EXAM 2
The nurse is caring for a 4-year-old body who has undergone an appendectomy. The child is unwilling to use the incentive spirometer. Which approach would be most appropriate to elicit the child's cooperation? A. "Can you blow this cotton ball across the tray?" B. "Can you cough for me please?" C. "You must blow in this or you might get pneumonia." D. "If you don't try, I will have to get the doctor."
"Can you blow this cotton ball across the tray?"
The nurse is performing a gastrointestinal assessment on a 7-year-old boy. The parents are assisting with the history. Which assessment findings are indicative of constipation? A. "Our child reports he is in pain because his bowel movements are so hard." B. "Our child tells us that his belly hurts a lot of the time." C. "I can tell he holds his bowel movements much of the time because of the way he stands." D. "Our child has only 3 to 4 bowel movements per week." E. "I find smears of stool in his underwear almost every day."
"Our child reports he is in pain because his bowel movements are so hard." "Our child tells us that his belly hurts a lot of the time." "I can tell he holds his bowel movements much of the time because of the way he stands." "I find smears of stool in his underwear almost every day."
After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states: A. "An infant's skin is thinner than adult's, so substances placed on the skin are absorbed more readily." B. "The infant's epidermis is loosely connected to the dermis, increasing the risk for breakdown." C. "An infant has less subcutaneous fat, which places the infant at a higher risk for heat loss." D. "The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented."
"The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented."
The school nurse is working with a 10-year-old girl with recurrent abdominal pain. The girl's teacher has been less than understanding about frequent absences and trips to the nurse's office. How should the nurse respond? A. "Be patient; she is trying some new medication." B. "The family is working toward improvement." C. "Please do not add to this family's stress." D. "The pain she is having is real."
"The pain she is having is real."
The nurse is assessing the tympanic temperature of several children. The nurse documents that the child with which temperature has a fever? A. 100.8 degree F (38.2 degrees C) B. 98.2 degrees F (36.8 degrees C) C. 100 degree F (37.8 degrees C) D. 99.2 degrees F (37.3 degrees C)
100.8 degree F (38.2 degrees C)
The nurse is caring for an infant with candidal diaper rash. Which topical agent would the nurse expect the physician to order? A. Antifungals B. Retinoids C. Corticosteroids D. Antibiotics
A. Antifungals
A group of students are working on a presentation for a local health fair about safety for children. When developing this presentation, the students would address what cause as the most common in pediatric injury? A. Falls B. Automobile accidents C. Firearm use D. Sports
A. Falls
A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, how would the nurse document this murmur? A. Loud without a thrill B. Soft and easily heard C. Loud, audible with a stethoscope D. Loud with a precordial thrill
A. Loud without a thrill
A group of nursing students are reviewing the six links in the chain of infection and the nursing implications for each. The students demonstrate understanding of the information when they identify which precaution as helping to break the chain of infection to the susceptible host? A. Maintaining skin integrity B. Coughing into a handerchief C. Keeping linens dry and clean D. Washing hands frequently
A. Maintaining skin integrity
The parents of a child diagnosed with celiac disease ask the nurse what types of food they can offer their child. What recommendation would the nurse include in the teaching plan? A. Fruit juice B. Frozen yogurt C. Creamed spinach D. Rye bread
A. Fruit juice
A child with a suspected cardiovascular disorder is to undergo diagnostic testing and is scheduled for an echo cardiogram. When explaining this test to the child, what would the nurse most likely include? A. "A special wand that picks up sound is used to check your heart." B. "Small patches are attached to your chest to check the heart rhythm." C. "This test will check the pattern of how your heart is beating." D. "They'll take a picture of your chest to look at the heart's size."
A. "A special wand that picks up sound is used to check your heart."
The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching? A. "I need to feed him every hour to make sure he eats enough." B. "Small, frequent feedings are best if tolerated." C. "Gavage feedings may be required for now." D. "The baby may need as much as 150 calories/kg/day
A. "I need to feed him every hour to make sure he eats enough."
The parents of a 7-month-old child with an infection ask the nurse about how to treat their child's fever. After providing teaching, the parents voice understanding with which statements? Select all that apply. A. "If my child's fever is under 102 degrees F, I don't need to make an appointment with the physician." B. "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." C. "Any fever is dangerous and can cause serious damage to brain cells if it goes on too long." D. "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection." E. "Having a temperature over 38 degrees C puts my child at risk for the infection spreading into the bloodstream."
A. "If my child's fever is under 102 degrees F, I don't need to make an appointment with the physician." B. "Even though people get frightened, fevers are not a bad thing during an infection unless it gets too high." D. "I can use acetaminophen to help with the symptoms of the infection but it won't get rid of the infection."
The nurse is caring for a newborn diagnosed with an atrial septal defect (ASD). The parents voice concern and state, "I can't believe this is happening. Will our child be okay?" What is the nurse's best response? A. "While each case is different, the majority of these defects correct on their own. Let's see what the tests show, then speak with the doctor." B. "Since there are no symptoms being exhibited right now, your child will likely not require surgery until the age of 3 years." C. "Most children have no symptoms of this defect." D. "If the defect isn't treated it can cause problems such as pulmonary hypertension, heart failure, atrial arrhythmias, or stroke."
A. "While each case is different, the majority of these defects correct on their own. Let's see what the tests show, then speak with the doctor."
A 7-year-old child with a family history of cardiovascular disease is being screened for hyperlipidemia. When reviewing the child's laboratory test results, which total cholesterol level would be of significant concern? A. 210 mg/dL B. 150 mg/dL C. 120 mg/dL D. 180 mg/dL
A. 210 mg/dL
The nurse has developed a plan of care for a 12-month-old hospitalized with dehydration as a result of rotovirus. Which intervention would the nurse include in the plan of care? A. Maintaining the intravenous (IV) fluid rate as ordered. B. Offering Kool-Aid or Popsicles as tolerated. C. Encouraging consumption of fruit juice. D. Encouraging milk products to boost caloric intake.
A. Maintaining the intravenous (IV) fluid rate as ordered.
The nurse is performing a physical examination on a 9-year-old boy how has experienced a tick bite on his lower leg and is suspected of having Lyme disease. Which assessment finding would the nurse expect to find? A. Ring-like rash on lower leg B. Hypersalivation C. Swelling in the neck D. Confusion and anxiety
A. Ring-like rash on lower leg
When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? A. Strawberry tongue B. Hirsutism or striae C. Malar rash D. Cafe au lait spots
A. Strawberry tongue
A group of students are preparing for a class exam on skin disorders. As part of their preparation, they are reviewing information about acne vulgaris and its association with increased sebum production. The students demonstrate understanding of the information when they identify which areas as having the highest sebaceous gland activity? Select all that apply. A. Upper Chest B. Back C. Shoulder D. Face E. Neck
A. Upper Chest B. Back D. Face
A nurse is caring for a 14-year-old girl scheduled for a barium swallow/upper gastrointestinal (GI) series. Before providing instructions, what would be the priority? A. Screening the girl for pregnancy B. Reminding her to drink plenty of fluids after the procedure C. Reminding the girl about potential light-colored stools D. Ordering bowel preparation
A. Screening the girl for pregnancy
A nurse is assessing the skin of a child with cellulitis. What would the nurse expect to find? A. Warmth at skin disruption site B. Honey-colored exudate C. Papules progressing to vesicles D. Red, raised hair follicles
A. Warmth at skin disruption site
The mother of a 5-year-old child with eczema is getting a check-up for her child before school starts. What will the nurse do during the visit? A. Assess the compliance with treatment regimens B. Change the bandage on a cut on the child's hand C. Assess the child's fluid volume D. Discuss systemic corticosteroid therapy
Assess the compliance with treatment regimens
The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. What information would the nurse include? A. Applying sunscreen at least 1 hour before going outside in the sun B. Using a sunscreen with para-aminobenzoic acid (PABA) with an SPF of at least 10n C. Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. D. Using artificial ultraviolet (UV) tanning beds instead of sun exposure
Avoiding sun exposure between the hours of 10 a.m. and 2 p.m.
When examining the abdomen of a child, which technique would the nurse use last? A. Percussion B. Inspection C. Palpation D. Auscultation
C. Palpation
What would the nurse include when teaching an adolescent about tinea pedis? A. "Wear nylon or synthetic socks every day." B. "Dry the area between your toes really well." C. "Go barefoot when you are in the locker room at school." D. "Keep your feet moist and open to air as much as possible."
B. "Dry the area between your toes really well."
A nursing instructor is teaching a group of students about the action of antipyretic agents in children. The instructor determines that the teaching has been successful when the students identify which action as the primary action? A. Cause vasodilation to promote heat loss B. Decrease the temperature to a set point C. Block release of histamine D. Promote prostaglandin production
B. Decrease the temperature to a set point
After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common? A. Distributive B. Hypovolemic C. Septic D. Cardiogenic
B. Hypovolemic
A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. A. Applying topical nystatin to the diaper area B. Refraining from using rubber pants over diapers C. Using a blow dryer on warm to dry the diaper area D. Using scented diaper wipes to clean the area E. Washing the diaper area with an antibacterial soap
B. Refraining from using rubber pants over diapers C. Using a blow dryer on warm to dry the diaper area
Which finding would lead the nurse to suspect that a child is experiencing moderate dehydration? A. Tenting of skin B. Sunken fontanels C. Dusky extremities D. Hypotension
B. Sunken fontanels
The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A. Immediately administer another dose. B. Administer next dose as ordered in 12 hours. C. Contact the physician. D. Offer a snack and administer another dose.
B. Administer next dose as ordered in 12 hours.
A nurse suspects that an adolescent may have community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA). What would the expect to assess? Select all that apply. A. History of a recurrent sore throat B. Erythematous rash over the trunk and face C. Participation in contact sport D. Raised fluctuant lesions E. Recent cut on the lower leg
C. Participation in contact sport D. Raised fluctuant lesions E. Recent cut on the lower leg
A nurse is providing care to a newborn. The nurse suspects that the newborn is developing sepsis based on which assessment finding? A. Increased urinary output B. Interest in feeding C. Temperature instability D. Wakefulness
C. Temperature instability
The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction? A. "I must make sure I use lukewarm water instead of hot water." B. "We should leave his skin moist before applying medication or moisturizer." C. "After bathing, I need to rub his skin everywhere to make sure he is completely dry." D. "Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment."
C. "After bathing, I need to rub his skin everywhere to make sure he is completely dry."
The nurse is determining maintenance fluid requirements for a child who weighs 25kg. How much fluid would the child need per day? A. 1,560mL B. 1,700mL C. 1,600mL D. 1,650mL
C. 1,600mL
The nurse is preparing a teaching plan for the parents of a child who has been diagnosed with a congenital heart defect. What would the nurse be least likely to include? A. Prevention of infection. B. Signs of complications. C. Maintenance of strict bed rest. D. Daily weight assessment.
C. Maintenance of strict bed rest.
A newborn has been diagnosed with Group B streptococci infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which cause? A. Nonsterile catheter insertion B. Improper handwashing C. Mother's birth canal D. Contaminated formula
C. Mother's birth canal
The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after the surgery and wonders if it is possible. How should the nurse respond? A. "We will have to wait and see what happens after the surgery." B. "There is a good chance that you will be able to breastfeed almost immediately." C. "Breastfeeding is likely to be possible, but check with the surgeon." D. "After the suture line heals, breastfeeding can resume."
C. "Breastfeeding is likely to be possible, but check with the surgeon."
A teenage girl with psoriasis tells the nurse that she is so embarrassed by the plaque on her skin that she doesn't want to go to school. What is the best response by the nurse? A. "Sunlight really helps the plaque areas heal. Maybe going to a tanning bed routinely will help." B. "Have you been applying your medication and emollients to your skin as directed by your physician?" C. "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis." D. "You can't miss school because of your skin. Can you wear clothes that will cover the areas?"
C. "It must be really difficult for you. Tell me how you are taking care of your skin on a daily basis."
The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation? A. "I don't notice any rapid breathing patterns." B. "The baby usually drinks all of her bottle." C. "The baby seems more comfortable over my shoulder." D. "My baby does not make any grunting noises."
C. "The baby seems more comfortable over my shoulder."
The nurse determines that it is necessary to implement airborne precautions for children with which infection? A. Scarlet fever B. Streptococcus group A C. Measles D. Rubella
C. Measles
The client has a heavily draining wound for which there is an order to change the dressing every 4 hours. The nurse becomes busy and does not change the dressing as ordered. Which chain of infection has the nurse allowed to flourish? A. Susceptible host B. Mode of transmission C. Reservoir D. Portal of exit
C. Reservoir
A group of nursing students are reviewing information about childhood infectious diseases. The students demonstrate understanding of this information when they identify which disease as a common childhood exanthema? A. Rabies B. West Nile virus C. Rubella D. Mumps
C. Rubella
The nurse is preparing to obtain a blood specimen via capillary heel puncture. Which action would be most appropriate for the nurse to do? A. Elevate extremity used after puncturing it. B. Squeeze the area to facilitate specimen collection. C. Wipe away the first drop of blood with dry gauze. D. Apply a cool compress for several minutes before collection.
C. Wipe away the first drop of blood with dry gauze.
A child with heart failure is receiving supplemental oxygen. The nurse understands that in addition to improving oxygen saturation, this intervention also has what effect? A. Promote diuresis B. Increase pulmonary vascular resistance C. Mobilize secretions D. Cause vasodilation
D. Cause vasodilation
A nurse is caring for a 5-year-old who is ill and bed bound. When conducting a skin examination for signs of pressure ulcers, the nurse pays attention to which area? A. Sacral area B. Upper arm C. Hip area D. Occipit
D. Occipit
A nurse is working with an adolescent who is slightly overweight and was recently diagnosed with hypertension. They are discussing nutritional management. Which statement by the adolescent demonstrates understanding of the information? A. "If I skip breakfast, I can eat a much bigger lunch." B. "I can eat any amount at a meal as long as I don't eat between meals." C. "I have to make sure that I don't eat a lot of salty foods" D. "I should eat plenty of fresh fruits and vegtables."
D. "I should eat plenty of fresh fruits and vegtables."
A nurse is providing care and post-operative education following surgery for correction of tracheoesophageal fistula. Which statement by the parents would be indicative of effective education? A. "TPN will never be necessary." B. "My baby will be able to eat right after surgery." C. "The use of antibiotics is unlikely." D. "Oral feedings usually begin within 1 week of surgery."
D. "Oral feedings usually begin within 1 week of surgery."
While reviewing various studies about the use of antipyretics possibly prolonging illness, the nurse notes that there are benefits to their use for the child with fever. What would the nurse identify as the best explanation related to the benefit of antipyretics? A. They slow the growth of bacteria. B. They encourage T-cell proliferation. C. They increase neutrophil production. D. They help decrease fluid requirements.
D. They help decrease fluid requirements.
The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis? A. Coughing B. Hypothermia C. Rash on face D. Edematous neck
Hypothermia
A group of students are reviewing information about fluid balance and losses in children in comparison to adults. The students demonstrate a need for additional review when they state that: A. Fever plays a greater role in insensible fluid losses in infants and children. B. The infant's immature kidneys have a tendency to over concentrate urine. C. A higher metabolic rate plays a major role in increased insensible fluid losses. D. Children have proportionately greater amount of body water than do adults.
The infant's immature kidneys have a tendency to over concentrate urine.