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92 Cards in this Set
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The parent of a terminally ill child expressed concern to the nurse that the child’s sister believes that it’s her fault that the child is hospitalized. Which of the following should the nurse tell the parent?
a. Refer the child’s sister for pediatric counseling b. Ask the child why she believed it’s her fault c. Allow long-term visitation for the child’s sister d. Assess the child’s understanding of death |
B. Ask the child why she believed it’s her fault
The child’s irrational fears and guilt should be dismissed. The length of visit should be relatively short, based on the child’s developmental age. |
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The nurse is performing discharge teaching about using the home apnea monitor. Which of the following statements should the nurse include in the teaching?
a. “home apnea monitors are used to detect obstructive apnea or hypoxemia” b. “cables and wires should be threaded through the lower end of the child’s clothes” c. “use lotion on the child’s chest before attaching leads to prevent skin breakdown” d. “immediately perform CPR if alarm goes off” |
B. “Cables and wires should be threaded through the lower end of the child’s clothes”
Home apnea monitors don’t detect obstructive apnea or hypoxemia. The monitor interprets the struggle to breathe as respiratory activity. In responding to an alarm, first observe the infant if the alarm is for a real event or a loose lead. |
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The parents asked a charge nurse information about their child 17-year-old who was admitted earlier due to an accident in school. The charge nurse found out that the child died 5 minutes ago due to a massive hemorrhage. What should be the charge nurse’s next action?
a. Inform the parents about the death of the child b. Ask the parents to wait in the private waiting room c. Inform physician about the parents d. Escort the parents to a quiet private room |
D. Escort the parents to a quiet private room
The best nursing intervention is to give the parents an appropriate environment before they are told the news, so that they may begin grieving privately. Nurses as well as physicians are capable of breaking bad news to families with caring and empathy. |
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A nurse is assessing a child with signs and symptoms of Wiscott-Aldrich syndrome (WAS), which of the following assessment findings would be present in the child with the condition?
a. Failure to thrive b. Diarrhea c. Ecchymosis d. Cyanosis |
C. Ecchymosis
Wiskott–Aldrich syndrome (WAS) is a rare X-linked recessive disease characterized by eczema, thrombocytopenia (low platelet count), immune deficiency, and bloody diarrhea (secondary to the thrombocytopenia). The first clinical signs are petechiae, bruising of the skin and bloody diarrhea. |
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A nurse is developing the plan of care for a 5-year-old child admitted following extensive leg surgery. The parents asked the nurse that they wanted to help take care of the child during their stay. All of the following activities can be implemented for the parents, except:
a. Avoid repeatedly giving information to help reduce stress b. Let the parents explain equipment and procedures to the child c. Personalizing the child’s room with child’s belongings from home d. Allow for open visitation for the parents |
A. Avoid repeatedly giving information to help reduce stress
Information and updates should be provided frequently because parents forget or cannot concentrate on details due to stress. |
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A nurse is caring for a 5-year-old child following extensive leg surgery. The parent, who is also a nursing student, insists on providing all of the child’s care and tells the nurse how to care for the child. In caring for the child, the nurse should recognize that the parent is:
a. Assuming the nurse’s role b. Experiencing guilt about the child’s condition c. Not well trained to care for the child d. The expert in care of the child |
D. The expert in care of the child
The nurse recognizes that the philosophy of family-centered care states that the parents are the experts in the care of their child. It is critical that the nurse works collaboratively with the family in caring for the child. |
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A nurse is ordered to administer sterile ophthalmic ointment (eye prophylaxis) on a newborn. Which of the following is a correct administration procedure?
a. Hold the newborn in a supine position before administration b. Administer w/in 6 hours after birth c. Administer soon after giving IM vitamin K d. Swaddle or contain the newborn’s limbs and hold semi-upright before administration |
D. Swaddle or contain the newborn’s limbs and hold semi-upright before administration
Before administration, dim the room, swaddle or contain the newborn’s limbs, and hold semi-upright. Don’t attempt to pry the newborn’s eyes, or when the infant is supine or facing bright overhead lights. Eye prophylaxis should be administered w/in 1 hour of birth and before or a different time than the vitamin K injection. |
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The nurse is performing educational teaching to the parents of a child w/ asthma. Which of the following statement by the parents would require additional teaching?
a. “Asthma can go into remission over time” b. “continues medication therapy prevents development of chronic asthma” c. “asthma triggers include exercise, infection, or allergies” d. “I can give my child a corticosteroid when he has an asthma episode” |
B. “continues medication therapy prevents development of chronic asthma”
Asthma may go into remission or increase in severity overtime. Although current treatments are effective in controlling symptoms, the underlying severity of asthma is not prevented. Oral corticosteroids may be given as rescue therapy. |
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The parents of a terminally ill child asked the hospice nurse about signs of approaching death. Which of the following would be a sign of imminent death?
a. Change in respiratory pattern b. Feeling cold, even though body feels hot c. Loss of vision or hearing d. Decreased oral fluid intake |
A. Change in respiratory pattern
Cheyne-Stokes breathing (periods of shallow breathing alternating w/ apnea) is a sign of imminent death. Hearing is one of the last senses to diminish before death. |
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A 10-day-old newborn is weighed at the physician's office. The baby is breastfed and weighed 7 pounds, 8 ounces at birth. How much would the nurse expect the baby to weigh now?
a. 7 lbs, 8 oz b. 7 lbs, 1 oz c. 10 lbs d. 8 lbs |
A. 7 lbs, 8 oz
In the first week of life, most babies lose about 1/10 of their birth weight. By day 10, most babies are back to their original birth weight and gaining about 2/3 of an ounce per day. |
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A 7-year-old child is being seen after a month of starting her asthma medications. Which of the following reports by the parents indicate well control of the child’s asthma symptoms?
a. Child is experiencing symptoms once or twice a week b. Child uses albuterol daily for symptom control c. Child only had 2 nighttime awakenings last month d. Child can only play for 30 minutes before experiencing SOB |
A . Child is experiencing symptoms once or twice a week
Signs of well-controlled asthma in children under 12 yrs of age include symptoms 2 or fewer days a week, no more than one night time awakening, and no limitations w/ normal activity, school, or exercise. |
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All of the following are included in the plan of care for a child diagnosed w/ AIDS, except:
a. Use normal saline when providing mouth care b. Administer initial treatment of Nevirapine c. Encourage frequent small meals d. Monitor skin turgor |
B. Administer initial treatment of Nevirapine
Initial medication therapy should include a combination of several antiretroviral (ARV) drugs. At least 3 drugs from a minimum of 2 different categories should be used. |
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Which of the following best describes an 8-year-old child’s understanding of death?
a. Believes death is temporary b. Death is irreversible c. All people and self must die d. Better understands the association between illness and death |
B. Death is irreversible
School-age children have a more realistic understanding of death. By 8-10 years, they understand the permanence and irreversibility of death. |
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A nurse is doing a health promotion teaching for a family of a newborn. All of the following are included in the teaching except:
a. Encourage switching positions when bottle-feeding b. Position baby on his/her stomach for supervised play periods c. Avoid alternating the head position from left to right during sleep d. Encourage toys such as a mobile w/ contrasting colors and patterns |
C. Avoid alternating the head position from left to right during sleep
Beginning at birth, nightly alternating the head position from left to right during sleep helps prevent flat spots on the newborn’s head from supine positioning. |
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In caring for a preschool-age child with terminal illness, which of the following behavior responses should the nurse expect for the child?
a. Sleeps more than usual b. May have severe depression, or mood swings c. May feel angry or guilty d. Seems morbidly fascinated w/ death |
D. Seems morbidly fascinated w/ death
Preschool-age children believe death is temporary and has beginning experience w/ death of animals or plants. They may regress to an earlier developmental stage, have crying spells, ask many questions, and seem morbidly fascinated w/ death. |
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A nurse is providing nutrition teaching for the parents of a 6-month old infant. Which of the following foods should the nurse advise the parents to not give the infant?
a. Juice b. Bananas c. Honey d. Rice cereal |
C. Honey
Parents should be warned against feeding honey in the first year of life. At 6 months, reinforce proper introduction of new foods to include rice cereal, fruits and vegetables. Serve juice only in a cup and limit to no more than 6 oz daily. |
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The parent of a child w/ asthma asks her nurse what the purpose of the peak expiratory flow meter is. Which of the following should be the nurse’s response?
a. It determines the cause of asthma b. It identifies specific triggers of asthma c. It confirms diagnosis of asthma d. It assesses the severity of asthma |
D. it assesses the severity of asthma
Use of a peak expiratory flow meter can help assess the severity of asthma. The device measures the child’s ability to push air forcefully out of the lungs. |
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A nurse is reviewing lab values for a patient w/cancer receiving chemotherapy. The nurse noted that the patient’s platelet count is 20,000/microliter (low). Based on the finding, what would be the nurse’s next action?
a. Place patient on contact isolation b. Assess the patient’s LOC c. Administer stool softener d. Prepare to administer packed RBC |
C. Administer stool softener
Patients who are thrombocytopenic are at high risk for bleeding. Patients should be assessed for signs of bleeding and observe precautions to prevent bleeding such as using soft toothbrushes when providing oral care and administering stool softeners to prevent straining w/ constipation. |
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An individualized health plan should be developed for which school-age child?
a. A 10-year-old who will require a wheelchair for the next two months b. An 8-year-old who has a speech impediment c. A 7-year-old who experiences nocturnal enuresis d. A 10-year-old who has missed a week of school due to chicken pox |
A. A 10-year-old who will require a wheelchair for the next two months
The child who has complex health issues or who will need special arrangements to navigate the building should have an individualized health plan. The child w/ a speech impediment needs an individualized education plan. |
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Which of the following assessment findings would not be present in a patient w/ neuroblastoma?
a. Weight loss b. Irritability c. Tender, soft abdomen d. Fever |
C. Tender, soft abdomen
Clinical manifestations of neuroblastoma include weight loss, fatigue, fever, and a firm, non-tender abdomen. |
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A nurse is providing care teaching for a parent of a child admitted for lead poisoning. Which of the following should the nurse include in the teaching? [select all that apply]
a. Chelation therapy is needed if the child’s lead level reaches 30mg/dL b. Anorexia, abdominal pain, and vomiting are late manifestations of lead poisoning c. The parent should wash the child’s toys frequently d. Child should avoid foods with iron and calcium to help reduce lead levels e. Lead hazards should be removed from home before child is discharged |
C. The parent should wash the child’s toys frequently
E. Lead hazards should be removed from the home before child is discharged Chelation therapy is administered when blood lead level is greater than 44 mg/dL. Children who have dietary deficiencies of calcium, iron, vitamin C, or zinc are more susceptible to injury from lead ingestion. |
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Health promotion interventions for a young toddler include all of the following except:
a. Supporting breastfeeding b. “five a day” servings of fruit and vegetables c. “three a day” servings of dairy products d. Limiting daily fruit juice intake |
D. Limiting daily fruit juice intake
Health maintenance activities focus primarily on disease and injury prevention, w/ examples of feeding practices that avoid common choking foods and limiting daily fruit juice intake to prevent dental caries and excessive caloric intake. |
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A nurse is reviewing the treatment plan for a 16-year-old patient w/ asthma. To determine the correct treatment plan, the nurse should classify the severity of the patient’s asthma. All of the following should be assessed by the nurse except:
a. Allergies b. Lung function c. Severity of exacerbations d. Activity level |
A. Allergies
Classification of asthma severity is determined by looking at the patient’s lung function, severity of exacerbations, and any interference in normal activity. |
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A nurse is performing assessment on a child presented with complains of severe vomiting, the child has been seen in the facility several times per week with the same presenting symptoms. The child’s lab values are within normal limits, and the child shows no signs of illness. To determine Munchausen syndrome by proxy, which of the following from the parent’s history would help indicate confirmation of the condition?
a. The parent is currently divorced b. The parent is a nursing student in the local college c. The child has 5 younger siblings d. The child has a developmental disability |
B. The parent is a nursing student in the local college
The cause of Munchausen syndrome by proxy is often complex and rooted in the caretaker’s psychiatric illness. The disorder occurs in all socioeconomic classes. Often the perpetrator has some type of healthcare background, such as nursing or other allied health profession. |
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A child having difficulty breathing is given humidified oxygen by the nurse. The correct rationale for the intervention is that humidified oxygen:
a. Improves oxygenation b. Promotes ventilation c. Prevent thickening of mucous membranes d. Reaches lungs more rapidly |
C. Prevent thickening of mucous membranes
Humidified oxygen is used to prevent drying and thickening of mucous membranes. |
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The parent of a child w/ biliary atresia asked the nurse how the surgery (hepatoportoenterostomy) would help her child. The nurse would state that the primary purpose of the procedure is to:
a. Promote biliary production b. Promote absorption of fat soluble vitamins c. Slow the progression of liver disease d. Promote biliary flow |
D. Promote biliary flow
In hepatoportoenterostomy (Kasai procedure), a segment of the intestine is anastomosed to the porta hepatis. The primary purpose of the procedure is to promote bile flow to the liver. |
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The nurse is performing discharge care instructions for the parent of a child w/ celiac disease. Which of the following food items should the nurse teach the parent to include in the child’s diet?
a. Wheat bread and hotdog b. Corn and baked potato c. Rice and bologna d. Oatmeal and rye toast |
B. Corn and baked potato
Patients who have celiac disease should adhere to a gluten-free diet. Food products made of wheat, rye, and barley should be avoided. They should also avoid processed foods that contain gluten as filler. |
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A nurse working in the local community clinic noted bruises on a 3-year-old child’s leg, arm, and buttocks. The parents reported that the child has been very clumsy and bumping on furniture a lot. In assessing the child, which behavior is most indicative of abuse?
a. The child has dark spots on the buttocks b. The child cries when being held by the nurse c. The child tries to push the nurse away during assessment d. The child is extremely compliant during assessment |
D. The child is extremely compliant during assessment
The toddler who is indiscriminately friendly with unfamiliar adults is demonstrating behavior inconsistent with his developmental stage. This is a clinical manifestation of abuse. Toddlers in general are fearful of strangers, and would not openly accept the nurse initially. |
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The nurse is planning educational interventions to reduce the incidence of the number one cause of mortality in children ages 1-4. Recognizing the developmental needs of this age group, the nurse would focus the session on which topic?
a. Injury prevention b. SIDS prevention c. Child abuse prevention d. Malnutrition awareness |
A. Injury prevention
The most common cause of death for children between 1 – 19 years of age is unintentional injury. The major causes of unintentional injury mortality in childhood include motor vehicle, drowning, fires and burns, and suffocation. |
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Which of the following assessment findings would be present in a child diagnosed w/ Down syndrome? [select all that apply]
a. Simian line on the palm b. Long face c. Failure to thrive d. Flattened forehead e. Prominent jaw f. Small, low set ears |
A. Simian line on the palm
D. Flattened forehead F. Small, low set ears Physical characteristics of Down syndrome include simian line on hands, flattened forehead, short broad hands, epicanthal eye folds, and small, low set ears. |
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The nurse is planning an educational session for adolescents, specifically children ages 15 – 19 years, about the leading cause of morbidity among the target age group. Which of the following topics would the nurse focus on teaching?
a. Traumatic injuries b. Asthma c. Sexually transmitted infections d. Depression |
D. Depression
Morbidity is an illness or injury that limits activity, requires medical attention or hospitalization, or results in a chronic condition. Mental disorders (such as depression) are a leading cause of hospitalization in adolescents between 15 – 21 years. |
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Which of the following assessment findings isn’t present for a child w/ pyloric stenosis?
a. Blood tinged emesis b. Dehydration c. Irritable d. Hypoactive bowel sounds |
D. Hypoactive bowel sounds
A child w/ pyloric stenosis will have hyperactive bowel sounds upon auscultation. Emesis may become blood tinged because of repeated irritation to the esophagus. |
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A child who presents with signs of Down syndrome is being seen by a nurse. To determine confirmation of the diagnosis, the nurse should note that Down syndrome is correlated with which criteria?
a. Significant limitation in intellectual functioning and adaptive behavior at any age b. Significant limitation in intellectual functioning and adaptive behavior before 18 years of age c. IQ score of 75 or less d. IQ score of 70 or less |
B. Significant limitation in intellectual functioning and adaptive behavior before 18 years of age
Intellectual disability (mental retardation) is defined as significant limitation in intellectual functioning and adaptive behavior manifested before the age of 18 years. A low IQ score by itself doesn’t necessarily correlate w/ impairment in ability to carry out skills. |
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Which vaccine prevents development of epiglotitis in young children?
a. DTaP b. HiB c. IPV d. Pneumococcal vaccine |
B. HiB
Epiglotitis, previously a common serious illness, is rare in the US due to the HiB immunization. |
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The nurse is caring for a child admitted to the pediatric facility for dehydration, projectile vomiting, and weight loss. Further assessment findings include decreased serum potassium and sodium levels. The nurse would anticipate treatment for which potential condition?
a. Lead poisoning b. Metabolic alkalosis c. Metabolic acidosis d. Acetaminophen toxicity |
B. Metabolic alkalosis
Projectile vomiting is a classical sign of pyloric stenosis. Patients w/ the condition presents w/ dehydration, weight loss and metabolic alkalosis due to loss of gastric secretions. |
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A nurse is caring for a 5-year-old child is assigned for a palliative care program. The parents asked the nurse if the child has become terminally ill and now requires extensive care. In responding to the parents’ concern, the nurse should know that palliative care is:
a. Centered around curative interventions b. Assigned for a child with a prognosis of less than 6 months and show signs of deterioration c. Treatment that slow or stop the progression of disease d. Focused on symptom management |
D. Focused on symptom management
Palliative care is designed to relieve physical, social, emotional, and spiritual suffering in children and their families by managing symptoms and monitoring aspects of suffering during the course of the child’s illness. |
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The nursing student assigned to the ER is tasked to do assessments on the following patients. Which of the following should the nursing student assess first?
a. A 2-year-old child who has fever, and coarse breath sounds b. A 10-month-old child presenting w/ mild fever and cough c. A 3-year-old who is restless, has mild fever, and a “barking-seal” cough d. A 4-year-old who is drooling, anxious, and refuses to lie down |
D. A 4-year-old who is drooling, anxious, and refuses to lie down
Children w/ severe respiratory distress and narrowed airway often sit in a tripod position w/ arms on the legs leaning forward. Drooling is a classical sign of epiglotitis, a life-threatening condition. The child’s anxiety increases as it becomes more difficult to breathe. |
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An infant is being discharged after hypospadias repair. Which of the following discharge care instructions should the nurse tell the parents of the infant?
a. Bath the child in a tub to prevent displacing the stent b. Avoid using double diapers to prevent skin breakdown c. Limit the child’s activity for at least 2 weeks d. Call physician if urine becomes blood tinged |
C. Limit the child’s activity for at least 2 weeks
The child should avoid activities that put pressure on the surgical site. Child shouldn’t be bathed in the tub until the stent or catheter is removed. The urine will be blood tinged for several days. Double diapering is used to protect the stent from contamination by stool. |
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A nurse is providing post-op care for a child with a cleft lip. Which interventions are included in the plan of care for the child? [select all that apply]
a. Remove soft elbow immobilizers every 2 hours b. Provide child w/ pacifier when not feeding c. Apply cardiorespiratory monitor d. Use a long, soft straw for feeding e. Administer ordered pain medication f. Avoid positioning child on back or side |
A. Remove soft elbow immobilizers every 2 hours
C. Apply cardiorespiratory monitor E. Administer ordered pain medication Regular removal of immobilizers allow for skin and neurovascular checks. Child shouldn’t be left unattended when restraints are removed. The monitor enables early detection of abnormal respirations, facilitating prompt intervention. |
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A nurse is reviewing the recent lab results of a child admitted for nephrotic syndrome. Which of the following lab values would be present in the child with the condition?
a. Decreased protein in the urine b. Reduced serum albumin c. Increased serum protein d. Reduced lipid levels |
B. Reduced serum albumin
Nephrotic syndrome is characterized by edema, massive proteinuria, hypoalbuminemia, hypoproteinemia, hyperlipidemia, and altered immunity. |
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A nurse is performing discharge teaching to the parents of a 3-year-old child diagnosed w/ minimal change nephrotic syndrome (MCNS) about corticosteroid therapy. Which of the following statements made by the parents indicate understanding of the teaching?
a. The child has to keep taking steroids to prevent relapse b. Blood glucose should be monitored while taking the medication c. Increased caloric intake is needed while taking the medication d. Medication should be stopped when the swelling subsides |
B. Blood glucose should be monitored while taking the medication.
Adverse effects of corticosteroid therapy include hypertension, nausea, and hyperglycemia. It should be tapered gradually rather than abruptly discontinued. An evaluation of fasting blood sugar may be needed during therapy. |
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Assessment findings for a child w/ biliary atresia include
a. Clay colored stools and bruising b. Poor weight gain and foul, frothy stools c. Poor skin turgor and confusion d. Increased blood glucose levels and polyuria |
A. Clay colored stools and bruising
A child w/ biliary atresia may present bruising, prolonged bleeding, and intense itching. Stools have a putty-like consistency and are white or clay colored because of absence of bile pigments. |
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A nurse is preparing a care plan for a child with minimal change nephrotic syndrome (MCNS). Which of the following nursing diagnosis would be appropriate for the child?
a. Risk for impaired skin integrity b. Imbalanced nutrition: more than body requirements c. Fluid volume deficit d. Ineffective coping |
A. Risk for impaired skin integrity
Edema with nephrotic syndrome puts skin at risk for skin breakdown. Skin assessments should be done regularly, and skin should be kept clean and dry. |
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The nurse instructs the parents of a 5-year-old child that the most representative type of play usually seen in preschool children would be:
a. Two children sitting side by side, each playing with a toy truck b. The child who sits on the floor by himself playing with blocks c. The child who dresses up like a fireman d. Two children putting a puzzle together |
C. The child who dresses up like a fireman
Because fantasy life is so powerful at this age, the preschooler readily uses props to engage in dramatic play, that is, living out the drama of human life. |
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Which of the following should be included in the plan of care for a child newly admitted with nephrotic syndrome? [select all that apply]
a. Restrict protein in the diet b. Administer corticosteroid as scheduled c. Initiate contact isolation d. Administer yearly flu shot e. Restrict fluid intake f. Administer IV albumin |
B. Administer corticosteroid as scheduled
D. Administer yearly flu shot F. Administer IV albumin Corticosteroids are used to decrease proteinuria. IV albumin or diuretics may be used to reduce edema. A normal diet for the child’s age is recommended. No attempt should be made either to restrict or increase protein intake. Sodium restriction is recommended while child is edematous and has protein in the urine. |
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The nurse is preparing a 4-year-old for surgery. Which technique is most appropriate?
a. Use an anatomically correct doll to explain the procedure b. Allow the child to handle safe medical equipment c. Explain to the child that she will be put to sleep for the procedure d. Limit the teaching to one one-hour session |
B. Allow child to handle safe medical equipment
Handling medical equipment such as IV bags and stethoscopes increase interest and helps the child to focus. Teaching may have to be done in several short sessions rather than one long session. |
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Interventions included in the plan of care of a child admitted for severe extracellular fluid volume deficit includes: [select all that apply]
a. Take daily weights b. Assess LOC c. Measure abdominal girth d. Administer IV Lactated Ringer’s e. Place child on clear liquid diet f. Assess renal function |
A. Take daily weights
B. Assess LOC D. Administer IV lactated Ringer’s Interventions for a child w/ severe dehydration include weighing the child daily w/ the same scale, carefully assess LOC, pulse rate and quality. When child is severely dehydrated, IV fluids will be given; often lactated Ringer’s often accompanied w/ oral rehydration. |
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A nurse is administering a nebulizer treatment of tobramycin for a patient w/ cystic fibrosis. Which of the following is a potential side effect of the drug?
a. Anxiety b. Lethargy c. Weight gain d. Hearing loss |
D. Hearing loss
Like other aminoglycosides, tobramycin is ototoxic: it can cause hearing loss. |
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A 2-year-old child is brought to the ER by her parents for nausea and vomiting, unresponsiveness, and a recent seizure episode. A lumbar puncture is ordered for the child together with other diagnostic tests. The primary reason the lumbar puncture is ordered is to:
a. Reduce an increased intercranial pressure b. Determine presence of infection c. Assess CSF glucose level d. Prevent further brain damage |
C. Assess CSF glucose level
A lumbar puncture may be performed to assess the cerebrospinal fluid (CSF) for protein, glucose, or blood cells. |
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During an assessment of the neck of a 2-year-old child, the nurse notes firm, non-tender, moveable lymph nodes 1 cm in diameter in the cervical chain. The nurse would note the finding as:
a. Indicative of local infection b. A normal finding c. Indicates a tumor around the neck area d. A possible congenital defect |
B. A normal finding
Firm, clearly defined, nontender, movable lymph nodes up to 1 cm in diameter are common in young children. Enlarged, firm, warm, tender lymph nodes indicate a local infection. |
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A nurse received medication orders for an infant born at 30 weeks gestational age diagnosed w/ bronchopulmonary dysplasia (BPD). Which of the following medications from the order should the nurse question?
a. Prednisone b. Albuterol c. Furosemide d. Palivizumab |
A. Prednisone
Corticosteroids aren’t recommended for routine use in premature infants. Palivizumab is given monthly to prevent RSV infection. |
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A nurse performed home care teaching to the parents of a child who had a febrile seizure. Which statement made by the parent indicates a need for further teaching?
a. Anticonvulsants can help reduce my child’s seizure episodes b. I can give Tylenol when my child has a fever c. I have to place my child to his side when he’s having a seizure d. I have to note the duration of a seizure episode if it occurs |
A. Anticonvulsants can help reduce my child’s seizure episodes
Children w/ febrile seizures are usually not treated w/ an anticonvulsant because the seizure is usually over before arrival at the emergency department. Long term anticonvulsants aren’t recommended for simple febrile seizures because of their adverse effects. |
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During an otoscopic examination on an infant, in which direction is the pinna pulled?
a. Down and back b. Up and back c. Up and forward d. Down and forward |
A. Down and back
For children less than 3 years of age, pull the pinna down and back to straighten the auditory canal. |
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When performing assessment of a patient w/ meningitis, the nurse noted resistance when extending the patient’s leg at the knee. The nurse would document the finding as:
a. Positive Brudzinski sign b. Positive Kernig sign c. Nuchal rigidity d. A normal finding |
B. Positive Kernig sign
A positive Kernig sign is noted when the leg is bent at the hip and knee, and subsequent extension in the knee is painful (leading to resistance). |
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A 16-year-old female complaining of abdominal pain is waiting in the exam room with her mother. It is important that the nurse assess whether the girl is sexually active. What action should the nurse take to gather the data?
a. Let the physician ask the question, so the girl does not have to discuss it twice b. Ask the mother to leave the room when sexual history questions will be asked c. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician d. Ask the girl if she is sexually active, as the mother needs to know and be involved |
C. Suggest to the girl and mother that the mother can join her after the exam to discuss any findings with the physician
When adolescents are seen for health care visits, assess relationship w/ others. Provide time alone w/ both the adolescent and the parents so that everyone has time to talk freely and to ask questions. |
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The parents of a child diagnosed w/ cerebral palsy (CP) asked the nurse about the condition. The nurse would respond to the parents based on the fact that cerebral palsy is the condition characterized by:
a. A sac-like protrusion on the child’s back b. Acute inflammatory demyelization of many spinal nerve roots c. Abnormal muscle tone d. Involuntary movement, behavior and sensory alterations |
C. Abnormal muscle tone
CP is characterized by abnormal muscle tone and lack of coordination w/ spasticity. |
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Which of the following is true regarding pain in infants and children?
a. Children run the risk of becoming addicted to pain medication when used for pain management b. Children use distraction to cope w/ pain c. Children tolerate discomfort well d. Children tell you if they are in pain |
B. Children use distraction to cope w/ pain
Children use distraction to cope w/ pain, but they soon become exhausted w/ coping w/pain and fall asleep. Children don’t tolerate pain any better than adults, & may have less tolerance after prior experiences. Addiction is extremely rare when the child is treated for an acute condition. |
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The nurse is performing a teaching seminar about alterations in respiratory function in infants. The nurse would explain that Bronchopulmonary dysplasia (BPD) is:
a. An autosomal recessive gene disorder b. A disease caused by a virus c. A chronic lung disease d. Defined as an episode of apnea and involves a significant cardiovascular event |
C. A chronic lung disease
BPD, also called chronic lung disease, is the need for supplemental oxygen for at least 28 days after premature birth. |
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Which developmental considerations about pain should the nurse anticipate in a 4-year-old preschool child?
a. Uses common words for pain such as “owie” and “boo-boo” b. Denies pain in desire to be brave c. Fear of death and bodily injury d. Often believes pain is punishment |
D. Often believes pain is punishment
A pre-school child often believes pain is punishment, someone is accountable, and has the language skills to express pain on a sensory level. |
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When discussing about a higher risk for infants and young children getting an ear infection, the nurse should note that the Eustachian tube in infants and young children is:
a. Shorter, wider, and more horizontal b. Shorter, narrower, and more horizontal c. Shorter, wider, and more diagonal d. Shorter, narrower, and more diagonal |
A. Shorter, wider, and more horizontal
During sucking, yawning, and other movements, the tube opens for a short period which allows free passage of air between nasopharynx and middle ear – leading to an increased risk for infection. |
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Which of the following assessment procedures is used to detect strabismus?
a. 6 cardinal fields of gaze b. Snellen eye chart c. Cover-uncover test d. Red reflex |
C. Cover-uncover test
Corneal light reflex and cover-uncover test are used to detect eye muscle imbalance and used to confirm diagnosis of strabismus. |
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Which actions by the nurse are appropriate when caring for a visually impaired child? [select all that apply]
a. Lightly touch the child before speaking b. Tell the child when you are entering or leaving the room c. When walking, walk slightly behind the patient for safety d. Encourage use of all senses e. Encourage independence in child |
B. Tell the child when you are entering or leaving the room
D. Encourage use of all senses E. Encourage independence in child When caring for a visually impaired child, call the child’s name and speak before touching the child. When walking, walk slightly ahead and have child hold staff’s arm. |
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A 16-year-old female patient is being discharged on an anticonvulsant medication, Tegretol (Carbamazepine). What should the nurse include in the discharge teaching regarding the adverse effects of the medication?
a. Neural birth defects b. Hyperthyroidism c. UTI d. Increased menstrual bleeding |
A. Neural birth defects
Adolescent females need to be educated about potential tetragenocity of some anticonvulsants, such as valproic acid and carbamazepine, which are associated w/ neural tube defects and heart defects. |
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An 18-year-old patient who is 3 months pregnant is in the local health center for her routine immunizations. Which of the following vaccines is contraindicated for the patient?
a. Measles, mumps, rubella (MMR) b. Meningococcal c. Influenza d. Hepatitis B |
A. Measles, mumps, rubella (MMR)
MMR and varicella vaccines are contraindicated in patients who are pregnant or have a possibility of pregnancy w/in 4 weeks. |
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A nurse is tasked to perform assessments on a 3-year-old child being evaluated for possible hydrocephalus. Which of the following signs and symptoms should the nurse note as an early sign of the condition?
a. Rapid increasing head circumference b. Sunsetting eyes c. Bulging fontanels d. Nausea and vomiting |
D. Nausea and vomiting
Head enlargement and bulging fontanels wouldn’t be present in a child after closure of the sutures/fontanels around 12-18 months. Early signs and symptoms present in the child include headache upon rising w/ nausea and vomiting, fussiness, sleepiness, and loss of interest in daily activities. |
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A nurse is reviewing medication orders for a patient w/ otitis media. Which medication from the order should the nurse question?
a. Benadryl b. Amoxicillin c. Tylenol d. Antipyrine/benzocaine ear drops |
A. Benadryl
Decongestants and antihistamines aren’t recommended due to the lack of benefit and concerns regarding side effects. |
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A 6-year-old child is to receive regularly scheduled immunizations. The parent states the child is not feeling well, and asks the nurse to defer the immunizations until next week. The nurse's best response is to:
a. Check the child’s temperature b. Ask if the child has ever had a reaction to immunizations c. Give the parent an immunization appointment for next week d. Ask if the child has missed school |
A. Check the child’s temperature
The child's temperature will help the nurse decide if the child has a mild or severe illness. Immunizations may be given if the child has a mild illness, with or without fever. Postponing the immunization might result in a missed opportunity if the parent does not keep the appointment. The nurse should ask about previous reactions to immunizations, but this is not related to withholding the immunization because the child is not feeling well. |
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A nurse is providing patient care teaching to the parent of a child w/ chickenpox. Which of the following statements by the parent indicates accurate understanding of the teaching?
a. “I will give my child Tylenol 3 times a day for the duration of the illness” b. “I will take my child to our primary doctor when she feels very sick” c. “I can apply calamine lotion on open lesions to help prevent itching” d. “I can send her back to school when she has dry, crusted lesions” |
D. “I can send her back to school when she has dry, crusted lesions”
Chicken pox is no longer contagious if the lesions have already dried and crusted over. Tylenol should only be given when the child has fever, not 3x a day, every day, during the illness. |
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A nurse in the pediatric facility is assigned to care for a child w/ sickle cell disease. In constructing a care plan for the child, the nurse should note that the primary reason for hospitalization of patients w/ the condition is:
a. Respiratory distress b. Bacterial infection c. Acute pain d. Anemia |
C. Acute pain
The most common reason for hospitalization of a child w/ sickle cell anemia is acute painful episodes. Pain results from avascular necrosis of bone marrow typically experienced in the back, abdomen, chest, and joints. |
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A 6-year-old child is admitted to the pediatric hospital for sore throat and high fever. Further assessment shows red “sandpaper-like” rash in the neck, groin, and axillary area. Lab results show presence of group A streptococci bacteria. Which of the following would be the expected diagnosis for the patient?
a. Varicella (chicken pox) b. Rubeola (measles) c. Scarlet fever d. Hand-foot-mouth disease |
C. Scarlet fever
Scarlet fever is caused by group A beta-hemolytic streptococci bacteria and characterized by erythematous, confluent, sandpaper rash concentrated in the axilla, groin, and neck. |
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A nurse is performing discharge instructions for the parents of a 12-month-old child about proper administration of iron deficiency medication for the child. To facilitate absorption of medication, the nurse would recommend mixing drug with:
a. Formula b. Cow’s milk c. Water d. Orange juice |
D. Orange juice
Foods rich in vitamin C such as citrus fruits, broccoli, and orange juice facilitate absorption of iron. Cow’s milk is avoided for the 1st year of life because it can cause GI bleeding in the child. |
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A 17-year-old well child is in the community clinic to receive a series of hepatitis B vaccine. Before administering the vaccine, it is important to assess the patient if he had a history of a severe allergic reaction to:
a. Yeast b. Penicillin c. Eggs or chicken protein d. Gelatin |
A. Yeast
Contraindications for receiving a hepatitis B vaccine include prior anaphylaxis and serious hypersensitivity reactions due to a vaccine component (e.g., yeast) |
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A child w/ sickle cell disease is scheduled for a blood transfusion. The nurse caring for the child should also prepare which IV solution to administer before and after blood transfusion?
a. Lactated Ringer’s b. Normal saline w/ KCl c. 0.9% NS d. D5W |
C. 0.9% NS
To prevent hemolysis, IV fluid used before and after blood transfusion should be normal saline rather than D5W. |
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A nurse is ordered to administer medications to a patient diagnosed w/ mononucleosis. Which of the following medication orders for the patient should the nurse question?
a. Tylenol b. Ibuprofen c. Prednisone d. Amoxicillin |
D. Amoxicillin
Ampicillin and amoxicillin are contraindicated for patients w/ mononucleosis because they may cause a non-allergic rash. Corticosteroids may be used to control severe pharyngeal swelling and impending airway obstruction. |
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The parent of a child who had a tonsillectomy 1 week ago calls the nurse and reports that the child has a sore throat. Which of the following should be the nurse’s response?
a. Advise parent to give cool liquids for the child b. Advise parent to bring child to the emergency department c. Advise parent to encourage child to do deep coughing exercise d. Advise parent to give ibuprofen if pain persists |
A. Advise parent to give cool liquids for the child
Most children have a sore throat 7 – 10 days after tonsillectomy. Have child drink adequate cool drinks to help bring down swelling. Ibuprofen should not be given due to an increased risk for bleeding. |
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A child w/ sickle cell disease is scheduled for a blood transfusion. The nurse should anticipate which blood product to administer for the child?
a. Packed red blood cells b. Fresh frozen plasma c. Whole blood d. Albumin |
A. Packed red blood cells
Packed red blood cells increase the number of red blood cells available to carry oxygen to tissue cells. |
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A pediatric nurse is ordered to administer a combination MMR/Varicella vaccine (a live attenuated virus vaccine) to her patients. Which of the following patients should not receive the live virus vaccine? [select all that apply]
a. Patient experiencing cold symptoms b. Patient who has a severe allergic reaction to neomycin c. Patient recently exposed to an infectious disease d. Patient experiencing mild fever e. Patient receiving chemotherapy |
B. Patient who has a severe allergic reaction to neomycin
E. Patient receiving chemotherapy Contraindications for receiving an MMR or Varicella vaccine include a history of anaphylactic reaction to the vaccine and hypersensitivity to neomycin or gelatin, and immunocompromised patients. Immunizations may be given if the child has a mild illness, with or without fever. |
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Which of the following foods isn’t appropriate for a patient who had a recent tonsillectomy?
a. Frozen juice pops b. Mashed potatoes c. Orange juice d. Ice cream |
C. Orange juice
Citrus juices may produce a burning sensation in the throat and should be avoided for the first week post-tonsillectomy. |
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A home care nurse visits a child who had a tonsillectomy 1 week ago. During assessment, the nurse noted foul mouth odor and white patchy areas at the back of the throat. The child’s temperature is 100F. What should be the nurse’s best action?
a. Contact physician immediately b. Have child rinse mouth w/ mouthwash c. Document finding d. Have child drink cool water w/ a straw |
C. Document finding
Foul mouth odor and white areas at the back of the throat are normal findings 7-8 days after tonsillectomy. Straws and mouthwash should be avoided. Tylenol may be administered as prescribed. |
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A nurse is caring for a child post-cardiac catheterization. Which intervention isn’t appropriate for the patient?
a. Encourage fluids b. Maintain on bed rest for 5 hours c. Keep head of bed at fowler’s position d. Keep leg straight when lying down |
C. Keep head of bed at fowler’s position
After cardiac catheterization, head of the bed shouldn’t be elevated as flexion of hips isn’t permitted during the period. |
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Heart defects that increase pulmonary blood flow include:
a. Coarctation of the aorta (COA) b. Aortic stenosis (AS) c. Pulmonic stenosis (PS) d. Atrial septal defect (ASD) |
D. Atrial septal defect (ASD)
Heart defects that increase pulmonary blood flow include patent ductus arteriosus (PDA), atrial septal defect (ASD), and ventricular septal defect (VSD). |
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The parents of a child w/ impetigo phoned the local clinic and asked the nurse how to observe for development of crusts on the affected area. When answering the parent’s question, the nurse should know that crusts are:
a. Linear cracks in the skin b. Dilated, superficial blood vessels c. Dried residue of serum, pus, or blood d. Replacement of destroyed tissue w/ fibrous tissue |
C. Dried residue of serum, pus, or blood
Crusts are dried serum, pus, or blood usually mixed with epithelial and sometimes bacterial debris. |
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A nurse is ordered to administer an IM medication for a 2-year-old child. Which of the following is the most appropriate way of explaining the procedure to the patient?
a. Use drawings, pictures, books and contact w/ equipment b. Explain throughout the procedure what is happening c. Give explanation just before administering the medication d. Allow child to play out the procedure by “giving an injection” to a doll |
C. Give explanation just before administering the medication
The toddler’s concept of time is limited. Give explanation just before the procedure. |
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A nurse is caring for a child who had persistent fever lasting for 5 days. Assessment findings include swollen bright red tongue, diarrhea, peripheral edema, and an oral temperature of 103F. Which medication should the nurse administer for the child?
a. Amoxicillin b. Aspirin c. Tylenol d. Tobramycin |
B. Aspirin
Swollen bright red (strawberry) tongue, diarrhea, peripheral edema, and high fever lasting 5 days or longer are s/s of Kawasaki disease. High doses of aspirin are given while the fever is high and then a decreased dose once the fever has dropped. |
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Surgery is performed on a child w/ a patent ductus arteriosus (PDA) to prevent which of the following complications?
a. Decreased pulmonary blood flow b. Mixed pulmonary and systemic circulation c. Increased pulmonary congestion d. Left-to-right shunting of blood |
C. Increased pulmonary congestion
A patent ductus arteriosus (PDA) allows blood to flow from the aorta (high pressure) to the pulmonary artery (low pressure). If the PDA stays open, increased pulmonary congestion can occur. |
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When caring for a child diagnosed w/ tetralogy of fallot (TOF), the nurse noted increased depth and rate of respirations. The child’s SpO2 is 88%, what should be the nurse’s next action?
a. Reposition child to a high-fowler’s position b. Place child to a knee-chest position c. Call a code d. Administer high-flow oxygen |
B. Place child to a knee-chest position
Hypercyanotic episodes become life threatening if not treated immediately. If a hypercyanotic episode occurs, the patient should be placed in a knee-chest position to decrease the return of systemic venous blood to the heart. |
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Which interventions should be included in a nursing care plan for a child diagnosed w/ muscular dystrophy (MD)? [select all that apply]
a. Prescribed steroids and antibiotics to reverse progression of disease b. Limit mobility and ambulation to prevent fractures c. Teach ROM exercises d. Encourage high-fiber, high-protein foods e. Provide high-calorie, high-carb foods |
C. Teach ROM exercises
D. Encourage high-fiber, high-protein foods MD is characterized by progressive muscle fiber degeneration and muscle wasting. There is no cure for the disease and the goal of medical management is provide support and prevent complications such as infection or spinal deformities. |
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The nurse is assessing a child for signs of type 1 diabetes. Which of the following would be most indicative of this problem?
a. Complains of dysuria b. Thick skin folds in the neck and axilla c. Obesity d. Excessive appetite |
D. Excessive appetite
Classical signs of type 1 diabetes include polyuria, polydipsia, polyphagia. Obesity and presence of thick skin folds in neck and axilla area (acanthosis nigricans) are manifestations of type 2 diabetes. |
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A child is admitted to the emergency department w/ severe abdominal pain, irritability, and fever. Further assessment findings are 400 mg/dL blood glucose, deep / rapid respirations, fruity breath odor, and hypotension. Which action should the nurse do first?
a. Prepare to administer IV insulin b. Administer short-acting insulin IM through the abdomen c. Give child ½ cup of orange juice d. Give glucagon IM |
A. Prepare to administer IV insulin
Medical management for diabetic ketoacidosis (DKA) includes isotonic IV fluids and electrolytes for dehydration and acidosis. Short-acting insulin is administered by continuous infusion to decrease serum glucose level. |
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A nurse is ordered to prepare and administer initial IV treatment for a child w/ type 1 diabetes experiencing signs and symptoms of diabetic ketoacidosis (DKA). Which of the following should the nurse prepare to administer?
a. IV infusion of NPH insulin b. Normal saline IV infusion c. 50% dextrose IV infusion d. Potassium IV infusion |
B. Normal saline IV infusion
Medical management for diabetic ketoacidosis (DKA) includes isotonic IV fluids and electrolytes for dehydration and acidosis. Rehydration is the initial step in treating DKA. NPH is never administered by IV route. |
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A newborn experiencing difficulty breathing and cyanosis soon after birth is ordered to receive supplemental oxygen and Prostaglandin E1 (PGE1). PGE1 is given to the patient for:
a. Prevention of pulmonary congestion of blood b. maintaining systemic blood flow c. prophylaxis for infective endocarditis d. Prevention of hypercyanotic episodes |
B. Maintaining systemic blood flow
Transposition of the great arteries (TGA) is manifested as cyanosis apparent soon after birth which progresses to hypoxia and acidosis. PGE1 is given to keep the ductus arteriosus open to maintain systemic or pulmonary blood flow until palliative procedure can be performed. |
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A mother of a child w/ CHF asks the nurse if breastfeeding is better than bottle-feeding. In answering the parent's question, the nurse should note that breast milk reduces infections and it:
a. is naturally low in sodium b. doesn't cause dyspnea when feeding c. is easily digested by the child d. doesn't have contraindications w/ medications |
A. is naturally low in sodium
The mother who chooses to breastfeed should be encouraged as breast milk reduces infections and is naturally low in sodium. |
