NCLEX Q's SAUNDERS

The clinic nurse is reviewing the health care providers prescription for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the prescription if which is noted in the childs record? 1. The child is 18 months old 2. The child is being bottle-fed 3. A sibling is using lindane for the treatment of scabies 4. The child has a history of resp infections

1 Used with caution in children 2-10

Which interventions should the nurse include when creating a care plan for a child with hepatitis? 1. Provide a low-fat, well-balanced diet. 2. Teaching the child effective hand-washing techniques. 3. Scheduling playtime in the playroom with other children 4. Notifying the health care provider if jaundice is present 5. Instructing the parents to avoid administering medications unless prescribed. 6. Arranging for indefinite home schooling because the child will not be able to return to regular school.

1, 2, 5 Hep is an acute r chronic inflammation of the liver that may be caused by a virus, a medication reaction, or other disease processes. Can be viral- no playtime in the playrooms with other children. The child can return to school 1 week after jaundice. The liver is affected, so some medications may become dangerous because the liver cannot detoxify and excrete them. Hand washing is the most effective measure to control the spread of hepatitis.

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all 1. Provide a soft diet 2. Position the child on the left side 3. Administer an antihistamine twice daily 4. Irrigate the right ear with normal saline every 8 hours 5. Administer ibuprofen forever every 4 hours as prescribed and as needed 6. Instruct the parents about the need to administer the prescribed antibiotics for the full course of therapy.

1,5,6 Child will have fever, pain, loss of appetite, and possible ear drainage. Child may be irritable, lethargic, and roll on head/ pull affected ear. Childs fevers should be treated with ibuprofen. Position on affected side to facilitate drainage. Soft diet is recommended to prevent pain associated with chewing. The ear should not be irrigated because it could exacerbate further.

The nurse is performing an assessment on a 10 y/o child suspected to have hodgkin's disease. Which assessment findings are characteristic of the disease? Select all 1. Abdominal pain 2. Fever and malaise 3. Anorexia and weight loss 4. Painful, enlarged inguinal lymph nodes 5. Painless, firm, and movable adenopathy in the cervical area

1,6 Hodgkins disease (a type of lymphoma) is a malignancy of the lymph nodes. Specific clinical manifestations associated with Hodgkin's disease include painless, firm, and movable adenophathy in the cervical and supraclavicular areas and abdominal pain as a result of enlarged retroperitoneal nodes.

The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "Limping, if a weight bearing limb is affected, is a clinical manifestation." 4. "The symptoms of the disease in the early stage are almost always attributed to normal growing pains."

2 Osteosarcoma is manifested clinically by progressive, insidious, and intermittent pain at the tumor site. By the time these kids receive medical attention, they may be in considerable pain from the tumor.

Which specific nursing intervention are implemented in the care of a child with leukemia who is at risk for infection? Select all 1. Maintain the child in a semiprivate room 2. Reduce exposure to environmental organisms 3.Use strict aseptic technique for all procedures 4. Ensure that anyone entering the child's room wears a mask 5. Apply firm pressure to a needle-stick area for at least 10 minutes

2,3,4

A mother brings her 3 week old infant to a clinic for a phenylketonuria re-screening blood test. The test indicates a serum phenylalanine level of 1 mg/dl (60.5 mcmol/L). The nurse reviews this result and makes which interpretation? 1. It is positive 2. It is negative 3. It is inconclusive 4. It requires screening at 6 weeks

2 Pheylketonuria is a genetic autosomal recessive disorder that results in genetic nervous system damage from toxic levels of phenylalanine (essential amino acid) in the blood. It is characterized by blood phenylalanine levels greater than 20 mg/dL (12.1 mcmol/L) NORM LEVEL is 0 to 2 mg/dL.

A 4 y/o child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and excessively tired and is bruising easily. On physical exam, lymphadeopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm3 4. WBC count 4500 mm3

2 The confirmatory test for leukemia is microscopic examination of bone marrow obtained by bone marrow aspirate and biopsy, which is considered positive if blast cells are present. An altered platelet count occurs as a result of the disease, but also may occur as a result of chemotherapy and does not confirm the diagnosis.

The nurse is preparing to care for a child after a tonsillectomy, The nurse documents on the plan of care to place the child in which position? 1. Supine 2. Side-lying 3. High Fowlers's 4. Trendelenburg

2. The child should be placed prone or side-lying to facilitate drainage.

A 10 y/o child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer which prescription? 1. Injection of factor X 2. IV infusion of Iron 3. IV infusion of factor VIII 4. Intramuscular injection of iron using the Z-track method

3 A kid with hemophilia A is at risk for joint bleedingg after a fall. Factor VIII would be prescribed IV to replace the missing clotting factor and minimize the bleeding.

The nurse is caring for a newborn with a suspected diagnosis of imperforate anus. The nurse monitors the infant, knowing that which is a clinical manifestation associated with the disorder? 1. Bile-stained fecal emesis 2.The passage of currant jelly-like-stools 3. Failure to pass meconium stool in the first 24 hours after birth 4. Sausage-shaped mass palpated in the upper right abdominal quadrant

3 Imperforate anus is the incomplete development or absence of the anus. It should be diagnosed on newborn assessment, however a rectal thermometer or tube may be necessary to determine latency if meconium is not passed in the first 24 hours.

The mother of a 6 year old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been sick. The mother reports that she checked the childs urine and it was positive for ketones.The nurse should instruct the mother to take which action? 1. Hold the next dose of insulin 2. Come to the clinic immediately 3. Encourage the child to drink liquids 4. Administer and additional dose of regular insulin

3 Liquids are essential to the clearing of ketones. Taking the child to the clinic immediately is unnecessary

The nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atrasia with tracheoesphageal fistula is suspected The nurse expects to note which most likely sign of this condition documented in the record? 1. Incessant Crying 2. Couging at nighttime 3. Choking with feedings 4. Severe Projectile Vomiting.

3 In esophageal atresia and tracheoesophageal fistual, the esophagus terminates before it reaches the stomach, ending in a blind pouch, and a fistula is present that forms an unnatural connection with the trachea. . 3 C's- coughing, choking, cyanosis.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's Disease. The nurse reviews the assessment findings documented in the record, knowing that which sign most likely led the mother to seek health care for the infant? 1. Diarrhea 2. Projectile Vomiting 3. Regurgitation of feedings 4. Foul-smelling ribbon-like stools.

4 Chronic constipation beginning in the first month of life and resulting in pellet-like or ribbon-like stools that are foul-smelling is a clinical manifestation of this disorder. Delayed passage or absence of meconium stool in the neonatal period is also a sign.

A child with type 1 diabetes mellitus is brought to the ED by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of IV infusion? 1. Potassium infusion 2. NPH insulin infusion 3. 5% dextrose infusion 4. Normal Saline infusion

4 Hyperglycemia occurs with DKA. Rehydration is the initial step. Dextrose solutions are added when the glucose gets back to a stable level. IV potassium may be required, but it would not be part of the initial infusions

The nurse is preparing to care for a child with a diagnosis of intussussception. The nurse receives the childs record and expects to note which sign of this disorder documented? 1. Watery Diarrhea 2. Ribbon-like stools 3. Profuse projectile vomiting 4. Bright red blood and mucous in the stools.

4 Intussusception is a telescoping of 1 portion of the bowel into another. It results in an obstruction to the passage of intestinal contents. Child typically presents with severe abdominal pain that is cramps and intermittent, causing the child to draw knees to chest. Vomiting may be present, but not projectile. Bright red blood and muss are passed through the rectum and commonly are described as jelly like.

The clinic nurse instructs parents of a child with sickle cell anemia about the precipitating factors related to sickle cell crisis. Which, if identified by the parents as a precipitating factor, indicates the need for further instruction? 1. Stress 2. Trauma 3. Infection 4. Fluid Overload

4 Sickle cell kids should have 1 1/2- 2 times the daily requirement of fluids to prevent dehydration