Pediatric Nursing NCLEX Practice Exam:
Part 1
1. 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
A family’s behavioral patterns and values are passed
from one generation to the next. Pediatric health care
providers must be aware of the demographic trends and
be culturally competent to deliver the safest, highest
quality care possible to children of widely differing
groups.
Option A: Cultural background commonly plays a major
role in determining a family’s health practices. Health
and health care disparities are inextricably linked;
cultural competence on the part of the health care
provider is necessary to minimize and ultimately
eliminate any differences in the quality of health care.
Option B: Physical characteristics do not indicate a
child’s culture. Folk illnesses often do not have a
corresponding illness from a biomedical or scientific
perspective and may not be perceived as an illness or
affliction by another cultural group.
Option C: 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. In
addition to language differences, cultural differences
regarding nonverbal communication can create
communication barriers between a child, family, and the
health care provider.
2. 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 transferrin
A negative nitrogen balance may result from inadequate
protein intake and is best detected by measuring the
total protein level. An increase in the protein intake
produces an increase in nitrogen losses via higher
amino acid oxidation, especially in the fed state, and a
trend toward positivation of the nitrogen balance.
Nitrogen balance and nitrogen levels at four levels of
nitrogen intake in healthy adult subjects (data from Price
et al. 1994).
Option A: TIBC (total iron-binding capacity)—measures
the total amount of iron that can be bound by proteins in
the blood. Since transferrin is the primary iron-binding
protein, the TIBC test is a good indirect measurement of
transferrin availability—the amount of transferrin that is
available to bind to iron.
Option B: Hemoglobin (Hb) is the protein contained in
red blood cells that is responsible for the delivery of
oxygen to the tissues. To ensure adequate tissue
oxygenation, a sufficient hemoglobin level must be
maintained. When the hemoglobin level is low, the
patient has anemia. An erythrocytosis is the
consequence of too many red cells; this results in
hemoglobin levels above normal.
Option D: Measuring serum transferrin levels would
help detect iron-deficiency anemia, not a negative
nitrogen balance. Transferrin can be used to assess the
iron level in the body along with other markers in the
body. Transferrin level testing is used to determine the
cause of anemia, examine iron metabolism and
determine the iron-carrying capacity of the blood.
3. 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 first?
A. Heart rate, respiratory rate, and blood pressure
B. Recent exposure to communicable diseases
C. Number of immunizations received
D. Height and weight
The most important data to obtain on a child’s arrival in
the emergency department are vital sign measurements.
Salicylate toxicity is a medical emergency. Intentional
ingestion or accidental overdose can cause severe
metabolic derangements, making treatment difficult. In
an acute salicylate overdose, the onset of symptoms will
occur within 3 to 8 hours. The severity of symptoms is
dependent on the amount ingested.
Option B: If the patient can provide history, there are
several important pieces of information to obtain. These
include time of ingestion, amount ingested, as well as
formulation. The latter is important as it may affect the
rate of absorption.
Option C: It is critical to determine if there were any
other substances ingested as this may complicate
treatment and increase mortality. Determine whether
this was accidental or intentional. This information
should be corroborated by family, friends, or EMS
personnel.
Option D: The nurse should gather these data later.
Aspirin has the propensity to form bezoars which will
delay absorption. Aspirin can cause pyloric sphincter
spasms, which increases the amount of time in the
stomach allowing for more absorption.
4. 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 (Atropine)
D. Lidocaine hydrochloride (Xylocaine)
Succinylcholine 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.
Atropine is occasionally used as a premedication. Its
anticholinergic effects reduce ACH-mediated
bradycardia that can accompany endotracheal
intubation.
Option A: Epinephrine is one of the most commonly
used agents in various settings as it functions as a
medication and hormone. It is currently FDA-approved
for various situations, including emergency treatment of
type 1 hypersensitivity reactions, including anaphylaxis,
induction, and maintenance of mydriasis during
intraocular surgeries and hypotension due to septic
shock.
Option B: Isoproterenol is not used in rapid-sequence
intubation because of its profound cardiac effects.
Isoproterenol is a beta-1 and beta-2 adrenergic receptor
agonist indicated primarily for bradydysrhythmias. The
administration and subsequent post-administration
monitoring of this medication are complex and
necessitate an interprofessional approach to its usage.
Option D: Lidocaine is used in adults only. The drug is
commonly used for local anesthesia, often in
combination with epinephrine (which acts as a
vasopressor and extends its duration of action at a site
by opposing the local vasodilatory effects of lidocaine).
5. Nurse Walter 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
At age 3, gross motor development and refinement in
eye-hand coordination enable a child to ride a tricycle.
Most 3-year-olds are able to walk a line, balance on a
low balance beam, skip or gallop, and walk backward.
They can usually pedal a tricycle, catch a large ball, and
jump with two feet.
Option B: The fine motor skills required to tie shoelaces
develop around age 5. By age 3, kids can usually wash
and dry their hands, dress themselves with a little
assistance, and turn pages in a book. Most preschoolers
can hold a writing instrument with their fingers, not their
fists.
Option C: The gross motor skills required for roller-
skating develop around age 5. Most children by age 3
develop more large muscle movements (gross motor
skills). These generally include running, climbing,
jumping in place, kicking a ball, and bending over easily.
Option D: The gross motor skills required for jumping
rope develop around age 5. Give the child time
outdoors. Let them run and play. Climbing in and out of
boxes is a favorite game. Remember to watch them
closely when outside—they can move pretty fast when
they want to.
6. Dr. Jones 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 inflammation
C. To decrease proteinuria
D. To prevent infection
The primary purpose of administering corticosteroids to
a child with nephritic syndrome is to decrease
proteinuria. It helps relieve the inflammation in the
kidney and promotes healing. The proteinuria usually
ranges in the sub nephrotic range (less than 3.5 g/day),
but it can go up to the nephrotic range. A 24-hours
urinary protein assay is required if the attendant
nephrotic syndrome is suspected.
Option A: Corticosteroids have no effect on blood
pressure. Antihypertensives are administered in patients
with elevated blood pressure despite dietary salt, fluid
restriction, and loop diuretics. In severe cases,
hypertension is treated with ACE inhibitors, ARBs, and
nifedipine.
Option B: Although they help reduce inflammation, this
is not the reason for their use in patients with nephritic
syndrome. Proteinuria in non-nephrotic (i.e., less than
3.5 gm/day) range and may cause foamy urine when
protein content is high.
Option D: Corticosteroids may predispose a patient to
infection. Immunosuppressive drugs reduce and block
the antigenic effects of the inciting agents. It is most
useful for rapidly progressive glomerulonephritis. The
use of corticosteroids and immunomodulators is
controversial in certain causes of nephritic syndrome,
including staphylococcal endocarditis. It can aggravate
sepsis and result in increased mortality.
7. What should be the initial bolus of crystalloid fluid
replacement for a pediatric patient in shock?
A. 20 ml/kg
B. 10 ml/kg
C. 30 ml/kg
D. 15 ml/kg
Fluid volume replacement must be calculated to the
child’s weight to avoid overhydration. Initial fluid bolus is
administered at 20 ml/kg, followed by another 20 ml/kg
bolus if there is no improvement in fluid status. Shock is
a life-threatening manifestation of circulatory failure.
Circulatory shock leads to cellular and tissue hypoxia
resulting in cellular death and dysfunction of vital
organs.
Option B: Obtain two large-bore IVs or central line.
Place the patient in the Trendelenburg position.
Aggressive IV fluid resuscitation with 2 to 4 L of isotonic
crystalloids. PRBC transfusion if ongoing bleeding.
Appropriate medical or interventional strategies to treat
the underlying etiology. Continue with isotonic
crystalloids and use vasopressors if needed
Option C: Immediate treatment with intravenous (IV)
fluid should be initiated, followed by vasopressor
therapy, if needed, to maintain tissue perfusion.
Depending on the underlying etiology of shock, specific
therapies might also be needed.
Option D: The initial approach to management is the
stabilization of the airway and breathing with oxygen and
oral mechanical ventilation when needed. Peripheral IV
or intraosseous infusion (IO) access should be obtained.
Central venous access may be required in the setting of
shock if there is difficulty securing peripheral venous
access, or the patient needs prolonged vasopressor
therapy or large-volume resuscitation.
8. 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
SIDS can occur any time between 1 week and 1 year of
age. The incidence peaks at 2 to 4 months of age.
Sudden infant death syndrome (SIDS) is the abrupt and
unexplained death of an infant less than 1-year old.
Despite a thorough investigation (a careful review of
clinical history, death scene investigation, and a
complete autopsy), a cause for the patient’s demise is
not identified.
Option A: SIDS frequently occurs during sleep, and it is
the leading cause of death in infants one to twelve
months of age in the United States. Due to
inconsistencies in the use of SIDS as a diagnostic term,
sudden unexpected infant death (SUID) was introduced.
Option C: The peak incidence occurs between 2 and 4
months, and 90 percent of cases occur before six
months of age. According to the Centers for Disease
Control and Prevention (CDC), the incidence of SIDS in
2017 was 35.4 per 100,000 live births in the United
States.
Option D: Prior to the introduction of campaigns to
reduce SIDS deaths, death rates were noted to vary
significantly between Asian populations, aboriginal
people in Australia, the population of the United
Kingdom, the population of the United States, and the
population of New Zealand.
9. Which of the following would be inappropriate when
administering chemotherapy to a child?
A. Monitoring the child for both general and specific
adverse effects
B. Observing the child for 10 minutes to note for
signs of anaphylaxis
C. Administering medication through a free-flowing
intravenous line
D. Assessing for signs of infusion infiltration and
irritation
When administering chemotherapy, the nurse should
observe for an anaphylactic reaction for 20 minutes and
stop the medication if one is suspected. Anaphylaxis is a
severe allergic reaction, which can cause shock, low
blood pressure, and occasionally death. Food allergies,
including allergy to peanuts and tree nuts, are said to
account for the majority of fatal or near-fatal
anaphylactic reactions in the U.S.A. Care is taken
especially when chemotherapy medications are known
to be common allergic reaction producers, to
premedicate to prevent or lessen the reaction.
Option A: Chemotherapy is associated with both
general and specific adverse effects, therefore close
monitoring for them is important. A major challenge for
the nurse caring for a child with fever and neutropenia is
monitoring for signs of sepsis (e.g., peripheral perfusion,
temperature of extremities, level of consciousness, vital
signs, and pulse oximetry).
Option C: Education of the family and child regarding
the treatment plan or protocol (e.g., chemotherapy,
radiotherapy, and/or surgery) is crucial to relieving
parents’ fears and anxieties. Even though the
explanation of the diagnosis and treatment plan
supports the hope that their child may survive cancer,
the word cancer still conveys a life-threatening illness.
Option D: Because most infectious origins develop from
the child’s own endogenous flora, the nurse should
encourage the parents/child to adhere to strict
handwashing practices, perform frequent mouth care,
perineal hygiene, and avoid the use of rectal
thermometers owing to the chance of introducing
pathogens through the rectal mucosa. Protective
isolation and food sterilization have little impact on
decreasing infectious rates in neutropenic children.
10. Which of the following is most likely associated with
a cerebrovascular accident (CVA) resulting from
congenital heart disease?
A. Polycythemia
B. Cardiomyopathy
C. Endocarditis
D. Low blood pressure
The child with congenital heart disease develops
polycythemia resulting from an inadequate mechanism
to compensate for decreased oxygen saturation.
Secondary erythrocytosis of cyanotic congenital heart
disease (CCHD) is pathologically different from primary
erythrocytosis of polycythemia vera (PV). An association
between elevated hematocrit and thrombosis has been
established in PV patients, and treatment guidelines
recommend maintaining hematocrit <45%.
Option B: The most common etiology of dilated
cardiomyopathy (DCM) is idiopathic and without an
identifiable cause. DCM can have a familial or genetic
predisposition although these cases are usually
classified under idiopathic if no clear genetic link is
identified. DCM has been associated with mutations in
genes for Desmin (cytoskeletal), Lamin C (nuclear
membrane), or Myosin (contractile proteins).
Option C: The leading cause of endocarditis in the
pediatric population remains Staphylococcus aureus,
followed by Viridans-type streptococci (alpha-hemolytic
streptococci). Other organisms are involved but less
frequently. Usually, staphylococcal endocarditis is more
common in patients with an unremarkable history of
heart disease.
Option D: When cardiac output decreases, peripheral
resistance should increase via constriction of terminal
arterioles to decrease vessel caliber to maintain blood
pressure. When peripheral resistance decreases,
cardiac output will increase via increased heart rate to
maintain blood pressure.
11. Clay is an 8-year-old boy diagnosed with heart
failure. Which of the following shows that he is strictly
following the directed therapeutic regimen?
A. Daily use of an antibiotic
B. Pulse rate less than 50 beats/minute
C. Normal weight for age
D. Elevation in red blood cell (RBC) count
Adequate weight for height demonstrates adequate
nutritional intake and lack of edema. Symptoms of heart
failure include those due to excess fluid accumulation
(dyspnea, orthopnea, edema, pain from hepatic
congestion, and abdominal distention from ascites) and
those due to a reduction in cardiac output (fatigue,
weakness) that is most pronounced with physical
exertion.
Option A: Daily use of antibiotics is not indicated in
heart failure. Diuretics, beta-blockers, angiotensin-
converting enzyme inhibitors, angiotensin receptor
blockers, angiotensin receptor neprilysin inhibitor,
hydralazine plus nitrate, digoxin, and aldosterone
antagonists can produce an improvement in symptoms.
Option B: A pulse rate less than 50 beats/minute,
bradycardia, probably indicates digoxin toxicity. Chronic
presentations (months) differ in that fatigue, anorexia,
abdominal distension, and peripheral edema may be
more pronounced than dyspnea. The anorexia is
secondary to several factors including poor perfusion of
the splanchnic circulation, bowel edema, and nausea
induced by hepatic congestion.
Option D: An elevated RBC count demonstrates
polycythemia. Cardiac troponin (T or I), complete blood
count, serum electrolytes, blood urea nitrogen,
creatinine, liver function test, and brain natriuretic
peptide (BNP). BNP (or NT-proBNP) level adds greater
diagnostic value to the history and physical examination
than other initial tests mentioned above.
12. Bryce is a child diagnosed with coarctation of aorta.
While assessing him, Nurse Zach would expect to find
which of the following?
A. Squatting posture
B. Absent or diminished femoral pulses
C. Severe cyanosis at birth
D. Cyanotic ("tet") episodes
Absent or diminished femoral pulse is a classic
characteristic of coarctation of the aorta. In patients with
neonatal coarctation evolving while the patent ductus
arteriosus is closing, the lower extremity saturation can
be low as perfusion to the lower body can be maintained
by ductal patency. In the era of lower extremity pulse
oximetry screening in newborns, a neonate could often
pass with an acceptable saturation as it is less common
for the ductus to contribute significantly unless other left
heart structures are hypoplastic.
Option A: Tet spells require a rapid and aggressive
approach including positioning (knee-chest) to increase
systemic vascular resistance, oxygen therapy to cause
pulmonary vasodilation and systemic vasoconstriction,
intravenous fluid bolus to improve the right ventricle
filling and pulmonary flow; morphine, intravenous beta-
blockers to help improve the right ventricle outflow
obstruction by relaxing the muscle, and intravenous
phenylephrine to increase systemic afterload.
Option C: Severe cyanosis at birth is seen in such
defects as transposition of the great vessels. The
degree of cyanosis is dependent on the amount of
mixing between the two parallel circuits. Factors
affecting intracardiac mixing include the size and
presence of an ASD or VSD. Cyanosis is not affected by
exertion or supplemental oxygen.
Option D: Tet episodes are characteristic of Tetralogy
of Fallot. “Tet spells” or hypercyanotic episodes present
during infancy or toddler age and decrease after 4 to 5
years of age. Dehydration or agitation commonly
precipitate tet spells, and if patients do not receive
prompt and adequate treatment, they can develop
severe cyanosis and hypoxia that, subsequently, can
cause syncope and even death.
13. Appropriate intervention is vital for many children
with heart disease in order to go on to live active, full
lives. Which of the following outlines an effective nursing
intervention to decrease cardiac demands and minimize
cardiac workload?
A. Feeding the infant over long periods
B. Allowing the infant to have her way to avoid conflict
C. Scheduling care to provide for uninterrupted rest
periods
D. Developing and implementing a consistent care plan
Organizing nursing care to provide for uninterrupted
periods of sleep reduces cardiac demand. Allow for rest
periods between care; disturb only when necessary for
care and procedures. This promotes rest and conserves
energy.
Option A: Feeding time should be restricted to a
maximum of 45 minutes or discontinued sooner if the
infant tires. Rest decreases metabolic rate, decreasing
myocardial and oxygen demand. Fatigue and exertional
dyspnea are common problems with low cardiac output
states. Close monitoring of the patient’s response
serves as a guide for optimal progression of activity.
Option B: In an attempt to get her own way, the child
may cry. Excessive crying should be limited; however,
an appropriate limit setting should still be observed.
Avoid allowing the infant to cry for long periods of time,
use soft nipple for feeding; cross-cut nipple; if unable for
infant to ingest sufficient calories by mouth,gavage-feed
infant.
Option D: Developing and implementing a consistent
care plan can be important, but it is not related to
decreasing cardiac demands or workload. Assist parents
to plan for care and rest schedules. Provides rest and
prevents overexertion, minimizes energy expenditure.
14. Arrange these parts of the conduction system of the
heart in the correct order as an action potential would
pass through them.
SA node
AV node
Atrioventricular bundle
R and L bundle of His
Purkinje fibers
Rationale:
1. The SA node is the natural pacemaker of the heart.
2. The electrical stimulus from the SA node eventually
reaches the AV node and is delayed briefly so that the
contracting atria have enough time to pump all the blood
into the ventricles.
3. Once the atria are empty of blood the valves between
the atria and ventricles close.
4. At this point, the atria begin to refill and the electrical
stimulus passes through the AV node and Bundle of His
into the Bundle branches and Purkinje fibers.
15. The procedure that has to be performed in order to
shift the high pressure from the right ventricle to the left
ventricle in Transposition of the Great Arteries (TGA) is:
A. Rashkind Procedure
B. Rastelli Procedure
C. Pulmonary Artery Banding
D. Jatene Procedure
The Jatene procedure, arterial switch operation, or
arterial switch, is an open heart surgical procedure used
to correct dextro-transposition of the great arteries (d-
TGA). The arterial switch procedure, also known as the
Jatene switch procedure, is an intervention designed to
correct D-transposition of the great arteries (D-TGA) at
the level of the aorta and main pulmonary artery. It is
generally preferred over atrial switch procedures for
simple D-TGA due to improved outcomes.
Option A: A Balloon Atrial Septostomy (Rashkind
procedure) is a procedure that is used to create an
opening in the wall between the upper chambers of the
heart (atria). This is performed in certain cases to
improve blood oxygenation, particularly for congenital
heart defects. A deflated balloon catheter is guided into
the heart and into a small hole in the atrial septum. The
balloon is then inflated, creating a larger hole in the atrial
septum.
Option B: The Rastelli operation was originally used for
the repair of d-transposition of the great vessels with
ventricular septal defect and pulmonary stenosis. It has
subsequently been utilized for a variety of congenital
heart defects characterized by two ventricles and
overriding of the aorta with severe pulmonary stenosis
or pulmonary atresia. Pulmonary atresia with ventricular
septal defect and double outlet right ventricle with
pulmonary stenosis or atresia are anatomic subtypes
also frequently submitted for the Rastelli procedure.
Cyanosis is the prevailing preoperative pathophysiology.
Option C: The purpose of PAB is to lessen pulmonary
artery pressure and excess pulmonary blood flow. PAB
requires the insertion of a band around the pulmonary
artery to reduce blood flow into the lungs. A variety of
banding materials are used; one commonly used
material is polytetrafluoroethylene.
16. Veronica’s parents were told that their daughter
needs ribavirin (Virazole). This drug is used to treat
which of the following?
A. Cystic fibrosis
B. Otitis media
C. Respiratory syncytial virus (RSV)
D. Bronchitis
Ribavirin is an antiviral medication used for treating RSV
infection and for children with RSV who are
compromised (such as children with bronchopulmonary
dysplasia or heart disease). There is a single antiviral
medication approved for use against RSV in the United
States, ribavirin. It is a nucleoside analog with
application in several RNA viruses, and it shows in vitro
activity against RSV and may be administered in
aerosolized form.
Option A: A new class of medications known as CFTR
modulator therapies is designed to correct the
dysfunction by improving production, intracellular
processing, or function of the CFTR protein caused by
the mutated gene. Each medication is targeted at a
specific dysfunction caused by a specific gene mutation.
Ivacaftor is used in the treatment of class 3
dysfunctions, where a mutation at G551D is the primary
aberration. This was the first medication to directly
impact the protein channel rather than treating the
effects of CF.
Option B: Once the diagnosis of acute otitis media is
established, the goal of treatment is to control pain and
to treat the infectious process with antibiotics. Non-
steroidal anti-inflammatory drugs (NSAIDs), such as
acetaminophen, can be used to achieve pain control.
When a bacterial etiology is suspected, the antibiotic of
choice is high-dose amoxicillin for ten days in both
children and adult patients who are not allergic to
penicillin.
Option D: Antitussive agents like dextromethorphan,
codeine, and guaifenesin are frequently used in clinical
practice to suppress cough based on their effectiveness
in chronic bronchitis and studies on cough in the
common cold. Beta-agonists are routinely used in acute
bronchitis patients with wheezing. Analgesic and
antipyretic agents may be used to treat associated
malaise, myalgia, and fever.
17. Which of the following infants is least probable to
develop sudden infant death syndrome (SIDS)?
A. Baby Angela who was premature
B. A sibling of Baby Angie who died of SIDS
C. Baby Gabriel with prenatal drug exposure
D. Baby Gabby who sleeps on his back
Infants who sleep on their back are least likely to
develop SIDS. However, SIDS has been associated with
infants who sleep on their abdomens. The incidence of
SIDS declined by more than 50 percent in the United
States after physicians began to promote “On the back
to sleep.” After the American Academy of Pediatrics
(AAP) issued a recommendation for supine sleeping in
1992, the incidence of SIDS decreased.
Option A: Several studies identify the prone sleeping
position, sleeping on soft surfaces, sleeping with soft
objects, co-sleeping with a parent/parents, maternal
smoking during pregnancy, maternal age less than 20
years, late/no prenatal care, preterm birth, low birth
weight, lack of breastfeeding, and overheating as risk
factors in SIDS deaths.
Option B: Siblings of SIDS infants have an increased
risk of dying as a result of SIDS. Siblings are 5-6 times
more likely to die from SIDS than the general population.
After investigation, not all sibling deaths can be
attributed to SIDS. Sibling deaths were found to be
attributable to inborn errors of metabolism, abuse, and
malnourishment.
Option C: Maternal drug use and exposure to smoke
from tobacco are associated with a higher incidence of
SIDS. Exposure to secondhand smoke is an
independent risk factor for SIDS, and the risk increases
with an increasing amount of exposure. Maternal drug
use is associated with a higher incidence of SIDS,
although it is not clear whether this is a direct or an
indirect effect.
18. Archie who weighs 44 lb has been given an order for
amoxicillin 500 mg b.i.d. The drug text notes that the
daily dose of amoxicillin is 50 mg/kg/day in two divided
doses. What dose in milligrams is safest for this child?
A. 1000 mg
B. 750 mg
C. 500 mg
D. 250 mg
First, calculate the child’s weight in kg: 44/2.2 = 20 kg.
Then calculate the appropriate daily dose according to
the drug text: 50 mg/kg/day = 50 mg x 20 kg = 1,000
mg/day. the abbreviation b.i.d. means twice daily;
therefore 1,000 divided by 2 equals 500 mg.
Option A: There are 3 primary methods for the
calculation of medication dosages, as referenced above.
These include Desired Over Have Method or Formula,
Dimensional Analysis, and Ratio and Proportion (as
cited in Boyer, 2002).
Option B: Desired over Have or Formula Method is a
formula or equation to solve for an unknown quantity (x),
much like ratio proportion. Drug calculations require the
use of conversion factors, such as when converting from
pounds to kilograms or liters to milliliters. Simplistic in
design, this method allows us to work with various units
of measurement, converting factors to find our answer.
Option D: It is useful in checking the accuracy of the
other calculation methods as mentioned above, thus
acting as a double or triple check. A basic formula,
solving for x, guides us in the setting up of an equation:
D/H x Q = x, or Desired dose (amount) = ordered Dose
amount/amount on Hand x Quantity.
19. Immunization of children with Haemophilus
influenzae type B (Hib) vaccine decreases the incidence
of which of the following conditions?
A. Bronchiolitis
B. Laryngotracheobronchitis (LTB)
C. Epiglottitis
D. Pneumonia
Epiglottitis is a bacterial infection of the epiglottis
primarily caused by Hib. Administration of the vaccine
has decreased the incidence of epiglottitis. By the early
1990s, the use of the Hib conjugate vaccine caused a
99% drop in infections caused by Hib. Widespread use
of the Hib vaccine has also been shown to significantly
decrease rates of epiglottitis, which usually occurs in
children.
Option A: Bronchiolitis is usually caused by Respiratory
Syncytial Virus (RSV). RSV accounts for the majority of
cases, although in about 30% of infants, there may be 2
viruses present at the same time. It is important to know
that the respiratory syncytial virus is just one cause of
bronchiolitis. The infection can occur in individuals of
any age, but overall, the most severe symptoms tend to
be common in infants.
Option B: Acute LTB is of viral origin. Croup is most
often a viral infection that affects the subglottic airway,
commonly caused by the parainfluenza virus. Other
viruses that are known to cause croup include the
respiratory syncytial virus (RSV), rhinovirus, enterovirus,
influenza, and adenovirus.
Option D: The most common bacterial organisms
causing pneumonia in children are pneumococci,
streptococci, and staphylococci. The etiology of
pneumonia in the pediatric population can be classified
by age-specific versus pathogen-specific organisms.
Neonates are at risk for bacterial pathogens present in
the birth canal, and this includes organisms such as
group B streptococci, Klebsiella, Escherichia coli, and
Listeria monocytogenes. Streptococcus pneumoniae,
Streptococcus pyogenes, and Staphylococcus aureus
can be identified in late-onset neonatal pneumonia.
20. Which of the following is the best method for
performing a physical examination on a toddler
A. From head to toe
B. Distally to proximally
C. From abdomen to toes, the to head
D. From least to most intrusive
When examining a toddler or any small child, the best
way to perform the exam is from least to most intrusive.
Stay at the child’s level as much as possible. Do not
tower. Examine painful areas last-get general
impression of overall attitude. Be honest. If something is
going to hurt, tell them that in a calm fashion.
Option A: Starting at the head or abdomen is intrusive
and should be avoided. The last items to perform in the
physical exam should always be those things that are
most threatening to the child, including looking in the
ears and mouth.
Option B: Proceeding from distal to proximal is
inappropriate at any age. In general, when evaluating
any child, observation is the best initial diagnostic tool.
The degree of alertness and interaction, responsiveness
to parents, and respiratory status are all valuable
measures of illness that may either suggest or eliminate
concerns of toxicity.
Option C: After observation, it is important to begin the
exam with auscultation of the heart and lungs as this is
usually when the child is calm, quiet, and most
cooperative. While doing the actual physical exam, try to
use the parent’s lap as much as possible as the child is
most comfortable there.
21. An 11-year-old girl with celiac disease was
discharged from the hospital. An appropriate teaching
was carried out by the nurse if the parents are aware of
avoiding which of the following?
A. Chicken
B. Wheat
C. Milk
D. Rice
Children with celiac disease cannot tolerate or digest
gluten. Therefore, because of its gluten content, wheat
and wheat-containing products must be avoided. Celiac
disease is an autoimmune condition that causes severe
damage to the lining of the small intestine. Gluten — a
protein found in wheat, barley, and rye — triggers its
symptoms.
Option A: All animal proteins, fruits, vegetables, nuts,
seeds, legumes, herbs, and spices are naturally gluten-
free. There are many naturally gluten-free grains and
specialty products, too.
Option C: All types of plain cow’s milk are naturally free
of gluten. However, some dairy products are not gluten-
free. Once flavorings or other ingredients have been
added to milk it may no longer be gluten-free, so it’s
important to read the label to see if the product contains
gluten or not.
Option D: Rice is generally gluten-free. This includes all
varieties, such as white or brown, long or short grain,
and fragranced or not fragranced. There are thousands
of types of rice, but only about 100 kinds are sold
around the world.
22. Will is being assessed by Nurse Lucas for possible
intussusception. Which of the following would be least
likely to provide valuable information?
A. Abdominal palpation
B. Family history
C. Pain pattern
D. Stool inspection
Because intussusception is not believed to have familial
tendencies, obtaining a family history would provide the
least amount of information. The causes of
intussusception are not clearly known. About 90% of
cases of intussusception in children arise from an
unknown cause. They can include infections, anatomical
factors, and altered motility.
Option A: A sausage-shaped mass may be palpated in
the right upper quadrant. Physical examination may
reveal a “sausage-shaped” mass. Children may cry,
draw their knees up to their chest, or experience
dyspnea with paroxysms of pain.
Option C: Acute, episodic abdominal pain is
characteristic of intussusception. Early symptoms
include periodic abdominal pain, nausea, vomiting
(green from bile), pulling legs to the chest, and cramping
abdominal pain. Pain is intermittent because the bowel
segment transiently stops contracting.
Option D: Stool inspection would reveal possible
indicators of intussusception. Later signs include rectal
bleeding, often with “red currant jelly” stool, and
lethargy. “Currant jelly” stools, containing blood and
mucus, are an indication of intussusception.
23. Baby Ellie is diagnosed with gastroesophageal reflux
(GER). Which of the following nursing diagnoses would
be inappropriate?
A. Risk for aspiration
B. Impaired oral mucous membrane
C. Deficient fluid volume
D. Imbalanced nutrition: Less than body requirements
GER is the backflow of gastric contents into the
esophagus resulting from relaxation or incompetence of
the lower esophageal (cardiac) sphincter. No alteration
in the oral mucous membranes occurs with this disorder.
Option A: Avoid placing the patient in a supine position,
have the patient sit upright after meals. Supine position
after meals can increase regurgitation of acid. Elevate
HOB while in bed to prevent aspiration by preventing the
gastric acid to flow back into the esophagus.
Option C: Instruct the patient to avoid highly seasoned
food, acidic juices, alcoholic drinks, bedtime snacks, and
foods high in fat. These can reduce the lower
esophageal sphincter pressure.
Option D: Encourage small frequent meals of high
calories and high protein foods. Small and frequent
meals are easier to digest. Obtain a nutritional history.
Determining the feeding habits of the client can provide
a basis for establishing a nutritional plan.
24. Nurse Joyce is assessing a child’s cultural
background, she 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
A family’s behavioral patterns and values are passed
from one generation to the next. Pediatric health care
providers must be aware of the demographic trends and
be culturally competent to deliver the safest, highest
quality care possible to children of widely differing
groups.
Option A: Cultural background commonly plays a major
role in determining a family’s health practices. Health
and health care disparities are inextricably linked;
cultural competence on the part of the health care
provider is necessary to minimize and ultimately
eliminate any differences in quality of health care.
Option B: Physical characteristics do not indicate a
child’s culture. Folk illnesses often do not have a
corresponding illness from a biomedical or scientific
perspective and may not be perceived as an illness or
affliction by another cultural group.
Option C: 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. In
addition to language differences, cultural differences
regarding nonverbal communication can create
communication barriers between a child, family, and the
health care provider.

25. Nurse Kathy is aware that the most common

assessment finding in a child with ulcerative colitis is:

A. Intense abdominal cramps

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

Ulcerative colitis causes profuse diarrhea. The most

common assessment finding in a child with ulcerative
colitis is profuse diarrhea. The main symptom of
ulcerative colitis is bloody diarrhea, with or without
mucus. Other symptoms include blood in the toilet, on
toilet paper, or in the stool. Characteristically, it involves
inflammation restricted to the mucosa and submucosa of
the colon. Typically, the disease starts in the rectum and
extends proximally in a continuous manner.

Option A: Ulcerative colitis causes intense abdominal

cramps. Associated symptoms also include urgency or
tenesmus, abdominal pain, malaise, weight loss, and
fever, depending on the extent and severity of the
disease. The onset of the disease is typically gradual,
and patients will likely experience periods of
spontaneous remission and subsequent relapses.
Option C: Ulcerative colitis causes anal fissures. There
are some extraintestinal manifestations (EIMs) that are
also present in 10% to 30% of patients with ulcerative
colitis. Extraintestinal manifestations associated with
disease activity include episcleritis, scleritis, and uveitis,
peripheral arthropathies, erythema nodosum, and
pyoderma gangrenosum.
Option D: Abdominal distensions are more common in
Crohn’s disease. Patients with flare-ups of Crohn’s
disease typically present with abdominal pain (right
lower quadrant), flatulence/bloating, diarrhea (can
include mucus and blood), fever, weight loss, anemia. In
severe cases, perianal abscess, perianal Crohn’s
disease, and cutaneous fistulas can be seen.