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TERNOPIL STATE MEDICAL UNIVERSITY

June 3, 2024

INSTITUTE OF NURSING

INTERNATIONAL NURSING SCHOOL

ASSOCIATE DEGREE NURSING PROGRAM

NURSING CARE OF CHILDREN

Methodical Instruction

for

PRACTICAL CLASS # 1 (5 hours)

Theme: UNIT TEST #1

Instructor: Dr. Nataliya Haliyash, MD, BSN

Room No.: _____, Institute of Nursing.

STUDENT OBJECTIVES

1. The term newborn is applied to infants from birth to:

2. The infant mortality rate (IMR) is the number of infant deaths:

3. The most common major neurological abnormality seen in low birth weight (LBW) infants is:

4. Immunization rates should be at which of the following percentages to provide herd immunity?

5. Herd immunity is a concept that refers to:

6. Today, which of the following causes of death accounts for the majority of deaths in children ages 1 to 19?

7. For children under 1 year of age, what is the leading cause of unintentional injury-related deaths?

8. The leading cause of injury-related death for children aged 1 to 4 years is:

9. The leading cause of injury-related deaths in adolescents aged 14 to 19 is by:

10. Which of the following describes the exchange of information between families and professionals in family-centered care?

11. Placing no limits on the ages or numbers of visitors and providing sleeping facilities for the caregivers in a child’s room in a health care facility will most likely bring which of the following results?

12. Atraumatic care refers to:

13. Which of the following actions by the nurse best exemplifies atraumatic care?

14. An appropriate method for teaching preschool children would be:

15. Adolescents learn best when they:

16. Which of the following activities best exemplifies cognitive learning?

17. Affective learning activities would include:

18. Psychomotor learning activities include:

19. A nurse is providing education to a family with a young child. The family members state that they have a gun in the house. Which of the following statements made by the nurse would be most important?

20. Which of the following nursing interventions would be supportive of the philosophy of atraumatic care?

21. In the majority of cases, pediatric clients are asked to give their consent or permission before receiving a procedure or treatment. This process is referred to as which of the following terms?

22. A family is involved in an automobile accident. The father, who is unconscious, and his 14-year-old son, who has suffered life-threatening injuries, are transported by ambulance to the hospital. The hospital staff attempt to contact the mother; however, they learn from the housekeeper that the mother is out of the country and not reachable by phone. Which of the following actions would be most reasonable and prudent on the part of the hospital staff?

23. A nurse is working in the emergency room when a child is brought in with injuries and a history that suggests sexual abuse. The child is not cooperative. Which of the following reasons presents the best rationale for waiting until the child is cooperative, instead of restraining and forcing the child to submit to the examination?

24. Although the age varies among states, the majority of states define a minor as being a person under the age of:

25. Most states permit a child under age 18 to consent to certain types of care without parental or guardiaotification or consent. The types of care that most often do not require the consent or notification of the parents or guardian include:

26. Emancipation is a legal recognition that a minor meets which of the following criteria?

27. In some states a minor can become emancipated without going through the courts by:

28. You are working in an adolescent residential treatment center. When admitting an adolescent to your unit, you need to get parental consent for care. You discover that the adolescent’s parents are divorced. One parent and a stepparent are caring for the adolescent. You would have the consent forms signed by:

29. The parents of a critically ill child are refusing medical treatment for the child. Which of the following terms identifies a legal rule that allows the state to make legal decisions in the best interest of the child?

30. A child is being considered as a donor for a kidney transplant. Which of the following areas must be evaluated before any genetic testing is ordered on a child?

31. In the case of Tarosoff v. The Regents of the University of California (1976), the court said that health care providers have a duty to breach confidentiality when:

32. You are the nurse working with an adolescent who has just been diagnosed with a sexually transmitted disease. In your state the provider of care has an obligation to report sexually transmitted diseases to the local health department. Your best action is which of the following?

33. At 9:00 AM you taught a client about the importance of voiding into a collection hat in the bathroom toilet. At 11:00 AM you find the client removed the hat and voided directly into the toilet. Which of the following statements would be best in charting this failure to follow your directions?

34. When several children all have appropriate tissue matches for the same donated organ, the basis for the decision as to which child gets the organ is that the organ is given to the child who:

35. A 17-year-old client presents to the emergency department following an automobile accident. The client was a restrained driver accompanied by her infant child. Both appear in stable condition. Which of the following actions would be necessary prior to initiating treatment for the client?

contact the client’s legal guardian for treatment consent

seek consent from the client prior to initiating treatment

contact the father of the child for treatment consent for the client

begin emergency treatment immediately and seek consent later

36. Sociologists define the family as a group of people:

with blood ties, adoption, guardianship, or marriage

with a focus on perpetuating the species

who are living together

who have strong emotional ties

37. Which of the following definitions best matches the U.S. Bureau of Census definition of family?

everyone in a household regardless of relationship

father, mother, and children

a group of two or more people related by birth, marriage, or adoption and residing together

a household of only those related by marriage(s) or birth, which would include extended family

38. Nurses using a contemporary definition should identify a client’s family by asking which of these questions?

Who do you consider to be your family?

Are your parents and siblings living?

Are you married and do you have any children?

Who lives with you in your household?

39. The major goal of the nurse using Neuman’s nursing theory would be to:

assist the individual to identify helpful and antagonistic family members

help keep the family structure stable within its environment

enhance interactions between all extended family and the individual

minimize ineffective communication between family and society

40. The major focus of the developmental theory of family is:

systems within which the family operates

predictable stages with specific issues and tasks

assessment of growth in holistic measures

relationships among individual members

41. An advantage of the developmental theory of families approach is that it provides nurses with information about:

what to expect of families at different points in their life cycle

pathology in the family and how it affects individuals

growth of individuals compared with other family members

limitations of individuals and families

42. A genogram is a method for recording and mapping information about:

morbidity, mortality, and onset of illnesses of all family members, usually for three generations

genealogy for as many generations back as the family can be traced

genocide in the population of an ethnic group, neighborhood, or town

illness in a military group during a particular period of history or time

43. An ecomap is best described as a:

visual presentation of the condition of the environment in an area

visual representation of a family in relation to the community

drawing of the location of ecological projects in a given area

tool of the ecotourist, which demonstrates what has been seen or done

44. The nuclear family consists of:

husband and wife

husband, wife, and their natural and adoptive children

any couple regardless of gender, and children acquired by the couple

any couple regardless of gender

45. The American Academy of Pediatrics has said that discipline should not only include setting limits and punishing for wrongdoing but also help children learn:

rules, regulations, and goals of living in a world with others

never to do the offending behavior again

the feeling of guilt

to be remorseful for wrongdoing to others

46. Cephalocaudal development proceeds in which direction?

head downward

foot to midsection, followed by head to midsection

toe to head

extremities in toward the tailbone section of the body

47. Infants start grasping with the whole hand, and as they develop they begin to use just the fingers. This development is an example of which of the following types of development?

cephalocaudal

anterior-posterior

proximodistal

internal-external

48. When comparing the development of a number of children, you would expect which aspect of developmental change to be the same in all the children?

basic sequence of changes

length of each change

onset of each change

response

49. When comparing the way infants react to pain with the way older children respond to pain, you will find that:

there is little difference between the way infants and children respond to pain

infants respond with their whole body while children can localize the pain

children will cry more and infants will withdraw more

infants will refuse to nurse during pain while children will continue to eat

50. The nurse is working with the caregivers of a child who is 2-1/2 years old. The nurse advises the caregivers that it is important for the child to know what it feels like to have a wet diaper. This advice was given because of which rationale?

The nurse is acting on an old wives’ tale and has no rationale.

Childreeed to know the connection between being wet and being changed by a caregiver.

Children have to be able to tell a caregiver they are wet before they can be successfully toilet trained.

This is an important sensory experience for maximum development of brain potential.

51. Which of the following best describes the ego, according to Freudian theory?

the conscience

the irrational, selfish, impulsive part of the personality

the rational and controlling part of the personality

the inner self

52. From birth to 1 year of age, the infant is in which of the following stages, according to Freudian theory?

oral

phallic

anal

genital

53. Freud theorized that methods used to toilet-train children might have a lasting effect on their personality. Children who had rigid, severe toilet training would most likely show which of the following behaviors later in life?

narcissistic

self-mutilating

meticulous and hypercritical

bullying to others and aggressive

54. Which of the following activities are most closely identified with the latency stage suggested by Freud?

The id is out of control, and the child struggles with antisocial thoughts and deeds.

The child increasingly identifies with the same-sex parent and has intense involvement with same-sex peers.

Energies are directed toward sexual thoughts and curiosity about opposite-sex parent and peers.

The superego has not yet developed, and the child has little focus on society and useful skills.

55. Erikson’s psychosocial theory of development differed from Freud’s ideas of development in that Erikson viewed:

children as being controlled by caregivers and society with little room for exploring the environment on their own

children as being controlled by the superego and being afraid to displease the caregivers

humans as rational creatures with the ego–rather than the id, superego, or conflicts–controlling thoughts, feelings, and actions

children as having no sexual interests or conflicts of any kind, with this issue not arising until young adulthood

56. In order to help an infant accomplish the basic task of infancy (according to Erikson’s stages of psychosocial development), caregivers must consistently do which of the following things?

Provide entertainment and stimulation for psychological growth.

Talk with the child during the child’s waking hours.

Hold the baby in a way that the baby prefers.

Meet need for comfort, security, predictability, food, and warmth.

57. Sullivan believed that personality development is mainly the result of:

biochemical types and amounts and being either in balance or out of balance

genetic inheritance

childhood experiences, interpersonal encounters, and the mother-child relationship

extended family influences

58. According to Sullivan’s stages of interpersonal development, the primary task of the first stage is:

to learn to rely on others, especially the primary caregiver, to gratify physiological needs and achieve satisfaction

to satisfy egotistical and narcissistic needs

to learn how to please the caregivers and others

to become independent of caregivers and separate oneself from the environment and significant people

59. Sullivan theorized that the “good me” and the “bad me” fuse around which age?

6 months

12 months

9 months

18 months

60. The neonatal or newborn period of life is defined as the first:

24 hours

7 days

48 hours

28 days

61. In fetal circulation, most blood will bypass the fetal lungs via the:

inferior vena cava

foramen ovale

ductus venosus

ductus arteriosus

62. When the fetus makes the transition to becoming a newborn and extrauterine life begins, there occurs a series of changes, including decreased pulmonary vascular resistance, increased pulmonary blood flow, increased pressure of the left atrium, decreased pressure of the right atrium, and closure of which of the following structures?

foramen ovale

inferior vena cava

ductus venosus

superior vena cava

63. After a long labor, the mother is concerned about the swelling of her baby’s scalp. The newborn is 24 hours old. The nurse palpates the scalp and finds swelling that extends across the suture lines. In addition to explaining the probable cause of the swelling and the time of resolution, the nurse explains that the term for this condition is:

cephalohematoma

molding

caput succedaneum

crepitation

64. The nurse instructing the mother on how to care for the umbilical cord of the newborn would direct the mother to:

wash the cord only with warm water and gently dry it

apply 70% isopropyl alcohol or hydrogen peroxide to the base next to the skin and to the cord with each diaper change

use a solution of baby shampoo and water on the cord, rinse, and dry carefully

wash the cord with a solution of Ivory soap and water, dry, air for 30 minutes, and apply triple antibiotic ointment after baths and diaper changes

65. The nurse is assessing neonatal reflexes. As the nurse moves the neonate’s head slowly to the right or left, the eyes move more slowly than the head and do not immediately adjust to the position of the head. This reflex is called:

cat’s eye

doll’s eye

head lag reflex

eye delay

66. The nurse is teaching the caregivers about the immediate care of the newborn circumcised with a plastic bell. The nurse would instruct the caregivers to:

gently lift the ring and squeeze warm water from a cotton ball onto the tip of the penis when changing the diaper

take the bell off when the baby is awake, active, and likely to pull on the bell and dislodge it

pull the ring off in 5 to 7 days when the circumcision is near or completely healed

wash the bell and the penis with alcohol several times a day

67. The normal newborn uses what behavior or ability to protect him- or herself from overstimulation and to free energy to meet physiologic demands?

deep sleeping

constitution

crying

habituation

68. Prior to discharge from the hospital, the newborn most often will receive a screening blood test to rule out which of the following conditions?

Addison’s disease and pituitary dysfunction

Down syndrome and autism

phenylketonuria and hypothyroidism

Marfan’s syndrome and cerebral palsy

69. A type of fat found primarily in the subscapular, axillary, adrenal, and mediastinal regions of the newborn is which of the following?

pure fat

brown fat

triglycerides

glycerol

70. The usual recommended sleeping position for a normal newborn is which of the following positions?

prone

semi-Fowler’s with the head elevated by a pillow

supine

feet elevated slightly

71. Newborns who have craniofacial abnormalities and gastroesophageal reflux should be positioned in which of the following positions for sleeping?

side-lying (left)

supine

prone

side-lying (right)

72. The current practice of feeding newborns is:

to place them on a frequent feeding schedule

an on-demand feed

to offer five feedings a day

to set up a specific schedule

73. The nurse teaching the new mother about breast care will advise the mother to wash the breasts:

with plain water

with alcohol and cotton swabs

with soap and water

with a peroxide-and-water solution

74. In teaching the mother how to remove the newborn from the breast, the nurse would offer which of the following instructions?

Gently slap the newborn’s cheek or hand to get him or her distracted enough to stop feeding.

Pull on the baby’s ear that is opposite the breast where the baby is feeding.

Push on the baby’s cheeks to open the baby’s mouth.

Place a finger in the side of the baby’s mouth and between the jaws to release suction.

75. The mother asks the nurse how long a can of opened liquid formula or a prepared bottle will be good if it has been refrigerated. The nurse responds that once opened or mixed, the refrigerated formula or bottle must be used within:

12 hours

48 hours

24 hours

72 hours

76. The nurse making a home visit notices the mother microwaving a bottle before feeding it to the newborn. The nurse will do some teaching about which of the following concepts?

77. A nurse assessing a newborn in the hospital finds swelling in the area of the newborn’s clavicle, and the baby cries if touched in that area. If the clavicle is broken, the nurse will realize that:

78. Which of the following statements best describes respiratory distress syndrome?

79. The nurse is doing the examination of a neonate who is just an hour old. The nurse finds that the baby has a dry, cracking skin, but no vernix or lanugo, and the skin appears greenish in color. What is the likely cause of these signs?

80. The age range for an infant is defined as which of the following time spans?

81. A mother asks the nurse when a soft spot on the baby’s head will close. The best response by the nurse is which of the following responses?

82. A mother notices that her 6-month-old child grasps things such as a spoon in her palms. This mother asks when her daughter will be able grasp a spoon between the thumb and fingers. She has been trying to teach the child this skill without success. The best response by the nurse would be:

83. In assessing the amount of head lag in an infant, the nurse will:

84. Infant head control is judged by the:

amount of neck wrinkling

presence or absence of head lag

ability to hold head without support

rigidity of the neck and head

85. Locomotion, or the ability to move from place to place without assistance, is dependent on:

developed muscles in the upper arm

head control and sitting without support

leg muscle strength

the ability to roll over

86. A mother asks the nurse to tell her what creeping is. She is expecting her baby to crawl any day and another mother says that her baby creeps. The nurse explains that creeping is when the baby:

87. A mother asks the nurse to explain what fine motor skills are. She has heard that it has something to do with the ability to draw and color within the lines in school-aged children, and she is curious to know what this means in an infant. The nurse would explain that fine motor development is the ability to:

88. Which of the following statements best describes object permanence?

89. The nurse would instruct the mother of a baby under 2 months to contact the health care provider if the baby’s temperature is at which of the following readings or higher?

90. Most common reactions to immunizations last how many days?

91. The general treatment of common reactions to immunizations is:

92. The mother asks the nurse to describe the common reactions to immunizations. The nurse tells the mother that they usually consist of redness, swelling, and tenderness at the injection site, along with:

93. A caregiver calls the pediatrician’s office and is desperate to talk with the pediatrician or the nurse. The baby has red swollen gums and is teething and fussy. The caregiver wants to know what intervention to take to soothe the irritable baby. The nurse will most likely suggest:

94. A caregiver asks the nurse when his baby can have semisolid foods like infant cereal and applesauce. The nurse replies that the introduction of semisolid foods usually occurs between:

95. The nurse is talking with caregivers regarding the introduction of new foods to their baby, who has been on cereals and is now ready to start on vegetables and fruits. The most important advice the nurse will give the caregivers is to:

96. Unless there is some contraindication, the nurse knows to check with the caregivers to be certain that most fruits and vegetables have been added, as well as strained meats, by the time that the infant is how many months old?

97. The mother of an 8-month-old infant tells the nurse that the baby is eating almost no baby cereal or baby food but nurses very well. The nurse would advise the mother to:

98. When teaching the caregivers about the selection of a baby’s semisolid food, the nurse would tell them to:

select jars of baby food with salt content under 400 micrograms (mcg) per jar

add a little regular refined white sugar to the baby food, as babies prefer sweet-tasting foods

buy baby foods with added artificial sweetener or add one packet per jar

do not add sugar or salt to a baby’s food and select products preferably with no added salt or sugar

99. The nurse is working with the caregivers of a 6-month-old baby. Both caregivers are extremely neat and have talked about the difficult adjustment to changes the baby has brought to their orderly and scheduled lives. In giving anticipatory guidance, at some appropriate point, the nurse will talk about what it will be like when the child wants to eat semisolid foods. The nurse’s most important focus in this anticipatory guidance will be:

how messy the baby will be during feeding time

ways to keep the mealtime messes to a minimum

the caregivers’ psychological needs and support of each other during this time

the baby’s need to increase autonomy and to explore the texture and smell of food

100. It is important for the nurse to encourage caregivers to do which of the following while changing, feeding, or interacting with a baby?

Talk softly in baby talk.

Play music.

Provide a quiet time without talk.

Talk to the baby in adult talk.

101. A 2-week-old baby’s caregivers seek help from the nurse in understanding the baby’s recent unexplained episodes of crying and inability to be consoled, no matter what they try. The nurse explains that this is probably colic. The caregivers ask: “What causes colic? Have we been doing something wrong?” The nurse’s best response is:

“In most cases we don’t really know what causes colic, so don’t blame yourselves. We will do some checking to see if it might be an infection.”

“I don’t know if you have been doing something wrong or not. Let’s look at what routines you have and your parenting practices.”

“Do you think you have been doing anything wrong?”

“What have you been feeding this baby, and how much at a time?”

102. The nurse teaches the caregivers of a colicky baby some comfort measures. Which of the following measures would the nurse most likely teach them to use?

Place a garlic-and-oil potion around the infant’s neck, to be worn 24 hours a day.

Use a front carrier and white noise and swaddle the baby, or take the baby for a car ride.

Place the infant on the stomach (prone) to sleep as long as it has the symptoms of colic.

Keep the infant’s stomach full at all times so there is no room for any gas to form.

103. Based on a recommendation from the American Academy of Pediatrics, the nurse will advise the caregivers to do which of the following to help prevent sudden infant death syndrome?

Have the baby sleep in a prone position.

Have the baby sleep in a supine or side-lying position.

Provide hourly checks while the baby is sleeping.

Avoid the use of a pacifier at night.

104. You are the nurse assessing a baby, and you find the baby has a little dryness of the scalp. You would teach the mother to prevent cradle cap (seborrhea) by:

washing the hair every other day with a mild baby shampoo

rinsing the hair with vinegar whenever the hair is washed

washing the hair no more than once a week

applying alcohol to the baby’s scalp on a daily basis

105. The nurse will teach the mother to avoid using baby powder on the baby. The mother asks why not, and the nurse will explain that the most important reasoot to use a baby powder with silicates (and typically baby powders are a mixture of hydrous magnesium silicate) is that:

it might get into the baby’s eyes

it can cause a severe aspiration pneumonia

it might trigger some serious allergies

it can clog the skin and cause skin eruptions

106. A nurse is providing education on motor development to the parents of an infant. Which statement made by the nurse would be the most accurate?

“For the infant to willingly grasp an object, the infant must first develop the involuntary grasp reflex.”

“Supination usually follows pronation.”

“In order to pick up an object, the infant must be able to release it.”

“A child must be able to pick up an object before the child can place the object in the mouth.”

107. A nurse is performing a physical assessment on an infant. The infant has good head control with no head lag, sits with support, and is able to roll from back to abdomen unassisted. The nurse is aware that the infant is likely within which of the following age groups?

2 to 3 months

7 to 8 months

4 to 6 months

9 to 12 months

108. A parent of an infant is asking when the child should be able to independently eat Cheerios. The nurse is aware that this action will require the development of the neat pincer grasp, which typically occurs at which of the following weeks?

28 weeks

40 weeks

36 weeks

52 weeks

109. A family is planning to integrate solid foods into the infant’s diet. Which of the following foods would be recommended for an infant?

cereal

peanut butter

grapes

kernel corn

110. Most toddlers can climb stairs by how many months?

111. All of a child’s deciduous teeth usually erupt by how many months of age?

112. Which of the following best describes the term physiologic anorexia?

period of decreased appetite as a result of decreased caloric need

refusing to eat in order to get secondary gains from behavior

not eating, which brings a variety of changes in body function

changes in appetite due to fluctuating eating habits

113. Which of the following foods would be best for the toddler?

bacon, fried egg, toast and butter, and whole milk

sliced white turkey breast, green beans, and skim milk

fried chicken leg, potatoes and gravy, and ice cream

hot dog, french fries, and pudding

114. Caregivers complain to the nurse that their 2-year-old child insists on having his own way and is very stubborn about wanting things done at the same time in the same way every day. The best response by the nurse is which of the following responses?

“Usually stubbornness can be corrected with behavior modification.”

“You will need to teach your child that the caregiver is the one in charge.”

“Routines provide a sense of security and control over the environment.”

“Coming up with a way to change this presents a challenge to caregivers.”

115. A caregiver is upset that her 34-month-old girl has begun to wet the bed and suck her thumb after being admitted to the hospital. This caregiver asks the nurse to explain why this is happening. The nurse’s best response is which of the following?

“This behavior is a defense mechanism when normal routines are changed.”

“Your daughter probably does not like the primary nurse who has been assigned.”

“Your toddler is angry, and this is her way of letting us know that she is unhappy.”

“Bed-wetting and thumb sucking are just a way of getting even with you for abandoning her.”

116. Which of the following is the best initial approach when a child has shown signs of regression?

Have the child sit in time-out and think about what he or she is doing and about his or her feelings.

Ignore the regression, and compliment the child on positive attributes and behaviors.

Ask the child why he or she is behaving like a little baby.

Distract the child with new foods and new activities.

117. The nurse is doing some teaching with caregivers who are trying to toilet train their 26-month-old child. When teaching toilet-training methods, which of the following behaviors would the nurse most likely recommend to the caregivers?

Have the child go without diapers and clean up any feces or urine on the floor themselves.

Use time-out and withdrawal of privileges for not using the toilet.

Remind the child as frequently as every 15 minutes about the availability of the toilet.

Use a calm, relaxed approach, praise for success, and no punishment at all.

118. A father asks the nurse why his toddler engages in fantasy and make-believe in play. The best answer by the nurse is:

“Some children use fantasy to escape their stressful world, so the more stressful their life is, the more they fantasize.”

“Fantasy helps the toddler cope with caregiver expectations and helps the child conceptualize how he or she wishes the world to be.”

“Your child probably does not have enough playmates to keep busy in reality-based play.”

“Some children are just more imaginative and creative than others, and these children engage in fantasy play.”

119. Caregivers ask the nurse how they need to deal with their toddler who is a picky eater and eats very little at mealtime. In addition to telling the caregivers that this is not unusual behavior for a toddler, which of the following statements by the nurse would be most helpful?

“Serve 1 tablespoon per year of age of each of the major food groups, and make the child sit at the table until this is consumed.”

“Serve more vegetable and fruit juice as well as protein shakes, allowing the child to drink when unwilling to eat.”

“Offer smaller amounts of food to encourage the toddler to ask for more, and serve frequent nutritious snacks throughout the day.”

“Serve new foods frequently, as children like variety and the child may be tired of the same old foods at every meal.”

120. Caretakers of toddlers need to keep which of the following substances on hand to administer in an emergency under the direction of appropriate professionals?

charcoal

syrup of ipecac

80-proof whiskey

Narcan

121. For the toddler who is 12 months of age, which of the following cognitive advancements is anticipated to be occurring?

122. Which of the following factors is most important in the prevention of pediatric obesity?

123. The parents of a toddler who is a “picky eater” are seeking advice from the nurse. Which of the following suggestions made by the nurse would be considered the most accurate?

124. Children usually have all 20 of their deciduous teeth by which of the following ages (in years)?

125. A mother is talking with the nurse and is expressing concern that her 5-year-old still occasionally urinates in her underwear instead of going to the bathroom. Which of the following questions by the nurse would be most helpful in determining if this is a normal occurrence?

“Do you remind her to go to the bathroom every 2 hours?”

“Is she the firstborn or not?”

“Has she started school already?”

“Do these accidents occur when she is engaged in some activity?”

126. A child is talking to the pediatric nurse. This child answers his own question of “Why does the sun shine?” with the answer, “To see me when I play outside.” The nurse explains to the mother that this is an example of:

egocentrism

animism

transductive reasoning

idiosyncratic thinking

127. To help a preschooler sleep at night, the nurse will recommend to the caregivers that they:

avoid milk drinks at bedtime

have the child watch television until he or she falls asleep

read a bedtime story and establish a firm bedtime

provide soda or coffee with milk at bedtime

128. The father asks a nurse for advice on how to deal with his child’s nightmares. The best advice from the nurse would be:

have the child get into bed with the father

sleep in the child’s bed with him

have the child get up and play a game

comfort and reassure the child that nightmares are not real

129. A nurse is assessing the play of a 4-year-old. Which of the following best describes what the nurse would observe in the play of this age preschooler?

playing alongside but not with playmates, taking toys away from others, using a pounding bench, and playing with a musical toy

interactive play, obeying limits, creating an imaginary friend, and engaging in fantasy play

engaging in group sports or games and playing with puppets

playing by him- or herself in the corner, engaged in putting a puzzle together

130. The nurse will advise caregivers not to allow their child to watch programs with violence or programs where people make poor choices and behave badly because:

these shows are too long considering the amount of time children are allowed to watch television

preschoolers cannot differentiate between reality and fantasy and may use the behaviors of actors on television to deal with their own problems

young children keep these pictures in their minds all their lives and affect them when they are older

preschoolers begin to confuse the actors with their caregivers and accuse their caregivers of doing what the actors did

131. A caregiver asks the nurse why her preschooler grinds her teeth at night. The best response by the nurse is which of the following statements?

“This is a common practice during the preschool years; it may be a way she releases tension and calms herself so she can fall asleep.”

“This is the time when permanent teeth are trying to grow, and the pain causes grinding at night.”

“Loss of baby teeth will cause the mouth to get out of adjustment, and this causes grinding at night.”

“You are probably keeping your child up too late at night and not making sure the child gets a nap.”

132. Which of the following statements by caregivers of a preschooler would best indicate that the caregivers were paying attention to the teachings of the nurse on how to decrease the incidence of illnesses in their child?

“We don’t let our child play with other children unless the caregivers assure us they are not ill.”

“Our child’s temperature is taken every morning and every night, and if it is elevated, we call the health care practitioner.”

“We make certain that our child washes her hands after using the bathroom and before eating.”

“Our child takes a vitamin pill every day, eats a balanced diet, and takes sufficient fluids.”

133. The caregivers can best minimize separation issues associated with school by:

134. A parent asks the pediatric nurse, “How tall is the average 6-year-old boy, and how much does the average 6-year-old boy weigh?” After advising the parent that each child is unique and growth is affected by many factors, the nurse would give the average height and weight for a 6-year-old boy as:

135. The school nurse is talking with a group of parents about the growth and development of their school-aged children. A parent asks the nurse, “Just what are growing pains?” Which of the following is the best response?

136. The pediatric nurse is working with the parents of a school-aged child who has growing pains. The nurse recommends that the parents try which of the following as comfort measures?

137. The pediatrician has been speaking with a mother about the “prepubescent period.” Later the mother asks the nurse, “What does prepubescence mean?” Which of the following is the nurse’s best response?

138. A father asks the nurse to explain what people mean when they use the term latency, because someone recently referred to his 7-year-old child as being in “latency.” Which of the following is the most accurate response the nurse could give?

139. The nurse assessing a young school-aged child finds that this child has the skill of classification. Having this skill means the child will be able to do which of the following?

140. The nurse assessing a young school-aged child finds that the child has the skill of conservation. When the nurse tells the parents that their child has the skill of conservation, they ask what this means. The nurse explains that conservation is the ability to:

141. The nurse is assessing a 6-year-old child’s thought processes. The nurse will find which of the following types of thinking?

142. Routine physical examinations on children include height, weight, vital signs, physical examination, vision and hearing screening, diet assessment, screening for alcohol and other drug use, and screening for which of the following?

143. The nurse is working in an immunization clinic and is assessing the immunization records of the children presenting there to see what immunizations they need. When the nurse finds a child who has not received a measles-mumps-rubella (MMR) booster or a tetanus, diphtheria and pertussis (DTaP) booster between ages 4 and 6, the nurse will tell the parents to have this booster or boosters given to their child at what age?

144. When a school-aged child has a malocclusion, the parents need to:

advise the school nurse

take the child to an orthodontist

do nothing, as this will be outgrown

take the child to the pediatrician

145. The school nurse is called to the playground to attend to a child who has had a tooth knocked out during a playground fight. Which of the following would be the best action for the nurse to take?

Have the child gargle with hot salt water and put the tooth in an envelope so the child can put it under his or her pillow.

Apply an ice pack to the side of the face where the tooth came out, and have the child rinse the mouth several times with ice-cold water.

Gently rinse the tooth with water, put the tooth back into the socket, and call the caregivers to take the child to the dentist.

Call the parents immediately so they can contact the dentist to find out what the dentist wants them to do.

146. Which of the following best identifies how Piaget described play during the school-age years?

work that is fun

a moral character builder

interactive socialization

games with rules

147. Adolescence is broken down into how many distinct periods?

two

four

three

five

148. Puberty is best defined as the:

beginning of adolescence

state of development when reproduction first is possible and the adolescent growth spurt starts

period between childhood and adulthood in which a person matures and readies for adult life

time when thinking changes to include abstraction and the consideration of others’ viewpoints

149. The Tanner stages are a rating for which of the following in females?

sequence of secondary sexual characteristics with stages describing breast and pubic hair growth

ability to be independent of caregivers and care for oneself while living alone

readiness for marriage or mating and readiness for childbearing activities, with a scoring of 1 to 100

sequence of emotional and psychological changes occurring in adolescence and ending in maturity

150. An adolescent boy is concerned that his pajamas are wet in the morning and worries that he is losing control over his bladder or beginning to wet the bed. His father explains that this dampness is most likely due to:

nocturnal emissions, a normal occurrence in adolescents

changes in the prostate gland during adolescence

temporary bladder changes that occur as the male matures

excessive masturbation, and he needs to decrease the amount

151. What criteria does the nurse use to determine that an adolescent male is late in physiological development and needs to be referred to a health care practitioner?

if testicular enlargement of 2.5 centimeters has not been attained by age 14

when the shoulders have not widened and the hips narrowed by age 16

if interest in sexual activity is not evident by age 17

if the penis has not attained a full length of 6 inches by age 15

152. A father asks the nurse why his 18-year-old daughter is so idealistic and is so often involved in political or social causes. The father is especially concerned because his daughter recently turned down a family outing to an amusement park in order to attend a rally to benefit indigenous people in a third-world country. Of the following, which response by the nurse would be best?

“When children do not have enough limits set at home, they often fall in with peer groups who engage in these activities.”

“She has obvious talent for politics, and this may be something she will want to do as her life’s work.”

“This is your daughter’s way of being different from you and exerting independence from her family.”

“This is a normal phase that adolescents go through. They interpret the world in an excessively idealistic perspective and often engage in causes.”

153. Elkind had a term for adolescents’ exaggerated notion of their own uniqueness. He said that adolescents either experience an extreme sense of isolation, thinking no one has experienced what they have and therefore cannot understand, or think they are immortal and that bad things only happen to other people. The term Elkind used for these two beliefs was:

immortality and isolation complex

Eros versus Thanatos

paradox of life and death

personal fable

154. A school nurse is talking with an adolescent who shares about her ideology and career aspirations in terms of what her caregivers and other important adults in her life have to say. This adolescent cannot explain why she has these beliefs other than to quote authority figures. Using Marcia’s theory of adolescents occupying one of four identity statuses, the nurse will find this student occupying which of the following identity statuses?

identity achievement

identity diffusion

foreclosed

moratorium

155. The way adolescents think about themselves as either male or female, their biological makeup, personal experiences, and social expectations and recommendations about how males and females should think and behave is referred to most correctly by which of the following terms?

masculinity versus femininity

sexual identity

gender identity

personal makeup

156. The most fundamental peer relationship and the one most likely to be based on similar interests and emotional support is the:

clique

friendship dyad

crowd

gang

157. Which of the following statements best describes the term crowd when used to describe peer relationships?

an association of two to four cliques with relations less intimate than in the cliques

a large number of peers who gather periodically to socialize

the number of people that when exceeded makes socialization uncomfortable

five or more people who are engaged in observational and encouraging behaviors

158. The nurse is working with adolescents to get them to improve their diet. Which approach would be most helpful in achieving this goal?

Send dietary information to the caregivers of the adolescents.

Have the adolescents get involved in meal planning after receiving information on dietary needs.

Show a film on dietary needs and what happens to the body if those needs are not met.

Have a series of lectures by a variety of health specialists on dietary needs of the adolescent.

159. The nurse is assessing a 17-year-old adolescent female who is underweight and has not achieved any of the normal reproductive milestones, including menarche. She has also not achieved the anticipated height. The nurse will most suspect and assess for which of the following conditions?

eating disorders such as bulimia and anorexia

endocrine problems, especially thyroid insufficiency

deficiency of growth hormone

genetic predisposition to slow growth

160. The nurse working with adolescents is acting on which of the following assumptions in regard to the sexual activity of adolescents today?

Only about one-fourth of adolescents have had sexual intercourse by age 18.

Over one-half of adolescents have experienced sexual intercourse by age 18.

The number of sexually active adolescents has dropped by one-half in the last decade.

Teenagers are becoming sexually active at a much later age than in the last decade.

161. You are the school nurse working with an adolescent who has come back to school after making a suicidal gesture of a superficial cut on his wrist over the weekend. This teenager says he was just seeking more attention from his caregivers and that it is not a problem anymore. Which of the following actions would be best on your part?

Take a matter-of-fact, nonjudgmental attitude and send the student back to class.

Tell the student that you are taking this attempt seriously and work on a suicide prevention plan with him, which includes professional counseling.

Leave this problem to the caregivers, as suicide threats and gestures are a common way that adolescents get attention from caregivers and others.

Make certain the student knows he can count on you to help and can call you at any time.

162. The average head circumference of an infant at birth is how many inches?

163. A caregiver asks the nurse about giving the infant cow’s milk instead of formula. The nurse will need to teach the caregiver that cow’s milk is unacceptable until after the:

baby has been weaned from the bottle or breast

baby’s first birthday

infant has started iron-fortified cereal

infant is eating table foods

164. The pediatric nurse practitioner has a small toy hooked onto the stethoscope and is observed to be humming at times during the physical examination of a child. The reason for the toy and humming is most likely:

to provide a distraction to increase cooperativeness

to entertain and keep the nurse in a good mood to work with children

something that has little to do with the examination of the child

to keep the child focused so he or she won’t get into things in the exam room

165. The nurse will perform all invasive or uncomfortable procedures such as ear inspection at what point during the physical examination?

in a sequential manner

last

first

optional

166. At what age are children old enough to have their temperature taken orally?

10 months

3 years

18 months

5 to 6 years or more

167. Which of the following methods of taking the temperature of a child is considered to be most accurate?

oral

axillary

rectal

tympanic

168. The nurse is ready to take the temperature of a child who is to be discharged from the hospital if the temperature is within the normal range. The health care practitioner and family are waiting to hear about the temperature. The nurse considers taking an axillary temperature but decides instead to take the temperature orally. What is the most likely reason that the nurse decided to take the temperature orally in this case?

The axilla is not sensitive to early temperature changes, and accuracy was critical in this case.

An oral temperature is much quicker to determine than an axillary temperature.

Locating an axillary thermometer might be more difficult than finding an oral one.

The oral temperature reading is easier and safer to get when compared to an axillary temperature.

169. The nurse is preparing to count the respirations of an infant. The nurse will count the respirations for:

15 seconds, watching the chest

1 minute, watching the chest

30 seconds, watching the abdomen

1 minute, watching the abdomen

170. The nurse on the pediatric unit is assigned to care for four children. One of the children is 18 months old and the rest are 3, 4, and 4-1/2 years old. The youngest is in for observation, the 3-year-old has a cardiac problem, and the two older children are in for tests. After a report the nurse takes the children’s vital signs. The nurse would need to take the pulses in which of the following ways?

radial pulse on all the children

radial on the two older children and apical on the 18-month-old and the child with a cardiac problem

apical on all children under 5

apical only on the child with a cardiac problem

171. The nurse would expect to find which of the following resting respiratory rates in the normal newborn?

172. A caregiver asks the nurse to explain his infant’s weight loss of 10% of birth weight, which occurred by the third or fourth day after birth. The nurse would explain that this weight loss is known as physiological weight loss and is due to which of the following causes?

not being nourished any longer by the rich placenta

the exhaustion of the baby after the birth experience

the loss of extracellular fluid and meconium

the time it takes to learn to suckle adequately

173. Head circumference is measured in children with known or suspected hydrocephalus and children less than how many months old?

174. A child’s weight must fall in what percentile range to be considered normal enough not to warrant further investigation?

5% -95%

20%-80%

10%-90%

25%-75%

175. The African-American caregivers of a baby who was born just hours beforehand remark to the nurse that their baby seems to have a reddish color. The most accurate reply by the nurse is:

“Your baby is healthier than most and has a great color.”

“This is probably due to genetic makeup.”

“It is normal for dark-skinned newborns to have a ruddy appearance.”

“We will run some tests on your baby to see if this is due to bilirubin.”

176. The Caucasian caregivers of a newborn who is just hours old remark to the nurse that they are concerned about the bluish-purple color of the hands and feet of the baby. The best reply by the nurse would be:

“This is normal in light-skinned babies and will disappear with warming.”

“We will keep an eye on this and if it gets worse, we will call the health care practitioner.”

“The baby needs to stay in the incubator in the nursery and you can visit there.”

“Perhaps you have some darker-complexioned people in your family.”

177. The nurse notices that a 6-month-old infant born to Latino caregivers has deep-blue, almost black coloration over the lumbar and sacral areas of the spine and the buttocks. The nurse’s first guess in looking for causes would be:

child abuse

lack of bathing

ritual painting

Mongolian spots

178. The caregivers notice that the baby has a dark-black tuft of hair and a dimple over the lumbosacral area. This occurrence is:

normal and common

normal and rare

abnormal and may indicate spina bifida

abnormal and may indicate cancer

179. A thick, cheesy, protective deposit of sebum and shed epithelial cells on the surface of the skin is referred to as:

sebum epithelium

vernix caseosa

epitheliosis

the third skin

180. While assessing a child, the nurse pinches up a small section of the child’s skin between the thumb and forefinger, then quickly releases it. The nurse is assessing for:

hydration

excess fat

skin tension

pain tracks

181. The nurse is assessing an 8-month-old infant for head lag, pulling the infant by the hands from a supine to a sitting position. The head does not stay in line with the body when being pulled forward. Which of the following statements best represents the significance of this finding?

This is a normal finding, as the infant’s head will not stay in line until after 8 months of age.

The nurse has not conducted the test correctly and must do it again using proper technique.

Significant head lag after the age of 6 months may indicate brain injury and needs further investigations.

Head lag should not be tested until the child is over 1 year of age.

182. Which of the following best defines craniosynostosis?

premature ossification of suture lines resulting in early fusion of the bones of the skull

sinus openings into the cranium allowing for changes in intracranial pressure

wider spaces thaormal between the bones of the cranium

changes in the size and shape of the skull due to the absence of lymph and sinus openings

183. Patency of the nares must be determined at birth because:

of the possibility of polyps

mouth breathing will exhaust the newborn

the baby will have nasal flaring if not patent

newborns are nose breathers

184. The nurse is listening to the lungs of a child and finds that this child has stridor. The best course of action on the part of the nurse is to get prompt attention for the child to prevent which of the following problems?

pneumonia

epiglottitis

bronchitis

pericarditis

185. Developmental dysplasia of the hip (DDH) can be tested for up until an infant is 1 year of age. The test used to assess for DDH is which of the following tests?

Bartholomew’s sign

Tinel’s sign

Ortolani’s sign

cuff rotator sign

186. A child comes to see the pediatrician and breaks out the next day in the characteristic lesions of chickenpox. The nurse working in this pediatric clinic knows that:

this is not a problem, as the child was not contagious before the skin lesions erupted

only children physically touched by the child who developed chickenpox were exposed

all the children in the doctor’s office that day need to be quarantined and isolated

the doctor needs to see and evaluate all the children who were in the office and exposed

187. The school nurse is working with teenaged parents and their babies in a high school program designed to keep these parents in school and to teach them how to care for their children. The nurse teaches the mothers to change diapers on:

a soft towel that can be washed as needed

a washable surface that is disinfected after each use

upholstered furniture that can be wiped off

a changing station with a cushioned cover

188. Which of the following best describes the term vertical transmission?

oral intake of germs that go through the body and are secreted rectally

when the person contracts the disease or infection while awake and standing

droplet infection that drops downward into the respiratory tract

the process of transmitting a disease from one generation to another

189. Infections that can be transmitted through vertical transmission are:

influenza, meningitis, and varicella

rubella, herpes, and human immunodeficiency virus

staphylococci, streptococci, and Escherichia coli

hepatitis B and C and Rickettsia rickettsii

190. You are a nurse working with toddlers and preschoolers. One of the children has a skin infection, which is diagnosed as tinea corporis. In assessing this condition, you would ask the caregivers which of the following questions?

“What kind of detergent have you been using?”

“Has your child been swimming in a public swimming pool?”

“Does your child have any known contact allergies?”

“Has your child been playing with cats or dogs?”

191. You are a nurse working with children of various ages. You would teach the caregivers not to give acetylsalicylic acid (aspirin) to children:

of any age

under 13 years

under 6 years

under 18 years

92. The school nurse, on discovering any outbreaks of head lice, scabies, and pinworms, will teach the children to avoid:

sitting next to infected children

wearing head scarves or any head covering

keeping their coats and hats on their desks and to instead hang them on the coat rack

sharing and swapping clothing, as well as avoiding sharing personal items

193. Erythema infectiosum, or fifth disease, has which of the following characteristics?

intensely red “slapped cheeks” appearance

swelling and tenderness in the fifth digits

various sizes and shapes of red rash areas

redness of the feet as if the child was in hot water

194. You are a nurse working in a pediatric clinic. Your goal is to have accurate, up-to-date immunization records on all the children who come to the clinic. Which of the following record-keeping efforts would best help you meet your goal?

Have the caregivers document all the immunizations and dates of immunizations for each child.

Have caregivers list all those who gave immunizations to their children and sign consent forms for release of information; then combine the records into one.

Assume that immunizations are not up-to-date and begin the process at the beginning.

Have the caregiver document all past immunizations with a note that this is caregiver recall and then chart new immunizations.

195. You are being oriented to the pediatric unit. You notice that after giving a vaccination, the nurse records, in addition to the date of administration, the name of the vaccination, the site and route, the nurse’s name and title, and which of the following information?

parents’ or legal guardian’s full names and permanent addresses

the manufacturer, lot number, and expiration date of the vaccine

any adverse reaction sustained by the recipient

the height, weight, vital signs, health status, and blood work of the child

196. Which of the following includes the two true permanent contraindications to vaccination?

consistent occurrence of otitis media and upper respiratory infections after vaccinations in the past

history of severe anaphylactic reaction to a vaccine or its component and encephalopathy within 7 days of administration of DTaP

diarrhea, stomach cramping, and nausea after vaccinations in the past

multiple allergies to mold, grasses, trees, and dust and taking allergy vaccines for 2 years or more in the past 5-year period

197. The school nurse is talking with a group of adolescent females about the measles, mumps, and rubella (MMR) vaccine. The school nurse will caution the female students not to take the vaccine if there is any chance they may be pregnant or become pregnant in the next 3 months. The reason the nurse tells the students not to take the vaccine during the first 3 months of pregnancy is:

This vaccine can cause developmental abnormalities in the fetus during the first trimester.

The baby could be prematurely vaccinated against MMR.

The vaccine could cause the fetus to develop measles or mumps while in utero and this is hard to treat.

The vaccine during this time will cause the mother to have adverse side effects and be severely ill.

198. You are working on the medical unit at the hospital. A client says he may have been exposed to diphtheria. The client has a low-grade fever and some nasal discharge. In order to diagnose or rule out diphtheria in this client, the physician will order which of the following tests?

sputum culture

gastric analysis

blood and stool cultures

nose and throat cultures

199. The Epstein-Barr virus is responsible for which of the following?

erythema infectiosum

mumps

infectious mononucleosis

roseola

200. You are the school nurse advising the caregivers of a student who has mumps. The mother asks how long this student must remain at home. The school nurse will tell the caregivers that students with mumps must stay home until they meet which of the following criteria?

Nine days have passed after the beginning of the parotid swelling.

The parotid swelling has resolved.

The student is free of any pain in the parotid area.

The student is totally free of fever for at least 2 days.

201. An infant of 4 months is hospitalized with a case of pertussis. The child is started on erythromycin orally for 14 days. The nursing staff will enforce observation of respiratory isolation for how long?

until the child is no longer coughing

5 days after initiation of antibiotic treatment

until the child is fever free for 1 week

when the child has been on cough medicine 2 weeks

202. Which of the following tests is used in diagnosing polio?

nasal culture

arterial blood gases

stool culture

magnetic resonance imaging (MRI)

203. Group A beta-hemolytic streptococci cause which of the following diseases?

varicella

diphtheria

measles

scarlet fever

04. A father calls the school nurse and asks when his daughter, who has chickenpox, can return to school. The best reply by the nurse would be:

whenever she is fever free for 2 days

when there are no new lesions

when the itching has stopped

when all lesions are crusted over

205. The transmission of tetanus to humans is when a skin wound comes in contact with:

rusty metals such as a rusted nail

soil contaminated with animal feces

the bite of an insect carrying the tetanus organisms

the saliva of an infected dog

206. The caregivers of a child with chickenpox telephone the nurse and ask what they can do about their child scratching the lesions. The best answer by the nurse would be:

“Offer the child a reward for not scratching, and keep a behavioral chart with stars for not scratching.”

“Wrap tape around the hands and tips of the fingernails, and paint the lesions with clear nail polish.”

“Put body lotion on the lesions during the day and night, cut the nails short, and use Epsom salts in the bathwater.”

“Cut the fingernails short, cover the hands at night, and use a drying solution such as calamine, oatmeal, or baking soda in bathwater.”

207. Caregivers ask the nurse how children or adolescents can contract syphilis. The best response by the nurse is which of the following?

by sexual intercourse

transplacentally, at delivery, by sexual intercourse, or through sexual abuse

anal, oral, or vaginal contact with semen

by contact with any body fluids of an infected person

208. A baby is found to have congenital syphilis. Which of the following treatments would you expect to see ordered?

erythromycin IM twice a day for 14 days

single dose of procaine penicillin G IM daily for 10 days or a regimen of aqueous crystalline penicillin G IV

penicillin V potassium crushed and administered in the feeding bottle with the baby’s formula or expressed mother’s milk

tetracycline for 14 days

209. A mother calls the pediatric nurse and says that her child has nocturnal anal itching and sleeplessness. The nurse will most likely instruct the mother to do which of the following things?

Press a transparent tape against the perianal region in the morning before the child has a bowel movement.

Give the child over-the-counter Benadryl for 2 nights to see if it gets better.

Apply Vaseline to the anal area before bedtime and in the morning.

After the child voids and defecates, wash the anal area with soap and water and rinse well.

210. Enterobius (pinworms) is diagnosed in a child. The treatment will most likely be instructions on washing all bed linens, clothing, and toys; handwashing; and using hygiene practices, as well as which of the following regimens?

mebendazole (Vermox) for all family members simultaneously

metronidazole (Flagyl) for all family members simultaneously

penicillin V potassium for 10 days for the child only

mebendazole (Vermox) for the child only

211. A preschooler is admitted to the pediatric unit with a febrile illness. The nurse is aware that acetylsalicylic acid should not be administered to a preschooler, because doing so may result in which of the following conditions?

Reye’s syndrome

renal insufficiency

Raynaud’s disease

hepatitis B

212. A child presents to the emergency department after stepping on a nail. The nurse is aware that the child may need a booster dose of tetanus if the last injection was how many year(s) ago?

213. A child recently received the diphtheria, tetanus, and pertussis (DTaP) immunization. Which of the following would represent a reaction that would be considered a contraindication to receiving the immunization again?

upper respiratory infection

emesis and diarrhea

otitis media

encephalopathy

214. A child presents to the emergency department with a fever and pallor. Upon assessment, the nurse notes a red facial rash, as well as a rash on the child’s trunk and limbs. Which of the following conditions does the nurse suspect the client has?

fifth disease

diphtheria

cytomegalovirus (CMV)

infectious mononucleosis

215. A child presents to the emergency department with a rash on the upper body and head, coryza, fever, cough, and conjunctivitis. Based upon the clinical presentation, which of the following interventions would be most important for the nurse to consider implementing first?

exclusion of the child from school for 7 to 10 days

respiratory isolation

comfort measures, including rest, fluids, and fever management

supportive care to the parents of the child

216. Which of the following statements best describes acute pain?

discomfort lasting 3 to 5 days and due to a specific cause such as surgery or injury

discomfort that comes on suddenly and lasts less than 8 hours

a sharp hurting in a specific location that comes and goes suddenly

any hurting that is not considered long-lasting by the individual experiencing it

217. A mother tells the nurse that her child has experienced pain lasting for long periods of time with the pain coming and going. The nurse would describe this pain in her assessment as which of the following kinds of pain?

acute pain

strange pain

moderate pain

chronic pain

218. Nociceptors are best described as nerve receptors specific to which of the following?

inflammation

pressure

pain

sprain

219. A general rule that nurses can use in deciding whether an intervention or procedure would hurt a child is to ask which of the following questions?

“Would this hurt an adult?” If the answer is yes, then it would hurt a child.

Ask the child: “Do you think this will hurt a lot, some, or not at all?”

Ask the mother: “Do you think this procedure or intervention will hurt your child?”

“Has this child had this procedure or intervention in the past? If so, what was the pain history?”

220. Which of the following statements best describes the term tolerance?

the ability to take a particular medication without feeling worse after taking it

being able to take a medication even if it does have adverse side effects

the need to use increasing doses of a medication over time to achieve the desired result

putting up with taking various medications even when you do not feel they are necessary

221. When children experience pain it is:

character building

likely to interrupt sleep, appetite, and play

only because they are not focusing on something else

going to be of lesser duration and intensity than adults experience

222. The nurse working with infants knows that infants have a unique response to pain, which is to exhibit which of the following behaviors?

yawn several times over a couple of minutes

claw at the air with their hands

utter piercing cries and arch the back in an extreme way

withdraw, cry, and have a furrowed brow and a taut tongue

223. When the preschooler is sitting still or lying still for a long time and not engaging in physical activity, the nurse will most suspect and assess for which of the following conditions?

pain

dizziness

nausea

boredom

224. The nurse is preparing to give the school-aged child an injection. If there are no contraindications, the nurse’s best course of action is to do which of the following?

Ask a parent which site is preferred.

Offer the child a choice of sites.

Select a site without consulting anyone.

Ask the outgoing shift nurse what site would be best.

225. The nurse knows that when hospitalized adolescents underrate their pain and hide it, the adolescent is most likely denying pain to:

show strength or get out of the hospital earlier

get the nursing staff in trouble with the doctor

keep from getting cut off from phoning friends

avoid having to take pain medication of any type

226. The PQRST pain assessment measures:

past quick responses to stimulation of tough pain

presence, quality, radiation or location, severity, and timing of pain

the type of pain: pinlike, quiet or dull, radiant, stinging, and tolerable

client’s quality rating of strength and tolerability of pain level

227. The Wong-Baker method for assessing pain in children uses:

a system of six different colors for ranking pain from red hot to none in cool shades of blue on a rating scale of 5 to 0

six different faces ranging from smiling to very distressed with downturned mouth and severe frown on a rating scale of 0 to 5

pictures of children in various activities from playing happily to crying over a scraped knee

a play kit with dolls who show various expressions including three who have expressions of mild, moderate, and severe pain

228. The Oucher pain assessment tool is for use with children of ages:

1 to 2 years

12 to 14 years

3 to 12 years

15 to 18 years

229. The Oucher pain assessment tool is a scale with faces ranking pain from:

0 to 100

1 to 10

1 to 5

0 to 20

230. The nurse has asked a child to rate her pain on a scale of 0 to 10. The child ranks the pain at a 5. The nurse will chart this in which of the following ways?

ranks pain at a 5

states pain is at a 5 on a 10-point scale

admits to a moderate level of pain

midpoint of scale in terms of pain

231. Which of the following goals is most associated with good pain management?

Maximize function (eating, walking, and participating in the recovery process).

Minimize the amount of pain medication required by smaller dosing.

Make the child feel good at least 90% of the time.

Reduce requests for pain medication to one per shift by time of discharge.

232. A child continues to complain of pain after being given all the medication that is safe to administer. Which of the following actions should the nurse take?

Provide cutaneous stimulation such as massage, rubbing, holding, and applying heat or cold as indicated.

Distract the child as much as possible, and give the next pain medication a little early.

Ask the mother to tell the child that she can’t have any more medication.

Tell the child she will have to wait for more pain medication, and let the child know when she can have more.

233. The nurse has given a child an opioid for pain relief. Which of the following signs or symptoms would the nurse most likely find on assessment if the child has side effects from the opioid?

dizziness, drowsiness, and lethargy

irregular pulse and stomach cramps

rapid breathing and rapid pulse

nausea, vomiting, and itching

234. The physician orders an adult dose of morphine for a 14-year-old who weighs 55 kilograms. The nurse administering opioid pain medication to children is aware when checking the physician’s orders that it is safe to give an adult dose to children who weigh more than how many kilograms?

235. A pediatric client who has a terminal illness and is in a lot of pain is given an opioid analgesic, which is titrated. The nurse receiving report on this client hears the word titrated and knows this means:

to pass through a special fine-mesh micron filter to remove any impurities

to deliver small, frequent doses of the medication prescribed to the child until the desired effect (pain management) is observed

to give a bolus and follow up the bolus with several small doses if there is breakthrough pain

to mix with a special titration solution, which will better dissolve the opiate because this medication is difficult to dissolve fully

236. Opioids have a unique characteristic in that they have:

no addicting qualities

no ceiling dose

only beneficial side effects

a preconscious effect

237. An alternative to prn dosing of medication for children is reverse prn medication delivery, which is best explained by which one of the following statements?

The nurse gives the pain medication at regular intervals whether it is needed or not.

The nurse decides when the child needs the medication and has a flexible schedule and a given amount to be used during a specific interval.

The nurse assesses the client’s pain at the prescribed time when medication is permitted to be given and gives the medication if pain is present.

Pain medication is given when the child is pain free, and this is accomplished by giving medication before pain breaks through.

238. The pediatrician orders ibuprofen for a child. When you administered this medication, you will give it with which of the following?

sips of water

food or milk

6 ounces of water

prune or apple juice

239. The nurse is working with a child who is going to have a bone marrow aspirate. The physician orders TAC (tetracaine, adrenaline, and cocaine). Which of the following is the route of administration?

nasal inhalation

subcutaneous

application to the skin, covered with a dressing prior to the procedure

IV using a very slow drip over approximately 4 hours prior to procedure

240. You are assessing a school-aged child who tells you “it hurts around my belly button.” In reviewing the chart you find this child has been sleeping at night without waking and has experienced some constipation. You base your actions on which of the following suspicions?

This pain is probably just reoccurring constipation possibly due to dehydration.

These symptoms fit those associated with recurrent abdominal pain syndrome (RAPS).

Nonmalignant abdominal tumors often present with these symptoms.

Appendicitis can present with referred pain into the umbilical area.

241. Topical medication absorption in infants and children is:

greater due to thinner skin and greater surface-to-weight ratio

slower due to less vascularity in infants and children

about the same as in older children

not typically used in infants due to poor tolerance

242. The nurse notices that the infant is wearing a plastic-coated diaper. If a topical medication were to be prescribed and it were to go on the stomach or buttocks, the nurse would teach the caregivers to:

put the diaper on as usual

apply an ice pack for 5 minutes to the outside of the diaper

avoid covering the area of the topical medication with the diaper

avoid the use of clothing on top of the diaper

243. The nurse is preparing to give an injection to a preschooler. The nurse has selected the deltoid muscle. What is the maximum amount of solution that the nurse can give in the deltoid of a preschooler?

244. What is the maximum amount of solution a nurse can give an adolescent in the deltoid muscle?

245. The nurse is preparing to give an intramuscular injection to an infant with a small muscle mass. The best angle for giving the injection will most probably be which of the following?

246. You are the nurse preparing to give an injection to a child who is combative. Which of the following approaches would be best on your part?

247. You are administering a suppository to a 2-year-old child. You would lubricate the suppository and insert it using which of the following gloved fingers?

248. A nurse has been administering an analgesic via the intravenous route for a hospitalized child. The physician has changed the route of administration to by mouth and has increased the dosage of the medication. Which of the following explanations would be the best response for identifying why the dosage was increased?

249. A nurse is attempting to administer medications to a preschool-aged child. Which of the following statements made by the nurse would be most appropriate given the child’s developmental stage?

250. A nurse is calculating the appropriate pediatric dose based upon the body surface area (BSA) of the child and the typical adult dosage. The recommended adult dose is 30 milligrams (mg) intravenous every 6 hours. The child’s BSA is 0.6 m2. Which of the following dosages is accurate?

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