Test Bank for Essentials of Pediatric Nursing, 1st

Edition: Theresa Kyle

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Test Bank for Essentials of Pediatric Nursing, 1st Edition: Theresa Kyle

1. When providing care to a newborn infant who was born at 29 weeks' gestation, the
nurse integrates knowledge of potential complications, being alert for signs and
symptoms of which of the following?
A) Neonatal conjunctivitis
B) Facial deformities
C) Intracranial hemorrhage
D) Incomplete myelinization
Ans: C
Feedback:
Premature infants have more fragile capillaries in the periventricular area than term
infants, which puts them at greater risk for intracranial hemorrhage. Neonatal
conjunctivitis can occur in any newborn during birth and is caused by viruses, bacteria,
or chemicals. Facial deformities are typical of babies of alcoholic mothers. Incomplete
myelinization is present in all newborns.

2. The nurse knows that children have larger heads in relation to the body and a higher
center of gravity. When developing a teaching plan for parents, the nurse includes
information about an increased risk for which of the following problems?
A) Febrile seizures
B) Head trauma
C) Caput succedaneum
D) Posterior plagiocephaly
Ans: B
Feedback:
The larger head size in relation to the body, coupled with a higher center of gravity,
causes children to hit their head more readily when involved in motor vehicle accidents,
bicycle accidents, and falls. Febrile seizures are not related to anatomy or physiology.
Caput succedaneum is an edematous area on the scalp caused by pressure of the uterus
or vagina during head-first delivery. Posterior plagiocephaly is caused by early closure
of the lamboid suture.

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3. The nurse is caring for a child hospitalized with Reye syndrome who is in the acute
stage of the illness. The nurse would assess the child most carefully for which of the
following?
A) Indications of increased intracranial pressure
B) An increase in the blood glucose level
C) A decrease in the liver enzymes
D) A presence of protein in the urine
Ans: A
Feedback:
Reye syndrome is characterized by brain swelling, liver failure, and death in hours if
treatment is not initiated. Therefore, increased intracranial pressure could occur. Liver
enzyme levels typically increase. Blood glucose levels and protein in the urine are not
characteristic of this illness.

4. The physician has ordered rectal diazepam (Valium) for a 2-year-old boy with status
epilepticus. Which of the following instructions is essential for the nurse to teach the
parents?
A) Monitor their child's level of sedation.
B) Watch for fever indicating infection.
C) Gradually reduce the dosage as seizures stop.
D) Monitor for an allergic reaction to the medication.
Ans: A
Feedback:
Diazepam is useful for home management of prolonged seizures and requires that the
parents be educated on its proper administration. Monitoring the child's level of sedation
is key when giving diazepam because it slows the central nervous system. Parents need
to monitor the overall health of the child, including temperature when needed, but that
has nothing to do with the diazepam. When the use of an anticonvulsant is stopped,
gradual reduction of the dosage is necessary to prevent seizures or status epilepticus.
This is not done without a physician's order. Monitoring for allergic reactions is
necessary when any medications have been prescribed, but is not specific to diazepam.

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5. As a result of seizure activity, a computed tomography (CT) scan was performed and
showed that an 18-month-old child has intracranial arteriovenous malformation. When
developing the child's plan of care, the nurse would expect to implement actions to
prevent which of the following?
A) Drug interactions
B) Developmental disabilities
C) Hemorrhagic stroke
D) Respiratory paralysis
Ans: C
Feedback:
Intracranial hemorrhage or hemorrhagic stroke is a risk for children with intracranial
arteriovenous malformation. Drug interactions are a risk for children who are treated
with combinations of anticonvulsants for epilepsy. Children with hydrocephalus are at
an increased risk for developmental disabilities. Respiratory paralysis is a risk of
botulism that typically affects infants younger than 6 months of age.

6. A 16-year-old boy complains to the school nurse of headaches and a stiff neck. Which
of the following signs and symptoms would alert the nurse that the child may have
bacterial meningitis?
A) Fixed and dilated pupils
B) Frequent urination
C) Sunset eyes
D) Sunlight is “too bright”
Ans: D
Feedback:
Photophobia, or intolerance of light, is another symptom of bacterial meningitis. Fixed
and dilated pupils are a symptom of head trauma and warrant prompt intervention.
Frequent urination is a symptom of a type I Arnold-Chiari malformation. Sunset eyes
indicate increased intracranial pressure typical of hydrocephalus.

7. A 4-year-old boy has a febrile seizure during a well-child visit. Which of the following
would be a priority?
A) Hyperextending the child's head while placing him on his side
B) Using a tongue blade to pry open the child's jaw
C) Loosening the child's clothing to ensure a patent airway
D) Protecting the child from harm during the seizure
Ans: D
Feedback:
During a seizure, the child should not be held down in a specific position. Protecting the
child's head and body during the seizure is the priority. Ensuring a patent airway is an
important intervention but is not accomplished by loosening the child's clothing or
hyperextending his head. The child should be placed on his side and nothing should be
inserted into his mouth to forcibly open the jaw.

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8. The nurse has developed a teaching plan for the family of a 2-year-old boy who holds
his breath when he gets frustrated. Which of the following will be most important to
include in this plan?
A) Provide cuddle time whenever the child begins to act out.
B) Explain the child's behavior to the parents.
C) Encourage the parents to interact more with the child.
D) Stay close to prevent injury when he gets frustrated.
Ans: D
Feedback:
Encourage the parents to maintain a safe environment when an episode is occurring, but
to avoid giving extra attention to the child after the event since this could encourage
repetition of the behavior. It is important for the parents to understand what is
happening, but rewarding the child with cuddle time when he is misbehaving provides
incorrect reinforcement of behaviors. Encouraging the parents to interact more with the
child may be helpful, but the priority is safety for the child.

9. The nurse is caring for an 8-year-old boy who has chronic epilepsy. Which of the
following would be most important to address when teaching the child and parents
about living with this condition?
A) Multiple corrective surgeries to slowly remove diseased parts of his brain
B) Physical, occupational, and speech therapy to maximize his potential
C) Support for maintaining self-esteem because of his altered lifestyle
D) Hyperventilation therapy to counteract the periods of decreased oxygenation
Ans: C
Feedback:
The effects of living with a seizure disorder can be devastating, and it is essential for the
child to receive support to maintain self-esteem. While corrective surgery is possible, it
would only be performed once. Physical, occupational, speech, and hyperventilation
therapy are not indicated for treatment of epilepsy.

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10. A 4-year-old boy has a history of seizures and has been started on a ketogenic diet.
Which of the following food selections would be most appropriate for his lunch?
A) Fried eggs, bacon, and iced tea
B) A hamburger on a bun, French fries, and milk
C) Spaghetti with meatballs, garlic bread, and a cola drink
D) A grilled cheese sandwich, potato chips, and a milkshake
Ans: A
Feedback:
The ketogenic diet involves a high intake of fats, adequate protein intake, and a very
low intake of carbohydrates, resulting in a state of ketosis. The child is kept in a mild
state of dehydration. Eggs and bacon are high in fat; the tea does not contain any
carbohydrates. Therefore, this is the best choice. The hamburger is fat and protein, the
bun is a carbohydrate, and the French fries and the milk both contain fat and protein, but
both contain a lot of carbohydrates. The pasta and the sauce for the spaghetti are
carbohydrates, the meatballs are protein, and the garlic bread is a carbohydrate, as is the
cola drink. The grilled cheese sandwich has the fat and protein from the cheese, but the
bread and chips are primarily carbohydrates, and the milkshake has fat, protein, and
carbohydrates. Only the selection in A contains a ketogenic meal.

11. A child with increased intracranial pressure is being treated with hyperventilation. The
nurse understands the need for this treatment is based on which of the following?
A) PaCO2 levels decrease, causing vasoconstriction.
B) Drainage of cerebrospinal fluid occurs.
C) Activity is controlled via a stimulator.
D) Hyperexcitability of the nerves is reduced.
Ans: A
Feedback:
Hyperventilation decreases PaCO2, which results in vasoconstriction and therefore
decreases intracranial pressure. A shunt would allow for drainage of cerebrospinal fluid.
A vagal nerve stimulator is used to provide an appropriate dose of stimulation to
manage seizure activity. Anticonvulsants decrease the hyperexcitability of nerves.

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12. The nurse assesses a child's level of consciousness, noting that the child falls asleep
unless he is stimulated. The nurse documents this finding as:
A) Confusion
B) Obtunded
C) Stupor
D) Coma
Ans: B
Feedback:
Obtunded is a state in which the child has limited responses to the environment and falls
asleep unless stimulation is provided. Confusion involves disorientation; the child may
be alert but responds inappropriately to questions. Stupor exists when the child responds
only to vigorous stimulation. Coma is a state in which the child cannot be aroused even
with painful stimuli.

13. During a well-child visit, the nurse assesses an infant's ability to suck on a pacifier. The
nurse is assessing which cranial nerve?
A) Olfactory
B) Trigeminal
C) Facial
D) Accessory
Ans: B
Feedback:
To test the trigeminal nerve, the nurse would note the strength of the infant's suck on a
pacifier, thumb, or bottle. The olfactory nerve is not assessed in infants and young
children. The facial nerve is assessed by noting the symmetry of facial expressions. For
the infant, this would be assessed during spontaneous crying or smiling. The accessory
nerve is assessed when the infant is in the sitting position and symmetry of the head
position is noted.

14. The nurse inspects the eyes of a child and observes that the sclera is showing over the
top of the iris. The nurse documents this finding as:
A) Decorticate posturing
B) Nystagmus
C) Doll's eye
D) Sunsetting
Ans: D
Feedback:
Sunsetting is when the sclera of the eyes is showing over the top of the iris. Decorticate
posturing includes adduction of the arms, flexion at the elbows with the arms held over
the chest, and flexion of the wrists with both hands fisted and the lower extremities
adducted and extended. Nystagmus is manifested by involuntary rapid rhythmic eye
movements. Doll's eye is a maneuver that tests for symmetric eye movement to the
opposite side when the head is turned in the other direction.

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15. Which of the following would lead the nurse to suspect that a child is beginning to
develop increased intracranial pressure?
A) Bradycardia
B) Cheyne-Stokes respirations
C) Fixed, dilated pupils
D) Projectile vomiting
Ans: D
Feedback:
Projectile vomiting is an early sign of increased intracranial pressure. Bradycardia,
Cheyne-Stokes respirations, and fixed dilated pupils are late signs of increased
intracranial pressure.

16. A nurse is talking with the parents of a child who has had a febrile seizure. The nurse
would integrate an understanding of which of the following into the discussion?
A) The child's risk for cognitive problems is greatly increased.
B) Structural damage occurs with febrile seizure.
C) The child's risk for epilepsy is now increased.
D) Febrile seizures are benign in nature.
Ans: D
Feedback:
Parents need reassurance that febrile seizures, although frightening, are benign in nature.
Children who experience one or more febrile seizures are at no greater risk of
developing epilepsy than the general population. No evidence exists that febrile seizures
cause structural damage or cognitive declines.

17. A nurse is preparing a school-aged child for a lumbar puncture. The nurse would expect
to position the child in which manner?
A) On her side with the head flexed forward and knees flexed to the abdomen
B) Sitting upright with the head flexed forward to the chest
C) Supine with arms and legs pronated and extended
D) Prone with the arms flexed under the chest
Ans: A
Feedback:
When a lumbar puncture is performed on a child, the child is placed on his or her side
with the head flexed forward and knees flexed to the abdomen. An infant would be
positioned sitting upright with the head flexed forward. A supine position with the arms
and legs pronated and extended suggests decerebrate posturing. A prone position is not
used for a lumbar puncture.

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18. A group of nursing students are reviewing information related to seizures that occur in
infants and children. The students demonstrate a need for additional review when they
identify which type as common in neonates?
A) Tonic
B) Focal clonic
C) Multifocal clonic
D) Myoclonic
Ans: D
Feedback:
Five major types of seizures have been recognized in the neonatal period: subtle, tonic,
focal clonic, multifocal clonic, and myoclonic. Of these, myoclonic seizures rarely
occur during the neonatal period. Subtle seizures affect preterm and full-term neonates.
Tonic seizures primarily occur in preterm neonates. Focal clonic and multifocal clonic
are more common in full-term neonates.

19. Hydrocephalus is suspected in a 4-month-old infant. Which of the following would the
nurse expect to assess?
A) Sunken fontanels
B) Diminished reflexes
C) Lower extremity spasticity
D) Skull symmetry
Ans: C
Feedback:
Hydrocephalus is manifested by spasticity of lower extremities, bulging fontanels, brisk
reflexes, and skull asymmetry.

20. A nurse is providing teaching to the parents of a child who has had a shunt inserted as
treatment for hydrocephalus. The parents demonstrate understanding of the teaching
when they state which of the following?
A) “Having the shunt put in decreases his risk for developmental problems.”
B) “If he doesn't get an infection in the first week, the risk is greatly reduced.”
C) “He will need more surgeries to replace the shunt as he grows.”
D) “The shunt will help to prevent any further complications from his disease.”
Ans: C
Feedback:
Parents need to know that hydrocephalus is a chronic illness that requires lifelong
follow-up and regular evaluations, including future surgeries as the child grows. The
risk for infection is ever present, but is most common 1 to 2 months after shunt
placement. The child with a shunt and hydrocephalus is at risk for potential growth and
developmental disabilities as well as complications such as infection and malfunction of
the shunt.

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21. A nurse is preparing a presentation for an expectant parent group about neural tube
defects and prevention. Which of the following would the nurse emphasize?
A) Smoking cessation
B) Aerobic exercise
C) Increased calcium intake
D) Folic acid supplementation
Ans: D
Feedback:
The cause of neural tube defects is unknown, but there is strong evidence to support the
use of folic acid supplementation for prevention. Smoking cessation and aerobic
exercise are general health recommendations unrelated to neural tube defects. Increased
calcium intake is important for fetal growth and development, but it is not linked to
preventing neural tube defects.

22. A 15-year-old adolescent is brought to the emergency department by his parents. The
adolescent is febrile with chills that started suddenly. He states, “I had a sinus infection
and sore throat a couple of days ago.” The nurse suspects bacterial meningitis based on
which of the following? Select all answers that apply.
A) Complaints of stiff neck
B) Photophobia
C) Absent headache
D) Negative Brudzinski sign
E) Vomiting
Ans: A, B, E
Feedback:
In addition to the adolescent's complaints and history, other findings suggesting
bacterial meningitis include complaints of a stiff neck, photophobia, headache, positive
Brudzinski sign, and vomiting.

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23. A child is brought to the emergency department after sustaining a concussion. The child
is to be discharged home with his parents. Which of the following would the nurse
include in the child's discharge instructions?
A) “Expect his headache to get worse initially and then disappear.”
B) “Wake him every 2 hours to check his movement and responses.”
C) “Call your medical provider if he vomits more than five times.”
D) “Any watery fluid draining from his ears is normal.”
Ans: B
Feedback:
The nurse should instruct the parents to wake the child every 2 hours to ensure that he
moves normally and wakes enough to recognize and respond appropriately to them. The
parents should be instructed to call the physician or nurse practitioner or bring the child
back to the emergency department if he experiences a constant headache that gets
worse, vomits more than two times, or has oozing of blood or watery fluid from his ears
or nose.

24. A nurse is preparing a presentation for a local health fair about meningitis and has
developed a display that lists the following causes:
Streptococcus group B
Haemophilus influenzae type B
Streptococcus pneumoniae
Neisseria meningitidis
Which of these would the nurse highlight as the most common cause of meningitis in
newborns?
A) Streptococcus group B
B) Haemophilus influenzae type B
C) Streptococcus pneumoniae
D) Neisseria meningitides
Ans: A
Feedback:
Meningitis due to Streptococcus group B along with Escherichia coli is most common
in newborns and infants. H. influenzae type B is a common cause in infants between the
ages of 6 and 9 months. S. pneumoniae and N. meningitides are common causes in
children older than 3 months and in adults.

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25. A group of students are reviewing information about head injuries in children. The
students demonstrate understanding of this information when they identify which of the
following as the most common type of skull fracture in children?
A) Linear
B) Depressed
C) Diastatic
D) Basilar
Ans: A
Feedback:
The most common type of skull fracture in children is a linear skull fracture, which can
result from minor head injuries. Other, less common types of skull fractures in children
include depressed, diastatic, and basilar.

26. During class, a student states, “I didn't think children could have strokes. I thought this
only occurred in older adults.” When responding to the student, which of the following
would be most important for the instructor to integrate into the response?
A) Strokes in children often have an identifiable cause.
B) The signs and symptoms in children are different from an adult.
C) Research has identified specific treatments for children.
D) Ischemic strokes are more common than hemorrhagic strokes.
Ans: D
Feedback:
In children, ischemic strokes are more common than hemorrhagic strokes. However, the
cause of the stroke in many children remains unidentified. Signs and symptoms are
similar to those in adults and will vary based on age; underlying cause, if known; and
location of the stroke. Historically, children have been excluded from adult stroke
studies and thus, many treatments used have had to be adapted from adult studies.

27. A 10-month-old is brought to the emergency department by her parents after they found
her face down in the bathtub. The mother said, “I just left the bathroom to answer the
phone. When I came back, I found her.” Which of the following assessments would be
the priority?
A) Airway, breathing, and circulation
B) Level of consciousness
C) Vital signs
D) Pupillary response
Ans: A
Feedback:
With a submersion injury, hypoxia is the primary problem. Therefore, assessment of
airway, breathing, and circulation are the priority assessments for which the nurse would
institute resuscitative measures. Other assessments such as level of consciousness, vital
signs, and papillary response would be done once the child's airway, breathing, and
circulation are assessed and emergency interventions are instituted.

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Test Bank for Essentials of Pediatric Nursing, 1st Edition: Theresa Kyle

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