NR328_NR 328 Pediatric Final Questions: 100 QUESTIONS, ANSWERS, AND RATIONALE (GRADED A)

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Pediatric Practice Questions 1. A 1-day-old infant, born at 39 weeks' gestation, weighs 4 pounds, 7 ounces at birth. A pediatrician diagnoses the neonate with intrauterine growth restriction... (IGR). An RN observes the newborn to be irritable, difficult to con- sole, restless, fist-sucking, and demonstrating a high- pitched, shrill cry. Based on these assessment data, the RN should: 2. A 3-year-old child is hospitalized with multiple fractures as a result of a car accident. What is the best way for a nurse to assess this child's pain level? 3. A 7-year-old child is hospitalized for a tonsillectomy. What are priority nursing actions when caring for this child after surgery? Select all that apply. 4. A 12-month-old child with infantile eczema is seen at the clinic for several open lesions on the arms and legs. What should a nurse caution the child's parents against? 5. A 13-year-old client diagnosed with beta-thalassemia is hospitalized for blood transfusion. What are the priority nursing diagnoses related to this child's care? Select all that apply. 6. A charge nurse is creating nursing assignments for a pediatric unit when one of the oncoming nurses calls to say, "Sorry, I'll be a few minutes late since I have a child home ill with the chickenpox." What type of assignment would be most acceptable for the nurse who will be late? 7. A charge nurse is seated in front of a bank of cardiac monitors on a pediatric unit. There are four children receiving cardiac monitoring. Which finding should the charge nurse communicate at once to the child's nurse? 8. A child arrives in an emergency department with a chief complaint of asthma exacerbation. Which assessment information is most important for the nurse to obtain first? 9. A child diagnosed with hypopituitarism is to begin receiving daily injections. At what time should a nurse instruct the child's parents to administer the injection each day? 10. A child hospitalized with hydrocephalus is being treated with an externalized ventricular drain (EVD). A nurse begins the afternoon assessment and discovers that the drain is positioned several inches below the child's ear level. What should be the nurse's priority action? 11. A child is admitted for treatment of lead poisoning. A nurse recognizes that the priority nursing diagnosis for this child is: 12. A child is admitted with acute exacerbation of asthma. A physician orders 100% oxygen via mask. Which physician order should be a nurse's next priority? 13. A child is receiving chemotherapy for the treatment of osteosarcoma. Which morning laboratory result must a nurse report immediately to the physician? 14. A child is seen in an emergency department following the ingestion of lighter fluid. Which nursing action is of the highest priority at this time? 15. A child recovering from abdominal surgery removes the nasogastric tube accidentally. A nurse replaces the nasogastric tube and places it to low wall suction. Two hours later, the nurse discovers that there is no drainage from the tube. What should be the nurse's first action? 16. A child with status post-Harrington rod placement for the correction of scoliosis is being cared for on the pediatric unit. The child suddenly experiences facial sweating and complains of a headache. A nurse notes also a slower heart rate on the monitor. What action should the nurse take first? 17. A child with type 1 diabetes is being prepared for dis- charge from a hospital. What should a nurse include as part of the teaching regarding diabetes care? 18. A child with type 1 diabetes is receiving insulin based on carbohydrate intake. The child's insulin-to-carbohydrate ratio is 15:1. Of the items listed on the child's lunch menu shown below, the child ate 2 slices of bread, a slice of cheese, a glass of milk, a cup of soup, and half of a banana. How many units of insulin should the nurse administer based on the client's carbohydrate count? Round to the nearest whole number. 19. A child, hospitalized with nephrotic syndrome, has been receiving corticosteroids for a week. What should the nurse recognize as early evidence that the child is responding well to treatment? 20. A client is attending a newborn discharge class and asks a nurse about the bump on the infant's head. Upon assessment, the neonate has a large, diffuse swelling on the left occiput that crosses the sagittal suture line. The nurse should explain to the mother that: Select all that apply. 21. A clinic nurse has a follow-up appointment with an adolescent with juvenile idiopathic arthritis (JIA). What topic should be the nurse's top priority? 22. A clinic nurse prepares to perform a physical assessment on a preschool child. What are the appropriate actions for the nurse to take when preparing for and perform- ing the examination? Prioritize the nurse's actions by placing each correct step in sequential order. 23. A hospitalized child is experiencing sickle cell vaso-occlusive crisis. The child is currently receiving an intra- venous (IV) fluid bolus, pain medication every 4 hours, and warm compresses to the extremities per physician orders. During the midday assessment, the child reports no pain. Which action should a nurse take? 24. A newborn arrives in a neonatal intensive care unit with a myelomeningocele. A physician writes orders to keep the infant in the prone position. A nurse should know that the most important rationale behind this order is to: 25. A nurse admits a teenager in sickle cell crisis to a pediatric unit. The child has an elevated heart rate but normal blood pressure, respiratory rate, and temperature. The child has an oxygen saturation of 98% on room air and rates pain in the extremities at an 8 on a 1-to-10 numeric pain rating scale. Which actions should the nurse perform at this time? Prioritize the nurse's actions by placing each correct intervention in priority order. 26. A nurse and nursing student are caring for a child who sustained a head injury as a result of a fall from a play structure. The nurse knows the nursing student is pre- pared to care for the child when the student states: 27. A nurse assesses a child who is 12 hours status post- tonsillectomy and adenoidectomy. The child reports feeling nauseated and shows the nurse a moderate amount of red-tinged vomitus in the emesis basin. Which action should the nurse take first? 28. A nurse assesses the respiratory status of an infant. Which finding should be of most concern to the nurse? 29. A nurse attempts to give a newborn infant the first bottle feeding. While sucking, the infant becomes cyanotic and coughs, and formula is seen coming out of the infant's nose. What should be the nurse's first action? 30. A nurse enters the room of a child following the placement of a ventriculoperitoneal shunt. The child is sitting up in bed, crying, and has vomited a small amount on the bed linens. What are the priority nursing actions? Select all that apply. 31. A nurse is caring for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which laboratory test would the nurse be least likely to obtain? 32. A nurse is caring for a child newly diagnosed with congen- ital heart disease. The nurse should monitor the child with the understanding that the earliest sign of heart failure is: 33. A nurse is caring for a child with acute glomerulonephritis. Which nursing assessment should be the nurse's first priority when caring for this child? 34. A nurse is caring for a child with meningococcemia who is on a ventilator. This morning, the nurse finds the child's mother sitting at the bedside, crying. The mother tells the nurse, "I thought it was the flu. This is my fault because I should have come to the hospital earlier." What is the best action by the nurse in response to the mother's statements? 35. A nurse is caring for a child with tetralogy of Fallot. Which assessment findings should the nurse expect? Select all that apply. 36. A nurse is caring for a newborn infant diagnosed with hypospadias. The parents ask when the surgical repair will be complete. The nurse knows that the most likely time for completion of the surgical repair will be: 37. A nurse is performing discharge teaching with the parents of a preschooler diagnosed with cystic fibrosis. What part of the teaching plan will best assist the parents to prevent future pulmonary infections in this child? 38. A nurse is planning to teach a child safety class to a group of new parents. When preparing a lesson regarding car seats, what should the nurse recommend? 39. A nurse is planning to teach a group of 10-year-old children about drug and alcohol prevention. Which characteristics of this age group are important for the nurse to consider when developing the teaching plan? Select all that apply. 40. A nurse is preparing to administer an unpleasant-tasting liquid medication to a toddler. What is the best method for administering this medication? 41. A nurse is working with a nursing student in caring for an infant who has just returned from the surgical recovery area following a cleft lip repair. Which action by the nursing student should cause the nurse to intervene? 42. A nurse is working with a nursing student in the care of a young child status post-appendectomy. The student checks the current order of IV gentamicin and discovers the ordered dose is above the safe dose range based on the child's weight. What should be the nurse's first action? 43. A nurse performs a head-to-toe assessment on a newborn. Which finding should be of greatest concern to the nurse? 44. A nurse performs a scoliosis screening at a local school. Which assessment finding by the nurse would least likely result in a scoliosis referral? 45. A nurse prepares to administer a chelating agent to a child with lead poisoning. Which laboratory tests should be obtained prior to the administration of this agent? 46. A nurse prepares to administer spironolactone (Aldactone) to an infant with congenital heart disease. The nurse understands that the main purpose of this medication is to: 47. A nurse prepares to insert a nasogastric tube in a 10-month-old child. Which actions should the nurse take to complete this procedure? Prioritize the nurse's actions by placing each correct step in sequential order. 48. A nurse should suspect Hirschsprung's disease in a child who has which type of stooling pattern? 49. A nurse teaches a child with spina bifida how to perform urinary self-catheterization. Which steps should the nurse include in the teaching? Place each correct step in sequential order. 50. A nurse visits the home of a toddler. With what aspect of the home environment would the nurse be most concerned? . 51. A nurse visits the home of a young child to administer the Denver II developmental assessment. The child is unable to perform several required items, and the parent expresses concern regarding the child's performance. What is the best way for the nurse to respond to the parent's concerns? 52. A nurse would be most correct in withholding digoxin (Lanoxin) prescribed to an infant if the heart rate falls below which parameter? 53. A nursing student prepares to administer eyedrops to a young child. What action by the nursing student should cause a registered nurse to intervene? 54. A physician orders penicillin 200,000 units/kg/day IV q6h for a child weighing 16 kg. The penicillin on hand comes prepared in a concentration of 250,000 units/mL. In order to administer the correct dose, a nurse calculates that _______ mL of penicillin should be administered to the child. Fill in the blank. 3.2. 55. A physician prescribes digoxin (Lanoxin) for a toddler with congestive heart failure (CHF). Before administering the medication, it is most important for the nurse to: 56. A school nurse advises the dietary staff that a special lunch tray must be created for a student who has celiac disease. What recommendation should the nurse provide to the dietary staff? 57. A school nurse is creating an informational brochure for parents regarding the treatment of head lice. What form of treatment should the nurse caution against? 58. A school nurse is preparing to teach a group of teenagers how to prevent meningitis. What aspect of meningitis prevention should the nurse be certain to include in the presentation? 59. A school-age child visits a school nurse and states that a family member has been behaving inappropriately by touching the child near the groin area. What should be the school nurse's priority action? 60. A school-age child visits a school nurse with complaints of dizziness and shaking. The nurse confirms that the child has a history of type 1 diabetes mellitus when the child becomes diaphoretic and begins to faint. What should be the nurse's first action? 61. A toddler with Kawasaki disease is being evaluated by a primary care clinic nurse 1 week following discharge. The nurse understands that it is a priority to instruct the parents to contact the clinic immediately if the child: 62. A young child diagnosed with iron-deficiency anemia is prescribed a liquid iron supplement. A nurse provides the parents with instructions on administration and should be certain to advise them that: 63. An infant in a newborn nursery is identified as having phenylketonuria (PKU). What is the best initial source of nutrients for an infant with this diagnosis? 64. An infant is admitted for probable pyloric stenosis. A physician orders IV fluids and makes the infant NPO pending a surgical consult. The infant is crying vigorously and the parents express frustration that they cannot feed their baby even though the surgery is not yet definite. Which is the best action for the nurse to take now? 65. An infant is admitted to a pediatric unit with labored breathing and moderate amounts of thick nasal secretions. What nursing intervention is most likely to improve the infant's oxygenation? 66. An infant is brought to an emergency department with a chief complaint of nausea and vomiting. Which nursing assessment finding should indicate to a nurse that the infant's dehydration is severe? 67. An infant is hospitalized following a febrile seizure. When a nurse teaches the infant's family about the prevention of future seizures, what would be the nurse's best recommendation? 68. An infant is hospitalized for congenital adrenal hyperplasia (CAH). Which medication should a nurse anticipate to be part of the child's treatment plan? 69. An LVN/LPN from an orthopedic unit is floated to a child health unit. In creating assignments, which child should the charge nurse avoid assigning to the LVN/LPN? 70. An RN and LVN/LPN are working as a team on a pediatric unit. Which task should the RN perform rather than delegating to the LVN/LPN? 71. In assessing the reflexes of a 15-month-old child, which finding would indicate that the child is experiencing normal development? 72. In developing a plan of care for a hospitalized preschooler, a nurse recognizes that it is most essential to consider: 73. In doing a child's admission assessment, which signs and symptoms should a nurse recognize as most likely related to rheumatic fever? 74. The mother of a child asks a clinic nurse how to safety- proof the home. What should the nurse recognize as the most effective means to prevent accidental poisoning? 75. The parent of a young child phones an advice nurse to report that the child is ill. The child has a reddish pin- point rash most concentrated in the axilla and groin areas, a high fever, flushed cheeks, and abdominal pain. The parent also reports that the child's tongue is dark red with white spots. A nurse should recognize these symptoms as indicative of which infection? 76. The parents of a 2-year-old child ask a nurse how to best assist the child to accomplish developmental tasks at this age. What is the best response by the nurse? 77. The parents of a child recently discharged with acute spasmodic laryngitis contact a nurse to report that the child continues to have croupy coughing spells at nighttime but is otherwise fine. What should the nurse recommend? 78. The parents of a newborn infant ask a nurse how to prevent future ear infections. What is the best advice the nurse should provide these parents? 79. What assessment findings should a nurse expect in a child with acute post-streptococcal glomerulonephritis? Select all that apply. 80. What is the priority nursing diagnosis for an infant receiving treatment for hyperbilirubinemia? 81. What should be the expected weight of an infant at 12 months of age whose birth weight was 3600 grams? 82. When preparing an intramuscular injection for a 1-week-old infant, which needle would be the most appropriate for the nurse to select? 83. When providing anticipatory guidance to the parents of a child with hemophilia, a nurse should stress that: 84. When providing client teaching to the caregivers of a young child with sickle cell disease, a nurse should stress that: 85. When teaching a class on home safety to new parents, on which type of exposure should a nurse focus as the primary cause of lead poisoning in children? 86. When visiting the home of a school-age child who is dying, what would be the best action by a hospice nurse? 87. Which assessment findings would cause a nurse to withhold scheduled immunizations in a child? Select all that apply. 88. Which child would be the best roommate for a 9-year- old child with myelodysplasia who is hospitalized for a foot infection? 89. Which conditions in children and/or adolescents should a nurse identify as being associated with metabolic alkalosis? Select all that apply. 90. Which nursing intervention should a nurse perform on a young child suspected of having a diagnosis of acute epiglottitis whose oxygen saturation measures 93% on room air? 91. Which orders should a nurse question for a 5-month-old infant with hypoplastic left heart syndrome who is hospitalized awaiting the second stage of surgical repair? Select all that apply. 92. Which response to hospitalization is a nurse most likely to observe in a 4-year-old child? 93. Which statement made by the mother of a child with cystic fibrosis should indicate to a nurse that the mother is in need of further teaching regarding the administration of pancreatic enzymes? 94. Which symptom(s), if present in a child, should a nurse recognize as being characteristic of Kawasaki disease? Select all that apply. 95. Which would be an abnormal finding when doing a well-child checkup on a 1-week-old infant? 96. While preparing for an admission, a nurse hears the alarm sound on the cardiac monitor of a child in the next bed. The nurse views the screen and sees what appears to be ventricular fibrillation. What is the best initial action by the nurse? 97. While suctioning a child with a tracheostomy tube in place, a nurse discovers that the suction catheter will not advance inside the tracheostomy tube and the child is becoming pale and anxious, with noticeable suprasternal retractions. What should be the nurse's priority action? [Show More]

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