1 .

The nurse is preparing an educational program on immunizations for

parents of children 11 to 12 years of age. To ensure the information presented
is accurate for this age group, which immunizations should the nurse plan to
address?
A. Haemophilus influenza, varicella, and human papillomavirus (HPV)
B. Mumps, measles, and rubella (MMR); pneumococcal (PPSV); and hepatitis A
C. Diphtheria-tetanus-pertussis (DTaP), meningococcal, and haemophilus influenza
D. Mumps, measles, and rubella (MMR); diphtheria-tetanus-pertussis (DTaP); and hepatitis B

2. The nurse is storing vaccines for future use. What should the nurse do so
they are properly stored? Select all that apply.
A. Place all vaccines in a temperature-controlled refrigerator.
B. Complete periodic checks of the expiration date on the vaccines.
C. Place bulk supplies of vaccines in a temperature- controlled freezer.
D. Avoid storing vaccines on the shelf in the door of the refrigerator.
E. Do not store food or beverage in the same refrigerator or freezer as the vaccines.

3. The new nurse asks the experienced nurse why the first dose of the MMR
vaccine is normally given at 12 to 15 months of age and not earlier, except
with international travel. Which explanation by the experienced nurse is
correct?
A. “Giving the first dose of the vaccine at 12 to 15 months of age allows the correct interval before
the next booster at age 12 years.”
B. “A live virus is being given; the chance of measles, mumps, or rubella developing is much higher
if given at an earlier age.”
C. “A first dose at this age provides passive immunity and decreases the incidence of a child
developing any of the diseases-”
D. “If given earlier, the vaccine may neutralize the passive immunity to measles from the child’s
mother and no immunity may result.”

4. The nurse observes a colleague about to administer an IM injection to the

12-month-old. Which intervention requires the nurse to intervene?
A. Prepares to give no more than 2 mL of fluid
B. Plans to give the injection using a 1-inch needle
C. Plans to give the injection in the dorsal gluteal site
D. Plans to give the injection after applying lidocaine/ prilocaine cream
5. The nurse working on the pediatric unit has scheduled medications to
administer at this time. Which assessments should prompt the nurse to
conclude that the prescribed medication should be withheld and the HCP
immediately notified?
A. Oral hydrocodone with acetaminophen to the 10-year-old with burn injuries who is feeling dizzy
and light-headed
B. Oral acetaminophen to the 6—month-old with a fever of 102°F (389°C) from an infection who
has developed a rash
C. Clindamycin IV to the 16-year-old male with aspiration pneumonia from near-drowning who has
a BP of 92/56 mm Hg
D. Phenobarbital IV to the 5-year-old with intermit- tent seizures who states feeling tired and
appears to be drowsy

6. The nurse notes from the child’s MAR illustrated that the child is to receive
the first dose of a newly prescribed medication at 0800 hours. The drug
reference book recommends an initial pediatric dose of lamotrigine of 0.6
mg/kg/day in two divided doses for the first 2 weeks. Which action by the
nurse is most appropriate?

A. Administer the medication as written on the MAR.

B. Telephone the health care provider to question the dose.
C. Ask the parent If this is the dose the child had been taking.
D. Consult the pharmacist to verify whether the dose is correct.
7. The hospitalized child who has a blood lead level of 50 mcg/dL is to receive
succimer 10 mg/kg oral capsule q8h for 5 days. The child weighs 20 kg. Which
intervention by the student nurse should be corrected by the observing
nurse?

A. Prepares to give the total dose of one 1OO-mg capsule with applesauce
B. Sprinkles the beads of two 1OO-mg capsules into pudding for administration
C. Offers fluids frequently during the shift to increase the child’s urine output
D. Explains to a parent that chelation therapy removes the lead from the blood

8. The child, admitted to the ED, is experiencing nausea and vomiting,

salivation, respiratory muscle weakness, and depressed reflexes an hour after
exposure to pesticides. Which medications should the nurse anticipate
administering to the child?
A. Atropine and flumazenil
B. Atropine and pralidoxime
C. Epinephrine and naloxone
D. Epinephrine and digoxin immune Fab

9. The 5-year-old is receiving an IV infusion of D5 with 0.45 NaCl at 100 mL/hr.

Which assessment findings suggest excessive parenteral fluid intake? Select
all that apply.
A. Dyspnea
B. Lethargy
C. Gastric distention
D. Crackles in lung bases
E. Temperature of 102°F (389°C)

10. The nurse has completed swaddling the 2-month-old infant, prepared
supplies to cannulate the scalp vein for an IV infusion, and cleansed and
shaved the hair at the site over the temporal bone. Place the remaining steps
in the order that they should be performed by the nurse.
A. Return in 60 minutes and reswaddle the infant ill a mummy restraint.
B. With an assistant holding the infant’s head, insert a scalp vein needle and observe for
blood return.
C. Apply lidocaine/prilocaine cream to the site selected and unswaddle the infant after the
cream application.
D. Cleanse the shaved area with an antiseptic solution.
E. Remove the mummy restraint after initiating the infusion and comfort the infant.
F. Initiate the infusion and cover the infusion needle with a gauze dressing.
11 . The 8-year-old child with gastroenteritis is prescribed to receive 500 mL
of lactated Ringer’s (LR) solution over the next 10 hours. How many milliliters
per hour should the nurse administer? __________ mL (Record your answer as a
whole number.)

12. The new nurse is initiating TPN for four hospitalized pediatric clients. The
experienced nurse should intervene when observing the new nurse attach the
TPN infusion tubing to which IV line?
A. The catheter inserted in the right external jugular vein of the 2-year-old
B. The catheter inserted in the right subclavian vein of the 4-year-old
C. The peripherally inserted IV catheter in a hand vein of the l2-year—old
D. The PICC located in the right upper arm of the 6-year-old

13. The child with CF is prescribed vitamin A supplements. Which finding by

the clinic nurse indicates that the vitamin has been effective?
A. Skill is supple and healthy.
B. Viscosity of secretions is decreased.
C. Number of bleeding episodes is reduced-
D. Pancreatic enzyme absorption is increased.

14. The child with CF is receiving albuterol. Which response should the nurse
expect if albuterol is achieving the desired therapeutic effect?
A. Increased heart rate
B. Improved weight gain
C. Fewer hospitalizations
D. Fewer adventitious lung sounds

15. While the nurse is completing the assessment of the child with Reye’s
syndrome, the parent states that multiple OTC medications were given before
hospitalization to treat the child’s influenza symptoms. Which medication
stated by the parent is most important for the nurse to report to the HCP?
A. Acetaminophen
B. Bismuth subsalicylate
C. Pseudoephedrine
D. Diphenhydramine

16. The nurse is caring for the child from Italy. The child is crying, and the
interpreter is stating that the child has extreme pain. What should be the
nurse’s priority?
A. Administer morphine sulfate 1 mg intravenously as prescribed.
B. Have the child’s mother, who knows limited English, ask the child what hurts.
 C. Assess the level of the child’s pain using an appropriate FACES pain rating scale.
D. Ask the HCP to change the pain medication dosage due to inadequate pain control.

17. The HCP prescribed a dose of acetaminophen according to weight

recommendations for the child weighing 48 1b. The package insert states that
the recommended dose is 15 mg per kg. What dose should the nurse
administer? _____ mg (Record your answer as a whole number.)

18. The adolescent, who is receiving morphine sulfate via PCA, has itching.
Which medication listed on the client’s MAR should the nurse plan to
administer to relieve the itching?
A. Diazepam
B. Diphenhydramine
C. Naloxone hydrochloride
D. Butenafine hydrochloride

19. The nurse is preparing to administer morphine sulfate IV to the child in severe pain. The child has an
IV infusion of DSW at 50 mL/hr through a PICC. Which intervention is best when administering the
medication?

A. Disconnect the infusion, inject 3 mL of normal saline, and give the morphine sulfate
undiluted.
B. Question the prescribed medication because morphine sulfate cannot be given through
a PICC line.
C. Give the morphine sulfate undiluted into the existing IV tubing’s medication port closest
to the child-
D. Dilute the morphine sulfate with 5 mL of NS and give over 5 minutes into the IV tubing
port closest to the child.

20. The HCP’s progress notes state a plan to initiate an oral NSAID for the
child’s pain. Based on this information, the nurse should consult with the HCP
when noting that which medication was the only analgesic prescribed?
A. Naproxen
B. Tolmetin
C. Ibuprofen
D. Hydromorphone
21 . A dose of albuterol 5 mg by nebulization is prescribed for the pediatric
client experiencing wheezing from an asthma episode. The medication vial
contains 2.5 mg per 3 mL. How many milliliters of medication should the
nurse prepare for administration by nebulization? _________ mL (Record your
answer as a whole number.)

22. The home care nurse is observing the child with asthma self-administer a
dose of albuterol via a metered-dose inhaler with a spacer. Within a short
time, the child begins to wheeze loudly. What should the nurse do?
A. Reassure the parent that this usually only occurs with the initial dose.
B. Notify the HCP; wheezing may indicate paradoxical bronchospasms.
C. Consult with the HCP to have the child’s medication dosage increased.
D. Reassess the technique; eye contact with albuterol can cause wheezing.

23. The parent of the 2—year—old with asthma has been given instructions
about asthma control and Step Therapy. Which statement, if made by the
parent, should indicate to the nurse that the parent has an adequate
understanding of the instructions?
A. “If my child has wheezing twice a week or less, I should add the nebulized corticosteroid
and make an appointment.”
B. “If my child has a respiratory tract infection I should add the nebulized corticosteroid
and make an appointment.”
C. “If my child has to use the nebulizer less than twice a week, I should add the nebulized
corticosteroid and make an appointment.”
D. “If my child has nighttime awakenings with wheezing twice a month or more, I should
add the nebulized corticosteroid and make an appointment.”

24. The 3-year-old with LTB is receiving aerosolized racemic epinephrine.

Which assessment finding should the nurse recognize as indicating that the
treatment is having an adverse effect?
A. Heart rate of 180 beats/min
B. Blood pressure of 60/40 mm Hg
C. Respiratory rate of 25 breaths/min
D. Pulse oximetry of 90% on room air
25. The initial treatment regimen of isoniazid, rifampin, and ethambutol is
prescribed for the adolescent who has a positive tuberculin skin test. The
client confides that she thinks she may be pregnant and asks if she should be
taking these medications. Which rationale should be the basis for the nurse’s
response?
A. These drugs cross the placental barrier, and treatment should be withheld until the
postpartum period.
B. The medications should be taken, but the diagnosis is an indication for tennination of
the pregnancy.
C. The medications should be postponed because the risk for hepatitis is greatly increased
ill the intrapartum period.
D. The medications should be taken; untreated TB represents a far greater hazard to the
pregnant woman and her fetus.

26. The HCP prescribes amoxicillin for the 8—month-old with acute otitis
media that has not resolved- Which statement to the parents is correct
regarding the primary purpose of amoxicillin?
A. “It will reduce the child’s fever.”
B. “It will reduce the child’s severe ear pain.”
C. “lit will shrink swollen tissue in the Eustachian tube.”
D. “It will treat the probable organism, Haemoplrilus influenzae.”
27. The nurse is assessing the child’s ear with an otoscope prior to
administering medications to treat persistent otitis media. Which assessment
finding should the nurse expect?
ANSWER: A

A. This illustration shows otitis media characterized by a bulging contour to the tympanic
membrane, unclear ossicular landmarks, and yellowish middle ear effusion.
B. This illustration shows a perforated meanic membrane, not otitis media.
C. This illustration shows a normal left ear tympanic membrane. The ossicular landmarks
can be identified through the tympanic membrane. The nurse would not expect to see a
normal tympanic membrane when the child has persistent otitis media.
D. This illustration shows the presence of a foreign body in the ear canal.
28. The child weighing 20 kg is to receive ceftriaxone 2 g IVPB q12h and
dexamethasone 3 mg IV—push q6h for 4 days to treat Haemopllilus influenzae
type b meningitis. The drug reference states that the usual dose of ceftriaxone
is 100 mg/kg/dose with a maximum daily dose of 4 g. The recommended dose
of dexamethasone for treating H. influenzae type b meningitis is 0.15 mg/kg
q6h for 2 to 4 days. Based on the medications prescribed and these findings,
which conclusion by the nurse is correct?
A. The dose of ceftriaxone is too high.
B. The dose of dexamethasone is too low.
C. Both medications are safe to administer as Prescribed.
D. The ceftriaxone should be given before the Dexamethasone.

29. The 12-year-old weighing 50 kg is hospitalized with bacterial pneumonia

and an upper respiratory tract infection. The nurse is reviewing the child’s
serum laboratory report illustrated. Based on the findings, which HCP order is
most important for the nurse to question?
 A. Amikacin sulfate 375 mg IVPB q12h
B. Guaifenesin 50-100 mg q4h pm for cough
C. Dextrose 5% in 0.25 NaCl with 20 mEq/L KCL at 90 mL/hr
D. Acetaminophen 325—650 mg q4—6h prn, not to exceed 3000 ing/24 hr

30. The nurse is teaching the 14-year-old who is being given captopril for the
first time. Which explanation would be most appropriate?
A. “Captopril will help to control your asthma.”
B. “Captopril will help to control your heart rate.”
C. “Captopril will help to control your blood sugar.”
D. “Captopril will help to control your blood pressure.”
31 . The HCP orders a digitalizing dose of digoxin 225 mcg IV now to be given
to a 3-year—old. The pharmacy sends a solution of 500 mcg in 50 mL Of D 5W.
How many mL should the nurse administer? ____ mL (Round your answer to
the nearest tenth.)

32. The nurse is discharging the child with sickle cell disease who has
undergone a splenectomy. The child has an allergy to penicillin. The nurse
should anticipate teaching about which prophylactic medication?
A. Epoetin
B. Amoxicillin
C. Morphine sulfate
D. Erythromycin ethylsuccinate
33. The 16-year-old, hospitalized for barbiturate overdose, is receiving low-
dose dopamine at 1 mcg/kg/min. Which finding in the client’s medical record
illustrated should prompt the nurse to conclude that dopamine is effective?

A. Decrease in PACs
B. Increase in urine output
C. Decrease in pulse pressure
D. Increase in the diastolic BP

34. The nurse is showing the parents the preferred site for their child’s insulin
administration via an insulin pump. Place an X within the oval for the
preferred site.
The abdomen allows for a more consistent rate of absorption of insulin and is the preferred site for
insulin administration via an insulin pump; it can be placed on either side of the umbilicus. The site is
rotated within the abdominal area (green shaded area of the abdomen). More rapid absorption of
insulin can occur when administered into the arms or legs.

35. The l1-year—old with type 1 DM is learning to use insulin pens for basal-
bolus insulin therapy with both a very-long-acting insulin and rapid-acting
insulin. Which action by the child should indicate to the nurse that additional
teaching is needed?
A. The child holds the insulin glargine pen against the skin for 10 seconds after
administering the correct amount of insulin.
B. The child counts the number of carbohydrates eaten at breakfast and selects the insulin
lispro pen for covering the carbohydrates eaten.
C. The child counts the number of carbohydrates eaten at lunch and selects the insulin
glargine pen for covering the carbohydrates eaten.
D. The child determines that the blood glucose level at bedtime is within the normal range,
eats a piece of turkey, and tells the nurse that coverage is not needed with insulin lispro.

36. The nurse completes teaching insulin administration to the parent of the
toddler newly diagnosed with type 1 DM. The nurse concludes that the
teaching was successful when the parent makes which statement?
A. “NPH insulin is only given at night immediately before the bedtime snack.”
B. “I should use only the buttocks for the insulin injections until the child is older.”
C. “Insulin lispro acts within 15 minutes and peaks 30 to 90 minutes after injection.”
D. “Insulin detemir can be added to the insulin lispro pen to reduce the number of
injections.”
37. The nurse is evaluating the effectiveness of lispro and glargine insulins
being administered to the 2-year-old with type 1 DM. Which findings 011 the
serum laboratory report indicate that treatment is effective? Place an X next
to each laboratory result that reflects that treatment is effective-

The treatment goal for children with type 1 DM is blood glucose levels within the normal range (60—105
mg/dL for a 2-year-old). Hgb A“. levels are indicative of the average blood glucose levels over the past 2
to 3 months; normal A1c is 3.9% to 7.7 0/o. Although the other laboratory values are normal, these do
not indicate the effectiveness of insulin therapy.
38. The parent of the child brought to the ED states to the nurse, “My child is
sweaty and shaky; I think some of my medication is gone.” The parent hands
the nurse the medication bottle illustrated- Which action should the nurse
take first?

A. Start an infusion of D5W at 40 mL./hr.

B. Give glucagon 1 mg subcutaneously-
C. Check the child’s blood glucose level.
D. Determine how many tablets were taken.

39. Trimethoprim-sulfamethoxazole is prescribed for the child who develops

a UTI. What infonnation should the nurse address when teaching the parents
about administering the medication? Select all that apply.
A. Weigh the child daily ill the morning.
B. Take the child’s temperature once daily.
C. Encourage the child to drink plenty of fluids.
D. Administer the medication at the prescribed times.
E. If a rash occurs, report this immediately to the HCP-

40. The 9—year-old with SLE is receiving large doses of prednisolone- Which
laboratory finding should the nurse recognize as an untoward effect of the
medication?
A. Total bilirubin of 4 mg/dL
B. WBC count of 18,000/mm3
 C. Serum sodium of 130 mEq/L
D. Random glucose of 130 mg/dL

41 . The child is to start on medication therapy for enuresis that has not
resolved with behavioral interventions. Which medication should the nurse
anticipate being prescribed for the child?
A. Lorazepam
B. Desmopressin
C. Nitrofurantoin
D. Spironolactone

42. Oral ranitidine 2 mg/kg twice daily is prescribed for the infant weighing
16 lb 8 oz. The medication is supplied as 15 mg/mL. How many milliliters
should the nurse instruct the parent to withdraw in the syringe provided with
the ranitidine to administer one dose?

___________ mL (Record your answer as a whole number.)

43. The nurse is reviewing information for the 6-month-old who is being given
ranitidine. Which filldillg should the nurse identify as an adverse effect of
ranitidine?
A. A heart rate of 110 bpm
B. Oral temperature of 102.7°F (393°C)
C. Spitting up some formula after each feeding
D. A hard, pebble-like bowel movement every 2 days

44. The 14-year-old who has GERD is receiving lansoprazole. Which response
should the nurse expect if lansoprazole is achieving the desired therapeutic
effect?
A. Increased appetite
B. Increased GI motility
C. Decreased epigastric pain
D. Decreased rectal flatulence

45. The nurse is preparing to care for the 14-month-old newly hospitalized
toddler with bacterial gastroenteritis and severe dehydration- Which initial
collaborative interventions should the nurse expect to implement? Select. all
that apply.
A. IV antibiotic to treat infection
B. Oral fluids for fluid rehydration
 C. 1V fluid therapy for rehydration
D. Analgesics for pain and discomfort
E. An antidiarrheal to control diarrhea
F. Antipyretic for elevated temperature

46. The nurse is preparing to administer IV fluids to the 13-kg child who has
dehydration. The daily IV fluid requirement is to administer 1000 mL / 50
mL/kg over 10 kg. How many milliliters per hour should the nurse calculate to
administer the IV therapy correctly?

____________ mL/hr (Record your answer as a whole number)

47. The 6-month-old hospitalized with dehydration is being rehydrated with

IV fluids. Which findings should indicate to the nurse that the treatment is
having the desired effect? Select all that apply.
A. Flat fontanelle
B. Absence of crying
C. Light yellow urine
D. Rapid respirations
E. Moist mucous membranes

48. The nurse is developing the plan of care for the 7-year-old with encopresis
who has been started on lactulose. Which outcome would be most appropriate
for the nurse to establish?
A. 2-pound weight gain
B. Nighttime continence
C. Blood glucose 70—1 10 mg/dL
D. Normal bowel movement daily

49. The clinic nurse is teaching the parent how to give eye drops to the 3-year
—old who has bacterial conjunctivitis and purulent drainage out of both eyes,
swollen eyelids, and inflamed conjunctiva. What information should the
nurse provide?
A. Restrain the child prior to administering the eye drops.
B. Have the child sitting when administering the eye drops.
C. Place the child in a head-down position to instill the eye drops-
D. Obtain the child’s cooperation by describing the procedure in detail.
50. The clinic nurse is reviewing prescriptions with the parents of the school-
aged child with newly diagnosed generalized contact dermatitis. Which
prescription should the nurse question with the HCP?
A. Oral prednisone
B. Calamine lotion
C. Oral diphenhydramine
D. Hydrocortisone cream

51 . Methylphenidate hydrochloride is prescribed for the child with ADHD.

The nurse should teach the parents to administer the medication in which
way?
A. Whenever the child exhibits inattention behaviors
B. Whenever the child exhibits hyperactive behaviors
C. With a snack before bed to calm the child for sleep
D. During or after meals if the medication decreases appetite

52. The nurse is administering Phenobarbital 300 mg IV to the child weighing

18 kg who is in status epilepticus. Which actions should the nurse take to
safely administer the medication? Select all that apply.
A. Administer the phenobarbital over 20 minutes.
B. Monitor the IV site for signs of extravasation.
C. Dilute the phenobarbital dose in 10 mL DSW.
D. Administer the phenobarbital via IV piggyback.
E. Identify incompatible medications or solutions being infused.
F. Inject the phenobarbital over 10 minutes in the port closest to the child.

53. The 4-year-old with meningitis is to receive ceftriaxone 750 mg IVPB over
30 minutes. The pharmacy provided 750 mg in 50 mL DSW to be infused IVPB
through a microdrip infusion sys- tem (tubing drop factor 60 gtt/min). At what
rate, in gtt per min, should the nurse program the IVPB pump?

________ gtt/min (Record your answer as a whole number.)

54. The 17-year-old female is about to have a drug screen test for
employment. The adolescent tells the nurse of a recent UTI that was treated
with antibiotics- Which antibiotic, if identified by the client, could produce a
false-positive urine screening test for opioids?
A. Cephalexin
B. Ceftazidime
C. Amoxicillin
D. Ciprofloxacin

55. The nurse is assessing the 13-year-old who has been taking somatropin
recombinant. Which findings should the nurse report to an HCP?
A. Erythematous palmar rash
B. Blood pressure of 122/74 mm Hg
C. Random blood glucose of 158 mg/dL
D. X-ray report noting epiphyseal closure

56. The 16-year-old is taking acyclovir. Which statement, if made by the

adolescent, should indicate to the nurse that the medication is having the
desired therapeutic effect?
A. “I am having a regular menstrual cycle now.”
B. “That bad odor from my vagina is now gone.”
C. “All those sores on my labia are getting better.”
D. “I don’t have that green vaginal discharge anymore.”
57. The nurse is developing the plan of care for the 4-year-old client who is
taking metronidazole for giardiasis. Which measures should be included in
the plan of care? Select all that apply.
A. Assess cardiac status.
B. Assess for signs of infection.
C. Reinforce strict hand washing.
D. Give metronidazole with food.
E. Monitor results of stool samples.

58. The nurse is concerned that the adolescent may be developing a side effect
of methotrexate. Which test or exam results should the nurse review prior to
administration?
A. Folic acid level
B. Serum electrolytes
C. Complete blood count
D. Activated partial prothrombin time

59. Prior to administering filgrastirn, the nurse reviews the laboratory report
results for the 3-year-old who completed the second round of chemotherapy
three weeks ago. Which finding indicates a therapeutic response to filgrastim?
A. Hematocrit of 31%
B. Eosinophil count of 6%
3
C. WBC count of 6800/mm
3
D. Platelet count of 150,000/mm

60. The nurse is teaching the parent of the 3-year—~old being treated with
vincristine sulfate for Wilms’ tumor. The nurse should inform the parents to
immediately notify the HCP of which most significant adverse effect?
A. The child develops diarrhea-
B. The child’s hair begins to fall out.
C. The child develops dysphagia and paresthesia.
D. 4- The child has signs or symptoms of depression.