DEVELOPMENTAL MILESTONES

One month
lifts head intermittently when prone
momentary visual fixation on human faces and objects
Two months
“social smile”
responds to familiar voices by moving the whole body
no head control yet; head lags when pulled to sitting
(Implication: support head and neck when carrying the baby).
Sheds tears
Three months
can raise head, but not chest, when on prone
head in bobbing motion; some head control when pulled to sit
babbles and coes
Four months
grasps objects within reach and brings to mouth
(Implication: diaper pins, clips, etc. should be kept out of reach)
head control when pulled to sit, no lag, head steady when upright
laughs aloud
Five months
rolls over
(Implication: raise side rails of cribs to prevent accidental falls).
raking grasp
Six months
doubles birth weight
eruption of first tooth (usually lower central incisor)
sits with minimal support
can be pulled from sitting to standing position
Seven months
plays with feet
says “dada” or “mama” but not specific
pivots (creeps) when on prone (Implication: keeps rails on stairs secured).
thumb-finger grasp
Eight months
sits alone steadily without support for an indefinite period
Nine months
can hold bottle with good hand-mouth coordination
crawls
understands simple gestures and requests (e.g. bye-bye)
takes some steps when held
neat pincer grasp
Ten months
pulls self to stand
responds to own name
Eleven months
stands with assistance
attempts to walk with help
Twelve months
walks with help
triples birth weight
drinks from a cup
can say 2 words
Three years of age
pedals a bike
walks backwards
climbs stairs
uses scissors
helps dress himself
Four years of age
climbs and jumps well
uses alternate steps when climbing stairs
throws ball overhand
brushes teeth
Five years of age
runs and hops well; jumps rope
skips; balances on 1 foot 8 seconds
ties shoelaces
Seven years of age
appearance of first molars and lateral incisors
visual acuity is 20/20
withdrawn and moody, likes to be alone watching tv or listening to the radio
is seldom able to complete a task
psychosomatic illnesses may be common
Eight years of age
with 10-11 permanent teeth
onset of secondary sexual characteristics
prefers playmates of own sex
are dogmatic and self-righteous
collecting stamps, etc. is a favorite hobby
Nine years of age
more interested in friends than in family
lying and stealing may become problems
try become parent of the same sex
worry and complain a great deal
Ten years of age
cooperative and affectionate
are peer-oriented
with secret language
companionship is more important than play
Eleven years of age
are critical of adults
beginning hero-worship
moody and with beginning interest in the opposite sex

Pediatric Drill 10

1.) Which achievement best characterizes the physical development of a 3-month-old infant?
A.) A strong Moro reflex
B.) A strong tonic-neck reflex
C.) The ability to roll over intentionally
D.) The ability to lift the head and chest from a prone position

2.) Birth weight typically triples by the end of the first
A.) 4 months
B.) 6 months
C.) 8 months
D.) 12 months

3.) Which statements best characterizes the normal state of mutuality between an infant and his primary caregiver during the first few months?
A.) The caregiver immediately responds to the infant’s cries
B.) The caregiver understand the infant’s distress signals
C.) The infant learns that the caregiver will feed him when he is hungry and reposition him when he is restless
D.) The caregiver recognizes the infant’s signal for restlessness, and the infant quiets when the caregiver repositions him

4.) At which age does an infant learn to distinguish himself from his caregivers?
A.) 3 moths
B.) 6 months
C.) 9 months
D.) 12 months

5.) Which behavior indicates that an infant distinguishes himself from his primary caregiver?
A.) Smiling at his caregiver
B.) Putting his fingers in his caregiver’s mouth
C.) Crying when his caregiver leaves
D.) Crawling away from his caregiver


6.) By which age can most children wash their hands and brush their teeth with only minimal supervision
A.) Age 2
B.) Age 3
C.) Age 6
D.) Age 8

7.) Which situation best demonstrates the parallel play typical of toddlers?
A.) Two toddlers sharing crayons to color separate pictures
B.) Two toddlers playing a board game with the play therapist
C.) Two toddlers seated next to each other playing with separate dolls
D.) A toddler seated on the play therapist’s lap playing with a music box

8.) Which toy would be most appropriate for a 3-month-old infant?
A.) A soft cube with different textures on each side
B.) A picture book of baby animals
C.) An activity box placed in the infant’s crib
D.) A set of wooden blocks

9.) Which toy would be most appropriate for a 2-year-old-child
A.) A bicycle with training wheels
B.) A pull toy that makes noise
C.) A miniature car or truck
D.) A 10-piece wooden puzzle

10.) Which question effectively elicits information about a caregiver’s knowledge of toilet training?
A.) “Have you had any experience with toilet training?”
B.) “Has your child shown any interest in toilet training?”
C.) “What do you know about toilet training?”
D.) “Why do you want to toilet train your child?”

11.) All of the following statements about toilet training are true except:
A.) The child should be given detailed instructions and explanations about elimination
B.) Toilet-training sessions should last no longer than 10 minutes
C.) Using negative control may hinder toilet training
D.) placing a stool below the toilet serves as a footrest and provides greater stability for the child

12.) Which of the following is the normal order of sexual maturity in girls?
A.) Appearance of pubic hair, menarche, breast enlargement
B.) Menarche, breast enlargement, appearance of pubic hair, menarche
C.) Breast enlargement, appearance of pubic hair, menarche
D.) Appearance of pubic hair, breast enlargement, menarche

13.) The first sign of sexual development in boys usually is:
A.) Growth of pubic hair
B.) Testicular enlargement
C.) Nocturnal emissions
D.) Deepening voice

14.) Piaget’s sensorimotor stage is characterized by all of the following except:
A.) Reflexive behavior
B.) Intentional reaching or grasping for an object
C.) Habitual repetitive behavior
D.) Regarding inanimate objects as alive

15.) Menarche usually occurs:
A.) At the onset of puberty
B.) In Tanner’s stage II
C.) In Tanner’s stage IV
D.) At the onset of senescence

16.) Tanner’s stage I of male sexual maturation is characterized by:
A.) Increased testicular size
B.) Onset of penile growth and pubic hair development
C.) Increased genital development and increased growth of pubic and axillary hair
D.) Fully mature genitalia and pubic hair

17.) Receptive language problems’ are associated with
A.) Poor grammar
B.) Speech pattern or sound alterations
C.) Environmental deprivation
D.) Problems with decoding

18.) The inability to process symbols and abstract ideas results from:
A.) Aphasia
B.) Articulation errors
C.) Dysfluency
D.) Voice rhythm disorder

19.) Stuttering is the most common form of
A.) Articulation error
B.) Dysfluency
C.) Voice disorder
D.) Decoding problems

20.) All of the following are classic signs of hearing impairment in infants and young children except:
A.) Unresponsiveness to noise or simple oral commands
B.) Gesturing rather than speaking
C.) Continuing babbling
D.) Avoidance of social interaction
21).Which achievement best characterizes the physical development of a 3-month-old infant?

A.) A strong Moro reflex
B.) A strong tonic-neck reflex
C.) The ability to roll over intentionally
D.) The ability to lift the head and chest from a prone position

22.) Birth weight typically triples by the end of the first

A.) 4 months
B.) 6 months
C.) 8 months
D.) 12 months

23.) Which statements best characterizes the normal state of mutuality between an infant and his primary caregiver during the first few months?

A.) The caregiver immediately responds to the infant’s cries
B.) The caregiver understand the infant’s distress signals
C.) The infant learns that the caregiver will feed him when he is hungry and reposition him when he is restless
D.) The caregiver recognizes the infant’s signal for restlessness, and the infant quiets when the caregiver repositions him

24.) At which age does an infant learn to distinguish himself from his caregivers?

A.) 3 moths
B.) 6 months
C.) 9 months
D.) 12 months

25.) Which behavior indicates that an infant distinguishes himself from his primary caregiver?

A.) Smiling at his caregiver
B.) Putting his fingers in his caregiver’s mouth
C.) Crying when his caregiver leaves
D.) Crawling away from his caregiver

26.) By which age can most children wash their hands and brush their teeth with only minimal supervision

A.) Age 2
B.) Age 3
C.) Age 6
D.) Age 8

27.) Which situation best demonstrates the parallel play typical of toddlers?

A.) Two toddlers sharing crayons to color separate pictures
B.) Two toddlers playing a board game with the play therapist
C.) Two toddlers seated next to each other playing with separate dolls
D.) A toddler seated on the play therapist’s lap playing with a music box

28.) Which toy would be most appropriate for a 3-month-old infant?

A.) A soft cube with different textures on each side
B.) A picture book of baby animals
C.) An activity box placed in the infant’s crib
D.) A set of wooden blocks

29.) Which toy would be most appropriate for a 2-year-old-child

A.) A bicycle with training wheels
B.) A pull toy that makes noise
C.) A miniature car or truck
D.) A 10-piece wooden puzzle

30.) Which question effectively elicits information about a caregiver’s knowledge of toilet training?

A.) “Have you had any experience with toilet training?”
B.) “Has your child shown any interest in toilet training?”
C.) “What do you know about toilet training?”
D.) “Why do you want to toilet train your child?”

31.) All of the following statements about toilet training are true except:

A.) The child should be given detailed instructions and explanations about elimination
B.) Toilet-training sessions should last no longer than 10 minutes
C.) Using negative control may hinder toilet training
D.) placing a stool below the toilet serves as a footrest and provides greater stability for the child


32.) Which of the following is the normal order of sexual maturity in girls?

A.) Appearance of pubic hair, menarche, breast enlargement
B.) Menarche, breast enlargement, appearance of pubic hair, menarche
C.) Breast enlargement, appearance of pubic hair, menarche
D.) Appearance of pubic hair, breast enlargement, menarche

33.) The first sign of sexual development in boys usually is:

A.) Growth of pubic hair
B.) Testicular enlargement
C.) Nocturnal emissions
D.) Deepening voice

34.) Piaget’s sensorimotor stage is characterized by all of the following except:

A.) Reflexive behavior
B.) Intentional reaching or grasping for an object
C.) Habitual repeatitive behavior
D.) Regarding inanimate objects as alive

55.) Menarche usually occurs:

A.) At the onset of puberty
B.) In Tanner’s stage II
C.) In Tanner’s stage IV
D.) At the onset of senescence

36.) Tanner’s stage I of male sexual maturation is characterized by:
A.) Increased testicular size
B.) Onset of penile growth and pubic hair development
C.) Increased genital development and increased growth of pubic and axillary hair
D.) Fully mature genitalia and pubic hair

38.) The inability to process symbols and abstract ideas results from:

A.) Aphasia
B.) Articulation errors
C.) Dysfluency
D.) Voice rhythm disorder

39.) Stuttering is the most common form of

A.) Articulation error
B.) Dysfluency
C.) Voice disorder
D.) Decoding problems

40.) All of the following are classic signs of hearing impairment in infants and young children except:

A.) Unresponsiveness to noise or simple oral commands
B.) Gesturing rather than speaking
C.) Continuing babbling
D.) Avoidance of social interaction

Answers

Pediatric Drill 9

Question 1Which of the following should the nurse do next after noting that an 8-month-old child's posterior fontanel is slightly open?

1. Check the child's head circumference
2. Document this as a normal finding
3. Question the mother about the child's delivery
4. Schedule an x-ray of the child's head

Question 2. Which of the following nursing diagnoses would the nurse identify as the priority for a 4-month-old infant with heart failure and congenital heart disease?

1. Activity Intolerance
2. Risk for Infection
3. Impaired Mobility
4. Ineffective Health Maintenance

Question 3. When developing a plan of care that includes interventions aimed at preventing complications of a low platelet count in a child with leukemia, which of the following is most appropriate?

1. Consulting with a physician about the use of a stool softener
2. Placing the child in protective isolation
3. Using heparin instead of saline to flush an intermittent IV access device
4. Eliminating raw vegetables and fruits from the child's diet

Question 4. The nurse teaches the parent about the normal reaction that an infant may experience 12 to 24 hours after DTaP immunization. The nurse determines that the teaching is effective when the parent asks which of the following?

1. "Will the lethargy make it harder to breast-feed?"
2. "How much acetaminophen (Tylenol) can I give for the fever?"
3. "Can you give loperamide (Imodium) to an infant?"
4. "What kind of nose spray can I use for the baby's congestion?"

Question 5. Which of the following would indicate effective therapy in a neonate born at 38 weeks gestation and given oxygen as a treatment for cold stress?

1. Heart rate is 200 bpm at rest
2. Respiratory rate is 48 breaths/minute at rest
3. Axillary temperature is 98 c
4. Blood pressure is 56/30 mm Hg

Question 6. After uncomplicated abdominal surgery, which of the following would be most appropriate when determining if an alert school-aged child is ready to drink oral fluids?

1. Ask if the child wants something to drink
2. Auscultate the child's abdomen for bowel sounds
3. Determine that the child has a gag reflex
4. Palpate the epigastric area for discomfort

Question 7. A young child who has undergone a tonsillectomy refuses to let the nurse look at the tonsillar beds to check for bleeding. To assess whether the child is bleeding from the tonsillar beds, which of the following would be most appropriate?

1. Assess capillary refill
2. Force open the mouth with a tongue blade
3. Monitor for decreased blood pressure
4. Observe for frequent swallowing

Question 8. Which of the following interventions would be included in the plan of care for the child with juvenile rheumatoid arthritis to reduce joint pain in the morning just after arising?

1. Having the child sleep in a sleeping bag
2. Increasing pain medication at bedtime
3. Having the child sleep with the joints flexed
4. Awakening the child once nightly to exercise the joints

Question 9. A mother brings her 18-month-old child to the clinic because the child "eats ashes, crayons, and paper." Which of the following information would be most important to obtain first about this toddler?

1. Currently cutting large teeth
2. Experiencing a growth spurt
3. Experiencing changes in the home environment
4. Eating a soft, low-roughage diet

Question 10. While examining a 12-month-old child, the nurse notes that the child can stand independently but cannot walk without support. Which of the following actions would be most appropriate?

1. Ask the mother if the child uses a walker at home
2. Do nothing because this is a normal finding in a child this age
3. Initiate a consultation with a developmental specialist
4. Tell the mother that the child may have a developmental delay

Question 11. Which of the following laboratory values would the nurse interpret as associated with cold stress in a 1-day-old preterm neonate?

1. Bilirubin level of 13 mg/dL
2. Glucose level of 15 mg/dL
3. Hematocrit of 65%
4. Hemoglobin level of 23.5 g/dL

Question 12. An 18-month-old child with acquired immunodeficiency syndrome (AIDS) is seen in the clinic for health maintenance. Which of the following vaccines would the nurse anticipate administering to this toddler?

1. Diphtheria-tetanus-acellular pertussis
2. Varicella
3. Measles, mumps, and rubella
4. Hemophilus influenza

Question 13. A 2-month-old child returns from a cardiac catheterization. The child's fontanel is flat. The diaper is dry. The respiratory rate is 20 breaths/minute and breath sounds are decreased bilaterally. The child is limp although she moves all extremities when stimulated. The dressing over the insertion site is intact, clean, and dry. The pedal pulses are palpable bilaterally and equal to the heart rate. Which of the following nursing diagnoses would be most appropriate?

1. Ineffective Tissue Perfusion related to thrombus formation
2. Deficit Fluid Volume related to inability to take in fluids
3. Risk for Injury related to disruption of vessel integrity
4. Ineffective Breathing Pattern related to sedation

Question 14. Which of the following would the nurse most likely assess in a child who has sustained full-thickness burns?

1. Blanching to the touch
2. Excessive bleeding
3. Minimal complaints of pain
4. Blistering, moist appearance

Question 15. Which of the following would be the priority nursing diagnosis for a 4-week-old infant with a diagnosis of pyloric stenosis?

1. Constipation
2. Deficient Fluid Volume
3. Imbalanced Nutrition, less than body requirements
4. Impaired Swallowing

Question 16. Immediately after the return of an 18-month-old child to his room following insertion of a ventriculoperitoneal shunt, which of the following would the nurse do first?

1. Ask the child to state his name and where he is
2. Palpate his anterior fontanel
3. Position him on the side opposite the shunt site
4. Check his pupil size and reactivity to light

Question 17. When performing a physical assessment on an 18-month-old child, which of the following would be best?

1. Have the mother hold the toddler on her lap
2. Assess the respiratory and cardiac systems first
3. Carry out the assessment from head to toe
4. Assess motor function by having the child run and walk


Question 18. At 3 AM, the mother of a 3-year-old child calls the emergency room nurse and reports the child has a temperature of 101.1 degreess f, a runny nose, and a barky cough that "gets going and won't stop." The mother states that she just gave the child acetaminophen (Tylenol). Which of the following should the nurse recommend next?

1. Sitting with the child in a steamy warm bathroom
2. Running a steam vaporizer near the child's bedside
3. Giving the child an over-the-counter decongestant
4. Administering aspirin in 2 hours

Question 19. When developing a seminar on injury prevention to be presented to a group of parents of children from 2 to 18 years, the nurse would place the first priority on discussing the use of which of the following?

1. Child restraints in automobiles
2. Helmets for biking and skating
3. Special locks for cabinets
4. Topical bug repellent in summer

Question 20. The mother of a 9-month-old infant asks about adding new foods to his diet. The child is being breast-fed and takes formula and cereal when at the sitter's. Which of the following would the nurse instruct the mother to do?

1. Mix new foods with formula or breast milk
2. Mix new foods with more familiar foods
3. Offer new foods one at a time
4. Offer new foods after giving formula or breast milk

Question 21. After the nurse instructs the parents of a 5-month-old infant about the purpose of the Denver Developmental Screening Test (DDST), which of the following statements by the parents about what the test measures would indicate that the teaching was effective?

1. Intelligence quotient
2. Emotional development
3. Social and physical abilities
4. Potential for future development

Question 22. Which of the following would lead the nurse to suspect that a neonate with an infection is developing septic shock?

1. Axillary temperature is 99.8 c
2. Blood pressure is 45/25 mm Hg
3. Heart rate during sleep is 205 bpm
4. Respiratory rate while awake is 32 breaths/minute

Question 23. The mother says that the infant's physician recommends certain foods, but the infant refuses to eat them after breast-feeding. The nurse should suggest that the mother alter the feeding plan by doing which of the following?

1. Offering dessert followed by some vegetables and meat
2. Offering breast milk as long as the infant refuses to eat solid foods
3. Mixing pureed food with some breast milk in a bottle with a large-holed nipple
4. Allowing the infant to nurse for a few minutes then offering solid foods

Question 24. The parents express concern about the condition of their premature neonate. To meet the short-term goals of decreasing the parents' fears and fostering bonding, which of the following would the nurse include in the plan of care?

1. Allowing the parents to see and touch their neonate
2. Arranging for a visit with another couple who have an ill preterm neonate
3. Encouraging the parents to participate in the neonate's care
4. Telling the parents not to worry because the neonate is doing well

Question 25. After resuming feedings in an infant who has undergone a pyloroplasty, which of the following would be most appropriate?

1. Keeping the head of the bed flat with the infant lying supine
2. Offering several ounces of an oral electrolyte solution initially
3. Placing the infant in a prone position after each feeding
4. Starting feedings with 5 to 10 mL, slowly increasing amounts as tolerated

Question 26. After teaching the parents of a 15-month-old child who has undergone cleft palate repair how to use elbow restraints, which of the following statements by the parents indicates effective teaching?

1. "We'll keep the restraints in place continuously until the doctor says it's okay to remove them."
2. "We can take off the restraints while our child is playing but we'll make sure to put them back on at night."
3. "The restraints should be taped directly to our child's arms so that they will stay in one place."
4. "We'll remove the restraints temporarily at least three times a day to check his skin then put them right back on."

Question 27. Which of the following methods for checking placement of a gavage feeding catheter would be most appropriate after introducing the catheter into the neonate's stomach?

1. Aspirating stomach contents through the catheter with a syringe
2. Auscultating clear breath sounds after instilling a small amount of air into the catheter
3. Aspirating water back into a syringe after introducing it into the catheter
4. Flushing the catheter with a small amount of water

Question 28. On observing a parent propping a bottle for a 2-month-old child in the waiting room, the nurse explains the dangers of this to the parent. Which of the following statements indicates that the parent has understood the nurse's teaching?

1. "I didn't know it would cause my baby to gain too much weight."
2. "I can see how it might cause choking, but how does it cause dental caries?"
3. "So, because I prop the bottle, I might have trouble weaning the child?"
4. "I will stop propping the bottle so my child will sleep through the night."

Question 29. A preschool client immobilized in a spica cast complains of having trouble breathing after meals. Which of the following actions would be best?

1. Encourage the client to drink more between meals
2. Teach the child pursed-lip breathing
3. Give the client a laxative after meals
4. Offer the client small feedings several times a day

Question 30. When determining the effectiveness of teaching a child's mother about sickle cell disease, which of the following statements by the mother indicates the need for additional teaching?

1. "I've started to give him some extra fluids with and between meals."
2. "I'm concerned about how the hospital staff will manage his pain."
3. "He's going to be playing on a soccer team when he's feeling better."
4. "I've told the child's father that both he and I are carriers of the disease."

Question 31. After the nurse has taught the parents of a 5-year-old boy who has leukemia how to talk with their child about death and dying, which of the following would indicate that the parents have age-appropriate expectations about their child's reaction to his impending death?

1. "He is too young to understand what is happening to him."
2. "He might think he can cause his death because he has misbehaved."
3. "He will accept his death as caused by his disease."
4. "He will understand how much his siblings will miss him."

Question 32. When preparing to conduct prenatal and parenting classes for a group of parents, the clinic's nursing staff will be providing childcare for the parents' children who range in age from 13 months to 6 years. The clinic has a playroom. Which of the following activities would be most appropriate to include?

1. Free play with adult supervision
2. A group sing-along
3. Drawing and painting projects
4. Viewing cartoon videos

Question 33. When completing an assessment of a healthy adolescent client, which of the following would be most appropriate?

1. Obtain a detailed account of the adolescent's prenatal and early developmental history
2. Discuss sexual preferences and behaviors with the parents present for legal reasons
3. Discuss the client's smoking with parents present in the room
4. Assess the adolescent in private; gather additional information from the parents

Question 34. When discussing a 7-month-old infant's motor skill development with the mother, the nurse should explain that by age 7 months, an infant most likely will be able to do which of the following?

1. Walk with one hand held
2. Eat successfully with a spoon
3. Stand while holding onto furniture
4. Sit alone using the hands for support

Question 35. When planning a screening clinic for scoliosis, the nurse would anticipate targeting which of the following groups?

1. Preadolescents at the beginning of a growth spurt
2. Toddlers who have diets low in calcium and vitamin D
3. Preschoolers who are entering kindergarten
4. Infants whose mothers have had no prenatal care

Question 36. When assessing a 6-month-old child with a large ventricular septal defect, the nurse notices that the child has gained 5 pounds in 1 month. The mother reports that the child has not been wetting many diapers in the last week, although the child is taking the prescribed amounts of formula. "I think it is because he seems to sweat so much." Auscultation of the lung fields reveals fine crackles in the bases. The child's digoxin level is 1 mg/mL. Which of the following nursing diagnoses would be most appropriate?

1. Imbalanced Nutrition: More Than Body Requirements
2. Excess Fluid Volume
3. Risk for Injury
4. Urinary Retention

Question 37. Assessment of a child with rheumatic fever reveals chorea. Which of the following would the nurse consider to be most important?

1. Explain to the child and family that the chorea will disappear over time
2. Institute measures to keep the child in a warm environment
3. Perform neurologic checks every 4 hours until the chorea subsides
4. Promote ambulation by giving aspirin every 4 hours

Question 38. The mother of a 15-month-old child who is coughing and having trouble breathing telephones the clinic to ask advice because she suspects that her child has croup. Which of the following instructions would be most appropriate?

1. Administer acetaminophen (Tylenol) every 4 hours
2. Take the child into the bathroom and run the hot water
3. Give over-the-counter cough syrup every 6 hours
4. Get the child to take as much fluid as possible

Question 39. The mother of an infant with a congenital heart defect involving decreased pulmonary blood flow tells the nurse that her child has not been gaining weight even with an increased-calorie formula. The mother states that the infant starts out with a good suck but tires and quits after 2 ounces. The infant is receiving oxygen through a nasal cannula as necessary and is on digoxin therapy. Which of the following should the nurse suggest to the mother?

1. Cut a large hole in the nipple
2. Feed the infant every 2 hours
3. Have the infant tested for digoxin toxicity
4. Increase the oxygen for feedings

Question 40. The mother of an 8-year-old child with a fluid restriction of 1000 mL/day is staying with the child in the room. Which of the following would be most appropriate for the nurse to include in the child's plan of care?

1. Discussing the fluid restriction with the mother and child, allowing them to decide how to allocate the fluids over the 24 hours
2. Explaining to the mother that hospital personnel will assume the responsibility for providing fluids to the child.
3. Letting the child drink fluid until the limit is reached and then allowing the child to drink no more fluids
4. Telling the mother exactly how much fluid the child can have each hour, showing her examples of the amount

Question 41. A mother asks the nurse when she should wean her 4-month-old infant from breast-feeding and begin using a cup. Which of the following would the nurse explain as the best indication of the infant's readiness to be weaned?

1. Taking solid foods well
2. Sleeping through the night
3. Shortening the nursing time
4. Eating on a regular schedule

Question 42. A 10-day-old neonate brought to the clinic by the parents is lethargic and tachypneic with a heart rate of 200 bpm. Which of the following would be the nurse's primary focus initially?

1. Temperature pattern over the last few days
2. Number of wet diapers in the past 24 hours
3. Pupillary response now and 30 minutes later
4. Sleep patterns over the past week

Question 43. The physician orders eye patching for a child with strabismus. Which of the following statements by the child's mother would indicate the need for additional teaching about this treatment?

1. "You see, his problem eye is patched."
2. "I keep the patch on even when he fusses."
3. "I have to watch him when he walks because he is clumsy."
4. "I take the patch off at night when he goes to bed."


Question 44. A mother of an ill child is concerned because the child "isn't eating well." Which of the following strategies devised by the mother to help increase the child's intake should the nurse advise against using?

1. Allowing the child to choose his meals from an acceptable list of foods
2. Letting the child substitute items on his tray for other nutritious foods
3. Asking the child to say why he is not eating
4. Telling the child he must eat or else he will not get better

Question 45. Initial nursing interventions for a child admitted to the hospital with a diagnosis of meningitis due to H. influenzae should include which of the following?

1. Keeping the child well hydrated
2. Maintaining a quiet, cool environment
3. Keeping the child positioned flat in the bed
4. Placing the child on airborne precautions

Question 46. A 23-month-old child pulled a pan of hot water off the stove and spilled it onto her chest and arms. Her mother was right there when it happened. Which of the following should the mother have done immediately?

1. Apply ice directly to the burned areas
2. Place the child in the bathtub of cool water
3. Apply antibiotic ointment to the burned areas
4. Call the neighbor to come over and help her

Question 47. Parents ask for advice about handling their 2-year-old's negativism. Which of the following would be the best recommendation?

1. Ignore this behavior because it is a stage the child is going through
2. Set realistic limits for the child, then be sure to stick to them
3. Encourage the grandmother to visit frequently to relieve them
4. Punish the child for misbehaving or violating set, strict limits

Question 48. When preparing to give a neonate the first feeding by nipple, for which of the following reasons would the nurse anticipate using a 5 mL feeding of sterile water first?

1. Ascertain the patency of the neonate's esophagus
2. Determine if the neonate can retain the feeding
3. Ensure that the neonate has the energy to take oral feedings
4. Ensure that the mother will be able to feed the neonate

Question 49. Which of the following would the nurse include in the plan of care for a child with a fracture in skeletal traction to prevent osteomyelitis?

1. Encouraging the child to eat nutritious foods
2. Administering prophylactic antibiotics as ordered
3. Maintaining the child in reverse isolation
4. Protecting the child from visitors with colds

Question 50. A nurse working in a neonatal intensive care unit is developing infection control policies. Which of the following policies would the nurse expect to include as the single most effective means of preventing the spread of infection?

1. Having everyone coming in contact with neonates perform frequent hand and arm washing.
2. Keeping each neonate in an isolation incubator that is opened as infrequently as possible
3. Maintaining a ventilation system in the unit that provides for continuous clean-air exchange
4. Requiring everyone who comes in contact with neonates to wear gowns and masks


ANSWERS

Pediatric Drill 8

Question 1. A 4 year-old child is recovering from chicken pox (varicella). The parents would like to have the child return to day care as soon as possible. In order to ensure that the illness is no longer communicable, what should the nurse assess for in this child?

1. All lesions crusted
2. Elevated temperature
3. Rhinorrhea and coryza
4. Presence of vesicles

Question 2. A nurse is doing preconceptual counseling with a woman who is planning a pregnancy. Which of the following statements suggests that the client understands the connection between alcohol consumption and fetal alcohol syndrome?

1. "I understand that a glass of wine with dinner is healthy."
2. "Beer is not really hard alcohol, so I guess I can drink some."
3. "If I drink, my baby may be harmed before I know I am pregnant."
4. "Drinking with meals reduces the effects of alcohol."

Question 3. The school nurse suspects that a third grade child might have Attention Deficit Hyperactivity Disorder. Prior to referring the child for further evaluation, the nurse should

1. Observe the child's behavior on at least 2 occasions
2. Consult with the teacher about how to control impulsivity
3. Compile a history of behavior patterns and developmental accomplishments
4. Compare the child's behavior with classic signs and symptoms
Looking for answers(s):3

Question 4. In evaluating the growth of a 12 month-old child, which of these findings would the nurse expect to be present in the infant?

1. Increased 10% in height
2. 2 deciduous teeth
3. Tripled the birth weight
4. Head > chest circumference

Question 5. A mother asks about expected motor skills for a 3 year-old child. Which of the following would the nurse emphasize as normal at this age?

1. Jumping rope
2. Tying shoelaces
3. Riding a tricycle
4. Playing hopscotch

Question 6. A nurse arranges for a interpreter to facilitate communication between the health care team and a non-English speaking client. To promote therapeutic communication, the appropriate action for the nurse to remember when working with an interpreter is to

1. Promote verbal and nonverbal communication with both the client and the interpreter
2. Speak only a few sentences at a time and then pause for a few moments
3. Plan that the encounter will take more time than if the client spoke English
4. Ask the client to speak slowly and to look at the person spoken to

Question 7. The nurse is assigned to care for a client newly diagnosed with angina. As part of discharge teaching, it is important to remind the client to remove the nitroglycerine patch after 12 hours in order to prevent what condition?


1. Skin irritation
2. Drug tolerance
3. Severe headaches
4. Postural hypotension

Question 8. Which of these parents’ comment for a newborn would most likely reveal an initial finding of a suspected pyloric stenosis?

1. I noticed a little lump a little above the belly button.
2. The baby seems hungry all the time.
3. Mild vomiting that progressed to vomiting shooting across the room.
4. Irritation and spitting up immediately after feedings.

Question 9. A postpartum mother is unwilling to allow the father to participate in the newborn's care, although he is interested in doing so. She states, "I am afraid the baby will be confused about who the mother is. Baby raising is for mothers, not fathers." The nurse's initial intervention should be what focus?

1. Discuss with the mother sharing parenting responsibilities
2. Set time aside to get the mother to express her feelings and concerns
3. Arrange for the parents to attend infant care classes
4. Talk with the father and help him accept the wife's decision

Question 10. A client who has been drinking for five years states that he drinks when he gets upset about "things" such as being unemployed or feeling like life is not leading anywhere. The nurse understands that the client is using alcohol as a way to deal with

1. Recreational and social needs
2. Feelings of anger
3. Life’s stressors
4. Issues of guilt and disappointment

Question 11. A nurse aide is taking care of a 2 year-old child with Wilm's tumor. The nurse aide asks the nurse why there is a sign above the bed that says DO NOT PALPATE THE ABDOMEN? The best response by the nurse would be which of these statements?

1. "Touching the abdomen could cause cancer cells to spread."
2. "Examining the area would cause difficulty to the child."
3. "Pushing on the stomach might lead to the spread of infection."
4. "Placing any pressure on the abdomen may cause an abnormal experience."

Question 12. The nurse is teaching diet restrictions for a client with Addison's disease. The client would indicate an understanding of the diet by stating

1. "I will increase sodium and fluids and restrict potassium."
2. "I will increase potassium and sodium and restrict fluids."
3. "I will increase sodium, potassium and fluids."
4. "I will increase fluids and restrict sodium and potassium."

Question 13. The father of an 8 month-old infant asks the nurse if his infant's vocalizations are normal for his age. Which of the following would the nurse expect at this age?
1. Cooing
2. Imitation of sounds
3. Throaty sounds
4. Laughter

Question 14. A diabetic client asks the nurse why the health care provider ordered a glycolsylated hemoglobin (HbA) measurement, since a blood glucose reading was just performed. You will explain to the client that the HbA test:

1. Provides a more precise blood glucose value than self-monitoring
2. Is performed to detect complications of diabetes
3. Measures circulating levels of insulin
4. Reflects an average blood sugar for several months

Question 15. The nurse is planning to give a 3 year-old child oral digoxin. Which of the following is the best approach by the nurse?

1. "Do you want to take this pretty red medicine?"
2. "You will feel better if you take your medicine."
3. "This is your medicine, and you must take it all right now."
4. "Would you like to take your medicine from a spoon or a cup?"

Question 16. The nurse is caring for a client with a deep vein thrombosis. Which finding would require the nurse's immediate attention?

1. Temperature of 102 degrees Fahrenheit
2. Pulse rate of 98 beats per minute
3. Respiratory rate of 32
4. Blood pressure of 90/50

Question 17. What is the major developmental task that the mother must accomplish during the first trimester of pregnancy?

1. Acceptance of the pregnancy
2. Acceptance of the termination of the pregnancy
3. Acceptance of the fetus as a separate and unique being
4. Satisfactory resolution of fears related to giving birth

Question 18. The nurse would expect the cystic fibrosis client to receive supplemental pancreatic enzymes along with a diet

1. High in carbohydrates and proteins
2. Low in carbohydrates and proteins
3. High in carbohydrates, low in proteins
4. Low in carbohydrates, high in proteins

Question 19. The nurse enters a 2 year-old child's hospital room in order to administer an oral medication. When the child is asked if he is ready to take his medicine, he immediately says, "No!". What would be the most appropriate next action?

1. Leave the room and return five minutes later and give the medicine
2. Explain to the child that the medicine must be taken now
3. Give the medication to the father and ask him to give it
4. Mix the medication with ice cream or applesauce

Question 20. An eighteen month-old has been brought to the emergency room with irritability, lethargy over 2 days, dry skin and increased pulse. Based upon the evaluation of these initial findings, the nurse would assess the child for additional findings of

1. Septicemia
2. Dehydration
3. Hypokalemia
4. Hypercalcemia

Question 21. The nurse is planning care for a 2 year-old hospitalized child. Which of the following will produces the most stress at this age?

1. Separation anxiety
2. Fear of pain
3. Loss of control
4. Bodily injury

Question 22. A recovering alcoholic asked the nurse, "Will it be ok for me to just drink at special family gatherings?" Which initial response by the nurse would be best?

1. "A recovering person has to be very careful not to lose control, therefore, confine your drinking just at family gatherings."
2. "At your next AA meeting discuss the possibility of limited drinking with your sponsor."
3. "A recovering person needs to get in touch with their feelings. Do you want a drink?"
4. "A recovering person cannot return to drinking without starting the addiction process over."

Question 23. The nurse is assigned to a client who has heart failure . During the morning rounds the nurse sees the client develop sudden anxiety, diaphoresis and dyspnea. The nurse auscultates, crackles bilaterally. Which nursing intervention should be performed first?

1. Take the client's vital signs
2. Place the client in a sitting position with legs dangling
3. Contact the health care provider
4. Administer the PRN antianxiety agent

Question 24. After successful alcohol detoxification, a client remarked to a friend, "I’ve tried to stop drinking but I just can’t, I can’t even work without having a drink." The client’s belief that he needs alcohol indicates his dependence is primarily

1. Psychological
2. Physical
3. Biological
4. Social-cultural

Question 25. The nurse is caring for a depressed client with a new prescription for an SSRI antidepressant. In reviewing the admission history and physical, which of the following should prompt questions about the safety of this medication?

1. History of obesity
2. Prescribed use of an MAO inhibitor
3. Diagnosis of vascular disease
4. Takes antacids frequently

Question 26. The nurse is caring for a toddler with atopic dermatitis. The nurse should instruct the parents to
1. Dress the child warmly to avoid chilling
2. Keep the child away from other children for the duration of the rash
3. Clean the affected areas with tepid water and detergent
4. Wrap the child's hand in mittens or socks to prevent scratching

Question 27. The nurse detects blood-tinged fluid leaking from the nose and ears of a head trauma client. What is the appropriate nursing action?

1. Pack the nose and ears with sterile gauze
2. Apply pressure to the injury site
3. Apply bulky, loose dressing to nose and ears
4. Apply an ice pack to the back of the neck

Question 28. A client with emphysema visits the clinic. While teaching about proper nutrition, the nurse should emphasize that the client

1. Eat foods high in sodium increases sputum liquefaction
2. Use oxygen during meals improves gas exchange
3. Perform exercise after respiratory therapy enhances appetite
4. Cleanse the mouth of dried secretions reduces risk of infection

Question 29. The nurse is providing instructions to a new mother on the proper techniques for breast feeding her infant. Which statement by the mother indicates the need for additional instruction?

1. "I should position my baby completely facing me with my baby's mouth in front of my nipple."
2. "The baby should latch onto the nipple and areola areas."
3. "There may be times that I will need to manually express milk."
4. "I can switch to a bottle if I need to take a break from breast feeding."

Question 30. Immediately following an acute battering incident in a violent relationship, the batterer may respond to the partner’s injuries by

1. Seeking medical help for the victim's injuries
2. Minimizing the episode and underestimating the victim’s injuries
3. Contacting a close friend and asking for help
4. Being very remorseful and assisting the victim with medical care

Question 31. A client refuses to take the medication prescribed because the client prefers to take self-prescribed herbal preparations. What is the initial action the nurse should take?

1. Report the behavior to the charge nurse
2. Talk with the client to find out about the preferred herbal preparation
3. Contact the client's health care provider
4. Explain the importance of the medication to the client

Question 32. The nurse is performing an assessment on a child with severe airway obstruction. Which finding would the nurse anticipate finding?

1. Retractions in the intercostal tissues of the thorax
2. Chest pain aggravated by respiratory movement
3. Cyanosis and mottling of the skin
4. Rapid, shallow respirations

Question 33. The nurse is caring for several 70 to 80 year-old clients on bed rest. What is the most important measure to prevent skin breakdown?

1. Massage legs frequently
2. Frequent turning
3. Moisten skin with lotions
4. Apply moist heat to reddened areas

Question 34. The nurse will administer liquid medicine to a 9 month-old child. Which of the following methods is appropriate?

1. Allow the infant to drink the liquid from a medicine cup
2. Administer the medication with a syringe next to the tongue
3. Mix the medication with the infant's formula in the bottle
4. Hold the child upright and administer the medicine by spoon

Question 35. Which of the actions suggested to the RN by the PN during a planning conference for a 10 month-old infant admitted 2 hours ago with bacterial meningitis would be acceptable to add to the plan of care?

1. Measure head circumference
2. Place in airborne isolation
3. Provide passive range of motion
4. Provide an over-the-crib protective top

Question 36. The nurse is discussing nutritional requirements with the parents of an 18 month-old child. Which of these statements about milk consumption is correct?

1. May drink as much milk as desired
2. Can have milk mixed with other foods
3. Will benefit from fat-free cow's milk
4. Should be limited to 3-4 cups of milk daily

Question 37. The nurse is caring for a client with COPD who becomes dyspneic. The nurse should

1. Instruct the client to breathe into a paper bag
2. Place the client in a high Fowler's position
3. Assist the client with pursed lip breathing
4. Administer oxygen at 6L/minute via nasal cannula

Question 38. In preparing medications for a client with a gastrostomy tube, the nurse should contact the health care provider before administering which of the following drugs through the tube?

1. Cardizem SR tablet (diltiazem)
2. Lanoxin liquid
3. Os-cal tablet (calcium carbonate)
4. Tylenol liquid (acetaminophen)

Question 39. A 24 year-old male is admitted with a diagnosis of testicular cancer. The nurse would expect the client to have

1. Scrotal discoloration
2. Sustained painful erection
3. Inability to achieve erection
4. Heaviness in the affected testicle

Question 40. In taking the history of a pregnant woman, which of the following would the nurse recognize as the primary contraindication for breast feeding?

1. Age 40 years
2. Lactose intolerance
3. Family history of breast cancer
4. Uses cocaine on weekends

Question 41. The most common reason for an Apgar score of 8 and 9 in a newborn is an abnormality of what parameter?

1. Heart rate
2. Muscle tone
3. Cry
4. Color

Question 42. Based on principles of teaching and learning, what is the best initial approach to pre-op teaching for a client scheduled for coronary artery bypass?

1. Touring the coronary intensive unit
2. Mailing a video tape to the home
3. Assessing the client's learning style
4. Administering a written pre-test

Question 43. A nurse is assigned to a client who is a new admission for the treatment of a frontal lobe brain tumor. Which history offered by the family members would be anticipated by the nurse as associated with the diagnosis and communicated?

1. "My partner's breathing rate is usually below 12."
2. "I find the mood swings and the change from a calm person to being angry all the time hard to deal with."
3. "It seems our sex life is nonexistant over the past 6 months."
4. "In the morning and evening I hear complaints that reading is next to impossible from blurred print."

Question 44. A 9 year-old is taken to the emergency room with right lower quadrant pain and vomiting. When preparing the child for an emergency appendectomy, what must the nurse expect to be the child's greatest fear?
1. Change in body image
2. An unfamiliar environment
3. Perceived loss of control
4. Guilt over being hospitalized

Question 45. A home health nurse is caring for a client with a pressure sore that is red, with serous drainage, is 2 inches in diameter with loss of subcutaneous tissue. The appropriate dressing for this wound is

1. A transparent film dressing
2. Wet dressing with debridement granules
3. Wet to dry with hydrogen peroxide
4. Moist saline dressing

Question 46. The nurse, assisting in applying a cast to a client with a broken arm, knows that

1. The cast material should be dipped several times into the warm water
2. The cast should be covered until it dries
3. The wet cast should be handled with the palms of hands
4. The casted extremity should be placed on a cloth-covered surface

Question 47. The nurse prepares for a Denver Screening test with a 3 year-old child in the clinic. The mother asks the nurse to explain the purpose of the test. What is the nurse’s best response about the purpose of the Denver?

1. It measures a child’s intelligence.
2. It assesses a child's development.
3. It evaluates psychological responses.
4. It helps to determine problems.

Question 48. A client admits to benzodiazepine dependence for several years. She is now in an outpatient detoxification program. The nurse must understand that a priority during withdrawal is

1. Avoid alcohol use during this time
2. Observe the client for hypotension
3. Abrupt discontinuation of the drug
4. Assess for mild physical symptoms

Question 49. The nurse is monitoring the contractions of a woman in labor. A contraction is recorded as beginning at 10:00 A.M. and ending at 10:01 A.M. Another begins at 10:15 A.M. What is the frequency of the contractions?

1. 14 minutes
2. 10 minutes
3. 15 minutes
4. 9 minutes

Question 50. A victim of domestic violence tells the batterer she needs a little time away. How would the nurse expect that the batterer might respond?

1. With acceptance and views the victim’s comment as an indication that their marriage is in trouble
2. With fear of rejection causing increased rage toward the victim
3. With a new commitment to seek counseling to assist with their marital problems
4. With relief, and welcomes the separation as a means to have some personal time


ANSWERS

Pediatric Drill 7

Question 1. At a well baby clinic the nurse is assigned to assess an 8 month-old child. Which of these developmental achievements would the nurse anticipate that the child would be able to perform?

1. Say 2 words
2. Pull up to stand
3. Sit without support
4. Drink from a cup

Question 2. A polydrug user has been in recovery for 8 months. The client has began skipping breakfast and not eating regular dinners. The client has also started frequenting bars to "see old buddies." The nurse understands that the client’s behavior is a warning sign to indicate that the client may be

1. headed for relapse
2. feeling hopeless
3. approaching recovery
4. in need of increased socialization

Question 3. At the day treatment center a client diagnosed with Schizophrenia - Paranoid Type sits alone alertly watching the activities of clients and staff. The client is hostile when approached and asserts that the doctor gives her medication to control her mind. The client's behavior most likely indicates

1. Feelings of increasing anxiety related to paranoia
2. Social isolation related to altered thought processes
3. Sensory perceptual alteration related to withdrawal from environment
4. Impaired verbal communication related to impaired judgment

Question 4. When teaching adolescents about sexually transmitted diseases, what should the nurse emphasize that is the most common infection?

1. Gonorrhea
2. Chlamydia
3. Herpes
4. HIV

Question 5. A client is admitted with the diagnosis of meningitis. Which finding would the nurse expect in assessing this client?

1. Hyperextension of the neck with passive shoulder flexion
2. Flexion of the hip and knees with passive flexion of the neck
3. Flexion of the legs with rebound tenderness
4. Hyperflexion of the neck with rebound flexion of the legs



Question 6. A client is admitted with a diagnosis of hepatitis B. In reviewing the initial laboratory results, the nurse would expect to find elevation in which of the following values?

1. Blood urea nitrogen
2. Acid phosphatase
3. Bilirubin
4. Sedimentation rate

Question 7. A Hispanic client in the postpartum period refuses the hospital food because it is "cold." The best initial action by the nurse is to
1. Have the unlicensed assistive personnel (UAP) reheat the food if the client wishes
2. Ask the client what foods are acceptable or bad
3. Encourage her to eat for healing and strength
4. Schedule the dietitian to meet with the client as soon as possible

Question 8. What is the most important aspect to include when developing a home care plan for a client with severe arthritis?

1. Maintaining and preserving function
2. Anticipating side effects of therapy
3. Supporting coping with limitations
4. Ensuring compliance with medications

Question 9. A client is experiencing hallucinations that are markedly increased at night. The client is very frightened by the hallucinations. The client’s partner asked to stay a few hours beyond the visiting time, in the client’s private room. What would be the best response by the nurse demonstrating emotional support for the client?

1. "No, it would be best if you brought the client some reading material that she could read at night."
2. "No, your presence may cause the client to become more anxious."
3. "Yes, staying with the client and orienting her to her surroundings may decrease her anxiety."
4. "Yes, would you like to spend the night when the client’s behavior indicates that she is frightened?"

Question 10. During an examination of a 2 year-old child with a tentative diagnosis of Wilm's tumor, the nurse would be most concerned about which statement by the mother?

1. My child has lost 3 pounds in the last month.
2. Urinary output seemed to be less over the past 2 days.
3. All the pants have become tight around the waist.
4. The child prefers some salty foods more than others.

Question 11. The nurse is caring for a child receiving chest physiotherapy (CPT). Which of the following actions by the nurse would be appropriate?

1. Schedule the therapy thirty minutes after meals
2. Teach the child not to cough during the treatment
3. Confine the percussion to the rib cage area
4. Place the child in a prone position for the therapy

Question 12. The nurse is assessing a child for clinical manifestations of iron deficiency anemia. Which factor would the nurse recognize as cause for the findings?

1. Decreased cardiac output
2. Tissue hypoxia
3. Cerebral edema
4. Reduced oxygen saturation

Question 13. First-time parents bring their 5 day-old infant to the pediatrician's office because they are extremely concerned about its breathing pattern. The nurse assesses the baby and finds that the breath sounds are clear with equal chest expansion. The respiratory rate is 38-42 breaths per minute with occasional periods of apnea lasting 10 seconds in length. What is the correct analysis of these findings?


1. The pediatrician must examine the baby
2. Emergency equipment should be available
3. This breathing pattern is normal
4. A future referral may be indicated

Question 14. A victim of domestic violence states to the nurse, "If only I could change and be how my companion wants me to be, I know things would be different." Which would be the best response by the nurse?

1. "The violence is temporarily caused by unusual circumstances; don’t stop hoping for a change."
2. "Perhaps, if you understood the need to abuse, you could stop the violence."
3. "No one deserves to be beaten. Are you doing anything to provoke your spouse into beating you?"
4. "Batterers lose self-control because of their own internal reasons, not because of what their partner did or did not do."

Question 15. Post-procedure nursing interventions for electroconvulsive therapy include

1. Applying hard restraints if seizure occurs
2. Expecting client to sleep for 4 to 6 hours
3. Remaining with client until oriented
4. Expecting long-term memory loss

Question 16. Which type of accidental poisoning would the nurse expect to occur in children under age 6?

1. Oral ingestion
2. Topical contact
3. Inhalation
4. Eye splashes

Question 17. A mother asks the nurse if she should be concerned about the tendency of her child to stutter. What assessment data will be most useful in counseling the parent?

1. Age of the child
2. Sibling position in family
3. Stressful family events
4. Parental discipline strategies

Question 18. A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to feeling sad and hopeless, the nurse would assess for

1. Anxiety, unconscious anger, and hostility
2. Guilt, indecisiveness, poor self-concept
3. Psychomotor retardation or agitation
4. Meticulous attention to grooming and hygiene

Question 19. A nurse is to present information about Chinese folk medicine to a group of student nurses. Based on this cultural belief, the nurse would explain that illness is attributed to the..

1. Yang, the positive force that represents light, warmth, and fullness
2. Yin, the negative force that represents darkness, cold, and emptiness
3. Use of improper hot foods, herbs and plants
4. A failure to keep life in balance with nature and others

Question 20. A pre-term newborn is to be fed breast milk through nasogastric tube. Why is breast milk preferred over formula for premature infants?

1. Contains less lactose
2. Is higher in calories/ounce
3. Provides antibodies
4. Has less fatty acid

Question 21. A nurse is caring for a client with multiple myeloma. Which of the following should be included in the plan of care?

1. Monitor for hyperkalemia
2. Place in protective isolation
3. Precautions with position changes
4. Administer diuretics as ordered

Question 22. The nurse assesses a client who has been re-admitted to the psychiatric in-patient unit for schizophrenia. His symptoms have been managed for several months with fluphenazine (Prolixin). Which should be a focus of the first assessment?

1. Stressors in the home
2. Medication compliance
3. Exposure to hot temperatures
4. Alcohol use

Question 23. A nurse is conducting a community wide seminar on childhood safety issues. Which of these children is at the highest risk for poisoning?

1. 9 month-old who stays with a sitter 5 days a week
2. 20 month-old who has just learned to climb stairs
3. 10 year-old who occasionally stays at home unattended
4. 15 year-old who likes to repair bicycles

Question 24. A 30 month-old child is admitted to the hospital unit. Which of the following toys would be appropriate for the nurse to select from the toy room for this child?

1. Cartoon stickers
2. Large wooden puzzle
3. Blunt scissors and paper
4. Beach ball

Question 25. Which nursing action is a priority as the plan of care is developed for a 7 year-old child hospitalized for acute glomerulonephritis?

1. Assess for generalized edema
2. Monitor for increased urinary output
3. Encourage rest during hyperactive periods
4. Note patterns of increased blood pressure

Question 26. The nurse is talking to parents about nutrition in school aged children. Which of the following is the most common nutritional disorder in this age group?

1. Bulimia
2. Anorexia
3. Obesity
4. Malnutrition

Question 27. The mother of a 15 month-old child asks the nurse to explain her child's lab results and how they show her child has iron deficiency anemia. The nurse's best response is

1. "Although the results are here, your doctor will explain them later."
2. "Your child has less red blood cells that carry oxygen."
3. "The blood cells that carry nutrients to the cells are too large."
4. "There are not enough blood cells in your child's circulation."

Question 28. The nurse is preparing a 5 year-old for a scheduled tonsillectomy and adenoidectomy. The parents are anxious and concerned about the child's reaction to impending surgery. Which nursing intervention would be best to prepare the child?

1. Introduce the child to all staff the day before surgery
2. Explain the surgery 1 week prior to the procedure
3. Arrange a tour of the operating and recovery rooms
4. Encourage the child to bring a favorite toy to the hospital

Question 29. A 38 year-old female client is admitted to the hospital with an acute exacerbation of asthma. This is her third admission for asthma in 7 months. She describes how she doesn't really like having to use her medications all the time. Which explanation by the nurse best describes the long-term consequence of uncontrolled airway inflammation?

1. Degeneration of the alveoli
2. Chronic bronchoconstriction of the large airways
3. Lung remodeling and permanent changes in lung function
4. Frequent pneumonia

Question 30. In a child with suspected coarctation of the aorta, the nurse would expect to find

1. Strong pedal pulses
2. Diminishing cartoid pulses
3. Normal femoral pulses
4. Bounding pulses in the arms

Question 31. A 2 year-old child has just been diagnosed with cystic fibrosis. The child's father asks the nurse "What is our major concern now, and what will we have to deal with in the future?" Which of the following is the best response?

1. "There is a probability of life-long complications."
2. "Cystic fibrosis results in nutritional concerns that can be dealt with."
3. "Thin, tenacious secretions from the lungs are a constant struggle in cystic fibrosis."
4. "You will work with a team of experts and also have access to a support group that the family can attend."

Question 32. The nurse should recognize that physical dependence is accompanied by what findings when alcohol consumption is first reduced or ended?

1. Seizures
2. Withdrawal
3. Craving
4. Marked Tolerance

Question 33. A client is admitted with a pressure ulcer in the sacral area. The partial thickness wound is 4cm by 7cm, the wound base is red and moist with no exudate and the surrounding skin is intact. Which of the following coverings is most appropriate for this wound?
1. Transparent dressing
2. Dry sterile dressing with antibiotic ointment
3. Wet to dry dressing
4. Occlusive moist dressing

Question 34. The nurse is caring for residents in a long term care setting for the elderly. Which of the following activities will be most effective in meeting the growth and development needs for persons in this age group?

1. Aerobic exercise classes
2. Transportation for shopping trips
3. Reminiscence groups
4. Regularly scheduled social activities

Question 35. The client who is receiving enteral nutrition through a gastrostomy tube has had 4 diarrhea stools in the past 24 hours. The nurse should

1. Review the medications the client is receiving
2. Increase the formula infusion rate
3. Increase the amount of water used to flush the tube
4. Attach a rectal bag to protect the skin

Question 36. The nurse assesses delayed gross motor development in a 3 year-old child. The inability of the child to do which action confirms this finding?

1. Stand on 1 foot
2. Catch a ball
3. Skip on alternate feet
4. Ride a bicycle

Question 37. The nurse is talking with a client. The client abruptly says to the nurse, "The moon is full. Astronauts walk on the moon. Walking is a good health habit." The client’s behavior most likely indicates

1. Neologisms
2. Dissociation
3. Flight of ideas
4. Word salad

Question 38. A client was admitted to the psychiatric unit with a diagnosis of bipolar disorder. He constantly bothers other clients, tries to help the housekeeping staff, demonstrates pressured speech and demands constant attention from the staff. Which activity would be best for the client?

1. Reading
2. Checkers
3. Cards
4. Ping-pong

Question 40. During the evaluation phase for a client, the nurse should focus on

1. All finding of physical and psychosocial stressors of the client and in the family
2. The client's status, progress toward goal achievement, and ongoing re-evaluation
3. Setting short and long-term goals to insure continuity of care from hospital to home
4. Select interventions that are measurable and achievable within selected timeframes

Question 41. The nurse is caring for a client with an unstable spinal cord injury at the T7 level. Which intervention should take priority in planning care?

1. Increase fluid intake to prevent dehydration
2. Place client on a pressure reducing support surface
3. Use skin care products designed for use with incontinence
4. Increase caloric intake to aid healing

Question 42. The nurse admits a client newly diagnosed with hypertension. What is the best method for assessing the blood pressure?

1. Standing and sitting
2. In both arms
3. After exercising
4. Supine position

Question 43. (In planning care for a child diagnosed with minimal change nephrotic syndrome, the nurse should understand the relationship between edema formation and

1. Increased retention of albumin in the vascular system
2. Decreased colloidal osmotic pressure in the capillaries
3. Fluid shift from interstitial spaces into the vascular space
4. Reduced tubular reabsorption of sodium and water

Question 44. The nurse is making a home visit to a client with chronic obstructive pulmonary disease (COPD). The client tells the nurse that he used to be able to walk from the house to the mailbox without difficulty. Now, he has to pause to catch his breath halfway through the trip. Which diagnosis would be most appropriate for this client based on this assessment?

1.. Activity intolerance caused by fatigue related to chronic tissue hypoxia
2. Impaired mobility related to chronic obstructive pulmonary disease
3. Self care deficit caused by fatigue related to dyspnea
4. Ineffective airway clearance related to increased bronchial secretions

Question 45. The nurse is caring for a client who has developed cardiac tamponade. Which finding would the nurse anticipate?

1. Widening pulse pressure
2. Pleural friction rub
3. Distended neck veins
4. Bradycardia

Question 46. A mother wants to switch her 9 month-old infant from an iron-fortified formula to whole milk because of the expense. Upon further assessment, the nurse finds that the baby eats table foods well, but drinks less milk than before. What is the best advice by the nurse?

1. Change the baby to whole milk
2. Add chocolate syrup to the bottle
3. Continue with the present formula
4. Offer fruit juice frequently

Question 47. A 65-year-old Hispanic-Latino client with prostate cancer rates his pain as a 6 on a 0-to-10 scale. The client refuses all pain medication other than Motrin, which does not relieve his pain. The next action for the nurse to take is to

1. Ask the client about the refusal of certain pain medications
2. Talk with the client's family about the situation
3. Report the situation to the health care provider
4. Document the situation in the notes

Question 48. Privacy and confidentiality of all client information is legally protected. In which of these situations would the nurse make an exception to this practice?

1. When a family member offers information about their loved one
2. When the client threatens self-harm and harm to others
3. When the health care provider decides the family has a right to know the client's diagnosis
4. When a visitor insists that the visitor has been given permission by the client

Question 49. At the geriatric day care program a client is crying and repeating "I want to go home. Call my daddy to come for me." The nurse should

1. Invite the client to join the exercise group
2. Tell the client you will call someone to come for her
3. Give the client simple information about what she will be doing
4. Firmly direct the client to her assigned group activity

Question 50. Which of the following nursing assessments in an infant is most valuable in identifying serious visual defects?

1. Red reflex test
2. Visual acuity
3. Pupil response to light
4. Cover test


ANSWERS

Pediatric Drill 6

Question 1. Which of the following would be commonly assessed in early acute glomerulonephritis (AGN)?

1. Dysuria, pedal edema, decreased urinary output
2. Seizures, increased urinary output, pale-colored urine
3. Tea-colored urine, anorexia, facial puffiness
4. Vomiting, bright red urine, abdominal distention

Question 2. Which of the following is the earliest sign of puberty in females?

1. Adrenarche
2. Growth spurt
3. Menarche
4. Thelarche

Question 3. A home health nurse notes excessive swallowing in a 7-year-old boy who had a tonsillectomy 1 week ago. Which of the following would be the nurse's priority intervention?

1. Administer aspirin because excessive swallowing indicates pain.
2. Administer extra fluids for dehydration.
3. Examine the child's throat for bleeding.
4. Instruct the child to spit out secretions instead of swallowing them.

Question 4. Which of the following complications would the nurse least expect to develop in a child with meningitis?

1. Cerebral palsy
2. Disseminated intravascular coagulation (DIC)
3. Hydrocephalus
4. Pneumonia

Question 5. Which of the following is exemplified by a 4-year-old sibling of a sudden infant death syndrome victim who believes that she caused her sibling's death because she wished for it?

1. Abstract thinking
2. Concrete thinking
3. Magical thinking
4. Formal operational thinking

Question 6. The nurse develops a teaching plan for a mother who is concerned about her 6-month-old child awakening and crying frequently at night until comforted based on the nurse's understanding of which of the following?

1. Improper feeding
2. Maternal anxiety
3. Night terrors
4. Separation anxiety

Question 7. Which of the following would the nurse include when developing a parental teaching plan about the characteristics of febrile seizures?

1. Are more common in schoolagers
2. Are relatively benign in nature
3. Occur as the fever peaks
4. Result in moderate neurologic problems

Question 8. To test a schoolager's sense of conservation, which of the following would the nurse do?

1. Give the child a group of numbered blocks and have him arrange them according to some ordinal scale.
2. Give the child a mixture of stamps, wrappers, and shells and have him group them according to some classification system.
3. Show the child two equal-length pencils side by side, then move them out of alignment to see if he realizes they are still the same length.
4. State a situation to the child, then have him anticipate the consequences and rethink the action in a different direction.

Question 9. Which of the following statements, if voiced by the parents of a female child receiving co-trimoxazole (Bactrim) for a urinary tract infection (UTI), would indicate the need for additional teaching?

1. "We'll call the physician immediately if a rash occurs."
2. "We'll continue to give her the medication until it is finished."
3. "We'll make arrangements to have her white blood cell (WBC) count checked routinely."
4. "We'll try to make sure that she doesn't go outside in the sun."

Question 10. At which of the following ages would a child typically experience the most age-related psychological stress from a hypospadias repair?

1. 2 years
2. 4 years
3. 6 years
4. 8 years

Question 11. A nurse finds a 3-year-old boy simulating sexual intercourse with some dolls. The nurse should recognize this as which of the following?

1. A sign of possible sexual abuse
2. A symptom of developmental delay
3. Normal curiosity during play
4. The child's inexperience with doll play


Question 12. Which of the following assessments would be least likely to create a suspicion of Munchausen Syndrome by Proxy (MSP) in an infant admitted for persistent diarrhea?

1. Parent totally refuses to leave the hospital
2. Parent who gives history inconsistent with findings
3. Parent who is over-friendly to staff
4. Parent with little knowledge of child's illness

Question 13. When planning the care for children with primary enuresis, the nurse bases the plan on the knowledge of which of the following?

1. An underlying urological abnormality is common.
2. The child has had difficulty with toilet training.
3. The disorder is benign and self-limiting.
4. There is an underlying psychological disorder.

Question 14. A 2-year-old being treated for nephrotic syndrome develops a temperature of 99.8°F and a slight cough. Which of the following should the nurse do?

1. Assess the child for signs of a respiratory infection.
2. Encourage fluids to decrease fever.
3. Give the child a lozenge for sore throat.
4. Increase activity to prevent pneumonia.

Question 15. The nurse prepares to administer acetaminophen 200 mg as ordered for fever for a child who weighs 44 lb. What is the maximum safe dose for this child if acetaminophen should be given at 10 to 15 mg/kg per dose?

1. 200
2. 320
3. 300
4. 230

Question 16. When reviewing the laboratory results of a child with a possible urinary tract infection, which of the following collection method results indicates an infection when the colony count is more than 1,000 colonies/ml of a single organism?

1. Catheterized specimen
2. Clean catch specimen
3. Routine specimen
4. Suprapubic tap specimen

Question 17. Which of the following preventive measures should the nurse include in the teaching plan for a female child to prevent urinary tract infections?

1. Avoid tight jeans.
2. Empty bladder every 5 to 6 hours.
3. Use nylon underwear.
4. Wipe self back to front.

Question 18. Which of the following would the nurse do first when a child has a sudden and unexpected seizure?

1. Clear the area of hazards to prevent harm.
2. Place a tongue blade in the child's mouth to prevent aspiration.
3. Restrain the child to prevent injury.
4. Shake the child to ascertain level of consciousness (LOC).

Question 19. Which of the following complications would the nurse least expect to develop in a child with meningitis?

1. Cerebral palsy
2. Disseminated intravascular coagulation (DIC)
3. Hydrocephalus
4. Pneumonia

Question 20. When evaluating the effectiveness of client teaching for an adolescent with mild mental retardation, which of the following would indicate the need for further teaching?

1. Adequate performance of activities of daily living (ADLs)
2. Avoidance of sexual discussions
3. Demonstration of practical skills
4. Dressing like peers

Looking for answers(s):2

Question 21. Which of the following would be most beneficial when caring for an infant with Nonorganic Failure to Thrive (NOFTT)?

1. Alternating staff for each feeding for variety
2. Changing routines when the child refuses feedings
3. Gradually introducing new foods to the child's diet
4. Stimulating the child with play during feedings

Question 22. Which of the following dietary measures would the nurse expect to institute for the child with acute glomerulonephritis (AGN)?

1. Decreased calcium
2. Decreased sodium
3. Increased nitrogen
4. Increased protein

Question 23. Which of the following is a primary prevention strategy for mental retardation?

1. Infant stimulation programs
2. Neonate screening
3. Prenatal diagnosis
4. Rubella vaccine

Question 24. The infant of a 13-year-old runaway mother is not held, fed, or changed consistently. This child is likely to develop a sense of which of the following?

1. Doubt
2. Guilt
3. Inferiority
4. Mistrust

Question 25. When monitoring the urine of a child with acute glomerulonephritis, which of the following values would be the most important to monitor?

1. Blood
2. pH
3. Protein
4. Specific gravity

Questions 26. In teaching age-related sources of stress to a group of parents and teachers, which of the following is a source of stress for 6-year-olds?

1. Infrequent interaction with peers
2. Interruption of sense of decorum
3. Own criticalness of performance
4. Sitting still for long periods

Question 27.
The nurse is caring for a child who has Kawasaki Disease (KD). Which of the following nursing interventions are appropriate? Select all that apply:

1. Administer prescribed prophylactic anticonvulsant medication.
2. Encourage fluids to maintain adequate kidney function.
3. Provide mouth care using lubricated ointment.
4. Use passive range of motion (ROM) if arthritis develops.
5. Assess for signs of heart failure.

Question 28. In evaluating a 10-year-old's psychosocial development, the nurse notes that the child is within normal for age. Therefore, the child has attained a sense of which of the following?

1. Autonomy
2. Identity
3. Industry
4. Initiative

Question 29. The nurse understands that the incidence of Reye's syndrome has decreased because of the association with which of the following?

1. Administration of immune toxoid
2. Decreased administration of aspirin for viral infections
3. Earlier identification of the disorder
4. Improved diagnostic testing for the disorder

Question 30. Which of the following would the nurse expect a 21-year-old with an IQ of 30 to be able to do?

1. Conform to daily routines.
2. Demonstrate social skills.
3. Perform simple tasks.
4. Travel alone to familiar places.

Question 31. Which of the following are true about pediatric pain management? Select all that apply:

1. Acute pain can lead to depression.
2. Young children have difficulty expressing their pain.
3. Pain scales can be effective for children.
4. I.M. pain therapy is preferable and effective.
5. The pain threshold is the maximum level of tolerance for pain.
2 3

Question 32. Which of the following would the nurse identify as the primary outcome when planning nursing care for a child with mental retardation?

1. The child will demonstrate self-care measures.
2. The child will demonstrate vocational skills.
3. The child will develop communication skills.
4. The child will obtain optimum development.

Question 33. Which of the following organisms would the nurse suspect as the most likely cause of bronchiolitis?

1. Haemophilus influenzae
2. Mycoplasma pneumoniae
3. Parainfluenza virus
4. Respiratory syncytial virus (RSV)

Question 34. Which of the following is not a common signal that a child is ready for toilet training?

1. Ability to stay dry for 4 hours
2. >Expression of willingness to please parents
3. Regular bowel movements
4. Skills to indicate urge to go to the bathroom

Question 35.
Which of the following assessments would be noted in children with Minimal Change Nephrotic Syndrome (MCNS)?

1. Foul-smelling urine, frequency, dysuria
2. High blood pressure, hematuria, facial edema
3. Malaise, flank pain, high fever
4. Proteinuria, marked edema, slightly decreased blood pressure

Question 36. Which of the following would be included in the care plan for a child receiving oral phenytoin (Dilantin) for seizures?

1. Encouraging fluids
2. Giving rigorous oral hygiene
3. Monitoring blood pressure every 4 hours
4. Providing meticulous skin care

Question 37. A 16-year-old who is diagnosed with depression suddenly cheers up and gives her cherished teddy bear to her favorite nurse. Which of the following is the priority for the nurse at this time?

1. Assess the adolescent for possible suicidal ideation.
2. Give the bear back and discuss transitional objects.
3. Praise her mood change and her passage from childhood.
4. Tell her mother to call for a psychiatric referral.

Question 38. The mother of a 7-year-old with acute glomerulonephritis (AGN) states that she is worried that her child will end up needing dialysis for the rest of his life. On which of the following would the nurse base the response to this mother?

1. Most children have relapses but do not need dialysis.
2. Most children have renal failure and need dialysis.
3. Most children only need temporary dialysis.
4. Most children return to normal functioning.

Question 39. A mother asks why her daughter needs further evaluation after having two urinary tract infections (UTIs). The nurse bases her explanation on the understanding that which of the following is commonly associated with UTIs?

1. Acute glomerulonephritis (AGN)
2. Nephrotic syndrome
3. Pyelonephritis
4. Vesicoureteral reflux (VUR)

Question 40. Which of the following is the first step in assessing suicidality?

1. Accessibility
2. Lethality
3. Proximity
4. Specificity

Question 41. When performing a neonate examination, a nurse suspects mild hypospadias. Which of the following demonstrates the nurse's understanding about the rationale for reporting this finding as soon as possible?

1. Circumcision should be postponed.
2. Infection must be prevented.
3. It requires immediate repair.
4. Undescended testes may be present.

Question 42. When a nurse is caring for a child who is receiving ribavirin (Virazole), the nurse plans interventions based on the knowledge of which of the following?

1. Contact precautions are discontinued during administration.
2. Pregnant nurses should not care directly for the infant.
3. Ribavirin is given via nebulizer four times per day.
4. Ribavirin is used for any infant with respiratory syncytial virus (RSV) bronchiolitis.

Question 43. Which of the following reflects the child's level of moral development when a 2 1/2-year-old child states that the nurse is "a bad girl" after she administers an I.M. injection?

1. Conventional/"law and order"
2. Conventional/interpersonal concordance
3. Preconventional/naive instrumentation
4. Preconventional/punishment-obedience

Question 44. Based on the nurse's knowledge of the organism primarily responsible for causing urinary tract infections (UTIs) in children, which of the following would be included in a teaching plan on prevention?

1. Escherichia coli
2. Klebsiella
3. Mycoplasma
4. Proteus

Question 45. Which of the following nursing diagnoses would be least likely associated with Minimal Change Nephrotic Syndrome (MCNS)?

1. Fatigue
2. Deficient fluid volume
3. Risk for impaired skin integrity
4. Risk for infection

Question 46. The nurse instructs the mother of an 8-year-old with group A beta-hemolytic streptococcal tonsillitis to take his prescribed penicillin for 10 days, primarily to prevent which of the following?

1. Acute poststreptococcal glomerulonephritis
2. Juvenile rheumatoid arthritis
3. Rheumatic fever
4. Subacute bacterial endocarditis

Question 47. Which of the following behaviors would be a cause of concern for a 5-year-old child whose pet hamster just died?

1. Acting sad and tearful
2. Sleeplessness and loss of appetite
3. Trying to dig it up from its grave
4. Wanting to buy the dead animal food

Question 48. Which of the following infection control precautions should the nurse initiate when a child is admitted for possible meningococcal meningitis?

1. Airborne precautions
2. Contact precautions
3. Droplet precautions
4. Neutropenic precautions

Question 49. When managing an abused child, the nurse should be aware that this child is most likely to do which of the following?

1. Compensate by doing well in school.
2. Develop aggressive behavior toward other children.
3. Develop overly strong peer attachments.
4. Seek assistance from teachers.

Question 50. A mother is concerned because her 16-month-old child is not walking yet. Which of the following would be the home health nurse's best response?

1. "Give him more time; children grow at their own pace."
2. "Refer this to your primary care physician."
3. "Try using high-topped shoes to support his ankles."
4. "Use a walker; it will help to strengthen his legs."

ANSWERS

Pediatric Drill 5

Question 1. For which of the following would the nurse monitor when caring for a child who is receiving vincristine (Oncovin)?

1. Cardiac abnormalities
2. Foot drop
3. Hemorrhagic cystitis
4. Moon face

Question 2. Which of the following is the primary nursing goal when caring for the child with erythema subitum (roseola)?

1. Experience of minimal discomfort
2. Maintenance of normal body temperature
3. Maintenance of skin integrity
4. Minimization of long-term complications

Question 3. The nurse institutes proper infection control precautions for a 1-year-old brought to the emergency department with coryza, conjunctivitis, and small red, blue-white centered spots on her buccal mucosa because the nurse suspects which of the following?

1. Fifth disease
2. Roseola
3. Rubella
4. Rubeola

Question 4. Which of the following would be the nurse's least concern for a child requiring prolonged immobilization?

1. Decreased catabolic activity related to muscle atrophy
2. Decreased movement of secretions from the tracheobronchial tree
3. Dependent edema related to decreased venous return
4. Hypercalcemia due to bone demineralization

Question 5. Which of the following is characteristic of Duchenne muscular dystrophy?

1. Death between ages 15 and 25
2. Early weakness of the shoulder muscles
3. Intervals without disease progression
4. Onset in the first year of life

Question 6. Which of the following would the nurse expect to find in a child with hypopituitarism?

1. Delay evident in first year
2. Delayed primary tooth eruption
3. Skeletal proportions normal for age

Question 7. When caring for a child with mumps, which of the following complications would the home health nurse expect as least likely to occur?

1. Arthritis
2. Bronchiolitis
3. Encephalitis
4. Orchitis

Question 8. Which of the following assessment findings would be exhibited in a child with Cushing syndrome?

1. Decreased appetite and paleness
2. Decreased blood pressure and acidosis
3. Hypoglycemia and skin thickening
4. Increased susceptibility to infection and virilization

Question 9. Which of the following interventions would be included in the care plan to prevent the most serious shunt complication?

1. Checking for inflammation at operative site and shunt tracts
2. Observing behavior, blood pressure, and pulse
3. Positioning carefully, flat on operative side
4. Providing meticulous skin care

Question 10. Upon admission of a 4-year-old child to rule out leukemia, the parents ask the nurse when they will know the diagnosis. The nurse's response is based on the knowledge that the results of which of the following confirms leukemia?

1. Bone marrow aspiration
2. Complete blood count
3. Lumbar puncture
4. Peripheral blood smear

Question 11. Which of the following manifestations would the nurse include in the teaching plan for a mother who is concerned that her 15-year-old daughter may have acquired hypothyroidism because the girl's grandmother had it?

1. Constipation, dry skin, sparse hair
2. Diarrhea, weight loss, and short stature
3. Lethargy, mental retardation, growth failure
4. Urine retention, coarse hair, cold hands

Question 12. Which of the following would be inappropriate to assist a child with cerebral palsy in performing his activities of daily living (ADLs)?

1. Allowing for frequent rest periods
2. Decreasing calories to prevent weight gain
3. Encouraging activity with signs of fatigue
4. Praising the child for his accomplishments

Question 13. Which of the following client statements indicates that a 15-year-old with alopecia secondary to chemotherapy requires more teaching?

1. "I think I'll use a scarf so I can look better."
2. "If I need chemo again, my hair won't fall out as bad."
3. "I'll wear a cap or bandana in the sun."
4. "My hair will start to regrow in 1 year."

Question 14. When evaluating the effectiveness of the preoperative teaching plan with the parents of children diagnosed with Wilms' tumor, which of the following would indicate to the nurse that the parents require further teaching?

1. Asking about the child's blood pressure
2. Encouraging the child to discuss fears
3. Frequently palpating the child's abdomen
4. Stating that they will discuss alopecia after surgery

Question 15.
Which of the following agents would the nurse suspect as the probable cause of mood swings in a child with leukemia?

1. Allopurinol
2. Granulocyt colony-stimulating factor
3. L-asparaginase
4. Steroids

Question 16. A mother is upset because her 8-year-old daughter developed a right breast mass. She asks the nurse what she should do. The nurse bases her response on knowing that the breast mass is most likely due to which of the following?

1. Gynecomastia
2. Precocious pseudo puberty
3. Precocious thelarche
4. The onset of puberty

Question 17. When evaluating the effectiveness of teaching about exchange diets for an adolescent with diabetes mellitus, which of the following fast food choices, when stated by the client, indicates understanding about using the least amount of exchange equivalents?

1. A taco
2. Cheeseburger
3. Roast beef sandwich
4. Three slices of pizza

Question 18. Which of the following maternal deficiencies is associated with the development of neural tube defects (NTDs)?

1. Amino acid
2. Ascorbic acid
3. Folic acid
4. Valproic acid

Question 19. When assessing children for early signs of increased intracranial pressure (ICP), the nurse monitors the child for which of the following?

1. Altered pupil reactivity
2. Decreased level of consciousness (LOC)
3. Early morning headache
4. Papilledema

Question 20. Which of the following actions would be most appropriate when caring for a child with leukemia who has a platelet count of 20,000/mm?

1. Discouraging nose-blowing
2. Increasing iron-rich foods in the diet
3. Instituting strict isolation
4. Medicating for pain every 4 hours

Question 21. The mother of a child with scarlet fever demonstrates the need for more teaching when she states which of the following?

1. "I can give my child gargles and lozenges for sore throat."
2. "I will administer the full 10-day course of penicillin."
3. "I'll give the child a soft diet of small, frequent meals."
4. "I'll keep the child in isolation until the rash disappears."

Question 22. When planning nursing care, which of the following childhood illnesses does not require antibiotics?

1. Diphtheria
2. Pertussis
3. Poliomyelitis
4. Scarlet fever

Question 23. For a child with which of the following would the nurse question an order for a lumbar puncture?

1. Encephalitis
2. Increased intracranial pressure (ICP)
3. Leukemia
4. Meningitis

Question 24. Which of the following would be inappropriate for a child in a Boston or Thoraco-Lumbo-Sacral Orthosis?

1. Brace removal every 2 hours for skin care
2. Compliance with brace use
3. Maintenance of positive body image
4. Maintenance of skin integrity

Question 25. Which of the following is the most appropriate response to the mother of a child with varicella who asks how long her child will be contagious?

1. "For 3 to 4 days after the very first lesions begin to appear."
2. "For a total of 10 to 21 days."
3. "From the appearance of cold symptoms until when the lesions are crusted."
4. "Starting from the time when there are lesions present."

Question 26. When planning the postoperative care of an infant with hydrocephalus, which of the following would the nurse expect as the most common type of shunt used?

1. Ventricular bypass
2. Ventriculoatrial (VA)
3. Ventriculoperitoneal (VP)
4. Ventriculopleural

Question 27. When assessing a 4-year-old child with a brain tumor, which of the following preoperative assessments would the nurse consider least important?

1. Behavior
2. Cranial enlargement
3. Headaches
4. Projectile vomiting

Question 28. When assessing an infant with developmental dysplasia of the hip (DDH), the nurse would most likely note which of the following?

1. Positive Ortolani's sign
2. Positive Trendelenburg sign
3. Shortening of unaffected limb
4. Symmetry of the gluteal folds

Question 29. After teaching a group of parents about cancer and associated cardinal signs and symptoms, which of the following signs and symptoms, if stated by the group, would indicate to the nurse that the group needs more teaching?

1. Localized pain
2. Sudden vision changes
3. Unexplained bleeding
4. Unusual mass or swelling

Question 30. For which of the following should the nurse be alert when a 3-year-old child with sickle cell anemia develops erythema infectiosum?

1. Chest pain and fever
2. Increased arthralgia
3. Neurologic impairment
4. Profound anemia


Question 31. Which of the following parental statements indicates the need for additional teaching about human growth hormone (HGH)?

1. "Our child will reach adult height, but slower than his peers."
2. "The best time to administer the medication would be at bedtime."
3. "This medication is expensive to buy."
4. "We'll administer the medication with food, but we won't give it with milk."

Question 32. Which of the following would the nurse be sure to include in the teaching plan as the most common cause of Cushing syndrome in children?

1. Adrenal hyperplasia
2. Adrenocortical neoplasm
3. Extra pituitary lesion
4. Use of large amounts of corticosteroids

Question 33. Which of the following clinical assessments would be included when caring for an infant with hydrocephalus?

1. Ataxia
2. Increased head circumference
3. Papilledema
4. Vomiting

Question 34. Which of the following should the school nurse do first when a child with diabetes mellitus becomes unresponsive during recess?

1. Administer 3 to 6 ounces of orange juice.
2. Administer glucagon as prescribed.
3. Give the child milk and peanut butter crackers.
4. Immediately transport the child by car to the hospital.

Question 35. Which of the following foods would be inappropriate for a 6-year-old in a full body cast?

1. Apple juice
2. Cereal
3. Hamburger
4. Milk shakes

Question 36. To provide effective client teaching, the nurse is aware that idiopathic hypopituitarism is usually related to which of the following?

1. Constitutional growth delay
2. Familial short stature
3. Growth hormone (GH) deficiency
4. Psychosocial dwarfism


Question 37. When caring for children who have received bone marrow transplants, the nurse is aware that graft-versus-host disease (GVHD) least commonly occurs with which of the following?

1. Allogenic
2. Autologous
3. Human leukocyte antigen (HLA) system complex
4. Syngeneic

Question 38. Which of the following systems is least likely associated with the development of complications in the long-term follow-up of childhood cancer survivors?

1. Endocrine
2. Reproductive
3. Respiratory
4. Skeletal

Question 39. Which of the following might a parent notice in a child with early retinoblastoma

1. Blindness
2. Inflamed conjuctiva
3. Protruding eyes
4. White appearing in the lens

Question 40. The mother of a 4-year-old admitted with a fractured femur states, "He ran into a door and his bones break easy because he has that real common kind of brittle bone disease." Which of the following assessments would help the nurse to confirm the mother's statement?

1. Blue sclera
2. Different staged bruises
3. Lack of tooth development
4. Marked limb deformity

Question 41. Which of the following parental statements indicates the need for additional teaching about the use of long-acting desmopressin acetate (DDAVP)?

1. "The drug should last for 48 to 72 hours."
2. "We might see breakthrough urination in the evening."
3. "We should watch for headaches and nausea."
4. "We will administer it intranasally through a flexible tube."

Question 42. The parents of a child who has been newly diagnosed with cerebral palsy question the nurse about the child's prognosis. The nurse bases her response on knowing which of the following?

1. Cerebral palsy is nonprogressive with variable outcomes.
2. The child will become progressively worse.
3. The condition improves gradually with stimulation.
4. The illness progression is variable, but results in predicted patient outcomes.

Question 43. Which of the following denotes the primary reason for teaching testicular self-examination of males ages 13 to 14 who are at least at Tanner's stage III of development?

1. Testicular cancer is most common in males ages 15 to 34.
2. They will become more comfortable with their own sexuality.
3. They will become more familiar with their own anatomy.
4. They will develop a health promotion habit important in later life.

Question 44. Which of the following would be an early sign of insulin-dependent diabetes mellitus (IDDM) in children?

1. Abdominal discomfort and nausea
2. Marked increase in fluid intake
3. Recurrent Candida infections
4. Sudden onset of bedwetting

Question 45. Which of the following conditions is most commonly associated with ethical and moral issues regarding life support withdrawal and organ donation?

1. Anencephaly
2. Encephalocele
3. Meningocele
4. Microcephaly

Question 46. Which of the following would be least likely to occur when providing routine postoperative care for an infant with myelomeningocele?

1. Cognitive delays
2. Head circumference increase
3. Latex allergy
4. Urine retention

Question 47. Which of the following is an early warning sign of cerebral palsy?

1. Failure to sit without support at age 5 months
2. Failure to smile by age 3 months
3. Poor head control at age 2 months
4. Pushing food out of mouth with tongue at age 3 months

Question 48. Which of the following would be the most appropriate mouth care for a 2-year-old with stomatitis?

1. Hydrogen peroxide
2. Lemon and glycerin swabs
3. Plain water
4. Viscouse lidocaine

Question 49. Which of the following psychosocial stressors is likely to be imposed upon an immobilized 2-year-old?

1. Guilt
2. Inferiority
3. Mistrust
4. Shame

Question 50. In addition to the usual postoperative care, immediate postoperative care of the adolescent who had a Luque repair of scoliosis includes which of the following?

1. Administering nonopioids for pain
2. Assessing for neurologic integrity
3. Encouraging frequent voiding
4. Logrolling every 2 hours

ANSWERS