NCLEX Style Peds Q's
A child with Kawasaki disease is admitted to the pediatric ward. Which of the following medications will you expect to be a part of the treatment? Select all that apply. A. Gamma Globulin B. Warfarin. C. Acetaminophen D. Aspirin E. Atenolol
A, B, & D The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms such as fever and joint pain so an antipyretic, antiplatelet, and gamma globulin is used. Treatment aims with Kawasaki disease point to minimize the risk of coronary artery aneurysm (CAA) formation, which peaks two to four weeks after illness onset, by decreasing the inflammation of the coronary arteries. Supportive care is also essential.
Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing
A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief.
A nurse provides medication instructions to a first-time mother. Which statement made by the mother indicates a need for further instructions? A. "I should mix the medication in the baby food and give it when I feed the child". B. "I should administer the oral medication sitting in an upright position and with the head elevated". C. "I will give my child a toy after giving the medication". D. "I will offer my child a juice drink after swallowing the medication".
A. "I should mix the medication in the baby food and give it when I feed the child".
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
A. Pulmonary secretions are abnormally thick. CF is identified by abnormally thick pulmonary secretions. Researchers now know that cystic fibrosis is an autosomal recessive disorder of exocrine gland function most commonly affecting persons of Northern European descent at a rate of 1 in 3500. It is a chronic disease that frequently leads to chronic sinopulmonary infections and pancreatic insufficiency. The most common cause of death is end-stage lung disease.
Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following? A. Status asthmaticus B. Reactive airway disease C. Intrinsic asthma D. Extrinsic asthma
A. Status asthmaticus Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. One of the most common causes of emergency room visits in the United States is status asthmaticus, an acute, emergent episode of bronchial asthma that is poorly responsive to standard therapeutic measures.
Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? A. "He holds his left leg so stiff that I have a hard time putting on his diapers." B. "My baby won't lift his head up and look at me; he's so floppy." C. "My baby's left hip tilts when I pull him to standing position." D. "I'm very worried because my baby has not rolled all the way over yet."
B. "My baby won't lift his head up and look at me; he's so floppy." Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to a 90-degree angle by age 4 months with only a partial head lag by age 2 months. Clinical signs and symptoms of cerebral palsy can include micro- or macrocephaly, excessive irritability or diminished interaction, hyper- or hypotonia, spasticity, dystonia, muscle weakness, the persistence of primitive reflexes, abnormal or absent postural reflexes, incoordination, and hyperreflexia.
Baby Melody is a neonate who has a very-low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? A. Meconium aspiration syndrome B. Bronchopulmonary dysplasia (BPD) C. Respiratory syncytial virus (RSV) D. Respiratory distress syndrome (RDS)
B. Bronchopulmonary dysplasia (BPD) Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very-low-birth-weight and extremely low-birth-weight neonates with lung disorders. Injury from mechanical ventilation and reactive oxygen species to premature lungs in the presence of antenatal factors predisposing the lungs to BPD form the basis of pathogenesis of BPD in preterm neonates.
Nurse Jeremy is evaluating a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output.
B. Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.
An infant with a patent ductus arteriosus is admitted to the pediatric unit ward. The nurse anticipates which of the following medications will be given to the infant? A. Prednisone B. Ibuprofen C. Penicillin D. Albuterol
B. Ibuprofen When surgical ligation is not indicated, prostaglandin inhibitors (e.g. nonsteroidal anti-inflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. In April 2006, the US Food and Drug Administration approved the use of ibuprofen lysine (NeoProfen) for the closure of clinically significant PDA in premature neonates. Ibuprofen's mechanism of action for closure of PDA is believed to be through the inhibition of prostaglandins.
When developing a plan of care for a hospitalized child, nurse Mary knows that children in which age group is most likely to view illness as a punishment for misdeeds? A. Infancy B. Preschool age C. School age D. Adolescence
B. Preschool age Preschool-age children are most likely to view illness as a punishment for misdeeds. When children in this age group become seriously ill, they may think it's punishment for something they did or thought about. They don't understand how their parents could not have protected them from this illness.
Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? A. A fever that started 3 days ago B. Lack of interest in food C. A recent episode of pharyngitis D. Vomiting for 2 days Incorrect
C. C. A recent episode of pharyngitis A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Activation of the innate immune system begins with a pharyngeal infection that leads to the presentation of S. pyogenes antigens to T and B cells. CD4+ T cells are activated and production of specific IgG and IgM antibodies by B cells ensues (Cunningham, Pathogenesis of group A streptococcal infections, 2000).
Which of the following is the most common permanent disability in childhood? A. Scoliosis B. Muscular dystrophy C. Cerebral palsy D. Developmental dysplasia of the hip (DDH)
C. Cerebral palsy Cerebral palsy is the most common permanent disability of childhood. It is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. A cerebral palsy is a group of permanent disorders affecting the development of movement and causing a limitation of activity. Non-progressive disturbances that manifest in the developing fetal or infant brain lead to cerebral palsy.
After explaining to the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching? A. Feeling different from peers B. Poor self-image C. Cognitive delays D. Dependency
C. Cognitive delays Children with seizure disorders do not necessarily have cognitive delays. Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy.
Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? A. Klebsiella B. Staphylococcus C. Escherichia coli D. Pseudomonas
C. Escherichia coli E. coli is the most common organism associated with the development of UTI. Escherichia coli is the most common organism in uncomplicated UTI by a large margin. Pathogenic bacteria ascend from the perineum, causing the UTI. Women have shorter urethras than men and therefore are far more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria.
Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure? A. Headache B. Respiratory distress C. Extreme bradycardia D. Constipation
C. Extreme bradycardia Extreme bradycardia is a cardinal sign of digoxin toxicity. Increased intracellular calcium from the poisoning of the Na-K transporter and AV nodal blockade from increased vagal tone are the primary causes of digoxin toxicity. The former leads to increased automaticity and inotropy; the latter leads to decreased dromotropy.
Olivia is an adolescent who has seizure disorder; which of the following would not be a focus of a teaching program? A. Ability to obtain a driver's license B. Drug and alcohol abuse C. Increased risk of infections D. Peer pressure
C. Increased risk of infections Adolescents with seizure disorders are at no greater risk for infections than other adolescents. Adolescence is the period during which the child's identity as an individual in his/her own right should be consolidated. Achieving independence from parents, establishing healthy interpersonal relationships outside the family and choosing a vocation are essential developmental tasks of adolescence.
Which of the following tests is most effective in diagnosing hemophilia? A. Bleeding time B. Complete blood count (CBC) C. Partial thromboplastin time (PTT) D. Platelet count
C. Partial thromboplastin time (PTT) PTT is abnormal in hemophilia. Therefore, this test will be the most helpful in diagnosing the disorder. In both hemophilia A and B, PTT will be prolonged (intrinsic pathway disruption), whereas PT and BT will be normal. The PTT could be as prolonged as 2 to 3 times the high normal range. Once PTT is found to be prolonged, it should be followed by a mixing study.
A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child's vision, the nurse should ask: A. "Do you have any problems seeing different colors?" B. "Do you have trouble seeing at night?" C. "Do you have problems with glare?" D. "How are you doing in school?"
D. "How are you doing in school?" A child's poor progress in school may indicate a visual disturbance. Most children do not have 20/20 vision until after six years of age, but at any age, visual acuity should be approximately equal between the eyes. The Multi-Ethnic Pediatric Eye Disease Study provided updated norms for visual acuity in children two and a half to six years of age.
A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? A. Sepsis B. Meningitis C. Mitral valve disease D. Aneurysm formation
D. Aneurysm formation Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.
It is considered as the bluntly rounded portion of the heart. A. Base B. Pericardium C. Aorta D. Apex
D. Apex The blunt, rounded point of the heart is the apex. The apex (the most inferior, anterior, and lateral part as the heart lies in situ) is located on the midclavicular line, in the fifth intercostal space. It is formed by the left ventricle. The general structure of the heart is quite uniform in healthy individuals. However, some variations do occur.
When assessing a child's cultural background, the nurse in charge should keep in mind that: A. Heritage dictates a group's shared values B. Physical characteristics mark the child as part of a particular culture C. Cultural background usually has little bearing on a family's health practices D. Behavioral patterns are passed from one generation to the next
D. Behavioral patterns are passed from one generation to the next. A family's behavioral patterns and values are passed from one generation to the next. Pediatric health care providers must be aware of the demographic trends and be culturally competent to deliver the safest, highest quality care possible to children of widely differing groups.
When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A. Rheumatoid arthritis B. Permanent nerve damage C. Osteomyelitis D. Bone growth disruption
D. Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening. Sometimes, changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or a bit longer or shorter than expected.
Hannah, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? A. Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model B. Initiating a teenage parent support group with first and second-time mothers C. Using audiovisual aids that show discussions of feelings and skills D. Providing age-appropriate reading materials
D. Providing age-appropriate reading materials. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The Adolescent Family Life (AFL) demonstration projects, organized through the Office of Adolescent Pregnancy Programs (OAPP), are aimed to support young families through social support and medical care.
A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following routes will you expect the nurse to administer the vaccine? A. Intramuscularly in the vastus lateralis muscle. B. Intramuscularly in the deltoid muscle. C. Subcutaneously in the gluteal area. D. Subcutaneously in the outer aspect of the upper arm.
D. Subcutaneously in the outer aspect of the upper arm. (MMR) the vaccine is administered subcutaneously in the outer aspect of the upper arm. The dosage for both MMR and MMRV is 0.5 mL. Both vaccines are administered by the subcutaneous route.
A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites
D. Systematically rotate injection sites. It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.
Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. Aortic stenosis (AS) B. Coarctation of aorta C. Patent ductus arteriosus (PDA) D. Tetralogy of Fallot
D. Tetralogy of Fallot Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect in the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of a defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.
A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription? A. Blood pressure B. Height C. Weight D. Urine output
D. Urine output When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria. The body becomes dehydrated when it loses more fluids than it consumes. When the body doesn't have enough fluids, it can't process potassium properly, and potassium builds up in the blood, which can lead to hyperkalemia.
