Peds Nclex questions

An important nursing intervention when caring for a child who is experiencing a seizure would be which of the following? a. Describe and record the seizure activity observed. b. Restrain the child when seizure occurs to prevent bodily harm. c. Place a tongue blade between the teeth if they become clenched. d. Suction the child during a seizure to prevent aspiration.

a. Describe and record the seizure activity observed Rationale: When a child is having a seizure, the priority nursing care is observation of the child and seizure. The nurse then describes and records the seizure activity.

Labored breathing is referred to as: a. dyspnea. b. tachypnea. c. hypopnea. d. orthopnea.

a. dyspnea. Rationale: Dyspnea is labored breathing.

How much folic acid is recommended for women of childbearing age? a. 1.0 mg b. 0.4 mg c. 1.5 mg d. 2.0 mg

b. 0.4 mg Rationale: It has been estimated that a daily intake of 0.4 mg of folic acid in women of childbearing age will prevent 50% to 70% of cases of neural tube defects.

Which of the following terms is used when a patient remains in a deep sleep, responsive only to vigorous and repeated stimulation? a. Coma b. Stupor c. Obtundation d. Persistent vegetative state

b. Stupor Rationale: Stupor exists when the child remains in a deep sleep, responsive only to vigorous and repeated stimulation.

The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts.

b. The mother's presence will reduce anxiety and ease child's respiratory efforts. Rationale: The family's presence will decrease the child's distress.

Skin testing for tuberculosis (TB) (the Mantoux test) is recommended: a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who reside in high-prevalence regions.

d. periodically for children who reside in high-prevalence regions Rationale: Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years.

Spastic cerebral palsy is characterized by which of the following? a. Hypertonicity and poor control of posture, balance, and coordinated motion b. Athetosis and dystonic movements c. Wide-based gait and poor performance of rapid, repetitive movements d. Tremors and lack of active movement

a. Hypertonicity and poor control of posture, balance, and coordinated motion Rationale: Hypertonicity and poor control of posture, balance, and coordinated motion are part of the classification of spastic cerebral palsy.

The most common clinical manifestation(s) of brain tumors in children is which of the following? a. Irritability b. Seizures c. Headaches and vomiting d. Fever and poor fine motor control

c. Headaches and vomiting Rationale: Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children.

Which of the following is descriptive of a concussion? a. Petechial hemorrhages cause amnesia. b. Visible bruising and tearing of cerebral tissue occur. c. It is a transient and reversible neuronal dysfunction. d. A slight lesion develops remote from the site of trauma.

c. It is a transient and reversible neuronal dysfunction. Rationale: A concussion is a transient, reversible neuronal dysfunction with instantaneous loss of awareness and responsiveness resulting from trauma to the head.

Which of the following is the initial clinical manifestation of generalized seizures? a. Being confused b. Feeling frightened c. Losing consciousness d. Seeing flashing lights

c. Losing consciousness Rationale: Loss of consciousness is a frequent occurrence in generalized seizures and is the initial clinical manifestation.

The Heimlich maneuver is recommended for airway obstruction in children older than: a. 1 year. b. 4 years. c. 8 years. d. 12 years.

a. 1 year. Rationale: The Heimlich maneuver is recommended for airway obstruction in children older than 1 year. Younger than 1 year, back blows and chest thrusts are administered.

Which of the following types of seizures may be difficult to detect? a. Absence b. Generalized c. Simple partial d. Complex partial

a. Absence Rationale: Absence seizures may go unrecognized because little change occurs in the child's behavior during the seizure.

A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea

a. Asthma Rationale: Asthma may have these chronic symptoms.

An infant's parents ask the nurse about preventing OM. Which of the following should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position.

a. Avoid tobacco smoke. Rationale: Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses.

Which of the following is the priority nursing intervention when a child is unconscious after a fall? a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.

a. Establish adequate airway. Rationale: Respiratory effectiveness is the primary concern in the care of the unconscious child. Establishment of an adequate airway is always the first priority.

Which of the following problems is most often associated with myelomeningocele? a. Hydrocephalus b. Craniosynostosis c. Biliary atresia d. Esophageal atresia

a. Hydrocephalus Rationale: Hydrocephalus is a frequently associated anomaly in 80% to 90% of children

Which of the following statements is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics.

d. It is treated with a broad range of antibiotics Rationale: Historically AOM has been treated with a range of antibiotics. However, new research shows that antibiotics do not improve outcomes in children with uncomplicated AOM.

CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test

d. Sweat chloride test Rationale: A sweat chloride test result greater than 60 mEq/L is diagnostic of CF.

An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions? a. "I should administer all of the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours."

a. "I should administer all of the prescribed medication." Rationale: Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria

It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days.

c. After taking antibiotics for 24 hours. Rationale: After children have taken antibiotics for 24 hours, they are no longer contagious to other children.

A child is diagnosed with influenza, probably type A disease. Management includes which of the following? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride to reduce symptoms d. Antibiotics to prevent bacterial infection

c. Amantadine hydrochloride to reduce symptoms Rationale: Amantadine may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C.

Which of the following types of fractures describes traumatic separation of cranial sutures? a. Basilar b. Compound c. Diastatic d. Depressed

c. Diastatic Rationale: Diastatic skull fractures are traumatic separations of the cranial sutures.

Latex allergy is suspected in a child with spina bifida. Appropriate nursing interventions include which of the following? a. Avoid using any latex product. b. Use only nonallergenic latex products. c. Administer medication for long-term desensitization. d. Teach family about long-term management of asthma.

a. Avoid using any latex product. Rationale: Care must be taken that individuals who are at high risk for latex allergies do not come in direct or secondary contact with products or equipment containing latex at any time during medical treatment.

Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime.

a. Avoid using for more than 3 days Rationale: Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion.

An adolescent boy is brought to the emergency department after a motorcycle accident. His respirations are deep, periodic, and gasping. There are extreme fluctuations in blood pressure. Pupils are dilated and fixed. The nurse should suspect what type of head injury? a. Brainstem b. Skull fracture c. Subdural hemorrhage d. Epidural hemorrhage

a. Brainstem Rationale: Signs of brainstem injury include deep, rapid, periodic or intermittent, and gasping respirations. Wide fluctuations or noticeable slowing of the pulse, widening pulse pressure, or extreme fluctuations in blood pressure are consistent with a brainstem injury.

A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which of the following? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis

a. Bronchitis Rationale: Bronchitis is characterized by these symptoms and occurs in children older than 6 years.

What clinical manifestations would suggest hydrocephalus in a neonate? a. Bulging fontanel and dilated scalp veins b. Closed fontanel and high-pitched cry c. Constant low-pitched cry and restlessness d. Depressed fontanel and decreased blood pressure

a. Bulging fontanel and dilated scalp veins Rationale: Bulging fontanels, dilated scalp veins, and separated sutures are clinical manifestations of hydrocephalus in neonates.

An infant has developed staphylococcal pneumonia. Nursing care of the child with pneumonia includes which of the following? (Select all that apply.) a. Cluster care to conserve energy b. Round-the-clock administration of antitussive agents c. Strict intake and output to avoid congestive heart failure d. Administration of antibiotics

a. Cluster care to conserve energy d. Administration of antibiotics Rationale: Antibiotics are indicated for a bacterial pneumonia. Often the child will have decreased pulmonary reserve, and the clustering of care is essential.

Which of the following best describes a neuroblastoma? a. Diagnosis is usually made after metastasis occurs. b. Early diagnosis is usually possible because of the obvious clinical manifestations. c. It is the most common brain tumor in young children. d. It is the most common benign tumor in young children.

a. Diagnosis is usually made after metastasis occurs. Rationale: Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site.

In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed.

a. Diet should be high in carbohydrates and protein. Rationale: Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.

Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected.

a. If it is present in a child, both parents are carriers of this defective gene. Rationale: CF is an autosomal recessive gene inherited from both parents.

Which of the following drugs would be used to treat a child who has increased ICP resulting from cerebral edema? a. Mannitol b. Epinephrine hydrochloride c. Atropine sulfate d. Sodium bicarbonate

a. Mannitol Rationale: For increased ICP, mannitol, an osmotic diuretic, administered intravenously, is the drug used most frequently for rapid reduction.

What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections

a. Meconium ileus Rationale: The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration.

When caring for the child with Reye syndrome, the priority nursing intervention would be which of the following? a. Monitor intake and output. b. Prevent skin breakdown. c. Observe for petechiae. d. Do range-of-motion exercises.

a. Monitor intake and output. Rationale: Accurate and frequent monitoring of intake and output is essential for adjusting fluid volumes to prevent both dehydration and cerebral edema.

Which of the following is the most common problem of children born with a myelomeningocele? a. Neurogenic bladder b. Mental retardation c. Respiratory compromise d. Cranioschisis

a. Neurogenic bladder Rationale: Myelomeningocele is one of the most common causes of neuropathic (neurogenic) bladder dysfunction among children.

The nurse is caring for a 5-year-old child who is scheduled for a tonsillectomy in 2 hours. Which of the following actions should the nurse include in the child's postoperative care plan? (Select all that apply.) a. Notify the surgeon if the child swallows frequently. b. Apply a heat collar to the child for pain relief. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. e. Encourage the child to cough frequently.

a. Notify the surgeon if the child swallows frequently. c. Place the child on the abdomen until fully wake. d. Allow the child to have diluted juice after the procedure. Rationale: Frequent swallowing is a sign of bleeding in children after a tonsillectomy. The child should be placed on the abdomen or the side to facilitate drainage. The child can drink diluted juice, cool water, or popsicles after the procedure.

An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Which of the following interventions should be included in the child's postoperative care? (Select all that apply.) a. Observe closely for signs of infection. b. Pump the shunt reservoir to maintain patency. c. Administer sedation to decrease irritability. d. Maintain Trendelenburg position to decrease pressure on the shunt. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention.

a. Observe closely for signs of infection. e. Maintain an accurate record of intake and output. f. Monitor for abdominal distention. Rationale: Infection is a major complication of ventriculoperitoneal shunts. Observation for signs of infection is a priority nursing intervention. Intake and output should be measured carefully. Abdominal distention could be a sign of peritonitis or a postoperative ileus.

Which of the following tests is never performed on an awake child? a. Oculovestibular response b. Doll's head maneuver c. Funduscopic examination for papilledema d. Assessment of pyramidal tract lesions

a. Oculovestibular response Rationale: The oculovestibular response (caloric test) involves the instillation of ice water into the ear of a comatose child. The caloric test is painful and is never performed on an awake child or one who has a ruptured tympanic membrane.

Effective CPR on a 5-year-old child should include which of the following? a. One breath to every five chest compressions b. Two breaths to every 15 chest compressions c. Reassessment of child after 50 cycles of compression and ventilation d. Reassessment of child every 10 minutes that CPR continues

a. One breath to every five chest compressions Rationale: One breath to five chest compressions is the standard for infants.

Which of the following types of seizures involves both hemispheres of the brain? a. Focal b. Partial c. Generalized d. Acquired

c. Generalized Rationale: Clinical observations of generalized seizures indicate that the initial involvement is from both hemispheres.

The nurse enters a room and finds a 6-year-old child who is unconscious. After calling for help and before being able to use an automatic external defibrillator, what steps should the nurse take? Place in correct order. a. Place on a hard surface. b. Administer 30 chest compressions with two breaths. c. Feel carotid pulse while maintaining head tilt with the other hand. d. Use the head tilt-chin lift maneuver and check for breathing. e. Place heel of one hand on lower half of sternum with other hand on top. f. Give two rescue breaths.

a. Place on a hard surface. d. Use the head tilt-chin lift maneuver and check for breathing. f. Give two rescue breaths. c. Feel carotid pulse while maintaining head tilt with the other hand. e. Place heel of one hand on lower half of sternum with other hand on top. b. Administer 30 chest compressions with two breaths.

A 10-year-old child, without a history of previous seizures, experiences a tonic-clonic seizure at school. Breathing is not impaired, but some postictal confusion occurs. The most appropriate initial action by the school nurse is which of the following? a. Stay with child and have someone call emergency medical service (EMS). b. Notify parent and regular practitioner. c. Notify parent that child should go home. d. Stay with child, offering calm reassurance.

a. Stay with child and have someone call emergency medical service (EMS). Rationale: The EMS should be called to transport the child because this is the child's first seizure.

The treatment of brain tumors in children consists of which of the following therapies? (Select all that apply.) a. Surgery b. Bone marrow transplantation c. Chemotherapy d. Stem cell transplantation e. Radiation f. Myelography

a. Surgery c. Chemotherapy e. Radiation Rationale: Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination.

Which of the following tests aid in the diagnosis of CF? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa

a. Sweat chloride test, stool for fat, chest radiograph films Rationale: A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF.

Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited.

a. There is heightened airway reactivity. Rationale: In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function.

Why are cool-mist vaporizers rather than steam vaporizers recommended in home treatment of respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced.

a. They are safer. Rationale: Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam.

A child with CF receives aerosolized bronchodilator medication. This medication should be administered: a. before chest physiotherapy (CPT). b. after CPT. c. before receiving 100% oxygen. d. after receiving 100% oxygen.

a. before chest physiotherapy (CPT). Rationale: Bronchodilators should be given before CPT to open bronchi and make expectoration easier.

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times. Since admission, she has been alert and oriented. Her mother asks why a CT scan is required when she "seems fine." The nurse should explain that she: a. may have a brain injury. b. needs this because of her age. c. may start having seizures. d. probably has a skull fracture.

a. may have a brain injury. Rationale: The child's history of the fall, brief loss of consciousness, and vomiting four times necessitates evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan.

The nurse is preparing a school-age child for computed tomography (CT scan) to assess cerebral function. The nurse should include which of the following statements in preparing the child? a. "Pain medication will be given." b. "The scan will not hurt." c. "You will be able to move once the equipment is in place." d. "Unfortunately no one can remain in the room with you during the test."

b. "The scan will not hurt." Rationale: For CT scans, the child must be immobilized. It is important to emphasize to the child that at no time is the procedure painful.

Which of the following statements best describes a subdural hematoma? a. Bleeding occurs between the dura and the skull. b. Bleeding occurs between the dura and the cerebrum. c. Bleeding is generally arterial, and brain compression occurs rapidly. d. The hematoma commonly occurs in the parietotemporal region.

b. Bleeding occurs between the dura and the cerebrum Rationale: A subdural hematoma is bleeding that occurs between the dura and the cerebrum as a result of a rupture of cortical veins that bridge the subdural space.

Cardiopulmonary resuscitation (CPR) is begun on a toddler. Which of the following pulses is usually palpated because it is the most central and accessible? a. Radial b. Carotid c. Femoral d. Brachial

b. Carotid Rationale: In a toddler, the carotid pulse is palpated.

Which of the following is the most important consideration in managing TB in children? a. Skin testing b. Chemotherapy c. Adequate nutrition d. Adequate hydration

b. Chemotherapy Rationale: Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months.

The nurse is assessing a child with croup. Examining the child's throat by using a tongue depressor might precipitate which of the following? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection

b. Complete obstruction Rationale: If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place

β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection

b. Dilate the bronchioles Rationale: These medications work to dilate the bronchioles in acute exacerbations.

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse. The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is which of the following? a. Discuss with parents the child's previous experiences with pain. b. Discuss with practitioner what analgesia can be safely administered. c. Explain that analgesia is contraindicated with a head injury. d. Explain that analgesia is unnecessary when child is not fully awake and alert.

b. Discuss with practitioner what analgesia can be safely administered. Rationale: A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and the promotion of comfort and relief of anxiety.

Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB)

b. Epiglottitis Rationale: Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment.

The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which of the following is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red.

b. Monitor arterial blood gases. Rationale: Arterial blood gases are the best way to monitor carbon monoxide poisoning.

The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage high-protein diet.

b. Monitor pulse oximet Rationale: Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS.

The vector reservoir for agents causing viral encephalitis in the United States is which of the following? a. Tarantula spiders b. Mosquitoes and ticks c. Carnivorous wild animals d. Domestic and wild animals

b. Mosquitoes and ticks Rationale: Viral encephalitis, not attributable to a childhood viral disease, is usually transmitted by mosquitoes and ticks. The vector reservoir for most agents pathogenic for humans and detected in the United States are mosquitoes and ticks; therefore most cases of encephalitis appear during the hot summer months.

The nurse is closely monitoring a child who is unconscious after a fall and notices that the child suddenly has a fixed and dilated pupil. The nurse should interpret this as which of the following? a. Eye trauma b. Neurosurgical emergency c. Severe brainstem damage d. Indication of brain death

b. Neurosurgical emergency Rationale: The sudden appearance of a fixed and dilated pupil(s) is a neurosurgical emergency. The nurse should immediately report this finding.

Which of the following best describes why children have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses.

b. Repeated exposure to organisms causes increased immunity. Rationale: Children have increased immunity after exposure to a virus.

Five-year-old José is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which of the following? a. Removal of tumor will stop the various symptoms. b. Usually the postoperative dressing covers the entire scalp. c. He is not old enough to be concerned about his head being shaved. d. He is not old enough to understand the significance of the brain.

b. Usually the postoperative dressing covers the entire scalp Rationale: José should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing.

When taking the history of a child hospitalized with Reye syndrome, the nurse should not be surprised that a week ago the child had recovered from which of the following? a. Measles b. Varicella c. Meningitis d. Hepatitis

b. Varicella Rationale: Most cases of Reye syndrome follow a common viral illness such as varicella or influenza.

Asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites.

b. a viral infection. Rationale: Viral illnesses cause inflammation that causes increased airway reactivity in asthma.

The Glasgow Coma Scale consists of an assessment of: a. pupil reactivity and motor response. b. eye opening and verbal and motor responses. c. level of consciousness and verbal response. d. ICP and level of consciousness.

b. eye opening and verbal and motor responses. Rationale: The Glasgow Coma Scale assesses eye opening and verbal and motor responses.

A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug: a. may cause mucus to thicken. b. may cause voice alterations. c. is given subcutaneously. d. is not indicated for children younger than 12 years.

b. may cause voice alterations. Rationale: One of the only adverse effects of DNase is voice alterations and laryngitis.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him: a. prone and tube feed. b. prone, turn head to side, and nipple feed. c. supine in infant carrier and nipple feed. d. supine, with defect supported with rolled blankets, and nipple-feed.

b. prone, turn head to side, and nipple feed. Rationale: In the prone position, feeding is a problem. The infant's head is turned to one side for feeding.

A 5-year-old girl sustained a concussion when she fell out of a tree. In preparation for discharge, the nurse is discussing home care with her mother. Which of the following statements made by the mother indicates a correct understanding of the teaching? a. "I should expect my child to have a few episodes of vomiting." b. "If I notice sleep disturbances, I should contact the physician immediately." c. "I should expect my child to have some behavioral changes after the accident." d. "If I notice diplopia, I will have my child rest for 1 hour."

c. "I should expect my child to have some behavioral changes after the accident." Rationale: The parents are advised of probable posttraumatic symptoms that may be expected. These include behavioral changes and sleep disturbances.

A 3-year-old child is hospitalized after a near-drowning accident. The child's mother complains to the nurse, "This seems unnecessary when he is perfectly fine." The nurse's best reply would be which of the following? a. "He still needs a little extra oxygen." b. "I'm sure he is fine, but the doctor wants to make sure." c. "The reason for this is that complications could still occur." d. "It is important to observe for possible central nervous system problems."

c. "The reason for this is that complications could still occur." Rationale: All children who have a near-drowning experience should be admitted to the hospital for observation. Although many children do not appear to have suffered adverse effects from the event, complications such as respiratory compromise and cerebral edema may occur 24 hours after the incident.

A child is brought to the emergency department after experiencing a seizure at school. There is no previous history of seizures. The father tells the nurse that he cannot believe the child has epilepsy. The nurse's best response is which of the following? a. "Epilepsy is easily treated." b. "Very few children have actual epilepsy." c. "The seizure may or may not mean that your child has epilepsy." d. "Your child has had only one convulsion; it probably won't happen again."

c. "The seizure may or may not mean that your child has epilepsy." Rationale: Seizures are the indispensable characteristic of epilepsy; however, not every seizure is epileptic. Epilepsy is a chronic seizure disorder with recurrent and unprovoked seizures.

A child has been seizure free for 2 years. A father asks the nurse how much longer the child will need to take the anti-seizure medications. The nurse includes which of the following in the response? a. Medications can be discontinued at this time. b. The child will need to take the drugs for 5 years after the last seizure. c. A step-wise approach will be used to reduce the dosage gradually. d. Seizure disorders are a life-long problem. Medications cannot be discontinued.

c. A step-wise approach will be used to reduce the dosage gradually. Rationale: A predesigned protocol is used to wean a child gradually off antiseizure medications, usually when the child is seizure free for 2 years and has a normal electroencephalogram (EEG).

A young child's parents call the nurse after their child was bitten by a raccoon in the woods. The nurse's recommendation should be based on which of the following? a. Child should be hospitalized for close observation. b. No treatment is necessary if thorough wound cleaning is done. c. Antirabies prophylaxis must be initiated. d. Antirabies prophylaxis must be initiated if clinical manifestations appear.

c. Antirabies prophylaxis must be initiated. Rationale: Current therapy for a rabid animal bite consists of a thorough cleansing of the wound and passive immunization with human rabies immune globulin (HRIG) as soon as possible

Which of the following neurologic diagnostic tests gives a visualized horizontal and vertical cross section of the brain at any axis? a. Nuclear brain scan b. Echoencephalography c. CT scan d. Magnetic resonance imaging (MRI)

c. CT scan Rationale: A CT scan provides a visualization of the horizontal and vertical cross sections of the brain at any axis.

Which of the following is a clinical manifestation of increased intracranial pressure (ICP) in infants? (Select all that apply.) a. Low-pitched cry b. Sunken fontanel c. Diplopia and blurred vision d. Irritability e. Distended scalp veins f. Increased blood pressure

c. Diplopia and blurred vision d. Irritability e. Distended scalp veins Rationale: Diplopia and blurred vision, irritability, and distended scalp veins are signs of increased ICP in infants.

Which of the following drugs is considered the most useful in treating cardiac arrest? a. Bretylium b. Lidocaine hydrochloride c. Epinephrine hydrochloride d. Naloxone (Narcan)

c. Epinephrine hydrochloride Rationale: Epinephrine works on alpha and beta receptors in the heart and is the most useful drug in cardiac arrest.

A recommendation to prevent neural tube defects is the supplementation of which of the following? a. Vitamin A throughout pregnancy b. Multivitamin preparations as soon as pregnancy is suspected c. Folic acid for all women of childbearing age d. Folic acid during the first and second trimesters of pregnancy

c. Folic acid for all women of childbearing age Rationale: The widespread use of folic acid among women of childbearing age has decreased the incidence of spina bifida significantly.

An appropriate nursing intervention when caring for an unconscious child would be which of the following? a. Change the child's position infrequently to minimize the chance of increased ICP. b. Avoid using narcotics or sedatives to provide comfort and pain relief. c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. d. Give tepid sponge baths to reduce fever, since antipyretics are contraindicated.

c. Monitor fluid intake and output carefully to avoid fluid overload and cerebral edema. Rationale: Often comatose patients cannot cope with the quantity of fluids that they normally tolerate. Overhydration must be avoided to prevent fatal cerebral edema.

Which of the following terms is used to describe a child's level of consciousness when the child is arousable with stimulation? a. Stupor b. Confusion c. Obtundation d. Disorientation

c. Obtundation Rationale: Obtundation describes a level of consciousness in which the child is arousable with stimulation.

It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome

c. Slowed growth Rationale: The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs.

A 10-year-old boy on a bicycle has been hit by a car in front of the school. The school nurse immediately assesses airway, breathing, and circulation. The next nursing action should be which of the following? a. Place on side. b. Take blood pressure. c. Stabilize neck and spine. d. Check scalp and back for bleeding.

c. Stabilize neck and spine. Rationale: After determining that the child is breathing and has adequate circulation, the next action is to stabilize the neck and spine to prevent any additional trauma.

A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend which of the following? a. Soccer b. Running c. Swimming d. Basketball

c. Swimming Rationale: Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming.

Which of the following is a progressive infantile spinal muscular atrophy and the most common paralytic form of the floppy infant syndrome? a. Kugelberg-Welander disease b. Charcot-Marie-Tooth disease c. Werdnig-Hoffmann disease d. Duchenne muscular dystrophy

c. Werdnig-Hoffmann disease Rationale: Werdnig-Hoffmann disease (spinal muscular atrophy type 1) is the most common paralytic form of floppy infant syndrome (congenital hypotonia). It is characterized by progressive weakness and wasting of skeletal muscle caused by degeneration of anterior horn cells.

The nurse is talking to a parent with a child who has a latex allergy. Which of the following statements by the parent would indicate a correct understanding of the teaching? a. "My child will have an allergic reaction if he comes in contact with yeast products." b. "My child may have an upset stomach if he eats a food made with wheat or barley." c. "My child will probably develop an allergy to peanuts." d. "My child should not eat bananas or kiwis."

d. "My child should not eat bananas or kiwis." Rationale: There are cross-reactions between latex allergies and a number of foods such as bananas, avocados, kiwi, and chestnuts.

Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following? a. Fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear

d. A feeling of fullness in the ear Rationale: OME is characterized by feeling of fullness in ear or other nonspecific complaints.

Which of the following may be beneficial in reducing the risk of Reye syndrome? a. Immunization against the disease b. Medical attention for all head injuries c. Prompt treatment of bacterial meningitis d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza

d. Avoidance of aspirin and ibuprofen for children with varicella or those suspected of having influenza Rationale: Although the etiology of Reye syndrome is obscure, most cases follow a common viral illness, either varicella or influenza. A potential association exists between aspirin therapy and the development of Reye syndrome, so use of aspirin is avoided.

The nurse should recommend medical attention if a child with a slight head injury experiences which of the following? a. Sleepiness b. Vomiting, even once c. Headache, even if slight d. Confusion or abnormal behavior

d. Confusion or abnormal behavior Rationale: Medical attention should be sought if the child exhibits confusion or abnormal behavior, loses consciousness, has amnesia, has fluid leaking from the nose or ears, complains of blurred vision, or has an unsteady gait.

An important nursing consideration when caring for a 10-month-old infant with respiratory syncytial virus (RSV)/bronchiolitis would be which of the following? a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours.

d. Encourage to drink 8 ounces of formula every 4 hours. Rationale:Hydration is very important in children with RSV bronchiolitis to loosen secretions and prevent shock.

The nurse is caring for a 10-month-old infant with respiratory syncytial virus (RSV) bronchiolitis. Which of the following interventions should be included in the child's care? (Select all that apply.) a. Place in a mist tent. b. Administer antibiotics. c. Administer cough syrup. d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring.

d. Encourage to drink 8 ounces of formula every 4 hours. e. Cluster care to encourage adequate rest. f. Place on noninvasive oxygen monitoring. Rationale: Hydration is important in children with RSV bronchiolitis to loosen secretions and prevent shock. Clustering of care promotes periods of rest. The use of noninvasive oxygen monitoring is recommended

What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration.

d. Give small amounts of favorite fluids frequently to prevent dehydration Rationale: Preventing dehydration by small frequent feedings is an important intervention in the febrile child.

The parents of a child with cerebral palsy ask the nurse if any drugs can decrease their child's spasticity. The nurse's response should be based on which of the following? a. Anticonvulsant medications are sometimes useful for controlling spasticity. b. Medications that would be useful in reducing spasticity are too toxic for use with children. c. Many different medications can be highly effective in controlling spasticity. d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available.

d. Implantation of a pump to deliver medication into the intrathecal space to decrease spasticity has recently become available. Rationale: Baclofen, given intrathecally, is best suited for children with severe spasticity that interferes with activities of daily living and ambulation.

The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which of the following? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak

d. Inability to speak Rationale: The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child.

The nurse is assessing a child who was just admitted to the hospital for observation after a head injury. Which of the following is the most essential part of the nursing assessment to detect early signs of a worsening condition? a. Posturing b. Vital signs c. Focal neurologic signs d. Level of consciousness

d. Level of consciousness Rationale: The most important nursing observation is assessment of the child's level of consciousness. Alterations in consciousness appear earlier in the progression of an injury than do alterations of vital signs or focal neurologic signs.

Which of the following refers to a hernial protrusion of a saclike cyst of meninges, spinal fluid, and a portion of the spinal cord with its nerves through a defect in the vertebral column? a. Rachischisis b. Encephalocele c. Meningocele d. Myelomeningocele

d. Myelomeningocele Rationale: A myelomeningocele has a visible defect with an external saclike protrusion, containing meninges, spinal fluid, and nerves.

Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following? a. Do not administer pancreatic enzymes if child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal.

d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Rationale: Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole.

The nurse is caring for a child with severe head trauma after a car accident. Which of the following is an ominous sign that often precedes death? a. Papilledema b. Delirium c. Doll's head maneuver d. Periodic and irregular breathing

d. Periodic and irregular breathing Rationale: Periodic or irregular breathing is an ominous sign of brainstem (especially medullary) dysfunction that often precedes complete apnea.

Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2-agonists

d. Short-acting β2-agonists Rationale: Short-acting β2 agonists are the first treatment in an acute asthma exacerbation.

The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a. becomes fussy. b. has a cough. c. has a fever over 99° F. d. shows signs of an earache.

d. Shows signs of an earache. Rationale: If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and should be referred to a practitioner for evaluation.

The mother of a 1-month-old infant tells the nurse she worries that her baby will get meningitis like her oldest son did when he was an infant. The nurse should base her response on which of the following? a. Meningitis rarely occurs during infancy. b. Often a genetic predisposition to meningitis is found. c. Vaccination to prevent all types of meningitis is now available. d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children.

d. Vaccination to prevent Haemophilus influenzae type b meningitis has decreased the frequency of this disease in children. Rationale: H. influenzae type b meningitis has been virtually eradicated in areas of the world where the vaccine is administered routinely.

A child is unconscious after a motor vehicle accident. The watery discharge from the nose tests positive for glucose. The nurse should recognize that this suggests: a. diabetic coma. b. brainstem injury. c. upper respiratory tract infection. d. leaking of cerebrospinal fluid (CSF).

d. leaking of cerebrospinal fluid (CSF). Rationale: Watery discharge from the nose that is positive for glucose suggests leaking of CSF from a skull fracture.

Children taking phenobarbital and/or phenytoin may experience a deficiency of: a. calcium. b. vitamin C. c. fat-soluble vitamins. d. vitamin D and folic acid.

d. vitamin D and folic acid. Rationale: Deficiencies of vitamin D and folic acid have been reported in children taking phenobarbital and phenytoin.