NCELX Questions Pediatric Nursing
When developing a plan of care for a hospitalized child, nurse Mary knows that children in which age group is most likely to view illness as a punishment for misdeeds? A. Infancy B. Preschool age C. School age D. Adolescence
Correct Answer: B. Preschool age Preschool-age children are most likely to view illness as a punishment for misdeeds. When children in this age group become seriously ill, they may think it's punishment for something they did or thought about. They don't understand how their parents could not have protected them from this illness. Option A: Separation anxiety, although seen in all age groups, is most common in older infants. Keeping a consistent routine is important for a baby and their caregivers. Because babies can't talk about their needs, fear is often expressed by crying. Option C: Fear of the unknown, loss of control, and separation from family and friends can be the school-aged child's main sources of anxiety and fear related to death. They may fear their own death because of the uncertainty of what happens to them after they die. Option D: Fear of death is typical of adolescents. Adolescents also fear mutilation. Most teens are starting to establish their identity, independence, and relation to peers. The main theme in teens is feeling immortal or being exempt from death. Their realization of their own death threatens all of these objectives.
The nurse is aware that the most common assessment finding in a child with ulcerative colitis is: A. Intense abdominal cramps B. Profuse diarrhea C. Anal fissures D. Abdominal distention
Correct Answer: B. Profuse diarrhea The most common assessment finding in a child with ulcerative colitis is profuse diarrhea. The main symptom of ulcerative colitis is bloody diarrhea, with or without mucus. Other symptoms include blood in the toilet, on toilet paper, or in the stool. Characteristically, it involves inflammation restricted to the mucosa and submucosa of the colon. Typically, the disease starts in the rectum and extends proximally in a continuous manner. Option A: Ulcerative colitis causes intense abdominal cramps. Associated symptoms also include urgency or tenesmus, abdominal pain, malaise, weight loss, and fever, depending on the extent and severity of the disease. The onset of the disease is typically gradual, and patients will likely experience periods of spontaneous remission and subsequent relapses. Option C: Ulcerative colitis causes anal fissures. There are some extraintestinal manifestations (EIMs) that are also present in 10% to 30% of patients with ulcerative colitis. Extraintestinal manifestations associated with disease activity include episcleritis, scleritis, and uveitis, peripheral arthropathies, erythema nodosum, and pyoderma gangrenosum. Option D: Abdominal distensions are more common in Crohn's disease. Patients with flare-ups of Crohn's disease typically present with abdominal pain (right lower quadrant), flatulence/bloating, diarrhea (can include mucus and blood), fever, weight loss, anemia. In severe cases, perianal abscess, perianal Crohn's disease, and cutaneous fistulas can be seen.
Which of the following would Nurse Tony suppose to regard as a cardinal manifestation or symptom of digoxin toxicity to his patient Clay diagnosed with heart failure? A. Headache B. Respiratory distress C. Extreme bradycardia D. Constipation
Correct Answer: C. Extreme bradycardia Extreme bradycardia is a cardinal sign of digoxin toxicity. Increased intracellular calcium from the poisoning of the Na-K transporter and AV nodal blockade from increased vagal tone are the primary causes of digoxin toxicity. The former leads to increased automaticity and inotropy; the latter leads to decreased dromotropy.
A child with Kawasaki disease is admitted to the pediatric ward. Which of the following medications will you expect to be a part of the treatment? Select all that apply. A. Gamma Globulin B. Warfarin. C. Acetaminophen D. Aspirin E. Atenolol
Correct Answer: A, B, & D The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms such as fever and joint pain so an antipyretic, antiplatelet, and gamma globulin is used. Treatment aims with Kawasaki disease point to minimize the risk of coronary artery aneurysm (CAA) formation, which peaks two to four weeks after illness onset, by decreasing the inflammation of the coronary arteries. Supportive care is also essential.
Scott is a teenager suffering from osteomyelitis; the nurse would expect which of the following symptoms? Select all that apply. A. Fever B. Irritability C. Pallor D. Tenderness E. Swelling
Correct Answer: A, B, D, & E The symptoms for acute and chronic osteomyelitis are very similar and include fever, irritability, fatigue, nausea, tenderness, redness (not pallor in option C), and warmth in the area of the infection, swelling around the affected bone, and lost range of motion.
Which of the following should be included when developing a teaching plan to prevent urinary tract infection? Select all that apply. A. Maintaining adequate fluid intake B. Avoiding urination before and after intercourse C. Emptying bladder with urination D. Wearing underwear made of synthetic material such as nylon E. Keeping urine alkaline by avoiding acidic beverages F. Avoiding bubble baths and tight clothing
Correct Answer: A, C, & F Even with proper antibiotic treatment, most UTI symptoms can last several days. In women with recurrent UTIs, the quality of life is poor. About 25% of women experience such recurrences. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief.
When a child injures the epiphyseal plate from a fracture, the damage may result in which of the following? A. Rheumatoid arthritis B. Permanent nerve damage C. Osteomyelitis D. Bone growth disruption
Correct Answer: D. Bone growth disruption The epiphyseal plate is a significant region of bone growth. Hence, any disruption may result in limb shortening. Sometimes, changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or a bit longer or shorter than expected.
A child with thalassemia was given deferoxamine (Desferal); which of the following should alert the nurse to notify the physician? A. Decreased hearing B. Hypertension C. Red urine D. Vomiting
Deferoxamine is ototoxic. Thus, any hearing problem should be immediately addressed to the physician. Chronic deferoxamine therapy can lead to sensorineural hearing loss and retinopathy. Hearing and vision loss can be reversible if the patient discontinues DFO early in the course. A screening hearing exam should be performed in the clinic every six months and a formal audiogram every 12 months.
Nurse Kathy is assessing infantile reflexes in a 9-month-old baby; which of the following would she identify as normal? A. Persistent rooting B. Bilateral parachute C. Absent moro reflex D. Unilateral grasp
The parachute reflex appears to be normal at about 9 months of age. Persistence of primitive reflexes past 4 to 6 months or absence before this time when they should have been present is predictive of cerebral palsy. The presence of 5 or more abnormal reflexes correlated with the development of cerebral palsy or mental delays.
A nurse provides medication instructions to a first-time mother. Which statement made by the mother indicates a need for further instructions? A. "I should mix the medication in the baby food and give it when I feed the child". B. "I should administer the oral medication sitting in an upright position and with the head elevated". C. "I will give my child a toy after giving the medication". D. "I will offer my child a juice drink after swallowing the medication".
Correct Answer: A. "I should mix the medication in the baby food and give it when I feed the child". The nurse would teach the mother to avoid putting medications in foods because it may cause an unpleasant taste to the food, and the child may refuse to accept the same food in the future. Additionally, the child may not consume the entire serving and would not require medication dosage.
In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following? A. Anterior pituitary gland hypofunction B. Posterior pituitary gland hyperfunction C. Parathyroid gland hyperfunction D. Thyroid gland hyperfunction
Correct Answer: A. Anterior pituitary gland hypofunction Short stature usually results from diminished or deficient growth hormone, which is released from the anterior pituitary gland. Growth hormone production from the anterior pituitary is regulated by the stimulatory and inhibitory control of the hypothalamus. Hypothalamus produces growth hormone-releasing hormone that stimulates the somatotrophs of the anterior pituitary to secrete growth hormone.
Nurse Elena is handling a 7-year-old child who has cystitis. Which of the following would Nurse Elena expect when assessing the child? A. Dysuria B. Costovertebral tenderness C. Flank pain D. High fever
Correct Answer: A. Dysuria Dysuria is a symptom of a lower urinary tract infection (UTI) such as cystitis. Common symptoms include frequency, dysuria, urgency, suprapubic pain, cloudy urine, hematuria, nausea, vomiting, and fever. A history is the most important tool for the diagnosis of acute uncomplicated cystitis, and it should be supported by a focused examination and urinalysis.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
Correct Answer: A. Pulmonary secretions are abnormally thick. CF is identified by abnormally thick pulmonary secretions. Researchers now know that cystic fibrosis is an autosomal recessive disorder of exocrine gland function most commonly affecting persons of Northern European descent at a rate of 1 in 3500. It is a chronic disease that frequently leads to chronic sinopulmonary infections and pancreatic insufficiency. The most common cause of death is end-stage lung disease.
Alice is rushed to the emergency department during an acute, severe prolonged asthma attack and is unresponsive to usual treatment. The condition is referred to as which of the following? A. Status asthmaticus B. Reactive airway disease C. Intrinsic asthma D. Extrinsic asthma
Correct Answer: A. Status asthmaticus Status asthmaticus is an acute, prolonged, severe asthma attack that is unresponsive to usual treatment. Typically, the child requires hospitalization. One of the most common causes of emergency room visits in the United States is status asthmaticus, an acute, emergent episode of bronchial asthma that is poorly responsive to standard therapeutic measures.
Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares to the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following? A. The child should be allowed to play because doing so can foster healthy self-esteem. B. The risk for fractures is increased because a GH deficiency results in fragile bones. C. Activity could aggravate insulin sensitivity, causing hyperglycemia. D. Activity would aggravate the child's joints, already over tasked by obesity.
Correct Answer: A. The child should be allowed to play because doing so can foster healthy self-esteem. Engaging in peer-group activities can aid foster a sense of belonging and a positive self-concept. T-ball is a good sport to choose because physical stature is not an important consideration in the ability to participate, unlike some other sports, such as basketball and football. Physical examination may not reveal any significant findings as the presentation is usually subtle.
In pediatric gastroesophageal reflux disease (GERD), the immaturity of lower esophageal sphincter function is manifested by frequent transient lower esophageal relaxations, which result in retrograde flow of gastric contents into the esophagus. Which statement about the esophagus is true? Select all that apply. A. It is a cartilaginous tube. B. It has upper and lower sphincters. C. It lies anterior to the trachea. D. It extends from the nasal cavity to the stomach. E. It is a highway for food and drinks to travel along to make it to the stomach. F. All statements describe the esophagus.
Correct Answer: B & E Upper and lower esophageal sphincters, located at the upper and lower ends of the esophagus, respectively, regulate the movement of food into and out of the esophagus. If the mouth is the gateway to the body, then the esophagus is a highway for food and drink to travel along to make it to the stomach.
Mrs. Cooper is concerned about her 4-month-old son's unusual condition; which of the following statements made by her would indicate that the child may have cerebral palsy? A. "He holds his left leg so stiff that I have a hard time putting on his diapers." B. "My baby won't lift his head up and look at me; he's so floppy." C. "My baby's left hip tilts when I pull him to standing position." D. "I'm very worried because my baby has not rolled all the way over yet."
Correct Answer: B. "My baby won't lift his head up and look at me; he's so floppy." Hypotonia or floppy infant is an early manifestation of cerebral palsy. Typically, the infant lifts his head to a 90-degree angle by age 4 months with only a partial head lag by age 2 months. Clinical signs and symptoms of cerebral palsy can include micro- or macrocephaly, excessive irritability or diminished interaction, hyper- or hypotonia, spasticity, dystonia, muscle weakness, the persistence of primitive reflexes, abnormal or absent postural reflexes, incoordination, and hyperreflexia.
Mr. and Mrs. Robertson's son was diagnosed with idiopathic thrombocytopenic purpura. They should be aware that the drug to be avoided is: A. Acetaminophen B. Aspirin C. Codeine D. Morphine
Correct Answer: B. Aspirin Aspirin exerts an antiplatelet action and therefore may increase platelet destruction in ITP. Aspirin inhibits platelet function by acetylating platelet cyclooxygenase, increasing the risk of bleeding because it adds a prolonged platelet functional defect to the quantitative defect already present from the severe thrombocytopenia.
Baby Melody is a neonate who has a very-low-birth-weight. Nurse Josie carefully monitors inspiratory pressure and oxygen (O2) concentration to prevent which of the following? A. Meconium aspiration syndrome B. Bronchopulmonary dysplasia (BPD) C. Respiratory syncytial virus (RSV) D. Respiratory distress syndrome (RDS)
Correct Answer: B. Bronchopulmonary dysplasia (BPD) Close monitoring of inspiratory pressure and O2 concentration is necessary to prevent BPD, which is related to the use of high inspiratory pressures and O2 concentrations especially in very-low-birth-weight and extremely low-birth-weight neonates with lung disorders. Injury from mechanical ventilation and reactive oxygen species to premature lungs in the presence of antenatal factors predisposing the lungs to BPD form the basis of pathogenesis of BPD in preterm neonates.
The 6-year-old son of Mr. and Mrs. Peters is admitted to the healthcare facility with the diagnosis of idiopathic hypopituitarism. His height is measured below the third percentile and weight at the 40th percentile. Which of the following would be the firstaction of his attending nurse? A. Recommend orthodontic referral for underdeveloped jaw. B. Collaborate with a dietician to access his caloric needs. C. Provide for a tutor for his precocious intellectual ability. D. Place him in a room with a 2-year-old boy.
Correct Answer: B. Collaborate with a dietician to access his caloric needs. Because the child's weight is excessive for his height, he needs a dietary assessment and a weight-loss program. Weight gain typically is out of proportion to growth, resulting in relative obesity. This obesity is truncal in distribution; skull and head circumference growth are typically preserved, producing the impression of a large head.
Nurse Jeremy is evaluating a client's fluid intake and output record. Fluid intake and urine output should relate in which way? A. Fluid intake should double the urine output. B. Fluid intake should be approximately equal to the urine output. C. Fluid intake should be half the urine output. D. Fluid intake should be inversely proportional to the urine output.
Correct Answer: B. Fluid intake should be approximately equal to the urine output. Normally, fluid intake is approximately equal to the urine output. Any other relationship signals an abnormality. One general principle for all patient scenarios is to replace whatever fluid is being lost as accurately as possible. The strategy of managing a patient's fluid differs depending on each patient's clinical condition. If they can drink adequate fluid volumes by mouth, this should be the first choice. Some patients can tolerate other enteral options, such as feeding tubes. IV plus oral orders are effective for those unable to meet their total daily fluid requirements enterally.
An infant with a patent ductus arteriosus is admitted to the pediatric unit ward. The nurse anticipates which of the following medications will be given to the infant? A. Prednisone B. Ibuprofen C. Penicillin D. Albuterol
Correct Answer: B. Ibuprofen When surgical ligation is not indicated, prostaglandin inhibitors (e.g. nonsteroidal anti-inflammatory drugs [NSAIDs]) are used to close the ductus arteriosus. In April 2006, the US Food and Drug Administration approved the use of ibuprofen lysine (NeoProfen) for the closure of clinically significant PDA in premature neonates. Ibuprofen's mechanism of action for closure of PDA is believed to be through the inhibition of prostaglandins.
When educating parents regarding known antecedent infections in acute glomerulonephritis, which of the following should the nurse cover? A. Scabies B. Impetigo C. Herpes simplex D. Varicella
Correct Answer: B. Impetigo Impetigo, a bacterial infection of the skin, may be caused by streptococci and may precede acute glomerulonephritis. Although most streptococcal infections do not cause acute glomerulonephritis, when they do, a latent period of 10 to 14 days occurs between the infection, usually of the skin (impetigo) or upper respiratory tract, and the onset of clinical manifestations.
A child diagnosed with intellectual disability (ID) is under the supervision of Nurse Tasha. The nurse is aware that the signs and symptoms of mild ID include which of the following? A. Few communication skills B. Lateness in walking C. Mental age of a toddler D. Noticeable developmental delays
Correct Answer: B. Lateness in walking Mild intellectual disability is minimally noticeable in young children, with one of the signs being a delay in achieving developmental milestones, such as walking at a later stage. Individuals with an intellectual disability have neurodevelopmental deficits characterized by limitations in intellectual functioning and adaptive behavior. These disabilities originate and manifest before the age of 18 and can be associated with a considerable number of related and co-occurring problems.
Dustin who was diagnosed with Hirschsprung's disease has a fever and watery explosive diarrhea. Which of the following would Nurse Joyce do first? A. Administer an antidiarrheal. B. Notify the physician immediately. C. Monitor the child every 30 minutes. D. Nothing. (These findings are common in Hirschsprung's disease.)
Correct Answer: B. Notify the physician immediately. For the child with Hirschsprung's disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified directly. Further important pointers in the history of patients with suspected HD include clinical features of Hirschsprung's associated enterocolitis (HAEC), multiple episodes of overflow constipation, and soft distended abdomen.
Molly, with suspected rheumatic fever, is admitted to the pediatric unit. When obtaining the child's history, the nurse considers which information to be most important? A. A fever that started 3 days ago B. Lack of interest in food C. A recent episode of pharyngitis D. Vomiting for 2 days
Correct Answer: C. A recent episode of pharyngitis A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Activation of the innate immune system begins with a pharyngeal infection that leads to the presentation of S. pyogenes antigens to T and B cells. CD4+ T cells are activated and production of specific IgG and IgM antibodies by B cells ensues (Cunningham, Pathogenesis of group A streptococcal infections, 2000). Option A: The most common presenting features of ARF are fever (>90% of patients) and arthritis (75% of patients). The most serious manifestation is carditis (>50% of patients) because it can lead to chronic rheumatic heart disease—while all other clinical features fully resolve, often within weeks. Option B: The child with ARF may exhibit a lack of interest in food, but this cannot be specific only to ARF. The main clinical manifestation of ARF carditis reflects the involvement of the endocardium, which presents as valvulitis of the mitral valve (mitral regurgitation) and, less frequently, of the aortic valve (aortic regurgitation). Option D: Although the child may have a history of vomiting, this finding is not specific to rheumatic fever. A number of other clinical features are often observed in patients with ARF but are not included as manifestations in the Jones Criteria, including lethargy, abdominal pain, and epistaxis, as well as rapid sleeping pulse rate and tachycardia out of proportion to fever.
Which of the following is the most common permanent disability in childhood? A. Scoliosis B. Muscular dystrophy C. Cerebral palsy D. Developmental dysplasia of the hip (DDH)
Correct Answer: C. Cerebral palsy Cerebral palsy is the most common permanent disability of childhood. It is a group of disabilities caused by injury or insult to the brain either before or during birth, or in early infancy. A cerebral palsy is a group of permanent disorders affecting the development of movement and causing a limitation of activity. Non-progressive disturbances that manifest in the developing fetal or infant brain lead to cerebral palsy.
After explaining to the parents about their child's unique psychological needs related to a seizure disorder and possible stressors, which of the following interests uttered by them would indicate further teaching? A. Feeling different from peers B. Poor self-image C. Cognitive delays D. Dependency
Correct Answer: C. Cognitive delays Children with seizure disorders do not necessarily have cognitive delays. Epilepsy is one of the most serious neurological conditions and has an impact not only on the affected individual but also on the family and, indirectly, on the community. A global approach to the individual must take into account cognitive problems, psychiatric comorbidities and all psychosocial complications that often accompany epilepsy.
The American Association on Mental Deficiency (AAMD), now American Association on Intellectual and Developmental Disabilities (AAIDD) definition of mental retardation emphasizes which of the following? A. An IQ level that must be below 50 B. Cognitive impairment occurring after age 22 years C. Deficits in adaptive behavior with intellectual impairment D. No responsiveness to contact
Correct Answer: C. Deficits in adaptive behavior with intellectual impairment. Mental retardation is part of a broad category of developmental disability and is defined by the American Association of Mental Deficiency as "significantly subaverage, general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period (18 years of age)."
Mr. and Mrs. Andrews' child was diagnosed with Duchenne's muscular dystrophy; which of the following usually is the first indication of the condition? A. Inability to suck in the newborn B. Lateness in walking in the toddler C. Difficulty running in the preschooler D. Decreasing coordination in the school-age child
Correct Answer: C. Difficulty running in the preschooler Usually, signs and symptoms of Duchenne's muscular dystrophy are not noticed until ages 3 to 5 years. Typically weakness starts with the pelvic girdle, evidenced as difficulty running in the preschooler. Duchenne's muscular dystrophy usually is not diagnosed in the infant or toddler period.
Which of the following organisms is the most common cause of urinary tract infection (UTI) in children? A. Klebsiella B. Staphylococcus C. Escherichia coli D. Pseudomonas
Correct Answer: C. Escherichia coli E. coli is the most common organism associated with the development of UTI. Escherichia coli is the most common organism in uncomplicated UTI by a large margin. Pathogenic bacteria ascend from the perineum, causing the UTI. Women have shorter urethras than men and therefore are far more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria.
While Lawrence is being assessed at the clinic, Nurse Rachel observed that the child appears to be small, with an immature face and chubby body build. Her parents stated that their child's rate of growth of all body parts is somewhat slow, but her proportions and intelligence remain normal. As a knowledgeable nurse, you know that the child has a deficiency of which of the following? A. Antidiuretic hormone (ADH) B. Parathyroid hormone (PTH) C. Growth hormone (GH) D. Melanocyte-stimulating hormone (MSH)
Correct Answer: C. Growth hormone (GH) GH stimulates protein anabolism, promoting bone and soft-tissue growth. A lack of GH would lead to decreased synthesis of somatomedin, resulting in decreased linear growth and decreased fat metabolism, and increased glucose uptake in muscles, resulting in excessive subcutaneous fat hypoglycemia.
Mr. and Ms. Byers' child failed to pass meconium within the first 24 hours after birth; this may indicate which of the following? A. Celiac disease B. Intussusception C. Hirschsprung's disease D. Abdominal-wall defect
Correct Answer: C. Hirschsprung's disease Failure to pass meconium within the first 24 hours after birth may be a sign of Hirschsprung's disease, a congenital anomaly resulting in mechanical obstruction due to weak motility in an intestinal segment. History of the colonic obstruction, which might occur during the early neonatal period till adulthood, along with failure to pass meconium during the first 48 hours of the life, which presents in up to 90% of the affected patients, is highly compatible with the impression of HD.
Olivia is an adolescent who has seizure disorder; which of the following would not be a focus of a teaching program? A. Ability to obtain a driver's license B. Drug and alcohol abuse C. Increased risk of infections D. Peer pressure
Correct Answer: C. Increased risk of infections Adolescents with seizure disorders are at no greater risk for infections than other adolescents. Adolescence is the period during which the child's identity as an individual in his/her own right should be consolidated. Achieving independence from parents, establishing healthy interpersonal relationships outside the family and choosing a vocation are essential developmental tasks of adolescence.
When creating a teaching program for the parents of Jessica who is diagnosed with pulmonic stenosis (PS), Nurse Alex would keep in mind that this disorder involves which of the following? A. A single vessel arising from both ventricles B. Obstruction of blood flow from the left ventricle C. Obstruction of blood flow from the right ventricle D. Return of blood to the heart without entry to the left atrium
Correct Answer: C. Obstruction of blood flow from the right ventricle. PS refers to an obstruction of blood flow from the right ventricle. Pulmonic stenosis is a defect of the pulmonic valve in which the valve is stiffened, causing an obstruction to flow. This disease is typically congenital, benign, and diagnosed in pediatric patients with potentially curative treatments.
Which of the following tests is most effective in diagnosing hemophilia? A. Bleeding time B. Complete blood count (CBC) C. Partial thromboplastin time (PTT) D. Platelet count
Correct Answer: C. Partial thromboplastin time (PTT) PTT is abnormal in hemophilia. Therefore, this test will be the most helpful in diagnosing the disorder. In both hemophilia A and B, PTT will be prolonged (intrinsic pathway disruption), whereas PT and BT will be normal. The PTT could be as prolonged as 2 to 3 times the high normal range. Once PTT is found to be prolonged, it should be followed by a mixing study.
A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child's vision, the nurse should ask: A. "Do you have any problems seeing different colors?" B. "Do you have trouble seeing at night?" C. "Do you have problems with glare?" D. "How are you doing in school?"
Correct Answer: D. "How are you doing in school?" A child's poor progress in school may indicate a visual disturbance. Most children do not have 20/20 vision until after six years of age, but at any age, visual acuity should be approximately equal between the eyes. The Multi-Ethnic Pediatric Eye Disease Study provided updated norms for visual acuity in children two and a half to six years of age.
A 5-year-old girl Hannah is recently diagnosed with Kawasaki disease. Apart from the identified symptoms of the disease, she may also likely develop which of the following? A. Sepsis B. Meningitis C. Mitral valve disease D. Aneurysm formation
Correct Answer: D. Aneurysm formation Kawasaki disease is a rare childhood illness that affects the blood vessels. 20% to 25% of children can develop aneurysm formation if not intervened. Treatment depends on the degree of the disease but is often immediate treatment with IV gamma globulin or aspirin. Corticosteroids can sometimes lessen impending complications. Children who experience the disease usually need lifelong follow-up appointments to keep an eye on heart health.
It is considered as the bluntly rounded portion of the heart. A. Base B. Pericardium C. Aorta D. Apex
Correct Answer: D. Apex The blunt, rounded point of the heart is the apex. The apex (the most inferior, anterior, and lateral part as the heart lies in situ) is located on the midclavicular line, in the fifth intercostal space. It is formed by the left ventricle. The general structure of the heart is quite uniform in healthy individuals. However, some variations do occur.
Which of the following instructions should Nurse Cheryl include in her teaching plan for the parents of Reggie with otitis media? A. Placing the child in the supine position to bottle-feed B. Giving prescribed amoxicillin (Amoxil) on an empty stomach C. Cleaning the inside of the ear canals with cotton swabs D. Avoiding contact with people who have upper respiratory tract infections
Correct Answer: D. Avoiding contact with people who have upper respiratory tract infections. Otitis media is commonly precipitated by an upper respiratory tract infection. Therefore, children prone to otitis should avoid people known to have an upper respiratory tract infection. Acute otitis media is the second most common pediatric diagnosis in the emergency department following upper respiratory infections. Although otitis media can occur at any age, it is most commonly seen between the ages of 6 to 24 months.
When assessing a child's cultural background, the nurse in charge should keep in mind that: A. Heritage dictates a group's shared values B. Physical characteristics mark the child as part of a particular culture C. Cultural background usually has little bearing on a family's health practices D. Behavioral patterns are passed from one generation to the next
Correct Answer: D. Behavioral patterns are passed from one generation to the next. A family's behavioral patterns and values are passed from one generation to the next. Pediatric health care providers must be aware of the demographic trends and be culturally competent to deliver the safest, highest quality care possible to children of widely differing groups.
In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the following? A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells. B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels C. A general inflammatory response due to an autoimmune reaction from hypoxia D. Local tissue damage with ischemia and necrosis due to obstructed circulation
Correct Answer: D. Local tissue damage with ischemia and necrosis due to obstructed circulation Characteristic sickle cells tend to clump, which results in weak and inadequate blood flow to the tissue, local tissue damage, and eventual ischemia and necrosis. There is increased adhesion of erythrocytes followed by the formation of heterocellular aggregates, which physically cause small vessel occlusion and resultant local hypoxia.
Steve is diagnosed with celiac disease and experiences celiac crisis secondary to upper respiratory tract infection; which of the following would Nurse Nancy expect to assess? A. Lethargy B. Weight gain C. Respiratory distress D. Watery diarrhea
Correct Answer: D. Watery diarrhea Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergics. Celiac crisis is typically characterized by severe watery diarrhea. Celiac crisis is a life-threatening syndrome in which patients with celiac disease have profuse diarrhea and severe metabolic disturbances.
Which of the following applies to the defect emerging from residual peritoneal fluid confined within the lower segment of the processus vaginalis? A. Inguinal hernia B. Incarcerated hernia C. Communicating hydrocele D. Noncommunicating hydrocele
Correct Answer: D. Noncommunicating hydrocele With a noncommunicating hydrocele, most commonly seen at birth, residual peritoneal fluid is trapped within the lower segment of the processus vaginalis (the tunica vaginalis). There is no communication with the peritoneal cavity and the fluid usually is absorbed during the first months after birth.
Nurse Emma is planning a client education program for sickle cell disease (SCD); What topic should be included in the plan of care? A. Aerobic exercise to improve oxygenation B. Fluid restraint to 1 qt (1 L)/day C. A high-iron, high-protein diet D. Proper hand washing and infection avoidance
Correct Answer: D. Proper handwashing and infection avoidance Prevention of infection is vital in the prevention of sickle cell crisis. Patients with SCD are especially at risk for infections with encapsulated organisms because of their functional asplenia, as well as because of functionally immunocompromised state (increased bone marrow turnover and altered complement activation).
Hannah, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective? A. Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model B. Initiating a teenage parent support group with first and second-time mothers C. Using audiovisual aids that show discussions of feelings and skills D. Providing age-appropriate reading materials
Correct Answer: D. Providing age-appropriate reading materials. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The Adolescent Family Life (AFL) demonstration projects, organized through the Office of Adolescent Pregnancy Programs (OAPP), are aimed to support young families through social support and medical care.
A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following routes will you expect the nurse to administer the vaccine? A. Intramuscularly in the vastus lateralis muscle. B. Intramuscularly in the deltoid muscle. C. Subcutaneously in the gluteal area. D. Subcutaneously in the outer aspect of the upper arm.
Correct Answer: D. Subcutaneously in the outer aspect of the upper arm. (MMR) the vaccine is administered subcutaneously in the outer aspect of the upper arm. The dosage for both MMR and MMRV is 0.5 mL. Both vaccines are administered by the subcutaneous route.
A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts? A. Always keep insulin vials refrigerated B. Increase the amount of insulin before exercise C. Ketones in the urine signify a need for less insulin D. Systematically rotate injection sites
Correct Answer: D. Systematically rotate injection sites. It is necessary to rotate injection sites because injecting in the same place much of the time can cause hard lumps or extra fat deposits to develop. Insulin delivery is by multiple daily injections (MDI) or an insulin pump to simulate endogenous insulin physiology. Multiple daily injections include basal insulin once or twice daily, and bolus insulin typically is given at meals three or more times daily and is based on carbohydrate content and current blood glucose.
Which of the following disorders leads to cyanosis from deoxygenated blood entering the systemic arterial circulation? A. Aortic stenosis (AS) B. Coarctation of aorta C. Patent ductus arteriosus (PDA) D. Tetralogy of Fallot
Correct Answer: D. Tetralogy of Fallot Tetralogy of Fallot consists of four major anomalies: ventricular septal defect, right ventricular hypertrophy, pulmonic stenosis (PS), aorta overriding the ventricular septal defect. PS impedes the flow of blood to the lungs, causing increased pressure in the right ventricle, forcing deoxygenated blood through the septal defect in the left ventricle. As a result of this decreased pulmonary flow, deoxygenated blood is shunted into the systemic circulation. The increased workload on the right ventricle causes hypertrophy. The overriding aorta receives blood from both the right and left ventricles. This is the definition of a defect with decreased pulmonary blood flow where unoxygenated blood is shunted into the systemic circulation.
A physician prescribes an IV solution of 500 ml 0.45% Saline with an incorporation of 20mEq potassium chloride for a child with dehydration. The nurse should check which of the following before administering this IV prescription? A. Blood pressure B. Height C. Weight D. Urine output
Correct Answer: D. Urine output When it comes to hypotonic dehydration, electrolyte loss exceeds water loss. The priority assessment for the nurse is to check the urinary output before the administration. Potassium chloride is contraindicated for patients with oliguria or anuria. The body becomes dehydrated when it loses more fluids than it consumes. When the body doesn't have enough fluids, it can't process potassium properly, and potassium builds up in the blood, which can lead to hyperkalemia.
