Practice Questions
A nurse is developing a plan of care for child who was 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 care plan? 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 him know someone is there. *d. Using the child's body parts to refer to the area where he may have postop pain. e. Speaking to the child in a voice that is slightly louder than the usual tone of voice.
*a. Explaining instructions using simple and specific terms the child understands. *b. Allowing the child to explore the postoperative equipment with his hands. *d. Using the child's body parts to refer to the area where he may have postop pain.
In a child with diabetes insipidus, the nurse could expect which characteristics of the urine? a. Pale in color; specific gravity less than 1.006 b. Concentrated; specific gravity less than 1.006 c. Concentrated; specific gravity greater than 1.033 d. Pale in color; specific gravity greater than 1.033
*a. Pale in color; specific gravity less than 1.006
A nurse is questioned by a nursing student about the difference between hypospadias and epispadias. Which response by the nurse is best? a. "Episadias defects can only occur in males, affects sterility and the urethra is longer than normal. Hypospadias defects can occur in either sex, never affects sterility or the urethral meatus is proportionally larger than the length of the meatus." b. "The difference between the defects is the length of the urethra, size of the urethral meatus, the sex of the child, and the position of the opening. In hypospadias, the abnormal opening occurs dorsal to the penis. In epispadias, the abnormal opening occurs below the vagina." c. "Hypospadias is an abnormal opening on the ventral side of the penis and epispadias is an abnormal opening of the dorsal side of the penis." d. "Hypospadias is an abnormal opening on the dorsal side of the penis and epispadias is an abnormal opening on the ventral side of the penis.
*c. "Hypospadias is an abnormal opening on the ventral side of the penis and epispadias is an abnormal opening of the dorsal side of the penis."
When educating the family of a child with seizures, it is appropriate to tell them to call emergency medical services (911) if the child has a seizure and which of the following findings listed below? a. Continuous vomiting for 30 minutes after the seizure. b. Stereotypic or automatous body movements during the onset. c. Lack of expression, pallor, or flushing of the face during the seizure. d. Unilateral or bilateral posturing of one or more extremities during the onset.
Answer - A Options B, C, & D are all clinical manifestations that are expected when a child has a seizure. Parents do not need to call EMS every time their child has a seizure. But if symptoms occur that indicate increased ICP, such as continuous vomiting for 30 minutes after a seizure, then parents should call EMS.
The nurse is educating a group of older school-age children who were recently diagnosed with type 1 diabetes and their parents about disease management. Which guideline is most accurate regarding insulin injections? a. Self-injection techniques should only be taught when the child can reach all injection sites. b. At age 11, the child should be old enough to administer most of their injections. c. Self-injection techniques are not usually taught until the child reaches age 16. d. The parents do not need to be involved in learning how to administer the injections.
Answer - B. Children between ages 8 and 10 are developmentally ready to begin to give their own injections with adult supervision. Their fine motor skills are developed enough to accomplish this skill. Beginning to recognize signs and symptoms of hypoglycemia is appropriate for 4- to 6-year-old children because of their beginning ability to verbalize how they feel. Measuring insulin accurately in a syringe is more appropriate for 10- to 12-year-old children, who have better fine motor skills. Because of the complexity of disease management, assuming responsibility for self-care is appropriate for an older adolescent.
The nurse is assessing a child that experienced a traumatic injury to the head. What statement identifies a difference between children and adults that may produce a life-threatening complication for a child? a. Cerebral tissues in children are softer, thinner, and more flexible. b. A child's skull can expand more than an adult's can. c. Greater portions of a child's blood volume flows to the head. d. Hematomas in children can include subdural, epidural, and intracerebral.
Answer - B. Because a child's skull can expand more than an adult's can, a greater amount of posttraumatic edema can occur before we are able to assess any neurological problems or deficits. The suture lines and fontanels allow for expansion of the skull. Also A is technically a correct statement, but it's not the reason why it's a life-threatening complication, because this is helpful as it allows for diffusion of an impact.
The nurse is caring for an adolescent client postoperatively after having a portion of the thyroid gland removed 6 hours prior. The client rates incisional pain 6/10. The prescribed orders include morphine 1 to 2 mg IV every hour as needed for pain. The client is alert with vital signs within normal limits. How will the nurse best manage the client's pain? a. administer morphine 1 mg IV and reassess pain level in 20 minutes b. administer morphine 2 mg IV and reassess pain level in 1 hour c. administer morphine 1 mg IV and repeat the dose in 1 hour d. administer morphine 1 mg IV followed by morphine 2 mg IV in 1 hour
Answer - a With a range dosage, start with the lowest amount and then reassess the pain to determine the effectiveness. If the pain has not improved, then in 1 hour, the nurse can increase the dose.
A 10-year-old child with acute glomerulonephritis is admitted to the pediatric unit. The nurse should ensure that which action is part of the child's care? a. Taking vital signs every 4 hours and obtaining daily weight. b. Ensuring that albumen infusions are administered every evening. c. Checking every urine specimen for protein and specific gravity. d. Ensuring that the child has accurate input and output and eats a high-protein diet.
Answer: A Vital signs should be taken every 4 hours on a pediatric unit to monitor a child's condition. Obtaining daily weights can provide an indication of the adequacy of urinary output, which is a measure of renal function.
A pediatric client is being treated for hyperthyroidism with propylthiouracil. The nurse suspects that the dose of medication is inadequate when assessing which signs and/or symptoms. Select all that apply. a. Tachycardia b. Diarrhea c. Cold intolerance d. Irritability e. Weight gain
Answer: A, B, D Since the dose is inadequate, the child would continue to exhibit clinical manifestations of hyperthyroidism which are tachycardia, diarrhea, and irritability. Cold intolerance & weight gain are clinical manifestations of hypothyroidism.
Which nuring intervention should be included to support the goal of avoiding injury, respiratory distress, and aspiration during a seizure? a. Placing a rolled blanket or towel under the neck to hyperextend the head. b. Placing a hand under the child's head for support. c. Using pillows to prop the child into the sitting position. d. Place a padded tongue blade or small plastic airway between the teeth.
Answer: C Placing a hand, a small cushion, or a blanket under the head will help prevent injury to the child's head. The head should not be hyperextended, but the head should be positioned in the midline if possible. The child should not be propped up in a sitting position but be eased onto the floor to prevent falling off of the pillow. Do not put anything into the child's mouth.
When assessing a preschooler who has sustained a head trauma, the nurse notes that the child appears to be obtunded. Which finding supports this level of consciousness? a. no motor or verbal response to noxious (painful) stimuli b. remains in a deep sleep; responsive only to vigorous and repeated stimulation c. can be roused with stimulation d. limited spontaneous movement; sluggish speech
Answer: C The child is obtunded if he can be aroused with stimulation. If the child shows no motor or verbal response to noxious stimuli, he's comatose. If the child remains in a deep sleep and is responsive only to vigorous and repeated stimulation, he's stuporous. If the child has limited spontaneous movement and sluggish speech, he's lethargic.
A nurse is caring for a toddler with Down syndrome. To help the toddler cope with painful procedures, the nurse can: a. prepare the child by positive self-talk. b. establish a time limit to get ready for the procedure. c. hold and rock the child and give the child a security object. d. count and sing with the child.
Answer: C The toddler with Down syndrome may have difficulty coping with painful procedures and may regress during illness. Holding, rocking, and giving the child a security object is helpful because it may be comforting to the child. An older child or a child without Down syndrome may benefit from positive self-talk, time limits, and diversionary tactics, such as counting and singing; however, the success of these tactics depends on the child.
A 4-month-old infant is brought the emergency department following a seizure. What findings would lead the nurse to suspect the infant has experienced abusive head trauma or shaken baby syndrome? Select all that apply. a. Vomiting b. Difficulty breathing c. Head lag d. Lack of vocalization e. Hypotonia
Answer: a, b, d Severe abusive head trauma (AHT) manifests as seizures, shock, or severe respiratory distress leading to death. Many cases present with more subtle signs of increased intracranial pressure such as irritability, poor feeding, or vomiting. Failure to smile or vocalize indicates a change in level of consciousness. Increased tone is associated with AHT versus hypotonia.Head lag can still a be normal finding at 4 months.
A child with idiopathic nephrotic syndrome is receiving corticosteroids. What statements by the parent about corticosteroids indicate further instruction is needed? Select all that apply. a. "My child's appetite is decreased because of the steroids." b. "My child will need 7 to 10 days of steroids for nephrotic syndrome." c. "Steroids help decrease how much protein is being lost in the urine." d. "Steroids increase the risk of my child getting an infection." e. "Steroids are commonly prescribed and have few side effects."
Answers: a, b, e Steroids are usually prescribed for several months to reduce the renal inflammation. Long term steriod use has many side effects and 1 of them is increased appetite. Increased appetite is considered a side effect because it leads to overeating and unnecessary weight gain.
The nurse is educating the parents of a child being treated with an antiepilepsy drug. Which statement by the parent indicates that the teaching has been effective? a. "My child will wear a medical identification bracelet." b. "I will keep a seizure frequency chart for my child." c. "My child will stay away from potentially hazardous activities." d. "I will stop the drug immediately if my child has a side effect."
B - Maintaining a seizure frequency chart helps the provider evaluate the effectiveness of the medication. Avoidance of hazardous activities & wearing a medical ID bracelet are ways to minimize danger related to seizure activity, but they do not track the medication efficacy. And, seizure meds should never be stopped abruptly due to the potential for the development of status epilepticus.
A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises would the nurse provide to the child and family? Select all that apply. a. Avoid foods high in folic acid. b. Drink plenty of fluids. c. Use cold packs to relieve joint pain. d. Report a sore throat to an adult immediately. e. Restrict activity to quiet board games. f. Wash hands before meals and after playing.
B, D, F Sickle cell anemia is an autosomal recessive genetic disease passed down through families in which red blood cells form an abnormal sickle or crescent shape. Fluids would be encouraged to prevent stasis in the bloodstream, which can lead to sickling. Sore throats and all other cold symptoms would be reported promptly because they may indicate an infection, which can precipitate a crisis (red blood cells sickle and obstruct blood flow to tissues). Children with sickle cell anemia would learn appropriate measures to prevent infection, such as proper hand-washing techniques and good nutrition. Folic acid intake would be encouraged to help support new cell growth; new cells replace fragile sickled cells. Warm packs would be applied to promote comfort and relieve pain; cold packs cause vasoconstriction. The child would maintain an active, normal life but would avoid excessive exercise, which can precipitate an attack. When the child experiences a crisis, the child will typically limit activity according to the pain level.
Start of Hematology questions
Whoop whoop whoop
The nurse recognizes that the parent of a 5-year-old female patient who was recently diagnosed with precocious puberty needs additional education about the pharmacologic management when which of the following statement is made? a. "I feel better knowing that she can stop taking those shots for her disease in 2 years." b. "I understand that I will have to give her a shot under the skin every day." c. "My husband and I will take turns giving her the shot for this problem." d. "I will let my daughter practice giving fake shots to her stuffed animal."
a. "I feel better knowing that she can stop taking those shots for her disease in 2 years."
Which statement by a nurse would be the best response to a mother who wants to know what the first indication will be that her child's acute glomerulonephritis is improving? a. "Your child's urine output will increase." b. "Your child's urine will be free from protein." c. "Your child's blood pressure will stabilize." d. "Your child's energy will increase a lot."
a. "Your child's urine output will increase."
The nurse is providing teaching for parents who are planning to administer prescribed growth hormone to their child at home. The parents ask the nurse what the best time is to give the medication. What is the best response? *a. At bedtime b. Allow the child to choose the time c. In the morning with breakfast d. After dinner
a. At bedtime
An infant with a myelomeningocele is scheduled for surgery to close the defect. Which nursing action would best facilitate parent-infant relationships in the preoperative period? a. Encouraging the parents to stroke and comfort the infant. b. Allowing the parents to cuddle the infant in their arms. c. Referring the parents to the Spina Bifida Association of America. d. Demonstrating feeding techniques in the prone position.
a. Encouraging the parents to stroke and comfort the infant. y'all know myelomeningocele is spina bifida, right? just making sure. :D
Which of the following interventions should the nurse follow when administering a medication intranasally? a. Have the child lie on the same side where the medication was administered for several minutes after the medication is given. b. Have the child blow his or her nose after administering the medication. c. Have the child lie on the opposite side of where the medication was administered for several minutes after the medication is given. d. Ask the child if he or she swallowed the medication, as this indicates that the medication will be absorbed.
a. Have the child lie on the same side where the medication was administered for several minutes after the medication is given.
The nurse is caring for a child diagnosed with hydronephrosis. Which of the following manifestations is consistent with complications of the disorder? a. Hypertension b. Hypotension c. Hypothermia d. Tachycardia
a. Hypertension
The nurse is caring for a 6-month-old just admitted to the unit who is irritable, has bulging fontanels, and has been vomiting for the last six hours. The nurse knows that these clinical manifestations are indicative of which of the following? a. Increased intracranial pressure. b. Skull fracture. c. Myleomeningocele d. Meningocele
a. Increased intracranial pressure.
The nurse is providing postoperative care to a pediatric patient with sickle cell disease. What is the most important intervention for the nurse to include in the plan of care? a. Increasing fluids b. Preparing the child psychologically c. Discouraging coughing d. Limiting the use of morphine
a. Increasing fluids Increasing fluids is the most important intervention to keep the sickled blood cells moving well and not getting trapped in organs and tissues. Preparing the child is important but not the priority. Discouraging coughing and limiting the use of morphine is not included in the plan of care.
All of the following should be followed by the nurse when measuring a child's height except: a. Measure the child to the nearest full inch. b. Use the supine position to measure an 18-month-old child. c. For a supine measurement, place the soles of the feet in a 90-degree angle to the footboard. d. Measure the child when the child is barefoot.
a. Measure the child to the nearest full inch
A 5-year-old is diagnosed with acute otitis media. Which nursing intervention would be primary? a. Relief of pain b. Administration of a mydriatic c. Cautioning the child not to pull on the ear d. Cautioning the child not to blow the nose
a. Relief of pain
A 10-year-old child who is admitted with sickle cell disease and acute severe pain is started on a PCA pump for pain management. Which of the following systems is most important for the nurse to assess? a. Respiratory b. Cardiovascular c. Neurological d. Musculoskeletal
a. Respiratory Rationale: Morphine is used for pain management for children with sickle cell disease experiencing acute severe pain. Since respiratory depression is a potential side effect of morphine, the respiratory system is the most important system to assess and monitor.
The nurse is being observed by a group of nursing students while assessing a child in vaso-occlusive crisis. A student asks the nurse why he did not palpate the child's abdomen. What is the most appropriate response by the nurse? a. Risk of splenic rupture b. Risk of inducing vomiting c. Increase in abdominal pain d. Risk of blood cell destruction
a. Risk of splenic rupture Since sickled cells get trapped in the spleen and cause inflammation, if the nurse palpates the abdomen and exerts too much pressure in the area of the spleen, then it may cause rupture of the spleen.
The nurse is caring for a 6-month-old infant diagnosed with otitis media. Which clinical manifestation would likely have been noted in this child? a. Shaking the head and pulling the ear b. Severe vomiting and confusion c. High-pitched cry and nuchal rigidity d. Body stiffening and loss of consciousness
a. Shaking the head and pulling the ear
A 6-year-old child is admitted to the pediatric intensive care unit (PICU) after suffering a severe closed head injury on the left temporal area. An intracranial pressure (ICP) monitor is in place and reveals and ICP of 40 mm Hg. Based on this assessment data, would of the following would be the best position for the child to be placed? a. Supine with head midline. c. Supine with the head turned to the right. d. Supine with the head turned to the left. e. Side-lying on the left with the head turned to the right.
a. Supine with head midline.
A 3-month old infant has a ventriculoperitoneal (VP) shunt inserted. What intervention should the nurse plan to perform? a. Teach the parents the signs of increased intracranial pressure. b. Keep the infant in the prone position. c. Observe for signs of leakage of cerebrospinal fluid. d. Apply a sterile moist dressing to the incision.
a. Teach the parents the signs of increased intracranial pressure.
A 4 year-old child is admitted after being hit in the head by a baseball. Which portion of the head is it most important for the nurse to assess due to the potential for injury to the middle meningeal artery? a. Temporal areas. b. Occipital area. c. Frontal areas. d. Basilar area.
a. Temporal areas.
A 7-year-old child with osteosarcoma is being treated with chemotherapy. Which medication would the nurse expect the physician to order most commonly as a prophylaxis against Pneumocystis jirovecii? a. Trimethoprim-sulfamethoxazole b. Ketoconazole c. Filgastim d. Prednisone
a. Trimethoprim-sulfamethoxazole Trimethoprim-sulfamethoxazole is an antibiotic used in the prevention and treatment of Pneumocystis jirovecii in individuals with a compromised immune system. Ketoconazole is used to treat fungal infections. Filgastim is used to stimulate e production of granulocytes. Prednisone is used to suppress the immune system and to decrease edema caused by tumors or tumor necrosis.
Which of the following assessment findings in the 5 year-old child with diabetes insipidus would warrant the nurse contacting the physician immediately? a. Urinary output of greater than 100 mL/hr b. Serum sodium of 135 mEq/L c. Weight unchanged for 2 consecutive days d. Blood pressure of 90/60.
a. Urinary output of greater than 100 mL/hr
A 10-year-old boy is being prepared for a bone marrow transplant. The nurse can determine that the child understands this treatment when he says: a. "I'll be much better after this blood goes to my bones." b. "I won't feel too good until my body makes healthy cells." c. "This will help all of the medicine they give me to work better." d. "You won't have to wear a mask and gown after my transplant."
b. "I won't feel too good until my body makes healthy cells." The transplant takes time to work and produce healthy cells. So it will take some time before the child feels better.
The nurse is providing discharge teaching to the parents of a 3-year-old girl on how to obtain a clean-catch urine specimen. What is the most appropriate statement by the nurse? a. "Collect the urine sample right after her nap." b. "Never collect the first voided specimen of the day." c. "Collect the urine sample at the beginning of urination." d. "We no longer recommend washing the perianal area before collecting the specimen."
b. "Never collect the first voided specimen of the day."
A nurse is caring for a 9-year-old boy with nocturnal enuresis with no physiologic cause. He says he is embarrassed and wishes that he could stop wetting his pants and the bed at night. How should the nurse respond? a. "You will outgrow this in a few years. You just need to be patient with your body as it grows." b. "There are several things we can do to help you achieve your goal." c. "There are almost 5 million people that have your problem." d. "The pull-ups look just like underwear. No one has to know."
b. "There are several things we can do to help you achieve your goal."
A 12-year-old male was just diagnosed with type 1 diabetes. As the nurse teaches him about insulin injections, he asks why he cannot take the diabetic pills that his uncle takes. What would be the best response by the nurse? a. "You will be able to take the pills once you reach you reach adulthood." *b. "You have a different type of diabetes where the pill will not work." c. "We have to test you to see if you can take the diabetic pill." d. "You might be able to switch between taking the pills and insulin if you eat right."
b. "You have a different type of diabetes where the pill will not work."
A child is admitted with complaints of weight loss and lack of energy. The child's ears and cheeks are flushed. The nurse observes an acetone odor to the child's breath. The child's serum glucose level is 325 mg/dL, BP is 104/60, pulse is 88 and respirations are 16. Which of the following does the nurse expect the physician to order first? a. Subcutaneous administration of glucagon b. Administration of IV regular insulin by continuous infusion pump c. Administration of regular insulin subcutaneously every 2 hours as needed by sliding scale insulin d. Administration of IV fluids in boluses of 20 mL/kg
b. Administration of IV regular insulin by continuous infusion pump
Which complications are the three main consequences of leukemia? a. Bone deformities, spherocytosis and infection. b. Anemia, infection, and bleeding tendencies. c. Lymphocytopoiesis, growth delays, and hirsutism. d. Polycythemia, decreased clotting time, and infection.
b. Anemia, infection, and bleeding tendencies Leukemia is a primary disorder of the bone marrow in which the normal elements are replaced with abnormal WBCs. These abnormal WBCs, lymphoblasts are fragile and immature, lacking the infection-fighting capabilities of the normal WBC. The growth of lymphoblasts is excessive and the abnormal cells replace the normal cells in the bone marrow. The proliferating leukemic cells demonstrate massive metabolic needs, depriving normal body cells of needed nutrients and resulting in fatigue, weight loss or growth arrest, and muscle wasting. The bone marrow becomes unable to maintain normal levels of RBCs, WBCs, and platelets, so anemia, neutropenia, thrombocytopenia, infection & bleeding tendencies may result.
A child hospitalized with hydrocephalus is being treated with an externalized ventricular drain (EVD). A nurse begins the afternoon assessment and discovers that the drain is positioned several inches below the level of the child's external meatus. What should be the nurse's priority action? a. Raise the drain to the level of the child's external meatus. b. Clamp the drain and complete a neurological assessment. c. Quickly elevated the head of the bed. d. Leave the drain as is and monitor the CSF drainage hourly.
b. Clamp the drain and complete a neurological assessment.
What is the most important intervention for the nurse to include in the care plan for a male infant following surgical repair of hypospadias? a. Sterile dressing changes every 4 hours b. Frequent assessment of the tip of the penis c. Removal of the suprapubic catheter on the 2nd postoperative day d. Urethral catheterization if voiding does not occur over an 8-hour period
b. Frequent assessment of the tip of the penis
A nurse is developing a teaching plan for parents of a toddler who has just been diagnosed with sickle cell disease. Which statement is important to emphasize in the teaching plan? a. If they have any children, those children will probably have sickle cell disease too. b. Knowing how to prevent vaso-occlusive crisis is an important part of the parent's role. c. The child will have a greater tendency to bleed and should avoid contact sports. d. Vaso-occlusive crisis will occur eventually, requiring medical care in the emergency department.
b. Knowing how to prevent vaso-occlusive crisis is an important part of the parent's role. Option A is too general and needs to be more specific stating the chances of having a child with sickle cell trait or sickle cell disease, or a child unaffected. Option B is the correct answer because it is important to teach parents how to prevent a vaso-occlusive crisis. Option C is not true for sickle cell disease, but would be important for the parents of a child with hemophilia. Option D is not accurate. It is a preventable condition.
A child is brought to the emergency department with a head injury. When assessing a child with an acute head trauma, which of the following would the nurse initially check? a. Ocular signs. b. Level of consciousness. c. Muscular strength. d. Superficial injuries to the head.
b. Level of consciousness.
The nurse is reviewing lab results of a neonate who has the possible diagnosis of congenital hypothyroidism. The nurse is most concerned by which results? a. High level of T4 and low level of TSH b. Low level of T4 and high level of TSH c. Normal TSH and high level of T4 d. Normal T4 and low level of TSH
b. Low level of T4 and high level of TSH
A 3-year-old girl with a Wilms tumor is returning to the unit after a simple nephrectomy. Which of the following actions have the highest priority in caring for this child? a. Maintaining NPO. b. Monitoring the BP every 2 hours. c. Turning her every 2 hours. d. Administering pain medication every 4 hours.
b. Monitoring the BP every 2 hours. Since a Wilms tumor involves the kidney and removal of the affected portion of the kidney, it is important to monitor the BP frequently because of the role the kidney has in maintaining blood pressure. If you use the ABC's to answer this question, then A: no answer about airway. B: no answer about airway. C: monitoring BP is in this category. Option A - Maintaining NPO does not have the highest priority because we only implement this until the child is awake from anesthesia. Then the child can begin having ice chips or sips of water. Hydration is important and oral hydration needs be instituted as soon as a provider's order is obtained. Option C -This is important if a patient has an altered level of consciousness or musculoskeletal problems that prevent voluntary movement of their body. A child who had a simple nephrectomy should have voluntary control of movement. I would anticipate that being too active would be more of a problem than not being able to move. Option D - Administering pain medication is important postoperatively for any patient but using the ABC's, it does not occur until "G."
Which of the following assessment findings would indicate vaso-occlusive crisis in a child with sickle cell disease? a. Painful urination b. Pain with ambulation c. Complaints of sore throat d. Fever with associated rash
b. Pain with ambulation Pain with ambulation is a clinical manifestation of sickle cell disease. Painful urination, complaints of sore throat, and fever associated with rash are clinical manifestations of other conditions
The nurse is assessing a 14-year-old girl with a tumor. Which of the following findings would indicate Ewing sarcoma? a. Child complains of dull bone pain just above the knee. b. Palpation reveals non-tender swelling on the right ribs. c. Parents report a mass on the abdomen that crosses the midline. d. Palpation reveals asymptomatic mass on the upper back.
b. Palpation reveals non-tender swelling on the right ribs. Ewing sarcoma is most frequently found in flat bones (pelvis, chest wall, vertebrae) & long bone diaphysis. Also, there is usually a palpable mass that is non-tender.
A child has demonstrated a sudden onset of thyrotoxicosis. The nurse anticipates that, besides anti-thyroid therapy, the child is likely also to receive which medication? a. ibuprofen (Motrin) b. Propranolol (Inderal) c. Digoxin (Lanoxin) d. metformin (Glucophage)
b. Propranolol (Inderal)
A parent of a child with Wilms tumor asks the nurse about surgery. Which statement concerning the type of surgery for Wilms tumor is most accurate? a. Surgery is only done if chemotherapy and radiation fail. b. Surgery is usually performed within 24 to 48 hours of admission. c. Surgery is the least favorable therapy for the treatment of Wilms tumor. d. Surgery will be delayed until the child's overall health status improves.
b. Surgery is usually performed within 24 to 48 hours of admission. Surgery is usually performed as soon as possible after the diagnosis is made since that is the treatment method for this tumor.
A 5-year-old child is brought to the emergency department unconscious after being hit by a car. The most helpful information for the nurse performing the neurological assessment is the nurse's knowledge of: a. Normal growth and development. b. The child's usual behavior and status. c. The child's past medical history. d. The child's growth and developmental progress during infancy.
b. The child's usual behavior and status.
The nurse is caring for a child who was not wearing a helmet, fell off of a bike, and sustained a head injury. Which of the following clinical manifestations would indicate the child is experiencing increased intracranial pressure? a. Hypotension b. Widened pulse pressure. c. Narrow pulse pressure. d. Tachycardia.
b. Widened pulse pressure. meaning that the value is higher
The nurse has finished teaching the parents of a 10-month-old male ways to prevent another acute otitis media infection. Which statement by the mother indicates she has the correct understanding of the information provided? a. "I should continue to smoke in the house." b. "Because the infection is in my son's ear, hand washing is not important." c. "I should continue to breastfeed my son because it lowers the incidence of acute otitis media." d. "Immunizations will not help prevent another otitis media infection."
c. "I should continue to breastfeed my son because it lowers the incidence of acute otitis media."
What statement made by the parents of a child undergoing hypospadias repair implies the need for further teaching about the primary objective of surgical correction? a. "The purpose is to improve the physical appearance of the genitalia for psychological reasons." b. "The purpose is to enhance the child's ability to void in the standing position." c. "The purpose is to decrease the chance of developing urinary tract infections." d. "The purpose is to preserve a sexually adequate organ."
c. "The purpose is to decrease the chance of developing urinary tract infections."
A child having myringotomy tubes placed asks, "How and when will the tubes be removed?" What is your best response? a. "You will have them replaced every 2 months until you reach age 18." b. "The tubes remain in place for 6 months and then are dissolved by vinegar." c. "The tubes remain in place for 6 to 12 months until they come out by themselves." d. "The tubes are not removed; they grow permanently into place."
c. "The tubes remain in place for 6 to 12 months until they come out by themselves."
The nurse is teaching the parents of a 15-year-old who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which of the following symptoms should the parents seek medical care immediately? a. Earache, stiff neck or sore throat b. Blisters, ulcers or a rash appear c. A temperature of 101.5 degrees Fahrenheit d. Difficulty or pain when swallowing
c. A temperature of 101.5 degrees Fahrenheit Since children who are undergoing chem typically have a suppressed immune system, then a fever is concerned an emergent occurrence since this may be a sign of infection. To prevent or provide rapid evaluation of the fever and its cause, the parents should contact the provider or take the child to the ED. With a compromised immune system, the child could develop sepsis.
The nurse is administering cyclophosphamide as ordered to a 12-year-old child with nephrotic syndrome. Which of the following instructions is most accurate regarding administration of this cytotoxic drug? a. Administer in the evening on an empty stomach and cannot void for 30 minutes after administration b. Provide adequate hydration and encourage voiding as needed during administration c. Administer in the morning, encourage fluids and voiding during and after administration d. Encourage fluids, adequate food intake and voiding before and after administration
c. Administer in the morning, encourage fluids and voiding during and after administration
Which of the following is the priority for the nurse to assess in the plan of care for a child who had a closure of a neural tube defect? a. The presence of a urinary tract infection. b. An alteration in bowel function. c. An increased intracranial pressure. d. An alteration in the motor function in the legs.
c. An increased intracranial pressure.
What is the treatment of choice for severe aplastic anemia? a. Liver transplantation b. Exchange transfusions c. Bone marrow transplantation d. Administration of IV immunoglobulins
c. Bone marrow transplantation Aplastic anemia is failure of the bone marrow to produce cells. Therapeutic management of aplastic anemia in children involves HSCT from a human leukocyte antigen (HLA)-matched sibling donor; if one is not available, immunosuppressive therapy or high-dose cyclophosphamide can be given.
The nurse is caring for a young infant who has been admitted with a possible diagnosis of meningitis. Which of the following assessment findings should the nurse report? a. Generalized floppiness. b. Subnormal temperature. c. Change in feeding pattern. d. Low-pitched cry.
c. Change in feeding pattern.
A school-aged child with acute glomerulonephritis has a nursing diagnosis of impaired urinary elimination related to fluid retention and impaired glomerular filtration. Which patient goal best addresses the expected outcome for this diagnosis? a. Exhibits no evidence of infection b. Engages in activities appropriate to capabilities c. Demonstrates no periorbital, facial or body edema d. Maintains a fluid intake of more than 2000 mL in a 24-hour period
c. Demonstrates no periorbital, facial or body edema
Which observation when plotting height and weight on a growth chart would indicate that a 4 year-old child has a growth hormone deficiency? a. Upward shift of 1 percentile or more b. Upward shift of 5 percentiles or more c. Downward shift of 2 percentiles or more d. Downward shift of 5 percentiles or more
c. Downward shift of 2 percentiles or more
The nurse is assessing a child with juvenile hypothyroidism. The nurse documents which of the assessment findings that is consistent with this condition? a. Accelerate growth b. Diarrhea c. Dry skin d. Yellow sclera
c. Dry skin
A teenage mother arrives at the clinic with her newborn infant who was recently diagnosed with congenital hypothyroidism. When instructing the mother about administering levothyroxine, what information should the nurse include? a. Crush the medication and place it in a full bottle of formula or breast milk to disguise the taste. b. Administer the medication every 3rd day for 2 weeks, then every other day for 2 weeks and then prn. c. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula. d. Explain that the medication will no longer be needed after the child reaches 5 years of age.
c. Give the crushed medication in a syringe or in the nipple mixed with a small amount of formula.
The nurse is assessing an infant with suspected hemolytic uremic syndrome. Which of the following characteristics of this condition would the nurse expect to assess, including information from the electronic medical record? a. Hemolytic anemia, acute renal failure, & hypotension b. Dirty green colored urine, elevated erythrocyte sedimentation & depressed serum complement level c. Hemolytic anemia, thrombocytopenia & acute renal failure d. Thrombocytopenia, hemolytic anemia, & nocturia several times each night
c. Hemolytic anemia, thrombocytopenia & acute renal failure
Which one of the following nursing assessment findings would supply data about a major complication in an infant with a myelomeningocele? a. Obtaining the infant's weight. b. Monitoring the infant's urinary output every shift. c. Measuring the infant's head circumference daily. d. Assessing the infant's blood pressure every 12 hours.
c. Measuring the infant's head circumference daily.
A 12-year-old child was admitted to the neurosurgical unit for observation after receiving a head injury. The details of how the injury occurred are unknown. It is now 12 hours after the injury and the child has demonstrated no signs or symptoms of a head injury. Which of the following would be the priority intervention for the nurse to perform? a. Promote rest by creating a quiet environment. b. Administer opioids for complaints of a headache. c. Monitor the level of consciousness every hour as ordered. d. Question the child about the circumstances leading to the injury.
c. Monitor the level of consciousness every hour as ordered.
A newborn arrives in a neonatal intensive care unit with a myelomeningocele. A physician writes orders to keep the infant in the prone position. A nurse should know that which one of the following is the most important rationale behind this order? a. Prevent infection. b. Promote circulation to the lower extremities. c. Prevent trauma to the meningeal sac. d. Promote comfort.
c. Prevent trauma to the meningeal sac.
A 5-year-old child is admitted with sickle cell disease. Which assessment finding is most concerning to the nurse? a. Heart rate 135 b. Blood pressure 125/79 c. Pulse oximeter reading 90% d. Temp 100.5 orally
c. Pulse oximeter reading 90% Using the ABC's of prioritization, there is no assessment data for airway, but there is for breathing. A pulse oximeter reading of 90% is concerning and the nurse should intervene immediately.
A child has experienced symptoms of hypoglycemia and has eaten sugar cubes. The priority intervention by the nurse would be to have the child ingest which of the following next? a. Four cups of water b. Candy bar or cake frosting c. Slice of bread with peanut butter d. Chicken or fish without bread
c. Slice of bread with peanut butter
The nurse is caring for an 11-year-old boy diagnosed with acute glomerulonephritis. When reviewing the boy's health history, which of the following will likely be noted? a. The boy has a history of recurrent urinary tract infections b. The boy has a family history of renal disorders c. The boy has a recent history of an upper respiratory infection d. The boy has a history of hypotension
c. The boy has a recent history of an upper respiratory infection
The nurse is caring for a 9-year-old girl presenting with fever, dysuria, flank pain, urgency and hematuria. The nurse would expect which of the following tests to be ordered first to reveal preliminary information about the urinary tract? a. Total protein, globulin and albumin b. Creatinine clearance c. Urinalysis d. Urine culture and sensitivity
c. Urinalysis
The nurse is administering methimazole (Tapazole) to a 12-year-old recently diagnosed with hyperthyroidism. The child has been receiving the medication 3 times a day for 2 weeks. She suddenly reports onset of a severe sore throat. What would be the appropriate nursing action? a. Continue to give the medication or she will continue to exhibit signs of hyperthyroidism. b. Offer lozenges for the relief of the sore throat. c. Withhold the dose and report this to the physician. d. Ask the child's parents to rate the pain on a scale from 0 - 10.
c. Withhold the dose and report this to the physician.
To help prevent complications from sickle cell disease during ages 2 months to 5 years, which medication is prescribed on a daily basis? a. diphenhydramine b. acetaminophen c. penicillin d. hydroxyurea
c. penicillin Penicillin is given prophylactically to prevent pneumococcal infections. The sickle cells clog the blood vessels in the spleen. This leads to damage and poor protection against infection. To prevent severe infection in the child with sickle cell anemia, a variety of interventions are necessary.
The nurse is preparing an adolescent diagnosed with leukemia for a lumbar puncture. The nurse determines that the child understands the reason for the procedure when the child states that the procedure is done to: a. "Make sure I don't have meningitis along with my cancer." b. "Relieve some of the pressure on my brain." c. "Remove the blood cancer cells so I don't have to have surgery." d. "Check to see if the cancer has spread through my spinal cord and brain."
d. "Check to see if the cancer has spread through my spinal cord and brain." The purpose of the LP is to determine if the cancer cells in the CSF that metastasized to the brain and spinal cord.
A nurse and nursing student are caring for a child who sustained a head injury as a result of a fall from a play structure. Which statement by the nursing student best indicates that the student is prepared to care for the child? a. "I will be sure to let you know if the child's pupils become fixed and dilated." b. "I will keep the child straight in the supine position." c. "I will notify the physician if the child becomes sleepy." d. "I will look for any changes in the child's respirations, pulse or blood pressure."
d. "I will look for any changes in the child's respirations, pulse or blood pressure."
The parents of a 3-week-old healthy newborn ask the nurse why their child is intermittently cross-eyed. What is the nurse's best response? a. "An eye patch may be necessary for 6 weeks to correct your child's vision." b. "Your child will likely need an ophthalmology consult." c. "Surgery may be necessary to correct your child's vision." d. "It is normal to have eye crossing in the newborn period."
d. "It is normal to have eye crossing in the newborn period."
The nurse is assessing a patient in the ED suspected of being in vaso-occlusive crisis. Which assessment findings would indicate that the patient is having a vaso-occlusive crisis? a. Hypotension and thready pulse b. Pallor and poor capillary refill c. Anemia, jaundice and reticulocytosis d. Acute leg pain and swelling of both hands
d. Acute leg pain and swelling of both hands Acute leg pain & swelling of both hands are clinical manifestations of vaso-occlusive crisis. The sickled cells get trapped in the distal vessels and tissues which leads to hypoxia, pain, and edema in the extremities. Options A & B are not clinical manifestations of sickle cell disease but may indicate hypovolemic shock, severe dehydration, or a cardiac issue. Option C may indicate a problem with another hematological problem other than sickle cell disease or a liver problem.
The nurse is reviewing the interventions listed in the plan of care for a child in vaso-occlusive crisis. What is the most important intervention for the nurse to implement? a. Administering analgesics b. Monitoring fluid restrictions c. Encouraging activity as tolerated d. Administering oxygen as ordered
d. Administering oxygen as ordered This is a prioritization question and should be answered using the ABC's. There are no answer choices related to airway. For breathing, the choice is Option D and is the best choice in this scenario for a child experiencing a vaso-occlusive crisis.
Which of the following conditions most warrants the pediatric patient with sickle cell disease to receive a blood transfusion? a. Hemoglobin 6.9 b. Pain unrelieved by morphine c. Elevated reticulocyte count d. Coughing and respiratory difficulty
d. Coughing and respiratory difficulty Rationale: Coughing and respiratory difficulty are clinical manifestations of acute chest syndrome in a child with sickle cell disease. Thus, a blood transfusion may be needed to improve oxygenation. Option A - a hemoglobin of 6.9 may also indicate a need for a blood transfusion, but coughing and respiratory difficulty are indicative of a more serious condition. Option B - pain unrelieved by morphine is concerning but is not the most concerning. The dosage of morphine may need to be increased along with other pain medications and nonpharmacological methods included in the management plan. Option C - this is not an indication that a blood transfusion is needed. The child may have an elevated reticulocyte count because the body is producing more RBCs in attempt to improve oxygenation
The nurse is caring for an infant who is born with hydrocephalus and has a shunt inserted. Which of the following signs indicates that the shunt is functioning properly? a. Positive sunset sign. b. A bulging fontanel. c. Widened suture lines. d. Decreasing daily head circumference.
d. Decreasing daily head circumference.
The nurse is working with a newborn in adrenal crisis. All of the following interventions by the nurse are appropriate except a. Address the newborn with ambiguous genitalia as "baby," not he, she or it. b. Support the family until sexual assignment of the newborn can be determined. c. Administer cortisone as prescribed. d. Describe the sex organs of the newborn as penis until corrective surgery can take place.
d. Describe the sex organs of the newborn as penis until corrective surgery can take place.
Which of the following interventions would be best for the child who has developed mucositis as a side effect of chemotherapy? a. Using lemon glycerin swabs for oral hygiene. b. Keeping the child NPO until all sores are healed. c. Having the child swish and swallow viscous lidocaine. d. Giving the child pudding for breakfast.
d. Giving the child pudding for breakfast. Mucositis is a painful condition where there is impaired skin integrity of the mucous membranes. Using lemon glycerin swabs would increase the pain due to the chemical solution on the swabs. It may take several weeks for the mucositis to resolve and the impaired skin integrity may remain until the chemotherapy is completed. Thus, it would not be therapeutic to have the child be NPO for 6-12 weeks. The child would not be prescribed viscous lidocaine initially unless other measures had failed and the child was refusing all foods and fluids. Giving the child something soft that is not spicy or hot in temperature is the best choice since the child may be able to eat this without further pain or discomfort.
The nurse is assessing an infant with diabetes insipidus. What initial observation would the nurse expect? a. Dehydration b. Inability to be aroused c. Extreme hunger d. Irritability
d. Irritability Irritability is an early sign of fluid and sodium loss in an infant. Infants cannot report that they "don't feel well" or that they are thirsty, but they can cry and be fussy.
A child is seen in the pediatrician's office for complaints of bone and joint pain. Which other assessment finding may indicate leukemia? a. Abdominal pain b. Increased activity level c. Increased appetite d. Petechiae
d. Petechiae Leukemia often results in bleeding tendencies, which can manifest as petechiae. Children with leukemia usually have a decreased activity level and decreased appetite not increased activity level or increased appetite. Children with leukemia may have nausea and vomiting, but do not usually have abdominal pain.
Which condition assessed by the nurse would be an early warning sign of childhood cancer? a. Difficulty swallowing b. Frequent cough or hoarseness c. Change in bowel and bladder habits d. Swellings, lumps or masses anywhere on the body
d. Swellings, lumps or masses anywhere on the body Difficulty swallowing may be an early sign of esophageal cancer or brain tumor, but it not specific to childhood cancers. Options B & C are possible warning signs for cancer in adults. Option D are warning signs of cancer in children,
The nurse is educating the parents of a 4-year-old boy with strabismus. Teaching for the parents would include the: a. need for ultraviolet-protective glasses postoperatively. b. importance of completing the full course of oral antibiotics. c. possibility that multiple operations may be necessary. d. importance of patching as prescribed.
d. importance of patching as prescribed.
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