peds midterm

A child is diagnosed with hemolytic-uremic syndrome (HUS). Review of the child's laboratory test results would reveal which finding? a.Decreased platelets and leukocytosis b. Decreased blood urea nitrogen (BUN) and creatinine c.Hypernatremia and hypokalemia d. Respiratory acidosis and proteinuria

a

A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What would the nurse include in the teaching plan? a. "Keep the specimen from coming into contact with any urine." b. "Give the child bismuth and then collect the next specimen." c. "Bring the specimen to the laboratory on the third day." d. "Obtain the specimen from the toilet after the child has a bowel movement."

a

A nurse is preparing a teaching plan for the family of a child with allergic rhinitis. When describing the immune reaction that occurs, the nurse would identify the role of which immunoglobulin? a. IgE b. IgG c. IgM d. IgA

a

A nursing instructor is developing a class presentation about the medications used to treat peptic ulcer disease. Which drug class would the instructor be least likely to include in the presentation? a. Prokinetics b. Antibiotics c. Histamine antagonists d. Proton pump inhibitors

a

After teaching a group of new parents about their newborns' eyes and vision, which statement by the group indicates effective teaching? a. "We won't know the baby's eye color until he's at least 6 months old." b. "A newborn can focus with both eyes at the same time shortly after birth." c. "Our newborn can see at distances of about 1 to 2 feet." d. "A baby can easily distinguish colors, but they must be bright colors."

a

The nurse assesses a child's level of consciousness, noting that the child falls asleep unless he is stimulated. What is the child's level of consciousness? a. Obtunded b. Confusion c. Coma d. Stupor

a

The nurse has developed a plan of care for a 6-year-old with muscular dystrophy. He was recently injured when he fell out of bed at home. Which intervention would the nurse suggest to prevent further injury? a. Recommend raising the bed's side rails when a caregiver is not present. b. Recommend the bed's side rails be raised throughout the day and night. c. Encourage a loose restraint to be used when he is in bed. d. Suggest a caregiver be present continuously to prevent falls from bed.

a

The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a: a. macule. b. vesicle. c.papule. d. scale.

a

The nurse is conducting a physical examination of a child following a comprehensive health history. What should be the focus of the physical examination? a. Chief complaint b.The parents c.The child d. Developmental age

a

The nurse is examining a 15-month-old child who was able to walk at the last visit and now can no longer walk. What would be the nurse's best intervention in this case? a.Schedule a full evaluation since this may indicate a neurologic disorder. b.Note the regression in the child's chart and recheck in another month. c.Ask the parents if they have changed the child's schedule to a less active one. d. Document the findings as a developmental delay since this is a normal occurrence.

a

The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. What would the nurse be least likely to include? a. Maintenance of strict bed rest b.Prevention of infection c. Signs of complications d. Daily weight assessment

a

The nurse is providing care to several children who have been brought to the clinic by the parents reporting cold-like symptoms. The nurse would most likely suspect sinusitis in which child? a. A 7-year-old with halitosis and thick, yellow nasal discharge b.A 5-year-old with nasal congestion and sore throat c.A 2-year-old with thin watery nasal discharge d.A 3-year-old with sneezing and coughing

a

The parents of an 11-year-old boy who is dying from cancer are concerned that he is not eating. Which intervention would serve both the parents' and child's needs? a. Serving small meals of things the child likes b.Straightening up around the child before meals c.Urging the child to eat one good meal per day d. Administering antiemetics as ordered for nausea

a

The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all that apply. a. At 12 months the infant walks independently. b. At 7 months the infant sits alone with some use of hands for support. c. At 2 months the infant rolls from supine to prone to back again. d. At 6 months the infant pulls to stand up. e. At 9 months the infant crawls with the abdomen off the floor. f. At 1 month the infant lifts and turns the head to the side in the prone position.

a,b,e,f

A mother of three brings her children in for their vaccinations. The mother tells the nurse that her mother recently died and her husband just lost his job due to his company downsizing. Which parenting behaviors is the nurse likely to observe? Select all that apply. a.The mother rarely looks at her infant when the nurse is assessing the child. b. The mother voices pride in the academic accomplishments of her 7-year-old child. c. The mother becomes very frustrated and tells the nurse she can't handle her toddler's temper tantrum. d. The mother utilizes the correct size of infant car seat for her 3-month-old child. e. The mother asks if the nurse has suggestions on ways to potty train her toddler.

a,c

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. Photophobia b.Negative Brudzinski sign c. Complaints of stiff neck d.Vomiting e.Absent headache

a,c,d

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful? a. "It's normal if he says he feels like his heart skipped a beat." b. "He should avoid taking a bath for about 3 days but he can shower." c. "He can't eat but he can drink fluids for the next 24 hours." d. "This pressure dressing needs to stay on for 5 days from now."

b

A child with spastic cerebral palsy is to receive botulin toxin. The nurse prepares the child for administration of this drug by which route? a.Subcutaneous injection b. Intramuscular injection c.Intravenous infusion d.Oral

b

As a result of seizure activity, a computed tomography (CT) scan was performed and showed that an 18-month-old child has intracranial arteriovenous malformation. When developing the child's plan of care, what would the nurse expect to implement actions to prevent? a.Drug interactions b. Hemorrhagic stroke c. Respiratory paralysis d. Developmental disabilities

b

The nurse is assessing the neuromusculoskeletal system of a newborn. What is an abnormal assessment finding? a. Lack of purposeful muscular control b. Sluggish deep tendon reflexes c. Absence of hypotonia d. Full range of motion in extremities

b

The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? a."We should leave his skin moist before applying medication or moisturizer." b."After bathing, I need to rub his skin everywhere to make sure he is completely dry." c. "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment." d. "I must make sure I use lukewarm water instead of hot water."

b

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was: a. 100 beats per minute. b. 80 beats per minute. c. 120 beats per minute. d. 140 beats per minute.

b

The nurse is teaching a group of students about myelinization in a child. Which statement by the students indicates that the teaching was successful? a. The speed of nerve impulses slows as myelinization occurs. b. The process occurs in a head-to-toe fashion. c. Nerve impulses become less specific in focus with myelinization. d. Myelinization is completed by 4 years of age.

b

The nurse is teaching the student nurse how to perform a physical assessment based on the child's developmental stage. Which statement accurately describes a recommended guideline for setting the tone of the examination for a school-age child? a. Address the child by name; speak to the caregiver and do the most invasive parts last. b. Include the child in all parts of the examination; speak to the caregiver before and after the examination. c. Keep up a running dialogue with the caregiver, explaining each step as you do it. d. Speak to the child using mature language and appeal to his or her desire for self-care.

b

The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? a. Poisoning b. Unintentional injuries c. Diseases d. Drowning

b

A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which is the best action for the nurse to take? a.Do nothing because responding to the bell proves he does not have a hearing deficit. b.Ask the mother to observe for signs that the infant is not hearing well. c. Immediately schedule the infant for a newborn hearing screening. d. Screen again with the bell at the 2-month-old health supervision visit.

c

A nurse is caring for a 14-year-old girl following myelography. What is the priority nursing action? a. Monitoring for a decrease in spasticity b. Observing for mental confusion or hallucinations c. Observing for signs of meningeal irritation d. Assessing motor function

c

A nurse is preparing a presentation for an expectant parent group about neural tube defects and prevention. Which would the nurse emphasize? a. Smoking cessation b.Aerobic exercise c. Folic acid supplementation d. Increased calcium intake

c

A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement? a."If he doesn't get an infection in the first week, the risk is greatly reduced." b."Having the shunt put in decreases his risk for developmental problems." c. "He will need more surgeries to replace the shunt as he grows." d. "The shunt will help to prevent any further complications from his disease."

c

After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: a."An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss." b. "An infant's skin is thinner than an adult's, so substances placed on the skin are absorbed more readily." c. "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented." d. "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown."

c

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow? a. Tetralogy of Fallot b.Transposition of the great vessels c. Atrial septal defect d. Hypoplastic left heart syndrome

c

For which child would nonopioid analgesics be recommended? a.A child with severe postoperative pain b. A child with a broken arm c.A child with juvenile arthritis d. A child with end-stage cancer

c

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? a. Mode of transmission b. Portal of exit c.Reservoir d.Susceptible host

c

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? a. "It is best to just ignore this and to not respond to his questions." b. "You have to keep repeating that his grandfather is never coming back." c. "This is normal; children his age do not understand the permanence of death." d. "He will eventually figure this out on his own."

c

The mother of a 7-year-old boy with autism tearfully reports feeling as if she is not qualified to care for her child. Which initial action by the nurse is most appropriate? a. Recommend the child's mother seek counseling. b. Encourage the child's mother to keep a journal to best identify areas needing improvement in the home routine. c. Recognize the mother's positive accomplishments in caring for her child. d. Tell the child's mother that this is a common feeling when caring for a special needs child.

c

The nurse is caring for a 3-year-old boy with amblyopia. Which intervention would be most appropriate to include in the child's plan of care? a. Encouraging frequent hand washing b. Rinsing the eye with cool water c. Promoting eye safety d. Educating the family about the disease

c

The nurse is caring for a 7-year-old boy who needs his left leg immobilized. What is the priority nursing intervention? a. Explain that a restraint will be applied if he cannot hold still. b. Enlist the assistance of a child life specialist. c. Explain to the boy that he must keep his leg very still. d. Apply a clove-hitch restraint to the boy's left leg.

c

The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? a. The child's and parents' feeling of anxiety and depression b.How the pain impacts the child's and family's stress level c. The pain's history, onset, intensity, duration, and location d. The child's cognitive level and emotional response

c

The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The cilent is demonstrating oliguria. What does the nurse expect to find when reviewing the client's records? a. Higher fluid output than fluid intake b.Increased glomerular filtration rate (GFR) c. Elevated BUN and creatinine levels d.A pattern of below-normal blood pressure

c

The nurse is caring for a special needs infant. Which intervention will be most important in helping the child reach her maximum developmental potential? a. Preparing a plan for her to transition to college b. Serving on an individualized education program committee c.Directing her parents to an early intervention program d. Monitoring her progress in elementary school

c

The nurse is caring for an infant with a temporary ileostomy. As part of the plan of care, the nurse monitors for skin breakdown around the stoma. If redness occurs, what would be most appropriate to promote healing and prevent further skin breakdown? a.Clean the area well with a scented diaper wipe. b.Use a barrier wafer to attach the appliance. c.Apply a barrier/healing cream or paste on the skin. d.Sanitize the area with an alcohol wipe after each diaper change.

c

The nurse is explaining to parents that the preschooler's developmental task is focused on the development of initiative rather than guilt. What is a priority intervention the nurse might recommend for parents of preschoolers to stimulate initiative? a. As a parent, decide how and with whom the child will play. b. Do not set limits on the preschooler's behavior as this results in low self-esteem. c. Reward the child for initiative in order to build self-esteem. d.Change the routine of the preschooler often to stimulate initiative.

c

The nurse is implementing care for a hospitalized toddler. What communication technique would the nurse use with the child to reflect the child's developmental level? a. Communicate solely through play. b. Remain nonjudgmental to avoid alienation. c.Allow the child extra time to complete thoughts. d. Provide simple but honest and straightforward responses.

c

The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action would be most appropriate for the nurse to do? a. Apply a cool compress for several minutes before collection. b. Elevate the extremity used after puncturing it. c.Wipe away the first drop of blood with dry gauze. d. Squeeze the area to facilitate specimen collection.

c

The nurse is teaching parents interventions appropriate to the emotional development of their toddlers. What is a recommended intervention for this age group? a. Distract toddlers from exploring their own body parts, particularly their genitals. b. Offer toddlers many choices to foster control over their environment. c. Do not blame toddlers for aggressive behavior; instead, point out the results of their behavior. d. Remove children's security blankets at this stage to help them assert their autonomy.

c

The nurse working with children in a hospital setting notes that they are being discharged earlier and earlier. Which is a primary reason for this trend? a. Increased funding for home care b.Nursing shortages c. Cost containment d. National health care initiatives

c

When preparing to apply a restraint to a child, what would be most important for the nurse to do? a. Use a limb restraint rather than a jacket restraint for most issues. b. Plan to use a square knot to secure the restraint to the side rails. c. Explain that safety, not punishment, is the reason for the restraint. d. Expect to keep the restraint on for at least 8 hours.

c

The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply. A. The trachea and chest wall are less compliant. B. The tongue is smaller. C.The nasal passages are narrower. D.The larynx is more funnel shaped. E. There are significantly fewer alveoli. F. The bronchi and bronchioles are shorter and wider.

c,d,e

A nurse is reviewing the medical record of a child with hearing loss and notes that the child's hearing loss is in the range 40 to 60 decibels (dB). The nurse interprets this as indicating what level of hearing loss? a. Severe loss b. Mild loss c. Profound loss d.Moderate loss

d

A parent asks the nurse about immunizing her 7-month-old daughter against the flu. Which response by the nurse would be most appropriate? a. "She really doesn't need the vaccine until she reaches 1 year of age." b. "She will probably receive it the next time she is to get her routine shots." c. "The vaccine has many side effects, so she wouldn't get it until she's ready to go to school." d. "Since your daughter is older than 6 months, she should get the vaccine every year."

d

A physician orders a medication dosage that is above the normal dosage. The nurse administers the medication without questioning the dosage. What error did the nurse make? a.The nurse has not made an error, but the physician did by ordering the wrong dosage of medication. b. The nurse performed an act outside the scope of practice for nursing. c. The nurse has committed an act of maleficence by administering the medication. d. The nurse violated one of the "rights" of medication administration.

d

After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason? a. To promote dispersion over the cornea b. To enhance systemic absorption c. To stabilize the eyelid d. To ensure the medication stays in the eye

d

An 8-year-old girl is scheduled for a renal ultrasound. What would the nurse include in the plan of care when preparing the child for this test? a.Withholding food and fluids after midnight b.Checking the child for allergies to shellfish c.Ensuring the child has a full bladder d. Informing the child she should feel no discomfort

d

Bacterial pneumonia is suspected in a 4-year-old boy with fever, headache, and chest pain. Which assessment finding would most likely indicate the need for this child to be hospitalized? a. Oxygen saturation level of 96% b.Pale skin color c. Fever d.Tachypnea with retractions

d

The mother of a 3-week-old infant old brings her daughter in for an evaluation. During the visit, the mother tells the nurse that her baby is spitting up after feedings. Which response by the nurse would be most appropriate? a."Your daughter might have an allergy." b. "Don't worry; you're just feeding her too much." c."We need to tell the doctor about this." d."Infants this age commonly spit up."

d

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess? a. Systolic ejection murmur b. Right ventricular heave c. Fixed split-second heart sound d. Holosystolic harsh murmur along the left sternal border

d

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description? a. Alveoli reach adult numbers by 3 years of age. b. Toddlers typically have strong abdominal muscles by the age of 2. c.Urine output in a toddler typically averages approximately 30 mL/hour. d. Myelinization of the brain and spinal cord is complete at about 24 months.

d

The nurse is inspecting the genitals of a prepubescent girl. Which is a normal sign of the onset of puberty? a. Presence of labial adhesions b. Swelling or redness of the labia minora c. Lesions on the external genitalia d. Appearance of pubic hair around 11 to 13 years old

d

The nurse is performing a cognitive assessment of a 2-year-old. Which behavior would alert the nurse to a developmental delay in this area? a.The child cannot say name, age, and gender. b. The child has a vocabulary of 40 to 50 words. c.The child cannot follow a series of two independent commands. d. The child does not point to named body parts.

d

The nurse is providing anticipatory guidance for parents of a preschooler regarding sex education. What is a recommended guideline when dealing with this issue? a. Be prepared to thoroughly cover a topic before the child asks about it. b. Expand upon the topic when answering questions to prevent further confusion. c. Provide a less than honest response to shelter the child from knowledge that is too advanced. d. Before answering questions, find out what the child thinks about the subject.

d

The nurse is providing anticipatory guidance for parents of a school-age child on teaching the dangers of drugs and alcohol. What advice might be helpful for these parents? a. Discussions with children need to be based on facts and focused on the past and future. b. School-age children are not ready to absorb information that deals with drugs and alcohol. c. Parents must prevent their child from being exposed to messages that are in conflict with their values. d. School-age children can think critically to interpret messages seen in advertising, media, and sports.

d

The nurse is providing parental teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which response indicates a need for further teaching? a "Nonsteroidal anti-inflammatory drugs like ibuprofen are helpful." b. "Cool compresses may help cool the burn." c. "He should avoid hot showers or baths for a couple of days." d. "He should manually peel off any flaking skin."

d

The nurse is providing postsurgical care for an infant who has undergone a hypospadias repair. Which action by the nurse would be most important to help keep the area clean while maintaining proper position of the drainage tubing? a.Keeping the drainage tube taped in an upright position b. Administering antibiotics as ordered c. Administering analgesics as prescribed d.Using a double-diapering technique

d

The nurse is providing teaching on how to administer nasal drops. Which response by the parents indicates a need for further teaching? a. "We need to be careful not to stimulate a sneeze." b. "We must not let the dropper make contact with the nasal membranes." c. "Our daughter should lie on her back with her head hyperextended." d. "She needs to remain still for at least 10 minutes after administration."

d

The nurse is taking a health history of an 11-year-old girl with recurrent abdominal pain. Which response would lead the nurse to suspect irritable bowel syndrome? a. "I don't take any medicine right now." b. "The pain doesn't wake me up in the middle of the night." c. "The pain comes and goes." d. "I always feel better after I have a bowel movement."

d

The nurse uses family-centered care to care for children in a pediatric office. Upon what concept is family-centered care based? a. The care provider is the constant in the child's life and the primary source of strength. b. The child must be prepared to be his or her own source of strength during times of crisis. c. The wishes of the family should direct the nursing care plan for the child. d. The family is the constant in the child's life and the primary source of strength.

d

At which age would the nurse expect to find the beginning of object permanence? A. 6 months B. 12 months c. 9 months d. 1 month

A

Based on Erikson's developmental theory, what is the major developmental task of the adolescent? a. Finding an identity b. Mastering motor skills c. Gaining independence d. Coordinating information

A

A 4-year-old is brought to the emergency department with a burn. What would alert the nurse to the possibility of child abuse? a. Clear delineations are noted between burned and nonburned skin areas. b.Parents state that the injury occurred approximately 15 to 20 minutes ago. c.The burn area appears asymmetric and nonuniform. d. Burn assessment correlates with mother's report of contact with a portable heater.

a