Peds Module self exam questions

Peds Module1 Growth & Development Quiz  Question 1 The nurse is providing family-centered care for a 6-year-old boy with cancer. Which of the following actions is least likely to be a problem for case management?    Parents initiate actions to solve problems independently. Parents initiating actions to solve problems independently is not a problem. It is a sign that they are taking their place as an active part of the interdisciplinary team. Communication may be more difficult, anxiety will need supportive action, and family opinions must be regarded with respect, but the benefits of family-centered care far outweigh the case management challenges it presents.   Question 2 The nurse is caring for a 3-year-old boy with encephalitis. Which of the following actions would demonstrate atraumatic care? Providing EMLA prior to lumbar puncture Providing EMLA prior to lumbar puncture is an example of atraumatic care. An anxious mother does not necessarily have to stay in the waiting room. The presence of a parent during procedures is supportive to the child and should be encouraged because it can reduce stress. The explanation of what will happen should be on the child's level, and the child should be removed from his hospital room for an IV insertion.   Question 3 The nurse is caring for a 4-week-old girl and her mother. Which of the following is the most appropriate subject for anticipatory guidance.    Telling how to introduce rice cereal  Telling how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.   Question 4 The nurse is examining a 10-month-old boy who was born 10 weeks early. Which of the following findings is cause for concern?    The child's head size is 19.5 inches. The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. Birth weight doubles by about 6 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.   Question 5 The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. Which of the following is the priority intervention?    Asking the mother if the child uses Spanish words  Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.   Question 6 When instructing the parents of a toddler about appropriate nutrition, which of the following would the nurse recommend?    Approximately 16 to 24 ounces of milk per day Milk intake should be limited to 16 to 24 ounces per day, with fruit juice limited to 4 to 6 ounces per day. A toddler's total fat intake should be 20% to 30% of total calories. The daily recommended fiber intake is 19 grams.   Question 7 The nurse emphasizes that a toddler under the age of 18 months should never be spanked primarily for which reason?    There is an increased risk for physical injury in this age group. Spanking should never be used with toddlers less than 18 months of age because there is an increased possibility of physical injury. Although spanking or other forms of corporal punishment lead to a pro-violence attitude, create resentment and anger in the child, and are a poor model for learning effective problem-solving skills, the risk of physical injury in this age group is paramount.   Question 8 The parents of 1-year-old girl, both of whom have perfect teeth, are concerned about their child getting dental caries. Which is the best advice the nurse can provide?    Tell the parents to limit eating to meal and snack times.  Telling the parents to limit eating to meal and snack times is the best advice. This reduces the amount of exposure the child's teeth have to food. Urging them to take the child to see a dentist is sound advice but doesn't suggest actions they can take now to prevent caries. Carbohydrates react with oral bacteria to cause caries, but they should not be reduced from the diet. Avoiding fluoridated toothpaste may help prevent fluorosis.   Question 9 The mother of a 4-year-old boy tells the nurse that her son occasionally wets his pants during the day. How should the nurse respond?    “Tell me about the circumstances when this occurs.” Bladder control is present in 4- and 5-year-olds, but an occasional accident may occur, particularly in stressful situations or when the child is absorbed in an interesting activity. The nurse needs to ask an open-ended question to determine the circumstances when the child has had accidents. Simply telling the mother that it is normal does not address the mother's concerns. The nurse does need to gather more information, because accidents in a previously potty-trained child can be a sign of diabetes.   Question 10 The nurse is providing teaching about accidental poisoning to the family of a 3-year-old. The nurse understands that a child of this age is at increased risk of accidental ingestion due to which sensory alteration?    A less discriminating sense of taste The young preschooler may have a less discriminating sense of taste than the older child, making him or her at increased risk for accidental ingestion. A less discriminating sense of touch and developing visual acuity would not increase the risk. Hearing is intact at birth and it does not increase the child's risk for accidental ingestion.   Question 11 The nurse is conducting a well-child examination of a 5-year-old girl. The girl was  inches at her last examination at age 4. Which of the following height measurements would be within the normal range of growth expected for a preschooler?     inches The average preschool-age child will grow  to 3 inches per year. A measurement of  inches would indicate a 3-inch increase and would be within the normal range.   Question 12 A mother has brought her 6-year-old son in for a check-up because the child is complaining of stomachaches. It is the beginning of the school year. Which of the following might the mother also mention?    The child cries before going to school. The mother has a child with a slow-to-warm temperament. The child may also be crying before going to school. Making friends the first day of school and enjoying the crowds in the lunchroom are typical of a child with an easy temperament. Irritability is typical of a child with a difficult temperament.   Question 13 Two working parents are discussing with the school nurse the possibility of their 12-year-old girl going home alone after school. Which of the following suggestions should the nurse make?    Purchase caller ID for the phone.  Having caller ID allows the child to answer the phone if Mom or Dad calls while ignoring all other calls. Rather than entertaining the child, this would be a better time for homework, age-appropriate chores, and limited entertainment. If the child goes to a friend's house, it should be prearranged between the parents, not spur-of-the-moment. It is safer if the child does not answer the phone instead of taking a message.   Question 14 The nurse is caring for a 7-year-old girl who is scheduled for a hernia repair and is very scared. Which of the following fears would she also most likely have at this age?    Fear of being kidnapped At this age, the child will be fearful of being kidnapped. She has outgrown her fears of harm to her body, noises, and dogs, all of which are typical preschooler fears.   Question 15 During a health check-up without his parents, a 17-year-old tells the nurse he is gay. Which of the following approaches should the nurse take?    “Tell me what makes you think you are gay.” The nurse needs to get more information from the teenager (assessment) before making any comment and then proceed in a sensitive and caring way. Comments about being at risk or needing to know about safe sex are negative and should be replaced with health-promotion comments. Denying the statement shows the teenager that you are not an ally.   Question 16 The school nurse is preparing a program on sexuality and birth control for a class of 14- to 16-year-olds. Which of the following behaviors will have the most influence on how the information is presented?    Adolescents tend to take risks. Adolescents are risk-takers. This tendency enables them to overcome common sense and their own better judgment. Although adolescents are capable of abstract thinking and understand that actions have consequences, they are not yet committed to these attributes. Changing body image would not have significant influence on the presentation.   Question 17 The nurse is preparing a class for a group of adolescents about promoting safety. Which of the following would the nurse plan to include as the leading cause of adolescent injuries?    Car accidents  Although firearms, water, and fires all pose a risk for injury for adolescents, most adolescent injuries are due to motor vehicle crashes.   Question 18 A 3-year-old child is scheduled for a hearing screening. The nurse would prepare the child for screening by which method?    Conditioned play audiometry For children between the ages of 2 and 4 years, conditioned play audiometry would be an appropriate method for hearing screening. Auditory brain stem response and evoked otoacoustic emissions are appropriate hearing screening methods for newborns through age 6 months. Visual reinforcement audiometry is appropriate for ages 6 months to 2 years.   Question 19 A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which of the following is the best action for the nurse to take?    Immediately schedule the infant for a newborn hearing screening. Guidelines for infant hearing screen recommend universal screening with an Auditory Brainstem Response (ABR) or Evoked Otoacoustic Emissions (EOAE) test by 1 month of age. All the other answers rely on behavior observation. Studies have shown that behavioral observations are not a reliable method of screening for hearing loss.   Question 20 When assessing the vision of a 2-month-old, the nurse would use which of the following?    Black-and-white checkerboard For infants less than 6 months of age, objects such as a black-and-white checkerboard or concentric circles are best because an infant's vision is more attuned to these high-contrast patterns than to colors. High-contrast animal figures such as pandas or Dalmatians also work well.   Question 21 The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond?    “This is normal; her circulatory system will take a few days to adjust.”  The nurse should tell the parents that this is normal and that the baby's circulatory system is adjusting to extrauterine life. Using the technical term acrocyanosis would most likely scare the parents. Telling the parents that the child may have a circulatory problem is inaccurate as this is a normal variation. Acrocyanosis and the mottling caused by cooling and warming are two different variations.   Question 22 The nurse is measuring the blood pressure of a 12-year-old boy with an oscillometric device. The boy's reading is greater than the 90th percentile for gender and height. What is the appropriate nursing action?    Repeat the blood pressure reading using auscultation. The nurse should repeat the reading using auscultation. The nurse should not use the Doppler ultrasound method in this circumstance. The nurse would only measure the blood pressure in all four extremities with a child presenting with cardiac complaints.   Question 23 The nurse is preparing to assess the pulse of an 18-month-old. Which pulse would be most difficult for the nurse to palpate?    Radial In a child less than 2 years of age, the radial pulse is very difficult to palpate, whereas the pedal, brachial, and femoral pulses are usually easily palpated.   Question 24 The nurse is caring for a 10-year-old in traction. The boy has a nursing diagnosis of deficient diversional activity related to confinement in bed that is evidenced by verbalization of boredom and lack of participation in play, reading, and schoolwork. Which of the following would be the best intervention?    Enlist the aid of a child life specialist. The nurse should enlist the aid of a child life specialist to provide suggestions for appropriate activities. Offering the child reading materials or encouraging him to complete his homework would most likely be met with resistance as he has already verbalized his boredom and disinterest in play, reading, and schoolwork. The parents could offer the child life specialist ideas about the boy's likes and dislikes; however, the child life specialist could offer expertise in assisting hospitalized children.   Question 25 The nurse is caring for an 11-year-old girl preparing to undergo an MRI scan. Which of the following statements would best help prepare the girl for the test and decrease anxiety?    “The machine makes a very loud rattle; however, headphones will help.” The nurse should acknowledge that an MRI is loud and briefly describe the noises the machine makes. Then, the nurse should immediately offer a solution: headphones. Telling the girl she won't hear a sound is untrue. Telling her that there are loud sounds isn't enough and could increase anxiety. Comparing the MRI scanner to the sound of a machine gun is not appropriate imagery for a child.   Question 2 When assessing a family for barriers to health care, the nurse would consider which factor to be most important?    Finances Financial barriers are one of the most important factors that limit care. Families may not have any medical insurance, may not have enough insurance to cover the services they need, or may not be able to pay for services. Language, health care workers' attitudes, and transportation are also barriers to health care but are not as fundamentally important as finances.   Question 3 The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which of the following is the priority intervention to promote adequate growth?    Monitoring the child's weight and height Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.   Question 4 Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned?    Step Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.   Question 5 A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate?    “Keep the baby sitting up for about 30 minutes afterwards.”  Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended. Question 7 The nurse is providing anticipatory guidance to the parents of an 18-month-old girl. Which guidance will be most helpful for toilet teaching?    Advising them to use praise, not scolding The most helpful guidance for toilet teaching is to urge the parents to use only praise, but never to scold, throughout the process. It is best for the same-sex parent to demonstrate toilet use. Bowel control will occur first. It may take additional months for nighttime bladder control to be achieved. Curiosity is a sign of readiness for toilet teaching, but by no means a sure sign.   Question 8 The nurse is teaching the parents of an overweight 18-month-old girl about diet. Which intervention will be most effective for promoting proportionate growth?    Remove high-calorie, low-nutrient foods from diet. The most effective intervention will be to remove high-calorie, low-nutrient foods from the diet in order to reduce the number of calories and increase the nutritional value. Exercise is also important, but a child this age should have 30 minutes of structured physical activity plus several hours of unstructured physical activity per day. The parents should set an example for good eating habits. Dietary fat should not be restricted for an 18-month-old child because it is necessary for nervous system development.   Question 9 The mother of a 5-year-old boy calls the nurse and seeks advice on how to assist the child with the recent death of his paternal grandfather. The boy keeps asking when his grandpa is coming back. How should the nurse respond?    “This is normal; children his age do not understand the permanence of death.” The nurse needs to remind the mother that preschoolers do not completely understand the concept of death or its permanence. Telling the mother that it is best to ignore the boy's questions or that the boy will eventually figure this out on his own does not teach. Repeating that the grandfather is not coming back does not consider the developmental stage of the child and is inappropriate.   Question 10 A nurse is caring for a 4-year-old girl. The mother says that the girl is afraid of cats and dogs and does not like to go to the playground anymore because she wants to avoid the dogs that are often being walked at the park. What should the nurse tell the mother?    “Acknowledge her fear and help her develop a strategy for dealing with it.”  Preschoolers have vivid imaginations and experience a variety of fears. It is best to acknowledge the fear, rather than minimize it, and then collaborate with the child on strategies for dealing with the fear. Avoiding the playground will not address the child's fears. Forcing the child to face her fear without enlisting her input to help deal with the fear does not teach. It is also important for the mother to find out if an incident involving cats and dogs occurred without her knowledge.   Question 11 Which food suggestion would be most appropriate for the mother of a preschooler to ensure an adequate intake of calcium?    White beans To ensure an adequate intake of calcium, the nurse should suggest white beans, because 1 ounce of dried white beans when cooked provides 160 mg of calcium. Spinach, fortified cereal, and lentils are good sources of iron.  Question 14 During a well-child check-up, the parents of a 9-year-old boy tell the nurse that their son's friends told him that soccer is a stupid game, and now he wants to play baseball. Which comment by the nurse best explains the effects of peer groups?    “Acceptance by friends, especially of the same sex, is very important at this age.” Peer relationships, especially of the same sex, are very important and can influence the child's relationship with his parents. They can provide enough support that he can risk parental conflict and stand his ground about playing soccer. At this age, peer groups are made up of the child's best friends, and they happen to be playing baseball. Peer groups have rules and take up sides against the soccer player. Peers are an authority, so the child will let his parents know their opinions.   Question 15 The nurse is teaching the parents of a 12-year-old boy about appropriate approaches when raising an adolescent. Which of the following comments should be included in the discussion?    “Try to be open to his views.” It is most important to be open to the child's views. This will encourage the child to consider parental concerns and promote communication. Being judgmental about his friends will make the child defensive about his choice of friends. Rules need to be flexible so they can apply to new situations. Avoid condescension. The child will appreciate being treated like a young man.   Question 16 The nurse is providing suggestions to a female adolescent about foods to help meet her nutritional requirements for iron. Which food would the nurse suggest as a good source of iron?    Peanut butter Peanut butter is a good source of iron. Broccoli, yogurt, and white beans are good sources of calcium.    Question 18 The nurse is performing a vision screening for a 4-year-old child. Which of the following screening charts would be best for determining the child's visual acuity?    Allen figures The Allen figures chart is reliable for assessing visual acuity for a preschool child. The Snelling chart requires that the child has a good knowledge of the alphabet. This is not an expectation for a 4-year-old child. The Ishihara and Color Vision Testing Made Easy (CVTME) charts are designed to assess color vision discrimination and not visual acuity.   Question 19 During the health history, the mother of a 4-month-old child tells the nurse she is concerned that her baby is not doing what he should be at this age. What is the nurse's best response?    “Tell me what concerns you.” Asking about the mother's concerns is assessment and is the first thing the nurse should do. The mother has intimate knowledge of the infant and can provide invaluable information that can help structure the nurse's assessment. Relying on the physical assessment ignores the value of the mother's input. A screening questionnaire is no substitute for a developmental assessment. Minimizing the mother's concerns reduces communication between the mother and the nurse.   Question 20 A 2-week-old child responds to a bell during an initial health supervision examination. The child's records do not show that a newborn hearing screening was done. Which of the following is the best action for the nurse to take?    Immediately schedule the infant for a newborn hearing screening.  Guidelines for infant hearing screen recommend universal screening with an Auditory Brainstem Response (ABR) or Evoked Otoacoustic Emissions (EOAE) test by 1 month of age. All the other answers rely on behavior observation. Studies have shown that behavioral observations are not a reliable method of screening for hearing loss.   Question 21 While auscultating the heart of a 5-year-old child, the nurse notes a murmur that is soft and quiet and heard each time the heart is auscultated. The nurse documents this finding as which of the following?    Grade 2 A grade 2 murmur is soft and quiet and is heard each time the chest is auscultated. A grade 1 murmur is barely audible and is heard at some times and not at other times. A grade 3 murmur is audible with intermediate intensity. A grade 4 murmur is audible and accompanied by a palpable thrill.   Question 22 A mother brings her 3-1/2-year-old daughter to the emergency department because the child has been vomiting and having diarrhea for the past 36 hours. When assessing this child's temperature, which method would be least appropriate?    Rectal Obtaining the child's temperature via the rectal route would be least appropriate because the child has diarrhea, and insertion of the thermometer might traumatize the rectal mucosa. Additionally, the rectal route is highly invasive and a child of this age fears body invasion. Using the oral route might be problematic due to the child's age and inability to cooperate, especially in light of the child's vomiting. However, it would not be as dangerous as obtaining a rectal temperature. The tympanic or axillary method would be the most appropriate method.   Question 23 The nurse is conducting a routine health assessment of a 3-month-old boy and notices a flat occiput. The nurse provides teaching and emphasizes the importance of tummy time. Which of the following responses by the mother indicates a need for further teaching?    “He must be positioned on his tummy as much as possible.”  The nurse needs to emphasize that the boy must have tummy time while he is observed and awake, and to remind the mother that the baby should still sleep on his back. The other statements are correct.   Question 24 When preparing to apply a restraint to a child, which of the following would be most important for the nurse to do?    Explain that safety, not punishment, is the reason for the restraint. Before applying a restraint, the nurse needs to explain the reason for the restraint to the child, emphasizing that the restraint is for safety, not to punish the child. The least restrictive type of restraint should be used, and it should be applied for the shortest time necessary. A clove hitch knot is used to secure the restraint with ties to the bed or crib frame, not the side rails.   Question 25 The nurse is caring for a 7-year-old boy who needs his left leg immobilized. What is the priority nursing intervention?    Explain to the boy that he must keep his leg very still. An explanation about the desired goal is necessary and appropriate for a 7-year-old child to understand what is required. In many cases, this will be all that is needed. Explaining that a restraint will be applied if the boy cannot hold still will likely be perceived as a threat or punishment. All alternative measures need to be tried before the use of restraints. Enlisting the assistance of the child life specialist is not a priority. Question 1 The nurse is preparing to administer a topical anesthetic for a 10- year-old girl with a chin laceration. The nurse would expect to apply which of the following as ordered in preparation for sutures?    TAC (tetracaine, epinephrine, cocaine)   TAC (tetracaine, epinephrine, cocaine) is commonly used for lacerations that require suturing. The agent can be applied directly to the wound with a cotton ball or swab for 20 to 30 minutes until the area is numb. EMLA and iontophoretic lidocaine are applied to intact skin, not to open wounds or lacerations. A vapocoolant spray, which should not be applied over a wound, is only effective for 1 to 2 minutes.   Question 2 Pentazocine is prescribed for a child with moderate pain. The nurse identifies this drug as an example of which type?     Mixed opioid agonist-antagonist   Pentazocine is classified as a mixed opioid agonist-antagonist. Ibuprofen, ketorolac, and naproxen are examples of NSAIDs that inhibit prostaglandin synthesis. Morphine, codeine, and fentanyl are examples of opioids.   Question 3 The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect?    Increased pressure on nociceptive fibers Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.   Question 4 The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment?    The pain's history, onset, intensity, duration, and location Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.   Question 5 When describing the role of white blood cells in infection, the nurse identifies which type as important in combating bacterial infections?    Neutrophils  Elevations in certain portions of white blood cell count reflect different processes occurring in the body. Neutrophils function to combat bacterial infection. Eosinophils function in allergic disorders and parasitic infections. Basophils combat parasitic infections and some allergic disorders. Lymphocytes function in viral infections.   Question 6 The nurse is preparing a plan of care for a 5-year-old boy with chickenpox. Which of the following nursing interventions should be questioned?     Provide alcohol baths as needed.   Treatments such as sponging the child with alcohol or cold water are not appropriate interventions for fever management. The other interventions are appropriate.   Question 7 After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time?    After the lesions have crusted   Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.   Question 8 The nurse is performing a physical exam for a 9-year-old boy who complains of a stiff neck and pain in his arms and legs. He has never been vaccinated for polio. Which of the following assessment findings would suggest the child has polio?    Positive Kernig's sign A positive Kernig's sign would further suggest that this unvaccinated child could have polio. Swelling in the neck is a symptom of mumps. Confusion and anxiety are symptoms of rabies. Conjunctivitis is a symptom of Lyme disease.   Question 9 A newborn is suspected of having persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion?    Echocardiogram An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension. Chest x-ray would most likely be used to aid in the diagnosis of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC.   Question 10 The nurse is caring for a 3-year-old girl with a respiratory disorder. Which of the following activities would require preoxygenating the child?    Suctioning a tracheostomy tube Oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.   Question 11 A newborn with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which of the following would the nurse anticipate for this newborn?    Extracorporeal membrane oxygenation (ECMO) If conventional measures are ineffective, then the nurse would need to prepare the newborn for ECMO. Hyperoxygenation, ventilatory support, and suctioning are typically used initially to promote tissue perfusion. If these are ineffective, then ECMO would be the next step.   Question 12 The nurse is assessing a 7-year-old boy with pharyngitis. Which of the following symptoms would be least likely to be observed?    Working hard to breathe Disorders of the nose and throat do not result in increased work of breathing, so that would not be observed by the nurse. Difficulty swallowing, sore throat, and headache are consistent with pharyngitis as is the rash, which would be fine, red, and sandpaper-like (called scarletina-form).   Question 13 When developing the plan of care for a child with burns requiring fluid replacement therapy, which of the following would the nurse expect to include?    Administration of most of the volume during the first 8 hours With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer's lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hour.   Question 14 The nurse is teaching the mother of a toddler about burn prevention. Which of the following responses from the mother indicates a need for further teaching?    “I will set our water heater at 130 degrees.”   If the temperature of the water heater is set at 130 degrees, a child can be burned significantly in only 30 seconds. The recommended maximal home hot water heater temperature is 120 degrees. The other statements are correct.   Question 15 The nurse is caring for a child with widespread itching and has recommended bathing as a treatment to relieve the itching. Which of the following responses from the mother indicates a need for further instruction?    “After bathing, I need to rub his skin everywhere to make sure he is completely dry.” nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. The other statements are correct.   Question 16 A nurse is caring for a 14-year-old girl who received an electrical burn. The nurse would expect to prepare the girl for which of the following diagnostic tests as ordered?    Electrocardiographic monitoring   Electrocardiographic monitoring is important for the child who has suffered an electrical burn to identify possible cardiac arrhythmias, which can be noted for up to 72 hours after a burn injury. Fiberoptic bronchoscopy and xenon ventilation-perfusion scanning may be ordered to evaluate an inhalation injury, not an electrical burn. Pulse oximetry is used to evaluate pulmonary function and would not be indicated in the case of an electrical burn.   Question 17 When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. The nurse interprets these findings to suggest which of the following?    Neurofibromatosis The hallmark of neurofibromatosis is caf-au-lait spots appearing all over the body, particularly the trunk and extremities. Additional findings include benign tumors, axillary freckling, and pigmented nevi. Klinefelter syndrome is associated with a lack of secondary sex characteristics, decreased facial hair, gynecomastia, decreased pubic hair, and hypogonadism. Fragile X syndrome is manifested by minor dysmorphic features and developmental delay. Sturge-Weber syndrome is associated with facial nevus, seizures, hemiparesis, and intracranial calcifications.   Question 18 Which of the following would lead the nurse to suspect that a child has Turner syndrome?    Webbed neck Manifestations of Turner syndrome include webbed neck, low posterior hairline, wide-spaced nipples, edema of the hands and feet, amenorrhea, and absence of secondary sex characteristics, along with short stature and slow growth. Microcephaly is commonly associated with trisomy 13. Gynecomastia and cognitive delay are associated with Klinefelter syndrome.   Question 19 After teaching a class about inborn errors of metabolism, the instructor determines that additional teaching is needed when the class identifies which of the following as an example of an inborn error of metabolism?    Achondroplasia   Achondroplasia is an autosomal dominant genetic disorder, not an inborn error of metabolism. Galactosemia, maple syrup urine disease, and Tay-Sachs are considered inborn errors of metabolism.   Question 20 The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which of the following instructions should be questioned?    Adhering to the special dietary needs of the child Children with Down syndrome do not require a special diet unless underlying gastrointestinal disease is present. However, a balanced, high-fiber diet and regular exercise are important. Getting cervical x-rays between 3 and 5 years of age is the screening method for atlantoaxial instability, which is seen in about 14% of children with Down syndrome. Evaluation by a pediatric cardiologist before 3 months of age, including echocardiogram, is important since children with Down syndrome are at higher risk for heart disease. The child will be more susceptible to infectious diseases. Question 1 The nurse is preparing a child for a lumbar puncture. How far ahead of the procedure should the nurse apply the EMLA cream?    Three hours For a deeper procedure such as a lumbar puncture, the nurse needs to apply the cream 2 to 3 hours before the procedure. For a superficial procedure, the EMLA should be applied at least 1 hour before the procedure.   Question 2 The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which of the following statements indicates the mother understands the technique?    “We'll repeat 'quick stick, feel better, go home soon' several times.” Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.   Question 3 The nurse is caring for a child who is complaining of chronic pain. Which of the following is the priority nursing assessment?    The pain's history, onset, intensity, duration, and location Assessment of the child's pain is key; it is the priority assessment and is the only answer that focuses on the child's physiologic need. Assessment of how the pain impacts the child's and family's stress, feelings of anxiety, hopelessness, and depression, as well as the child's cognitive level and emotional response, are secondary after the pain is explored.   Question 4 The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect?    Increased pressure on nociceptive fibers Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.   Question 5 A 3-year-old boy has been on chemotherapy for cancer. He complains about a sore throat, is experiencing malaise, and has a temperature of 99.8 °F orally. His mother calls the child's physician. What is the appropriate information for the nurse to tell his mother at this time?    Plan to bring the child into the physician's office today. The child could be very ill and some chemotherapy agents mask the signs of infection. There needs to be an assessment of the child. Aspirin is not used in children of this age because of the chance of Reyes syndrome. The other options are incorrect because they do not address the need of the child being assessed.   Question 6 There are six links in the chain of infection, each of which has nursing implications. Which of the following precautions helps break the chain of infection to the susceptible host?    Maintaining skin integrity Maintaining the integrity of the patient's skin and mucous membranes is a precaution that will break the chain of infection at the susceptible host. Keeping linens dry and clean is a precaution to take at the reservoir link. Washing hands frequently breaks the chain at the mode of transmission. Coughing into a handkerchief is a precaution for the portal of exit.   Question 7 Which of the following would be most important to include when teaching the parents of a child with pinworm?    “Make sure the child washes his hands after using the bathroom.” The most effective measure to prevent pinworms or its recurrence is good hand hygiene, especially after using the bathroom and before eating. Sealing the child's clothing in a plastic bag is appropriate for pediculosis capitis. Having the child wear shoes at all times is helpful in preventing hookworm. Use of a cream that remains on for a specified time is associated with scabies.   Question 8 The nurse is performing a physical examination of an 8-year-old girl who was bitten by her kitten. Which of the following assessments would be most indicative of cat scratch disease?    Swollen lymph nodes Lymph nodes, especially under the arms, can become painful and swollen due to cat scratch disease. Strawberry tongue is typical of scarlet fever. Infected tonsils and an edematous neck are symptoms of diphtheria.   Question 9 A newborn is suspected of having persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion?    Echocardiogram An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension. Chest x-ray would most likely be used to aid in the diagnosis of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC.   Question 10 The nurse is examining a 5-year-old boy. Which of the following signs or symptoms is a reliable first indication of respiratory illness in children?    Rapid, shallow breathing   Tachypnea, or rapid, shallow breathing, is often the first sign of respiratory illness in infants and children. Slow, irregular breathing; lethargy; and listlessness are signs that the child's condition is becoming dangerous. Cyanosis (a bluish tinge to the lips) or the degree of cyanosis present is not always an accurate indication of the severity of respiratory involvement.   Question 11 The nurse prepares to administer a gavage feeding to a newborn with transient tachypnea. This type of feeding is necessary because:    Oxygen demands need to be reduced In the newborn with transient tachypnea, the respiratory rate is high, increasing the oxygen demand. Thus, measures are initiated to reduce this demand. Gavage feedings are one way to do so. With transient tachypnea, enzyme activity and kidney function are not affected. This condition typically resolves within 72 hours. The risk for hyperbilirubinemia is not increased.   Question 12 A newborn with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which of the following would the nurse anticipate for this newborn?    Extracorporeal membrane oxygenation (ECMO)   If conventional measures are ineffective, then the nurse would need to prepare the newborn for ECMO. Hyperoxygenation, ventilatory support, and suctioning are typically used initially to promote tissue perfusion. If these are ineffective, then ECMO would be the next step.   Question 13 The nurse is caring for an infant with candidal diaper rash. Which of the following medications would the nurse expect to administer as ordered?    Topical antifungals Candidal diaper rash would require a fungicide. The nurse would expect to administer topical antifungals as ordered. Corticosteroids are not typically recommended for young infants, and are used for atopic dermatitis and certain types of contact dermatitis. Antibiotics would be ineffective against fungal infections. Retinoids are indicated for moderate to severe acne.   Question 14 Which of the following would the nurse expect to find in a child with cellulitis?    Warmth at skin disruption site Cellulitis is manifested by erythema, pain, edema, and warmth at the site of skin disruption. Red raised hair follicles would indicate folliculitis. Papules progressing to vesicles and a honey-colored exudate would suggest nonbullous impetigo.   Question 15 The nurse is providing teaching about home care for an 8-year-old boy with widespread sunburn on his back and shoulders. Which of the following responses indicates a need for further teaching?    “He should manually peel off any flaking skin.” If skin flaking occurs, the child should be discouraged from manually 'peeling' the flaked skin as it can cause further injury. The other statements are correct.   Question 16 The nurse is caring for 15-year-old boy who has sustained burn injuries. The nurse observes the burn developing a violaceous color with discharge and a foul odor. The nurse suspects which of the following infections?    Invasive burn cellulitis Invasive burn cellulitis results in the burn developing a violaceous, dark-brown or black color with a discharge and foul odor. In burn wound cellulitis, the area around the burn becomes increasingly red, swollen, and painful early in the course of burn management. Burn impetigo is characterized by multifocal, small, superficial abscesses. Staphylococcal scalded skin syndrome is not a burn infection; however, it is managed similarly to burns.   Question 17 The nurse is caring for 3-day-old girl with Down syndrome whose mother had no prenatal care. Which of the following will be the priority nursing diagnosis?    Nutrition: altered, less than body requirements related to the effects of hypotonia Children with Down syndrome may have difficulty sucking and feeding due to lack of muscle tone and the structure of their mouths and tongues. This can lead to poor nutritional intake, and makes this the priority diagnosis. This also uses the strategy that physiologic needs have priority using Maslow's hierarchy of needs. Deficient knowledge due to lack of information about the disorder is a close second in priority, as the mother did not know of her daughter's condition before birth and has much to learn now. This child is at risk for a number of complications such as infection, heart disease, and leukemia, and will require frequent assessment. Most children with Down syndrome experience some degree of mental retardation, but early intervention will allow the child maximum development within the limits of the disease. Mobility is delayed but should not be a problem at this time.   Question 18 The nurse is counseling a couple who suspect that they could bear a child with a genetic abnormality. What is the most important guideline for the nurse to follow while working with this family?      Present the information in a nondirective manner.   It is essential to respect client autonomy and present information in a factual, nondirective manner. In these situations, the nurse needs to understand that the choice is the couple's to make. Gathering information for three generations obtains a broad overview of what has been seen in both sides of the family. Maintaining confidentiality of the information is as important as with any other client information gathered. Informing family of the need for information is necessary because of its personal nature.   Question 19 When teaching a class about trisomy 21, the instructor would identify this disorder as due to which of the following?    Nondisjunction Trisomy 21 is an example of a genetic disorder involving an abnormality in chromosomal number due to nondisjunction. X-linked recessive inheritance disorders, such as hemophilia and Duchenne muscular dystrophy, involve altered genes on the X chromosome. Genomic imprinting disorders, such as Prader-Willi syndrome, involve expression of only the maternal or paternal allele, with the other being inactive. Autosomal dominant inheritance disorders, such as neurofibromatosis and achondroplasia, involve a single gene in the heterozygous state that is capable of producing the phenotype, thus overshadowing the normal gene.   Question 20 The nurse is preparing a presentation to a local community group about genetic disorders and the types of congenital anomalies that can occur. Which of the following would the nurse include as a major congenital anomaly?    Cleft palate Cleft palate is considered a major congenital anomaly, one that creates a significant medical problem or requires surgical or medical management. Overlapping digits, polydactyly, and umbilical hernia are considered minor congenital anomalies because they do not cause an increase in morbidity in and of themselves. Question 1 The nurse is conducting a pain assessment of a 10- year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action?    Obtain an order for a different medication   Increasing the dose of the acetaminophen will not help his pain because he has reached as high a dose of that medication that will work. This is known as the ceiling effect, but explaining that to him will not help his pain. Guided imagery is not the best therapy for his pain, so the physician needs to order a different medication to manage his pain.   Question 2 The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which of the following statements indicates the mother understands the technique? “We'll repeat 'quick stick, feel better, go home soon' several times.” Thought stopping is a technique that involves the use of short, concise phrases of positive ideas. Doing so helps to promote the child's sense of control. Imagining a favorite beach in Florida is using imagery. Talking about a favorite funny movie involves humor. Letting body parts go limp is a relaxation technique.   Question 3 The nurse is explaining the effects of heat application for pain relief. Which of the following would the nurse be likely to include as an effect?    Increased pressure on nociceptive fibers Heat causes an increase in blood flow. This alters capillary permeability, leading to a reduction in swelling and pressure on nociceptive fibers. Heat also may trigger the release of endogenous opioids, which mediate the pain response.   Question 4 When assessing a child's pain, which of the following is most important?    Using the same tool to assess the child's pain each time   Although obtaining a pain rating, documenting the assessment, and asking the child's parents about the pain are important, the most important aspect of pain assessment is to use the same tool each time so that appropriate comparisons can be made and effective interventions can be planned and implemented. Consistency allows the most accurate assessment of the child's pain.   Question 5 Studies have shown that the use of antipyretics may prolong illness, but they do have benefits to the child with fever. Which of the following statements best explains the benefit of antipyretics?    They help decrease fluid requirements.   Antipyretics provide symptomatic relief by increasing comfort in the child and decreasing fluid requirements, which helps to prevent dehydration. They do not slow the growth of bacteria, increase neutrophil production, or encourage T-cell proliferation.   Question 6 A mother brings her 8-year-old son for evaluation because of a rash on his lower leg. Which finding would support the suspicion that the child has Lyme disease?    Playing in the woods about a week ago   Lyme disease is caused by the bite of an infected tick, with a rash appearing 7 to 14 days after the tick bite. Ticks are commonly found in wooded areas. Therefore, reports of the child playing in the woods about 7 days ago would support the diagnosis of Lyme disease. A papular and vesicular rash is commonly associated with varicella (chickenpox). A high fever for 3 to 5 days before a rash suggests roseola. Extreme pruritus with visible nits would suggest pediculosis.   Question 7 After teaching the parents of a child with varicella zoster, the nurse determines that the parents have understood the teaching when they state that their child can return to school at which time?    After the lesions have crusted   Children with chickenpox (varicella zoster) can return to school once the lesions have crusted.   Question 8 A 3-year-old boy has been on chemotherapy for cancer. He complains about a sore throat, is experiencing malaise, and has a temperature of 99.8 °F orally. His mother calls the child's physician. What is the appropriate information for the nurse to tell his mother at this time?    Plan to bring the child into the physician's office today. The child could be very ill and some chemotherapy agents mask the signs of infection. There needs to be an assessment of the child. Aspirin is not used in children of this age because of the chance of Reyes syndrome. The other options are incorrect because they do not address the need of the child being assessed.   Question 9 A newborn is suspected of having persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion?    Echocardiogram An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension. Chest x-ray would most likely be used to aid in the diagnosis of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC.   Question 10 A rapid Strep test has confirmed that a 5-year-old girl has a Group A Strep infection. Which of the following interventions will the nurse have the parents do last?    Discard the child's toothbrush. The last thing the parents need to do is discard the child's toothbrush once the infection has resolved so that she does not reinfect herself. Using a cool mist humidifier in the child's room and encouraging her to drink liquids or eat ice chips will begin immediately. Administering antibiotics will begin immediately and continue until the entire prescription is used.   Question 11 The nurse is examining an 8-year-old boy with tachycardia and tachypnea. Which one of these noninvasive tests can determine the extent of hypoxia?    Pulse oximetry Pulse oximetry is a useful tool for determining the extent of hypoxia. It can be used by the nurse for continuous or intermittent monitoring. Pulmonary function testing measures respiratory flow and lung volumes and is indicated for asthma, cystic fibrosis, and chronic lung disease. Peak expiratory flow testing is used to monitor the adequacy of asthma control. Chest x-rays can show hyperinflation, atelectasis, pneumonia, foreign bodies, pleural effusion, and abnormal heart or lung size.   Question 12 The nurse is caring for a 3-year-old girl with a respiratory disorder. Which of the following activities would require preoxygenating the child?    Suctioning a tracheostomy tube Oxygenation may be necessary before, and is always performed after, suctioning a child with a tracheostomy tube. Providing tracheostomy care, administering drugs with a nebulizer, and suctioning with a bulb syringe do not require supplemental oxygen.   Question 13 After teaching a class about the differences in the skin of infants and adults, the nurse determines that additional teaching is necessary when the class states which of the following?   “The infant has a lower risk for damage from ultraviolet radiation because the skin is more pigmented.” Infants have less pigmentation in their skin, placing them at increased risk for skin damage from ultraviolet radiation. The infant's skin is thinner, the epidermis is loosely connected, and there is less subcutaneous fat.   Question 14 The nurse is preparing a class for a group of adolescents about reducing the risk of skin cancer. Which of the following would the nurse include?    Avoid sun exposure between the hours of 10 a.m. and 2 p.m. Avoiding sun exposure between the hours of 10 a.m. and 2 p.m. is one method of reducing the risk for skin cancer. Sunscreens with an SPF of 15 or greater that are fragrance- and PABA-free should be used. Sunscreen should be applied at least 30 minutes before exposure and then reapplied at least every 2 hours while exposed. Artificial ultraviolet light, including tanning beds, should be avoided.   Question 15 The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse makes a note of which of the following descriptions in the medical chart?    Presence of macule A macule is a flat, discolored area on the skin. A papule is a small, raised bump on the skin. A vesicle is a fluid-filled bump on the skin. Scaling is flaking of the skin.   Question 16 When developing the plan of care for a child with burns requiring fluid replacement therapy, which of the following would the nurse expect to include?    Administration of most of the volume during the first 8 hours With fluid replacement therapy, most of the volume is administered during the first 8 hours. Crystalloids (such as Ringer's lactate) are administered for the first 24 hours, and then colloids are used once capillary permeability is less of a concern. Fluid replacement is determined by the amount of body surface area burned. Hourly urine output is expected to be at least 1 mL/kg/hour.   Question 17 The nurse is teaching a couple about the pros and cons of genetic testing. Which of the following statements best states the capabilities of genetic testing?    “Some genetic tests can give a probability for developing a disorder.”   The fact that some tests only provide a probability for developing a disorder raises a problem. A serious limitation of these susceptibility tests is that some people who carry a disease-associated mutation never develop the disease. The other statements affirm the value of genetic tests.   Question 18 When performing a physical examination on a small child, the nurse observes approximately 8 to 10 light-brown spots concentrated primarily on the trunk and extremities, two small lumps on the posterior trunk, and axillary freckling. The nurse interprets these findings to suggest which of the following?    Neurofibromatosis The hallmark of neurofibromatosis is caf-au-lait spots appearing all over the body, particularly the trunk and extremities. Additional findings include benign tumors, axillary freckling, and pigmented nevi. Klinefelter syndrome is associated with a lack of secondary sex characteristics, decreased facial hair, gynecomastia, decreased pubic hair, and hypogonadism. Fragile X syndrome is manifested by minor dysmorphic features and developmental delay. Sturge-Weber syndrome is associated with facial nevus, seizures, hemiparesis, and intracranial calcifications.   Question 19 The nurse is teaching a couple about X-linked disorders. They are concerned that they might pass on hemophilia to their children. Which of the following responses indicates the need for further teaching?    “If the father doesn't have it, then his kids won't either.” Hemophilia is an X-linked recessive disorder. This means that both the father and the mother must have the gene for hemophilia to pass it on to their children. Also, their male children will have hemophilia, while their female children have only a 50% chance of having the disorder. If the father has hemophilia and the mother has hemophilia, their children will have the disease. If the father has hemophilia and the mother is a carrier, all their children have a 50% chance of getting the disease.   Question 20 The nurse is taking a health history for a 15-month-old boy who is not yet speaking. Which of the following findings would be eliminated as a risk factor for this possible genetic disorder?    The child is male and Caucasian.   Being male and Caucasian are risk factors for acute lymphoblastic leukemia, not genetic disorders. The fact that the child's grandmother and father have hearing impairments suggests a genetic disorder. The fact that the mother was 37 when she became pregnant and had a breech delivery 3 weeks early are also risk factors for genetic disorders. Q