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PEDIATRIC NURSING Situation: The school health nurse conducts health education classes to graduating high school students. 1. When teaching an adolescent about the rules for safer sex, which of the following would you include? A. Anal sex carries a little risk in contracting STD’s. B. Choosing sexual partner is extremely important. C. Sex during menstrual flow carries little risk. D. Always use a condom when having sexual intercourse Answer: B Rationale: Sexual relationships expose both partners to any diseases of the other partner. Choosing partners carefully reduces the risk of disease. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, 2003, Vol. 1, p.88) 2. Responsible Parenthood means: A. The couple must focus on the use of contraception to prevent pregnancy. B. The parents understands their responsibility and have appropriate plan for their family based on their capability to support them. C. The use of natural family planning and attending seminars before marriage. D. Both parents save up for the future of their children Answer: B Rationale: Responsible parenthood involves understanding of couple’s responsibility and having appropriate plan for their family based on the ability to sustain their needs. It does not solely focus on the use of contraception or any form of family planning. It includes all the decisions an individual or couple make about having children. These decisions usually include if and when to have children, how many children to have, and how they are spaced. (Reference: Cuevas F. Public Health Nursing in the Philippines,10 th Edition, 2007) 3. An example of methods used in natural family planning includes: A. Calendar Method and Billings Method B. Calendar Method and Condom C. Contraceptive pills and Cervical Mucus D. Tubal ligation and vasectomy Rationale: A. Calendar and Billings Method are both natural family planning methods. Condom and contraceptive pills are artificial methods whereas Tubal ligation and vasectomy are permanent methods of family planning. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 1, 2003, p.101-116) 4. A 40 year old woman, a heavy smoker, visits your family planning clinic. She told you that she has a very irregular menstrual cycle. She wants a highly reliable contraceptives. Assuming that all of the following methods of birth control are acceptable for her, which of the following would be the best recommendation? A. The Mini pill B. A spermicidal suppository C. A diaphragm and spermicidal suppository D. Calendar and Billings method Rationale: C. Combined diaphragm and suppository is the best choice for her considering her age and smoking habits. The combined effect of two methods is more reliable. Mini-pill contains only progesterone. Without estrogen content, ovulation may occur, but because the progestins have not allowed the endometrium to develop fully, implantation will not take place. When used correctly, they 99.5% effective in preventing conception. Because women occasionally forget to take them and there are individual differences in women’s physiology, the typical failure rate is round 3%. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Effectiveness of natural family planning methods such as calendar and Billings methods vary mainly on couple’s ability to refrain from having sex on fertile days. Failure rates usually range from 10% to 20%. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 1, 2003, p.101-114) 5. A young client who has become sexually active asks the nurse. “What is the most effective way to prevent a pregnancy?” the nurse’s best response would be: A. “Abstain from sex” B. “Use birth control pills” C. “Have an IUD inserted D. “Use condom and foam” Rationale: A. Health teaching guidelines for adolescents regarding sexuality involves saying “no” and being firm about their intentions to participate in sexual relations. Pregnancy can occur with any sexual encounter unless you use prevention to avoid it. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 1, 2003, p.924) Situation: Nurse Matteo is assigned at the nursery of the National General Medical Center. His clinical exposure as a novice nurse is proving to be professionally satisfying. 6. Vitamin K is administered to all neonates immediately after birth because: A. their fetal blood cells are prone to coagulation problems B. their immature livers predispose them to low vitamin K levels C. they lack intestinal organisms to synthesize vitamin K D. they all experience avitaminosis Answer: C. Neonates have sterile GI tracts at birth and, therefore, are incapable of synthesizing vitamin K until about 8 days after birth. At 8 days, the intestinal tract becomes colonized with organisms. Reference: Straight A’s in Maternal – Neonatal Nursing © 2004 Lippincott Williams & Wilkins Companion CD. The Normal Neonate. Item No. 2. 7. While evaluating a neonate in the surgery, you check his hips for signs of dislocation. Which of the following signs indicates that the hips are in the normal position? A. Both legs abduct easily B. Skin folds are asymmetrical C. A click is heard when hip integrity is assessed D. The femur head is felt to slip forward in the acetabulum Answer: A. Inspection of a neonate’s hips during assessment should reveal symmetrical skin folds, easy abduction of both legs, and absence of a click or sense that the femur is moving within the acetabulum. Reference: Straight A’s in Maternal – Neonatal Nursing © 2004 Lippincott Williams & Wilkins Companion CD. The Normal Neonate. Item No. 5. 8. A new mother asks you why her neonate is voiding so often. Your best reply is that the: A. kidneys of the neonate can’t concentrate urine well B. intestines of a neonate aren’t yet absorbing fluid C. fluid retained during fetal life is being excreted D. neonate’s fluid intake is too great for his age Answer: A. The neonate’s kidneys are immature at birth and, therefore, unable to properly concentrate urine. This causes the neonate to void frequently. A neonate’s intestines don’t regulate the amount of fluid excreted. Fluid isn’t retained during fetal life; it’s excreted after the kidneys form. Frequent voiding in neonates isn’t a sign of excess fluid intake. Reference: Straight A’s in Maternal – Neonatal Nursing © 2004 Lippincott Williams & Wilkins Companion CD. The Normal Neonate. Item No. 6.
Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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9. Which characteristic best describes a breast-fed neonate’s stools, as compared with a formulafed neonate’s stools? A. Soft and seedy C. Light yellow in color B. Dry D. Less frequent Answer: A. A breast-fed infant passes soft, seedy stools that have a sweet-and-sour odor and are mustard yellow. Breast milk is easier to digest than formula, so a breast-fed neonate also has more frequent stools. A formula-fed neonate has less frequent, dry, light yellow stools. Reference: Straight A’s in Maternal – Neonatal Nursing © 2004 Lippincott Williams & Wilkins Companion CD. The Normal Neonate. Item No. 8. 10. You’re assessing a neonate. Normal assessment findings include: A. absent Babinski’s reflex and pale skin B. heart rate of 130 to 140 beats/minute and acrocyanosis C. absence of head control and a relaxed posture while awake D. respiratory rate of 60 breaths/minute and expiratory grunting Answer: B. Heart rate of 130 to 140 beats/minute is within normal range, and acrocyanosis (cyanosis of the extremities) is normal in the neonate. Acrocyanosis generally lasts 7 to 10 days. If Babinski’s reflex is absent and the skin is pale, the neonate may have central nervous system damage. Absence of head control and a relaxed posture while awake are signs of prematurity. A respiratory rate of 60 breaths/minute and expiratory grunting may indicate a respiratory disorder. Reference: Straight A’s in Maternal – Neonatal Nursing © 2004 Lippincott Williams & Wilkins Companion CD. The Normal Neonate. Item No. 15. Situation: On her duty to the rural health center, Jean, a student nurse assist the doctor on duty in examination of children. Aaron, a two year old, is hyperactive, negativistic and exhibit tantrums and mother verbalize that she has difficulty in caring for Aaron. She asks Jean what she can do for him. Jean then reviewed Aaron’s stage of development and considered this in taking care of him and in providing health education for Aaron’s mother. 11. Jean reviewed Kohlberg’s theory of development. According to the theorist, toddlers: A. Do the right thing because their parent tells him or her to and to avoid punishment B. Have moral judgments that are based on universal human rights C. Act base on their value, care and loyalty to others D. Judge based on understanding and social order Rationale: A toddler is considered to be in preconventional stage of moral development wherein child does right because a parent tells him or her to and to avoid punishment. Option B pertains to post conventional stage whereas options C and D pertain to conventional stage. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 2, 2003, 789) 12. Aaron’s mother asked Jean why her son is negativistic and has temper tantrums. Which of the following would be the student nurse’s best response? A. “Aaron is not effectively coping with stress“ B. “Aaron’s need for affection isn’t met.” C. “This is a normal behavior for his age.” D. “He is expressing his need for identity.” Rationale: Negativism and temper tantrums are common behaviors exhibited by toddlers. Through these behaviors, they can show degree of autonomy and independence enough to know what they want, but do not have the vocabulary or the wisdom to express their feelings in a more socially acceptable way. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 2, 2003, 843) 13. When you examine a toddler, you suggest to his mother that the activity that could foster his developmental task according to Erickson would be; A. Spoon feed him every meal time C. Allow him push pull toys Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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B. Read him story every night D. Have him watch puppet show and TV Rationale: Toddlers should develop sense of autonomy or independence. Expression of autonomy can be shown through provision of toys that exhibits sense of power in manipulation or toys they can play with by themselves and that require action. These toys include push pull toys, squeaky frogs they can squeeze, blocks they can stack, and toy telephone they can talk on. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 2, 2003, 834) 14. The child’s universal language is: A. Behavior C. Touching B. Crying D. Play Rationale: According to Pilliterri, urge parents to encourage language development by naming objects as they play with their child. Option B pertains to infants. Option A and C are not applicable for toddlers. (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 1,2003, p.863) 15. Which of the following describes the type of play observed with toddlers? A. Solitary C. Competitive B. Parallel D. Fantasy Rationale: All during toddler period, children play beside the children next to them or parallel play (side by side play). Option A is for infants. Competitive play is for school-age. Fantasy is among preschool (Reference: Pillitteri A. Maternal and Child Health Nursing, 3rd Edition, Vol. 1,2003, p.865) 16. While observing a two-year-old girl recently admitted to the hospital, the nurse becomes concerned by which of the following characteristics? A. the child is not yet potty trained B. the child replies “no” to every questions C. the child cannot share toys D. the child recognizes 4-6 words Rationale: D. A two-year-old should have a 300 word vocabulary. A 4-6 word vocabulary indicate health problems, such as hearing or motor loss. 17. A three-year-old girl is brought to the physician’s office with persistent otitis media. In order to assess factors which may be contributing to the unresolved illness, the nurse should ask the parents which question? A. “Is anyone smoking around the child?” B. “Is the child playing with other children with otitis media?” C. “Does the child get water is her ears during the bath?” D. “Has the child had a fever recently?” Rationale: A. Allergies to common irritants such as smoke can cause congestion and chronic otitis media. 18. An 18-month-old girl is admitted for a surgical repair of the cleft palate. She returns from the operating room, supine, with an IV, and a mist tent on room air. Which is the priority nursing action? A. medicate for pain B. check the IV for signs of infiltration C. turn the child on her side D. review the postoperative orders Rationale C. Airway is always an immediate priority. Turning the child on her side will protect the child from aspiration. 19. In planning care for the four-year-old admitted to the hospital, the nurse would include which toy? Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. a plastic stethoscope B. a brightly colored mobile C. a jigsaw puzzle D. a helium balloon Rationale: A. Pre-school play centers on imitation of adults. Providing a stethoscope allows the child to imitate the health personnel and to ease the fear of unfamiliar equipment. 20. When the mother of a five-year-old boy expresses concern over her son’s stuttering, which response by the nurse is least appropriate? A. vocal hesitancy is common in children younger than age seven B. it may help if you stop your son and encourage him to begin the word over C. singing songs or nursery rhymes may ease stuttering D. look directly at you son while he is speaking Rationale: B. Stopping the child mid-word or mid-sentence often draws attention to the stuttering and may actually worsen it. 21. A two-year-old girl is admitted to the hospital with croup. She has been placed in a mist tent with room air. Which statement by the parents indicates effective client teaching? A. “The mist will give my child extra fluids.” B. “My child must remain in the mist tent at all times.” C. “My child may have toys inside the mist tent.” D. “The mist tent will provide the extra oxygen my child needs.” Rationale: C. The goal is to keep the child quiet and calm to reduce oxygen demand. Toys may help achieve this goal. 22. A one-year-old boy is brought to the physician’s office with fever, irritability, and loss of appetite. A diagnosis of otitis media is made, and the child is placed on amoxicillin (Augmentin) 150 mg p.o TID for 10 days. Which nursing instructions must be includes in the child’s plan of care? A. “Drink clear fluids while in the medication.” B. “Take an extra nap, since amoxicillin may cause drowsiness.” C. “Stay indoors until the medication is finished.” D. “Take the medication for the full length of time.” Rationale: D. A full course of an antibiotic must be given to ensure that the medication is completely effective. Incomplete courses may result in recurrent and/or resistant infections. 23. A two-year-old boy is receiving Bleomycin (blenoxane) IV. His mother tells the nurse that it is time for her son to have his polio immunization. What is the best response by the nurse? A. “We will schedule it for next week.” B. “The cancer drug will delay any possibility of polio.” C. “Your son’s immunization will need to be delayed until a later time.” D. “I’ll call the doctor later today.” Rationale: C. You remembered it was unsafe to give a live virus vaccine while the client was being treated for cancer. The vaccine will need to be given at a later date. 24. A three-year-old boy is admitted with laryngotracheobronchitis. His parents seem extremely anxious and the child is crying. Which nursing diagnosis has the highest priority? A. potential infection B. ineffective airway clearance C. altered parenting D. impaired tissue perfusion Rationale: B. ABC’s. Laryngotracheobronchitis can result is impaired airway clearance because of upper airway is of immediate concern. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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25. A four-month-old infant is admitted with a ventricular septal defect, and undergoes a cardiac catheterization. Post-catheterization, which sign would alert the nurse to a potential complication? A. pedal pulses palpable bilaterally B. apical pulse 140 beats/minute C. blood pressure 96/40 D. groin dressing intact with small amount of blood noted Rationale: D. Any bleeding from the entry site of the cardiac catheter could indicate potential hemorrhage. 26. A 12-year-old with a myelomeningocele at L2 is being seen at the clinic. Which statement by the child would indicate the need for more client teaching? A. “I always drink three extra glasses of water every day.” B. “My teacher says I need remedial reading.” C. “I only need to catheterize myself twice a day now.” D. “I do wheelchair exercises while watching TV.” Rationale: C. Infrequent emptying of the bladder can result in stasis and urinary tract infections. Catheterization should be performed every four hours. 27. In planning care for a newborn with a surgical repair of a myelomeningocele, the nurse should be aware that this child is prone to develop which of the following? A. osteomyelitis B. decubitis C. otitis media D. hydrocephalus Rationale: D. In the surgical repair of the myelomeningocele, the pathway for the cerebral spinal fluid has been altered. Therefore, the child is at risk for hydrocephalus. 28. A nurse working in an adolescent clinic should know which of the following about obesity? A. in teenagers, it is commonly due to hypothyroidism, hypopituitarism, or other endocrine problem B. obesity is no more likely to be associated with emotional conflicts to be associated with emotional conflicts in teenagers who are not obese, than in teenagers who are obese C. during adolescence, obesity is highly correlated with significant psychopathology D. obesity is often associated with poor recognition of either hunger or satiation Rationale: D. Persons who become obese have poor recognition of feelings of hunger or satiation after eating. Normal weight persons tend to eat when they feel hungry, but obese individuals tend to eat when they see food, whether they are hungry or not. 29. A nurse is caring for four children of different ages. Which child is showing appropriate cognitive development according to Piaget’s theory? A. A 3-year-old who understands the concept of conservation B. A 4-year-old who believes the intravenous machine is alive C. A 2-year-old who is just beginning to demonstrate object permanence D. An 11-year-old who thinks bad thoughts caused his illness Rationale: B. The preoperational period of thought occurs from 2–7 years of age. During this period, a child might think an inanimate object that lights up, such as an intravenous machine, is alive. This is called animism. Conservation does not occur until the concrete operational stage-7– 11 years. Object permanence begins at 8–12 months of age, and is fully developed by 24 months. Magical thinking, such as bad thoughts cause illness, is characteristic of the preoperational stage, 2–7 years. 30. A nurse plans to offer an infant a pacifier during the period he is NPO. The rationale for this intervention is based on which theorist? A. Erikson B. Piaget Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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C. Freud D. Kohlberg Rationale: C. Freud describes the infancy stage as the oral stage. The baby obtains pleasure and comfort through the mouth; therefore, offering a pacifier while an infant is NPO can be comforting. Erikson describes the infant stage as a need to establish trust vs. mistrust. Parent presence would be important for this theory. Piaget describes infancy as a stage of sensorimotor learning. The baby learns from movement and sensory input. Kohlberg’s theory relates to moral development, and the preconventional stage begins at age 4. 31. Sally, age 12 months, weighs 21 pounds. The nurse reviews the child’s record and finds out that her birth weight was 7 pounds. In planning care, the nurse knows that the child: A. Has not gained the expected weight related to the birth weight. B. Must not be eating enough. C. Should be referred to Protective Services immediately for being severely underweight. D. Falls within normal weight gain related to the birth weight. Rationale: D. An infant should triple her birth weight by 12 months. This child is on target for weight gain, and does not need any further intervention. 32. A preschool-age client needs a central line dressing change. The most appropriate technique to use to explain this procedure is to: A. show a picture of the procedure in a book B. explain the procedure with few words C. let the child perform a dressing change on a doll D. explain the procedure to the child’s mother as the child listens Rationale: C. Handling the equipment is the best method for teaching a preschool-age child. This will help the child to focus and to not lose interest in the teaching session. Showing pictures of the procedure, explaining in words, and letting the child listen while explaining the procedure to the parent will not effectively keep the child’s attention. 33. A parent has understood the teaching for introducing solid foods to her child if she states: A. “I can start to feed rice cereal at 2 months of age.” B. “I will begin with cereal, then introduce meats next.” C. “I will introduce one new food at a time.” D. “I will begin to wean my baby from the bottle after I start rice cereal, at 6 months of age.” Rationale: C. New foods should be introduced one at a time, so that if a food allergy or intolerance develops, it will be easy to identify. Rice cereal should not be started until 4–6 months. Rice cereal is the first solid food, followed by vegetables, then fruits, and lastly meats, at 8–10 months. The infant should not be weaned until 1 year of age. 34. The nurse is preparing to assess an infant under the age of 6 months. The infant is quiet and awake, sucking on a pacifier. The nurse should start with: A. An otoscopic exam. B. A lung, heart, and abdomen exam. C. An oral exam. D. An exam for hip dysplasia. Rationale: B. The sequence of the exam should be flexible, to capture opportunities for auscultating the lungs, heart, and abdomen when the infant is quiet or asleep. The otoscopic, oral, and hip exams are more invasive, and should be done toward the end of the assessment. 35. The nurse palpates the anterior fontanel of a 12-month-old infant. Identify the area where the nurse is palpating. A. Anterior fontanel B. Posterior fontanel C. Suture lines D. Lambdoid Suture Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Rationale: A. The anterior fontanel is located at the front of the anterior portion on the top of the skull. It normally is diamond shaped. It closes between 12–18 months of age. The posterior fontanel is triangular in shape, and closes between 2–3 months of age. Inaccurate identification would include the posterior fontanel, or any of the suture line areas. 36. A three-month-old client is being admitted with pyloric stenosis. She has an IV of D50.2 N/S at 22 cc/h. She is NPO awaiting surgery. Which nursing assessment takes priority? A. Urine output 30 cc/2h B. IV site red C. Skin turgor elastic D. Baby acts slightly irritable Rationale: B. Excellent choice! Because the child is NPO, maintaining IV access is critical. These children often come into the hospital with fluid and electrolyte imbalances because of the vomiting. IV fluids are essential. 37. The nurse walked into the room to assess a four-year-old admitted with croup. The mother says, “He never wets the bed at home, I am so embarrassed.” The nurse helps the mother and then invites her into the hall. Which of the following statements is the nurse’s most appropriate response to the mother’s statement? A. “I know this can really be embarrassing, but I don’t have kids myself, so I understand it doesn’t bother me.” B. “It is uncommon for children to regress during a hospitalization. His toileting skills will return when he is feeling better.” C. “It is probably due to the medication we are giving him or his infection.” D. “I plan to discuss your child’s incontinency with the physician as this may require further investigation.” Rationale: B. A recently gained skill such as toilet training is often temporarily lost due to the stress of hospitalization. It is appropriate to reassure the mother that this is are expected behavior in young children and the previous continence will be regained when his health is regained. 38. An ASO titer is drawn on an 11-year-old in the hospital with acute glomerulonephritis. The mother asks the nurse why the titer was drawn. Which response by the nurse is most justifiable? A. “This will tell us if he’s ever had the measles.” B. “This will tell us if he’s had a recent strep infection.” C. “This lab work is done routinely on all patients.” D. “This is done to determine the level of antibiotic is his blood.” Rationale: B. ASO (anti-streptolysin) titer indicates that the child has had a recent strep infection. In determining a definitive diagnosis for acute glomerulonephritis, this may be documented as it is usually the result of a strep infection. 39. A nine-year-old is admitted for surgery for slipped capital femoral epiphysis. Knowing the main concern of a child of this age, the nurse would want to plan strategies to do which of the following? A. arrange for his parents to be with him continuously B. obtain a telephone to be at his bedside C. plan with the physician to obtain Patient Controlled Analgesia postoperatively D. provide special hospital pajamas Rationale: C. School age children have an extreme fear of needles. They will endure large amounts of pain just to avoid an injection. Obtaining Patient Controlled Analgesia will help to avoid some injections, while obtaining pain relief for this child. 40. A four-year-old who had hydrocephalus as an infant is admitted with a malfunctioning ventroperitoneal shunt. Following new shunt placement, the nurse conducts a postoperative check. Which of the following would demand an immediate response from the nurse? A. sleepy, very difficult to arouse Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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B. pupils equal and reactive to light C. B/P 100/60, apical pulse of 90 D. urine output 33 cc in 2 hours Rationale: A. The child may be sleepy following surgery, but should be easily aroused. Lethargy could indicate increased intracranial pressure. 41. The nurse is working in a busy pediatric emergency room. In which of the following cases would she maintain a high index of suspicion of physical abuse? A. a three-year-old female with 15% burns in a splash pattern over the face and chest reportedly sustained when she pulled on the tablecloth and a teapot fell, spilling over her B. a 14-year-old male with many bruises on bony prominences, in various stages of healing. The child is reportedly clumsy C. a six-year-old with a spiral fracture of the tibia and fibula which reportedly occurred while riding his bicycle D. a nine-month-old next drowning, who reportedly climbed into the tub and turned on the water Rationale: D. Maybe a nine-month-old could climb into the tub, but turn the water on? This should definitely be followed up. The injury does not coincide with the reported cause of the accident. 42. Upon assessing gestational age of a baby, the nurse determines that he is 40 weeks gestational age. Which of the following characteristics are most likely to be found in this baby? A. lanugo abundant over shoulders and lower coccyx B. pinna of ear springs back slowly when folded C. vernix well distributed over entire body D. creases covering the entire bottom of both feet Rationale: D. The full term infant should have creases on the soles of their feet. 43. A complete blood count is ordered on a two-month-old child with cyanotic heart disease. The results are a hemoglobin of 18 g/dl and a hematocrit of 51%. Which of the following statements reflects the most appropriate interpretation of this information? A. the body is compensating for tissue hypoxia by increasing RBC production B. the child may be anemic. This is a low hemoglobin for a two-month-old child and the hematocrit is within normal limits C. the child is severely dehydrated, and the loss of vascular fluid has elevated the hematocrit. The hemoglobin is within normal limits D. This laboratory data would be considered within normal limits for a two-month-old child Rationale: A. The body is attempting to compensate. Both values are elevated to increase the oxygen-carrying capacity to the tissues. 44. While making an initial home visit, the community health nurse notes several bruises and old burns on the 10-month-old child. Which is the nurse’s priority action? A. call the child protection hotline and report possible abuse B. discuss the family with the physician and social worker at the next team meeting C. tell the mother that child protection will be notified if injuries are noted on the next visit D. carefully record the visit for follow-up Rationale: A. As a mandated reporter the nurse is obligated to report any cases of suspected abuse. You do not need to prove the case, just report the facts as you know them. This is a law. 45. A two-year-old is admitted to the hospital with vomiting and possible dehydration. Which of the following findings would most concern the nurse? A. potassium 2.5 mEq/L B. blood glucose 150 mg/dl C. weight loss 10 grams D. urine specific gravity 1.020 Rationale: A. The normal potassium level if 5-5.0 mEq/L. This level indicates hypokalemia, which could cause arrhythmias or even cardiac arrest. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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46. A 12-year-old girl had a ventro-peritoneal shunt placed to treat hydrocephalus in infancy. In counseling the child about health management of the ventro-peritoneal shunt, the nurse would consider the teaching effective if the child states: A. “I should drink plenty of fluids and stay rested.” B. “I may need to wear glasses as a teenager.” C. “I can take prochlorperazine (Compazine) for vomiting.” D. “If I get a really hard headache, I should call the doctor.” Rationale: D. A headache is a sign of increased intracranial pressure. The child correctly identifies this is an indication to notify the physician. 47. A mother brings her 18-month-old to the pediatric emergency room. The child has sustained a fractured left femur. Which statement by the mother might make the nurse suspect a problem of child abuse? A. “She is so active and gets into everything.” B. “She was riding her bicycle and her foot got caught in the spoke.” C. “My daughter slipped out of her high chair because the strap was too loose.” D. “My daughter climbed up on a chair and fell down.” Rationale: B. This statement does not seem reasonable as 18-month-old children are not developmentally ready to be riding bikes. This should make the nurse suspicious that the mother may be trying to hide something. 48. At a boy scout camp the nurse encounters a child who exhibits a high-pitched inspiratory sounds, and cyanosis. Describes the procedure which the nurse should institute. A. stand behind the child and apply an upward thrust below the xiphoid B. monitor the child; if respirations cease, use the Heimlich maneuver C. behind the child forward and deliver back flows to dislodge the object D. begin cardiopulmonary resuscitation Rationale: A. You have correctly evaluated the data as the child with an inadequate gas exchange, and then selected the correct procedure for the Heimlich maneuver on a child. 49. An 18-month-old is being admitted with a diagnosis of Wilm’s tumor. Which nursing intervention takes priority? A. checking vital signs every 8 hours for incidence of hypertension B. placing a sign over the bed which says “Do Not Palpate the Abdomen.” C. raising the head of the bed to ease breathing D. monitoring the urinary output every 2 hours Rationale: B. These tumors are usually encapsulated. It is very important to protect this encapsulation and help contain the tumor. Decreasing palpation of the abdomen may protect this encapsulation. 50. The nurse who is assigned to care for a child with cerebral palsy should obtain information concerning his abilities, limitations, interest, and habits, because the aim of therapy is to: A. assess the child’s assets and potentialities and capitalize on these in the habilitative process, while ignoring limitations B. reverse abnormal functioning and restore brain damage through rehabilitation C. provide a therapeutic program that avoids subjecting the child to frustrating experiences that decrease his achievement D. develop an individualized therapeutic program that utilizes the child’s assets and abilities to provide experiences that permit him to achieve success as well as help to cope with frustration and failure Rationale: D. This goal statement includes recognizing the client’s assets and helping him cope with frustrations and failures due to his limitations. This option is a global response. It states appropriate goals of therapy in general terms, and it also includes the true part of option A. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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51. A mother is watching her school-age child learn self-care techniques after being recently diagnosed with type 1 diabetes. Which is a correct statement? A. “Bandura’s theory states children learn new behaviors best when imitating others.” B. “Erikson’s stages describe school-age children learning by attaining goals.” C. “Piaget believes learning will take place more quickly when abstract thinking develops.” D. “Freud’s description of personality development affects learning ability.” Rationale: A. Goal attainment, developing abstract thinking, and personality development are not as closely related to learning self-care as is Bandura’s social learning theory, which is described in option A. 52. During a developmental assessment, a parent complains that she has a “difficult” toddler. What advice would the nurse offer to the parent? A. “Toddlers are flexible. Accepting new rules will occur quickly.” B. “Do not expect the child to adapt quickly to new situations.” C. “Encourage associative play and this will get better.” D. “Spanking your child will make the difficult behavior improve.” Rationale: B. Toddlers are not flexible and do not adapt to anything quickly. Associative play does not occur until preschool age, and spanking should not be encouraged. 53. A mother who uses time-out as a method of discipline for her 5-year-old child is asking the nurse what type of parenting this exemplifies. What is the response that would be the most appropriate? A. Indifferent B. Authoritative C. Authoritarian D. Permissive Rationale: B. The authoritative parent sets limits while establishing an atmosphere of open discussion, thus promoting developmental integrity and trust. Permissive and indifferent parents do not set limits whereas authoritarian parents use stricter methods of discipline than do authoritative parents. 54. Which is the most important nursing intervention to facilitate communication with a hospitalized preschool-age child? A. Provide detailed explanations of procedures to the child. B. Encourage the child to engage in play with dolls, puppets, or safe medical equipment. C. Ask the child to write a story about the hospitalization. D. Keep visitors to a minimum. Rationale: B. Play with dolls, puppets, or safe medical equipment is a developmentally appropriate means by which preschool children are able to express themselves. Detailed explanations and writing a story are not developmentally appropriate for a preschool age child. Visitors are important to children this age. Parents should be allowed to stay at all times. 55. A nurse is assessing a 2-year-old boy with the following vital signs: temperature 97.8°F axillary, apical pulse 100, respirations 28 breaths per minute, blood pressure 125/80. Which action by the nurse would be most appropriate? A. Reevaluate the child’s temperature in 1 hour B. Report the blood pressure to the physician C. Assess for additional signs of respiratory distress in the child D. Determine why the child has tachycardia Rationale: B. All of the vital signs listed are normal for a 2-year-old child except for the blood pressure. This reading is greater than the 99th percentile for a 2-year-old child, and should be reported promptly to the physician. 56. Which statement indicates nutrition counseling has been effective for the mother of a 6month-old infant? Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. “I will start my infant on rice cereal since it is iron fortified and has little chance of causing allergy.” B. “I will start my infant on egg whites since they are high in iron and protein and have little chance of causing allergy.” C. “I will start feeding fruits and vegetables and progress to whole grain cereals as tolerated.” D. “I know that I can start feeding my baby strained meats for the iron and protein and progress to the more irritating fruits and vegetables.” Rationale: A. Rice cereal is the recommended first food for infants since it has a low risk of causing allergy, and it is iron fortified. Infants should not have egg whites as they can cause severe allergies. Foods should be introduced one at a time, and the infant should progress to other single-ingredient cereals, followed by fruits and vegetables. 57. Which observation during a healthcare visit alerts the nurse to the need for further developmental assessment in an infant? A. A four-month-old has just started to roll from front to back. B. A nine-month-old now stands while holding on the furniture. C. A nine-month-old is able to sit with support from pillows on each side. D. A 12-month-old says two words, “dog” and “bottle.” Rationale: C. The child should sit independently without support by nine months. Thus, the ninemonth-old sitting only with support indicates the need for more extensive developmental assessment. 58. The nurse knows that teaching about car seat safety to the parents of a 4-year-old child has been effective when which statement is made? A. “Now that our child is 4 years old, weighs 40 pounds, and is 42 inches tall, we can move to a forward-facing booster seat.” B. “Now that our child is 4 years old, she can sit in the regular car seat and use the seat belt and shoulder belt like adults.” C. “Now that our child is 4 years old, she can sit in her booster seat in the front seat.” D. “Our 4-year-old must stay in her forward-facing car seat until she is 6 years old.” Rationale: A. The child can be in a forward-facing booster seat at this weight and height. The child should continue to use a belt positioning booster seat until her knees extend to the edge of the seat and the shoulder belt fits appropriately. Children should not be in the front seat of a vehicle with passenger side air bags. 59. Which is the best advice the nurse can give to parents asking for help in handling their toddler’s temper tantrums? A. “I think you should start using time-outs when he throws a temper tantrum.” B. “Reward him for good behavior and the temper tantrums will decrease.” C. “There is nothing to be done. They are a symptom of emotional instability.” D. “Temper tantrums will increase in number through the preschool years.” Rationale: A. A time-out lets the child know there are limits and also removes him from the stimulus causing the tantrum. Rewards are not the best option as they will be interpreted as a reward for the behavior, which may be repeated in order to get more rewards. Temper tantrums are common at this age. They do not indicate emotional disturbance. Tantrums should decrease as the child ages. With age a child is better able to maintain control and to feel in control of situations. 60. The high school principal asks the school nurse to provide injury prevention information to the students. What does the nurse identify as priority for the majority of students? A. Driving and substance abuse B. CPR and emergency care C. Sports injuries D. Driving patterns Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Rationale: A. School dances, social gatherings, and dating increase during high school along with drug and alcohol experimentation. Cognitive impairment related to alcohol and drug consumption can cause motor vehicle accidents leading to injuries. Although learning CPR, avoiding sports injuries, and fire prevention are important, they are not the priority in this age group. 61. The nurse is preparing a disaster education plan for school-age children to discuss fire prevention and fire evacuation planning. What information is priority in the plan? A. It is essential for the child to stay with the family at the time of the fire. B. The child and family need to have a definite evacuation plan in place. C. The child should stay indoors in the event of a fire. D. It is important the child remember to drink more water than usual after a fire. Rationale: B. Evacuation education is priority. The child should be instructed to evacuate if indicated, not to find parents and other family members. As each fire situation is different, the child may be required to evacuate the building for the outdoors. Finally, while drinking the water after fire exposure is important, it is not the priority in fire prevention and evacuation planning. 62. A school nurse is packing a portable emergency bag for a potential disaster. Which indicates the need for further education in disaster preparedness? A. A list of staff and students and their location B. A blueprint of the school and its grounds C. Handheld portable radios with batteries D. A portable automatic external defibrillator Rationale: D. An automatic external defibrillator is not indicated in this population as it is unusual for children to present with ventricular fibrillation. The blue-print, portable radios, and lists of staff and students are important to include. 63. Which is the correct developmental stage at which a child begins to have a more realistic understanding of death? A. Preschooler B. Adolescent C. School age D. Preteen Rationale: C. Cognitively after age 6 or so, children are able to understand that death is permanent and occurs from varied causes. Preschoolers have magical thinking and believe death is temporary. Many preschoolers believe that bad thoughts and/or behavior cause death. The understanding occurs during the school-age years. The adolescent understands death much like an adult. There is no developmental stage by the name of preteen. 64. A nurse obtains a history from a breastfeeding mother with a small 3-month-old infant who has been vomiting. Which would give the nurse an indication this infant has severe dehydration? A. The infant is having a seizure B. The pulse rate is slightly elevated C. Skin turgor is normal D. Mucous membranes are dry Rationale: A. Seizure activity is usually not noted until the child is severely dehydrated. Slight elevation of pulse rate can be seen in moderate dehydration. Dry mucous membranes are seen in moderate dehydration. Normal skin turgor indicates no signs of mild dehydration. 65. The nurse notes changes in a toddler with heart failure since the shift yesterday. Which finding is the most significant for extracellular fluid volume overload? A. Jugular venous distention B. Weight gain of 0.8 kg C. Weak pulse D. Presence of lung crackles Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Rationale: B. Rapid weight gain is the most sensitive index of extracellular fluid volume excess. Assessment of jugular vein distention is difficult in young children. It is an assessment finding in older children. A bounding pulse is indicative of fluid excess. Presence of lung crackles may occur as a sign of pulmonary edema, but it may be a later sign and is not the most characteristic of pulmonary edema. 66. The parents of a child who had a tonsillectomy 3 days ago call about concerns with symptoms they are seeing. Which symptom would alert the nurse that the child may be having a postoperative problem? A. The child has white crusts on the back of the throat B. The child is having increased swallowing. C. The child will only eat Popsicles. D. The child complains of throat pain. Rationale: B. The child having increased swallowing could be a sign of increased bleeding from the surgical site. White crusts on the back of the throat, eating only Popsicles, and complaining of throat pain are all normal following a tonsillectomy. 67. A child is brought to the emergency department with an abrupt onset of decreased appetite, stridor, high fever, and agitation. What information is needed to determine the nurse’s priority intervention? A. Determine if the child has been drooling. B. Ask if the child will lie down. C. Ask if the child has been around anyone sick. D. Auscultate the child’s breath sounds. Rationale: A. If the child has been drooling, epiglottitis is a possibility. Since the child is agitated, only interventions that do not worsen the agitation should be initiated to maintain a patent airway. Asking the child to lie down may assist in determination of epiglottitis versus bacterial tracheitis, but is not the most important assessment and may cause the child’s condition to deteriorate. Asking if the child has been around anyone sick is not the priority; airway assessment is the priority in this situation. Since this child is already agitated, listening to breath sounds may worsen the agitation, causing the airway to become more reactive if this is epiglottitis. 68. A child is being treated with dexamethasone in conjunction with other chemotherapy for treatment of leukemia. On a follow-up visit, the pediatric oncology clinic nurse expects which as a side effect? A. Weight gain B. Decreased blood pressure C. Anorexia D. Improved mood Rationale: A. Administration of steroids causes weight gain. Steroids cause an elevation of blood pressure, an increase in appetite, and mood instability and irritability. 69. A child with leukemia has a white blood cell count of 10,000, a red blood cell count of 5, and platelets of 20,000. The child is also fairly active, visiting the playroom twice a day. When planning this child’s care, which risk should the nurse consider most significant? A. Infection B. Anemia C. Hemorrhage D. Pain Rationale: C. The platelet count is decreased, thus putting the child at risk for hemorrhage. The white blood cell count is normal; however, a differential should be analyzed. The red blood cell count is within normal limits. Anemia is not a priority; however, hemoglobin and hematocrit levels should be monitored. Pain should always be considered, but it is not the focus in this situation. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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70. A 3-year-old female with nephrotic syndrome is being admitted to the general pediatric floor. Who is the most appropriate roommate for this child? A. A 2-year-old female recovering from varicella B. A 4-year-old female with a fractured femur C. A 6-year-old male postoperative appendectomy D. A 3-year-old female with cystic fibrosis Rationale: B. A 4-year-old child with a fractured femur is a developmentally appropriate roommate for a 3-year-old female. Exposure to this child will not promote infection. The patients with varicella and cystic fibrosis are not appropriate roommates due to the risk of infection for the patient on hemodialysis. The child who is postoperative appendectomy is a male and thus is not the most appropriate choice. 71. When a child with type 1 diabetes is sick, which is the most appropriate recommendation? A. The usual dose of insulin may need to be decreased or omitted. B. Test blood glucose if the urine ketones are positive. C. Urine ketones are tested when the glucose level is greater than 200 mg/dL. D. Maintain fluid intake, avoiding fluids that contain carbohydrates. Rationale: C. Urine ketones are tested when the blood glucose level is greater than 200 mg/dL. Blood glucose levels may need to be monitored more frequently than is routine. The usual dose of insulin may actually need to be increased. Higher blood glucose levels may necessitate increases in insulin doses. The child will need increased fluid intake, greater than normal demands. If the child cannot eat to maintain food intake, fluids should have carbohydrates to maintain the usual caloric intake. 72. Identify the priority nursing diagnosis for an adolescent with hyperthyroidism? A. Disturbed Body Image related to changes in appearance caused by process of metabolic disorder. B. Imbalanced Nutrition: More than Body Requirements related to decreased metabolic needs. C. Risk for Decreased Fluid Volume related to excess salt excretion. D. Constipation related to thyroid medication side effects. Rationale: A. A teenager is most affected by changes in body image. Teenagers who are different from their peers or have a change in appearance may have a difficult time adjusting and need emotional and psychosocial support. Metabolic needs are higher than usual in hyperthyroidism, leading to a potential inability to meet the body’s requirements. Fluid volume deficit is not associated with hyperthyroidism. The child may have increased appetite, weight loss, diaphoresis, and weakness. 73. The parent of a child recently diagnosed with viral meningitis is concerned about permanent effects from the disease. Her neighbor’s child had viral encephalitis with learning and mobility sequelae as a result. How should the nurse respond to her concerns? A. “Let’s wait and see if this disease becomes viral encephalitis.” B. “Have they been playing together?” C. “Most children with viral meningitis have future learning problems. You’ll need to make plans for a special school.” D. “Children who have viral meningitis usually have a complete recovery without permanent effects.” Rationale: D. Prognosis for viral meningitis is excellent. Some children with viral encephalitis may also have complete recoveries but many have intellectual, visual, auditory, or motor deficits. Viral meningitis is a different disease than viral encephalitis. There is no connection. Viral encephalitis is not contagious. It occurs as a response to a virus, specifically herpes simplex type 1. 74. An infant is brought to the emergency department with assessment findings of failure to thrive, vomiting, and a decreased level of consciousness. Which should the nurse suspect? A. Influenza B. Reaction to the dTaP immunization Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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C. Shaken baby syndrome D. A malabsorption syndrome Rationale: C. Clinical manifestations of shaken baby syndrome include seizure, lethargy, failure to thrive, and vomiting. It is caused by the tearing of the nerve fibers as the brain moves back and forth. Influenza is an acute illness and should not have accompanying signs of failure to thrive or a decreased level of consciousness. Response to the DTaP immunization includes fever and irritability. A malabsorption syndrome can cause failure to thrive but not a decreased level of consciousness. 75. A 6-year-old child is having burn care following premedication for pain. The child is not cooperative for dressing changes and begins screaming and kicking. What is the best action by the nurse? A. Inform the child that cooperation is necessary for proper healing and will shorten the hospital stay. B. Allow the parents to change the dressings with coaching from the nurse. C. Allow the child to participate in the dressing change process as much as possible. D. Inform the child that restraints will be used if there is no cooperation. Rationale: C. The school-age child is striving for feelings of achievement and control. Giving the child the opportunity to help with the procedure will provide a sense of control and accomplishment. Effective pain management improves the chance the child will participate. A shortened hospital stay is no guarantee with or without cooperation and should never be used as leverage with a child. The parents may not be able to tolerate the procedure and may not wish to participate. The school-age child will not respond well to threats and further loss of control. 76. During a routine developmental screening, the nurse is concerned about the development of a 5-year-old. Which of the following would be recommended? A. Refer the child to a social worker. B. Tell the parent to take the child to a physical therapist. C. Refer the child to a trained specialist to administer developmental testing. D. Tell the mother that the child should be retested in a year. Rationale: C. If a developmental delay or abnormality is suspected, a specific developmental screening test is needed. Early intervention is important for developmental delay. Referring the child to a social worker or other therapist, or advising about physical therapy, would require further testing. 77. Which of the following assessment questions and instructions used by the nurse would give information regarding relationship issues of the child? A. “Describe your infant’s temperament to me.” B. “What does your toddler like to do at school?” C. “Tell me about your child’s after school activities.” D. “How does your infant comfort himself?” Rationale: A. Asking what the toddler likes to do at school, asking about after school activities, and asking how the child comforts himself are not questions directed towards relationships. Obtaining a description of the infant’s temperament is directed towards assessing relationships. 78. The nurse is assessing a newborn, and notes all of the findings. Which of the following nursing assessments would cause the nurse to be concerned? A. Baby enjoys sucking on a pacifier and sleeps 16 hours a day. B. Baby is nursing every 2–2½ hours and has 2 stools daily. C. Birth weight is 6 pounds, 10 ounces. Present weight is 5 pounds, 4 ounces. D. Baby is sleeping in between feedings and is not babbling. Rationale: C. In the first week of life, most babies lose about one-tenth of their birth weight. Nursing every 2–2½ hours is a normal feeding schedule for a newborn. A newborn who has lost more than 10% of her birth weight should be evaluated. Sleeping in between feedings and sucking on a pacifier are normal newborn responses. Newborns do not vocalize by babbling. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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79. A new mother asks the nurse whether breastfeeding is better than formula for her newborn. Which response by the nurse is most appropriate? A. “It often is easier to breastfeed, because you do not have to prepare bottles.” B. “Breastfeeding is best for your baby; of course you should choose this.” C. “There are no advantages to breastfeeding. You should do what is best for you.” D. “There are many benefits to breastfeeding; let me tell you more about it.” Rationale: D. Despite the obvious health and developmental advantages of breastfeeding, efforts are needed to promote breastfeeding. The nurse’s statement should respond to the informationseeking question by the mother. Studies have shown breastfeeding to have obvious health benefits. The nurse never should be judgmental. There are advantages to breastfeeding. Breastfeeding often is not easier than bottle-feeding. 80. The father of a 9-month-old infant tells the nurse that his wife picks up the baby immediately whenever she begins to cry. The most appropriate response by the nurse is: A. “It is important for the child to learn to comfort herself. Does the baby try to calm herself by sucking her thumb?” B. “It is OK to pick her up often; eventually, she will stop crying.” C. “Most infants do not know how to calm themselves. It is important to be responsive when they cry.” D. “At 9 months, she is too young to learn to calm herself. Wait until she is 2 years old before letting her cry longer.” Rationale: A. An important indication of infant mental health is the ability to comfort oneself. The nurse should offer helpful information to the parent. Telling the father that infants cannot learn to calm themselves is providing false information. 81. The nurse inquires about the activity level of a 3-year-old. The mother states that the child loves to play at the park, and that they go there as much as possible. The nurse encourages the mother to continue to take the child to the park for play. What important principle is guiding the nurse’s response? A. Socialization with other toddlers helps develop communication skills. B. Allowing the toddler to walk, run, and hop enhances the child’s kinaesthesia. C. Maternal bonding is enhanced through play. D. Only an emotionally happy child can enjoy the park. Rationale: B. There is no information regarding socialization in the response of the mother. Kinaesthesia, or the sense of one’s body position and movement, develops during these years. Maternal bonding is enhanced through play might be true, but it does not enhance the development of kinaesthesia. The response “Only an emotionally happy child can enjoy the park” is an unsupported statement. 82. The father of a 2½ - year-old asks the nurse how to prevent early-childhood dental cavities. The best response by the nurse would be: A. “Your child has only baby teeth; they will eventually fall out, and so there is no need to worry.” B. “Make sure your child’s diet is nutritious, and limit snacks high in sugar.” C. “Take the child to the dentist to see if he has any cavities.” D. “Let the child watch you brush your teeth so that he can learn how to do it himself.” Rationale: B. Early-childhood caries are caused by inadequate preventive care. The nurse’s best response should be helpful and accurate, should offer advice, and should address the parents’ concern as to prevention. Telling the parent there is no need to worry is not supportive and not appropriate. Taking the child to the dentist diagnoses dental cavities but doesn’t prevent them from occurring. Letting the child watch how the parent brushes his teeth is fine, but does not address the client’s needs. 83. The nurse needs to obtain the height of a 3-year-old as part of routine health screening. To obtain an accurate measurement, the child will: Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Be measured in a recumbent position. B. Remove his shoes and stand upright, with head level. C. Stand with his feet wide apart. D. Face the wall as he is measured. Rationale: B. Once the child can stand to be measured, sometime between 2–3 years of age, charts for standing height rather than recumbent length are used. The head actually is kept level, and feet are kept close together. The child faces away from the measuring tool. 84. Mother of a 3-year-old tells the nurse that her child has frequent nightmares. The statement by the mother that indicates the need for more teaching is: A. “I usually talk quietly and rub her back to reassure her.” B. “I read her a story until she calms down.” C. “I take her to my bed so she will calm down.” D. “I stay with her awhile to reassure her.” Rationale: C. Nightmares are frightening dreams; parents can reassure the child, rub her back, and provide some repeat of the bedtime routine. Taking her to the parents’ bed so she will calm down could cause more problems, as it does not help the child to calm herself. Talking quietly and rubbing her back to reassure her would be helpful. Reading a story until she calms down and staying with her awhile to reassure her are appropriate actions. 85. Most schools include curricula regarding human sexuality. What is the most appropriate age group for the nurse to include in her instruction? A. 12-year-olds B. 9-year-olds C. 11-year-olds D. 15-year-olds Rationale: B. Children can receive information in school beginning approximately in the fourth grade. Nine years old is the age when most children first have the cognitive ability to comprehend human sexuality. An 11-, 12-, or 15-year-old already has had the cognitive ability to comprehend human sexuality; teaching should occur before pubertal changes. 86. A 7-year-old sibling of a child with special needs is acting out in school. This behavior has been attributed to jealousy over the attention the special needs child receives. The school nurse should suggest to the parents that the sibling should: A. Have a special time or activity with each parent alone. B. Be dealt with using behavior modifications. C. Be asked to participate in the care of the special needs child to understand why the child needs more attention. D. Be evaluated by a psychologist to rule out any mental illness. Rationale: A. Siblings need to be recognized with their own personal time with caregivers. Jealousy and aggression are common with siblings of chronically ill children. Siblings should not be responsible for any portion of care of the ill child, due to potential remorse and/or guilt. 87. A 2-year-old with epilepsy is showing signs of developmental delay. The nurse has been working with the family to support development. The response from the parents that indicates the need for further teaching is: A. “He has a schedule by which we abide at all times.” B. “We make sure he is always in a playpen or enclosed area when he plays.” C. “He has temper tantrums all the time. We stay near, but don’t give in to what he gets mad about.” D. “He gets his Depakote every day at the same time. He hasn’t shown signs of a seizure since he was 6 months old.” Rationale: B. Enclosed areas and overprotection by the parents can affect opportunities for growth and development. Following a schedule, not giving in to temper tantrums, and giving medication at the same time all are correct methods to facilitate safety and normal growth and development. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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88. A 6-year-old with a neural tube defect has to endure daily catheterizations. What is the most appropriate nursing action to encourage this child to learn self-catheterization? A. Explain the procedure, and ask the child to watch how to perform the catheterization. B. Wait until the child is 8 years old, when fine motor skills are sufficiently developed to perform the procedure. C. Allow the child to catheterize an anatomically correct doll using similar equipment. D. Have the child’s older sibling of the same sex assist with catheterizations. Watching the sibling participate might increase the child’s desire to learn. Rationale: C. The school-age years are when you need to begin to identify aspects of the child’s care for which the child can learn to assume responsibility under the supervision of the parents. Having the child practice catheterizations on an anatomically correct doll will help him learn how to catheterize himself in the near future. This fosters independence and helps with the child’s development. Children learn through repetitive play, which breeds acceptance and control. Children at the age of 6 have the skills to perform simple procedures. Allowing the sibling to participate is inappropriate. 89. The mother of a trainable adolescent with Down syndrome states to the school nurse, “I don’t know what’s going to happen to my child when I die. How will he take care of himself?” What is the nurse’s best response? A. “There will always be somebody to take care of him. Don’t worry, everything will be okay.” B. “Is there a relative who can take care of him if something happens? You need to develop a plan for the future.” C. “I am sure there is something we can do. Let me look into alternative care and see what kind of insurance you have.” D. “We do have a program that will assist with vocational learning. I need to get your consent first; then, we can look at alternatives.” Rationale: D. Any disabled client has a right to a vocational plan with the goal of living an independent life. The types of insurance and relative care are personal matters that should not influence the vocational plan. It is inappropriate for the nurse to make promises on issues over which she has no control due to the unpredictability of life. 90. The nurse needs to administer a medication to a 6-month-old. The most appropriate technique is to: A. Mix the medication in one ounce of infant formula, and feed it to the child. B. Position the child upright, and use an oral syringe to administer the medication. C. Pour the medicine from a medication cup into the inside of the infant’s cheek. D. Position the infant supine, and squirt the medicine into the child’s mouth. Rationale: B. Oral medication to infants should be administered via an oral syringe into the inside of the cheek. The infant should be positioned upright to avoid aspiration. The nurse should avoid mixing medication in more than a very small amount of food or formula, to ensure that the medicine is taken. Medicine cups are not appropriate for infants. Administering a medication to a child in the supine position increases the risk of aspiration. 91. The nurse is teaching a postpartum client about the normal stooling pattern of a neonate. Which color and consistency best describes the typical appearance of meconium? A. soft, pale yellow B. hard, pale brown C. sticky, green black D. loose golden yellow 92. A mother of a term neonate asks what the thick, white cheesy coating is on his skin. Which correctly describes this finding? A. lanugo B. milia Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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C. nevus flammeus D. vernix 93. Which drug is routinely given to the neonate within 1 hour of birth? A. erythromycin ophthalmic ointment B. gentamycin C. nystatin D. Vitamin A 94. A neonate undergoing phototherapy treatment needs to monitored for which adverse effect? A. hyperglycemia B. increased insensible water loss C. severe decrease in platelet count D. increased GI transit time 95. Which immunoglobulin (Ig) provides immunity against bacterial and viral pathogens through passive immunity? A. IgA B. IgE C. IgG D. IgM 96. Which neonatal behavior is most commonly associated with fetal alcohol syndrome (FAS)? A. hypo activity B. high birth weight C. poor wake and sleep patterns D. high threshold of stimulation 97. An initial assessment of a female neonate shows pink tinged vaginal discharge. Which factor is the probable cause? A. cystitis B. birth trauma C. neonatal candidiasis D. withdrawal of maternal hormones 98. A woman delivers a 3,250 g neonate at 42 week’s gestation. expected during an examination of this neonate? A. absent lanugo B. absence of sole creases C. breast bud of 1-2 mm in diameter D. leathery, cracked and wrinkled skin
Which physical finding is
99. one minute after birth, a neonate has a heart rate of 60 beats/minute. Five minutes after birth, his heart rate is 80 beats/min. Which Apgar heart rate score should he receive? A. 0 B. 1 C. 2 D. 3 100. When assessing a male neonate , the nurse notices that the urinary meatus is located on the ventral surface of the penis. How should the nurse document this finding? A. as the normal loation for the urinary meatus B. as epispadias C. as hypospadias D. as cryptorchidism Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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101.While performing physical assessment of a 12 month-old, the nurse notes that the infant’s anterior fontanelle is still slightly open. Which of the following is the nurse’s most appropriate action? a. Notify the physician immediately because there is a problem. b. Perform an intensive neurologic examination. c. Perform an intensive developmental examination. d. Do nothing because this is a normal finding for the age. D. The anterior fontanelle typically closes anywhere between 12 to 18 months of age. Thus, assessing the anterior fontanelle as still being slightly open is a normal finding requiring no further action. Because it is normal finding for this age, notifying he physician or performing additional examinations are inappropriate. 102.When teaching a mother about introducing solid foods to her child, which of the following indicates the earliest age at which this should be done? a. 1 month b. 2 months c. 3 months d. 4 months D. Solid foods are not recommended before age 4 to 6 months because of the sucking reflex and the immaturity of the gastrointestinal tract and immune system. Therefore, the earliest age at which to introduce foods is 4 months. Any time earlier would be inappropriate. 103.The infant of a substance-abusing mother is at risk for developing a sense of which of the following? a. Mistrust b. Shame c. Guilt d. Inferiority A. According to Erikson, infants need to have their needs met consistently and effectively to develop a sense of trust. An infant whose needs are consistently unmet or who experiences significant delays in having them met, such as in the case of the infant of a substance-abusing mother, will develop a sense of uncertainty, leading to mistrust of caregivers and the environment. Toddlers develop a sense of shame when their autonomy needs are not met consistently. Preschoolers develop a sense of guilt when their sense of initiative is thwarted. Schoolagers develop a sense of inferiority when they do not develop a sense of industry. 104.Which of the following toys should the nurse recommend for a 5-month-old? a. A big red balloon b. A teddy bear with button eyes c. A push-pull wooden truck d. A colorful busy box D. A busy box facilitates the fine motor development that occurs between 4 and 6 months. Balloons are contraindicated because small children may aspirate balloons. Because the button eyes of a teddy bear may detach and be aspirated, this toy is unsafe for children younger than 3 years. A 5-month-old is too young to use a push-pull toy. 105.The mother of a 2-month-old is concerned that she may be spoiling her baby by picking her up when she cries. Which of the following would be the nurse’s best response? a. “ Let her cry for a while before picking her up, so you don’t spoil her” b. “Babies need to be held and cuddled; you won’t spoil her this way” c. “Crying at this age means the baby is hungry; give her a bottle” d. “If you leave her alone she will learn how to cry herself to sleep” B. Infants need to have their security needs met by being held and cuddled. At 2 months of age, they are unable to make the connection between crying and attention. This association does not Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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occur until late infancy or early toddlerhood. Letting the infant cry for a time before picking up the infant or leaving the infant alone to cry herself to sleep interferes with meeting the infant’s need for security at this very young age. Infants cry for many reasons. Assuming that the child s hungry may cause overfeeding problems such as obesity. 106.When assessing an 18-month-old, the nurse notes a characteristic protruding abdomen. Which of the following would explain the rationale for this finding? a. Increased food intake owing to age b. Underdeveloped abdominal muscles c. Bowlegged posture d. Linear growth curve B. Underdeveloped abdominal musculature gives the toddler a characteristically protruding abdomen. During toddlerhood, food intake decreases, not increases. Toddlers are characteristically bowlegged because the leg muscles must bear the weight of the relatively large trunk. Toddler growth patterns occur in a steplike, not linear pattern. 107.If parents keep a toddler dependent in areas where he is capable of using skills, the toddle will develop a sense of which of the following? a. Mistrust b. Shame c. Guilt d. Inferiority B. According to Erikson, toddlers experience a sense of shame when they are not allowed to develop appropriate independence and autonomy. Infants develop mistrust when their needs are not consistently gratified. Preschoolers develop guilt when their initiative needs are not met while schoolagers develop a sense of inferiority when their industry needs are not met. 108.Which of the following is an appropriate toy for an 18-month-old? a. Multiple-piece puzzle b. Miniature cars c. Finger paints d. Comic book C. Young toddlers are still sensorimotor learners and they enjoy the experience of feeling different textures. Thus, finger paints would be an appropriate toy choice. Multiple-piece toys, such as puzzle, are too difficult to manipulate and may be hazardous if the pieces are small enough to be aspirated. Miniature cars also have a high potential for aspiration. Comic books are on too high a level for toddlers. Although they may enjoy looking at some of the pictures, toddlers are more likely to rip a comic book apart. 109.When teaching parents about the child’s readiness for toilet training, which of the following signs should the nurse instruct them to watch for in the toddler? a. Demonstrates dryness for 4 hours b. Demonstrates ability to sit and walk c. Has a new sibling for stimulation d. Verbalizes desire to go to the bathroom D. The child must be able to sate the need to go to the bathroom to initiate toilet training. Usually, a child needs to be dry for only 2 hours, not 4 hours. The child also must be able to sit, walk, and squat. A new sibling would most likely hinder toilet training. 110.When teaching parents about typical toddler eating patterns, which of the following should be included? a. Food “jags” b. Preference to eat alone c. Consistent table manners d. Increase in appetite Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Toddlers become picky eaters, experiencing food jags and eating large amounts one day and very little the next. A toddler’s food gags express a preference for the ritualism of eating one type of food for several days at a time. Toddlers typically enjoy socialization and limiting others at meal time. Toddlers prefer to feed themselves and thus are too young to have table manners. A toddler’s appetite and need for calories, protein, and fluid decrease due to the dramatic slowing of growth rate. 111.Which of the following suggestions should the nurse offer the parents of a 4-year-old boy who resists going to bed at night? a. “Allow him to fall asleep in your room, then move him to his own bed.” b. “Tell him that you will lock him in his room if he gets out of bed one more time.” c. “Encourage active play at bedtime to tire him out so he will fall asleep faster.” d. “Read him a story and allow him to play quietly in his bed until he falls asleep.” D. Preschoolers commonly have fears of the dark, being left alone especially at bedtime, and ghosts, which may affect the child’s going to bed at night. Quiet play and time with parents is a positive bedtime routine that provides security and also readies the child for sleep. The child should sleep in his own bed. Telling the child about locking him in his room will viewed by the child as a threat. Additionally, a locked door is frightening and potentially hazardous. Vigorous activity at bedtime stirs up the child and makes more difficult to fall asleep. 112.When providing therapeutic play, which of the following toys would best promote imaginative play in a 4-year-old? a. Large blocks b. Dress-up clothes c. Wooden puzzle d. Big wheels B. Dress-up clothes enhance imaginative play and imagination, allowing preschoolers to engage in rich fantasy play. Building blocks and wooden puzzles are appropriate for encouraging fine motor development. Big wheels and tricycles encourage gross motor development. 113.Which of the following activities, when voiced by the parents following a teaching session about the characteristics of school-age cognitive development would indicate the need for additional teaching? a. Collecting baseball cards and marbles b. Ordering dolls according to size c. Considering simple problem-solving options d. Developing plans for the future D. The school-aged child is in the stage of concrete operations, marked by inductive reasoning, logical operations, and reversible concrete thought. The ability to consider the future requires formal thought operations, which are not developed until adolescence. Collecting baseball cards and marbles, ordering dolls by size, and simple problem-solving options are examples of the concrete operational thinking of the schoolager. 114.A hospitalized schoolager states: “I’m not afraid of this place, I’m not afraid of anything.” This statement is most likely an example of which of the following? a. Regression b. Repression c. Reaction formation d. Rationalization C. Reaction formation is the schoolager’s typical defensive response when hospitalized. In reaction formation, expression of unacceptable thoughts or behaviors is prevented (or overridden) by the exaggerated expression of opposite thoughts or types of behaviors. Regression is seen in toddlers and preshcoolers when they retreat or return to an earlier level of development. Repression refers to the involuntary blocking of unpleasant feelings and experiences from one’s Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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awareness. Rationalization is the attempt to make excuses to justify unacceptable feelings or behaviors. 115.After teaching a group of parents about accident prevention for schoolagers, which of the following statements by the group would indicate the need for more teaching? a. “Schoolagers are more active and adventurous than are younger children.” b. “Schoolagers are more susceptible to home hazards than are younger children.” c. “Schoolagers are unable to understand potential dangers around them.” d. “Schoolargers are less subject to parental control than are younger children.” C. The schoolager’s cognitive level is sufficiently developed to enable good understanding of and adherence to rules. Thus, schoolagers should be able to understand the potential dangers around them. With growth comes greater freedom and children become more adventurous and daring. The school-aged child is also still prone to accidents and home hazards, especially because of increased motor abilities and independence. Plus the home hazards differ from other age groups. These hazards, which are potentially lethal but tempting, may include firearms, alcohol, and medications. School-age children begin to internalize their own controls and need less outside direction. Plus the child is away from home more often. Some parental or caregiver assistance is still needed to answer questions and provide guidance for decisions and responsibilities. 116.Which of the following skills is the most significant one learned during the schoolage period? a. Collecting b. Ordering c. Reading d. Sorting C. The most significant skill learned during the school-age period is reading. During this time the child develops formal adult articulation patterns and learns that words can be arranged in structure. Collective, ordering, and sorting, although important, are not most significant skills learned. 117.A child age 7 was unable to receive the measles, mumps, and rubella (MMR) vaccine at the recommended scheduled time. When would the nurse expect to administer MMR vaccine? a. In a month from now b. In a year from now c. At age 10 d. At age 13 C. Based on the recommendations of the American Academy of Family Physicians and the American Academy of Pediatrics, the MMR vaccine should be given at the age of 10 if the child did not receive it between the ages of 4 to 6 years as recommended. Immunization for diphtheria and tetanus is required at age 13. 118.The adolescent’s inability to develop a sense of who he is and what he can become results in a sense of which of the following? a. Shame b. Guilt c. Inferiority d. Role diffusion D. According to Erikson, role diffusion develops when the adolescent does not develop a sense of identity and a sense or where he fits in. Toddlers develop a sense of shame when they do not achieve autonomy. Preschoolers develop a sense of guilt when they do not develop a sense of initiative. School-age children develop a sense of inferiority when they do not develop a sense of industry. 119.Which of the following would be most appropriate for a nurse to use when describing menarche to a 13-year-old? a. A female’s first menstruation or menstrual “periods” Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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b. The first year of menstruation or “period” c. The entire menstrual cycle or from one “period” to another d. The onset of uterine maturation or peak growth A. Menarche refers to the onset of the first menstruation or menstrual period and refers only to the first cycle. Uterine growth and broadening of the pelvic girdle occurs before menarche. 120.A 14-year-old boy has acne and according to his parents, dominates the bathroom by using the mirror all the time. Which of the following remarks by the nurse would be least helpful in talking to the boy and his parents? a. “This is probably the only concern he has about his body. So don’t worry about it or the time he spends on it.” b. “Teenagers are anxious about how their peers perceive them. So they spend a lot of time grooming.” c. “A teen may develop a poor self-image when experiencing acne. Do you feel this way sometimes?” d. “You appear to be keeping your face well washed. Would you feel comfortable discussing your cleansing method?” A. Stating that this is probably the only concern the adolescent has and telling the parents not to worry about it or the time her spends on it shuts off further investigation and is likely to make the adolescent and his parents feel defensive. The statement about peer acceptance and time spent in front of the mirror for the development of self image provides information about the adolescent’s needs to the parents and may help to gain trust with the adolescent. Asking the adolescent how he feels about the acne will encourage the adolescent to share his feelings. Discussing the cleansing method shows interest and concern for the adolescent and also can help to identify any patient-teaching needs for the adolescent regarding cleansing. 121.Which of the following should the nurse suspect when noting that a 3-year-old is engaging in explicit sexual behavior during doll play? a. The child is exhibiting normal pre-school curiosity b. The child is acting out personal experiences c. The child does not know how to play with dolls d. The child is probably developmentally delayed. B. Preschoolers should be developmentally incapable of demonstrating explicit sexual behavior. If a child does so, the child has been exposed to such behavior, and sexual abuse should be suspected. Explicit sexual behavior during doll play is not a characteristic of preschool development nor symptomatic of developmental delay. Whether or nor the child knows how to play with dolls is irrelevant. 122.Which of the following statements by the parents of a child with school phobia would indicate the need for further teaching? a. “We’ll keep him at home until phobia subsides.” b. “We’ll work with his teachers and counselors at school.” c. “We’ll try to encourage him to talk about his problem.” d. “We’ll discuss possible solutions with him and his counselor.” A. The parents need more teaching if they state that they will keep the child home until the phobia subsides. Doing so reinforces the child’s feelings of worthlessness and dependency. The child should attend school even during resolution of the problem. Allowing the child to verbalize helps the child to ventilate feelings and may help to uncover causes and solutions. Collaboration with the teachers and counselors at school may lead to uncovering the cause of the phobia and to the development of solutions. The child should participate and play an active role in developing possible solutions. 123.When developing a teaching plan for a group of high school students about teenage pregnancy, the nurse would keep in mind which of the following? a. The incidence of teenage pregnancies is increasing. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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b. Most teenage pregnancies are planned. c. Denial of the pregnancy is common early on. d. The risk for complications during pregnancy is rare. C. The adolescent who becomes pregnant typically denies the pregnancy early on. Early recognition by a parent or health care provider may be crucial to timely initiation of prenatal care. The incidence of adolescent pregnancy has declined since 1991, yet morbidity remains high. Most teenage pregnancies are unplanned and occur out of wedlock. The pregnant adolescent is at high risk for physical complications including premature labor and low-birth-weight infants, high neonatal mortality, iron deficiency anemia, prolonged labor, and fetopelvic disproportion as well as numerous psychological crises. 124.When assessing a child with a cleft palate, the nurse is aware that the child is at risk for more frequent episodes of otitis media due to which of the following? a. Lowered resistance from malnutrition b. Ineffective functioning of the Eustachian tubes c. Plugging of the Eustachian tubes with food particles d. Associated congenital defects of the middle ear. B. Because of the structural defect, children with cleft palate may have ineffective functioning of their Eustachian tubes creating frequent bouts of otitis media. Most children with cleft palate remain well-nourished and maintain adequate nutrition through the use of proper feeding techniques. Food particles do not pass through the cleft and into the Eustachian tubes. There is no association between cleft palate and congenial ear deformities. 125.While performing a neurodevelopmental assessment on a 3-month-old infant, which of the following characteristics would be expected? a. A strong Moro reflex b. A strong parachute reflex c. Rolling from front to back d. Lifting of head and chest when prone D. A 3-month-old infant should be able to lift the head and chest when prone. The Moro reflex typically diminishes or subsides by 3 months. The parachute reflex appears at 9 months. Rolling from front to back usually is accomplished at about 5 months. 126.By the end of which of the following would the nurse most commonly expect a child’s birth weight to triple? a. 4 months b. 7 months c. 9 months d. 12 months D. A child’s birth weight usually triples by 12 months and doubles by 4 months. No specific birth weight parameters are established for 7 or 9 months. 127.Which of the following best describes parallel play between two toddlers? a. Sharing crayons to color separate pictures b. Playing a board game with a nurse c. Sitting near each other while playing with separate dolls d. Sharing their dolls with two different nurses C. Toddlers engaging in parallel play will play near each other, but not with each other. Thus, when two toddlers sit near each other but play with separate dolls, they are exhibiting parallel play. Sharing crayons, playing a board game with a nurse, or sharing dolls with two different nurses are all examples of cooperative play. 128.Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia? a. Instituting infection control precautions Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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b. Encouraging adequate intake of iron-rich foods c. Assisting with coping with chronic illness d. Administering medications via IM injections A. Acute lymphocytic leukemia (ALL) causes leukopenia, resulting in immunosuppression and increasing the risk of infection, a leading cause of death in children with ALL. Therefore, the initial priority nursing intervention would be to institute infection control precautions to decrease the risk of infection. Iron-rich foods help with anemia, but dietary iron is not an initial intervention. The prognosis of ALL usually is good. However, later on, the nurse may need to assist the child and family with coping since death and dying may still be an issue in need of discussion. Injections should be discouraged, owing to increased risk from bleeding due to thrombocytopenia. 129.Which of the following information, when voiced by the mother, would indicate to the nurse that she understands home care instructions following the administration of a diphtheria, tetanus, and pertussis injection? a. Measures to reduce fever b. Need for dietary restrictions c. Reasons for subsequent rash d. Measures to control subsequent diarrhea A. The pertusis component may result in fever and the tetanus component may result in injection soreness. Therefore, the mother’s verbalization of information about measures to reduce fever indicates understanding. No dietary restrictions are necessary after this injection is given. A subsequent rash is more likely to be seen 5 to 10 days after receiving the MMR vaccine, not the diphtheria, pertussis, and tetanus vaccine. Diarrhea is not associated with this vaccine. 130.Which of the following actions by a community health nurse is most appropriate when noting multiple bruises and burns on the posterior trunk of an 18-month-old child during a home visit? a. Report the child’s condition to Protective Services immediately. b. Schedule a follow-up visit to check for more bruises. c. Notify the child’s physician immediately. d. Don nothing because this is a normal finding in a toddler. A. Multiple bruises and burns on a toddler are signs child abuse. Therefore, the nurse is responsible for reporting the case to Protective Services immediately to protect the child from further harm. Scheduling a follow-up visit is inappropriate because additional harm may come to the child if the nurse waits for further assessment data. Although the nurse should notify the physician, the goal is to initiate measures to protect the child’s safety. Notifying the physician immediately does not initiate the removal of the child from harm nor does it absolve the nurse from responsibility. Multiple bruises and burns are not normal toddler injuries. 131.Which of the following is being used when the mother of a hospitalized child calls the student nurse and states, “You idiot, you have no idea how to care for my sick child”? a. Displacement b. Projection c. Repression d. Psychosis B. The mother is using projection, the defense mechanism used when a person attributes his or her own undesirable traits to another. Displacement is the transfer of emotion onto an unrelated object, such as when the mother would kick a chair or bang the door shut. Repression is the submerging of painful ideas into the unconscious. Psychosis is a state of being out of touch with reality. 132.Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease? a. Susceptibility to respiratory infection b. Bleeding tendencies c. Frequent vomiting and diarrhea Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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d. Seizure disorder A. Children with congenital heart disease are more prone to respiratory infections. Bleeding tendencies, frequent vomiting, and diarrhea and seizure disorders are not associated with congenital heart disease. 133.Which of the following would the nurse do first for a 3-year-old boy who arrives in the emergency room with a temperature of 105 degrees, inspiratory stridor, and restlessness, who is learning forward and drooling? a. Auscultate his lungs and place him in a mist tent. b. Have him lie down and rest after encouraging fluids. c. Examine his throat and perform a throat culture d. Notify the physician immediately and prepare for intubation. D. The child is exhibiting classic signs of epiglottitis, always a pediatric emergency. The physician must be notified immediately and the nurse must be prepared for an emergency intubation or tracheostomy. Further assessment with auscultating lungs and placing the child in a mist tent wastes valuable time. The situation is a possible life-threatening emergency. Having the child lie down would cause additional distress and may result in respiratory arrest. Throat examination may result in laryngospasm that could be fatal. 134.Which of the following would the nurse need to keep in mind as a predisposing factor when formulating a teaching plan for child with a urinary tract infection? a. A shorter urethra in females b. Frequent emptying of the bladder c. Increased fluid intake d. Ingestion of acidic juices A. In females, the urethra is shorter than in males. This decreases the distance for organisms to travel, thereby increasing the chance of the child developing a urinary tract infection. Frequent emptying of the bladder would help to decrease urinary tract infections by avoiding sphincter stress. Increased fluid intake enables the bladder to be cleared more frequently, thus helping to prevent urinary tract infections. The intake of acidic juices helps to keep the urine pH acidic and thus decrease the chance of flora development. 135.Which of the following should the nurse do first for a 15-year-old boy with a full leg cast who is screaming in unrelenting pain and exhibiting right foot pallor signifying compartment syndrome? a. Medicate him with acetaminophen. b. Notify the physician immediately c. Release the traction d. Monitor him every 5 minutes B. Compartment syndrome is an emergent situation and the physician needs to be notified immediately so that interventions can be initiated to relieve the increasing pressure and restore circulation. Acetaminophen (Tylenol) will be ineffective since the pain is related to the increasing pressure and tissue ischemia. The cast, not traction, is being used in this situation for immobilization, so releasing the traction would be inappropriate. In this situation, specific action not continued monitoring is indicated. 136.At which of the following ages would the nurse expect to administer the varicella zoster vaccine to child? a. At birth b. 2 months c. 6 months d. 12 months D. The varicella zoster vaccine (VZV) is a live vaccine given after age 12 months. The first dose of hepatitis B vaccine is given at birth to 2 months, then at 1 to 4 months, and then again at 6 to 18 months. DtaP is routinely given at 2, 4, 6, and 15 to 18 months and a booster at 4 to 6 years. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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137.When discussing normal infant growth and development with parents, which of the following toys would the nurse suggest as most appropriate for an 8-month-old? a. Push-pull toys b. Rattle c. Large blocks d. Mobile C. Because the 8-month-old is refining his gross motor skills, being able to sit unsupported and also improving his fine motor skills, probably capable of making hand-to-hand transfers, large blocks would be the most appropriate toy selection. Push-pull toys would be more appropriate for the 10 to 12-month-old as he or she begins to cruise the environment. Rattles and mobiles are more appropriate for infants in the 1 to 3 month age range. Mobiles pose a danger to older infants because of possible strangulation. 138.Which of the following aspects of psychosocial development is necessary for the nurse to keep in mind when providing care for the preschool child? a. The child can use complex reasoning to think out situations. b. Fear of body mutilation is a common preschool fear c. The child engages in competitive types of play d. Immediate gratification is necessary to develop initiative. B. During the preschool period, the child has mastered a sense of autonomy and goes on to master a sense of initiative. During this period, the child commonly experiences more fears than at any other time. One common fear is fear of the body mutilation, especially associated with painful experiences. The preschool child uses simple, not complex, reasoning, engages in associative, not competitive, play (interactive and cooperative play with sharing), and is able to tolerate longer periods of delayed gratification. 139.Which of the following is characteristic of a preschooler with mid mental retardation? a. Slow to feed self b. Lack of speech c. Marked motor delays d. Gait disability A. Mild mental retardation refers to development disability involving an IQ 50 to 70. Typically, the child is not noted as being retarded, but exhibits slowness in performing tasks, such as selffeeding, walking, and taking. Little or no speech, marked motor delays, and gait disabilities would be seen in more severe forms mental retardation. 140.Which of the following assessment findings would lead the nurse to suspect Down syndrome in an infant? a. Small tongue b. Transverse palmar crease c. Large nose d. Restricted joint movement B. Down syndrome is characterized by the following a transverse palmar crease (simian crease), separated sagittal suture, oblique palpebral fissures, small nose, depressed nasal bridge, higharched palate, excess and lax skin, wide spacing and plantar crease between the second and big toes, hyperextensible and lax joints, large protruding tongue, and muscle weakness. 141.While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised? a. Sucking ability b. Respiratory status c. Locomotion d. GI function Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Because of the defect, the child will be unable to from the mouth adequately around nipple, thereby requiring special devices to allow for feeding and sucking gratification. Respiratory status may be compromised if the child is fed improperly or during postoperative period, Locomotion would be a problem for the older infant because of the use of restraints. GI functioning is not compromised in the child with a cleft lip. 142.When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions? a. Supine b. Prone c. In an infant seat d. On the side B. Postoperatively children with cleft palate should be placed on their abdomens to facilitate drainage. If the child is placed in the supine position, he or she may aspirate. Using an infant seat does not facilitate drainage. Side-lying does not facilitate drainage as well as the prone position. 143.While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? a. Regurgitation b. Steatorrhea c. Projectile vomiting d. “Currant jelly” stools C. Projectile vomiting is a key symptom of pyloric stenosis. Regurgitation is seen more commonly with GER. Steatorrhea occurs in malabsorption disorders such as celiac disease. “Currant jelly” stools are characteristic of intussusception. 144.Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)? a. Fluid volume deficit b. Risk for aspiration c. Altered nutrition: less than body requirements d. Altered oral mucous membranes D. GER is the backflow of gastric contents into the esophagus resulting from relaxation or incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous membranes occurs with this disorder. Fluid volume deficit, risk for aspiration, and altered nutrition are appropriate nursing diagnoses. 145.Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)? a. Vomiting b. Stools c. Uterine d. Weight A. Thickened feedings are used with GER to stop the vomiting. Therefore, the nurse would monitor the child’s vomiting to evaluate the effectiveness of using the thickened feedings. No relationship exists between feedings and characteristics of stools and uterine. If feedings are ineffective, this should be noted before there is any change in the child’s weight. 146.Discharge teaching for a child with celiac disease would include instructions about avoiding which of the following? a. Rice b. Milk c. Wheat d. Chicken
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C. Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content, wheat and wheat-containing products must be avoided. Rice, milk, and chicken do not contain gluten and need not be avoided. 147.Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory infection? a. Respiratory distress b. Lethargy c. Watery diarrhea d. Weight gain C. Episodes of celiac crises are precipitated by infections, ingestion of gluten, prolonged fasting, or exposure to anticholinergic drugs. Celiac crisis is typically characterized by severe watery diarrhea. Respiratory distress is unlikely in a routine upper respiratory infection. Irritability, rather than lethargy, is more likely. Because of the fluid loss associated with the severe watery diarrhea, the child’s weight is more likely to be decreased. 148.Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? a. Notify the physician immediately b. Administer antidiarrheal medications c. Monitor child ever 30 minutes d. Nothing, this is characteristic of Hirschsprung disease A. For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a life-threatening situation. Therefore, the physician should be notified immediately. Generally, because of the intestinal obstruction and inadequate propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung disease. The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes. Hirschsprung disease typically presents with chronic constipation. 149.A newborn’s failure to pass meconium within the first 24 hours after birth may indicate which of the following? a. Hirschsprung disease b. Celiac disease c. Intussusception d. Abdominal wall defect A. Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. Failure to pass meconium is not associated with celiac disease, intussusception, or abdominal wall defect. 150.When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information? a. Stool inspection b. Pain pattern c. Family history d. Abdominal palpation C. Because intussusception is not believed to have a familial tendency, obtaining a family history would provide the least amount of information. Stool inspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. Current, jelly-like stools containing blood and mucus are an indication of intussusception. Acute, episodic abdominal pain is characteristics of intussusception. A sausage-shaped mass may be palpated in the right upper quadrant. 151. The mother of a 9 month-old infant is concerned that the head circumference of her baby is greater than the chest circumference. The BEST response by the nurse is: Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. “These circumference normally are the same, but in some babies this just differs.” B. “Perhaps your baby was small for gestational age or premature.” C. “This is normal until the age of 1 year, when the chest will be greater.” D. “Let me ask you a few questions, and perhaps we can figure out the cause of this difference.” 152. Which of the following approaches would work best when the nurse is communicating with an infant? A. Use an adult voice just as you would for anyone. B. Communicate through the caregivers. C. Allow the child time to warm up to the nurse. D. Respond only after the child cries for a while. 153. The nurse assessing newborn babies and infants during their hospital stay after birth will notice which of the following symptoms as a primary manifestation of Hirschsprung’s disease? A. A fine rash over the trunk B. Failure to pass meconium during the first 24 to 48 hours after birth C. The skin turns yellow and then brown over the first 48 hours of life D. High-grade fever 154. The nurse assessing a child or adolescent with a diagnosis of dysrhytmic disorder would find which of the following symptoms? A. Labile mood and hyperactive thyroid with an increase in circulating thyroid hormones and associated symptoms B. Severe shaking of the hands when trying to hold a glass of water or other object C. A depression that is deeper, more acute, and more likely to lead to suicide than major depressive disorder D. A depressed or irritable mood for most of the day, on most days, for 2 or more years and low energy or fatigue. 155. One of four factors describing the experience of sexually abused children and the effect it has on their growth and development is stigmatization that occurs when: A. a child blames him or herself for the sexual abuse and begins to withdraw and isolate B. newspapers and the media don’t keep sexual abuse private and accidentally or on purpose reveal the name of the victim C. the child has been blamed by the abuser for his or her sexual behaviors, saying that the child asked to be touched or did not make the abuser to stop D. the child’s agony is shared by other members of the family or friends when the sexual abuse becomes public knowledge 156. Infant head control is judged by the: A. ability to hold the head without support B. presence or absence of head lag C. rigidity of the neck and head D. amount of neck wrinkling 157. Following circumcision of a 1-day-old infant, what is the most effective strategy for ensuring urinary elimination? A. Feeding the infant B. Having nonconstrictive gauze over the penis. C. Keeping the infant on his side. D. Checking for first void postcircumcision. Rationale: A (pg 965) the infant has had feeding restrictions prior to the circumcision so feeding him afterwards will satisfy him with fluid to help him void. The gauze is to prevent Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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irritation friction from covers on the penis; side-lying position has no influence on the urethra to expel urine; the first void is an evaluate measure and does not lead to voiding as feeding would. 158. The mother of a child in well-baby clinics asks the nurse which immunizations contain live virus. What is the nurse’s best response? A. MMR and varicella. B. Hib and PPV. C. DTaP and IPV D. DTaP and Hib. Rationale: A (pg 958) The measles , mumps, and rubella vaccine (MMR) and varicella (chickenpox) contain lives virus. 159. The nurse is caring for a 2- week- old baby who is showing clinical manifestations of heart murmur, widened pulse pressure, cardiomegaly, bounding pulses, and tachycardia. The assessment finding indicates that which of the following shunt systems from fetal circulation has failed to close? A. Ductus venosus B. Ductus arteriosus C. Ligamentum arteriosum D. Foramen ovale. Rationale: A. (pg. 935) Heme in the stool can be early warning sign of necrotizing enterocolitis. All the other activities should be assessed prior to each feeding. 160. The nurse has been discussing promotion of growth and development with a family whose 15-month old son has a cyanotic heart defect. Which statement by the father indicates a need for further teaching? A. ‘’I need to feed him slowly and allow frequent rest periods.’’ B. ‘’I need to play quiet games and activities with my son.’’ C. ‘’I need to provide highly nutritious foods.’’ D. ‘’I need to limit my son’s interactions with other children.’’ Rationale: A. (pg. 913) Normal height is 29-32 inches; normal weight is between 19 to 27 pounds. 161. The mother of a newborn learns that her infant son has lost 8 ounces since his birth 2 days ago. The nurse explains that this weight loss is normal. What explanation will the nurse provide for the weight loss result? A. Feeding infants every 4 hours instead of every 3 hours. B. Loss of fluid from the cord stump. C. Limited food intake since birth. D. Regurgitation of feedings. Rationale: A. (pg. 911) The most common side effect of epidural anesthesia is a sudden drop in material blood pressure, which can compromise fetal blood flow. 162. The nurse is playing with a 2 year-old child with tetralogy of Fallot, who suddenly squats on the floor. What is the best initial nursing action? A. Return the child to bed immediately. B. Allow the child to remain in that position. C. Place the child in a chair. D. Call the physician immediately. Rationale: B. (pg. 909) The squatting position serves to decrease venous return by occluding the femoral vein through hip flexion, to lessen the workload on the right side of the heart, and to increase arterial oxygen saturation. Returning the child to bed or placing in a chair would not lessen workload on the right side of the heart, and to increase arterial oxygen saturation. Returning the child to bed or placing in a chair would not lessen the heart’s workload as the squatting does. They physician would already be award of this condition. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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163. A 21/2-year-old child is hospitalized for severe otitis media. He was toilet trained prior to being hospitalized but is having “accidents” now that he is in hospital. What is the best explanation for this change in behavior? A. It is unrealistic for a child at age 21/2 to be toilet trained. B. The nurse did not show the child where the bathroom is located. C. A child of this age needs a parent available to assist with toileting. D. It is normal for a child to experience regressive behavior due to the stress of hospitalization. Rationale: D. (pg. 893) Regressive behavior is frequently seen in children who are under stress. This age is appropriate for toilet- training and the child could be assisted by anyone. 164. A 2-year old is admitted to the hospital with meningitis. What is the highest priority? A. Inform the parents of the child’s condition. B. Maintain a quiet environment. C. Maintain for changes in intracranial pressure. D. Maintain bed rest. Rationale: C. (pg. 893) All are important: however, changes in intracranial pressure can be lifethreatening. 165. A young child with bronchial asthma is admitted for the second time in 1 month. Cystic fibrosis is suspected. Which physiological assessment is most likely to be seen in the child with cystic fibrosis? A. Expectoration of large amounts of thin, frothy mucus with coughing, and bubbling ronchi for lung sounds. B. High serum sodium chloride levels and low sodium chloride levels in the sweat. C. Large, loose, foul smelling tools with normal frequency or a chronic diarrhea of unformed stools. D. Obesity from malabsorption of fats and polycythemia from poor oxygenation of tissues. Rationale: C. (pg. 892) The obstruction of the pancreatic duct with thick mucus prevents digestive enzymes from entering the duodenum, thus preventing digestion of food. Undigested food (mainly fats and protein) are excreted in the stool, increasing the bulk to twice the normal amount. Expectoration is very difficult because the excess mucus produced is tenacious and viscous. Elevated sweat chloride above 60 mmol/L is consistent with the diagnosis of cystic fibrosis. 166. One of the mothers verbalized that her child has difficulty realizing that the amount of orange juice in two cups of different diameters is the same because a taller amount appears in one cup. After explaining the child’s cognitive development, the mother would correctly verbalized that this perception occurs in the preschooler because A. intuitional thought has not matured. B. preschoolers are unaware of the property of conservation. C. this requires concrete thinking. D. preschoolers are unaware of the concept of permanence. Rationale: B. Conservation is the ability to discern that a change in shape does not change volume. It is learned in the school-age period. 167. A mother of a 4-year-old tells the nurse that her son is a "picky eater." The nurse should inform the mother that she should: A. Increase the amount of carbohydrates in the daily menu plan. B. Administer vitamins twice a day to her child. C. Be more concerned with the quantity of food than the quality of food. D. Recognize this is common for preschoolers as their caloric requirements have decreased slightly. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Rationale: D. The preschooler will be influenced by others' eating habits and demonstrate their likes and dislikes for food preferences. The caloric requirement decreases slightly, to 90 kcal/kg/day. Quality, not quantity, is important. It is not necessary to give vitamins after infancy unless the child is at nutritional risk. 168. The nurse is aware that preschoolers are afraid of the dark. When planning care for this child, the nurse would A. appreciate that fear of the dark is universal with preschoolers. B. ask if an animal frightened the preschooler lately. C. begin a behavior modification program for the preschooler. D. perform a Denver Developmental Screening Test to determine developmental age. Rationale: A. Fear of the dark is an almost universal fear among preschoolers because of their keen imagination. 169. A 4-year-old tells the nurse he has an imaginary friend. His parents are concerned because he refuses to do anything without his friend’s help. Which of the following nursing diagnoses is most applicable for his family? A. Compromised family coping related to abnormal behavior of child. B. Deficient knowledge of normal preschool development. C. Disturbed thought processes related to deep-set psychological need. D. Social isolation related to unwillingness to relate except through imaginary friend. Rationale: B. Because a preschooler’s imagination is at a peak, imaginary friends are not uncommon. 170. The developmental task of preschoolers is to achieve a sense of A. Autonomy versus shame and doubt. B. cognition versus attitude. C. Initiative versus Guilt. D. accomplishment versus inefficiency. Rationale: C. Developing a sense of initiative, or learning how to do things, is the developmental task of the preschool period. 171. The appropriate way that Bennet would advise a toddler’s mother to handle temper tantrums would be to: A. appear to ignore them. B. distract him with a toy when he begins breath holding. C. promise him a special activity if he will stop. D. mimic his behavior by also holding her breath. Rationale: A. Rewarding temper tantrums can teach children that they are an effective method of interaction. Ignoring tantrums teaches that they are ineffective. 172. The nurse plans to conduct health teaching focusing on toilet training. Which of the following is the most important factor for successful toilet training? A. Age of the child B. Developmental readiness of the child C. Toilet training at scheduled time D. Primary caregiver’s flexibility 173. One of the toddlers’ mother verbalized concern because her child takes her blanket everywhere. Which advice would be most appropriate for her regarding this? A. Have her daughter evaluated by a child psychologist. B. Understand that this is probably a normal event. C. Make subtle efforts to remove the blanket. D. Destroy the blanket by cutting off a strip from it every day. Rationale: B. Blankets or favorite toys serve as transitional objects or security objects. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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147. Which measure would Bennet suggest an infant’s mother use to relieve teething discomfort? A. Provide her with a fluid diet for 2 days. B. Offer her Aspergum to chew. C. Ask her pediatrician for a sedative for her. D. Give her a cold teething ring to chew. Rationale: D. Cold can be very soothing for the tender gum lines during teething. A sedative is not necessary for normal teething discomfort. 175. During interaction with the parents, the mother of a 2-year-old tells Cherie, that she is constantly scolding him for having wet pants. She says her son was trained at 12 months, but since he started to walk, he wets all the time. Which nursing diagnosis would be most applicable? A. Deficient parental knowledge related to inappropriate method for toilet training. B. Excess fluid volume related to inability to control urination. C. Ineffective coping related to lack of self-control of 2-year-old. D. Total urinary incontinence related to delayed toilet training. Rationale: A. It is probable that a child toilet trained at 12 months was not truly trained; his mother was trained to remind him or place him on a toilet frequently during the day. When the child begins to play independently, the “training” is no longer effective. 176. The best way for parents to aid a toddler in achieving his developmental task would be to A. Urge him to dress himself completely alone. B. give him small household chores to do. C. help him learn to count. D. Allow him to make simple decisions. Rationale: D. Making decisions is primary practice toward achieving independence. 177. In evaluating the health teaching on breastfeeding, which of the following statement made by the mother, would reveal correct understanding on breastfed infants? A. Stools of breastfed infants are usually harder than those of bottle-fed infants. B. Breastfed infants usually have fewer stools than bottle-fed infants. C. Breastfed infants are less likely to be constipated than bottle-fed infants. D. Stools of breastfed infants tend to have a strong odor. Rationale: C. The stools of breastfed infants tend to be yellow and looser than those of bottle-fed babies. 178. According to the mother, her 10-year-old becomes very upset and expresses sympathy for his friend whose dog has just died. The nurse would document that this kind of reaction is an indication that the child has achieved which step in cognitive thought? A. Conservation. B. Accommodation. C. Comprehension. D. Irreversibility. Rationale: B. Accommodation means the ability to view situations from another’s view. 179. One of the parents of a school-age child with school phobia have taken her to three different psychiatrists trying to resolve this problem. Based on this, which of the following nursing diagnoses would be most appropriate? A. Disturbed thought processes related to difficulty in school adjustment. B. Compromised parental coping related to inability to enforce school attendance. C. Noncompliance with expected school behavior related to school phobia. D. Ineffective tissue perfusion, cerebral, related to anxiety over attending school. Rationale: B. School phobia may be a problem of both parent and child.
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180. The parents of a 10-year-old are concerned because she does not eat breakfast before she leaves for school. The best suggestion that Nurse Maria could give regarding this would be to A. allow the child to take a breakfast to eat on the school bus. B. limit privileges if a complete breakfast is not eaten. C. be certain to act as role models by eating breakfast themselves. D. encourage the child to collect prizes from cereal she eats. Rationale: C. Role modeling is as important in building good nutrition habits as it is in other aspects of the child’s life. 181. A mother tells Nurse Maria that her 6-year-old has been biting his fingernails since he began first grade. After analyzing the cause of this as increased stress, which of the following would Nurse Maria advice the mother regarding this problem ? A. Encourage the child to drink more milk for stronger nails. B. distract the child by teaching him a new skill, such as whistling. C. Allow some time every day for the child to talk about new experiences. D. allow the child to choose a reward for not biting his nails. Rationale: C. Beginning school can be a time of extreme stress for children. Allowing them time to discuss these experiences allows them to put experiences in perspective and begin to deal with them. 182. Nurse Maria explains to the parents that the Boy Scouts is an organization that continues to be a favorite with school-age boys because : A. Fathers participate in Boy Scouts. B. no girls are included in the organization. C. Merit badges require completing small tasks for rewards. D. hiking is a favorite school-age activity. Rationale: C. An organization that allows school-age children to complete small tasks and receive rewards helps develop a sense of industry. 183. Which of the following is considered as the first sign of puberty that Angel will notice? A. "The appearance of breast buds." B. "An increase in energy and appetite." C. "The occurrence of the first menarche." D. "Appearance of body odor." Rationale: A. Puberty is a process that brings about the development of secondary sex characteristics, which begin, with the appearance of breast buds at 9 to 11 years followed by the growth of pubic hair. Menarche follows approximately 1 year later. Body odor may result later because of an increase in secretions from the apocrine glands. 184. Angel refuses to wear the clothes her mother bought for her. She wants to look like the other kids at school and wear clothes like they wear. The nurse would explain that this behavior is an example of teenage rebellion related to internal conflicts of: A. Autonomy vs. shame and doubt. B. Trust vs. mistrust. C. Identity vs. role confusion. D. Initiative vs. inferiority. Rationale: C. Erikson's theory of psychosocial development states that the child is faced with conflicts that need to be resolved. Erikson identifies stages of personality development. Identity vs. role confusion (12 to 19 years) is a period when adolescents search for answers regarding their future. During this time, the child rejects the identity presented by his parents and attempts to create his own identity. Identity is often based on peers. Positive outcomes result in optimism and confidence. Negative outcomes result in sense of purposelessness or deviance. 185. When encouraging Angel to develop and maintain her sense of identity, the nurse would plan to Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Provide the opportunity for individual decision making. B. Provide physical comfort to the individual. C. Ask the parents what the adolescent is capable of doing. D. Provide care until the adolescent insists on being independent. Rationale: A. Knowing who you are includes how to make decisions to advance your welfare. Providing opportunities to do this is important. 186. Safety is a major concern when taking care of teen-agers. In conducting health education for Angel and her peers, the primary focus of the nurse would be on which of the following areas? A. Falls B. Motor vehicle accidents C. Firearms D. Bar related accidents Rationale: B. Accidents are the leading cause of death and injury among adolescents. Motor vehicular accidents and sport injuries are the most common accidents. Teenagers may use driving as an outlet for stress, as a way to assert independence or as a way to impress peers. Adolescents are at risk for sport injuries because their coordination skills are not yet fully developed. 187. Angel is concerned with the presence of acne on her face. After attending lecture on this, she would correctly identify that the basic cause of acne is A. lack of showering adequately after gym class. B. activation of androgen hormones. C. vitamin deficiency from an inadequate diet. D. thyroid gland secretions increasing with adolescence. Rationale: B. As androgen rises with puberty, sebaceous glands are activated to increase production of sebum, which leads to plugging of ducts (comedones). 188. Baby girl Luisa was born large for gestational age. After being delivered vaginally, this infant should be carefully assessed for: A. Increased intracranial pressure B. Hypothermia C. Decreased red blood levels (anemia) D. Hyperglycemia Answer: A 189. A pregnant woman’s blood test revealed a very low hemoglobin levels. The physician considers the woman severely anemic. Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy? A. Hemorrhage could be possible B. Erythroblastosis fetalis C. Small for gestational age (SGA) baby D. Large for gestational age (LGA) fetus Answer: D Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus. 190. At what APGAR score at 5 minutes after birth should resuscitation be initiated? A. 1-2 B. 3-5 C. 6-8 D. 9-10 Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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Answer: A An APGAR of 1-2 is a sign of fetal distress which requires resuscitation. The baby is alright if the score is 8-10. 191. A newborn of 4 hours displays grunting respirations and a respiratory rate of 70 breaths/minute. The priority nursing intervention would be to: A. Begin resuscitative measures and call for help. B. Continue to monitor respiratory status variations are normal. C. Obtain vital signs every 15 minutes. D. Transfer the newborn to the mother’s room for feeding. Answer: A 192. Which of the following characteristics will distinguish a postmature neonate at birth? A. Minimal vernix caseosa, leather-like skin, observable dryness B. Lanugo very observable on the shoulders and vernix caseosa in the skin C. Plenty of lanugo and vernix caseosa covering the body D. Pinkish skin with good turgor 1Answer: A A post mature fetus has the appearance of an old person with dry wrinkled skin and the vernix caseosa has already diminished. 193. The following are signs and symptoms of fetal distress EXCEPT: A. FHR is 160 bpm, weak and irregular B. The pre-contraction FHR is 130 bpm, FHR during contraction is 118 bpm and FHR after uterine contraction is 126 bpm C. Fetal heart rate (FHR) decreased during a contraction and persists even after the uterine contraction ends D. The FHR is less than 120 bpm or over 160 bpm Answer: B The normal range of FHR is 120-160 bpm, strong and regular. During a contraction, the FHR usually goes down but must return to its pre-contraction rate after the contraction ends. 194. In which position should the newborn with intracranial hemorrhage be placed? A. Prone B. Side-lying C. Slightly elevated head of bed D. Supine Answer: C 195. Which action should nurse Marian include in the care plan for a 2 month old with heart failure? A. Feed the infant when he cries. B. Allow the infant to rest before feeding. C. Bathe the infant and administer medications before feeding. D. Weigh and bathe the infant before feeding. Answer: B Rationale: Because feeding requires so much energy, an infant with heart failure should rest before feeding.
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196. When teaching parents of a neonate the proper position for the neonate’s sleep, the nurse Patricia stresses the importance of placing the neonate on his back to reduce the risk of which of the following? a. Aspiration b. Sudden infant death syndrome (SIDS) c. Suffocation d. Gastroesophageal reflux (GER) Answer: B Rationale: Supine positioning is recommended to reduce the risk of SIDS in infancy. The risk of aspiration is slightly increased with the supine position. Suffocation would be less likely with an infant supine than prone and the position for GER requires the head of the bed to be elevated. 197. A decision to withhold "extraordinary care" for a newborn with severe abnormalities is actually: A. The same as pediatric euthanasia B. A decision to let the newborn die C. Presuming that the newborn has no rights D. Unethical and illegal medical nursing practice Answer B Explanation: A. Euthanasia is a deliberate intervention to cause death. B. Based on the family's decision, extraordinary care does not have to be employed; the infant's basic needs are met, and nature is allowed to take its course. C. If the infant's physical needs are met and comfort is provided, the infant's rights are not ignored; "extraordinary," not "all," care is being withheld. D. It is neither unethical or illegal to withhold extraordinary treatments; once such treatment is started, it becomes a legal issue. 198. An infant is born with a bilateral cleft palate and right cleft lip. Plans are made to begin reconstruction immediately. Nursing intervention to promote parent-infant bonding should include: A. Demonstrating a positive acceptance of the infant. B. Placing the baby in a nursery away from view of the general public. C. Explaining to the parents that the infant will look normal after the surgery. D. Encouraging the parents to limit contact with the infant until after surgery. Answer A Explanation: A. By demonstrating acceptance of the infant, without regard for the defect, the nurse acts as a role model for the parents, thus enhancing their acceptance. B. Infants with cleft palates can remain in the newborn nursery; they should not be hidden. C. This is false reassurance; it does not promote parent-infant bonding.D. The parents should be encouraged to have frequent contact with their infant to promote bonding. 199. Smoking is contraindicated in pregnancy because A. Nicotine causes vasodilation of the mother’s blood vessels B. Nicotine will cause vasoconstriction of the fetal blood vessels C. Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus D. The smoke will make the fetus feel dizzy Answer: C Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus. 200. Baby Tina a 3-month-old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site? A. Avoid touching the suture line, even when cleaning. B. Place the baby in prone position. C. Give the baby a pacifier. D. Place the infant’s arms in soft elbow restraints. Answer: D Soft restraints from the upper arm to the wrist prevent the infant from touching her lip but allow him to hold a favorite item such as a blanket. Because they could damage the operative site, such as objects as pacifiers, suction catheters, and small spoons shouldn’t be placed in a baby’s mouth after cleft repair. A baby in a prone position may rub her face on the sheets and traumatize the operative site. The suture line should be cleaned gently to prevent infection, which could interfere with healing and damage the cosmetic appearance of the repair. 201. A moro reflex is the single best assessment of neurologic ability in a newborn. What is the best way to test this reflex? A. Observe the infant while she is on her abdomen to see whether she can turn her head. B. Lift the infant’s head while she is supine and allow it to fall back 1 inch. C. Shake the infants crib until the infant responds by flailing her arms. D. make a sharp noise, such as clapping your hands, to wake the infant. 202.Beth Ruiz has milia on her nose. What is the necessary therapy for this? A. Ice packs to reduce inflammation. B. Warm heat to increase circulation C. No therapy is necessary for milia. D. Lancing the lesions so they drain. 203.Beth had apgar scores of 6 and 8. The five areas assessed with Apgar scoring are: A. Heart rate, respiratory effort , muscle tone, reflex irritability, and color. B. Respiratory rate, abdominal tone, reflex irritability, color, head circumference. C. Color, breathing rate, cry, amount of brown fat, response to an adult voice. D. Abdominal tone, persistence, gastric acidity, arterial pressure, response to pain. 204.Ms. Ruiz is preparing to take her new daughter home. On about what day of life can she expect her baby’s umbilical cord to fall off? A. day 1. B. Day 2 to 3. C. Day 6 to 10. D. Day 30. 205.Newborns need more fluid than adults, because their extracellular fluid component differs from that of adults. How much of a newborn’s body weight is extracellular fluid? A. 20%, compared with 35% in an B. 35%, compared with 20% in C. 50%, compared with 70% in an D. 70%, compared with 40% in an
adult an adult adult adult
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206.How does breast milk help prevent infection in a newborn? A. it is rich in faftty acid, so bacteria are destroyed by it. B. It is always flowing forward in the breast, so it is not static. C. it contains maternal antibodies and viral binding factors. D. It is low in lactose, so it becomes a poor culture medium. 207.Palaka wants to lose the weight she gained in pregnancy, so she is reluctant to increase her caloric intake for breast feeding. By howmuch should a lactating mother increase her caloric intake during the first 6 months after birth? A. 200 kcal/day B. 350 kcal/day C. 500 kcal/day D. 1000 kcal/day 208.Baby Atkins was given a drug at birth to reverse the effects of a narcotic given to his mother in labor. What drug is commonly used for this? A. Sodium chloride B. Morphine sulphate C. Penicillin G D. Naloxone (narcan) 209.Why are small for gestational age newborns are at risk for difficulty maintaining body temperature? A. They are preterm so are born relatively in small size. B. They are more active than usual so throw off covers. C. They do not have as many fat stores as other infants. D. Their skin is more susceptible to conduction of cold. 210.Baby Atkins has surfactant administered at birth. The purpose of surfactant is to: A. Help raise lung secretions by relaxing the airway. B. Prevent alveoli from collapsing on expiration. C. paralyze respiratory muscles to synchronize breathing. D. reduce gastric secretions by action on the pancreas. 211.Baby Atkins develops hyperbilirubinemia. What is a method use to treat hyperbilirubinemia ina newborn? A. Keeping infants in a warm and dark environment. B. Early feeding to speed passage of meconium. C. gentle exercise to stop muscle breakdown. D. Administration of a cardiovascular stimulant. 212.Why are infants of diabetic mothers fed early A. Their stomachs are empty at birth. B. To help prevent hypoglycemia. C. Their mothers could not eat during labor. D. To clear mucus from their intestinal tracts. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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213.John is 6 years old. What body system is reaching its peak point of development at this time? A. Neurological system. B. Lymphatic system. C. Reproductive system. D. Musculoskeletal system. 214.John, 6 years old, is a school age child. What must he learn, according to Erikson, to complete the developmental task of this period? A. How to be creative B. How to think abstractly C. How to trust others D. How to do things well 215.Suppose John, 6 years old, tells you his broken leg wants to get better. What type of thinking is he using? A. Magical thinking B. Deductive reasoning C. Concrete operational thinking D. Sensorial thought 216.Bryan is 2 months old. At what age would you expect him to sit securely? A. 2.5 months B. 6 months C. 8 months D. 12 months 117.How many words does a typical12 month old infant use? A. two, plus ‘mama” and “dada” B. About 12 words C. Twenty or more words D. About 50 words 118.Which action would show an infant has developed object permanence? A. he looks for a cheerio that falls off his highchair tray. B. He cries when he is either hungry or lonely. C. He prefers a large yellow ball to a small red one. D. He smiles when the mobile on his crib jingles. 119.You review infant safety with bryan’s mother. What are the two of the most common type of accidents in infants? A. Drowning and homicide B. Poisoning and burns C. Falls and auto accidents D. Aspiration and falls 120.Bryan’s mother is concerned about him developing baby bottle syndrome. What would be her best action to prevent this? Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. use plastic rather than glass bottle B. Boil the formula to reduce the curd C. Don’t put bryan to bed with a bottle D. Check the expiration date on formula 121. What type of sentence should Jason, a 2 year old, have mastered? A. Red ripe tomatoes B. Daddy come C. Old MacDonald D. Please, please 123. Jason answers every request of his mother by saying, “No!” How can she minimizes this? A. Tell Jason she doesn’t want him to say no anymore. B. Answer all Jason’s question by saying “No” C. Reduce the number of questions she asks Jason D. Explain he is not using good communication skills. 124.Jason’s mother uses “timeout” for punishment. What is a good rule for this? A. The child should sit still for as many minutes as his age. B. The child should sit still for as many minutes as he misbehaved. C. Timeout activities can include quiet play or reading books D. Children are not ready for timeout until school age. 123. Cathy asks constant questions. How many does a typical 3 year old ask in a day time? A. Less than 50 B. 100-200 C. 300-400 D. 1200 or more 124.Cathy will need to change to a new bed because her baby sister will need Cathy’s old crib. What measure would you suggest that her parents take to help decrease sibling rivalry between Cathy and her new sister? A. Ask her to get her crib ready for the new baby. B. Tell her she will have to share with the baby. C. Move her to the new bed before the baby arrives D. Explain the new sisters grow up to become best friends. 125.Cathy’s parents want to know how to react to her when she begins to masturbate while watching television. What would you suggest? A. They give her “time out” when this begins. B. They refuse to allow her to watch television C. They remind her some activities are private D. they scheduled a health check up for vaginal disease. 126.Shelly has belonged to a series of clubs for 9 year olds. A usual characteristic of clubs for this age child is; A. The clubs has formal rules and regulations. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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B. it is designed to help shy children socialize. C. It is designed to spite or exclude another child D. Clubs include both boys and girls. 127. if Shelly eats candy, what is the best type in terms of preventing caries? A. Salt water taffy B. A chocolate bar C. Chewy caramels D. hard candy 128. School agers can begin drug abuse. What is a common household product frequently abused by school agers? A. grated orange peel B. Laundry bleach C. Aerosol cooking oil D. Shredded cabbage 129. Raul is concerned about developing body odor. What body glands are responsible for this? A. Adipose glands B. Apocrine glands C. Liver cystic glands D. Dermal pod glands 130. Raul is entering final stage of cognitive development. This stage is termed; A. Formal operational thought B. Cognitive attainment C. Concrete operational thought D. Scientific formulating 131. Raul admits he has experimented with cocaine. A typical change in facial appearance that occurs with cocaine use is; A. Frown lines in the forehead B. Thin fissured lips C. loss of eyebrow hair D. Absent nasal hair 132. You take a health history on Keoto from her father. What question should you ask at the end of every interview? A. Do you have a ride so you can get home? B. Is there anything else you’d like to discuss? C. Am I a good interviewer? Im trying hard D. do you have another child who also needs care? 133. Keoto’s sister is 2 y/o . procedure?
at what age you should include blood pressure as a routine
A. 1 y/o B. 2 y/o C. 3 y/o Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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D. 6 y/o 134. You typically gag children to inspect the back of their throat. When is it important not to elicit a gag reflex? A. When children are under 5 years of age B. When a child has symptoms of epiglottitis C. When a boy has a possible inguinal hernia D. When a girl has a geographic tongue 135. Keoto has a sinus arrhythmia. This refers to: A. A wide spaced rib cage B. Faint, barely audible heart sounds C. increased heart rate on inspiration D. An abnormal heart rate in a child 136. Keoto’s father wants to be sure keoto’s immunization are up to date. immunization for varicella usually given?
When is the
A. At 12 to 18 months of age B. As a preschooler booster C. At 16 years of age D. it isnot recommended for children 137. Barry tells you he hate school. Which response would be the best example of paraphrasing? A. “Tell me again what you said” B. “School?” C. “You’re telling me you’re unhappy with school?” D. “Hate is a strong emotion for a teenager to feel” 138. You want Barry to increase his cognitive understanding of his condition. Which statement from him would be best show he has increased cognitive knowledge? A. “Ifeel so much better now about the care I need” B. “I understand I have to take two types of medicines” C. I’ve finally learned how to swallow big capsules” D. “I hate having to take medicines but will take it” 139. You want to use a board game to teach Barrymore about his hypercholesterolemia. At what age are children first ready for completion and so enjoy board games? A. 3 y/o B. 6 y/o C. 10 y/o D. 14 y/o 140. Young children are more at risk for dehydration with vomiting than adults are. because;
This is
A. They have a smaller stomach and intestines than adults B. They have proportionally more extracellular water than adults. C. Children metabolize fluid more slowly than do most adults D. They maintain more fluid inside body cells than do adults. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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141. Suppose Becky shows signs of separation anxiety. The first stage of separation anxiety is marked by; A. Loud, demanding crying. B. silent, sullen protest. C. Quiet introspective thought D. inability to respond verbally 142. You want to encourage Becky to drink a lot of water, which action would do this best? A. Scold her for not cooperating to make herself well again. B. offer her small glasses of fluid so she can drink these frequently C. offer her large glasses of fluid so she doesn’t have to drink so often. D. Alert her if she doesn’t drink fluid, she will have to receive an IV. 143. You worry about Becky aspirating a toy you give her. Which of the following items is most apt to be aspirated? A. pages in a coloring book B. Clothing from a baby doll C. Pieces of colored chalk D. Blocks 2 inches square 144. Becky will have a large bandage on her foot after surgery. Which type of therapeutic play would be best for her? A. letting her hold and handle a medicine syringe B. Giving her a doll and a bandage to change C. helping her insert an NG tube into a puppet D. teaching her a rhyme about good girls 145. You are going to restrain T.J to draw a blood sample from his hand. What type of restraint would be best? A. ask his mother to hold him tightly on her lap. B. Apply a jacket restraint to confine his body. C. Ask a fellow nurse to hold his hand firmly. D. Use a mummy restraint so he can’t be hurt. 146. T.J will have a 24 hour urine specimen collected. You would time this from: A. the time of discard specimen. B. The first urine voided in the morning. C. A set time, such as 8am D. the first voiding after the discard urine. 147. T.J is younger brother receives total parenteral nutrition. occur with this?
Why does dehydration tend to
A. The glucose solution leads to dieresis B. infection occurs easily and causes fever C. Only 100ml of fluid can be infuse daily D. Children tend to develop diarrhea Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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148. You are going to give acetaminophen (Tylenol) to terry in the emergency room. She has no ID band inplace as yet. What would be the best way to identify her? A. Ask her what is her name. B. tell her you need to know her name. C. Ask a parent to identify her for you. D. Ask her to see her school bus pass I.D 149. Suppose terry needed to have eardrops. What is the best technique for giving them? A. have her place them herself to give a sense of control. B. Refrigerate the drug first so it numbs the ear canal C. Pull the pinna of her ear down to straighten the canal D. keep her head turned to the side to help retain the drops 150. Terry is going to have an intravenous antibiotic infused by piggyback inserted into her dominant hand. What would be the best activity for her while her medicine infuses? A. listening to a story you read. B. Coloring a hospital brochure C. Completing a jigsaw puzzle D. Fingerpainting or drawing 151. You teach Robin imaging to help reduce pain from blood drawing. Why does a technique such as imagery work well for children? A. Children pain is not as acute as an adults. B. Intravenous pain relief in not effective in children C. Children imagination are at their peak D. childrens muscle are less tense than adults muscle 152.Robin was given analgesia intravenously. administer analgesia to children?
Why is the I.M route infrequently used to
A. The average child has a tremendous fear of injection. B. IM doses must be larger in children than in adults C. IM medications must be administered cold or chilled. D. IM solution are readily confused with IV solutions. 153. Suppose Robin are scheduled for conscious sedation to have her repeat bone marrow aspiration. Which would be the best explanation to prepare her for this? A. “you’ll be given a special medicine to put you to sleep for surgery” B. “I’ll give you some medicine, but you’ll still be awake and feel pain” C. “Conscious sedation is an analgesic, not anesthetic, method of pain relief” D. “I’ll give you medicine so you’re very sleepy but can still talk to me” 154. What is the most important consideration in the care of the child with an omphalocele at birth? A. Position the infant on his stomach to contain the intestine. B. Wrap the omphalocele in cold icy gauze to prevent fever. C. Keep the infant seated upright under a radiant warmer. D. Contain the intestine in a sterile saline-lined bowel bag. Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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155.Which is an important nursing measure for a newborn with diaphragmatic hernia? A. Feed the infant immediately to decrease air in the intestine. B. Keep the infant positioned head down so the intestine can expand. C. Wrap the infant’s abdomen tightly to better contain intestine. D. Position the infant in an infant chair to contain intestine in abdomen. 156. Baby Sparrow may be developing increased intracranial pressure. What vital sign changes occur with this? A. Decreased temperature; increased blood pressure B. Increased respirations; decreased pulse rates C. Increased temperature; decreased pulse rate D. Decreased blood pressure; increased temperature 157. Which is an important care measure to teach parents of a child with torticollis? A. Encourage the infant to turn his head to stretch the neck. B. Wrap the infant’s neck in a warm towel twice daily C. Massage the infants shoulders and torso at bed time D. Administer 1 grain of aspirin with each bottle feeding 158. What is a typical description of an infant with Down syndrome? A. Holds arms stiff and pronated. B. Muscle are hypotonic or flaccid C. Head is larger than other infants D. Skin is ruddy and vein streaked. 159. Michael was born with choanal atresia. What is the best way to assess if this is present? A. Observe if a newborn can breathe while lying on his stomach. B. Close the infants mouth to see if he can breathe through his nose. C. Assess if the infant’s palatine tonsils are blocking his airway. D. Listen for the sound of either stridor or wheezing on inhalation. 160. Suppose Michael is diagnosed as having a streptococcal pharyngitis. The chief danger of such an infection is; A. Lymph nodes will swell and obstruct the airway. B. Infection may spread and cause a tooth abscess. C. A small number of children develop kidney disease. D. Four out of five children will develop lung abscess. 161. Suppose Michael’s 4 year old roommate spits up dark red blood following her tonsillectomy. Your best action in relation to this would be; A. Suction the back of her throat. B. Encourage her to cough vigorously. C. Perform a Heimlich maneuver D. Continue to observe her for bleeding. 162. Michael has a barking cough, sore throat, and high fever. You want to see if his throat looks sore. Your best procedure to do this would be; Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Gag him with a tongue blade to inspect his tonsils. B. Ask him to press down on his tongue with a finger. C. Elicit a gagreflex using only one gloved finger D. Inspect his throat visually only 163. Children with cystic fibrosis take the pancreatic enzyme pancrelipase before each meal. You would prepare this by; A. Opening the capsule and adding it to warm tea. B. Adding it to atleast 8 ounces of milk to drink. C. Sprinkling it into small amount of applesauce. D. Teaching the child how to swallow large capsule 164. Megan has a heart murmur from a tetralogy of Fallot, a congenital heart disorder. This type of murmur is termed: A. Innocent B. Functional C. Organic D. Symmetrical 165. Megan is scheduled for a cardiac catheterization. arrhythmias after this procedure?
Why might a child develop cardiac
A. The dye inserted can create inflamed heart chambers. B. The many x-rays taken lead to a weakened heart muscle C. The catheter can irritate nerves in the heart septum D. Latex allergy can cause symptoms of unusual heart rate. 166. Megan will be scheduled for open heart surgery. What type of fluid imbalance is apt to occur after surgery? A. Hypervolemia from aldosterone production B. Hypercalcemia from calcium release from bones C. Hypernatremia from excess sodium retention D. Hypokalemia from excess urine dieresis 167. Suppose Megan has a simple ventricular septal defect. With this condition, in which direction would blood shunt? A. From the left to right ventricle. B. From the right ventricle to aorta. C. From the right to left ventricle D. From the left ventricle to the left atria 168.You need to teach CPR to Megan’s parents before hospital discharge. What is the ratio of ventilation to compression used for resuscitating the infant? A. One to five B. One to ten C. Two to fifteen D. Three to fifteen
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169. When Dexter’s mother learned he had an immunologic disease, she was concerned that he had developed AIDS. What is the transmission method by which most children acquire HIV infection? A. Blood transfusion B. Shared bath towels C. Placental transfer D. Sneezing and coughing 170. Any child can have an anaphylactic reaction to a food or drug. What is the drug of choice you would want to have available to treat anaphylactic reaction? A. Prednisone B. Epinephrine C. Penicillin D. Ibuprofen 171. Dexter is atopic or prone to allergies. In the hospital he has no toys. What would be a poor choice of a toy to make for him? A. A paper deck of cards B. A cloth bean bag C. A latex glove balloon D. A tounge blade puppet. 172. If a smallpox epidemic should occur, it will be important to be able to distinguish chickenpox (varicela) from smallpox. What are the stages of chickenpox lesions? A. Macular, papular, vesicular, and crusting B. Macular,crusting, and extensive peeling C. Papular,vesicular, and pruritic crusting D. Maculopapular lesion with fine flaking 173. Which is the best description of mumps (infectious parotitis)? A. Cervical lymph nodes become swollen. B. Swelling behind the child’s ear occur. C. Swelling above the jaw line occur. D. The adenoid tonsils are red and swollen. 174. For a child with infectious mononucleosis, why must abdominal palpation be performed gently? A. Regional lymphnodes are painful B. The enlarged spleen can rupture C. red cells pocket just under skin D. Petechiae form easily from bruising 175. Marty has developed scarlet fever. What is the mark of scarlet fever lesions? A. They appear on skin and mucous membrane B. The crusts that form are mildly contagious C. The lesions weep a clear, sticky fluid D. Lesions are dark brown and black Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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176. Marty had a pinworm infection last year. A typical symptoms of this infection to assess for would be; A. Nausea and vomiting B. Anal itching on awakening C. Loose, bloody stools D. Mild jaundice and itching 177. Lana, who has thalassemia major, is scheduled for a bone marrow transplant. Which is the best instruction for her regarding this? A. She must not move while the bone marrow is infused into her B. She will not be allowed to eat raw fruit following the transplant. C. Her hip bones will feel tender from the marrow transplantation. D. She will not need any further bone marrow aspiration after this 178. Lana has received iron chelation therapy in the past iron chelation therapy is: A. A procedure to remove excess iron from the childs body B. A procedure to help iron move effectively into haemoglobin C. A therapy to increase the iron level in bone and muscle cells D. A therapy to convert iron into calcium to increase heart action. 179. Joey, who has a sickle cell anemia, has had two vasoocclusive crises in the past year. a vaso occlusive crisis occurs because; A. An enlarged spleen causes blood to pool there B. Dehydration leads to thrombosed sickle cells C. Hemorrhage reduces a child’s total blood volume D. Decreased platelet number leads to poor coagulation 180. Auto immune acquired hemolytic anemia can occur in any child. The usual cause of this disorder is; A. Allergy to the protein found in fish B. A mutant gene similar to sickle-cell C. An elevated eosinophil cell count D. Antibody production against red cells 181. Disseminated intravascular coagulation can occur in any child with a critical illness. The drug of choice you would expect to administer to this condition is; A. Erythroprotein, to stimulate red cells B. Methotrexate, to decrease red cell number C. Heparin, to halt abnormal coagulation D. Prednisone, to decrease immune reaction 182. Barry has frequent bouts of vomiting. What secondary electrolyte problem often occurs when metabolic alkalosis results from vomiting? A. Acidosis B. Hyponatremia C. Hypokalemia D. Hyperchlorosis Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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183. Barry’s mother tells you she often makes milkshakes with raw eggs. organism is easily spread this way?
What infectious
A. Pneumococcus B. Salmonella C. Streptococcus A. D. H. pylori 184. Barry’s older sister had pyloric stenosis as an infant. Vomiting with pyloric stenosis typically occurs; A. Immediately after feeding B. An hour after feeding C. On arising in the morning D. When the infant cries 185. Barrry’s family likes to eat shellfish. What form of hepatitis is most apt to be contracted by eating contaminated shellfish? A. Hepatitis B B. Hepatitis A C. Hepatitis E D. Hepatitis D 186. Kwashiorkor is a disorder common in developing countries. This disorder occurs because of lack of what nutrient? A. Water soluble vitamins B. Fats and triglycerides C. Quality protein D. Vitamin K 187. Carol has voiding cystourethrogram last year to help diagnose her urinary tract infection. Why is a voiding cystourethrogram a difficult test for preschool children? A. Reading the instruction for the test is difficu B. Lying in an MRI machine is dark and scary C. They feel uncomfortable voiding in public D. The dye capsules may be too large to swallow 188. The appearance of a child with hypospadias is; A. The urethra opens on the underside of the penis B. The bladder opens on the surface of the abdomen C. Urine drains into the rectum and is excreted with stool D. The child is unable to void, as there is no urethral meatus 189. What is typically the first symptom of acute glomerulonephritis? A. Low blood pressure from excessive aldosterone B. “Old blood” in urine from kidney bleeding C. dependent edema from protein accumulation D. pain on urination from urethra inflammation 190. What is an important nursing intervention for children with nephritic syndrome? Prepared by: Archie D. Alviz, R.N., R.M., N.C.II |
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A. Caution them not to eat salt, as salt irritates the bladder B. Encourage them to walk a mile daily for exercise C. Teach them to test their urine for proteinuria D. teach them to take their temperature daily 191. How would you best explain kidney transplantation to a child? A. A new kidney will be placed in your abdomen B. The new kidney will be placed in your bladder C. You must never eat eggs after a kidney transplant D. Your uterine will be brown for the rest of your life. 192. Suppose a girl develops precocious puberty. What advice would you give her parents? A. Excess estrogen causes children to be intersexed or hermaphrodites B. Although her sexual appearance is advanced, the girl cannot conceive C. To remember to treat the child appropriately for her chronologic age, not the age she appears to be D. To not allow the child to eat processed meats, which contain hormones 193. Navi wants to have breast augmentation as soon as she’s 18. What advice would you give her regarding this? A. She will not be able to breast feed after augmentation. B. Breast implant cause a high degree of fibrocystic disease C. She cannot do breast self examination with implants D. Implants do not increase the risk of breast cancer 194. Candidal vaginal infections can occur as an opportunistic infection when adolescents are prescribed antibiotics. What are the typical symptoms of a candidal vaginal infection? A. yellow pinpoint vaginal lesions B. Pruritc reddened vaginal walls C. White, cheese-like vaginal discharge D. vaginal atrophy with final scarring
195. Rob’s sister developed hyperthyroidism (Grave’s disease) at puberty. appearance she would have shown?
Which is a typical
A. Slow, lethargic movements. B. Swollen protuberant abdomen C. Jittery, nervous mannerism D. reduced intellectual processing 196. Rob has his adrenal gland function assessed. What is the effect on a child when sufficient aldosterone cannot be produced? A. Substantially fewer red blood cells are produced. B. There is an overall decreased urine output C. An excessive amount of sodium is lost in urine D. The child’s growth rate increases abnormally
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197. When Rob was first diagnosed with diabetes mellitus he experienced a “honeymoon” period. This means; A. He developed an unnatural craving for sweets B. puberty occurred because of glucose stimulation C. His need for injectable insulin was drastically reduced D. he became light headed or “giddy” every afternoon 198. Tasha has a full neurologic examination after a seizure. What cranial nerve is assessed when you asked a child to raise her shoulders as you push against them? A. Nerve VII or facial B. Nerve VIII or auditory C. Nerve XI or accessory D. Nerve XII or hypoglossal 199. What information would you want parents to know about their child with cerebral; palsy? A. Symptoms of cerebral palsy usually fade by puberty B. All children with cerebral palsy are cognitively challenged C. Cerebral palsy may be associated with a vaccine reaction D. Symptoms may seem to grow worse as fine motor skill is needed 200. Tasha is diagnosed as having bacterial meningitis. respiratory precautions for this condition?
How long should she placed on
A. 4 hours B. 24 hours C. Ten days D. 30 days
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