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WorksheetsEnd of chapter ?'s for Peds final
Total questions: 139
Worksheet time: 2hrs 44mins
The nurse is developing a community outreach program to help reduce childhood mortality. What topic below would be essential to include?
Human immunodeficiency virus
Congenital anomalies
Motor vehicle accidents
Low birth rate
The nurse is assessing the vital signs of a child who is being evaluated in an urgent care center. The child is to be seen by the PNP. The mother asks, "Why is my child seeing the PNP and not the doctor?" What is the best response by the nurse?
"The PNP functions similar to the physician's assistant, so you should be perfectly at ease."
"The child may be seen by the physician instead if you like."
"Seeing the PNP is just one more step in having your child evaluated in this setting."
"The PNP is an experienced RN with advanced education in the diagnosis and treatment of children."
When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in?
Pregnancy counseling
Depression
Contraception
Tuberculosis
The school nurse is planning a screening program. What items should be included to address issues related to the "new morbidity"?
Academic difficulties, violence, and other mental health issues
The number of children with chronic illness at the school
Statistics related to health insurance coverage of the children
HIV infection, asthma, and respiratory allery testing
A single mother asks the nurse for suggestions on disciplining her 2-year-old son. Which suggestion would be most appropriate?
Encourage the mother to emphasize the inappropriate behavior
Wait an hour or so before enforcing the discipline
Have the child spend 2 minutes in time-out
Withhold a privilege from the toddler for a week
The nurse is teaching a group of students about the possible effects of immigration on the health status of children. Which response by the group would indicate the need for additional teaching?
The children of immigrants have better access to preventative care
The children of immigrants have limited involvement in activities due to the language barrier
The children of immigrants lack adequate support systems
The children of immigrants face increased stressors due to relocation
Which would the nurse identify as a protective factor for youth violence?
Exposure to family violence
Limited involvement in social activities
Inconsistency of parental support
Commitment to academic performance
In an effort to control healthcare costs, what is the best recommendation by the nurse?
"Shop around to find the most inexpensive health insurance plan."
"Find a job that provides family health insurance at a minimal cost."
"Stress primary prevention, using the healthcare system for check-ups."
"Avoid seeing the physician until your child becomes ill."
The mother of a 3-month-old boy asks the nurse about starting solid foods. What is the most appropriate response by the nurse?
"It's okay to start puréed solids at this age if fed via the bottle."
"Infants don't require solid foods until 12 months of age."
"Solid foods should be delayed until age 6 months, when the infant can handle a spoon on his own."
"The tongue extrusion reflex disappears at age 4 to 6 months, making it a good time to start solid foods."
The father of a 2-month-old girl is expressing concern that his infant may be getting spoiled. What is the nurse's best response?
"She just needs love and attention. Don't worry; she's too young to spoil."
"Consistently meeting the infant's needs helps promote a sense of trust."
"Infants need to be fed and cleaned; if you are sure those needs are met, just let her cry."
"Consistency in meeting needs is important, but you are right, holding her too much will spoil her."
Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior?
Crying when left with the sitter may indicate difficulty with building trust.
Stranger anxiety should not occur until toddlerhood; this concern should be investigated.
Seperation anxiety is normal at this age; the infant recognizes parents as separate beings.
Perhaps the sitter doesn't meet the infant's needs; choose a different sitter.
The nurse is providing anticipatory guidance to the mother of a 6-month-old infant. What is the best instruction by the nurse in relation to the infant's oral health?
"Start brushing her teeth after all the baby teeth come in."
"Use a washcloth with toothpaste to clean her mouth."
"Clean your baby's gums, then new teeth, with a washcloth."
"Rinse your baby's mouth with water after every feeding."
A 9-month-old infant's mother is questioning why cow's milk is not recommended in the first year of life as it is much cheaper than formula. What rationale does the nurse include in her response?
It is permissable to substitute cow's milk for formula at this age as he is so close to 1 year old.
Cow's milk is poor in iron and does not provide the proper balance of nutrients for the infant.
As long as the mother provides whole milk, rather than skim, she can start cow's milk in infancy.
If the mother cannot afford the infant formula, she should dilute it to make it last longer.
The nurse is caring for a hospitalized 30-month-old who is resistant to care, is angry, and yells "no" all the time. The nurse identifies this toddler's behavior as
problematic, as it interferes with needed nursing care
normal for this stage of growth and development
normal because the child is hospitalized and out of his routine
The mother of a 15-month-old is concerned about speech delay. She describes her toddler as being able to understand what she says, sometimes following commands , but using only one or two words with any consistency. What is the nurse's best response to this information?
The toddler should have a developmental evaluation as soon as possible.
If the mother would read to the child, then speech would develop faster.
Receptive language normally develops earlier than expressive language.
The mother should ask her child's physician for a speech therapy evaluation.
A 2-year-old is having a temper tantrum. What advice should the nurse give the mother?
For safety reasons, the toddler should be restrained during the tantrum.
Punishment should be initiated, as tantrums should be controlled.
The mother should promise the toddler a reward if the tantrum stops.
The tantrum should be ignored as long as the toddler is safe.
What is the best advice about nutrition for the toddler?
Encourage cup drinking and give water between meals and snacks.
Encourage unlimited milk intake, because toddlers need the protein for growth.
Avoid sugar-sweetened fruit drinks and allow as much natural fruit juice as desired.
Allow the toddler unlimited access to the sippy cup to ensure adequate hydration.
To gain cooperation from a toddler, what is the best approach by the nurse?
Immediately pick the toddler up from the mother's lap.
Kneel in front of the toddler while he or she is on the mother's lap.
Do the nursing tasks quickly so the toddler can play.
Ask the toddler if it is okay if you begin the needed task.
The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler's behavior as:
Problematic; the child is old enough to begin to have a basis in reality
Normal, because the child is hospitalized and out of her routine
Normal for this stage of growth and development
Problematic, as it interferes with the needed nursing care
The mother of a 3-year-old is concerned about her child's speech. She describes her preschooler as hesitating at the beginning of sentences and repeating consonant sounds, What is the nurse's best response?
Hesitency and dysfluency are normal during this period of development
Reading to the child will help model appropriate speech
Expressive language concerns warrant a developmental evaluation
The mother should ask her child's physician for a speech therapy evaluation
The mother of a 4-year-old asks for advice on using time-out for discipline with her child. What advice should the nurse give the mother?
If spanking is not working, then time-out is not likely to be helpful either
Place the child in time-out for 4 minutes
Use time-out only if removing privileges is unsuccessful
The child should stay in time-out until crying ceases
A 5-year-old child is not gaining weight appropriately. Organic problems have been ruled out. What is the priority action by the nurse?
Allow the child unlimited access to the sippy cup to ensure adequate hydration
Encourage sweets for the extra caloric content
Teach the mother about nutritional needs of the preschooler
Assess the child's usual intake pattern at home
The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration?
A lack of fully developed hearing
A less discriminating sense of touch
Visual acuity that has not fully developed
A less discriminating sense of taste
The successful resolution of developmental tasks for the school-age child, according to Erikson, would be identified by:
Learning from repeating tasks
Developing a sense of worth and competence
Using fantasy and magical thinking to cope with problems
Developing a sense of trust
Which of the following are reasons that stealing occurs in school-age children? (Choose all that apply.)
To escape punishment
High self-esteem
Low expectations of family/peers
Lack of sense of property
Strong desire to own something
Which activities will promote weight loss in an obese school-age child? (Choose all that appply.)
Unlimited computer and TV time
Role modeling by family
Becoming active in sports
Eating unstructured meals
Involving child in meal planning and grocery shopping
Samantha, a 10-year-old girl, is brought into your clinic for a well-child examination. Her mother states "Samantha's friend group seems to be so much more important to her these days." As the nurse caring for her, how would you explain the role of peers in the school-age child?
This allows her the opportunity to learn conflict management
This helps her to shape her concept of self and provides security as she gains independence from her parents
This will encourage her to remain dependent on her teachers and family
This will help her to work through her fears of body safety
The mother of two sons, ages 6 and 9, states they want to play on the same baseball team. As the school nurse, what advice would you give their mother?
Having boys on the same team will make it more convenient for the mother
Levels of coordination and concentration differ, so the boys need to be on different teams
Put the boys on the same team because they are both school-age children
It is best to avoid putting the boys on the same team to prevent sibling rivalry
When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Select all that apply.)
Accept the adolescent as a unique individual
Provide strict, inflexible rules
Listen and try to be open to the adolescent's views
Respect the adolescent's privacy
Provide unconditional love
In developing a weight-loss plan for an adolescent, which would the nurse include? (Select all that apply.)
Have parents make all of the meal plans
Eat slowly and place the fork down between each bite
Have the family exercise together
Refer to an adolescent weight-loss program
Keep a food and exercise diary
Which is associated with early adolescence? (Select all that apply.)
Uses scientific reasoning to solve problems
Still at times wants to be dependent upon parents
Incorporates own set of morals and values
Is influenced by peers and values memberships in cliques
What has the most influence in deterring an adolescent from beginning to drink alcohol?
Drinking habits of parents
Drinking habits of peers
Drinking philosophy of adolescent's culture
Drinking philosophy of adolescent's religion
When providing atraumatic care to a child, which action would be the most appropriate?
Applying restraints for any procedure that would be uncomfortable
Keeping the lights on in the child's room throughout the day and night
Limiting the use of topical anesthetics for painful injections
Allowing parents and children an informed choice about being together
When caring for children, how does the nurse best incorporate the concept of family-centered care?
Encourages the family to allow the physician to make health care decisions for the child
Uses the concepts of respect, family strengths, diversity, and collaboration with the family
Advises the family to choose a pediatric provider who is on the child's health care plan
Recognizes that families undergoing stress related to the child's illness cannot make good decisions
When working with children and families, which is a critical strategy for promoting therapeutic communication?
Detailed explanations
Attentive listening
Comforting touch
Closed-ended questions
The nurse is caring for a 2-year-old in the hospital, and the mother expresses concern that the toddler will be scared. Which response by the nurse would be most appropriate?
"Don't worry; we practice family-centered and atraumatic care here."
"We will do our best to minimize the stress that your child experiences."
"It will probably be upsetting for you as well, so you should stay home."
"Our practice of atraumatic care will eliminate all pain and stress for your child."
When planning education for a child and parents, what is the first step the nurse should take?
Decide which procedures and medications the child will be discharged on
Determine the child's and family's learning needs and styles
Ask the family if they have ever performed this type of procedure
Tell the child and family what the goals of the teaching session are
During the health interview, the mother of a 4-month-old says, "I'm not sure my baby is doing what he should be." What is the nurse's best response?
"I'll be able to tell you more after I do his physical."
"Fill out this developmental screening questionnaire and then I can let you know."
"Tell me more about your concerns."
"All mother's worry about their babies. I'm sure he's doing well."
An infant boy is at your facility for his initial health supervision visit. He is 2 weeks old and responds to a bell during his examination. You review all his birth records and find no documentation that a newborn hearing screening was performed. What is the best action by the nurse?
Do nothing; responding to the bell proves the infant does not have a hearing deficit
Schedule the infant immediately for newborn hearing screening
Ask the mother to observe for signs that the infant is not hearing well
Screen again with the bell at the infant's 2-month health supervision visit
A 15-month-old girl is having her first health supervision visit at your facility. Her mother has not brought a copy of the child's immunization record but believes she is fully immunized. "She had immunizations 3 months ago at the local health department." Which would be the best action by the nurse?
Ask the mother to bring the records to the 18-month health supervision visit
Start the "catch-up" schedule because there are no immunization records
Keep the child at the facility while the mother returns home for the records
Call the local health department and verify the child's immunization status
A 4-year-old child is having a vision screening performed. Which screening chart would be best for determining the child's visual acuity?
Snellen
Ishihara
Allen figures
CVTME
Which facility fulfills the characteristics of a medical home?
An urgent care center
A primary care pediatric practice
A mobile outreach immunization program
A dermatology practice
A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child's developmental level?
Playing a game with the child
Talking with the child about the teddy bear next to him
Using a screening tool during a follow-up office visit
Asking the 10-year-old sibling about the child
Which statement indicates the best sequence for the nurse to conduct an assessment in a nonemergency situation?
Introduce yourself, ask about any problems, take a history, and do the physical examination
Perform the physical examination and then ask the family if there are any problems in the child's life
Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns
Get a complete history of the family's health beliefs and practices, and then assess the child
What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health?
Explain to the child what's going to happen when the child asks questions
Explain what is going to happen in words the child can understand
Force the child to cooperate by having a parent hold him or her down
Give the child a sticker before beginning the examination
A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially?
Listening to the bowel sounds
Counting the heart rate
Checking the temperature
Looking into the ears
Which assessment finding is considered normal in children?
Irregular respiratory rate and rhythm
Split S2 and sinus arrhythmia
Decreased heart rate with crying
Genu varum past the age of 5 years
The nurse is preparing a 5-year-old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action?
Allow the mother to remove the underwear
Tell the boy he is acting childishly
Notify the OR that the underwear is on
Allow the boy to keep his underwear on
A 6-month-old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention?
Tie the restraint loosely to prevent skin breakdown
Leave the baby unrestrained when directly observed
Position the restrained infant prone to prevent aspiration
Place the infant in a room near the nurses' station
A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action?
Ask that the child's desired foods be sent up from the kitchen
Negotiate with the child to eat at least part of the food on the tray
Remove a privilege
Offer the child cereal and milk from stock on the nursing unit
The nurse providing home care to a 2-year-old listens to the child's parents talk about how the child and family are adjusting to the child's current illness. Which of the following roles is the nurse participating in?
Case management
Child and family advocacy
Direct nursing care
Child and family education
A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?
Increased risk for infection
Increased health care costs
Need to be transferred if overnight stay is required
Increased disruption of family functioning
The parents of a 5-year-old with special health care needs talk to the parents of a 10-year-old with a similar condition for quite a while each day. What is the nurse's interpretation of this behavior?
The nurse has not provided enough emotional support for the parents
This relationship between the children's parents is potentially unhealthy
Support between parents of special children is extremely valuable
Confidentiality is a pressing issue in this particular situation
The nurse is caring for a child who has received all possible medical care for cancer yet continues to experience relapse and metastasis. It is time to make the transition from curative care attempts to palliative care. What is the most important nursing consideration at this time?
The health care professionals should make the decision about the child's care
The family may lose a sense of hope, so cancer treatments should continue
Involve the family in the decision-making process about the shift to palliative care
Palliative care can take place only at home, so the child should be discharged
The nurse is caring for a 3-year-old with a gastrostomy tube and tracheostomy who is on supplemental oxygen and multiple medications. The mother is rooming in during this hospitalization. What is the priority nursing action?
Incorporate the mother's assistance in care when convenient
Recognize the mother as the expert on her child's needs and care
Recommend that the mother go home to get some rest
Provide family-centered care since the mother is there
The nurse is caring for a child with a developmental disability who is starting kindergarten this year. The mother is tearful and doesn’t want the child to go to school. What is the best response by the nurse?
“Do you need some time alone to collect yourself?”
“You’ve known for a while this time would come.”
“Can I call your husband or a friend for you?”
“It is normal to feel stressed or sad at this time.”
The parents of a child with a developmental disability ask the nurse for advice about disciplining their child. What is the best response by the nurse?
“You should choose methods that are most congruent with your values about discipline.”
“Children like this really can’t follow directions, so they may be very hard to discipline.”
“Punish your child only for socially unacceptable or offending behaviors.”
“Spanking works well for this type of child, as they really don’t like pain.”
A 3-year-old child is to receive a medication that is supplied as an enteric-coated tablet. What is the best nursing action?
Crush the tablet and mix it with apple sauce.
Dissolve the medication in the child’s milk.
Place a pill in the posterior part of the pharynx and tell the child to swallow.
Check with the prescriber to see if an alternative form can be used.
The nurse is caring for an infant who weighs 8.2 kg and is NPO and receiving IV fluid therapy. What rate does the nurse calculate as meeting the child’s daily fluid requirements?
82 mL per hour
41 mL per hour
34 mL per hour
22 mL per hour
When administering ear drops to a 2-year-old, which action would be most appropriate?
Tell the child that the drops are to treat his infection.
Pull the pinna of the child’s ear down and back.
Have the child turn his head to the opposite side after giving the drops.
Massage the child’s forehead to facilitate absorption of the medication.
The nurse is preparing to assess the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use?
FACES pain rating scale and poker chip tool
FACES pain rating scale, observation of the child, and parent report
Asking the parents to rate their child’s pain using the word-graphic rating scale
Visual analog scale
When developing the plan of care for a child in pain, the nurse identifies appropriate strategies aimed at modifying which factors influencing pain?
Gender
Cognitive level
Previous pain experiences
Anticipatory anxiety
An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, “I’ve been practicing really hard and long to get myself ready for my meet this weekend.” The area is tender to the touch. The nurse determines that the adolescent is most likely experiencing which type of pain?
Cutaneous pain
Deep somatic pain
Visceral pain
Neuropathic pain
After teaching a child’s parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching?
“We’ll have her focus on her hand and count each finger slowly.”
“We’ll read some of her favorite stories to her.”
“We’ll have her imagine that she’s at the beach this summer.”
“She likes to play video games, so we’ll bring in some from home.”
A child is scheduled for a bone marrow aspiration at 4 PM. The nurse would plan to apply EMLA cream to the intended site at which time?
1:30 PM
3:00 PM
3:30 PM
4:00 PM
Compared with adults, why are infants and children at an increased risk for infection and communicable diseases?
The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies.
The infant demonstrates an increased inflammatory response.
Cellular immunity is not functional at birth.
Infants have an increased risk for infection until they receive their first set of immunizations.
A mother calls the clinic because her 2-year-old daughter has a rectal temperature of 37.8°C (100°F). She wonders how high a fever should be before she should give medications to reduce it. What is the best response by the nurse?
“All fevers should be treated to prevent seizures.”
“Antipyretics should be used with any rise in temperature. They can help change the course of the infection.”
“Give your child aspirin when her fever is above 38°C (100.4°F).”
“In a normal healthy child, if your child is not uncomfortable, fevers less than 39°C (102.2°F) do not require medication.”
A neonate should be evaluated by a physician if which signs and symptoms are present?
Acting fussier than normal
Refusing the pacifier
Rectal temperature above 38°C
Mottling that is present during bathing
The public health nurse has been asked to provide information to local child care centers on controlling the spread of infectious diseases. What is the best information the nurse can provide?
The etiology of common infectious diseases
Proper handwashing techniques
The physiology of the immune system
Why children are at a higher risk of infection than adults
When compared with adults, why are infants and children at an increased risk of head trauma?
The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed.
The development of the nervous system is complete at birth but remains immature.
The spine is very immobile in infants and young children.
The skull is more flexible due to the presence of sutures and fontanels.
At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment the nurse finds:
Narrow sutures
Sunken fontanels
A rapid increase in head circumference
Increase in weight since last visit
A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, you are called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention?
Prevention of injury by removing the child from his bed
Prevention of injury by placing a tongue blade in the child’s mouth
Prevention of injury by restraining the child
Prevention of injury by placing the child on his side and opening his airway
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:
Educate the family on ways to prevent bacterial meningitis.
Initiate appropriate isolation precautions and begin intravenous antibiotics.
Assess the infant’s fontanels.
Encourage the mother to hold the infant and feed her.
Which situation would cause the nurse to become concerned about possible hearing loss?
A 12-month-old who babbles incessantly, making no sense
An 8-month-old who says only “da”
A 3-month-old who startles easily to sound
A 3-year-old who drops the letter “s”
A 4-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder?
Acute otitis media
Acute tympanic effusion
Otitis interna
Otitis externa
The nurse is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention?
Place the child prone postoperatively for comfort.
Teach the family use of the contact lens.
Place elbow restraints on the infant.
Provide a mobile for optical stimulation.
A 2-year-old has been prescribed eye patching for strabismus 6 hours per day. What teaching does the nurse provide for the mother?
Try to patch 6 hours per day, but if you miss some it is OK.
Patching is necessary to strengthen vision in the weaker eye.
Patching will keep the eye from turning in.
Since the child is so young, patching can be delayed until school age.
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention?
Attempt to calm the infant by placing him in his mother’s lap and offering him a bottle.
Alert the physician or nurse practitioner to the situation and ask for an order for a stat chest radiograph.
Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure.
Bring the emergency equipment to the room and begin bag-valve-mask ventilation.
A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention?
Airway maintenance and 100% oxygen by mask.
100% oxygen and pulse oximetry monitoring.
Airway maintenance and continued reassessment.
100% oxygen and provision of comfort.
The nurse is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child’s mother indicates an understanding of how to administer the supplemental enzymes?
“I will stop the enzymes if my child is receiving antibiotics.”
“I will decrease the dose by half if my child is having frequent, bulky stools.”
“Between meals is the best time for me to give the enzymes.”
“The enzymes should be given at the beginning of each meal and snack.”
Which of these factors contributes to infants’ and children’s increased risk for upper airway obstruction as compared with adults?
Underdeveloped cricoid cartilage and narrow nasal passages.
Small tonsils and narrow nasal passages.
Cylinder-shaped larynx and underdeveloped sinuses.
Underdeveloped cricoid cartilage and smaller tongue.
Which is the most appropriate treatment for epistaxis?
With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose.
With the child lying down and breathing through the mouth, pinch the lower third of the nose closed.
With the child sitting up and leaning forward, apply pressure to the bridge of the nose.
With the child sitting up and leaning forward, pinch the lower third of the nose closed.
The nurse is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is the nurse least likely to assess?
obesity from overeating
clubbing of the nail beds
squatting during play activities
exercise intolerance
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding?
gallop and rales
blood pressure discrepancies in the extremities
right ventricular hypertrophy on ECG
heart murmur
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem?
previous streptococcal throat infection
history of open-heart surgery at 5 years of age
playing too much soccer and not getting enough rest
exposure to a sibling with pneumonia
The nurse is caring for a child after a cardiac catheterization. What is the nursing priority?
Allow early ambulation to encourage activity participation.
Check pulses above the catheter insertion site for strength and quality.
Assess extremity distal to the insertion site for temperature and color.
Change the dressing to evaluate the site for infection.
While assessing a 4-month-old infant, the nurse notes that the baby experiences a hypercyanotic spell. What is the priority nursing action?
Provide supplemental oxygen by face mask.
Administer a dose of IV morphine sulfate.
Begin cardiopulmonary resuscitation.
Place the infant in a knee-to-chest position.
A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38°C, pulse 140, and respiratory rate 38. He has lost 6 oz since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing diagnosis?
Thermoregulation alteration
Pain (abdominal) related to diarrhea
Fluid volume deficit related to excessive losses and inadequate intake
Alteration in nutrition, less than body requirements, related to decreased oral intake
A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would the nurse prioritize for immediate reporting to the physician?
Temperature 101.9°F
Rebound tenderness and abdominal guarding
Parents will be leaving the child alone in the hospital.
Child can tolerate only sips of fluid without nausea.
A 3-day-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which response indicates to the nurse that the parent needs more teaching?
“My infant is at risk for dehydration.”
“My infant needs to stay under the lights, except during feeding time.”
“My infant can continue to breastfeed during this time.”
“My infant has a serious liver disease.”
A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead the nurse to believe that this infant may need further intervention?
Poor weight gain
Small “spits” after feeding
Sleeps through the night
Difficult to burp
The nurse is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority nursing assessment?
Determine the child’s weight.
Ask if the family has traveled outside of the country.
Assess circulation and perfusion.
Send a stool specimen to the laboratory.
The nurse is performing education for the parents of an infant with bladder exstrophy. Which statement by the parents would indicate an understanding of the child’s future care?
“Care will be no different than that of any other infant.”
“My infant will only need this one surgery.”
“My child will wear diapers all his life.”
“We will need to care for the urinary diversion.”
A 4-year-old girl presents with recurrent urinary tract infection. A prior workup did not reveal any urinary tract abnormalities. What is the priority nursing action?
Obtain a sterile urine sample after completion of antibiotics.
Teach appropriate toileting hygiene.
Prepare the child for surgery to reimplant the ureters.
Administer antibiotics intramuscularly.
A 5-year-old who had a renal transplant 9 months ago and has no history of chickenpox presents to the pediatric clinic for his vaccinations. Which is the most appropriate set to give?
DTaP, IPV
DTaP, IPV, MMR, varicella
DTaP, IPV, varicella
IPV only
When the nurse is caring for a child with hemolytic uremic syndrome or acute glomerulonephritis and the child is not yet toilet trained, which action by the nurse would best determine fluid retention?
Test urine for specific gravity.
Weigh child daily.
Weigh the wet diapers.
Measure abdominal girth daily.
A boy with Duchenne muscular dystrophy is admitted to the pediatric unit. He has an ineffective cough. Lung auscultation reveals diminished breath sounds. What is the priority nursing intervention?
Apply supplemental oxygen.
Notify the respiratory therapist.
Monitor pulse oximetry.
Position for adequate airway clearance.
A 7-year-old child with cerebral palsy has been admitted to the hospital. Which information is most important for the nurse to obtain in the history?
Age that the child learned to walk
Parents’ expectations of the child’s development
Functional status related to eating and mobility
Birth history to identify cause of cerebral palsy
The nurse is caring for a child with cerebral palsy who requires a wheelchair to attain mobility. Which intervention would help the child achieve a sense of normality?
Encourage follow-through with physical therapy exercises.
Restrict the child to a special needs classroom.
Encourage after-school activities within the limits of the child’s abilities.
Ensure the school is aware of the child’s capabilities.
The nurse is caring for orthopedic children who are in the postoperative period following spinal fusion. What is the most appropriate activity to delegate to unlicensed assistive personnel?
Ambulate the children twice daily to promote mobility.
Encourage commode use to promote bowel function.
Provide diversionary activities, as the children must stay flat on their backs.
Assist with log-rolling the children every 2 hours.
The nurse is teaching about skin care for atopic dermatitis. Which statement by the parent indicates that further teaching may be necessary?
“I will use Vaseline or Crisco to moisturize my child’s skin.”
“A hot bath will soothe my child’s itching when it is severe.”
“I will buy cotton rather than wool or synthetic clothing for my child.”
“I will apply a small amount of the prescribed cream after the bath.”
The nurse is caring for a child who has received significant partial-thickness burns to the lower body. What is the priority assessment in the first 24 hours after injury?
fluid balance
wound infection
respiratory arrest
separation anxiety
The nurse is caring for a child in the emergency department who was bitten by the family dog, who is fully immunized. What is the priority nursing action?
Administer rabies immunoglobulin.
Refer the child to a counselor.
Assess the depth and extent of the wound.
Administer a tetanus booster.
The nurse is caring for an infant on the pediatric unit who has a very red rash in the diaper area, with red lesions scattered on the abdomen and thighs. What is the priority nursing intervention?
Administer griseofulvin with a fatty meal.
Institute contact isolation precautions.
Apply topical antibiotic cream.
Apply topical antifungal cream.
A varsity high-school wrestler presents with a “rug burn” type of rash on his shoulder that is not healing as expected, despite use of triple antibiotic cream. Two other wrestlers on his team have a similar abrasion. What infection should the nurse be most concerned about, based on the history?
tinea cruris
MRSA
impetigo
tinea versicolor
A child on the pediatric unit has morning laboratory results of Hgb 10.0, Hct 30.2, WBC 24,000, and platelets 20,000. What is the priority nursing assessment?
Assess for pallor, fatigue, and tachycardia.
Monitor for fever.
Assess for bruising or bleeding.
Determine intake and output.
A child with hemophilia fell while riding his bicycle. He was wearing a helmet and did not lose consciousness. He has a mild abrasion on his knee that is not oozing. He is complaining of abdominal pain. What is the priority nursing assessment?
Perform neurologic checks.
Assess ability to void frequently.
Carefully assess his abdomen.
Examine his knee frequently.
A 14-year-old with thalassemia asks for your assistance in choosing her afternoon snack. Which choice is the most appropriate?
Peanut butter with rice cake
Small spinach salad
Apple slices with cheddar cheese
Small burger on wheat bun
The nurse is caring for a child who has just been admitted to the pediatric unit with sickle cell crisis. He is complaining that his right arm and leg hurt. What is the priority nursing intervention?
Administer pain medication every 3 hours intravenously until pain is controlled.
Perform passive range of motion of the arm and leg to maintain function.
Try acetaminophen for pain first, moving up to opioids only if needed.
Use narcotic analgesics and warm compresses as needed to control the pain.
A 5-year-old has been diagnosed with Wilms tumor. What is the priority nursing intervention for this child?
Educate the parents about dialysis, as the kidney will be removed.
Measure abdominal girth every shift.
Avoid palpating the child’s abdomen.
Monitor BUN and creatinine every 4 hours.
A child with leukemia has the following am laboratory results: Hgb 8.0, Hct 24.2, WBC 8,000, platelets 150,000. What is the priority nursing assessment?
Monitor for fever.
Assess for bruising or bleeding.
Determine intake and output.
Assess for pallor, fatigue, and tachycardia.
A child with leukemia received chemotherapy about 10 days ago. She presents today with a temperature of 100.4°F, an absolute neutrophil count of 500, and mild bleeding of the gums. What is the priority nursing intervention?
Administer IV antibiotics as ordered.
Provide vigorous oral care frequently with a firm toothbrush.
Monitor pulse and blood pressure for changes.
Administer packed red blood cell transfusion.
A child with cancer is receiving chemotherapy, and his mother is concerned that the nausea and vomiting associated with chemotherapy are reducing his ability to eat and gain weight appropriately. What is the most appropriate nursing action?
Administer an antiemetic at the first hint of nausea.
Offer the child’s favorite foods to encourage him to eat.
Start antiemetic drugs prior to the chemotherapy infusion.
Maintain IV fluid infusion to avoid dehydration.
The nurse is caring for a 6-year-old with juvenile idiopathic arthritis. The mother states that she has trouble getting her daughter out of bed in the morning and believes the girl’s behavior is due to a desire to avoid going to school. What is the best advice by the nurse?
Refer the girl to a psychologist for evaluation of school phobia related to chronic illness.
Administer a warm bath every morning before school.
Give the child her prescribed NSAIDs 30 minutes before getting out of bed.
Allow her to stay in bed some mornings if she wants.
A 14-year-old with systemic lupus erythematosus wants to know how to care for her skin. What should the nurse teach this adolescent?
Careful sun tanning will give her skin an attractive color.
No special skin care is needed.
Use sunscreen daily to avoid rashes.
Use makeup to camouflage the butterfly rash on her face.
The mother of a child with hypogammaglobulinemia reports that her child had a fever and slight chills with an intravenous gammaglobulin infusion last month. She wants to know what other course of treatment might be available. What is the best response by the nurse?
Administration of acetaminophen or diphenhydramine prior to the next infusion may decrease the incidence of fever or chills.
Giving the gammaglobulin intramuscularly is recommended to prevent a reaction.
Talk to her physician or nurse practitioner about alternative medications that may be used to boost the gammaglobulin level in the blood.
If the child is no longer experiencing frequent infections, then the IV infusions may not be necessary.
A 4-month-old infant born to an HIV-infected mother is going into foster care because the mother is too ill to care for the child. The foster mother wants to know if the infant is also infected. What is the best response by the nurse?
“It’s too early to know; we have to wait until the infant has symptoms.”
“Since the mother is so ill, it’s likely the child is also infected with HIV.”
“The ELISA test is positive, so the child is definitely infected.”
“The PCR test is positive; this indicates HIV infection, which may or may not progress to AIDS.”
A mother has received instructions about avoiding wheat and soy allergens. Which response by the mother would indicate that further education is needed?
“I will not feed my child any breads made with wheat flour.”
“I will allow my child to eat semolina pasta, the kind he loves.”
“I will not feed my child shakes made with soy protein.”
“I will read labels to be sure I am avoiding wheat and soy.”
What is the priority nursing intervention for the child recently admitted with Guillain–Barré syndrome?
Perform range-of-motion exercises.
Take temperature every 4 hours.
Monitor respiratory status closely.
Assess skin frequently.
A young mother brings her new baby, diagnosed with congenital hypothyroidism, to the clinic so she can learn how to administer levothyroxine. The nurse should include which of the following instructions?
Crush the medication and place it in a full bottle of formula to disguise the taste.
Administer the medication every other day.
Use an oral dispenser syringe or nipple to give the crushed medication mixed with a small amount of formula.
Tell the mother that the medication will not be needed after the age of 7.
During a well-child examination, which of the following comments made by the parent would indicate the possibility of a GH deficiency?
“I have to buy my child new clothes every 2 to 3 months.”
“I have to buy my child much larger shirts than pants but then the sleeves are too long.”
“My child wears out his clothes before he outgrows them.”
“I can hand down my child’s clothes to his younger brother.”
The nurse is caring for a 14-year-old boy with type 1 DM. He takes NPH insulin every morning at 7:30 AM. Which assessment data will the nurse use to evaluate the therapeutic effectiveness of the medication?
Presence of signs and symptoms of hypoglycemia or hyperglycemia during the morning physical assessment
Blood glucose level at 1630
Appetite and food intake at lunch
Blood glucose level before breakfast
When monitoring the blood glucose level of a 12-year-old child with type 2 DM, your reading is 50 mg/dL. Which is the most appropriate action?
Encourage the child to get out of bed and increase activity.
Take the child’s vital signs.
Ask the child about frequent urine output.
Give the child 4 oz of orange juice.
You are counseling a couple, one of whom is affected by neurofibromatosis, an autosomal dominant disorder. They want to know the risk of transmitting the disorder. The nurse should tell them that each offspring has a:
One in four (25%) chance of getting the disease.
One in eight (12.5%) chance of getting the disease.
One in one (100%) chance of getting the disease.
One in two (50%) chance of getting the disease.
The nurse working in a women’s health clinic determines that genetic counseling may be appropriate for a woman:
Who just had her first miscarriage at 10 weeks.
Who is 30 years old and planning to conceive.
Whose history reveals a close relative with fragile X syndrome.
Who is 18 weeks pregnant and whose triple screen came back normal.
A child born with a single transverse palmar crease, a short neck with excessive skin at the nape, a depressed nasal bridge, and cardiac defects is most likely to have which autosomal abnormality?
Trisomy 21
Trisomy 18
Trisomy 14
Trisomy 13
A mother brings her 4-day-old infant to the clinic with vomiting and poor feeding. The newborn was healthy at birth. The nurse should suspect:
Sturge–Weber syndrome
An inborn error of metabolism
Trisomy 18
Turner syndrome
The nurse is caring for a child with Down syndrome. What should the nurse’s focus be?
Teaching hygiene skills to the child in order to increase self-esteem.
Screening for anomalies and teaching about prevention of respiratory infection.
Finding opportunities to increase socialization for the child and family.
Expecting walking at age 1 year and toilet training completion at age 2 years.
The nurse is caring for a child with Turner syndrome admitted to the unit for treatment of a kidney infection. What characteristics associated with this syndrome may the nurse expect to find upon assessment?
Microcephaly, polydactyly
Low-set ears, cleft lip
Short stature, webbed neck
Gynecomastia, taller than average
The nurse is caring for a child with ADHD. Which behavior would the nurse not expect the child to display?
Moody, morose behavior with pouting
Interruption and inability to take turns
Forgetfulness and easy distractibility
Excessive motor activities and fidgeting
An adolescent girl who has been receiving treatment for anorexia nervosa has failed to gain weight over the past week despite eating all of her meals and snacks. What is the priority nursing intervention?
Increase the teen’s daily caloric intake by at least 500 calories.
Ensure that the teen’s entire fluid intake includes calories.
Supervise the teen for 2 hours after all meals and snacks.
Assess the teen’s anxiety level to determine need for medication.
A 15-year-old girl has been making demands all day, exaggerating her every need. She is now crying, saying she has nothing to live for and threatening to kill herself. What is the priority nursing action?
Ignore her continued exaggerated and melodramatic behavior.
Consult with the physician or nurse practitioner to increase her antidepressant dose.
Leave the girl alone for a little while until she composes herself.
Take the girl’s suicidal threat seriously and provide close supervision.
When trying to manage aggressive or impulsive behaviors in children or adolescents, what is the best nursing intervention?
Train the child to be assertive.
Provide consistency and limit setting.
Allow the child to negotiate the rules.
Encourage the child to express feelings.
The nurse is caring for an adolescent who says, “I’m sick of this. I wish I weren’t alive anymore.” What is the best response by the nurse?
“I often feel sad and sick of things.”
“Have you thought about hurting yourself?”
“Are you trying to escape your problems?”
“Do your parents know about this feeling?”
An unresponsive toddler is brought to the emergency department. Assessment reveals mottled skin color, respiratory rate of 10 breaths per minute, and a brachial pulse of 52 bpm. What is the priority nursing action?
Prepare the defibrillator and draw up code medications.
Provide 100% oxygen with a bag-valve-mask and start chest compressions.
Start chest compressions and provide 100% oxygen via nonrebreather mask.
Begin an IV fluid infusion and administer epinephrine IV.
A 10-year-old child in respiratory distress requires intubation. Which sizes of endotracheal tubes will the nurse prepare?
9.5 mm and 10.0 mm
8.5 mm and 9.0 mm
6.0 mm and 6.5 mm
6.5 mm and 7.0 mm
A preschooler presents to the emergency department with a history of vomiting, diarrhea, and fever over the past few days. She is receiving 100% oxygen via nonrebreather mask. Vital signs are temperature 104.5°F, pulse 144 bpm, respiratory rate 22 breaths per minute, and BP 70/50 mm Hg. She is listless and difficult to arouse and has weak peripheral pulses and prolonged capillary refill. What nursing intervention takes priority?
Administering acetaminophen rectally for the high fever
Administering IV antibiotics for the infection
Preparing the child for endotracheal intubation
Giving an IV bolus of normal saline 20 mL/kg
Assessment of a 12-year-old who crashed his bicycle without a helmet reveals the following: temperature 99.2°F, pulse 100 bpm, respiratory rate 24 breaths per minute with easy work of breathing, and BP 102/70 mm Hg. What is the priority action by the nurse?
Assess neurologic status while observing for obvious injuries.
Administer IV fluid bolus of normal saline at 20 mL/kg.
Remove the cervical collar if he complains that it bothers him.
Listen for bowel sounds while assessing for pain.
An 18-month-old child is brought to the emergency department via ambulance after an accidental ingestion. What is the priority nursing action?
Take the child’s vital signs.
Give oral syrup of ipecac.
Insert a nasogastric tube.
Start an IV line.
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