PEDS Exam 3 Practice Questions

Which assessment finding indicates adequate peripheral perfusion for a child after a cardiac catheterization?

1. Capillary refill is greater than 3 seconds.

2. Lower extremities are warm, with a capillary refill of less than 3 seconds.

3. Sensation is decreased with a weakened dorsalis pedis pulse.

4. Dorsalis pedis pulse is palpable but posterior tibial pulse is weak.

2. Lower extremities are warm, with a capillary refill of less than 3 seconds.

Which initial laboratory data does the nurse anticipate for a child who is admitted to the hospital with a cyanotic heart defect?

1. A low platelet count

2. A high white blood cell count

3. A high hemoglobin

4. A low hematocrit

3. A high hemoglobin

The nurse admits a child with a ventricular septal defect (VSD) to the pediatric unit. Which is the priority nursing diagnosis for this child?

1. Hypothermia related to decreased metabolic state

2. Acute Pain related to the effects of a congenital heart defect

3. Ineffective Tissue Perfusion (peripheral) related to cyanosis secondary to congenital heart defect

4. Impaired Gas Exchange related to pulmonary congestion secondary to the increased pulmonary blood flow

4. Impaired Gas Exchange related to pulmonary congestion secondary to the increased pulmonary blood flow

Which heart defect should the nurse suspect for an infant whose upper extremities have stronger pulses than the lower extremities and blood pressure is higher in the arms than in the legs?

1. Transposition of the great vessels

2. Patent ductus arteriosus

3. Coarctation of the aorta

4. Atrial septal defect

3. Coarctation of the aorta

An infant with tetralogy of Fallot (TOF) is having a hypercyanotic episode ("tet" spell). Which nursing interventions are appropriate? Select all that apply.

1. Administer oxygen.

2. Place the child in knee-chest position.

3. Administer morphine and propranolol intravenously as ordered.

4. Draw blood for a serum hemoglobin.

5. Administer diphenhydramine (Benadryl) as ordered.

1, 2, 3

An infant who is diagnosed with a mild heart defect will not have surgical correction for at least 2 years. Which information should the nurse include in the discharge teaching

regarding management in the home environment?

1. "Your child will have a low-grade fever until the defect is repaired."

2. "It is important for your child to maintain normal activity."

3. "Your child is not at risk for congestive heart failure."

4. "It is important to avoid antipyretics for the treatment of fever."

2. "It is important for your child to maintain normal activity."

A 2-month-old infant with a congenital heart defect is admitted to the pediatric intensive care unit with congestive heart failure. Which intervention should the nurse include in the infant's plan of care?

1. Monitor respirations during active periods.

2. Give larger feedings less often to conserve energy.

3. Organize activities to allow for uninterrupted sleep.

4. Force fluids appropriate for age.

3. Organize activities to allow for uninterrupted sleep.

A toddler is prescribed digoxin (Lanoxin) for cardiac failure. Which should the nurse instruct the toddler's parents to monitor for as a manifestation associated with digoxin toxicity?

1. Bradycardia

2. Tinnitus

3. Ataxia

4. Hypotension

1. Bradycardia

Which teaching point should the nurse include in the discharge instructions for a pediatric client who has undergone cardiac surgery?

1. Should not receive routine immunizations.

2. Should be restricted from most play activities.

3. Fever is expected for several weeks following the surgery.

4. Prophylactic antibiotics are required for any dental, oral, or upper respiratory tract procedures.

4. Prophylactic antibiotics are required for any dental, oral, or upper respiratory tract procedures.

Which parental statement regarding the use of cyclosporin A after a heart transplant indicate correct understanding of the information presented by the nurse?

1. "This medication is used to treat hypertension."

2. "This medication is used to reduce serum cholesterol level."

3. "This medication is used to prevent rejection."

4. "This medication is used to treat infections."

3. "This medication is used to prevent rejection."

Which clinical manifestation does the nurse anticipate for a pediatric client who is admitted with congestive heart failure (CHF)?

1. Tachycardia

2. Weight loss

3. Hypertension

4. Bradycardia

1. Tachycardia

Which is the rationale the nurse provides to the parents of an infant diagnosed with congestive heart failure (CHF) for the prescribed spironolactone?

1. Produces rapid diuresis

2. Blocks reabsorption of sodium and water in renal tubules

3. Spares potassium

4. Promotes vascular relaxation

3. Spares potassium

Which laboratory test does the nurse anticipate for a child who is admitted to the hospital with suspected rheumatic fever?

1. Erythrocyte sedimentation rate

2. Throat culture

3. C-reactive protein

4. Antistreptolysin-O (ASO) titer

4. Antistreptolysin-O (ASO) titer

Which athletic activity should the nurse recommend for a school-age child who is diagnosed with pulmonary artery hypertension?

1. Golf

2. Basketball

3. Cross-country running

4. Soccer

1. Golf

Which treatment options should the nurse anticipate for a 10-month-old infant admitted to the emergency department with supraventricular tachycardia? Select all that apply.

1. Administering intravenous adenosine (Adenocard)

2. Administering intravenous amiodarone (Cardarone)

3. Preparing for cardioversion

4. Applying ice to the face

5. Having the child perform a Valsalva maneuver

1, 2, 3, 4

Which assessment data would cause the nurse to suspect that a pediatric client is experiencing hypovolemic shock? Select all that apply.

1. Dyspnea

2. Bradycardia

3. Tachycardia

4. Capillary refill time greater than 3 seconds.

5. Blood pressure 72/42 mmHg

1, 3, 4

Which is the priority nursing action when providing care to a pediatric client who is diagnosed with hypovolemic shock?

1. Assessing the cause of bleeding

2. Establishing an open airway and administering oxygen

3. Administering analgesics for pain control

4. Providing replacement of volume

2. Establishing an open airway and administering oxygen

The nurse is teaching a pregnant client about fetal circulation. Which is the correct sequence of blood flow that indicates the pregnant client understands the information presented?

1. Ductus arteriosus

2. Ductus venosus

3. Foramen ovale

2, 3, 1

Which parental statement indicates correct understanding for the reason a cardiac catheterization is needed for a child who is diagnosed with a congenital heart defect?

1. "This procedure will keep the ductus arteriosus open and oxygenated and unoxygenated blood mixed."

2. "This procedure is used to close the ductus arteriosus to prevent mixing of arterial and venous blood."

3. "This procedure will redirect the blood so that blood bypasses the right ventricle."

4. "This procedure connects the ventricle to the atrium."

1. "This procedure will keep the ductus arteriosus open and oxygenated and unoxygenated blood mixed."

Which feeding techniques should the nurse include in the teaching session for the parents of an infant who is being discharged in order to gain weight for the corrective surgery needed for a congenital heart defect? Select all that apply.

1. Breastfeed if possible.

2. Complete each feeding within 30 minutes.

3. Position the infant flat to promote swallowing.

4. Dilute the formula with extra water to ensure adequate fluid intake.

5. Burp the infant frequently.

1, 2, 5

Which age-appropriate information should the nurse provide to a 4-year-old girl who is being emotionally prepared for open heart surgery?

1. The name of the surgeon who will be performing the procedure

2. What the surgical procedure will entail

3. The purpose of the heart-lung machine used during the procedure

4. What the environment will look and sound like when the child wakes up

4. What the environment will look and sound like when the child wakes up

A child is admitted to the pediatric medical unit with a diagnosis of Kawasaki disease. Which provider prescription should the nurse question?

1. Contact isolation

2. Oral aspirin every 8 hours

3. Echocardiogram

4. Vital signs every 4 hours

1. Contact isolation

A school-age client is diagnosed with rheumatic fever. Which parental statement indicates the need for further education by the nurse?

1. "I understand rheumatic fever is a strep infection of the heart."

2. "My child will be on bed rest for several weeks."

3. "My child will be treated with aspirin and/or corticosteroids."

4. "Once my child has recovered, she will still need to be monitored for sequelae to the disease."

1. "I understand rheumatic fever is a strep infection of the heart."

Which is the priority action by the school nurse for an adolescent who drops to the ground and is unresponsive during a high school basketball game?

1. Initiating cardiopulmonary resuscitation (CPR)

2. Calling 911

3. Offering the parents comfort

4. Assessing for hemorrhage

1. Initiating cardiopulmonary resuscitation (CPR)

Which is an appropriate statement for the nurse to include in the discharge instructions to the parents of a child who is recovering from cardiac surgery?

1. "The child will have a fever for several weeks following the surgery."

2. "The child will be restricted from most play activities."

3. "The child will not receive routine immunizations."

4. "The child will receive prophylactic antibiotics prior to any dental procedures."

4. "The child will receive prophylactic antibiotics prior to any dental procedures."

Which cardiovascular manifestations should the nurse anticipate for a pediatric client diagnosed with early compensated hypovolemic shock? Select all that apply.

1. Tachycardia

2. Weak distal pulses

3. Thready distal pulses

4. Normal blood pressure

5. Decrease in systolic blood pressure

1, 2, 4

Which cardiovascular manifestations should the nurse anticipate for a pediatric client diagnosed with moderate uncompensated hypovolemic shock? Select all that apply.

1. Tachycardia

2. Weak distal pulses

3. Thready distal pulses

4. Normal blood pressure

5. Decrease in systolic blood pressure

3, 5

Which strategies should the nurse recommend for a school-age client who is at risk for developing hypertension as an adult? Select all that apply.

1. Using seasoning substitutes for salt

2. Providing a list of foods high in sodium

3. Decreasing television time

4. Increasing physical activity

5. Monitoring blood pressure daily

1, 2, 3, 4

Which clinical manifestations does the nurse anticipate for a pediatric client who is diagnosed with the subacute stage of Kawasaki disease? Select all that apply.

1. High fever

2. Diarrhea

3. Thrombocytosis

4. Joint pain

5. Beau lines

3, 4

The mother of a toddler-age client states, "My daughter seems to be at an increased risk for complications associated with respiratory infections." Which response by the nurse is accurate?

1. "You are incorrect in your assessment."

2. "The younger child's airways are smaller and more easily occluded."

3. "Air passages are more likely to become blocked with mucus because younger children

make more mucus than older children."

4. "Toddlers do not breathe as deeply as do older children."

2. "The younger child's airways are smaller and more easily occluded."

Which nursing diagnosis should the nurse include in the plan of care for an infant diagnosed with acute bronchiolitis due to respiratory syncytial virus (RSV)?

1. Activity Intolerance

2. Ineffective Peripheral Tissue Perfusion

3. Acute Pain

4. Decreased Cardiac Output

1. Activity Intolerance

A toddler-age client presents to the emergency department with a sore throat and difficulty swallowing. The nurse suspects acute epiglottitis. Which nursing action is avoided based on the current assessment data?

1. Throat culture

2. Medical history

3. Vital signs

4. Auscultation of breath sounds

1. Throat culture

Which nursing action is appropriate for the parents of a 4-month-old infant who died due to sudden infant death syndrome (SIDS)?

1. Sheltering parents from the grief by not giving them any personal items of the infant, such as footprints

2. Allowing parents to hold, touch, and rock the infant

3. Advising parents that an autopsy is not necessary

4. Interviewing parents to determine the cause of the incident

2. Allowing parents to hold, touch, and rock the infant

Which immunization should the nurse include in a teaching session for parents of a toddler-age client to decrease the risk for epiglottitis?

1. Hepatitis B

2. Polio

3. Measles, mumps, and rubella (MMR)

4. Haemophilus influenzae type B (HIB)

4. Haemophilus influenzae type B (HIB)

The nurse receives a phone call from the parent of a child who is prescribed rifampin (Rimactane) for treatment of tuberculosis because she saw that the child's urine was orange. Which response by the nurse is accurate?

1. "Encourage your child to drink cranberry juice."

2. "An orange discoloration of urine is expected while your child is on this medication."

3. "Bring your child to the clinic for a urinalysis."

4. "Bring your child to the clinic for a radiograph of the kidneys."

2. "An orange discoloration of urine is expected while your child is on this medication."

Which parental statement at the conclusion of a teaching session regarding environmental controls for childhood asthma indicates correct understanding of the information presented?

1. "We're glad the dog can continue to sleep in our child's room."

2. "We'll keep the plants in our child's room dusted."

3. "We'll be sure to use the fireplace often to keep the house warm in the winter."

4. "We will replace the carpet in our child's bedroom with tile."

4. "We will replace the carpet in our child's bedroom with tile."

Which assessment data would cause the nurse to suspect that a newborn requires further testing for cystic fibrosis?

1. Rectal prolapse

2. Constipation

3. Steatorrheic stools

4. Meconium ileus

4. Meconium ileus

Which parental statement indicates correct understanding regarding pancreatic enzyme administration in the treatment of cystic fibrosis?

1. "I will administer this medication 4 times each day."

2. "I will administer this medication twice each day."

3. "I will administer this medication with meals and snacks."

4. "I will administer this medication every 6 hours around the clock."

3. "I will administer this medication with meals and snacks."

Which should the nurse include in a teaching session for the mother of a 3-year-old client who is concerned about her child choking?

1. Show the mother how to do cardiac compressions and rescue breathing.

2. Recommend the mother perform back blows and chest thrusts.

3. Teach the mother how to perform abdominal thrusts.

4. Tell the mother to do nothing until the child loses consciousness.

3. Teach the mother how to perform abdominal thrusts.

Which positions are appropriate for the nurse to include in a plan of care for the infant who is diagnosed with acute respiratory distress? Select all that apply.

1. Upright

2. Semi-Fowler position

3. Prone position

4. With the infant's head hyperextended

5. With the infant's head in a sniffing position

2, 5

Which nursing action is appropriate when providing care to a newborn with a respiratory rate of 102 breaths per minute with lungs that are clear to auscultation?

1. Administering the bath to the neonate in the nursery

2. Transferring to the neonatal intensive care unit for further observation

3. Allowing the neonate to room-in to promote bonding

4. Providing the first feeding in the nursery

2. Transferring to the neonatal intensive care unit for further observation

Which independent nursing action is appropriate for a 2-month-old infant who is a direct admission to the pediatric unit with a diagnosis of ALTE (apparent life-threatening event)?

1. Place the child on an apnea monitor.

2. Place the child on nasal cannula oxygen.

3. Draw blood for arterial blood gases.

4. Place the child on contact isolation.

1. Place the child on an apnea monitor.

Which is the priority nursing action for a premature neonate who is experiencing apnea?

1. Administering oxygen

2. Performing back blows and chest thrusts

3. Calling a code blue

4. Providing stimulation by stroking the back

4. Providing stimulation by stroking the back

Which statements should the nurse include in the discharge medication teaching for a child diagnosed with asthma who is prescribed cromolyn sodium (a mast cell stabilizer)? Select all that apply.

1. "The medication works to prevent exacerbations."

2. "The medication should be administered at the first symptom of an asthmatic attack."

3. "The medication should be taken on a daily basis."

4. "The medication should not be administered if the child has a cold."

5. "The medication desensitizes the child against specific allergens."

1, 3

Which is the priority nursing action for a child who presents in the emergency department after a motor vehicle accident with a sucking wound of the chest?

1. Placing the child in a Trendelenburg position

2. Beginning rescue breathing for the child

3. Beginning cardiac resuscitation for the child

4. Covering the child's wound with an air occlusive dressing

4. Covering the child's wound with an air occlusive dressing

Which data collected during the respiratory assessment would indicate the pediatric client is compromised? Select all that apply.

1. Lung sounds clear to auscultation

2. Stridor

3. Substernal retractions

4. Nasal flaring

5. Strong cry

2, 3, 4

Which should the nurse assess to determine oxygenation during the respiratory assessment for a pediatric client? Select all that apply.

1. Mucous membranes

2. Nail beds

3. Skin

4. Sclerae

5. Corneas

1, 2, 3

Which nursing actions are appropriate when providing care to a pediatric client who has sustained a smoke-inhalation injury? Select all that apply.

1. Assessing for respiratory distress

2. Auscultating the lungs for wheezing

3. Prescribing oxygen for low saturations

4. Administering prescribed prophylactic antibiotic therapy

5. Providing support to the family

1, 2, 5

Which pediatric clients would require a nursing assessment for blunt chest trauma? Select all that apply.

1. A preschool-age client who is admitted after a house fire.

2. A toddler-age client who is admitted for injuries sustained in a motor vehicle accident.

3. A school-age client who is admitted for observation after a skateboarding accident.

4. An adolescent client admitted for an asthma exacerbation.

5. An infant admitted to rule out cystic fibrosis.

2, 3

Which nursing assessment data would indicate that a pediatric client sustained a large pulmonary contusion in a motor vehicle crash? Select all that apply.

1. Eupnea

2. Dyspnea

3. Hemoptysis

4. Fever

5. Crackles

2, 3, 4, 5

Which is the rationale for why young children are more prone to otitis media that the nurse should include in the teaching session with a parent?

1. The eustachian tube is shorter, wider, and horizontal in younger children.

2. The eustachian tube is shorter, more narrow, and horizontal in younger children.

3. The eustachian tube is longer, wider, and vertical in younger children.

4. The eustachian tube is longer, more narrow, and vertical in younger children.

1. The eustachian tube is shorter, wider, and horizontal in younger children.

Which neonate requires a close nursing assessment for the development of retinopathy of prematurity (ROP)?

1. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1400 g

2. 32-weeks'-gestation infant of African heritage with a congenital heart defect who needed no oxygen and weighed 1850 g

3. 28-weeks'-gestation female infant who was on short-term oxygen, weighed 1420 g, and was treated with phototherapy

4. 36-weeks'-gestation, small-for-gestational-age infant who was in an oxyhood for 12 hours and weighed 1800 g

1. 28-weeks'-gestation infant who has been on long-term oxygen and weighed 1400 g

Which is the priority nursing assessment for a pediatric client who is postoperative for tonsillectomy?

1. Arrhythmias

2. Dehydration

3. Increased blood sugar

4. Increased urinary output

2. Dehydration

A neonate is diagnosed with a herpes simplex viral infection of the eye. Which medication should the nurse prepare to administer?

1. Oral erythromycin

2. Fluoroquinolone eyedrops or ointment

3. Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment

4. Intravenous penicillin

3. Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment

A nurse is caring for a visually impaired 20-month-old client who has not begun to walk. Which nursing diagnosis would be appropriate for this child?

1. Self-care Deficit

2. Impaired Physical Mobility

3. Impaired Home Maintenance

4. Delayed Development

4. Delayed Development

A nurse is caring for a visually impaired school-age child. Which is the priority nursing intervention during the admission process to the hospital?

1. Explaining playroom policies

2. Orienting the child to where furniture is placed in the room

3. Taking the child on a tour of the unit

4. Letting the child touch equipment that will be used during the child's hospitalization

2. Orienting the child to where furniture is placed in the room

Which should the nurse include in the discharge instructions for the parents of an infant who is diagnosed with acute otitis media?

1. Keep the baby in a flat position during sleep.

2. Administer a decongestant.

3. Place the baby to sleep with a pacifier.

4. Administer acetaminophen (Tylenol) to relieve discomfort.

4. Administer acetaminophen (Tylenol) to relieve discomfort.

Which parental statements indicate correct understanding of the care that is needed for a pediatric client after the insertion of tympanostomy tubes? Select all that apply.

1. "It is important to limit my child's diet after surgery and only allow soft, bland foods."

2. "I should restrict my child to quiet activities after surgery."

3. "I should plan to administer a decongestant to my child for 1 to 2 weeks following surgery."

4. "It is important for my child to drink plenty of fluids after the procedure."

5. "I will remind my child to use ear plugs prior to showering and swimming."

2, 4, 5

Which nursing action is appropriate when providing care to a child with a mild hearing loss who reads lips to enhance adaptation during hospitalization?

1. Touching the child lightly before speaking

2. Using a picture board as the main means of communication

3. Speaking in a loud voice while facing the child

4. Speaking directly to the parents for communication

1. Touching the child lightly before speaking

Which is an appropriate nursing intervention for a child who experiences epistaxis?

1. Laying the child down and applying a warm pack.

2. Tilting the child's head back, squeezing the bridge of the nose, and applying a warm moist pack to the nose.

3. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose.

4. Immediately packing the nares with a cotton ball soaked with phenylephrine (Neo-Synephrine).

3. Tilting the child's head forward, squeezing the nares below the nasal bone, and applying ice to the nose.

Which parental statement indicates correct understanding of discharge instructions for a pediatric client after a tonsillectomy?

1. "We will call the healthcare provider for any indication of ear pain."

2. "We will be sure to give our child adequate amounts of citrus juices."

3. "We will plan on administering acetaminophen (Tylenol) for pain."

4. "We will keep our child on bed rest for 10 days after the surgery."

3. "We will plan on administering acetaminophen (Tylenol) for pain."

Which information should the nurse include in a teaching session regarding treatment for the common cold in the pediatric population?

1. Aspirin should be taken for alleviation of fever if the common cold is contracted.

2. Antibiotics will eliminate the nasopharyngitis virus.

3. Vaccinations can prevent contraction of a nasopharyngitis virus.

4. Proper hand washing can prevent the spread of the common cold.

4. Proper hand washing can prevent the spread of the common cold.

Which assessment finding is considered normal for a school-age client?

1. Tonsils are large and seem to fill the throat.

2. Child is complaining of sore throat and drooling

3. White patches are observed on the tonsils.

4. Throat appears red, and child has a low-grade fever

1. Tonsils are large and seem to fill the throat.

Which topics should the nurse include in a teaching session to the parents of a 10-month-old infant who experiences frequent ear infections? Select all that apply.

1. Prohibiting tobacco smoke in the home

2. Avoiding use of a pacifier while the child is sleeping

3. Breastfeeding the infant

4. Cleaning the child's ears nightly with peroxide

5. Avoiding use of wood-burning stoves

1, 2, 5

Which is the reason for a healthcare provider to recommend that a preschool-age male client with a documented hearing loss should attend preschool at least 2 days per week?

1. Help the child recognize his hearing deficit.

2. Increase the child's socialization skills.

3. Improve the child's immunity by increased exposure to organisms.

4. Teach other children that children are different.

2. Increase the child's socialization skills.

Which screening tool should the nurse use to screen a pediatric client for esotropia?

1. Examine the eye with an otoscope.

2. Check for the "red reflex" in the eyes.

3. Perform the cover-uncover test.

4. Use a tonometer to evaluate the eyes.

3. Perform the cover-uncover test.

Which is a priority nursing assessment the nurse includes in the plan of care for a pediatric client who has received a cochlear implant?

1. Ringing in the ears

2. Pharyngitis

3. Hearing loss

4. Bacterial meningitis

4. Bacterial meningitis

Which nursing actions are appropriate when providing care to a 12-year-old client who has lost several teeth as a result of a facial injury? Select all that apply.

1. Not worrying about the tooth loss, as children this age still have their "baby" teeth

2. Only handling the lost tooth by the roots and avoiding touching the crown of the tooth

3. Rinsing the lost tooth with sterile saline

4. Placing the tooth back into its socket and taking the child to an emergency dental facility

5. Keeping the tooth clean and dry during transport to an emergency dental facility

3, 4

Which parental statements indicate correct understanding of the anatomy and physiology of the infant's mouth, nose, and throat? Select all that apply.

1. "My baby will breathe through her mouth during the first 3 months of life."

2. "When my baby has a cold she may have trouble with bottle feedings."

3. "My baby's tonsils will be largest during infancy."

4. "I should expect my baby's first tooth to erupt during the first 6 months of life."

5. "I should expect my baby to lose her first tooth during the first year of life."

2, 4

Which common eye disorders should the nurse include in a teaching session for the parents of pediatric clients? Select all that apply.

1. Hyperopia

2. Myopia

3. Astigmatism

4. Strabismus

5. Cataracts

1, 2, 3

Which visual screenings should the school nurse conduct when conducting annual assessments for school-age children? Select all that apply.

1. Light reflex assessment

2. Cover-uncover test

3. Acuity testing

4. Visualization of the tympanic membrane

5. Cranial nerve VIII testing

1, 2, 3

Which should the nurse include in the plan of care for a pediatric client who is diagnosed with periorbital ecchymosis? Select all that apply.

1. Apply ice to the site for 5 to 15 minutes every hour for the first 1 to 2 days.

2. Apply warm compresses beginning on day 3.

3. Apply antibiotic ointment to the conjunctiva for 7 to 10 days.

4. Apply a patch to the affected eye for 5 to 7 days.

5. Apply antibiotic drops to the conjunctiva for 7 to 10 days.

1, 2

Which should the nurse include in the plan of care for a pediatric client diagnosed with otitis media with effusion? Select all that apply.

1. Administration of antibiotic drops per order

2. Administration of pain relief measures

3. Assessment of hearing acuity over several months

4. Assessment of speech

5. Assessment of development

2, 3, 4, 5

A 4-year-old child is admitted to the hospital secondary to dehydration. Laboratory tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. Which condition does the nurse suspect based on the current data?

1. Hypernatremia

2. Metabolic acidosis

3. Hypotonic dehydration

4. Isotonic dehydration

3. Hypotonic dehydration

A nurse is taking care of four different pediatric clients. Which child is at greatest risk for dehydration?

1. 7-year-old child with migraine headaches

2. 4-year-old child with a broken arm

3. 2-year-old child with cellulitis of the left leg

4. 18-month-old child with tachypnea

4. 18-month-old child with tachypnea

Which parental statement indicates correct understanding of preventive techniques for heat-related illnesses when children exercise?

1. "Wearing dark clothing during exercise is recommended."

2. "Water is the fluid of choice to replenish fluids."

3. "During activity, stop for fluids every 15 to 20 minutes."

4. "Hydration should occur at the end of an exercise session."

3. "During activity, stop for fluids every 15 to 20 minutes."

The nurse is assessing an infant brought to the clinic because of diarrhea. The infant is alert but has dry mucous membranes. Which additional assessment data indicates to the nurse that the infant is experiencing an early to moderate stage of dehydration?

1. Bradycardia

2. Tachycardia

3. Increased blood pressure

4. Normal fontanels

2. Tachycardia

In the morning, a nurse receives change-of-shift report on four pediatric clients, each of whom has some form of fluid-volume excess. Which of the children should the nurse see first?

1. The child with tachypnea and pulmonary congestion

2. The child with hepatomegaly and normal respiratory rate

3. The child with dependent and sacral edema and regular pulse

4. The child with periorbital edema and normal respiratory rate

1. The child with tachypnea and pulmonary congestion

The nurse is caring for a child on bed rest who has severe edema in a left lower extremity due to blocked lymphatic drainage. Which nursing diagnosis would take priority?

1. Risk for Impaired Skin Integrity

2. Risk for Altered Body Image

3. Risk for Imbalanced Nutrition: Less Than Body Requirements

4. Risk for Activity Intolerance

1. Risk for Impaired Skin Integrity

A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a licensed vocational nurse (LVN), cautions the LVN to immediately report which clinical manifestation?

1. Seizures

2. Respiratory distress

3. Hyperthermia

4. Bradycardia

1. Seizures

A nurse is planning care for a child with hyperkalemia. Which manifestation associated with the documented hyperkalemia requires immediate intervention by the nurse?

1. Hyperthermia

2. Respiratory distress

3. Seizures

4. Cardiac arrhythmias

4. Cardiac arrhythmias

A child with croup has an increased PCO2, a decreased pH, and a normal HCO3 blood gas value. Which does the nurse report to the healthcare provider based on these data?

1. Uncompensated metabolic alkalosis

2. Uncompensated metabolic acidosis

3. Uncompensated respiratory acidosis

4. Uncompensated respiratory alkalosis

3. Uncompensated respiratory acidosis

The nurse is expecting the admission of a child with severe isotonic dehydration. Which intravenous fluid prescription does the nurse anticipate for this child?

1. 0.9% normal saline (NS)

2. D5 0.2% (1⁄4) normal saline

3. D5W

4. Albumin

1. 0.9% normal saline (NS)

A 6-year-old child is hypokalemic. Which menu choice should the nurse encourage for this child?

1. Pizza with a fruit plate

2. Chicken strips with chips

3. Fajita with rice

4. A hamburger with French fries

1. Pizza with a fruit plate

A child is admitted to the hospital for hypercalcemia and is placed on diuretic therapy. Which diuretic would the nurse expect to give?

1. Furosemide (Lasix)

2. Hydrochlorothiazide (Aquazide)

3. Spironolactone (Aldactone)

4. Mannitol (Osmitrol)

1. Furosemide (Lasix)

The nurse is completing the intake and output record for a child admitted for fluid volume deficit. The child has had the following intake and output during the shift:

Intake:

4 oz of Pedialyte

One-half of an 8-oz cup of clear orange Jell-O

Two graham crackers

200 mL of D51/2 sodium chloride IV

Output:

345 mL of urine

50 mL of loose stool

How many milliliters should the nurse document as the client's total intake? Give thenumerical answer only. Do not include any units of measurement.

440mL

A child is being treated for dehydration with intravenous fluids. The child currently weighs 13 kg and is estimated to have lost 7% of his normal body weight. The nurse is double-checking the IV rate the healthcare provider prescribed. The formula the healthcare provider used was for maintenance fluids: 1000 mL for 10 kg of body weight plus 50 mL for every kilogram over 10 for 24 hours. Replacement fluid is the percentage of lost body weight × 10 per kg of body weight. According to the calculation for maintenance plus

replacement fluid, which hourly IV rate will the nurse implement for 24 hours?

1. 88 mL/hr

2. 86 mL/hr

3. 81 mL/hr

4. 83 mL/hr

2. 86 mL/hr

A 9-month-old infant is hospitalized with vomiting and diarrhea. The mother questions why her child needed hospitalization since her school-age nephew had the same symptoms and was treated at home. Which should the nurse include in the explanation to the infant's mother? Select all that apply.

1. Infants have a lower proportion of their body weight as water.

2. The percentage of extracellular fluid is higher in the infant than the school-age child.

3. School-age children have a larger body surface area.

4. The school-age child's kidneys are more mature and better able to conserve water.

5. The metabolic rate of the school-age child is higher.

2, 4

As a result of opioid administration, a child's respirations are slow and shallow. Which should the nurse anticipate when assessing the child's arterial blood gas?

1. Increased PCO2 and respiratory acidosis

2. Decreased PCO2 and respiratory alkalosis

3. Low pH and low PCO2

4. High pH and high PCO2

1. Increased PCO2 and respiratory acidosis

Which rationale will the seasoned nurse share with the novice nurse regarding why the specific gravity for infants is lower than for older children?

1. The infant has a greater body surface area.

2. The infant has a higher basal metabolic rate.

3. The infant has a greater percentage of body weight that is water.

4. The infant's kidneys are less able to concentrate urine.

4. The infant's kidneys are less able to concentrate urine.

Which is the priority nursing assessment when providing care for an infant at risk for dehydration?

1. Urine output

2. Urine specific gravity

3. Vital signs

4. Daily weight

4. Daily weight

Which pediatric client diagnoses necessitate close monitoring for respiratory acidosis? Select all that apply.

1. Aspiration

2. Epiglottitis

3. Sepsis

4. Meningitis

5. Cystic fibrosis

1, 2, 5

Which pediatric client diagnoses necessitate close monitoring for respiratory alkalosis? Select all that apply.

1. Aspiration

2. Epiglottitis

3. Sepsis

4. Meningitis

5. Cystic fibrosis

3, 4

The nurse is assessing a pediatric client who is experiencing metabolic acidosis. Which assessment questions should the nurse include when interviewing the child's parents? Select all that apply.

1. "Has your child consumed any aspirin?"

2. "Has your child consumed any boric acid?"

3. "Has your child consumed any antifreeze?"

4. "Has your child consumed any baking soda?"

5. "Has your child consumed any antacids?"

1, 2, 3

The nurse is assessing a pediatric client who is experiencing metabolic alkalosis. Which assessment questions should the nurse include when interviewing the child's parents? Select all that apply.

1. "Has your child consumed any aspirin?"

2. "Has your child consumed any boric acid?"

3. "Has your child consumed any antifreeze?"

4. "Has your child consumed any baking soda?"

5. "Has your child consumed any antacids?"

4, 5

Which age-appropriate techniques should the nurse implement in order to encourage a young child to participate in deep breathing exercises? Select all that apply.

1. Showing the child how to use the "blow bottle"

2. Using a pinwheel that the child plays with and asking the child to blow until it turns

3. Asking the child to blow bubbles in a glass of water using a straw

4. Having the child blow scraps of paper across the bedside table with a straw

5. Telling the child that a "shot" will be needed if the child does not follow the nurse's directions

2, 3, 4