Peds Final

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Peds Final
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2014-12-08 18:42:46
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Peds Final
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  1. 1.     A school-age child is admitted to the hospital for a tonsillectomy. The nurse
    caring for this patient is assessing the child 8 hours after surgery. During
    the nurse’s assessment, the child’s parent tells the nurse that the child is in
    pain. Which of the following observations should be of most concern to the
    nurse?
    a. The child’s heart rate and blood pressure are elevated.

    b. The child complains of having a sore
    throat.

    c. The child is refusing to eat solid
    foods.

     d. The child is swallowing excessively
    Answer:  d. Rationale: Excessive swallowing is a sign that the child is swallowing blood. This should be considered a medical emergency, and the physician should be contacted immediately. The child is likely bleeding and will need to return to surgery
  2. 2. A 7-year-old female with asthma is playing a soccer game in gym class. During the game the child begins to cough, wheeze, and have difficulty catching her breath. The school nurse is called to the soccer field. Which of the following should the nurse administer to provide quick relief?

    a. Prednisone.
    b. Singulair.
    c. Albuterol.
    d. Flovent
    Answer:  c. Rationale: Albuterol is the quick-relief bronchodilator of choice for treating an asthma attack.
  3. 3. Reye's syndome affects the:
    a. Stomach and the intestine
    b. Islet of Langerhans
    c. Liver and the brain
    d. heart and the blood vessels
    Answer: c. Liver and the brain
  4. 4. An abdominal S-Shaped curvature of the spine seen in school-aged children is:
    a. sclerosis
    b. sciatica
    c. scabies
    d. scoliosis
    Answer: d.scoliosis
  5. 5. Aspirin has been ordered for the child with Rheumatic Fever in order to:

    a. Keep the PDA open.
    b. Reduce joint inflammation.
    c. Decrease swelling of strawberry tongue.
    d. Treat ventricular hypertrophy of endocarditis.
    Answer is d. Rationale: Joint inflammation is experienced in RF; aspirin therapy helps with inflammation and pain.
  6. 6. What two physiological changes occur as a result of hypoxemia in CHF?

    a. Polycythemia and clubbing.
    b. Anemia and barrel chest.
    c. Increased white blood cells and low platelets.
    d. Elevated erythrocyte sedimentation rate and peripheral edema.
    Answer: a.  Rationale: The hypoxemia stimulates erythropoiesis, which causes polycythemia, in an attempt to increase oxygen by having more red blood cells carry oxygen. Clubbing of the fingers is a result of the polycythemia and hypoxemia.
  7. 7. A 2-month old baby hasn't received any immunizations. Which immunizations should the nurse prepare to administer?

    a. measles, mumps, reubella (MMR); diptheria, tetanus, pertussis (DTP); and hepatitis B (HepB)
    b. polio (IPV), DTP, MMR
    c. varicella, Haemophilus influenzae type b (HIB), IPV, and DTP
    d. HIB, DTP, HepB; and IPV
    Answer: d. Rationale- The current immunizations recommended for a 2-month old who hasn't received any immunizations are HIB, DTP, HePB, and IPV. The first immunizations for MMR and varicella are recommended when a child is 12 months old.
  8. 8. A nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

    a. Increased crying
    b. Coughing at nighttime
    c. choking with feedings
    d. severe projectile vomiting
    Answer: c. Rationale- Any child who exhibits the “3 Cs”—coughing and choking with feedings and unexplained cyanosis—should be suspected of tracheoesophageal fistula. Options A, B, and D are not specifically associated with tracheoesophageal fistula.
  9. 9. Which response by the mother of a newborn daughter verifies her understanding of the priority teaching instructions concerning newborns and sleep?

    a . "I know to expect my baby to sleep for 6 hours through the night because she take formula in a bottle."
    b. "I need to put my baby to sleep on her back for naps and during the night."
    c. "I need to make sure my baby is sleeping on my pillow when she is in bed with me."
    d. "I know that my baby should be rocked to sleep, so that she gets into the habit."
    b. "I need to put my baby to sleep on her back for naps and during the night."
  10. The parents of a 3-week-old infant call the pediatrician's office to speak with a nurse. They are concerned that their baby does not seem to be able to hold his head up very easily. They also report that "his arms and legs show very little movement." The infant is eating and voiding fine. Which of the following would be the best action by the nurse?

    A. Offer dates and times of the well-child clinics in the community, so the parents can take the newborn to be developmentally screened
    B. Call and make a physical therapy referral appointment for the newborn so the family can be given specific muscle-strengthening exercises to administer.
    C. Encourage parents to put the infant on the floor for 10 minutes three times a day for "tummy time," to increase the newborn's muscle strength.
    D. Make an appointment for the parents to bring the newborn in to the office to meet with the pediatrician as soon as possible.
    C. Encourage parents to put the infant on the floor for 10 minutes three times a day for "tummy time," to increase the newborn's muscle strength.
    (this multiple choice question has been scrambled)
  11. 11. A 10-day old baby is weighed at the physician’s office. The baby is breastfed and weighted 7 lbs. 8 oz. at birth. How much would the nurse expect the baby to weigh now?

    A. 8 lbs
    B. 10 lbs
    C. 7 lbs 8 oz
    D. 7 lbs 1 oz
    D. 7 lbs 1 oz
    (this multiple choice question has been scrambled)
  12. 12. An important history intake question for the child diagnosed with osteomyelitis in the lower leg would be:

    a) “Have you ever walked with a limp?”
    b) “Have you recently had a cut or sore on your lower leg?”
    c) “Do you have numbness and tingling in your toes?”
    d) “Have you broken your leg I the past?”
    • Correct answer: b. Rationale: Osteomyelitis
    • often develops from a skin infection.
  13. 13. Which laboratory finding is of greatest concern in a child who has sickle cell disease and is experiencing a sickle cell crisis?

    a) “Oxygen Saturation (SaO2) of 92%
    b) hemoglobin of 10.7g/dL
    c) Hematocrit of 37%
    d) Reticulocyte count of 0.5%
    Answer: d. Rationale: A reticulocyte count of 0.5%, which is normal, is suggestive that the bone marrow has not increased production of RBC’s to accommodate the loss of RBC’s in the cycling process.
  14. 14. When planning care for a 8-year-old boy with Down syndrome, the nurse should:

    a. Plan interventions according to the developmental level of a 7-year-old child because that’s the child’s age
    b. Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays
    c. Assess the child’s current developmental level and plan care accordingly
    d. Direct all teaching to the parents because the child can’t understand
    Answer: c. Rationale: Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age. Because children with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed. A child with Down syndrome is capable of learning, especially a child with mild limitations.
  15. 15. When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following?

    a. A reduced white blood cell count
    b. A decreased platelet count
    c. Shallow respirations 
    d. Tachypnea
    Answer: d. Rationale: The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.
  16. 16. The nurse needs to take the blood pressure of a preschool boy for the first time. Which action would be best in gaining his cooperation?

    A. Permitting him to handle equipment and see the dial move before putting the cuff in place
    B. Explaining to him how the blood flows through the arm and why the blood pressure is important
    C. Taking his blood pressure when a parent is there to comfort him
    D. Telling him that this procedure will help him get well faster.
    A. Permitting him to handle equipment and see the dial move before putting the cuff in place
    (this multiple choice question has been scrambled)
  17. 17. Maria, age 10, requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging her to take her medicine before school. What is the most appropriate nursing action to promote Maria's compliance?

    A. Asking Maria to bring her medicine containers to each appointment so they can be counted
    B. Suggesting time-outs when she forgets her medicine
    C. Discussing with her mother the damaging effects of nagging
    D. Establishing a contract with her, including rewards
    D. Establishing a contract with her, including rewards
    (this multiple choice question has been scrambled)
  18. 18. The nurse is caring for a 1-year-old diagnosed with acute renal failure (ARF). Edema is noted throughout the child’s body, and the liver is enlarged. The child’s urine output is less than 0.5 mL/kg/hr, and vital signs are as follows: HR 146, BP 176/92, and RR 42. The child is noted to have nasal flaring and retractions with inspirations. The lung sounds are coarse throughout. Despite receiving oral Kayexalate, the child’s serum potassium continues to rise. Which treatment will provide the most benefit to the child?

    a. Additional rectal Kayexalate
    b. Intravenous furosemide
    c. Endotracheal intubation and ventilator assistance
    d. Placement of a Tenckhoff catheter for peritoneal dialysis
    Answer:  d. Rationale: Placement of a Tenckhoff catheter for peritoneal dialysis is needed when the child’s condition deteriorates despite medical treatment
  19. 19. Over the last week, an infant with a repaired myelomeningocele has had a high-pitched cry and been irritable. Length, weight, and head circumference have been at the 50th percentile. Today length is at the 50th percentile, weight is at the 70th percentile, and head circumference is at the 90th percentile. The nurse should do which of the following?

    a. Tell the parent this is normal for an infant with a repaired myelomeningocele
    b. Tell the parent this might mean the baby has increased intracranial pressure
    c. Suspect the baby’s intracranial pressure is low because of a leak
    d. Refer the baby to the neurologist for follow-up care
    Answer:  b. Ratioanle: The increase in head size is one of the first signs of increased intracranial pressure; other signs include high-pitched cry and irritability.
  20. 20. A nurse is caring for an infant with spina bifida cystica (meningomyelocele type) who had the sac surgically removed. The nurse plans which of the following in the postoperative period to maintain the infant's safety?

    a) covering the back dressing with a binder
    b) placing the infant in a head-down position
    c) strapping the infant in a baby seat sitting up
    d) elevating the head with the infant in the prone position
    Answer: d. Rationale: Elevating the head will decrease the chance of cerebrospinal fluid collecting in the cranial cavity. The infant needs to be prone for several days to decrease the pressure on the surgical site on the back. Binders and a baby seat should not be used because of the pressure they would exert on the surgical site
  21. 21. A nurse is caring for a child with Reye's syndrome. The nurse monitors for signs of which major problem associated with this syndrome?

    a) protein in the urine
    b) symptoms of hyperglycemia
    c) increased intracranial pressure
    d) a history of staphylococcus infection
    Answer: c. Rationale: Intracranial pressure and encephalopathy are major problems associated with Reye's syndrome. Protein is not present in the urine. Reye's syndrome is related to a history of viral infections, and hypoglycemia is a symptom of this disease
  22. 22. In infants with hydrocephalus, the early signs of ventricular shunt malfunction are:

    a. A high-pitched cry, colic, and pupillary changes
    b.A tense fontanelle, vomiting, and irritability c. Anorexia, and changes in pulse and respiration
    d. Headaches, lethargy, and loss of appetite
    a. A high-pitched cry, colic, and pupillary changes
  23. 23. The pediatric nurse instructs parents who are concerned about the spread of illness at their children's daycare centers to inquire about the facilities':

    a. Immunization rates among enrolled children
    b. Infection control practices
    c. Reported cases of diarrhea during the previous year
    d. Staff-to-child ratios
    Answer: a.
  24. Which of the following is an accuratestatement regarding pediatric physiologycompared to adult physiology?

    A. Children’s eustachian tubes are more vertical compared to adults
    B. Children’s cardiac output is stroke volume dependent
    C. Children have lower oxygenand caloric needs
    D. Infant’s kidneys cannot effectively concentrate urine
    D. Infant’s kidneys cannot effectively concentrate urine
    (this multiple choice question has been scrambled)
  25. A patient newly diagnosed with asthma is learning how to use a metered dose inhaler with a spacer. Which of the following statements would indicate a need for further instruction?

    A. . “I should shake the inhaler prior to using it.”
    B. D. “I should not cover theexhalation slots with my lipswhen using my inhaler.”
    C. C. “I should hold my breath for approximately 10 seconds after inhaling the medication.”
    D. B. “I should take a big breath in prior to depressing the inhaler.”
    D. B. “I should take a big breath in prior to depressing the inhaler.”
    (this multiple choice question has been scrambled)
  26. A 5-year-old tells you that “mommy, my stepfather, my brother, and my stepsister live at my house.” The nurse identifies this family structure as:
    A. D. Traditional nuclear
    B. C. Blended
    C. . Binuclear
    D. B. Extended
    B. C. Blended
    (this multiple choice question has been scrambled)
  27. A 15-year-old patient is trying to solve a moral dilemma, and is using herown set of standards, values and beliefs to help guide her decision. Whichof the following statement is most accurate?

    A. C. The patient is demonstrating characteristics of Kolhberg’s Postconventional stage, which is delayed for her age
    B. B. The patient is demonstrating characteristics of Kolhberg’s Conventional stage, which is appropriate for her age
    C. A. The patient is demonstrating characteristics of Kolhberg’s Postconventional stage, which is appropriate for her age
    D. D. The patient is demonstrating characteristics of Kolhberg’s Conventional stage, which is delayed for her age
    C. A. The patient is demonstrating characteristics of Kolhberg’s Postconventional stage, which is appropriate for her age
    (this multiple choice question has been scrambled)
  28. Which of the following are triggers or precipitating factors that can cause sickling of blood cells in patients with sickle cell anemia? [Select all tha tapply].

    A. A. dehydration
    B. B. fever
    C. C. emotional stress
    D. D. pollen
    E. E. high altitude
    • A. A. dehydration
    • B. B. fever
    • C. C. emotional stress
    • E. E. high altitude
  29. A hospital notices a large number of patients admitted for bronchiolitis and wants to develop a strategy plan to help decrease the number of patients admitted with this disorder. Which of the following interventions are most likely to be effective and are appropriate based on this stated goal? (Select all that apply)

    a. Placing all patients with respiratory syncytial virus in isolation precautions
    B. Starting an educational programregarding the use of Synagis (palivizumab)in high-risk infants
    C. C. Providing the Synagis vaccine to allinfants
    D. D. Starting a program to help educate parents about the importance of receiving the Haemophilus influenzae type B vaccine(Hib) vaccine
    E. E. Starting a marketing campaign topromote the importance avoiding sickcontacts, especially in summer months
    • a. Placing all patients with respiratory syncytial virus in isolation precautions
    • B. Starting an educational programregarding the use of Synagis (palivizumab)in high-risk infants
  30. An infant age 4 months comes to the clinic for a well-infant check-up.Immunizations she should receive are DTaP (diphtheria, tetanus, acellularpertussis) and IPV (inactivated poliovirus vaccine). She is recovering from acold and has a low-grade temp but is otherwise healthy. Her older sister hascancer and is receiving chemotherapy. Nursing considerations include which of the following?

    A. C. DTaP and IPV are contraindicated because her sister is immunocompromised
    B. B. DTaP and IPV are contraindicated because she has a fever
    C. D. IPV is contraindicatedbecause her sister is immunocompromised
    D. A. DTaP and IPV can be safely given
    D. A. DTaP and IPV can be safely given
    (this multiple choice question has been scrambled)
  31. A child is admitted with a suspected diagnosisof Munchausen syndrome by proxy (MSBP).An important consideration in the care of this Child is:

    A. B. Reassure parents that the cause of the disorder will be found
    B. D. Support parents as they cope with diagnosis of a chronic illness
    C. C. Teach the parents how to obtain necessary specimens
    D.Monitor parents whenever they are with the child
    D.Monitor parents whenever they are with the child
    (this multiple choice question has been scrambled)
  32. A baby with known tricuspid atresia is being delivered. Which of the following interventions should the nurse be prepared to perform immediately following birth?

    A. A. Prepare the newborn for a balloon atrial septostomy(cardiac cath procedure)
    B. B. Prepare the newborn foropen heart surgery
    C. D. Administer Lasix
    D. C. Administer Prostaglandin E
    D. C. Administer Prostaglandin E
    (this multiple choice question has been scrambled)
  33. A child is born with congenital clubfeet. When the parents ask the nurse how this will be corrected, the nurse should explain that:

    A. Frequent serial casting is tried first
    B. Surgical intervention is always needed
    C. Children outgrow condition
    D. Traction is tried first
    when they start walking
    A. Frequent serial casting is tried firs
    (this multiple choice question has been scrambled)
  34. Which of the following children with acute otitis media is most likely to be prescribed antibiotic treatment?

    A. B. 3-year-old whose case is mildbut the diagnosis is certain
    B. C. 5-year-old whose case ismoderate and the diagnosis isuncertain
    C. A. 15-month-old whose case is moderate but the diagnosis is certain
    D. D. 18-month-old whose case ismoderate and the diagnosis isuncertain
    C. 15-month-old whose case ismoderate but the diagnosis iscertain
    (this multiple choice question has been scrambled)
  35. An infant with pyloric stenosis is admitted after vomiting for 5 days, which nursing diagnosis would be the highest priority for this patient?

    A. Anxiety related to loss of bodily control
    B. Deficient fluid volume
    C. Ineffective airway clearance
    D. Imbalanced nutrition: less than body requirements
    B. Deficient fluid volume
    (this multiple choice question has been scrambled)
  36. Which question would be a priority when interviewing the mother of a child with suspected intussusception?

    A. How many times has your child vomited in the last two days?
    B. How many meals has your child eaten today?
    C. What do your child’s stools look like?
    D. How many times has your child urinated in the last 24 hours?
    C. What do your child’s stools look like?
    (this multiple choice question has been scrambled)
  37. Which assessment finding would be common for a child with Hirschsprung’s disease?

    A. Cyanosis of distal extremities
    B. Scaphoid abdomen
    C. Weight less than normal for age and height
    D. Hyperactive reflexes
    C. Weight less than normal for age and height
    (this multiple choice question has been scrambled)
  38. Which method for assessment would be best when assessing a toddler?
    A. Least invasive to most invasive
    B. Auscultate, then inspect
    C. From head-to-toe
    D. Distally to proximally
    A. Least invasive to most invasive
    (this multiple choice question has been scrambled)
  39. The nurse understands which of the following organisms is responsible for Rheumatic Fever?

    A. Haemophilus influenza
    B. Group A streptococcus
    C. Staphylococcus aureus
    D. Streptococcal pneumonia
    B. Group A streptococcus
    (this multiple choice question has been scrambled)
  40. The nurse assessing a 9-month-old would be concerned with which of the following findings?

    A. The baby is not able to say two syllable words
    B. The mother has not given him finger foods C. The baby does not unsupported
    D. The baby cries whenever themother leaves the room
    C. The baby does not unsupported
  41. The nurse assessing a newborn suspects tracheoesophageal fistula if the infant exhibits which of the following symptoms?

    A. Excessive amount of frothysaliva in mouth
    B. Jaundice
    C. Absence of sucking
    D. Bile stained emesis
    A. Excessive amount of frothysaliva in mouth
    (this multiple choice question has been scrambled)
  42. Which of the following nursing interventions prevent increased intracranial pressure in the infant who has recently experienced a traumatic brain injury?

    A. Avoid activities that cause pain or crying
    B. Suction child frequently
    C. Turn patient every hour
    D. Provide developmentally appropriate stimulation frequently
    A. Avoid activities that cause pain or crying
    (this multiple choice question has been scrambled)
  43. The temperature of a child who is unconscious is 105F due to unknown etiology. The priority nursing action would be to do which of the following?

    A. Administer aspirin immediately
    B. Complete a pain assessment
    C. Apply a cooling blanket
    D. Continue to monitor the temperature
    C. Apply a cooling blanket
    (this multiple choice question has been scrambled)
  44. The major goals of children with CP include which of the following?

    A. Recognizing the disorder and promoting the optimal development possible
    B. Preventing spread to individuals in close proximity
    C. Reversing the degenerative process that has occurred
    D. Treating the underlying defect and preventing developmental regression
    A. Recognizing the disorder and promoting the optimal development possible
    (this multiple choice question has been scrambled)
  45. The nurse understands which of the following factors predispose an infant to dehydration?

    A. Decreased surface area
    B. Lower metabolic rate
    C. Decreased daily exchange of extracellular fluid
    D. Immature kidney function
    D. Immature kidney function
    (this multiple choice question has been scrambled)
  46. In a non-potty trained toddler child with nephrotic syndrome, the best way to detect fluid retention is to do which of the following?

    A. Weigh the patient daily at the same time of the day
    B. Measure abdominal girth daily at the same time of the day
    C. Test urine for hematuria
    D. Count the number of wetdiapers each day
    A. Weigh the patient daily at the same time of the day
    (this multiple choice question has been scrambled)
  47. Which of the following is the period of time interval between early manifestations of disease and the overt clinical symptoms

    A. Incubation period
    B. Desquamation period
    C. Prodromal period
    D. Period of communicability
    C. Prodromal period
    (this multiple choice question has been scrambled)
  48. What is the main purpose of the Healthy People 2020 initiative?

    A.To improve the overall well-being of children and adults by establishing standardized goals based on current health concerns
    B.To increase the number of people with health insurance
    C.To decrease the incidence of obesity
    D.To provide nutritious food items for those who cannot afford it
    A.To improve the overall well-being of children and adults by establishing standardized goals based on current health concerns
    (this multiple choice question has been scrambled)
  49. Which of the following are components of culture theory?
    [Select all that apply.]
    a.Culture is integrated into life and uses symbols
    b.Culture is based on shared values and beliefs
    c. Culture is learned and static
    d.Many different theories on culture and nursing care within the context of culture currently exist.
    • a.Culture is integrated into life and uses symbols
    • b.Culture is based on shared values and beliefs
    • d.Many different theories on culture and nursing care within the context of culture currently exist.
  50. The major cause of death for children older than 1 year is which of the following?

    Childhood cancer
    Unintentional injuries
    Heart disease
    Congenital anomalies
    Unintentional injuries (accidents) are the leading cause of death after age 1 year through adolescence.
  51. What type of family structure is represented when a mother, her children, and a stepfather live together in one household?

     Traditional
    Nuclear
    Blended
    Extended
    Binuclear
    A blended family contains at least one stepparent, stepsibling, or half-sibling.

    The tradition nuclear family consists of two parents and their biological children. No other relatives or nonrelatives are present in the household. An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.
  52. A 16-year-old girl arrives at a walk-in clinic and says she thinks she might be pregnant because she is two weeks late. The best response by the nurse is:

     "Do you have a parent here that can consent for us to draw your blood?"

    "Many times adolescents have irregular periods. Why don't you come back in a few weeks if you still have not had your period."

    "Go ahead and have a seat and fill out these papers, and then we will take you back and draw your blood."

    "Were you using protection when you had sex?"
    "Go ahead and have a seat and fill out these papers, and then we will take you back and draw your blood."

    There are certain medical conditions that teens under the age of 18 can be treated for without parental consent, and pregnancy is one of them. Other medically emancipated conditions may include treatment for STIs, drug abuse, and mental health services (can vary by state law).
  53. Which of the following are components of family-centered care? [Select all that apply.]

    Respect
    Collaboration
    Partnership
    Paternalism
    • Respect
    • Collaboration
    • Partnership

    Correct. Family-centered care is an effective partnership/collaboration between the patient, patient's family, and healthcare professionals that respects the family's strengths, values, beliefs, and experiences.
  54. A patient demonstrates a low self-esteem, acts out with delinquent behavior and seems to crave attention from the nursing staff. Based on this information, the parenting style most likely used is?

    Authoritarian
    Authoritative
    Permissive
    Indifferent
    The parenting style that is evidenced is most likely indifferent, based on the child's desire for attention and low self-esteem.
  55. Match the following interventions with the appropriate level of prevention.

    immunizations
    administering insulin to a patient with type I diabetes
    G&D surveillance
    safety education programs
    PKU screening
    Burn rehabilitation

    A. tertiary prevention
    B. tertiary prevention
    C. secondary prevention
    D. primary prevention
    E. secondary prevention
    F. primary prevention
    Immunizations and safety education programs are primary prevention measures,

    G&D surveillance and PKU screening are secondary prevention measures, and

    administering insulin and any type of rehabilitation are tertiary prevention measures
  56. Which of the following is a federally funded program that aims to improve patient outcomes by providing nutritious food items for those who cannot afford it?

    Medicaid
    WIC
    Healthy People 2020
    FMLA
    WIC is a federally funded program that aims to improve patient outcomes by providing nutritious food items for those who cannot afford it.
  57. To date, what are the two public health interventions that have had the greatest impact on child health outcomes?

     Immunizations and pasteurization
     Immunizations and clean drinking water
     Clean drinking water and pasteurization
     Clean drinking water and sterilization of instruments
    Immunizations and clean drinking water
  58. Which of the following are components of the FLACC scale?
    [Select all that apply.]

     Color
    Capillary refill time
    Leg position
    Facial expression
    Activity
    FLACC is an acronym for face, legs, activity, cry, and consolability.

    • It assesses a child's
    • facial expression (relaxed or smiling, grimacing, frowning, etc.),
    • leg position (relaxed, restless, or kicking),
    • activity (moving easily, squirming, or rigid/arched),
    • crying (no cry, whimpers/groans, or crying/ sobbing), and
    • consolability (relaxed, easily consoled, or inconsolable).
  59. Which of the following is an accurate statement regarding pediatric physiology compared to adult physiology?

     Children are more susceptible to complications of dehydration due to a higher body water content
    Children's respiratory rate should be slower than adults
    Children's cardiac ventricles are more compliant than adults
    Children have a lower metabolic rate
    Children are more susceptible to complications of dehydration due to a higher body water content (70% in infants, 65% in children, vs. 60% in adults).
  60. The parents of a hospitalized 3-year-old are concerned about their young child experiencing pain from so many procedures. The nurse's response should be based on knowledge that children:

    May react to painful stimuli but are unable to remember the pain experience.
    Do not tolerate pain any better than adults.
    Run the risk of becoming addicted to pain medication.
    Do not need pain medication unless they tell you they are in pain.
    Evidence shows that infants and children have demonstrated memory of painful procedures. Also, children may be afraid to express pain, as they may fear that the treatment for pain will be worse than the pain itself. Addition is extremely rare when the child is treated for an acute condition (less than 1%).
  61. Which of the following nonpharmacologic interventions appears to be the most effective in decreasing neonatal procedural pain?

    : Commercial warm packs
    Tactile stimulation
    Doing procedure during infant sleep
    Oral sucrose and nonnutritive sucking
    Sucrose in contact with the oral mucosa promotes natural pain relief by activating endogenous opioids. Research has also shown that neonates and infants derive pleasure and comfort from nonnutritive sucking.
  62. What is the normal urinary output for pediatric patients?

    1-2ml/kg/hour
    1-2 ml/lb/hour
    2-3 ml/kg/hour
    2-3 ml/lb/hou
    Normal output is 1-2ml/kg/hour. It should be more towards the 2ml/kg/hour for younger children, and will shift closer to 1ml/kg/hr when in adolescence as the child get bigger.
  63. All of the following are examples of effective communication techniques for the adolescent population EXCEPT:

    Using a straight-forward approach
    Forcing interactions when necessary
    Remaining nonjudgmental
    Providing privacy
    Forcing interactions when necessary
  64. Which of the following is an important consideration for the nurse who is communicating with a very young child?

    Speak loudly, clearly, and directly.
    Use transition objects, such as a doll.
    Do not be honest with young children if the answer will cause them anxiety.
    Initiate contact with the child when the parent is not present
    Selected Answer:


    • Use transition
    • objects, such as a doll.




     




    Response Feedback:


     Using a transition object allows the young child an opportunity to evaluate an unfamiliar person (the nurse). This will facilitate communication with this age child.

    • Speaking loudly will tend to increase anxiety in very young children. The nurse must
    • be honest with the child. Attempts at deception will lead to a lack of trust.
    • Whenever possible, the parent should be present for interactions with young
    • children.
  65. The nurse's approach, when introducing hospital equipment to a preschooler who seems afraid, should be based on which of the following principles?

    The child may think the equipment is alive.
    The child is too young to understand what the equipment does.
    Explaining the equipment will only increase the child's fear.
    One brief explanation will be enough to reduce the child's fear.
    The child may think the equipment is alive.

    Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. The child should be given simple concrete explanations about what the equipment does and how it will feel to the child. Simple, concrete explanations will help alleviate the child's fear. The preschooler will need repeated explanations as reassurance
  66. Match the following age groups with the appropriate cognitive developmental stage as described by Piaget.

    Birth-2
    Ages 2-7
    Ages 7-11
    Ages 11-adulthood

    A. Concrete Operational
    B. Preoperational
    C. Formal Operational
    D. Sensorimotor
    • Birth-2 D. Sensorimotor
    • Ages 2-7 B. Preoperational
    • Ages 7-11 A. Concrete Operational
    • Ages 11-adulthood C. Formal Operational
  67. The nurse has discussed with a group of new mothers appropriate support of the young infant to prevent injuries from falls. The mother who needs further education is the mother who states:

    "By the time my baby is 6 months old, he will be able to sit without support."
    "I never leave my baby unattended on my bed."
    "My baby is not allowed to crawl or play near the stairs."
    "Before my child is standing, I need to place the crib mattress at its lowest level."
    "By the time my baby is 6 months old, he will be able to sit without support."

    • Children
    • will typically not be able to sit without support until 8 months of age. Babies
    • should not be unattended on raised surfaces, as they could roll and fall off
    • (or even wiggle and fall off, prior to them being able to roll). The crib
    • should be lowered to the lowest setting prior to the infant being able to
    • stand, so they do not fall over the crib rails.
  68. A recently hospitalized 2-year-old patient screams and shouts that he wants a bottle. His parents are puzzled, stating that he has been drinking from a cup for the past year. The nurse explains that:

    Irritability is exhibited in all age groups.
    Temper tantrums often represent the child's need for parental attention.
    Various forms of punishment are necessary when such behaviors occur.
    Regression to an earlier behavior often helps the child cope with stress and anxiety.
    Regression to an earlier behavior often helps the child cope with stress and anxiety

    . Regression, or the return to a former or less developed state, is a normal coping mechanism in response to stress in young children. Children will usually catch back up to where they were when the stressor is no longer present
  69. The mother of a 6-month-old infant is concerned that the infant's anterior fontanel is still open. Which of the following statements made by the nurse is most appropriate?

    "It is slightly concerning that the anterior fontanel is still open. I will mention it to the doctor to see if a referral should be made."
    "It is normal for the anterior fontanel to remain open at this age. The anterior fontanel typically closes between 9 and 15 months."
    "It is normal for the anterior fontanel to remain open at this age. The anterior fontanel typically closes between 12 and 18 months."
    "It is normal for the anterior fontanel to remain open at this age. The anterior fontanel typically closes between 15 and 24 months."
    "It is normal for the anterior fontanel to remain open at this age. The anterior fontanel typically closes between 12 and 18 months."
  70. Match the following age groups with the appropriate psychosocial developmental stage as stated by Erikson.

    Infant
    Toddler
    Preschool
    School-Age
    Adolescent

    A. Industry vs. inferiority
    B. Autonomy vs. self-doubt
    C. Trust vs. Mistrust
    D. Initiative vs. shame and guilt
    E. Identity vs. role confusion
    • Infant C. Trust vs. Mistrust
    • Toddler B. Autonomy vs. self-doubt
    • Preschool D. Initiative vs. shame and guilt
    • School-Age A. Industry vs. inferiority
    • Adolescent E. Identity vs. role confusion
  71. Which of the following is the typical concept of play for school-age children?

    Solitary play
    Parallel play
    Associative play
    Cooperative play
  72. The mother of a 2-year-old asks a clinic nurse about appropriate and safe toys for the child. The nurse tells the mother that the most appropriate toy for a 2-year-old is which of the following?

    A child's miniature farm set
    A wagon
    A jack set with marbles
    A child's miniature golf set
    A wagon
  73. Which of the following is NOT one of Kohlberg's stages of moral development?

    Preconventional
    Formal conventional
    Conventional
    Postconventional
    Formal conventional

    Kohlberg's stages of moral development are preconventional until age 7, conventional from ages 7-11, and postconventional from age 12 and older.
  74. The nurse discusses dental care with the parents of a 3-year-old. The nurse explains that by the age of 3, children should have:

    5 teeth
    10 teeth
    15 teeth
    20 teeth
    By 3 years of age, a child should have all his/her baby teeth, which consists of a total of 20 teeth.
  75. Which of the following approaches would be best to use to ensure a positive response when first addressing a toddler?

    Assume an eye-level position and talk quietly.
    Call the toddler's name while picking him or her up.
    Call the toddler's name and say, "I'm your nurse."
    Stand by the toddler, addressing him or her by name.
    Assume an eye-level position and talk quietly.

    t is important that the nurse assume a position at the child's level when communicating with the child. By speaking quietly and focusing on the child, the nurse should be able to obtain a positive response. The nurse should engage the child and inform the toddler what is going to occur. If the nurse picks up the child without explanation, the child is most likely going to become upset. The toddler may not understand the meaning of the phrase, "I'm your nurse." If a positive response is desired, the nurse should assume the child's level when speaking if possible
  76. Growth and development follows which of the following patterns?

    Distal to proximal
    Cephalocaudal
    More complex to simple
    G&D does not follow a specific pattern
    Cephalocaudal
  77. The NICU nurse is providing instructions to a new mother regarding the psychosocial development of her newborn son. Using Erikson's psychosocial development theory, the nurse instructs the mother to:

    Anticipate all the needs of the newborn infant
    Avoid the newborn infant during the first 5 minutes of crying
    Let the newborn cry himself to sleep
    Allow the newborn to signal a need
    Allow the newborn to signal a need
  78. A 16-year-old is admitted to the hospital for acute appendicitis and an appendectomy is performed. Which nursing intervention is appropriate to facilitate normal psychosocial development postoperatively?

    Encourage the child to rest and read
    Encourage the parents to room in with the child
    Allow the child to interact with others in his or her same age group
    Allow the family to bring in the child's favorite computer games
    Allow the child to interact with others in his or her same age group
  79. The nurse should refer which of the following children for a developmental screening, as they are exhibiting a growth and/or developmenal delay.

    The 12 month old infant whose birth weight has only tripled.
    The 4-month-old whose parent states she does not turn her head to locate sounds.
    The 6-month-old who cannot transfer objects from hand to hand. T
    he 7-month-old who has not learned object permanence.
    The 12-month-old who has not learned the names of body parts yet.
    The 4-month-old whose parent states she does not turn her head to locate sounds.

     The birth weight should triple by 12 months of age, so that is expected. Infants typically do not transfer objects from hand to hand until 7 months of age, so it is okay for a 6-month-old child to not be performing this skill. Object permanence is not typically learned until 9 months of age, so a 7-month-old who could not do this would not be considered delayed. Learning the names of body parts does not typically happen until toddlerhood. However, infants should be turning to locate sounds at 3 months, so a 4-month-old not performing this could possible indicate a hearing problem which would need to be evaluated.
  80. The nurse must assess a 10-month-old infant. He is sitting on his father's lap and appears to be afraid of the nurse and of what might happen next. Which of the following initial actions by the nurse would be most appropriate?

    Initiate a game of peek-a-boo.
    Ask father to place the infant on the examination table.
    Undress the infant while he is still sitting on his father's lap.
    Talk softly to the infant while taking him from his father
    Initiate a game of peek-a-boo.

    Peek-a-boo is an excellent means of initiating communication with infants while maintaining a safe, nonthreatening distance. The child will most likely become upset if separated from his father. As much of the assessment as possible should be done on the father's lap. The nurse should have the father undress the child as needed for the examination.
  81. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The most appropriate nursing action is which of the following?

    Ask her why she wants to know.
    Determine why she is so anxious.
    Explain in simple terms how it works.
    Tell her she will see how it works as it is used
    Explain in simple terms how it works.
  82. Which of the following manifestations suggests that an infant is developing NEC?

    The infant absorbs bolus orogastric feedings at a faster rate than previous feedings
    The infant has bloody diarrhea
    The infant has increased bowel sounds T
    he infant appears hungry right before a scheduled feeding
    The infant has bloody diarrhea

    Feedings tend to take longer and often do not get absorbed before the next scheduled feeding. Bowel sounds tend to decrease. Bloody diarrhea can indicate that the infant has NEC.
  83. Which of the following nursing interventions would be appropriate for a 7-year-old patient with sickle cell who receives frequent blood transfusions? 
    [Select all that apply.]

    Administer PO Penicillin
    Administer Exjade daily
    Apply cold packs for aching joints
    Administer Morphine as needed for pain
    • Administer Exjade daily
    • Administer Morphine as needed for pain

     It would be appropriate for a patient of this age with SCA to receive either Morphine for pain or Exjade daily to help remove excess iron in the body in people who have received a large number of blood transfusions. PCN is not typically given after the age of five. Cold packs will cause vasoconstriction, and are thus contraindicated for a patient with SCA.
  84. A patients labs come back as the following: Complete Blood Count (CBC) is WNL, Prothrombin Time (PT) is WNL, Fibrinogen is WNL, and an elevated Activated Partial Thromboplastin Time (APTT). Which of the following statements is most accurate?

    We know the patient has Hemophilia A based on these lab results
    We know the patient has Hemophilia B based on these lab results
    The patient's labs indicate that the patient has excess clotting factors, and is subsequently at risk for clots.
    The patient could have either hemophilia A or B based on these lab results, and further testing is warranted.
    The patient could have either hemophilia A or B based on these lab results, and further testing is warranted.

    APTT measures how long it takes for blood to clot. It measures the clotting ability of factors VIII (8), IX (9), XI (11), and XII (12). If any of these clotting factors are too low, it takes longer than normal for the blood to clot. The results of this test will show a longer clotting time (i.e. it will be elevated) among people with hemophilia A or B. Further testing of Factor 8 and 9 levels is needed to determine the type.
  85. The nurse is providing homecare instructions to the parents of a child with Cystic Fibrosis (CF). Which of the following statements if made by the parents would indicate the need for further instruction? 
    [Select all that apply].

    "We will perform chest physiotherapy and postural drainage four times a day."
    "We will keep her away from the church nursery if any of the children are coughing and have fever or runny noses."
    "If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes."
    "The relay races and swimming at out Sunday school picnic next week will be good exercise for her."
    "My child will not need any special dietary intake."
    • "If her bowel movements are normal and her appetite is good, she does not need her pancreatic enzymes."
    • "My child will not need any special dietary intake."

    Children with CF require pancreatic enzymes with every meal and snack to counter malabsorption and nutritional problems. They require well-balanced diets with 120-150% of RDA calories and 200% RDA protein. Normal bowel movements indicate that enzyme dosage is appropriate. It is important to avoid other children with infections, but physical activity is encouraged within the child's capability. Chest percussion is a normal part of health maintenance for this child.
  86. A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by:

    Subcutaneous injection
    Intravenous injection
    Endotracheal tube
    Intramuscular injection
    Endotracheal tube

    Surfactant needs to go directly into the lungs, so ET tube is the correct choice.
  87. Primary prevention of intraventricular hemorrhages should consist of?
    [Select all that apply].

    Administering antibiotics to all premature infants
    Giving antenatal betamethasone if preterm labor is evident
    Quickly correcting fluid and electrolyte imbalances
    Maintaining adequate oxygenation in the newborn
    Drying the infant at birth
    • Giving antenatal betamethasone if preterm labor is evident,
    • quickly correcting fluid and electrolyte imbalances, and
    • maintaining adequate oxygenation in the newborn

    have all been shown to prevent IVH. While drying the infant at birth is important, it will not help prevent IVH. Furthermore, it is not necessary to give all premature infants antibiotics.
  88. What factors influence the outcomes of the at-risk newborn? [Select all that apply.]

    Birth weight
    Gestational age
    Type and length of newborn illness
    Environmental factors
    Maternal factors
    All are correct. Maternal factors such as age and parity, newborn weight, and gestational age also influence outcomes, as do environmental factors such as exposure to environmental dangers (toxic chemicals and illicit drugs).
  89. An infant was born at 25 weeks gestational age. At 11 weeks of age, the infant requires a 20% oxygen requirement. This infant would be classified as having?

    Mild Bronchopulmonary Dysplasia (BPD)
    Moderate Bronchopulmonary Dysplasia (BPD)
    Severe Bronchopulmonary Dysplasia (BPD)
    It is too early to determine the severity of the infants Bronchopulmonary Dysplasia (BPD).
    he infant needed oxygen for more than 28 days, thus BPD is applicable. Since the infant is now at a corrected GA of 36 weeks, it is not too early to determine. Since the infant has a 20% oxygen requirement, they would be classified as having moderate BPD
  90. A nurse is about to hang an IV containing caffeine to a neonate who is being treated for apnea of prematurity. The nurse should notify the physician prior to hanging the IV medication for all of the following assessment data EXCEPT?

    HR of 185 while neonate is crying
    Observance of a dysrhythmia
    Input of 50 ml/
    Output of 93ml
    Jitteriness
    HR of 185 while neonate is crying

    All of the data provided are manifestations of caffeine toxicity with the exception of the HR of 185 while crying. The HR should not be above 180 at rest, but it is common for the HR to elevate when the infant is crying. The nurse should calm the infant and retake the HR once the infant is no longer crying
  91. Which of the following is an appropriate nursing intervention for an infant suffering from neonatal abstinence syndrome

    Decreasing external stimuli
    Weaning doses of narcotics given to the infant
    Keeping the infant NPO
    Keeping to a fixed schedule to maintain a routine
    Decreasing external stimuli

    One of the main interventions for a patient suffering from NAS is decreasing as much external stimuli as possible. Other pertinent nursing interventions include providing adequate nutrition and hydration, promoting positive and nurturing maternal-infant relationships, and providing care on demand rather than on a fixed schedule to reduce irritability
  92. A preterm infant born at 25 weeks gestation who weighs 750 g (11% percentile for age). Based on this information, the infant would be classified as:

    Low-birth-weight (LBW) infant
    Very low-birth-weight (VLBW) infant
    Extremely low-birth-weight (ELBW) infant
    Small-for-gestational-age (SGA) infant
    Extremely low-birth-weight (ELBW) infant

    Correct. Less than 2500g is LBW, less than 1500g is VLBW, and less than 1000g is ELBW. SGA is less than the 10th percentile. As this neonate is in the 11th percentile, SGA does not apply.
  93. A 28 week preterm neonate is being treated for Necrotizing Enterocolitis (NEC). The nurse should clarify which of the following orders?

    Diet: breastfeed prn
    Insert NG tube, place to intermittent suction at 20 mmHg
    Place IV catheter
    Administer clindamycin
    Diet: breastfeed prn

    All of the orders are appropriate except the diet order. Neonates with NEC or suspected NEC are kept NPO, so the nurse should question the breastfeeding prn order. Antibiotics will be given IV, so both C and D are appropriate
  94. The order for desmopressin acetate (DDVAP) should be questioned for which of the following patients? [Select all that apply.]

    A patient with mild hemophilia A
    A patient with moderate hemophilia A
    A patient with severe hemophilia A
    A patient with hemophilia B
    A patient with Von Willebrand disorder
    • A patient with moderate hemophilia A
    • A patient with severe hemophilia A
    • A patient with hemophilia B
  95. The preterm newborn is experiencing vomiting, diarrhea, weight loss, irritability, tremors, high-pitched cry, frequent yawning, and tachypnea. What is the most likely cause of these manifestations?

    Sepsis
    Respiratory distress syndrome
    Intraventricular hemorrhage
    Maternal substance abuse
    Maternal substance abuse

     These s/s are most consistent with signs of withdrawal in the neonate. The two manifestations that differentiate it from possible sepsis are the shrill cry and yawning. Neonates suffering from withrawal also commonly have nasal manifestations (either stuffiness or runny nose). The severity of withdrawal that an infant experiences can be assessed by using a scoring system such as the Finnegan scale. This scale is based on observations and measurement of the responses to neonatal abstinence from substances. It evaluates the infant on potentially life-threatening signs such as vomiting, diarrhea, weight loss, irritability, tremors, and tachypnea.
  96. The nurse should be most concerned about which of the following when caring for a patient with severe combined immunodeficiency (SCID)?

    Risk for bleeding
    Risk for delayed growth and development
    Risk for ineffective coping
    Risk of infection
    Risk of infection


    Correct. Patients with SCID have almost no immune function, so risk for infection is of utmost importance.

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