Peds Focus Review Practice
When describing the various changes that occur in organ systems during adolescence, what would the nurse include? A) Significant increase in brain size B) Ossification completed later in girls C) Decrease in heart rate D) Decrease in activity of sebaceous glands
Ans: C Feedback: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.
21. A child is diagnosed with a helminthic infection. Which treatments would the nurse expect to be prescribed? Select all that apply. A. Erythromycin B. Albendazole C. Pyrantel pamoate D. Acyclovir E. Metronidazole F. Permethrin
Answer: B, C Rationale: Drugs used to treat helminthic infections include albendazole and pyrantel pamoate. Erythromycin is used to treat bacterial infections. Acyclovir is used to treat viral infections. Metronidazole is used to treat trichomoniasis. Permethrin is used to treat pedicu
26. The nurse is preparing a class for a group of adolescents about promoting safety. What would the nurse plan to include as the leading cause of adolescent injuries? A) Motor vehicles B) Firearms C) Water D) Fires
Ans: A Feedback: Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.
18. A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally? A. Recombinant human DNase B. Bronchodilators C. Anti-inflammatory agents D. Pancreatic enzymes
Answer: D Rationale: Pancreatic enzymes are administered orally to promote adequate digestion and absorption of nutrients. Recombinant human DNase, bronchodilators, and anti-inflammatory agents are typically administered by inhalation.
10. After teaching a group of parents about language development in toddlers, what if stated by a member of the group indicates successful teaching? A) "When my 3-year-old asks 'why?' all the time, this is completely normal." B) "A 15-month-old should be able to point to his eyes when asked to do so." C) "At age 2 years, my son should be able to understand things like under or on." D) "An 18-month-old would most likely use words and gestures to communicate." Ans: A
Ans: A Feedback: Language development occurs rapidly in a toddler. By age 3 years, "why" and "what" questions dominate in the child's language. Pointing to named body parts is characteristic of a 2-year-old. Understanding concepts such as on, under, or in is typical of a 3-year-old. A 1-year-old would communicate with words and gestures.
.The nurse is teaching the student nurse the sequence for performing the assessment techniques during a physical examination. What is the appropriate order? A) Inspection, palpation, percussion, auscultation B) Inspection, percussion, palpation, auscultation C) Palpation, percussion, inspection, auscultation D) Inspection, auscultation, palpation, percussion
Ans: A Feedback: The physical examination of children, just as for adults, begins with a systematic inspection: checking color, warmth, characteristics, and texture visually and smelling for any odor. Palpation follows inspection to validate observations. Next, percussion is used to determine the location, size, and density of organs or masses. The stethoscope is used last to auscultate the heart, lungs, and abdomen.
The nurse is preparing a class for a group of adolescents about promoting safety. What would the nurse plan to include as the leading cause of adolescent injuries? A) Motor vehicles B) Firearms C) Water D) Fires
Ans: A Feedback: Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.
7. The nurse uses family-centered care to provide care for children in a pediatric office. Upon what concept is family-centered care based? A) The family is the constant in the child's life and the primary source of strength. B) The care provider is the constant in the child's life and the primary source of strength. C) The child must be prepared to be his or her own source of strength during times of crisis. D) The wishes of the family should direct the nursing care plan for the child.
Ans: A Feedback: Family-centered care involves a partnership between the child, family, and healthcare providers in planning, providing, and evaluating care. Family-centered care enhances parents' and caregivers' confidence in their own skills and also prepares children and young adults for assuming responsibility for their own healthcare needs. It is based on the concept that the family is the constant in the child's life and the primary source of strength and support for the child.
37. When providing care to a child with aplastic anemia, which nursing diagnosis would be the priority? A) Risk for injury B) Imbalanced nutrition, less than body requirements C) Ineffective tissue perfusion D) Impaired gas exchange
Ans: A Feedback: For the child with aplastic anemia, safety is of the utmost concern, with injury prevention essential to prevent hemorrhage. Nutrition, tissue perfusion, and gas exchange may or may not be associated with the child's condition.
22.The nurse is caring for a 6-year-old child who has multisystem trauma due to a motor vehicle accident. The child is receiving total parenteral nutrition (TPN). What is a recommended nursing intervention for children on TPN? A) Initially, check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. B) Be vigilant in monitoring the infusion rate, change the rate as necessary, and report any changes to the healthcare provider or nurse practitioner. C) If for any reason the TPN infusion is interrupted or stops, begin an infusion of a 10% saline at the same infusion rate as the TPN. D) Administer TPN continuously over an 8-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.
Ans: A Feedback: Initially, the nurse should check blood glucose levels frequently, such as every 4 to 6 hours, to evaluate for hyperglycemia. Throughout TPN therapy, the nurse should be vigilant in monitoring the infusion rate and report any changes in the infusion rate to the healthcare provider or nurse practitioner immediately. Adjustments may be made to the rate, but only as ordered by the healthcare provider or nurse practitioner. If for any reason the TPN infusion is interrupted or stops, the nurse should begin an infusion of a 10% dextrose solution at the same infusion rate as the TPN. TPN can be administered continuously over a 24-hour period, or after initiation it may be given on a cyclic basis, such as over a 12-hour period during the night.
16.The nurse is preparing to administer an intramuscular injection to an 8-month-old infant. Which site would the nurse select? A) Rectus femoris B) Vastus lateralis C) Dorsogluteal muscle D) Deltoid
Ans: B Feedback: The preferred injection site in infants is the vastus lateralis muscle. An alternative site is the rectus femoris. The dorsogluteal site is not used in children until the child has been walking for at least 1 year. The deltoid muscle is used as a site in children after the age of 4 or 5 years.
2.The nurse is caring for a 7-year-old girl hospitalized in isolation. The nurse notices that she has begun sucking her thumb and changing her speech patterns to those of a toddler. What condition is the girl manifesting? A) Regression B) Suppression C) Repression D) Denial
Ans: A Feedback: Sucking the thumb and changing of speech pattern (such as to baby talk) are signs of regression, a defense mechanism used by children to deal with unpleasant experiences by returning to a previous stage that may be more comfortable to the child. Suppression is a conscious inhibition of an idea or desire. Repression is an unconscious inhibition of an idea or desire. Denial would be exhibited by expressions of resignation instead of true contentment, not thumb sucking or baby talk.
The nurse is interviewing a 3-year-old girl who tells the nurse: "Want go potty." The parents tell the nurse that their daughter often speaks in this type of broken speech. What would be the nurse's appropriate response to this concern? A) "This is a normal, common speech pattern in the 3-year-old and is called telegraphic speech." B) "This is considered a developmental delay in the 3-year-old and we should consult a speech therapist." C) "This is a condition known as echolalia and can be corrected if you work with your daughter on language skills." D) "This is a condition known as stuttering and it is a normal pattern of speech development in the toddler."
Ans: A Feedback: Telegraphic speech is common in the 3-year-old. Telegraphic speech refers to speech that contains only the essential words to get the point across, much like a telegram. In telegraphic speech, the nouns and verbs are present and are verbalized in the appropriate order (Feigelman, 2016b). Echolalia (repetition of words and phrases without understanding) normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language. Stuttering usually has its onset at between 2 and 4 years of age. It occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start
The nurse is providing home care instructions for a 13-year-old girl recently diagnosed with systemic lupus erythematosus. Which response by the girl indicates a need for further teaching? A) "I need to wear sunscreen in the summer to prevent rashes. B) "I need to eat a healthy diet, exercise, and get plenty of sleep." C) "I need an eye examination every year." D) "I need to be careful when it is cold; I should always wear gloves."
Ans: A Feedback: The nurse needs to emphasize that the girl should apply sunscreen every day, not just in the summer, to prevent rashes resulting from photosensitivity. A healthy diet, sleep, yearly eye examinations, and protection from cold weather are appropriate measures.
The parent of a 6-month-old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent? A) "Thumb sucking is a healthy self-comforting activity." B) "Thumb sucking leads to the need for orthodontic braces." C) "Caregivers should pay special attention to the thumb sucking to stop it." D) "Thumb sucking should be replaced with the use of a pacifier."
Ans: A Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.
47. The nurse is assessing a child with aplastic anemia. What would the nurse expect to assess? Select all that apply. A) Ecchymoses B) Tachycardia C) Guaiac-positive stool D) Epistaxis E) Severe pain F) Warm tender joints
Ans: A, B, C, D Feedback: Assessment findings associated with aplastic anemia include ecchymoses, epistaxis, guaiac-positive stools, and tachycardia. Severe pain and warm tender joints are most often associated with sickle cell crisis.
20.A nurse is developing a plan of care for a child who is admitted to the hospital for surgery. The child is visually impaired. What would be most appropriate for the nurse to include in the child's plan of care? Select all that apply. A) Explaining instructions using simple and specific terms the child understands B) Allowing the child to explore the postoperative equipment with his hands C) Touching the child on his shoulder before letting the child know someone is there D) Using the child's body parts to refer to the area where he may have postoperative pain E) Speaking to the child in a voice that is slightly louder than the usual tone of voice
Ans: A, B, D Feedback: When interacting with a visually impaired child, the nurse would make directions and instructions simple and specific, encourage exploration of objects such as postoperative equipment through touch, and use the parts of the child's body as reference points for the location of items or for this child, his or her postoperative pain. The nurse should identify him- or herself first before touching the child and speak in a tone of voice that is appropriate to the situation.
When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. What accurately describes these factors? Select all that apply. A) Increased physical growth B) Insufficient psychomotor coordination C) Tiredness, lack of energy D) Lack of impulsivity E) Peer pressure F) Inexperience
Ans: A, B, E, F Feedback: Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes
17. When assessing adolescents for health risks, the nurse must keep in mind the factors related to the prevalence of adolescent injuries. What accurately describes these factors? Select all that apply. A) Increased physical growth B) Insufficient psychomotor coordination C) Tiredness, lack of energy D) Lack of impulsivity E) Peer pressure F) Inexperience
Ans: A, B, E, F Feedback: Influencing factors related to the prevalence of adolescent injuries include increased physical growth, insufficient psychomotor coordination for the task, abundance of energy, impulsivity, peer pressure, and inexperience. Impulsivity, inexperience, and peer pressure may place the teen in a vulnerable situation between knowing what is right and wanting to impress peers. On the other hand, teens have a feeling of invulnerability, which may contribute to negative outcomes.
The nurse is providing atraumatic care to children in a hospital setting. What are principles of this philosophy of care? Select all that apply. A) Avoid or reduce painful procedures. B) Avoid or reduce physical distress. C) Minimize parent-child interactions. D) Provide child-centered care. E) Minimize child control. F) Use core primary nursing.
Ans: A, B, F Feedback: When using atraumatic care, the nurse would avoid or reduce painful procedures, avoid or reduce physical distress, use core primary nursing, maximize parent-child interactions, provide family-centered care, and provide opportunities for control, such as participating in care, attempting to normalize daily schedule, and providing direct suggestions.
21. The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). What would the nurse identify as supporting this diagnosis? Select all that apply. A) Positive antinuclear antibody (ANA) B) Increased C3 levels C) Thrombocytopenia D) Decreased C4 levels E) Increased hematocrit
Ans: A, C, D Feedback: Laboratory findings may include decreased hemoglobin and hematocrit, decreased platelet count, and low white blood cell count. Complement levels, C3 and C4, will also be decreased. Though not specific to SLE, the ANA is usually positive in children with SLE.
23.A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the healthcare provider to prescribe? Select all that apply. A) Intravenous immunoglobulin B) Ibuprofen C) Acetaminophen D) Aspirin E) Alprostadil
Ans: A, D Feedback: In the acute phase, high-dose aspirin in four divided doses daily and a single infusion of intravenous immunoglobulin are used. Acetaminophen is used to reduce fever. Nonsteroidal anti-inflammatory agents such as ibuprofen are avoided while the child is receiving aspirin therapy. Alprostadil is used to temporarily keep the ductus arteriosus patent in infants with ductal-dependent congenital heart defects.
Based on Erikson's developmental theory, what is the major developmental task of the adolescent? A) Gaining independence B) Finding an identity C) Coordinating information D) Mastering motor skills
Ans: B Feedback: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years, the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.
9.After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify what as a characteristic of therapeutic play? A) Focus on coping B) Use of a highly structured format C) Dramatization of emotions D) Expression of feelings
Ans: B Feedback: Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted out or dramatized, allowing the child to express his or her feelings.
26.The parents of a child receiving total parenteral nutrition ask the nurse why their child must have their blood glucose monitored so frequently since they are not diabetic. What is the best response by the nurse? A) "We like to keep a close check on the blood glucose for all children receiving total parenteral nutrition." B) "It is important to monitor the blood glucose level because the solution has a high concentration of carbohydrates that convert to glucose." C) "This is a good time for us to monitor your child in case they start developing signs of diabetes related to receiving total parenteral nutrition." D) "I would suggest you ask the healthcare provider why blood glucose checks have been ordered so frequently." Ans: B
Ans: B Total parenteral nutrition has a high concentration of carbohydrates, which convert to glucose. Informing the parents that this is the reason for frequent monitoring of the blood glucose adequately addresses their question. It is routine for any client receiving total parenteral nutrition to have frequent monitoring of blood glucose, but this does not answer the parent's question. There is no need to monitor a child for diabetes without reason. There is no reason to suggest asking the healthcare provider when this question can be answered by the nurse.
5.Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned? A) Plantar grasp B) Step C) Babinski D) Neck righting
Ans: B Feedback: Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.
During a health history, the nurse explores the sleeping habits of a 3-year-old boy by interviewing his parents. Which statement from the parents reflects a recommended guideline for promoting healthy sleep in this age group? A) "Our son sleeps through the night, and we insist that he takes two naps a day." B) "We keep a strict bedtime ritual for our son, which includes a bath and bedtime story." C) "Our son still sleeps in a crib because we feel it is the safest place for him at night." D) "Our son occasionally experiences night walking so we allow him to stay up later when this happens.
Ans: B Feedback: Consistent bedtime rituals help the toddler prepare for sleep; the parent should be advised to choose a bedtime and stick to it as much as possible. The nightly routine might include a bath followed by reading a story. A typical toddler should sleep through the night and take one daytime nap. Most children discontinue daytime napping at around 3 years of age. When the crib becomes unsafe (that is, when the toddler becomes physically capable of climbing over the rails), then he or she must make the transition to a bed. Attention during night waking should be minimized so that the toddler receives no reward for being awake at night.
26.After teaching the mother about follow-up immunizations for her daughter, who received the varicella vaccine at age 14 months, the nurse determines that the teaching was successful when the mother states that a follow-up dose should be given at which time? A) When the child is 20 to 36 months of age B) When the child is 4 to 6 years of age C) When the child is 11 to 12 years of age D) When the child is 13 to 15 years of age
Ans: B Feedback: A second dose of varicella vaccine should be given when the child is 4 to 6 years of age. Hepatitis A vaccine should be given to infants at age 12 months, with a repeat dose given in 6 to 12 months. The human papillomavirus (HPV) vaccine should be given to children beginning at age 11 to 12 years, with catch-up doses to begin at 13 to 14 years of age.
Based on Erikson's developmental theory, what is the major developmental task of the adolescent? A) Gaining independence B) Finding an identity C) Coordinating information D) Mastering motor skills Ans: B
Ans: B Feedback: According to Erikson, it is during adolescence that teenagers achieve a sense of identity. The toddler developed a sense of trust in infancy and is ready to give up dependence and to assert his or her sense of control and autonomy. The psychosocial task of the preschool years is establishing a sense of initiative versus guilt by mastering skills. In the school-age years, the child develops concrete operations and is able to assimilate and coordinate information about the world from different dimensions.
.The nurse is caring for a 7-year-old boy who needs his left leg immobilized. What is the priority nursing intervention? A) Enlist the assistance of a child life specialist. B) Explain to the boy that he must keep his leg very still. C) Apply a clove-hitch restraint to the boy's left leg. D) Explain that a restraint will be applied if he cannot hold still.
Ans: B Feedback: An explanation about the desired goal is necessary and appropriate for a 7-year-old child to understand what is required. In many cases, this will be all that is needed. Explaining that a restraint will be applied if the boy cannot hold still will likely be perceived as a threat or punishment. All alternative measures need to be tried before the use of restraints. Enlisting the assistance of the child life specialist is not a priority.
23.The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment? A) How the pain impacts the child's and family's stress level B) The pain's history, onset, intensity, duration, and location C) The child's and parents' feeling of anxiety and depression D) The child's cognitive level and emotional response
Ans: B Feedback: Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.
22.When preparing to apply a restraint to a child, what would be most important for the nurse to do? A) Expect to keep the restraint on for at least 8 hours. B) Explain that safety, not punishment, is the reason for the restraint. C) Plan to use a square knot to secure the restraint to the side rails. D) Use a limb restraint rather than a jacket restraint for most issues.
Ans: B Feedback: Before applying a restraint, the nurse needs to explain the reason for the restraint to the child, emphasizing that the restraint is for safety, not to punish the child. The least restrictive type of restraint should be used, and it should be applied for the shortest time necessary. A clove-hitch knot is used to secure the restraint with ties to the bed or crib frame, not the side rails.
41. A child with suspected sickle cell disease is scheduled for a hemoglobin electrophoresis. When reviewing the child's history, what would the nurse identify as potentially interfering with the accuracy of the results? A) Use of iron supplementation B) Blood transfusion 1 month ago C) Lack of fasting for 12 hours D) History of recent infection
Ans: B Feedback: Blood transfusion within the previous 12 weeks may alter the results of the hemoglobin electrophoresis. Iron supplements can increase serum ferritin levels. Children should fast for 12 hours before having a specimen obtained for iron levels. A history of infection might interfere with the white blood cell count results, not hemoglobin electrophoresis.
6. When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess? A) Hirsutism or striae B) Strawberry tongue C) Malar rash D) Café au lait spots
Ans: B Feedback: Dry, fissured lips and a strawberry tongue are common findings with Kawasaki disease. Acne, hirsutism, and striae are associated with anabolic steroid use. Malar rash is associated with lupus. Café au lait spots are associated with neurofibromatosis.
1. The nurse is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching? A) "We will leave fireworks displays to the professionals." B) "I will set our water heater at 130 degrees." C) "All sleepwear should be flame retardant." D) "The handles of pots on the stove should face inward."
Ans: B Feedback: If the temperature of the water heater is set at 130°F, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120°F. Leaving fireworks to the professionals, using flame -retardant sleepwear, and turning the handles of pots on the stove inward are correct.
9. The nurse is caring for a 2-month-old with a cleft palate. The child will undergo corrective surgery at age 3 months. The mother would like to continue breastfeeding the baby after surgery and wonders if it is possible. How should the nurse respond? A) "There is a good chance that you will be able to breastfeed almost immediately." B) "Breastfeeding is likely to be possible but check with the surgeon." C) "After the suture line heals, breastfeeding can resume." D) "We will have to wait and see what happens after the surgery."
Ans: B Feedback: Postoperatively, some surgeons allow breastfeeding to be resumed almost immediately. However, the nurse needs to advise the mother to check with the surgeon to determine when breastfeeding can resume. Telling the mother that she has to wait until the suture line heals may be inaccurate. Telling her to wait and see does not answer her question.
A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information? A) "This is a primitive reflex known as the plantar grasp." B) "This is a primitive reflex known as the palmar grasp." C) "This is a protective reflex known as rooting." D) "This is a protective reflex known as the Moro reflex."
Ans: B Feedback: Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."
The nurse is teaching good sleep habits for toddlers to the mother of a 3-year-old boy. Which response indicates the mother understands sleep requirements for her son? A) "I'll put him to bed at 7 PM, except Friday and Saturday." B) "He needs 12 hours of sleep per day including his nap." C) "I need to put the side down on the crib so he can get out." D) "His father can give him a horseback ride into his bed."
Ans: B Feedback: The mother understands her child needs 12 hours of sleep and one nap per day. Routines, such as the same bedtime every night, promote good sleep. However, a horseback ride to bed may cause problems because it may not provide a calming transition from play to sleep. A bath and reading a book would be better. If the child can climb out of a crib, he needs to be in a youth bed or regular bed to avoid injury.
10. The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation? A) "My baby does not make any grunting noises." B) "The baby seems more comfortable over my shoulder." C) "The baby usually drinks all of her bottle." D) "I don't notice any rapid breathing patterns."
Ans: B Feedback: The nurse should be alert to statements indicating that the baby seems to be more comfortable when she is sitting up or over her mother's shoulder than when she is lying flat. Grunting or rapid breathing would be a cause for concern. Drinking all of the bottle would be considered normal.
9.After teaching a group of students about therapeutic play, the instructor determines that additional teaching is needed when the students identify what as a characteristic of therapeutic play? A) Focus on coping B) Use of a highly structured format C) Dramatization of emotions D) Expression of feelings
Ans: B Feedback: Therapeutic play is nondirected play, focused on helping the child cope with feelings and fears. Real-life stressors and emotions can be acted out or dramatized, allowing the child to express his or her feelings.
22. A nurse is performing a primary survey on a child who has sustained partial thickness burns over his upper body areas. What action should the nurse take first? A) Inspect the child's skin color. B) Assess for a patent airway. C) Observe for symmetric breathing. D) Palpate the child's pulse.
Ans: B Feedback: When performing a primary survey, the nurse first assesses the child's airway for patency and then intervenes accordingly to ensure that the airway is patent. Next the nurse would evaluate the child's skin color, respiratory effort, and symmetry of breathing and breath sounds. Then the nurse would determine the pulse strength, perfusion status, and heart rate.
26. A nurse is preparing a presentation for a local parent group about burn prevention and care in children. What would the nurse be least likely to include in the presentation when describing how to care for a superficial burn? A) Using cool water over the burned area until the pain lessens B) Applying ice directly to the burned skin area C) Covering the burn with a clean, nonadhesive bandage D) Giving the child acetaminophen for pain relief
Ans: B Feedback: With a superficial burn, ice should not be applied to the skin. Using cool water over the burn area; covering with a clean, nonadhesive bandage; and using acetaminophen for pain relief are appropriate to include in the presentation.
18. A nurse is preparing a class for parents of infants about managing diaper dermatitis. What advice would the nurse include in the presentation? Select all that apply. A) Applying topical nystatin to the diaper area B) Using a blow dryer on warm to dry the diaper area C) Refraining from using rubber pants over diapers D) Using scented diaper wipes to clean the area E) Washing the diaper area with an antibacterial soap
Ans: B, C Feedback: For diaper dermatitis, topical products such as ointments or creams containing vitamins A, D, and E; zinc oxide; or petrolatum help to provide a barrier. Nystatin is an antifungal agent used for diaper candidiasis. Using a blow dryer on warm to dry the area, avoiding the use of rubber pants, and using unscented diaper wipes or ones free of preservatives are appropriate. The area should be washed with a soft cloth, without harsh soaps.
28. The nurse is caring for a 6-month-old with a cleft lip and palate. The mother of the child demonstrates understanding of the disorder with which statements? Select all that apply. A) "My smoking during pregnancy didn't have anything to do with this disorder. Smoking primarily causes low birth weight." B) "I know my baby takes a lot longer to feed than most children this age." C) "It really worries me that my baby may have some other disorders that haven't been detected yet." D) "I wonder if my baby will develop speech problems when language development begins?" E) "Thankfully there are healthcare providers that specialize in correcting this type of disorder."
Ans: B, C, D, E Feedback: Feeding and speech are especially difficult for the child with cleft lip and palate until the defect is repaired. Cleft lip and palate occurs frequently in association with other anomalies and has been identified in more than 350 syndromes. Plastic surgeons or craniofacial specialists, oral surgeons, dentists or orthodontists, and prosthodontists are some of the healthcare providers that specialize in repair of this disorder. The mother is incorrect in stating that smoking is not associated with cleft lip or palate. Maternal smoking during pregnancy is a major risk factor for the disorder.
28. The mother of a 15-year-old girl has contacted the clinic to report that her daughter has burned the back of her hand with a curling iron. The child's mother reports the burn is mild but states her daughter is complaining of pain. After consulting with the healthcare provider, what instructions can the nurse anticipate will be recommended? Select all that apply. A) Apply a thin film of protective cocoa butter. B) Run cool water over the injured area. C) Apply ice for 15 to 20 minutes each hour until the pain subsides. D) Take acetaminophen using the manufacturer's guidelines. E) Apply a thin layer of petroleum jelly to the burned area.
Ans: B, D Feedback: Mild burns may be cared for at home. Cool water may be run over the injured tissue. Acetaminophen or ibuprofen may be administered for pain. Ointments and creams including butter, margarine, cocoa butter, and petroleum jelly should not be applied.
13.The nurse is completing an admission of a 10-year-old boy. Which actions will help the nurse establish a trusting and caring relationship with the child and his family? Select all that apply. A) The nurse should not minimize the child's fears by smiling. B) The nurse should initiate introductions. C) The nurse should not use formal titles at the introduction. D) The nurse should maintain eye contact at the appropriate level. E) The nurse should start communication with the child first and then move on to the family. F) The nurse should use age-appropriate communication with the child.
Ans: B, D, F Feedback: Regardless of the site of care, nursing care must begin by establishing a trusting, caring relationship with the child and family. The nurse should smile, start introductions, give his or her title, and let the child and family know what will happen and what is expected of them. The nurse should also maintain eye contact at the appropriate level, communicate with children at age-appropriate levels, and, with a younger child, start with the family first so the child can see that the family trusts you.
21.The nurse is explaining to the student nurse the therapeutic effects of total parenteral nutrition (TPN). What accurately describes the use of TPN? A) It is used short term to supply additional calories and nutrients as needed. B) It is delivered via the peripheral vein to allow rapid dilution of hypertonic solution. C) It is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. D) It is usually used when the child's nutritional status is within acceptable parameters.
Ans: C Feedback: TPN is a highly concentrated solution of carbohydrates, electrolytes, vitamins, and minerals. TPN provides all nutrients to meet a child's needs. It is delivered via central venous access to allow rapid dilution of hypertonic solution. It is usually used in a child with a nonfunctioning gastrointestinal (GI) tract, such as a congenital or acquired GI disorder; a child with severe failure to thrive or multisystem trauma or organ involvement; and preterm newborns.
14. A nurse is instructing a parent on how to obtain a stool culture for ova and parasites from a child with diarrhea. What would the nurse include in the teaching plan? A. "Give the child bismuth and then collect the next specimen." B. "Obtain the specimen from the toilet after the child has a bowel movement." C. "Keep the specimen from coming into contact with any urine." D. "Bring the specimen to the laboratory on the third day."
Ans: C Rationale: A stool specimen for culture must be free of urine, water, and toilet paper. Therefore, the parent needs to understand how to collect the specimen so that it does not come into contact with any these. In addition, the specimen should not be retrieved out of toilet water. Mineral oil, barium, and bismuth interfere with the detection of parasites. In such cases, spec imen collection should be delayed for 7 to 10 days. Once the specimen is collected, it should be brought to the laboratory immediately
9. The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching? A) "The baby may need as much as 150 calories/kg/day." B) "Small, frequent feedings are best if tolerated." C) "I need to feed him every hour to make sure he eats enough." D) "Gavage feedings may be required for now."
Ans: C Feedback: Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.
The nurse has seen a 15-year-old girl and a 16-year-old boy during health surveillance visits. Which physical characteristics would be seen in both teenagers? A) Decreased respiratory rates of 15 to 20 breaths per minute B) Eruption of the last four molars C) Increased shoulder, chest, and hip widths D) Fully functioning sweat and sebaceous glands
Ans: C Feedback: Both teenagers are in the middle state of adolescence, which is marked by an increase in shoulder, chest, and hip widths. Decreased respiratory rate occurs in early adolescence, as do fully functioning sweat and sebaceous glands. Eruption of the last four molars occurs in late adolescence.
. When describing the various changes that occur in organ systems during adolescence, what would the nurse include? A) Significant increase in brain size B) Ossification completed later in girls C) Decrease in heart rate D) Decrease in activity of sebaceous glands
Ans: C Feedback: During adolescence, the heart rate decreases while the systolic blood pressure increases. Brain growth continues, but the size of the brain does not increase significantly. Ossification is more advanced in girls and occurs at an earlier age. Sebaceous gland activity increases during adolescence.
24.The nurse is instructing a 7-year-old child and his parents about using his prescribed corrective lenses. What would the nurse include in these instructions? A) "Make sure to take your glasses off from time to time to allow your eyes to rest." B) "Remove your glasses with both hands and lay them with the lens upright on the surface." C) "Clean the glasses every day with a mild soap and water or commercial cleaning agent." D) "Use paper towels or tissues to dry and periodically clean the lenses."
Ans: C Feedback: Eyeglasses should be cleaned daily with mild soap and water or a commercial cleaning agent. The glasses should be worn at all times, but when removed, they should be removed with both hands and placed on their side (not directly on the lens on any surface). A soft cloth, not paper towels, tissues, or toilet paper, should be used to clean the lenses.
14.A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the healthcare provider will most likely order which medication? A) Alprostadil B) Heparin C) Indomethacin D) Spironolactone
Ans: C Feedback: Indomethacin is the drug typically ordered to close a patent ductus arteriosus. Alprostadil would be indicated to maintain the ductus arteriosus temporarily in infants with ductal-dependent congenital heart defects. Heparin would be used for prophylaxis and treatment of thromboembolic disorders, especially after surgery. Spironolactone would be used to manage edema due to heart failure and to treat hypertension.
10.The nurse is administering immunizations to children in a neighborhood clinic. What is the most frequent route of administration? A) Oral B) Intradermal C) Intramuscular D) Topical
Ans: C Feedback: Intramuscular (IM) administration delivers medication to the muscle. In children, this method of medication administration is used infrequently because it is painful, and children often lack adequate muscle mass for medication absorption. However, IM administration is used to administer certain medications, such as many immunizations.
27. The parents of a 5-year-old bring their son to the emergency department because of significant eyelid edema. The mother states, "He scratched himself near his eye a couple of days ago while playing outside in the yard." The nurse suspects periorbital cellulitis based on which finding? A) Evidence of discharge B) Reddened conjunctiva C) Purplish discoloration of eyelid D) Altered visual acuity
Ans: C Feedback: Periorbital cellulitis is a bacterial infection of the eyelids and tissue surrounding the eye. The bacteria may gain entry into the skin via an abrasion, laceration, insect bite, foreign body, or impetiginous lesion. It may also result from a nearby bacterial infection such as sinusitis. Findings include marked eyelid edema, purplish or red color of the eyelid, clear conjunctivae, absence of discharge, and normal visual acuity.
25. The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan? A) Place the baby on a soft mattress with a firm, flat pillow for the head. B) Place the head of the bed near the window to provide fresh air, weather permitting. C) Place the baby on his or her back when sleeping. D) If the baby sleeps through the night, wake him or her up for the night feeding.
Ans: C Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age, night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.
28.After teaching a group of students about visual disorders, the instructor determines that the teaching was successful when the students identify what as the most common cause of visual difficulties in children? A) Astigmatism B) Strabismus C) Refractive errors D) Nystagmus
Ans: C Feedback: The most common cause of visual difficulties in children is refractive errors. Astigmatism, strabismus, and nystagmus are other common visual disorders in children but are less common than refractive errors.
4.The nurse is caring for a 6-year-old visually impaired boy and is about to begin the physical examination. Which intervention would be most appropriate to promote effective communication with the child? A) Show him the stethoscope. B) Describe the examination room. C) Use his name before touching him. D) Allow him to explore the exam room.
Ans: C Feedback: When interacting with a visually impaired child, it is a good communication technique to use his name to gain his attention before touching him. Letting him listen to his heart with the stethoscope, describing the examination room, and promoting exploration by touch are sound ways to interact, but are not specific to communicating with the child at the beginning of the assessment.
1.The nurse is caring for children in a healthcare provider's office where health supervision is practiced. Which are some points of focus of health supervision? Select all that apply. A) Making referrals for all healthcare needs B) Monitoring disease incidence C) Optimizing the child's level of functioning D) Monitoring quality of care provided E) Teaching parents to prevent injury F) Providing care developed from national guidelines
Ans: C, E, F Feedback: Health supervision involves providing services proactively, with the goal of optimizing the child's level of functioning. It ensures the child is growing and developing appropriately and it promotes the best possible health of the child by teaching parents and children about preventing injury and illness (e.g., proper immunizations and anticipatory guidance). The framework for the health supervision visit is developed from national guidelines available through the U.S. Department of Health and Human Services (DHHS), the American Medical Association (AMA), and the American Academy of Pediatrics (AAP). Making referrals and monitoring disease incidence and quality of care provided may occur with this model, but they are not key focal points.
The nurse teaching safety to teens knows that which of these is the leading cause of death among adolescents? A) Drowning B) Poisoning C) Diseases D) Unintentional injuries
Ans: D Feedback: Unintentional injuries are the leading cause of death in adolescents (Curtin, Heron, Miniño, & Warner, 2018). Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids (Curtin et al., 2018). Males are more likely than females to die of any type of injury (Curtin et al., 2018).
A 6-year-old boy has been admitted to the hospital with burns. The nurse notes carbonaceous sputum. What action would be the priority? A) Determining the burn depth B) Eliciting a description of the burn C) Estimating burn extent D) Ensuring a patent airway
Ans: D Feedback: Carbonaceous sputum is a sign of potential airway injury due to smoke inhalation. Therefore, the nurse should ensure a patent airway while obtaining a brief history and simultaneously evaluating the child and providing emergency care. If the burn does not pose an immediate, life-threatening risk, the nurse would obtain an indepth history and elicit a description of the burn. Determining the burn depth and extent are part of the secondary survey.
2. The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next? A) Contact the healthcare provider. B) Offer a snack and administer another dose. C) Immediately administer another dose. D) Administer next dose as ordered in 12 hours.
Ans: D Feedback: Digoxin should be administered at regular intervals, every 12 hours, 1 hour before or 2 hours after feeding. If the child vomits digoxin, the nurse should not give a second dose and should wait until the next scheduled dose. It is not necessary to contact the healthcare provider.
24. As part of a clinical conference with a group of nursing students, the instructor is describing the burn classification. The instructor determines that the teaching has been successful when the group identifies what as characteristic of full-thickness burns? A) Skin that is reddened, dry, and slightly swollen B) Skin appearing wet with significant pain C) Skin with blistering and swelling D) Skin that is leathery and dry with some numbness
Ans: D Feedback: Full-thickness burns may be very painful, numb, or pain-free in some areas. They appear red, edematous, leathery, dry, or waxy and may display peeling or charred skin. Superficial burns are painful, red, dry, and possibly edematous. Partialthickness and deep partial-thickness burns are very painful and edematous and have a wet appearance or blisters.
21.The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the healthcare provider if the infant's apical pulse rate was: A) 140 beats per minute B) 120 beats per minute C) 100 beats per minute D) 80 beats per minute
Ans: D Feedback: In an infant, if the apical pulse rate is less than 90 beats per minute, the dose is held and the healthcare provider should be notified.
The school nurse is preparing a talk on the influence of the media on school-age children to present at the next PTO meeting. Which fact might the nurse include in the introduction? A) Children in the United States spend about 6 hours a day either watching TV or playing video games. B) A child will see 2,000 murders by the end of grade school and 20,000 commercials a year. C) A school-age child cannot determine what is real from what is fantasy; therefore, TV and video games can lead to aggressive behavior. D) Parents should limit television watching and videogame playing to 2 hours per day.
Ans: D Feedback: Parents should limit television watching and videogame playing to 2 hours per day. Children in the United States spend about 4 hours a day either watching TV or playing video games. A child will see 8,000 murders by the end of grade school and 40,000 commercials a year. Although school-age children can determine what is real from what is fantasy, research has shown that this amount of time in front of the TV—watching it or playing video games—can lead to aggressive behavior, less physical activity, and altered body image.
23. The nurse is administering a hepatitis B vaccine to a child. What is the classification of this type of vaccine? A) Killed vaccines B) Toxoid vaccines C) Conjugate vaccines D) Recombinant vaccines
Ans: D Feedback: Recombinant vaccines use genetically engineered organisms. The hepatitis B vaccine is produced by splicing a gene portion of the virus into a gene of a yeast cell. The yeast cell is then able to produce hepatitis B surface antigen to use for vaccine production. Killed vaccines contain whole dead organisms; they are incapable of reproducing but are capable of producing an immune response. Toxoid vaccines contain protein products produced by bacteria called toxins. The toxin is heat -treated to weaken its effect, but it retains its ability to produce an immune response. Conjugate vaccines are the result of chemically linking the bacterial cell wall polysaccharide (sugar-based) portions with proteins.
The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.
Ans: D Feedback: Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount
The nurse emphasizes that a toddler younger than the age of 18 months should never be spanked primarily for which reason? A) Spanking in a child this age predisposes the child to a pro-violence attitude. B) The child will become resentful and angry, leading to more outbursts. C) Spanking demonstrates a poor model for problem-solving skills. D) There is an increased risk for physical injury in this age group.
Ans: D Feedback: Spanking should never be used with toddlers younger than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.
24.The nurse is monitoring a child who has received epidural analgesia with morphine. The nurse is careful to monitor for which adverse effect of the medication? A) Epidural hematoma B) Arachnoiditis C) Spinal headache D) Respiratory depression
Ans: D Feedback: The nurse needs to monitor for signs of respiratory depression, a potential adverse effect of the opioid medication. Epidural hematoma, arachnoiditis, and spinal headache are potential adverse effects of the insertion of the epidural catheter.
32. The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management? A) Administer a nonsteroidal anti-inflammatory drug (NSAID) as ordered. B) Use guided imagery and therapeutic touch. C) Administer meperidine as ordered. D) Initiate pain assessment with a standardized pain scale.
Ans: D Feedback: The nurse should first initiate pain assessment with a standardized pain scale upon admission and provide frequent evaluations of pain. Administering NSAIDs or meperidine and the use of nonpharmacologic pain management techniques are all appropriate. However, the first action is to assess the child's pain to provide a baseline for future comparison.
8. The nurse is caring for an 8-year-old girl who requires numerous venipunctures and injections daily. The nurse understands that the child is exhibiting signs of sensory overload and enlists the assistance of the child life specialist. What should the therapeutic play involve to best deal with the child's stressors? A) Puppets and dolls B) Drawing paper and crayons C) Wooden hammer and pegs D) Sewing puppets with needles
Ans: D Feedback: The nurse understands that the child may benefit from supervised needle play to assist the child undergoing frequent blood work, injections, or intravenous procedures. The child life specialist can determine what form of therapeutic play is best, but the nurse can recommend interventions based on his or her knowledge of the specific child.
The nurse teaching safety to teens knows which of these is the leading cause of death among adolescents. A) Drowning B) Poisoning C) Diseases D) Unintentional injuries
Ans: D Feedback: Unintentional injuries are the leading cause of death in adolescents (Curtin, Heron, Miniño, & Warner, 2018). Motor vehicle accidents are the leading cause of injury death followed by poisoning, primarily due to drug overdose from opioids (Curtin et al., 2018). Males are more likely than females to die of any type of injury (Curtin et al., 2018).
12. After teaching a class on the role of white blood cells in infection, the instructor determines that the teaching was successful when the class identifies which type of white blood cells as important in combating bacterial infections? A. Neutrophils B. Eosinophils C. Basophils D. Lymphocytes
Answer: A Rationale: Elevations in certain portions of the white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.
6. The nurse is educating the parents of a 7-year-old boy with asthma about the medications that have been prescribed. Which drug would the nurse identify as an adjunct to a β2-adrenergic agonist for treatment of bronchospasm? A. Ipratropium B. Montelukast C. Cromolyn D. Theophylline
Answer: A Rationale: Ipratropium is an anticholinergic administered via inhalation to produce bronchodilation without systemic effects. It is generally used as an adjunct to a β2-adrenergic agonist. Montelukast decreases the inflammatory response by antagonizing the effects of leukotrienes. Cromolyn prevents release of histamine from sensitized mast cells. Theophylline provides for continuous airway relaxation.
9. When developing the plan of care for a child with cerebral palsy, which treatment would the nurse expect as least likely? A. Skeletal traction B. Physical therapy C. Orthotics D. Occupational therapy
Answer: A Rationale: Skeletal traction would be the least likely treatment for a child with cerebral palsy. Physical therapy, orthotics and braces, and occupational therapy are all common treatments used for cerebral palsy.
18. An 8-year-old girl was diagnosed with a closed fracture of the radius at approximately 2 p.m. The fracture was reduced in the emergency department and her arm placed in a cast. At 11 p.m. her mother brings her back to the emergency department due to unrelenting pain that has not been relieved by the prescribed narcotics. Which action would be the priority? A. Notifying the doctor immediately B. Applying ice C. Elevating the arm D. Giving additional pain medication as ordered
Answer: A Rationale: The nurse should notify the doctor immediately because the girl's symptoms are the classic sign of compartment syndrome. Immediate treatment is required to prevent excessive swelling and to detect neurovascular compromise as quickly as possible. The ice should be removed and the arm brought below the level of the heart to facilitate whatever circulation is present. Giving additional pain medication will not help in this situation.
17. A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect to position the child in which manner? A. On her side with the head flexed forward and knees flexed to the abdomen B. Sitting upright with the head flexed forward to the chest C. Supine with arms and legs pronated and extended D. Prone with the arms flexed under the chest
Answer: A Rationale: When a lumbar puncture is performed on a child, the child is placed on his or her side with the head flexed forward and knees flexed to the abdomen. An infant would be positioned sitting upright with the head flexed forward. A supine position with the arms and legs pronat ed and extended suggests decerebrate posturing. A prone position is not used for a lumbar puncture.
41. The school nurse has performed scoliosis screening. Based on this assessment, which children require the nurse to implement a referral to the healthcare provider? Select all that apply. A. The child with asymetric shoulder elevation B. The child with a limb length discrepancy C. The child with a lateral curve of the spine D. The child with a one-sided hump upon bending over E. The child who's sibling had scoliosis surgically corrected F. The child who has uneven balance
Answer: A, B, C, D Rationale: Scoliosis is defined by a lateral curve of the spine greater than 10 degrees.This curve causes displacement of the ribs. The nurse would first inspect the back in a standing position and note any asymetric shoulder elevation, the prominence of one scapula, an uneven curve at the waistline, or a rib hump on one side. While standing the nurse could also assess for leg length discrepancy and this could be measured. The nurse would then have the child bend over and observe for a pronounced hump on one side. The nurse should notify the parents and refer the child to the healthcare provider for evaluation if any of these symptoms are found. The sibling with a scoliosis repair would not be a concern unless it was known the family had a genetic
24. The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? A. "Give your child high-calorie foods and snacks." B. "Feed your child foods that are high in protein." C. "Administer water soluble vitamins." D. "Give panreatic enzymes with meals." E. "Give your child foods high in fat."
Answer: A, B, D Rationale: Children with cystic fibrosis (CF) have trouble digesting and absorbing nutrients. They tend to be underweight. For optimal health, their diets should be high in calories and high in protein, with the supplementation of fat soluble vitamins and pancreatic enzymes. This diet
26. A parent with a child who has cystic fibrosis asks the nurse how to determine if the child is receiving an adequate amount of pancreatic enzymes. How should the nurse respond? Select all that apply. A. "The dose is adequate when your child is only having 1 to 2 stools per day. B. "The dose is adequate when your child's weight is improving." C. "The dose prescribed is based on your child's pancreatic laboratory values so it should be correct." D. "When your child starts to eat more quantity of food you will need to adjust the amount of enzyme pills." E. "You will need to give your child less enzyme pills when high-fat foods are eaten."
Answer: A, B, D Rationale: Pancreatic enzymes are required for the child with cystic fibrosis (CF) to help absorb nutrients from the diet and to aid in digestion. They are given with each meal and snack the child eats. The number of capsules required at each dose depends upon the diagnosis of how the pancreas is functioning and the amount of food needing to be digested. The pancreatic laboratory values may detemine a baseline for the number of pills to start with, but the dosage i s adjusted regularly. The dosage of pancreatic enzymes is adjusted until an adequate growth pattern is established and the child is having no more than 1 to 2 stools per day. The child should be given an increased number of enzyme pills when a meal with high-fat content is consumed, not fewer.
15. A group of nursing students are reviewing the medications used to treat asthma. The students demonstrate understanding of the information when they identify which agent as appropriate for an acute episode of bronchospasm? A. Salmeterol B. Albuterol C. Ipratropium D. Cromolyn
Answer: B Rationale: Albuterol is a short-acting β2-adrenergic agonist that is used for treatment of acute bronchospasm. Salmeterol is a long-acting β2-adrenergic agonist used for long-term control or exercise-induced asthma. Ipratropium is an anticholinergic agent used as an adjunct to β2- adrenergic agonists for treatment of bronchospasm. Cromolyn is a mast cell stabilizer used prophylactically but not to relieve bronchospasm during an acute wheezing episode.
7. The nurse is caring for a 2-month-old with cerebral palsy. The infant is limp and flaccid with uncontrolled, slow, worm-like, writhing, and twisting movements. What word would the nurse use when documenting these observations? A. Spastic B. Athetoid C. Ataxic D. Mixed
Answer: B Rationale: Athetoid cerebral palsy is characterized by abnormal, involuntary movement. It affects all four extremities with possible involvement of the face, neck, and tongue. The movements increase in periods of stress. Dysarthria and drooling may be present as well. Spastic cerebral palsy is characterized by poor control of posture, balance, and movement; e xaggeration of deep tendon reflexes; and hypertonicity of affected extremities. Ataxic is characterized by poor coordination, unsteady gait, and wide-based gait
10. The nurse is preparing a teaching plan for the parents of a child with a urinary tract infection (UTI). In educating the parents, the nurse would recommend that the child avoid: A. a liberal fluid intake. B. caffeine. C. cranberry juice. D. cotton underwear.
Answer: B Rationale: Caffeine is an irritant to the bladder and should be avoided. Liberal fluid intake and cranberry juice should be encouraged. The child should wear cotton underwear to avoid perineal irritation.
17. A nurse is preparing a presentation for a local parent group about urinary tract infections (UTIs) in children. Which organism would the nurse incorporate into the presentation as the most common cause? A. Klebsiella B. Escherichia coli C. Staphylococcus aureus D. Pseudomonas
Answer: B Rationale: E. coli most commonly causes UTI. Other less common causative organisms include Klebsiella, S. aureus, and Pseudomonas.
12. What information would the nurse include in the preoperative plan of care for an infant with myelomeningocele? A. Positioning supine with a pillow under the buttocks B. Covering the sac with saline-soaked nonadhesive gauze C. Wrapping the infant snugly in a blanket D. Applying a diaper to prevent fecal soiling of the sac
Answer: B Rationale: For the infant with a myelomeningocele, saline-soaked nonadhesive gauze or antibiotic-soaked gauze is used to keep the sac moist. The infant is positioned prone, with a folded towel under the abdomen, so that the urine and feces flow away from the sac. A warmer or isolette is used to keep the infant warm. Blankets are avoided because they could place excess pressure on the sac. Diapering may be contraindicated to avoid placing pressure on the sac.
20. While presenting a panel discussion to a group of parents about urinary tract infections (UTIs) in children, one of the parents asks the nurse, "Why would my daughter be more at risk than my son?" Which response by the nurse would be most accurate? A. "Girls have a smaller bladder size than boys do." B. "A girl's urethra is closer to the rectal opening." C. "A girl's urethra is longer than a boy's urethra." D. "Her kidneys are less well protected."
Answer: B Rationale: In females, the urethra is shorter, which allows bacteria to enter the bladder. It also is closer in physical proximity to the rectum, leading to possible contamination. Bladder size does not differ between boys and girls. The kidneys are less well protected in the abdomen, increasing the risk for injury but not UTIs.
3. The nurse is caring for a 10-year-old with Duchenne muscular dystrophy. As part of the plan of care, the nurse focuses on maintaining his cardiopulmonary function. Which intervention would the nurse implement to best promote maximum chest expansion? A. Deep-breathing exercises B. Upright positioning C. Coughing D. Chest percussion
Answer: B Rationale: The nurse should emphasize that the child's position should be arranged to promote maximum chest expansion. This is usually in the upright position. Deep-breathing exercises are for strengthening/maintaining respiratory muscles. Coughing helps clear the airways. Chest percussion helps loosen secretions in lungs.
19. The nurse is caring for an active 14-year-old boy who has recently been diagnosed with scoliosis. He is dismayed that a "jock" like himself could have this condition, and is afraid it will impact his spot on the water polo team. Which response by the nurse would best address the boy's concerns? A. "If you wear your brace properly, you may not need surgery." B. "The good news is that you have very minimal curvature of your spine." C. "Let's talk to another boy with scoliosis, who is winning trophies for his swim team." D. "Let's talk to the doctor about your treatment options.
Answer: C Rationale: Because this boy is concerned about limiting his participation in water polo and perceives scoliosis as a disease that does not affect "jocks," putting the child in contact with someone with the same problem would be helpful. Telling the adolescent about not needing surgery if he wears his brace or that his curvature is minimal may or may not be true in his case and thus would be false reassurance. Although these suggestions and also the suggestion about talking to the doctor about treatment options could be helpful by engaging his input in the treatment, these do not address his specific concerns about his body image.
39. An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A. Plastic deformity B. Buckle fracture C. Spiral fracture D. Greenstick fracture
Answer: C Rationale: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse.
19. Hydrocephalus is suspected in a 4-month-old infant. Which would the nurse expect to assess? A. Sunken fontanels B. Diminished reflexes C. Lower extremity spasticity D. Skull symmetry
Answer: C Rationale: Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk reflexes, and skull asymmetry.
39. An 18-month-old was brought to the emergency department by her mother, who states, "I think she broke her arm." The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal? A. Plastic deformity B. Buckle fracture C. Spiral fracture D. Greenstick fracture
Answer: C Rationale: A spiral fracture is very rare in children. A spiral femoral or humeral fracture, particularly in a child younger than 2 years of age, should always be thoroughly investigated to rule out the possibility of child abuse. Plastic, buckle, and greenstick fractures are common in children and do not usually suggest child abuse
19. When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess? A. Dullness over the lung fields B. Increased diaphragmatic excursion C. Decreased tactile fremitus D. Hyperresonance over the liver
Answer: C Rationale: Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lung fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.
1. The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis? A. Rash on face B. Edematous neck C. Hypothermia D. Coughing
Answer: C Rationale: Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.
20. A nurse is providing teaching to the parents of a child who has had a shunt inserted as treatment for hydrocephalus. The parents demonstrate understanding of the teaching when they make what statement? A. "Having the shunt put in decreases his risk for developmental problems." B. "If he doesn't get an infection in the first week, the risk is greatly reduced." C. "He will need more surgeries to replace the shunt as he grows." D. "The shunt will help to prevent any further complications from his disease."
Answer: C Rationale: Parents need to know that hydrocephalus is a chronic illness that requires lifelong follow-up and regular evaluations, including future surgeries as the child grows. The risk for infection is ever present, but is most common 1 to 2 months after shunt placement. The child with a shunt and hydrocephalus is at risk for potential growth and developmental disabilities as well as complications such as infection and malfunction of the shunt.
4. A 6-year-old child with cerebral palsy has been admitted to the hospital for some tests. The child's condition is stable. A parent remains with the child, but the parent is obviously exhausted and stressed. Which response by the nurse would be most appropriate? A. "Would you like me to bring you a blanket and pillow?" B. "You are doing such a wonderful job with your child." C. "Your child is in good hands; consider going home to get some sleep." D. "Are you planning to spend the night or to go home?"
Answer: C Rationale: Providing daily, intense care can be quite demanding and tiring. When a child with cerebral palsy is admitted to the hospital, this may serve as a time of respite for family and primary caregivers. The nurse should remind the parent that the child is in good hands and urge the parent to go home. Asking whether the parent is planning to stay might make the parent feel obligated to stay. Asking if the parent wants a blanket or pillow does not encourage the parent to leave the hospital. Telling the parent he or she is doing a good job is nice, but does not encourage the parent to take a break.
18. When reviewing infectious diseases in the pediatric population, nursing students identify which disease as a common childhood exanthema? A. Mumps B. Rabies C. Rubella D. West Nile virus
Answer: C Rationale: Rubella is a common childhood exanthema. Mumps is a viral infection. Rabies is a zoonotic infection. West Nile virus is a vector-borne disease.
1. The nurse is teaching the mother of a 5-year-old boy with a myelomeningocele who has developed a sensitivity to latex. Which response from his mother indicates a need for further teaching? A. "He needs to get a medical alert identification." B. "I will need to discuss this with his caregivers." C. "A product's label indicates whether it is latex-free." D. "He must avoid all contact with latex."
Answer: C Rationale: The Food and Drug Administration (FDA) requires that all medical supplies be labeled if they contain latex, but this is not the case with consumer products. The mother must be familiar with products that contain latex. The Spina Bifida Association of America maintains an updated list of latex-containing products. Getting a medical alert identification, talking with his caregivers, and avoiding all contact with latex are correct
16. A child with cerebral palsy has undergone surgery for placement of a baclofen pump. Which instruction would the nurse include when teaching the parents about caring for their child? A. Wait 48 hours before allowing the child to take a tub bath. B. Do not allow the child to sleep on the left side for about 4 weeks. C. Call the helath care provider if the child's temperature is over 100.5°F (38°C). D. Discourage the child from stretching or bending forward for 4 weeks.
Answer: D Rationale: After insertion of a baclofen pump, the parents should discourage any twisting at the waist, reaching high overhead, stretching, or bending forward or backward for 4 weeks. The child would avoid tub baths for about 2 weeks and avoid sleeping on the stomach for 4 weeks. The parents should notify the health care provider if the child's temperature is greate r than 101.5°F (38.6°C)
7. A 4-year-old boy has a febrile seizure during a well-child visit. What action would be a priority? A. Hyperextending the child's head while placing him on his side B. Using a tongue blade to pry open the child's jaw C. Loosening the child's clothing to ensure a patent airway D. Protecting the child from harm during the seizure
Answer: D Rationale: During a seizure, the child should not be held down in a specific position. Protecting the child's head and body during the seizure is the priority. Ensuring a patent airway is an important intervention but is not accomplished by loosening the child's clothing or hyperextending his head. The child should be placed on his side and nothing should be inserted into his mouth to forcibly open the jaw.
16. A nurse is talking with the parents of a child who has had a febrile seizure. The nurse would integrate an understanding of what information into the discussion? A. The child's risk for cognitive problems is greatly increased. B. Structural damage occurs with febrile seizure. C. The child's risk for epilepsy is now increased. D. Febrile seizures are benign in nature.
Answer: D Rationale: Parents need reassurance that febrile seizures, although frightening, are benign in nature. Children who experience one or more febrile seizures are at no greater risk of developing epilepsy than the general population. No evidence exists that febrile seizures cause structural damage or cognitive declines.
