Peds Exam 2 Review Questions
Content
Peds Exam 2 Review Questions Alterations in Respiratory Function 1. The mother of an infant who has had recurrent respiratory infections asks the nurse why infants are at increased risk for complication from respiratory infections. The best response by the nurse explains that in infants, the: a. b. c. d. Airway structures are larger, allowing for entry of larger number of organisms Respiratory rate is slower than in adults Parents are unable to accurately assess respiratory problems Airways are narrower and more easily obstructed
2.. The mother of a neonate hospitalized with an upper respiratory tract infection asks why her baby won’t take her bottle. The nurse’s best answer would be: a. She’s probably not hungry b. It’s okay because we are giving her IV fluids, therefore she is not hungry c. Newborns breathe through their noses. Congestion may be interfering with her breathing and eating at the same time. d. She might need a different type of formula. We’ll call the physician to get a new order. 3. A 4 yr old female child presents to the ED with a sore throat, difficulty swallowing, and a suspected diagnosis of acute epiglottitis. Initial assessment of the child should include: (Select all that apply) a. b. c. d. e. Throat culture Vital signs Past medical history Auscultation of chest Observation of swallowing ability
4. The nurse is providing homecare instructions to the parents of a child with cystic fibrosis. Which statements by the parents indicate that they do not understand the treatment regimen? (Select all that apply) a. We will perform chest physiotherapy and postural drainage 4 times a day b. We will keep her away from the church nursery if any of the children are coughing and have fever or runny noses c. If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes d. The relay race and swimming at our Sunday school picnic will be good exercise for her e. My child will not need any special dietary intake. 5. A 14 yr old child with history of cystic fibrosis is admitted to the Pediatric unit with assessment findings of crackles, increased cough, and greenish sputum. A 2 week hospitalization is anticipated. Which nursing intervention holds the highest priority?
a. b. c. d.
Referral to Child Life Services for school lesson plans Arranging for liberal visitation from peers Taking a diet history Gaining IV access
6. A 7 yr old is brought into the ED for an acute asthma attack. He is wheezing, tachypneic, diaphoretic, and looks frightened. The nurse should anticipate the patient to have: a. IV methylprednisolone b. Albuterol c. Oral prednisone d. Cromolyn sodium 7. The nurse would select which of the following as an appropriate nursing diagnosis for the family of a toddler being treated for acute laryngotracheobronchitis? a. b. c. d. Anticipatory grieving related to loss of airway Impaired growth and development related to acute onset of illness Impaired social interaction related to confinement in hospital Fear/anxiety related to dyspnea and noisy breathing
8. A child with bacterial pneumonia is crying and says it hurts when he coughs. Then nurse would teach the child to: a. b. c. d. Hug his teddy bear when he coughs Ask for pain medicine before he coughs Take a sip of water before coughing Try very hard not to cough
9. An infant with chronic bronchopulmonary dysplasia (BPD) and a tracheostomy is being discharged on home oxygen therapy. Which statement by the mother indicates that further teaching is needed before discharge? a. I will call my pediatrician if she gets a fever or has more secretions than usual from her tracheostomy. b. I have a cute bib to loosely cover her tracheostomy when she eats and when we go outside into the wind c. We are so glad that the baby will get to go with us on our camping trip to Yellowstone National Park. We have been waiting for her to get well so we can go. d. We have already notified Alabama Power Company that our baby is coming home today 10. The mother if an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse’s response would be based on the knowledge that the majority of infections that cause bronchiolitis are a result of: a. b. c. d. Klebsiella infection Mycoplasma pneumoniae Respiratory syncytial virus (RSV) Hemophilus influenzae
11. An 18 month old boy who was seen in the ED with respiratory distress is admitted to the nursing unit with a diagnosis of pneumonia. Following the initial work up, the child is still short of breath, but is rubbing his eyes as if he is sleepy. The mother wants to lay the child down for his nap, but he refuses to lie down. The nurse would suggest which of the following as the most effective strategy to help the child rest? a. b. c. d. Rock the baby until he is asleep and then lay him down Hold him in her arms while he sleeps Allow him to sleep in an upright position Give him an over-the-counter sleeping pill
12. Which statement by an 8 yr old girl who has asthma indicates that she understands the use of a peak expiratory flow meter? a. My peak flow meter can tell me if an asthma episode might be coming, even though I might still be feeling okay b. When I do my peak flow, it works best if I do three breaths without pausing in between breaths. c. I always start with the meter reading about halfway up. That way I don’t waste any breath. d. If I use my peak flow meter every day, I will not have an asthma attack. 13. I child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart would indicate the need for counseling regarding nutrition and gastrointestinal complications? a. b. c. d. Frothy, foul smelling stools Weight unchanged from yesterday Consumed 80% breakfast (bacon, bites of toast, fruit cup) Eats three snacks every day
14. A 16 year old was diagnosed with cystic fibrosis as an infant. At this time, the nurse anticipates that the adolescent will need additional teaching related to: a. b. c. d. Obtaining a sweat chloride test The effect of pancreatic enzymes on the sex hormones Increased need for a weight reduction diet Reproductive ability.
15. A 9 month old infant has been admitted to the pediatric unit with RSV infection. The nurse assigned to provide care to this infant will need to be assigned to care for other clients as well. The charge nurse should assign the nurse which of the following children as an appropriate assignment? (Select all that apply) a. b. c. d. e. A toddler with neuroblastoma undergoing chemotherapy A 10 year old with a fractured femur in traction An infant with immunodeficiency A preschooler with impetigo A 3 yr old with aplastic anemia Alterations in Musculoskeletal Function
16. A 6 yr old child has a cast applied for a fractured radius. The nurse completes an orthopedic assessment on this child. Which of the following symptoms requires immediate attention and should be reported to the physician? a. b. c. d. Capillary refill of 4 seconds in the affected hand Edema in the affected fingers that improves with elevation Child describing feeling of affected hand being “asleep” Skin surrounding the cast is warm
17. Which of the following nursing care measures takes highest priority in caring for a child in skeletal traction? a. b. c. d. Assessing bowel sounds every shift Assessing temperature very four hours’ Providing adequate nutrition Providing age-appropriate activities
18. A 5 month old infant is being assessed for developmental dysplasia of the hip. The nurse concludes that positive signs and symptoms that indicate this disorder include: (Select all that apply) a. b. c. d. e. Ortolani sign Barlow sign Allis sign Trendelenburg sign Asymmetric thigh and gluteal folds
19. A child is admitted with osteogenesis imperfecta (OI). In reviewing laboratory findings, the nurse would expect to find abnormal levels of: a. b. c. d. Calcium Phosphorus Precollagen type 1 Vitamin D
20. The physician has written the following orders for a child with Duchene muscular dystrophy hospitalized for a respiratory infection. The nurse should question the order for: a. b. c. d. Physical therapy Antibiotic therapy Passive range of motion exercises Strict bed rest
21. A 4 yr old child with osteogenesis imperfecta (OI) is admitted to the hospital unit for an unrelated condition. The nurse determines that which nursing diagnosis has the highest priority for this child? a. Impaired skin integrity related to cast b. Pain related to fractures c. Risk for injury related to disease
d. Disturbed body image related to short stature 22. A child is admitted to the hospital unit with a diagnosis of “rule of acute onset of Legg-CalvePerthes (LCP) disease.” The symptom that would not be associated with LCP is: a. b. c. d. Swelling and redness of the involved joint(s) Stiffness in the morning after rest’ Insidious limp after activities Referred pain to the knee
23. An adolescent diagnosed with idiopathic structural scoliosis describes all of the following symptoms. Which one would the nurse conclude is not associated with this diagnosis? a. b. c. d. Back pain Skirts that hang unevenly Unequal shoulder heights Uneven waist angles
24. A 15 yr old who has a diagnosis of scoliosis is being seen in the outpatient clinic. The nurse is planning care for this adolescent and develops the following nursing diagnoses. Which nursing diagnosis should take the highest priority? a. b. c. d. Disturbed body image related to treatment of scoliosis Diversional activity deficit related to treatment of scoliosis Anxiety related to outcome of treatment of scoliosis Fear related to treatment and unknown outcomes
25. An adolescent is returning to the hospital unit after surgical spinal fusion for scoliosis. The nurse would include which of the following in the immediate postoperative care of this client? (Select all that apply) a. b. c. d. e. Oral analgesia for pain Logrolling every 2 hrs Nasogastric intubation Straight cath every 4 hours Use of an incentive spirometer every hr while awake
26. A child is admitted to the hospital with a diagnosis of “rule out osteomyelitis”. Which of the following serum laboratory values noted by the nurse supports this diagnosis? a. b. c. d. Decreased white blood cell (WBC) count Positive blood cultures Increased hematocric (HCT) Increased BUN Alterations in Skin Integrity 27. When bathing a 3 yr old with eczema, the nurse tells the mother to have the bathwater: (select all that apply)
a. b. c. d. e.
As hot as the child can tolerate Hot to the touch on the inner wrist Tepid to touch Cool with soap bubbles added Without harsh or perfumed soaps or bubble bath
28. When assessing a child’s hair and scalp, the nurse notices what looks like dandruff, but it does not flake off easily. The nurse suspects the child has: a. b. c. d. Scabies Eczema Pediculosis capitus Impetigo
29. A child has been admitted to the burn unit with a circumferential burn to the right leg. The nurse will position the client: a. b. c. d. Flat in bed With the right leg dependent On the left side With the right leg elevated
30. A 3 yr old child is suspected of having eczema. The nurse assessed for which of the following as a major symptom of eczema? a. b. c. d. Pruritus Pustules Vesicles Lichenification
31. A child has been diagnosed with eczema. While taking the nursing history, the nurse will assess for a family history of: a. b. c. d. Scabies Cellulitis Asthma Impetigo
32. A child will be treated for cellulites of the left leg. The nurse will include in the care plan, the need for: a. b. c. d. Continuing oral antibiotics until the prescription is completed. Strict bed rest with the left leg elevated Increased fluid intake Limiting visitors to prevent spreading infection
33. The emergency department nurse hears a radio transmission from an ambulance stating that a 10 yr old boy is en route who sustained partial thickness burns to his right arm and abdomen after tossing gasoline on a fire. On admission to the ED the nurse expects the appearance of the burn site to be: a. Smooth and bright red
b. Bright red with numerous blisters c. White and waxy d. Dark brown and firm 34. Permethrin 5% (Elimite) is prescribed for a 10 yr old child diagnosis with scabies. What instructions should the nurse provide for the mother? a. b. c. d. Apply the lotion liberally from head to toe Wrap the child in a clean sheet after treatment Leave the lotion on for 10 minutes, then rinse Apply lotion only after the child has had a bath and dried thoroughly
35. When assessing a child with a possible diagnosis of facial cellulites, the nurse will want to question the parent about a recent history of: a. b. c. d. Otitis media Cat scratch Sunburn Dental caries
36. In teaching a group of school-age children, a nurse would explain that lice on a child can be most easily spread by: a. b. c. d. Sitting close to someone who has lice Sharing hats at recess Riding in the same care Sharing a seat on the same bus
37. A 5 yr old boy was brought to the ED after being burned trying to put out a fire in his closet where he was playing with matches. The priority nursing assessment for this child would be: a. b. c. d. Level of pain Airway patency Psychological needs Signs of infection
38. Intravenous morphine sulfate is ordered for a 13 yr old girl hospitalized with major burns to 30% of her body. A LPN asked the RN why the morphine is given by IV route when the child can talk and swallow. The RN should explain to the LPN that, when given by the IV route, morphine does which of the following: a. b. c. d. Has a longer half life Has a predictable absorption rate Prevents ileus Leads to fewer side effects Health Promotion of the School Aged Child 39. School age children receive health care in a variety of settings. What setting offers health promotion and health maintenance that is easily accessible to the school aged child?
a. b. c. d.
Pediatrician’s primary care office Community based primary care clinics School based clinics Summer camp health clinics
40. The parent of a 10 yr old brings the child to the clinic for a health exam. The child asks the mother to wait outside during the exam. The most appropriate response by the nurse would be: a. b. c. d. Your mom can wait in the waiting room and I’ll call her when the exam is finished. Your mom needs to stay with you during the exam Why do you want your mom to wait outside? She cannot, I need to ask her questions.
41. The nurse is discussing oral health with the mother of a 10 yr old. In providing health promotion guidance, the nurse would include the following information: a. b. c. d. Your child will begin loosing teeth soon, usually the front teeth first. The loss of teeth during the next 4 yrs will accelerate. Your child should see a dentist every 18 months. It is important to know if your water contains fluoride, as this is necessary for good dental health
42. Most schools include curricula regarding human sexuality. What is the most appropriate age group for the nurse to include in her instruction? a. b. c. d. 12 yr olds 9 yr olds 11 yr olds 15 yr olds
43. The mother of a 12 yr old tells the nurse that her child wants to spend more time with her friends and less time with her family. The nurse’s replay should be based on the knowledge that: normal a. The next important psychosocial task is a sense of identity. This child shows movement towards accomplishing that task. b. The psychosocial task at this age is a sense of industry. This child is abnormally precocious. c. This could lead to unhealthy relationships, as the child is too young to spend so much time with her peers. d. This child is showing an unhealthy need to separate from her family.
44. The nurse observes on the chart of an 11 yr old that he has missed some of his immunizations. The appropriate corrective action would be to: a. Immediately start the child on missed immunizations and create a schedule to follow. b. Begin a new immunization schedule, repeating any that have already been given. c. Have the child go to the lab to draw titers for all of the immunizations. d. Do nothing; the child is too old to get immunized. Health Promotion of the Adolescent
45. The nurse is working with a new adolescent patient. The greeting by the nurse that indicates awareness of the needs of the adolescent client is: a. b. c. d. I will talk with your parents first and then you can tell me shy you are here. Please let me know what your concerns are and if you have any questions. Before we begin, I will need to know if you are sexually active. I will do the physical exam first, and then we will talk about your history.
46. During the assessment, the nurse asks the adolescent, “What things have you accomplished that you feel proud about?” The domain the nurse is assessing is: a. b. c. d. Social interactions Spiritual health Physical health Mental health
47. During a routine exam, an adolescent girl informs the nurse that she has been sexually active for over one year. The best response by the nurse would be: a. b. c. d. You must be tested for STD’s now Do you have any questions about contraceptives of sexually transmitted diseases? I will need to report this information to your parents. Let me give you some condoms.
48. The mother of an adolescent complains that he sleeps until noon on the weekends. Which response by the nurse is accurate? a. b. c. d. Teens need more sleep due to the rapid growth of the body He is probably depressed. Have you noticed any changes in his eating habits? No matter what time he goes to bed, get him up before 9am Your child should not be up late.
49. The school nurse is preparing health education content regarding injury prevention during adolescence. The nurse should: a. exclude information regarding firearms b. Not provide information about the use of illegal drugs as that should only be presented by the police dept. c. Include information regarding safe driving, drinking while driving, and statistics of adolescent automobile crashes. d. Not present information on abuse within relationships due to the age of the adolescents. Care of the Hospitalized Child 50. A 9 month old is admitted to the hospital for treatment of a bacterial infection. The most important intervention in order to decrease the stressors of hospitalization for the infant would be:
a. Encourage parents to remain at the bedside and actively participate in the infant’s care b. Provide a brightly lit environment for the infant c. Play tapes of the mother’s voice d. Assign the same nurse to the infant as much as possible. 51. The nursing intervention that best promotes a sense of autonomy in the hospitalized toddler is to: a. b. c. d. Allow the child to participate in dressing changes Allow the child to assist in decisions related to medical treatments Allow the child to choose which medication to take first Provide a consistent caregiver to the child
52. The nurse needs to administer a medication to a 6 month old. The most appropriate technique is to: a. b. c. d. Mix the medication in 1 oz of infant formula and feed to the child Position the child upright and use an oral syringe to administer the medication Pour the medicine from a medicine cup into the inside of the infant’s cheek Position the infant supine and squirt the medicine into the child’s mouth
53. Which technique is most appropriate when performing a procedure on a preschooler? a. b. c. d. Perform the procedure in the treatment room Perform the procedure in the child’s hospital bed Allow the child to decide when the procedure will be performed Ask the parents to help restrain the child so the procedure can be performed
54. The parent of a hospitalized child states, “I do not know why my child has to have so many tests.” What is the most appropriate nursing diagnosis? a. b. c. d. Parental anxiety related to hospitalization of the child Fear related to hospitalization of the child Parental knowledge deficit related to illness and procedures Ineffective coping related to hospitalization of the child Pain in Children 55. A 3 yr old is hospitalized with a fractured femur. The pain assessment tool most appropriate for this child is: a. b. c. d. FLACC scale Poker chip tool Number scale Faces pain rating scale
56. The nurse assesses a 6 yr old who was admitted 4 hrs ago following an appendectomy. The child had morphine IV for pain immediately after surgery. The nurse notes that the child has
shallow respirations and is lying very still. When asked if he has pain, the child very quickly says “NO!” The most appropriate action by the nurse would be to: a. b. c. d. Reassess the child in 1 hour Administer the prescribed dose of morphine Call the physician to report signs of resp distress Ask the child’s parents to notify the nurse if the child complains of pain.
57. The nurse assumes care of a 3 yr old hospitalized following a MVC. The child has been receiving IV morphine for pain related to multiple fractures, and is sleeping soundly. The nurse notes vital signs as follows: Temp 98.1 axillary, pulse 96, respirations 10, BP 105/60. Pulses are 2+ in all four extremities. Based on this assessment, the nurse’s priority nursing diagnosis is: a. b. c. d. Acute pain related to multiple fractures Ineffective breathing related to opioid use Decreased cardiac output related to injury Altered tissue perfusion related to multiple fractures
58. Which infant behavior is most indicating of effective pain control measures? a. b. c. d. Sucking vigorously on a pacifier Mild moaning or whimpering Relaxed with occasional movement of arms or legs Alert and moving about frequently in the crib
59. The nurse is a patient advocate for a child receiving a venipunture. The nurse should discuss pain management with the physician and suggest: a. b. c. d. Sedation Sub-Q lidocaine IV analgesia Topical application of EMLA cream or ELA-MAX/ LMX4
60. A 10 yr old is hospitalized with a fractured femur. In addition to pain medication, what will best provide pain relief for this child? a. b. c. d. Providing age appropriate video games or board games use of massage Parents’ presence at the bedside Encouraging deep breathing exercises
61. Which of the f0llowing complementary therapies for pain management are appropriate for infants? (Select all that apply) a. b. c. d. e. Pacifier Stories Imagery Oral sucrose solution Music/singing
2.. The mother of a neonate hospitalized with an upper respiratory tract infection asks why her baby won’t take her bottle. The nurse’s best answer would be: a. She’s probably not hungry b. It’s okay because we are giving her IV fluids, therefore she is not hungry c. Newborns breathe through their noses. Congestion may be interfering with her breathing and eating at the same time. d. She might need a different type of formula. We’ll call the physician to get a new order. 3. A 4 yr old female child presents to the ED with a sore throat, difficulty swallowing, and a suspected diagnosis of acute epiglottitis. Initial assessment of the child should include: (Select all that apply) a. b. c. d. e. Throat culture Vital signs Past medical history Auscultation of chest Observation of swallowing ability
4. The nurse is providing homecare instructions to the parents of a child with cystic fibrosis. Which statements by the parents indicate that they do not understand the treatment regimen? (Select all that apply) a. We will perform chest physiotherapy and postural drainage 4 times a day b. We will keep her away from the church nursery if any of the children are coughing and have fever or runny noses c. If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes d. The relay race and swimming at our Sunday school picnic will be good exercise for her e. My child will not need any special dietary intake. 5. A 14 yr old child with history of cystic fibrosis is admitted to the Pediatric unit with assessment findings of crackles, increased cough, and greenish sputum. A 2 week hospitalization is anticipated. Which nursing intervention holds the highest priority?
a. b. c. d.
Referral to Child Life Services for school lesson plans Arranging for liberal visitation from peers Taking a diet history Gaining IV access
6. A 7 yr old is brought into the ED for an acute asthma attack. He is wheezing, tachypneic, diaphoretic, and looks frightened. The nurse should anticipate the patient to have: a. IV methylprednisolone b. Albuterol c. Oral prednisone d. Cromolyn sodium 7. The nurse would select which of the following as an appropriate nursing diagnosis for the family of a toddler being treated for acute laryngotracheobronchitis? a. b. c. d. Anticipatory grieving related to loss of airway Impaired growth and development related to acute onset of illness Impaired social interaction related to confinement in hospital Fear/anxiety related to dyspnea and noisy breathing
8. A child with bacterial pneumonia is crying and says it hurts when he coughs. Then nurse would teach the child to: a. b. c. d. Hug his teddy bear when he coughs Ask for pain medicine before he coughs Take a sip of water before coughing Try very hard not to cough
9. An infant with chronic bronchopulmonary dysplasia (BPD) and a tracheostomy is being discharged on home oxygen therapy. Which statement by the mother indicates that further teaching is needed before discharge? a. I will call my pediatrician if she gets a fever or has more secretions than usual from her tracheostomy. b. I have a cute bib to loosely cover her tracheostomy when she eats and when we go outside into the wind c. We are so glad that the baby will get to go with us on our camping trip to Yellowstone National Park. We have been waiting for her to get well so we can go. d. We have already notified Alabama Power Company that our baby is coming home today 10. The mother if an infant diagnosed with bronchiolitis asks the nurse what causes this disease. The nurse’s response would be based on the knowledge that the majority of infections that cause bronchiolitis are a result of: a. b. c. d. Klebsiella infection Mycoplasma pneumoniae Respiratory syncytial virus (RSV) Hemophilus influenzae
11. An 18 month old boy who was seen in the ED with respiratory distress is admitted to the nursing unit with a diagnosis of pneumonia. Following the initial work up, the child is still short of breath, but is rubbing his eyes as if he is sleepy. The mother wants to lay the child down for his nap, but he refuses to lie down. The nurse would suggest which of the following as the most effective strategy to help the child rest? a. b. c. d. Rock the baby until he is asleep and then lay him down Hold him in her arms while he sleeps Allow him to sleep in an upright position Give him an over-the-counter sleeping pill
12. Which statement by an 8 yr old girl who has asthma indicates that she understands the use of a peak expiratory flow meter? a. My peak flow meter can tell me if an asthma episode might be coming, even though I might still be feeling okay b. When I do my peak flow, it works best if I do three breaths without pausing in between breaths. c. I always start with the meter reading about halfway up. That way I don’t waste any breath. d. If I use my peak flow meter every day, I will not have an asthma attack. 13. I child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart would indicate the need for counseling regarding nutrition and gastrointestinal complications? a. b. c. d. Frothy, foul smelling stools Weight unchanged from yesterday Consumed 80% breakfast (bacon, bites of toast, fruit cup) Eats three snacks every day
14. A 16 year old was diagnosed with cystic fibrosis as an infant. At this time, the nurse anticipates that the adolescent will need additional teaching related to: a. b. c. d. Obtaining a sweat chloride test The effect of pancreatic enzymes on the sex hormones Increased need for a weight reduction diet Reproductive ability.
15. A 9 month old infant has been admitted to the pediatric unit with RSV infection. The nurse assigned to provide care to this infant will need to be assigned to care for other clients as well. The charge nurse should assign the nurse which of the following children as an appropriate assignment? (Select all that apply) a. b. c. d. e. A toddler with neuroblastoma undergoing chemotherapy A 10 year old with a fractured femur in traction An infant with immunodeficiency A preschooler with impetigo A 3 yr old with aplastic anemia Alterations in Musculoskeletal Function
16. A 6 yr old child has a cast applied for a fractured radius. The nurse completes an orthopedic assessment on this child. Which of the following symptoms requires immediate attention and should be reported to the physician? a. b. c. d. Capillary refill of 4 seconds in the affected hand Edema in the affected fingers that improves with elevation Child describing feeling of affected hand being “asleep” Skin surrounding the cast is warm
17. Which of the following nursing care measures takes highest priority in caring for a child in skeletal traction? a. b. c. d. Assessing bowel sounds every shift Assessing temperature very four hours’ Providing adequate nutrition Providing age-appropriate activities
18. A 5 month old infant is being assessed for developmental dysplasia of the hip. The nurse concludes that positive signs and symptoms that indicate this disorder include: (Select all that apply) a. b. c. d. e. Ortolani sign Barlow sign Allis sign Trendelenburg sign Asymmetric thigh and gluteal folds
19. A child is admitted with osteogenesis imperfecta (OI). In reviewing laboratory findings, the nurse would expect to find abnormal levels of: a. b. c. d. Calcium Phosphorus Precollagen type 1 Vitamin D
20. The physician has written the following orders for a child with Duchene muscular dystrophy hospitalized for a respiratory infection. The nurse should question the order for: a. b. c. d. Physical therapy Antibiotic therapy Passive range of motion exercises Strict bed rest
21. A 4 yr old child with osteogenesis imperfecta (OI) is admitted to the hospital unit for an unrelated condition. The nurse determines that which nursing diagnosis has the highest priority for this child? a. Impaired skin integrity related to cast b. Pain related to fractures c. Risk for injury related to disease
d. Disturbed body image related to short stature 22. A child is admitted to the hospital unit with a diagnosis of “rule of acute onset of Legg-CalvePerthes (LCP) disease.” The symptom that would not be associated with LCP is: a. b. c. d. Swelling and redness of the involved joint(s) Stiffness in the morning after rest’ Insidious limp after activities Referred pain to the knee
23. An adolescent diagnosed with idiopathic structural scoliosis describes all of the following symptoms. Which one would the nurse conclude is not associated with this diagnosis? a. b. c. d. Back pain Skirts that hang unevenly Unequal shoulder heights Uneven waist angles
24. A 15 yr old who has a diagnosis of scoliosis is being seen in the outpatient clinic. The nurse is planning care for this adolescent and develops the following nursing diagnoses. Which nursing diagnosis should take the highest priority? a. b. c. d. Disturbed body image related to treatment of scoliosis Diversional activity deficit related to treatment of scoliosis Anxiety related to outcome of treatment of scoliosis Fear related to treatment and unknown outcomes
25. An adolescent is returning to the hospital unit after surgical spinal fusion for scoliosis. The nurse would include which of the following in the immediate postoperative care of this client? (Select all that apply) a. b. c. d. e. Oral analgesia for pain Logrolling every 2 hrs Nasogastric intubation Straight cath every 4 hours Use of an incentive spirometer every hr while awake
26. A child is admitted to the hospital with a diagnosis of “rule out osteomyelitis”. Which of the following serum laboratory values noted by the nurse supports this diagnosis? a. b. c. d. Decreased white blood cell (WBC) count Positive blood cultures Increased hematocric (HCT) Increased BUN Alterations in Skin Integrity 27. When bathing a 3 yr old with eczema, the nurse tells the mother to have the bathwater: (select all that apply)
a. b. c. d. e.
As hot as the child can tolerate Hot to the touch on the inner wrist Tepid to touch Cool with soap bubbles added Without harsh or perfumed soaps or bubble bath
28. When assessing a child’s hair and scalp, the nurse notices what looks like dandruff, but it does not flake off easily. The nurse suspects the child has: a. b. c. d. Scabies Eczema Pediculosis capitus Impetigo
29. A child has been admitted to the burn unit with a circumferential burn to the right leg. The nurse will position the client: a. b. c. d. Flat in bed With the right leg dependent On the left side With the right leg elevated
30. A 3 yr old child is suspected of having eczema. The nurse assessed for which of the following as a major symptom of eczema? a. b. c. d. Pruritus Pustules Vesicles Lichenification
31. A child has been diagnosed with eczema. While taking the nursing history, the nurse will assess for a family history of: a. b. c. d. Scabies Cellulitis Asthma Impetigo
32. A child will be treated for cellulites of the left leg. The nurse will include in the care plan, the need for: a. b. c. d. Continuing oral antibiotics until the prescription is completed. Strict bed rest with the left leg elevated Increased fluid intake Limiting visitors to prevent spreading infection
33. The emergency department nurse hears a radio transmission from an ambulance stating that a 10 yr old boy is en route who sustained partial thickness burns to his right arm and abdomen after tossing gasoline on a fire. On admission to the ED the nurse expects the appearance of the burn site to be: a. Smooth and bright red
b. Bright red with numerous blisters c. White and waxy d. Dark brown and firm 34. Permethrin 5% (Elimite) is prescribed for a 10 yr old child diagnosis with scabies. What instructions should the nurse provide for the mother? a. b. c. d. Apply the lotion liberally from head to toe Wrap the child in a clean sheet after treatment Leave the lotion on for 10 minutes, then rinse Apply lotion only after the child has had a bath and dried thoroughly
35. When assessing a child with a possible diagnosis of facial cellulites, the nurse will want to question the parent about a recent history of: a. b. c. d. Otitis media Cat scratch Sunburn Dental caries
36. In teaching a group of school-age children, a nurse would explain that lice on a child can be most easily spread by: a. b. c. d. Sitting close to someone who has lice Sharing hats at recess Riding in the same care Sharing a seat on the same bus
37. A 5 yr old boy was brought to the ED after being burned trying to put out a fire in his closet where he was playing with matches. The priority nursing assessment for this child would be: a. b. c. d. Level of pain Airway patency Psychological needs Signs of infection
38. Intravenous morphine sulfate is ordered for a 13 yr old girl hospitalized with major burns to 30% of her body. A LPN asked the RN why the morphine is given by IV route when the child can talk and swallow. The RN should explain to the LPN that, when given by the IV route, morphine does which of the following: a. b. c. d. Has a longer half life Has a predictable absorption rate Prevents ileus Leads to fewer side effects Health Promotion of the School Aged Child 39. School age children receive health care in a variety of settings. What setting offers health promotion and health maintenance that is easily accessible to the school aged child?
a. b. c. d.
Pediatrician’s primary care office Community based primary care clinics School based clinics Summer camp health clinics
40. The parent of a 10 yr old brings the child to the clinic for a health exam. The child asks the mother to wait outside during the exam. The most appropriate response by the nurse would be: a. b. c. d. Your mom can wait in the waiting room and I’ll call her when the exam is finished. Your mom needs to stay with you during the exam Why do you want your mom to wait outside? She cannot, I need to ask her questions.
41. The nurse is discussing oral health with the mother of a 10 yr old. In providing health promotion guidance, the nurse would include the following information: a. b. c. d. Your child will begin loosing teeth soon, usually the front teeth first. The loss of teeth during the next 4 yrs will accelerate. Your child should see a dentist every 18 months. It is important to know if your water contains fluoride, as this is necessary for good dental health
42. Most schools include curricula regarding human sexuality. What is the most appropriate age group for the nurse to include in her instruction? a. b. c. d. 12 yr olds 9 yr olds 11 yr olds 15 yr olds
43. The mother of a 12 yr old tells the nurse that her child wants to spend more time with her friends and less time with her family. The nurse’s replay should be based on the knowledge that: normal a. The next important psychosocial task is a sense of identity. This child shows movement towards accomplishing that task. b. The psychosocial task at this age is a sense of industry. This child is abnormally precocious. c. This could lead to unhealthy relationships, as the child is too young to spend so much time with her peers. d. This child is showing an unhealthy need to separate from her family.
44. The nurse observes on the chart of an 11 yr old that he has missed some of his immunizations. The appropriate corrective action would be to: a. Immediately start the child on missed immunizations and create a schedule to follow. b. Begin a new immunization schedule, repeating any that have already been given. c. Have the child go to the lab to draw titers for all of the immunizations. d. Do nothing; the child is too old to get immunized. Health Promotion of the Adolescent
45. The nurse is working with a new adolescent patient. The greeting by the nurse that indicates awareness of the needs of the adolescent client is: a. b. c. d. I will talk with your parents first and then you can tell me shy you are here. Please let me know what your concerns are and if you have any questions. Before we begin, I will need to know if you are sexually active. I will do the physical exam first, and then we will talk about your history.
46. During the assessment, the nurse asks the adolescent, “What things have you accomplished that you feel proud about?” The domain the nurse is assessing is: a. b. c. d. Social interactions Spiritual health Physical health Mental health
47. During a routine exam, an adolescent girl informs the nurse that she has been sexually active for over one year. The best response by the nurse would be: a. b. c. d. You must be tested for STD’s now Do you have any questions about contraceptives of sexually transmitted diseases? I will need to report this information to your parents. Let me give you some condoms.
48. The mother of an adolescent complains that he sleeps until noon on the weekends. Which response by the nurse is accurate? a. b. c. d. Teens need more sleep due to the rapid growth of the body He is probably depressed. Have you noticed any changes in his eating habits? No matter what time he goes to bed, get him up before 9am Your child should not be up late.
49. The school nurse is preparing health education content regarding injury prevention during adolescence. The nurse should: a. exclude information regarding firearms b. Not provide information about the use of illegal drugs as that should only be presented by the police dept. c. Include information regarding safe driving, drinking while driving, and statistics of adolescent automobile crashes. d. Not present information on abuse within relationships due to the age of the adolescents. Care of the Hospitalized Child 50. A 9 month old is admitted to the hospital for treatment of a bacterial infection. The most important intervention in order to decrease the stressors of hospitalization for the infant would be:
a. Encourage parents to remain at the bedside and actively participate in the infant’s care b. Provide a brightly lit environment for the infant c. Play tapes of the mother’s voice d. Assign the same nurse to the infant as much as possible. 51. The nursing intervention that best promotes a sense of autonomy in the hospitalized toddler is to: a. b. c. d. Allow the child to participate in dressing changes Allow the child to assist in decisions related to medical treatments Allow the child to choose which medication to take first Provide a consistent caregiver to the child
52. The nurse needs to administer a medication to a 6 month old. The most appropriate technique is to: a. b. c. d. Mix the medication in 1 oz of infant formula and feed to the child Position the child upright and use an oral syringe to administer the medication Pour the medicine from a medicine cup into the inside of the infant’s cheek Position the infant supine and squirt the medicine into the child’s mouth
53. Which technique is most appropriate when performing a procedure on a preschooler? a. b. c. d. Perform the procedure in the treatment room Perform the procedure in the child’s hospital bed Allow the child to decide when the procedure will be performed Ask the parents to help restrain the child so the procedure can be performed
54. The parent of a hospitalized child states, “I do not know why my child has to have so many tests.” What is the most appropriate nursing diagnosis? a. b. c. d. Parental anxiety related to hospitalization of the child Fear related to hospitalization of the child Parental knowledge deficit related to illness and procedures Ineffective coping related to hospitalization of the child Pain in Children 55. A 3 yr old is hospitalized with a fractured femur. The pain assessment tool most appropriate for this child is: a. b. c. d. FLACC scale Poker chip tool Number scale Faces pain rating scale
56. The nurse assesses a 6 yr old who was admitted 4 hrs ago following an appendectomy. The child had morphine IV for pain immediately after surgery. The nurse notes that the child has
shallow respirations and is lying very still. When asked if he has pain, the child very quickly says “NO!” The most appropriate action by the nurse would be to: a. b. c. d. Reassess the child in 1 hour Administer the prescribed dose of morphine Call the physician to report signs of resp distress Ask the child’s parents to notify the nurse if the child complains of pain.
57. The nurse assumes care of a 3 yr old hospitalized following a MVC. The child has been receiving IV morphine for pain related to multiple fractures, and is sleeping soundly. The nurse notes vital signs as follows: Temp 98.1 axillary, pulse 96, respirations 10, BP 105/60. Pulses are 2+ in all four extremities. Based on this assessment, the nurse’s priority nursing diagnosis is: a. b. c. d. Acute pain related to multiple fractures Ineffective breathing related to opioid use Decreased cardiac output related to injury Altered tissue perfusion related to multiple fractures
58. Which infant behavior is most indicating of effective pain control measures? a. b. c. d. Sucking vigorously on a pacifier Mild moaning or whimpering Relaxed with occasional movement of arms or legs Alert and moving about frequently in the crib
59. The nurse is a patient advocate for a child receiving a venipunture. The nurse should discuss pain management with the physician and suggest: a. b. c. d. Sedation Sub-Q lidocaine IV analgesia Topical application of EMLA cream or ELA-MAX/ LMX4
60. A 10 yr old is hospitalized with a fractured femur. In addition to pain medication, what will best provide pain relief for this child? a. b. c. d. Providing age appropriate video games or board games use of massage Parents’ presence at the bedside Encouraging deep breathing exercises
61. Which of the f0llowing complementary therapies for pain management are appropriate for infants? (Select all that apply) a. b. c. d. e. Pacifier Stories Imagery Oral sucrose solution Music/singing
