MIDTERM ch 15, 16, 18, 19 Flashcards
What is the primary goal of pain assessment in pediatric patients?
a) To determine the child’s pain tolerance level
b) To identify the source of pain for diagnostic purposes
c) To provide accurate information about the pain’s location, intensity, and effects on functioning
d) To assess the parent’s perception of the child’s pain
c) To provide accurate information about the pain’s location, intensity, and effects on functioning
Rationale: The primary goal of pain assessment in children is to gather precise details about the location and intensity of pain and understand how it affects the child’s overall functioning. This information guides appropriate pain management strategies.
What type of information is crucial to obtain from parents during a pain history assessment of a child?
a) The child’s pain tolerance level
b) The child’s preferred activities
c) The child’s typical response to pain and coping strategies
d) The parent’s medical history
c) The child’s typical response to pain and coping strategies
Rationale: Parents can provide valuable information about how the child typically expresses, copes with, and manages pain, as well as what works best to alleviate it.
When assessing a child’s pain history, what is the primary reason for asking parents about the child’s preferred word for pain?
a) To improve communication with the child
b) To determine the child’s literacy level
c) To teach the child standardized medical terminology
d) To gauge the child’s maturity level
a) To improve communication with the child
Rationale: Knowing the child’s preferred term for pain facilitates clear and effective communication between the nurse and the child.
A child has had several painful procedures in the past. What behavior might this child exhibit during future painful experiences compared to a child with fewer painful experiences?
a) Increased stress and anxiety
b) Fewer overt signs of stress
c) Hypervigilance to the environment
d) Increased reliance on parents for comfort
b) Fewer overt signs of stress
Rationale: Children with a history of several painful experiences may not exhibit the same types of stressful behaviors as those with limited pain experiences due to learned coping mechanisms.
When conducting a pain history, why is it important to ask older children about their past experiences with painful procedures?
a) To assess their pain tolerance
b) To compare their pain threshold with their peers
c) To determine if they understand the purpose of the procedure
d) To develop a pain management plan based on previous effective strategies
d) To develop a pain management plan based on previous effective strategies
Rationale: Understanding what interventions have been effective in the past helps tailor a pain management plan that meets the child’s individual needs.
Why might children modify their pain descriptions during an assessment?
a) They want to avoid medical interventions.
b) They lack the vocabulary to describe pain accurately.
c) They adjust their responses based on what they think will happen as a result.
d) They are unsure of the purpose of the questions.
c) They adjust their responses based on what they think will happen as a result.
Rationale: Children may alter their pain descriptions depending on their expectations about what actions the nurse or caregiver might take.
When asking parents about what works best to alleviate their child’s pain, which type of response should the nurse prioritize?
a) Specific interventions that the child prefers
b) General advice from the parent’s own experiences
c) The effectiveness of over-the-counter medications
d) The child’s history of medication allergies
a) Specific interventions that the child prefers
Rationale: Understanding what the child finds effective for pain relief ensures that the nurse can implement strategies that align with the child’s preferences and comfort.
A nurse is assessing a child’s pain history. Which question would best help identify the child’s coping strategies?
a) “What do you do when something hurts?”
b) “Where do you hurt the most?”
c) “What medicines have you taken for pain?”
d) “Who helps you when you are in pain?”
a) “What do you do when something hurts?”
Rationale: This question directly explores the child’s personal strategies for managing pain, which is critical for developing an effective pain management plan.
During a pain history assessment, why is it important to ask children what they want the nurse to do for their pain?
a) To establish rapport with the child
b) To involve the child in creating a care plan
c) To teach the child self-management skills
d) To assess the child’s understanding of their condition
b) To involve the child in creating a care plan
Rationale: Asking children for their input on pain management promotes a sense of control and helps the nurse develop a care plan tailored to the child’s needs and preferences.
Which factor is most important when selecting a pain assessment tool for use in pediatric patients?
a) The tool is simple to use and quick to administer
b) The tool requires minimal input from parents or caregivers
c) The tool is approved by the healthcare facility
d) The tool is validated and reliable for the target population
d) The tool is validated and reliable for the target population
Rationale: The most important factors in selecting a pain assessment tool are its validity (accuracy in measuring the intended concept) and reliability (consistency of results). These ensure that the tool provides accurate and trustworthy data.
A nurse uses a pain assessment tool with a pediatric patient. Which outcome demonstrates the tool’s reliability?
a) It provides consistent pain scores across different raters.
b) It measures both physical and emotional aspects of pain.
c) It identifies pain intensity on a 0-10 scale.
d) It includes both subjective and objective pain data.
a) It provides consistent pain scores across different raters.
Rationale: Reliability refers to the ability of a pain assessment tool to yield consistent results when used by the same or different raters, ensuring its dependability in clinical practice.
What is the primary purpose of using behavioral pain scales, such as the Neonatal Infant Pain Scale (NIPS), in nonverbal children?
a) To standardize pain management protocols
b) To identify physical causes of pain
c) To quantify pain based on observed behaviors
d) To assess the effectiveness of medication compliance
c) To quantify pain based on observed behaviors
Rationale: Behavioral pain scales, like NIPS, are used to objectively measure and quantify pain in nonverbal children by observing their physical and behavioral indicators.
A nurse using the Faces, Legs, Activity, Cry, and Consolability (FLACC) tool observes that a nonverbal child has tense legs, is fidgeting, crying occasionally, and is difficult to console. What is the nurse’s next step?
a) Provide pain medication based on the FLACC score.
b) Notify the physician immediately.
c) Reassess the child’s pain in 30 minutes.
d) Document the behaviors and reassess using another tool.
a) Provide pain medication based on the FLACC score.
Rationale: The FLACC tool quantifies pain based on observed behaviors, and the score guides the nurse in providing appropriate interventions, such as pain medication.
When using the Neonatal Infant Pain Scale (NIPS), which of the following behaviors would the nurse assess?
a) Verbal expression of pain and vital signs
b) Crying, facial expressions, and limb movement
c) Reflex responses and oxygen saturation levels
d) Sleep patterns and respiratory rate
b) Crying, facial expressions, and limb movement
Rationale: The NIPS tool evaluates specific physical and behavioral indicators, including crying, facial expressions, and movement, to assess pain in neonates and nonverbal children.
A 6-month-old infant is being assessed for pain using the FLACC tool. Which of the following would contribute to the scoring?
a) Duration of crying and heart rate changes
b) Facial grimacing and difficulty consoling the infant
c) Sleeping patterns and muscle tone
d) Parent’s report of pain behaviors
b) Facial grimacing and difficulty consoling the infant
Rationale: The FLACC tool assesses five categories: facial expression, leg movement, activity level, crying, and consolability to evaluate pain in nonverbal children.
Which statement accurately describes the FLACC tool in pediatric pain assessment?
a) It is suitable for children who can verbalize their pain intensity.
b) It provides a numerical pain score based solely on vital signs.
c) It is designed to assess behavioral indicators of pain in nonverbal children.
d) It evaluates cognitive responses to pain stimuli.
c) It is designed to assess behavioral indicators of pain in nonverbal children.
Rationale: The FLACC tool is an observational scale used to assess pain in nonverbal children by evaluating behavioral indicators such as facial expressions, leg movement, activity, crying, and consolability.
Which facial expression would indicate the highest level of pain in an infant according to the scoring criteria?
a) Restful face with neutral expression
b) Furrowed brow, chin, and jaw with tight facial muscles
c) Occasional grimace with relaxed facial muscles
d) Open mouth with no visible expression
b) Furrowed brow, chin, and jaw with tight facial muscles
Rationale: Tight facial muscles and furrowing of the brow, chin, and jaw are indicators of severe pain in an infant according to the characteristic scoring criteria.
When assessing an intubated infant, which observation would indicate a “silent cry”?
a) Lack of sound with no facial movement
b) Loud, continuous moaning
c) Intermittent crying with relaxed breathing patterns
d) Obvious facial movements without audible crying
d) Obvious facial movements without audible crying
Rationale: Silent crying may occur in intubated infants, indicated by visible facial movements despite the absence of sound.
Which arm movement suggests the presence of pain in an infant?
a) Tense, straight arms with rigidity
b) Random movements of arms
c) Slow, controlled arm movements
d) Relaxed arms with no visible tension
a) Tense, straight arms with rigidity
Rationale: Tense or rigid arm movements, or rapid extension and flexion, are indicators of pain in an infant.
What breathing pattern is most consistent with moderate pain in an infant?
a) Usual breathing pattern maintained
b) Gagging or holding breath
c) Irregular or faster than usual breaths
d) Loud gasping with intermittent pauses
c) Irregular or faster than usual breaths
Rationale: Moderate pain can cause changes in breathing, such as irregular or faster-than-usual patterns, as described in the scoring criteria.
What leg movement would score the lowest on the pain scale for an infant?
a) Tense, straight legs with rigidity
b) Random movements of legs
c) Rapid extension and flexion
d) No movement of legs
b) Random movements of legs
Rationale: Relaxed, random leg movements indicate a lack of pain, which corresponds to the lowest pain score.
An infant is thrashing and fussy during an assessment. How would you classify the infant’s state of arousal?
a) Quiet and peaceful
b) Restless and alert
c) Alert and thrashing
d) Sleeping peacefully
c) Alert and thrashing
Rationale: Thrashing and fussiness are indicative of pain, which corresponds to a higher score on the state of arousal criteria.
Which cry pattern is most consistent with severe pain in an infant?
a) Quiet, not crying
b) Mild moaning or intermittent cry
c) Loud screaming with a rising, shrill, continuous cry
d) Occasional whimpering
c) Loud screaming with a rising, shrill, continuous cry
Rationale: A loud, shrill, continuous cry is indicative of severe pain according to the scoring criteria.
What state of arousal would indicate that an infant is experiencing mild pain?
a) Quiet and peaceful
b) Alert and settled
c) Sleeping peacefully
d) Fussy but not thrashing
d) Fussy but not thrashing
Rationale: Mild pain may cause the infant to become fussy, restless, or slightly agitated, but not exhibit severe behaviors like thrashing.
During a pain assessment, the nurse observes an infant gagging and holding their breath. How should this breathing pattern be scored?
a) Relaxed, usual breathing
b) Drawing breath with irregularity
c) Gagging or holding breath
d) Continuous, rapid breathing
c) Gagging or holding breath
Rationale: Gagging or holding breath indicates pain and corresponds to a higher score in the breathing patterns category of the pain assessment criteria.
What is a critical step in using the FLACC scale to assess pain in a child?
a) Observing the child for at least 15 minutes
b) Using the scale only for children older than 1 year of age
c) Administering analgesics before conducting the assessment
d) Uncovering the legs and body for accurate observation
d) Uncovering the legs and body for accurate observation
Rationale: Observing the child’s legs and body uncovered ensures accurate assessment of movements and muscle tension, which are key indicators in the FLACC scale.
A nurse observes a child who is squirming, occasionally moaning, and reassured by occasional touching. What is the most likely FLACC score?
a) 2
b) 4
c) 6
d) 8
b) 4
Rationale: Squirming (1 in Activity), occasional moaning (1 in Cry), and being reassured by touch (1 in Consolability) result in a FLACC score of 4, indicating moderate pain.
What is the correct interpretation of a total FLACC score of 7?
a) No pain
b) Mild pain
c) Moderate pain
d) Severe pain
d) Severe pain
Rationale: A total FLACC score of 7 indicates significant pain, as scores of 7 to 10 are categorized as severe pain.
A nurse observes a child lying quietly, moving easily, and showing a relaxed expression. What is the total FLACC score for this observation?
a) 0
b) 2
c) 4
d) 6
a) 0
Rationale: The child’s relaxed expression, quiet position, and lack of discomfort indicate no observable pain, resulting in a score of 0 in all categories.
Which category of the FLACC scale assesses the child’s ability to be soothed by a caregiver?
a) Face
b) Activity
c) Cry
d) Consolability
d) Consolability
Rationale: The “Consolability” category measures how easily the child can be comforted through interventions such as touching, hugging, or talking.
A nurse notes that a postoperative child is frequently frowning with a clenched jaw and a quivering chin. What is the appropriate FLACC score for the “Face” category?
a) 0
b) 1
c) 2
d) 3
c) 2
Rationale: Frequent frowning, a clenched jaw, and a quivering chin indicate significant pain, which corresponds to a score of 2 in the “Face” category
Which observation would receive a score of 2 in the “Legs” category of the FLACC scale?
a) Legs in a normal position or relaxed
b) Legs shifting uneasily or tense
c) Legs kicking or drawn up
d) Legs squirming slightly but relaxed
c) Legs kicking or drawn up
Rationale: A score of 2 in the “Legs” category indicates severe discomfort, shown by kicking or drawing up the legs.
What is the primary purpose of the FLACC scale in pediatric nursing?
a) To evaluate acute postoperative pain in infants and young children
b) To assess chronic pain in nonverbal children
c) To determine the effectiveness of analgesics in older children
d) To measure emotional responses to pain in toddlers
a) To evaluate acute postoperative pain in infants and young children
Rationale: The FLACC scale is specifically designed to measure acute pain in infants and young children, particularly after surgery, until they can self-report pain.
Which of the following statements about pain assessment in children with intellectual disabilities is correct?
a) All children with intellectual disabilities require behavioral pain assessment tools.
b) Self-report tools are ineffective for children with intellectual disabilities.
c) Behavioral tools are used when self-reporting is not possible.
d) Pain assessment in this population is unnecessary due to their limited awareness of pain.
c) Behavioral tools are used when self-reporting is not possible.
Rationale: While many children with intellectual disabilities can use simple self-report tools, behavioral pain assessment tools are essential when self-reporting is not feasible.
What should the nurse consider when selecting a pain assessment method for a child with intellectual disability?
a) The child’s ability to communicate verbally
b) The severity of the child’s physical disability
c) The availability of advanced diagnostic tools
d) The child’s age and caregiver preferences
a) The child’s ability to communicate verbally
Rationale: The child’s capacity for verbal communication determines whether self-report tools or behavioral assessment methods are most appropriate for assessing pain.
A child with a severe intellectual disability cannot use self-report pain tools. What is the next best option for assessing their pain?
a) Observing behavioral cues using an appropriate pain assessment tool
b) Conducting frequent physical examinations for pain indicators
c) Relying solely on caregiver reports of the child’s pain
d) Administering pain medication without assessment
a) Observing behavioral cues using an appropriate pain assessment tool
Rationale: Behavioral pain assessment tools are designed to evaluate nonverbal expressions of pain, which are critical in assessing children who cannot self-report.
Which approach is most appropriate for assessing pain in a child with intellectual disability who can communicate using simple language?
a) Behavioral pain assessment tools only
b) Self-report pain tools designed for younger children
c) Comprehensive neurological evaluations
d) Pain diaries maintained by caregivers
b) Self-report pain tools designed for younger children
Many children with intellectual disabilities can use simple self-report tools to communicate their pain, making this method effective for those who can express themselves verbally.
What is the primary challenge in assessing pain in children with severe intellectual disabilities?
a) Difficulty in determining the location of pain
b) Inability to self-report pain accurately
c) Lack of effective behavioral pain assessment tools
d) Limited understanding of pain by caregivers
b) Inability to self-report pain accurately
Rationale: Children with severe intellectual disabilities may struggle to self-report pain, requiring the use of alternative assessment methods such as behavioral tools.
What is a key advantage of the Poker Chip Tool in pain assessment for children?
a) It incorporates behavioral observations into the assessment.
b) It provides a visual and tactile way for children to indicate pain intensity.
c) It allows children to rank different types of pain simultaneously.
d) It eliminates the need for verbal communication in pain assessment.
b) It provides a visual and tactile way for children to indicate pain intensity.
Rationale: The Poker Chip Tool uses physical chips to represent units of pain, making it a practical and interactive method for children to self-report their pain intensity.
Which of the following self-report tools is most appropriate for assessing pain in a 5-year-old child?
a) Numeric Pain Rating Scale
b) Visual Analog Scale
c) Verbal Descriptor Scale
d) Oucher Scale
d) Oucher Scale
Rationale: The Oucher Scale is specifically designed for children and includes visual representations and numeric ratings that are age-appropriate for young children, such as a 5-year-old.
A nurse is using the Faces Pain Rating Scale with a child. What does this tool primarily assess?
a) The physical location of the child’s pain
b) The child’s behavioral response to pain
c) The child’s subjective pain intensity
d) The duration of the child’s pain experience
c) The child’s subjective pain intensity
Rationale: The Faces Pain Rating Scale helps children visually express the intensity of their pain, making it a subjective self-report tool.
Which pain assessment method is considered the gold standard for evaluating pain intensity in children who can self-report?
a) Behavioral observation tools
b) Physiological indicators
c) Self-report pain scales
d) Parental reporting
c) Self-report pain scales
Rationale: Self-report pain scales are the most reliable method for assessing pain intensity in children and adolescents who can understand and use them effectively.
What is a key advantage of using the Faces Pain Rating Scale in pediatric care?
a) It evaluates pain in nonverbal children.
b) It is validated for all age groups, including neonates.
c) It simplifies communication by using familiar visuals.
d) It provides an objective measurement of pain intensity.
c) It simplifies communication by using familiar visuals.
Rationale: The scale’s use of cartoon-like faces makes it relatable and easy for children to understand, facilitating effective self-reporting of pain intensity.
A nurse is using the Wong-Baker Faces Pain Rating Scale to assess a 6-year-old’s pain. The child points to a face with tears and a very sad expression. What does this response indicate?
a) Mild pain
b) Moderate pain
c) Severe pain
d) No pain
c) Severe pain
Rationale: Faces with tears or a very sad expression represent severe pain levels on the Wong-Baker Faces Pain Rating Scale.
Which age group is the Wong-Baker Faces Pain Rating Scale most appropriate for?
a) Infants younger than 3 years
b) Children aged 3 years through adolescence
c) Adults with cognitive impairments
d) Elderly patients with communication difficulties
b) Children aged 3 years through adolescence
Rationale: The Wong-Baker scale is specifically designed for children aged 3 years and older, as they can understand and use visual aids to describe their pain intensity.
What is the primary purpose of the Faces Pain Rating Scale in pediatric pain assessment?
a) To evaluate a child’s behavioral response to pain
b) To quantify the physiological effects of pain on the child
c) To allow children to self-report pain intensity visually
d) To determine the cause of a child’s pain
c) To allow children to self-report pain intensity visually
Rationale: The Faces Pain Rating Scale helps children express their subjective pain intensity through visual representations, making it ideal for those unable to use numeric scales.
What unique feature of the Oucher Scale enhances its cultural appropriateness in pediatric pain assessment?
a) It uses cartoon faces to depict pain intensity.
b) It incorporates photographs of children from different cultural groups.
c) It includes both numeric and verbal descriptors of pain.
d) It uses a horizontal scale to represent pain intensity.
b) It incorporates photographs of children from different cultural groups.
Rationale: The Oucher Scale features photographs of children from four cultural groups (White, African American, Hispanic, and Asian), making it more culturally inclusive and relatable for diverse populations.
How does the Oucher Scale combine visual and numeric pain assessment methods?
a) By displaying six photographs alongside a vertical Visual Analog Scale
b) By using culturally adapted photographs without numeric scores
c) By placing photographs and cartoon faces on the same scale
d) By combining pain descriptions with parental observations
a) By displaying six photographs alongside a vertical Visual Analog Scale
Rationale: The Oucher Scale integrates photographs of varying pain expressions with a vertical Visual Analog Scale, allowing for both visual and numeric pain intensity reporting.
A nurse is using the Oucher Scale with a 7-year-old Hispanic child. What is the most important step to ensure accurate pain assessment?
a) Using the Visual Analog Scale portion exclusively
b) Selecting the culturally appropriate photographic set for the child
c) Explaining that the scale is only an estimate of pain
d) Asking the parents to choose the photograph that best matches the child’s pain
b) Selecting the culturally appropriate photographic set for the child
Rationale: The nurse should use the photographic set that aligns with the child’s cultural background to improve understanding and accuracy in pain assessment.
What is the primary purpose of the Poker Chip Tool in pediatric pain assessment?
a) To assess chronic pain intensity
b) To quantify acute procedural pain
c) To assess the child’s behavioral response to pain
d) To monitor the effectiveness of pain medication
b) To quantify acute procedural pain
Rationale: The Poker Chip Tool is designed to help quantify acute procedural pain by allowing the child to select the number of chips that correspond to their pain intensity.
How does the Poker Chip Tool help a child communicate their pain intensity?
a) By asking the child to describe their pain verbally
b) By using a set of colored chips to represent different pain levels
c) By using chips to represent the number of pain episodes
d) By allowing the child to select the number of chips that match the severity of their pain
d) By allowing the child to select the number of chips that match the severity of their pain
Rationale: The child chooses the number of chips (from 1 to 4) that best represents their pain intensity, making it a visual and tactile way for children to communicate their pain.
Which of the following is a key advantage of using the Poker Chip Tool with pediatric patients?
a) It allows children to express pain without verbal communication.
b) It requires no explanation for children under the age of 3.
c) It combines verbal descriptors and physical gestures to assess pain.
d) It is only suitable for children who have had previous pain experiences.
a) It allows children to express pain without verbal communication.
Rationale: The Poker Chip Tool is particularly useful for children who may have difficulty verbalizing their pain, allowing them to express their pain intensity through a non-verbal method.
Which of the following is a limitation of using the Numeric Pain Scale with younger school-age children?
a) It requires a high level of verbal communication.
b) It is not effective for children who cannot mark the line accurately.
c) It is not suitable for children with cognitive impairments.
d) It is primarily designed for assessing chronic pain, not acute pain.
b) It is not effective for children who cannot mark the line accurately.
Rationale: Younger school-age children may have difficulty understanding the concept of the line and accurately marking their pain level, limiting the effectiveness of the Numeric Pain Scale for this age group.
When using the Numeric Pain Scale, what does the child do to indicate their level of pain?
a) They select a picture that best represents their pain.
b) They rate their pain on a scale from 1 to 5.
c) They mark the location on the 10-cm line that corresponds to their pain.
d) They verbally describe their pain using a set of predefined terms.
c) They mark the location on the 10-cm line that corresponds to their pain.
Rationale: The Numeric Pain Scale involves the child marking the point on the 10-cm line that represents their pain level, with one end indicating “no pain” and the other indicating “worst possible pain.”
Which statement is true regarding the use of the Numeric Pain Scale for younger school-age children?
a) Younger children can easily mark the line independently without assistance.
b) Younger children may have difficulty understanding the concept of numbers and directions.
c) The scale is primarily used to assess pain in children under 3 years old.
d) Younger children use this scale to identify the cause of their pain.
b) Younger children may have difficulty understanding the concept of numbers and directions.
Rationale: Younger school-age children may struggle with understanding numbers and directions, which makes the Numeric Pain Scale less effective for them compared to older children.
For which age group is the Numeric Pain Scale (Visual Analog Scale) typically most effective?
a) Older school-age children and adolescents
b) Infants and toddlers
c) Younger school-age children
d) Elderly patients with cognitive impairments
a) Older school-age children and adolescents
Rationale: The Numeric Pain Scale is most effective for older school-age children and adolescents who can understand numbers and directions to mark their pain on the line. Younger children often have difficulty with the concept of numbers and directions.
Which of the following is a primary feature of the Numeric Pain Scale (Visual Analog Scale)?
a) A series of photographs depicting varying pain expressions
b) A 10-cm line with pain descriptors at each end
c) A set of colored chips to represent pain intensity
d) A combination of verbal and behavioral pain descriptors
a) A series of photographs depicting varying pain expressions
Rationale: The Numeric Pain Scale is a 10-cm line with descriptors such as “no pain” and “worst possible pain” at each end. The child marks where their pain falls on the scale, allowing for quantification.
Which characteristic distinguishes the Word-Graphic Rating Scale from the Numeric Pain Scale?
a) The use of a 10-cm horizontal or vertical line with numeric markers
b) The use of words to describe increasing pain intensity rather than numbers
c) The inclusion of visual images of pain expressions
d) The use of a scale that is only suitable for adults
b) The use of words to describe increasing pain intensity rather than numbers
Rationale: The Word-Graphic Rating Scale uses descriptive words (such as mild, moderate, severe) to represent increasing pain intensity across a 10-cm line, instead of numeric values.
How is pain quantified and recorded when using the Word-Graphic Rating Scale?
a) By having the child verbalize their pain level
b) By using a millimeter ruler to measure the point on the line marked by the child
c) By selecting a corresponding picture from a series of images
d) By assigning a number based on the child’s verbal response
b) By using a millimeter ruler to measure the point on the line marked by the child
Rationale: The Word-Graphic Rating Scale uses a millimeter ruler to measure the location on the 10-cm line where the child marks their pain, allowing for quantification of the pain intensity.
Which of the following is a key benefit of the Word-Graphic Rating Scale for pediatric pain assessment?
a) It does not require the child to understand numbers or numeric values.
b) It uses cartoon characters to express pain intensity, making it more relatable to children.
c) It is a highly effective tool for infants and toddlers.
d) It allows for an accurate self-report from children under 2 years old.
a) It does not require the child to understand numbers or numeric values.
Rationale: The Word-Graphic Rating Scale uses descriptive words rather than numbers, making it easier for children who may have difficulty understanding numeric values to communicate their pain intensity.
A 2-month-old infant comes in for a well-child visit. Which of the following vaccines should the nurse prepare to administer?
A. MMR
B. Varicella
C. Hepatitis B, DTaP, Hib, IPV, PCV13, and RV
D. Influenza
C. Hepatitis B, DTaP, Hib, IPV, PCV13, and RV
The parent of a 4-year-old child asks about the vaccines needed for school entry. The nurse should recommend which of the following?
A. Hepatitis A and Hepatitis B
B. DTaP, IPV, MMR, and Varicella
C. Influenza and Hepatitis A
D. RV and Hib
B. DTaP, IPV, MMR, and Varicella
A nurse is preparing to administer the first dose of the MMR vaccine. What is the minimum age at which the MMR vaccine can be administered?
A. 6 months
B. 9 months
C. 12 months
D. 15 months
C. 12 months
A 6-month-old infant receives their first dose of the influenza vaccine. What should the nurse tell the parents regarding follow-up?
A. No further doses are needed for the rest of the season
B. A booster dose is needed in 6 months
C. A second dose is needed at least 4 weeks later
D. The vaccine will last for 3 years
C. A second dose is needed at least 4 weeks later
Which of the following children would be eligible for the HPV vaccine?
A. A 9-year-old boy
B. A 4-year-old girl
C. A 6-month-old infant
D. An 18-month-old boy
A. A 9-year-old boy
A 15-month-old child is in the clinic for routine vaccines. Which vaccine is contraindicated if the child has a history of an anaphylactic reaction to gelatin?
A. Hib
B. DTaP
C. Hepatitis A
D. MMR
D. MMR
A mother brings her 2-month-old infant for their well visit. She reports the baby received the first Hepatitis B vaccine at birth. What should the nurse do next?
A. Administer only DTaP, Hib, IPV, PCV13, and RV
B. Administer the second dose of Hepatitis B along with other recommended vaccines
C. Skip Hepatitis B entirely at this visit
D. Check for Hepatitis B immunity before giving another dose
B. Administer the second dose of Hepatitis B along with other recommended vaccines
A child receives the varicella vaccine at 12 months. When should the nurse schedule the next dose?
A. At 15 months
B. At 4–6 years
C. At 18 months
D. No additional dose is needed
B. At 4–6 years
Which statement by a parent indicates understanding of the Rotavirus vaccine schedule?
A. “It’s okay to start the first dose after 15 weeks.”
B. “My baby can receive the last dose at 10 months.”
C. “The vaccine is given orally.”
D. “It protects against measles.”
C. “The vaccine is given orally.”
A 12-year-old is due for their annual wellness visit. Which vaccine should the nurse recommend?
A. Tdap booster
B. Hepatitis B booster
C. Varicella vaccine
D. RV vaccine
A. Tdap booster
The parent of a 6-month-old asks why their child is receiving the PCV13 vaccine. What is the correct explanation?
A. It protects against polio.
B. It helps prevent bacterial infections like pneumonia.
C. It prevents hepatitis.
D. It provides immunity against measles.
B. It helps prevent bacterial infections like pneumonia.
Which of the following is an appropriate calculation method for determining IV fluid bolus requirements in pediatric patients with dehydration?
a) 10–15 mL/kg for mild dehydration
b) 30–40 mL/kg for moderate dehydration
c) 20 mL/kg for severe dehydration
d) 50 mL/kg for mild dehydration
c) 20 mL/kg for severe dehydration
Rationale: In cases of severe dehydration, a common practice is to administer a 20 mL/kg bolus to rapidly restore circulatory volume.
A pediatric patient in shock requires an IV bolus of normal saline. The child weighs 18 kg. How much normal saline will be given based on a typical bolus of 20 mL/kg?
a) 150 mL
b) 200 mL
c) 360 mL
d) 400 mL
c) 360 mL
Rationale: To calculate the bolus, multiply the weight (18 kg) by the prescribed volume (20 mL/kg). 18 kg × 20 mL = 360 mL.
What is the primary component of fluid maintenance for a 3-year-old child who weighs 15 kg and is receiving IV fluids?
a) Sodium chloride 0.9%
b) D5 0.45% saline
c) Ringer’s lactate
d) 0.25% sodium chloride
b) D5 0.45% saline
Rationale: D5 0.45% saline is used for maintenance fluids, as it provides a balance of electrolytes and glucose. It is typically given at 4 mL/kg/hr for the first 10 kg of weight and 2 mL/kg/hr for the next 10 kg.
Which of the following is a contraindication for the administration of IV bolus fluids in pediatric patients?
a) Mild dehydration
b) Severe hyponatremia
c) Shock with hypotension
d) Gastroenteritis with vomiting
a) a) Mild dehydration
Rationale: IV bolus fluids are contraindicated in cases of severe hyponatremia, as the rapid infusion of fluids could worsen the electrolyte imbalance and cause cerebral edema.
A pediatric patient who weighs 20 kg is prescribed maintenance IV fluids. According to the Holliday-Segar method, how much fluid should the nurse calculate for the first 10 kg of weight?
a) 500 mL
b) 1,000 mL
c) 1,500 mL
d) 2,000 mL
b) 1,000 mL
Rationale: For the first 10 kg of weight, the fluid requirement is 100 mL/kg. Therefore, for a 20 kg child, the fluid requirement for the first 10 kg is 10 × 100 mL = 1,000 mL.
What is the typical infusion rate for a pediatric bolus of IV fluids during resuscitation for dehydration or shock?
a) 1–2 mL/kg/hr
b) 10–20 mL/kg over 20 minutes
c) 50–100 mL/kg over 24 hours
d) 10–15 mL/kg over 1 hour
b) 10–20 mL/kg over 20 minutes
Rationale: A typical IV fluid bolus during resuscitation in pediatric patients is 10–20 mL/kg given over 20 minutes to rapidly restore circulatory volume.
Which IV fluid is most commonly used for pediatric patients who require maintenance therapy?
a) 0.9% sodium chloride
b) D5W (5% dextrose in water)
c) Lactated Ringer’s
d) D5 0.45% saline
d) D5 0.45% saline
Rationale: D5 0.45% saline is commonly used for maintenance therapy in pediatric patients, as it provides both fluids and some glucose. It’s an appropriate balance for long-term hydration.
A 2-year-old child with mild dehydration is prescribed an IV fluid bolus of 20 mL/kg. The child weighs 12 kg. What is the total volume of the bolus to be administered?
a) 120 mL
b) 240 mL
c) 300 mL
d) 200 mL
b) 240 mL
Rationale: To calculate the bolus, multiply the child’s weight (12 kg) by the prescribed bolus volume (20 mL/kg). Therefore, 12 kg × 20 mL = 240 mL.
Which of the following is the primary goal when administering IV fluids for bolus therapy in pediatric patients?
a) To maintain electrolyte balance
b) To rapidly restore circulatory volume and perfusion
c) To promote nutrition and growth
d) To maintain blood pressure at normal levels
b) To rapidly restore circulatory volume and perfusion
Rationale: Bolus therapy is designed to rapidly restore circulatory volume and improve perfusion, especially in cases of dehydration or shock.
A 4-year-old child is receiving IV fluids for maintenance. The child weighs 14 kg. What is the correct daily fluid requirement based on the Holliday-Segar method?
a) 900 mL
b) 1,400 mL
c) 1,000 mL
d) 1,200 mL
b) 1,400 mL
Rationale: According to the Holliday-Segar method, the daily fluid requirement for a child weighing 14 kg is 1,400 mL. For the first 10 kg of weight, give 100 mL/kg, and for the next 4 kg, give 50 mL/kg.
A 3-year-old child presents with a red nasal mucosa, clear nasal discharge, and an infected throat with enlarged tonsils. The nurse suspects nasopharyngitis (common cold). What is the most likely causative agent of this condition?
a) Respiratory syncytial virus (RSV)
b) Streptococcus pneumoniae
c) Rhinovirus
d) Epstein-Barr virus
c) Rhinovirus
Rationale: Rhinovirus is the most common virus causing nasopharyngitis (common cold). It typically results in symptoms like nasal congestion, clear discharge, and throat irritation, as described in the scenario.
A 2-year-old child with nasopharyngitis presents to the clinic. The nurse informs the parent that the condition is most communicable during which time frame?
a) 1–2 days after symptoms appear
b) 3–4 days after symptoms appear
c) 1–3 days before symptoms develop
d) 4–10 days after symptoms begin
c) 1–3 days before symptoms develop
Rationale: Nasopharyngitis is communicable several hours before symptoms develop and for 1 to 2 days after they begin. This is the period during which the infection can spread to others.
What is the typical incubation period for nasopharyngitis (common cold) in children?
a) 3 to 7 days
b) 1 to 3 days
c) 5 to 10 days
d) 7 to 14 days
b) 1 to 3 days
Rationale: Nasopharyngitis typically has an incubation period of 1 to 3 days after exposure to the viral or bacterial pathogen.
A child with nasopharyngitis develops vesicles on the soft palate and pharynx. What should the nurse suspect?
a) Strep throat
b) Mononucleosis
c) Hand, foot, and mouth disease
d) Viral nasopharyngitis
d) Viral nasopharyngitis
Rationale: Vesicles on the soft palate and pharynx can be seen in viral nasopharyngitis. This is a common feature in viral upper respiratory infections, which may include rhinovirus or coronavirus infections.
A parent of a child with nasopharyngitis asks how the infection spreads. What is the best response from the nurse?
a) “The infection spreads only through direct contact with respiratory droplets.”
b) “The infection is spread through the air when the child coughs or sneezes.”
c) “The infection spreads when an infected person touches an uninfected person’s hand, and that person touches their nose or mouth.”
d) “The infection is contracted from contaminated surfaces in the environment.”
c) “The infection spreads when an infected person touches an uninfected person’s hand, and that person touches their nose or mouth.”
Rationale: Nasopharyngitis is primarily spread through self-inoculation, where an infected person touches an uninfected person’s hand, and the uninfected person touches their nose or mouth, spreading the virus.
A 2-month-old infant presents with lethargy, irritability, and poor feeding. The nurse suspects nasopharyngitis. Which additional symptom would be concerning and suggest a more severe infection in an infant under 3 months of age?
a) Fever
b) Sneezing
c) Vomiting
d) Diarrhea
a) Fever
Rationale: In infants younger than 3 months of age, fever may be absent with nasopharyngitis, but its presence could indicate a more severe infection that requires further investigation and management.
A 4-month-old infant with nasopharyngitis is experiencing irritability, vomiting, and diarrhea. What should the nurse consider as the most likely cause of these symptoms in this age group?
a) Dehydration from poor feeding
b) Gastrointestinal infection unrelated to nasopharyngitis
c) Nasopharyngitis-related viral gastrointestinal symptoms
d) Meningitis
c) Nasopharyngitis-related viral gastrointestinal symptoms
Rationale: In infants over 3 months, nasopharyngitis can be associated with gastrointestinal symptoms such as vomiting and diarrhea, due to the viral nature of the infection.
Which symptom would be most concerning if seen in an infant under 3 months of age with nasopharyngitis?
a) Irritability
b) Lethargy
c) Sneezing
d) Fever
d) Fever
Rationale: Fever in an infant younger than 3 months of age with nasopharyngitis is concerning and may indicate a more serious infection, requiring further assessment and potentially urgent intervention.
An older child with nasopharyngitis reports generalized muscle aches, chills, and a headache. What is the most likely cause of these symptoms?
a) Secondary bacterial infection
b) Symptoms related to the viral nature of nasopharyngitis
c) Asthma exacerbation
d) Allergy-induced symptoms
b) Symptoms related to the viral nature of nasopharyngitis
Rationale: In older children, generalized muscle aches, chills, and headache are typical symptoms of viral nasopharyngitis, due to systemic involvement in the viral infection.
A 4-year-old child with nasopharyngitis is experiencing a dry, irritated nose and throat, chills, and fever. The nurse should prioritize which of the following interventions?
a) Administer an antipyretic for fever
b) Offer fluids frequently to prevent dehydration
c) Encourage rest to reduce irritability
d) Apply a humidifier in the child’s room
b) Offer fluids frequently to prevent dehydration
Rationale: Children with nasopharyngitis may experience anorexia, fever, and irritability, which can lead to dehydration. Offering fluids frequently helps prevent dehydration and supports recovery.
A 7-year-old child with nasopharyngitis complains of malaise, chills, and a headache. Which additional symptom would confirm the diagnosis of nasopharyngitis?
a) Severe sore throat with pus
b) A productive cough with green sputum
c) Sneezing and a dry, irritated nose
d) Difficulty swallowing and drooling
c) Sneezing and a dry, irritated nose
Rationale: Sneezing and a dry, irritated nose are hallmark symptoms of nasopharyngitis, along with other systemic symptoms like malaise, chills, and headache, confirming the diagnosis.
An infant younger than 3 months is diagnosed with nasopharyngitis. Which of the following assessments would the nurse need to prioritize?
a) Respiratory rate and oxygen saturation
b) Stool consistency and frequency
c) Assessment of rashes or skin lesions
d) The ability to feed and fluid intake
d) The ability to feed and fluid intake
Rationale: In infants, poor feeding and irritability can indicate worsening of nasopharyngitis or complications like dehydration. Ensuring adequate feeding and fluid intake is a priority to prevent dehydration and support recovery.
A child presents with recurrent episodes of nasopharyngitis. Which of the following underlying conditions should the nurse prioritize ruling out?
a) Asthma
b) Viral infection
c) Hypertension
d) Gastroesophageal reflux
a) Asthma
Rationale: If a child continues to have upper respiratory infections, underlying conditions such as asthma, allergies, or polyps should be ruled out. These conditions can predispose the child to frequent respiratory infections.
The nurse is teaching parents how to manage their child’s nasal congestion. Which of the following instructions is most appropriate for a child under 9 months of age?
a) Use nasal decongestant drops or sprays regularly
b) Administer normal saline nose drops every 3 to 4 hours
c) Use a nasal spray for children over 6 years of age
d) Recommend over-the-counter antihistamines for allergic rhinitis
b) Administer normal saline nose drops every 3 to 4 hours
Rationale: For infants under 9 months of age, the appropriate management for nasal congestion is to use normal saline nose drops every 3 to 4 hours, especially before feeding, and suction if necessary.
A parent is concerned about giving over-the-counter cough and cold medications to their child. Which of the following is an important guideline the nurse should provide?
a) Avoid using any cold medications for children under 2 years unless prescribed by a healthcare provider
b) Ensure the child receives adult doses of cough medications
c) Use household spoons to measure the exact dose of liquid medication
d) Administer cough and cold medications regularly for 7-10 days, regardless of symptom improvement
a) Avoid using any cold medications for children under 2 years unless prescribed by a healthcare provider
Rationale: Cough and cold medications should not be used for children under 2 years of age unless specifically directed by a healthcare provider due to safety concerns.
The nurse is advising parents on the safe use of over-the-counter medications for their child with nasopharyngitis. What is the most important recommendation for parents when measuring liquid medications?
a) Use a household spoon to measure the liquid medication
b) Double the recommended dose to ensure effectiveness
c) Only use the measuring device that comes with the medication
d) Consult the pharmacist for the exact amount of medication
c) Only use the measuring device that comes with the medication
Rationale: Parents should use the measuring device provided with the liquid medication to ensure accurate dosing, as using household spoons can lead to incorrect amounts being administered.
The nurse is discussing home remedies for a child with nasopharyngitis. Which of the following actions should the nurse take?
a) Recommend using herbal remedies without consulting a healthcare provider
b) Suggest using unverified home remedies as an alternative to prescribed treatments
c) Advise against the use of all home remedies regardless of the child’s condition
d) Tell parents to consult a healthcare provider before using any home remedies or herbal products
Tell parents to consult a healthcare provider before using any home remedies or herbal products
Rationale: Parents should consult a healthcare provider before using home remedies or herbal products to ensure they are safe and effective for their child.
A parent of a child with nasopharyngitis asks how to reduce the spread of infection at home. Which of the following recommendations should the nurse provide?
a) Encourage the child to share food, dishes, and utensils to promote good nutrition
b) Ensure the child avoids contact with infected individuals and practices frequent hand hygiene
c) Discourage the use of tissues and hand hygiene as it is not effective for viral infections
d) Limit cleaning surfaces, as it does not significantly reduce infection spread
b) Ensure the child avoids contact with infected individuals and practices frequent hand hygiene
Rationale: To reduce the spread of infection, it is crucial to avoid contact with infected individuals, practice good hand hygiene, and properly dispose of tissues. Cleaning surfaces regularly also helps prevent the spread of infection.
What is the appropriate management for a child with nasopharyngitis experiencing fever?
a) Administer aspirin to reduce the fever
b) Encourage the child to engage in strenuous physical activity to combat the infection
c) Administer acetaminophen to reduce fever and enhance comfort
d) Use decongestant sprays for fever management
c) Administer acetaminophen to reduce fever and enhance comfort
Rationale: Acetaminophen is commonly used to reduce fever and enhance comfort in children with nasopharyngitis. Aspirin should be avoided due to the risk of Reye syndrome.
A child with nasopharyngitis is exhibiting a dry, irritated nose and throat, chills, and fever. Which of the following interventions is most appropriate?
a) Provide frequent fluids to liquefy secretions
b) Encourage vigorous physical activity to improve circulation
c) Restrict fluid intake to reduce nasal congestion
d) Use nasal decongestants for long-term relief
a) Provide frequent fluids to liquefy secretions
Rationale: Encouraging frequent fluid intake helps liquefy secretions and prevent dehydration, which is important in children with nasopharyngitis.
The nurse is providing discharge teaching for a child with nasopharyngitis. What is the most important recommendation regarding physical activity during the illness?
a) Encourage the child to engage in strenuous physical activity to improve circulation
b) Restrict all activity until the child is symptom-free for 24 hours
c) Suggest that the child continue with normal physical activities, including school
d) Allow the child to engage in quiet play, such as reading or watching television
d) Allow the child to engage in quiet play, such as reading or watching television
Rationale: During nasopharyngitis, children should avoid strenuous physical activity and engage in quiet play to conserve energy and promote comfort while recovering.
A nurse is educating parents about the safe use of cough and cold medications for their child. Which of the following should the nurse emphasize?
a) Over-the-counter cough and cold products can be safely used for children under 2 years of age
b) Medications should be used for 7-10 days regardless of symptom improvement
c) The dose should be based on the child’s weight and age, and only the recommended dose should be given
d) Use of adult cough and cold medications is appropriate for children over 2 years of age
c) The dose should be based on the child’s weight and age, and only the recommended dose should be given
Rationale: It is essential to administer medications according to the child’s weight and age and to follow the dosing recommendations on the medication label.
The nurse is assessing a child with nasopharyngitis. Which of the following would be a red flag indicating a possible complication rather than simple nasopharyngitis?
a) Mild fever and irritability
b) Nasal congestion and dry throat
c) Sneezing and mild headache
d) Difficulty breathing and increased respiratory rate
d) Difficulty breathing and increased respiratory rate
Rationale: Difficulty breathing and an increased respiratory rate may indicate respiratory distress or a more severe infection, requiring immediate medical attention and intervention.
A child with sinusitis is prescribed amoxicillin. Which of the following side effects should the nurse instruct the parent to report to the healthcare provider immediately?
a) Mild rash on the child’s arms
b) Decreased appetite and mild stomach upset
c) Severe diarrhea and signs of dehydration
d) Slight cough and runny nose
c) Severe diarrhea and signs of dehydration
Rationale: Severe diarrhea, especially with signs of dehydration, could indicate an adverse reaction to antibiotics or an associated infection, and the healthcare provider should be notified immediately.
Which of the following symptoms in a child with sinusitis would most likely indicate the need for referral to an otolaryngologist?
a) Recurrent episodes of sinusitis with persistent symptoms despite treatment
b) Mild headache and nasal congestion
c) Difficulty feeding and poor appetite
d) Mild fever and cough for 5 days
a) Recurrent episodes of sinusitis with persistent symptoms despite treatment
Rationale: Children with recurrent or persistent sinusitis should be referred to an otolaryngologist for further evaluation and management, especially if symptoms do not improve with initial treatment.
A nurse is reviewing the treatment plan for a child with sinusitis. Which of the following interventions has not been shown to be effective in treating sinusitis in children?
a) Administration of antibiotics for bacterial sinusitis
b) Use of saline nose drops for nasal congestion
c) Administration of antihistamines for nasal drainage
d) Use of nasal irrigation to clear nasal passages
c) Administration of antihistamines for nasal drainage
Rationale: Antihistamines have not been shown to be effective in treating nasal drainage associated with sinusitis in children. The use of saline drops and nasal irrigation may provide comfort and relief.
Which of the following diagnostic tests is most useful in confirming a diagnosis of sinusitis in a child with recurrent episodes?
a) Percussion and illumination of the sinuses
b) Computed tomography (CT) scan
c) Nasal swab culture for bacterial pathogens
d) Blood culture for viral pathogens
a) Percussion and illumination of the sinuses
Rationale: The diagnosis of sinusitis is primarily based on clinical history and physical examination, including percussion and illumination of the sinuses. Imaging (CT or MRI) is generally reserved for suspected complications.
A nurse is assessing a child with sinusitis who has malodorous breath, fever, and swelling around the eyes. What is the most appropriate action for the nurse to take?
a) Continue monitoring the child at home and suggest saline nasal irrigation
b) Administer acetaminophen and encourage fluids to relieve symptoms
c) Call the healthcare provider for further evaluation, as these may be signs of complications
d) Recommend over-the-counter decongestants to reduce symptoms
c) Call the healthcare provider for further evaluation, as these may be signs of complications
Rationale: Malodorous breath, fever, and swelling around the eyes could indicate orbital or other serious complications of sinusitis, and immediate medical attention is necessary.
A 5-year-old child is diagnosed with acute bacterial sinusitis and prescribed amoxicillin. Which of the following actions is the most important for the nurse to reinforce when teaching the parent about antibiotic therapy?
a) Antibiotics should be discontinued as soon as the child feels better.
b) The full course of antibiotics should be completed, even if symptoms improve.
c) Amoxicillin should be given with food to prevent gastrointestinal upset.
d) Antibiotics can be given only for 3 days to avoid overuse.
b) The full course of antibiotics should be completed, even if symptoms improve.
Rationale: To ensure complete eradication of the infection and prevent antibiotic resistance, the full course of antibiotics must be taken as prescribed, even if the child feels better.
Which of the following children is most at risk for developing acute bacterial sinusitis after a viral upper respiratory infection (URI)?
a) A 3-year-old with mild URI symptoms who is eating and playing normally
b) A 6-month-old with URI symptoms and no fever
c) A 4-year-old with persistent cough and purulent nasal discharge for 8 days
d) A 7-year-old with mild throat congestion but no nasal discharge
c) A 4-year-old with persistent cough and purulent nasal discharge for 8 days
Rationale: Children with persistent symptoms such as cough and purulent nasal discharge for 7 days or more after a URI are at an increased risk for developing bacterial sinusitis.
A child with sinusitis is experiencing persistent cough from postnasal drip. Which of the following interventions should the nurse prioritize to alleviate this symptom?
a) Administer decongestants to reduce nasal swelling
b) Use saline nose drops followed by bulb suctioning before feedings
c) Encourage the child to drink large amounts of water
d) Recommend antihistamines for nasal drainage
b) Use saline nose drops followed by bulb suctioning before feedings
Rationale: Saline nose drops and bulb suctioning help clear nasal passages and alleviate postnasal drip, which is causing the cough in this child.
A nurse is teaching a parent how to administer antibiotics for their child diagnosed with acute bacterial sinusitis. Which of the following statements by the parent indicates a need for further teaching?
a) “I will make sure to complete the full course of antibiotics, even if my child starts feeling better.”
b) “I will give the antibiotics with food to reduce stomach upset.”
c) “I will call the doctor if my child has any side effects from the medication.”
d) “If my child starts feeling better, I can stop giving the medication.”
“If my child starts feeling better, I can stop giving the medication.”
Rationale: The parent should be educated to complete the entire course of antibiotics, even if the child starts feeling better, to ensure complete eradication of the infection and prevent resistance.
A child presents with a history of a recent upper respiratory infection (URI) and persistent nasal discharge, fever, and cough for 10 days. The physician diagnoses acute bacterial sinusitis. Which of the following findings would most strongly support the diagnosis of acute bacterial sinusitis in this child?
a) Mild cough lasting for 3 days
b) Temperature of 38°C (100.4°F) and clear nasal discharge
c) History of chronic sinus infections and no fever
d) Fever of 39°C (102.2°F) and purulent nasal discharge for 3 days
d) Fever of 39°C (102.2°F) and purulent nasal discharge for 3 days
Rationale: Acute bacterial sinusitis is often diagnosed when a child presents with severe symptoms, such as a fever of 39°C (102.2°F) and purulent nasal discharge for at least 3 days.
A 6-year-old child presents with a sore throat, mild fever, and erythema of the tonsils, along with a history of exposure to a family member with strep throat. A throat culture is ordered. What is the priority action for the nurse when awaiting the results of the rapid strep test?
a) Administer acetaminophen for fever and throat pain
b) Instruct the child to gargle with salt water for relief
c) Encourage the child to rest and drink cool, nonacidic fluids
d) Initiate intravenous antibiotics while waiting for the results
c) Encourage the child to rest and drink cool, nonacidic fluids
Rationale: While awaiting results, it is important to provide symptomatic relief, including rest and fluids to prevent dehydration. Administering antibiotics before a diagnosis is confirmed can lead to unnecessary side effects or antibiotic resistance.
A child with pharyngitis is found to have a peritonsillar abscess. Which of the following symptoms most strongly suggests this diagnosis?
a) Mild throat redness and low-grade fever
b) Difficulty swallowing, drooling, and respiratory distress
c) Nasal congestion and runny nose
d) Painful neck stiffness and headache
b) Difficulty swallowing, drooling, and respiratory distress
Rationale: These are classic signs of peritonsillar abscess, which often causes difficulty swallowing, drooling, and respiratory distress due to the swelling and pus formation around the tonsils.
Which of the following laboratory findings is most consistent with a diagnosis of group A beta-hemolytic streptococcus (GABHS) pharyngitis?
a) Positive rapid strep test with negative traditional culture
b) Negative rapid strep test and negative traditional culture
c) Positive throat culture for Streptococcus pneumoniae
d) Positive rapid strep test confirmed by a negative throat culture
a) Positive rapid strep test with negative traditional culture
Rationale: A positive rapid strep test followed by a negative traditional culture may indicate early infection, which would still be treated based on clinical signs and symptoms.
Which of the following treatments would be appropriate for a child diagnosed with viral pharyngitis?
a) Oral penicillin for 10 days
b) Intravenous antibiotics and hydration
c) Symptomatic treatment with acetaminophen and cool fluids
d) Erythromycin for 10 days
c) Symptomatic treatment with acetaminophen and cool fluids
Rationale: Viral pharyngitis is treated with symptomatic care only, including acetaminophen for fever and throat pain, and cool fluids for hydration and comfort.
A nurse is educating parents of a child diagnosed with strep throat about the importance of completing the 10-day course of antibiotics. Which of the following complications could result if treatment is not completed?
a) Meningitis and rheumatic fever
b) Asthma and pneumonia
c) Gastrointestinal bleeding and peptic ulcer disease
d) Hepatitis and renal failure
a) Meningitis and rheumatic fever
Rationale: If streptococcal pharyngitis is not fully treated, it can lead to serious complications like rheumatic fever, which can affect the heart, and meningitis.
Which of the following is the most likely outcome for a child with strep throat who has been treated with penicillin and shows improvement within 24 hours?
a) The child is no longer contagious and can return to school
b) The child will need to be hospitalized for further observation
c) The child should continue antibiotics for 10 days, regardless of improvement
d) The child’s symptoms should worsen, requiring a change in antibiotics
a) The child is no longer contagious and can return to school
Rationale: Once treated with antibiotics for 24 hours, a child with strep throat is no longer contagious and can return to school or daycare.
Which of the following is the primary goal of nursing care for a child with pharyngitis and difficulty swallowing?
a) Prevent dehydration and alleviate throat pain
b) Administer the first dose of antibiotics
c) Assess for signs of respiratory failure
d) Ensure the child avoids eating solid food
a) Prevent dehydration and alleviate throat pain
Rationale: The main priority is to prevent dehydration and relieve discomfort, which can be achieved through small sips of cool fluids and acetaminophen for pain relief.
A child with a peritonsillar abscess is admitted for treatment. Which of the following interventions is most likely to be included in the child’s plan of care?
a) Warm salt water gargles and throat lozenges
b) Intravenous antibiotics and possible drainage of the abscess
c) Oral antibiotics and close observation at home
d) Complete rest and no fluids for 24 hours
b) Intravenous antibiotics and possible drainage of the abscess
Rationale: Peritonsillar abscess often requires intravenous antibiotics and may necessitate drainage to resolve the infection.
Which of the following is a typical symptom of retropharyngeal abscess in a child with pharyngitis?
a) Unilateral neck swelling and stiffness
b) Difficulty turning the head to one side
c) Decreased neck movement and neck pain
d) Severe headaches and photophobia
c) Decreased neck movement and neck pain
Rationale: Retropharyngeal abscess often causes neck pain and decreased neck movement due to the swelling and infection around the lymph nodes.
A nurse is caring for a child who is receiving treatment for strep throat with penicillin. Which of the following signs should prompt the nurse to suspect an allergic reaction to the medication?
a) Mild rash and low-grade fever
b) Abdominal cramps and nausea
c) Difficulty breathing and swelling of the lips
d) Throat pain and difficulty swallowing
c) Difficulty breathing and swelling of the lips
Rationale: Difficulty breathing and swelling of the lips are signs of a serious allergic reaction (anaphylaxis) and require immediate medical attention.
Which of the following is an appropriate home care instruction for a child diagnosed with viral pharyngitis?
a) Administer antibiotics as prescribed
b) Encourage drinking warm, acidic fluids
c) Use throat lozenges or sprays for throat relief
d) Provide cool, nonacidic fluids and rest
d) Provide cool, nonacidic fluids and rest
Rationale: Viral pharyngitis requires supportive care, including hydration with nonacidic fluids and plenty of rest to promote recovery.
A 5-year-old child with pharyngitis is showing signs of dehydration. Which of the following interventions should the nurse prioritize?
a) Encourage the child to drink large amounts of water at once
b) Administer intravenous fluids and monitor intake
c) Recommend salt water gargles to soothe the throat
d) Limit fluids to prevent abdominal discomfort
b) Administer intravenous fluids and monitor intake
Rationale: If a child is showing signs of dehydration, intravenous fluids may be necessary to restore hydration, and careful monitoring of intake is critical.
Which of the following is an important consideration when prescribing antibiotics for a child with bacterial pharyngitis?
a) Monitoring for side effects such as gastrointestinal upset
b) Discontinuing antibiotics as soon as the child feels better
c) Administering antibiotics for only 3 days
d) Treating all family members of the child prophylactically
a) Monitoring for side effects such as gastrointestinal upset
Rationale: Antibiotic therapy should be continued as prescribed, but side effects such as gastrointestinal upset should be monitored and managed appropriately.
A 4-year-old child with pharyngitis is suspected to have a retropharyngeal abscess. Which of the following is the most appropriate diagnostic tool to confirm this condition?
a) Throat culture
b) Chest X-ray
c) Rapid strep test
d) CT scan or MRI of the neck
d) CT scan or MRI of the neck
Rationale: A CT scan or MRI of the neck is the most appropriate diagnostic tool to confirm a retropharyngeal abscess.
A nurse is caring for a child diagnosed with strep throat who is receiving penicillin. The nurse should educate the parents about the importance of completing the entire 10-day course. What is the most serious consequence of not completing the antibiotic regimen?
a) Development of sinusitis and middle ear infections
b) Increased risk of antibiotic resistance
c) Return of symptoms after a few days
d) Potential for developing rheumatic fever
d) Potential for developing rheumatic fever
Rationale: If strep throat is not completely treated, it can lead to serious complications such as rheumatic fever, which can cause long-term damage to the heart.
A 3-year-old child presents with irritability, ear pain, and a fever following an upper respiratory infection. The tympanic membrane is bulging, and there is fluid behind it. What is the most likely diagnosis for this child?
a) Otitis externa
b) Otitis media
c) Sinusitis
d) Mastoiditis
b) Otitis media
Rationale: The child’s symptoms, including fever, ear pain, and a bulging tympanic membrane with fluid behind it, are consistent with otitis media, which is often preceded by upper respiratory infections.
A nurse is caring for a child with otitis media. Which of the following should the nurse include in the discharge teaching?
a) Avoid pacifier use for several weeks
b) Complete the full course of prescribed antibiotics
c) Encourage frequent use of nasal decongestants
d) Limit fluid intake to prevent further ear infections
b) Complete the full course of prescribed antibiotics
Rationale: It is crucial for the parents to understand the importance of completing the full course of antibiotics to prevent recurrence and ensure the infection is fully treated.
Which of the following conditions is most likely to increase a child’s risk for recurrent otitis media?
a) Exclusive breastfeeding for the first 6 months of life
b) Attending daycare and exposure to secondhand smoke
c) Use of a pacifier for less than 2 hours per day
d) Immunizations according to the recommended schedule
b) Attending daycare and exposure to secondhand smoke
Rationale: Children who attend daycare and are exposed to secondhand smoke are at increased risk for recurrent otitis media due to higher exposure to pathogens and irritants.
Which of the following is the most common causative organism for acute otitis media?
a) Streptococcus pneumoniae
b) Escherichia coli
c) Staphylococcus aureus
d) Mycoplasma pneumoniae
a) Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common causative organism for acute otitis media, followed by Haemophilus influenzae and Moraxella catarrhalis.
A 4-year-old child with chronic otitis media is evaluated for hearing loss. The nurse understands that the fluid accumulation in the middle ear may result in:
a) Impaired transmission of sound, leading to hearing loss
b) Fluid drainage from the external ear canal
c) Increased frequency of respiratory infections
d) An increase in vocal pitch
a) Impaired transmission of sound, leading to hearing loss
Rationale: Fluid accumulation in the middle ear can prevent the efficient transmission of sound, leading to hearing loss, which can affect speech and language development.
A child with otitis media presents with night awakenings and crying. The nurse understands that this is likely due to:
a) Increased pressure in the middle ear when prone or supine
b) Anxiety related to the illness
c) Pain from ear infections radiating to the jaw
d) Fever and discomfort
a) Increased pressure in the middle ear when prone or supine
Rationale: Night awakenings and crying are common in children with otitis media due to increased pressure in the middle ear when lying down, which worsens the pain.
Which of the following is a known risk factor for otitis media in children?
a) Having a sibling with no history of ear infections
b) Attending a Montessori school
c) Exposure to maternal smoking during pregnancy
d) Use of a pacifier for several hours a day
d) Use of a pacifier for several hours a day
Rationale: Prolonged pacifier use can alter the dynamics of the eustachian tube, increasing the risk of otitis media.
A 2-year-old child with otitis media has persistent symptoms despite antibiotic therapy. The nurse should be concerned about the potential for which of the following?
a) Acute viral otitis media
b) Spontaneous resolution of the infection
c) The development of an ear canal blockage
d) Chronic otitis media with effusion
d) Chronic otitis media with effusion
Rationale: If symptoms persist despite treatment, the child may develop chronic otitis media with effusion, which is characterized by the presence of fluid in the middle ear without acute infection.
A child with Down syndrome is at increased risk for otitis media. Which of the following factors is most likely contributing to this increased risk?
a) Structural abnormalities in the eustachian tube
b) Delayed motor development
c) Higher incidence of upper respiratory infections
d) Excessive fluid intake
a) Structural abnormalities in the eustachian tube
Rationale: Children with Down syndrome are at increased risk for otitis media due to structural abnormalities in the eustachian tube, which can impair proper drainage and airflow.
A nurse is assessing a child with otitis media who is presenting with diarrhea and vomiting. Which of the following is most likely contributing to these symptoms?
a) The child’s reaction to the antibiotics
b) Fluid accumulation in the middle ear
c) The systemic effect of the ear infection
d) The child’s refusal to eat or drink
c) The systemic effect of the ear infection
Rationale: Diarrhea and vomiting are common systemic symptoms associated with otitis media, likely due to the body’s response to the infection.
Which of the following is the most important preventive measure to reduce the risk of otitis media in infants?
a) Early introduction of solid foods
b) Breastfeeding for the first 6 months of life
c) Avoiding immunizations
d) Limited exposure to other children
b) Breastfeeding for the first 6 months of life
Rationale: Breastfeeding has been shown to be protective against infections, including otitis media, by providing passive immunity and reducing the risk of illness.
A nurse is educating parents on the signs and symptoms of otitis media. Which of the following should the nurse include as an early sign of otitis media in a child?
a) Ear drainage
b) Pulling at the ear
c) Complaints of ear itching
d) Persistent fever for more than 72 hours
b) Pulling at the ear
Rationale: Pulling at the ear is an early sign of ear pain associated with otitis media, often seen in younger children who are unable to verbalize their discomfort.
A child diagnosed with otitis media is being treated with antibiotics. Which of the following interventions would be most important for the nurse to include in the plan of care?
a) Administering acetaminophen for pain and fever
b) Applying warm compresses to the ear for relief
c) Encouraging the child to chew gum to relieve pressure
d) Ensuring the child completes the full course of antibiotics
d) Ensuring the child completes the full course of antibiotics
Rationale: Completing the full course of antibiotics is essential to fully treat the infection and prevent the development of resistant organisms.
A 6-year-old child with a history of recurrent otitis media is being assessed for speech delays. The nurse understands that untreated or recurrent otitis media can result in:
a) Improved cognitive function
b) Delayed speech and language development
c) Increased motor development
d) Better understanding of auditory processing
b) Delayed speech and language development
Rationale: Chronic fluid in the middle ear can impair sound transmission, leading to delays in speech and language development.
A child with otitis media is being discharged with instructions on managing the infection. Which of the following instructions should the nurse emphasize to the parents?
a) Avoid all contact with the child for the next 72 hours
b) Keep the child’s head elevated during sleep to reduce ear pressure
c) Provide hot fluids to help reduce fluid in the ear
d) Limit the child’s physical activity until the infection clears
b) Keep the child’s head elevated during sleep to reduce ear pressure
Rationale: Keeping the child’s head elevated helps alleviate pressure in the middle ear, which can reduce pain and improve comfort during sleep.
