Pediatric NCLEX Questions
The mother of an infant with myelomeningocele asks if her baby is likely to have any other defects. The nurse responds based on the understanding that myelomeningocele is commonly associated with which disorder? a. excessive CSF within the cranial cavity b. abnormally small head c. congenital absence of the cranial vault d. overriding of the cranial sutures
Answer: a. excessive CSF within the cranial cavity
A 12-year-old with leukemia will be taking vincristine. The nurse should encourage the child to eat what kind of diet? a. high-residue b. low-residue c. low-fat d. high-calorie
Answer: a. high-residue Rationale: vincristine may cause constipation, so the client should be encouraged to eat a high-residue (fiber) diet
A 3-month-old infant with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the HIGHEST priority? a. instituting droplet precautions b. administering acetaminophen c. obtaining history information from the parents d. orienting the parents to the pediatric unit
Answer: a. instituting droplet precautions
Which signs and symptoms would lead the nurse to suspect a child has Tetralogy of Fallot? Select all that apply. a. murmur b. history of squatting c. bounding pulses d. cyanosis e. faint pulse f. tachypnea
Answer: a. murmur b. history of squatting d. cyanosis f. tachypnea
A 12-year-old with rheumatic fever has a history of long-term aspirin use. Which client statement MOST indicates that the client is experiencing a serious adverse reaction to aspiration? a. "I hear ringing in my ears" b. "I put lotion on my itchy skin" c. "My stomach hurts after I take that medicine" d. "These pills make me cough"
Answer: a. "I hear ringing in my ears"
Nursing care management of the child with bacterial meningitis includes which interventions? Select all that apply. a. administration of IV antibiotics b. intravenous fluids at 1.5 times maintenance c. decreasing environmental stimuli d. neurologic checks every 4 hours e. administration of IV anticonvulsants
Answers: a. administration of IV antibiotics c. decreasing environmental stimuli d. neurologic checks every 4 hours
Which assessment findings should lead the nurse to suspect that a toddler is experiencing respiratory distress? Select all that apply. a. coughing b. respiratory rate of 35 breaths/min c. heart rate of 95 beats/min d. restlessness e. malaise f. diaphoresis
Answers: a. coughing b. respiratory rate of 35 breaths/min d. restlessness f. diaphoresis
After a tonsillectomy and adenoidectomy, which finding should alert the nurse to suspect early hemorrhage in a 5-year-old child? a. drooling of bright red secretions b. pulse rate of 95 bpm c. vomiting of 25 mL of dark brown emesis d. BP of 95/56 mm HG
Answer: a. drooling of bright red secretions
Parents bring a 10-month-old boy with myelomeningocele and hydrocephalus with a ventriculoperitoneal shunt to the ED. His symptoms include vomiting, poor feeding, lethargy, and irritability. What interventions by the nurse are the MOST appropriate? Select all that apply. a. weigh the child b. listen to bowel sounds c. palpate the anterior fontanelle d. obtain vital signs e. assess pinch and quality of the child's cry
Answers: a. weigh the child b. listen to bowel sounds d. obtain vital signs e. assess pinch and quality of the child's cry
Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply. a. fever b. petechiae c. epistaxis d. anorexia e. bone pain f. shortness of breath
Answers: b. petechiae c. epistaxis
During the acute stage of meningitis, a 3-year-old child is restless and irritable. Which intervention would be MOST appropriate to institute? a. limiting conversation with the child b. keeping extraneous noise to a minimum c. allowing the child to play in the bathtub d. performing treatments quickly
Answer: b. keeping extraneous noise to a minimum
A teaching care plan to prevent transmission of respiratory syncytial virus (RSV) should include what information? Select all that apply. a. the virus can be spread by direct contact b. the virus can be spread by indirect contact c. palivizumab is recommended to prevent RSV for all toddlers in daycare d. the virus is typically contagious for 3 weeks e. older children seldom spread RSV f. frequent hand-washing helps reduce the spread of RSV
Answer: a. the virus can be spread by direct contact b. the virus can be spread by indirect contact f. frequent hand-washing helps reduce the spread of RSV
The nurse is monitoring an infant with meningitis for signs of increased ICP. The nurse should assess the infant for which signs or symptoms? Select all that apply. a. irritability b. headache c. mood swings d. bulging fontanelle e. emesis
Answers: a. irritability d. bulging fontanelle e. emesis
When explaining to parents how to reduce the risk of sudden infant death syndrome (SIDS), the nurse should teach about which measures? Select all that apply. a. maintain a smoke-free environment b. use a wedge for side-lying positions c. breast-feed the baby d. place the baby on his or her back to sleep e. use bumper pads over the bed rails f. have the baby sleep in the parent's bed
Answer: a. maintain a smoke-free environment c. breast-feed the baby d. place the baby on his or her back to sleep
An 18-month-old with a congenital heart defect is to receive digoxin twice a day. Which instructions should the nurse give to the parents? a. digoxin enable the heart to pump more effectively with a slower and more regular rhythm b. signs of toxicity include increased pulse and visual disturbances c. digoxin is absorbed better if taken with meals d. if the child vomits within 15 minutes of administration, the dosage should be repeated
Answer: a. digoxin enable the heart to pump more effectively with a slower and more regular rhythm
An infant is being treated at home for bronchiolitis. What should the nurse teach the parent about home care? Select all that apply. a. offering small amounts of fluids frequently b. allowing the infant to sleep prone c. calling the clinic if the infant vomits d. writing down how much the infant drinks e. performing chest physiotherapy every 4 hours f. watching for difficulty breathing
Answer: a. offering small amounts of fluids frequently f. watching for difficulty breathing
What type of diet should the nurse teach the parents to give an older infant with cystic fibrosis? a. low-protein diet b. high-fat diet c. low-carbohydrate diet d. high-calorie diet
Answer: d. high-calorie diet
Which sign should lead the nurse to suspect that a child with meningitis has developed disseminated intravascular coagulation (DIC)? a. hemorrhagic skin rash b. edema c. cyanosis d. dyspnea on exertion
Answer: a. hemorrhagic skin rash
A child with cystic fibrosis is receiving gentamicin. Which nursing action is most appropriate? a. monitoring intake and output b. obtaining daily weights c. monitoring the client for indications of constipation d. obtaining stool samples for hemoccult testing
Answer: a. monitoring intake and output
A child has viral pharyngitis. What should the nurse advise the parents to do? Select all that apply. a. use a cool mist vaporizer b. offer a soft-to-liquid diet c. administer amoxicillin d. administer acetaminophen e. place the child on secretion precautions
Answer: a. use a cool mist vaporizer b. offer a soft-to-liquid diet d. administer acetaminophen
The nurse is proving postoperative care for an infant who had a ventriculoperitoneal shunt placed to correct hydrocephalus. Which clinical finding warrants immediate intervention? a. abdominal distention b. lethargy c. facial edema d. headache
Answer: a. abdominal distention Rationale: abdominal distention in a pediatric client with a ventriculoperitoneal shunt can be an indication of peritonitis and requires intervention
When planning home care for the child with Legg-Calve-Perthes disease, what should be the PRIMARY focus for family teaching? a. need for intake of protein-rich foods b. gentle stretching exercises for both legs c. management of the corrective appliance d. relaxation techniques for pain control
Answer: c. management of the corrective appliance
A 16-month-old child diagnosed with Kawasaki disease is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. What should the nurse do FIRST? a. apply lotion to the hands and feet b. offer foods the toddler likes c. place the toddler in a quiet environment d. encourage the parents to get some rest
Answer: c. place the toddler in a quiet environment
A nurse is planning care for a 12-year-old with rheumatic fever. The nurse should teach the parents to: a. observe the child closely b. allow the child to participate in activities that will not tire him c. provide for adequate periods of rest between activities d. encourage someone in the family to be with the child 24 hours a day
Answer: c. provide for adequate periods of rest between activities
Discharge teaching for a 3-month-old infant with a cardiac defect who is to receive digoxin should include which information? Select all that apply. a. give the medication at regular intervals b. mix the medication with a small volume of breast milk or formula c. repeat the dose one time if the child vomits immediately after administration d. notify the healthcare provider of poor feeding or vomiting e. make up any missed doses as soon as realized f. notify the healthcare provider if more than two consecutive doses are missed
Answer: a. give the medication at regular intervals d. notify the healthcare provider of poor feeding or vomiting f. notify the healthcare provider if more than two consecutive doses are missed
The triage nurse in the emergency department must prioritize the children waiting to be seen. Which child is in the GREATEST need of emergency medical treatment? a. a 6-year-old with a fever of 104 F (40 C), a muffled voice, no spontaneous cough, and drooling b. a 3-year-old with a fever of 100 F (37.8 C), a barky cough, and mild intercostal retractions c. a 4-year-old with a fever of 101 F (38.3 C), a hoarse cough, inspiratory stridor, and restlessness d. a 12-year-old with a fever of 104 F (40 C), chills, and a cough with thick yellow secretions
Answer: a. a 6-year-old with a fever of 104 F (40 C), a muffled voice, no spontaneous cough, and drooling Rationale: this child is exhibiting signs and symptoms of epiglottitis, which is a medical emergency
As part of the preoperative teaching for the family of a child undergoing a Tetralogy of Fallot repair, the nurse tells the family upon returning to the pediatric floor that the child may: a. be placed on a reduced sodium diet b. have an activity restriction for several days c. be assigned to an isolation room d. have visits limited to a select few
Answer: a. be placed on a reduced sodium diet
A child has had open heart surgery to repair a Tetralogy of Fallot with a patch. The nurse should instruct the parents to: a. notify all healthcare providers before invasive procedures for the next 6 months b. maintain adequate hydration of at least 10 glasses of water a day c. provide for frequent rest periods and naps during the first 4 weeks d. restrict the ingestion of bananas and citrus fruit
Answer: a. notify all healthcare providers before invasive procedures for the next 6 months Rationale: children who have undergone open heart surgery with a patch are at risk for infection, especially subacute bacterial endocarditis
The parent of a 16-month-old child calls the clinic because the child has a low-grade fever, cold symptoms, and a hoarse cough. What should the nurse suggest that the parent do? a. offer extra fluids frequently b. bring the child to the clinic immediately c. count the child's respiratory rate d. use a hot air vaporizer
Answer: a. offer extra fluids frequently
A child is admitted with a fracture of the femur and is placed in skeletal traction. What should the nurse assess FIRST? a. the pull of traction on the pin b. the Ace bandage c. the pin sites for signs of infection d. the dressings for tightness
Answer: a. the pull of traction on the pin
After teaching the parents of a child newly diagnosed with leukemia about the disease, which description if given by the parent BEST indicates understanding of the nature of leukemia? a. "The disease is an infection resulting in increased white blood cell production" b. "The disease is a type of cancer characterized by an increase in immature WBC's" c. "The disease is an inflammation associated with enlargement of the lymph nodes" d. "The disease is an allergic disorder involving increased circulating antibodies in the blood"
Answer: b. "The disease is a type of cancer characterized by an increase in immature WBC's"
The nurse reports to the healthcare provider signs of increased ICP in an infant with myelomeningocele who has which finding? a. minimal lower extremity movement b. a high-pitched cry c. overflow voiding only d. a fontanelle that bulges with crying
Answer: b. a high-pitched cry
When assessing a child after heart surgery to correct Tetralogy of Fallot, which finding should alert the nurse to suspect a low cardiac output? a. bounding pulses and mottled skin b. altered level of consciousness and thready pulses c. capillary refill of 2 seconds and BP of 96/67 mm Hg d. extremities warm to the touch and pale skin
Answer: b. altered level of consciousness and thready pulses
What should be part of the nurse's teaching plan for a child with epilepsy being discharged on a regimen of phenytoin? a. drink plenty of fluids b. brush teeth after each meal c. have someone be with the child during waking hours d. report signs of infection
Answer: b. brush teeth after each meal Rationale: phenytoin can cause gingival hyperplasia
When teaching the parents of a child with a ventricular septal defect who is scheduled for a cardiac catheterization, the nurse explains that this procedure involves the use of which technique? a. ultra-high-frequency sound waves b. catheter placed in the right femoral vein c. cutdown procedure to place a catheter d. general anesthesia
Answer: b. catheter placed in the right femoral vein Rationale: in children, cardiac catheterization usually involves a right-sided approach because septal defects permit entry into the left side of the heart
A 4-year-old has been scheduled for a cardiac catheterization. To help prepare the family, the nurse should: a. advise the family to bring the child to the hospital for a tour a week in advance b. explain that the child will need a large bandage after the procedure c. discourage bringing favorite toys that might become associated with pain d. explain that the child may get up as soon as the vital signs are stable
Answer: b. explain that the child will need a large bandage after the procedure
A 15-year-old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which signs and symptoms require the most immediate nursing interventions? a. fatigue and anorexia b. fever and petechiae c. swollen neck lymph glands and lethargy d. enlarged liver and spleen
Answer: b. fever and petechiae Rationale: fever and petechiae associated with acute lymphocytic leukemia indicate a suppression of normal WBC's and thrombocytes by the bone marrow an put the client at risk for other infections and bleeding
Before placement of a ventriculoperitoneal shunt for hydrocephalus, an infant is irritable, lethargic, and difficult to feed. To maintain the infant's nutritional status, which action would be MOST appropriate? a. feed the infant just before doing any procedures b. give the infant small, frequent feedings c. feed the infant in a horizontal position d. give large, less frequent feedings
Answer: b. give the infant small, frequent feedings
A child with cystic fibrosis has been admitted to the pediatric unit. What type of diet should the nurse request for the client? a. high-fat, high-carbohydrate b. high-calorie, high-protein c. high-calorie, high-carbohydrate d. high-carbohydrate, high-protein
Answer: b. high-calorie, high-protein Rationale: necessary to ensure adequate growth
At a follow-up appointment after being hospitalized, an adolescent with a history of cystic fibrosis describes his stool to the nurse. Which description should the nurse interpret as indicative of continued problems with malabsorption? a. soft with little odor b. large and foul-smelling c. loose with bits of food d. hard with streaks of blood
Answer: b. large and foul-smelling
When interviewing the parents of a 2-year-old child, a history of which illnesses should lead the nurse to suspect pneumococcal meningitis? a. bladder infection b. middle ear infection c. fractured clavicle d. septic arthritis
Answer: b. middle ear infection
When developing the plan of care for a newly admitted 2-year-old child with the diagnosis of Kawasaki disease, which intervention should be the priority? a. taking vital signs ever 6 hours b. monitoring intake and output every hour c. minimizing skin discomfort d. providing passive ROM exercises
Answer: b. monitoring intake and output every hour
A 10-year-old with leukemia is taking immunosuppressive drugs. To maintain health, the nurse should instruct the child and parents to: a. continue with immunizations b. not receive any live attenuated vaccines c. receive vitamin and mineral supplements d. stay away from peers
Answer: b. not receive any live attenuated vaccines
Which information should the nurse include when completing discharge instructions for the parents of a 12-month-old child diagnosed with Kawasaki disease and being discharged home? a. offer the child extra fluids every 2 hours for 2 weeks b. take the child's temperature daily for several days c. check the child's BP daily until the follow-up appointment d. call the healthcare provider if the irritability lasts for more than 2 weeks
Answer: b. take the child's temperature daily for several days Rationale: recurrence of fever may develop
Which outcome indicates that the activity restriction necessary for a 7-year-old with RF during the acute phase has been effective? a. joints demonstrate absence of permanent injury b. the resting HR is between 60 and 100 bpm c. the child exhibits a decrease in chorea movements d. the subcutaneous nodules over the joints are no longer palpable
Answer: b. the resting HR is between 60 and 100 bpm
A preschooler with a history of repaired lumbar myelomeningocele is in the ED with wheezing and a skin rash. Which questions should the nurse ask the parent FIRST? a. "Is your child taking any medications?" b. "Who brought your child to the ED?" c. "Is your child allergic to bananas or any other food?" d. "What are you doing to treat your child's skin rash?"
Answer: c. "Is your child allergic to bananas or any other food?" Rationale: children with myelomeningocele are at high risk for development of latex allergy because of repeated exposure to latex products during surgery and bladder catheterizations
A nurse is teaching the parents of a pre-schooler about the possibility of postoperative hemorrhage after a tonsillectomy and adenoidectomy. When should the nurse explain that the risk of bleeding is the greatest? a. 1-3 days post-op b. 4-6 days post-op c. 7-10 days post-op d. 11-14 days post-op
Answer: c. 7-10 days post-op
A charge nurse is making assignments for a group of children on a pediatric unit. The nurse should MOST avoid assigning the same nurse to care for a 2-year-old with RSV and: a. an 18-month-old with RSV b. a 9-year-old 8 hours postappendectomy c. a 1-year-old with a heart defect d. a 6-year-old with sickle cell crisis
Answer: c. a 1-year-old with a heart defect
The nurse is caring for a 7-year-old who has undergone a cardiac catheterization 2 hours ago finds the dressing and bed saturated with blood. The nurse should FIRST: a. assess the vital signs b. reinforce the dressing c. apply pressure just above the catheter insertion site d. notify the healthcare provider
Answer: c. apply pressure just above the catheter insertion site
The nurse is caring for a newborn with a large ventricular septal defect. The client has undergone pulmonary artery banding. Which assessment findings indicate that the pulmonary artery band is functioning effectively? a. capillary refill is less than 3 seconds b. urine output is greater than 1 mL/kg/hr c. breath sounds are clear and equal bilaterally d. radial pulses are bounding
Answer: c. breath sounds are clear and equal bilaterally Rationale: Pulmonary artery banding is a palliative treatment used in pediatric clients with congenital cardiac defects with increased pulmonary blood flow. The pulmonary artery band reduces excessive pulmonary blood flow and protects the lungs from irreversible damage.
Which medication prescription to help relieve pain in a child with leukemia should the nurse question? a. hydromorphone b. acetaminophen with codeine c. ibuprofen d. acetaminophen with hydrocodone
Answer: c. ibuprofen Rationale: ibuprofen prolongs bleeding time and is contraindicated in clients with leukemia
When teaching the family of an older infant who has had a spica cast applied for DDH, which information should the nurse include when describing the abduction stabilizer bar? a. it can be adjusted to a position of comfort b. it is used to lift the child c. it adds strength to the cast d. it is necessary to turn the child
Answer: c. it adds strength to the cast *the bar cannot be removed or adjusted unless the entire cast is taken off and replaced
When developing the discharge teaching plan for the parents of a child who has undergone a cardiac catheterization for ventricular septal defect, which information should the nurse expect to include? a. restriction of the child's activities for the next 3 weeks b. use of sponge baths until the stitches are removed c. use of prophylactic antibiotics before receiving any dental work d. maintenance of a pressure dressing until a return visit with the healthcare provider
Answer: c. use of prophylactic antibiotics before receiving any dental work
A 14-year-old has just had a plaster cast placed on his lower left leg. To provide safe cast care, the nurse should: a. petal the cast as soon as it is put on b. keep the child in the same position for 24 hours until the cast is dry c. use only the palms of the hand when handling the cast d. notify the healthcare provider if the client feels heat
Answer: c. use only the palms of the hand when handling the cast Rationale: the wet plaster cast should be handled using only the palms of the hands to prevent indentation of the cast surface
A 16-month-old child is seen in the clinic for a checkup for the first time. The nurse notices that the toddler limps when walking. Which would be appropriate to use when assessing this toddler for developmental dysplasia of the hip (DDH)? a. Ortolani's maneuver b. Barlow's maneuver c. Adam's position d. Trendelenburg's sign
Answer: d. Trendelenburg's sign
Which intervention is the GREATEST priority for the therapeutic management of a child with CHF caused by pulmonary stenosis? a. educating the family about the signs and symptoms of infection b. administering enoxaparin to improve left ventricular contractibility c. assessing HR and BP every 2 hours d. administering furosemide to decrease systemic venous congestion
Answer: d. administering furosemide to decrease systemic venous congestion
A child who limps and has pain has been found to have Legg-Calve-Perthes disease. What should the nurse expect to include in the child's plan of care? a. initiation of pain control measures, especially at night when acute b. promotion of ambulation despite the child's discomfort in the affected hip c. prevention of flexion in the affected hip and knee d. avoidance of weight bearing on the head of the affected femur
Answer: d. avoidance of weight bearing on the head of the affected femur
A nurse evaluates discharge teaching as successful when the parents of a school-age child with a ventriculoperitoneal shunt insertion identify which sign as signaling a blocked shunt? a. decreased urine output with stable intake b. tense fontanelle and increased head circumference c. elevated temperature and reddened incisional site d. irritability and increasing difficulty with eating
Answer: d. irritability and increasing difficulty with eating
An 8-week-old infant with congenital heart disease is being discharged. What is the MOST important information for the nurse to convey regarding feeding? a. allow the infant 1 hour to complete each feeding b. position the infant in an upright position after each feeding c. give feedings per nasogastric tube to conserve energy d. provide a higher calorie formula or fortified breast milk
Answer: d. provide a higher calorie formula or fortified breast milk Rationale: fortified breast milk or a high-calorie formula will help the infant gain weight and conserve energy
Which statement obtained from the nursing history of a toddler should alert the nurse to suspect that the child has had a febrile seizure? a. the child has had a low-grade fever for several weeks b. the family history is negative for convulsions c. the seizure resulted in respiratory arrest d. the seizure occurred when the child had a respiratory infection
Answer: d. the seizure occurred when the child had a respiratory infection Rationale: Most febrile seizures occur in the presence of an upper respiratory infection, otitis media, or tonsillitis. Febrile seizures typically occur during a temperature rise rather than after prolonged fever.
A child with Tetralogy of Fallot becomes upset, cries, and thrashes around when a blood specimen is obtained. The child becomes cyanotic, and the respiratory rate increases to 44 breaths/min. Which action should the nurse do FIRST? a. obtain a prescription for sedation for the child b. assess for an irregular heart rate and rhythm c. explain to the child that it will only hurt for a short time d. place the child in a knee-to-chest position
Answer: d.place the child in a knee-to-chest position Rationale: the child is experiencing a "tet" or cyanotic episode
An infant has been transferred from the ICU to the pediatric floor after undergoing surgery to correct a heart defect. Which tasks can the nurse delegate to the LPN/VN? Select all that apply. a. administering oral medications b. administering IV morphine c. obtaining vital signs d. monitoring hygiene e. circulation checks f. discharge teaching
Answers: a. administering oral medications c. obtaining vital signs d. monitoring hygiene
A 10-year-old has a 5 lb. of Buck's extension traction on his left leg. What finding should the nurse assess the child for? Select all that apply. a. dryness of the skin, by removing the foam wraps and boot b. alignment of the shoulder, hips, and knees c. frayed rope near pulleys d. correct amount of traction weight on fracture e. pressure on the coccyx
Answers: b. alignment of the shoulder, hips, and knees c. frayed rope near pulleys d. correct amount of traction weight on fracture e. pressure on the coccyx
A child with cerebral palsy is to begin botulinum toxic type A injections. Which treatment goals should the healthcare team set for the child related to botulinum toxin? Select all that apply. a. improved nutritional status b. decreased pain from spasticity c. improved motor function d. enhanced self-esteem e. reduced caregiver strain and improved self-care f. decreased speech impediments
Answers: b. decreased pain from spasticity c. improved motor function d. enhanced self-esteem e. reduced caregiver strain and improved self-care
The nurse is teaching the parents of a child with myelomeningocele how to prevent UTI's. What should the care plan include for this child? Select all that apply. a. provide meticulous skin care b. use Crede's maneuver to empty the bladder c. encourage frequent emptying of the bladder d. assure adequate fluid intake e. use tight-fitting diapers around the meature
Answers: b. use Crede's maneuver to empty the bladder c. encourage frequent emptying of the bladder d. assure adequate fluid intake
Which clinical manifestations would lead the nurse to suspect an infant has hydrocephaly? Select all that apply. a. depressed fontanelle b. headache c. vomiting d. low-pitched cry e. irritability f. pupillary changes g. bulging fontanelle
Answers: c. vomiting e. irritability f. pupillary changes Rationale: hydrocephaly is a block in the flow of cerebrospinal fluid
