Pediatrics practice questions

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Scoliosis

lateral curvature of a portion of the spine

which lab test result is most important for the nurse to follow when monitoring the care of the client when an acetaminophen overdose? 1. liver function test 2. chest x-ray 3. bleeding time 4. WBC count

liver function test

the nurse is asked to explain the major difference between a clubfoot and a positional deformity to a student nurse. which statement, if made by the nurse, is appropriate? 1. "A clubfoot can be passively corrected, but a positional deformity must be corrected with surgery and casting" 2. "A clubfoot corrected with surgery and casting, but a positional deformity can be passively corrected" 3. "A clubfoot is not correctable, but a positional deformity is correctable" 4. "A clubfoot is correctable, but a positional deformity is not correctable"

"A clubfoot corrected with surgery and casting, but a positional deformity can be passively corrected"

The nurse counsels the parents of a child diagnosed with iron deficiency anemia. The nurse instructs the parents about how to administer the prescribed liquid iron supplement. Which instruction is the most important for the nurse to include?

"Administer the liquid iron supplement through a straw."

The nurse interviews a 15 year old client. The nurse is most concerned if the adolescent makes which statement

"I don't perspire like other kids"

The nurse observes the child walk up and down steps. The nurse notes the child has a steady gait and can use short sentences. The nurse estimates the child's age to be how many months?

24 months

The 17 months old child sucks a thumb, especially at night when quieting for sleep. Which suggestion by the nurse is best?

"Don't intervene; it will subside. the behavior usually peaks at 24 months

The nurse counsels the school-aged diagnosed with type 1 diabetes. The child tells the nurse about sometimes going to the park after school with friends. It is most important for the nurse to include which instruction?

"Eat extra food before going to the park to play with you friends."

the nurse instructs the parent about the appropriate way to instill ear drops in the right ear of the 2-year-old child. the nurse determines teaching is effective if the parent makes which statement? 1. "I should pull my child's ear down and back" 2. "I will have my child stand next to me" 3. "I will place a dry cotton pledget in my child's ear" 4. "My child should lie on the right side after I instill the drops"

"I should pull my child's ear down and back"

The nurse performs discharge teaching for parents with a child in a hip spica cast. The nurse determines further teaching is necessary if one of the.. make which statement?

"I will place my child in a supine position to eat."

The nurse performs a well-baby assessment on the 10-month-old infant. The nurse should intervene if the mother makes which statement?

"My baby drinks about 40 oz. of cow's milk each day."

The nurse admits the infant suspected of having pyloric stenosis. During the nursing history, the nurse expects the parents to make which..?

"My baby has frequent projectile vomiting."

the nurse in the well-child clinic received a phone call from the parent of the 6-month-old who received the DTaP vaccine 3 days ago. the nurse is most concerned if the parent makes which statement? 1. "There is redness and swelling at the injection site" 2. "My baby is crying continuously" 3. "My baby's temperature is 101F (38.3C) 4. "My baby seems to be eating less"

"My baby is crying continuously"

The 3 year old child is seen in the local clinic for croup. The child's parents ask the nurse what to do for the child at home to alleviate symptoms. Which suggestions by the nurse is most appropriate?

"Stand with your child in front of an open freezer"

A client delivers a healthy 8-lb, 2-oz infant. The client mentions to the nurse that the baby's "soft spot" bulges out when the baby cries. Which statement made by the nurse is most appropriate?

"The anterior fontanel will normally bulge out when the baby coughs or cries."

The woman delivers a healthy 8-lb, 2-oz infant. She mentions to the nurse that her baby's "soft spot" seems very large. Which statement, if made by the nurse, is most appropriate?

"The baby's anterior "soft spot" will remain for approximately 1 1/2 years."

The woman delivers a healthy 8lb, 2oz infant. she mentions to the nurse that her baby's "soft spot" seems very large. which statement, if made by the nurse, is most appropriate? 1. "both of the baby's fontanels should close within 1 month" 2. "the baby could be brain damaged if the soft spot is injured" 3. "the baby's posterior fontanel should close after 1 year" 4. "The baby's anterior "soft spot" will remain for approximately 1 ½ years"

"The baby's anterior "soft spot" will remain for approximately 1 ½ years"

A brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates teaching is successful?

"The brace should be worn 23 hours a day"

the nurse observes the child walk up and down steps. the nurse notes the child has a steady gait and can use short sentences. the nurse estimates the child's age to be how many months?

24 months

The young child diagnosed with autism is admitted to the pediatric unit with a tracheotomy after swallowing a small toy. The unlicensed assistive personnel reports to the nurse that the child does not maintain eye contact. Which response by the nurse is best?

"The inability to maintain eye contact is a characteristic of autism."

The nurse cares for the infant diagnosed with Down syndrome. The nurse discusses Down Syndrome with the parents. The nurse thinks further instruction is required if the infant's mother makes which statement?

"There is a greater risk of having a child with ds if the mother is under the age of 35."

The nurse at the local high school is discussing hypercholesterolemia in health class. Which statement, if made by a student to the nurse.. need for further teaching?

"There is no treatment for hypercholesterolemia."

Nurse observes the child walk up and down stairs. Nurse notes the child has steady gait and can use short sentences. She estimates the child is how old?

24 months.

The nurse talks with a group of adolescents about their nutritional needs. Which statement is best?

"You have increased need for most nutrients"

The nurse instructs the parents of the 4-year-old diagnosed with grade II vesicoureteral reflux. It is most important for the nurse to.. in discharge teaching?

"Your child will be receiving a continuous low-dose antibacterial."

the nurse interviews a 15-year-old client. the nurse is most concerned if the adolescent makes which statement? 1. "sometimes I feel really tired" 2. "I don't perspire like other kids" 3. "I can be a real klutz sometimes" 4. "I have two pimples on my forehead"

"i don't perspire like other kids"

the 1-week-old child is diagnosed with hemophilia A. neither the mother nor the father has the disease. which statement, if made by the nurse to the parents, correctly describes the hemophilia trait?

"it is an x-linked recessive trait found primarily in males."

The nurse observes the child walk up and down steps. The nurse notes the child has a steady gait and can use short sentences. The nurse estimates the child's age to be how many months?

24 months.

the nurse observes the child walk up and down steps. the nurse notes the child has a steady gait and can use short sentences. the nurse estimates the child's age to be how many months? 1. 6mos 2. 12mos 3. 14mos 4. 24mos

24mos

Nurse cares for the infant diagnosed with gastroesophageal reflux. The infant presents with anemia, forceful vomiting, and weight loss. The nurse should take which action?

Thicken formula w/ rice cereal

The nurse considered the developmental stage of a child before choosing a toy. A push pull toy is appropriate for which age group?

18 - 20 months

the nurse considers the developmental stage of a child before choosing a toy. a push-pull toy is appropriate for which age group? 1. 6wks-3mos 2. 6-8 months 3. 18-20 months 4. 4-5 years

18-20 months

Incubation period for chicken pox

2 - 3 weeks.

Age at greatest risk for poisoning

2 years old

Incubation period for chickenpox

2-3 weeks (10-21 days)

the child with attention deficit hyperactive disorder (ADHD) is taking methylphenidate. the nurse knows that methylphenidate is prescribed for this child for which effect?

central nervous system stimulant

the nurse instructs the 10-year-old client about how to collect a 24-hour urine specimen at home using a clean, empty jar. the nurse should recommend that the client use which jar?

48-ounce jar

The nurse instructs the 10-year-old client about how to collect a 24-hour urine specimen at home using a clean, empty jar. The nurse should recommend that the client use which jar?

48-ounce jar.

the nurse instructs the 10-year-old client about how to collect a 24-hour urine specimen at home using a clean, empty jar. the nurse should recommend that the client use which jar? 1. 8oz jar 2. 16oz jar 3. 48oz jar 4. 128oz jar

48oz jar

6. The nurse cares for the 4-year-old child with a suspected dx of cystic fibrosis. The quantitative sweat chloride test is administered. The nurse knows that which result confirms the dx of cystic fibrosis?

69 mEq/L

The infant is able to assume a sitting position, plays "peek-a-boo," and is starting to say "mama" and "dada." The nurse identifies that these behaviors are characteristic of which age?

9 months

The infant is able to assume a sitting position, plays peek a boo, and is starting to say mama and dada. The nurse identifies that these behaviors are characteristics of which age?

9 months

the infant is able to assume a sitting position, plays "peek-a-boo," and is starting to say "mama" and "dada." the nurse identified that these behaviors are characteristic of which age? 1. 5 months 2. 6 months 3. 9 months 4. 1 year

9 months

The nurse recognizes that which child is at greatest risk for poisoning?

A 2 year old

The instructor teaches nursing students about the chronic form of immune thrombocytopenia purpura, ITP. A person in which age is likely to develop ICP?

A young child. Most common in young especially after a viral infection. thrombocytopenia is acquired platelet disorder, excessive destruction of platelets due to autoimmune response.

The neighbor of the nurse comes running to the nurse's house saying "I just found my 2 year old in the kitchen surrounded by several bottles of cleaning solution and the bottles are all open!" Which action by the nurse is BEST? a. call poison control b. ask child if they drank anything c. give ipecac syrup with water d. give mix of milk and burned toast.

A. call poison control center. Assess the child, initiate steps to stop the exposure like empty the mouth of pills, plants and call for instructions.

The nurse is monitoring a client with an acetaminophen overdose. Which lab test is MOST important for the nurse to follow? a. liver function test b. chest xray c. bleeding time d. WBC count

A. liver function test. Monitor AST and ALT because liver damage is potential problem.

the nurse notes a two-day-old infant shows a tendency to bleed the nurse understands this is most likely caused by which reason

Absence of intestinal bacteria needed for the production of Vit K. Vit K given at birth. baby able to produce on own by day eight.

Which medication does the nurse have available for acetaminophen overdose?

Acetylcysteine

Which medication does the nurse have available for the treatment of acetaminophen overdose?

Acetylcysteine

Nurse cares for the school-aged child reporting joint pain in the extremities. Parent state that their child had a sore throat about 10 days ago that did not require tx. The nurse anticipates the HCP will order which test?

Antistreptolysin O (ASO) titer

Prior to surgery for myelomeningocele, which action does the nurse perform to care for the area of the defect?

Applies a moist, sterile dressing. helps to not dry out and prevents from infection.

The nurse identifies which reaction as an adverse effect most often identifies with the measles, mumps and rubella (MMR) immunizations?

Arthritis

The nurse plans care for an infant client diagnosed with a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant?

Asepsis.

The nurse plans care for the infant diagnosed with a myelomeningocele. Which principle of nursing care is most important to apply when caring for this infant?

Asepsis.

The nurse plans care for the infant diagnosed with a myelomeningocele. Which principle of nursing care is MOST important to apply when caring for this infant?

Asepsis. Infection may cause meningitis and damage the brain; the CNS is very delicate; asepsis is extremely important.

The nurse in the pediatric clinic performs a well child assessment on the 6-month-old infant. As the infant is sitting quietly on the mother's lap, the nurse obtains an apical heart rate of 190 bpm. Which action by the nurse is most appropriate?

Ask the mother if the infant has been crying

The nurse cares for the 2-week-old infant diagnosed with developmental dysplasia of the hip (DDH). The nurse notes which finding is consistent diagnosis of DDH?

Asymmetry of the gluteal folds

Student nurse prepares to discuss cardiac defects that cause increased pulmonary blood flow. Student nurse identifies which cardiac defect affects pulmonary blood flow?

Atrial septal defect

Surgical repair of a congenital heart defect is performed on the 5 month old infant. Which measure is MOST important for the nurse to include in the post-op care plan? a. admin pain meds to prevent crying b. elevate head to reduce respiratory effort. c. admin laxatives to prevent straining. d. milk the chest tubes to maintain patency.

B. elevate the head to reduce respiratory effort.

When assessing the 9 month old child, the nurse expects which reflex to be present?

Babinkski's - babinski's reflex disappears at 12 months`

When assessing the 9 month old child, the nurse expects which reflex to be present?

Babinski's

The four-week-old infant is brought to health care provider by the parent. The infant is vomiting and has abdominal distention. The infant is diagnosed as having pyloric stenosis and is admitted to the hospital. The nurse should expect the infant's emesis to have which of these qualities?

Be projectile.

The nurse in the peds clinic counsels the mother of a 6-year old who has developed new-onset constipation. Which is the most common reason new-onset constipation in a 6-year old?

Beginning school

Infant weight gain

Birth weight doubles by 4 to 6 months Birth weight triples by 1 year

The nurse cares for an infant admitted to the ER. The mother reports that the child fell off the changing table. The nurse performs an assessment and identifies which symptom as an early sign of increased intracranial pressure (ICP)?

Bulging fontanel

The 3 year old child is brought to the ED with a history of vomiting and diarrhea for the past three days. Which finding is the nurse MOST likely to see? a. shortness of breath b.. slow heart rate c. sunken eyes d. tremors

C. sunken eyes. V and D for 3 days will exhibit signs of fluid volume deficit.

The nurse cares for the 7-year-old child dx with osteomyelitis of the right arm. Which finding would the nurse expect to observe?

Child holds right arm in a semi-flexed position

The nurse cares for a 7-year-old girl dx with central precocious puberty. It is most important for the nurse to include which statement when counseling the child's mother?

Child should dress in age-appropriate clothing

Nurse observes 10 year old dx with ADHD. Nurse expects to observe

Child wanders the hallways

The parent of the child diagnosed with frequent acute otitis media asks the nurse why this keeps happening to the child. The nurses' response should be based on which explanation?

Children have a shorter auditory, or Eustachian, tube

Anterior fontanel

Close at 12-18 months. Easily felt, open and flat. Bulging occurs with ICP. Depressed with dehydration.

Posterior fontanel

Closes by 2-3 months. Triangular 0.5-1.0 centimeter. Not easily palpated.

The 6 month old baby has a cyanotic heart defect. The nurse knows that a cyanotic congenital heart defect is associated with which symptom?

Clubbing of the fingers

The 6-month-old baby has a cyanotic congenital heart defect. The nurse knows that a cyanotic congenital heart defect is associated with which symptom?

Clubbing of the fingers.

School nurse discusses triggers that precipitate asthma with school-aged children. The nurse determines that teaching is effective if a parent makes which statement?

Cold air can trigger my child's asthma attack

The peds nurse cares for the 4-year old admitted with a dx of hirschsprung disease. The nurse expects to find which s&s:

Constipation, abd distension, ribbon-like stools

Nurse cares for the child immediately after supratentorial craniotomy to remove a brain tumor. The nurse notes that the child's apical pulse and bp is decreased. Which action should nurse take?

Contact the HCP

Nurse instructs the mother of the young child dx with moderate dehydration due to diarrhea. Nurse determines that teaching was successful if mother makes which statement?

D. Offer child ½ cup of oral rehydration after each diarrheal stool

The nurse knows DTaP vaccine protects against which diseases?

Diphtheria, pertussis, tetanus.

DTaP vaccine

Diphtheria, tetanus toxoid, acellular pertussis. Given at 2, 4, 6, 18 months and at age 4-6 years.

The nurse knows DTaP vaccine protects against which diseases?

Diphtheria, tetanus, pertussis.

To prevent parent-child disturbances, the nurse should complete which action?

Discuss with the parents any problems or fears about childbearing that they may have

To prevent parent-child disturbances, the nurse should complete which action?

Discuss with the parents any problems or fears about childrearing that they may have.

To prevent disturbed parent-child interactions, the nurse completes which action?

Discusses with the parents any problems or fears about child rearing they may have.

The nurse monitors a 13-month-old for speech and hearing development. To better understand the child's speech dev., its most important for nurse to ask the parents which question?

Does your child say da, na, ya ya?

A 4 year old is brought to the emergency room with a diagnosis of acute epiglottis. Which assessment finding, if made by the nurse, is most significant?

Drooling of saliva

The nurse understands that which food is most likely to cause an allergy in a 6 month old infant?

Eggs

Surgical repair of a congenital heart defect is performed on the 5 month old infant. Which measure is most important for the nurse to include in the postoperative care plan?

Elevate the client's head to reduce respiratory effort

The pediatric nurse instructs families of children dx with diabetes about the differences between hypoglycemia and hyperglycemia. Which info should the nurse include in the presentation?

Hyperglycemia causes fruity breath odor

The parent brings the 6-month-old baby to the clinic for a check-up. The parent reports the baby had a check-up at 2 months of age and received the first DTaP. Which action by the nurse is most appropriate?

Give second DTaP.

The parent brings a 6 month old baby to the clinic. The baby had a check up at 2 months and received the first DTaP. What should the nurse do first?

Give second DTaP. At six months the child is ready for the third shot but when schedule off, just continue.

Give the second DTaP

DTap Vaccine

Given at 2,4,6 months, 18 months and age 4-6 yrs. Give IM in thigh. Convulsion serious adverse effect of DTaP. Persistent crying seen with pertussis.

The 8 months old child is about to receive an immunization injection when the child begins to cry. Which comment by the nurse is the most appropriate?

I know you are frightened. It will be over soon

The nurse visits the family with 3 small children who live in a 3 bedroom home built in the 1952. The nurse counsels the family about how to avoid lead poisoning. the nurse determines that teaching is effective if the parents make which statement?

I wet mop all of the floors and wash all the window sills weekly

The nurse observes the preschool-age client playing with several other children of about the same age. The nurse identifies which play activity as the one in which the child is most likely to engage?

Imitating the actions of the nurse or health care provider.

The adolescent is evaluated for scoliosis. The client asks the nurse, what is scoliosis?, which statement by the nurse BEST describes scoliosis?

Is it a lateral curvature of a portion of the spine

Nurse reviews the record of the child dx with acute glomerulonephritis. Nurse identifies which finding is most commonly associated with this dx?

Impetigo 14 days ago

A 1-week-old client diagnosed with hemophilia A. Neither parent has the disease. Which statement correctly describes the hemophilia trait?

It is an X-linked recessive trait found primarily in males.

Nurse admits a child dx with hemophilia A. It is most important for the nurse to assess for which symptom?

Joint pain

Which lab test result is most important for the nurse to follow when monitoring the care of the client with an acetaminophen overdose?

Liver function test

The nurse knows MMR is a vaccine for which diseases?

Measles, mumps, rubella.

The nurse cares for the child dx with Wilms tumor. Preoperatively, it is most important for the nurse to include which action in the plan

Measure the child's abdominal girth.

Which medication should the nurse have available for the treatment of acetaminophen overdose?

Mucomyst

Which medication should the nurse have available for the treatment of acetaminophen overdose?

Mucomyst.

The nurse in the well-child clinic receives a phone call from the parent of the 6 month old who received the DTaP vaccine 3 days ago. The nurse is most concerned if the parent makes which statement?

My baby is crying contiously

The nurse in the well-child clinic counsels the parent of the newborn about normal growth and development. The nurse determines teaching is effective if the parent makes which statements?

My baby will double his birth weight at 5 months

Which medication should the nurse have available for the treatment of acetaminophen overdose? 1. Vitamin K 2. Mycomyst 3. Aspirin 4. Narcan

Mycomyst

A toddler client has nausea, vomiting, and diarrhea. Which implementation is best for the nurse to use to maintain an adequate fluid intake?

Offer oral rehydration solutions (ORS) to re hydrate.

Which implementation is the best way for the nurse to maintain an adequate fluid intake for a toddler with nausea, vomiting, and diarrhea?

Offer oral rehydration solutions (ORS) to rehydrate.

The toddler has nausea, vomiting, and diarrhea. Which implementation is BEST for the nurse to use to maintain an adequate fluid intake?

Offer oral rehydration solutions ORS to rehydrate. They contain Na, K+, chloride, citrate and GLU.

The nurse provides instructions to the parents of a child being discharged after a myringotomy with tympanostomy tubes inserted. It is most important for the nurse to respond to which statement made by the parents?

Our child loves to jump off the dock into lake

The nurse knows that vitamin E (Alpha-Tocopherol) is given to premature infants to prevent which condition?

Oxidation of red blood cells

The nurse cares for the newborn diagnosed with developmental dysplasia of the hip (DDH). The nurse expects which method of treatment to be used for the newborn?

Pavlik harness.

A newborn diagnosed with DDH aka developmental dysplasia of the hip, will be treated with...

Pavlik harness. Holds the hips in wide abduction. If not corrected after a few months, then surgery.

Nurse prepares to discharge a new mother and the newborn. It is most important for the nurse to include which discharge instruction about SIDS?

Place on back during sleep

The nurse observes the five-year-old child playing with several other children about the same age. The nurse identifies which play activity as the one in which the child is MOST likely to engage?

Playing with a toy telephone and imitating the doctor.

The nursing student cares for clients in the pediatric clinic. The nursing student reports to the nurse that a 12-year-old child has a bp of 150/... which response by the nurse is best?

Please show me the bp cuff that you used

An infant client is diagnosed with a cyanotic congenital heart defect (CCHD). The nurse knows a cyanotic congenital heart defect is associated with which symptom as reported by the parent?

Poor feeding with no or very poor weight gain.

A parent brings a newborn client to the health care provider's office. The newborn is vomiting, has abdominal distention, and is diagnosed with pyloric stenosis. Which characteristic of the newborn's emesis does the nurse expect?

Projectile and forceful.

Which intervention does the nurse recognize as MOST important to promote maximum mobility in infants?

Provide a safe play area.

Which intervention does the nurse recognize as most important to promote maximum mobility in infants?

Provide a safe play area.

Which intervention should the nurse recognize as most important to promote maximum mobility in infants?

Provide a safe play area.

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched. Gone by 12 months.

The nurse knows which signs or symptoms of rubeola are exhibited before the appearance of the rash?

Runny nose, sneezing and coughing.

The nurse knows which signs and symptoms of rubeola are exhibited before the appearance of the rash

Runny nose, sneezing, and coughing

The nurse understands that, according to Erickson, adolescence is regarded as the period associated with establishment of which developmental goal?

Sense of identity and intimacy

The home care nurse monitors the pediatric client diagnosed with a chronic seizure disorder. The nurse should intervene if which finding is observed?

The parent takes the child's temperature using an oral electronic thermometer.

Nurse cares for 5-year old dx with asthma. Nurse demonstrates to child's parents how to measure the peak expiration... nurse asks child to forcefully exhale into meter, and the nurse notes the results are in red zone. The nurse knows that the red zone presents which finding?

Severe airway narrowing may be occurring

A school-age client is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe?

Short stature.

The nurse admits the infant suspected of having intussusception. During the nursing assessment, the nurse expects to obtain which information?

The parents state that the infant's stools look like currant jelly

Nurse cares for the pre-adolescent admitted with RLQ abd pain, decreased bowel sounds, and fever. The HCP suspects that the child has appendicitis. The nurse knows that the child's appendix has ruptured if which finding is noted?

The pre-adolescent reports a sudden decrease in pain.

Nurse cares for the infant dx with rsv receiving ribavirin. Nurse should intervene if which action.

The pregnant nursing assistive personnel (NAP) gives the child a bath

The nurse counsels the parent of an infant diagnosed with non-organic failure to thrive (NFTT). The nurse notes that the mother appears depressed and is expressing feelings of inadequacy and resentment toward her infant. Which approach by the nurse is most appropriate?

Structure environment so that the mother feels accepted

The 3 year old child is brought to the emergency room with a history of vomiting and diarrhea for the past three days. Which finding is the nurse most likely to see?

Sunken eyes

Nurse cares for the child dx with cardiac dysrhythmia. Nurse knows which dysrhythmia is not a common one found in children?

Supravent. tachy.

Nurse cares for the young child dx with HF. Nurse recognizes which findings is one of the earliest indicators.

Tachycardia

The child is in the emergency room for a puncture wound contaminated with dirt. The nurse knows that the health care provider will order which medications?

Tetanus immune globulin

A brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates teaching is successful?

The brace should be worn 23 hours a day. Remove for bathing. 4-6 year program.

The nurse performs a home care visit for the child diagnosed with cystic fibrosis. The nurse should intervene if which finding is observed?

The child takes the pancreatic enzymes one hour after eating.

The inability to maintain eye contact is a characteristic of autism.

The young child with autism is in the OR. UAP reports to RN that he doesn't maintain eye contact. What is the BEST response by the nurse?

The inability to maintain eye contact is a characteristic of autism.

The school nurse monitors the kindergarten-aged child dx with HIV. The school nurse should intervene if which finding is observed?

The kindergarten teacher reports that the child bit another child

The 18 month old child is admitted to the hospital. When the parents leave, the child starts to cry loudly, and the nurses attempt to console the child. After a while the child stops crying and becomes quiet and withdrawn. The nurse thinks that the child has accepted the situation and has adjusted well to the separation. Which statement is TRUE?

The nurse fails to see that the child has entered the second stage of separation anxiety

The school nurse assesses the physical development of school-age children. Which is the most valuable tool for this assessment?

The weight and height compared to standard tables

The 2-year-old child is brought to the clinic for extensive facial burns. The child's parent states that they resulted from the child's running into a lighted cigarette. The child is holding on to the parent and doesn't want to let go to be examined. Which is the best rationale for the nurse to suspect this parent is abusing the child?

There is little relationship between the extent of the child's burns and the history

The 1 year old child is admitted to the hospital for evaluation and a bone marrow aspiration is performed. The nurse expects the test to be performed using which site?

Tibia

The one year child is admitted to the hospital for a bone marrow aspiration. The nurse expects the test to be performed using which site?

Tibia. The tibia is used in children up to two years old to obtain bone marrow aspirations. analgesia or anesthesia is used.

The nurse cares for the child after tonsilectomy. The child vomits bright red blood. Which action should the nurse take first?

Turn the child to the side

Parent of an infant brings child to ped clinic because of noticing the infant has edema of the hands and feet. The nurse observes wide spaced nipples as low posterior hairline. Nurse knows these findings are consistent with the dx of which genetic disorder?

Turner synd

An 8 month old child present with stunted growth, and chromosomal studies show that the child has only 45 chromosomes. The nurse should identify that the child's condition is due to which diagnosis?

Turner's syndrome

The nurse cares for the infant dx with type 1 spinal muscular atropy (werding-hoffman). nurse identifies which statement is true about this disease?

Type 1 is characterized by progressive weakness and wasting of skeletal muscles.

Nurse cares for 18-month-old dx with stage IV neuroblastoma. During a discussion with the child's parents, the parents shouts at the... "I have brought my child in for all checkups. The hcp should have found this sooner." Which response by the nurse is most appropriate?

We are doing everything we can

The nurse cares the child dx with nephrotic syndrome. The nurse knows that which finding is a common characteristic associated with nephrotic syndrome?

Weight gain

Tonic neck

When lying on back w/head turned to one side, arm and leg outstretched to that side. Disappears 3-4 months.

The home care nurse cares for the child dx with a seizure disorder. The child's parents calls to report that the child had a tonic-clonic seizure... most important for the nurse to follow up which statement made by parent?

When the seizure first began, I tried to move my child to the bed

Club foot vs positional deformity

a clubfoot is corrected with surgery and casting, but a positional deformity can be passively corrected

the nurse cares for clients in the pediatric clinic. the nurse should investigate which child for a possible speech impairment? 1. a 3-month-old who babbles 2. an 8-month old who laughs 3. a 4-year-old who shows an understanding of speech 4. a 5-year-old who uses single words

a 5-year-old who uses single words

the school nurse assesses children enrolled in the kindergarten class. the nurse is most concerned if which finding is observed?

a child walks down stairs by placing both feet on one step

stepping reflex

a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking

The nurse identifies which reaction as an adverse effect MOST often identified with the measles, mumps and rubella immunizations? a. arthritis b. convulsions c. high pitched cry d paralysis

a. arthritis. worrisome adverse effect that can occur following the MMR immunization, other adverse effects include rash and fever. Given at 12-15 months and 4-6 years. Admin SubQ. Do not receive if pregnant or immunosuppressed.

the child is admitted with lead poisoning. which symptom does the nurse expect to see? 1. anemia, hearing impairment, and distractibility 2. tinnitus, confusion, hyperthermia 3. polycythemia, hypo-activity, impaired liver function 4. shortness of breath, dependent edema, bounding pulse

anemia, hearing impairment, and distractibility

the nurse understands that which principle should serve as the basis for managing childhood weight problems? 1. allow for slower weight gain control compared to linear growth 2. allow for slow weight loss, approximately one pound per week 3. allow for weight loss only by exercise 4. allow for weight loss only under physician supervision

allow for slower weight gain control compared to linear growth

allow the child to engage in imaginary play

the 5 1/2-year-old child comes to the clinic for a routine exam. the parent reports that the child likes to jump and climb, questions everything, and is often observed interacting with an "imaginary" best friend. the nurse should advise the parent to take which action? 1. encourage the child to play more often with other children 2. tell the child that the playmate is not real 3. allow the child to engage in imaginary play 4. never leave the child alone

allow the child to engage in imaginary play

Characteristic feature of cystic fibrosis

an altered viscosity of mucus

the 18-month-old toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. the nurse should expect to see which characteristic feature of cystic fibrosis? 1. an absence of gastric enzymes 2. an altered viscosity of mucus 3. an absence of liver enzymes 4. poor ventilatory functioning

an altered viscosity of mucus

the child is admitted with lead poisoning. which symptom does the nurse expect to see?

anemia, hearing impairment, and distractibility.

prior to surgery for myelomengingocele, which action should the nurse perform to care for the area of the defect? 1. cleanse the defect and leave the the defect open to air 2. apply a dry, sterile dressing 3. apply a moist, sterile dressing 4. apply antibiotic ointment and leave the area open to air

apply a moist, sterile dressing

the nurse identifies which reaction as an adverse effect most often identified with the measles, mumps, and rubella (MMR) immunizations? 1. arthritis 2. convulsions 3. high-pitched cry 4. paralysis

arthritis

the nurse plans care for the infant diagnosed with myelomeningocele. which principle of nursing care is most important to apply when caring for this infant?

asepsis

the nurse plans care for the infant diagnosed with myelomeningocele. which principle of nursing care is most important to apply when caring for this infant? 1. asepsis 2. exercise 3. hygiene 4. rest

asepsis

when assessing the 9-month-old child, the nurse expects which reflex to be present? 1. babinski's 2. moro's 3. tonic neck 4. grasp

babinski's

the four-week-old infant is brought to a health care provider by the parent. the infant is vomiting and has abdominal distention. the infant is diagnosed as having pyloric stenosis and is admitted to the hospital. the nurse should expect the infant's emesis to have which of these qualities?

be projectile

An infant is vomiting and has abdominal distention. They are dx with pyloric stenosis. The nurse should expect the emesis to

be projectile. other symptoms include weight loss, constipation, dehydration, visible peristaltic waves.

after an aspirin overdose, it is most important for the nurse to assess for which problem? 1. bleeding 2. nausea 3. tinnitus 4. decreased temperature

bleeding

Truncal incurvation

body curves toward side of trunk stroked.

which artery should the nurse use to assess the pulse and rate of an infant during cardiopulmonary resuscitation? 1. femoral artery 2. apical artery 3. carotid artery 4. brachial artery

brachial artery

The child with attention deficit hyperactive disorder (ADHD) is taking methylphenidate. The nurse knows that methylphenidate is prescribed for this child for which effect? 1. central nervous system depressant 2. antianxiety 3. sedative 4. central nervous system stimulant

central nervous system stimulant

myelomeningocele

bulging sac-like lesion at spine filled with spinal fluid, meninges , portion of spinal cord and nerves. Hydrocephalus. Surgical repair.

Home care nurse visits the home of the toddler diagnosed with non-organic FTT. The nurse instructs the toddler's parents about mealtimes. Which suggestion by the nurse is most appropriate? a. give them 10 min to eat. b. insist they eat certain foods. c. develop a structured routine for bathing, sleeping and playing. d. invite other children to eat with toddler.

c. develop a structured routine for bathing, sleeping and playing. unstructured life style will be reflected in their unwillingness to eat.

the neighbor of the nurse comes running to the nurse's house saying, "i just found my 2-year-old in the kitchen surrounded by several bottles of cleaning solutions and the bottles were all open!" which action by the nurse is best? 1. call the poison control center 2. ask the child if the child drank anything 3. give the child ipecac syrup with two glasses of water 4. give the child a mixture of milk and burned milk

call the poison control center

the 15-month-old child crawls but is not yet able to walk. the parents are concerned and ask the nurse if this is normal. which is the best initial response by the nurse 1. I will refer you to a specialist 2. Is there any sign of paralysis? 3. It might be wise to stop carrying him for a while 4. Children often set their own pace

children often set their own pace

The 6-month-old baby has a cyanotic congenital heart defect. The nurse knows that a cyanotic congenital heart defect is associated with which symptom? 1. pedal edema 2. clubbing of the fingers 3. obligate nose breathing 4. warm, dry skin

clubbing of the fingers

the 6-month-old baby has a cyanotic congenital heart defect. the nurse knows that a cyanotic congenital heart defect is associated with which symptom?

clubbing of the fingers

the clinic nurse teaches a parent how to care for a child with impetigo. the nurse knows that the greatest danger associated with an impetigo infection is the risk of which complication?

developing glomerulonephritis secondary to streptococcus infection

the 7-year-old child is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. which clinical manifestation is the nurse most likely to observe?

delicate features

the 7-year-old child is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. which clinical manifestation is the nurse most likely to observe? 1. abnormal body proportions 2. early sexual maturation 3. delicate features 4. coarse, dry skin

delicate features

the home care nurse visits the home of the toddler diagnosed with nonorganic failure to thrive (NFTT). the nurse instructs the toddler's mother about mealtime. which suggestion by the nurse is most appropriate? 1. give the toddle 10 minutes to eat his meal 2. insist that the toddler eat certain foods 3. develop a structured routine for bathing, sleeping, and playing 4. invite other children to eat with the toddler

develop a structured routine for bathing, sleeping, and playing

the nurse knows DTaP vaccine protects against which diseases?

diphtheria, pertussis, tetanus

the nurse knows DTaP vaccine protects against which diseases? 1. diphtheria, polio, typhoid fever 2. diphtheria, pertussis, typhoid fever 3. diphtheria, pertussis, tetanus 4. diphtheria, polio, tetanus

diphtheria, pertussis, tetanus

to prevent parent-child disturbances, the nurse should complete which action?

discuss with the parents any problems or fears about childrearing that they may have

to prevent parent-child disturbances, the nurse should complete which action? 1. report potential abuse to the appropriate authorities 2. discuss with the parents any problems or fears about childrearing that they may have 3. tell the parents that if their attitudes don't' change, action will have to be taken by the medical staff 4. suggest to the parents that they have the child stay with a relative until they feel confident in their roles

discuss with the parents any problems or fears about childrearing that they may have

the 17-month-old child sucks a thumb, especially at night when quieting for sleep. which suggestion by the nurse is best? 1. put a negative reinforcer, such as red pepper, on the thumb 2. don't intervene; it will subside. the behavior usually peaks at 24 months 3. it is a common form of self-stimulation. it should be discouraged. 4. it will cause the teeth to malform. I would wrap the thumb at bedtime

don't intervene; it will subside. the behavior usually peaks at 24 months

a 4-year-old child is brought to the emergency room with a diagnosis of acute epiglottis. which assessment finding, if made by the nurse, is most significant? 1. increased fever 2. drooling of saliva 3. increased cough and dyspnea 4. increased heart rate

drooling of saliva

the nurse understands that which food is most likely to cause an allergy in a 6-month-old infant? 1. cereals 2. vegetables 3. fruits 4. eggs

eggs

surgical repair of a congenital heart defect is performed on the 5-month-old infant. which measure is most important for the nurse to include in the postoperative care plan? 1. administer pain medications to the client to prevent crying 2. elevate the client's head to reduce respiratory effort 3. administer laxatives to the client to prevent straining 4. milk the chest tubes to maintain tube patency

elevate the client's head to reduce respiratory effort

give second DTaP

the parent brings the 6-month-old baby to the clinic for a check-up. the parent reports the baby had a check-up at 2 months of age and received the first DTaP. which action by the nurse is most appropriate? 1. repeat first DTaP, starting the schedule again 2. give second DTaP 3. give MMR 4. give two DPT vaccinations today

give second DTaP

The nurse anticipates that the child with a diagnosis of idiopathic hypothyroidism will be given which hormone?

growth hormone

the nurse anticipates that the child with a diagnosis of idiopathic hypopituitarism will be given which hormone? 1. estrogen 2. parathormone 3. growth hormone 4. thyroxine

growth hormone

the nurse observes parents interacting with their newborn shortly after birth. it is most important for the nurse to make which assessment during this observation? 1. proper parenting skills 2. healthy or pathologic relationships 3. normal neurologic functioning of the infant 4. parental knowledge of the infant's behavioral responses

healthy or pathologic relationships

The home care nurse visits a preschool age client diagnosed at birth with phenylketonuria, PKU. The nurse assesses the child's intake for the previous week. The child should not have:

high protein foods: milk, meat, peanut butter, beans.

the 8-month-old child is about to receive an immunization injection when the child beings to cry. which comment by the nurse is the most appropriate? 1. don't cry. it will be better if you try to behave 2. i know you are frightened. it will be over with soon 3. a big person like you shouldn't cry. you know it isn't going to hurt 4. please stop crying. there is nothing to be afraid of

i know you are frightened. it will be over with soon

the nurse instructs the parents of a 7-year-old child diagnosed with cystic fibrosis about required dietary modifications. which adjustment is like to be made in a normal diet? 1. increased protein 2. increased fat 3. increased carbohydrate 4. increased potassium

increased protein

Palmar grasp

infant grasps examiner's finger when stroked against palm/plantar surface of infant. Gone by 3 months.

the 4-year-old child sustains a deep partial-thickness burn. based on an understanding of growth and development, the nurse anticipates which hospital experiences will probably be most upsetting to the child? 1. intramuscular (IM) injections 2. daily examination by the health care provider 3. taking oral medicine when a parent is not there 4. having the nurse say 'no' to requests

intramuscular (IM) injections

the 18-month-old child drinks drain cleaner and is brought to the emergency department. which piece of equipment is most essential for the nurse to have on hand?

intubation tray

the 18-month-old child drinks drain cleaner and is brought to the emergency department. which piece of equipment is most essential for the nurse to have on hand? 1. intubation tray 2. EKG machine 3. dialysis machine 4. gastric lavage tube

intubation tray

the adolescent is evaluated for scoliosis. the client asks the nurse, what is scoliosis? which statement by the nurse best describes scoliosis? 1. It is an inward curvature of the lower spine 2. It is an exaggerated convexity in the thoracic region of the spine 3. It is the herniation of an intervertebral disc 4. it is a lateral curvature of a portion of the spine

it is a lateral curvature of a portion of the spine

The 1 week old child is diagnosed with hemophilia A. Neither the mother nor the father has the disease. Which statement, if made by the nurse to the parents, correctly describes the hemophilia trait? 1. it is an x linked recessive trait found primarily in females 2. it is an x linked dominant trait found primarily in females 3. it is an x linked recessive trait found primarily in males 4. it is an x linked dominant trait found primarily in males

it is an x linked recessive trait found primarily in males

which action should the nurse take to minimize separation anxiety experienced by a toddler? 1. provide a different nurse each shift until the child responds warmly to one 2. reassure the parents that the child is getting along fine without them 3. bring other children in to visit with the child 4. keep toys from home in the bed with child

keep toys from home in the bed with child

the nurse knows MMR is a vaccine for which diseases?

measles, mumps, rubella

the nurse knows MMR is a vaccine for which diseases? 1. measles, mumps, rubeola 2. measles, mumps, roseola 3. measles, mumps, rubella 4. measles, mumps, chickenpox

measles, mumps, rubella

MMR vaccines

measles, mumps, rubella. Given at 12-15 months and second dose is given at 4-6 years. fyi: measles and rubeola are the same thing.

which medication should the nurse have available for the treatment of acetaminophen overdose?

mucomyst

which statement, if made to the nurse by the parent of an 8-month-old child, indicates possible delay in the child's development? 1. my child has almost doubled the birth weight 2. my child smiles at me when I walk in the room 3. My child doesn't seem to like the grandparents 4. My child can't say 'mama' yet

my child has almost doubled the birth weight

the nurse performs an assessment on the child admitted with a diagnosis of acute asthma. the nurse determines which observation by the parents is significant to determine the cause of the acute asthma attack? 1. my child slept on a new pillow last night 2. my child plays indoor tennis three times per week 3. my child takes a daily vitamin supplements 4. my child is allergic to shellfish

my child slept on a new pillow last night

the nurse counsels the parents of a child with down's syndrome. which statement, if made by the parents to the nurse, indications further teaching is necessary? 1. my child's development will become more rapid in time 2. my child's motor skills will always be slow 3. play is a good way to teach my child 4. my child responds to affection

my child's development will become more rapid in time

the home care nurse visits the 3-year-old child diagnosed at birth with phenylketonuria. the nurse assesses the child's intake for the previous week. the nurse is most concerned if the child's parent makes which statement? 1. my child snacks on oranges 2. my child eats low-protein pasta for dinner 3. my child really likes potato chips 4. my child's favorite lunch is peanut butter and jelly sandwich

my child's favorite lunch is peanut butter and jelly sandwich

the nurse knows which signs or symptoms of rubeola are exhibited before the appearance of the rash? 1. diarrhea, intestinal cramps, and lack of appetite 2. runny nose, sneezing, and coughing 3. itching, fever, and cold sores 4. sore throat and swollen lymph nodes

runny nose, sneezing, and coughing

which implementation is the best way for the nurse to maintain an adequate fluid intake for a toddler with nausea, vomiting, and diarrhea?

offer oral rehydration solutions (OHS) to rehydrate.

which implementation is the best way for the nurse to maintain an adequate fluid intake for a toddler with nausea, vomiting, and diarrhea? 1. keep the toddler NPO and give hypotonic solutions IV 2. force fluids and give hypertonic solutions IV 3. provide Jell-O and popsicles and increase fluid intake 4. offer oral rehydration solutions to rehydrate

offer oral rehydration solutions to rehydrate

the nurse knows vitamin E (alpha-tocopherol) is given to premature infants to prevent which condition? 1. oxidation of red blood cells 2. complications of circumcision 3. fat-soluble vitamin deficiency 4. respiratory distress syndrome

oxidation of red blood cells

the nurse cares for the newborn diagnosed with developmental dysplasia of the hip (DDH). the nurse expects which method of treatment to be used for the newborn?

pavlik harness

the nurse cares for the newborn diagnosed with developmental dysplasia of the hip (DDH). the nurse expects which method of treatment to be used for the newborn? 1. pavlik harness 2. double diapering 3. placing a small pillow between the legs 4. bracing the affected leg

pavlik harness

the nurse observes the five-year-old child playing with several other children about the same age. the nurse identifies which play activity as the one in which the child is most likely to engage? 1. playing independently, but with he same toy as another child 2. playing with a toy telephone and imitating the doctor 3. playing doctor with another child 4. playing with a doctor doll

playing with a toy telephone and imitating the doctor

the nurse observes the five-year-old child playing with several other children about the same age. the nurse identifies which play activity as the one in which the child is most likely to engage?

playing with a toy telephone and imitating the doctor.

The nurse cares for the infant diagnosed with a cyanotic congenital heart defect. The nurse understands that chronic hypoxia from this disorder can result in which finding?

polycythemia

the nurse cares for the infant diagnosed with a cyanotic congenital heart defect. the nurse understands that chronic hypoxia from this disorder can result in which finding? 1. intellectual disability 2. polycythemia 3. respiratory infections 4. fluid retention

polycythemia

The 3 day old infant is born with a myelomeningocele The nurse caring for the neonate should place the infant in which position?

prone

the 3-day-old infant is born with a myelomeningocele. the nurse caring for the neonate should place the infant in which position? 1. prone 2. fowler's 3. trendelenburg's 4. side-lying

prone

which intervention should the nurse recognize as most important to promote maximum mobility in infants?

provide a safe play area

which intervention should the nurse recognize as most important to promote maximum mobility in infants? 1. encourage daily exercise 2. use a playpen whenever possible 3. provide a safe play area 4. teach noncompetitive activities

provide a safe play area

the 4-year-old child was crying near the fireplace when the clothing caught fire and enveloped the child in flames. the nurse was in the home. which action should the nurse take first? 1. obtain the child's respirations 2. transport the child to the hospital 3. push the child to the ground and make the child roll 4. remove the child's clothing as quickly as possible

push the child to the ground and make the child roll

the nurse understands that, according to erikson, adolescence is regarded as the period associated with establishment of which developmental goal 1. sense of trust 2. sense of autonomy 3. sense of identity and intimacy 4. sense of initiative

sense of identity and intimacy

the nurse counsels the parent of an infant diagnosed with nonorganic failure to thrive (NFTT). the nurse notes that the mother appears depressed and is expressing feelings of inadequacy and resentment toward her infant. which approach by the nurse is most appropriate? 1. structure environment so that the mother feels accepted 2. refer her to a family therapist 3. tell her she is an unfit mother 4. recommend that she attend child care classes

structure environment so that the mother feels accepted

the nurse knows that which type of feeding is most commonly used with infants who are intolerant of cow's milk? 1. evaporated milk-based formula 2. medium-chain-triglyceride-based formula 3. predigested-protein-based formula 4. soy based formula

soy based formula

The nurse knows that which type of feeding is most commonly used with infants who are intolerant of cow's milk?

soy-based formula

Moro:

startle reflex. Disappears after 3-4 months.

the 3-year-old child is brought to the emergency room with a history of vomiting and diarrhea for the past three days. which finding is the nurse most likely to see? 1. shortness of breath 2. slow heart rate 3. sunken eyes 4. tremors

sunken eyes

a brace is ordered for the adolescent to correct a scoliosis deformity. which statement, if made by the parent to the nurse, indicates teaching is successful? 1. a bed board may replace the brace at night 2. my child's diet should be low in calories 3. daily tub baths are preferred to showers 4. the brace should be worn 23h a day

the brace should be worn 23h a day

the nurse performs a home care visit for the child diagnosed with cystic fibrosis. the nurse should intervene if which finding is observed?

the child takes the pancreatic enzymes one hour after eating

the nurse performs a home care visit for the child diagnosed with cystic fibrosis. the nurse should intervene if which finding is observed? 1. the child eats a high-protein, high-calorie diet 2. the child had two to three stools per day 3. the child swallows the pancreatic enzyme capsules whole 4. the child takes the pancreatic enzymes one hour after eating

the child takes the pancreatic enzymes one hour after eating

The nurse performs a home care visit for the child diagnosed with cystic fibrosis. The nurse should intervene if she sees...

the child taking the pancreatic enzyme on hour after eating. Enzymes should be taken BEFORE meal or within 30 min of eating.

the young child diagnosed with autism is admitted to the pediatric unit with a tracheotomy after swallowing a small toy. the unlicensed assistive personnel reports to the nurse that the child does not maintain eye contact. which response by the nurse is best? 1. the child is frightened due to the hospitalization 2. i should perform a neurological assessment 3. thank you for bringing that observation to my attention 4. the inability to maintain eye contact is a characteristic of autism

the inability to maintain eye contact is a characteristic of autism

the nurse performs assessments in the well-baby clinic. the nurse identifies which finding is a warning sign of cerebral palsy (CP)?

the infant has poor head control after 3 months

the nurse supervises the family caring for the child diagnosed with cerebral palsy. the nurse should intervene if which finding is observed? 1. the parent allows the child to rest prior to a physical therapy session 2. the child wears a helmet when ambulating in the house 3. the older sister places a toy in the child's hands 4. the parents offer high-calorie snacks to the child

the older sister places a toy in the child's hands

the home care nurse monitors the pediatric client diagnosed with a chronic seizure disorder. the nurse should intervene if which finding is observed

the parent takes the child's temperature using an oral electronic thermometer

the home care nurse monitors the pediatric client diagnosed with a chronic seizure disorder. the nurse should intervene if which finding is observed 1. the parent takes the child's temperature using an oral electronic thermometer 2. the parent encourages the child to play with boats during bath time 3. the child wears a helmet when riding a bicycle 4. the child eats peanut butter and jelly sandwiches

the parent takes the child's temperature using an oral electronic thermometer

the 1-year-old child is admitted to the hospital for evaluation and bone marrow aspiration is performed. the nurse expects the test to be performed using which site? 1. sternum 2. iliac crest 3. tibia 4. scapula

tibia

An infant is found to have an excessive amount of oral secretions after birth. During the first feeding the infant has a choking episode accompanied by cyanosis. The nurse knows these symptoms are indicative of which problem?

tracheoesophageal defect

an infant is found to have an excessive amount of oral secretions after birth. during the first feeding the infant has a choking episode accompanied by cyanosis. the nurse knowns that these symptoms are indicative of which problem? 1. pyloric stenosis 2. tracheoesophageal defect 3. cleft palate 4. hydrocephalus

tracheoesophageal defect

an 8-month-old child present with stunted growth, and chromosomal studies show that the child only has 45 chromosomes. the nurse should identify that the child's condition is due to which diagnosis? 1. klinefelter's syndrome 2. down's syndrome 3. phenylketonuria 4. turner's syndrome

turner's syndrome

School nurse administers glucagon IM to a child dx with type 1 Diabetes. The child immediately begins to vomit. What action should the nurse take first?

Place the child on the side

which guideline is appropriate for the nurse to give a mother concerning the developmental age of her 7-year-old child?

the child's periods of shyness should be tolerated

which guideline is appropriate for the nurse to give a mother concerning the developmental age of her 7-year-old child? 1. the child's periods of shyness should be tolerated 2. nightmares are not characteristic of this age and the reasons for their occurrence should be investigated 3. the child's participation in groups or clubs should be encouraged 4. severe punishment may be necessary for acts of independence

the child's periods of shyness should be tolerated

The 15 month old child crawls but is not yet able to walk. The parents are concerned and ask the nurse if this is normal. Which is the best initial response by the nurse?

Children often set their own pace

Nurse performs a nutritional assessment on the 3-month-old infant. Which question best assists the nurse to obtain a dietary hx from parents?

How many oz of formula does your infant drink each day?

The nurse counsels the mother of the child diagnosed with attention deficit disorder. Which statement by the nurse is most appropriate?

Hug your child after a task is correctly performed

The nurse discusses dental hygiene with the parents of a 12-month-old infant. Which statement, if made by the parents to the nurse, indicates.. further instruction?

"We use toothpaste to polish the teeth."

Which action should the nurse take to minimize separation anxiety experienced by a toddler?

Keep toys from home in the bed with the child

The nurse knows Vitamin E is given to premature infants to prevent which condition?

Oxidation of red blood cells. Fragile cells break apart since the cell walls are weakened in the absence of sufficient vitamin E.

Prior to surgery for myelomeningocele, which action should the nurse perform to care for the area of the defect?

Apply a moist, sterile dressing

the nurse counsels the mother of the child diagnosed with attention deficit disorder. which statement by the nurse is most appropriate? 1. "You must consider your child's chronological age when setting goals" 2. "Do not expect your child to succeed if faced with a difficult task" 3. "Limit the number of toys and materials that you offer your child" 4. "Hug your child after a task is correctly performed"

"Hug your child after a task is correctly performed"

The nurse instructs the parent about the appropriate way to instill ear drops in the right ear of the 2 year old child. The nurse determines teaching is effective if the parent makes which statement?

"I should pull my child's ear down and back."

the nurse visits the family with three small children who live in a three bedroom home built in 1952. the nurse counsels the family about how to avoid lead poisoning. the nurse determines that teaching is effective if the parents make which statement? 1. "I plan to scrap paint off the walls after the children go to bed tonight" 2. "My children eat meals whenever they are hungry" 3. "I wet mop all of my floors and wash all of the window sills weekly" 4. "I'm going to leave that patch of dirt uncovered so the children will have somewhere to dig"

"I wet mop all of my floors and wash all of the window sills weekly"

The nurse counsels the mother of a 4-year-old diagnosed with group A B-hemolytic Streptococcus infection of the upper airway. Which statement made by the mother to the nurse, indicates an understanding of the nurse's instructions?

"I will buy my child a new toothbrush tomorrow."

Nurse instructs the family of the child diagnosed with sickle cell disease on how to minimize the vaso-occlusive. The nurse determines that further teaching is required if the family makes which statement?

"If my child experiences pain, I will apply cold compresses."

The nurse cares for a preterm infant diagnosed with patent ductus arteriosus (PDA) receiving indomethacin 0.1 mg/kg intravenously (IV). The mother asks the nurse why her baby is receiving the medication. Which response by the nurse is best?

"Indomethacin is given to close the patent ductus arteriosus."

The 1-week-old child is diagnosed with hemophilia A. Neither the mother nor the father has the disease. Which statement, if made by the nurse to the parents, correctly describes the hemophilia trait?

"It is an X-linked recessive trait found primarily in males."

The charge nurse of a newborn nursery instructs mothers on how to assess their infants' hearing. Which statement, if made by the mother to the nurse, indicates that teaching is successful?

"My baby may startle when I make a loud noise close to her head."

the nurse in the well-child clinic counsels the parent of the newborn about normal growth and development. the nurse determines teaching is effective if the parent makes which statements? 1. "My baby will double his birth weight in 2 months" 2. "My baby will double his birth weight at 3 months" 3. "My baby will double his birth weight at 5 months" 4. "My baby will double his birth weight at 12 months"

"My baby will double his birth weight at 5 months"

the nurse counsels the parent of a 12-year-old diagnosed with chickenpox about when the child can return to school. the nurse determines that teaching is effective if the parent makes which statement? 1. "My child can return to school after the blisters stop erupting" 2. "My child can return to school when the itching is controlled" 3. "My child can return to school when the lesions are crusted" 4. My child can return to school when the macules disappear

"My child can return to school when the lesions are crusted"

The nurse performs an assessment on the 5-year-old child suspected of having Duchenne muscular dystrophy. Which assessment data obtained.. parent will assist the medical team with this diagnosis?

"My child can't ride a bike."

Which statement, if made to the nurse by the parents of an 8 month old child, indicates a possible delay in the child's development

"My child has almost doubled the birth weight"

The nurse performs an assessment on the child admitted with a diagnosis of acute asthma. The nurse determines that which observation by the parents is significant to determine the cause of the acute asthma attack?

"My child slept on a new pillow last night"

The nurse counsels the parents of a child with Down's Syndrome. Which statement, if made by the parents to the nurse, indicates further teaching is necessary?

"My child's development will become rapid in time"

The home care nurse visits the 3-year-old diagnosed at birth with phenylketonuria. The nurse assesses the child's intake for the previous week. The nurse is most concerned if the child's parent makes which statement?

"My child's favorite lunch is a peanut butter and jelly sandwich"

The home care nurse visits a child client diagnosed at birth with phenylketonuria. The nurse assesses the client's intake for the previous week. The nurse is most concerned with the parent makes which statement?

"My child's favorite lunch is a peanut butter and jelly sandwich."

The home care nurse visits the 3-year-old child diagnosed at birth with phenylketonuria. The nurse assesses the child's intake for the previous week. The nurse is most concerned if the child's parent makes which statement?

"My child's favorite lunch is a peanut butter and jelly sandwich."

A brace is ordered for the adolescent to correct a scoliosis deformity. Which statement, if made by the parent to the nurse, indicates teaching is successful?

"The brace should be worn 23 hours a day."

"my child's favorite lunch is a peanut butter and jelly sandwich."

the woman delivers a healthy 8lb, 2oz infant. she mentions to the nurse that her baby's "soft spot" seems very large. which statement, if made by the nurse, is most appropriate?

"the baby's anterior "soft spot" will remain for approximately 1 1/2 years."

a brace is ordered for the adolescent to correct a scoliosis deformity. which statement, if made by the parent to the nurse, indicates teaching is successful?

"the brace should be worn 23 hours a day."

"the inability to maintain eye contact is a characteristic of autism"

the nurse talks with a group of adolescents about their nutritional needs. which statement is best? 1. "you have a need for fatty foods" 2. "you need vitamin supplements daily" 3. "you have an increased need for most nutrients" 4. "you need to increase your intake of iron"

"you have an increased need for most nutrients"

Cyanotic heart defects

- tetralogy of fallout - transposition of the great vessels - truncus arteriosus - total anomalous venous return

Rooting and sucking

-present at birth -disappears at 9 months

A parent calls the clinic to report that the child has been exposed to varicella zoster (chicken pox). The nurse should tell the parent that the incubation period for chickenpox is which length of time?

2-3 weeks

a parent calls the clinic to report that the child has been exposed to varicella zoster (chickenpox) the nurse should tell the parent that the incubation period for chickenpox is which length of time? 1. 1 day 2. 2-4 days 3. 1 week 4. 2-3 weeks

2-3 weeks

The nurse instructs the 10-year-old client about how to collect a 24-hour urine specimen at home using a clean, empty jar. The nurse recommends the client use which size jar?

A 48-ounce jar.

The nurse cares for the clients i the pediatric clinic. The nurse should investigate which child for a possible speech impairment?

A 5 year old who uses single words

The school nurse assesses children enrolled in the kindergarten class. The nurse is most concerned if which finding is observed?

A child walks down stairs by placing both feet on one step.

The nurse is asked to explain the major difference between a clubfoot and a positional deformity to a student nurse. Which statement, if made by the nurse is appropriate?

A clubfoot is corrected with surgery and casting, but a positional deformity can be passively corrected.

The nurse understands that which principle should serve as the basis for managing childhood weight problems?

Allow for a slower weight gain compared to linear growth

The nurse understands which principle serves as the basis for managing childhood weight problems?

Allow for slower weight gain compared to linear growth.

A preschool-age client comes to the clinic for a routine exam. The parent reports the child likes to jump and climb, questions everything, and is often observed interacting with an "imaginary" best friend. The nurse advises the parent to take which action?

Allow the child to engage in imaginary play.

The 5 1/2-year-old child comes to the clinic for a routine exam. The parent reports that the child likes to jump and climb, questions everything, and is often observed interacting with an "imaginary" best friend. The nurse should advise the parent to take which action?

Allow the child to engage in imaginary play.

the 18 month old toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse should expect to see which characteristic feature of cystic fibrosis?

An altered viscosity of mucus

Child is admitted with lead poisoning. What symptom does the nurse expect to observe?

Anemia, hearing impairment and distractibility. Also irritability, sleepiness, nausea, vomiting, increased ICP.

The child is admitted with lead poisoning. Which symptom does the nurse expect to see?

Anemia, hearing impairment, and distractibility.

The child is admitted with lead poisoning. Which symptoms does the nurse expect to see?

Anemia, hearing impairment, distractibility

A child client is admitted with chronic lead poisoning. Which symptoms does the nurse expect to see?

Anemia, seizures, and learning disabilities.

A parent of a 6 month old who received the DTaP vaccine 3 days ago calls and the nurse is MOST concerned if the parent says.. a. there is redness and swelling at the injection site. b. my baby is crying continuously. c. baby's temp is 101 degrees. d. baby seems to be eating less.

B. baby is crying continuously - is a side effect along with convulsions, high fever and loss of consciousness. redness is expected and higher temp and eating less are both side effects.

A four year old child is brought to ED with diagnosis of acute epiglottitis. Which assessment finding is MOST significant? a. increased fever. b. drooling of saliva. c. increased cough and dyspnea. d. increased heart rate.

B. drooling of saliva. Drooling, agitation, and absence of spontaneous cough are predictive of epiglottitis. do not attempt throat inspection unless immediate intubation can be performed.

After an aspirin overdose, it is MOST important for the nurse to assess for which problem?

Bleeding

Nurse presents a conference about GI dysfunction in children. Nurse discusses the difference between ulcerative colitis and Crohn's. The nurse determines that further teaching is required if an attendee makes which statement?

Bloody diarrhea is common in Crohn's

Nurse cares for the child with dx of rule out aplastic anemia. To confirm the dx, the nurse expects to use which test?

Bone marrow aspiration

Nurse cares for a 10-month old admitted for surgical repair of coarctation of the aorta. The nurse expects which finding?

Bounding pulses in the arms and weak femoral pulses

Which artery should the nurse use to assess the pulse rate of an infant during cardiopulmonary resuscitation?

Brachial artery

Which artery should the nurse use to assess the pulse rate of an infant during cardiopulmonary resuscitation?

Brachial artery. The brachial artery near the axilla in the infant.

The nurse cares for a client recuperating from a splenectomy. Which health care need does the nurse address in the immediate post-op period? a. need for genetic counseling. b. need to increase oral fluids. c. need to breathe deeply frequently d. the need to conserve energy

C. the need to breathe deeply frequently. Splenectomy scar is near diaphragm, there is a need to encourage the client to breathe deeply in order to avoid atelectasis.

The nurse in a pediatric clinic is doing health audits and notices that a toddler client is on a delayed immunization schedule per the parents request. The client is 17 months old, and it has been 3 weeks since the initial administration of the measles, mumps, and rubella (MMR) vaccine. Which is the best response by the nurse?

Call the parents, and explain that the child will need to be seen in the next week to receive their second dose of the MMR vaccine to keep on schedule.

The neighbor of the nurse comes running to the nurse's house saying, "I just found my 2 year old in the kitchen surrounded by several bottles of cleaning solutions and the bottles are all open!" Which action by the nurse is best?

Call the poison control center

Child with ADHD is taking methylphenidate. the nurse knows this medication has what effect?

Central nervous system stimulant.

The chid with attention deficit hyperactive disorder (ADHD) is taking methylphenidate. The nurse knows that methylphenidate is prescribed for this child for which effect?

Central nervous system stimulant.

The child with attention deficit hyperactive disorder (ADHD) is taking methylphenidate. The nurse knows that methylphenidate is prescribed for this child for which effect?

Central nervous system stimulant.

the parent of a child diagnosed with frequent acute otitis media asks the nurse why this keeps happening to the child. the nurse's response should be based on which explanation? 1. Children have a weaker tympanic membrane 2. Children have an immature immune system 3. Children have a shorter auditory, or eustachian, tube 4. During play, dirt is frequently introduced into children's ears

Children have a shorter auditory, or eustachian, tube

The 7-year-old is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe?

Delicate features

The 7-year-old child is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse most likely to observe?

Delicate features.

A 7 year old child is admitted to the hospital with a diagnosis of idiopathic hypopituitarism. Which clinical manifestation is the nurse MOST likely to observe?

Delicate features. Clients also have fine skin, increased insulin sensitivity and premature aging common later in life.

The home care nurse visits the home of the toddler diagnosed with non-organic failure to thrive (NFTT). The nurse instructs the toddler's mother about mealtime. Which suggestion by the nurse is most appropriate?

Develop a structured routine for bathing, sleeping and playing

The clinic nurse teaches the parent how to care for a child with impetigo. the greatest danger assc with impetigo infections is the risk of ?

Developing a glomerulonephritis secondary to streptococcus infection.

The clinic nurse teaches the parent how to care for a child with impetigo. The nurse knows that the greatest danger associated with an impetigo infection is the risk of which complication?

Developing glomerulonephritis secondary to streptococcus infection

The clinic nurse teaches the parent how to care for a child with impetigo. The nurse knows that the greatest danger associated with an impetigo infection is the risk of which complication?

Developing glomerulonephritis secondary to streptococcus infection.

The nurse in the peds clinic assess a 12-month-old infant. The infant fell to the floor from a high chair. It is most important for the nurse to assess for which injury?

Head injury

The nurse observes parents interacting with their newborn shortly after birth. It is important for the nurse to make which assessment during this observation?

Healthy of pathologic relationships

A student nurse presents a conference on hematological disorders in children. The student nurse identifies which information should be included.. presentation about immune thrombocytopenia purpura (ITP)?

Immune thrombocytopenia purpura is caused by excessive destruction of platelets. There is discoloration due to petechiae, and the bone marrow is normal.

The nurse instructs the parents of a 7 year old child diagnosed with cystic fibrosis about required dietary modifications. Which adjustment is likely to be made in a normal diet?

Increased protein

Nursing student presents at a conference about signs of CP. Which statement will the nursing student include in the presentation?

Infant has poor head control after 3 months of age

Warning sign of cerebral palsy:

Infant has poor head control after 3 months. Earliest signs of CP are delayed gross motor development, stiff or rigid arms or legs, arching back, floppy or limp body posture.

The nurse instructs parents about car safety for infants. It is most important for the nurse to include which piece of info in the presentation?

Infant should be in a rear-facing car seat

Nurse cares for the infant receiving O2 through an O2 hood. Which observation requires an intervention by the nurse?

Infant's parent covers the infant with a brightly colored nylon blanket

Nurse plans care for infants on the peds unit. The nurse understands that careful assessment of infants... for which reason?

Infants have larger amounts of ECF than adults.

The school nurse plans scoliosis screening for a class of fifth graders. Which is the correct screening procedure for scoliosis?

Instruct the child to bend forward from the waist

Nurse plans care for the child dx with cystic fibrosis. nurse determines which action is most important?

Instruct the family on how to perform chest physiotherapy

The 4 year old child sustains a deep partial thickness burn. Based on an understanding of growth and development, the nurse anticipates which hospital experience will probably be the most upsetting to the child?

Intramuscular (IM) injections

The nurse cares for the young child scheduled to receive the hepatitis B vaccine. The nurse identifies which method is best administer the vaccine..?

Intramuscularly in the deltoid muscle

A toddler client accidentally drinks some drain cleaner and is brought to the emergency department. Which piece of equipment is most essential for the nurse when caring for this client?

Intubation tray

The 18-month-old child drinks some drain cleaner and is brought to the emergency department. Which piece of equipment is most essential for the nurse to have on hand?

Intubation tray.

The 18-month-old child drinks drain cleaner and is brought to the ED. Which piece of equipment is most essential for the nurse to have on hand?

Intubation tray. With this caustic substance, there is the potential for massive swelling which would compromise respirations. Should be immediately available so that the airway may be protected.

Nurse identifies which statement as a true statement about otitis media?

Is caused by a dysfunction of the middle ear.

Nurse performs an assessment on a 15-month old. The infant's parents tells nurse that child has started to walk, is eating with a spoon, and builds a two-block tower. During the visit, the parent mentions that the toddler's right eye sometimes "glows" which response by nurse is best?

Is light shining in the toddler's eye when this happens?

A 1 week old client diagnosed with hemophilia A, neither parent has the disease. Which statement correctly describes the hemophilia trait?

It is an X-linked recessive trait found primarily in males. Hemophilia is a hereditary bleeding disorder.

The nurse counsels the parent of a 12 year old diagnosed with chickenpox about when the child can return to school. The nurse determines that teaching is effective if the parent makes which statement?

My child can return to school when the lesions are crusted

Nurse in peds clinic assesses a child reporting chronic headaches. Which statement by the child to nurse requires immediate follow up?

My headaches have started causing me to awaken at night

The nurse in the peds clinic assess a child reporting chronic headaches. Which statement, if made by the child to the nurse, requires immediate follow-up?

My headaches have started causing me to awaken at night.

The 3 day old infant is born with myelomeningocele (spin bifida). The nurse caring for the neonate should place the infant in what position?

Prone - prone position helps prevent pressure on fatlike protrusion on the back

The 4 year old child was crying near the fireplace when the clothing caught fire and enveloped the child in flames. The nurse was in the home. Which action should the nurse take first?

Push the child to the ground and make the child roll

The nurse cares for a young child diagnosed with a respiratory infection. The nurse understands that children are more prone to respiratory infection.. which reason?

The child's airway is a smaller diameter than is found in adults

Which guideline is appropriate for the nurse to give the mother concerning the developmental age of her 7-year-old child?

The child's periods of shyness should be tolerated.

Which guideline is appropriate for the nurse to give to a parent concerning the normal developmental of the young school-age child?

The child's periods of shyness should be tolerated.

The nurse performs assessments in the well-baby clinic. The nurse identifies which finding is a warning sign of cerebral palsy (CP)?

The infant has poor head control after 3 months.

The nurse performs assessments in the well-baby clinic. The nurse identifies which finding is a warning sign of cerebral palsy(CP)?

The infant has poor head control after 3 months.

The 5 month old infant is brought to the clinic by a parent for a well- baby check up. The nurse expects to make which observation?

The infant puts their feet to their mouth when lying supine

the 5-month-old infant is brought to the clinic by a parent for a well-baby check-up. the nurse expects to make which observation 1. The infant sits without support 2. The infant transfers an object from hand-to-hand 3. The infant puts their feet to their mouth when lying supine 4. The infant appears afraid of strangers

The infant puts their feet to their mouth when lying supine

the 4-month-old infant is seen in the well-child clinic. the nurse is most concerned if which finding is observed? 1. The infant's head turns to the side when a sound is made at the level of the ear 2. The infant's head lags when pulled from a lying to sitting position 3. The infant is drooling 4. The infant smiles spontaneously

The infant's head lags when pulled from a lying to

The 4 month old infant is seen in the well-child clinic. The nurse is most concerned if which finding is observed?

The infant's head lags when pulled from a lying to a sitting position

The four month old infant is seen in the well child clinic. The nurse is concerned if which finding is observed?

The infant's head lags when pulled from a lying to a sitting position.

The nurse cares for the infant immediately after insertion of a shunt due to hydrocephalus. Which observation by the nurse should be reported to the health care provider immediately?

The infant's pupils are dilated

the 18-month-old child is admitted to the hospital. when the parents leave, the child starts to cry loudly, and the nurse attempts to console the child. after a while the child stops crying and becomes quiet and withdrawn. the nurse thinks that the child has accepted the situation and has adjusted well to the separation. which statement is true? 1. The nurse is correct and has acted appropriately 2. The nurse fails to see that the child has entered the second stage of separation anxiety 3. The nurse fails to see that the child has entered third state of separation anxiety 4. The nurse is falsely interpreting undesirable behavior

The nurse fails to see that the child has entered second state of separation anxiety

The pediatric nurse performs an exam on the three-year-old. The nurse suspects the child may have strabismus. Which observation, made by.. may indicate this type of visual impairment?

The nurse observes that the child closes one eye when looking around the room.

The nurse supervised the family caring for the child diagnosed with cerebral palsy. The nurse should intervene if which finding is observed?

The older sister places a toy in the child's hands

The nurse prepares to administer digoxin to an infant. Which finding would cause the nurse to hold the infant's digoxin and contact the health care provider?

The parent reports the infant vomited four times during the night.

A toddler client is diagnosed with a tonic-clonic seizure disorder. The home health nurse intervenes if which finding is observed?

The parent takes the child's temperature using an oral electronic thermometer.

An infant is found to have an excessive amount of oral secretions after birth. During the first feeding the infant has a chocking episode accompanied by cyanosis. The nurse knows that these symptoms are indicative of which problem?

Tracheoesophageal defect

Tracheoesophageal defect. Group of congenital anomalies in which the esophagus ends in a blind pouch and the trachea is attached to the esophagus via a fistula. infant will have resp difficulty from birth and experience choking with first feeding.

the nurse recognizes that which child is at greatest risk for poisoning? 1. a 5-month-old 2. a 2-year-old 3. a 5-year-old 4. a 7-year-old

a 2-year-old

the school nurse assesses children enrolled in the kindergarten class. the nurse is most concerned if which finding is observed? 1. a child throws and catches a ball 2. a child is able to neatly tie shoelaces 3. a child eats with fingers 4. a child walks down stairs by placing both feet on one step

a child walks down stairs by placing both feet on one step

Nurse is observing kindergarten children. She is concerned to observe..

a child walks down the stairs by placing both feet on one step. At kindergarten age, the kid should use alternating feet down stairs.

The nurse provides care for an infant diagnosed with a cyanotic congenital heart defect. the nurse understands that chronic hypoxia from this disorder can result in which finding? a. intellectual disability b. polycythemia c. respiratory infections d. fluid retention.

b. polycythemia. in chronic hypoxia, the body tries to compensate by producing more red blood cells to carry the limited amount of oxygen available to the tissues.

THe nurse cares for the infant immediately after insertion of a shunt due to hydrocephalus. Which observation should be reported to HCP immediately? a. infant is flat in bed. b. pupils are dilated. c. suture line is pink. d. bowel sounds are in all four quadrants.

b. pupils are dilated: indicated increased intracranial pressure. lying flat is appropriated to prevent too rapid reduction of intracranial fluid. Appropriate for suture to be pink.

The 3 year old child is seen in local clinic for croup. The parents ask the nurse what to do for the child at home to alleviate symptoms. Which suggestion by the nurse is MOST appropriate? a. let child rest and call HCP if child gets worse. b. place a pan of water below window and leave open. c. put child in bathroom with hot water running and leave until improvement. d. stand with your child in front of an open freezer.

d. cool air will constrict edematous blood vessels. use a cold water vaporizer or take the child to cool basement. offer fluids that child likes.

the clinic nurse teaches a parent how to care for a child with impetigo. the nurse knows that the greatest danger associated with an impetigo infection is the risk of which complication? 1. infecting a potentially large group of people 2. developing glomerulonephritis secondary to streptococcus infection 3. acquiring a superinfection 4. progressive tissue necrosis and gangrene

developing glomerulonephritis secondary to streptococcus infection

the 3-year-old child is seen in the local clinic for croup. the child's parent asks the nurse what to do for the child at home to alleviate symptoms. which suggestion by the nurse is most appropriate? 1. just let your child rest and call the health care provider if your child gets worse 2. place a pan of water below the window in the bedroom and leave the window open 3. place your child in the bathroom with hot water running and leave your child there until there is improvement 4. stand with your child in front of an open freezer

stand with your child in front of an open freezer

the nurse performs assessments in the well-baby clinic. the nurse identifies which finding is a warning sign of cerebral palsy (CP)? 1. the infant has poor head control after 3 months 2. the infant sits with support by 8 months 3. the infant uses arms and legs to crawl across the room 4. he infant smiles at the mother by 3 months

the infant has poor head control after 3 months

the nurse cares for the infant immediately after insertion of a shunt due to hydrocephalus. which observation by the nurse should be reported to the health care provider immediately? 1. the infant in lying flat in bed 2. the infant's pupils are dilated 3. the suture line is pink 4. bowel sounds are heard in all quadrants

the infant's pupils are dilated

the school nurse assesses the physical development of school-age children. which is the most valuable tool for this assessment? 1. the thickness of skin folds over the deltoid muscle and scapula 2. the weight and heigh compared to standard tools 3. the rate of increase in head circumference

the weight and heigh compared to standard tools

the 2-year-old child is brought to the clinic for extensive facial burns. the child's parent states that they resulted from the child's running into a lighted cigarette. the child is holding on to the parent and doesn't want to let go to be examined. which is the best rational for the nurse to suspect this parent is abusing the child? 1. the injury is on the face 2. the parent is upset about the accident 3. the child is clinging to the parent, refusing to cooperate with the nurse 4. there is little relationship between the extent of the child's burns and the history

there is little relationship between the extent of the child's burns and the history

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