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1. Andrea with suspected rheumatic fever is admitted to the


pediatric unit. When obtaining the child’s history, the nurse
considers which information to be most important?

A. A fever that started 3 days ago


B. Lack of interest in food
C. A recent episode of pharyngitis
D. Vomiting for 2 days

2. Nurse Liza is administering a medication via the


intraosseous route to a child. Intraosseous drug
administration is typically used when a child is:

A. Under age 3
B. Over age 3
C. Critically ill and under age 3
D. Critically ill and over age 3

3. When assessing a child’s cultural background, the nurse in


charge should keep in mind that:

A. Cultural background usually has little bearing on a


family’s health practices
B. Physical characteristics mark the child as part of a
particular culture
C. Heritage dictates a group’s shared values
D. Behavioral patterns are passed from one generation to
the next

4. While examining a 2-year-old child, the nurse in charge


sees that the anterior fontanel is open. The nurse should:

A. Notify the doctor


B. Look for other signs of abuse
C. Recognize this as a normal Onding
D. Ask about a family history of Tay-Sachs disease

5. The nurse is aware that the most common assessment


Onding in a child with ulcerative colitis is:

A. Intense abdominal cramps


B. Profuse diarrhea
C. Anal Ossures
D. Abdominal distention

6. When administering an I.M. injection to an infant, the nurse


in charge should use which site?

A. Deltoid
B. Dorsogluteal
C. Ventrogluteal
D. Vastus lateralis

7. A child with a poor nutritional status and weight loss is at


risk for a negative nitrogen balance. To help diagnose this
problem, the nurse in charge anticipates that the doctor will
order which laboratory test?

A. Total iron-binding capacity


B. Hemoglobin
C. Total protein
D. Serum transferring
8. When developing a plan of care for a male adolescent, the
nurse considers the child’s psychosocial needs. During
adolescence, psychosocial development focuses on:

A. Becoming industrious
B. Establishing an identity
C. Achieving intimacy
D. Developing initiative

9. When developing a plan care for a hospitalized child, nurse


Mica knows that children in which age group are most likely
to view illness as a punishment for misdeeds?

A. Infancy
B. Preschool age
C. School age
D. Adolescence

10. Nurse Taylor suspects that a child, age 4, is being


neglected physically. To best assess the child’s nutritional
status, the nurse should ask the parents which question?

A. “Has your child always been so thin?”


B. “Is your child a picky eater?”
C. “What did your child eat for breakfast?”
D. “Do you think your child eats enough?”

11. A female child, age 2, is brought to the emergency


department after ingesting an unknown number of aspirin
tablets about 30 minutes earlier. On entering the examination
room, the child is crying and clinging to the mother. Which
data should the nurse obtain Orst?

A. Heart rate, respiratory rate, and blood pressure


B. Recent exposure to communicable diseases
C. Number of immunizations received
D. Height and weight
12. A mother asks the nurse how to handle her 5-year-old
child, who recently started wetting the pants after being
completely toilet trained. The child just started attending
nursery school 2 days a week. Which principle should guide
the nurse’s response?

A. The child forgets previously learned skills


B. The child experiences growth while regressing,
regrouping, and then progressing
C. The parents may refer less mature behaviors
D. The child returns to a level of behavior that increases the
sense of security.

13. A female child, age 6, is brought to the health clinic for a


routine checkup. To assess the child’s vision, the nurse
should ask:

A. “Do you have any problems seeing different colors?”


B. “Do you have trouble seeing at night?”
C. “Do you have problems with glare?”
D. “How are you doing in school?”

14. During a well-baby visit, Jenny asks the nurse when she
should start giving her infant solid foods. The nurse should
instruct her to introduce which solid food Orst?

A. Applesauce
B. Egg whites
C. Rice cereal
D. Yogurt

15. To decrease the likelihood of bradyarrhythmias in children


during endotracheal intubation, succinylcholine (Anectine) is
used with which of the following agents?

A. Epinephrine (Adrenalin)
B. Isoproterenol (Isuprel)
C. Atropine sulfate
D. Lidocaine hydrochloride (Xylocaine)

16. A 1 year and 2-month-old child weighing 26 lb (11.8 kg) is


admitted for traction to treat congenital hip dislocation. When
preparing the patient’s room, the nurse anticipates using
which traction system?

A. Bryant’s traction
B. Buck’s extension traction
C. Overhead suspension traction
D. 90-90 traction

17. Mandy, age 12, is 7 months pregnant. When teaching


parenting skills to an adolescent, the nurse knows that which
teaching strategy is least effective?

A. Providing a one-on-one demonstration and requesting a


return demonstration, using a live infant model
B. Initiating a teenage parent support group with Orst – and
– second-time mothers
C. Using audiovisual aids that show discussions of feelings
and skills
D. Providing age-appropriate reading materials

18. When performing a physical examination on an infant, the


nurse in charge notes abnormally low-set ears. This Ondings
is associated with:

A. Otogenous tetanus
B. Tracheoesophageal Ostula
C. Congenital heart defects
D. Renal anomalies

19. Nurse Raven should expect a 3-year-old child to be able to


perform which action?

A. Ride a tricycle
B. Tie the shoelaces
C. Roller-skates
D. Jump rope

20. Nurse Betina is teaching a group of parents about otitis


media. When discussing why children are predisposed to this
disorder, the nurse should mention the signiOcance of which
anatomical feature?

A. Eustachian tubes
B. Nasopharynx
C. Tympanic membrane
D. External ear canal

21. The nurse is evaluating a female child with acute


poststreptoccocal glomerulonephritis for signs of
improvement. Which Onding typically is the earliest sign of
improvement?

A. Increased urine output


B. Increased appetite
C. Increased energy level
D. Decreased diarrhea

22. Dr. Smith prescribes corticosteroids for a child with


nephritic syndrome. What is the primary purpose of
administering corticosteroids to this child?

A. To increase blood pressure


B. To reduce inlammation
C. To decrease proteinuria
D. To prevent infection

23. Parents bring their infant to the clinic, seeking treatment


for vomiting and diarrhea that has lasted for 2 days. On
assessment, the nurse in charge detects dry mucous
membranes and lethargy. What other Ondings suggests a
luid volume deOcit?
A. A sunken fontanel
B. Decreased pulse rate
C. Increased blood pressure
D. Low urine speciOc gravity

24. How should the nurse May prepare a suspension before


administration?

A. By diluting it with normal saline solution


B. By diluting it with 5% dextrose solution
C. By shaking it so that all the drug particles are dispersed
uniformly
D. By crushing remaining particles with a mortar and pestle

25. What should be the initial bolus of crystalloid luid


replacement for a pediatric patient in shock?

A. 20 ml/kg
B. 10 ml/kg
C. 30 ml/kg
D. 15 ml/kg

26. Becky, age 5, with intelligence quotient of 65 is admitted


to the hospital for evaluation. When planning care, the nurse
should keep in mind that this child is:

A. Within the lower range of normal intelligence


B. Mildly retarded but educable
C. Moderately retarded but trainable
D. Completely dependent on others for care

27. Maureen, age 12, is brought to the clinic for evaluation for
a suspected eating disorder. To best assess the effects of
role and relationship patterns on the child’s nutritional intake,
the nurse should ask:

A. “What activities do you engage in during the day?”


B. “Do you have any allergies to foods?”
C. “Do you like yourself physically?”
D. “What kinds of food do you like to eat?”

28. Sudden infant death syndrome (SIDS) is one of the most


common causes of death in infants. At what age is the
diagnosis of SIDS most likely?

A. At 1 to 2 years of age
B. At I week to 1 year of age, peaking at 2 to 4 months
C. At 6 months to 1 year of age, peaking at 10 months
D. At 6 to 8 weeks of age

29. When evaluating a severely depressed adolescent, the


nurse knows that one indicator of a high risk for suicide is:

A. Depression
B. Excessive sleepiness
C. A history of cocaine use
D. A preoccupation with death

30. A child is diagnosed with Wilms’ tumor. During


assessment, the nurse in charge expects to detect:

A. Gross hematuria
B. Dysuria
C. Nausea and vomiting
D. An abdominal mass

Answers and Rationales

1. Answer C. A recent episode of pharyngitis is the most


important factor in establishing the diagnosis of
rheumatic fever. Although the child may have a history of
fever or vomiting or lack interest in food, these Ondings
are not speciOc to rheumatic fever.
2. Answer C. In an emergency, intraosseous drug
administration is typically used when a child is critically ill
and under age 3.
3. Answer D. A family’s behavioral patterns and values are
passed from one generation to the next. Cultural
background commonly plays a major role in determining
a family’s health practices. Physical characteristics do
not indicate a child’s culture. Although heritage plays a
role in culture, it does not dictate a group’s shared values
and its effect on culture is weaker than that of behavioral
patterns.
4. Answer A. Because the anterior fontanel normally closes
between ages 12 and 18 months, the nurse should notify
the doctor promptly of this Onding. An open fontanel
does not indicate abuse and is not associated with Tay-
Sachs disease.
5. Answer B. Ulcerative colitis causes profuse diarrhea,
intense abdominal cramps, anal Ossures, and abdominal
distentions are more common in Crohn’s disease.
6. Answer D. The recommended injection site for an infant
is the vastus lateralis or rectus femoris muscles. The
deltoid is inappropriate. The dorsogluteal and
ventrogluteal sites can be used only in toddlers who have
been walking for about 1 year.
7. Answer C. A negative nitrogen balance may result from
inadequate protein intake and is best detected by
measuring the total protein level. Measuring total iron-
bi8nding capacity, hemoglobin, and serum transferring
levels would help detect iron-deOciency anemia, not a
negativenitrogen balance.
8. Answer B. According to Erikson, the primary
psychosocial task during adolescence is to establish a
personal identity confusion. The adolescent attempts to
establish a group identity by seeking acceptance and
approval from peers, and strives to attain a personal
identity by becoming more independent form the family.
Becoming industrious is the developmental task of the
school-age child, achieving intimacy is the task of the
young adult, and developing initiative is the task of the
preschooler.
9. Answer B. Preschool-age children are most likely to view
illness as a punishment for misdeeds. Separation
anxiety, although seen in all age group, is most common
in older infants. Fear of death is typical of older school-
age children and adolescents. Adolescents also fear
mutilation.
10. Answer C. The nurse should obtain objective information
about the child’s nutritional intake, such as by asking
about what the child ate for a speciOc meal. The other
options ask for subjective replies that would be open to
interpretation.
11. Answer A. The most important data to obtain on a child’s
arrival in the emergency department are vital sign
measurements. The nurse should gather the other data
later.
12. Answer D. The stress of starting nursery school may
trigger a return to a level of successful behavior from
earlier stages of development. A child’s skills remain
intact, although increased stress may prevent the child
from using these skills. Growth occurs when the child
does not regress. Parents rarely desire less mature
behaviors.
13. Answer D. A child’s poor progress in school may indicate
a visual disturbance. The other options are more
appropriate questions to ask when assessing vision in a
geriatric patient.
14. Answer C. Rice cereal is the Orst solid food an infant
should receive because it is easy to digest and is
associated with few allergies. Next, the infant can receive
pureed fruits, such as bananas, applesauce, and pears,
followed by pureed vegetables, egg yolks, cheese, yogurt,
and Onally, meat. Egg whites should not be given until
age 9 months because they may trigger a food allergy.
15. Answer C. Succinycholine is an ultra-short-acting
depolarizing agent used for rapid-sequence intubation.
Bradycardia can occur, especially in children. Atropine is
the drug of choice in treating succinylcholine-induced
bradycardia. Lidocaine is used in adults only. Epineprine
bolus and isoproterenol are not used in rapid-sequence
intubation because of their profound cardiac effects.
16. Answer A. Bryant’s traction is used to treat femoral
fractures of congenital hip dislocation in children under
age 2 who weigh less than 30 lb (13.6 kg). Buck’s
extension traction is skin traction used for short-term
immobilization or to correct bone deformities or
contractures; overhead suspension traction is used to
treat fractures of the humerus; and 90-90 traction is used
to treat femoral fracture in children over age 2.
17. Answer D. Because adolescents absorb less information
through reading, providing age-appropriate reading
materials is the least effective way to teach parenting
skills to an adolescent. The other options engage more
than one of the senses and therefore serve as effective
teaching strategies.
18. Answer D. Normally the top of the ear aligns with an
imaginary line drawn across the inner and outer canthus
of the eye. Ears set below this line are associated with
renal anomalies or mental retardation. Low-set ears do
not accompany otogenous tetanus, tracheoesophageal
Ostula, or congenital heart defects.
19. Answer A. At age 3, gross motor development and
reOnement in eye-hand coordination enable a child to ride
a tricycle. The One motor skills required to tie shoelaces
and the gross motor skills requires for roller-skating and
jumping rope develop around age 5.
20. Answer A. In a child, Eustachian tubes are short and lie
in a horizontal plane, promoting entry of nasopharyngeal
secretions into the tubes and thus setting the stage for
otitis media. The nosopharynx, tympanic membrane,
external ear canal have no unusual features that would
predispose a child to otitis media.
21. Answer A. Increased urine output, a sign of improving
kidney function, typically is the Orst sign that a child with
acute poststreptoccocal glomerulonephritis (APSGN) is
improving. Increased appetite, an increased energy level,
and decreased diarrhea are not speciOc to APSGN.
22. Answer C. The primary purpose of administering
corticosteroids to a child with nephritic syndrome is to
decrease proteinuria. Corticosteroids have no effect on
blood pressure. Although they help reduce inlammation,
this is not the reason for their use in patients with
nephritic syndrome. Corticosteroids may predispose a
patient to infection.
23. Answer A. In an infant, signs of luid volume deOcit
(dehydration) include sunken fontanels, increased pulse
rate, and decreased blood pressure. They occur when the
body can no longer maintain suqcient intravascular luid
volume. When this happens, the kidneys conserve water
to minimize luid loss, which results in concentrated
urine with a high speciOc gravity.
24. Answer C. The nurse should shake a suspension before
administration to dispersed drug particles uniformly.
Diluting the suspension and crushing particles are not
recommended for this drug form.
25. Answer A. Fluid volume replacement must be calculated
to the child’s weight to avoid over-hydration. Initial luid
bolus is administered at 20 ml/kg, followed by another
20 ml/kg bolus if there is no improvement in luid status.
26. Answer B. According to the American Association on
Mental DeOciency, a person with an intelligence quotient
(IQ) between 50 and 70 is classiOed as mildly mentally
retarded but educable. One with an IQ between 35 and
50 is classiOed as moderately retarded but trainable. One
with an IQ below 36 is severely and profoundly impaired,
requiring custodial care.
27. Answer C. Role and relationship patterns focus on body
image and the patient’s relationship with others, which
commonly interrelated with food intake. Questions about
activities and food preferences elicit information about
health promotion and health protection behaviors.
Questions about food allergies elicit information about
health and illness patterns.
28. Answer B. SIDS can occur any time between 1 week and
1 year of age. The incidence peaks at 2 to 4 months of
age.
29. Answer D. An adolescent who demonstrates a
preoccupation with death (such as by talking about
death frequently) should be considered at high risk for
suicide. Although depression, excessive sleepiness, and
a history of cocaine use may occur in suicidal
adolescents, they also occur in adolescents who are not
suicidal.
30. Answer D. The most common sign of Wilms’ tumor is a
painless, palpable abdominal mass, sometimes
accompanied by an increase in abdominal girth. Gross
hematuria is uncommon, although microscopic
hematuria may be present. Dysuria is not associated
with Wilms’ tumor. Nausea and vomiting are rare in
children with Wilms’ tumor.

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