Pediatrics Final: Chapters 10-20

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Question 1

Question
A 5-year-old boy visits the physician's office with an upper respiratory infection. Which approach would give nurse Kyle the most information about the child's developmental level?
Answer
  • Playing a game with the child
  • Talking with the child about the teddy bear next to him
  • Using a screening tool during a follow-up office visit
  • Askin the 10-year-old sibling about the child

Question 2

Question
Which statement indicates the best sequence for nurse Carrie to conduct an assessment in a nonemergency situation?
Answer
  • Introduce yourself, ask about any problems, take a history, and do the physical examination
  • Perform the physical examination and then ask the family if there are any problems in the child's life
  • Do the physical examination while at the same time asking about the child's previous illnesses; then talk about the family's concerns
  • Get a complete history of the family's health beliefs and practice, and then asses the child

Question 3

Question
What approach by nurse Carina would most likely encourage a child to cooperate with an assessment of physical and developmental health?
Answer
  • Explain to the child what's going to happen when the child asks questions
  • Force the child to cooperate by having a parent hold him or her down
  • Explain what is going to happen in words the child can understand
  • Give the child a sticker before beginning the examination

Question 4

Question
A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially?
Answer
  • Listening to the bowel sounds
  • Counting the heart rate
  • Checking the temperature
  • Looking in the ears

Question 5

Question
Which assessment finding is considered normal in children?
Answer
  • Irregular respiratory rate and rhythm
  • Split S2 and sinus arrhythmia
  • Decreased heart rate with crying
  • Genu varum past the age of 5 years

Question 6

Question
Nurse Shelly is preparing a 5-year-old boy for surgery on his lower leg. His mother is helping him into the hospital gown and the boy fights removal of his underwear. What is the most appropriate nursing action?
Answer
  • Allow the mother to remove the underwear
  • Tell the boy he is acting childishly
  • Notify the OR that the underwear is on
  • Allow the boy to keep his underwear on

Question 7

Question
A 6-month-old infant requires restraint to prevent removal of his nasogastric tube. What is the priority nursing intervention?
Answer
  • Tie the restraint loosely to prevent skin breakdown
  • Leave the baby unrestrained when directly observed
  • Position the restrained infant prone to prevent aspiration
  • Place the infant in a room near the nurses' station

Question 8

Question
Nurse Kevin provides home care to a 2-year-old and listens to the child's parents talk about how the child and family are adjusting to the child's current illness. Which of the following roles is Kevin participating in?
Answer
  • Case management
  • Child and family advocacy
  • Direct nursing care
  • Child and family education

Question 9

Question
A 10-year-old child on a regular diet refuses to eat the food on her meal tray. She requests chicken nuggets, French fries, and ice cream. What is the best nursing action?
Answer
  • Ask that the child's desired foods be sent up from the kitchen
  • Negotiate with the child to eat at least part of the food on the tray
  • Remove a privilege
  • Offer the child cereal and milk from stock on the nursing unit

Question 10

Question
A child is to undergo a tympanostomy tube placement in a freestanding outpatient surgery center. What is the major disadvantage associated with this location?
Answer
  • Increased risk for infection
  • Increased health care costs
  • Need to be transferred if overnight stay is required
  • Increased disruption of family functioning

Question 11

Question
The parents of a 5-year-old with special health care needs talk to parents of a 10-year-old with a similar condition for quite a while each day. What is the nurse's interpretation of this behavior?
Answer
  • The nurse has not provided enough emotional support for the parents
  • This relationship between the children's parents is potentially unhealthy
  • Support between parents of special children is extremely valuable
  • Confidentiality is a pressing issue in this particular situation

Question 12

Question
Nurse Crissy is caring for a child who has received all possible medical care for cancer, yet continues to experience relapse and metastasis. It is time to make the transition from curative care attempts to palliative care. What is the most important nursing consideration at this time?
Answer
  • The health care professionals should make the decision about the child's care
  • The family may lose a sense of hope, so cancer treatments should continue
  • Involve the family in the decision-making process about the shift to palliative care
  • Palliative care can take place only at home, so the child should be discharged

Question 13

Question
Nurse Shelly is caring for a 3-year-old with a gastrostomy tube and tracheostomy who is on supplemental oxygen and multiple medications. The mother is rooming in during this hospitalization. What is the priority nursing action?
Answer
  • Incorporate the mother's assistance in care when convenient
  • Recognize the mother as the expert on her child's needs and care
  • Recommend that the mother go home to get some rest
  • Provide family-centered care since the mother is there

Question 14

Question
Nurse DeAnna is caring for a child with a developmental disability who is starting kindergarten this year. The mother is tearful and doesn't want the child to go to school. What is the best response by DeAnna?
Answer
  • "Do you need some time alone to collect yourself?"
  • "You've known for a while this time would come."
  • "Can I call your husband or a friend for you?"
  • "It is normal to feel stressed or sad at this time."

Question 15

Question
The parents of a child with a developmental disability ask the nurse for advice about disciplining their child. What is the best response by nurse Michelle?
Answer
  • "You should choose methods that are most congruent with your values about discipline."
  • "Children like this really can't follow directions, so they may be very hard to discipline."
  • "Punish your child only for socially unacceptable or offending behaviors."
  • "Spanking works well for this type of child, as they really don't like pain."

Question 16

Question
Nurse Kim is preparing to administer an intramuscular injection to an infant. What is the most appropriate site for this injection?
Answer
  • Deltoid muscle
  • Vastus lateralis
  • Dorsogluteal
  • Rectus femoris

Question 17

Question
A 3-year-old child is to receive a medication that is supplied as an enteric-coated tablet. What is the best nursing action?
Answer
  • Crush the tablet and mix it with applesauce
  • Dissolve the medication in the child's milk
  • Place a pill in the posterior part of the pharynx and tell the child to swallow
  • Check with the prescriber to see if an alternative form can be used

Question 18

Question
Nurse Katrina is caring for an infant who weighs 8.2 kg and is NPO and receiving IV fluid therapy. What rate does nurse Katrina calculate as meeting the child's daily fluid requirements?
Answer
  • 82 mL per hour
  • 41 mL per hour
  • 34 mL per hour
  • 22 mL per hour

Question 19

Question
When administering ear drops to a 2-year-old, which action would be most appropriate?
Answer
  • Tell the child that the drops are to treat his infection
  • Pull the pinna of the child's ear down and back
  • Have the child turn his head to the opposite side after giving the drops
  • Massage the child's forehead to facilitate absorption of the medication

Question 20

Question
Nurse Hannah is preparing to asses the pain of a 3-year-old child who had surgery the day before. Which pain assessment method would be most appropriate for the nurse to use?
Answer
  • FACES pain rating scale and poker chip tool
  • FACES pain rating scale, observation of the child, and parent report
  • Asking the parents to rate their child's pain using the word-graphic rating scale
  • Visual analog scale

Question 21

Question
When developing the plan of care for a child in pain, nurse Tanya identifies appropriate strategies aimed at modifying which factors influencing pain?
Answer
  • Gender
  • Cognitive level
  • Previous pain experiences
  • Anticipatory anxiety

Question 22

Question
An adolescent who is a competitive swimmer comes to the emergency department complaining of localized aching pain in his shoulder. He states, "I've been practicing really hard and long to get myself ready for my meet this weekend." The area is tender to the touch. Nurse Oziel determines that the adolescent is most likely experiencing which type of pain?
Answer
  • Cutaneous pain
  • Deep somatic pain
  • Visceral pain
  • Neuropathic pain

Question 23

Question
After teaching a child's parents about the different methods of distraction that can be used for pain management, which statement by the parents indicates a need for additional teaching?
Answer
  • "We'll have her focus on her hand and count each finger slowly."
  • "We'll read some of her favorite stories to her."
  • "We'll have her imagine that she's at the beach this summer."
  • "She likes to play video games, so we'll bring in some from home."

Question 24

Question
A child is scheduled for a bone marrow aspiration at 4 p.m. Nurse Ashley would plan to apply EMLA cream to the intended site at which time?
Answer
  • 1:30 p.m.
  • 3:00 p.m.
  • 3:30 p.m.
  • 4:00 p.m.

Question 25

Question
Compared with adults, why are infants and children at an increased risk for infection and communicable diseases?
Answer
  • The infant has had limited exposure to disease and is losing the passive immunity acquired from maternal antibodies
  • The infant demonstrates an increased inflammatory response
  • Cellular immunity is not functional at birth
  • Infants have an increased risk for infection until they receive their first set of immunizations

Question 26

Question
A mother calls the clinic because her 2-year-old daughter has a rectal temperature of 37.8 degrees Celsius (100 degrees Fahrenheit). She wonders how high a fever should be before she should give medications to reduce it. What is the best response by nurse Zaviera?
Answer
  • "All fevers should be treated to prevent seizures."
  • "Antipyretics should be used with any rise in temperature. They can help change the course of the infection."
  • "Give your child aspirin when her fever is above 38 degrees Celsius (100.4 degrees Fahrenheit)."
  • In a normal healthy child, if your child is not uncomfortable, fevers less than 39 degrees Celsius (102.2 degrees Fahrenheit) do not require medication."

Question 27

Question
A neonate should be evaluated by a physician if which signs and symptoms are present?
Answer
  • Acting fussier than normal
  • Refusing the pacifier
  • Rectal temperature above 38 degrees Celsius
  • Mottling that is present during bathing

Question 28

Question
Public Health Nurse Mo has been asked to provide information to local child care centers on controlling the spread of infectious diseases. What is the best information that Mo can provide?
Answer
  • The etiology of common infectious diseases
  • Proper hand washing techniques
  • The physiology of the immune system
  • Why children are at higher risk of infection than adults

Question 29

Question
When compared with adults, why are infants and children at an increased risk of head trauma?
Answer
  • The head of the infant and young child is large in proportion to the body and the neck muscles are not well developed
  • The development of the nervous system is complete at birth but remains immature
  • The spine is very immobile in infants and young children
  • The skull is more flexible due to the presence of sutures and fontanels

Question 30

Question
At a well-child visit, hydrocephalus may be suspected in an infant if upon assessment nurse Bryn finds:
Answer
  • Narrow sutures
  • Sunken fontanels
  • A rapid increase in head circumference
  • Increase in weight since last visit

Question 31

Question
A 10-year-old child is admitted to the hospital due to history of seizure activity. As his nurse, Hillary is called into the room by his mother, who states he is having a seizure. What would be the priority nursing intervention?
Answer
  • Prevention of injury by removing the child from his bed
  • Prevention of injury by placing a tongue blade in the child's mouth
  • Prevention of injury by restraining the child
  • Prevention of injury by placing the child on his side and opening his airway

Question 32

Question
A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be:
Answer
  • Educate the family on ways to prevent meningitis
  • Initiate appropriate isolation precautions and begin intravenous antibiotics
  • Assess the infant's fontanels
  • Encourage the mother to hold the infant and feed her

Question 33

Question
Which situation would cause nurse Susan to become concerned about possible hearing loss?
Answer
  • A 12-month-old who babbles incessantly, making no sense
  • An 8-month-old who says only "da"
  • A 3-month-old who startles easily to sound
  • A 3-year-old who drops the letter "s"

Question 34

Question
A r-year-old complains of extreme pain when the tragus is touched. Though not diagnostic, this sign is most indicative of which disorder?
Answer
  • Acute otitis media
  • Acute tympanic effusion
  • Otitis interna
  • Otitis externa

Question 35

Question
Nurse Ashley is caring for an infant who has undergone surgery for infantile glaucoma. What is the priority nursing intervention?
Answer
  • Place the child prone postoperatively for comfort
  • Teach the family use of the contact lens
  • Place elbow restraints on the infant
  • Provide mobile for optical stimulation

Question 36

Question
A 2-year-old had been prescribed eye patching for strabismus 6 hours per day. What teaching does nurse Trish provide for the mother?
Answer
  • Try to patch 6 hours per day, but if you miss some it is OK
  • Patching is necessary to strengthen vision in the weaker eye
  • Patching will keep the eye from turning in
  • Since the child is so young, patching can be delayed until school age

Question 37

Question
A 5-month-old infant with RSV bronchiolitis is in respiratory distress. The baby has copious secretions, increased work of breathing, cyanosis, and a respiratory rate of 78. What is the most appropriate initial nursing intervention?
Answer
  • Attempt to calm the infant by placing him in his mother's lap and offering him a bottle
  • Alert the physician to the situation and ask for an order for a state chest radiograph
  • Suction secretions, provide 100% oxygen via mask, and anticipate respiratory failure
  • Bring the emergency equipment to the room and begin bag-valve-mask ventilation

Question 38

Question
A toddler has moderate respiratory distress, is mildly cyanotic, and has increased work of breathing, with a respiratory rate of 40. What is the priority nursing intervention?
Answer
  • Airway maintenance and 100% oxygen by mask
  • 100% oxygen and pulse oximetry monitoring
  • Airway maintenance and continued reassessment
  • 100% oxygen and provision of comfort

Question 39

Question
Nurse Laura is caring for a child with cystic fibrosis who receives pancreatic enzymes. Which statement by the child's mother indicates an understanding of how to administer the supplemental enzymes?
Answer
  • "I will stop the enzymes if my child is receiving antibiotics."
  • "I will decrease the dose by half if my child is having frequent, bulky stools."
  • "Between meals is the best time for me to give the enzymes."
  • "The enzymes should be given at the beginning of each meal and snack."

Question 40

Question
Which of these factors contributes to infants' and children's increased risk for upper airway obstruction as compared with adults?
Answer
  • Underdeveloped cricoid cartilage and narrow nasal passages
  • Small tonsils and narrow nasal passages
  • Cylinder-shaped larynx and underdeveloped sinuses
  • Underdeveloped cricoid cartilage and smaller tongue

Question 41

Question
Which is the most appropriate treatment for epistaxis?
Answer
  • With the child lying down and breathing through the mouth, apply pressure to the bridge of the nose
  • With the child lying down and breathing through the mouth, pinch the lower third of the nose closed
  • With the child sitting up and leaning forward, apply pressure to the bridge of the nose
  • With the child sitting up and leaning forward, pinch the lower third of the nose closed

Question 42

Question
Nurse Amarvir is caring for a 5-year-old child with a congenital heart anomaly causing chronic cyanosis. When performing the history and physical examination, what is nurse Amarvir least likely to assess?
Answer
  • Obesity from overeating
  • Clubbing of the nail beds
  • Squatting during play activities
  • Exercise intolerance

Question 43

Question
A 2-day-old infant was just diagnosed with aortic stenosis. What is the most likely nursing assessment finding?
Answer
  • Gallop and rales
  • Blood pressure discrepancies in the extremities
  • Right ventricular hypertrophy on ECG
  • Heart murmur

Question 44

Question
Sam, age 11, has a diagnosis of rheumatic fever and has missed school for a week. What is the most likely cause of this problem?
Answer
  • Previous streptococcal throat infection
  • History of open heart surgery at 5 years of age
  • Playing too much soccer and not getting enough rest
  • Exposure to a sibling with pneumonia

Question 45

Question
Nurse Jessica is caring for a child after a cardiac catheterization. What is the nursing priority?
Answer
  • Allow early ambulation to encourage activity participation
  • Check pulses above the catheter insertion site for strength and quality
  • Assess extremity distal to the insertion site for temperature and color
  • Change the dressing to evaluate the site for infection

Question 46

Question
While assessing a 4-month-old infant, nurse Bao notes that the baby experiences a hypercyanotic spell. What is the priority nursing action?
Answer
  • Provide supplemental oxygen by face mask
  • Administer a dose of IV morphine sulfate
  • Begin cardiopulmonary resuscitation
  • Place the infant in a knee-to-chest position

Question 47

Question
A mother brings her 6-month-old infant to the clinic. The child has been vomiting since early morning and has had diarrhea since the day before. His temperature is 38 degrees Celsius, pulse 140, and respiratory rate 38. He has lost 6 ounces since his well-child visit 4 days ago. He cries before passing a bowel movement. He will not breastfeed today. What is the priority nursing diagnosis?
Answer
  • Thermoregulation alteration
  • Pain (abdominal) related to diarrhea
  • Fluid volume deficit related to excessive losses and inadequate intake
  • Alteration in nutrition, less than body requirements, related to decreased oral intake

Question 48

Question
A child presents with a 2-day history of fever, abdominal pain, occasional vomiting, and decreased oral intake. Which finding would nurse Laura prioritize for immediate reporting to the physician?
Answer
  • Temperature 101.9 degrees Fahrenheit
  • Rebound tenderness and abdominal guarding
  • Parents will be leaving the child alone in the hospital
  • Child can tolerate only sips of fluid without nausea

Question 49

Question
A 3-year-old infant presenting with physiologic jaundice is hospitalized and placed under phototherapy. Which response indicates to nurse Harmeet that the parent needs more teaching?
Answer
  • "My infant is at risk for dehydration."
  • "My infant needs to stay under the lights, except during feeding time."
  • "My infant can continue to breastfeed during this time."
  • "My infant has a serious liver disease."

Question 50

Question
A 3-month-old infant presents with a history of vomiting after feeding. The plan for the infant is to rule out GER. What information from the history would lead nurse Emily to believe that this infant may need further intervention?
Answer
  • Poor weight gain
  • Has small "spits" after feeding
  • Sleeps through the night
  • Is difficult to burp

Question 51

Question
Nurse Shannon is caring for a child who has had diarrhea and vomiting for the past several days. What is the priority nursing assessment?
Answer
  • Determine the chid's weight
  • Ask if the family has traveled outside of the country
  • Assess circulation and perfusion
  • Send a stool specimen to the lab
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