PEDS FINAL EXAM

During a health history assessment, the mother of a 10-year-old girl tells you that her daughter does not have time to "play" because she is busy going to gymnastics, cheerleading, art class, flute lessons, reading club, and soccer. What should the nurse's response be?

"Play helps children to develop cognitively, socially, physically, and emotionally."

A mother reports to the nurse that her 4-year-old does everything that she does. She says she is becoming somewhat frustrated with these actions. What would be the best response by the nurse to this mother?

"Preschoolers' imitating is a healthy behavior. It is part of their imagination and normal growth and development

The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature reading has a fever?

100.8

The nurse is caring for a child who is beginning to show signs and symptoms of anaphylaxis. Which intervention would be the priority?

Assessing patency of the airway

The nurse is educating a first-time mother who has a 1-week-old infant. Which anticipatory guidance is accurate?

Explaining that the child will need frequent feedings every 2 to 3 hours

Based on Erikson's developmental theory, what is the major developmental task of the adolescent?

Finding an identity

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which would the nurse emphasize?

Folic acid supplementation

When describing anaphylaxis to a group of parents whose children have experienced anaphylaxis from insect stings, the nurse integrates knowledge that this response is related to which mmunoglobulin?

IgE

When teaching a group of new parents about newborn care and development, which immunoglobulin would the nurse explain as being primarily responsible for the passive immunity exhibited by newborns?

IgG

The nurse is caring for a child hospitalized with Reye syndrome who is in the acute stage of the illness. The nurse would assess the child most carefully for what finding?

Indications of increased intracranial pressure

The nurse has just completed an assessment on a child who voices an interest in how things are made and who needs support when they are not successful. The child further reports he is involved in clubs and sports outside the home. The nurse is aware that this child is in which of Erikson's states of development?

Industry versus inferiority

The developmental task of the school-aged period, according to Erikson, is gaining a sense of:

Industry versus inferiority.

A nurse is giving instructions to the father of a boy who is receiving chemotherapy including methotrexate regarding how best to care for the boy during this period of treatment. Which of the following should she mention to him?

Keep him away from people with known infections

What finding would lead the nurse to suspect that a child is beginning to develop increased intracranial pressure?

Projectile vomiting

A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority?

Protecting the child from harm during the seizure

The nurse is teaching the parents of a 6-month-old infant about proper dental care. Which action will the nurse indicate as most likely to cause dental caries in this infant?

Putting the infant to bed with a bottle of milk or juice

The nurse is doing an in-service training on clinical manifestations seen in communicable diseases. Which skin condition best describes erythema?

Redness of the skin produced by congestion of the capillaries

The nurse teaches parents of adolescents that teenagers need the support of parents and nurses to facilitate healthy lifestyles. What should be a priority focus of this guidance?

Reducing risk-taking behavior

The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which link in the chain of infection has the nurse allowed to flourish?

Reservoir

The nurse is performing a physical examination on a 9-year-old boy who has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find?

Ring-like rash on lower leg

A new mother, when asked by a nurse, explains that her 4-month-old infant has been nursing regularly every 3 to 4 hours and seems satisfied. However, the mother recently introduced solid food in the form of unbuttered popcorn to the baby as a supplement, to "get her used to eating solid food." She felt that the popcorn would be safe because it is soft on the baby's gums. What should be the primary nursing diagnosis in this situation?

Risk for aspiration related to feeding the infant an inappropriate food

The nurse is interviewing the caregivers of a child brought to the emergency unit. The caregiver states, "She has a history of seizures but this time it lasted more than 30 minutes and she just keeps having them." The most accurate description of this child's condition would be:

The child is in status epilepticus

The nurse knows that the school-age child is in Erikson's stage of industry versus inferiority. Which best exemplifies a school-aged child working toward accomplishing this developmental task?

The child signs up for after-school activities

The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?

The newborn does not respond to a loud noise

The nurse is preparing an educational program for parents of preschool-age children to promote personal safety. Which information should the nurse include in this program? Select all that apply.

a. Explaining who police are and what they look like b. Teaching to never talk with or accept a ride from a stranger c. Never enter into a street without an adult

A 15-year-old adolescent is brought to the emergency department by his parents. The adolescent is febrile with chills that started suddenly. He states, "I had a sinus infection and sore throat a couple of days ago." The nurse suspects bacterial meningitis based on which findings? Select all that apply.

a. complaints of stiff neck b. Vomiting c. Photophobia

An adolescent female with anemia has been prescribed a diet high in iron. Selection of which meal indicates to the nurse that the client understands the prescribed diet?

baked chicken, steamed cauliflower, garden salad

The nurse and a client are discussing the client's preschool child. The client states, "When I tell my child it's time for bed, he/she screams and cries for almost an hour each night before going to sleep." The client and the nurse decide that the next course of action is:

follow a routine and set a bedtime

After assessing a 10-year-old girl, the nurse documents the appearance of breast buds, identifying this as what body change?

thelarche

A nurse observes a child engaged in parallel play in a nursery. What is an example of parallel play?

A boy sitting beside a girl in the floor, each playing independently with a separate set of blocks

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves which of the following?

Bacteria

The nurse is assigned an infant with a possible neurological disorder. Which of the following assessment findings should you communicate to the physician as a late sign of increased intracranial pressure?

Decorticate posturing and fixed and dilated pupils

The nurse is playing a game with a toddler in the hospital room. What is the most important benefit of this nurse-client interaction?

Developing a trusting relationship with the nurse

A 6-year-old has had a viral infection for the past 5 days and is having severe vomiting, confusion, and irritability, although he is now afebrile. During the assessment, the nurse should ask the parent which question?

Did you use any medications like aspirin for the fever?"

The nurse is assessing children in an ambulatory clinic. Which child would be most likely to have iron-deficiency anemia?

"A 15 year old adolescent who has heavy menstrual period"

The nurse is educating the parents of a 10-year-old girl in ways to help their child avoid tobacco. Which suggestion should be part of the nurse's advice?

"As parents, you need to be good role models."

What nursing action should the nurse take when caring for a child with aplastic anemia?

Assess the child's blood pressure every hour

A child allergic to insect stings presents to the school nurse stating, "A bee stung me on the playground." Which action by the nurse is priority?

Assess the client's airway and breathing rate

Parents of a preschool child are discussing a recent story in the local news about a child being abducted. The parents are concerned about the safety of their child and wonder what to tell the child to keep the child safe but without frightening the child. Which would be the best recommendation for the nurse to give these parents?

Explain in a calm and everyday manner how the child should stay away from strangers in cars

The nurse is performing an assessment of the reproductive system of a 17-year-old girl. What would alert the nurse to a developmental delay in this girl?

Lack of occurrence of first menstrual period

The nurse is caring for a 5-year-old girl post-tonsillectomy. The girl looks out the window and tells the nurse that it is raining and says, "The sky is crying because it is sad that my throat hurts." The nurse understands that the girl is demonstrating which mental process?

Magical thinking

A parent brings her 3-year-old child in for a sick visit for the third time this year. The child, who attends a preschool program, continues to develop upper respiratory infections. The parent is frustrated with the situation and asks the nurse for advice. What would be the best recommendation for the nurse to give to the parent in this situation?

Make sure that frequent handwashing is being stressed at the preschool

A 3½-year-old shouts, "Look out for Boo-ga-loo!" as the nurse enters the exam room. The father explains Boo-ga-loo is his daughter's imaginary friend. How should the nurse respond?

"Tell me about Boo-ga-loo."

The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective?

The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog

The parents of a 12-year-old girl report their daughter is missing an increasing amount of school. They further share that the child says she feels ill and begs to stay home. What action by the parents will be most therapeutic?

The parents need to attempt to determine why the child is avoiding school

The nurse is performing a physical assessment of a 3-year-old girl. What finding would be a concern for the nurse?

The toddler's anterior fontanel (fontanelle) is not fully closed

The nurse is assessing an 6-month-old infant at a well-baby visit and is answering questions from the new mother. Which response should the nurse prioritize when addressing the mother's question concerning what the infant should be learning at this point in life?

Trust

A child comes to the emergency department with difficulty breathing from severe bronchoconstriction. The parent informs the nurse that the child ate a peanut, to which the child is allergic. Which type of reaction is this client having?

Type I: anaphylaxis

A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development?

Unable to support head

Food allergies have become more and more common in the last few decades. Which of the following are common food allergies of childhood? Select all that apply

a. Eggs b. Peanuts c. Milk

A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner?

On her side with the head flexed forward and knees flexed to the abdomen

The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which behavior will have the most influence on how the information is presented?

Adolescents tend to take risks.

A 16-year-old boy reports to the school nurse of headaches and a stiff neck. Which sign or symptom would alert the nurse that the child may have bacterial meningitis?

Patient reports that sunlight is too bright

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

Pernicious anemia

After teaching the parents of a child with chickenpox (varicella zosters), the nurse determines that the parents have understood the teaching when they state that their child can return to school

After the lesions have crusted

Once a temper tantrum has started, which intervention is appropriate?

Move objects out of the way or move the toddler to prevent injury.

The school nurse is performing a vision screening for a 7-year-old child. Which finding should trigger a referral?

Slight misalignment of the eyes

After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections?

Neutrophils

Dexamethasone is often prescribed for the child who has sustained a severe head injury. Dexamethasone is a(n):

Steroid

The parents of a child with a bleeding disorder ask the nurse about appropriate activities and sports that they should encourage the child to participate in. What activity would be the safest for the infant?

Swimming

While evaluating the development of a 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this infant demonstrated?

Object permanence

The nurse is preparing to post a sign above a crib of an infant with a Wilms tumor. Which statement should the nurse post immediately?

"Do not palpate abdomen"

The nurse is assessing the gross motor skills of an 8-year-old boy. Which interview question would facilitate this assessment?

"Do you participate in any sports?"

The nurse is collecting data from the caregivers of a child admitted with seizures. Which statement indicates the child most likely had an absence seizure?

"He was just staring into space and was totally unaware."

The parents of a 5-year-old have just found out that their child has head lice. Whichstatement by the parents would support the nursing diagnosis of deficient knowledge?

"I can't believe it. We're not unclean, poor people."

The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching?

"I will set our water heater at 130 F (54 C)"

After teaching a mother how to remove a tick from her 6-year-old boy's arm, the nurse determines that additional teaching is needed when the mother makes what statement?

"I'll grasp the tick and pull it away quickly."

A child receiving chemotherapy wants to have a large birthday party and invite all the classmates. When the parents asks the nurse about this, what is the nurse's best response?

"It is better to avoid large groups right now"

The nurse is speaking to a parent of a 4-year-old. The parent states that she has trouble getting her child to go to bed at night. Which is the best response by the nurse?

"It's just as important to establish a morning wake-up time as it is as establishing a bedtime. Children tend to do better when they have a normal routine to follow."

A 10-year-old who is receiving chemotherapy has received ondansetron before this therapy session. About an hour later, the child tells the nurse that his mouth feels really dry. The child has urinated several times and his skin turgor is normal. Which response by the nurse would be most appropriate?

"The drug you got to help with the nausea can cause dry mouth"

A teenage boy and his mother have come to the office for a routine visit. In the hallway, his mother confides that she is concerned because her son is playing games that the girls play, and she has noticed that when he plays any role-playing games his character is very feminine. She tells you that she is worried about his sexual orientation. What is the best response to her concerns?

"This behavior may be exploratory or reflect peer pressure, so do not make assumptions regarding sexual orientation."

A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information?

"This is a primitive reflex known as the palmar grasp."

The parent of a toddler notices the child plays nicely next to another toddler but does not play with that child. The parent expresses concern about this behavior to the nurse during an examination. Which response by the nurse is appropriate?

"This is called parallel play and is normal for this age group."

The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond?

"This is normal; children his age do not understand the permanence of death."

The nurse is teaching the parents of a 12-year-old boy about common approaches when raising an adolescent. Which instruction is most important?

"Try to be open to his views."

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate?

1. "Keep the baby sitting up for about 30 minutes afterward."

When developing the plan of care for a 5-year-old boy with Rocky Mountain spotted fever, the nurse knows the cause of the illness is:

Bite of a tick

The nurse is educating an adolescent's parents on the importance of self-esteem. Which factor will the nurse include as being most important to an adolescent's self-esteem?

Body image

A nurse is administering a blood transfusion to a child. About 35 minutes after beginning the transfusion, the child develops pruritus and urticaria. Some wheezing is noted. Which action would the nurse take first?

Discontinue the transfusion

The nurse is teaching parents of an 11-year-old child how to deal with the issue of peer pressure regarding the use of tobacco and alcohol. Which suggestion by the nurse provides the best course of action for the parents?

Discuss tobacco and alcohol use and effects with the child

A nurse is teaching a class to new parents on how to prevent the spread of infection in their children. What is the best suggestion the nurse could offer to these parents?

Encourage frequent hand hygiene

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching?

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority?

Ensure a patient airway

A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?

Playing in the woods about a week ago

A nursing instructor is teaching students about the chain of infection. What does the instructor tell students is responsible for allowing the pathogen to enter?

Portal of entry

A group of nursing students are reviewing information about humoral and cellular immunity. The students demonstrate understanding of this material when they identify which of the following as involved in cellular immunity?

T cells

The nurse is watching toddlers at play. Which normal behavior would the nurse observe?

Toddlers engage in parallel play

The nurse is assessing a 3-year-old child. The nurse notes the child is able to understand that objects hidden from sight still exist. The nurse correctly documents that the child is displaying:

object permanence

Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned?

step

The nurse is discussing home safety with the parents of a 10-year-old client. Which statement by the client's parents most concerns the nurse?

"Our child swims alone before we get home from work."

The nurse is caring for an 8-year-old girl. She is reviewing her nutritional requirements and describing interventions that promote healthy eating habits. Which response by the girl's mother indicates a need for further discussion?

"My daughter must stay at the table until she has cleaned her plate."

During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups?

"Acceptance by friends, especially of the same sex, is very important at this age."

What finding is consistent with increased intracranial pressure (ICP) in an infant?

Buldging fontanel

A 4-year-old child is brought to the emergency department after being in a motor vehicle accident. The child experienced head trauma in the accident. When assessing the child, which will be the first change noted in the presence of increasing intercranial pressure?

Change in level of consciousness

A child is diagnosed with a helminthic infection. Which treatments would the nurse expect to be prescribed? Select all that apply

a. Pyrantel pamoate b. albendazole

The school nurse is teaching parents risk factors for suicide in adolescents. What would the nurse discuss? Select all that apply.

a. Substance use disorder b. Family disorganization c. Mental health changes d. History of previous suicide attempt

The school nurse is providing nutritional guidance to a 9th-grade health class. Which foods should the nurse recommend as good sources for calcium?

cheese, yogurt, and white beans

Any individual taking phenobarbital for a seizure disorder should be taught:

never to discontinue the drug abruptly.