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The nurse is preparing to administer an immunization to a four-year-old child. Which of the following actions should the nurse plan to take?
administer the immunization using a 24-gauge needle
A nurse is reviewing the laboratory report of an infant who is receiving treatment for severe dehydration. The nurse should identify which of the following laboratory values indicates effectiveness of the current treatment?
sodium 140
The nurse is providing teaching about Social Development to the parents of a preschooler. Which of the following play activities should the nurse recommend for the child?
playing dress-up
A nurse is teaching the parents of a newborn about ways to prevent sudden infant death syndrome SIDS. Which of the following instructions should the nurse include?
Give the infant a pacifier at bedtime.
A nurse is assessing an infant who has pneumonia. Which of the following findings is the priority for the nurse to report to the provider?
Nasal flaring
A school nurse is assessing a school-age child blood pressure while he is seated
in a chair. The child starts to experience a tonic-clonic seizure. Which of the following actions should the nurse take first?
Assist the child to a side-lying position on the floor
A nurse is receiving change-of-shift Report on for children. Which of the following children should the nurse assesses first?
A toddler who has a concussion and an episode of forceful vomiting
A nurse in the emergency department is caring for an adolescent who has severe abdominal pain due to appendicitis. Which of the following locations should the nurse identify as McBurney's point?
A is correct. The nurse should identify the lower right quadrant of the abdomen
between the umbilicus and the anterior iliac crest as the location of Burney's
point.

A nurse is providing teaching to the family of a school-age child who has juvenile idiopathic arthritis. Which of the following instructions should the nurse include in the teaching?
Encourage the child to perform independent self-care
A nurse is assessing a client who has a new diagnosis of celiac disease. Which of the following clinical manifestations should the nurse expect?
Steatorrhea
A nurse is providing teaching to an adolescent about how to manage tinea pedis. Which of the following statements by the Adolescent indicates an understanding of the teaching?
I should I seal my non washable shoes in plastic bags for a couple of weeks
A Nurse is teaching the parents of a school-aged child who has a new diagnosis of osteomyelitis of the tibia. The nurse should identify that which of the following statements by the parents indicates an understanding of the teaching?
My child will receive antibiotics for several weeks
A nurse is auscultating the lungs of an adolescent who has asthma. The nurse should identify the sound as which of the following? Click the audio button to listen.
tachypnea
A nurse in an emergency department is caring for a school-age child who is experiencing an anaphylactic reaction. Which of the following is the priority action by the nurse?
Administer IM epinephrine to the
child
A nurse at an urgent care clinic is assessing an adolescent client who has an upper respiratory tract infection. Which of the following findings should the
nurse recognize as a manifestation of pertussis?
Dry, hacking cough
A nurse is providing teaching about car seat use to the mother of a six-monthold
infant. Which of the following statements by the mother indicates an understanding of the teaching?
I should secure the car seat using lower
anchors and tethers instead of the seat belt
A nurse is assessing the pain level of a three-year-old toddler. Which of the
following pain assessment scales should the nurse use?
FACES Pain rating scale
A nurse is caring for a preschooler who is scheduled for hydrotherapy treatment for wound debridement following a burn injury. Which of the following actions should the nurse take prior to the procedure?
Administer an analgesic to the child
A nurse is caring for a 10-year-old child following a head injury. Which of the following findings should the nurse identify as an indication that the child is developing diabetes insipidus?
Sodium 155
A nurse is creating a plan of care for a toddler who has minimal change nephrotic syndrome mcns and 3 + pitting edema. Which of the following interventions should the nurse include in the plan?
Administer corticosteroids to the toddler
A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistent asthma. Which of the following instructions should the nurse include?
Pulmonary function test will be performed every 12 to 24 months to evaluate how your child is responding to therapy
A nurse is assessing a three-year-old toddler at a well-child visit. Which of the following manifestations should the nurse report to the provider?
respiratory rate 45/min
A nurse is preparing an adolescent for a lumbar puncture. Which of the following actions should the nurse take?
Apply topical analgesic cream to the site one hour prior to the procedure
A nurse is providing teaching to the parents of a toddler about the administration of a prescribed eye drops and eye ointment. Which of the following instructions should the nurse include?
Administer the eye drops 3 minutes before the ointment
The nurse is providing discharge teaching to the parent of an 18-month old toddler who has dehydration as a result of acute diarrhea. Which of the following statements by the parent indicates an understanding of the teaching?
I will monitor my child's number of wet diapers
A nurse is preparing to collect a sample from a toddler for a sickle turbidity test. Which of the following actions should the nurse plan to take?
perform a finger stick
A nurse is caring for a school-age child who has peripheral edema. Which of the following assessments should the nurse perform to confirm peripheral
edema?
Palpate the dorsum of the child's feet
A nurse in the emergency department is caring for a toddler who has partial thickness burns on his right arm. Which of the following actions should the nurse take?
Cleanse the affected area with mild soap and water
A nurse is performing hearing screenings for children at a community health
fair. Which of the following children should the nurse refer to a provider for
a more extensive hearing evaluation?
An infant who is 8 months old and is not yet making babbling sounds
A nurse is providing dietary teaching to the parent of a school-age child who has cystic fibrosis. Which of the following statements should the nurse make?
You should offer your child high protein meals and snacks
throughout the day
The nurse is providing dietary teaching to the parent of a school-age child
who has celiac disease. The nurse should recommend that the parent offer
which of the following foods tote child?
rice pudding
A nurse is providing teaching to the parents of a preschooler who has heart failure and who is to begin taking Digoxin twice-daily. Which of the following instructions should the nurse include in the teaching?
Brush the child teeth after giving the medication
A nurse is providing teaching to the parent of a school-age child who has oral candidiasis and is to begin taking oral Nystatin. Which of the following
instructions should the nurse include?
Check the medication prior to
Administration
The nurse is providing anticipatory guidance to the mother of a toddler.
Which of the following expected Behavior characteristics of toddlers should the nurse include in the teaching?
expresses likes and dislikes
The nurse is reviewing the laboratory report of a school-age child who is experiencing fatigue. Which of the following findings should the nurse
recognize as an indication of anemia?
Hematocrit 28%
A nurse is creating a plan of care for an infant who has an epidural hematoma with a skull fracture. Which of the following actions should the nurse include in the plan?
implements seizure precautions for the infants
A nurse in an emergency department is performing a physical assessment on a 2-week old male infant. Which of the following manifestations is the priority for the nurse to report to the provider?
substernal retractions
A nurse is providing discharge teaching to the parents of a three-month-old infant following acheiloplasty. which of the following instructions should the nurse include?
apply a thin layer of antibiotic ointment on your babies' suture line daily for the next three days
A nurse is caring for a hospitalized preschooler. The child's mother is going
home for a few hours while another relative stay with the child. Which of the following statements should the nurse make to explain to the child when her mother will return?
your mommy will be back after you eat
A nurse is planning developmental activities for a newly admitted 10-year-old
child who has neutropenia. Which of the following actions should the nurse plan to take?
Provide the child with a book about Adventure
A nurse in the emergency department is caring for a school-age child who has
epiglottitis.Which of the following actions should the nurse take?
monitor the child's oxygen saturation
A nurse in an Emergency Department is assessing a three-month-old infant who has rotavirus and is experiencing acute vomiting and diarrhea. Which of the following manifestations should the nurse identify as an indication that
the infant has moderate to severe dehydration?
sunken anterior fontanel
A nurse is creating a plan of care for a newly admitted adolescent who has bacterial meningitis. How long should the nurse plan to maintain the Adolescent in droplet precautions?
for 24 hours following initiation of antimicrobial therapy
A school nurse is assessing an adolescent who presents with multiple Burns in various stages of healing. Which of the following behaviors should the nurse identify as suggestive of possible physical abuse?
denies discomfort during assessment of injuries
A nurse is assessing an adolescent who received a sodium polystyrene sulfonate enema. Which of the following findings indicates effectiveness of the medication?
The Adolescents serum potassium level is 4.1
A nurse is planning care for a toddler who has a serum lead level of 4 mcg/dL. Which of the following actions should the nurse plan to take?
schedule the toddler for a yearly screening
A nurse is assessing a school-age child immediately post-operative following a
perforated appendix repair. Which of the following findings should the nurse expect?
absence of peristalsis
A nurse is teaching the parents of a toddler who has cognitive
impairment about toilet training. which of the following instructions should the nurse include in the teaching?
Award the child with a sticker when he sits on the potty chair
A nurse in a provider's office is caring for a school-age child who has varicella. The parent askthe nurse when her child will no longer be contagious. Which of the following responses should the nurse make?
When your child lesions are crusted, 6 days after they appear
A nurse is caring for a school-age child who has primary nephrotic syndrome
and is taking prednisone. Following one week of treatment, which of the
following clinical manifestations indicate to the nurse that the medication is effective?
Decrease edema
A nurse is caring for a toddler who has spastic (pyramidal) cerebral palsy. Which of the following clinical manifestations should the nurse expect? Select all that apply.
Ankle clonus
Exaggerated stretch reflexes
Contractures
A nurse is assessing the vital signs of a 10 year old child following a burn injury. Which of thefollowing clinical manifestations indicate early septic shock?
Temperature 39.1 degrees Celsius or 102.4 degrees Fahrenheit
A nurse is creating a plan of care for a preschooler who has Wilms tumor and is scheduled for surgery. Which of the following interventions should the nurse include?
Avoid palpating the abdomen when bathing the child before surgery
A charge nurse in an emergency department is preparing an in-service for a group of newly licensed nurses on the clinical manifestations of child maltreatment. Which of the following clinical manifestations should the charge nurse include as suggestive of potential physical abuse?
Symmetric Burns of the lower extremities
The nurse is caring for a 15 year old client following a head injury. Which of
the following findings should the nurse identify as an indication that the child is
developing syndrome ofinappropriate antidiuretic hormone secretion SIADH?
Mental confusion
A nurse in a provider's office is preparing to administer immunizations to a
toddler during awell-child visit. Which of the following actions should the
nurse plan to take?
Prescriptions:
-tuberculin skin test (TST)
-measles mumps rubella
vaccine
-inactivated influenza vaccine
-diphtheria, tetanus, and pertussis (DTaP vaccine)
Vital signs
-respiratory rate 24/minute
-heart rate 115/minute
-temperature 37.4 degrees Celsius or 99.3 degrees Fahrenheit
History and physical
-Age 12 months 9 days
-height 71.1cm/28-in
allergies
neomycin - anaphylactic reaction
caregiver reports:
-rhinitis with clear nasal drainage for 2days
-occasional non productive cough for 2 days
-history of asthma
Withhold the measles mumps and rubella MMR vaccine
A nurse is caring for a preschooler who has been receiving IV fluids via a peripheral IV catheter. When preparing a to discontinue the IV fluids and
catheter, which of the followingactions should the nurse plan to take? Place
the steps in order of performance.
1) turn off the IV pump
2) occlude the IV tubing
3) remove the tape securing the catheter
4) apply pressure over the catheter insertion site
A nurse is reviewing the dietary choices of an adolescent who has iron deficiency anemia. the nurse should identify that which of the following menu items has the highest amount of iron?
1/2 cup raisins
A nurse is creating an educational plan to teach parents about protecting their
children fromsun burns. Which of the following instructions should the nurse
plan to include?
Choose a waterproof sunscreen with an SPF of at least 15
A nurse is providing care to a group of children at a pediatric clinic. Which of the following children meets the criteria to receive a varicella vaccine?
A child who has a cold and nasal discharge.
A nurse is preparing a 4-year-old child for discharge following a bilateral myringotomy with tympanostomy tube placement. The mother asks what to do if the tubes fall out. Which of the following instructions should the nurse give the parent?
Call the health care clinic to report that the tubes have fallen out.
A nurse is caring for a toddler who has intussusception. Which of the following manifestations should the nurse expect?
Mucus and blood in stools.
A nurse is planning to monitor a client for dehydration following several episodes of vomiting and an increase in the client’s temperature. Which of the following findings should the nurse identify as an indication that the client is dehydrated?
Urine specific gravity 1.034.
A nurse is caring for a child who is having a tonic-clonic seizure and vomiting. Which of the following actions is the nurse’s priority?
Move the child into side- lying position.
A 10-year-old child was admitted with full-thickness burns affecting more than 15% of the child’s body surface. What manifestations of hypovolemic shock would you observe for over the next 48 hrs? Select all choices that apply:
- Rapid pulse.
- Decreased blood pressure.
- Pallor.
A nurse is providing teaching to a school-age child who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the child indicates a need for additional teaching?
"I should not take my regular insulin when I am sick."
A nurse is gathering information from a 1-year-old child who has been diagnosed with Wilms’ tumor. Which of the following symptoms should the nurse anticipate?
Abdominal Mass
A nurse is caring for a 2-year-old child who has been diagnosed with nephrotic syndrome. The nurse collects data knowing that a common characteristic associated with nephrotic syndrome is:
Generalized edema
A nurse is attending a continuing education course about communicable diseases. The nurse should identify that varicella has which of the following incubation periods?
2 to 3 weeks