Exam 1 Peds
A father calls in the evening of his son's first MMR vaccination with concerns that he has a fever of 102.3 F, measured from a temporal thermometer. He has no other symptoms of illness such as a rash, cough or runny nose. The nurse's best response is: A. "Fevers can happen after vaccines and are usually not serious, give him a dose of Tylenol and recheck the temperature in 30 minutes". B. "The fever concerns me after his vaccination, let's have you bring him back to clinic tomorrow." C. "That high of a fever after his MMR shot needs immediate evaluation. Can you drive him to the emergency room?"
A
SSRIs can be prescribed for anxiety and/or depression in children. A. True B. False
A
The family systems theory explains that: a. The family unit is a complex social system that should be viewed as a whole rather than as individual elements. b. Changes in one individual within a family is unlikely to influence the entire family unit. c. Individuals within the family should be independently managed as their behavior is unlikely to influence the family. d. Individuals are unlikely to be affected by their family system dynamics.
A
Which example most appropriately demonstrates social development theories (Erikson & Piaget) for infants? A. Infant cries and is picked up and comforted by parent; infant explores environment by motor and oral means. B. Infant should be provided independence when possible; language is used for demands. C. Infant may develop guilt if they tried something and failed; infant's imagination is strong but complex abstract thoughts are difficult.
A
Which infant gross motor example should require further evaluation? A. Rolling at 6 weeks B. Head lag at 2 months C. Absent Babinski reflex at 4 months D. Unable to sit without support at 7 months
A
Which is appropriate therapeutic play for a four-year-old prior to a procedure? A. A lot of the time for medical play to explore equipment. B. Ensure parents are not present for procedure. C. Have the child watch set up equipment for procedure D. Tell the child to be brave during procedure.
A
Which is not an appropriate way to administer medication to a child? A. Put the dose into the child's 4 ounce bottle. B. Put the dose into a small bite of chocolate pudding. C. Put into a small bite of applesauce. D. Put the dose into a five ML of apple juice.
A
Which of the following nursing recommendations is MOST appropriate to provide to parents of a typically-developing 12month-old? A. Be sure to place baby gates at the top and bottom of stairways B. Putting baby to sleep on their back is safest C. It is important that your child interact with other kids to practice sharing and taking turns. D. Now that he is 12 months old, he can drink whatever kind of milk the rest of the family drinks.
A
Which of the following scenarios of a school-ager warrants further nursing assessment? A. Inability to categorize objects by size and shape B. Tracking at the 83rd percentile for height and weight C. Needs assistance with organization and managing time D. Tracking at the 9th percentile for height and weight
A
Which parent statement about preschooler social development would require further education? A. "Last night, our son dressed up like Mom, he must want to be a girl" B. "I have taught my daughter that it is wrong to lie but sometimes I think she lies to make me happy." C. "Our 4-year-old daughter loves imitating her big sister, it drives her older sister bonkers." D. "My son thinks he caused Grandma to fall and get hurt because she told him no cookies before dinner and he was angry at her"
A
Which statement about the management of ADHD is false? A. Dosing of ADHD medication is weight-based B. Sometimes "drug holidays" are needed due to potential appetite suppression in stimulants C. The parents of a child prescribed Strattera, a non-stimulant, should receive education about the possible risk of suicidal ideation in its users D. Stimulants are generally the first-line medication for ADHD but behavioral and environmental techniques should be tried first or in conjunction
A
Which statement from a nurse you are training about adolescent development would require educational intervention? A. "If a child or teen is overweight or obese, we should teach them about the importance of exercise and dieting" B. "Schools should have an 8:30 am or later start for teens because they tend to get tired later in the evening and need to sleep in later than kids" C. "Teens can think about the future and consequences but may engage in risky activities because those bad things' wouldn't happen to them' " D. "If I am trying to get our teen patient to open up to me, I should ask open-ended questions, be non-judgmental, and be honest and welcoming"
A
A child, age 4 years, tells the nurse that she "needs a Band-Aid" where she had an injection. Which of the following is the best nursing action? a. Apply a Band-Aid. b. Ask her why she wants a Band-Aid. c. Explain why a Band-Aid is not needed. d. Show her that the bleeding has already stopped.
A Children in this age-group still fear that their insides may leak out at the injection site. Provide the Band-Aid.
Which of the following are common signs/symptoms of anxiety in children? (SELECT ALL THAT APPLY) A. Difficulty falling asleep at night B. Restlessness C. Abdominal pain D. Headache E. Frequent worrying
A,B,C,D,E
Which of the following are side effects or potential complications from SSRI therapy in children? (SELECT ALL THAT APPLY) A. Serotonin syndrome B. Nausea/vomiting C. Hyperglycemia D. Low platelet levelsE. Suicidal ideation
A,B,E
An 8-year-old girl is being admitted to the hospital from the emergency department with an injury from falling off her bicycle. Which of the following will help her most in her adjustment to the hospital? a. Explain hospital schedules to her, such as mealtimes. b. Use terms such as "honey" and "dear" to show a caring attitude. c. Explain when parents can visit and why siblings cannot come to see her. d. Orient her parents, since she is too young, to her room and hospital facility.
A.
The mother of a 2-month-old infant tells the nurse at the well-child visit, "I am concerned that my son will get sick from all of these shots. I got a cold after my flu shot last year." What is the nurse's best response? A. "It is common to have symptoms such as mild congestion after some vaccines as our immune system is making antibodies to protect against the actual disease." B. "Children must develop a mild form of each disease after vaccinations in order for the shots to work." C. "Since you had that reaction to the vaccination, we should avoid immunizing your baby until he is older." D. "Don't worry, your baby will not get sick after his shots today."
A.
The mother of a 7-month-old infant newly diagnosed with cystic fibrosis is rooming in with her infant. She is breastfeeding and provides all the care except for medication administration. The nurse includes in the care plan: A. Ensuring that the mother has breaks from providing care so that she may rest and allow nurses to assist with the infant's care. B. Making sure the mother is providing all of the infant's care. C. Determining whether other family members can provide the necessary care so the mother can rest. D. Contacting the social worker because of the mother's interference with the nursing care.
A.
The nurse's best description regarding the Human Papilloma Virus (HPV) vaccine when providing education to a 10-year old girl and her family is: A. "This vaccine will protect your child from cancer." B. "This vaccine will protect your child from sexually transmitted infections (STIs)." C. "This vaccine should be given after you are sexually active."
A.
Which of the following situations is the MOST concerning for potential suicidal ideation? A. Sudden improvement of mood in a severely depressed child B. An adolescent with anxiety with persistent and consistent headache and abdominal pain C. School avoidance in a child who has experienced bullying D. An adolescent whose mother was recently diagnosed with end stage breast cancer
A. Worried about a suicidal plan.
Antibiotics are indicated in which condition? A. Pertussis B. Measles C. Poliomyelitis D. Mononucleosis E. Varicella
A. bacterial "whooping cough"
A school-age child taking Methylphenidate, a psychostimulant for ADHD, comes to clinic for routine follow-up. Which of the following is the PRIORITY nursing action? A. Accurate growth measurement, documentation and assessment B. Assessment of elimination patterns, specifically presence of constipation or diarrhea C. Vision and hearing screening D. Review of developmental milestone achievement as an infant and toddler
A. growth suppression*
A 10-year-old girl needs to have another IV started. She keeps telling the nurse, "Wait a minute," and, "I'm not ready." The nurse should recognize that: A. IV insertions are viewed as punishment. B. This is expected behavior for a school-age child. C. Protesting like this is usually not seen past the preschool years. D. The child has successfully manipulated the nurse in the past.
B
A 17-month-old is brought into the clinic and the nurse notes the toddler has tooth decay on the maxillary upper incisors and the nurse learns that the toddler falls asleep with a bottle of milk each night as part of the bedtime routine. Which educational recommendation should the nurse include to wean the toddler off the bottle? A. Brush the toddler's teeth after the bedtime bottle B. Do not give any bottles before bed, recommend water sippy cup C. Give the bottle only at night D. Ensure that the family has enough fluoride in the home water supply
B
Normal urine output for pediatric patient is; A. voiding every hour B. one ML per KG per hour C. 250 ML every eight hours D. 30 ML per hour.
B
Parents of an 18-month-old report concern that their child is not yet potty trained. Which of the following is the nurse's BEST response? A. Sometimes potty training takes time. If you are consistent, I am sure it will come along soon. B. Many kids are not ready to start potty training until around 2 ½ or 3 years old. C. Using a reward system with positive reinforcement is the best method for most children to become potty trained.
B
The mother of a 2-month-old brings her baby in for her well-child visit. The older brother, Gavin, was diagnosed with Autism Spectrum Disorder (ASD) six months ago. The mother states "I am worried about giving my baby vaccines since learning about Gavin's autism". What is the nurse's best response? A. "I will let the provider know, and we will not administer vaccinations today." B. "Would you mind if we discussed your concerns with the provider?" C. "Every parent is worried about their baby getting autism, and your child will still get her shots today." D. "I will let the provider know that you refuse immunizations today."
B
The nurse is counseling parents of a teen about the mRNA COVID-19 vaccine. The mother states: "I know this is a new vaccine, how does it even work?" Which of the following is theBEST response? A. The vaccine gives a little bit of the virus that is already dead to the immune system, so it can recognize and stop COVID when it comes in the body. B. The vaccine provides instructions on how to make part of the virus called the spike protein, which then causes the immune system to recognize and stop COVID if it enters the body. C. The mRNA vaccines have shown to be very safe and effective in kids in preventing them from getting sick with COVID. There are some long-term effects of the virus for some children like chronic fatigue and fogginess we want to prevent.
B
The parents of a 4-month-old infant cannot visit except on weekends. Which action by the nurse indicates an understanding of the emotional needs of a young infant? A. Place her in a room away from other children. B. Assign her to the same nurse as much as possible. C. Tell the parents that frequent visiting is unnecessary. D. Assign her to different nurses so she will have varied contacts.
B
Which example most appropriately demonstrates a language milestone for infants? A. Silence or crying until 4 months old B. Babbling at 6 months C. 2-word sentence by 12 months D. Smiling and eye contact by 8 months
B
Which example most appropriately demonstrates language development for toddlers? A. 2-year-old calls everyone "mama" B. 2.5-year-old says "more snacks" C. 15-month-old says "I want to watch Bluey"
B
Which example most appropriately demonstrates social development theories (Erikson & Piaget) for toddlers? A.Toddler cries and is picked up and comforted by parent; toddler explores environment by motor and oral means. B.Toddler should be provided independence when possible. "No"is said frequently. Parallel play is seen among peers. C.Toddler has concrete thinking. Interactive play among peers.
B
Which example most appropriately represents typical adolescent social development? A. 13-year-old who is has put together an intricate Star WarsDeath Star LEGO model B. 17-year-old that wants to leave family Thanksgiving dinner by 7 pm to see their friend group C. 15-year-old that dresses uniquely and is withdrawn from peers D. 14-year-old that is disengaged in school and would prefer to play the solo online game World of Warcraft
B
Which nursing intervention should take place prior to all vaccination administrations? A. Document the vaccination to be administered on the immunization record and medical record. B. Provide vaccine information statement handout and answer all questions. C. Administer the most painful vaccination first, and then alternate injection sites. D. Refer to the vaccination as "baby shots" so the parent understands that the baby will be receiving an injection.
B
Which of the following milestones is expected in a 24-month-old? A. Getting dressed independently B. Able to turn the pages of a book one at a time C. Speaking in 3-5-word sentences D. Able to ride a tricycle
B
Which recommendation about infant activity, safety, and mental health is false? A. Infants do not require constant stimulation, no screens until about 2 years B. Parents that put down their crying colicky infant are exhibiting neglectful behavior C. Nurses should provide anticipatory guidance to parents about preventing infant injuries, such as suffocation and falls D. When riding in a vehicle, infants should be placed in a rear-facing car seat that has a 5-point harness
B
Which statement from a parent requires further education regarding care of toddlers? A."My daughter only seems to want macaroni and cheese and milk" B."My son should have been potty trained by 2, he doesn't want to learn" C."If he drinks a bottle of milk before bed, I will brush his teeth before laying him down" D."These temper tantrums are tough for me to deal with. I try to distract her but sometimes I let her scream it out"
B
Which would be the priority nursing action on finding the varicella vaccine at room temperature on the shelf in the medication room? A. Ensure that the varicella vaccine integrity is intact. If intact, follow the five rights of medication administration. B. Do not administer this batch of the vaccine. C. Check the vaccine expiration date and lot number and administer per protocol. D. Ask the father if the child has had any prior reactions to varicella.
B
You are the nurse evaluating a five-year-old girl admitted to the pediatric unit after falling off her bicycle resulting in a fractured right arm. she lives with her family, including two older sisters, mother, maternal grandparents and aunt 25 miles away from the hospital. The nurse completes a holistic assessment of the child throughout the shift and notes the following findings; A. Living with non traditional family B. Frequent yelling amoung family members C. Only responds by nodding yes
B
The nurse is concerned about a 4-year-old who is not yet (SELECT ALL THAT APPLY): A. Understanding sarcasm B. Able to use a spoon well C. Telling time D. Copy a circle E. Run well
B, D, E
The transfer of immunity in-utero from mother to fetus is considered Active immunity Passive immunity Herd immunity
B. passive
Which of the following examples supports development of Erickson's initiative? A. Parents initiating skin to skin contact with their infant to promote attachment B. A mom praising her 4-year-old child for helping make holiday decorations, even when they end up looking messy C. A father encouraging his toddler to explore her environment safely D. A child working hard over time and reaching a goal of completing a complex Lego set correctly.
B. preschoolers
All examples show expected school ager social development except? A. 6-year-old that can categorize shapes, colors, and sizes of various objects B. 8-year-old that cannot think abstractly, they think logically about space and time C. 10-year-old that believes there is more water in the tall thin glass compared to the short wide glass D. At recess, the rules of tag and the boundaries of the game are must be discussed first
C
Parents are frustrated with toilet training their 2-year-old. Both parents work full time and claim that they do not have time to spend on toilet training. What is the BEST response that the nurse can tell the parents? A. "You will have to invest some time if the child is to become potty trained". B. "Do you think your child is stubborn? Many times kids with persistent personalities have a harder time toilet training." C. "A child needs to be both physically and psychologically ready to learn the skills needed to become continent". D. "Have the child sit on the toilet until the child voids. Consistency is key".
C
The following are true infant nutrition recommendations except? A. Infant nutrition requirements are about 120 kcal/kg/day B. A 4 kg infant should consume approximately 480 kcal/day C. Infants can start drinking cow's milk at 9 months D. Infants who are exclusively breastfed should receive iron and vitamin D supplementation E. Infants should avoid honey, seafood, and juice
C
The following statements are true regarding infant physical development except? A. The ears, nose, and throat (mouth) are usually evaluated last B. Infants lose 10% of their birthweight 3-5 days after birth and should regain to birthweight after 2 weeks C. Infants with colic have gastrointestinal issues that cause them to be malnourished and delay physical milestone obtainment D. Infants with plagiocephaly frequently also have torticollis E. Strabismus in infants requires referral to pediatric ophthalmology if present after4 months
C
Which example demonstrates expected fine motor development for infants? A. Persistent fisting at 4 months B. Involuntary palmar grasp at 6 months C. Pincer grasp at 9 months D. Raking grasp at 12 months
C
Which is not a standard of care when caring for a child in a restraint? A. Providing range of motion to two hours, while the child is in restraints. B. Offering routine toileting, and changing of diapers. C. Releasing both restraints every hour five minutes D. Ensuring nutrition, hydration needs are met.
C
Which of the following measurements is concerning for potential childhood obesity/overweight? A. BMI 98% for age in an 18-month-old toddler B. A 10-year-old who increased from the 50th percentile for weight to the75th percentile for weight in 1 year C. 12-year-old whose BMI is at the 99th percentile for age D. A 15-year-old whose height and weight are both at the 90th percentile forage.
C
Which of the following scenarios is an absolute contraindication for a child to receive the diphtheria, tetanus, and pertussis (DTaP) vaccine? A. 6-month old who is exhibiting cold symptoms but no fever. B. 4-month old with a temperature of 101.9 F, who is breastfeeding normally. C. A 5-year old who developed hives and wheezing after his 12-month dose of DTaP. D. A 12-month old with a strong family history of seizures.
C
Which statement about school-ager development requires further evaluation or education? A. "I learned how to French braid my American Girl Doll's hair" B. "I wish I got a better grade on the math test but my Mom knows I studied a lot" C. "When I turn 8, I don't have to use the booster seat anymore" D. "Jayden is my best friend, we're in soccer and swimming together"
C
Which statement is false when considering a pediatric cardiac assessment? A. many children have innocent murmurs b. occultation should be completed using the bell and diaphragm of the stethoscope. C. A buzz is commonly felt D. Ausulctation should be completed with the child laying and sitting.
C
Which vital sign would you want to get first when assessing a resting infant a. temperature B. pulse c. respiratory rate, d. blood pressure
C
A major premise of family-centered care is that: a. the child is the focus of all interventions. b. nurses are the authorities in the child's care. c. parents are the experts in caring for their child. d. decisions are made for the family to reduce stress.
C.
A nurse is working with family members who have been striving to improve their functioning as a family unit. What behavior would suggest to the nurse that the family is meeting its goals? a. The children are in multiple activities to develop talents. b. The desire to be understood guides most communication. c. Family members gave up some activities in order to eat dinner together on most nights. d. The parents have a strong desire for the children to succeed.
C.
A 2-year-old presents to the ED with fever, cough, hoarse voice. Throat assessment showed erythema and frothy gray patches on the tonsils. Which of the following is the BEST INITIAL action? A. Request order for antibiotics B. Place child on 2L oxygen per nasal cannula C. Institute appropriate isolation D. Place an IV for access and hydration
C. diptheria, bacterial, vaccine available
A child with ADHD has recently started taking Ritalin (methylphenidate). Which of the following findings should alert the nurse that the child may be having a common side effect from the medication regimen? A. Persistent nocturnal enuresis (bed wetting) B. Petechiae noted on the face and neck C. Falling asleep at school D. Decline in visual acuity E. Excessive appetite
C. #1 priority is education. Monitor height and weight if put on stimulants.
Around which age is screening for AutismSpectrum Disorder (ASD)recommended? A. 3-6 months B. 9-12 months C. 18-24 months D. 3-5 years
C. *with Autism Social interaction is affected*
Which of the following vaccines should not be administered to an immunocompromised child? A. Inactivated Polio Vaccine (IPV) B. Haemophilus Influenza B (HIB) C. Varicella (Chickenpox) D. Hepatitis B (HepB)
C. Don't give live vaccines! MMR, Varicella, fluist
Which of the following is the BEST description of Erickson's Autonomy? A. The child can separate from parents without anxiety B. The child is open to trying something new C. The child is attempting to gain independence D. The child can determine that an item exists even when it is not seen
C. Toddler age
A toddler presents to the emergency department with fever 103 F, vesicular and maculopapular (red raised) rash on the chest. The child is scratching the rash aggressively. Which of the following is the PRIORITY nursing action? A. Determine immunization status B. Obtain an order for broad spectrum antibiotics C. Neurologic and respiratory assessment D. Apply O2 per nasal cannula and oxygen saturation monitoring
C. varicella (chicken pox), causes encephalitis (measles also causes this).
A spinal tap must be done on a 9-year-old boy. While he is waiting in the treatment room, the nurse observes that he seems composed. When the nurse asks him if he wants his mother to stay with him, he says, "I am fine." Which of the following is the best interpretation of this situation? A. This child is unusually brave. B. He has learned that support doesn't help. C. 9-year-old boys do not usually want a parent present during the procedure. D. Children in this age-group often do not request support, even though they need and want it.
D
Assessment of pain in a child would include all of the following except; A. asking the child to rate their pain, B. asking the parent about pain concerns their child C. using a pain scale appropriate for age D. assuming a crying child has pain
D
Which example of preschooler development would warrant further evaluation? A. 5-year-old who is a picky eater and only wants to eat macaroni and cheese for all meals B. 3.5-year-old that screams and cries shortly after going to bed who appears awake but has no memory of their upset C. 3-year-old that is throwing a temper tantrum because their screen time is restricted D. 4-year-old that speaks 8 words, creates 2-word sentences
D
Which physical assessment finding is of concern, and should be further evaluated? A. An open anterior fontanelle on a seven month old, b. a closed posterior fontanelle on a five month old, C. a two month old with head leg d. a 2 cm supra, clavicular lymph node.
D
Which is the nurse's best response to the mother of a 2-month old who is going to get IPV immunization when the mother tells the nurse the older brother is immunocompromised. A. "Your baby should not be immunized because your immunocompromised son could develop polio." B. "Your baby should receive the oral poliovirus vaccine instead so your immunocompromised son does not get sick." C. "You should separate your 2-month old child from the immunocompromised son for 7 days after the IPV injection." D. "Your baby can be immunized with the IPV, the inactivated polio in the vaccine will not be contagious."
D.
During the developmental assessment, the nurse is concerned because the 12-month-old is not yet: A. Walking independently B. Turning the pages of a book one at a time C. Speaking in two-word sentences D. Using a pincer grasp
D. 9 month old red flag
11. Which of the following is an example of demonstrating Erikson's concept of identity? A. A father encouraging his preschooler to try new activities like the basketball team B. A child working hard over time to master a complex sewing project C. A mother allowing time for the toddler to pick out which shirt to wear D. A teen asking the school counselor about where to go to college
D. adolescents developing sense of self
All are modifiable risk factors to decrease the likelihood of sudden infant death syndrome (SIDS) except? A. Prone sleeping B. Soft bedding, bumpers, pillows, & blankets C. Co-sleeping D. Infant put to sleep in car seat, swing, sling E. Prematurity
E
Which of the following communicable diseases has a characteristic finding of splenomegaly? A. Parvovirus B. Mumps C. Influenza D. Poliomyelitis E. Mononucleosis
E. no contact sports for at least a month!
True or False: The mRNA vaccines to prevent coronavirus (COVID-19) have a risk of altering the DNA in developing children. True False
False
Which of the following assessment findings are EXPECTED in a toddler boy? stranger anxiety palpable chest thrill unlabored respirations accompanied by intercostal retractions bilaterally descended testes refusal to take oral medication capillary refill of 4 seconds in toes
Stranger anxiety bilaterally descended testes Refusal to take oral medication
After numerous research trials in several countries, there is NO clinical evidence suggesting a link between Autism Spectrum Disorder (ASD) and vaccine administration. True False
True
A mother is worried about her three children developing an inherited medical condition because many members of her family have died from this disease. To start an assessment of this family, which tool should the nurse choose? a. Ecomap b. Genogram c. Problem list d. Quantitative tool
b.
