Pediatrics

A nurse is caring for a child with Kawasaki disease. Which of the following is the primary system involved with this diagnosis? 1. cardiovascular 2. gastrointestinal 3. integumentary 4. Respiratory

Cardiovascular ; cardiovascular changes occur due to inflammation of the arterioles, venules, and capillaries.

A nurse is reinforcing teaching about self-administration of insulin to the parent of a school-age child newly diagnosed with diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching? 1. "I will be sure my child aspirates before injecting the insulin" 2. "The insulin can be injected anywhere there is adipose tissue" 3. "I will be sure my child rotates sites after 5 injections in one area" 4. "The insulin should be injected at a 90-degree angle"

"I will be sure my child aspirates before injecting the insulin"

A nurse is reinforcing teaching with the guardian of a child who has a new diagnosis of the rheumatic fever. Which of the following statements by the guardian indicates an understanding of the teaching? 1. "I should not give my child aspirin for pain or fever" 2. "My child will take antibiotics for 6 months" 3. "My child might have a period of irregular movement of the extremities" 4. "I should expect there to be blood in my child's urine"

"My child might have a period of irregular movement of the extremities" ; the child might experience chorea - temporary lack of coordination and presence of sudden, irregular movements or periods of clumsiness.

A nurse is teaching the mother of a child who has cystic fibrosis and is prescribed pancreatic enzymes three times per day. Which of the following statements indicates the mother understands the information? 1. "My child will take the enzymes to improve metabolism" 2. "My child will take the enzymes following meals" 3. "My child will take the enzymes to help digest the fat in foods" 4. "My child will take the enzymes 2 hours before meals"

"My child will take enzymes to help digest the fat in foods" ; pancreatic enzymes should be taken immediately before meals.

A nurse is reinforcing teaching a parent of a child who has a fracture of the epiphyseal plate. Which of the following is an appropriate statement by the nurse? 1. "The blood supply to the bone is disrupted" 2. "Normal bone growth can be affected" 3. "Bone marrow can be lost through the fracture" 4. "The healing process will take longer"

"Normal bone growth can be affected" ; it can affect growth in a child so it needs to be detected and treated rapidly. Children heal fractures in less time than adults because of the generous blood supply to the bone.

A nurse is caring for a school-aged child who has mild persistent asthma. Which of the following is an expected finding? (SATA) - symptoms are continuous throughout the day - daytime symptoms occur more than twice a week - nighttime symptoms occur approximately twice a month - minor limitations occur with normal activity - peak expiratory flow is greater than or equal to 80% of predicted value

-Daytime symptoms occur more than twice a week - Minor limitations occur with normal activity - Peak expiratory flow is greater than or equal to 80% of predicted value

A nurse administers subcutaneous NPH insulin (Humulin N) at 0700 to a child who has diabetes. The nurse should observe for hypoglycemia caused by the onset of the medication beginning at which of the following times? 1. 0715 2. 0730 3. 1000 4. 1200

1000 ; NPH insulin (Humulin N) is an intermediate-acting insulin and has an expected onset of 3-4 hours.

A nurse is caring for a preterm newborn who is in an incubator. The nurse should make sure that the maximum oxygen concentration to deliver to this client is 1. 30% 2. 40% 3. 50% 4. 60%

40% ; oxygen concentration higher than 40% can cause retinal damage and visual impairment.

A nurse is caring for a group of children. The nurse should identify that which of the following children is at risk for impaired elimination? 1. a child with hyperglycemia 2. a child with enuresis 3. a child with hypothyroidism 4. a child who has juvenile idiopathic arthritis

A child who has hyperglycemia ; manifestations are polyuria, lethargy, confusion, thirst, nausea, vomiting, abdominal pain, dehydration, rapid respirations, and fruity breath.

A nurse is caring for a child with a suspected diagnosis of bacterial meningitis. Which of the following is the priority action by the nurse? 1. administer antibiotics when available 2. reduce environmental stimuli 3. document intake and output 4. maintain seizure precautions

Administer antibiotics when available

A nurse is reinforcing teaching to the parents of a child who has cystic fibrosis and has a prescription for pancrelipase (Pancrease) capsule. Which of the following should the nurse include in the teaching? 1. administer the medication with meals and snacks 2. capsules must be taken whole 3. this medication may be discontinued when symptoms diminish 4. this medication may cause diarrhea

Administer the medication with meals and snacks

A nurse is caring for a 3y/o female child who is prescribed an indwelling urinary catheter. Which of the following actions should the nurse take when performing this procedure? 1. place a nonsterile drape under the buttocks 2. use a catheter that is 12 French in size 3. insert the catheter another 10cm after urine returns 4. apply 2% lidocaine lubricant into the urethral meatus

Apply 2% lidocaine lubricant into the urethral meatus ; this decreases the discomfort the child might experience

A nurse is collecting data from a 7-month-old infant. Which of the following would indicate the need for further evaluation? 1. uses a unidextrous grasp 2. has a fear of strangers 3. shows preferences towards foods 4. babbles one-syllable sounds

Babbles one-syllable sounds; the infant should babble in changed syllables.

A nurse is collecting data from an 18-month-old toddler who has just presented to the urgent care clinic. Which of the following data should the nurse investigate further? 1. respiratory rate 25/min 2. blood pressure 120/80 3. heart rate 110/min 4. rectal temperate 99.3F

Blood pressure 120/80

A nurse is monitoring an infant who is 3 months old and has sneezing, coughing, nasal congestion, intermittent fever, and apneic spells. These findings are associated with which of the following diagnoses? 1. influenza 2. bronchiolitis 3. croup 4. epiglottitis

Bronchiolitis;

A nurse is collecting data from an 11-month-old infant. Which of the following clinical manifestations is suggestive of a central nervous system infection? 1. oliguria 2. bulging fontanel 3. negative brudzinski sign 4. jaundice

Bulging fontanel ; a CNS infection causes increase intracranial pressure. A positive brudzinski signs is a manifestation of CNS infection.

A nurse is collecting data about a 2 y/o who has AIDS. Based on the client's risk for opportunistic infections associated with AIDS, the nurse should inspect the inside of the child's mouth for 1. candidiasis 2. gingivitis 3. canker sores 4. Koplik spots

Candidiasis ; oral thrush is often the initial opportunistic infection noted in children who have AIDS.

A nurse is caring for an adult client who has atopic dermatitis. Which of the following is an expected finding? 1. acute rash following plant allergen exposure 2. chronic rash with thick skin 3. curving, white ridges between fingers 4. visible nits on scalp hair

Chronic rash with thick skin ; atopic dermatitis is a chronic rash. A sign in an adult client is lichenification (thick, "leathery" skin).

A nurse is attending a continuing education course about communicable disease. During which of the following stages is a disease contagious? 1. communicability period 2. convalescent period 3. incubation period 4. prodromal period

Communicability period

A nurse is reinforcing health promotion teaching to the parents of a toddler. Which of the following is the leading cause of death among this age group? 1. congenital anomalies 2. respiratory distress 3. unintentional injuries 4. sudden infant death syndrome

Congenital anomalies

A nurse is educating the parents of an infant about symptoms that should be reported to the provider. What finding should be immediately reported? 1. difficulty evacuating bowels 2. mild diarrhea 3. decreased urine output 4. abdominal distention

Decreased urine output

The nurse is caring for a hospitalized adolescent. The nurse understands that which major developmental task is important during adolescence? 1. building a sense of trust 2. learning to utilize creative energies 3. learning to defer gratification 4. defining a sense of self

Defining a sense of self

A nurse is caring for an adolescent who has acne and a new prescription for isotretinoin. For which of the following adverse effects should the nurse monitor? 1. hypersalivation 2. depression 3. bradycardia 4. hyperreflexia

Depression ; isotretinoin can cause mental changes such as suicidal thoughts, aggression, emotional lability, and depression.

A nurse is caring for a child who just underwent insertion of a ventriculoperitoneal shunt. Which of the following positions would be appropriate for the client? 1. on the operative side 2. a 45-degree head elevation 3. prone 4. dorsal recumbent

Dorsal recumbent ; lying flat on the back keeps the head level with the body, which reduces the risk of cerebrospinal fluid flowing too rapidly, leading to rapid decompression.

Which clinical manifestation would the nurse recognize associated with the presentation of rheumatic fever? 1. irritability, poor concentration and behavioral problems 2. purulent nasal discharge 3. cough 4. polyarthritis

Polyarthritis

A nurse is caring for a preschool child who has croup. Which of the following findings should the nurse report to the provider? 1. barky cough 2. paroxysmal attacks of laryngeal spasm at night 3. bilateral crackles heard in lungs 4. drooling of saliva

Drooling of saliva ; drooling can indicate epiglottitis which requires immediate medical attention.

A nurse is contributing to the plan of care for a child who has type 1 diabetes mellitus and is experiencing an acute illness. Which of the following actions should the nurse include in the plan of care? 1. monitor blood glucose levels q6h 2. withhold insulin until the illness has passed 3. encourage increased fluid intake 4. administer glucagon q3h

Encourage increased fluid intake ; this flushes out ketones and prevents dehydration. Blood glucose levels should be monitored at least q3h.

A nurse is caring for a 6 month old who is postoperative following a myringotomy. Which of the following is an appropriate method to determine the infant's pain level? 1. FLACC pain scale 2. OUCHER pain scale 3. Faces pain scale 4. visual analog pain scale

FLACC pain scale ; appropriate for infants and children between ages of 2 months and 7 years

A nurse is collecting data from an infant. Which of the following developmental skills is a 1-month-old infant able to do? 1. display a social smile 2. follow movements with eyes 3. turn head to noise 4. make babbling sounds

Follow movements with eyes; an infant can smile at 2 months and can turn their head and make babbling sounds at 3 months.

A nurse is reinforcing teaching to the guardian of a toddler who is receiving chemotherapy and has developed stomatitis. Which of the following instructions should the nurse include in the teaching? 1. administer viscous lidocaine before feedings 2. brush teeth using a firm toothbrush 3. frequently rinse the mouth with chlorhexidine mouthwash 4. increase vitamin C intake by offering orange slices

Frequently rinse the mouth with chlorhexidine mouthwash ; lidocaine might depress gag reflex and increase risk for aspiration. Use a soft, sponge tooth brush and avoid acidic foods.

A nurse in a pediatric clinic is caring for a child with iron deficiency anemia who has a prescription for ferrous sulfate tablets. Which of the following instructions should be given to the parent regarding administration of this medication 1. give with an 8 oz glass of milk 2. administer at meal time 3. give with orange juice 4. administer at bedtime

Give with orange juice ; citrus fruit or juice aids absorption of this medication.

A nurse is caring for a child who has type 1 DM and has been receiving insulin via infusion pump. Which of the following lab test would verify the average blood glucose level over the past 2 months? 1. postprandial blood glucose 2. fasting blood glucose 3. glycosylated hemoglobin 4. mean corpuscular hemoglobin

Glycosylated hemoglobin ; provides accurate average of client's blood glucose level over the past 120 days.

A nurse is collecting data from a child who has iron deficiency anemia. Which of the following data signifies that adherence to ferrous sulfate therapy has occurred? 1. occasional vomiting and nausea 2. green, tarry stools 3. tolerates milk 4. weight gain

Green, tarry stools

The nurse is collecting data for a 2-month-old with suspected pyloric stenosis. Which findings indicates pyloric stenosis? 1. hard, moveable "olive-like mass" in upper right quadrant 2. abdominal pain and irritability 3. perianal fissures and skin tags 4. sausage-shaped mass in the upper mid abdomen

Hard, moveable "olive-like mass" in upper right quadrant ; the client will experience vomiting often after feedings, demonstrate constant hunger and show signs of dehydration and failure to gain weight

A nurse is preparing to obtain a peak expiratory flow rate from an adolescent. Which of the following actions should the nurse take? 1. document the average of the client's three attempts 2. instruct the client to exhale slowly over 5 seconds into the meter 3. determine the zone according to the client's age 4. have the client stand during the procedure

Have the client stand during the procedure ; the nurse should document the highest result of three attempts.

A nurse is caring for a school-age child who has hypogalcemia. Which of the following manifestations should the nurse expect? 1. oliguria 2. hypotension 3. paralytic ileus 4. flushed skin

Hypotension

A nurse is collecting data from an infant that has a coarctation of the aorta. Which of the following is a clinical manifestation? 1. increased blood pressure in the arms with decreased blood pressure in the legs 2. decreased blood pressure in the arms with increased blood pressure in the legs 3. severe generalized cyanosis 4. pulmonary edema

Increased blood pressure in the arms with decreased blood pressure in the legs

A nurse is planning care for a child who is admitting with mumps. Which of the following is an appropriate action for the nurse to take? 1. initiate standard precautions 2. initiate airborne precautions 3. initiate droplet precautions 4. initiate contact precautions

Initiate droplet precautions

A nurse is reinforcing teaching with the guardian of a school-aged child who has acute bacterial conjunctivitis and a new prescription for sulfacetamide. Which of the following instructions should the nurse include? 1. remove dried drainage with cold washcloth 2. instill medication immediately after cleansing eye 3. apply an occlusive gauze over the child's eye 4. cleanse the eye by gently wiping from the outer aspect of the eye inward toward the nose

Instill medication immediately after cleansing the eye ; cleanse the eye by wiping from the inner to the outer canthus.

A nurse is reviewing serum laboratory results for four children. Which of the following values should the nurse report to the provider? 1. WBC 10,000 2. Lead 2mcg/dL 3. RBC 4.9 4. Iron 38 mcg/dL

Iron 38mcg/dL; normal value is 60-170.

A nurse is caring for a school-aged child who has hemophilia A. Which of the following should the nurse recognize as a manifestation of this disorder? 1. joint pain and stiffness 2. concave fingernails 3. prominent frontal bossing 4. increased risk of infection

Joint pain and stiffness ; can occur as a result of bleeding into the joint.

Discharge planning for a child with Duchenne's muscular dystrophy should include teaching about which diet? 1. low calorie, high protein, and high fiber 2. low calorie, high protein, and low fiber 3. high calorie, high protein, and restricted fluids 4. high calorie, high protein, and high fiber

Low calorie, high protein, high fiber ; patients need low calorie to prevent excessive weight gain, high protein for healing, and high fiber to promote GI motility

A nurse in a clinic is preparing to administer immunizations to a 5 y/o. The child's immunizations are current. Which of the following immunizations should the nurse administer to the client at this visit? 1. MMR 2. Haemophilus influenzae type B (Hib) 3. Pneumococcal conjugate vaccine (PCV) 4. Hepatitis B (HBV)

MMR ; first dose is given at 12-15 months. second dose given prior to school at age 4-6.

Which of the following is a clinical manifestation of a large patent ductus arteriosus? 1. cyanosis with crying 2. machinery-like murmur 3. weak pulses 4. chronic hypoxemia

Machinery-like murmur ; patent ductus arteriosus is failure of the artery connecting the aorta and pulmonary artery to close after birth causing a left-to-right shunt.

A nurse is planning care for a child who has juvenile rheumatoid arthritis. Which of the following is an appropriate action for the nurse to take? 1. administer opioids on a schedule 2. schedule prolonged periods of complete joint immobilization daily 3. apply cool compresses for 20 minutes every hour 4. maintain night splints to the affected join

Maintain night splints to the affected joint ; maintaining night splints to the affected joints will assist in range of motion.

A nurse is preparing a toddler for suturing of a minor facial laceration. The nurse should place the toddler in which of the following restraints? 1. mummy restraint 2. jacket restraint 3. elbow restraints 4. wrist restraints

Mummy restraints ; used when a short-term restraint is needed for treatment of the toddler that involves the head and neck.

A nurse is reinforcing teaching to an adolescent diagnosed with type 1 diabetes. Which of the following should the nurse include in the teaching? 1. administer glucagon (GlucaGen) for hyperglycemia 2. obtain an influenza vaccine annually 3. inject insulin in deltoid muscle 4. take glyburide (DiaBeta) with breakfast

Obtain an influenza vaccine annually ; glucagon is for hypoglycemia, not hyperglycemia. Glyburide is contraindicated for clients with type 1 diabetes.

A nurse is assisting in the care of a male child who has acute post-streptococcal glomerulonephritis (APSGN). For which of the following manifestations should the nurse monitor? 1. hypotension 2. oliguria 3. epispadias 4. chordee

Oliguria ; due to decreased glomerular filtration rate and retention of sodium and water

A pediatric client in sickle cell crisis comes to the hospital with his mother. When collecting data from the client, the nurse should expect to find which of the following manifestation? 1. fever 2. bradycardia 3. pain 4. constipation

Pain ; a client in sickle cell crisis generally has severe pain resulting from tissue hypoxia and necrosis

A nurse is caring for an infant who has a congenital heart defect. Which of the following is associated with increased pulmonary blood flow? 1. coarctation of the aorta 2. patent ductus arteriosus 3. tetralogy of fallot 4. tricuspid artesia

Patent ductus arteriosus ; the area between the pulmonary artery and aorta remains open, allowing the blood to flow through the patent ductus arteriosus and back to the pulmonary artery and lungs.

A nurse is caring for a school-age child whose mother reports dandruff and a rash on the back of her child's neck. The nurse notices white flakes don't brush off the hair. The nurse suspects which of the following disorders? 1. pediculosis capitis 2. psoriasis 3. seborrheic dermatitis 4. tinea capitis

Pediculosis capitis ; head lice. Nits are cemented to the hair shaft. They are silvery to white in color, similar to dandruff. A papular rash may be present at the nape of the neck secondary to scratching.

A nurse is caring for a 1-month-old infant who has a NG tube in place for intermittent feedings. Which of the following actions should the nurse take? 1. position the head of the crib at a 30 degree angle between feeding 2. place the infant on the left side after feeding 3. administer feedings over 5 min 4. flush the tube with 30mL of tap water

Position the head of the crib at 30 degree angle between feedings ; this prevents aspiration.

A nurse is collecting data from 9-month-old infant. Which of the following findings would require further intervention? 1. positive babinski reflex 2. positive moro reflex 3. negative doll's eye reflex 4. negative crawl reflex

Positive Moro reflex ; this reflex should disappear approximately 3-4 months of age. A crawl reflex disappears after 6 months and babinski disappears after 1 year.

What should be included in planning care for a child who has sickle cell crisis? 1. active ROM exercises daily 2. application of cold compresses to the affected area 3. promote hydration with IV and oral fluids 4. implement pain management on PRN basis

Promote hydration with IV and oral fluids ; hydration is needed to reduce blood viscosity and prevent sickling.

A nurse is assisting with planning dietary needs for a toddler. Which of the following interventions should the nurse include in the plan of care? 1. give the toddler 1/2 cup (113g) of fruit daily 2. encourage the toddler to drink 8oz of juice daily 3. give the child 40 0z of milk daily 4. provide 1 Tbsp (15g) of solid food for each year of age.

Provide 1 Tbsp (15g) of solid food for each year of age

A nurse is planning care for a child who has nephrotic syndrome and a prescription for corticosteroids. Which of the following interventions should the nurse recommend? 1. provide a low-sodium diet 2. encourage increased fluid intake 3. obtain urine ketone levels weekly 4. administer pancreatic enzymes with each meal

Provide a low-sodium diet ; decreased edema associated with nephrotic syndrome. Do not increase fluid intake because of risk for edema. Monitor urine albumin levels to evaluate effectiveness of treatment.

A nurse is collecting data on an infant who has possible cerebral palsy. Which of the following manifestations of cerebral palsy should the nurse expect to find? 1. tracks an object in surrounding with eyes 2. sits with pillow 3. smiles when mother appears at three months 4. uses pincher grasp to pick up a toy

Sits with pillow props at months.

A nurse is selecting a toy for hospitalized 6-month-old. Which of the following toys is developmentally appropriate for the infant? 1. colorful stacking rings 2. colorful crib mobile that plays music 3. soft toy that squeaks or crackles when squeezed 4. wooden farm animal puzzle with large pieces

Soft toy that squeaks or crackles when squeezed; the toy should be light, soft, and easy to handle.

A women in her first trimester of pregnancy does not have immunity to rubella. The nurse recognizes that the client understands the teaching when she tells the nurse that she plans to be immunized 1. when she is not pregnant and does not plan any future pregnancies 2. soon after she gives birth 3. immediately 4. a month before attempting pregnancy again

Soon after she gives birth ; because the rubella vaccine contains a live virus, immunization during pregnancy can be dangerous for the fetus.

Following several episodes of vomiting with an increasing temp in a 2 y/o, the nurse plans to monitor for dehydration. Which of the following findings indicates the child is dehydrated? 1. specific gravity 1.034 2. irritable behavior 3. BP 90/58 4. depressed fontanel

Specific gravity of 1.034 ; elevated specific gravity reflects concentrated urine associated with dehydration. Expected specific gravity for urine is 1.008-1.030.

A nurse is assisting the provider with developmental assessment of a toddler. Which of the following behaviors should the nurse recognize as an expected finding? 1. walks backeard with heel to toe 2. stands on one foort for several seconds 3. uses scissors to cut out shapes 4. prints letters with a pencil

Stands on one foot for several seconds

A nurse is contributing to the plan of care for an infant who has bronchiolitis and is tachypneic. Which of the following actions should the nurse include in the plan of care? 1. provide high flow oxygen via facemask 2. implement chest percussion every 2hours 3. suction nasal passages with bulb syringe 4. initiate airborne precautions

Suction nasal passages with bulb syringe ; this decreases respiratory effort. Droplet precautions should be implemented.

A nurse is reinforcing instruction on immunizations with a client who is at 12 weeks gestation. Which of the following would be safe for the nurse to administer? (SATA) - mumps - tetanus - rubeola - influenza (inactivated) - recombinant hepatitis B

Tetanus, Influenza (inactivated), Recombinant hepatitis B ; inactivated vaccines are safe to administer during pregnancy.

A nurse is collecting physical data from a 4y/o child who has diarrhea and has been vomiting for 24 hours. Which of the following sites should the nurse grasp to determine the child's skin turgor? 1. sacral area 2. top of the child's hand 3. sternal area 4. the child's abdomen

The child's abdomen

A nurse correctly understands which of the following characteristics is a possible developmental delay for a 3-month old client? 1. the infant is unable to point to bojects 2. the infant demonstrates stranger anxiety 3. the infant is unable to sit with support 4. the infant does not raise his head when placed on his abdomen

The infant does not raise his head when placed on his abdomen

A nurse is reinforcing teaching about nutrition to a parent of a toddler. Which of the following should be included in the teaching? 1. toddlers have increased appetite 2. toddlers have a decrease nutritional need 3. offer foods that are mixed together 4. fill the plate with multiple food choices

Toddlers have a decrease nutritional need; toddlers experience a decrease in appetite, prefer to have food separated, and should be offered small amounts of food.

The nurse should identify which of the following as an indication that the preschooler experienced an allergic reaction to contrast dye? 1. jaundice 2. hematuria 3. urticaria 4. petechiae

Urticaria ; manifestations of allergic reaction include urticaria, itching, flushing of the skin, possible anaphylaxis

A nurse is reinforcing teaching with the guardian of an infant who has Down Syndrome. Which of the following instructions should the nurse include to decrease the child's risk of an upper respiratory infection? 1. rinse the infant's mouth with water before feeding 2. limit the infant's fluid intake 3. use a cool mist vaporizer in the infant's room 4. avoid applying lip balm to the infant's lips

Use a cool mist vaporizer in the infant's room ; helps thin respiratory secretions and decrease the infant's risk for an upper respiratory infection.

A nurse is preparing to administer a scheduled immunization to a 5 y/o. Which of the following should the nurse administer? 1. Haemophilus influenza type b (Hib) 2. Hepatitis B (HepB) 3. Varicella vaccine 4. Meningococcal (MCV4)

Varicella vaccine ; first dose is recommended at 12-15 months. second dose recommended at 4-6 years.

A nurse is caring for a child who has acute appendicitis. Which of the following should the nurse anticipate when reviewing this client's lab values? 1. WBC level 17,00/mm^3 2. neutrophil level 3,000/mm^3 3. a WBC shift to the right 4. an increase in lymphocytes

WBC level 17,000/mm^3 ; expected reference range for a child is 4,500-13,500. Appendicitis is an acute bacterial infection.