Child/Pediatric Health NCLEX

A 15yo parent brings a 4mo old infant for a well baby check up. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action?

Assess the infant's pattern and frequency of crying

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address?

Avoiding participation in contact sports (aortic root disease is the major cause of morbidity and mortality in Marfan syndrome. Therefore, competitive or contact sports are discouraged d/t the risk of cardiac injury or sudden death)

The nurse is planning care for a child being admitted w/Kawasaki disease and should give priority to which nursing intervention?

Monitor for a gallop heart rhythm and decreased urine output (Kawasaki disease causes inflammation of the arterial walls and can lead to scarring of the coronary arteries or development of coronary aneurysms.)

A nurse is assessing a 1mo old infant w/an atrial septal defect (ASD). Which assessment finding does the nurse expect?

Murmur

Developmental milestones age 18 months

Walks up/down stairs w/help; throws a ball overhand; jumps in place; builds 3-4 block tower; turns 2-3 pages; scribbles; uses cup & spoon; 10+word vocabulary; identifies common objects; has temper tantrums; understands ownership; imitates others

The nurse is caring for a child who had a tonsillectomy. Which of the following are appropriate nursing interventions?

1. Educate parents to expect ear pain and give acetaminophen as needed 2. Notify the HCP about frequent, increased swallowing (expected findings: white, fluid filled exudate in the throat w/halitosis/bad breath, low grade fever and referred ear pain. Suctioning can cause trauma and induce bleeding; drinking through a straw creates suction that can cause bleeding; )

A teenage client w/sickle cell disease reports having a vaso-occlusive crisis (pain crisis). Family members say that the client is just "drug seeking." Which expected lab findings would help confirm the presence of a sickle cell crisis?

1. Elevated bilirubin 2. Elevated reticulocyte count 3. Hemoglobin <10

A nurse is assessing a 12mo old who has recurrent otitis media. Which risk factor should the nurse discuss with the infants parents?

1. Frequency of pacifier use 2. Infant's immunization status 3. Infant's position while drinking from a bottle

Which is a management concern for a male teenage client w/CF?

1. Frequent respiratory infections 2. Infertility 3. Vitamin A deficiency (manifestations include recurrent sinus and pulmonary infections, pancreatic malabsorption; deficiency of fat-soluble vitamins and infertility)

A nurse is caring for a 3mo old who has bacterial meningitis. Which clinical findings support this dx?

1. Frequent seizures 2. High pitched cry 3. Poor feeding 4. Vomiting (other findings <2yo: nuchal rigidity and bulging fontanel)

The nurse is assessing a 4yo boy in a pediatric clinic. Which behaviors by the client would concern the nurse for possible Duchenne muscular dystrophy?

1. Frequently trips and falls at home 2. Places hands on the thighs to push up to stand 3. Walks on tiptoes and has disproportionately large calves

Which nursing interventions should be included in the plan of care for a newborn w/suspected esophageal atresia (EA) and tracheoesophageal fistula (TEF)?

1. Keep the infant NPO 2. Maintain the infant supine w/the head elevated 30 degrees 3. Place suction equipment by the infants bed

The nurse plans care for a child being admitted w/a dx of measles. Which will the nurse include in the plan of care?

1. Place the pt on airborne precautions in a negative pressure room 2. Recommend postexposure prophylaxis for unvaccinated, susceptible family members (limiting exposure is not necessary as long as those in contact w/the pt have immunity or have received postexposure prophylaxis)

The parent of a 2yo tells the nurse at the well child clinic "I m concerned b/c my child does not like to be cuddled, does not respond when called by name, and does not make eye contact when being fed." What is the priority question for the nurse to ask when completing the health history?

"How many words can your child say?"

The nurse is caring for a 7yo child dx'd w/nephrotic syndrome who will be discharged soon. Which statement by the parent indicates the need for reinforcement of teaching?

"I'll organize a lot of play dates to keep my child's spirits up"' (home management includes a low sodium diet w/attractive foods; infection prevention; fluid restriction for severe edema; monitoring of weight gain and proteinuria to detect relapse)

The nurse is teaching the parents of a toddler about health promotion. Which statement by one parent requires clarification?

"If my child refuses a meal, I will wait a few miutes and try again." (avoid giving toddlers options that allow them to say "no" and refrain from forcing toddlers to eat, allow them a 15-30 minute period to calm down before meals and use time outs for management of temper tantrums"

The triage nurse is assessing an unvaccinated 4mo old for fever, irritability, and open mouthed drooling. After the infant is successfully treated for epiglottitis, the parents wonder how this could have been avoided. Which response by the nurse would be most appropriate?

"Most cases of epiglottitis are preventable by standard immunization"

Which of the following statements made by the mother of a child recently dx'd w/celiac disease indicates a need for further teaching?

"My child can have small amounts of foods containing wheat as long as she remains symptom free" (consuming even small amounts, even in the absence of sx's will increase the risk of damage. Rice, corn and potatoes do not have gluten"

The nurse is providing teaching for parents of a child dx'd w/fifth disease. Which statement by a parent indicates a need for further teaching?

"Our child's condition is communicable until the rash disappears" (communicable only prior to onset of symptoms; spreads via respiratory secretions.)

The parent of a 6yo calls the nurse and reports that the child was playing outside in the snow and the child's feet now appear red and swollen. What is the best response by the nurse?

"Place the child's feet in warm water immediately" (re-warming the affected area by immersion in warm water (104F). They can also be given warm liquids to drink and should be seen by a HCP asap)

The clinic nurse reviews teaching provided to the parent of a child being considered for GHR therapy at home. Which statement by the parent indicates that teaching has been effective?

"Treatment will require a daily injection under my child's skin" (GHR is an option for children who are not growing according to accepted standards. The txmt should begin as soon as delays are noted and continue until bone growth begins to cease.)

For the past month, the nurse has been providing care to a 7yo client recently dx'd w/type 1 diabetes mellitus. Initially, the family seemed devastated over the diagnosis. The client's parent stated "Our lives will never be the same." What statement now made by the parent best indicates that nursing interventions have been effective?

"We will not let this disease take control of our child's life"

A 2mo old recently dx'd w/developmental dysplasia (DDH) is beginning treatment w/Pavlik harness. Which instructions should the nurse provide to the parents?

1. "Dress the child in a shirt and knee socks under the straps." 2. "Lightly massage the skin under the straps daily" 3. "Place the diaper under the straps"

The nurse has provided instructions about home care management for the parents of a child dx'd w/rotavirus infection. Which statements by the parents indicate that teaching has been effective?

1. "Hand washing is extremely important in slowing the spread of rotavirus." 2. "I will observe my child for decreased urination and dry mucous membrantes." 3. "My child can spread the infection with contaminated hands, toys, and food." (easily spread via the fecal-oral route. It is not treated with abx b/c it is a viral infection. Vaccinations available for <8mo old. Infected are at risk for dehydration)

The nurse provides DC teaching for the parents of a child newly dx'd w/hemophilia A. Which statements by the parents indicate that teaching has been effective?

1. "Our child should wear a medical alert bracelet at all times." 2. "We should avoid giving our child OTC medication containing aspirin" 3. "We should encourage a non-contact sport such as swimming"

The nurse is reviewing anticipatory guidance w/the parent's of a 6mo old infant w/phenylketonuria. Which statements by the nurse are appropriate?

1. A low-phenylalanine diet is required 2. Meat and dairy products should not be introduced into the diet 3. Special infant formula is required (PKU requires lifetime dietary restrictions. Infants should be given special formulas. For children and adults, high phenylalanine foods (meats, eggs, milk) should be restricted and replaced w/protein substitutes)

A nurse is caring for a school aged pt who has fever, somnolence, and a skin rash from suspected meningococcal meningitis. Which interventions should be implemented for this pt?

1. Allow the pt to self-position for comfort 2. Keep the client NPO status 3. Minimize the environmental stimuli (droplet precautions, raising HOB and removing pillow. Droplet precautions should continue for 24 hours after initiation of abx therapy)

A parent calls the clinic nurse concerned about a 5yo w/a nosebleed. The parent says the child had a similar incident one week ago while at school. Which instructions should the nurse provide?

1. Apply a cold cloth to the bridge of the nose 2. Apply continuous pressure to the nose for 10 min 3. Keep the child calm and quiet

The student nurse is reviewing the medical record of a 4yo dx'd w/failure to thrive (FTT). The nurse correctly identifies which clinical and psychosocial factors that have likely contributed to the child's condition?

1. Child is bottle fed 4 times/day and at bedtime 2. Child's parent is incarcerated for spousal abuse 3. Parent worries about having enough money to buy food 4. The children eat at various times of the day in front of the television

The home health nurse is visiting an infant who recently had surgery to repair tetralogy of Fallot. The nurse should teach the parents to report which findings indicative of heart failure to the health care provider.

1. Cool extremities 2. Puffiness around the eyes 3. Reduction in number of wet diapers (signs of HF in presence of congenital heart defect... tachypnea, dyspnea, tachycardia, pale, cool extremities, weight gain, reduction in wet diapers and puffiness around eyes)

When monitoring an infant w/ a left-to-right sided heart shunt, which findings would the nurse expect during the physical assessment?

1. Diaphoresis during feedings 2. Heart murmur 3. Poor weight gain (eg. patent ductus arteriosus, atrial septal defect, ventricular septal defect...result in excess blood flow to the lungs. Manifestations include heart murmur, poor weight gain, diaphoresis w/exertion and signs of heart failure)

The summer camp nurse and parent of a 9yo w/juvenile idiopathic arthritis (JIA) are discussing appropriate physical activities for the child. Which of the following activities should be included?

1. Stationary bicycling 2. Swimming 3. Yoga

The nurse plans to teach the parents of a child dx'd w/pediculosis capitis. Which instructions should the nurse include in the teaching plan?

1. soak your child's comb and hair accessories in boiling water for 10 minutes 2. Use a nit comb daily for 2 weeks after pediculicide treatment 3. Vacuum your furniture, carpets and mattresses every few days (Pediculosis capitis is head lice; household pets do not transmit human lice)

Hemoglobin levels for newborns

12.5-20.5

Which infant is most likely to require oral iron supplementation?

2mo old born at 34 weeks gestation who is bottle fed with breast milk (premature babies require iron supplementation by at 2-3 months)

When performing developmental screenings in the well child clinic, the registered nurse understands that which child is at highest risk of developing autism spectrum d/o?

4yo whose 10yo sibling has the d/o

The nurse receives 4 prescriptions for a child dx'd w/hemophilia A who was brought to the ED following an injury on the playground. The child has vomited once and has a HA. Which prescription should the nurse carry out?

Administer IV factor VIII (risk for intracranial bleeding)

Several clients check into the ER at the same time. Which pt should be seen first?

7yo who is restless after tonsillectomy surgery 3 days ago. (pt is at risk for hemorrhage and life threatening airway compromise up to 14 days after surgery. S&S include restlessness, frequent swallowing or throat clearing, vomiting of blood, and pallor

The school nurse is caring for 4 clients w/type 1 diabetes mellitus. Which of these clients should the nurse assess first?

9yo who is sweating after recess and irritably states, "I'm so hungry!" (sx of hypoglycemia: sweating & pallor, irritability, tremors & weakness, tachycardia, drowsiness, hunger)

The nurse is triaging clients from the waiting room. The care of which client is a priority?

A 2yo who ingested a button battery approximately 30 minutes ago and is asymptomatic. (Alkaline battery ingestion can cause corrosive damage to the esophagus and intestine and result in perforation...it is an emergency by endoscopy)

The nurse assesses 4 children in the clinic. Which assessment finding requires the nurse's priority action?

A 3mo old with a fever, vomiting, high pitched cry and irritability (could indicate serious underlying infection and increased intracranial pressure)

The nurse assesses a child w/intussusception. Which assessment findings require priority intervention?

Abdominal rigidity with guarding (intestinal perforation and peritonitis are common complications of intestinal obstruction and is a surgical emergency. A sausage shaped right sided mass is commonly felt on palpation and is an expected finding, not an emergency)

A 2yo suspected of having retinoblastoma. The nurse recognizes which sign as being most characteristic of this disease?

Absence of red reflex (white glow of the pupil)

A mother reports to the pediatric nurse that her 3yo child coughs at night and at times until he vomits. The symptoms have not improved over the past 2 months despite multiple OTC cough medications. What should the nurse explore r/t a possible etiology?

Ask about exposure to triggers such as pet dander (pediatric asthma can present as night coughing until the child vomits)

A nurse is caring for a child with acute glomerulonephritis. Frequent monitoring of which of the following is a priority?

Blood pressure

The parent of an 11mo old child calls the pediatric outpatient clinic and tells the nurse that the child was exposed to measles 2 days ago during a family trip to a theme park. What is the best response by the nurse?

Bring the baby into the clinic for MMR vaccine. (a child <12mo can and should receive MMR when there is an outbreak and the child is at risk. The child will need to be re-vaccinated b/w 12-15mo and again b/w 4-6yo)

Several children are brought to the ER after a boating accident in which they were thrown into the water. The children are now 6 hours post admission to the clinical observation unit. Which client should the nurse evaluate first?

Client who received CPR for 2 minutes on the scene and whose respiratory rate has now dropped from 61/min to 18/min (submersion injury...observe for at least 6 hours for new or worsening respiratory failure. Changes in pattern, rate, O2 sat and LOC can signal impending respiratory failure)

The nurse is reinforcing DC teaching for the parents of a 1yo w/a newly dx'd cows milk allergy. Which nutrients normally provided by milk should be obtained from other sources?

Calcium and Vitamin D

A 3 month old who weighs 8.8lbs (4kg) has just returned to the ICU after surgical repair of a congenital heart defect. Which finding by the nurse should be reported immediately to the doctor?

Chest tube output of 50mL in the past hour (drainage >3mL/kg/hr for 3 hours or >5-10mL/kg in 1 hour should be reported)

The nurse has assessed 4 children. Which finding requires immediate follow-up w/the HCP?

Child who had a surgical repair of hypospadias earlier today w/no urinary output in the past hour (a condition in which the urethral opening is on the underside of the penis. It is surgically corrected)

During a routine assessment of a developmentally normal 18mo old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention?

Educate the parent about physiologic anorexia (a period of decreased appetite that occurs in toddlers around age 18mo as a result of decreased metabolic needs)

The nurse is triaging a 7yo w/sickle cell crisis. The pt is SOB and vomiting and has severe generalized body and joint pains. Which assessment finding requires the most immediate intervention?

Enlarged spleen on palpation (splenic sequestration crisis is a potentially life threatening emergency of sickle cell disease. A rapidly enlarging spleen and hypotension are the characteristic assessment findings)

The nurse is caring for an infant dx'd w/Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action?

Episode of foul-smelling diarrhea and fever (Enterocolitis is a potentially fatal complication of Hirschsprung disease and is characterized by explosive, foul-smelling diarrhea, fever and worsening abdominal distention)

The nurse is providing d/c instructions to the parent of a child w/Kawasaki disease. The nurse informs the parent that the presence of which symptom should be immediately reported to the HCP?

Fever (parents should be instructed to check their temp every 6 hours for the first 48 hours following the last fever and then daily until the follow up visit)

A parent brings a 6mo old to the primary HCP after the child abruptly started crying and grabbing intermittently at the abdomen. The client's stool has a red, currant jelly appearance. What intervention does the nurse anticipate?

Give air (pneumatic) enema (Intussusception causes intermittent cramping. It is often treated successfully w/an air enema)

The nurse is gathering data on a 5 week old admitted w/a suspected dx of pyloric stenosis. The nurse should expect to find which lab value?

Hematorcrit of 57% (results in projectile vomiting, which leads to dehydration and hypokalemic metabolic alkalosis. Dehydration is manifested by hemocencentration and elevated blood urea nitrogen

The nurse who is caring for a 1mo old w/Tetralogy of Fallot will report which finding to the HCP?

Hemoglobin level of 24.9 (poor oxygenation can cause elevated levels of hemoglobin which increase blood viscosity.)

The nurse is teaching the parent of a 6yo about behavioral strategies for treating fecal incontinence d/t functional constipation. Which statement by the parent indicates a need for further teaching?

I will give my child a reward for each bowel movement while sitting on the toilet." (Rewards are given for the child's effort and participation, not for having bowel movements while sitting on the toilet)

The nurse has received report on 4 pediatric pt's on a tele unit. Which pt should the nurse assess first?

Infant pt w/ventricular septal defect w/reported grunting during feeding (may progress to CHF)

The nurse is admitting a 4yo dx'd w/Wilms tumor. The child is scheduled for a right nephrectomy in the morning. Which action is a priority in the preoperative care plan?

Instructions not to palpate the abdomen (palpating the abdomen could disrupt the tumor and cause dissemination of tumor cells)

The nurse is assessing a 3yo client in the ER and finds dyspnea, high fever, irritability, and open mouthed drooling w/leaning forward. The parents report that the symptoms started rather abruptly. The client has not received age-appropriate vaccinations. Which set of actions should the nurse anticipate?

Intubation in the operating room w/a prepared tracheotomy kit standing by.

The nurse planning teaching for the parents of a child newly dx's w/hemophilia will include information about which long term complication?

Joint destruction (d/t frequent bleeds into the joint spaces)

The nurse is performing well child examinations in a pediatric clinic. Which finding requires further evaluation?

Lateral curvature to the spine noted on examination of a 10yo girl (early detection of scoliosis and prompt treatment may reduce the need for surgical intervention)

The nurse is caring for a newborn w/patent ductus arteriosus. Which assessment finding should the nurse expect?

Loud machine-like murmur (blood shunts from the aorta to the pulmonary arteries. The child will be acyanotic but will have a machine like murmur heard on both systole and diastole)

A 12mo old w/Kawasaki's disease received IVIG 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed?

Measles, mumps, rubella (MMR), Varicella (Live vaccines should be delayed for up to 11 months after IVIG administration b/c it decreases the child's ability to produce the appropriate amount of antibodies to provide lifelong immunity)

The nurse is caring for a 2yo who is receiving a saline enema for treatment of intussusception. Reporting which client finding to the HCP is most important?

Passed a normal brown stool (passage of a normal stool indicates a reduction of the intussusception)

A nurse is caring for a 2yo w/ a new dx of strabismus. Which intervention should the nurse anticipate?

Patching the stronger eye (cross-eyed)

The nurse assesses a pediatric pt who was dx'd w/diarrhea caused by E.Coli. The nurse is most concerned w/which finding?

Petechiae noted on the trunk (Hemolytic uremic syndrome/HUS, is a life-threatening complication of E.Coli diarrhea. Manifestations include anemia/pallor, low platelets/petechiae and purpura, and AKI/low urine output)

A nurse is assisting a new mother as she is breastfeeding her infant. The infant has been dx'd w/tetralogy of Fallot. During feeding, the infant becomes cyanotic and is having difficulty breathing. What should be the nurse's first action?

Place the infant in the knee-chest position. (to relieve a hypercyanotic episode, or "tet spell", the nurse should place the infant or child in the knee-chest position)

The nurse is assessing a 4week old infant during a routine office visit. Which assessment finding is most likely to alert the nurse to the presence of right hip dysplasia?

Presence of extra gluteal folds on the right side

A nurse is caring for a 6yo client w/tonsillitis. Which further assessment finding requires immediate intervention?

Presence or trismus (Peritonsillar or retropharyngeal abscess is a serious complication that can result from tonsillitis. A "hot potato" of muffled voice, trismus/inability to open mouth, pooling of saliva and deviation of the uvula to one side are presenting features)

The school nurse evaluates a 9yo who is sweating, trembling and slurring while speaking. The pt has type 1 diabetes managed w/insulin glargine and NPH. What is the most appropriate action by the nurse?

Provide 4oz of regular soft drink

The nurse is caring for a 10yo dx'd w/osteomyelitis. What is the best activity the nurse can suggest to promote age specific growth and development during hospitalization?

Provide missed schoolwork (according to Erikson's stages of psychosocial development, school aged children deal w/the conflict of industry vs inferiority. Learning is a priority during this stage)

The nurse is caring for a 4yo who was hospitalized w/influenza. Which nursing action would be most effective to maintain psycho-social integrity?

Providing crayons to draw noses on face masks

A newborn had a bowel resection w/temporary colostomy for Hirschsprung's disease. The nurse should alert the HCP for which assessment finding postoperatively?

Stoma is gray-tinged at the edges but pin at the center on post-op day 5 (The colostomy should be beefy red in the immediate post-op period. Any discoloration to the stoma could indicate decreased blood supply to the area.)

The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn?

Swaddle the infant w/hips flexed and abducted

Several 12mo old infants are brought to the clinic for routine immunizations. Which situation would be the most important for the nurse to clarify w/the provider before administering the vaccination?

Varicella-zoster vaccine for client recently dx'd w/leukemia (Immunocompromised clients should not receive live vaccines)

A 14yo is scheduled for surgery to treat scoliosis. The child will be hospitalized for about a week and then dc'd home to recuperate for 3-4 weeks before returning to school. What is the best activity the nurse can recommend to promote age specific growth and development during this time?

Visits from friends (I answered "keeping up w/schoolwork)...friends play a significant role in the childs quest for identity and provide a source of support.

Developmental milestones age 12 months

Walks first steps indepedently; crawls up stairs; uses 2 finger pincer grasp; hits 2 objects together; says 3-5 words; uses non-verbal gestures; may have separation anxiety; searches for hidden objects

Developmental milestones age 3 years

Walks up stairs w/alternating feet; pedals a tricycle; jumps forward; draws a circle; feeds self w/o help; grips a crayon w/fingers instead of fist; 3-4 word sentences; asks "why" questions; states own age; begins associative play; toilet trained; except wiping

Developmental milestones age 2 years

Walks up/down stairs alone, 1 step at a time; runs w/out falling; kicks ball; builds 6-7 block tower; turns 1 book page; draws a line; 300+word vocabulary; 2-3 word phrases; states own name; begins parallel play; begins to gain independence from parents