NCLEX style PEDS question

When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Select all that apply.) a. Accept the adolescent as a unique individual b. Provide strict, inflexible rules c. Listen and try to be open to the adolescent's views d. Screen all of his or her friends e. Respect the adolescent's privacy f. Provide unconditional love

A, C, E, F

Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.) a. To escape punishment b. High self-esteem c. Low expectations of family/peers d. Lack of sense of property e. Strong desire to own something

A, D, E

What is the preferred injection site for infants 1. Vastus lateralis 2. Deltoid 3. Dorsal gluteal 4. Pre-tibial

1

Which statement indicates the best sequence for the nurse to conduct an assessment in a nonemergency situation? 1. Introduce yourself, ask about any problems, take a history, and do the physical examination. 2. Perform the physical examination and then ask the family if there are any problems in the child's life. 3. Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns. 4. Get a complete history of the family's health beliefs and practices, and then assess the child.

1 (Standard procedure for all pts)

A child is scheduled for a bone marrow aspiration at 4 PM. The nurse would plan to apply EMLA cream to the intended site at which time? 1. 1:30 PM 2. 3:00 PM 3. 3:30 PM 4. 4:00 PM

1 (takes long time for the cream to absorb into the deep tissue)

A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action? 1. Ask that the child's desired foods be sent up from the kitchen. 2. Negotiate with the child to eat at least part of the food on the tray. 3. Remove a privilege. 4. Offer the child cereal and milk from stock on the nursing unit.

1(Give child options that will encourage them to have control over their meal)

A child who weighs 33 pounds has an order for acetaminophen 10 mg/kg/dose, every 4 hours prn pain or fever. 1. How many milligrams will the child receive per dose? 2. Acetaminophen elixir is provided as 160 mg/5 mL. How many milliliters will the nurse administer per dose?

150 mg & 4.7 mL

A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially? 1. Listening to the bowel sounds 2. Counting the heart rate 3. Checking the temperature 4. Looking in the ears

2

An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain? 1. Cutaneous pain 2. Deep somatic pain 3. Visceral pain 4. Neuropathic pain

2

The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use? 1. FACES pain rating scale and poker chip tool 2. FACES pain rating scale, observation of the child, and parent report 3. Asking the parents to rate their child's pain using the word-graphic rating scale 4. Visual analog scal

2

What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health? 1. Explain to the child what's going to happen when the child asks questions. 2. Explain what is going to happen in words the child can understand. 3. Force the child to cooperate by having a parent hold him or her down. 4. Give the child a sticker before beginning the examination.

2

Which assessment finding is considered normal in children? 1. Irregular respiratory 2. Split S2 and sinus arrhythmia 3. Decreased heart rate with crying 4. Genu varum past the age of 5 years

2

When administering ear drops to a 2-year-old, which action would be most appropriate? 1. Tell the child that the drops are to treat his infection. 2. Pull the pinna of the child's ear down and back. 3. Have the child turn his head to the opposite side after giving the drops. 4. Massage the child's forehead to facilitate absorption of the medication.

2 (Children have shorter ear canals)

A 6-month-old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention? 1. Tie the restraint loosely to prevent skin breakdown. 2. Leave the baby unrestrained when directly observed. 3. Position the restrained infant prone to prevent aspiration. 4. Place the infant in a room near the nurses' station.

2 (Restraints are a last resort for any situation; restraints are more harmful)

A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level? 1. Playing a game with the child. 2. Talking with the child about the teddy bear next to him. 3. Using a screening tool during a follow-up office visit. 4. Asking the 10-year-old sibling about the child.

3

After teaching a child's parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching? 1. "We'll have her focus on her hand and count each finger slowly." 2. "We'll read some of her favorite stories to her." 3. "We'll have her imagine that she's at the beach this summer." 4. "She likes to play video games, so we'll bring in some from home."

3

The nurse providing home care to a 2-year-old listens to the child's parents talk about how the child and family are adjusting to the child's current illness. Which of the following roles is the nurse participating in? 1. Case management 2. Child and family advocacy 3. Direct nursing care 4. Child and family education

3

A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location? 1. Increased risk for infection 2. Increased health care costs 3. Need to be transferred if overnight stay is required 4. Increased disruption of family functioning

3 (outpatient surgery centers close)

An infant is to receive intermittent gavage feedings via a nasogastric tube every 6 hours. The feeding tube was inserted with a previous feeding and remains in place. The nurse is preparing to administer the next scheduled feeding. Place the events in the proper sequence. 1. Check the placement of the feeding tube. 2. Position the infant on his right side with the head of the bed slightly elevated. 3. Allow the feeding to come to room temperature. 4. Flush the tube with water. 5. Clamp the tube to prevent air from entering the stomach. 6. Pour the solution into the barrel of the syringe.

3, 1, 6, 4, 5, 2

A 3-year-old child is to receive a medication that is supplied as an enteric-coated tablet. What is the best nursing action? 1. Crush the tablet and mix it with apple sauce. 2. Dissolve the medication in the child's milk. 3. Place a pill in the posterior part of the pharynx and tell the child to swallow. 4. Check with the prescriber to see if an alternative form can be used.

4

When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factors influencing pain? 1. Gender 2. Cognitive level 3. Previous pain experiences 4. Anticipatory anxiety

4

The nurse is preparing a 5-year-old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action? 1. Allow the mother to remove the underwear. 2. Tell the boy he is acting childishly. 3. Notify the OR that the underwear is on. 4. Allow the boy to keep his underwear on.

4 (Don't want to make pt uncomfortable)

The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds. What is the nurse's best response? a. Hesitancy and dysfluency are normal during this period of development. b. Reading to the child will help model appropriate speech. c. Expressive language concerns warrant a developmental evaluation. d. The mother should ask her child's physician for a speech therapy evaluation.

A

What has the most influence in deterring an adolescent from beginning to drink alcohol? a. Drinking habits of parents b. Drinking habits of peers c. Drinking philosophy of adolescent's culture d. Drinking philosophy of adolescent's religion

A

What is the best advice about nutrition for the toddler? a. Encourage cup drinking and give water between meals and snacks. b. Encourage unlimited milk intake, because toddlers need the protein for growth. c. Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired. d. Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.

A

Samantha, a 10-year-old girl, is brought into your clinic for a well-child examination. Her mother states "Samantha's friend group seems to be so much more important to her these days." As the nurse caring for her, how would you explain the role of peers in the school-age child? a. This allows her the opportunity to learn conflict management. b. This helps her to shape her concept of self and provides security as she gains independence from her parents. c. This will encourage her to remain dependent on her teachers and family. d. This will help her to work through her fears of body safety.

B

The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother? a. If spanking is not working, then time-out is not likely to be helpful either. b. Place the child in time-out for 4 minutes. c. Use time-out only if removing privileges is unsuccessful. d. The child should stay in time-out until crying ceases.

B

The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother? a. Having the boys on the same team will make it more convenient for the mother. b. Levels of coordination and concentration differ, so the boys need to be on different teams. c. Put the boys on the same team because they are both school-age children. d. It is best to avoid putting the boys on the same team to prevent sibling rivalry.

B

The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by: a. Learning from repeating tasks b. Developing a sense of worth and competence c. Using fantasy and magical thinking to cope with problems d. Developing a sense of trus

B

The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. What is the nurse's best response? a. "She just needs love and attention. Don't worry; she's too young to spoil." b. "Consistently meeting the infant's needs helps promote a sense of trust."9-10mths would be more appropriate to "not spoil" c. "Infants need to be fed and cleaned; if you are sure those needs are met, just let her cry." d. "Consistency in meeting needs is important, but you are right, holding her too much will spoil her."

B (9-10mths would be more appropriate to "not spoil" the child, they should have the ability to self-soothe)

A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response? a. It is permissible to substitute cow's milk for formula at this age as he is so close to 1 year old. b. Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant. c. As long as the mother provides whole milk, rather than skim, she can start cow's milk in infancy. d. If the mother cannot afford the infant formula, she should dilute it to make it last longer.

B (Cow's milk anemia)

To gain cooperation from a toddler, what is the best approach by the nurse? a. Immediately pick the toddler up from the mother's lap. b. Kneel in front of the toddler while he or she is on the mother's lap. c. Do the nursing tasks quickly so the toddler can play. d. Ask the toddler if it is okay if you begin the needed task

B (always want to be at eye level, you won't look ominous, they can see your eyes)

The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as a. problematic, as it interferes with needed nursing care. b. normal for this stage of growth and development. c. normal because the child is hospitalized and out of his routine.

B (sense of autonomy)

In developing a weight-loss plan for an adolescent, which would the nurse include? (Select all that apply.) a. Have parents make all of the meal plans. b. Eat slowly and place the fork down between each bite. c. Have the family exercise together. d. Refer to an adolescent weight-loss program. e. Keep a food and exercise diary.

B, C, D, E

Which activities will promote weight loss in an obese school-age child? (Choose all that apply.) A. Unlimited computer and TV time B. Role modeling by family C. Becoming active in sports D. Eating unstructured meals E. Involving child in meal planning and grocery shopping F. Drinking three glasses of water per day

B, C, E

Which is associated with early adolescence? (Select all that apply.) a. Uses scientific reasoning to solve problems b. Still at times wants to be dependent upon parents c. Incorporates own set of morals and values d. Is influenced by peers and values memberships in cliques

B, D

The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse's best response to this information? a. The toddler should have a developmental evaluation as soon as possible. b. If the mother would read to the child, then speech would develop faster. c. Receptive language normally develops earlier than expressive language. d. The mother should ask her child's physician for a speech therapy evaluation

C

The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as: a. Problematic; the child is old enough to begin to have a basis in reality. b. Normal, because the child is hospitalized and out of her routine. c. Normal for this stage of growth and development. d. Problematic, as it interferes with needed nursing care

C

Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior? a. Crying when left with the sitter may indicate difficulty with building trust. b. Stranger anxiety should not occur until toddlerhood; this concern should be investigated. c. Separation anxiety is normal at this age; the infant recognizes parents as separate beings. d. Perhaps the sitter doesn't meet the infant's needs; choose a different sitter

C (Normal at 8mths and are able to recognize parents as separate individuals)

The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health? a. "Start brushing her teeth after all the baby teeth come in." b. "Use a washcloth with toothpaste to clean her mouth." c. "Clean your baby's gums, then new teeth, with a washcloth." d. "Rinse your baby's mouth with water after every feeding."

C (can't start brushing teeth at 6mths because they are not developed enough at 6mths they cant even sit up yet (reconsider at 8mths))

A 5-year-old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse? a. Allow the child unlimited access to the sippy cup to ensure adequate hydration. b. Encourage sweets for the extra caloric content. c. Teach the mother about nutritional needs of the preschooler. d. Assess the child's usual intake pattern at home.

D

The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration? a. A lack of fully developed hearing. b. A less discriminating sense of touch. c. Visual acuity that has not fully developed. d. A less discriminating sense of taste.

D

The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse? a. "It's okay to start puréed solids at this age if fed via the bottle." b. "Infants don't require solid food until 12 months of age." c. "Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own." d. "The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."

D (Milestone of child's physical ability)

A 2-year-old is having a temper tantrum. What advice should the nurse give the mother? a. For safety reasons, the toddler should be restrained during the tantrum. b. Punishment should be initiated, as tantrums should be controlled. c. The mother should promise the toddler a reward if the tantrum stops. d. The tantrum should be ignored as long as the toddler is safe.

D (have a plan in place to deal with an uncooperative child)