence
b. The adolescent is self-absorbed and self-centered and has sudden mood swings.
When discussing a child's precocious puberty with the parents, the nurse should tell them that: a. the child is not yet fertile b. dress and activities should be appropriate to chronological age c. appearance of secondary sexual characteristics doesn't proceed in the usual order d. heterosexual interest may also be advanced
b. dress and activities should be appropriate to chronological age
An appropriate intervention to provide comfort for the child with itching associated with chickenpox is to: a. Encourage frequent, warm baths b. Give aspirin or acetaminophen c. Give an anti-pruritic medication such as Benadryl d. Apply a thick coat of Caladryl lotion over open lesions
c. Give an anti-pruritic medication such as Benadryl Cool baths are recommended for relief of itching. Neither drug has antiitching effects. Antipruritic medicines such as diphenhydramine (Benadryl) are useful for severe itching, which interferes with sleep and may contribute to secondary infection. Caladryl lotion (contains Benadryl) should be applied sparingly over open lesions to minimize absorption.
A patient is prescribed doxycycline [Vibramycin]. The patient complains of gastric irritation, what should the nurse do? a. Instruct the patient to take the medication with milk b. Tell the patient to take an antacid with the medication c. Give the patient food, such as crackers or toast, with the medication d. Have the patient stop the medication immediately and contact the health care provider
c. Give the patient food, such as crackers or toast, with the medication
A child who receives valproic acid (Depakote) begins taking lamotrigine (Lamictal) because of an increase in the number of seizures. The nurse will observe this child closely for which symptom? a. Angioedema b. Hypohidrosis c. Rash d. Psychosis
c. Rash Increased risk for Steven's Johnson syndrome
Jordan is 7 years old and in chronic renal failure awaiting transplant. Which of the following lab values supports the diagnosis of chronic renal failure? a. K+ of 4.0 b. BUN of 12 c. Na+ 140 d. Creatinine of 2.5
d. Creatinine of 2.5
Why are infants particularly vulnerable to acceleration-deceleration head injuries? a. The anterior fontanel is not closed b. The nervous tissue is not well developed c. The scalp is very vascular d. Musculoskeletal support of the head and neck is insufficient
d. Musculoskeletal support of the head and neck is insufficient
A nurse is reviewing the laboratory report of a 2-year-old child who has diarrhea and has been vomiting for 24 hours. Which of the following findings should the nurse report to the provider? a. Hematocrit 40% b. Serum creatinine of 0.4 mg/dl c. BUN 6 mg/dl d. Potassium,, 2.5 mEq/L
d. Potassium,, 2.5 mEq/L A potassium of 2.5 mEq/L indicates hypokalemia, which can cause arrythmias or even cardiac arrest, therefore, the nurse should report this finding to the provider
A nurse is caring for an infant following surgical repair of a cleft lip and palate. Which of the following actions should the nurse take? a. Keep the infant's mouth open by using a tongue blade for four hours following surgery b. Place the infant in the prone position c. Clean the infant's incision with chlorhexidine d. Suction the infant gently with a bulb syringe PRN
d. Suction the infant gently with a bulb syringe PRN The nurse should gently suction the infant's mouth with a bulb syringe to maintain a patent airway
An adolescent boy tells the nurse that he has recently had homosexual feelings. The nurse's response should be based on what knowledge? a. This indicates that the adolescent is homosexual. b. This indicates that the adolescent will become homosexual as an adult. c. The adolescent should be referred for psychotherapy d. The adolescent should be encouraged to share his feelings and experiences.
d. The adolescent should be encouraged to share his feelings and experiences.
An important nursing intervention when caring for a child with myelomeningocele in the postoperative stage is to: a. place child on his or her side to decrease pressure on the spinal cord. b. apply a heat lamp to facilitate drying and toughening of the sac. c. keep skin clean and dry to prevent irritation from diarrheal stools. d. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.
d. measure head circumference and examine fontanels for signs that might indicate developing hydrocephalus.
A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to: A. Discuss using an intranasal glucocorticoid and loratadine [Claritin]. B. Report acute toxicity caused by pseudoephedrine. C. Suggest using an agent with a sympathomimetic drug only. D. Suggest using a topical decongestant to minimize systemic symptoms.
A. Discuss using an intranasal glucocorticoid and loratadine [Claritin].
A patient with a history of a severe anaphylactic reaction to penicillin has an order to receive cephalosporin. What should the nurse do? a. Administer the cephalosporin as ordered. b. Contact the health care provider for a different antibiotic. c. Administer a test dose of cephalosporin to determine reactivity. d. Have an epinephrine dose available when administering the cephalosporin.
B
What should the nurse include when teaching an adolescent with Crohn's Disease? a. Coping with stress and adjusting to chronic illness. b. Nutritional guidance and preventing constipation. c. Adjusting to chronic illness and preventing spread of illness to others. d. Preventing spread of illness to others and nutritional guidance.
a. Coping with stress and adjusting to chronic illness.
A 5-year-old is admitted to the hospital with suspected meningitis. Which nursing intervention would be included in the child's plan of care? a. Dim the lights and quiet the room as much as possible b. Play music the child enjoys c. Provide a high calorie diet d. Measure the child's head circumference
a. Dim the lights and quiet the room as much as possible
During an otoscopic examination of an infant, in which direction is the pinna pulled? a. Down and back b. Down and forward c. Up and back d. Up and forward
a. Down and back
A nurse is reviewing laboratory results of a school aged child who had surgery for an open fracture repair. Which of the following lab results is concerning for infection? a. ESR 18 mm/hr (normal 0-10) b. WBC 6,200 c. CRP 1.4 (normal 1-4) d. RBC 4.7
a. ESR 18 mm/hr (normal 0-10)
Josie's (age 5) mom and dad are concerned that she tires quickly and is taking extra naps. When you examine her, you notice that her skin appears pale, her mucous membranes and conjunctiva are also pale. Which lab value from the Complete Blood Count with Differential explains Josie's symptoms? a. Hemoglobin of 8.5gm/dL b. Hematocrit value of 45% c. White blood cell count of 14,000 d. Platelet count of 150,000
a. Hemoglobin of 8.5gm/dL
The nurse who is concerned about increased intracranial pressure in the infant assesses for: a. Irritability b. A pulsating anterior fontanel c. Photophobia d. Vomiting and Diarrhea
a. Irritability
Cystic Fibrosis may affect singular or multiple systems of the body. The primary factor responsible for possible multiple clinical manifestations is: a. Mechanical obstruction caused by increased viscosity of mucous gland secretions b. Atrophic changes in the mucosal wall of the intestines c. Hypoactivity of the autonomic nervous system d. Hyperactivity of the sweat glands
a. Mechanical obstruction caused by increased viscosity of mucous gland secretions
A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect? a. Widened pulse pressure b. Murmur at the left sternal border c. Diastolic murmur d. Cyanosis that increases with crying
b. Murmur at the left sternal border A VSD is an acyanotic heart defect. A systolic murmur can be best heard at the lower left sternal border. Sound is transmitted in the direction of blood flow, so any backflow of blood from the left to the right ventricle through the septal defect is best heard in this area.
A clinic nurse is teaching a family about the care of their 3-year-old with eczema. Which action would indicate the family understood the teaching? a. Bubble bath is always used to bathe the child b. Parents dress the child in loose cotton clothing c. Moisturizers are applied about 30 minutes after a bath d. The parents scrub the skin dry after bathing
b. Parents dress the child in loose cotton clothing Never use bubble bath to bathe a child with eczema. The child should be gently blotted dry after the bath and a moisturizer placed on him within three minutes of getting out of the bath. Loose cotton clothing helps decrease eczema irritation.
Molly is a 3 year old whose mother is concerned that she is "full of bruises" and has frequent bloody noses. The provider obtains some Complete Blood Count with a Differential to further explore this concern. Which of the following lab values explains Molly's bruising and bloody noses (epistaxis)? a. Sodium (Na) of 135 b. Platelet count of 20,000 c. Hemoglobin of 8.5 gm/dL d. White blood cell count of 16,000
b. Platelet count of 20,000
A infant with congenital heart defect is receiving palivizumab (Synagis). The purpose of this is to: a. Decrease toxicity of antiviral agents b. Prevent respiratory syncytial virus (RSV) infection c. Make isolation of the infant unnecessary d. Prevent secondary bacterial infection
b. Prevent respiratory syncytial virus (RSV) infection Synagis is a monoclonal antibody specific for respiratory syncytial virus (RSV). Monthly administration is expected to prevent infection with RSV. The goal of this drug is prevention of RSV. It will not affect the need to isolate the child if RSV develops. The antibody is specific to RSV, not bacterial infection. This will have no effect on antiviral agents.
A nurse is reviewing the laboratory report of an infant who is receiving treatment for severe dehydration. The nurse should identify that which of the following laboratory values indicates effectiveness of the current treatment? a. Urine specific gravity of 1.035 b. Sodium 140 mEq/L c. BUN 25 mg/dL d. Potassium 2.9 mEq/L
b. Sodium 140 mEq/L
Which statement best describes HIrschprung's disease? a. There is passage of excessive amounts of meconium in the neonate. b. The colon has an aganglionic segment c. It results in excessive peristaltic movements within the gastrointestinal tract. d. It results in frequent evacuation of solids, liquid, and gas.
b. The colon has an aganglionic segment
The nurse encourages the mother of a toddler with acute laryngotracheobronchitis (LTB; croup) to stay at the bedside as much as possible. The nurse's rationale for this action is described primarily in which statement? a. Mothers of hospitalized toddlers often experience guilt b. The mother's presence will reduce anxiety and ease the child's respiratory efforts c. Separation from the mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.
b. The mother's presence will reduce anxiety and ease the child's respiratory efforts
Which of the following is considered a mixed cardiac defect? a. Atrial septal defect b. Transposition of the great arteries c. Pulmonic Stenosis d. Patent ductus arteriosis
b. Transposition of the great arteries
Anna is 4 years old and has been vomiting and had diarrhea on and off for 48 hours. The provider obtains a urinalysis. Which of the following urinalysis values suggests Anna is dehydrated? a. Urine pH of 8.0 b. Urine specific gravity of 1.030 c. Urine white blood cell count of >100,000 d. Urine specific gravity of 1.001
b. Urine specific gravity of 1.030
A nurse is assessing a 3-year old child who is 1 day postoperative following a tonsillectomy. Which of the following methods should teh nurse use to determine if the child is experiencing pain? a. Ask the parents b. Use the FACES scale c. Check the child's temperature d. Use the numeric rating scale
b. Use the FACES scale Pain is a subjective experience even for a 3-year-old child. The FACES scale can be used to accurately determine the presence of pain in children as young as 3 years of age.
Nursing care of the infant or child with congestive heart failure would include: a. forcing fluids appropriate to age b. organizing activities to allow for uninterrupted sleep c. monitoring respirations during periods of activity d. giving larger feedings less often to conserve energy
b. organizing activities to allow for uninterrupted sleep Minimizing energy expenditure is a priority.
A nurse is providing teaching to the parents of a school-age child who has type 1 IDDM about management of hypoglycemia. Which of the following responses by the parents indicates an understanding of the teaching? a. "I will check my child's urine for glucose twice daily" b. "I will insist that my child lies down to rest for 30 minutes" c. "I will make sure the child drinks 240mL (8 ounces) of milk, as soon as possible d. "I will give my child 2 units of regular insulin"
c. "I will make sure the child drinks 240mL (8 ounces) of milk, as soon as possible Giving the child 10-15 g of simple carbohydrates such as 240mL of il will elevate the blood glucose level and alleviate hypoglycemia
A 12-year old child is in the urgent care clinic with a complaint of fever, headache, and sore throat. A diagnosis if strep throat is made with a rapid-strep test. Oral penicillin is prescribed. The nurse knows which of the following statements about strep throat: a. Children with strep throat are less likely to contract the illness again. b. A follow up throat culture is recommended following antibiotic therapy. c. Children with strep throat are at increased risk for the development of rheumatic fever and glomerulonephritis. d. Children with strep throat are at risk for rheumatoid arthritis as adults.
c. Children with strep throat are at increased risk for the development of rheumatic fever and glomerulonephritis.
You are assessing a newborn with a heart murmur. As part of your assessment you obtain four extremity blood pressures. The blood pressure in the upper extremities is 20mmHG greater than the pressure in the lower extremities. The femoral pulses are also weak. You recognize this grouping of symptoms as which congenital heart defect? a. Patent Ductus Arteriosis b. Tetrology of Fallot c. Coarctation of the Aorta d. Hypoplastic Left Heart Syndrome
c. Coarctation of the Aorta
Which of the following would the nurse expect to see if he/she was assessing a child with Fifth's Disease? a. Koplik Spots b. Hoarseness c. Facial Rash d. Splenomegaly
c. Facial Rash Koplik spots are measles, hoarseness/stridor is croup, and splenomegaly is mono.
Jack is 13 years old and has a vomiting and diarrhea illness for several days. When the provider orders a Complete Blood Count it is noted that Jack's hematocrit value is elevated at 53%. Which of the following is the best explanation for why hematocrit values are elevated when a patient is dehydrated? a. The hematocrit value rises to prevent Jack from bleeding during his illness b. The hematocrit value rises in response to the body trying to fight the infection c. Hematocrit represents the volume of cells in the blood. When the blood volume goes down in dehydration, the percentage of cells will rise d. The hematocrit is elevated as a result of the stress on Jack's body from the illness
c. Hematocrit represents the volume of cells in the blood. When the blood volume goes down in dehydration, the percentage of cells will rise
Which statement BEST describes pseudohypertrophic (Duchenne) muscular dystrophy? a. It is inherited as an autosomal dominant disorder. b. It is characterized by weakness of proximal muscles of both pelvic and shoulder girdles. c. It is characterized by muscle weakness usually beginning about 3 years old. d. Onset occurs in later childhood and adolescence.
c. It is characterized by muscle weakness usually beginning about 3 years old.
Patients who take certain diuretic medications(like furoseminde) for conditions such as complex congenital heart disease are at risk for hypokalemia, or low potassium in the blood. Which one of these lab values represents hypokalemia? a. Na+ of 125 b. K+ of 4.0 c. K+ of 2.5 d. Na+ of 140
c. K+ of 2.5
A patient newly diagnosed with asthma receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates understanding of this medication regimen? a. "I should use the glucocorticoid as needed when symptoms flare." b. "I will need to use the beta2-adrenergic agonist drug daily." c. "The beta2-adrenergic agonist suppresses the synthesis of inflammatory mediators." d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."
d. "The glucocorticoid is used as prophylaxis to prevent exacerbations."
Asthma is classified into four categories: mild intermittent, mild persistent, moderate persistent, and severe persistent. Clinical features used to determine these categories include: A. Pulmonary lung function tests B. Associated allergies C. Frequency of symptoms D. Frequency and severity of exacerbations a. A, B, C, D b. C, D c. A d. A, C, D
d. A, C, D Pulmonary lung function tests that include the peak expiratory flow rate is used as one of the diagnostic criteria for classifying severity. The frequency of symptoms is one of the diagnostic criteria for classifying severity. The frequency and severity of exacerbations are two of the diagnostic criteria for classifying severity. The clinical features that distinguish the categories of asthma do not include other allergies.
The MOST appropriate nursing interventions when caring for a child experiencing a seizure include: a. restraining the child to prevent bodily harm b. placing a padded tongue blade in between the teeth if they become clenched c. avoid suctioning the child during the seizure d. describing and documenting the seizure activity observed e. applying supplemental oxygen after an oral airway is inserted a. B, C, and D b. A and E c. all of the above d. C and D
d. C and D
Levi is 4 weeks old and comes into the ED for high fever and fussiness. As a part of his evaluation, the provider does a spinal tap. Which of the following Cerebral Spinal Fluid (CSF) values is NOT concerning for bacterial meningitis? a. CSF appearance is cloudy b. CSF glucose level of 20 c. CSF white blood cell count is 8 d. CSF glucose of 50
d. CSF glucose of 50
Maria is a 10-year-old girl who is brought to the emergency department by her parents because of generalized abdominal pain. She has had slight diarrhea for the past few hours. Her temperature is 99.5° F. Bowel sounds are present. The diagnosis is possible appendicitis. Several diagnostic tests are ordered. Appropriate nursing management in this preoperative period includes which of the following? a. Apply moist heat to the abdomen to relieve pain. b. Administer an enema to ensure total bowel evacuation preoperatively. c. Perform deep abdominal palpation to assess the level of pain. d. Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.
d. Ensure that diagnostic tests are administered as soon as possible to prevent delay in treatment.
The nurse assesses the neonate immediately after birth. A tracheoesophageal fistula should be suspected if what condition is present? a. Absence of sucking b. Clubfeet c. Jaundice d. Excessive amount of frothy saliva in the mouth
d. Excessive amount of frothy saliva in the mouth
The nurse is teaching a family how to care for their infant in a Pavlik harness for developmental dysplasia of the hip (DDH). What information should be included? a. remove the harness several times a day to prevent contractures b. Place a diaper over the harness, preferably a thin, super-absorbent one c. Apply lotion or powder to decrease skin irritation d. Hip stabilization usually occurs within 12 weeks
d. Hip stabilization usually occurs within 12 weeks
A nurse is teaching a newly hired nurse about the care of an infect who is postoperative following myelomeningocele repair. The nurse should teach the newly hired nurse to monitor the infant for which of the following complications? a. Osteomyelitis b. Congenital hypotonia c. Otitis media d. Hydrocephalus
d. Hydrocephalus The infant is at risk for hydrocephalus since surgery for the myselomeningocele repair alters the CSF pathway
The nurse is caring for an 8-year-old boy who had abdominal surgery 24 hours ago. The patient is quiet and watching television. The nurse's observations suggest that he is not experiencing pain, but when he is given a pain-rating scale, he indicates that he is experiencing moderate pain. The nurse's actions should be based on which of the following? a. Physiologic responses are the best indicators of pain. b. A child's behavior is a better indicator of pain than the child's rating of pain. c. School-age children as young as 8 years do not rate pain accurately. d. If a child's behavior appears to differ from the rating of pain, the child's pain rating should be believed.
d. If a child's behavior appears to differ from the rating of pain, the child's pain rating should be believed.
Which of the following factors predispose an infant to fluid imbalances? a. Lower metabolic rate b. Decreased daily exchange of extracellular fluid c. Decreased surface area d. Immature kidney functioning
d. Immature kidney functioning Infants have increased surface area in relation to their weight, higher metabolic rates, and increased exchange of extracellular fluids along with immature kidney function.
The cardiac surgeon recommends surgery to close a Patent Ductus Arteriosis to prevent: a. Pulmonary infection b. decreased workload on the left side of the heart c. Right to left shunt d. Increased pulmonary congestion
d. Increased pulmonary congestion
In one hour, you peek in on Emma. You hear a noise with every inspiration and as you look, you notice she now has nasal flaring. As you reassess her lung sounds you note wheezing on expiration on the posterior chest. Resp.=62/min, HR=148/min. Suprasternal and subcostal retractions are noted and are deeper than earlier. Her pulse ox is now at 89% and beeping as you are assessing her . What signs indicate her level of distress now? How might you intervene?
Distress = noisy inspirations, nasal flaring, wheezing expirations, high respiratory rate and heart rate, retractions. Intervene by suctioning nasal passages, head of bed higher, reassess (within 5 minutes, it should happen quickly) and then if still bad give supplemental oxygen.
Mason is 4 months old and hospitalized with pneumonia. The providers are concerned he has a serious bacterial pneumonia as evidenced by the "left shift" on his Complete Blood Count with differential. What is the best interpretation of the "left shift"? a. Mason's body is overwhelmed by bacterial infection and cannot produce white blood cells fast enough b. Mason's body is making extra platelets to help fight the infection c. Mason's body is making extra hemoglobin to help supply his body with oxygen d. Mason's bone marrow is releasing somewhat immature white blood cells known as band forms to help fight this bacterial infection.
d. Mason's bone marrow is releasing somewhat immature white blood cells known as band forms to help fight this bacterial infection.
Why are Infants prone to acceleration/deceleration head injuries? a. The anterior fontanel is not yet closed b. The nervous tissue is not well developed c. The scalp has increased vascularity d. Musculoskeletal support of the head is insufficient
d. Musculoskeletal support of the head is insufficient
During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is: a. Abnormal and requires further investigation. b. Abnormal unless it occurs in conjunction with knock-knee. c. Normal if the condition is unilateral or asymmetric d. Normal because the lower back and leg muscles are not yet well developed.
d. Normal because the lower back and leg muscles are not yet well developed.
A nurse is providing discharge teaching to the parent of an 18 month old toddler who has dehydration as a result of acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching? a. "I will monitor my child's number of wet diapers" b. "I will offer my child small amounts of fruit juice frequently" c. "I will give my child polyethylene glycol daily for 7 days" d. "I will avoid giving my child solid foods until his diarrhea has stopped."
a. "I will monitor my child's number of wet diapers"
A young child is diagnosed with vesicoureteral reflux. The nurse should know that this usually results in: a. Urinary obstruction b. Increased risk for urinary tract infection c. Infarction of renal vessels d. Incontinence
b. Increased risk for urinary tract infection
The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. The PRIORITY of nursing care is to: A. initiate isolation precautions as soon as the diagnosis is confirmed. B. initiate isolation precautions as soon as the causative agent is identified. C. administer antibiotic therapy as soon as it is ordered. D. administer sedatives/analgesics on a preventive schedule to manage pain.
C. administer antibiotic therapy as soon as it is ordered.
The major goals of therapy for children with cerebral palsy include: a. reversing degenerative processes that have occurred. b. curing underlying defect causing the disorder. c. preventing spread to individuals in close contact with the child. d. recognizing the disorder early and promoting optimal development.
d. recognizing the disorder early and promoting optimal development.
Emma is a 7 month old admitted with bronchiolitis. On admission her VS: temp 101.4F, resp. 54/min, HR 130/min. Pulse ox=93%, mild suprasternal retractions, resting comfortably, able to take a bottle well. Mom is holding her at bedside. What signs of distress do you see? Does her condition warrant further intervention? Would you classify her as mild, intermediate, or severe respiratory distress?
Signs of Distress = suprasternal retractions, fever, high respiratory rate, pulse ox is on the low side. Classify as mild, does require some ongoing care.
A 4-year old girl is brought to the emergency department. She has a "froglike" croaking sound on inspiration, is agitated, and is drooling. She insists on sitting upright. The nurse should: a. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation b. Auscultate her lungs and make preparations for placement in a mist tent. c. Make her lie down and rest quietly d. Examine her oral pharynx and report to the physician
a. Notify the physician immediately and be prepared to assist with a tracheostomy or intubation Examination of the oral pharynx may cause total obstruction. The child assumes a tripod position to facilitate breathing. Forcing the child to lie down will increase the respiratory distress and anxiety. Preparation should be made to care for her if an obstruction occurs. Sitting upright, drooling, agitation, and a frog-like cough indicate epiglottitis. This is a medical emergency, and tracheostomy or intubation may be necessary.
When caring for a child with acute renal failure, which nursing measure requires immediate attention? a. Serum potassium concentrations in excess of 7 mEq/L b. Sodium level of 135 c. Transfusion for hemoglobin of 8 d. Mannitol and furosemide for a urine output of 2ml/kg/hour
a. Serum potassium concentrations in excess of 7 mEq/L
The nurse is observing parents playing with their 10-month-old daughter. What should the nurse recognize as evidence that the child is developing object permanence? a. She looks for the toy the parents hid under the blanket. b. She returns the blocks to the same spot on the table. c. She recognizes that a ball of clay is the same when flattened out. d. She bangs two cubes held in her hands.
a. She looks for the toy the parents hid under the blanket.
A nurse is caring for a 6-week old infant following a pyloromyotomy. Which of the following forms of feeding should the nurse anticipate for the infant 6 hours after the procedure? a. Small frequent bottle feedings of electrolyte solution b. Bottle formula with added protein c. Bolus feedings by gastrostomy tube d. continuous nasoduodenal tube feedings
a. Small frequent bottle feedings of electrolyte solution Feedings begin 4-6 hours after the surgical procedure. The nurse should anticipate feeding the infant small, frequent increments of an electrolyte solution or sterile water.
An early sign of congestive heart failure in an infant is: a. Tachypnea b. bradycardia c. inability to sweat d. Increased urine output
a. Tachypnea
In a non-potty trained child with nephrotic syndrome, the best way to detect fluid retention is to: a. Weigh the child daily b. Test the urine for hematuria c. Measure the abdominal girth weekly d. Count the number of wet diapers
a. Weigh the child daily
An infant has severe contact diaper dermatitis. The provider orders a glucocorticoid- triamcinolone acetonide 0.1% cream to be applied 3 times daily. When teaching the parents about this medication, the nurse will instruct them to apply: a. A thick layer and massage the cream into the skin b. A thin layer and leave the diaper open as much as possible c. The cream and place an occlusive dressing over the area d. The cream and put the infants diaper on tightly
b. A thin layer and leave the diaper open as much as possible
A nurse is admitting an infant with asthma. What usually triggers asthma in infants? a. Medications b. A viral illness c. Exposure to cold air d. Allergy to dust or dust mites
b. A viral illness
A nurse is providing discharge teaching for a child who has cystic fibrosis. Which of the following instructions should the nurse include? a. Provide a low-calorie, low-protein diet. b. Administer pancreatic enzymes with meals and snacks. c. Implement fluid restriction during times of infection d. Restrict physical activity.
b. Administer pancreatic enzymes with meals and snacks.
You are reviewing the thyroid test results for a patient who is complaining of fatigue, dry skin and constipation. Which of the following suggests juvenile hypothyroidism? a. Normal TSH (thyroid stimulating hormone) b. Elevated TSH (thyroid stimulating hormone) c. Elevated T3 or T4 d. Low TSH (thyroid stimulating hormone)
b. Elevated TSH (thyroid stimulating hormone) Elevated TSH is the pituitary gland's way of trying to stimulate the thyroid gland to produce more thyroid hormone
Which of the following is the most appropriate method of rehydrating Brian? a. Administer intravenous fluids. b. Give an oral rehydration solution. c. Give soft drinks that have been diluted and decarbonated. d. Give small amounts of gelatin or clear liquids such as juice and water.
b. Give an oral rehydration solution.
Jessica is a 3 year old brought to the clinic for a well-child exam. As you approach Jessica, you notice she is crying inconsolably and clinging to her mother. The mother is talking softly to her and reassuring her all will be OK. Which of the following would you consider as you begin the assessment of the child? a. Begin the assessment as soon as possible to minimize time spent with child who is afraid. b. Gradually focus on the child or a favorite object such as a doll or toy. c. Remove the child from the mother's arms and begin a systematic head-to-toe assessment. d. Ask the mother to leave the room if the child does not stop crying
b. Gradually focus on the child or a favorite object such as a doll or toy.
The causative agent for erythema infectiosum (fifth disease) is: a. Paramyxovirus b. Human parvovirus B19 c. Group A Betaq hemolytic streptococci d. Human herpes virus types 1 and 2
b. Human parvovirus B19 Paramyxovirus causes mumps. Human parvovirus B19 is the causative agent. Human herpes virus types 1 and 2 are the major causes of herpetic infections in humans. Group A β-hemolytic streptococci is the causative agent for scarlet fever.
A nurse is providing dietary teaching to the parent of a child who has cystic fibrosis. Which of the following dietary recommendations should the nurse make? a. Decrease the child's calorie intake b. Increase the child's protein intake c. Increase the child's fiber intake d. Decrease the child's salt intake
b. Increase the child's protein intake The nurse should recommend increased protein intake as children with CF require 150% of the recommended daily allowances to meet their nutritional needs
Which situation would alert the school nurse that a child requires additional assessment for Legg-Calve-Perthes disease? a. A 16 year old girl with swollen knees and ankles who is limping b. A 7 year old girl complaining of a muscle spasm in her calf c. A 7 year old boy who is limping and states that his hip hurts d. A 10 year old boy with a fever and complaints of knee pain
c. A 7 year old boy who is limping and states that his hip hurts
A 5-year old is seen in the urgent care clinic with the following: sudden onset sore throat, temp 102.2, drooling, and difficulty swallowing, absence of cough, clear breath sounds. The child appears anxious. You anticipate which diagnosis: a. Strep throat (GABHS) b. Acute tracheitis c. Acute Epiglottitis d. Acute laryngotracheobronchitis
c. Acute Epiglottitis
A nurse is caring for a child who has cellulitis on the hand. Which of the following actions should the nurse take? a. Apply a topical antifungal medication b. Cleanse the area using Burrow solution c. Administer oral antibiotics d. Prepare for cryotherapy
c. Administer oral antibiotics Oral antibiotics are often prescribed for the treatment of cellulitis
Grace is 16 years old and likely has a urinary tract infection. Which of the following lab values on her urinalysis supports this diagnosis? a. Urine pH of 6.0 b. Specific gravity of 1.010 c. Bacteria count >100,000 d. Urine protein negative
c. Bacteria count >100,000
One of the goals for children with asthma is to prevent respiratory infection. This is because respiratory infection: a. Lessens effectiveness of medications b. Encourages exercise-induced asthma c. Can trigger an episode or aggravate an asthmatic state d. Increases sensitivity to allergens
c. Can trigger an episode or aggravate an asthmatic state The infection affects the asthma, not the medications. Exercise-induced asthma is caused by vigorous activity. Sensitivity to allergens is independent of respiratory infection. Respiratory infections can trigger an asthmatic attack. Annual influenza vaccine is recommended. All respiratory equipment should be kept clean.
Separation anxiety is something that affects children when they are hospitalized. Each developmental stage has a somewhat different reaction as they deal with this difficulty. What stage corresponds to the adolescent stage? a. May demonstration separation anxiety by refusing to eat, have difficulty sleeping, cry quietly, continually ask when parents will visit. b. Separation anxiety comes in stages: protest, despair, and detachment c. Loss of peer group contact may pose a severe emotional threat because of loss of groups status, inability to exert group control or leadership, and loss of group acceptance. d. May need and desire parental guidance or support from other adult figures but may be unable or unwilling to ask for it.
c. Loss of peer group contact may pose a severe emotional threat because of loss of groups status, inability to exert group control or leadership, and loss of group acceptance.
A 2-day old infant in the newborn nursery is diagnosed with developmental dysplasia of the hip (DDH) and treatment is started by the orthopedist. The nurse assists the parents by providing home care instructions that include: a. Return to the orthopedists office in 2 weeks to remove the hip spica cast b. The infant's bilateral foot casts should be elevated on pillows as much as possible c. Remove the Pavlik harness once a day for no more than 2 hours and inspect the skin d. Remove the Pavlik harness while the infant is awake to allow "tummy time".
c. Remove the Pavlik harness once a day for no more than 2 hours and inspect the skin
What represents the major stressor of hospitalization for children from middle infancy throughout the preschool years? a. Fear of pain b. Fear of bodily injury c. Separation anxiety d. Loss of control
c. Separation anxiety The major stress for children from infancy through the preschool years is separation anxiety, also called anaclitic depression. This is a major stressor of hospitalization. Loss of control, fear of bodily injury, and fear of pain are all stressors associated with hospitalization. However, separation from family is a primary stressor in this age-group.
A nurse is caring for a client with borderline personality disorder. Which of the following goals is a priority when planning care for this client? a. The client will take the medication as ordered b. The client will express frustration c. The client will refrain from self-mutilation d. The client will participate in group therapy
c. The client will refrain from self-mutilation
What describes moral development in younger school-aged children? a. The standards of behavior now come from within themselves. b. They do not yet experience a sense of guilt when they misbehave c. They know the rules and behaviors expected of them but do not understand the reasons behind them. d. They no longer interpret accidents and misfortunes as punishment for misdeeds.
c. They know the rules and behaviors expected of them but do not understand the reasons behind them.
The mother of a 20-month-old boy tells the nurse that he has a barking cough at night. His temperature is 37 degrees C. The nurse suspects croup and should recommend: a. Admitting to the hospital and observing for impending epiglottitis b. Controlling the fever with acetaminophen and calling if the cough gets worse at night c. Trying a cool mist vaporizer at night and watching for signs of difficulty breathing d. Trying over the counter cough medicine and coming to the clinic in the morning if there is no improvement
c. Trying a cool mist vaporizer at night and watching for signs of difficulty breathing. The child does not have a temperature to manage. Because the child is not having difficulty breathing, the nurse should teach the parents the signs of respiratory distress and tell them to come to the emergency room if they develop. Cool mist is recommended to provide relief. Cough suppressants are not indicated. This is characteristic of laryngotracheobronchitis, not epiglottitis.
A 3-year-old child is status postshunt revision for hydrocephaly. Part of the discharge teaching plan for the parents is signs of shunt malformation. Which signs are of shunt malformation? (2 correct answers) a. Dizziness b. Increased head circumference c. Vomiting d. Fever
c. Vomiting d. Fever Vomiting can be a sign of shunt malformation related to increased intracranial pressure. Fever can be a sign of shunt malformation and is a very serious complication. The anterior fontanel closes between 12 and 18 months old. Dizziness is difficult to assess in a 3 year old and is not necessarily a sign of shunt malformation.
Children who undergo chemotherapy are at risk for opportunistic infections. Which of the following lab values represents the reason why a patient may be at risk for an opportunistic infection? a. Hemoglobin of 12.0 b. Platelet count of 150,000 c. WBC of 1,000 d. WBC of 8,000
c. WBC of 1,000
The most important nursing intervention related to congenital hypothyroidism is: a. facilitation of parent-child bonding b. helping parents deal with future prospects for the child c. early identification of the disorder d. initiating referrals for cognitive development
c. early identification of the disorder
When evaluating the extent of an infant's dehydration, the nurse should recognize that the symptoms of severe dehydration include: a. tachycardia, decreased tears, 5% weight loss. b. normal pulse and blood pressure, intense thirst. c. tachycardia, parched mucous membranes, sunken eyes, and fontanel d. irritability, moderate thirst, normal eyes, and fontanel.
c. tachycardia, parched mucous membranes, sunken eyes, and fontanel
A 12-year-old who was in a ATV accident has a left long leg cast for a tibia-fibula fracture. He requests pain medication at 2:00am for a 10/10 pain rating. The nurse brings him the pain medication and notes that he has removed the pillows that kept his leg elevated. He complains of pain in the left foot, and the nurse notes there is 3+ edema in the exposed leg and foot, and she is unable to slip a finger under the cast. The nurse's priority is: a. Administer the pain medication and elevate the child's leg on the pillows b. Elevate the leg on the pillows and follow up in 2-3 hours to see if the edema has decreased. c. Let the child know he cannot have any pain medication until 0600 d. Notify the surgeon of the findings immediately.
d. Notify the surgeon of the findings immediately. If you can't get a finger under the cast, it is probably too tight and needs to be adjusted.
The nurse is preparing staff in-service about atraumatic care for pediatric patients. Which interventions should the nurse include? a. Help the child accept the loss of control associated with hospitalization b. Prepare the child for separation from parents during hospitalization by reviewing a video c. Help the child accept that pain is connected with a treatment or procedure d. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal.
d. Prepare the child before any unfamiliar treatment or procedure by demonstrating on a stuffed animal. In providing atraumatic care, the separation of child from parents during hospitalization is minimized. The nurse should promote a sense of control for the child. Preventing and minimizing bodily injury and pain are major components of atraumatic care.
A nurse in an emergency department is assessing a school-age child who is experiencing an acute asthma exacerbation. Which of the following findings is the priority for the nurse to report to the provider? a. Increased diaphoresis b. Excessively prolonged expiration c. Increased production of frothy sputum d. Sudden decrease in wheezing
d. Sudden decrease in wheezing Using the ABC framework, a sudden decrease in wheezing indicates ventilatory failure and imminent respiratory arrest
The parents of a 9-month-old infant tell the nurse that they have noticed foods such as peas and corn are not completely digested and can be seen in their infant's stool. The nurse bases her explanation on what fact? a. Children should not be given fibrous foods until the digestive tract matures at age 1 year. b. The infant should not be given any solid foods until this digestive problem is resolved. c. This is abnormal and requires further investigation. d. This is normal because of the immaturity of digestive processes at this age.
d. This is normal because of the immaturity of digestive processes at this age.
