Milena Milo

Question 1

118. what is the most common assessment finding in a child with ulcerative colitis?
     a. abdominal cramps
     b. bloody diarrhea
     c. anal fissures
     d. abdominal distention

Answer 1

b. bloody diarrhea

Question 2

23. The nurse is collecting data on a 5-year-old child admitted with the diagnosis of congestive heart failure. Which clinical manifestation observed during the physical assessment would be consistent with this diagnosis?
    a. Jerking movements of the arms and legs
    b. Scissoring of the legs with toes pointed down
    c. Failure to gain weight
    d. Spooning of the finger nails

Answer 2

c. Failure to gain weight

Feedback: In infants and older children, one of the first signs of CHF is tachycardia. other sings of CHF often seen in the older child include failure to gain weight, weakness, fatigue, restlessness, irritability, and a pale, mottled, or cyanotic color. Rapid respiration or tachypnea, dyspnea, and coughing with bloody sputum also are seen. Edema and enlargement of the liver and heart may be present. Jerking movements indicate seizure activity. Scissoring of the legs is seen in cerebral palsy, and clubbing of the fingers is seen in cystic fibrosis.

Question 3

128. A 10 month old child with recurrent otitis media is brought to the clinic for evaluation. To help determine the cause of the child’s condition, the nurse should ask the parents:
     a. “Does water ever get into the baby’s ears during shampooing?”
     b. “Do you give the baby a bottle to take to bed?”
     c. “Have you noticed a lot of wax in the baby’s ears?”
     d. ”Can the baby combine two words when speaking?”

Answer 3

b. “Do you give the baby a bottle to take to bed?”

Question 4

87. The nurse is caring for Jason an 8 year old with Idiopathic Thrombocytopenia Purpura (ITP). Which of the following is not considered a standard of care?
    a. intramuscular injections are avoided
    b. oral steroids are given when platelets fall below 20,00
    c. a splenectomy is sometimes performed
    d. contact sports are always prohibited

Answer 4

b. oral steroids are given when platelets fall below 20,00

Question 5

12. The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?
    a. “It is caused from taking birth control pills when a girl is younger than 13 years old.”
    b. “This disorder is usually seen after a girl has had a spontaneous abortion.”
    c. “Emotional stress can be a cause of this disorder.”
    d. “This is what happens if a 16-year-old girl has never had any periods at all.”

Answer 5

c. “Emotional stress can be a cause of this disorder.”

Feedback: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion does not cause secondary amenorrhea.

Question 6

122. The infant with cleft lip and palate is at risk for all of the following except:
     a. pneumonia
     b. otitis media
     c. altered bonding with parents
     d. gastroesophageal reflux

Answer 6

d. gastroesophageal reflux

Question 7

132. The nurse will do which of the following for the child with epiglottitis?
     a. avoid using oropharyngeal suctioning due to the potential of airway obstruction
     b. avoid using oropharyngeal suctioning due to contamination
     c. use oropharyngeal suctioning to remove secretions
     d. prepare to use a bag-mask ventilation

Answer 7

a. avoid using oropharyngeal suctioning due to the potential of airway obstruction

Question 8

105. Tony is a 10 year old with type 2 diabetes. Tony’s parents ask the nurse for more information about his diagnosis. The nurse bases her response on which of the following:
     a. Most children with type 2 diabetes develop thickening and darkening of the skin in the neck and axillary areas
     b. Most children with type 2 diabetes have no family history of diabetes
     c. Due to a greater awareness and increased education, the occurrence of type 2 diabetes has slightly decreased over the past decade
     d. Type 2 diabetes responds to diet, exercise and does not require medication

Answer 8

a. Most children with type 2 diabetes develop thickening and darkening of the skin in the neck and axillary areas

Question 9

20. The child with a surgically repaired myelomeningocele has a neurogenic bladder. How will the nurse best explain this problem to the parents?
    a. “Your child cannot properly control holding urine or emptying the bladder. “
    b. “Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection.”
    c. “Your child dribbles urine because the bladder either is overactive, pushing urine out, or is not active enough, becoming overfilled and causing urine to leak.”
    d. “While your child is young, urine leaking from the bladder will not be a problem because diapering is expected.”

Answer 9

b. “Old urine remains in the bladder because of poor emptying or overfilling, putting your child at risk for urinary tract infection.”

Explanation:
Parents need to understand that lack of urinary control is not the greatest problem. The larger threat is of urinary tract infection, which can result in kidney damage. Only one of the responses by the nurse carries the infection message. Continence is important. This along with the infection risk can be managed by clean intermittent catheterization (CIC) or other procedures.

Question 10

106. David is born with a myelomeningocele in his lumbar area. What pre-operative nursing care should you provide?
     a. position him in a supine position
     b. apply lotion and gently massage the meningocele
     c. exercise his legs and arms to prevent atrophy of the muscles
     d. place him in prone position with a light sterile dressing on the meningocele

Answer 10

d. place him in prone position with a light sterile dressing on the meningocele

Question 11

136. Lexy, is a 3 year old who is being admitted to the pediatric unit with a diagnosis of croup and moderate respiratory distress. Lexy’s plan of care should include all of the following except:
     a. Encourage developmentally appropriate play
     b. Encourage Lexy to consume oral fluids
     c. Administer oral decadrom
     d. If antibiotics are not well tolerated, administer IV antibitoics

Answer 11

d. If antibiotics are not well tolerated, administer IV antibitoics

Question 12

2. A child is diagnosed with bacterial conjunctivitis and is prescribed topical antibiotic therapy. The child’s mother asks when he can return to school. Which response by the nurse would be most appropriate?
   a. “You need to wait until you finish the entire prescription of antibiotic.”
   b. “Once the drainage is gone, he can go back to school.”
   c. “You can send him to school this afternoon after his first dose of antibiotic.”
   d. “He needs to be symptom-free for at least 72 hours.”

Answer 12

b. “Once the drainage is gone, he can go back to school.”

Feedback: For the child with bacterial conjunctivitis, the child may safely return to school or day care when the mocopurulent drainage is no longer present, usually after 24 to 48 hours of treatment with the topical antibiotic. There is no need to wait until the prescription is finished. The antibiotic is being given topically, not systemically. One dose of antibiotic is not sufficient to eradicate the infection. Typically 24 to 48 hours of treatment is needed to stop the drainage of treatment is needed to stop the drainage, which, when no longer present, indicates that the child can return to school.

Question 13

126. The nurse is caring for Amber, a 6 year old who has just been diagnosed with appendicitis. When the nurse is performing Amber’s assessment and gathering her history, she would expect to find which of the following?
     a. Amber complains of increased pain when the nurse releases her hand from her right lower quadrant
     b. Amber complains of increased pain when the nurse presses down on her right lower quadrant
     c. Amber has a decreased WBC count
     d. Amber has increased bowel sounds

Answer 13

a. Amber complains of increased pain when the nurse releases her hand from her right lower quadrant

Question 14

30. The nurse recognizes that which client has the greatest risk for suicidal behavior?
    a. A 16-year-old girl who just failed a math test
    b. A 9-year-old boy who had an uncle who died unexpectedly
    c. A 12-year-old girl whose parents have just gotten a divorce
    d. A 16-year-old boy who has had 12 girlfriends over the past year

Answer 14

d. A 16-year-old boy who has had 12 girlfriends over the past year

Question 15

89. Bobby is a 3 year old being evaluated for autism. The nurse would expect his mother to report all of the following except:
    a. Bobby likes to play with a shiny top.
    b. Bobby often rocks back and forth
    c. Bobby becomes very agitated when his routine is changed
    d. Bobby has periods of extreme lethargy,

Answer 15

d. Bobby has periods of extreme lethargy,

Question 16

37. The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder?
    a. The child speaks in complete sentences.
    b. The child sleeps at least 12 out of every 24 hours.
    c. The child responds warmly to the father but not to the mother.
    d. The child constantly stares at a rotating wheel on the crib mobile.

Answer 16

d. The child constantly stares at a rotating wheel on the crib mobile.

Question 17

115. Brian, an 12 month old is being evaluated in the developmental clinic. When the sole of the foot is stroked upward from the hel to the ball of the foot, Brian’s toes hyperextend. Brian’s father asks what this means. Which of the following is the nurse’s best response?
     a. “Brian seems to be very ticklish, it’s not something to worry about.”
     b. “Brian has a positive Babinski reflex which is expected in his age group”
     c. “Brian has a reflex that usually disappears at a younger age. We’ll need to evaluate him a little more to see how he’s developing.”
     d. “Brian has a strong reflex in his foot, tell me more about his birth.”

Answer 17

b. “Brian has a positive Babinski reflex which is expected in his age group”

Question 18

74. A patient who has tested positive for human immunodeficiency virus (HIV) delivers a girl. When she asks if her baby has acquired immunodeficiency syndrome (AIDS), how should the nurse respond?
    a. “don’t worry. Its too soon to tell.”
    b. “chances are shell be okay since you don’t have AIDS yet”
    c. “She may have acquired HIV in utero, but we won’t know for sure until she’s older”
    d. “All babies born to HIV positive women are infected with HIV. But your baby won’t have symptoms for years”

Answer 18

c. “She may have acquired HIV in utero, but we won’t know for sure until she’s older”

Question 19

100. The nurse expects to see a rise in the incidence of infectious disease in children of which age group?
     a. Infancy
     b. Toddler
     c. Preschool age
     d. School age

Answer 19

d. School age

Question 20

19. The nurse is providing care to a child with a long-leg hip spica cast. What is the priority nursing diagnosis?
    a. Risk for impaired skin integrity due to cast and location
    b. Deficient knowledge related to cast care
    c. Risk for delayed development related to immobility
    d. Self-care deficit related to immobility

Answer 20

a. Risk for impaired skin integrity due to cast and location

Feedback: Although deficient knowledge, risk for delayed development, and self-care deficit may be applicable, the child is at increased risk for skin breakdown due to the size of the cast and its location. In addition, the cast has an opening, which allows for elimination. Soiling of cast edges or leakage of urine or stool can lead to skin breakdown.

Question 21

147. The doctor orders Digoxin 18 mcg po bid for a child weighs 7 lbs. The safe range is 10 – 12 mcg/kg/day. The medication is supplied 50 mcg/ml, how many ml will you administer per dose? Round to the tenths place.

Answer 21

Answer: 0.4 mL

Question 22

51. The nurse has completed an education session with parents of children diagnosed with food allergies. Which statement by a parent would indicate a need for additional education?
    a. “I will make sure my daughter always has her EpiPen® with her all the time.”
    b. “If we need to use the EpiPen® we will need to notify her physician’s office the next business day.”
    c. “I have found a website that makes medical alert bracelets in my daughter’s favorite color.”
    d. “The grey part of the EpiPen® should never be removed until right before we use it.”

Answer 22

b. “If we need to use the EpiPen® we will need to notify her physician’s office the next business day.”

Question 23

116. The mother of an infant tells the nurse that her baby used to hold onto her finger whenever she touched her hand and that she stopped doing this a few weeks ago. Based on this information, the nurse knows that the baby is most likely how old?
     a. 4 weeks
     b. 8 weeks
     c. 3 months
     d. 4 months

Answer 23

d. 4 months

Question 24

8. The young child has been diagnosed with group A streptococcal pharyngitis. The physician orders amoxicillin 45 mg/kg in three equally divided doses. The child weighs 10.5 kg. Calculate how many milligrams the child will receive with each dose of amoxicillin.

Answer 24

Answer: 157.5 mg per dose

Question 25

58.	A nurse is counseling a couple who report that they are both carriers for a condition. The medical history reveals neither of them have symptoms of the condition. In the event this couple conceives a child. what is the likelihood they will have a child who will have the disorder?
A.	25%
B.	50%
C.	75%
D.	100%

Answer 25

A. 25%

Question 26

47. The nurse is providing care to a child who is intubated and the child’s condition is deteriorating. What would the nurse do first?
    a. Check if the tracheal tube is obstructed
    b. Assess for displacement of the tracheal tube
    c. Look for signs of a possible pneumothorax
    d. Check the equipment for malfunction

Answer 26

b. Assess for displacement of the tracheal tube

Question 27

36. The nurse has been working for several days with an adolescent who has anorexia nervosa. What is an indication that the adolescent is developing trust in the nurse?
    a. adolescent stating “You’re the best nurse on the unit”
    b. The adolescent telling the nurse purging occurs after each meal
    c. The adolescent stating the desire to eat again
    d. Saying which nurse’s orders the adolescent will follow

Answer 27

b. The adolescent telling the nurse purging occurs after each meal

Question 28

129. When planning care for a child with epiglottitis, the nurse should assign highest priority to which of the following interventions?
     a. Providing psychological support
     b. Ensuring respiratory patency
     c. Instituting infection control practices
     d. Administering prescribed drug patency

Answer 28

b. Ensuring respiratory patency

Question 29

65. The child may have developed thyroid storm. Which clinical manifestations of thyroid storm should the nurse expect to find? Select all that apply.
    a. Temperature of 103.2° F (39.6° C)
    b. Wet bed linen and report of feeling “sweaty”
    c. Apical heart rate of 172 beats per minute
    d. Report of feeling very tired and wanting to nap
    e. Mild-mannered and compliant demeanor

Answer 29

a. Temperature of 103.2° F (39.6° C)
b. Wet bed linen and report of feeling “sweaty”
c. Apical heart rate of 172 beats per minute

Question 30

111. Rachel is a three year old with spastic CP. The nurse is providing education regarding her care to her foster parents. Which of the following should be included in her care?
     a. Rachel should wear high top basketball shoes
     b. Rachel should consume a low calorie diet
     c. Rachel should attend a school for children with severe intellectual disabilities
     d. Rachel’s activity should be limited and stimulation kept to a minimum

Answer 30

a. Rachel should wear high top basketball shoes

Question 31

29. The nurse is caring for a 12-month-old child diagnosed with an autism spectrum disorder. What information from the mother during the health history should the nurse identify as being consistent with the disorder?
    a. The child speaks in complete sentences.
    b. The child sleeps at least 12 out of every 24 hours.
    c. The child responds warmly to the father but not to the mother.
    d. The child constantly stares at a rotating wheel on the crib mobile.

Answer 31

d. The child constantly stares at a rotating wheel on the crib mobile.

Question 32

119. You are caring for a 7-month old who is suspected of having intussusception. What clinical manifestations would most likely be present?
     a. abdominal pain, vomiting, anemia
     b. anorexia, fever, constipation
     c. anorexia, fever, diarrhea
     d. inconsolable crying, abdominal pain, currant-jelly appearing stools

Answer 32

d. inconsolable crying, abdominal pain, currant-jelly appearing stools

Question 33

11. The nurse is caring for a child on a pediatric unit who has hemodialysis 3 times per week due to renal failure. On the days between dialysis treatment, which meal would be acceptable for the child?
    a. Cheeseburger, french fries, and lemonade
    b. Grilled chicken, half of a banana, and flavored water
    c. Three egg omelet, bacon, and orange juice
    d. Tomato soup, crackers, and diet soda

Answer 33

b. Grilled chicken, half of a banana, and flavored water

Feedback: Since hemodialysis is usually performed only every other day, larger amounts of waste products build up in the child’s blood; therefore, the child must follow a stricter diet between hemodialysis treatments, though dietary restrictions are usually lifted while the child is actually undergoing the treatment. Since the kidneys are not functioning, foods high in sodium, protein, and potassium must be avoided.

Question 34

35. The nurse is caring for a 5-year-old. The child’s mother reports that he is extremely sensitive to sounds that most people do not notice and that he prefers complete silence. She explains that the boy is resisting going to school due to the noise and commotion. Additionally, the mother states that he will only wear 100% cotton clothing with all of the tags cut out. The nurse interprets these findings as indicating which disorder or condition?
    a. Anxiety disorder
    b. Sensory processing disorder
    c. Depression
    d. Obsessive-compulsive disorder

Answer 34

a. Anxiety disorder

b. Sensory processing disorder

Question 35

38. A 3-year-old girl had a near-drowning incident when she fell into a wading pool. Which intervention is the highest priority?
    a. Suctioning the upper airway to ensure airway patency
    b. Inserting a nasogastric tube to decompress stomach
    c. Covering the child with warming blankets
    d. Assuring the child stays still during an X-ray

Answer 35

a. Suctioning the upper airway to ensure airway patency

Question 36

94. The nurse is caring for a child who is at risk for congestive heart failure secondary to a congential heart defect that increases pulmonary blood flow. All of the following are examples of heart defects that increase pulmonary blood flow except:
A.	Patent ductus arteriosus (PDA)
B.	Atrial septal defect (ASD)
C.	Ventricular septal defect (VSD)
D.	Pulmonary stenosis

Answer 36

D. Pulmonary stenosis

Question 37

41. A 10 year old comes to the emergency department as a victim of child abuse. The child’s mother reports that he was hit in the head and other body areas with a baseball bat. Upon further examination, the child’s blood pressure is 84/40. What physiological action does the nurse anticipate?
    a. Shock from the head injury
    b. Shock from bleeding points other than the head injury
    c. A temporary physiologic adjustment to pain and trauma
    d. A normal response after a hit to the head

Answer 37

b. Shock from bleeding points other than the head injury

Question 38

34. A 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply.
    a. Complete blood cell count
    b. MRI
    c. CT scan
    d. Metabolic panel
    e. Chest X-ray

Answer 38

a. Complete blood cell count

d. Metabolic panel

Question 39

14. The caregiver of a child with a history of ear infections calls the nurse and reports that her son has just told her his urine “looks funny.” He also has a headache, and his mother reports that his eyes are puffy. Although he had a fever 2 days ago, his temperature is now down to 100℉ (37.8℃). The nurse encourages the mother to have the child seen by the care provider because the nurse suspects the child may have:
    a. a urinary tract infection.
    b. lipoid nephrosis (idiopathic nephrotic syndrome).
    c. acute glomerulonephritis.
    d. rheumatic fever.

Answer 39

c. acute glomerulonephritis.

Feedback: Acute glomerulonephritis is defined as inflammation and subsequent damage of the glomeruli leading to hematuria, proteinuria, and azotemia; it may be caused by primary renal disease or systemic conditions.
Glomerulonephritis signs and symptoms include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen.

Question 40

133. The nurse is caring for a child who is noted to have inspiratory stridor. The nurse knows that this indicates which of the following?
     a. The child is attempting to prolong the exchange of oxygen and carbon dioxide
     b. Air within the lungs has been replaced by fluid
     c. There is edema within the upper airway
     d. There is inflammation within the narrow passages of the lungs

Answer 40

c. There is edema within the upper airway

Question 41

72. Which treatments are common to both systemic lupus erythematosus and juvenile idiopathic arthritis? Select all that apply.
    a. Corticosteroids
    b. Nonsteroidal anti-inflammatories
    c. Antimalarials
    d. Antipyretics
    e. Antirheumatics

Answer 41

a. Corticosteroids

b. Nonsteroidal anti-inflammatories

Question 42

53. The mother of a child with myasthenia gravis has called the clinic and reports her child appears very anxious and the child’s heart is beating very fast. What action by the nurse is indicated?
    a. Instruct the child be brought to the emergency department promptly.
    b. Make an appointment for the child to be seen by the physician within 24 hours.
    c. Inquire about any changes in the child’s normal routine.
    d. Inquire about when the child’s last dose of medication was taken.

Answer 42

a. Instruct the child be brought to the emergency department promptly.

Question 43

70. The nurse is providing education to a 10-year-old child and her parents about the CT scan that has been ordered for the following day. What information should be included in the teaching provided? Select all that apply.
    a. Loud clicks and thumping sounds may be heard during the test.
    b. You will need to lie very still during the test.
    c. You will be asked to drink water prior to the test.
    d. After midnight you will not be able to eat or drink anything until after the test.
    e. This test will let us look inside at your tissues and organs.

Answer 43

b. You will need to lie very still during the test.

e. This test will let us look inside at your tissues and organs.

Question 44

26. After teaching a group of students about acute rheumatic fever, the instructor determines that the teaching was successful when the students identify which assessment finding?
    a. Janeway lesions
    b. Jerky movements of the face and upper extremities
    c. Black lines
    d. Osler nodes

Answer 44

b. Jerky movements of the face and upper extremities

Feedback: Sydenham chorea is a movement disorder of the face and upper extremities associated with acute rheumatic fever. Janeway lesions, black lines, and Osler nodes are associated with infective endocarditis.

Question 45

63. A child with diabetes reports that he is feeling a little shaky. Further assessment reveals that the child is coherent but with some slight tremors and sweating. A fingerstick blood glucose level is 70 mg/dL. What would the nurse do next?
    a. Administer a sliding-scale dose of insulin.
    b. Give 10 to 15 grams of a simple carbohydrate.
    c. Offer a complex carbohydrate snack.
    d. Administer glucagon intramuscularly.

Answer 45

b. Give 10 to 15 grams of a simple carbohydrate.

Question 46

99. Which of the following age groups of children are at greatest risk for sepsis?
    a. newborns
    b. toddlers at home
    c. toddlers at daycare
    d. adolescents

Answer 46

a. newborns

Question 47

7. The caregivers of a 2-year-old who has had a common cold for 4 days calls the nurse in the emergency department at 2 AM on a cold winter night to say that the child has awakened with a barking cough and an elevated temperature; she seems blue around her mouth. The nurse would most appropriately recommend what action to the caregiver?
   a. “Put a cool mist humidifier or vaporizer in the room to see if that relieves the cough. Call back if there’s no relief in an hour.”
   b. “Bundle the child up and take her out into the cold for a few minutes. Call back if the exposure to the cold air does not provide relief.”
   c. “Bring the child to the emergency room immediately.”
   d. “Turn on all of the hot water taps in the bathroom and close the door. Take the child into the steam-filled room for 15 minutes. If there is no relief, bring the child to the emergency room.”

Answer 47

c. “Bring the child to the emergency room immediately.”

Explanation:
Acute laryngotracheobronchitis generally occurs after an upper respiratory infection with fairly mild rhinitis and pharyngitis. The child develops hoarseness and a barking cough with a fever that may reach 104 to 105 degrees Fahrenheit. As the disease progresses, marked laryngeal edema occurs and the child’s breathing becomes difficult; the pulse is rapid and cyanosis may appear. Heart failure and acute respiratory embarrassment can result. The child needs to be treated immediately. Humidified air is helpful in reducing laryngospasm; humidifiers may be used in the child’s bedroom to provide high humidity. Cool humidifiers are recommended, but vaporizers also may be used. Taking the child into the bathroom and opening the hot water taps with the door closed is a quick method for providing moist air, if the water runs hot enough. Sometimes the spasm is relieved by exposure to cold air: for instance, when the child is taken out into the night to go to the emergency department or to see the physician.

Question 48

28. A mother asks why her infant with a cyanotic heart defect turns blue. What is the best response by the nurse?
    a. This is due to the lack of oxygen to the brain.
    b. This is due to a decreased amount of oxygen to the peripheral tissue.
    c. This is a sign of heart failure.
    d. This is considered a medical emergency and needs immediate surgery.

Answer 48

b. This is due to a decreased amount of oxygen to the peripheral tissue.

Question 49

148. Jennifer is ordered IV Cefazolin. She weighs 10kg.The safe dose of Cefazolin is 50-100 mg/kg/day. What is the maximum amount she can safely receive?

Answer 49

Answer: 1,000 mg/day

Question 50

139. Which activities will promote weight loss in an obese school-age child? (Choose all that apply.)
     a. Unlimited computer and TV time
     b. Role modeling by family
     c. Becoming active in sports
     d. Eating unstructured meals
     e. Involving child in meal planning and grocery shopping
     f. Drinking three glasses of water per day

Answer 50

b. Role modeling by family
c. Becoming active in sports
e. Involving child in meal planning and grocery shopping

Question 51

16. A child is getting a diagnostic work-up for nephrotic syndrome. Which lab results would the nurse expect to see?
    a. Proteinuria, hypoalbuminemia, and hypercholesterolemia
    b. Hematuria, proteinuria, and hyperalbuminemia
    c. Neutropenia, hematuria, and hypocholesterolemia
    d. Proteinuria, hyperalbuminemia, and hypocholesterolemia

Answer 51

a. Proteinuria, hypoalbuminemia, and hypercholesterolemia

Feedback: Proteinuria, hypoalbuminemia, and hypercholesterolemia, are diagnostic of a child with nephritic syndrome. the child will also present symptomatically with a sudden onset of edema. Hematuria is typically seen with glomerulonephritis.

Question 52

15. The nurse is caring for a client with hemolytic-uremic syndrome (HUS). The client is demonstrating oliguria. What does the nurse expect to find when reviewing the client’s records?
    a. A pattern of below-normal blood pressure
    b. Higher fluid output than fluid intake
    c. Elevated BUN and creatinine levels
    d. Increased glomerular filtration rate (GFR)

Answer 52

c. Elevated BUN and creatinine levels

Feedback: Oliguria is the result of acute renal failure associated with HUS. The BUN and creatinine level are indications of kidney function and are elevated with acute renal failure. Hypertension is associated with HUS. Output is decreased with renal failure, as is GFR

Question 53

141. Parents of an 8-month-old girl express concern that she cries when left with the babysitter. How does the nurse best explain this behavior?
     a. Crying when left with the sitter may indicate difficulty with building trust.
     b. Stranger anxiety should not occur until toddlerhood; this concern should be investigated.
     c. Separation anxiety is normal at this age; the infant recognizes parents as separate beings.
     d. Perhaps the sitter doesn’t meet the infant’s needs; choose a different sitter.

Answer 53

c. Separation anxiety is normal at this age; the infant recognizes parents as separate beings.

Question 54

146. The doctor orders Ferrous Sulfate 9 mg po tid the child weighs 13 lbs. The safe dosage is 3 –6 mg/kg/day. Is the ordered dose safe for a 24-hr period? Type yes or no.

Answer 54

Answer: yes

Question 55

137. The nurse is teaching a class to a froup of new parents. When a parent asks about sudden infant death syndrome, the nurse knows that all of the following are risk factors except:
     a. placing the infant in the prone position for sleep
     b. infants that are overheated during sleep
     c. infants that sleep with a parent
     d. infants who were large at birth

Answer 55

d. infants who were large at birth

Question 56

32. The nurse is caring for several adolescent clients on the mental health unit. Which clients should the nurse suggest to join a group therapy session? Select all that apply.
    a. Adolescents with depressive disorder
    b. Adolescents with uncontrolled aggressive behavior
    c. Adolescents with a history of substance use disorder
    d. Adolescents who have experienced rape
    e. Adolescents who have experienced the death of a loved one

Answer 56

a. Adolescents with depressive disorder
c. Adolescents with a history of substance use disorder
d. Adolescents who have experienced rape
e. Adolescents who have experienced the death of a loved one

Question 57

6. The nurse is caring for a child whose oxygen saturation levels frequently drop below 90%. Which data is most important to relate to the health care provider?
   a. Blood gases
   b. Vital signs
   c. Skin pallor
   d. Activity level

Answer 57

a. Blood gases

Question 58

27. A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant’s apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate?
    a. 118 beats/min
    b. 102 beats/min
    c. 94 beats/min
    d. 80 beats/min

Answer 58

d. 80 beats/min

Explanation:
Prior to administering each dose of digoxin, the nurse would count the apical pulse for 1 full minute, noting rate, rhythm, and quality. The nurse would withhold the dose and notify the health care if theapical pulse is less than 60 in an adolescent, less than 90 in an infant.

Question 59

134. The nurse is helping a nursing student who is caring for Joel, a 12 year old with cystic fibrosis. Joel has had problems with chronic hypoxemia most of his life. Which of the following would indicate that Joel is having acute respiratory distress?
     a. barrel shaped chest
     b. clubbing of the toes
     c. intercostal retractions
     d. having to take a breath after each sentence

Answer 59

c. intercostal retractions

Question 60

75. A child age 3, who tests positive for the human imunnodeficency virus (HIV) is placed in foster care. The foster parents ask the nurse how to prevent HIV transmission to other family members. How should the nurse respond?
    a. “Make sure the child uses disposable plates and utensils”
    b. “use isopropyl alcohol to clean surfaces contaminated with the child’s blood or body fluids”
    c. “Do not let the child share toys with other children.”
    d. “Wear gloves when you’re likely to come in contract with the child’s blood or body

Answer 60

d. “Wear gloves when you’re likely to come in contract with the child’s blood or body

Question 61

83. Chemotheray is used to treat acute lymphocytic leukemia. A side effect of this treatment is:
    a. ischemia
    b. alopecia
    c. cardiac toxicity
    d. cerebral edema

Answer 61

b. alopecia

Question 62

67. A nurse is teaching the parents of an infant with congenital adrenal hyperplasia about the signs and symptoms of adrenal crisis. The nurse determines that the teaching was successful when the parents correctly identify what sign of adrenal crisis?
    a. Bradycardia
    b. Constipation
    c. Fluid overload
    d. Persistent vomiting

Answer 62

d. Persistent vomiting

Question 63

49. A child is in the emergency department after a bee sting and experiencing bouts of nausea and vomiting. The client’s blood pressure is 68/40; pulse is 48. The child is hypoxic and dyspneic. Which medication should the nurse prepare to give this client?
    a. Benadryl
    b. Epinephrine
    c. Sudafed
    d. Prednisone

Answer 63

b. Epinephrine

Question 64

25. The nurse is reviewing nutritional recommendations with the parents of a teen diagnosed with hyperlipidemia. Which statements indicate an understanding of the recommended diet for this condition? Select all that apply.
    a. “I should plan to have vegetables with each evening meal served.”
    b. “Adding fresh fruits to my child’s lunch is a good idea.”
    c. “Cooking with palm oil will be helpful.”
    d. “I need to limit fat intake in meals to 40%.”
    e. “My child loves chicken and I can still serve it but I need to remove the skin.”

Answer 64

a. “I should plan to have vegetables with each evening meal served.”
b. “Adding fresh fruits to my child’s lunch is a good idea.”
e. “My child loves chicken and I can still serve it but I need to remove the skin.”

Feedback: Hyperlipidemia refers to high levels of lipids (fats/cholesterol) in the blood. High lipid levels are a risk factor for the development of atherosclerosis, which can result in coronary artery disease, a serious cardiovascular disorder occurring in adults. Dietary management is the first step in the prevention and management of hyperlipidemia in children older than 2 years of age. The diet should consist primarily of fruits, vegetables, low-fat dairy products, whole grains, beans, lean meat, poultry, and fish. As in adults, fat should account for no more than 30% of daily caloric intake. Fat intake may vary over a period of days, as many young children are picky eaters. Limit saturated fats by choosing lean meats, removing skin from poultry before cooking, and avoiding palm, palm kernel, and coconut oils as well as hydrogenated fats

Question 65

80. The clinic nurse is caring for Jessica, a 4 year old with a urinary tract infection (UTI). In order to prevent subsequent UTI’s, the nurse should teach Jessica’s parents to do all of the following except:
    a. Encourage Jessica to drink large amounts of clear fluids such as sprite
    b. Encourage Jessica’s mother to help ensure proper hygiene after toileting.
    c. Encourage a diet high in fiber to avoid constipation
    d. Offer Jessica a reward when she uses the toilet every 2 hours

Answer 65

a. Encourage Jessica to drink large amounts of clear fluids such as sprite

Question 66

127. The nurse is caring for Bobby, a four year old with celiac disease, when reviewing Bobby’s history the nurse would expect to find which of the following?
     a. Bobby has always been tall for his age
     b. Bobby has a history of fatty stools
     c. Bobby didn’t start solid food until he was 8 months old
     d. Bobby has an elevated hematocrit and hemoglobin

Answer 66

b. Bobby has a history of fatty stools

Question 67

88. Miranda is a 14 year old diagnosed with anorexia nervosa. The nurse would expect Miranda’s mother to report all of the following except:
    a. Miranda hasn’t had her period in several months
    b. Miranda has been avoiding her friends
    c. Miranda has been sleeping a lot more at night.
    d. Miranda has been reading cookbooks and clipping recipes

Answer 67

c. Miranda has been sleeping a lot more at night.

Question 68

96. How should the nurse instruct the parent of a child with chicken pox to limit the chances of developing a secondary infection?
    a. keep hands clean and nails short
    b. use daily bicarbonate baths
    c. use calamine lotion liberally
    d. use antibiotic ointment

Answer 68

a. keep hands clean and nails short

Question 69

131. Which of the following respiratory condtions is a medical emergency?
     a. asthma
     b. cystic fibrosis
     c. epiglottitis
     d. croup

Answer 69

c. epiglottitis

Question 70

84. The nurse is working with a group of students in the pediatric cancer clinic. In reviewing a student nurse’s project on leukemia, the nurse correctly challenges which of the following statements?
    a. Acute lymphocytic leukemia (ALL) is the most common type of leukemia in children.
    b. ALL peaks in school age children
    c. In adolescents, acute myelogenous leukemia (AML) is more common than ALL
    d. Only about 65% of children diagnosed with AML will live 5 years

Answer 70

b. ALL peaks in school age children

Question 71

48.	A 5-year-old is hospitalized after an asthma attack at school. The child tells the nurse that the janitor was cleaning in the classroom prior to the attack and that a lot of dust was in the air. The dust that likely caused the attack is known as a (an):
A.	antigen.
B.	immunogen.
C.	allergen.
D.	macrophage.

Answer 71

C. allergen.

Question 72

44. A nurse is assessing the blood pressure of a 5-year-old child brought into the emergency department after being involved in a motor vehicle accident. Which systolic blood pressure would the nurse identify as a cause for concern?
    a. 70 mm Hg
    b. 82 mm Hg
    c. 90 mm Hg
    d. 99 mm Hg

Answer 72

a. 70 mm Hg

Question 73

145. The doctor orders Amoxicillin 100 mg po q6 hr for a child that weighs 15 lbs. The Safe range is 25 – 30 mg/kg/day. Calculate the safe range.

Answer 73

Answer: 170-204mg/day or 42.5-51 mg/dose

Question 74

110. The nurse is caring for a child with cerebral palsy (CP). Which of the following statements is correct?
     a. CP is a progressive disorder characterized by abnormal coordination and muscle tone
     b. The majority of children with CP have some degree of intellectual disability
     c. CP is always caused by trauma that occurs at birth
     d. Children with CP often have speech, vision, or hearing difficulties

Answer 74

d. Children with CP often have speech, vision, or hearing difficulties

Question 75

43. After teaching a group of nursing students about shock in children, the instructor determines that the teaching was successful when the students identify which type of shock as most common?
    a. Septic
    b. Cardiogenic
    c. Hypovolemic
    d. Distributive

Answer 75

c. Hypovolemic

Question 76

73. Place in correct order the steps in the anaphylactic response.
    a. Exposure to allergen
    b. Rapid immune response
    c. Vasodilation
    d. Bronchoconstriction
    e. Circulatory collapse

Answer 76

a. 1a, 2b, 3c, 4d, 5e

Question 77

54. The nurse is preparing an informational brochure about risk factors for immune disorders. Which disease process can indicate a potential underlying immunologic disorder? Select all that apply.
    a. Persistent oral thrush
    b. Chronic cough
    c. Occasional rhinorrhea
    d. Extensive eczema
    e. Illness with a high-grade fever

Answer 77

a. Persistent oral thrush
b. Chronic cough
d. Extensive eczema

Question 78

149. You need to administer 250 mg of Cefazolin IV over 30 minutes. The medication comes premixed 25 mg/2 mL. What is your ml/hr rate?

Answer 78

Answer: 40 mL/hr

Question 79

86. The nurse is caring for 8-year-old Hailey who is admitted to the pediatric unit with a diagnosis of sickle cell crisis. Hailey’s oxygen saturations are 85% when the nurse applies oxygen. Which of the following is the rationale for why Hailey needs oxygen?
    a. Oxygen will reverse the sickling process
    b. Oxygen will help decrease the sickling process
    c. Oxygen will help decrease the viscosity of the blood
    d. Oxygen will help increase the viscosity of the blood

Answer 79

b. Oxygen will help decrease the sickling process

Question 80

142. The mother of a 15-month-old is concerned about a speech delay. She describes her toddler as being able to understand what she says, sometimes following commands, but using only one or two words with any consistency. What is the nurse’s best response to this information?
     a. The toddler should have a developmental evaluation as soon as possible.
     b. If the mother would read to the child, then speech would develop faster.
     c. Receptive language normally develops earlier than expressive language.
     d. The mother should ask her child’s physician for a speech therapy evaluation.

Answer 80

c. Receptive language normally develops earlier than expressive language.

Question 81

17. Which finding will cause the nurse to refer a 6-month-old child for further neuromuscular testing?
    a. Head lag when pulled from supine to sitting
    b. Bilaterally open rather than closed hands
    c. Supporting own weight when placed in standing position
    d. Equal withdrawal of lower extremities from pain

Answer 81

a. Head lag when pulled from supine to sitting

Explanation:
Head lag in the child requires referral. By 4 to 5 months, the infant should be able to maintain the head in a neutral position. The other assessment findings are normal for age, indicating no need for referral.

Question 82

62. The nurse is assessing a 13-year-old boy with type 2 diabetes mellitus. What would the nurse correlate with disorder?
    a. The parents report that their child had “a cold or flu” recently.
    b. Blood pressure is decreased when checking vital signs.
    c. The parents report that their son “can’t drink enough water.”
    d. Auscultation reveals Kussmaul breathing.

Answer 82

c. The parents report that their son “can’t drink enough water.”

Question 83

24. The nurse is caring for a 2-month-old infant who has been diagnosed with acute heart failure. The nurse is providing teaching about nutrition. Which statement by the mother indicates a need for further teaching?
    a. “The baby may need as much as 150 calories/kg/day.”
    b. “Small, frequent feedings are best if tolerated.”
    c. “I need to feed him every hour to make sure he eats enough.”
    d. “Gavage feedings may be required for now.”

Answer 83

c. “I need to feed him every hour to make sure he eats enough.”

Feedback: Although offering small frequent feedings is appropriate if the infant tolerates them, feeding every hour is not necessary. During the acute phase, continuous or intermittent gavage feedings may be needed to help the infant maintain or gain weight. Due to the increased metabolic demands, the infant may require as much as 150 calories/kg/day.

Question 84

144. The doctor orders 3 mL of Acetaminophen for a Child that weighs 10 pounds because they have a fever. Is this a safe amount to administer? Type yes or no.

Answer 84

Answer: No

Question 85

55. The young girl has been diagnosed with juvenile idiopathic arthritis (JIA) and has been prescribed methotrexate. Which statements by the child’s parent indicates that adequate learning has occurred? Select all that apply.
    a. “We’ll need to bring her back in for some lab tests after she starts methotrexate.”
    b. “She can take methotrexate with yogurt or chocolate milk.”
    c. “She may start feeling better by next week.”
    d. “Swimming sounds like a good exercise for her.”
    e. “A warm bath before bed might help her sleep better.”

Answer 85

a. “We’ll need to bring her back in for some lab tests after she starts methotrexate.”
d. “Swimming sounds like a good exercise for her.”
e. “A warm bath before bed might help her sleep better.”

Question 86

39. A group of students are reviewing information about respiratory arrest in children. The students demonstrate understanding of this information when they identify what common causes of respiratory arrest involving the upper airway? Select all that apply.
    a. Croup
    b. Asthma
    c. Pertussis
    d. Epiglottitis
    e. Pneumothorax

Answer 86

a. Croup

d. Epiglottitis

Question 87

81. The nurse is caring for Reggie, a 10-year-old with acute renal failure. When reviewing his lab results, the nurse would expect to find which of the following?
    a. Decreased BUN and Creatinine and increased sodium
    b. Increased BUN and Creatinine and decreased sodium
    c. Decreased BUN and Creatinine and decreased sodium
    d. Increased BUN and Creatinine and increased sodium

Answer 87

b. Increased BUN and Creatinine and decreased sodium

Question 88

97. A mother breastfeeding her infant is an example of what kind of immunity protection?
    a. naturally acquired
    b. passively acquired
    c. artificially acquired
    d. acquired immune

Answer 88

b. passively acquired

Question 89

104. The school nurse is called to the second grade classroom to check on Chrissy, a 7 year old with type 1 diabetes. She is found to be lethargic and confused. She falls to the ground but is still awake. Which of the following should the nurse do first?
     a. immediately obtain a finger stick blood sugar
     b. immediately call EMS for an ambulance
     c. Immediately administer a dose of rapid acting insulin
     d. immediately give a fast acting carbohydrate such as orange jucie

Answer 89

d. immediately give a fast acting carbohydrate such as orange jucie

Question 90

108. The nurse is testing the reflexes of 6 week old timothy. She records in the chart that he has positive fencing reflex. Which of the following describes the fencing reflexing?
     a. when the cheek is stroked, the infant will turn his head toward the stimuli and begin to suck
     b. when the infant is lying on his back with his head turned to one side, the infant will flex the opposite arm and leg and extend the arm and leg on the side the infant is facing
     c. when the infant is held upright with his feet touching a hard surface, he will move his legs and feet as if walking
     d. the infant will react to loud noises or sudden movement by extending his arms and legs and then retracting them

Answer 90

b. when the infant is lying on his back with his head turned to one side, the infant will flex the opposite arm and leg and extend the arm and leg on the side the infant is facing

Question 91

31. After an assessment, the nurse is concerned that a school-age child is at risk for developing a mental health disorder. Which assessment data will the nurse use to develop an appropriate plan care? Select all that apply.
    a. The parents recently divorced
    b. The father is unemployed and mother is infrequently home
    c. The child is learning to play the clarinet in music class in school
    d. The child is expected to care for younger siblings while mother sleeps
    e. There is history of multiple injuries obtained from a motor vehicle crash

Answer 91

a. The parents recently divorced
b. The father is unemployed and mother is infrequently home
d. The child is expected to care for younger siblings while mother sleeps
e. There is history of multiple injuries obtained from a motor vehicle crash

Question 92

64. The nurse is speaking with the parents of a child recently diagnosed with hypothyroidism. Which statement by a parent indicates an understanding of symptoms of this disorder?
    a. “When they get my son’s thyroid levels normal, he won’t be so tired.”
    b. “My son’s nervousness may be a symptom of his hypothyroidism.”
    c. “Heat intolerance is a caused by low thyroid levels.”
    d. “Most people with hypothyroidism have smooth, velvety skin.”

Answer 92

a. “When they get my son’s thyroid levels normal, he won’t be so tired.”

Question 93

138. Courtney is an 11 year old with chronic asthma. After being exposed to smoke, Courtney complains her chest feels tight, and it is difficult to breathe. She is speaking in 2 word sentences and audibly wheezing on expiration. Which medication is indicated?
     a. Leukotriene modifier
     b. Long acting inhaled beta 2 agonist
     c. Oral corticosteroids
     d. All of the above

Answer 93

c. Oral corticosteroids

Question 94

60. The nurse is assessing an infant and notes that the infant’s urine has a mousy or musty odor. What would the nurse suspect?
    a. Maple syrup urine disease
    b. Tyrosinemia
    c. Phenylketonuria
    d. Trimethylaminuria

Answer 94

c. Phenylketonuria

Question 95

56.	A nurse is conducting an in-service program for a group of perinatal nurses. After teaching the group about autosomal dominant and recessive inheritance patterns, the nurse determines that the group needs additional teaching when they identify which condition as an example of an autosomal dominant disorder?
A.	neurofibromatosis
B.	achondroplasia
C.	Huntington disease
D.	Tay-Sachs disease

Answer 95

D. Tay-Sachs disease

Question 96

82. A child, age 15 months, is admitted to the hospital. During initial nursing assessment, which statement by the mother most strongly suggests that the child has Wilm’s tumor?
    a. “My child has grown 3 inches in the past 6 months”
    b. “My child seems to be napping for longer periods”
    c. “My child’s abdomen seems bigger and the diapers are much tighter”
    d. “My childs appetitie has increased so much lately”

Answer 96

c. “My child’s abdomen seems bigger and the diapers are much tighter”

Question 97

78. The nurse is caring for Tim, a 10-year-old with Duchenne’s muscular dystrophy (DMD). Which documenting Tim’s assessment, the nurse notes the Gower’s sign was observed. Which of the following best describes Gower’s sign?
    a. A waddling gait was noted
    b. Tim’s oxygenation saturations drop while sleeping due to hypoventilation
    c. muscle wasting and contractures are noted in lower extremities
    d. while raising from a squatting position, Tim walks his hands up his legs.

Answer 97

d. while raising from a squatting position, Tim walks his hands up his legs.

Question 98

90. The nurse is caring for Michelle, a 14 year old who admits to suicidal ideation. After discussing suicide, Michelle asks the nurse to keep any information that she shared private. Which of the following is the nurse’s best option?
    a. In order to not destroy Michelle’s trust, keep Michelle’s confidence but remain with her to keep her safe.
    b. Keep Michelle’s confidence since she does not have a plan and is therefore not likely to harm herself
    c. Tell Michelle that her confidence will be kept private but share the discussion with the rest of the team
    d. Explain to Michelle that in order to keep her safe, it is important to share this discussion with the rest of the health care team.

Answer 98

d. Explain to Michelle that in order to keep her safe, it is important to share this discussion with the rest of the health care team.

Question 99

57. There are many steps in the process of genetic counseling and testing. Put these steps in the correct chronological order from first to last. All options must be used.
    a. assessment of family history
    b. physical examination of parents
    c. nuchal translucency screening
    d. amniocentesis
    e. explain results of genetic testing
    f. support couple in adjusting to diagnosis

Answer 99

a. 1a, 2b, 3c, 4d, 5e, 6f

Question 100

69. A 5-year-old child with type 1 diabetes is brought to the clinic by his mother for a follow-up visit after having his hemoglobin A1C level drawn. Which result would indicate to the nurse that the child is achieving long-term glucose control?
    a. 9.0%
    b. 8.2%
    c. 7.3%
    d. 6.9%

Answer 100

b. 8.2%

Question 101

92. You correctly identify that the abnormal changes in heart structure in tetralogy of fallot are:
    a. stenosis of the pulmonary vein, hypertrophy of the right ventricle, dextraposition of the aorta, and a ventricular septal defect
    b. Hypertrophy of the left ventricle, stenosis of the pulmonary veing. Ventricular septal defect, dextraposition of the aorta
    c. stenosis of the pulmonary artery, hypertrophy of the right ventricle, ventricular septal defect, dextraposition of the aorta
    d. stenosis of the pulmonary artery, hypertrophy of the left ventricle, patent ductus arteriosis, dextraposition of the aorta

Answer 101

c. stenosis of the pulmonary artery, hypertrophy of the right ventricle, ventricular septal defect, dextraposition of the aorta

Question 102

120. Which of the following assessments would you expect to note when caring for a child with pyloric stenosis?
     a. projectile vomiting of bile tinged emesis
     b. visible peristaltic waves
     c. metabolic acidosis
     d. non-projectile vomiting

Answer 102

b. visible peristaltic waves

Question 103

18. Which nursing diagnosis will the nurse prepare for the infant who is placed prone to protect the myelomeningocele repair site?
    a. Peripheral neurovascular dysfunction
    b. Disorganized infant behavior
    c. Risk for activity intolerance
    d. Risk for impaired skin integrity

Answer 103

d. Risk for impaired skin integrity

Feedback: The skin of the infant’s knees and elbows is exposed to both pressure and friction. Leakage of urine and stool makes skin cleanliness a challenge. Should voluntary movement of the legs be affected, they become more vulnerable to skin integrity problems. The neuromuscular dysfunction the infant experiences is neither peripheral nor vascular. Disorganized infant behavior does not reflect the reality of the situation, and risk for activity intolerance is not appropriate because little activity occurs

Question 104

45. A child has fallen off of a swing at the playground and her father states that she became groggy. After assessing a child’s airway, breathing, and circulation (ABCs), what would the nurse do next?
    a. Obtain a full set of vital signs.
    b. Remove the child’s clothing.
    c. Provide pain management.
    d. Assess level of consciousness.

Answer 104

d. Assess level of consciousness.

Question 105

107. What is the most important nursing intervention immediately following post-operative placement of ventriculoperitoneal shunt?
     a. place the child in reverse tredelenberg position
     b. place the child on his non-operative side
     c. keep the child in a sitting position to assist drainage
     d. pump the shunt intermittently for 8 hours

Answer 105

b. place the child on his non-operative side

Question 106

5. The nurse is caring for a 15-year-old boy with psoriasis. In addition to the plaques, what would the nurse expect to note?
   a. Fissures and scaling on palms and soles
   b. Fever and malaise
   c. Lichenification
   d. Hyperpigmentation

Answer 106

a. Fissures and scaling on palms and soles

Feedback: Fissures and scaling on the palms and soles are common findings with psoriasis. Fever and malaise, lichenification, and hyperpigmentation are noted with other integument disorders but are not typical physical findings with psoriasis.

Question 107

21. The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is providing discharge instructions about home care and safety recommendations to the boy and his parents. Which response indicates a need for further teaching?
    a. “We should avoid aspirin and drugs like ibuprofen.”
    b. “He can resume participation in football in 2 weeks.”
    c. “Swimming would be a great activity.”
    d. “Our son cannot take any antihistamines.”

Answer 107

b. “He can resume participation in football in 2 weeks.”

Explanation: The nurse must emphasize to the parents that they need to prevent trauma to their son by avoiding activities that may cause injury. Participation in contact sports like football is not recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be avoided because they could precipitate anemia. Swimming, a noncontact sport, is an appropriate choice.

Question 108

59. A pregnant woman undergoes a triple/quadruple screen at 16 to 18 weeks’ gestation. What would the nurse suspect if the woman’s level is decreased?
    a. Down syndrome
    b. sickle-cell anemia
    c. cardiac defects
    d. respiratory disorders

Answer 108

a. Down syndrome

Question 109

76. You are caring for a child who is immunosuppressed. You know that which of the following will be most helpful in determining the child’s ability to fight infection?
    a. sedimentation rate
    b. absolute neutrophil count
    c. white blood cell count
    d. bone marrow cell count

Answer 109

b. absolute neutrophil count

Question 110

4. The nurse is caring for a child with widespread itching and has recommended bathing as a relief measure. After teaching the mother about this, which statement from the mother indicates a need for further instruction?
   a. “After bathing, I need to rub his skin everywhere to make sure he is completely dry.”
   b. “I must make sure I use lukewarm water instead of hot water.”
   c. “Oatmeal baths are helpful; we can add Aveeno skin relief bath treatment.”
   d. “We should leave his skin moist before applying medication or moisturizer.”

Answer 110

a. “After bathing, I need to rub his skin everywhere to make sure he is completely dry.”

Feedback: The nurse needs to emphasize to the mother that she must only pat the child dry and not rub his skin. Rubbing can cause further itching. Additionally, the skin should be left moist prior to applying medication or moisturizer. Lukewarm water and oatmeal baths are appropriate.

Question 111

40. The nurse is caring for a child who is critically ill and requiring fluid resuscitation. Which intravenous fluids are appropriate for use? Select all that apply.
    a. 5% dextrose in water
    b. Normal saline
    c. Lactated Ringer’s
    d. 10% dextrose in water
    e. 5% lactated Ringer’s

Answer 111

b. Normal saline

c. Lactated Ringer’s

Question 112

9. When performing the physical examination of a child with cystic fibrosis, what would the nurse expect to assess?
   a. Dullness over the lung fields
   b. Increased diaphragmatic excursion
   c. Decreased tactile fremitus
   d. Hyperresonance over the liver

Answer 112

c. Decreased tactile fremitus

Feedback: Examination of a child with cystic fibrosis typically reveals decreased tactile fremitus over areas of atelectasis, hyperresonance over the lungs fields from air trapping, decreased diaphragmatic excursion, and dullness over the liver when enlarged.

Question 113

52. A nurse is caring for an infant whose mother is human immunodeficiency (HIV) positive. The nurse knows that which diagnostic test result will be positive even if the child is not infected with the virus?
    a. Erythrocyte sedimentation rate
    b. Immunoglobulin electrophoresis
    c. Polymerase chain reaction test
    d. Enzyme-linked immunosorbant assay (ELISA)

Answer 113

d. Enzyme-linked immunosorbant assay (ELISA)

Question 114

112. The nurse is teaching a class to a group of parents when one father asks for information about febrile seizures. The nurse should include all of the following except:
     a. there tends to be a family pattern to febrile seizures
     b. once a child has a febrile seizure, there is an increased risk for that child to have an additional seizure
     c. febrile seizures tend to occur as the temperature is rapidly rising
     d. febrile seizures are more common in children under the age of 8

Answer 114

b. once a child has a febrile seizure, there is an increased risk for that child to have an additional seizure

Question 115

101. Sandy receives NPH insulin daily in the morning. What is essential for her to know in relation to the insulin’s effect?
     a. Give herself the injection 30 minutes before breakfast
     b. have a mid-afternoon snack
     c. check her urine after each meal
     d. follow the American diabetic association menu carefully

Answer 115

b. have a mid-afternoon snack

Question 116

66. The nurse is speaking with the parents of a school-aged child recently diagnosed with diabetes mellitus regarding the differences between hypoglycemia and hyperglycemia. Which statement by a parent indicates a need for further teaching?
    a. “If I notice changes in my son like tearfulness or irritability, his blood sugar may be high.”
    b. “When my son’s breath smells fruity, it almost always indicates high blood sugar.”
    c. “If my son says he feels shaky, his blood sugar may be low.”
    d. “Dry flushed skin may be a sign if high blood sugar.”

Answer 116

a. “If I notice changes in my son like tearfulness or irritability, his blood sugar may be high.”

Question 117

123. Madison is a 4 week old with a cleft lip and palate who is scheduled for a surgical repair of the lip. Her mother asks the nurse why the lip and palate aren’t being repaired at the same time. The nurse’s best response is:
     a. “They prefer to schedule the repairs separately to avoid using too much anesthesia”
     b. “The palate is generally not repaired until Madison has begun talking”
     c. “The palate needs to have an opportunity to grow and the repair requires that Madison be drinking from an open cup, usually about 9-12 months of age”
     d. “It sounds like you have some unanswered questions. I can arrange to have you speak to the surgeon.”

Answer 117

c. “The palate needs to have an opportunity to grow and the repair requires that Madison be drinking from an open cup, usually about 9-12 months of age”

Question 118

42. The nurse is caring for a child who has had an endotracheal tube placed and is hooked to a ventilator. When assessing the child, the nurse notes that they child is exhibiting signs of poor oxygenation. What should the nurse do? Select all that apply.
    a. Assess tracheal tube placement.
    b. Assess for the presence of decreased breath sounds on one side of the chest.
    c. Assess for tracheal tube obstruction.
    d. Assess the ventilator equipment, checking to see that all tubing is connected correctly.
    e. Assess for decreased body temperature.

Answer 118

a. Assess tracheal tube placement.
b. Assess for the presence of decreased breath sounds on one side of the chest.
c. Assess for tracheal tube obstruction.
d. Assess the ventilator equipment, checking to see that all tubing is connected correctly.

Question 119

68. The nurse is teaching an 11-year-old boy and his family how to manage his diabetes. Which instruction does not focus on glucose management?
    a. Teaching that 50% of daily calories should be carbohydrates
    b. Instructing the child to rotate injection sites
    c. Encouraging the child to maintain the proper injection schedule
    d. Promoting higher levels of exercise than previously maintained

Answer 119

b. Instructing the child to rotate injection sites

Question 120

50. A nurse in the emergency department is examining an 18-month-old with lip edema, urticaria, stridor, and tachycardia. The nurse immediately suspects:
    a. severe polyarticular juvenile idiopathic arthritis.
    b. anaphylaxis
    c. systemic lupus erythematosus.
    d. severe combined immunodeficiency.

Answer 120

b. anaphylaxis

Question 121

71. The nurse is reviewing the laboratory test results of a child who is suspected of having systemic lupus erythematosus (SLE). What would the nurse identify as supporting this diagnosis? Select all that apply.
    a. Positive antinuclear antibody (ANA)
    b. Increased C3 levels
    c. Thrombocytopenia
    d. Leukopenia
    e. Increased hematocrit

Answer 121

a. Positive antinuclear antibody (ANA)
c. Thrombocytopenia
d. Leukopenia

Question 122

125. The nurse reviewing information on pyloric stenosis. Which of the following reflects accurate information?
     a. it occurs only in males
     b. vomiting will gradually become more projectile and contain more bile as the pylorus muscle thickens
     c. surgical correction involves spreading open the muscle around the pylric valve
     d. a sausage shaped mass can be palpated in the lower abdomen

Answer 122

c. surgical correction involves spreading open the muscle around the pylric valve

Question 123

22. The nurse is caring for a child with disseminated intravascular coagulation. The nurse notices signs of neurological deficit. Which nursing action is appropriate?
    a. Continue to monitor neurological signs
    b. Notify the physician
    c. Evaluate respiratory status
    d. Inspect for signs of bleeding

Answer 123

b. Notify the physician

Question 124

98. Matthew, a 5 year old has been diagnosed with fifth’s disease. The nurse would expect that Matthew’s rash would display which of the following characteristics?
    a. a red rash noted to the face that resembles a slapped cheek, progressing to the trunk, arms, and legs
    b. a red rash to the face that resembles a slapped cheek, progressing to the extremities especially the palms of the hands and soles and feet.
    c. a red rash starting on the upper back and neck, spreading down the trunk and to the extremities.
    d. a patchy red rash with honey colored crust noted around the mouth.

Answer 124

a. a red rash noted to the face that resembles a slapped cheek, progressing to the trunk, arms, and legs

Question 125

135. The nurse calls Mr. Webb to see how his 8 year old son Curtis is recovering from a tonsillectomy performed one day ago. Which of the following statements would indicate that Curtis needs to come to the emergency?
     a. “He is sleeping but appears to be swallowing a lot.”
     b. “He just had coffee colored emesis.”
     c. “He is complaining that his throat hurts more than earlier today.”
     d. “He is still not back to himself, he just wants to sleep and be left alone.”

Answer 125

a. “He is sleeping but appears to be swallowing a lot.”

Question 126

143. The nurse is caring for a hospitalized 4-year-old who insists on having the nurse perform every assessment and intervention on her imaginary friend first. She then agrees to have the assessment or intervention done to herself. The nurse identifies this preschooler’s behavior as:
     a. Problematic; the child is old enough to begin to have a basis in reality.
     b. Normal, because the child is hospitalized and out of her routine.
     c. Normal for this stage of growth and development.
     d. Problematic, as it interferes with needed nursing care.

Answer 126

c. Normal for this stage of growth and development.

Question 127

77. An infant is diagnosed with developmental dysplasia of the hip. On assessment, the nurse expects to note:
    a. symmetrical thigh and gluteal folds
    b. Ortolani’s sign
    c. increased hip abduction
    d. femoral lengthening

Answer 127

b. Ortolani’s sign

Question 128

3. After teaching a group of new parents about their newborns’ eyes and vision, which statement by the group indicates effective teaching?
   a. “Our newborn can see at distances of about 1 to 2 feet.”
   b. “We won’t know the baby’s eye color until he’s at least 6 months old.”
   c. “A baby can easily distinguish colors, but they must be bright colors.”
   d. “A newborn can focus with both eyes at the same time shortly after birth.”

Answer 128

b. “We won’t know the baby’s eye color until he’s at least 6 months old.”

Feedback: The eye color of an infant is determined by 6 to 12 months of age. A newborn sees beast at distances of about 8 to 10 inches. The optic nerve is not completed myelinated, so color discrimination is incomplete. the rectus muscles are uncoordinated at birth and mature over time, so binocular vision may be achieved by 4 months of age.

Question 129

103. Bobby is a 4 year old with hypothyroidism. All of the following are manifestations commonly seen in hypothyroidism except:
     a. bradycardia
     b. diarrhea
     c. weight gain
     d. fatigue

Answer 129

b. diarrhea

Question 130

10. The nurse is to obtain a stool specimen from a 4-year-old child who has very liquid stool. The child is ambulatory but weak. Which collection method would be most effective for the nurse to use?
    a. Apply a urine bag to the anal area.
    b. Use a tongue blade to scrape a specimen from a diaper.
    c. Have the child defecate into a container in the toilet.
    d. Use a clean bedpan to collect the specimen.

Answer 130

a. Apply a urine bag to the anal area.

Feedback: With very liquid stool, applying a urine bag to the anal area is most effective in collecting the specimen. Using a tongue blade to scrape a specimen from a diaper would be appropriate if the stool is formed. However, putting a diaper on a 4-year-old would be demeaning. Defecating into a collection container that sits at the back of the toilet would be more appropriate for an older child who is ambulatory. A bedpan would be appropriate if the child was bedridden.

Question 131

95. 3 week autumn was diagnosed with an atrial septal defect (ASD). Her plan of care should include:
    a. Monitor strict intake and output, weigh all diapers and weigh autumn weekly
    b. Provide high calorie formula and allow autumn to feed slowly over an hour
    c. Cluster all care so that oxygen demands are decreased
    d. Allow autumn to cry to encourage expansion and clearing of lung fields

Answer 131

c. Cluster all care so that oxygen demands are decreased

Question 132

13. A nurse is developing a teaching plan for the parents of an 8-year-old experiencing nocturnal enuresis. The nurse determines that additional teaching is needed when the parents identify what as an appropriate measure?
    a. Encouraging fluid intake after dinner
    b. Practicing bladder-stretching exercises
    c. Giving desmopressin intranasally
    d. Engaging the child in stress reduction measures

Answer 132

a. Encouraging fluid intake after dinner

Feedback: In many children, limiting fluids after dinner can be helpful for nocturnal enuresis. Bladder-stretching exercises also can be helpful. If these measures are ineffective, desmopressin may be prescribed. Stress factors may be contributing to the child’s problem. Therefore, measures to address stress and promote coping would be appropriate.

Question 133

109. Alex, a 4-year-old has been diagnosed with amblyopia in the left eye. His parents are very concerned and ask what will be done to treat his condition. Select the nurse’s best response.
     a. “Alex’s eye condition will be treated with prescription glasses; we should encourage him to help select the glasses he likes the most.”
     b. “Alex will most likely outgrow this condition; we will evaluate him again before he starts school”
     c. “Alex will need to wear a patch on his right eye.”
     d. “Alex will need to wear a patch on his left eye.”

Answer 133

c. “Alex will need to wear a patch on his right eye.”

Question 134

93. Children with congential heart conditions are extremely susceptible to:
    a. Gastrointestinal disorders
    b. Skin infections
    c. Allergic conditions
    d. Upper respiratory infections

Answer 134

d. Upper respiratory infections

Question 135

46. A 13-year-old boy has had a near-drowning experience. The nurse notices he has labored breathing and a cough. What is the priority intervention?
    a. Administer 100% oxygen by mask.
    b. Have the child sit up straight in a chair.
    c. Check his capillary refill time.
    d. Provide sedation as ordered.

Answer 135

a. Administer 100% oxygen by mask.

Question 136

79. The urine specimen of a child with acute glomerulonephritis would probably be:
    a. normal in color but very scant amount
    b. normal in color but cloudy due to loss of albumin
    c. normal in color and amount
    d. rusty brown color due to loss of blood

Answer 136

d. rusty brown color due to loss of blood

Question 137

33. The nurse is caring for a 13-year-old boy with a history of inappropriate behavior. Which statement by the mother would lead the nurse to suspect oppositional defiant disorder rather than conduct disorder?
    a. “He has frequent temper tantrums.”
    b. “He was pulling the neighbor’s dog around by his leash.”
    c. “He is constantly lying to me.”
    d. “He has stolen hundreds of dollars from my purse.”

Answer 137

a. “He has frequent temper tantrums.”

Question 138

124. The 1 day old neonate us suspected to have tracheoesophageal fistula. Which nursing intervention is most appropriate for this infant?
     a. avoiding suctioning unless cyanosis occurs
     b. Elevating the head of the bed/crib and giving nothing by mouth
     c. Elevating the neonate’s head for 1 hour after feedings
     d. giving the neonate only glucose water for the first 24 hours

Answer 138

b. Elevating the head of the bed/crib and giving nothing by mouth

Question 139

150. The doctor orders ibuprofen for a Child that weighs 82 pounds because they have a 5/10 pain in their right arm after falling off the monkey bars. How many mL will you administer?

Answer 139

Answer: 18.7 mL

Question 140

61. The nurse is talking with a pregnant woman who is a carrier for a genetic disorder. The woman does not have any symptoms of the disorder. The pregnant woman asks the nurse about the risk to her unborn baby. What is the most appropriate response by the nurse?
    a. “Since you are only a carrier for the gene, there is no risk to your baby.”
    b. “As a carrier of the gene there is a strong chance your child will be born with the disorder.”
    c. “We can only assess the potential risk after the baby’s father undergoes genetic testing.”
    d. “There is no way to assess the risk to the baby until after he is born.”

Answer 140

c. “We can only assess the potential risk after the baby’s father undergoes genetic testing.”

Question 141

117. forty-eight hours after birth, a neonate has not passed meconium. The nurse suspects which condition?
     a. hirschsprung’s disease
     b. celiac disease
     c. intussusception
     d. an abdominal wall defect

Answer 141

a. hirschsprung’s disease

Question 142

114. The nurse is working in the emergency room, when an ambulance arrives with a 10 year old who is having a generalized seizure. The EMT tells the nurse that Bobbi has been having a seizure for 35 minutes. They were unable to establish an IV line. Which of the following should the nurse do first?
     a. administer rectal diastat
     b. ask for assistance to hold Bobbi’s arm still and attempt to place an IV
     c. gather and prepare intubation equipment
     d. observe and record Bobbi’s seizure

Answer 142

a. administer rectal diastat

Question 143

102. As the nurse performing routine diabetic teaching with the child and family you know that it is important to reinforce that all of the following increase the body’s need for insulin except:
     a. overeating
     b. increased physical activity
     c. acute infections
     d. increased emotional strain

Answer 143

b. increased physical activity

Question 144

 The nurse is caring for a neonate who is suspected of having sepsis. Which assessment findings would the nurse interpret as most indicative of sepsis?

A) Rash on face
B) Edematous neck
C) Hypothermia
D) Coughing

Answer 144

C) Hypothermia

Feedback: Hypothermia is a sign of sepsis in neonates. A rash on the face is a symptom of scarlet fever. An edematous neck is a sign of diphtheria. Paroxysmal coughing is a symptom of pertussis.

Question 145

1. The mother of a school-aged child brings the child to the clinic for evaluation because he is having difficulty reading. His last visual screening was normal. He also reports headaches and dizziness. What would the nurse suspect?
   a. Astigmatism
   b. Myopia
   c. Hyperopia
   d. Nystagmus

Answer 145

a. Astigmatism

Feedback: Children with astigmatism often have blurry vision and difficulty seeing letters as a whole, affecting their reading ability. They may have headache and dizziness and often learn to tilt their heads slightly so that can focus more effectively (which leads to normal vision screening).

Question 146

130. You are caring for a school age child with cystic fibrosis. Which of the following sports would be most appropriate for this child?
     a. basketball
     b. golf
     c. swimming
     d. baseball

Answer 146

c. swimming

Question 147

113. Brock, a 12 year old with a ventriculoperitoneal shunt (VP), has a headache and photophobia after playing basketball. Which of the following is the nurses best instruction for Brock’s mother?
     a. “Give Brock Tylenol and see if her feels better in a few hours”
     b. “Give Brock Aspirin and see if he feels better in a few hours”
     c. “Brock was probably over stimulated, see if he feels better when he wakes up.”
     d. “You need to bring Brock to the emergency room to be evaluated”

Answer 147

d. “You need to bring Brock to the emergency room to be evaluated”

Question 148

140. When giving parents guidance for the adolescent years, the nurse would advise the parents to: (Choose all that apply.)
     a. Accept the adolescent as a unique individual
     b. Provide strict, inflexible rules
     c. Listen and try to be open to the adolescent’s views
     d. Screen all of his or her friends
     e. Respect the adolescent’s privacy
     f. Provide unconditional love

Answer 148

a. Accept the adolescent as a unique individual
c. Listen and try to be open to the adolescent’s views
e. Respect the adolescent’s privacy
f. Provide unconditional love

Question 149

91. A 10 month old infant with tetralogy of fallot experiences a cyanotic episode, or “blue spell”. To improve oxygenation during such an episode, the nurse should place the infant in which position?
    a. knee-to-chest
    b. fowlers
    c. trendelenburg’s
    d. prone

Answer 149

a. knee-to-chest

Feedback: The knee-to-chest position reduces venous return from the legs and increases systemic vascular resistance, maximizing pulmonary blood flow and improving oxygenation status. During a cyanotic episode, the child with TOF typically assumes this position instinctively. Fowler’s, Trendelenburg’s, and the prone positions don’t improve oxygenation.

Question 150

121. The nurse caring for 18 month old Kobe who has moderate diarrhea. Kobe’s plan of care should include all of the following except:
     a. Encourage Kobe to drink apple juice instead of milk
     b. Offer Kobe a snack of pretzels and bananas
     c. Ensure that all of Kobe’s diapers are weighed
     d. Monitor Kobe’s skin integrity around the diaper area

Answer 150

a. Encourage Kobe to drink apple juice instead of milk

Question 151

85. A toddler is diagnosed with iron-deficiency anemia. When teaching the parents about using supplemental iron elixir the nurse should provide which instruction?
    a. “Give iron with milk”
    b. “Give iron with a citrus fruit or juice”
    c. “Monitor the child for episodes of diarrhea”
    d. “Give iron before meals”

Answer 151

b. “Give iron with a citrus fruit or juice”

Feedback: Because iron preparations may stain the teeth, the nurse should instruct the parents to give the elixir with water or juice. The iron preparation shouldn’t be given with milk because milk impedes iron absorption. This preparation may darken the stools and cause constipation; parental instruction regarding increased fluid intake and fiber intake can relieve constipation. To prevent GI upset, the nurse should instruct the parents to mix the iron preparation with water or fruit juice and have the child take it with meals. (Giving it with fruit juice may be preferable because vitamin C enhances iron solubility and absorption.)