1. Which concept reinforces the development of a 11. When assessing a family, the nurse 22.
urse 22. The nurse is caring for a patient who has
sense of trust for an infant? They can predict
what is coming and their needs are consistently
met
2. What childhood vaccine provides some
protection against bacterial meningitis, epiglottitis,
and bacterial pneuomonia? Hib vaccine
3. The nurse is assessing breath sounds on a child.
Which is a physiologically expected auscultated
breath sound? Vesicular
4. Children do not like the discomfort associated
with venous, arterial, and capillary punctures.
Which of the following is the most appropriate
pain reduction technique to use with most children
before these painful procedures? Apply EMLA
cream topically over the site if time permits
5. A parent brings a 6 month old to the pediatric
clinic for her well baby examination. Her birth
weight was 8.2 lbs. The nurse weighing the infant
today would expect her weight to be at least? 16 lb
6. Along with birth, which of the following is a
significant risk predictor for infant mortality risk?
Gestational age
7. A child has been diagnosed with giardiasis.
Which prescribed medication should the nurse
expect to administer? Tinidazole (Tindamax)
8. A nurse is assessing a 2 ½ y.o toddler at a well
child visit. Which clinical finding should be
reported to the healthcare provider? Head
circumference exceeds chest circumference
(hydrocephaly)
9. Select the rational for the relationship between
children having anemia and lead poisoning.
Children with anemia absorb lead more easily
10. A 7 month old patient with up-to-date
immunization has a runny nose, low-grade fever,
and a paroxysmal cough that has worsened over the
past few days. The patient had coughed so hard
that scleral hemorrhages are present. The most
likely diagnosis is? Pertussis
32. Select the heart sound produced by vibrations
determines that the parents expect rules to be
followed rigidly and unquestioningly. This style
of parenting is called? Authoritarian
12. Parents ask the nurse if there was something
that should have been done during the pregnancy
to prevent the child’s cleft lip. Which statement
should the nurse give as a response? The
malformation occurs at approximately 6 weeks
of gestation, there is no known way to prevent
this
13. A 3 month old dies shortly after arrival to the
emergency department. The infant has subdural
and retinal hemorrhages but no external sign of
trauma. The nurse should suspect: Shaken baby
syndrome
14. Select the vaccines usually given to children
at 2 months of age according to the immunization
schedule. DTaP, IPV, PCV, HIB, RV
15. Which of the following statements is true of X
linked recessive inheritance? Affected males
have symptoms of the disorder
16. A newborn’s assessment reveal a fused digit
on the left hand. Which of the following is used to
define fused digits of the hands or feet?
Syndactaly
17. By which age should the nurse expect that an
infant will be able to pull to a standing position?
11 to 12 months
18. Which of the following nonpharmacologic
interventions appears to be effective in decreasing
neonatal procedural pain? Oral sucrose and
nonnutritive sucking
19. Which term describes irregular areas of deep
blue pigmentation seen predominantly in infants
of African, Asian, Native American, and Hispanic
descent? Mongolian spots
20. The Apgar score of an infant 5 minutes after
birth is 5. Which is the nurse’s best interpretation
of this? Resuscitation is likely to be needed
21. According to Piaget, adolescents tend to be in
what stage of cognitive development? Formal
operational thought
chosen to breastfeed her infant. Which statement
should the nurse include when teaching the
mother about breastfeeding problems that may
occur? If mastitis occurs, continue
breastfeeding while taking prescribed
antibiotics and apply warm compresses
23. A child with acetaminophen (Tylenol)
poisoning has been admitted to the emergency
department. What antidote does the nurse
anticipate being prescribed? N-acetylcysteine
(Mucomyst)
24. Exposure to which of the following
communicable diseases pose a serious threat to
fetuses during the first trimester of pregnancy?
Rubella
25. At which age should the nurse expect an
infant to begin smiling in response to pleasurable
stimuli? 2 months
26. One of the most common intestinal parasitic
pathogens in the United States acquired from a
contaminated water source such as a lake or
swimming pool is? Giardia intestinalis
27. What do morbidity statistics describe? The
prevalence of specific illness in the population
at a particular time
28. A child is admitted to the hospital with an
undiagnosed rash. The best initial nursing action
of the pediatric nurse should be? Place child in
contact precaution isolation
29. Which statement best describes the use of the
word ‘family’? A group that is what an
individual considers it to be
30. The nurse is ready to perform a physical exam
on a 9 month old infant. Where should the nurse
place the infant? On the parent’s lap
31. The parents of a child diagnosed with an
autosomal recessive condition consult the nurse
stating they want to have more children but are
worried about subsequent children also inheriting
the disease. What information should the nurse
provide to the parents? Each child has a 1 in 4
risk of inheriting the disease
within the heart chambers or in the major arteries
from the back and forth flow of blood. Murmur
33.Select from the following list the two basic
concepts used by Pediatric Nurses to foster family
centered care with children and their families:
Enabling and Empowerment
34. A child begins to blame his father for his
parent’s divorce and has displayed intense anger
towards his father. In which age group of children
is this most likely to occur? School age
35. The parents of an infant with a cleft palate ask
the nurse “What follow-up care will our infant
need after the repair?” Which is an accurate
response by the nurse? Your infant will need
follow-up care with audiologists and
orthodontists
36. A 6 y.o male is diagnosed with a heart
murmur that can be heard without the
stethoscope. The nursing student is aware that this
occurs at which of the following grade? VI
37. At what age should the nurse expect most
infants to be saying Mama or Dada? 10 months
38. The mother of a 3 month old breastfed infant
asks about giving her baby water because it is
summer and very warm. What should the nurse
tell her? Fluids in addition to breastmilk are
not needed
39. An infant with an isolated cleft lip is admitted
to the ICU for pre-op care. Which information
should the nurse plan to discuss while educating
the parents?(Select all) Use check support while
feeding with special nipples, the infant may be
restrained after surgery, and multiple
specialists will be assigned to infant’s care
40. Which of the following symptoms are usually
seen in a child with Rubeola (Measles)? Rash
appearing on the 3rd day, Kolpik spots, and
Conjunctivitis
41. What identified characteristics occur more
frequently in parents who abuse their children?
(Select all) Socially isolated, Few supportive
relationships, and Single parent families
42. The nurse is reviewing the Healthy People 202
leading health indicators for a child health
promotion program, Which are included in the
leading health indicators?(Select all) Improve
imnization rates, Increase access to healthcare,
Decrease tobacco use
43. Select the disorders from the list classified as
inborn error of metabolism diseases.(Select all)
Phenylketonuria, Galactocemia
44. Which is a sex chromosome abnormality that is
caused by the absence of an X chromosomes in a
female?
Turner
45. Identify the age group of children per Erickson
in the development stage of industry vs inferiority:
6-12
46. Which condition/behavior manifested by an 11
month old infant warrants further evaluation?
Unable to pull to a standing position
47. The nurse notes that a 12 month old infant who
weighed 6.5 lbs at birth now weighs 20.5 lbs. What
is the nurse’s evaluation of the infant’s current
weight? Infant’s weight is appropriate for the
age
48. A parent reports to the nurse that her child has
inflamed conjunctivae of both eyes with itching
and watery to thick stringy discharge. These
manifestations suggest? Allergic conjunctivitis
49. Select an initial assessment included in the
Apgar scoring system? Color
50. A 2 y.o is scheduled to have a tonsillectomy.
How would you educate the patient? Use picture
books and puppets and repeat explanations
51. You are observing a 5 month old for
developmental skills. Which of the following skills
would concern you if the infant was not
demonstrating? Turn head to locate sound
52. Which of the following is true regarding deaths
caused by unintentional injuries in childhood?
More deaths occur in males
53. A pregnant teen agrees to chromosome analysis
testing of her fetus. This is usually accomplished
through testing of which of the following?
Amniotic fluid
55. A Pediatric Nurse Practitioner (PNP) in the
peds clinic is assessing the reflexes of a 6 month
old infant. Which of the following reflexes should
usually not be seen at this age? Startle
56. Select the vaccines usually given to the
children at 12 months of age according to the
immunization schedule: DTaP, HEP A, MMR
57. The pediatric nurse is planning to educate and
empower a family to use the information provided
to build their competence. This preventative
measure is referred to as? Anticipatory guidance
58. A 17 month old child should be expected to be
in which stage according to Piaget?
Preoperations
59. Which of the following is the most consistent
and commonly used data for assessment of pain in
infants? Behavioral
60. Which of the following is an important
consideration when using the APPT pain rating
scale with children? Children color the area
with the color they choose to best describe their
pain
61. In terms of gross motor development what
should the nurse expect an infant age 5 months to
do? Turn from the abdomen to the back
62. The parent’s of a 12 month old child ask the
nurse if the child can eat hot dogs as do their other
children. The nurse’s reply should by based on
what? Hot dogs must be cut into small irregular
pieces to prevent aspiration
63. Infant mortality is defined as death in which
of the following parameter? First year of life
64. The Pediatric Nursing student is educating a
mother who plans to discontinue breast-feeding
when the infant is 9 month old. The nursing
student should advise her to include which foods
in her infant’s diet? Iron rich formula only
65. Select the viral communicable disease from
the following list, which has the classic symptoms
of photophobia, kolpik, spots on the buccal
mucosa, and a rash that begins on the face.
Rubeola
66. The parent of an 8.2 kg 9 month old infant is
borrowing a federally approved car seat from the
clinic. The nurse should explain that the safest
way to put in the car seat is what? Rear facing in
back seat
67. Parents ask the nurse about the characteristics
of autosomal dominant inheritance. Which
statement is characteristic of autosomal dominant
inheritance? Each child of a heterozygous
affected parent has a 50% chance of being
affected
68. Choose the prevention strategies that have
significantly decreased fatalities for children.
(select all) Bicycle helmets, car restraints, and
smoke detectors
69. Which of the following symptoms are usually
seen in a child with chickenpox? (Select all) Rash
in 3 stages, Vesicles that break easily, slight
fever
70. A foster parent is talking to the nurse about
the health care needs for the child who has
Foster children tend to have a higher than
normal incidence of acute and
71. Which of the following reflexes usually
disappear in a newborn around 3-4 months of
age? (Select all) Moro, Startle, Rooting
72. What developmental achievements are
demonstrated by a 4 y.o child? (Select all)
Commonly has an imaginary playmate, Tends
to be selfish and impatient, Fears are common
73. Identify the age group of children per
Erickson in the developmental stage of Autonomy
vs. Shame & Doubt. 1-3
74. The Phenylketonuria blood screen test will be
most reliable on a newborn if which of the
following occurs initially? Received breast milk
or formula at least 24 hours before the test
75. Pertussis vaccination should begin at which of
the following ages? 2 months
76. At what age is it safe to give infants whole
milk instead of commercial infant formula? 12
months
89. Which statement below best describes family
systems theory? Change in one family member
creates a change in other members
77. The components of the FLACC scale include
cry, leg movement, facial expression and activity.
Consolability
78. The Pediatric nurse should begin screening for
lead poisoning when a child reaches which age?
12 months
79. The nurse is finishing her shift on the pediatric
unit. Because her shift is ending, which
intervention takes top priority? Documenting the
care provided during her shift
80. Which of the following chromosomal
disorders seen in affected newborn causes
significantly shortened life span? Patau
Syndrome
81. Statistically how many children in the U.S
experience mental health problems that affects
their daily functioning? 1 out of 5 children
82. Which of the following body systems can be
severely affected with an increased lead level in a
developing child? Hematologic and neurologic
83. A breastfed infant has just been diagnosed
with galactosemia. The therapeutic management
of this include which? Stop breastfeeding the
infant
84. A blood pressure cuff size that is too small for
a child will give which of the following reading?
False high reading
85. What is the single most important factor to
consider when communicating with children?
Child’s developmental level
86. The most important criterion on which to base
the decision to report suspected child abuse is
which of the following? Incompatibility between
the history and injury observed
87. The nurse suspects that a child has ingested
some type of poison. What clinical manifestation
would be most suggestive that the poison was a
corrosive product? edema of the lips, tongue,
and pharynx
88. Children may believe that they are responsible
for their parent’s divorce and interpret the
separation as punishment. At which age is this
most likely to occur? 4 years
90. The nurse is caring for a child receiving a
continuous intravenous (IV) low dose infusion of
morphine for severe postoperative pain. The nurse
observes a slower respiratory rate and the child
cannot be aroused. The most appropriate
management of this child is for the nurse to do
which first? Administer naloxone (Narcan)
91. Evidence based practice in clinical management
is grounded in which of the following? Cohort
studies
92. Which is a sex chromosome abnormality that is
caused by the absence of an X chromosomes in a
female? Turner
93. Identify the age group of children per Erickson
in the developmental stage of industry vs.
inferiority? 6-12
94. Phenylketonuria is a genetic disease that results
in the body’s inability to correctly
Phenylalanine
95. Select an initial assessment included in the
Apgar scoring system. Color, heart rate, reflexes,
muscle tone, and respiration
96. The nurse is conducting a teaching session for
parents on nutrition. Which characteristics of
families should the nurse consider that can cause
families to struggle in providing adequate
nutrition? (Select all) Lower income, migrant
status, homelessness
97. Select the developmental milestones usually
seen in children during the toddler stage (1-3
years). (Select all) Two to three word sentences,
appears to be bowlegged and potbellied,
98. At what age can most infants sit steadily
unsupported? 8 months
99. A nurse is providing anticipatory guidance to
the parents of a toddler. Which of the following
should the nurse include in the teaching?
Expect negative behaviors associated with
negativism and ritualism, Develop food habits
that will prevent dental caries, and Expression
of bedtime fears is common
100. What should a nursing intervention to
promote parent-infant attachment include?
Explaining normalcy of specific infant
behaviors to parents
101. Identify the age group of children per
Erickson in the developmental stage of Initiative
vs Guilt. 3-6
102. Select the vaccines usually given to children
at 6 months of age according to the immunization
schedule. DTaP, RV, HIB, PCV
103. In the recovery room, the best immediate
post-op position for an infant who had cleft lip
repair is? Supine with the head turned to the
side
104. Which of the following is a classic finding in
infants diagnosed with Abusive Head Trauma?
Retinal hemorrhaging
105. The nurse is teaching student nurses about
newborn screening. Which statement made by the
student indicates understanding of the teaching?
The newborn screening is now mandatory in
all 50 states
106. When discussing discipline with the mother
of a 4 y.o child, the nurse should include which of
the following true statement? Parental control
should be consistent
107. The nurse is talking to a group of parents of
school-age children at an after-school program
about childhood health programs. Which of the
following statements should the nurse include in
the teaching? Childhood Obesity can be
prevented by lifestyle changes
108. A newborn’s assessment reveal an extra digit
on both hands. Which of the following terms is
used to define extra digits of the hands or feet?
Polydactaly
109. The nurse is administering the first hepatitis
A vaccine to an 18 month old child. When should
the child returns to the clinic for the second dose
of hepatitis A vaccination? After 6 months
111. What is the leading cause of death in
children older than 1 year in the U.S.?
Complications from childhood unintentional
injuries
112. A lesion which begins on the trunk and
spread to the face and proximal extremities
describes which of the following communicable
diseases? Varicella
113. Which of the following characteristics
describes the child at high risk for childhood
injuries? Male with a high activity level and a
stressful home life
114. Which of the following concepts provides a
rational approach to decision making that
facilitates best practice in nursing care? Evidence
Based Practice
115. A child has been diagnosed with giardiasis.
Which prescribed medication should the nurse
expect to administer? Metronidazole (Flagyl)
116. What is a function of brown adipose tissue
(BAT) in newborns? Generates heat for
distribution to other parts of body
117. When assessing a family, the nurse
determines that the parents exert little or no
control over their children. This style of parenting
is called? Permissive
118. A rash which begins on the trunk, does not
spread to the face but has sandpaper like quality,
describe which of the following communicable
diseases? Scarlet fever
119. What is the most common form of child
maltreatment? Child neglect
120. Which of the following chromosomal
disorders seen in affected newborns causes
significantly shortened life span? Edwards
Syndrome
121. During a well-baby visit a parent asks the
nurse when she should start giving solid foods.
The nurse should instruct her to introduce which
solid food first? Rice cereal
122. A Pediatric nursing student, while assisting
in teaching nutrition to new parents, informs them
that eating preferences are influenced primarily by
the family. At what age is lifelong eating habits
usually established? Age 3
123. Which of the following is the best method
for performing a physical examination on a
toddler? From least to most intrusive
124. What do mortality statistics describe? The
number of individuals who have died over a
specific period
125. A child has been admitted to the hospital
with a blood lead level of 42 mcg/dl. What
treatment should the nurse anticipate? Initiation
of chelation therapy
126. After the family, which has the greatest
influence on providing continuity b/w
generations? School
127. Identify the age group of children per
Erickson in the developmental stage of Identity vs.
Role Confusion. 13-21
128. Which is the leading cause of death in infants
younger than 1 in the U.S? Congenital anomalies
129. Select the vaccines usually given to children
at 12 months of age according to the
immunization schedule: IPV, VAR, MMR, HEP
A
130. The nurse is having difficulty
communicating with a hospitalized 6 yr old.
Which technique should be most helpful? Provide
supplies for the child to draw a picture
131. Which of the following is the causative agent
of scarlet fever? Group A β hemolytic
streptococci (GABHS)
132. An adolescent patient wants to make a
decision about treatment options, along with his
parents. Which moral value is the nurse
displaying when supporting the adolescent to
make decisions? Autonomy
1.The nurse is assessing a 12 year old child with
a foreign object in the left eye. What action
should the nurse take? Remove a freely
movable object with the pointed corner of
gauze pad moistened with water
2. A 10 year old is seen in the developmental
clinic with the following symptoms moderate
cognitive impairment, mitral valve prolapse,
autistic like behaviors such as social
anxiety.Which of the diagnosis below do these
symptoms best describe? Fragile X Syndrome
3. A 5 year old has bilateral eye patches in place
after surgery yesterday morning. Today he can
be out of bed. Which of the following is the most
important nursing intervention? Orient him to
his immediate surroundings
4. A 14 month old boy is hospitalized with
dehydration. He is inconsolable, screaming, and
rejecting your physical contact. What best
describes his response? Separation Anxiety-
PROTEST PHRASE
5.The Peds nurse receives a phone call from the
Pediatrician for a 10 y.o pt who weighs 40 kg for
Ceftazidime(Fortaz) 1.5 grams q 8 hrs IV. The
therapeutic dosage range is 90-150 mg/kg/24
hrs. What would be the best nursing action?
Administer the medication bc it is within the
therapeutic dose range
6.The nurse is preparing to administer a liquid
medication by a nasogastric feeding tube. What
is the first thing the nurse should do? Check the
pH of the gastric aspirate
7.What drug is an anglotensin-converting
enzyme(ACE) inhibitor? Captopril(Capoten)
54. Parents of a toddler ask the nurse “Should we
set rules for our child as part of a discipline
plan?” Which is an accurate response by the
nurse? Set clear and reasonable rules and
expect the same behavior regardless of the
circumstances
8.The nurse notes that the parents of a critically
ill child spend a lot of time talking to the parents
of another child who is seriously ill. They talk with
these parents more than the nurses. How should
the nurse interpret this situation? Parent to
parent support is valuable
9. A nurse in the Tb clinic is preparing to
administer Directly Observed Therapy(DOT) to a
pt with active Tb. Which of the following
medications will the nurse expect to administer?
Isoniazid
10.What strategy should the nurse recommend to
parents, to get the siblings of a child with special
needs involved in the child’s care? Request the
sibling’s help to design strategies that will work
at home
11.A parent of a child with a disability expresses
guilt to the nurse about the child’s condition.
What nursing intervention is most appropriate in
this situation? Explore the parent’s adjustment
responses
12. What behavior seen in children should be
addressed by the nurse who is providing care to a
child with chronic illness? An adolescent who is
becoming more dependent on family
13.The nurse understands that a preschool child
may react to death with what reaction? Joking
14.The practitioner has ordered a liquid oral
antibiotic for a toddler with otitis media. The
prescription reads 1 ½ tsp 4x/day.What should
the nurse consider in teaching the mother how to
give the medicine? Disposable calibrated oral
syringe
15.Tetralogy of fallout consists of pulmonic
stenosis, overriding aorta, ventricular septal
defect, and which of the following? Right
ventricular hypertrophy
133. A couple has given birth to their first child
with a recessive disorder. The genetic counselor
tells them that the risk of recurrence is one in four.
Which statement is a correct interpretation of this
information? The risk factor remains the same
for each pregnancy
16.Transposition of the Great Vessel(TGV) is
incompatible with life.Prostaglandin E is given to
children with this medical emergency to keep
which of the following shunts open in an infant
with TGV? Ductus Arterlosus
17.The physician suggests that surgery be
performed for patent ductus arteriosus(PDA) to
prevent which complication? Pulmonary vascular
congestion
18.A 4 y.o child seen in the ER has symptoms of
Kawasaki Disease(KD). Of the symptoms listed
below which can potentially develop and pose a
high risk for children with KD? Coronary artery
aneurysm
19.Which of the following actions by the school
nurse is most important in the prevention of
rheumatic fever(RF)? Refer children with sore
throats for throat cultures
20.A 5 y.o is admitted with bacterial pneumonia.
What signs and symptoms should the nurse
expect to assess with this disease process? Fever,
cough, chest pain
21.Which of the following test aids in the
diagnosis of cystic fibrosis(CF)? Sweat test, stool
for fat, chest x-ray films
22.A child diagnosed with Coarctation of Aorta is
scheduled for a f/u visit. While assessing the
pediatric nurse would expect to find which of the
following symptoms?
Absent or diminished femoral pulses
23.Select the parts of the fetal circulation of the
pediatric heart in the correct order as blood flows
from the placenta to the fetus:
Placenta-umbilical vein-ductus venosus-inferior
vena cava-R atrium
134. A parent brings a toddler, age 19 months, to
the clinic for a regular check-up. What should the
nurse expect to find when palpating the toddler’s
fontanels?
Closed posterior and anterior fontanels
24.A 4 y.o male is rushed to the emergency dpt
during an acute severe prolonged asthma attack
and is unresponsive to usual treatment. The
condition is referred to as which of the following?
Status Asthmaticus
25.A school nurse is educating a room full of 12-
12 y.o females on health and hygiene issues. She
included the following symptoms: high fever,
vomiting, diarrhea, oliguria, and hypotension to
best describe which illness? Toxic Shock
Syndrome(TSS)
26.The presence of which pair of factors is a good
predictor of a fluid deficit of at least 5% in an
infant? Capillary refill of greater than 2 secs and
weight loss
27.A nurse is reading a physician’s progress notes
in the client’s record and reads that the physician
has documented ‘insensible fluid loss of
approximately 800 ml daily.’ The nurse
understands that this type of fluid loss can mainly
occur through? Skin
28.A 6 y.o male in the peds ER has a history of
fluid loss and dehydration over the past 12 hrs.
The nursing assessment should include close
monitoring for the possibility of which of the
following? Impending shock
29.A 10 month old infant has acute otitis media
(AOM) and is being treated with oral antibiotics
for the 3rd time in the past 8 months. What
should the nurse include in the discharge
teaching to the infants parents?
The infant will need a f/u visit for possible
tympanostomy procedure and tubes
30.A parent prepares to administer pancreatic
enzymes to an infant with cystic fibrosis. As per
education she received the best action to
administer the enzymes is which of the following?
Increase the dose of pancreatic enzymes if infant
is having frequent bulky stool
110. An 8 month old infant is sitting contentedly
on the mother’s lap. The nurse is preparing to
perform a well baby checkup. Which of the
following steps should the nurse do first?
Auscultate heart and lung sounds
31.A 2 y.o has been placed in contact isolation
because of diagnosis of respiratory syncytial
virus(RSV)bronchlolitis. The father questions why
the staff is wearing masks and gowns every time
someone comes into the room. What is the best
response by the nurse? It is important for the
staff to wear the equipment to prevent
spreading it to others
32.During the assessment of a 9 y.o child the
nurse notes excessive drooling, the child is
fearful refuses to lay down. Which condition
does the nurse suspect? Epiglottitis
33.The nurse caring for a 6 y.o child who has
undergone cardiac catheterization 3 hrs ago
notes the dressing and bed saturated with blood.
Which initial action should the nurse take? Apply
pressure above the insertion site
34.Which of the following medication is
commonly used to treat Kawasaki’s Disease(KD)?
IVIG
35.A 10 y.o sustained a full thickness 3rd degree
burn on his left arm during a BBQ. What will be
required for healing from this injury?
Autografting
36.What intervention should be included in the
nursing care of a child with autism spectrum
disorder(ASD)? Decrease auditory and visual
simulation
37.Patients, parents, or legal surrogates must
receive sufficient information on which to make
informed health care decision. Informed consent
should include which of the following?(SELECT
ALL)
Nature of the illness or condition
Proposed care or treatment
Potential risks, benefits, or alternatives
38.A nurse in the Tb clinic is preparing to teach a
pt with active Tb about the medications. Which of
the following medications will the pt need to take
initially?(SELECT ALL)Rifampin, Isoniazid,
Ethambutol
39.Which of the following are part of the stages of
grief an individual may experience while dealing
with the death of a child?(SELECT ALL)
Ambivalence, Denial, Anger
40.The clinic nurse is assessing an infant. What
are the early signs of cognitive impairment the
nurse should discuss with the health care
provider?(SELECT ALL)
Unresponsiveness to the environment at 12
months of age, unable to speak 2-3 words at 24
months of age, head lag at 11 months of age
41.Select the surgical procedures usually done in
children to correct heart defects from the
following list(SELECT ALL)
Modified Blalock-Taussig Shunt
Bidirectional Glenn Shunt
42.A 15 y.o male referred to a cardiologist is
diagnosed with Infective Endocarditis. Which of
the following symptoms are usually seen with this
condition?(SELECT ALL)
Murmur, Osler nodes, Janeway spots
43.The healthcare provider prescribes
vancomycin 200 mg per intravenous
piggyback(IVPB) q 6 h for a child with CF. The
pharmacy send the meds to the unit in a 150 ml
bag with directions to run the medication over
120 mins. What ml/hr will the nurse set the IV
pump to run the medication over 120 mins? 75
ml/hr
44.A 46 lb 4 y.o pt is ordered to have
acetaminophen 10 mg/kg/dose oral suspension.
Medication bottle is labeled 300 mg/2 ml.
Calculate the dose to be administered. 3.1
45.A 13 month old child seen in the peds clinic
shows symptoms of tachycardia, tachypnea, cap
refills of 3 sec, and slight weight loss since the last
visit. Which level of dehydration is the child
entering? Moderate
46.A 6 y.o in the peds Er has a diagnosis of
hypovolemic shock. What are the most frequent
causes of this type of shock in children? Blood
Loss
47.Which behavior indicates an 18 month old is
developing a non-adaptive reaction to a
prolonged hospitalization? Ignores mother when
she arrives
48.What finding is the most reliable guide to the
adequacy of fluid replacement for a small child
with burns? Urinary output of 1-2 ml/kg of body
weight/hr
49.A 2 y.o child is receiving digoxin(Lanoxin). The
nurse should notify the practitioner and withhold
the medication if the apical pulse is less than
which rate? 90 beats/min
50.A 3 month old with a hypercyanotic spell.
What should be the nurse’s first action?
Place the child in knee chest position
51.What structural defects constitute tetralogy of
Fallot? Aortic stenosis, ventricular septal defect,
overriding aorta, right ventricular hypertrophy
52.What sign/symptom is a major clinical
manifestation of rheumatic fever(RF)?
Polyarthritis
53.What child has a cyanotic congenital heart
defect?2 month old with tetralogy of Fallot
54.A child is recovering from Kawasaki’s
Disease(KD). The child should be monitored for
which? Electrocardiograph(ECG) changes
55.An 18 month old child is seen in the clinic with
otitis media(OM). Oral amoxicillin is prescribed.
Instructions to the parent should include which of
the following?Medication may take 24-48 hrs to
make symptoms subside
56.What clinical finding may be present in an
older child with Coarctation of the Aorta?
High blood pressure in the upper extremities
57.A 5 y.o is seen in the urgent care clinic with the
following history and symptoms:sudden onset of
severe sore throat after going to bed, drooling
and difficulty swallowing, axillary temperature of
102.2 F(39.0 C), clear breath sounds, and absence
of cough. The child appears anxious and is
flushed. Based on these symptoms and history,
the nurse anticipates a diagnosis of?
Acute epiglottitis
58.Select from list below a reason for ‘Innocent’
heart murmurs in infants: Fever
59.A pediatric nurse who is caring for a 12 y.o pt
with septic shock perceives a potential
complication of fluid resuscitation upon which of
the following? Rales and rhonchi by auscultation
60.Of the statements below what statement best
represents infectious mononucleosis?
Lymphadenopathy is a common characteristic
61.A child who has a cardia catheterization is
being discharged. What should the nurse include
in the discharge instructions to the parents? Give
sponge baths for 3 days
to prevent infection
62.A nurse is reviewing the laboratory values of a
child with rheumatic heart disease. Which finding
does the nurse conclude is related to this
condition?
Positive antistreptolysin titer
63.The Pediatric Nurse assigned to an 8 y.o is
aware that the child’s fluid need will be increased
in which of the following circumstances? Shock
64.What type of dehydration occurs when the
electrolyte deficit exceeds the water deficit?
Hypotonic dehydration
65.A 10 y.o sustained a superficial 2nd degree
partial thickness burn on his left arm during a
BBQ. What is the expected time of healing for this
injury? 3-4 weeks
66.The nurse understands that a preschool age
child may react to death with what reaction?
Showing regressive behaviors
67.A parent requests info on her infants hearing.
Which of the following should the nurse say is a
clinical manifestation of hearing impairment in an
infant less than 12 months old? Responds to loud
noises as opposed to voice
68.The Cochlear implantation is a safe surgical
technique used to treat which of the following
types of hearing loss in children?
Sensorineural
69.What intervention should be included in the
nursing care of a child with autism spectrum
disorder(ASD)? Provide individualized care
70.The nurse is performing a physical assessment
on a 7 y.o child. The parents state that the child
has trouble seeing the board at school. What
visual impairment should the nurse suspect?
Myopia or nearsightedness
71.When caring for the intravenous(IV) site on a
child, the nurse should take which action? Flush
the site with normal saline per protocol
97.The nurse is teaching a group of female
adolescents about toxic shock syndrome and the
use of tampons. What statement by a participant
indicates a need for additional teaching: I can use
a superabsorbent tampon for more then 6 hrs
98.An 11 month old child seen in the Peds clinic is
diagnosed with Isotonic Dehydration. Which of
the following si true of Isotonic Dehydration?
Electrolyte and water deficits are in balanced
proportions
72.After returning from cardiac catheterization
the nurse determines that the pulse distal to the
catheter site is weaker. How does the nurse
respond? Observe this as a normal finding and
record the data
73.What drug is an angiotensin-converting
enzyme(ACE) inhibitor? Enalapril(Vasotec)
74.Which of the following is appropriate for a
hospitalized infant?Rattles, squeaking toys,
mobile toys
75.A school age child with CF takes 4 enzyme
capsules with meals. The child is having 4 or 5
bowel movements/day. The nurses action in
regard to the pancreatic enzymes is based on the
knowledge that the dosage is what? Needs to be
increased to decrease the number of bowel
movements/day
76.A school age child has asthma. The nurse
should teach the child that if a peak expiratory
flow rate is in the yellow zone that means that the
asthma control is what?
50-79% of a personal best and needs and
increase in the usual therapy
77.What drug is usually given first in the
emergency treatment of an acute severe asthma
episode in a young child? Short acting beta2-
agonists
78.What description applies to fragile X
syndrome? Second most common genetic cause
of cognitive impairment
79.A 10 y.o in the Peds ER has symptoms of
severe dehydration. What are signs of impending
shock which needs to be monitored for in this
child?(SELECT ALL)
Tachycardia, cool skin, hypoxemia
80.Which of the following are clinical
manifestations of a hearing impairment usually
seen in infants?(SELECT ALL) Absence of babbling
by 7 months, lack of startle reflex, responds to
loud noises as opposed to the voice
81.The nurse is assessing coping behaviors of a
family with a child with a chronic illness. What
indicates avoidance coping behaviors? (SELECT
ALL) Refuses to agree to treatment, Avoids staff,
family members, or child, Is unable to discuss
possible loss of the child
82.The nurse is interpreting a tuberculin skin test.
If the nurse finds a result of an induration 5 mm
or larger in which should the nurse document this
finding as positive?(SELECT ALL) A child receiving
immunosuppressive therapy, A child with a HIV
infection, A child living in close contact with a
known contagious case of tuberculosis
83.What does the nurse recognize as physical
signs of approaching death?(SELECT ALL) Mottling
of skin, Cheyne-Stokes respirations, decreased
appetite and thirst
84.Which statement is true concerning Fragile X
syndrome? The disease has no cure and
pharmaceuticals are used to manage symptoms
85.Which of the following describes moderate
persistent asthma symptoms? Symptoms seen on
a daily basis
86.What is a principle of palliative care that can
be included in the care of children? Uses a
multidisciplinary approach
87.When teaching a mother how to administer
eye drops where should the nurse tell her to
place them? Place in the small sac that is formed
when the lower eyelid is pulled down
88.What is the best method to verify the
placement of a nasogastric tube before each use?
Aspiration of stomach contents
89.Verbal informed consent via the telephone for
a minor child is appropriate when the parent is
not available in person. Which of the following is
true in this case?
The verbal consent is required to be in the
presence of 2 witnesses
90.A child with heart failure is in Lanoxin(digoxin).
The laboratory value a nurse must closely monitor
is which? Serum Potassium
91.An initial action of the nurse in caring for a
child with Status Asthmaticus is which of the
following? Administer beta 2 agonists as ordered
92.A 2 y.o child diagnosed with tetralogy of Fallot
becomes upset, crying, and thrashing around
when a blood specimen is obtained. The childs
color becomes blue and respiratory rate increases
to 44 bpm. Which of the following actions would
the nurse do first?Place the child in knee to chest
position
93.Select from the list below a reason for
‘innocent’ heart murmur in infants: Anemia
94.A nurse is evaluating the management of a
child with a history of asthma. Which statement
from the mother quires further investigation?
When my child has an attack she usually has to
use her rescue inhaler 4x before her breathing
improves
95.Which of the following would be involved in
the nursing care of a child with an atrial septal
defect? Preparing the child and family for
cardiac catheterization
96.The Pediatric Nurse assigned to an 8 y.o is
aware that the childs fluid need will be decreased
in which of the following circumstances?
Increased Intercranial Pressure
99.An 8 month old child seen in the peds clinic
with Otitis Media w Effusion(OME) what is the
best treatment option for this child?
Tympanostomy tubes
100.A 2 month old seen in peds clinic has
symptoms of tachypnea, retractions, anorexia,
apneic spells, copious nasal secretions and
wheezing. Which of the following do these
symptoms best describe?
RSV Bronchlolitis
101. Of the statements below what statement
best represents infectious mononucleosis?
Clinical signs and symptoms and blood tests are
both needed to establish the diagnosis
102.Which of the following is usually affected in
cystic fibrosis, resulting in excess multisystem
mucus build up that is difficult to clear? Exocrine
Gland
103.What are common respiratory symptoms
dying children experience? (SELECT ALL)
Cough, wheezing, shortness of breath
104.Provider order: Augmentin 375 mg po q8h.
Supply 75 ml bottle of reconstituted Augmentin
250mg/5ml. How many ml per dose? 7.5 ml
105. The nurse is giving discharge instructions to
the parents of a 5-year-old child who had a
tonsillectomy 4 hours ago. Which of the following
statements by the parent would indicate a
correct understanding of the teaching? "I can use
an ice collar on my child for pain control along
with analgesics."
106.What type of shock is characterized by a
hypersensitivity reaction causing massive
vasodilation and capillary leaks, which may occur
with drug or latex allergy? Anaphylactic Shock
107. A health care provider prescribes Osmitrol
(mannitol), 0.5 g/kg intravenously (IV) now for a
child with minimal change nephrotic syndrome.
The child weighs 10 kg. The medication label
states: “Osmitrol (mannitol) 20 g/100ml”. The
nurse prepares to administer the dose. How
many ml will the nurse prepare to administer the
dose? 25 ml
1.A child’s chart indicates Astigmatism. For what
should the nurse assess? Unequal curvatures in
refractive apparatus
2.A school nurse decides to initiate a safety
program for increasing the use of bicycle helmets.
The program is an example of: Primary
prevention
3.The nurse should expect the apical heart rate of
a stabilized neonate to be which of the following
ranges?
120-160 beats/min
4.Select the statement that is true concerning
upper respiratory infections(URI) in children
under 2 years old: Over the counter medications
are not recommended for treatment of the
common cold
5.What factor is most important for parents
implementing do not resuscitate(DNR) orders?
Acknowledgement by health care team that
child has no realistic chance for cure
6.Autism is a complex developmental disorder.
The diagnostic criteria for autism include delayed
or abnormal functioning in which area with onset
before age 3 years?
Ability to maintain eye contact
7.The nurse wants to provide a 3 month old infant
with stimulation. What is the best toy for the
nurse to provide?
Mobile with a music box
8.Select from the following list the maximum
volume of solution that should be administered in
a single IM site to an infant or a small child.
1 ml
9.The nurse is assessing the coping behaviors of
the parents of a child recently diagnosed with a
chronic illness. Which of the following should the
nurse consider an ‘approach behavior’ that results
in parental movement toward
adjustment?Anticipating future problems and
seeking guidance and answers
10.A 1 month old is admitted to the hospital. The
infant’s mother is 17 y.o and single and lives with
her parents. Who signs the consent form for the 1
month old infant? The infant’s mother
11.During a respiratory assessment, the nurse
notes a sinking in of soft tissue relative to the
cartilaginous and bony thorax. What is the term
for this finding?
Retractions
12.What is the best explanation for using pulse
oximetry on young children to determine oxygen
saturation?
Pulse oximetry is noninvasive
13.Secondary prevention for cognitive
impairment includes what activity? Newborn
screening for treatable inborn errors of
metabolism
14.When giving oral liquids from a syringe to an
infant or child, which is the best procedure to
use? Place the tip of the syringe into the pocket
formed between the lower teeth and cheek
15.A 2 y.o is scheduled to have a tonsillectomy.
How would you educate the pt?Use picture
books and puppets and repeat explanation
16.What condition is defined as reduced visual
acuity in one eye despite appropriate optical
correction? Amblyopia
17.When planning care for an 8 y.o boy with
Down syndrome, the nurse should:
Assess the child’s current developmental level
and plan care accordingly
18.At which age do most children have an adult
concept of death as being inevitable, universal,
and irreversible? 9-11 y.o.
19.The parents of a 3 y.o admitted for recurrent
diarrhea are upset that the practitioner has not
told them what is going on with their child. What
is the priority intervention for this family?
Help the family develop a written list of specific
questions to ask the practitioner
20.The nurse should expect a toddler to cope
with the stress of a short period of separation
from parents by displaying what? Regression
21.Which of the following age range of children
qualify to be included in Early Intervention
programs? Birth-3
22.What action should the school nurse take for
a child who has a hematoma (black eye) with no
hemorrhage into the anterior chamber?
Apply ice for the first 24 hrs
23.A 7 y.o child tested positive for Streptoccal
Pharyngitis, but she’s allergic to Penicillin. Which
of the following antibiotics is indicated as a
treatment option? Erythromycin
24.The nurse assesses the respiratory status of
an infant. Which finding should be of most
concern to the nurse? Expiratory grunting
25.A nurse in the Tb clinic is preparing to
administer Directly Observed Therapy(DOT) to a
pt with active Tb. Which of the following
medications will the nurse expect to administer?
Rifampin
26.Families progress through various stages of
reactions when a child is diagnosed with a
chronic illness or disability. After the shock
phase, a period of adjustment usually follows.
This is often characterized by what response?
Guilt and anger
27.What behavior seen in children should be
addressed by the nurse who is providing care to
a child with chronic illness? A preschooler who
refuses to participate in self-care
28.A 7 y.o child is in the end stages of cancer.
The parents ask you how they will know when
death is imminent. What physical sign is
indicative of approaching death? Difficulty
swallowing
29.The nurse is preparing to give acetaminophen
(Tylenol) to a child who has a fever. What
nursing action is appropriate? Check to be sure
the Tylenol dose does not exceed 15mg/kg
30.The potential effects of chronic illness or
disability on a child’s development vary at
different ages. Which of the following is a threat
to a toddlers normal development? Hindered
mobility
31.A first-time mother asks you what type of toy
would be best for her 2 ½ y.o. Your response is?
Push-pull toys, large balls, and stuffed animals
32.Which of the following should be included in
the nursing care of a child with autism spectrum
disorder(ASD)? Provide a structured routine for
the child to follow
33.A pediatric nurse is caring for a child who is
terminally ill and expected to die. Which of the
following procedures is usually no longer
necessary during the terminal phase? Measure
vital signs
1. Which of the following is standard therapy used
in the care of children with Osteogenesis
Imperfecta? Bisphosphonate Therapy and
physical therapy
2. An infant was assessed in peds clinic with the
following symptoms: visible peristalsis, failure to
thrive, an infant who is ‘always hungry’,
dehydration. What is the likely diagnosis? Pyloric
Stenosis
3. A 4 y.o male seen in the peds specialty renal
clinic has symptoms of end stage renal disease and
visual disturbances. Which of the following is likely
his diagnosis? Alport Syndrome
4. The parent of a child with growth hormone (GH)
deficiency is learning to administer GH therapy.
When is the best time for the parent to administer
the GH to the child? At bedtime using subQ
needle
5. A 10 y.o female seen in specialty peds clinic has
a diagnosis of Spina Bifida. On examination the
peds nurse observes dark tufts of hair at the lumbar
sacral region. Which of the following is the child’s
diagnosis? Spina Bifida Oculta
6. The nurse reviews the record of a newborn infant
and notes that a diagnosis of esophageal atresia with
tracheoesophageal fistula is suspected. The nurse
expects to note which MOST LIKELY sign of this
condition documented in the record? Choking with
feedings
7. While educating a new 7 y.o diabetic patient and
the parents, the pediatric nurse includes which of
the following times during the day when the child’s
blood sugar level needs to be monitored? Check
blood glucose levels ac and hs
8. A nurse evaluates discharge teaching as
successful when the parents of an infant with a
ventriculoperitoneal shunt insertion identify which
sign as signaling a blocked shunt? Tense fontanel
and increased head circumference
9. A nurse is caring for an infant with
myelomeningocele scheduled for a surgical closure
in the morning. Which interventions should the
nurse plan for the care of the myelomeningocele
sac? Cover with a sterile, moist, nonadherent
dressing
10. What is a common clinical manifestation of
juvenile hypothyroidism? Dry skin
11. A 3 y.o with a Wilms tumor is returning to the
unit after surgery to remove the tumor. Which of
the following is the highest post-op priority for the
nurse? Monitor vital signs especially blood
pressure (b/c tumor of kidney)
12. A common side effect of corticosteroid
(prednisone) therapy for a 11 y.o with a cancer
diagnosis is which of the following? Large
abdomen with striae
13. Which of the following describes the
pathophysiology of leukemia? Unrestricted
proliferation of immature white blood cells
(WBCs)
14. A 5 y.o male diagnosed with moderate
dehydration should be given Oral Rehydration
Solution by the nurse or parent with which of the
following rehydration therapy? 100ml/kg/4 hrs
15. A 10 y.o patient is undergoing hemodialysis
with an internal AV fistula in place. What do you
do to prevent anxiety and pain associated with the
shunt? Apply EMLA cream over fistula
16. An 18 month old male is scheduled for surgery
to reposition his undescended testes. What is this
child’s diagnosis? Cryptorchidism
17. A 2 y.o child is on prednisone for minimal
change nephrotic syndrome (MCNS). Which of the
following indicates the effectiveness of prednisone
therapy? Diuresis occurs as urinary protein
excretion diminishes
18. An 11 y.o child was just admitted to the
hospital for observation after a head injury. What
clinical manifestation is most essential for the
nurse to assess to detect early signs of a
neurological condition? Level of consciousness
19. A toddler with symptoms of sudden
inconsolable screaming or crying, drawing up of
the knees to the chest, vomiting, and a tender
distended abdomen will probably be diagnosed
with which of the following diseases?
Intussusception
20. Of the following which are possible signs of
Cerebral Palsy (CP) ? Select All.
-Poor head control after age 3 months
-Persistent primitive reflexes
-Feeding difficulties
21. The nurse is preparing to administer a unit of
packed red blood cells to a hospitalized child.
What are appropriate actions that applies to
administering blood? Select All.
-Administer the first 50 ml of blood slowly and
stay with the child
-Administer blood through an appropriate filter
-Infuse blood within 4 hours
22. The nurse is caring for an infant with suspected
pyloric stenosis. Which clinical manifestations
would indicate pyloric stenosis? Select All.
-Non-bilious vomiting and weight loss
-Projectile vomiting
-Olive-shaped mass above umbilicus
23. The nurse is assessing a 4 y.o boy in the
pediatric clinic. Which behaviors by the client
would concern the nurse for possible Duchenne
muscular dystrophy? Select all.
-Frequent trips and falls at home
-Places hands on thighs to push up to stand
-Walks on tiptoes and has disproportionately
large calves
24. A newborn seen in endocrinology specialty
clinic is diagnosed with hypothyroidism. Which of
the following are common symptoms of
hypothyroidism as seen in newborns? Select all.
Weight gain, dry skin, hair loss
25. The nurse is caring for an 18 month old with
rotavirus. Which of the following clinical
manifestations would the nurse expect to observe?
Mild fever and vomiting followed by onset of
watery stools
26.Which of the childhood cancers listed below
have a genetic link as a causative factor?
Retinoblastoma
27. A 12 y.o child is admitted to the PICU in acute
renal failure (ARF). The nurse prepares to
administer which of the following medication to
rapidly provoke a flow of urine? Mannitol
(Osmitrol) or furosemide (Lasix) or both
28. What statement is an advantage of a peritoneal
dialysis compared with hemodialysis? It is easy to
learn and can be done at home
29. A 3 y.o is admitted to the peds unit with
minimal change nephrotic syndrome. What clinical
manifestations are usually seen with this
diagnosis? Massive proteinuria,
hypoalbuminemia, and edema
30. A parent asks the nurse what would be the first
indication that acute glomerulonephritis was
improving. What would be the nurse’s best
response? Urine output will increase
31. A child seen in renal clinic is diagnosed with
Vesicoureteral Reflux (VUR). Primary reflux
usually occur as a result of which of the following?
Congenital anomaly
32. A 12 y.o child is seen in specialty clinic has ill
fitting clothes, a rib hump and hip asymmetry,
recently noticed by parents. Which of the
following is the likely diagnosis of this child?
Scoliosis
33. Which of the following musculoskeletal
disorders is associated with morning stiffness that
improves with activity? Juvenile Idiopathic
arthritis
34. A school age child with celiac disease asks for
guidance about snacks that will not exacerbate the
disease. What snack should the nurse suggest?
Popcorn
35. A 14 y.o is admitted to the emergency room
with a fracture of the right humerus epiphyseal
plate through the joint surface. What information
does the nurse know regarding this type of
fracture? This type of fracture requires different
management to prevent bone growth
complications
36. After a pyloromyotomy, a week old infant is
prescribed feedings of 1 to 2 oz of Pedialyte q 3
hrs then advance to breastmilk ad tolerated
postoperatively. The nurse should advance the
feeding if which occurs? The infant is taking the
Pedialyte without vomiting or distention
37. The nurse is evaluating the laboratory results
of a stool sample. What is a normal finding? The
laboratory reports a negative guaiac
38. What is an important consideration for the
identification and treatment of cryptorchidism in a
child by age 2 years? Treatment is necessary to
maintain the ability to be fertile when older
39. A 2 y.o child has simple constipation and is
brought to the clinic for evaluation. The
therapeutic plan initially includes: Dietary
modification
40. Diabetic ketoacidosis (DKA) results from an
excessive accumulation of which of the following?
Ketone bodies from fat metabolism
41. A school age child with acute diarrhea and mild
dehydration is given oral rehydration solution
(ORS). The child’s mother calls the clinic nurse
because he is also occasionally vomiting. The nurse
should recommend which of the following?
Continue to give ORS frequently in small
amounts
42. Erythema Migrans is an annular rash commonly
seen with which of the following infections? Lyme
Disease
43. A child has been diagnosed with scabies. Which
statement by the parent indicates understanding of
the nurse’s teaching about scabies? Everyone who
has been in close contact with my child will need
to be treated
44. After a tonic clonic seizure, what symptoms
should the nurse expect the child to experience?
Lethargy and confusion
45. Which of the following parameters would the
nurse monitor to evaluate the initial effectiveness of
thickened feedings for an infant with
gastroesophageal reflux (GER)? Vomiting
46. Of the following diagnosis, which would the
nurse identify as a priority for the infant with
tracheoesophageal fistula (TEF)? Risk of injury
related to increased potential for aspiration
47. A nurse is teaching clients in an outpatient
facility about the use of insulin to treat type 1
diabetes mellitus. For which of the following types
of insulin should the nurse tell the clients to expect
a peak effect 2 to 5 hrs after administration?
Regular insulin
48. The nurse is doing a neurologic assessment on a
2 month old infant after a car accident. Moro, tonic,
neck, and withdrawal reflexes are present. The
nurse should recognize that these reflexes suggest
which of the following? Neurologic health
49. A peds nurse is taking history of a child
hospitalized with Reye syndrome. Which of the
following is a common occurrence seen in patients
with Reye’s Syndrome? Cerebral Edema also
fatty liver
50. A toddler is admitted to the pediatric unit with
presumptive bacterial meningitis. The initial
orders include isolation, intravenous access,
cultures, and antimicrobial agents. The nurse
knows that the antibiotic therapy will begin:
When the medication is received from the
pharmacy
51. A 12 y.o is being treated with Buck’s Traction.
What are important nursing interventions for this
client? Verify that the skin traction maintains
the extremity in an extended position
52. A toddler is admitted to the hospital and report
leg pain an fever. Assessment reveals the toddler
is pale with body bruises. The health care provider
suspects acute lymphoblastic leukemia (ALL).
The nurse will inform the parents that
confirmation of the disease will be determined by
which test? Bone marrow biopsy
53. The student nurse is aware that the Ketogenic
diet is used as a therapy for seizure control in
children. Which of the following best describes
the Ketogenic diet? High fat, low carb, and
adequate protein diet
54. Children with steroid induced Cushing
syndrome should receive their medication at
which of the following times to lessen the
Cushingoid features? Give the drug: Early in the
morning upon awakening
55. Staging criteria exist for most tumors. Which
of the following relates to the meaning staging?
The higher the stage, the poorer the prognosis
56. A 2 y.o is hospitalized with suspected
intussusception. Which finding is associated with
intussusception? Currant jelly stools
57. The pediatric nurse is preparing to admit a 5
y.o with spina bifida cystica that was below the
second lumbar vertebra. What clinical
manifestations of spina bifida cystica below the
second lumbar vertebra should the nurse expect to
observe? Overflow incontinence with constant
dribbling of urine
58. A 5 y.o male diagnosed with mild dehydration
should be given Oral Rehydration Solution (ORS)
by the nurse or parent with which of the following
rehydration therapy? 50 ml/kg/ 4 hrs
59. The pediatric version of the Glasgow Coma
Scale is used on a 3 y.o male after falling from a
tree in his back yard. A score of 3 on his chart is
associated with? Poor outcome or Comatose
state
60. The following symptoms describes which of
the conditions listed below: Multiple fractures at
birth, growth failure, autosomal recessive
inheritance? Osteogenesis Imperfecta
61. What is the most common cause for the
overproduction of growth hormones in
acromegaly? Pituitary adenoma
62. A newborn seen in peds renal clinic receives a
diagnosis of Alport Syndrome. Which of the
following should be included in the counseling
given to the parents? Encourage parents to seek
genetic counseling
63. Duchenne Muscular Dystrophy (DMD) has
which of the following inheritance patterns?
X linked recessive trait
64. A 13 y.o male has a femoral shaft fracture.
The nurse recognizes that the approximate healing
time for this adolescent’s fracture is how long?
8-12 weeks
65. A nurse evaluates discharge teaching as
successful when the parents of a school aged child
with a ventriculoperitoneal shunt insertion identify
which sign as signaling a blocked shunt?
Irritability and increasing difficulty swallowing
66. Which of the following P’s will the pediatric
nurse assess on a 10 y.o male after a recent
fracture of the femur to determine the extent of his
injury? Select all. Pallor, pain, paresthesia
67. The nurse is planning care for a school-age
child with bacterial meningitis. What intervention
should be included? Keep environmental stimuli
to a minimum.
68. As part of the diagnostic evaluation of a child
with cancer, biopsies are important for staging.
What statement explains what staging means?
Extent of the disease at the time of diagnosis.
69. A child is admitted with acute
glomerulonephritis. What should the nurse expect
the urinalysis during this acute phase to show?
Hematuria and proteinuria.
70. When does idiopathic scoliosis become most
noticeable? During the preadolescent growth
spurt.
71. Parents of a newborn with ambiguous genitalia
want to know how long they will have to wait to
know whether they have a boy or girl. The nurse
answers the parents based on what knowledge?
Gender assignments involves collaboration
between the parents and a multidisciplinary
team./Gender assignment involves a complex
decision-making process
72. A 6-month-old infant with Hirschsprung disease
is scheduled for a temporary colostomy. What
should postoperative teaching to the parents include?
Assessing bowel function.
73. A 6-month-old infant with Hirschsprung disease
is scheduled for a temporary colostomy. What
should postoperative teaching to the parents include?
Skin and stoma care.
74. Which of the following pharmacology therapy is
used to treat infants and children with
Gastroesophageal Reflux Disease (GERD)? Zantac
(Ranitidine)
75. The nurse is assisting a child with celiac disease
to select foods from a menu. What foods should the
nurse suggest? Corn on the cob with butter
76. The nurse is evaluating the laboratory results of
a stool sample. What is a normal finding?
Stool pH 7.0
77. A child with hypopituitarism is being started on
growth hormone (GH) therapy. Nursing
considerations should be based on which
knowledge? Replacement therapy requires daily
subcutaneous injections
78. A 20-kg (44-lb) child in ketoacidosis is admitted
to the pediatric intensive care unit. What order
should the nurse not implement until clarified with
the physician? Begin intravenous line with D5
0.45% normal saline with 20 mEq of potassium
chloride. (0.9% normal saline should be given).
79. What statement is true concerning osteogenesis
imperfecta (OI)? It is an inherited disorder.
80. A child with juvenile idiopathic arthritis (JIA)
is started on a nonsteroidal anti-inflammatory drug
(NSAID). What nursing consideration should be
included? Check for abdominal pain and bloody
stools.
81. A child with juvenile idiopathic arthritis (JIA)
is started on a nonsteroidal anti-inflammatory drug
(NSAID). What nursing consideration should be
included? Give NSAIDS between meals.
82. The nurse is discussing home care with a mother
whose 6-year-old child has hepatitis A. What
information should the nurse include? Teach
infection control measures to family members.
(Hepatitis A can be transmitted through the
fecal-oral route)
83. A pediatric nurse admits a 5-year-old with
Hepatitis A. Which of the following clinical
manifestation? Fecal oral transmission
84. A 3-month-old seen in peds clinic has seborrhea
dermatitis (cradle cap). What instruction to give?
Shampoo the scalp daily until the crust is
removed.
85. The nurse is teaching parents about caring for
their infant with seborrheic dermatitis (cradle cap).
Which statement by the parents indicates
understanding of the teaching? “We will use a fine-
tooth comb to help remove the loosened crusts
from the strands of hair.” (antiseborrheic
shampoo should be done daily).
86. When giving instructions to a parent whose
child has scabies, what should the nurse include? Be
prepared for symptoms to last 2 to 3 weeks.
87. When giving instructions to a parent whose
child has scabies, what should the nurse include?
The scabies cream can be used for infants over 2
months old.
88. In a child with sickle cell anemia (SCA),
adequate hydration is essential to minimize sickling
and delay the vasoocclusion and hypoxia–ischemia
cycle. What information should the nurse share with
parents in a teaching plan? Check for moist
mucous membranes.
89. In a child with sickle cell anemia (SCA),
adequate hydration is essential to minimize sickling
and delay the vasoocclusion and hypoxia–ischemia
cycle. What information should the nurse share with
parents in a teaching plan? Monitor child for sign
of dehydration.
90. An 18-month-old with pediculosis capitis (head
lice). What is the drug of choice? Permethrin 1%.
91. The nurse is teaching the family of a child, age
8-years-old, with moderate hemophilia about home
care. What should the nurse tell the family to do to
minimize joint injury? Provide intravenous (IV)
infusion of factor VIII concentrates.
92. An 18-month-old child has been diagnosed with
pediculosis capitis (head lice). Which prescription
should the nurse question if ordered for the child?
Malathion (Ovide).
93. A 10-yar-old in peds clinic with fever, anorexia,
crampy abdominal pain preceding watery or bloody
diarrhea. What is the pathogen that causes the
diarrhea? Shigella.
94. A 2-year-old child has a chronic history of
constipation and is brought to the clinic for
evaluation. What should the therapeutic plan
initially include? Bowel cleansing.
95. The nurse is teaching infant care to parents with
an infant who has been diagnosed with osteogenesis
imperfecta (OI). What should the nurse include in
the teaching session? “Lift the infant by the
buttocks, not the ankles, when changing
diapers.”
96. What major complication is associated with a
child with chronic renal failure? Water and
sodium retention.
97. What bone disorder of childhood is caused by
an autosomal recessive defect in the synthesis of
collagen? Osteogenesis imperfecta.
98. A 4 yr old female seen in peds clinical has
urinary symptoms. What is the medical terminology
for inflammation of the bladder? Cystitis.
99. A 3-day-old infant presents with abdominal
distention, is vomiting, and has not passed any
meconium stools. What disease should the nurse
suspect? Hirschsprung disease.
100. A 4 week old infant has a femoral shaft
fracture. The nurse recognizes that the approximate
healing time for this infant’s fracture is how long?
2-3 weeks.
101. A 1 week old infant is evaluated in pediatric
renal clinic with a narrowing of the opening of his
foreskin. What is this condition called? Phimosis.
102. At which of the following ages is
recommendation made by the American Academy
of Pediatrics (AAP), for pre-adolescent and
adolescent females to be screened for Scoliosis?
10-12.
103. The pediatric nurse is preparing to admit a 5-
year-old child with hepatitis A. Which of the
following is a clinical feature of hepatitis A nurses
normally recognize? The mode of transmission is
primarily by the fecal oral route.
104. An 11-year-old girl with celiac disease was
discharged from the hospital. An appropriate
teaching was carried out by the nurse if the parents
are aware of avoiding which of the following?
Wheat.
105. The most common causative pathogen for
diarrhea seen in children around the world is which
of the following organisms? Rotavirus.
106. A pediatric nurse assesses a newborn with
symptoms of failure to pass meconium within 48
hrs after birth. Which of the following diseases will
be suspected in this newborn? Hirschsprung.
107. A young girl has just injured her ankle at
school. In addition to notifying the child’s parents,
what is the most appropriate, immediate action by
the school nurse? Apply ice.
108. A 3-year-old child has a femoral shaft
fracture. The nurse recognizes that the
approximate healing time for this child is how
long? 4 weeks.
109. A 10 y.o male with Legg-Calve Perthes
Disease is seen by a pediatrician. The student
nurse is aware… Partial weight bearing on the
affected side, staging of the disease process,
traction.
110. The nurse is preparing to admit a 7-year-old
child with Crohn disease. What clinical
manifestations should the nurse expect to observe?
Pain is common, diarrhea is moderate to severe,
weight loss is severe.
111. Signs and symptoms of child in summer
camp with Lyme disease? Treat with antibiotic
Doxycycline, spirochete that enters skin
through tick bite, disease seen in three stages.
112. Signs and symptoms of transfusion reaction?
Chills, shaking, flank pain, hyperthermia (NOT
hypothermia).
113. Child with sickle cell crisis, which signs and
symptoms shows a child is having minor cerebral
attack? Headache, weakness, visual
disturbances.
114. In teaching, the parent of a newly diagnosed 2
y.o child with pyelonephritis related to
vesicoureteral reflux (VUR), the nurse should
include which information? Have siblings
examined for VUR
115. The nurse is assisting with application of a
synthetic cast on a child with a fractured humerus.
What is an advantage of a synthetic cast over a
plaster of Paris cast? Drying time is faster
116. To assist in the prevention of urinary tract
infections (UTIs) in children, which of the
following is one of the best recommendations the
nurse should make to parents? Ensure clear
liquid intake of 2 L/day
117. The nurse notes that a child has lost 3.6 kg (8
lb) after 4 days of hospitalization for acute
glomerulonephritis. What is the most likely cause
of this weight loss? Reduction of edema
118. A young girl has just injured her ankle at
school. After notifying the child’s parents and
applying ice to the area, what is the next most
appropriate action by the school nurse? Elevate
the extremity to reduce edema formation
119. The nurse is assessing an infant with
intussusception. Which of the following clinical
findings should the nurse expect? Select all.
-Palpable sausage shaped abdominal mass
-Vomiting
-Stool mixed with blood and mucous
120. The nurse is planning care for a school age
child with bacterial meningitis. What intervention
should be included? Assess for signs of increased
intercranial pressure
121. The healthcare provider has prescribed
sulfasalazine (Azulfidine) 5mg/kg PO/dose bid
with juvenile arthritis.The child weighs 55 lb. The
nurse is preparing to administer the 0900 dose.
Calculate the dose the nurse should administer in
mg? 125 mg
122. A healthcare provider prescribes ondansetron
(Zofran) 0.15 mg/kg IV 30 minutes before
chemotherapy for a child with acute lymphoblastic
leukemia. The child weighs 22 kg. The medication
label states: Ondansetron 2mg/1 ml. The nurse
prepares to administer the dose. How many mL will
the nurse prepare to administer the dose?
1.7 mL
123. A 3-day-old infant presents with abdominal
distention, is vomiting, and has not passed any
meconium stools. What disease should the nurse
expect?
Hirschsprung disease.
124. A 10 yr. old child is seen in the peds clinic with
fever, colicky abdominal pain, and bloody diarrhea.
The pediatric nurse suspects the causative pathogen for
this child’s diarrhea is which of the following
pathogens?
Salmonella.
125. While educating a new 7yr old diabetic patient
and the parents, the pediatric nurse includes which of
the following times during the day when the child’s
blood sugar level needs to be monitored?
Check blood glucose levels ac and hs.
126. The pediatric version of the Glasgow Coma Scale
is used on a 3-year-old male after falling from a tree in
his back yard. A score of 3 on his chart is associated
with?
Deep coma.
127. The nurse is preparing to admit a 7-year-old child
with Crohn disease. What clinical manifestations
should the nurse expect to observe? (Select all that
apply.)
Pain is common.
Diarrhea is moderate to severe.
Anal and perianal lesions are common.
128. A full-term male has hypospadias. Which
statement describes hypospadias?
The urethral meatus opens on the underside of the
penis.
129. Children with salt losing type of Congenital
Adrenal Hyperplasia (CAH) need which of the
following replacement therapy?
Aldosterone.
130. A child with cerebral palsy is seen in peds
specialty clinic and will receive a Botox injection. The
peds nurse is aware the treatment is specifically for
which of the following conditions? Spasticity
131. The Transanal Soave pull through procedure
is scheduled to be done on an infant in the PICU,
the peds nurse is aware that the procedure will
correct which of the following defect?
Aganglionic megacolon.
132. The nurse is teaching the family of a child,
age 8 years, with moderate hemophilia about
home care. What should the nurse tell the family
to do to minimize joint injury?
Provide intravenous (IV) infusion of factor
VIII concentrates.
133. A 4 yr old in the PICU in unconscious after
a MVA, and is at risk for increased incranial
pressure (ICP). What nursing intervention will
reduce the risk of ICP?
Limit stimulation.
134. What intervention should be beneficial in
reducing the risk of Reye syndrome?
Avoidance giving aspirin to children after a
suspected vital illness.
135. An infant with recurring atopic dermatitis
(eczema) is seen in peds clinic because of a recent
exacerbation. Which suggestion should the nurse
provide to the parents?
Apply petroleum jelly to skin after daily bath.
136. A 12 yr. old child at summer camp has a rash,
and the nurse suspects Lyme disease. Which of
the following symptoms describe Lyme disease?
(Select all that apply.)
Caused by a spirochete that enters the skin
through a tick bite.
Disease initially seen in any of 3 stages.
Treated with oral antibiotic Doxycycline.
137. Which of the following are clinical
manifestations of minimal change nephrotic
syndrome, usually seen in children with this
disorder?
Massive proteinuria, hypoalbuminemia, and
edema.
138. A 4-year-old is seen in the ER with a fracture
of the humerus. Which of the following P’s are
assessed to determine the extent of the child’s
injury?
Pain and pulselessness.
139. Which of the following is a common
symptom seen in a newborn with a diagnosis of
hypothyroidism?
Constipation.
140. A child hospitalized with juvenile idiopathic
arthritis (JIA) complains of pain in the knees.
What intervention should help to relieve the
discomfort?
Applying warm, moist compresses to the
knees.
141. A pediatric nurse is caring for a newborn in
the NICU with clinical manifestations of bulging
fontanel and distended scalp veins and separated
sutures. Which of the following diagnosis the
symptoms suggest? Hydrocephalus.
142. A 5-year-old child is admitted to the hospital
in a sickle cell crisis. Which of the following
symptoms would indicate the child is having a
minor cerebral attack? Headache, Weakness
143. Which of the following treatment is the best
method for a 7-month-old infant with
Developmental Dysplasia of the Hip (DDH)?
Closed Reduction with Spica Casting.
144. Which of the following statements best
describes diabetes insipidus?
Diabetes insipidus is characterized by the
passage of large volumes of dilute urine.
145. A pediatric nurse is taking care of a child
diagnosed with Pyelonephritis. The nurse is aware
that the most common cause of Pyelonephritis is
which of the following?
VUR with infection.
146. How should a nurse instruct the parent of a
3-month-old with seborrheic dermatitis (Cradle
Cap) to shampoo the child’s hair?
Use a soft brush or fine tooth comb to gently
scrub the area.
147. The x-rays of a 5 yr old child seen in peds
clinic showed multiple fractures. The pediatric
nurse suspects child physical abuse. Which of the
following diagnosis should also be considered in
a child with multiple fractures
148. Which nursing intervention is priority for the
pediatric intensive care nurse to implement when
caring for a 15-yaer-old client diagnosed with
diabetic ketoacidosis (DKA)?
Assess for a fruity breath odor.
149. A 10 yr old female seen in a specialty peds
clinic has a diagnosis of Spina Bifida. On
examination the peds nurse observes the spinal sac
with meninges and nerves. Which of the following
is the child’s diagnosis?
Myelomeningocele.
150.During an absence seizure activity, what
symptoms should the nurse expect the child to
experience?
Brief loss of consciousness.
151. A 2-year-old has chronic constipation and is
brought to the clinic for evaluation. The therapeutic
plan initially includes what?
Bowel cleansing.
152. Staging is a part of the diagnostic evaluation of
a child with cancer. Which of the following explains
a function of cancer staging?
Accurate staging is used as the basis for
treatment protocols.
153. The pediatric nurse is preparing to admit a
foreign born 4-year-old child with hepatitis A.
Which of the following is a clinical feature of
hepatitis A nurses normally recognize?
The mode of transmission is primarily by the
fecal oral route.
154. Accurate staging of which tumor is the
mainstay of establishing initial treatment for a 12-
month-old infant with an abdominal mass that
crosses the midline?
Neuroblastoma.
155. A 4 yr old male is evaluated in peds specialty
clinic with symptoms of muscular weakness,
lordosis, calf muscle hypertrophy, and frequent
falls. Which of the following is a likely diagnosis?
Muscular dystrophy.
What type of dehydration is defined as
“dehydration that occurs in conditions in which
electrolyte and water deficits are present in
approximately balanced proportion?” Isotonic
dehydration
What do morbidity rates measure?
Prevalence of a specific illness in a population
What health promotion interventions have the
greatest impact on injury prevention?
Using a developmental approach to safety
counseling
What is the leading cause of death from unintentional
injuries in children?
Motor vehicles
In 1935, Title V of the Social Security Act was
passed. This was significant in the evolution of child
health care in the United States because it established
what?
Child Welfare Services
What nursing intervention is most descriptive of
atraumatic care of children?
Preparing a child before any unfamiliar treatment
or procedure
What is most suggestive that a nurse has a
nontherapeutic relationship with a patient or family?
Staff members are concerned about the nurse’s
actions with the patient or
family.
What is descriptive of nursing diagnoses?
They provide the basis for the selection of nursing
interventions.
Which of the following terms best describes a group
of people who share a set of values, beliefs, practices,
social relationships, laws, politics, economics, and
norms of behavior?
Culture
.What is one of the top factors affecting children and
directedly related to health disparities?
Poverty
Maria is a Spanish-speaking 5-year-old girl who has
started kindergarten in an English-speaking school.
Crying most of the time, she appears helpless and
unable to function in this new situation. What is the
best explanation for this behavior?
She is experiencing cultural shock.
A child who has been receiving morphine
intravenously will now start receiving it orally. The
nurse would anticipate that to achieve equianalgesia
(equal analgesic effect), the oral dose will be what
compared to the intravenous dose? Greater than the
intravenous dose
The father of a hospitalized child tells the nurse,
“He can’t have meat. We are Buddhist and
vegetarians.” What is the nurse’s best
intervention?
Order the child a meatless tray as requested.
What statement is true concerning folk remedies
in pediatric health care?
They may be used to reinforce the treatment
plan.
What genetic term refers to a recognized pattern
of malformations with a single specific cause?
Syndrome
What do trisomy 13, trisomy 18, and trisomy 21
have in common?
Diagnosis can be made early based on
physical characteristics.
What statement is accurate and describes the risk
of recurrence in autosomal dominant
inheritance?
Each child of a heterozygous affected parent
has a 50% chance of inheriting the mutated
allele.
A young woman who has recently become
engaged to be married asks the nurse when
genetic counseling is advisable. The couple does
not plan to have children for several years. What
would be the nurse’s recommendation?
Now if they are members of a population at
risk for certain diseases
Elevation of triple marker screening results
indicates the need for what during pregnancy?
Further diagnostic testing
What blood or body-fluid is most often used in
chromosome analysis of a fetus?
Amniotic fluid
A couple has given birth to their first child, a
boy with a recessive disorder. The genetic
counselor tells them that the risk of recurrence is
one in four for each child they have in the future.
What statement is a correct interpretation of this
information?
The risk factor remains the same for each
pregnancy.
What statement is true concerning the increased
use of telephone triage by nurses?
Access to high-quality health care services has
increased.
What is most likely to encourage parents to talk
about their feelings related to their child’s
illness?
Use open-ended questions.
What are some legal and ethical issues that arise
for the nurse when using an interpreter?
The family should be fully informed of all
aspects of procedures before consenting.
What approach would be best to use to ensure a
receptive response from a toddler?
Focus communication on the child and tell
him or her how a procedure will feel.
When the nurse interviews an adolescent, what is
important to help establish a relationship?
Display a genuine interest in the adolescent.
The nurse is taking a health history on a child. At
the beginning of the interview, a parent says, “I
brought him here because he always has
diarrhea.” Under what heading is this
information recorded?
Chief complaint
What statement explains why it can be difficult
to assess a child’s dietary intake?
Recall of food consumption is frequently
unreliable.
What approach is the most appropriate when
performing a physical assessment on a toddler?
Use minimum physical contact initially.
The nurse is assessing a 3-year-old African
American child who is being seen in the clinic
for the first time. The child’s height and weight
are at the 20th percentile on the commonly used
growth chart from the National Center for Health
Statistics (NCHS). When interpreting these data,
the nurse would recognize what?
The NCHS charts are accurate for U.S.
African American children.
A 5 year old has patient-controlled analgesia
(PCA) for pain management after abdominal
surgery. What information does the nurse
include in teaching the parents about the PCA?
The pump allows for a continuous basal rate
and delivers a constant amount of medication
to control pain.
When taking a child’s blood pressure, the nurse
would select a cuff with a bladder width that is
large enough to cover what percentage of the upper
arm? 40%
What is the normal age for binocularity, the ability
to fixate on one visual field with both eyes
simultaneously, to be achieved?
3 to 4 months
The nurse has a 2-year-old boy sit in “tailor”
position while palpating for the presence of the
testes. What is the rationale for this position?
It prevents the cremasteric reflex.
Kimberly is having a checkup before starting
kindergarten. The nurse asks her to do the “finger-
to-nose test.” What is the purpose of this test?
Cerebellar function
What is the most consistent and commonly used
indicator of pain in infants?
Facial expression of discomfort
The nurse is educating a new nurse on
identification of pain in children. What does the
nurse teach about physiologic measurements in
children’s pain assessment?
Not useful as the only indicator for pain
What self-report pain rating scales can be used in
children as young as 3 years of age?
FACES Pain Rating Scale
What information does the nurse include when
teaching parents about nonpharmacologic
strategies for pain management in children?
May reduce pain perception.
An intravenous line is needed in a school-age
child. What medication is appropriate analgesic for
use with this patient?
LMX (4% liposomal lidocaine cream) 30
minutes before the procedure
The nurses caring for a child are concerned about
the child’s frequent requests for pain medication.
During a team conference, a new nurse suggests
they consider administering a placebo instead of
the usual pain medication to see how the child
responds. The team educates the nurse on why this
is not appropriate and bases the decision on what
knowledge?
This practice is unjustified and unethical.
The nurse is caring postoperatively for an 8-year-old
child with multiple fractures and other traumatic
injuries from a motor vehicle crash. The child is
experiencing severe pain. What is an important
consideration in managing the child’s pain?
Plan a preventive schedule of pain medication
around the clock.
What is a common significant side effect from opioid
administration? Constipation
A school-age child with cancer is being prepared for
a procedure. The child says, “I have had one of these
before. They hurt.” The nurse bases her response on
what knowledge related to pain in this patient?
Commonly experience treatment-related moderate
to severe pain when they have cancer
The mother of a child is hepatitis B surface antigen
(HBsAg) negative, when would receive his or her
first dose of the hepatitis B virus (HBV) vaccine?
Birth before discharge from the hospital.
What is the appropriate site to administer an
intramuscular (IM) vaccine to a newborn?
The vastus lateralis muscle
The hepatitis A vaccine is now recommended for the
first dose started at what age?
1 year
What time frame has the Advisory Committee on
Immunization Practices (ACIP) of the Centers for
Disease Control and Prevention (CDC) and American
College of Obstetricians and Gynecologists
recommended that pregnant adolescents and women
who are not protected against pertussis receive the
tetanus, diphtheria, and pertussis (Tdap) vaccine?
Between 27 and 36 weeks of gestation or
postpartum before discharge from the hospital
What is an important consideration when the nurse is
discussing enuresis with the parents of a young child?
The child should be encouraged to take charge of
treatment interventions.
A mother calls the school nurse saying that her
daughter has developed school phobia. She has been
out of school for 3 days. What would the nurse
include in recommendations to the mother?
Immediately return the child to school.
What assessment findings would be anticipated is a
child with depression?
Change in appetite, resulting in weight loss or
gain
What illnesses does respiratory hygiene and
cough etiquette by the Centers for Disease
Control and Prevention (CDC) prevent?
RSV, influenza, and adenovirus
What is the most common piece of medical
equipment that can transmit harmful
microorganisms among patients?
Stethoscope
A 12-month-old child presents to the clinic for a
well visit after missing several appointments.
The child began her immunization schedule but
has missed several follow-up appointments and
doses of immunizations. What is the most
appropriate nursing intervention?
The child should only receive the missed
doses of immunizations based on catch-up
schedule.
What disease would require strict isolation of the
patient?
Chickenpox
An important role of the nurse in ambulatory
settings and schools is the identification of
communicable diseases for treatment and the
prevention of spread. What is an important
component related to the first period of the
contagiousness of disease?
Prodromal stage
What vaccinations are included in health
promotion during infancy? (Select all that
apply.)
Haemophilus influenzae type b (Hib)
Diphtheria, tetanus, and pertussis (DTaP)
Poliovirus
Hepatitis B virus (HBV)
The Hib conjugate vaccine protects an infant
against what diseases? (Select all that apply.)
Bacterial meningitis
Epiglottitis
Bacterial pneumonia
Septic arthritis
Sepsis
What is the most critical physiologic change
required of newborns at birth?
Transition from fetal to neonatal breathing
Neonates are predisposed to problems with
thermoregulation because of what factor?
A large body surface area favors heat loss to
the environment.
What tools would be most useful to assess
maternal and newborn attachment behaviors?
NCAST (Nursing Child Assessment Satellite
Training) Feeding Scale
The nurse is assessing a 3-day-old breastfed
newborn who weighed 3400 g (7 pounds, 8 oz)
at birth. The infant’s mother is now concerned
because the infant weighs 3147 g (6 pounds, 15
oz). The most appropriate nursing intervention is
what?
Explain that this weight loss is within normal
limits.
Where would nonpathologic cyanosis normally
be present in the newborn shortly after birth?
Feet and hands
What findings on physical assessment of a
neonate would indicate the need for further
evaluation?
Low-set ears
What findings would the nurse consider normal
in assessing the anterior fontanel of a neonate?
Pulsating anterior fontanel
The nurse is using a bulb syringe to suction a
neonate after delivery. What is an important
consideration?
Clear the pharynx before the nasal passages.
In the newborn, into what muscle is
intramuscular vitamin K administered?
Vastus lateralis
What does the American Academy of Pediatrics
recommend as the best form of infant nutrition?
Exclusive breastfeeding until 1 year of age
What is an important consideration in
understanding the reactions of parents when their
infant is born with physical defects?
The psychologic reaction is similar to that
with the death of an infant.
An infant is born with anencephaly. Based on the
knowledge of this diagnosis, what information
does the nurse consider when interaction with
the family?
The condition is incompatible with life.
What problem is most often associated with
myelomeningocele?
Hydrocephalus
An infant with hydrocephalus is hospitalized for
surgical placement of a ventriculoperitoneal shunt.
Postoperative nursing care would include what?
Monitor closely for signs of infection.
What clinical manifestations of developmental
dysplasia of the hip would be assessed in a
newborn?
Ortolani sign
A newborn with congenital clubfoot is being
treated with serial casts. The parents ask why so
many casts are required. What information is
accurate for the nurse to provide to the family?
They allow for gradual stretching of tight
structures.
What is a major long-term problem for a child with
a cleft lip and palate?
Faulty dentition
A newborn was admitted to the nursery with a
complete bilateral cleft lip and palate. The
physician explained the plan of therapy and
anticipates good results. However, the mother
refuses to see or hold her baby. What would be
included in the initial therapeutic approach to the
mother?
Encourage her to express her feelings.
The nurse assesses a neonate after spitting up the
first feeding and having a coughing episode during
the feeding. What assessment finding would
indicate possibility of esophageal atresia or
tracheoesophageal fistula?
Excessive amount of frothy saliva in the mouth
What is the earliest clinical manifestation of biliary
atresia?
Jaundice
The nurse is caring for a neonate born with an
omphalocele. What does initial management of this
neonate include?
Covering the omphalocele with saline-soaked
gauze and a plastic drape
Hypospadias refers to what?
Urethral opening along ventral surface of penis
Mr. and Mrs. Wilson have a newborn with
ambiguous genitalia. Tests are being done to assist
in gender assignment. The parents tell the nurse
that family and friends are asking what caused the
baby to be this way. What is the appropriate
information for the nurse to provide?
Explain the disorder so they can explain it to
others.
What is the initial action in the emergency treatment
of poisoning in a child?
Assess the child.
A 7-year-old child has ingested a toxic dose of iron.
The parent reports that the child vomited and had
gastric pain an hour ago but “feels fine” now. The
parent is not sure when the child ingested the iron
tablets. What is the appropriate recommendation by
the nurse? Bring the child to the hospital
immediately.
What is the most frequent source of symptomatic lead
poisoning in children?
Lead-based paint
What is descriptive of a parent who is an abuser?
Is likely a single parent or from a young parent
family.
What is a common characteristic of those who
sexually abuse children?
Pressure victim into secrecy.
Home care is being considered for a young child who
is ventilator dependent. What factor is most important
in deciding whether home care is appropriate?
Adequate family training
For case management to be most effective, who is the
most appropriate case manager?
One nurse
The home health nurse is caring for a child who
requires complex care. The family expresses
frustration related to obtaining accurate information
about their child’s illness and its management. What
is the best action for the nurse?
Answer questions in a straightforward manner
and get professional assistance when an answer is
unknown.
When administering a gavage feeding to a school-age
child, what is the appropriate action by the nurse?
Position the child on the right side after
administering the feeding.
What is defined as the forces that favor filtration from
the capillary?
Capillary hydrostatic pressure and interstitial
oncotic pressure
What conditions would cause a decrease of fluid
requirements for children?
Increased intracranial pressure
What is characteristic of a neonate’s vision?
Pupils react to light.
A family wants to begin oral feeding of their 4-
year-old son, who is ventilator dependent and
currently tube fed. They ask the home health
nurse to feed him the baby food orally. The
nurse recognizes a high risk of aspiration and an
already compromised respiratory status. What is
the most appropriate nursing action?
Acknowledge their request, explain the risks,
and explore with the family the available
options.
The home health nurse is planning care for a 3-
year-old boy who has Down syndrome and is on
continuous oxygen. He recently began walking
around furniture. He is spoon fed by his parents
and eats some finger foods. What is the most
appropriate goal to promote normal
development? Encourage mobility.
What is the appropriate description of a young
child who has an intelligence quotient (IQ) of
45?
Moderately cognitively impaired but
trainable
When a child with mild cognitive impairment
reaches the end of adolescence, what
characteristics would be expected?
Achieves a mental age of 8 to 12 years.
When would children with cognitive impairment
be referred for stimulation and educational
programs?
As young as possible.
Parents of a child with cognitive impairment ask
the nurse for guidance in toilet training. They
have older children who were successfully toilet
trained but do not know how to do this with the
impaired child. What would be included in the
nurses recommendation?
Determine the child’s readiness to begin toilet
training.
What is one of the major physical characteristics
of a child with Down syndrome?
Hypotonic musculature
A child with Down syndrome may be screened
for what before participating in some sports?
Atlantoaxial instability
Latex allergy is suspected in a child with spina
bifida. What are appropriate nursing
interventions to include in care of this patient?
Avoid using any latex product.
What is a common clinical manifestation of
autism? Early abnormal eye contact
The nurse would make a referral for
communication impairment in what situations?
First words not uttered before age 2 years
What represents the major stressor of
hospitalization for children from middle infancy
throughout the preschool years?
Separation anxiety
When a preschool child is hospitalized without
adequate preparation, how would the child likely
view this hospitalization? Punishment
What is usually the greatest threat to a
hospitalized adolescent?
Fear of altered body image
What is a common initial reaction of parents to
illness or injury and hospitalization in their
child? Frustration
A 6-year-old child needs to be hospitalized again
because of a chronic illness. The clinic nurse
overhears her school-age siblings tell her that
they are “sick of Mom always sitting with her in
the hospital and playing with her. . . . It isn’t fair
that you get everything and we have to stay with
the neighbors.” What is the nurse’s best
assessment of this situation?
Jealousy and resentment are common
reactions to the illness and hospitalization of a
sibling.
What is an appropriate nursing intervention to
minimize separation anxiety in a hospitalized
toddler? Encourage parents to room-in.
A 3-year-old child is being admitted for 1 week
of hospitalization. Her parents tell the nurse that
they are going to buy her “a lot of new toys
because she will be in the hospital.” What
understanding of the child’s age guides the
response by the nurse?
At this age, children often need the comfort
and reassurance of familiar toys from home.
What is important understanding for a nurse
working in an outpatient surgery center for
children? Families need to be prepared for what
to expect after discharge.
What would the nurse consider when having
informed consent forms signed for surgery and
procedures on children?
The risks and benefits of a procedure are part
of the consent process.
The nurse is planning how to prepare a 4-year-old
child for a diagnostic procedure. What guidelines
are appropriate for preparing a preschooler?
Tell the child procedures are never a form of
punishment.
The nurse is preparing a 12-year-old girl for a bone
marrow aspiration. She tells the nurse she wants
her mother with her “like before.” What is the
appropriate nursing action?
Grant her request.
What would be helpful word(s) to substitute for the
word “shot” when working with a 4-year-old
child? Medication under the skin
When would clear liquids be stopped before a
scheduled surgery? Two hours before surgery
What is a potential cause of a postoperative
decrease in blood pressure?
Vasodilating anesthetic agents
The nurse is caring for an unconscious 10-year-old
child. What would be included in skin care for this
child?
Use a drawsheet to move the child in bed to
reduce friction and shearing injuries
What is an appropriate intervention to encourage
food and fluid intake in a hospitalized child?
Give high-quality foods and snacks whenever
the child expresses hunger.
A 3-year-old child has a fever. Her mother calls the
nurse reporting a fever of 38.8° C (102° F) even
though the child had acetaminophen 2 hr ago.
What is the basis for the nurse’s actions?
Fevers such as this are common with viral
illnesses.
A young child is brought to the emergency
department with severe dehydration secondary to
acute diarrhea and vomiting. What is the
therapeutic management of this child?
Intravenous fluids
Rapid replacement of fluid is essential in the
treatment of what types of dehydration? Hypotonic,
isotonic
Depression of the central nervous system (CNS),
manifested by lethargy, delirium, stupor, and coma, is
observed in what?
Metabolic and respiratory acidosis
The nurse is assessing an infant brought to the clinic
with diarrhea. He is lethargic and has dry mucous
membranes. What would the nurse recognize as an
early sign of dehydration? Tachycardia
What is an appropriate nursing action when caring for
a child with an intravenous infusion?
Observe the insertion site frequently for signs of
infiltration.
Several types of long-term central venous access
devices are used. What is a benefit of using an
implanted port (e.g., Port-a-Cath)?
Easy access for blood work
What is a major complication of total parenteral
nutrition in children? Liver disease
What would the nurse recognize as an early clinical
sign of compensated shock in a child?
Apprehension
What occurs in septic shock? Massive vasodilation
What statement regarding burn injuries in children is
correct? The prognosis for a burned child is
directly related to the amount of tissue destroyed.
A child is developing respiratory failure. What are the
assessment findings to indicate the signs of hypoxia
are becoming severe? Somnolence
What is a primary intervention when an infant chokes
on a piece of food?
Blows between the shoulder blades.
The nurse is assessing a child with a cardiac history.
The child’s extremities are cool with thready pulses,
and urinary output is diminished. What do the
assessment findings suggest for this child?
Decreased contractility
What procedure use high-frequency sound waves
obtained by a transducer to produce an image of
cardiac structures? Echocardiography
Distortion of sound and problems in
discrimination are characteristic of what type of
hearing loss?
Sensorineural
What assessment finding would suggest to the
nurse a possible visual impairment in a child?
Excessive rubbing of the eyes
The nurse wears gloves during a dressing
change. What is the appropriate action when the
nurse removes the gloves?
Wash hands thoroughly.
A 2-year-old child is being admitted to the
hospital for possible bacterial meningitis. What
is the appropriate nursing intervention when
preparing for a lumbar puncture?
Place the child in a side-lying position.
What is an important nursing intervention when
performing a bladder catheterization on a young
boy?
Insert 2% lidocaine lubricant into the
urethra.
The nurse needs to do a heel stick on an ill
neonate to obtain a blood sample. What is
recommended to facilitate this procedure?
Wrap the foot in a warm washcloth.
When giving liquid medication to a crying 10-
month-old infant, what approach minimizes the
possibility of aspiration?
Administer the medication with an oral
syringe placed along the side of the infant’s
tongue.
The nurse is caring for a 12-year-old boy who
sustained major burns when he put charcoal
lighter on a campfire. The nurse observes that he
is “very brave” and appears to accept pain with
little or no response. What is the most
appropriate nursing action?
Request a psychologic consultation.
To prevent burns from hot water in the home,
what is the recommended water heater
thermostat setting?
49° C (120° F)
What urine tests of renal function is used to
estimate glomerular filtration?
Creatinine
An 18-month-old child has just been admitted
with croup. His parent is tearful and tells the
nurse, “This is all my fault. I should have taken
him to the doctor sooner so he wouldn’t have to
be here.” What is appropriate in the care plan for
this parent?
Clarify misconception about the illness.
A young child is diagnosed with vesicoureteral
reflux. What is a common recurrent complication
in a child with this diagnosis?
Recurrent urinary tract infections
What best describes the cause of most cases of
acute glomerulonephritis?
Antecedent streptococcal infection
In acute glomerulonephritis, what is the nurse is
aware that is an early warning sign of
encephalopathy?
Dizziness
What are the common clinical manifestations of
nephrotic syndrome?
Proteinuria, hypoalbuminemia, and edema
What is included in the therapeutic management
of nephrotic syndrome?
Corticosteroids
When does dialysis or transplantation becomes
necessary for a child in chronic renal failure?
Glomerular filtration rate falls below 10% to
15% of normal
What is an advantage of continuous cycling
peritoneal dialysis or continuous ambulatory
peritoneal dialysis for adolescents who require
dialysis?
Adolescents can carry out procedures
themselves.
What type of diarrhea is commonly seen in
malabsorption syndromes because the intestine
cannot absorb nutrients or electrolytes?
Chronic
What is the viral pathogen that frequently causes
acute diarrhea in young children?
Rotavirus
A stool specimen from a child with diarrhea
shows the presence of neutrophils and red blood
cells. This is most suggestive of what
conditions?
Bacterial gastroenteritis
A 2-month-old breastfed infant is successfully
rehydrated with oral rehydration solutions for acute
diarrhea. What instructions are include to the
mother specific to breastfeeding?
Continue breastfeeding.
The nurse is explaining to a parent how to care for
a child with vomiting associated with a viral
illness. What would the nurse include?
Brush teeth or rinse mouth after vomiting.
The school nurse is called to the cafeteria because
a child “has eaten something he is allergic to.” The
child is in severe respiratory distress. What is the
priority nursing intervention?
Have someone call for an ambulance or
paramedic rescue squad.
What helps nurses understand how the respiratory
tract in children is different from the respiratory
tract in adults?
Infants rely almost entirely on diaphragmatic-
abdominal breathing.
What is a measure of chest wall and lung
distensibility? Compliance
What blood oxygenation tests is the photometric
measurement of oxygen saturation?
Oximetry
What is included in nursing considerations related
to the administration of oxygen in an infant?
concentration.
The nurse is teaching a mother how to perform
chest physiotherapy and postural drainage on her
3-year-old child, who has cystic fibrosis. What
would the nurse include in the instructions for
performing percussion?
Cover the skin with a shirt or gown before
percussing.
The nurse is caring for an infant with a
tracheostomy when accidental decannulation
occurs. The nurse is unable to reinsert the tube.
What would be the nurse’s next action?
Try inserting a smaller tube.
What is included in the assessment for the
Glasgow Coma Scale?
Eye opening and verbal and motor response
What would be included in nursing interventions for
a child after a cardiac catheterization?
Assess the affected extremity for temperature and
color.
What is an early sign of heart failure that would be
recognized by the nurse? Tachypnea
What would be included in nursing care of an infant
with heart failure?
Organize activities to allow for uninterrupted
sleep.
What heart defects causes hypoxemia and cyanosis
because desaturated venous blood is entering the
systemic circulation? Tetralogy of Fallot
What information would a nurse counseling parents
on the home care of the child with a cardiac defect
before corrective surgery include?
Promote normality within the limits of the child’s
condition.
What is an important nursing consideration when
chest tubes will be removed from a child?
Administer analgesics before procedure.
What is included in the therapeutic management of
the child with rheumatic fever?
Administration of penicillin
What is the primary therapy for secondary
hypertension in children?
Treatment of underlying cause
What statement best describes hypopituitarism?
Skeletal proportions are normal for age.
What would the nurse include when discussing a
child’s precocious puberty with the parents?
Dress and activities should be appropriate to
chronologic age.
What is the primary clinical manifestation of diabetes
insipidus?
Polyuria, polydipsia
A 13-year-old girl is brought to the clinic with the
complaint of insomnia and hyperactivity. Other
symptoms include gradual weight loss despite a good
appetite; warm, flushed, and moist skin; and
unusually fine hair. What are these assessment
findings suggestive of for this child?
Hyperthyroidism
What factors predisposes the urinary tract to
infection?
Short urethra in girls
What is an important nursing responsibility
when a dysrhythmia is suspected?
Count the apical rate for 1 full minute and
compare with radial rate.
The nurse is explaining blood components to an
8-year-old child. What is the nurse’s best
description and action of platelets?
Help your body stop bleeding by forming a
clot (scab) over the hurt area.
What is the cause for the signs and symptoms
when hemoglobin falls sufficiently to produce
clinical manifestations? Tissue hypoxia
The nurse suspects a child is having an adverse
reaction to a blood transfusion. What is the
initial action by the nurse?
Stop transfusion and maintain a patent
intravenous line with normal saline and new
tubing.
The parent of a child receiving an iron
preparation tells the nurse that the child’s stools
are a tarry green color. What information does
the nurse included in discussion with this parent?
Normally expected change resulting from the
iron preparation
What is a priority nursing consideration when
caring for a child with sickle cell anemia?
Teach the parents and child how to recognize
the signs and symptoms of crises.
The parents of a child hospitalized with sickle
cell anemia tell the nurse that they are concerned
about narcotic analgesics causing addiction. The
nurse would explain what concerning narcotic
analgesics?
When they are medically indicated, children
rarely become addicted.
Chelation therapy is begun on a child with alpha-
thalassemia major. What is the purpose of this
therapy? Eliminate excess iron.
The school nurse is caring for a child with
hemophilia who fell on his arm during recess.
What supportive measures would the nurse
implement first?
Elevate the arm above the level of the heart.
What factors promote(s) wound healing?
Moist, crust-free wound environment
What is the initial therapeutic management of the
child with acute diarrhea and dehydration?
Oral rehydration solution
The school nurse is discussing prevention of
acquired immunodeficiency syndrome with
some adolescents. What is appropriate to
include?
Recreational drug users should not share
needles or other equipment.
What are included in nursing considerations
related to the administration of chemotherapeutic
drugs?
Many chemotherapeutic agents are vesicants
that can cause severe cellular damage if drug
infiltrates.
What pediatric oncologic emergencies are
caused by the rapid release of intracellular
metabolites during the initial treatment of some
cancers? Acute tumor lysis syndrome
What are the most common signs and symptoms
of leukemia related to bone marrow
involvement? Petechiae, fever, and fatigue
A child with lymphoma is receiving extensive
radiotherapy. What is the most common side
effect of this treatment? Malaise
What is included in the postoperative care of a
preschool child who has had a brain tumor
removed? Carefully monitor fluids because of
cerebral edema.
What best describes a neuroblastoma?
The diagnosis is usually made after metastasis
occurs.
What is most descriptive of the therapeutic
management of osteogenic sarcoma?
Treatment usually consists of surgery and
chemotherapy.
Where are Wilms tumors (nephroblastomas)
located? Kidney
What is a clinical manifestation of increased
intracranial pressure (ICP) in infants?
Irritability
What statement is correct regarding sports
injuries during adolescence?
Adolescents may not possess the insight and
judgment to recognize when an activity is
beyond their capabilities.
The nurse is doing a neurologic assessment on a
child whose level of consciousness has been
variable since sustaining a cervical neck injury 12
hr ago. What is the most essential in this
assessment? Reactivity of pupils
The nurse is caring for a child with multiple
injuries who is comatose. What information is
accurate related to pain in this child?
Requires astute nursing assessment and
management.
The nurse is caring for a 2-year-old girl who is
unconscious but stable after a car accident. Her
parents are staying at the bedside most of the time.
What is an appropriate nursing intervention?
Encourage the parents to hold, talk, and sing to
her as they usually would.
Why are infants particularly vulnerable to
acceleration–deceleration head injuries?
Musculoskeletal support of the head is
insufficient.
What findings would indicate to the nurse further
assessment and treatment is needed for a child with
mild head injury? Confusion or abnormal
behavior
A 3-year-old child is hospitalized after submersion
injury. The child’s mother complains to the nurse,
“This seems unnecessary when he is perfectly
fine.” What is the appropriate response by the
nurse?
“The reason for hospitalization is that
complications could still occur.”
The nurse is admitting a young child to the hospital
because bacterial meningitis is suspected. What is
a priority of nursing care?
Administer antibiotic therapy as soon as it is
available.
A child is brought to the emergency department
after experiencing a seizure at school. He has no
history of seizures. The father tells the nurse that
he cannot believe the child has epilepsy. What is
the best response by the nurse?
“The seizure may or may not mean that your
child has epilepsy.”
The nurse is caring for a child hospitalized with acute
adrenocortical insufficiency. Because of the sudden,
severe nature of the disease, the family needs a great
deal of emotional support. What is the most
appropriate nursing action?
Prepare the family for each procedure.
What statement best describes Cushing syndrome?
It is caused by excessive production of cortisol.
The parent of a 10-year-old child with diabetes asks
the nurse why home blood glucose monitoring is
being recommended. What is the basis for the nurse’s
explanation? Children have a greater sense of
control over the diabetes.
A school-age child recently diagnosed with type 1
diabetes mellitus asks the nurse if he can still play
soccer, play baseball, and swim. What is the basis of
knowledge for the response by the nurse?
Exercise is not restricted unless indicated by other
health conditions.
When a child develops diabetic ketoacidosis, what is
this considered by the nurse?
A life-threatening situation
When determining the etiology of a skin problem,
what is essential to the diagnosis of the lesions?
Careful inspection
What is the appropriate term to describe an abnormal
sensation such as burning or prickling?
Paresthesia
After surgical repair of a fractured femur a 10 yr old
has a long leg cast on. The toes on the child’s cast leg
are edematous, but has sensitivity, and movement.
What action should the nurse take?
Elevate the foot and leg on a pillow
Evidence-based practice in clinical management is
grounded in which of the following?
Clinical Research Studies
A preschool child needs a dressing change to an area
with a 2nd degree thickness burn. To prepare the
child, what strategy should the nurse implement?
Administer pain medication to prep for the
procedure
The nurse is preparing to administer a unit of packed
red blood cells to a hospitalized child. What are
appropriate actions that applies to administering
blood?
What is an important nursing consideration when
caring for a child with impetigo contagiosa?
Thoroughly wash hands and maintain
cleanliness when caring for an infected child.
What is the cause of ringworm, a skin disorder
frequently found in schoolchildren?
Fungus
What would the nurse include when explaining
how to manage pediculosis capitis?
Remove nits with a fine-tooth comb or
tweezers.
Matt’s mother tells the nurse that he keeps
scratching the areas where he has poison ivy.
What is the basis of knowledge for the response
by the nurse?
Scratching the lesions may cause them to
become secondarily infected.
The nurse stops to assist a child who has been hit
by a car while riding a bicycle. Someone has
activated the emergency medical system. Until
paramedics arrive, the nurse would consider
what in caring for this child who has experienced
severe trauma?
Rapid assessment should begin with ABC
status: airway, breathing, and circulation.
Immobilization causes what effects on the
cardiovascular system? Venous stasis
A young child has recently been fitted with a
knee, ankle, and foot orthosis (brace). What
would be included in care of the skin?
Contact a practitioner or orthotist if skin
redness does not disappear.
A child, age 10 years, sustained a fracture in the
epiphyseal plate of her right fibula when she fell
out of a tree. What does the nurse consider when
discussing this injury with her parents?
Bone growth can be affected by this type of
fracture.
What would cause a nurse to suspect that an
infection has developed under a cast?
“Hot spots” felt on the cast surface
A nurse is reviewing the laboratory values of a
child with rheumatic heart disease. Which
finding does the nurse conclude is related to this
condition?
Positive antistreptolysin titer
What results when ice is applied immediately
after a soft tissue injury, such as a sprained
ankle?
Produces deep tissue vasodilation.
A 4-year-old child is newly diagnosed with
Legg-Calvé-Perthes disease. Nursing
considerations include what?
Teach the family the care and management of
the corrective appliance.
The nurse is preparing an adolescent girl for
surgery to treat scoliosis. What would the nurse
include? Blood administration may be an
option.
What is an important nursing consideration when
caring for a child with juvenile idiopathic
arthritis? Teach the child and family the
correct administration of medications.
A 6-month-old infant does not smile, has poor
head control, has a persistent Moro reflex, and
often gags and chokes while eating. What are
these findings are most suggestive of in this
infant? Cerebral palsy
The parents of a child with cerebral palsy ask the
nurse if any drugs can decrease their child’s
spasticity. What is the basis for the nurse’s
response? Implantation of a pump to deliver
medication into the intrathecal space
decreases spasticity.
What clinical manifestations in an infant would
be suggestive of spinal muscular atrophy
(Werdnig-Hoffmann disease)?
Lying in the frog position
What is included in the therapeutic management
of a child with tetanus?
Antibiotics to control bacterial proliferation
at the site of injury
An adolescent has sustained a spinal cord injury.
What are the characteristics of the first stage,
known as spinal shock syndrome?
Flaccid paralysis below level of damage
A young boy has just been diagnosed with
pseudohypertrophic (Duchenne) muscular
dystrophy. What is included in his plan of care
for his family?
Recommend genetic counseling.
A hospitalized child with minimal change
nephrotic syndrome is receiving high dose
prednisone. What nursing goal is appropriate for
this child?
Promote adherence to the antibiotic regimen
A 4 yr old with Spina Bifida is prepared for a
straight catherization by the peds nurse. Which of
the following actions by the nurse is recommended
for this child?
Medicate the child with pain meds before the
procedure
Which of the following pain tool is most
appropriate for use in a 10 yr old child with Sickle
Cell Anemia, to outline the area of the child’s
pain?
APPT scale
Which of the following should be included in the
nursing care of a child with autism spectrum
disorder (ASD)
Assign the child to a private room
The nurse provides feeding instructions to a parent
of an infant diagnosed with gastro-esophageal
reflux (GER). Which instruction should the nurse
give the parent to assist in reducing the episodes of
emesis? (Select all that apply)
Provide smaller more frequent meals
Thicken the feedings by adding rice cereal to
the formula
Burp the infant frequently during feeding
Which of the following statements best describes
Duchenne (pseudo-hypertrophic) muscular
dystrophy (DMD)?
It had an X-linked inheritance problem
It is characterized by presence of the Gower
sign
Child exhibits a waddling gait, and lordosis
The nurse is doing a pre-hospitalization orientation
for a girl, age 7 years, who is scheduled for cardiac
surgery. As part of the preparation, the nurse the
nurse explains that after the surgery, the child will
be in the intensive care unit. How might the
explanation by the nurse be viewed?
Necessary information for the child and parents
An 15 month old child seen in the Peds clinic is
diagnosed with Hypertonic Dehydration. Which of
the following is true of Hypertonic Dehydration?
Electrolyte deficits is less than water deficits
Administer the blood with normal saline in a
piggyback setup
Administer the first 50ml of blood slowly and stay
with the child
Administer blood through an appropriate filter
A disorder in which the basement membrane of
the glomeruli becomes permeable to plasma
proteins describes which of the following
disorders?
Nephrotic syndrome
The components of the FLACC scale include
cry, leg movement, facial expression, and
activity. Choose the missing component from the
following list.
Consolability
A 9 yr old seen in pediatric endocrine clinic has
symptoms of Cushing’s syndrome. What is the
most common cause of Cushing’s syndrome as
manifested in children?
Adrenal adenoma

Which of the following is the most common
symptom of Seborrhea Dermatitis?
Scalp rash
A 10 yr old male with Legg-Calve Perthes Disease is
seen by the pediatrician. The student nurse is aware
that management of this disease includes which of the
following?
Rest, staging of the disease process, traction
Which clinical finding may be present in an older
child with Coarctation of the Aorta?
Diminished pulse in the lower extremities
A school-age child with cystic fibrosis takes four
enzyme capsules with meals. The child is having one
to two bowel movements per day. The nurse action in
regard to the pancreatic enzyme is based on the
knowledge that the dosage is what?
Needs to be increased to decrease the number of
bowel movements per day
Which of he following toys are appropriate for a
hospitalized preschool age child?
Coloring books, building blocks, clay
A newborn female infant in the NICU has signs
of ambiguous genitalia, and hyponatremia.
Which of the following is the infant’s likely
diagnosis?
Congenital Adrenal Hyperplasia
Major goals for the therapeutic management of
juvenile idiopathic arthritis (JIA) include?
Control pain, preserve joint function
Prevent skin breakdown, relieve symptoms
Reduce joint discomfort, regain proper
alignment
After studying about seizures, the student nurse
understands which of the following?
Complex partial seizures result in no loss of
consciousness
The nurse is caring for an adolescent client The health care provider has prescribed
receiving intravenous (IV) morphine for severe ondansetron (Zofran) 0.1 mg/kg as needed for a
pain. The nurse observes a respiratory rate child admitted for vomiting. The child weighs
shallow, and the client cannot be aroused. What 55lbs. Calculate the correct dose of Zofran in
priority nursing action should the nurse take? milligrams.
Discontinue intravenous infusion 2.5
A parent of a child with a disability expresses The nurse is caring for an 18-month-old with
feelings of guilt to the nurse about the child’s salmonella. Which of the following clinical
condition. What nursing intervention is most manifestations would the nurse expect to observe?
appropriate in this situation? Colicky abnormal pain and bloody diarrhea
Explore the parent’s adjustment responses
The nurse is teaching the family of a child with
Type 1 diabetes about insulin. What should the
nurse include in the teaching session?
Diabetic supplies should not be left in a hot
environment
After it has been opened, insulin is good for
up to 28 to 30 days
Insulin bottles that have been opened should
be stored at room temp or refrigerated

Which of the following is a common symptom seen
in an infant diagnosis of hypothyroidism?
Lethargy
The health care provider has prescribed
famotidine (Pepcid) 1mg/kg/day divided BID for
a child with gastroesophageal reflux disease,
child weights 33lb. The nurse is preparing to
administer the 0900 dose. Calculate the dose the
nurse should administer in milligrams.
7.5
The health care provider prescribes vancomycin
200mg per intravenous piggy back (IVPB) every
6 hours for a child with cystic fibrosis. The
pharmacy sends the medication to the unit in a
150ml bag with directions to run the medication
over 120 minutes. What milliliters per hour will
the nurse set the intravenous pump to run the
medication over 120 minutes?
75ml
What information should the nurse include when
teaching an adolescent with inflammatory Bowel
disease (IBD)?
How to cope with stress and adjust to chronic
illness
Which assessments are included in the Apgar
scoring system?
Muscle tone, color, reflex irritability
The healthcare provider has prescribed
sulfasalazine (Azulfidine) 5mg/kg PO per dose
twice a day for a child with juvenile arthritis.
The child weighs 55lb. The nurse is preparing to
administer the 0900 dose. Calculate the dose the
nurse should administer in milligrams.
125mg
The health care provider had prescribed
diazepam (Valium) 0.8mg/kg/day PO for a child
with cerebral palsy who weighs 110lb. The nurse
is preparing to administer the 1200 dose.
Calculate the dose the nurse should administer in
milligrams
10mg
One of the most important interventions when
caring for an infant with myelomeningocele in
the preoperative stage is which?
Watch for sign that might indicate developing
hydrocephalus
 1. A 1-year-old child goes to day care
is recovering from an episode of
otitis media. Which intervention is
most important for the nurse to
recommend to the patients in order to
prevent recurrence?
Ans: Smoking cessation by the
parents
2. A nurse is planning to test the visual
acuity of a 7-year-old. Which is the
best way to test visual acuity in this
child?
Ans: Position the child at a
distance of 10 ft (3 m) from a
chart.
3. Which assessment findings should
the nurse anticipate in a child with
suspected acute otitis media (AOM)?
Select all that apply.
Frequent pulling on the affected
ear, Refusal to eat, Restlessness
and irritability
4. The health care provider (HCP)
prescribes a 10-day course of amoxicillin for a 1-
year-old diagnosed with acute otitis media (AOM). “My child's fingernails should be kept short and
Which instruction is most important for the nurse to well-filed.”
review with the child's parents?
Ans: Return to the office if the child does not
improve within 48-72 hours
5. A 2-year-old is suspected of having
retinoblastoma. The nurse recognizes which sign as
being most characteristics of this disease?
Ans: Absent of red reflex
6. The nurse is performing an assessment on
a 2-year-old with otitis media. Which of the
following actions would be appropriate? Select all
that apply.
Ans: Do not insert the speculum into the bony
inferior part of the ear canal
Encourage the parents to have the child
vaccinated against influenza and pneumonia
Inspect the tympanic membrane for
redness, bulging, and perforation
Wait until the end of the assessment to
perform the otoscopic examination
1. A 2-year-old is diagnosed with atopic
dermatitis (eczema). Which instructions
should the nurse teach the parents? Select 1) The nurse is planning care for a child being
all that apply.
Ans: Apply emollient immediately after priority to which nursing intervention?
bath.
Give tepid baths with mild soap
Keep child's nails well-trimmed
2. What is the priority when caring for a 6-
month-old diagnosed with atopic
dermatitis?
Ans: Prevention of scratching
3. The parent of a 6-year-old calls the nurse 3) An 8-month-old infant is scheduled for a
and reports that the child was playing
outside in the snow and the child's feet
now appear red and swollen. What is the
best response by the nurse? Ans: Place
the child's feet in warm water
immediately
4. The nurse reinforces teaching for the
parents of a child with impetigo. Which of on a telemetry unit. Which client should the nurse
the following statements by a parent
indicates correct understanding of
teaching? Select all that apply.
Ans:
“I should wash my hands before and after
touching the infected area.”
“I will separate my child's towels from other
laundry and wash with hot water.”
“The infection could easily spread to other
children who come in contact with my child.”
5. A child's arm is burned from accidentally
spilling boiling water on it, and the parent RR – 24
calls the clinic. The nearest emergency
department is an hour away. Which
instructions would be appropriate to give Physical Assessment
the parent? Select all that apply.
Ans:
“Briefly soak the arm with cool water.”
“Cover the area with a clean, dry cloth.”
“Remove clothing, if not stuck to skin,
around the burn.”
6. The clinic nurse is reviewing self-care
management of acne vulgaris with an
adolescent client. Which client statement extremities.
indicates a need for further instruction?
Ans: “I have been scrubbing my face
twice daily with antibacterial soap.”
admitted with Kawasaki disease and should give
Monitor for a gallop heart rhythm and Promote a quiet period upon waking in the
decreased urine output. morning
Swaddle the infant during procedures
2) A nurse is assessing a 1-month-old infant with an
atrial septal defect (ASD). Which assessment 7) A nurse is assisting a new mother as she is
finding does the nurse expect? breastfeeding her infant. The infant has been
Murmur diagnosed with tetralogy of Fallot. During feeding,
the infant becomes cyanotic and is having difficulty
breathing. What should be the nurse's first action?
femorally inserted balloon angioplasty of a Place infant in knee to chest position
congenital pulmonic stenosis in the cardiac
catheterization laboratory. Which finding should the 8) The nurse is providing discharge instructions to
nurse report to the health care provider that could the parent of a child with Kawasaki disease. The
possibly delay the procedure? nurse informs the parent that the presence of which
Infant has severe diaper rash symptom should be immediately reported to the
health care provider?
4) The nurse receives report on 4 pediatric clients Fever
assess first? 9) A 3-month-old client has stopped breathing.
Infant client with ventricular septal defect with Identify the area where the nurse should check the
reported grunting during feeding client's pulse.
The brachial artery is used to detect a pulse in an
5) The emergency nurse is admitting a 12-year-old unresponsive client age <1 year.Located in
client who reports palpitation. Which action should between armpit and elbow.
the nurse anticipate?
Instructing the client to hold their breath and 10) The nurse is caring for a newborn with patent
bear down ductus arteriosus. Which assessment finding should
the nurse expect?
Click the exhibit button for additional Loud machine-like murmur.
information
VS 11) The nurse is assisting with an education
Temp – 97.1 conference for graduate nurses about infant CPR.
B/P – 114/74 Which of the following statements are appropriate
HR – 234 to include in the teaching? Select all that apply.
“A single rescuer responding to an unwitnessed
SpO2 – 97% infant arrest should perform 2 minutes of CPR
before retrieving a defibrillator.”
“You should assess the infant’s brachial pulse
Neuro – Alert and oriented to person, place, and for no longer than 10 seconds.”
time. Follows commands
Cardio – Tachycardia noted. + 1 radial pulses. 12) When monitoring an infant with a left-to-right-
+1 carotid pulses. Jugular veins 1 cm at 45- sided heart shunt, which findings would the nurse
degree angle. expect during the physical assessment?
Resp – Clear to auscultation. No adventitious Diaphoresis during feedings
sounds. Even and unlabored breathing. Heart murmur
Skin – Color appropriate for ethnicity. No Poor weight gain
cyanosis or mottling.
Extremities – No edema in upper or lower 13) Click on the area where the nurse should place
the thumbs or fingers to provide chest compressions
for an infant.
6) A nurse is teaching the parents of an infant with The thumbs should be positioned side by side,
tetralogy of Fallot. Which of the following actions just below the nipple line
should the nurse include to reduce the incidence of
hypercyanotic spells? Select all that apply. 14) A nurse auscultates a loud cardiac murmur on a
Encourage smaller, frequent feedings newborn with suspected trisomy 21 (Down
Offer a pacifier when the infant begins to cry syndrome). A genetic screen and an
echocardiogram are scheduled that day. The
neonate's vital signs are shown in the exhibit. What
would be an appropriate action for the nurse to
complete next?
Document the assessment finding
VS
Temp – 98.6
HR – 146
RR – 42
SpO2 – 98%
1. The nurse is reinforcing education to the
caregivers of a 9-year-old client
diagnosed with scarlet fever. The client
has a history of type 1 diabetes mellitus.
Which statement by the caregivers
indicates that further teaching is needed?
“We will not administer insulin if our
child is unable to eat.”
2. The nurse receives new prescription for a
6-month-old client with bacterial
meningitis. Which action is the priority of
care?
Administer 400 mg ceftriaxone IV
every 12 hours.
3. The nurse plans care for a child admitted
with measles. Which of the following
interventions will the nurse include in the
plan of care? (Select all that apply.)
Advise measles vaccination for
susceptible family members.
Place the client in a negative-pressure
isolation room.
Use a N95 respirator mask during
client contact.
4. A 12-month-old client has a high blood
lead level of 18 mcg/dL. The nurse
educates the parents about lead poisoning.
Which statements made by the parent
indicate that teaching is successful?
(Select all that apply.)
“I should get our home inspected for
the source of lead.”
“I will wash my child’s hands often,
especially before eating.”
“We will have to return for a follow-up
lead level.”
5. The nurse in a clinic is caring for an 8-
month-old with a new diagnosis of
bronchiolitis due to respiratory syncytial
virus (RSV). Which instructions can the
nurse anticipate reviewing with the
parent?
Use of saline drops and a bulb syringe
to suction nares.
6. A 12-month-old is found to have a
moderately elevated blood lead level.
Which of the following is the most
serious concern for this child?
Neurocognitive impairment.
7. The nurse is providing teaching for
parents of a child diagnosed with fifth
disease. Which statement by a parent
indicates a need for further teaching?
“Our child’s condition is
communicable until the rash
disappears.”
8. The nurse is planning care for an 8-year-
old client with mild cognitive impairment
who is hospitalized for diagnostic testing.
Which of the following interventions are
appropriate to include in the plan of care?
(Select all that apply.)
Consistently assign the same nurse and
unlicensed assistive personnel to care
for the client.
Provide appropriate toys based on
developmental level rather than
chronological age.
Reinforce parental limit-setting
measures for preventing self-injurious
behavior.
Use a picture board to facilitate
communication and promote
understanding of procedures.
9. The nurse receives 4 prescriptions for a
child diagnosed with hemophilia A who
was brought to the emergency department
following an injury on the school
playground. The child has vomited once
and has a headache. Which prescription
should the nurse carry out first?
Administer IV factor VIII.
10. Several 12-month-old infants are brought
to the clinic for routine immunizations.
Which situation would be most important
for the nurse to clarify with the provider
before administering the vaccination?
Varicella-zoster vaccine for client
recently diagnosed with leukemia.
11. The clinic nurse performs assessments on
four infants. The nurse should alert the
health care provider to see which client
first?
4-month-old who has sclera visible
above the iris (sunset eyes).
12. The public health nurse conducts a
teaching program for parents of infants.
Which statement by a participant
indicates that teaching has been
successful?
“My infant should be able to pick up
small finger foods by age 10 months.”
13. The nurse is teaching the parents of a 4-
month-old who has developed positional
plagiocephaly (flat head syndrome).
Which statement by the parents indicates
a need for further teaching?
“I should place the infant in the prone
position during naps.”
14. The parent of a 5-year-old child calls the
clinic to report the recurrence of a
nosebleed for which the child was seen a
week ago. Which of the following
instructions should the nurse reinforce?
(Select all that apply.)
Apply a cold cloth to the bridge of the
nose.
Apply pressure by pinching the nostrils
together.
Attempt to keep the child calm and
quiet.
15. What is the best activity for a school-aged
child hospitalized for vasoocclusive sickle
cell crisis?
Watching a favorite movie.
16. The nurse is caring for an infant with
suspected meningitis and preparing to
assist with a lumbar puncture. What is the
appropriate nursing intervention?
Hold the child with the head and knees
tucked in and the back rounded out.
17. The parent of an 11-month-old child calls
the pediatric outpatient clinic and tells the
nurse that the child was exposed to
measles 2 days ago during a family trip to
a theme park. What is the best response
by the nurse?
Bring the baby into the clinic for the
measles, mumps, rubella (MMR)
vaccine.
18. A client diagnosed with acute
glomerulonephritis has pitting edema in
both lower extremities, blood pressure of
170/80 mm Hg, and proteinuria. When
developing a plan of care for this client,
the nurse should include which most
accurate indicator of fluid loss or gain?
Daily weight measurements.
19. A 3-month-old who weighs 8.8 lb (4 kg)
has just returned to the intensive care unit
after surgical repair of a congenital heart
defect. Which finding by the nurse should
be reported immediately to the health care
provider?
Chest tube output of 50 mL in the past
hour.
20. The nurse is performing well-child
examination in a pediatric clinic. Which
finding requires further evaluation?
Lateral curvature to the spine noted on
examination of a 10-year-old girl.
21. The nurse assists with a staff education
conference about appropriate
nonpharmacological pain-management
interventions for newborns and infants.
Which of the following strategies should
be included in the presentation? (Select
all that apply.)
Administer an oral sucrose solution to a
newborn during a circumcision
procedure.
Assist the parent to hold a newborn
skin-to-skin during an immunization
injection.
Offer a pacifier to an infant while
performing venipuncture.
Swaddle an infant while leaving one
arm unwrapped during an IV dressing
change.
22. The nurse is reviewing discharge
instructions with the parents of a child
who just had a tracheostomy. Which
statement made by the parents indicates
teaching has been effective?
“I will always travel with two
tracheostomy tubes, one of the same
size and one a size smaller.”
23. Which of the following statements made
by the mother of a child recently
diagnosed with celiac disease indicates a
need for further teaching?
“My child can have small amounts of
foods containing wheat as long as she
remains symptoms free.”
24. The nurse is reviewing discharge teaching
with the parent of a child with acute
myelogenous leukemia who was admitted
with varicella-zoster virus. The client has
multiple lesions that have not crusted.
Which of the following instructions
should the nurse include? (Select all that
apply.)
“Apply diphenhydramine cream
sparingly to lesions after bathing your
child.”
“Keep giving your child the acyclovir at
home as prescribed to fight the virus.”
“You can give your child
acetaminophen for pain and fever.”
“Your child will no longer be infectious
after all the lesions crusted over.”
25. The nurse is discussing feeding and eating
practices with the mother of a 1-year-old.
Which statement made by the mother
indicates a need for further instruction?
“My child is fussy at bedtime so I put
him to sleep with a bottle of milk.”
26. The parent of a 21-day-old male infant
reports that the infant is “throwing up a
lot.” Which assessment should the nurse
make to help determine if pyloric stenosis
is an issue? (Select all that apply.)
Assess the parent’s feeding technique.
Check if the vomiting is projectile.
Compare current weight to birth
weight.
27. A 15-month-old begins to seize during
assessment for a high-grade fever. What
is the most appropriate nursing action?
Stay with the client and monitor oxygen
saturation levels.
28. A nurse on a pediatric unit is admitting a
school-aged child with suspected Reye
syndrome. Which information obtained
during the history taking is most
consistent with this condition?
Recent influenza infection.
29. The nurse is performing visual acuity
screenings on a group of students. Which
of the following student comments does
the nurse recognizes as indicating
possible myopia?
“I have to hold my book close to my
face so that the words are clear.”
“If I squint or close one eye, I can read
the road signs when we travel.”
“My parents always tell me that I am
sitting too close to the television.”
30. The nurse is caring for a child who has
had a tonsillectomy. Which of the
following are appropriate nursing
interventions? (Select all that apply.)
Anticipate ear pain and give
acetaminophen as needed.
Educate parents to expect the child to
develop bad breath postoperatively.
Notify the health care provider about
frequent, increased swallowing.
31. The nurse is gathering data on a 5-week-
old admitted with a suspected diagnosis of
pyloric stenosis. The nurse should expect
to find which laboratory value?
Hematocrit of 57% (0.57)
32. The nurse is caring for a 2-year-old who
is receiving a saline enema for treatment
of intussusception. Reporting which client
finding to the health care provider (HCP)
is most important?
Passed a normal brown stool.
33. The nurse is caring for a 7-year-old client
diagnosed with nephrotic syndrome who
will be discharged soon. Which statement
by the parent indicates the need for
further teaching?
“I’ll organize playdates to keep my
child’s spirits up during relapses.”
34. The nurse is caring for an infant with
osteogenesis imperfecta admitted with a
new fracture. The client also has old
fractures in multiple stages of healing but
no bruising, abrasions, or redness of the
skin. What nursing intervention should be
included in the plan of care?
Obtain blood pressure manually to
avoid cuff over-tightening.
35. A mother reports to the pediatric nurse
that her 3-year-old child coughs at night
and at times until he vomits. The
symptoms have not improved over the
past 2 months despite multiple over-the-
counter cough medications. What should
the nurse explore related to a possible
etiology?
Ask about exposure to triggers such as
pet dander.
36. The nurse is caring for a 4-year-old who
was hospitalized with influenza. Which
nursing action would be most effective to
maintain psychosocial integrity?
Providing crayons to draw noses on
facemasks.
37. The parents of a hospitalized preschooler
are concerned because their toilet-trained
child has started welting the bed. Which
response by the nurse is most helpful?
“It is normal for your child to regress
while hospitalized.”
38. The nurse is caring for an infant
diagnosed with Hirschsprung disease who
is awaiting surgery. Which assessment
finding requires the nurse’s immediate
action?
Episode of foul-smelling diarrhea and
fever.
39. What socioeconomic indicators would the
nurse identify as risk factors for a 2-
month-old infant to develop failure to
thrive (FTT)? (Select all that apply.)
Infant lives only with mother, who is
currently unemployed.
Infant’s primary caregiver has
cognitive disabilities.
Parents are socially and emotionally
isolated.
40. A 2-month-old infant has been admitted
to the hospital with suspected shaken
baby syndrome (abusive head trauma). In
reviewing the infant’s chart, the nurse
expects to encounter which of these
clinical findings?
Irritability and vomiting.
41. The mother of a 6-year-old child with
cystic fibrosis (CF) has received
instruction on the use of pancreatic
enzymes. Which statement made by the
mother indicates a need for further
teaching?
“It is okay for my child to chew this
medication.”
42. The pediatric nurse cares for a 16-year-
old client who is scheduled for an
appendectomy in the morning. Which of
the following interventions are
appropriate to support the client’s
psychosocial needs? (Select all that
apply.)
Encourage the client to have peers visit
while hospitalized.
Include the client as an active
participant when planning care.
Support the client in discussing
concerns about body image changes.
43. The nurse is admitting an infant who has
severe growth deficiency and facial
characteristics of indistinct philtrum, a
thin upper lip, and short palpebral
fissures. Which question should the nurse
ask to assess the cause of these clinical
findings?
“Is there a history of exposure to
alcohol in utero?”
44. The community health nurse is planning
an education program for adolescents
about skin care for acne vulgaris. Which
of the following teaching points are
appropriate to include? (Select all that
apply.)
A well-balanced diet can help support
healthy skin.
Antibacterial soap is harsh and can
worsen acne.
Squeezing or picking lesions may
increase the risk for infection and
scarring.
Use skincare products labeled as
noncomedogenic to prevent clogging
skin pores.
45. A 2-year-old in the emergency
department is suspected of having
intussusception. Which assessment
finding should the nurse expect?
Stools mixed with blood and mucus.
46. The nurse is caring for a 4-year-old client
with cystic fibrosis who uses a high-
frequency chest wall oscillation
(HFCWO) vest for chest psychotherapy.
After reinforcing education with the
client’s parents, which statement by a
parent requires further teaching?
“I will allow my child to have a snack
while using the HFCWO vest to
encourage cooperation.”
47. The clinic nurse is caring for a 3-year-old
client. Which task, if not observed or
reported by the parents as accomplished,
will cause the nurse concern?
Eats with a spoon.
48. A nurse is giving instructions related to
antibiotic eye drops to the parent of a 5-
year-old with bacterial conjunctivitis.
Which instruction is most important?
Wash hands before and after eye drop
instillation.
49. Several children seen at a local pediatric
clinic are found to have a hemoglobin
level of 10-11 g/dL (100-110 g/L). Which
dietary modification would most likely
help increase hemoglobin levels in these
clients?
Ensuring adequate intake of meat, fish,
and poultry.
50. The home health nurse is visiting an
infant who recently had surgery to repair
tetralogy of Fallot. Which of the
following signs of heart failure should the
nurse teach the parents to report to the
health care provider? (Select all that
apply.)
Cool extremities.
Puffiness around the eyes.
Reduction in number of wet diapers.
Weight gain.
51. The parents of a 5-year-old ask the school
nurse for advice on how to tell their child
about being adopted. Which
developmentally appropriate thought
about adoption by the child does the nurse
counsel the parents to anticipate?
Feels responsible for being placed for
adoption.
52. The clinic nurse cares for a 4-year-old
who has been diagnosed with a pinworm
infection. Which client symptom supports
this diagnosis?
Anal itching that is worse at night.
53. The parent of an 8-year-old client asks the
nurse for guidance on how to help the
client cope with the recent death of the
other parent. When developing a response
to the parent, the nurse considers that a
school-aged child is most likely to do
what?
Understand that death is permanent
but be curious about it.
54. The emergency department triage nurse is
assessing 4 pediatric clients. Which client
is a priority for further diagnostic workup
and definitive care?
1-year-old with ventriculoperitoneal
shunt who has “lethargy” and pulse of
78/min.
55. A nurse is caring for a 1-month-old client
who is being evaluated for congenital
hypothyroidism. The nurse should
recognize which of the following as
clinical manifestations of hypothyroidism
in infants? (Select all that apply.)
Difficult to awaken.
Dry skin.
Hoarse cry.
56. A newborn has a large
myelomeningocele. What nursing
intervention is priority?
Cover the area with a sterile, moist
dressing.
57. A nurse is teaching the parent of an 8-
month-old infant who had a febrile
seizure about management of future
fevers. Which instruction is appropriate to
include in the teaching?
“Give acetaminophen or ibuprofen
every 6 hours to control the fever.”
58. The nurse assesses 4 infants. Which
assessment finding would require follow-
up by the health care provider?
6-month-old with birth weight of 7 lb 3
oz (3.3 kg) who now weighs 12 lb (5.4
kg).
59. The school nurse is caring for 4 clients
with type 1 diabetes mellitus. Which of
the clients should the nurse assess first?
9-year-old who is sweating after recess
and irritably states, “I’m so hungry!”
60. The nurse is teaching a class on nutrition
and feeding practices for young children.
What should the nurse recommend as the
best snack for a toddler?
Slices of cheese.
61. In the emergency department, a pediatric
client is placed on mechanical ventilation
by means of an endotracheal tube. Several
hours later, the nurse enters the room and
finds the client in respiratory distress. It is
most important for the nurse to take
which of these actions?
Auscultate the client’s lung sounds.
62. A child is scheduled to have an
electroencephalogram (EEG). Which
statement by the parent indicates
understanding of the teaching?
“I will wash my child’s hair using
shampoo the morning of the
procedure.”
63. A nurse is talking with the parent of a 6-
year-old regarding sleep and rest. Which
information should be included?
Bedtime hours should be established.
64. The nurse is assessing an infant with
intussusception. Which of the following
clinical findings should the nurse expect?
(Select all that apply.)
Palpable sausage-shaped abdominal
mass.
Screaming and drawing of the knees up
to the chest.
Stool mixed with blood and mucus.
65. A nurse is speaking with the parent of a
toddler who believes the child has a
hearing deficit. Which findings support
this suspected diagnosis? (Select all that
apply.)
Behavior appears withdrawn.
Monotone speech.
Speaks with a loud voice.
66. A nurse is caring for a 2-year-old with a
new diagnosis of strabismus. Which
intervention should the nurse anticipate?
Patching the stronger eye.
67. A nurse receives report on a group of
clients. Which client should the nurse
assess first?
A toddler playing with small toys who
appears in distress, has circumoral
cyanosis, and cannot speak.
68. The nurse is reviewing teaching with the
parents of a child who has tinea capitis
(ringworm of the scalp) and is newly
prescribed griseofulvin oral suspension
and 1% selenium sulfide shampoo. Which
statement by the child’s parent requires
the nurse to intervene?
“I will discontinue the griseofulvin once
the ringworm stops itching and the
scales go away.”

69. The parent of a 15-month-old calls the nurse and says that the child developed a rash and mild fever after receiving a routine measles, mumps, rubella, and
varicella (MMRV) vaccine in the pediatric clinic 5 days ago. What is the best response by the nurse?
“What is your child’s temperature right now?”

70. The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents asks, “when
should I take my child to the dentist?”
What would be the best response from the nurse?
“The initial dentist visit should be soon after the child’s first tooth appears.”
71. A 14-year-old is scheduled for surgery to treat scoliosis. The child will be hospitalized for about a week and then discharged home to recuperate for 3-4 weeks before returning to school.
What is the best activity the nurse can recommend to promote age-specific growth and development during this time? Visits from friends.
 72. The nurse provides teaching for the parents of a 6-year-old client diagnosed with nocturnal enuresis. Which of the following instructions will the nurse include? (Select all that apply.)
Encourage the child to help change soiled pajamas and linens.
Prepare a calendar with the child for logging wet and dry nights.
Wake the child at a specified time each night to void.

73. The nurse is evaluating a parent’s understanding of home care management for a 2-week-old client after initial cast placement for treatment of congenital clubfoot. Which of the following
statements by the parent indicate a correct understanding? (Select all that apply.)
“I will check my baby’s toes several times a day to ensure that they are pink and warm.”
“My baby will need to have a new
cast applied weekly for 5-8 weeks.”
“When I bathe or diaper my baby, I will be sure to keep the cast dry.”

74. A child in the emergency department had a cast placed on the right arm for a nondisplaced fracture. The client is being discharged home with pain medications. Which statement by the
parent indicates that additional teaching is required?
“A tingling or burning sensation within the first 24-48 hours is not a concern.”

The child received the varicella immunization. The day after the injection, the parent calls the nurses say that the child has discomfort, slight redness, and 2 vesicles at the injection site.
What instruction would be appropriate for the nurse to provide to this parent? Cover the vesicles with a small bandage until they are dry ( 41% )

The nurse is providing education to the parents of a child diagnosed with chronic allergic rhinitis that is triggered
by dust and pollen. Which of the following statements by the parents indicate that the teaching has been effective? Select all that apply.
“We are planning to purchase a vacuum with a high efficiency particulate air filter. ”
“We should place hypoallergenic covers on our child's mattress and pillow.”
“We will dust our furniture with a damp washcloth every week.”

The clinic nurse supervises a student nurse who is preparing to administer routine vaccinations to a child diagnosed with hemophilia period which instructions should the clinic nurse provide to the
student?
Administer vaccines via the subcutaneous route.
Hold firm pressure on the site for 5 minutes.

The nurse just administered routine immunizations to what healthy 15-month-old. What information should the nurse provide the caregivers before they leave the clinic?
Redness at the injection sites and a mild fever are common ( 76% )

A parent calls the nurse Telehealth triage line with concerns about an allergic reaction to something a child ate. Which symptoms should the nurse instruct the patient to assess for to determine if the
child is having an anaphylactic reaction? Select all that apply.
Dyspnea, Lightheadedness, Skin rash (hives), Wheezing

A 12-month-old with Kawasaki disease received IV immunoglobulin (IVIG ) 2 months ago. The child is in the clinic for follow-up and scheduled immunizations. Which vaccine should be delayed?
Select all that apply. Measles, mumps, rubella (MMR) Varicella

A school-age child is brought to the emergency department due to nausea, vomiting, and severe right lower quadrant pain. The child's white blood cell count is 17,000/mm3 ( 17.0 x 109/L). Which
statement by the child is of most concern to the nurse?
“My belly doesn't hurt anymore.” ( 77% )
A nurse is reviewing the laboratory values for a
3-year-old client with nephrotic syndrome. The
nurse interprets the results to most clearly
reflect which physiologic process related to
nephrotic syndrome? Answer: Glomerular
injury
The nurse has provided teaching about home
care to the parent of a 10-year-old with cystic
fibrosis. Which of the following statements by
the parent indicate that teaching has been
effective? Select all that apply. Answer: “i will
give my child pancreatic enzymes with all
meals and snacks”, “I will increase my
child’s salt intake during hot weather”, “Our
child will need a high-carbohydrate, high-
protein diet.”
Several children are brought to the emergency
room after a boating accident in which they
were thrown into the water. The children are
now 6 hours post admission to the clinical
observation unit.Which client should the nurse
evaluate first? Answer: client who received
CPR for 2 minutes on the scene and whose
respiratory rate has now dropped from
61/min to 18/min
A nurse is caring for a child who is receiving
oxygen at 2 L/min by nasal cannula and
observes the current oxygen saturation and
pulse plethysmographic waveform on the pulse
oximeter. Which intervention should be the
nurse’s initial action? Answer: verify the
position and integrity of the finger probe
The summer camp nurse and parent of a 9-year- Instructions not to palpate the abdomen
old with juvenile idiopathic arthritis (JIA) are
discussing appropriate physical activities for the A nurse is caring for a child with acute
child. Which of the following activities should
be included? Select all that apply Answer:
stationary bicycling, swimming, yoga.
A 6-month-old client has been diagnosed with
cystic fribrosis. Which of the following would
be appropriate for the registered nurse to teach
the parents? Answer: perform manual chest
physiotherapy
The nurse assesses a child who has been treated
for an acute asthma exacerbation. Which client
assessment is the best indicator that treatment
has been effective? Answer: oxygen
saturation has increased from 88% to 93%.
When performing developmental screenings in
the well-child clinic, the registered nurse
understands that which child is at highest risk
of developing autism spectrum disorder?
Answer: 4-year-old whose 10-year-old sibling
has the disorder.
The nurse has assessed 4 children. Which
finding requires immediate follow-up with the
health care provider? Answer: child who had a
surgical repair of hypospadias earlier today
with no urinary output in the past two hours.
A child is brought to the school nurse after
having a permanent tooth knocked out during
gym class. Which action by the nurse is
appropriate?Answer: gently rinse the tooth
with sterile saline and reinsert it into the
gingival cavity.
The nurse recieves change of shift report on 4
clients. Which client should the nurse assess
first? Answer: 2-year-old with suspected
epiglottis
The nurse is admitting a 4-year-old diagnosed
with Wilms tumor. The child is scheduled for a
right nephrectomy in the morning. Answer:
glomerulonephritis. Frequent monitoring of
which of the following is a priority? Answer:
blood pressure
The nurse taught the caregiver of a child with
ventriculoperitoneal (VP) shunt about when to
contact the health care provider (HCP). The
caregiver shows understanding of the
instructions by contacting the HCP about which
symptom? Answer: The child vomits after
awakening from a nap and 1 hour later.
A nurse is caring for a 3-month-old infant who
as bacterial meningitis. Which clinical findings
support this diagnosis? Select all that apply.
Answer: Frequent seizures, High-pitched
cry, Poor feeding, Vomiting.
A 4-year-old boy is diagnosed with Duchenne
muscular dystrophy. Which nursing teaching is
most appropriate to reinforce for the child’s
parents? Answer: Remove throw rugs from
the home.
Which pediatric respiratory presentation in the
emergency department is a priority for nursing
care? Answer: Client with an acute asthma
exacerbation but no wheezing.
A 7-month-old infant is admitted to the unit
with suspected bacterial meningitis after
receiving an initial dose of antibiotics in the
emergency department. Frequent assessment of
which of the following is most important in
the plan of care? Answer: Fontanel
assessment
The nurse is assessing a 3-year-old client in the
emergency department and finds dyspnea, high
fever, irritability, and open-mouthed drooling
with leaning forward. The parents report that
the symptoms started rather abruptly. The
client has not received age-appropriate
vaccinations. Which set of actions should the
nurse anticipate? Answer: Intubation in the
operating room with a prepared
tracheotomy kit standing by.
The nurse assessed a a pediatric client who was
diagnosed with diarrhea caused by Escherichia
Coli. The nurse is most concerned with which
finding? Answer: Petechiae noted on the
trunk
The nurse is preparing for the admission of a 9-
year-old client with new-onset tonic-clonic
seizures. It is important for the nurse to ensure
that what is in the room? Select all that apply.
Answer: Oxygen delivery system, padding
on the bed side rails, Suction equipment.
A nurse is teaching the parent of a child who
has a new diagnosis of absence seizures. Which
statement by the parent indicates understanding
of the teaching? Answer: “My child May
stare and seem inattentive.”
The nurse cares for a child newly diagnosed
with cystic fibrosis. What should be included in
the clients multidisciplinary plan of care to be
discussed with the parents? Select all that
apply. Answer: Aerobic exercise, Chest
physiotherapy, Financial needs.
A 2-month-old recently diagnosed with
developmental dysplasia of the hip (DDH) is
beginning treatment with a Pavlik harness.
Which instructions should the nurse provide to
the parents? Select all that apply. Answer:
“Dress the child in a shirt and knee socks
under the straps.”, “Lightly massage the
skin under the straps daily.”, “Place the
diaper under the straps.”
A home health nurse is managing care for an
adolescent client with cystic fibrosis. Which of
the following potential complications should
the nurse consider when developing a nursing
care plan? Select all that apply. Answer:
Chronic hypoxemia, Frequent respiratory
infections, vitamin deficiencies.
A 2-year-old child is brought to the emergency
department for a severe sore throat and fever of
102.9 F (39.4 C). The nurse notes that the child
is drooling with distressed respirations and
inspiratory stridor. What action should the
nurse take first? Answer: Position the child
in tripod position on the parents lap.
The triage nurse is assessing an unvaccinated
4-month-old infant for fever, irritability, and
open-mothers drooling. After the infant is
successfully treated for epiglottis, the parents
wonder how this could have been avoided.
Which response by the nurse would be the
most appropriate? Answer: “Most cases of
epiglottitis are preventable by standard
immunizations.”
A child with autism spectrum disorder is being admitted to an acute care unit. Which is the most important nursing action? Answer: Placing a child in a private room away from the nurses
station

The school nurse assesses and 8-year-old with a history of asthma. The nurse notes mild wheezing and coughing. Which action should the nurse perform first? Answer: Asses the clients peak
expiratory flow.

The nurse is assessing a 4-week-old infant during a routine office visit. Which assessment finding is most likely to alert the nurse to the presence of right hip developmental dysplasia? Answer:
Presence of extra gluteal folds on the right side

The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn? Answer:
Swaddle the infant with hips flexed and abducted.

A 3-month-old with developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness. Which statement made by the parent indicates a need for further instruction? Answer: I will
adjust the harness straps every 3-5 days.

The nurse has been providing care for the past month to a 7-year-old client recently diagnosed with type one diabetes mellitus. Initially, the family seemed devastated about the diagnosis and the
client’s parents stated, “our lives will never be the same.” which statement made by the parent indicates that nursing interventions and education have been effective?
“we are working to manage this disease so that it cannot control our child's life .” ( 74% )

The nurse is planning a client care conference with the parents of a 3-year-old with newly diagnosed type 1 diabetes mellitus. What is the priority outcome for the caregivers?
Knowing how to keep blood sugar stable

The school nurse evaluates a 9-year-old who is sweating, trembling, and pale. The client has type 1 diabetes managed with insulin glargine and NPH. What is the most appropriate action by the nurse?
Provide 4 oz (120 mL) of a regular soft drink

A 6-year-old client was diagnosed with type 1 diabetes mellitus 2 years ago. The nurse would like to encourage the client to participate in disease management. Which of the following diabetes care
tasks are important for their child to perform? Select all that apply.
Choose insulin injection site with parental oversight of rotation schedule
Push plunger of insulin syringe after apparent inserts and stabilizes the needle
Select and clean the site for finger-stick blood glucose testing
Verbalize two or three signs and symptoms of hypoglycemia

The nurse is performing of physical examination on a 10-year-old client with abdominal discomfort. Which actions would be appropriate during the examination? Select all that apply.
Ask the client to describe the chief symptom
Conduct a head to toe assessment in the same manner as in adult assessment
Honor the clients request to be examined without parent present

The registered nurse is teaching the parent of a 6-year-old about behavioral start strategies for treating fecal incontinence due to functional Constipation. Which statement by the parent indicates a
need for further teaching?
“I will give my child a reward for each bowel movement while sitting on the toilet.”
A newborn is being evaluated for possible esophageal atresia with tracheoesophageal fistula. Which finding is the nurse most likely to observe?
Choking and cyanosis during feeding

A parent of a 7-month-old reports that the child has been crying and vomiting with a distended belly for the past 4 hours. The infant is now lying quietly in the parent's arms with a pulse of 200/min
and respirations of 60/min. Which of the following components of SBAR (situation, background, assessment, recommendation /read-back) communication is most important for the nurse to report to
the health care provider?
Client is now lethargic with abnormal vital signs

An overweight toddler is diagnosed with iron deficiency anemia. Which is the most likely explanation for the anemia?
Excessive intake of milk

The school nurse creates a cafeteria menu for a newly enrolled child with celiac disease. Which lunches would be appropriate for this child? Select all that apply.
Grilled chicken, baked potato, and strawberry yogurt, Mexican corn tacos with ground beef and cheese, Rice noodles with chicken and broccoli

The client nurse is caring for several clients during well-child visits. The nurse should recognize each client as most as being the most at risk for anemia?
3-month-old infant born at preterm gestation who is exclusively bottle-fed with breast milk

A nurse is evaluating a client's understanding about interest formula preparation period which of
the following clients statements indicate proper understanding? Select all that apply.
“I must wash the top of concentrated formula cans before opening.”
“On use prepared formula should be kept in the refrigerator and discarded after 48 hours.”

The nurse plans care for a pediatric client who has just undergone a cleft palate repair. which of the following interventions should the nurse include in the plan of care? Select all that apply.
Assist and encourage caregivers to hold and comfort the child
Position the child supine with an elevated head of bed after feedings
Remove elbow restraints per policy for skin and circulatory assessment

The nurse is reviewing anticipatory guidance with the parents of a 6-month-old infant with phenylketonuria. Which statements by the nurse are appropriate? Select all that apply.
“a low phenylalanine is required.”
“meat and dairy products should not be introduced into the diet.”
“special infant formula is required.”

The nurse is assessing a 3-month-old infant who was admitted to the floor 18 hours ago after undergoing surgical repair of a cleft lip. Which assessment finding would cause the nurse to be
concerned?
The client is prone while playing with the parent
The parent of a newborn is concerned about
the possibility of the child developing hip
dysplasia. Which intervention should the
nurse encourage to help reduce the risk in this
newborn?
Swaddle the infant with hips flex an
abducted
The nurses triage in a 7-year-old with sickle
cell crisis. The client is short of breath and
vomiting and has severe generalized body and
joint pains. Which assessment finding
requires the most immediate intervention?
Enlarged spleen on palpitation
The nurse is completing chemotherapy
education with an adolescent client. The client
states “I would rather continue to have cancer
than lose all of my hair.” how should the
nurse respond?
“how do you feel about meeting other teens
who are receiving chemotherapy?”
The nurse is planning teaching for the parents
of a child newly diagnosed with hemophilia
will include information about which long-
term complication?
Joint destruction
A teenage client with sickle cell disease is
admitted with a diagnosis of crisis. The
client's current prescription is morphine 2 mg
intravenous push every 4 hours PRN. The
client appears comfortable while watching
television and tells the nurse “I have severe
intolerable pain,” and rates it a “10.” what
action should the nurse take?
Called the HCP for patient control
analgesia (PCA) at a higher dose of the
same drug
A 6-month-old infant is brought to the
emergency department after experiencing
vomiting and diarrhea for 4 days. Which
prescription from the health care provider is
priority ?
IV normal Saline bolus 20 mL/kg over 1
hour
The nurse is caring for pediatric client with
end stage leukemia who is on comfort care
and is unresponsive. The child's parents ask,
“how can you tell if my child is in pain?”
which of these would the nurse describe as
signs of discomfort? Select all that apply.
Facial grimacing, groaning, knees bent up
near chest
The nurse provides discharge teaching for the
parents of a child newly diagnosed with
hemophilia A. Which statements by the
parents indicate that teaching has been
effective? Select all that apply.
“our child should wear a medical alert
bracelet at all times.”
“we should avoid giving our child over-the-
counter medicine containing aspirin.”
“we should encourage a non-contact sport
such as swimming.”
What is the best activity for school-aged child
hospitalized for vaso-ooclusive sickle cell
crisis?
Watching a favorite movie
A nurse manager on a pediatric oncology unit
is leading a discussion about personal coping
strategies that nurses can use to remain
effective when caring for dying children.
What should be included in this discussion?
Attending a child’s memorial service can
be helpful
The parents of a 5-year-old ask the school
nurse for advice on how to tell their child
about being adopted. Which developmentally
appropriate though about adoption by the
child does the nurse counsel the parents to
anticipate? Feels responsible for being
placed for adoption
1. What play behavior would the nurse
be most likely to observe in a group
of a 4-year-old children? Children
playing and borrowing blocks
from each other without directing
others
2. The nurse is conducting a
psychosocial developmental
checkup on a 2-year-old child.
What is the priority assessment
finding that should be reported to
the primary health care provider?
Does not talk or respond to being
talked to or read to
3. The nurse on a pediatric unit is
caring for a preschooler who
exhibits separation anxiety when
the parents go to work. Which
interventions should the nurse
implement? Select all that apply.
Encourage the parents to leave
the child’s favorite stuffed
animal, Establish a daily schedule
to similar to the child’s home
routine, Provide frequent
opportunities for play and
activity
4. The parents of a hospitalized 3-
month-old have to leave the infant
while they work. One parent fears
that the baby will cry as soon as
they walk out. The nurse teaches
both parents about separation
anxiety. Which statement by the
parent indicates that the teaching
has been effective? At this age, my
baby will not cry because we are
leaving
5. A nurse in a pediatric clinic is
performing a physical examination
of a 30-month-old child. Which
finding requires further evaluation?
Current weight is 6 times greater
than birth weight
6. The nurse is providing health
promotion education to the parent
of a toddler. Which statement by the
parent requires the nurse to clarify
teaching? If my child refuses a
meal, I will have them stay at the
table until they eat half the food
7. What communication strategies
would the nurse have in place when
establishing rapport with the
caregiver and an 8-year-old during a
health history interview? Select all
that apply. Allow the child to
describe their issue, Maintain an
eye level position when speaking
with the child, Use language that
both the child and caregiver can
understand
8. The school nurse is conducting an
educational session for middle
school teachers that is designed to
heighten awareness of school
bullying. The nurse recognizes that
further instruction is needed
when one of the teachers makes
which comment? Bullying is a
normal part of childhood growth
and development
9. A nurse on a pediatric unit is
reviewing interventions for a
toddler with a practical nurse who
will be caring for this child. Which
of the following are appropriate
activities to minimize the effect of
hospitalization on a toddler? Select
all that apply. Integrate preferred
snack foods in the day’s routine,
Plan a quiet play prior to usual
nap time, Provide 1 or 2 options
when choosing toys
10. A nurse is discussing the concept
of parallel play with parents of
toddlers. Which statement should
the nurse include to describe this
type of play? Children play near
other children but without
significant interaction
11. The nurse is caring for a
hospitalized 6-month-old client.
Which of the following
interventions should the nurse
implement to provide
developmentally appropriate care
for this client? Select all that apply.
Adhere to the child’s home
routine when possible during
hospitalization, Encourage
parents to bring the child’s
favorite toy from home, Promote
a quiet sleep environment with
reduced stimuli, Provide a
parent’s shirt for the child to hold
during procedures
12. A nurse is discussing parallel play
with the parent of a 2-year-old.
Which statement by the parent
indicates understanding of the
discussion? I set out a basket of
various balls in the backyard
when other children come to play
13. The nurse in a clinic is obtaining a
developmental history of an 18-
month-old during a well-child visit.
Which activities should the child be
able to perform? Select all that
apply. Goes up stairs while
holding a hand, Turns 2 pages in
a book at a time
14. A nurse is performing an
assessment of a 12-month-old child.
 Which of the following findings
would the nurse expect? Select all
that apply. Birth weight is tripled,
Fully developed pincer grasp, Sits
from a standing position
15. A nurse is discussing the fine
motor abilities of a 10-month-old
infant with the infant’s parent.
Which are developmentally
appropriate skills for an infant of
this age? Select all that apply.
Grasps a small doll by the arm,
transfers small objects from hand
to hand, Uses a basic pincer grasp
16. The nurse is caring for a preschool-
age child whose grandparent died 3
days ago. What intervention is
inappropriate? Avoid mentioning
the loved one’s death in the
child’s presence
17. The registered nurse has completed
a well-baby assessment of an 18-
month-old. Which assessment
findings prompted the nurse to
make a referral for a formal
developmental screening test? Uses
2 words, cannot hold a cup, can
seat self in a small chair
18. The nurse is educating a group of
parents about ways to decrease the
risk of sudden infant death
syndrome. Which of the following
recommendations should the nurse
suggest? Select all that apply.
Breastfeed the infant, Ensure the
infant’s vaccinations are updated,
Maintain a smoke-free
environment, Provide a firm
sleeping surface for the infant
19. The nurse is providing teaching to
the parents of a child with Marfan
syndrome. Which topic is the
priority for the nurse to address?
Avoiding participation in contact
sports
20. A nurse in a clinic is talking with a
parent about the onset of puberty in
boys. What is the first sign of
pubertal change that occurs?
Testicular enlargement
21. The nurse is providing care to a 9-
year-old client who is awaiting
surgery. Which intervention is
developmentally appropriate for this
client’s plan of care? Discuss the
procedure with the client using
simple diagrams with correct
anatomical terminology
22. A nurse is planning to complete a
physical examination of a toddler.
Which approach is an appropriate
intervention by the nurse?
Encourage the parent to be
involved with the child
23. A 15-year-old parent brings a 4-
month-old infant for a well-baby
checkup. The parent tells the nurse
that the baby cries all the time; the
parent has tried everything to keep
the infant quiet but nothing works.
What is the priority nursing action?
Assess the infant’s pattern and
frequency of crying
24. The parents of a 4-year-old tell the
nurse that the child won’t go to
sleep at night due to the fear of
tigers living under the bed. Which
response by the nurse is most
helpful? Night fears are common
at this age. Look under the bed
with your child
25. A 10-year-old weighs 99 lb (44.9
kg) and has a BMI of 24.8 kg/m2
(>95th percentile). Which is the
most important assessment for the
nurse to make before initiating a
weigh loss plan? Family’s
readiness for change
26. The nurse assessing a 2-year-old
should expect the child to be able to
perform which actions? Select all
that apply. Build a tower, Say own
name, Walk without help
27. The nurse cares for a 4-year-old
who is on long term, strict bed rest.
Which toy is most appropriate to
provide diversion and minimize
developmental delays? Puppets
28. The nurse prepares a 7-year-old
client for an influenza injection.
The nurse explains that the client
will receive “medicine under the
skin,” and the client is visibly
anxious. Which nursing
intervention is appropriate? Ask the
child to count to 10 during
injection
29. The clinic nurse is asked by the
mother of a 15-month-old, “I am
worried about my child’s sucking
and its effects on tooth alignment.
What should I do?” What is the
nurse’s best response? The risk for
misaligned teeth occurs when
thumb sucking persists after
eruption of permanent teeth
30. The clinic nurse reviews teaching
provided to the parent of a child
being considered for growth
hormone replacement therapy at
home. Which statement by the
parent indicates that teaching has
been effective? Treatment will
require a daily injection under
my child’s skin
31. A 9-year-old has terminal cancer,
but the parents do not want the child
to know the prognosis. The child
has been asking questions such as
what dying is like and whether the
child will die. Which action by the
nurse is most appropriate? Tell the
parents about the child’s
questions
32. The nurse is assessing a 3-month-
old during a well-child visit. Which
developmental finding should the
nurse expect to observe in the
client? Infant kicks legs, smiles,
and coos when a familiar face
comes into view
33. The public health nurse has
received a referral to make a
follow-up home visit to a 1-year-old
recently diagnosed with failure to
thrive (FTT). Which intervention is
the priority nursing action for this
child? Observe the child feeding
34. The nurse is discussing child safety
with the parents of a 12-month-old
who is just beginning to walk.
Which statement by the parents
indicates a need for further
instruction? When we can’t be
watching, we put our child in a
mobile child walker
35. The nurse is caring for a 10-year-
old diagnosed with osteomyelitis.
What is the best activity the nurse
can suggest to promote age-specific
growth and development during
hospitalization? Provide missed
schoolwork
36. A 5-year-old child is receiving
morphine sulfate for pain. Which
statement by the caregiver indicates
that further teaching is necessary?
My child is playing and so does
not need pain medication
37. The nurse is performing a well-
child assessment on a sleeping 2-
month-old client. Organize the
assessment in the correct order
based on the developmental age of
the client. Observe skin color and
respiratory pattern, Auscultate
heart and lungs, Palpate
fontanelles and abdomen, Assess
pupillary response, Elicit Moro
reflex
38. The nurse is assessing a 8-month-
old client during a well-child visit.
Which assessment finding should
the nurse report to the health care
provider? Infant’s head stays
behind the shoulders when raised
from a supine to a sitting position
39. The parent of a 1-year-old says to
the nurse, “I would like to start
toilet training my child as soon as
possible.” What information does
the nurse provide to the parent that
correctly describes a child’s
readiness for toilet training? Your
child may be ready to start toilet
training when able to
communicate and follow
directions
40. The nurse is reviewing the plan of
care for a 4-year-old client who will
receive daily dressing changes for
an infected leg wound. Which of the
 following interventions should the
nurse include in the plan of care for
a preschool-aged child? Select all
that apply. Allow the child’s
parents to stay during the
procedure, Emphasize that
dressing changes are not
punishment for misbehavior,
Encourage the child to voice
questions and concerns about the
procedure, Have the child place
bandages on a doll when
reinforcing education.
41. The nurse is reviewing the medical
record of a 4-year-old client with
failure to thrive. Which of the
following risk factors likely
contribute to the client’s condition?
Select all that apply. One parent is
incarcerated for spousal abuse,
One parent was diagnosed with
anorexia nervosa prior to having
children, Parents are concerned
about not having enough money
to buy food
42. The parent of a 2-year-old tells the
nurse at the well-child clinic, “I am
concerned because my child does
not like to be cuddled, does not
respond when called by name, and
does not make eye contact when
being fed.” What is the priority
question for the nurse to ask when
completing the health history? How
many words can your child say?
43. A distraught parent informs the
nurse of a bleeding in a 1-year-old
girl. What is an appropriate
response by the nurse after
assessing a small amount of bloody
mucus in the newborn’s diaper? We
will continue to monitor the
amount, color, and consistency of
the drainage
44. A 15-year-old client with type 1
diabetes mellitus (DM) is admitted
to the pediatric intensive care unit
with a blood glucose level of 460
mg/dL (25.5 mmol/L). The nurse
understands that which factor is
contributing to this client’s
noncompliant behavior? Client’s
psychosocial developmental stage
45. The parents of a 2-year-old client
ask how they can help their child
cope with hospitalization. Which of
the following suggestions should
the nurse give the parents? Select
all that apply. Follow as many
home routines as possible, Sleep
in the child’s hospital room at
night, Take child on regular visits
to the playroom
46. A 10-year-old is implementing
behavioral strategies to manage
nocturnal enuresis. The client tells
the nurse, “I want to go to sleep
away camp during the summer, but
if I have an accident, I’m afraid that
other kids with tease me. What is
the best response by the nurse? We
can ask your health care provider
about a medication trial that may
help
The nurse assesses a child with
intussusception. Which assessment findings
require priority intervention? Abdominal
rigidity with guarding
During a routine assessment of a
developmentally normal 18-month-old the
parent expresses concern about the small
amount of food the child consumes. What is
the nurse’s priority intervention?
Educate the parent about physiologic
anorexia
A parent brings a 6-month-old child to the
Primary Health care provider after the child
abruptly started crying and grabbing
intermittently at the abdomen. The client stool
has a red, currant Jelly appearance. What
intervention does the nurse anticipate? Give
air (pneumatic) enema
The nurse is educating the parents of a 6-
month-old about introducing solid foods into
the infant's diet. Which parental statement
indicates a need for further teaching? “I can
offer of variety of foods within the first
week of introducing solids.”
The nurse is reinforcing discharge teaching
for the parents of a 1-year-old with a newly
diagnosed cow’s milk allergy. Which
nutrients normally provided by milk should
be obtained from other sources? Select all that
apply. Calcium, vitamin D
A newborn had a bowel resection with
temporary colostomy for Hirschsprung's
disease. The nurse should alert the health care
provider (HCP) for which assessment finding
post operatively? Stoma is Gray-tinged at
the edges but pink at the center on
postoperative day 5
a nurse in the neonatal intensive care unit
discovers a cyanotic newborn with excessive
frothy mucus in the mouth. What should be
the nurse’s first action? Suction the infant’s
mouth
The clinic nurse supervises a graduate nurse
who is teaching the parents of a 2-year-old
with acute diarrhea about home management.
The nurse would need to intervene when the
graduate nurse provides which instruction?
“follow the bananas, rice, Apple sauce, and
toast diet for the next few days.”
the nurse is reinforcing education with the
parents of a 2-year-old child about diet
choices to promote growth. the family
observes a strict vegan diet. Which of the
following statements by the nurse are
appropriate? Select all that apply.
“it is important to feed your child fortified
breads and cereals to help with iron
intake.”
“try to pair foods high in iron with foods
high in vitamin C to aid iron absorption.”
“your child may require calcium and
vitamin D supplementations due to lack of
dairy intake.”
the clinic nurse is interviewing the parents of
a 6-month-old client about the infants diet.
Which statement by the parents is most
concerning? “infant oatmeal sweetened with
fresh honey is our baby's favorite
breakfast.”
1. The clinic nurse assesses an 8-year-
old client who reports a sore throat
and has a bright red, pruritic rash on
the chest that feels like bumps and
looks like sunburn. Which
diagnostic tool does the nurse
anticipate the health care provider
will prescribe?
A. Allergy skin test
B. Complete blood count
C. Rapid Streptococcal antigen
test
D. Skin Biopsy
2. Which discharge teaching
instructions should the nurse
provide to the parents of a 2-year-
old with group A streptococcal
pharyngitis? Select all that apply
A. Complete all the antibiotics
even if your child is feeling
better
B. Cool liquids and soft diet are
recommended
C. Keep your child at home from
daycare for at least a week
D. Replace your child’s
toothbrush 24 hours after
starting antibiotics
E. Throat lozenges may soothe
your child’s sore throat
3. The emergency nurse is triaging
four clients. Which client should the
nurse assess first?
A. 6-month-old client who is
constipated, cannot hold the
head up, and has a weak cry
after eating honey
B. A year-old client who has
elbow pain, swelling, and
deformity after falling from a
playground swing
C. A 6-year-old client who has a
fever and reports right-sided
abdominal pain and difficulty
tolerating food
D. A 9-year-old client who is
lethargic and reports having
painful urination and back pain
4. The clinic nurse provides teaching
for a parent of a child diagnosed
with scabies. Which instructions
should the nurse include in the
teaching plan? Select all that apply
A. All the persons in close
contact with the child need
treatment
B. Apply the permethrin cream
to all skin surfaces
C. Discard the child’s stuffed
animals
D. Fumigate all the living areas in
the home
E. Wash the child’s clothing
and bedding in hot water
5. A nurse manager on a pediatric
oncology unit is leading a
discussion about personal coping
 strategies that nurses can use to
maintain effective when caring for
dying children. What should be
included in the discussion?
A. Attending a child’s memorial
service can be helpful
B. Avoid expressing personal
feelings of grief or loss directly
with the family
C. Personal contact with the
family of the deceased should
end after they leave the
hospital
D. The length of daily exercises
should be increased
6. A parent calls the nurse telehealth
triage line with concerns about an
allergic reaction to something a
child ate. What symptoms should
the nurse instruct the parent to
assess to determine if the child is
having an anaphylactic reaction?
Select all that apply
A. Dyspnea
B. Fever
C. Lightheadedness
D. Skin rash (hives)
E. Wheezing
7. A nurse is teaching the parent of a
6-year-old with a urinary tract
infection (UTI) how to avoid repeat
infections. Which statements by the
patient indicate that the teaching has
been effective? Select all that
apply
A. “I just bought my child new
nylon panties”
B. “I will make sure my child
does not hold urine”
C. “I will not give my child any
more bubble baths”
D. “I will teach my child to wipe
from the front to the back”
E. “I will use antibacterial soap
for bathing my child”
8. A school nurse is educating the
parent of a young client with
pediculosis captitis. Which
statement by the parent indicates
understanding of the teaching?
A. “I will launder recently worn
clothing, sheets, and towels
in hot water”
B. “I will make sure all eating
utensils are placed in the
dishwasher”
C. “I will spray the house with
insecticide to control the
problem”
D. “I will throw away stuffed
animals and toys that cannot be
washed”
9. A nurse is caring for a 6-year-old
client with tonsilitis. Which further
assessment finding requires
immediate intervention?
A. Dry mucous membranes
B. Prescence of trismus
C. Pulling at the ears
D. Sandpaper-like skin rash
10. The nurse provides discharge
teaching for the parents of a child
newly diagnosed with hemophilia
A. Which statements by the parents
indicate that teaching has been
effective? Select all that apply
A. “A high-calorie, high-protein
diet is best for the child”
B. “It is extremely important that
we do not allow our child to
become dehydrated”
C. “Our child should wear a
medical alert bracelet at all
times”
D. “We should avoid giving our
child over-the counter
medicine containing aspirin”
E. “We should encourage a
noncontact sport such as
swimming”
11. A teenage client with sickle cell
disease is admitted with a diagnosis
of crisis. The client’s current
prescription is morphine 2 mg
intravenous push every 4 hours prn.
The client appears comfortable
while watching television and tells
the nurse “I have severe intolerable
pain”, and rates it at a “10”. What
action should the nurse take?
A. Call the clients healthcare
provider (HCP) to obtain
ibuprofen prescription for the
pain
B. Call the HCP for the patient-
controlled analgesia (PCA) at
a high dose of the same drug
C. Contact the HCP who issued
the prescription to switch to
meperidine
D. Realize the client is exhibiting
signs of addictive behavior and
needs an appropriate consult
12. The nurse just administered routine
immunization to a healthy 15-
month-old. What information
should the nurse provide the
caregivers before they leave the
clinic?
A. Call the office of the toddler’s
temperature is higher than 100
F A. “I need to go to the
B. Fussiness and anorexia are
common for 1 week after
immunizations
C. Redness at the injection sites
and a mild fever are common
D. The toddler’s activity level
should be restricted for 24
hours
13. A school age child is brought to the
emergency department due to
nausea, vomiting, and severe right
lower quadrant pain. The child’s
white blood cell count is
17,000/mm3 (17.0x10 9/L). Which
statement by the child is of most
concern to the nurse?
A. “I am hungry, and they will
not let me eat”
B. “I do not like hospitals and
want to go home”
C. “I’m so tired”
D. “My bell doesn’t hurt
anymore”
14. The nurse is triaging a 7-year-old
with sickle cell crisis. The client is
short of breath and vomiting and
has severe generalized body and
joint pain. Which assessment
finding requires the most
immediate intervention?
A. Blood work showing anemia
B. Enlarged spleen on palpation
C. Right arm weakness
D. Swelling of hands and feet
15. The nurse is planning care for a 3-
year-old who is admitted with
suspected pertussis infection.
Which instructions will the nurse
include in the plan of care? Select
all that apply
A. Institute droplet precautions
B. Monitor for signs of airway
obstruction
C. Offer small amounts of fluids
frequently
D. Place the child in a negative
pressure isolation room
E. Request an order for cough
suppressant
16. An adolescent client with a sore
throat is diagnosed with infectious
mononucleosis. Which comment by
the caregiver would alert the nurse
that additional instruction is
necessary?
pharmacy to pick up an
antibiotic”
B. “It is acceptable for my child
to have ibuprofen for
discomfort or fever”
C. “My child will be on bed rest
with a few activities for the
next 2 weeks”
D. “Participation in soccer
practice will not be allowed for
the next month”
17. A nurse is caring for a school-age
client with fever, somnolence, and a
skin rash from suspected
meningococcal meningitis. Which
of the following interventions
should the nurse plan to implement
for this client? Select all that apply
A. Elevate the head of the bed
30 degrees
B. Implement seizure
precautions
C. Keep a mask on the client at all
times
D. Minimize environmental
stimuli
E. Place client in a room with
negative pressure air flow
18. A 2-year-old is diagnosed with
atopic dermatitis (eczema). Which
instructions should the nurse teach
the parents? Select all that apply
A. Apply emollient immediately
after a bath
B. Dress child in wool pajamas
C. Give tepid baths with mild
soap
D. Keep child’s nails well-
trimmed
E. Thoroughly rub the skin after
baths
19. A 2-year-old child is brought to the
emergency department for a severe
sore throat and fever of 102.9 F
(39.4 C). The nurse notes that the
child is drooling with distressed
respirations and inspiratory stridor.
 What action should the nurse take
first?
A. Assess an accurate temperature
with a rectal thermometer
B. Directly examine the throat for
the presence of exudates
C. Obtain intravenous access for
anticipated steroid
administration
D. Position the child in tripod
position on the parents’ lap
20. A 4-year-old diagnosed with
Duchenne muscular dystrophy.
Which nursing teaching is most
appropriate to reinforce for this
child’s parent?
A. Increase intake of foods high
in iron
B. Lift weights to strengthen
weak muscles
C. Remove the rugs from the
home
D. Take the muscle relaxant
Baclofen on time
21. A home health care nurse is
managing care for an adolescent
client with cystic fibrosis. Which of
the following potential
complications should the nurse
consider when developing a nursing
care plan? Select all that apply
A. Chronic hypoxemia
B. Diabetes insipidus
C. Frequent respiratory
infections
D. Obesity
E. Vitamin deficiencies
22. The triage nurse is assessing an
unvaccinated 4-month-old infant for
fever, irritability, and open-mouthed
drooling. After the infant is
successfully treated to epiglottis, the
parents wonder how this could have
been avoided. Which response by
the nurse would be most
appropriate?
A. “it’s most important to know
for sure what could have
caused this episode”
B. “Most cases of epiglottis are
preventable by standard
immunizations”
C. “We are still waiting for the
formal report from the
microbiology laboratory”
D. “There is nothing you could
have done, the important thing
is that your child is safe now”
23. The nurse has provided teaching
about home care to a parent of a 10-
year-old with cystic fibrosis. Which
of the following statements by the
parent indicates that teaching has
been effective? Select all that
apply
A. “Chest physiotherapy is
administered only if
respiratory symptoms worsen”
B. “I will give my child
pancreatic enzymes with all
meals and snacks”
C. “I will increase my child’s
salt intake during the hot
weather”
D. “Our child will need a high-
carbohydrate, high-protein
diet”
E. “We will limit our child’s
participation in sports
activities”
24. The nurse is assessing a 4-week-old
infant during a routine office visit.
Which assessment finding is most
likely to alert the nurse for the
presence of right hip development
dysplasia?
A. Decreased right hip adduction
B. Presence of extra gluteal
folds on right side
C. Right leg longer than the left
leg
D. Right pelvic tilt with lordosis
25. The school nurse evaluates a 9-
year-old who is sweating,
trembling, and pale. The client has
type 1 diabetes managed with
insulin glargine and NPH. What is
the most appropriate action by the
nurse?
A. Administer scheduled dose of
NPH insulin
B. Give emergency glucagon IM
injection
C. Give peanut butter and
crackers
D. Provide a 4 oz (120 mL) of a
regular soft drink
26. The nurse is assessing a 4-year-old
boy in a pediatric clinic. Which
behaviors by the client would
concern the nurse for possible
Duchenne muscular dystrophy?
Select all that apply
A. Frequently trips and falls at
home
B. Has painful knees and elbows
in the morning
C. Places hands on the thighs to
push up to stand
D. Suddenly rigidly extends the
arms and legs
E. Walks on tiptoes and has
disproportionately large
calves
27. A 3-month-old child with
developmental dysplasia of the hip
(DDH) is being fitted for a Pavlik
harness. Which statement made by
the parent indicates a need for
further instruction?
A. “I should leave the harness on
during diaper changes”
B. “I will adjust the harness
straps every 3-5 days”
C. “I will inspect the skin under
the straps 2-3 times daily”
D. “The harness should keep my
baby’s legs bent and spread
apart”
28. A child with autism spectrum
disorder is being admitted to an
acute care unit. Which is the most
important nursing action?
A. Placing the child in a private
room away from the nurse’s
station
B. Placing the child in a private
room near the playroom
C. Placing the child in a semi-
private room near the nurse’s
station
D. Placing the child in a semi-
private room with another
child with autism spectrum
disorder
29. The nurse is preparing for the
admission of a 9-year-old client
with a new-onset tonic-clonic
seizures. It is important for the
nurse to ensure that what is in the
room? Select all that apply
A. Oral bite prevention device
B. Oxygen delivery system
C. Padding on the bed
siderails
D. Soft arm and leg restraints
E. Suction equipment
30. When monitoring an infant with
left-to-right sided heart shunt,
which findings would the nurse
expect during the physical
assessment? Select all that apply
A. Clubbing of fingertips
B. Cyanosis when crying
C. Diaphoresis during feedings
D. Heart murmur
E. Poor weight gain
31. A nurse is teaching the parent of a
child who has a new diagnosis of
absence seizures. Which statement
by the parent indicates
understanding of the teaching?
A. “My child may experience
incontinence”
B. “My child may seem
confused afterwards”
C. “My child may stare and seem
inattentive”
D. “My child will notice unusual
odors prior to the event”
32. The summer camp nurse and parent
of a 9-year-old with juvenile
idiopathic arthritis (JIA) are
discussing appropriate physical
activities for the child. Which of the
following activities should be
included? Select all that apply
A. Dodgeball
B. Reading a book
C. Stationary bicycling
D. Swimming
E. Yoga
33. A 7-month-old infant is admitted to
the unit with suspected bacterial
meningitis after receiving an initial
does of antibiotics in the emergency
department. Frequent assessment of
which of the following is most
important in the plan of care?
A. Babinski reflexes
B. Fontanel assessment
C. Pulse pressure
D. Pupillary light response
34. The nurse taught a caregiver of a
child with a ventriculoperitoneal
(VP) shunt about when to contact
the health care provider (HCP). The
caregiver shows understanding of
the instructions by contacting the
HCP about which symptom?
A. A temperature of 99 F (37 C)
that occurs during the evening
 B. The child cannot recall items
eaten for lunch during previous
day
C. The child vomits after
awakening from a nap and 1
hour later
D. The VP shut is palpated along
the posterior lateral portion of
the skull
35. The nurse is planning care for a
child being admitted for Kawasaki
disease and should give priority to
which nursing intervention?
A. Apply cool compress to the
skin of the hands and feet
B. Monitor for a gallop heart
rhythm and decreased urine
output
C. Prepare a quiet, non-
stimulating and restful
environment
D. Provide soft foods and liberal
amounts of clear liquids
36. A 2-month-old recently diagnosed
with developmental dysplasia of the
hip (DDH) is beginning treatment
with a Pavlik harness. What
instructions should the nurse
provide to the parents? Select all
that apply
A. “apply lotion under the straps
to protect the skin”
B. “Dress the child in a shirt
and knee socks under the
straps”
C. “Lightly massage the skin
under the straps daily”
D. “Place the diaper under the
straps”
E. “Remove the harness during
diaper changes”
37. The nurse is performing well-child
examinations in a pediatric clinic.
Which finding requires further
evaluation?
A. Bilateral bowlegs (genu
varum) in a 15-month-old
B. Chest rounded with the
anteroposterior diameter equal
to the lateral diameter in an
infant
C. Lateral curvature to the
spine noted on examination
of a 10-year-old girl
D. Presence of an S3 heart sound
in a 2 -year-old
38. A 3-month-old who weighs 8.8 Ib.
(4 kg) has just returned to the
intensive care unit after surgical
repair of a congenital heart defect.
Which finding by the nurse should
be reported immediately to the
health care provider?
A. Chest tube output of 50 mL
in the past hour
B. Heart rate of 150/min
C. Temperature of 97.5 F (36.4C)
D. Urine output of 8 mL in the
past hour
39. The nurse has received report on 4
pediatric clients on a telemetry unit.
Which client should the nurse
assess first?
A. Adolescent client with
coarctation of the aorta and
diminished femoral pulses
B. Infant client with ventricular
septal deficit with reported
grunting during feeding
C. Newborn client with patent
ductus arteriosus and a loud
machine-like systolic murmur
D. Preschool client tetralogy of
Fallot who has finger clubbing
and irritability
40. A nurse auscultates a loud cardiac
murmur on a newborn with
suspected trisomy 21 (Down
syndrome). A genetic screen and an
electrocardiogram are scheduled
that day. The neonates’ vital signs
are shown in the exhibit. What
should be an appropriate action for
the nurse to complete next?
A. Call the healthcare provider
(HCP) immediately
B. Document the assessment
findings
C. Place the neonate in a knee-
chest position
D. Provide oxygen to the neonate
41. The nurse is caring for an infant
with osteogenesis imperfecta
admitted with a new fracture. The
client also has old fractures in
multiple stages of healing but no
bruising, abrasions, or redness of
the skin. Which nursing
intervention should be included in
the plan of care?
A. During diaper changes,
carefully lift the infant by the
ankles
B. Lift from under the arms when
picking up the infant
C. Obtain blood pressure
manually to avoid cuff over-
tightening
D. Request a social work
consultation to assess for child
abuse
the nurse is reinforcing teaching to the parent
of a child diagnosed with ringworm. Which
statement by the parent indicates a need for
further teaching? “my child has been
infected by a worm and must be treated to
rid it from the body.”
The nurse has provided instructions about
home care management for the parents of a
child diagnosed with rotavirus infection.
Which statements by the parents indicate that
teaching has been effective? Select all that
apply.
“hand washing is extremely important in
slowing the spread of rotavirus.”
“I will observe my client for decreased
urination and dry mucous membranes.”
“my child can spread the infection with
contaminated hands, toys, and food.”
A school nurse is educating the parent of a
young client with pediculosis capitis. Which
statement by the parent indicates
understanding of the teaching? “I will
launder recently won clothing, sheets, and
towels in hot water.”
The nurse plans care for a 3-year-old who is
admitted with suspected pertussis infection.
Which instructions will the nurse include in
the plan of care? Select all that apply.
Institute droplet precautions, monitor for
signs of airway obstruction, offer small
amounts of fluids frequently
The most recent laboratory results for a 12-
month-old who is HIV-positive show a CD4
lymphocyte count of 500/mm3 and a CD4
lymphocyte percentage of 10%. The nurse
anticipates administering which
immunizations? Select all that apply.
Haemophilus Influenzae type B (Hib),
hepatitis A (Hep A), pneumococcal
conjugate vaccine (PCV)
The nurse is performing a physical
assessment on a 2-year-old with cold
symptoms and a fever at home of 101.7 F
(38.7 C). The parent is concerned about the
child's ability to cooperate during the
examination. Place the components of
assessment in the order the nurse would
perform them.
Interact with the parent in a friendly
manner, play with the child using a finger
puppet, measure the child's height and
weight, auscultate the child's heart and
lungs, take the child's vital signs
A 3-month-old infant has irritability, facial
edema, a 1-day history of diarrhea with
adequate oral intake, and seizure activity.
During assessment, the parents state that they
have recently been diluting formula to save
money. Which is the most likely cause for the
infant’s symptoms?
Hyponatremia due to water intoxication
The nurse is teaching the parents of a child
diagnosed with cystic fibrosis will advise the
parents to choose foods that satisfy which
recommended diet?
High calorie, high protein, high fat
The school nurse is teaching a class of 10-
year-old children about prevention of dental
caries. Which recommendations would be
part of the nurses teaching plan? Select all
that apply.
Chew sugar-free gum
Include milk, yogurt, and cheese in dietary
intake
Minimize consumption of sweet, sticky
foods
Rinse mouth with water after meals when
brushing is not possible
1. Reye’s syndrome is a development of
rare and severe illness rheumatic fever?
affecting children and a. Group A beta-
teenagers. Its hemolytic
development has been Streptococcus 8. Which of the following
linked with the use of 5. The following are
aspirin and which of considered functions
the following? of the Urinary
a. Varicella System, EXCEPT:
2. When performing a a. Absorption of
physical examination digested
on an infant, the nurse molecules
in charge notes 6. Spina bifida is one of
abnormally low-set the possible neural
ears. This finding is tube defects that can
associated with: occur during early
a. Renal embryological 9. Among toddlers and
anomalies development. Which of
3. The nurse is evaluating the following
a female child with definitions most
acute post accurately describes
streptococcal meningocele?
glomerulonephritis for a. Sac formation
signs of improvement. containing
Which finding typically meninges and
is the earliest sign of spinal fluid
improvement? 7. Bennett was rushed to
a. Increased urine the emergency
output department with
4. Which of the following possible increased
organisms is intracranial pressure
responsible for the (ICP); which of the
following is an early
clinical manifestation
of increased ICP in
older children?
a. Diplopia 10. You have learned that
should the nurse
include in the insulin
administration
instruction for the
parents of a child being
discharged on insulin?
a. Clean the site
of injection
with soap and
water and 11. The long-term
avoid alcohol
children up to age five,
femur fractures usually
result from a low
energy fall. In most
cases, the orthopedic 12. A child was brought to
surgeon realigns the
fracture using
fluoroscopy or x-ray
imaging as a guide and
immobilizes the leg in a
type of cast called a
spica cast.
Approximately how
many weeks does it
take for a fractured
femur to heal in a 3-
year-old?
a. 3-8 week
in babies and children
with developmental
dysplasia (dislocation)
of the hip (DDH), the
hip joint has not
formed normally.
Which of the following
is the most common
form of DDH?
a. Subluxation
complications seen in
thalassemia major are
associated to which of
the following?
a. Hemochromato
sis
the emergency
department with
complaints of nausea,
vomiting, fruity-
scented breath. The
resident on duty
diagnosed the child
with diabetes
ketoacidosis. Which of
the following should
the nurse expect to
administer?
a. Normal saline
IV infusion
2. an 8 year old is seen in peds
clinic with symptoms of
morning stiffness that
improves with activity. The
pediatric nurse suspects the
child has symptoms of which
of the following? ANS: B.
juvenile Idiopathic Arthritis
3. a 4 year old is seem in the ER
with a fractured of the
humerus. Which of the
following P’s are assessed to
determine the extent of the
child’s injury?
ANS: C. paralysis and pallor
4. a newborn is diagnosed with
Tracheoesophageal Fistula at
birth. An initial nursing
function is to assure that
which of the following orders
are implemented?
ANS: A. Suction as needed
5. a 10 year old child is admitted
with a hx of crohn disease.
The child’s plan of care should
include a diet that has which
of the following components?
ANS: B. increased calories
6. after a pyloromyotomy, a
week old infant is prescribed
feedings of 1 to 2 oz od
Pedialyte every 3 hours then
advance to breastmilk as
tolerated postoperatively. The
nurse should advance the
feeding if which occurs?
ANS: D. the infant is taking
Pedialyte without vomiting or
desertion
7. a child with extensive burns is
scheduled twice a day in a tub
to loosen and remove
sloughing tissue. What is the
term used for sloughing burn
would tissue? ANS: Eschar
8. a child is admitted for minimal
change nephrotic syndrome.
The nurse recognizes that the
child’s prognosis is related to
what factor?
ANS: D. Response to steroid
therapy.
9. a 7 year old child with acute
lymphatic leukemia is on
steroids. A common side
effect of corticosteroid
(prednisone) therapy is?
ANS: weight gain
10. The school nurse is caring for
a child with seizures. What is
the initial clinical
manifestation of absence
seizures that nurse needs to
be aware of?
ANS: Brief loss of consciousness.
11. a child’s chart indicated
Astigmatism. For what should
the nurse assess? ANS:
unequal curvatures in
refractive apparatus
12. which immunizations should
the nurse plan to administer
to normal healthy children
between the ages of 1 and 5
years? (select all that apply)
ANS: DTap, IPV, MMR
13. choose the prevention
strategies that have
significantly decreased
fatalities for children?
(select all that apply)
ANS: Bicycle helmets, car
restraints, smoke detectors
14. which of the following
describes the pathophysiology
of leukemia?
ANS: Unrestricted proliferation
of immature white blood cells
(WBCs)
15. a school-age child with celiac
disease asks for guidance
about snack that will not
exacerbate the disease, what
snack should the nurse
suggest?
ANS: D. potato chips
16. identify the age group of
children per Erickson in the
developmental stage of
identity vs role confusion ANS:
C. 13-21
17. a child with pyloric stenosis is
having excessive vomiting,
which of the following is a
potential complication?
ANS: metabolic Alkalosis
18. which of the following
instructions would be included
in the preventive teaching
plan about urinary tract
infections for a preschool
female child?
ANS: A. Wiping front to back
20. at which age should the nurse
expect an infant to begin
smiling in response to
pleasurable stimuli?
ANS: 2 months
21. Select the viral communicable
disease from the following list,
which has the classic
symptoms of a centripetal rash
seen in 3 stages, fever, anorexia,
and itchiness
A. Rubella
B. Scarlet fever
C. Rubeola
D. Varicella
22. What should a nursing
intervention to promote parent-
infant attachment include?
A. Alleviating stress for parents
by decreasing their
participation in the infant’s
care
B. Delaying parent infant
interactions until the second
period of reactivity
C. Explaining normalcy of
specific infant behaviors to
parents
D. Encouraging parents to hold
the infant frequently unless the
infant is fussy
23. A 2-year-old is scheduled to
have a tonsillectomy. How would
you educate the patient?
A. Describe the procedure as it is
about to be performed
B. Engage in conversations about
the procedure and encourage
the child to express his or her
thoughts
C. Provide a video and explain in
clear terms
D. Use picture books & puppets
and repeat explanations
24. What statement best describes
iron deficiency in infants?
A. It is caused by depression of
the hematopoietic system
B. Diagnosis is easily made
because of the infant’s
emaciated appearance
C. It results from a decreased
intake of milk and the
premature addition of solid
foods D. Hemoglobin levels
below the normal range
25. One of the most important
nursing interventions when caring
for an infant with
myelomeningocele in the
preoperative stage is which?
A. Apply a heat lamp to facilitate
drying and toughening of the
sac
B. Watch for signs that might
indicate developing
hydrocephalus
C. Place the infant in the prone
position
D. Take vital signs every hour
26. What statement is true
concerning osteogenesis
imperfecta (OI)?
A. Later onset disease usually runs
a more difficult course
B. It’s a disorder with varying
degrees of bone fragility
C. It is easily treated
D. Braces and exercises are of no
therapeutic value’
27. Evidence-based practice in
clinical management is grounded
in which of the following?
A. Systematic reviews
B. Clinical research studies
C. Expert opinions
D. Clinical practice guidelines
28. A school-age child has
asthma. The nurse should
teach the child that if a peak
expiratory flow rate is the
yellow zone, this means that
the asthma control is what?
A. Less than 50% of a
personal best and needs
immediate hospitalization
B. 50% of a personal best and
needs immediate emergency
bronchodilators
C. 80% of a personal best, and the
routine treatment plan can be
followed
D. 50% to 79% of a personal
best and needs an increase in the
usual therapy
29. An infant in the NICU was
born with hypospadias, which of
the following should be avoided
when a child has such condition?
A. Catherization
B. Intravenous pyelography (IVP)
C. Circumcision
D. Surgery
30. A child has had a short-arm
synthetic cast applied. What
should the nurse teach to the child
and parents about cast care?
A. When the cast becomes loose,
healing has begun
B. Observe the fingers for any
evidence of discoloration C.
Elevate the arm when resting
D. Child may resume swimming
after the cast dries
E. Do not allow the child to put
anything inside the cast
31. The nurse is teaching the
family of a child, age 8 years, with
moderate hemophilia about home
care. What should the nurse the
family to do to minimize joint
injury?
A. Encourage elevation and
application of ice to the
involved joint
B. Administer nonsteroidal anti-
inflammatory drugs (NSAIDs)
C. Administer DDVAP (synthetic
vasopressin)
D. Provide intravenous (IV)
infusion of factor VII
concentrates
32. A parent asks the nurse what
would be the first indication that
acute glomerulonephritis was
improving. What should be the
nurse’s best response?
A. Blood pressure will stabilize
B. Your child will have more
energy
C. Urine will be free of protein
D. Urine output will increase
33. Which of the following
symptoms are usually seen in the
child with Rubeola (Measles)?
A. Kolpik spots B. Rash
appearing on 3rd day C.
Conjunctivitis
D. Slapped cheek appearance
E. Bull’s neck
36. Which assessments are
included in the Apgar scoring
system? (select all that apply)
A. Blood glucose
B. Muscle tone
C. Blood pressure
D. Heart rate E. Respiratory
effort
37. A child with severe
anemia requires a unit of red
blood cells (RBC’s). The
nurse explains that the
transfusion is necessary for
which reason. A. Increase the
amount of oxygen available
to tissues
B. Allow her parents to come with
her
C. Fight the infection that she has
now
D. Help her body stop bleeding by
forming a clot (scab)
38. An 18-month-old child
is seen in the clinic with
Otitis media (OM). Oral
amoxicillin is prescribed
instructions to the parent
should include which of the
following? A. Stop giving
medication and come to the
clinic if fever is still present
in 24 hours
B. Immediately stop giving the
medication of hearing loss
develops
C. Continue medication until all
symptoms subside
D. Medication may take 24 to 48
hours to make symptoms
subside
39. Which of the following
therapy is usually ordered for
patients with active TB as part of
their medication management
plan?
A. Monotherapy
B. Occupational therapy
C. Physical therapy
D. Directly observed therapy
40. A young girl has just injured
her ankle at school. In addition to
notifying the child’s parents, what
is the most appropriate, immediate
action by the school nurse?
A. Obtain parental permission for
administration of acetaminophen
or aspirin
B. Apply ice
C. Observe for edema or
discoloration
D. Encourage child to assume a
position of comfort
41. A 5-year-old male is
diagnosed with diarrhea and mild
dehydration. Which of the
following oral rehydration
solution (ORS) should be given by
the nurse or parent to replace the
stool losses?
A. 50-100 mL/each stool
B. 250-275 mL/stool
C. 125-150 mL/stool
D. 150-250 mL/stool
44. The mother of a 6-month-old
infant has returned to work and is
expressing breast milk to be
frozen. She asks for directions on
how to safely thaw the breast milk
in the microwave. What should
the nurse recommend?
Do not thaw or heat breast milk
in a microwave oven.
46. The nurse teaches the mother of a
young child with Duchenne’s
muscular dystrophy about the
disease and its management.
Which of the following states by
the mother indicates successful
teaching?
My son will probably be unable
to walk independently by the
time he is 9 to 11 years old.
47. A child has been admitted to the
hospital with a blood lead level of
42 mcg/dL. What treatment
should the nurse anticipate?
Initiation of chelation therapy
48. Please select from the
following list the two basic
concepts used by pediatric nurses
to foster family centered care with
children and their families:
enabling and empowerment
51. A pediatric nurse plans to
educate the parents of a 2-
yeard old child who has
simple constipation. Which
of the following info should
be included in the teaching?
Include more fibers and
fluids
52. The nurse is preparing to
admit a 5-year old with spina
bifida cystica that was below
the second lumbar vertebra.
What clinical manifestations
of spina bifida cystica below
the second lumbar vertebra
should the nurse expect to
observe? SATA.
Lack of bowel control, flaccid,
partial paralysis of lower
extremites, overflow
incontinence with constant
dribbling of urine
53. When caring for the child with
Kawasaki disease, what should
the nurse know to provide safe
and effective care?
Therapeutic management
includes administration of
gamma globulin and salicylates.
54. What action should the school
nurse take for a child who has a
hematoma (black eye) with no
hemorrhage into the anterior
chamber?
Apply ice for the first 24 hours.
55. A health care provider prescribes
osmitrol (mannitol), 0.5 g/kg
intravenously now for a child with
minimal change nephrotic
syndrome. The child weighs 10
kg. The medication label states,
“Osmitrol (mannitol) 20g/100
ml.” The nurse prepares to
administer the dose. How many
milliliters will the nurse prepare to
administer the dose?
25
56. In a child with sickle cell
anemia, adequate hydration is
essential to minimize sickling and
delay the vasoocclusion and
hypoxia-ischemia cycle. What
information should the nurse share
with parents in a teaching plan?
 Monitor child for signs of
dehydration
7. At what age is it safe to give
infants whole milk instead of
commercial infant formula? 12
months
8. Exposure to which of the
following communicable
diseases pose a serious threat to
fetuses during the first trimester
of pregnancy?
Rubella
9. A pediatrics nurse is taking the
history of a child hospitalized
with Reye syndrome. Which of
the following is a common
occurrence seen in patients with
Reye syndrome? Fatty changes
in liver
0. A 7-month old infant seen in peds
clinic is diagnosed with Isotonic
Dehydration. The pediatric nurse
prepares to administer which of
the following fluids that will be
the most appropriate to rehydrate
this infant?
0.9% NaCl
61. An adolescent with
diabetes is admitted to the
ER for treatment of
hyperglycemia and
pneumonia. What are the
clinical manifestations of
diabetic hyperglycemia?
Thirst, fatigue, and
frequent urination
63. A 5-year old is seen in the
urgent care clinic with the
following history and
symptoms; sudden onset of
severe sore throat after going
to bed, drooling and difficulty
swallowing, axillary
temperature of 102.2F, clear
breath sounds, and absence of
cough. The child appears
anxious and is flushed. Based
on these symptoms and
history, the nurse anticipates a
diagnosis of? Acute epiglottis
64. Children with salt losing type
of Congenital Adrenal
hyperplasia (CAH) need
which of the following
replacement therapy?
aldosterone
65. Of the following, which are
possible signs of cerebral
palsy? (not sure)
Feeding difficulties, poor head
control after age 3 months,
persistent primitive reflexes
66. A nurse is providing
anticipatory guidance to the
parents of a toddler. Which of the
following should the nurse include
in the teaching?
Develop food habits that will
prevent dental caries, expression
of bedtime fears is common,
expect negative behaviors
associate with negativism and
ritualism
67. An 18-month old male is seborrheic dermatitis (cradle cap)
scheduled for surgery to reposition to shampoo the child’s hair?
his undescended tests. What is the Use a soft brush or fine tooth
child’s diagnosis? comb to gently scrub the area
Cryptorchidism (failure for
testes to descend) 73. A 6-year old child in the ED is
diagnosed with Lyme Disease.
69. A child has been diagnosed The nurse anticipates that the
with a Wilms tumor. What should health care provider orders will
preoperative nursing care include? include the administration of?
Careful bathing and handling amoxicillin
68. Of the statements below, 74. Verbal informed consent via the
what statement best telephone for a minor child is
represents infectious appropriate when the parent is not
mononucleosis? The available in person. Which of the
casusative pathogen is the following is true in this case? The
Epstein barr virus (EBV) verbal consent is required to be
in the presence of two witnesses.
70. A child diagnosed with
Coarctation of aorta is 75. The Cochlear implantation is a
scheduled for a follow up safe surgical technique used to
visit. While assessing, the treat which of the following types
pediatric nurse would expect of hearing loss in children?
to find which of the following sensorineural
symptom? Bounding pulses
in the upper extremities
71. Select the developmental
behaviors usually exhibited
by an infant (birth- 1 year).
SATA
head turns to locate sounds at 3
months
crawls by 10 months
moro reflex disappears by 4
months
plays peek a boo after 4 months
72. How should a nurse instruct
the parent of a 3-month old with