Peds Exam 1 NCLEX style questions
An infant who weighs 7.5 kg is to receive ampicillin (Omnipen) 25 mg/kg I.V. every 6 hours. How many milligrams should the nurse administer per dose? Record your answer using one decimal place. Answer: milligrams
187.5 milligrams RATIONALE: The nurse should calculate the correct dose using the following equation: 25 mg/kg × 7.5 kg = 187.5 mg
When making ethical decisions about caring for preschoolers, a nurse should remember to: 1. provide beneficial care and avoid harming the child. 2. make decisions that will prevent legal trouble. 3. do what she would do for her own child or loved ones. 4. be sure to do what the physician says.
1. provide beneficial care and avoid harming the child. RATIONALE: Nurses must provide beneficial care and avoid harming all clients. A nurse shouldn't base any decision solely on the desire to prevent legal trouble, on her own feelings for her loved ones, or what the physician says.
A teenage mother brings her 1-year-old child to the pediatrician's office for a well-baby checkup. She says that her infant can't sit alone or roll over. An appropriate response by the nurse would be: 1. "This is very abnormal. Your child must be sick." 2. "Let's see about further developmental testing." 3. "Don't worry, this is normal for her age." 4. "Maybe you just haven't seen her do it."
. "Let's see about further developmental testing." RATIONALE: Stating that further developmental testing is necessary is appropriate because at age 12 months a child should be sitting up and rolling over. Therefore, this child may have developmental problems. Saying the infant's behavior is abnormal or suggesting that the mother hasn't seen her infant do these milestones isn't therapeutic and can cut off communication with the mother. Telling the mother that the infant's behavior is normal misleads the mother with false reassurance.
A toddler develops acute otitis media and is ordered cefpodoxime proxetil (Vantin) 5 mg/kg P.O. every 12 hours. If the child weighs 22 lb (10 kg), how many milligrams will the nurse administer with each dose? 1. 50 mg 2. 100 mg 3. 110 mg 4. 220 mg
1. 50 mg RATIONALE: The dose is 5 mg/kg and the child weighs 10 kg. To determine the dose, the nurse would calculate: 5 mg/1 kg × 10 kg = 50 mg per dose.
Which activity would best occupy a 12-month- old child while the nurse is interviewing the parents? 1. String of large snap beads and a large plastic bowl 2. Riding toy 3. Several small puzzles 4. Paste, paper, and scissors
1. Stringing large beads is appropriate for 12 months. Note that the beads are large and therefore not subject to being swallowed. A riding toy and small puzzles would be more appropriate for a toddler. Paste, paper, and scissors are appropriate for a preschooler when used with supervision.
A school-age child presents to the office for a routine examination. Given the child's developmental level, a nurse should give highest priority to: 1. allowing the child to change into a gown while she isn't in the room. 2. allowing the child to play with medical equipment before the examination begins. 3. asking the parents to leave the room during the child's examination. 4. encouraging the child to hold a stuffed animal during the examination.
1. allowing the child to change into a gown while she isn't in the room. RATIONALE: School-age children tend to be very modest. The nurse should allow them to change into gowns while she isn't in the examination room. Children shouldn't have to take off their underwear for routine medical examinations. Playing with medical equipment is characteristic of younger children. The nurse shouldn't ask parents to leave the room unless the child requests that they not be present. A school-age child may feel too old to hold a stuffed animal during the examination.
What is a normal systolic blood pressure for a 3-year-old child? 1. 60 mm Hg 2. 93 mm Hg 3. 120 mm Hg 4. 150 mm Hg
2. 93 mm Hg RATIONALE: The normal range for systolic blood pressure in preschoolers is 82 to 110 mm Hg. The normal range for diastolic blood pressure is 50 to 78 mm Hg.
A child, age 3, is admitted to the pediatric unit with dehydration after 2 days of nausea and vomiting. The mother tells the nurse that her child's illness "is all my fault." How should the nurse respond? 1. "Maybe next time you'll bring the child in sooner." 2. "Tell me why you think this is your fault." 3. "Try not to cry in front of the child. It'll only upset her." 4. "Don't be so upset. Your child will be fine."
2. "Tell me why you think this is your fault." RATIONALE: Having the mother explain why she feels the illness is her fault is appropriate because many parents feel responsible for their child's illness and may need instruction about the actual cause of the illness. Pointing out that the mother could have brought the child in sooner could increase the mother's feelings of guilt. Telling the mother not to cry or be upset ignores her feelings
The mother of an 11-month-old infant reports to the nurse that her infant sleeps much less than other children. The mother asks the nurse whether her infant is getting sufficient sleep. What should be the nurse's initial response? 1. Reassure the mother that each infant's sleep needs are individual. 2. Ask the mother for more information about the infant's sleep patterns. 3. Instruct the mother to decrease the infant's daytime sleep to increase his nighttime sleep. 4. Inform the mother that her infant's growth and development are appropriate for his age, so sleep isn't a concern.
2. Ask the mother for more information about the infant's sleep patterns. RATIONALE: The nurse needs more information about the infant's sleep patterns to rule out potential problems before determining whether the infant is getting enough sleep. The nurse shouldn't offer advice or reassurance without knowing more about the infant's specific sleep habits.
The parents of a 3-year-old child are leaving for the evening. Which behavior would the nurse expect the child to exhibit? 1. Wave goodbye to the parents 2. Cry when the parents leave 3. Hide his/her head under the covers 4. Ask to go to the playroom
2. It is normal for a 3-year-old to cry when the parents leave. The child will probably not wave goodbye even though he/she is able to. The child is not likely to hide under the covers. The child will likely be too upset to ask to go to the playroom.
A nurse observes a 2½-year-old child playing with another child of the same age in the playroom on the pediatric unit. What type of play should the nurse expect the children to engage in? 1. Associative play 2. Parallel play 3. Cooperative play 4. Therapeutic play
2. Parallel play RATIONALE: Two-year-olds engage in parallel play, in which they play side by side but rarely interact. Associative play is characteristic of preschoolers, in which they are all engaged in a similar activity but there is little organization. School-age children engage in cooperative play, which is organized and goal-directed. Therapeutic play is a technique that can be used to help understand a child's feelings; it consists of energy release, dramatic play, and creative play.
A 3-year-old child has all of the following abilities. Which did he acquire most recently? 1. Walking 2. Throwing a large ball 3. Riding a tricycle 4. Stating his name
3. Riding a tricycle is 3-year-old behavior. Remember, "three years, three wheels." Children start to walk at about 1 year of age. Throwing a large ball and stating his name are 2-year-old behaviors. Remember to use developmental trends when determining the most recently acquired behavior—head to tail and simple to complex. Look for a complex lower body behavior.
What should a nurse do to ensure a safe hospital environment for a toddler? 1. Place the child in a youth bed. 2. Move stacking toys out of reach. 3. Pad the crib rails. 4. Move the equipment out of reach.
4. Move the equipment out of reach. RATIONALE: Moving the equipment out of reach ensures a safe environment because toddlers are curious and may try to play with items within their reach. Toddlers in a strange hospital environment still need the security of a crib. Stacking toys don't need to be moved out of reach because they don't present a safety hazard and are appropriate for this age-group. Padded crib rails are necessary only if seizure activity is present
How should a nurse position a 4-month-old infant when administering an oral medication? 1. Seated in a high chair 2. Restrained flat in the crib 3. Held on the nurse's lap 4. Held in the bottle-feeding position
4. Held in the bottle-feeding position RATIONALE: The nurse should hold an infant in the bottle-feeding position when administering an oral medication by placing the child's inner arm behind the back, supporting the head in the crook of the elbow, and holding the child's free hand with the hand of the supporting arm. A 4-month-old infant can't sit unsupported in a high chair. Administering medication to an infant lying flat could cause choking and aspiration. Holding the infant in the lap may cause the medication to spill.
An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child? 1. Encouraging the infant to hold a bottle 2. Keeping the infant on bed rest to conserve energy 3. Rotating caregivers to provide more stimulation 4. Maintaining a consistent, structured environment
4. Maintaining a consistent, structured environment RATIONALE: The nurse caring for an infant with inorganic failure to thrive should strive to maintain a consistent, structured environment because it reinforces a caring feeding environment. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care
A mother of a 4-year-old child asks the nurse how to talk with her daughter about strangers. The little girl is very friendly and her mother is concerned that her child could be abducted. The nurse should tell the mother: 1. to talk with her daughter about what she should do if a stranger talks to her. 2. that she lives in a safe town and shouldn't worry. 3. to talk with her daughter about bad people and remind her to tell Mommy if someone she doesn't know talks to her. 4. contact social services, which is better equipped to respond to her questions
1. to talk with her daughter about what she should do if a stranger talks to her. RATIONALE: Preschoolers can begin to take a role in their own safety. They must be taught what a stranger is and what to do if a stranger approaches them. Living in a safe town doesn't eliminate the need to warn a child about talking to strangers. Although it's appropriate for the mother to talk with her daughter about strangers and have the daughter tell her if a stranger approaches her, the child needs to be aware of what to do at the time that the situation occurs, not only afterward. Contacting social services isn't appropriate because the nurse is capable of answering the mother's questions.
A child has just been admitted to the facility and is displaying fear related to separation from his parents, the room being too dark, being hurt while in the hospital, and having many different staff members come into the room. Based on the nurse's knowledge of growth and development, the child is likely: 1. 7 to 12 months old (an infant). 2. 1 to 3 years old (a toddler). 3. 6 to 12 years old (a school-age child). 4. 12 to 18 years old (an adolescent
2. 1 to 3 years old (a toddler). RATIONALE: Toddlers show fear of separation from their parents, the dark, loud or sudden noises, injury, strangers, certain persons, certain situations, animals, large objects or machines, and change in environment. Infants show fear of strangers, the sudden appearance of unexpected and looming objects (including people), animals, and heights. School-age children show fear of supernatural beings, injury, storms, the dark, staying alone, separation from parents, things seen on television and in the movies, injury, tests and failure in school, consequences related to unattractive physical appearance, and death. Adolescents show fear of inept social performance, social isolation, sexuality, drugs, war, divorce, crowds, gossip, public speaking, plane and car crashes, and death.
In planning care for an 18-month-old child, the nurse would expect him to be able to do which of the following? 1. Button his shirt and tie his shoes 2. Feed himself and drink from a cup 3. Cut with scissors 4. Walk up and down stairs
2. An 18-month-old should be able to feed himself and drink from a cup. He may be messy. A 5- or 6-year-old can usually button a shirt and tie shoes. Cutting with scissors is appropriate for a preschool child. A 2-year-old child can go up and down stairs with both feet on the same step, and a 3-year-old child can go up and down stairs by alternating feet.
A nurse is caring for an adolescent who underwent surgery for a perforated appendix. When caring for this adolescent, the nurse should keep in mind that the main life-stage task for an adolescent is to: 1. resolve conflict with parents. 2. develop an identity and independence. 3. develop trust. 4. plan for the future
2. develop an identity and independence. RATIONALE: An adolescent strives for a sense of independence and identity. During this time, conflicts are heightened, not resolved. Trust begins to develop during infancy and matures during the course of development. Adolescents rarely finalize plans for the future; this normally happens later in adulthood
A chronically ill school-age child is most vulnerable to which stressor? 1. Mutilation anxiety 2. Anticipatory grief 3. Anxiety over school absences 4. Fear of hospital procedures
3. Anxiety over school absences RATIONALE: The school-age child is becoming industrious and attempts to master school-related activities. Therefore, school absences are likely to cause extreme anxiety for a school-age child who's chronically ill. Mutilation anxiety is more common in adolescents. Anticipatory grief is rare in a school-age child. Fear of hospital procedures is most pronounced in preschool-age children.
To establish a good interview relationship with an adolescent, which strategy is most appropriate? 1. Asking personal questions unrelated to the situation 2. Writing down everything the teen says 3. Asking open-ended questions 4. Discussing the nurse's own thoughts and feelings about the situation
3. Asking open-ended questions RATIONALE: Open-ended questions allow the adolescent to share information and feelings. Asking personal questions not related to the situation jeopardizes the trust that must be established because the adolescent may feel as though he's being interrogated with unnecessary questions. Writing everything down during the interview can be a distraction and doesn't allow the nurse to observe how the adolescent behaves. Discussing the nurse's thoughts and feelings may bias the assessment and is inappropriate when interviewing any client
A 5-year-old child had major surgery several days ago and is allowed to be up. When planning diversional activity, which action by the nurse is most appropriate? 1. Give the child a book to read. 2. Play a board game with the child. 3. Encourage the child to play house with other children. 4. Turn on the television so the child can watch cartoons
3. Five-year-old children like cooperative play, such as playing house. The other activities are solitary activities. Note that the child is several days postsurgery. Most 5-year-olds are not able to read a book by themselves. Playing a board game with a child is not wrong, but it is a solitary activity. Most 5-year-olds would prefer to play with other children. There is almost always a better alternative than turning on the television. This child is several days postsurgery and is able to be up and play with others.
A 2-year-old child is hospitalized for a fractured femur. During his first two days in the hospital, he lies quietly, sucks his thumb, and does not cry. Which is the best interpretation of his behavior? 1. He has made a good adjustment to being in the hospital. 2. He is comfortable with the nurses caring for him. 3. He is experiencing anxiety. 4. He does not have a good relationship with his parents.
3. The child's behavior is typical of the despair phase of toddler responses to anxiety. The child should cry. Lying quietly, sucking his thumb, and saying nothing are suggestive of severe anxiety, a bad adjustment to the hospital, and no comfort with the nurses. This anxiety response does not suggest a poor relationship with his parents. In fact, his severe separation anxiety may be because he is so close to his parents.
A toddler is in the hospital. The parents tell the nurse they're concerned about the seriousness of the child's illness. Which response to the parents is most appropriate? 1. "Please try not to worry. Your child will be fine." 2. "If you look around, you'll see other children who are much sicker." 3. "What seems to concern you about your child being hospitalized?" 4. "It must be difficult for you when your child is ill and hospitalized."
4. "It must be difficult for you when your child is ill and hospitalized." RATIONALE: Expressing concern is the most appropriate response because it acknowledges the parents' feelings. False reassurance, such as telling parents not to worry, isn't helpful because it doesn't acknowledge their feelings. Encouraging parents to look at how ill other children are also isn't helpful because the focus of the parents is on their own child. Asking what the concern is merely reinforces the parents' concern without addressing it.
A hospitalized 2.5-year-old child has a temper tantrum while her mother is bathing her. Her mother asks the nurse how she should handle this behavior. Which information should be included in the nurse's reply? 1. Temper tantrums in a hospitalized child indicate regression. 2. Tantrums suggest a poorly developed sense of trust. 3. Discipline is necessary when a child has a temper tantrum. 4. This behavior is a normal response to limit setting in a child of this age.
4. Temper tantrums are a normal response to limit setting in a 2-year-old child. Answer 1 might be correct if the child were older. However, temper tantrums in a 2-year-old child do not indicate regression; rather, they are normal for this age. Tantrums are not suggestive of a poorly developed sense of trust; they are normal. Ignoring the tantrum is preferable to discipline when a 2-year- old has a tantrum.
A nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is appropriate? 1. "Don't worry. It won't hurt." 2. "The test usually takes an hour." 3. "You must sleep the whole time that the test is being done." 4. "The special medicine will feel warm when it's put in the tubing."
4. "The special medicine will feel warm when it's put in the tubing." RATIONALE: To prepare a 4-year-old child without increasing anxiety, the nurse should provide concrete information in small amounts about nonthreatening aspects of the procedure. Therefore, saying the special medicine will feel warm is most appropriate. Saying that it won't hurt may prevent the child from trusting the nurse in the future. Explaining the time needed for the procedure wouldn't provide sufficient information. Stating that the child will need to sleep isn't true and could provoke anxiety.
A nurse is teaching the parents of a 6-month-old infant about usual growth and development. Which statements about infant development are true? Select all that apply. 1. A 6-month-old infant has difficulty holding objects. 2. A 6-month-old infant can usually roll from prone to supine and supine to prone positions. 3. A teething ring is appropriate for a 6-month-old infant. 4. Stranger anxiety usually peaks at 12 to 18 months. 5. Head lag is commonly noted in infants at age 6 months. 6. Lack of visual coordination usually resolves by age 6 months
2. A 6-month-old infant can usually roll from prone to supine and supine to prone positions. 3. A teething ring is appropriate for a 6-month-old infant. 6. Lack of visual coordination usually resolves by age 6 months. RATIONALE: Gross motor skills of the 6-month-old infant include rolling from front to back and back to front. Teething usually begins around age 6 months; therefore, a teething ring is appropriate. Visual coordination is usually resolved by age 6 months. At age 6 months, fine motor skills include purposeful grasps. Stranger anxiety normally peaks at 8 months of age. The 6-month-old infant also should have good head control and no longer display head lag when pulled up to a sitting position.
A nurse notes that an infant develops arm movement before fine-motor finger skills and interprets this as an example of which pattern of development? 1. Cephalocaudal 2. Proximodistal 3. Differentiation 4. Mass-to-specific
2. Proximodistal RATIONALE: Proximodistal development progresses from the center of the body to the extremities, such as from the arm to the fingers. Cephalocaudal development occurs along the body's long axis; for example, the infant develops control over the head, mouth, and eye movements before the upper body, torso, and legs. Mass-to-specific development, sometimes called differentiation, occurs as the child masters simple operations before complex functions and moves from broad, general patterns of behavior to more refined ones.
When developing a care plan for an adolescent, the nurse considers the child's psychosocial needs. During adolescence, psychosocial development focuses on: 1. becoming industrious. 2. establishing an identity. 3. achieving intimacy. 4. developing initiative.
2. establishing an identity. RATIONALE: According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity while overcoming role or identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers, and strives to attain a personal identity by becoming more independent from his family. Becoming industrious is the developmental task of the school-age child; achieving intimacy is the task of the young adult; and developing initiative is the task of the preschooler.
An infant, age 10 months, is brought to the well-baby clinic for a follow-up visit. The mother tells the nurse that she has been having trouble feeding her infant solid foods. To help correct this problem, the nurse should: 1. point out that tongue thrusting is the infant's way of rejecting food. 2. instruct the mother to place the food at the back and toward the side of the infant's mouth. 3. advise the mother to puree foods if the child resists them in solid form. 4. suggest that the mother force-feed the child if necessary.
2. instruct the mother to place the food at the back and toward the side of the infant's mouth. RATIONALE: The nurse should instruct the mother to place the food at the back and toward the side of the infant's mouth because it encourages swallowing. Tongue thrusting is a physiologic response to food placed incorrectly in the mouth. Offering pureed foods wouldn't encourage swallowing, which is a learned behavior. Force-feeding is inappropriate because it may be frustrating for both the mother and child and may cause the child to gag and choke when attempting to reject the undesired food; also, it may lead to a higher-than-normal caloric intake, resulting in obesity.
An emergency department nurse suspects neglect in a 3-year-old boy admitted for failure to thrive. Signs of neglect in the child would include: 1. slapping, kicking, and punching others. 2. poor hygiene and weight loss. 3. loud crying and screaming. 4. pulling hair and hitting
2. poor hygiene and weight loss. RATIONALE: Signs of neglect include poor hygiene and weight loss because neglect can involve failure to provide food, bed, shelter, health care, or hygiene. Slapping, kicking, pulling hair, hitting, and punching are examples of forms of physical abuse, not neglect. Loud crying and screaming are normal findings in a 3-year-old boy.
An 8-month-old infant is admitted with a febrile seizure. The infant weighs 17 lb (7.7 kg). The physician orders ceftriaxone (Rocephin), 270 mg I.M. every 12 hours. (The safe dosage range is 50 to 75 mg/kg daily.) The pharmacy sends a vial containing 500 mg, to which the nurse adds 2 ml of preservative-free normal saline solution. The nurse should administer how many milliliters? 1. None because this isn't a safe dosage 2. 0.08 ml 3. 1.08 ml 4. 1.8 ml
3. 1.08 ml RATIONALE: Because the infant weighs 17 lb (7.7 kg), the safe dosage range is 385 to 578 mg daily. The ordered dosage, 540 mg daily, is safe. To calculate the amount to administer, the nurse may use the following fraction method: 500 mg/2 ml = 270 mg/X ml 500X = 270 × 2 500X = 540 X = 540/500 X = 1.08 ml
Ten days after cardiac surgery, an 18-month-old child is recovering well. The child is alert and fairly active and is playing well with the parents. Discharge is planned soon. The nurse notes that the parents are still very reluctant to allow the child to do anything without help. What is the best initial action for the nurse to take? 1. Reemphasize the need for autonomy in toddlers 2. Provide opportunities for autonomy when the parents are not present 3. Reassess the parent's needs and concerns 4. Discuss the success of the surgery and how well the child is doing
3. Before the nurse can teach the parents, it will be necessary to reassess their needs and concerns. The question asks for the best initial action. Initially, the nurse should assess. Later, the nurse may emphasize the toddler's need for autonomy. The nurse may provide the child with opportunities to develop autonomy, although it would be better to teach the parents. The nurse may also discuss the success of the surgery and how well the child is doing, but this is not the initial action.
A 10-year-old girl is being treated for rheumatic fever. Which would be an appropriate activity while she is on bed rest? 1. Stringing large wooden beads 2. Engaging in a pillow fight 3. Making craft items from felt 4. Watching television
3. Craft work allows her to accomplish something while meeting her needs for rest. Industry is the developmental task for school-age children. The joint pains with rheumatic fever tend to be in the large joints, not the small ones, so craft work using finger activity would probably not be painful. Stringing large wooden beads is appropriate for younger children. Pillow fighting requires too much energy for a child on bed rest and is not appropriate for a hospital environment. Watching television is a solitary activity with no sense of accomplishment
Which relaxation strategy would be effective for a school-age child to use during a painful procedure? 1. Having the child keep his eyes shut at all times 2. Having the child hold his breath and not yell 3. Having the child take a deep breath and blow it out until told to stop 4. Being honest with the child and telling him the procedure will hurt a lot
3. Having the child take a deep breath and blow it out until told to stop RATIONALE: Having the child take a deep breath and blow it out is a form of distraction and will help the child cope better with the procedure. A child may prefer to keep his eyes open, not shut, during a procedure so he can see what is going on and can anticipate what is going to happen. Letting a child yell during a procedure is a form of helpful distraction. In addition, holding the breath isn't beneficial and could have adverse effects (such as feeling dizzy or faint). The nurse should prepare a child for a procedure by using nonpain descriptors and not suggesting pain. For example, the nurse might say, "Sometimes this feels like pushing or sticking, and sometimes it doesn't bother children at all."
According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage? 1. Trust versus mistrust 2. Initiative versus guilt 3. Industry versus inferiority 4. Identity versus role confusion
3. Industry versus inferiority RATIONALE: In middle childhood, the 6- to 12-year-old child is mastering the task of industry versus inferiority. The trust versus mistrust task is in infancy (birth to 1 year). In early childhood, the 1- to 3-year-old child is in the stage of initiative versus guilt. Identity versus role confusion occurs during adolescence.
When developing a care plan for a child, the nurse identifies which Eriksonian stage as corresponding to Freud's oral stage of psychosexual development? 1. Initiative versus guilt 2. Autonomy versus shame and doubt 3. Trust versus mistrust 4. Industry versus inferiority
3. Trust versus mistrust RATIONALE: Freud defined the first 2 years of life as the oral stage and suggested that the mouth is the primary source of satisfaction for the developing child. Erikson posited that infancy (from birth to age 12 months) is the stage of trust versus mistrust, during which the infant learns to deal with the environment through the emergence of trustfulness or mistrust. Initiative versus guilt corresponds to Freud's phallic stage. Autonomy versus shame and doubt corresponds to Freud's anal/sensory stage. Industry versus inferiority corresponds to Freud's latency period
