PEDS Midterm practice questions

A 2-year-old girl brought to the pediatric ED after 5 days of diarrhea. Today , child's parent estimates she has had six to eight episodes of watery diarrhea and only two wet diapers. She has a decreased appetite, but has been drinking well, including milk, water, and juice. Two other household members had diarrheal illnesses last week. There is no report of vomiting, fever, or changes to the diet which health teaching are indicated vs contraindicated? - continue clear fluids for the next 24 hrs - once she finishes rehydrating we can switch to 50% water/50% juice - continue to give 10 mLkg of oral rehydration solution for every episode of diarrhea - you can offer the child her regular diet now - when she is ready to eat start with the BRAT diet (Bananas, rice, applesauce, and toast) - count her wet diapers to monitor for dehydration

- continue clear fluids for the next 24 hrs: CONTRAINDICATED - once she finishes rehydrating we can switch to 50% water/50% juice: CONTRAINDICATED - continue to give 10 mLkg of oral rehydration solution for every episode of diarrhea: INDICATED - you can offer the child her regular diet now: INDICATED - when she is ready to eat start with the BRAT diet (Bananas, rice, applesauce, and toast): CONTRAINDICATED - count her wet diapers to monitor for dehydration: INDICATED

NurseNotes:A 6-week-old male infant is brought to pediatric urgent care for vomiting that began yesterday. His parent is worried that the vomiting is getting worse. He was previously well, without any known sick contacts or other exposures. Infant receives both breast milk (by breast and bottle) and an occasional bottle of formula. No diet changes for mother or infant. Parent reports no medications given to infant. - 2030 (UrgentCareAdmission) The nurse documents the following medical history and assessment findings: • Irritable but soothes when feeding • Feeds approximately every 1-2 hours, was feeding every 2-3 hours • Projectile emesis approximately 3 feet • Emesis described as milky white and entire feeding • Emesis occurs approximately 30-60 minutes after every feeding • An estimated three wet diapers in past 24 hours • Received 1-month immunizations 2 weeks ago • Anterior fontanel is soft and flat • Buccal mucosa moist and lips dry • Abdomen appears distended with visible peristaltic waves • Bowel sounds present in all four quadrants Choose 2 Actions toTake 1. Obtain complete blood count 2. Initiate NPO status 3. Insert peripheral IV 4. Begin oral rehydration 5. Begin thickenin

2 actions: 2. Initiate NPO status 3. Insert peripheral IV 1 diagnosis: 1. Hypertrophic pyloric stenosis 2 parameters: 1. weight 4. urinary output

◦ A 9-year-old child is brought to pediatric urgent care after a fall from a trampoline approximately 45 minutes earlier. The child experienced pain in their right wrist immediately. The parent applied ice right away and gave 1 dose of over-the-counter pain medication. The child is otherwise healthy, with no significant medical history. The nurse considers the client's care needs. Select the 4 care needs that the nurse would prioritize for this client. a. Immobilization b. Pain Management c. Prevention of Further Injury d. Restore Function e. Monitor Neurovascular Function f. Teach the child and family cast care

A, B, C, E a. Immobilization b. Pain Management c. Prevention of Further Injury e. Monitor Neurovascular Function

You are caring for patient with Bronchiolitis. You know that bronchiolitis :(SATA) a. Usually occurs in infants and young children b. Involves inflammation of upper airway c. is caused by a virus d. is characterized by inspiratory stridor CROUP

A, C a. Usually occurs in infants and young children c. is caused by a virus

Which nonpharmacologic intervention will the nurse provide for a preterm infant who requires a heel puncture ? Select all that apply. One, some, or all responses may be correct. a. Swaddling b. Guided imagery c. Nonnutritive sucking d. Thought stopping e. Kangaroo care f. Sedative administration

A, C, E a. Swaddling c. Nonnutritive sucking e. Kangaroo care

You recall that the pathophysiology of asthma includes: a. Airway inflammation b. Airway infection c. Bronchospasm d. Thick tenacious respiratory mucous e. Destruction of alveolar walls f. Airway obstruction

A, C, F a. Airway inflammation c. Bronchospasm f. Airway obstruction

Which vaccine is contraindicated for children who are immunocompromised ? Select all that apply, One, some , or all responses may be correct a. Varicella b. Tetanus c. Pertussis d. Inactivated polio e. Measles, mumps, and rubella (MMR)

A, E a. Varicella e. Measles, mumps, and rubella (MMR) *They are Live Vaxs*

Which isolation precautions should be observed when caring for a patient with Epiglottitis? a. Airborne b. Droplet c. Standard d. Contact

B, C b. Droplet c. Standard

The nurse is assessing pain in a 3-month-old infant. Which physiologic sign indicates acute pain in the infant? Select all that apply . One, some , or all responses may be correct. a. Decreased heart rate b. increased muscle tone c. Pallor or flushing d. Rapid, shallow respirations e. Dilated pupils

B, C, D, E b. increased muscle tone c. Pallor or flushing d. Rapid, shallow respirations e. Dilated pupils

Which of the following changes in a patient with Bronchiolitis may indicate impending respiratory failure? (SATA) a. Change in respiratory rate from 50 to 60 breaths per minute b. Change in apical pulse rate from 170 to 80 beats per minute c. Change in apical pulse rate from 170 to 190 beats per minute d. Change is respiratory rate from 50 to 20 breaths per minute

B, D b. Change in apical pulse rate from 170 to 80 beats per minute d. Change is respiratory rate from 50 to 20 breaths per minute

You are caring for a child with epiglottis , you recall : ( check all that apply ) a. Epiglottitis is usually caused by a virus b. Epiglottitis is usually caused by a bacterium c. Epiglottitis usually occurs in young children d. Epiglottitis is serious and communicable e. The incidence of epiglottitis has increased in recent years

B,C,D b. Epiglottitis is usually caused by a bacterium c. Epiglottitis usually occurs in young children d. Epiglottitis is serious and communicable

Which intervention would the nurse perform for the chil after an uncomplicated appendectomy? Select all that apply. One, some, or all responses may be correct. a. Irrigate the wound with saline. b. Cover the wound with tape. c. Listen for bowel sounds. d. Encourage intake of ice chips. e. Ensure complete bed rest.

C, D c. Listen for bowel sounds. d. Encourage intake of ice chips.

A nurse is caring for an infant with developmental dysplasia of the hip (DDH). Which clinical manifestation would the nurse , drawing on knowledge of DDH, expect to note? Select all that apply. One, some, or all responses may be correct. a. Lordosis b. Lack of Babinski c. Positive Ortolani and Barlow Sign d. Asymmetry of folds e. Shortening of limb on affected side

C, D, E c. Positive Ortolani and Barlow Sign d. Asymmetry of folds e. Shortening of limb on affected side

Which of the following should alert you to the possibility of postoperative hemorrhage in a patient who had tonsillectomy 6 hours ago? A. Slow heart rate B. Expectoration of reddish brown saliva C. Frequent swallowing D. Fever of 103

C. Frequent swallowing

The nurse is teaching the parents of preschoolers about preventing urinary tract infections (UTIs). Which strategy would the nurse instruct the parents to use to prevent UTIS ? Select all that apply. One, some, or all responses may be correct. a. "Give cranberry juice to your children on a regular basis." b. "Put a diaper on your child overnight." c. "Do not allow your children to urinate in public toilets. " d. "Encourage your children to drink 6 to 8 glasses of water each day" e. "Ensure that your children evacuate their bowels regularly."

D, E d. "Encourage your children to drink 6 to 8 glasses of water each day" e. "Ensure that your children evacuate their bowels regularly."

Which explanation would the nurse give the parents of a child scheduled for treatment of chordee? a. "It is a surgical release of the fibrous band from the penis." b. "It is a surgical closure of the inguinal defect in the abdomen." c. "It is a surgical lengthening of the urethral opening for better urination." d. " It is a surgical correction to allow a direct stream of urination to prevent infections ."

a. "It is a surgical release of the fibrous band from the penis."

Which therapeutic management would the nurse expect the primary health care provider to prescribe to a child with nasopharyngitis? a. Antipyretic b. Antihistamine c. Antibiotic d. Pseudoephedrine

a. Antipyretic

Which manifestation would the nurse FIRST observe to evaluate for an obstruction when caring for a child with foreign body aspiration? a. Coughing and gagging b. Wheezing and paroxysmal cough c. Asymmetric breath sounds and dyspnea d. Unilateral nasal drainage

a. Coughing and gagging

Which would the nurse teach the parents of the child with cystic fibrosis about the use of pancreatic enzymes? a. Extra enzymes must be taken with high-fat foods b. Enteric- coated beads may be chewed or crushed c. Mix the powder -form enzyme with the entire meal d. Fat-soluble forms of vitamins are added with the food

a. Extra enzymes must be taken with high-fat foods

Proventil (albuterol) is used as a frontline treatment for as asthma exacerbation. Its primary action is: a. Induce bronchodilation b. Decrease histamine release c. Decease coughing d. Reduce viscosity of respiratory mucous e. Decrease bronchial edema

a. Induce bronchodilation

Which condition would the nurse suspect for an adolescent who reports abdominal pain, nausea, constipation , and is sexually active? a. Pelvic inflammatory disease b. Primary dysmenorrhea c. Secondary dysmenorrhea d. Vaginitis

a. Pelvic inflammatory disease

Which is the therapeutic management for an infant who is found to have malrotation of the intestine? a. Scheduling surgery to remove the affected area b. Holding feedings until bowel sounds are present in all four quadrants c. Maintaining nothing-by-mouth (NPO) status until the intestine rotates back into normal position d. Beginning breastfeeding to help the intestine rotate back into normal position

a. Scheduling surgery to remove the affected area

What is the causative agent of chickenpox? a. Varicella-zoster virus b. Human parvovirus B19 c. Human herpesvirus type 6 d. Group A B-hemolytic Streptococcus

a. Varicella-zoster virus *also causes shingles*

What is the recommended age for a child to begin primary immunizations? a. At birth b. 2 months c. 4 months d. 1 year

a. at birth *Hep B*

Approximately how many kilograms would the nurse expect a 6-month -old infant to weigh if the infant weighed 3.5 kg at birth? a. 5.5 b. 7.0 c. 8.8 d. 9.8

b. 7.0 *wt should double*

The nurse is ready to begin the physical examination of an 8-month -old infant. The child is sitting contentedly on the mother's lap, chewing on a toy. Which would the nurse do first? a. Elicit reflexes b. Auscultate the heart and lungs c. Examine the eyes , ears , and mouth d. Examine the head and move systematically toward the feet .

b. Auscultate the ♡ and lung sounds

Which would the nurse recommend for a school-age child with acute diarrhea, occasional vomiting, and mild dehydration being given oral rehydration solution (ORS)? a. Alternating ORS and carbonated drinks b. Continuing to give ORS frequently in small amounts c. Bringing the child to the hospital for intravenous fluids d. Instituting nothing-by-mouth (NPO) status for the child for 8 hours and resuming ORS if the vomiting subsides

b. Continuing to give ORS frequently in small amounts

A 5-year-old boy is having a well-child visit before starting kindergarten. Which test does the nurse use to assess cerebellar function? a. Cover test b. Finger-to-nose test c. Eliciting deep tendon reflexes d. Biting down hard and opening the jaw

b. Finger-to-nose test

Which would the management of adolescent obesity include? a. Planning a low- calorie, low- protein diet b. Incorporating favorite foods into the diet c. Using nutritious foods as a method of reward d. Encouraging diversional activities during mealtimes

b. Incorporating favorite foods into the diet

Development of which psychosocial task is associated with the preschool period? a. Identity b. Initiative c. Intimacy d. Industry

b. Initiative

Which education would the nurse provide to the parent of an 18- month-old about proper restraint in motor vehicles? a. Fit the seat belt snugly over the toddler's abdomen . b. Place the car seat in the back seat of the car, rear -facing c. Transition the child to a forward - facing seat at 25 pounds . d. Place the car seat in the front passenger seat if there is an airbag

b. Place the car seat in the back seat of the car, rear -facing

Which statement by the parents would the nurse associate with cystic fibrosis? a. The infant has diarrhea b. The infant tastes salty c. The infant has loss of appetite d. The infant has a bugling fontanel

b. The infant tastes salty

Which would the nurse recognize as the most reliable indicator of pain in school-age children? a. Crying b. Verbal report c. Increased heart rate d. Increased blood pressure

b. Verbal Report

Parents bring their 1-week-old infant to clinic after the diagnosis of clubfoot was made at birth. Which statement by the parents indicated needs for further teaching? a. "Treatment will need to be started as soon as possible" b. "I realize my infant will require follow up care until fully grown" c. "I need to bring my infant back to the clinic in 2 months for a new cast" d. "I need to come to the clinic every week with my infant for casting"

c. "I need to bring my infant back to the clinic in 2 months for a new cast"

At what age would the nurse expect an infant to be able to say "mama" and "dada" with meaning ? a. 4 months b. 6 months c. 10 months d. 12 months

c. 10 months

Which is an important consideration for the school nurse planning a class on injury prevention for adolescents? a. Adolescents are generally not risk takers b. Adolescents often weigh the long -term consequences of serious injuries c. Adolescents often feel invincible, which may override their logical thinking d. Adolescent participation in sports should be limited to prevent permanent injuries.

c. Adolescents often feel invincible, which may override their logical thinking

Which are common clinical manifestations of acute poststreptococcal glomerulonephritis? a. Edema, increased urine volume , hypotension b. Edema, decreased urine volume, hypotension c. Edema, decreased urine volume, hypertension d. Edema, increased urine volume, hypertension

c. Edema, decreased urine volume, hypertension

Which assessment finding would the nurse recognize as a manifestation of AOM? a. Tinnitus or a feeling of fullness b. Rhinitis, cough, diarrhea c. Fever, otalgia , fussy d. Discolored tympanic membrane

c. Fever, otalgia , fussy

Which type of development is a 3-year-old child demonstrating when riding a tricycle? a. Cognition skills b. Fine motor skills c. Gross motor skills d. Socialization skills

c. Gross motor skills

According to Erikson, in which stage of psychosocial development is the adolescent? a. Trust versus mistrust b. Initiative versus guilt c. Identity versus identity confusion d. Autonomy versus shame and doubt

c. Identity versus identity confusion

A patient with nephrotic syndrome is receiving prednisone therapy. On a follow-up visit, the nurse finds that the child's condition shows no improvement. Which subsequent therapy would the nurse expect to be prescribed for treating the disease? a. Diuretic therapy b. Antibiotic therapy c. Immunosuppressive therapy d. Nonsteroidal antiinflammatory drug (NSAID) therapy

c. Immunosuppressive therapy

Which condition would the nurse expect when caring for a 3-month- old infant who presents with sudden acute abdominal pain, episodes of screaming , and drawing knees to the chest, followed by periods of comfort and red jelly -like stool ? a. Omphalocele b. Gastroschisis c. Intussusception d. Anorectal malformations

c. Intussusception

Which recommendation would the nurse include when educating a parent about infant safety and injury prevention? a. Refer to medication as candy to encourage cooperation. b. Provide mobile walkers to promote coordination and prevent falls c. Maintain one hand on the infant at all times during bathing d. Keep the infant's play area free of rugs, mats, and large objects.

c. Maintain one hand on the infant at all times during bathing

Which type of play is characteristic of toddlers? a. Tactile b. Solitary c. Parallel d. Cooperative

c. Parallel

Which is the most accurate method of determining the length of a child younger than 12 months of age? a. Standing height b. Recumbent length measured in the prone position c. Recumbent length measured in the supine position d. Estimation of length to the nearest centimeter or 1/2 inch

c. Recumbent length measured in the supine position

Vesicoureteral reflux increases the risk for which condition? a. Hypotension b. Incontinence c. Recurrent kidney infections d. Increased renal arterial perfusion

c. Recurrent kidney infections

Which gross motor developmental milestone would the nurse expect to observe in a 15-month-old? a. Jumping with both feet b. Pushing and pulling toys c. Walking alone, using a wide stance d. Going up and down stairs alone with two feet on each step

c. Walking alone, using a wide stance

Which education would the nurse provide to the parents of a toddler about bottle -mouth caries? a. this syndrome can be prevented entirely by breastfeeding b. providing a bottle of juice before bedtime is a prevention strategy c. offering a bottle of milk at nap-time or bedtime predisposes the child to this syndrome d. this syndrome is characterized by protruding upper front teeth, which are a result of sucking on a hard nipple

c. offering a bottle of milk at nap-time or bedtime predisposes the child to this syndrome

How would the nurse position the pina to visualize the eardrum of a 4 year old? a. pull pina upward b. pull pina downward c. pull pina up and back d. pull pina down and back

c. pull the pina up and back

The nurse is caring for a 5-year-old child after surgery . Which is the most appropriate way for the nurse to describe to the parents how a patient-controlled analgesic (PCA ) pump works? a. "The child will be free of pain with a PCA pump." b. "Only the child is allowed to push the button for a bolus." c. "There is a high risk of overdose with the PCA pump, so monitoring is continuous ." d. "The pump permits release of a continuous basal rate of pain medication to deliver constant pain control"

d. "The pump permits release of a continuous basal rate of pain medication to deliver constant pain control"

Which condition is prevented when by treating acute streptococcal pharyngitis with antibiotics ? a. Otitis media b. Diabetes insipidus c. Nephrotic syndrome d. Acute rheumatic fever

d. Acute rheumatic fever

Which intervention can the nurse implement to help involve a younger child in the physical examination process? a. Examine painful areas last b. Limit the number of people in the room. c. Perform the examination as quickly as possible. d. Allow the child to handle or hold the equipment

d. Allow the child to handle or hold the equipment

Which clinical symptom of tracheoesophageal fistula would the nurse recognize when assessing a neonate immediately after birth? a. Jaundice b. Absence of sucking c. Bile-stained vomitus d. An excessive amount of frothy saliva in the mouth

d. An excessive amount of frothy saliva in the mouth

At which age would the nurse expect the anterior fontanel to fuse? a. Third month of life b. Second month of life c. Between 6 and 12 months d. Between 12 and 18 months

d. Between 12 and 18 months

Against which condition does the human papillomavirus (HPV) vaccine protect? a. Meningitis b. Pertussis c. Hepatitis B d. Certain cancers

d. Certain cancers

A mother of two children tells the nurse that she has decided not to have her children immunized because her neighbor has a 9-year-old son with autism, and she is now convinced that the autism may have been caused by the immunizations her son received . What is the best response the nurse could give? a. Don't worry, there's no evidence that immunizations cause autism b. The law says you must immunize your children. Refusing to immunize is breaking the law. c. You must really be afraid Autism is a horrible condition for any parent to have to deal with d. I can understand your concerns. Would you like more information about the safety of immunizations

d. I can understand your concerns. Would you like more information about the safety of immunizations

Which anticipatory guidance would the nurse provide the family of a 6-month-old infant being seen for a well-baby check-up a. Keep the doors of appliances closed at all times. b. Never shake baby powder directly on the infant. c. Install a gate at the top and bottom of stairs. d. Keep the crib rails raised to full height at all times.

d. Keep the crib rails raised to full height at all times.

A child is allergic to neomycin. Which vaccine does the nurse instruct this child's parent to avoid? a. Tetanus b. Pertussis c. Inactivated polio d. Measles, mumps, and rubella (MMR)

d. Measles, mumps, and rubella (MMR)

Which is the leading cause of death among adolescents? a. Suicide b. Homicide c. Drowning d. Motor vehicle accident

d. Motor vehicle accident

Which task does Erikson describe as the primary focus of psychosocial development in school - age children? a. Sense of autonomy in which children want to do things for themselves b. Sense of trust in which children form basic trust in the people around them c. Sense of initiative in which children explore their world with all their senses and powers d. Sense of industry in which children have access to tasks that need to be done and are able to complete them

d. Sense of industry in which children have access to tasks that need to be done and are able to complete them

Which sign indicates the start of puberty in girls? a. Menarche b. An increase in height c. The appearance of pubic hair d. The appearance of breast buds

d. The appearance of breast buds

What is the current understanding for how nonpharmacologic strategies for pain management work in children? a. They make the pharmacologic strategies less effective. b. They work faster than most pharmacologic strategies do. c. The convince children that they are not experiencing pain. d. They provide coping strategies that help reduce pain perception

d. They provide coping strategies that help reduce pain perception