Pediatrics (Questions)

A

A child with lead poisoning is admitted to the facility for chelation therapy. The nurse must stay alert for which adverse effect of chelation therapy? a) seizures b) chills c) anaphylaxis d) heart failure

C

A chronically ill school-age child is most vulnerable to which stressor? a) mutilation anxiety b) anticipatory grief c) anxiety over school absences d) fear of hospital procedures

B

A client with bacterial meningitis is admitted to the inpatient unit. Which infection control measure should the nurse be prepared to use? a) reverse isolation b) respiratory isolation c) strict hand washing d) standard precautions

A (More common in girls, peak age is 8-15)

A nurse in a well-child clinic is assessing children for scoliosis. Which child is most at risk for scoliosis? a) 10-year-old girl b) 8-year-old boy c) teenage boy d) 6-year-old girl

Autonomy vs. Shame and Doubt

Erikson toddler stage

Hyperopia

Farsighted - can see far but not near

A (CI if under 8 due to risk of permanent teeth discoloration)

Tetracycline has been ordered to treat pneumonia in a 6-year-old client. Which is the appropriate nursing intervention? a) Call the healthcare provider to request a different antibiotic. b) Monitor the client's urinary output during treatment. c) Administer the medication with food to decrease the risk of nausea. d) Educate the caregiver regarding the increased risk of sunburn while taking this medication.

D (s/s of low cardiac output. Want UOP of 1 mL/kg/hr for this age, so this is an adequate amount)

Twelve hours after cardiac surgery, the nurse is assessing a 3-year-old who weighs 15 kg. The nurse should notify the surgeon about which clinical finding? a) strong peripheral pulses in all four extremities b) a urine output of 60 mL in 4 hours c) fluctuations of fluid in the collection chamber of the chest drainage system d) alterations in levels of consciousness

A (wouldn't be taking B or C yet)

What liquid does the nurse recommend the parents of a 1½-month-old infant with hypothyroidism use to administer levothyroxine with? a) small amount of formula or breast milk b) infant's bowl of cereal c) milk or orange juice d) large amount of water

12-18 months

When does the anterior fontanel close?

D (may need frequent suctioning to remove mucus) (A is correct, but D is priority)

An infant undergoes surgery to correct an esophageal atresia and tracheoesophageal fistula. Which nursing diagnosis has the highest priority during the first 24 hours postoperatively? a) risk for aspiration b) imbalanced nutrition: less than body c) requirements d) ineffective airway clearance e) impaired tissue perfusion

C

The nurse is discussing treatment options with the parents of a child who has been newly diagnosed with leukemia. Which of the following is the most appropriate information for the nurse to give the parents about treatment options? a) "Bone marrow transplant is the quickest treatment option." b) "Immunotherapy has fewer side effects than traditional therapies." c) "Chemotherapy has the greatest potential to cure the cancer." d) "There are numerous alternative therapies that are highly effective."

B

A school nurse is teaching 4th graders about preventing injuries when riding bicycles, skateboarding, or using scooters. Indicate which is the best way for the nurse to motivate the children to use safety equipment? a) Tell the children that wearing helmets and knee pads are the law and that their parents will get into trouble. b) Present slides of famous athletes wearing protective gear. c) Show the children an animated movie about a child who has a traumatic brain injury. d) Ask the children what they know about bicycle safety.

A

An IV infusion is to be administered through a scalp vein on an infant's head. What should the nurse tell the parents to prepare them for the procedure? a) It may be necessary to remove a small amount of hair from the infant's scalp. b) Visiting the infant will be delayed until the infusion has been completed. c) Holding the infant will be contraindicated while the infusion is being administered. d) A sedative will be given to the infant to help keep the child quiet.

D (meets nonnutritive sucking needs and ensures oral gratification)

Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4-week-old infant is fussy and restless. What action would be most appropriate at this time? a) Encourage the parents to hold the infant. b) Hang a mobile over the infant's crib. c) Give the infant more to eat. d) Give the infant a pacifier to suck on.

A (showing s/s of increased ICP. Lumbar puncture = RF herniation)

The emergency department nurse has admitted an infant with bulging fontanels, setting sun eyes, and lethargy. Which diagnostic procedure would be contraindicated in this infant? a) lumbar puncture b) magnetic resonance imaging c) arterial blood draw d) computerized tomography scan

A (RF Fe def anemia)

The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to which problem? a) iron deficiency b) vitamin C deficiency c) biotin deficiency d) folate deficiency

A (NPO to rest GI tract but given IVF --> no vomiting = clear liquids)

The nurse teaches the father of an infant hospitalized with gastroenteritis about the next step of the treatment plan once the infant's condition has been controlled. The nurse should determine that the father understands when he explains that which intervention will occur with his infant? a) The infant will receive clear liquids for a period of time. b) The infant will be allowed to go to the playroom. c) Formula and juice will be offered. d) Blood will be drawn daily to test for anemia.

A

After receiving a report, the nurse is making out assignments. Which client would be appropriate to assign to unlicensed assistive personnel? a) an 8-month-old with pneumonia who will be discharged today b) a 6-year-old with a femur fracture and a fever c) a 7-year-old transferred from the cardiac intensive care unit d) a 13-year-old adolescent with fluctuating vital signs and a new central line

D

An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder? a) metabolic acidosis b) hyperkalemia c) hypoglycemia d) metabolic alkalosis

Myopia

Nearsighted - can see near but not far

A

On initial assessment of a 7-year-old child with rheumatic fever, which finding would require contacting the primary care provider immediately? a) heart rate of 150 bpm b) swollen and painful knee joints c) twitching in the extremities d) red rash on the trunk

D (Rolling over expected 4-6 mo, sitting without support at 6 mo, crawling at 9 mo. Should be able to stand holding onto objects at 9 mo)

Which infant most needs a developmental referral for a gross motor delay? a) the 2-month-old who does not roll over b) the 4-month-old who does not sit without support c) the 6-month-old who does not crawl d) the 9-month-old who does not stand holding on

D (indicates HTN, complication of glomerulonephritis)

The nurse assesses a child with acute glomerulonephritis. Which finding should the nurse should report immediately to the health care provider? a) temperature of 100.2° F (37.9° C) b) serum sodium level of 135 c) weight loss of 1 lb (0.45 kg) d) blood pressure of 140/92 mm Hg

B

The nurse is caring for a 4-year-old child who is admitted for minor elective surgery. The child is frightened and anxious. Which of the following interventions would be most appropriate for the nurse to take to help the child? a) Provide teaching about the surgery. b) Encourage parental reinforcement. c) Introduce the child to the surgeon. d) Ask the child to explain what's frightening.

B (same for diarrhea or NG suction)

The nurse is caring for a 5-year-old child who had a hernia repair 1 day ago. The child is vomiting, has a nasogastric (NG) tube to low intermittent suction, and has diarrhea. Which of the following laboratory results would be the immediate priority for the nurse to assess? a) magnesium level b) potassium level c) chloride level d) calcium level

C (expected to cruise but not necessarily walk without support)

While examining an 11-month-old child, the nurse notes that the child can stand independently but cannot walk without support. How should the nurse intervene? a) Tell the mother that the child may have a developmental delay. b) Recommend the child uses a walker at home. c) Do nothing because this is a normal finding in a child this age. d) Initiate a consultation with a developmental specialist.

A

A school-age child diagnosed with attention deficit hyperactivity disorder is prescribed methylphenidate. What finding should alert the school nurse to the possibility that the child is experiencing a common side effect of the drug? a) loss of appetite b) vomiting c) photosensitivity d) weight gain

D

A school-age child is admitted to the hospital with the diagnosis of probable infratentorial brain tumor. During the child's admission to the pediatric unit, which action should the nurse anticipate taking first? a) Introduce the child to other clients of the same age. b) Eliminate the child's anxiety. c) Implement seizure precautions. d) Prepare the child and parents for diagnostic procedures.

D (meningitis = knee won't extend, attempts to extend the knee will cause pain) (A is Trosseau's sign and is for calcium) (Brudinzki's sign = test for nuchal rigidity by flexing pt neck and looking for leg/knee flexion)

The nurse assesses a child with fever, sensitivity to light, and a red rash on the back. How will the nurse assess for Kernig's sign? a) Place the child in the supine position, and inflate a blood pressure cuff on the arm. b) Have the child sit, and tap the child's face over the facial nerve area. c) Have the child stand, and ask the child to flex the neck by bringing the chin to the chest. d) Have the child lie supine with flexed knees, then ask the child to extend the knees.

B (should do right away to ensure line stays patent)

Which observation by the nurse indicates that the mother of a child receiving home IV nafcillin therapy requires further teaching? The mother: a) allows the antibiotic to run into the child's vein over a period of 30 minutes. b) flushes the venous access site with c) heparin 20 minutes after giving the antibiotic. d) stops the infusion when the area around the insertion site becomes hard and reddened. e) calls the home health nurse because the antibiotic solution will not infuse.

A

Which sign is an early indicator of heart failure in an infant with a congenital heart defect? a) tachycardia b) pulmonary edema c) poor weight gain d) tachypnea

A, B, C, D

Which strategies should the nurse use when counseling an adolescent to change eating habits for weight loss? Select all that apply. a) Eat only at certain times. b) Write down all foods eaten. c) Leave food on your plate. d) Eat the food at a slower pace. e) Do something else while eating.

C

A 10-month-old child with recurrent otitis media is brought to the clinic for evaluation. What is most important for the nurse to ask the family about the baby's symptoms? a) "Can the baby combine two words when speaking?" b) "Does water ever get into the baby's ears during shampooing?" c) "Do you give the baby a bottle to take to bed?" d) "Have you noticed a lot of wax in the baby's ears?"

A, C, E (teach to keep joints extended in bed to pv flexion deformities, heat increases circulation + decreases pain + increases mobility, ROM even when inflamed pv flexion deformities)

What information should the nurse include in the teaching plan of care for a child with juvenile rheumatoid arthritis and their family? Select all that apply. a) Sleep on a firm mattress to support the joints. b) Perform repetitive weight-bearing exercises with affected joints. c) Apply moist heat to affected joints as needed. d) Teach the child to keep joints flexed while in bed. e) Encourage range-of-motion exercises when joints are inflamed.

B (indicates meningitis)

When teaching a parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include? a) burning or pain with urination b) complaints of a stiff neck c) fever disappearing for longer than 24 hours, then returning d) history of febrile seizures

C

The parent of a 2-year-old is concerned because the child's right eye seems to turn in toward the nose when the child is tired. The nurse should: a) Assure the parent that this is a normal event when the child is tired. b) Advise the parent to continue to watch the child's eyes closely and, if the problem persists, to call the clinic. c) Test the child with the cover-uncover test and refer the parent and child to an ophthalmologist if the test is abnormal. d) Explain to the parent that the child will probably outgrow the weakness and the parent need not be concerned.

D

A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? a) inappropriate parental concern for the degree of injury b) absence of parents to question about the injury c) inappropriate response of the child to the injury d) incompatibility between the child's history and the injury

D (Is a lower UTI, common in women after 1st sexual intercourse)

A nurse is providing health teaching to a group of adolescent girls. The focus is on urinary tract infections. One of the girls tells the nurse that she wants to know more about cystitis. Which statement by the nurse is the most appropriate response? a) "This is a serious condition that occurs after intercourse or vaginal cleanses." b) "This is a minor bacterial infection of the bladder that can occur at anytime." c) "This condition happens frequently in young women and is not harmful." d) "This condition can result from irritation and inflammation from sexual activity."

D (early s/s of dig toxicity) (always listen apically before giving dig)

A toddler with a ventricular septal defect is receiving digoxin to treat heart failure. Which assessment finding should be the nurse's priority concern? a) hypertension b) hyperactivity c) tachycardia d) bradycardia

D

An adolescent is on the football team and practices in the morning and afternoon before school starts for the year. The temperature on the field has been high. The school nurse has been called to the practice field because the adolescent is now reporting that he has muscle cramps, nausea, and dizziness. Which action should the school nurse do first? a) Administer cold water with ice cubes. b) Take the adolescent's temperature. c) Have the adolescent go to the swimming pool. d) Move the adolescent to a cool environment.

B (b/c life and death situation)

A 16-year-old client is admitted to the emergency department following an accident. The client sustained a head injury, is unconscious, and has compound fractures of the right tibia and fibula. No family members accompanied the client and none can be reached by phone. The surgeon instructs the nurse to take the client to the operating room immediately. Which of the following actions should the nurse take regarding informed consent? a) Call the nursing supervisor and ask that the hospital lawyer be contacted. b) Keep the client in the emergency department until the family is contacted. c) Take the client to the operating room for surgery without informed consent. d) Contact the hospital chaplain to sign the consent on the client's behalf.

D (b/c infants have immature immune system)

A 9-month-old, well-nourished boy who lives with his extensive extended family tests positive for tuberculosis. What is a risk factor for tuberculosis in this child? a) being male b) being in the 95th percentile for height and weight c) having a mother who did not receive d) prenatal care until the second trimester of her pregnancy d) being an infant

D (platelets low - normal is 150-300x10)

A child with leukemia has petechiae; gums, lips, and nose that bleed easily; and bruising on various parts of her body. Which laboratory test results should the nurse correlate with these findings? a) partial thromboplastin time of 38 seconds b) serum calcium level of 5 mg/dL(1.25 mmol/L) c) fibrinogen level of 75 mg/dL (2.21 µmol/L) d) platelet count of 80 x 103/mm3 (80 X 109/L)

C

A child, age 2, with a history of recurrent ear infections is brought to the clinic with a fever and irritability. To elicit the most pertinent information about the child's ear problems, the nurse should ask the parent: a) "Does anyone in your family have hearing problems?" b) "Does your child's ear hurt?" c) "Does your child tug at either ear?" d) "Does your child have any hearing problems?"

A (throat problems common precursor to rheumatic fever)

A client with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the client's history, the nurse considers which information to be most important? a) a recent episode of pharyngitis b) lack of interest in food c) vomiting for 2 days d) a fever that started 3 days ago

D (elbow restraints keep the child from placing their fingers or an object in the mouth that would cause injury. Restraints are worn at all times except when removed to check the skin)

After teaching the parents of a 15-month-old child who has undergone cleft palate repair how to use elbow restraints, which statement by the parents indicates effective teaching? a) "We'll keep the restraints in place continuously until our health care provider says it's okay to remove them." b) "We can take off the restraints while our child is playing, but we'll make sure to put them back on at night." c) "The restraints should be taped directly to our child's arms so that they'll stay in one place." d) "We'll remove the restraints temporarily, one at a time, at least three times a day to check his skin, then put them right back on."

C (Can act out feelings - need creative play. Blocks are for younger population)

Anticipating that a preschool-age child in traction will have need for diversion, what should the nurse offer the child? a) a video game b) blocks c) hand puppets d) a remote controlled car