1. A nurse is teaching an adolescent with inflammatory bowel disease about treatment with corticosteroids. Which adverse effects are concerns for this client? Select all that apply.
3. Mood swings
5. Growth spurts
6. Adrenal suppression
2. A nurse is conducting an examination of a 6-month-old baby. During the examination, the nurse should be able to elicit which reflex?
3. When teaching a parent of a school-age child about signs and symptoms of fever that require immediate notification of the physician, which description should the nurse include?
1. Burning or pain with urination
2. Complaints of a stiff neck
3. Fever disappearing for longer than 24 hours, then returning
4. History of febrile seizures
4. After being hospitalized for status asthmaticus, a child, age 5, is discharged with prednisone (Deltasone) and other oral medications. Two weeks later, when the child comes to the clinic for a checkup, the nurse instructs the mother to gradually decrease the dosage of prednisone, which will be discontinued. The mother asks why prednisone must be discontinued. How should the nurse respond?
1. "Steroids increase the appetite, leading to obesity with prolonged use."
2. "Long-term steroid therapy may interfere with a child's growth."
3. "The child may develop a hypersensitivity to steroids with continued use."
4. "Prolonged steroid use may cause depression."
5. A hospitalized infant, age 10 months, begins to choke while eating and quickly becomes unconscious. A foreign object isn't visible in the infant's airway, but respirations are absent and the pulse is 50 beats/minute and thready. The nurse attempts rescue breathing, but the ventilations are unsuccessful. What should the nurse do next?
1. Deliver five back blows.
2. Deliver five chest thrusts.
3. Perform chest compressions.
4. Deliver five abdominal thrusts.
6. An adolescent is admitted for treatment of bulimia nervosa. When developing the care plan, the nurse anticipates including interventions that address which metabolic disorder?
2. Metabolic alkalosis
3. Metabolic acidosis
7. An infant is hospitalized for treatment of inorganic failure to thrive. Which nursing action is most appropriate for this child?
1. Encouraging the infant to hold a bottle
2. Keeping the infant on bed rest to conserve energy
3. Rotating caregivers to provide more stimulation
4. Maintaining a consistent, structured environment
8. During a well-baby visit, a mother asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first?
2. Egg whites
3. Rice cereal
9. A child who was hospitalized for sickle cell crisis is being discharged. Which parent outcome demonstrates effective teaching regarding prevention of future crises?
1. The parent verbalizes the need to stay away from persons with known infections.
2. The parent verbalizes appropriate dietary restrictions.
3. The parent verbalizes the need to restrict fluid intake.
4. The parent participates in an aerobic exercise program.
10. A nurse is teaching a parent how to administer antibiotics at home to a toddler with acute otitis media. Which statement by the parent indicates that teaching has been successful?
1. "I'll give the antibiotics for the full 10-day course of treatment."
2. "I'll give the antibiotics until my child's ear pain is gone."
3. "Whenever my child is cranky or pulls on an ear, I'll give a dose of antibiotics."
4. "If the ear pain is gone, there's no need to see the physician for another examination of the ears."
11. A child, age 15 months, is recovering from surgery to remove a Wilms' tumor. Which finding best indicates that the child is free from pain?
1. Decreased appetite
2. Increased heart rate
3. Decreased urine output
4. Increased interest in play
12. A toddler develops acute otitis media and is ordered cefpodoxime proxetil (Vantin) 5 mg/kg P.O. every 12 hours. If the child weighs 22 lb (10 kg), how many milligrams will the nurse administer with each dose?
1. 50 mg
2. 100 mg
3. 110 mg
4. 220 mg
13. A nurse is working on the pediatric unit. Which assignment best demonstrates primary care nursing?
1. Caring for the same child from admission to discharge
2. Caring for different children each shift to gain nursing experience
3. Taking vital signs for every child hospitalized on the unit
4. Assuming the charge nurse role instead of participating in direct child care
14. A 10-month-old infant with tetralogy of Fallot (TOF) experiences a cyanotic episode. To improve oxygenation during such an episode, the nurse should place the infant in which position?
15. A nurse has just administered a drug to a child. Which organ is most responsible for drug excretion in children?
16. A 44-lb preschooler is being treated for inflammation. The physician orders 0.2 mg/kg/day of dexamethasone (Decadron) by mouth to be administered every 6 hours. The elixir comes in a strength of 0.5 mg/5 ml. How many teaspoons of dexamethasone should the nurse give this client per dose? Record your answer using a whole number.
17. A child is receiving total parenteral nutrition (TPN). During TPN therapy, the most important nursing action is:
1. assessing vital signs every 30 minutes.
2. monitoring the blood glucose level closely.
3. elevating the head of the bed 60 degrees.
4. providing a daily bath.
18. A child with hemophilia is hospitalized after falling. Now the child complains of severe pain in the left wrist. What should the nurse do first?
1. Perform passive range-of-motion (ROM) exercises on the wrist.
2. Massage the wrist and apply a warm compress.
3. Elevate the affected arm and apply ice to the injury site.
4. Notify the physician.
19. A mother is discontinuing breast-feeding after 5 months. What should the nurse advise the mother to include in her infant's diet?
1. Iron-rich formula and baby food
2. Whole milk and baby food
3. Skim milk and baby food
4. Iron-rich formula alone
20. The physician suspects tracheoesophageal fistula in a 1-day-old neonate. Which nursing intervention is most appropriate for this child?
1. Avoiding suctioning unless cyanosis occurs
2. Elevating the neonate's head and giving nothing by mouth
3. Elevating the neonate's head for 1 hour after feedings
4. Giving the neonate only glucose water for the first 24 hours
21. According to Erikson's psychosocial theory of development, an 8-year-old child would be in which stage?
1. Trust versus mistrust
2. Initiative versus guilt
3. Industry versus inferiority
4. Identity versus role confusion
22. A nurse in the pediatric intensive care unit is caring for the only survivor of a house fire that killed seven people. Reporters from local newspapers and television stations are at the hospital, trying to obtain information about the child's condition. The nurse knows that she:
1. may not disclose information regarding the child's condition.
2. may disclose the child's condition, but not his name.
3. may make a statement about how sad she feels for the little boy's family and friends.
4. should contact an attorney because of the legal issues involved in caring for the child.
23. The parents of a healthy infant request information about advance directives. The nurse's best response is to:
1. suggest that the parents discuss the matter with an attorney.
2. tell the parents that they should discuss advance directives with the physician.
3. provide the parents with a brochure about advance directives.
4. ask open-ended questions about the parents' concerns.
24. A parent asks the nurse for advice on disciplining a 3-year-old child. Which statement made by a parent indicates understanding of accepted discipline techniques?
1. "I don't think children younger than 5 understand the purpose of time-out."
2. "My husband uses one form of punishment and I use a different form."
3. "I don't listen to excuses."
4. "We try to be united and consistent in our approach to discipline."
25. An infant is diagnosed with a congenital hip dislocation. On assessment, the nurse expects to note:
1. symmetrical thigh and gluteal folds.
2. Ortolani's sign.
3. increased hip abduction.
4. femoral lengthening.
26. A 9-year-old boy with diabetes mellitus tests his glucose level in the nurse's office before lunch. According to this sliding scale of insulin, he's due for 1 unit of regular insulin. What steps should a nurse follow after confirming the medication order, washing her hands, drawing up the appropriate dose, verifying the boy's identity, and putting on gloves? Put the following steps in chronological order.
1. Pinch the skin around the injection site
2. Release the skin and give the injection.
3. Clean site with an alcohol pad; loosen needle cover.
4. Select appropriate injection site with the child.
5. Cover the site with an alcohol pad.
6. Uncover needle; insert at 45- to 90- degree angle.
27. A nurse is preparing a child, age 4, for cardiac catheterization. Which explanation of the procedure is appropriate?
1. "Don't worry. It won't hurt."
2. "The test usually takes an hour."
3. "You must sleep the whole time that the test is being done."
4. "The special medicine will feel warm when it's put in the tubing."
28. A child has just been admitted to the facility and is displaying fear related to separation from his parents, the room being too dark, being hurt while in the hospital, and having many different staff members come into the room. Based on the nurse's knowledge of growth and development, the child is likely:
1. 7 to 12 months old (an infant).
2. 1 to 3 years old (a toddler).
3. 6 to 12 years old (a school-age child).
4. 12 to 18 years old (an adolescent).
29. A physician orders an antibiotic for a child, age 6, who has an upper respiratory tract infection. To avoid tooth discoloration, the nurse expects the physician to avoid prescribing which drug?
30. A nurse is reviewing her shift assignment. Which child should she assess first?
1. A 5-month-old infant with I.V. fluids infusing
2. An 11-month-old infant receiving chemotherapy through a central venous catheter
3. An 8-year-old child in traction with a femur fracture
4. A 14-year-old child who is postoperative and has a nasogastric tube and an indwelling urinary catheter
31. A toddler is in the hospital. The parents tell the nurse they're concerned about the seriousness of the child's illness. Which response to the parents is most appropriate?
1. "Please try not to worry. Your child will be fine."
2. "If you look around, you'll see other children who are much sicker."
3. "What seems to concern you about your child being hospitalized?"
4. "It must be difficult for you when your child is ill and hospitalized."
32. A 15-month-old toddler has just received his routine immunizations, including diphtheria, tetanus, and acellular pertussis; inactivated polio vaccine; measles, mumps, and rubella; varicella; and pneumococcal conjugate vaccine. What information should the nurse give to the parents before they leave the office? Select all that apply.
1. Minor symptoms can be treated with acetaminophen (Tylenol).
2. Minor symptoms can be treated with aspirin (A.S.A.).
3. Call the office if the toddler develops a temperature above 103° F (39.4° C), seizures, or difficulty breathing.
4. Soreness at the immunization site and mild fever are common.
5. The immunizations prevent the toddler from contracting their associated diseases.
6. The toddler should restrict his activity for the remainder of the day.
33. A mother of a 4-year-old child asks the nurse how to talk with her daughter about strangers. The little girl is very friendly and her mother is concerned that her child could be abducted. The nurse should tell the mother:
1. to talk with her daughter about what she should do if a stranger talks to her.
2. that she lives in a safe town and shouldn't worry.
3. to talk with her daughter about bad people and remind her to tell Mommy if someone she doesn't know talks to her.
4. contact social services, which is better equipped to respond to her questions.
34. A nurse is reviewing a care plan for an adolescent girl who's receiving chemotherapy for leukemia who was admitted for pneumonia. The adolescent's platelet count is 50,000 μl. Which item in the care plan should the nurse revise?
1. Keep a sign over the bed that reads "NO NEEDLE STICKS AND NOTHING PER RECTUM."
2. Use two peripheral I.V. intermittent infusion devices, one for blood draws and one for infusions.
3. Administer oxygen at a rate of 4 L/minute using a nonhumidified nasal cannula.
4. Use a tympanic membrane sensor to measure her temperature at the bedside.
35. A nurse practicing in a nurse-managed clinic suspects that an 8-year-old child's chronic sinusitis and upper respiratory tract infections may result from allergies. She orders an immunoglobulin assay. Which immunoglobulin would the nurse expect to find elevated?
1. Immunoglobulin E
2. Immunoglobulin D
3. Immunoglobulin G
4. Immunoglobulin M
36. A 14-year-old male reports having right lower quadrant pain, nausea, vomiting, and a low-grade fever for the past 12 hours. A physical examination reveals rebound tenderness and a positive psoas sign. Based on these findings, what should the nurse suspect?
37. When meeting with a family who'll learn that their 3-year-old is seriously ill, which action demonstrates the nurse's role as collaborator of care?
1. Providing the parents with information about financial assistance programs.
2. Informing the family of the diagnosis and recently discovered findings.
3. Coordinate the multidisciplinary services and providing information about them.
4. Referring and consulting with other specialties to help in treating the diagnosis.
38. An 8-month-old infant is admitted with a febrile seizure. The infant weighs 17 lb (7.7 kg). The physician orders ceftriaxone (Rocephin), 270 mg I.M. every 12 hours. (The safe dosage range is 50 to 75 mg/kg daily.) The pharmacy sends a vial containing 500 mg, to which the nurse adds 2 ml of preservative-free normal saline solution. The nurse should administer how many milliliters?
1. None because this isn't a safe dosage
2. 0.08 ml
3. 1.08 ml
4. 1.8 ml
39. A child, age 15 months, is admitted to the health care facility. During the initial nursing assessment, which statement by the mother most strongly suggests that the child has a Wilms' tumor?
1. "My child has grown 3" in the past 6 months."
2. "My child seems to be napping for longer periods."
3. "My child's abdomen seems bigger, and his diapers are much tighter."
4. "My child's appetite has increased so much lately."
40. A child is diagnosed with pituitary dwarfism. Which pituitary agent will the physician most likely order to treat this condition?
1. Corticotropin zinc hydroxide (Cortrophin-Zinc)
2. Somatrem (Protropin)
3. Desmopressin acetate (DDAVP)
4. Vasopressin (Pitressin)
41. A 4-year-old child is being treated for status asthmaticus. His arterial blood gas analysis reveals a pH of 7.28, PaCO2 of 55 mm Hg, and HCO3− of 26 mEq/L. What condition do these findings indicate?
1. Respiratory alkalosis
2. Metabolic acidosis
3. Respiratory acidosis
4. Metabolic alkalosis
42. A nurse is teaching parents about accident prevention for a toddler. Which guideline is most appropriate?
1. Always make the toddler wear a seat belt when riding in a car.
2. Make sure all medications are kept in containers with childproof safety caps.
3. Never leave a toddler unattended on a bed.
4. Teach rules of the road for bicycle safety.
43. An infant boy has just had surgery to repair his cleft lip. Which nursing intervention is important during the immediate postoperative period?
1. Cleaning the suture line carefully with a sterile solution after every feeding
2. Laying the infant on his abdomen to help drain fluids from his mouth
3. Allowing the infant to cry to promote lung reexpansion
4. Giving the baby a pacifier to suck for comfort
44. Before performing an otoscopic examination on a child, where should the nurse palpate for tenderness?
1. Tragus, mastoid process, and helix
2. Helix, umbo, and tragus
3. Tragus, cochlea, and lobule
4. Mastoid process, incus, and malleus
45. When assessing a child's cultural background, the nurse should keep in mind that:
1. cultural background usually has little bearing on a family's health practices.
2. physical characteristics mark the child as part of a particular culture.
3. heritage dictates a group's shared values.
4. behavioral patterns are passed from one generation to the next.
46. A nurse is teaching the parents of a 6-month-old infant about usual growth and development. Which statements about infant development are true? Select all that apply.
1. A 6-month-old infant has difficulty holding objects.
2. A 6-month-old infant can usually roll from prone to supine and supine to prone positions.
3. A teething ring is appropriate for a 6-month-old infant.
4. Stranger anxiety usually peaks at 12 to 18 months.
5. Head lag is commonly noted in infants at age 6 months.
6. Lack of visual coordination usually resolves by age 6 months.
47. How should a nurse position a 4-month-old infant when administering an oral medication?
1. Seated in a high chair
2. Restrained flat in the crib
3. Held on the nurse's lap
4. Held in the bottle-feeding position
48. A 4-year-old child is having a sickle cell crisis. The initial nursing intervention should be to:
1. place ice packs on the client's painful joints.
2. administer antibiotics.
3. provide oral and I.V. fluids.
4. administer folic acid supplements.
49. A child with sickle cell anemia is being treated for a crisis. The physician orders morphine sulfate, 2 mg I.V. The concentration of the vial is 10 mg/1 ml of solution. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.
50. Which relaxation strategy would be effective for a school-age child to use during a painful procedure?
1. Having the child keep his eyes shut at all times
2. Having the child hold his breath and not yell
3. Having the child take a deep breath and blow it out until told to stop
4. Being honest with the child and telling him the procedure will hurt a lot