nclex 100 questions and answers with rationale (pediatric nursing)

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(1)
(2)
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1.

A child with leukemia is being

discharged after beginning

chemotherapy. Which of the following

instructions will the nurse include when

teaching the parents of this child?

a) provide a diet low in protein and high carbohydrates

b) b) avoid fresh vegetables that are not cooked or peeled

c) c) notify the doctor if the child's temperature exceeds 101 F (39C)

d) d) increase the use of humidifiers throughout the house

(4)

Answer B

fresh fruits and vegetables harbor

microorganisms, which can cause infections in immune-compromised child. Fruits and vegetables should either be peeled or cooked. The physician should be notified of a temperature above 100F, a diet low in protein is not indicated, and humidifiers harbor fungi in the water containers.

(5)

2. A client with hemophilia has a very

swollen knee after falling from bicycle

riding. Which of the following is the first

nursing action?

a) initiate an IV site to begin administration of cryoprecipitate

b) type and cross-match for possible transfusion

c) monitor the client's vital signs for the first 5 minutes

d) apply ice pack and compression dressings to the knee

(6)

Answer D

rest, ice, compression, and elevation (RICE) are the immediate treatments to reduce the swelling and bleeding into the joint. These are the priority actions for bleeding into the joint of a client with hemophilia.

(7)

3. A client and her husband are positive

for the sickle cell trait. The client asks the

nurse about chances of her children having

sickle cell disease. Which of the following is

appropriate response by the nurse?

a) one of her children will have sickle cell disease b) only the male children will be affected

c) each pregnancy carries a 25% chance of the child being affected

d) if she had four children, one of them would have the disease

(8)

Answer C

In autosomal recessive traits, both parents are carriers. There is a 25% chance with each pregnancy that a child will have the disease.

(9)

4. An 8 year old child has been diagnosed

to have iron deficiency anemia. Which of

the following activities is most appropriate

for the child to decrease oxygen demands

on the body?

a) Dancing

b) playing video games c) reading a book

(10)

Answer C

reading a book is restful activity and can keep the child from becoming bored. Choices a, b, and d require too much energy for a child with

anemia and can increase oxygen demands on the body.

(11)

5. A 16 month old child diagnosed with

Kawasaki Disease (KD) is very irritable,

refuses to eat, and exhibits peeling skin

on the hands and feet. Which of the

following would the nurse interpret as

the priority?

a) applying lotions to the hands and feet b) offering foods the toddler likes

c) placing the toddler in a quiet environment d) encouraging the parents to get some rest

(12)

Answer C

One of the characteristics of children with KD is irritability. They are often inconsolable.

Placing the child in a quiet environment may

help quiet the child and reduce the workload of the heart. The child's irritability takes priority over peeling of the skin.

(13)

6.Which of the following should the nurse

do first after noting that a child with

Hirschsprung disease has a fever and

watery explosive diarrhea?

a. Notify the physician immediately

b. Administer antidiarrheal medications c. Monitor child ever 30 minutes

d. Nothing, this is characteristic of Hirschsprung disease

(14)

Answer A.

For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a

life-threatening situation. Therefore, the physician

should be notified immediately. Generally, because of the intestinal obstruction and inadequate

propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung disease. The child is acutely ill and requires intervention, with monitoring more frequently than every 30 minutes.

Hirschsprung disease typically presents with chronic constipation.

(15)

7. A newborn’s failure to pass meconium

within the first 24 hours after birth

may indicate which of the following?

a. Hirschsprung disease b. Celiac disease

c. Intussusception

(16)

Answer A

Failure to pass meconium within the first 24 hours after birth may be an indication of Hirschsprung

disease, a congenital anomaly resulting in mechanical obstruction due to inadequate motility in an

intestinal segment. Failure to pass meconium is not associated with celiac disease, intussusception, or abdominal wall defect.

(17)

8. When assessing a child for possible

intussusception, which of the following

would be least likely to provide valuable

information?

a. Stool inspection b. Pain pattern

c. Family history

(18)

Answer C.

Because intussusception is not believed to have a familial tendency, obtaining a family history would provide the least amount of information. Stool

inspection, pain pattern, and abdominal palpation would reveal possible indicators of intussusception. Current, jelly-like stools containing blood and

mucus are an indication of intussusception. Acute, episodic abdominal pain is characteristics of

intussusception. A sausage-shaped mass may be palpated in the right upper quadrant.

(19)

9. After teaching the parents of a

preschooler who has undergone T and A

(Tonsillectomy and Adenoidectomy) about

appropriate foods to give the child after

discharge, which of the following, if stated

by the parents as appropriate foods, indicates

successful teaching?

a) meatloaf and uncooked carrots b) pork and noodle casserole

c) cream of chicken soup and orange sherbet

(20)

Answer C

for the first few days after a T and A

(Tonsillectomy and Adenoidectomy), liquids and

soft foods are best tolerated by the child while the throat is sore. Avoid hard and scratchy foods until throat is healed.

(21)

10. A child diagnosed with tetralogy of

fallot becomes upset, crying and thrashing

around when a blood specimen is obtained.

The child's color becomes blue and

respiratory rate increases to 44 bpm.

Which of the following actions would the

nurse do first?

a) obtain an order for sedation for the child

b) assess for an irregular heart rate and rhythm

c) explain to the child that it will only hurt for a short time

d) place the child in knee-to-chest position

(22)

Answer D

the child is experiencing a "tet spell" or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with

tetralogy of fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases

vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need sedative. Once the child is in this position, the nurse may assess for an irregular heart rate and rhythm. Explaining to the child that it will only hurt for a short time does nothing to alleviate hypoxia.

(23)

11. Which of the following would the nurse

perform to help alleviate a child's joint pain

associated with rheumatic fever?

a) maintaining the joints in an extended position b) applying gentle traction to the child's

affected joints

c) supporting proper alignment with rolled pillows d) using a bed cradle to avoid the weight of bed

(24)

Answer D

for a child with arthritis associated with rheumatic

fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of the bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be

maintained in good alignment, not positioned in extension, to ensure that they remain functional. Applying gentle traction to the joints is not

recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good

alignment and changing the client's position are

recommended, but these measures are not likely to relieve pain.

(25)

12. Which of the following health teachings

regarding sickle cell crisis should be

included by the nurse?

a) it results from altered metabolism and dehydration

b) tissue hypoxia and vascular occlusion cause the primary problems

c) increased bilirubin levels will cause hypertension

d) there are decreased clotting factors with an increase in white blood cells

(26)

Answer B

tissue hypoxia occurs as a result of the

decreased oxygen-carrying capacity of the red blood cells. The sickled cells begin to clump

(27)

13. Which of the following should the

nurse expect to note as a frequent

complication for a child with congenital

heart disease?

a. Susceptibility to respiratory infection

b. Bleeding tendencies

c. Frequent vomiting and diarrhea d. Seizure disorder

(28)

Answer A

Children with congenital heart disease are more prone to respiratory infections.

Bleeding tendencies, frequent vomiting, and diarrhea and seizure disorders are not

(29)

14. While assessing a newborn with cleft lip,

the nurse would be alert that which of the

following will most likely be compromised?

a. Sucking ability

b. Respiratory status c. Locomotion

(30)

Answer A.

Because of the defect, the child will be unable to

from the mouth adequately around nipple, thereby requiring special devices to allow for feeding and sucking gratification. Respiratory status may be

compromised if the child is fed improperly or during postoperative period, Locomotion would be a

problem for the older infant because of the use of restraints. GI functioning is not compromised in the child with a cleft lip.

(31)

15. When providing postoperative care for the

child with a cleft palate, the nurse should

position the child in which of the following

positions?

a. Supine b. Prone

c. In an infant seat d. On the side

(32)

Answer B.

Postoperatively children with cleft palate should be placed on their abdomens to facilitate drainage. If the child is placed in the supine position, he or she may aspirate. Using an infant seat does not facilitate drainage. Side-lying does not facilitate drainage as well as the prone position

(33)

16. Which of the following nursing

diagnoses would be inappropriate for

the infant with gastroesophageal reflux

(GER)?

a. Fluid volume deficit b. Risk for aspiration

c. Altered nutrition: less than body requirements

(34)

Answer D

GER is the backflow of gastric contents into the esophagus resulting from relaxation or

incompetence of the lower esophageal (cardiac) sphincter. No alteration in the oral mucous

membranes occurs with this disorder. Fluid

volume deficit, risk for aspiration, and altered nutrition are appropriate nursing diagnoses

(35)

17. Which of the following parameters would

the nurse monitor to evaluate the

effectiveness of thickened feedings for an

infant with gastroesophageal reflux (GER)?

a. Vomiting b. Stools c. Uterine d. Weight

(36)

Answer A

Thickened feedings are used with GER to stop

the vomiting. Therefore, the nurse would monitor the child’s vomiting to evaluate the

effectiveness of using the thickened feedings. No relationship exists between feedings and characteristics of stools and uterine. If

feedings are ineffective, this should be noted before there is any change in the child’s weight.

(37)

18. An adolescent with a history of surgical

repair for undescended testes comes to the

clinic for a sport physical. Anticipatory

guidance for the parents and adolescent

would focus on which of the following as

most important?

a) the adolescent sterility

b) the adolescent future plans

c) technique for monthly testicular self-examinations

(38)

Answer C

Because the incidence of testicular cancer is

increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination monthly.

(39)

19. When developing the teaching plan for

the parents of a 12 month old infant with

hypospadias and chordee repair, which of

the following would the nurse expect to

include as most important?

a) assisting the child to become familiar with his dressing so he will leave them alone

b) encouraging the child to ambulate as soon as possible by using a favorite push toy

c) forcing fluids to at least 250 ml/day by offering his favorite juices

d) preventing the child from disrupting the catheter by using soft restraints

(40)

Answer D

The most important consideration for a

successful outcome of this surgery is maintenance of the catheters or stents. A 12 month old likes to explore his environment. Applying soft restraints will prevent the child from disrupting the

(41)

20. A school-aged client admitted to the

hospital because of decreased urine output

and periorbital edema is diagnosed with

glomerulonephritis. Which of the following

interventions would receive the highest

priority?

a) assessing vital signs every four hours b) monitoring intake and output every 12

hours

c) obtaining daily weight measurements d) obtaining serum electrolyte levels daily

(42)

Answer C

The child will glomerulonephritis experiences a problem with renal function that ultimately

affects fluid balance. Because weight is the best indicator of fluid balance, obtaining daily weights would be the highest priority.

(43)

21. When assessing a 12 year old child with

Wilm's tumor, the nurse should keep in mind

that it most important to avoid which of the

following?

a) measuring the child's chest circumference

b) palpating the child's abdomen

c) placing the child in an uprignt position d) measuring the child's occipitofrontal

(44)

Answer B

The abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. The child with Wilm's tumor should always be handled gently and carefully

(45)

22. When positioning the neonate with an

unrepaired myelomeningocele, which of the

following positions would be most

appropriate?

a) supine the hip at 90 degree flexion b) right side-lying position with knees

flexed

c) prone with hips in abduction

d) semi-fowler's position with chest and abdomen elevated

(46)

Answer C

Before surgery, the infant is kept in the prone

position to decrease tension on the sac. This allows for optimal positioning of the hips, knees, and feet because orthopedic problems are common. The

supine position is unacceptable because it causes pressure on the defect

(47)

23. A 4 year old with hydrocephalus is

scheduled to have a ventroperitoneal shunt in

the right side of the head. When developing

the child's postoperative plan of care, the

nurse would expect to place the preschooler in

which of the following positions immediately

after surgery?

a) on the right side, with the foot of the bed elevated

b) on the left side, with the head of the bed elevated

c) prone with the head of the bed elevated d) supine, with the head of the bed flat

(48)

Answer D

For at least the first 24 hours after insertion

of a ventriculoperitoneal shunt, the child is

positioned supine with the head of the bed flat to prevent too rapid decrease in CSF pressure. A rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the

operative site is to be avoided because it places pressure on the shunt valve, possibly blocking desired drainage of CSF. With continued

increased ICP, the child would be positioned with the head of bed elevated to allow gravity to aid drainage.

(49)

24. After talking with the parents of a child

with Down Syndrome, which of the following

would the nurse identify as an appropriate

goal of care of the child?

a) encouraging self-care skills in the child

b) teaching the child something new each day c) encouraging more lenient behavior limits

for the child

(50)

Answer A

The goal in working with mentally challenged children

is to train them to be as independent as possible,

focusing on the developmental skills. The child may not be capable of learning something new every day but

needs to repeat what has been taught previously.

Rather than encouraging more lenient behavior limits, the parents need to be strict and consistent when

setting limits for the child. Most children with Down syndrome are unable to achieve age-appropriate social skills due to their mental retardation. Rather, they

(51)

25. When teaching an adolescent with a

seizure disorder who is receiving Valproic

acid (Depakene), which of the following

would the nurse instruct the client to report

the health care provider?

a) three episodes of diarrhea b) loss of appetite

c) jaundice

(52)

Answer C

A toxic effect of valproic acid (Depakene) is liver

toxicity, which may manifest with jaundice and

abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as

(53)

26. A hospitalized preschooler with meningitis

who is to be discharged becomes angry when

the discharge is delayed. Which of the

following play activities would be most

appropriate at this time?

a) reading the child a story b) painting with water colors c) pounding on a pegboard

(54)

Answer C

The child is angry and needs a positive outlet for

expression of feelings. An emotionally tense child with pent-up hostilities needs a physical activity

that will release energy and frustration. Pounding on a pegboard offers the opportunity.

Listening to a story does not allow child to express emotions. It also places the child in a passive role and does not allow the child to deal with feelings in a healthy and positive way. Activities such as

paintings and stacking a tower of blocks require

concentration and fine movements, which could add to frustration.

(55)

27. The parents of a child tell the nurse they feel guilty because their child almost drowned. Which of the following remarks by the nurse would be most appropriate?

a) I can understand why you feel guilty, but these things happen

b) tell me a bit more about your feelings of guilt

c) you should not have taken your eyes off your child

d) you really shouldn't fell guilty; you're lucky because your child will be alright

(56)

Answer B

Guilt is a common parental response. The

parents need to be allowed to express their feelings openly in a nonthreatening,

(57)

28. The nurse teaches the parents of an

infant with developmental dysplasia of the

hip how to handle their child in a Pavlik

harness. Which of the following

interventions would be most appropriate?

a) fitting the diaper under the straps

b) leaving the harness off while the infant sleeps c) checking for the skin redness under straps

every other day

d) putting powder on the skin under the straps every day

(58)

Answer A

The Pavlik harness is worn over a diaper. Knee socks are also

worn to prevent the straps and foot and leg pieces from

rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be

inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided

because they can cake and irritate the skin. (Hip dysplasia is a condition in which the head of the femur is improperly rested in the acetabulum, or hip socket of the pelvis. The

characteristic manifestations are as follows: asymmetry of the gluteal and thigh folds; limited hip abduction in the affected hip; apparent shortening of the femur on the affected side (Galeazzi sign and Allis sign); weight bearing causes titling of the pelvis downward on the unaffected side (Trendelenberg sign); Ortolani click (in infant under 4 weeks of age).

(59)

29. When assessing the development of a 15

month old child with cerebral palsy, which of the

following milestones would the nurse expect a

toddler of this age to have achieved?

a) walking up steps b) using a spoon c) copying a circle

(60)

Answer D

Answer D

Delay in achieving developmental milestones is a

Delay in achieving developmental milestones is a

characteristic of children with cerebral palsy. A 15

characteristic of children with cerebral palsy. A 15

month old child can put a block in a cup. Walking up

month old child can put a block in a cup. Walking up

steps typically is accomplished at 18 to 24 months.

steps typically is accomplished at 18 to 24 months.

A child usually is able to use a spoon at 18 months.

A child usually is able to use a spoon at 18 months.

The ability to copy a circle is achieved at

The ability to copy a circle is achieved at

approximately 3 to 4 years of age.

(61)

30. The nurse teaches the mother of a young

child with Duchenne's muscular dystrophy

about the disease and its management. Which

of the following statements by the mother

indicates successful teaching?

a) my son will probably be unable to walk

independently by the time he is 9 to 11 years old b) muscle relaxants are effective for some children;

I hope they can help my son

c) when my son is a little bit older, he can have surgery to improve his ability to walk

d) I need to help my son be as active as possible to prevent progression of the disease

(62)

Answer A

Muscular dystrophy is an X-linked recessive disorder.

The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers. It is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9-11 years. There is no effective treatment for the disease. A

characteristic manifestation is Gower's sign -- the child walks the hands up the legs in an attempt to rise from sitting to standing position.

(63)

31. Which of the following foods would

the nurse encourage the mother to offer

to her child with iron-deficiency anemia?

a) rice cereal, whole milk, and yellow vegetables b) potato, peas, and chicken

c) macaroni, cheese and ham

(64)

Answer B

potato, peas, chicken, green vegetables, and

rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources.

(65)

32. Because of the risks associated with

administration of factor VIII

concentrate, the nurse would report which

of the following?

a) yellowing of the skin b) constipation

c) abdominal distention

(66)

Answer A

Because factor VIII concentrate is derived

from large pools of human plasma, the risk of hepatitis is always present.

(67)

33. When teaching the mother of an infant

who has undergone surgical repair of a cleft

lip how to care for the suture line, the

nurse demonstrates how to remove formula

and drainage. Which of the following

solutions would the nurse use?

a) mouthwash

b) providone - iodine (betadine) solution c) a mild antiseptic solution

(68)

Answer D

half-strength hydrogen peroxide is recommended for cleansing the suture line after cleft lip repair. The bubbling action of the hydrogen peroxide is

effective for removing debris. Normal saline also may be used. Mouthwashes frequently contain alcohol

which can be irritating. Povidone-iodine solution is not used because iodine contained in the solution can be absorbed through the skin, leading to toxicity. A mild antiseptic solution has some antibacterial properties but is ineffective in removing suture-line debris.

(69)

34. Which of the following nursing diagnosis

would the nurse identify as a priority for

the infant with tracheoesophageal fistula

(TEF)?

a) impaired parenting related to newborn's illness

b) risk of injury related to increased potential for aspiration

c) ineffective nutrition: less than body

requirements, related to poor sucking ability d) ineffective breathing pattern related to a

(70)

Answer B

because the blind pouch associated with

TEF fills quickly with fluids, the child is at risk for aspiration. Children with TEF usually develop aspiration pneumonia.

(71)

35. When the infant returns to the unit

after imperforate anus repair, the nurse

places the infant in which of the following

position?

a) on the abdomen, with legs pulled up under the body

b) on the back, with legs extended straight out

c) lying on the side with hips elevated

(72)

Answer C

after surgical repair for an imperforate anus, the infant should be positioned either supine with the legs suspended at 90-degree angle or on either side with the hips elevated to prevent pressure on the perineum. A neonate who is placed on the abdomen pulls the legs up under the body, which puts tension on the perineum, as does positioning the neonate

(73)

36. A child presents to the emergency

room with the history of ingesting a large

amount of acetaminophen. For which of

the following would the nurse assess?

a) hypertension

b) frequent urination

c) Right upper quadrant pain d) headache

(74)

Answer C

after ingesting a large amount of acetaminohen,

the child would complain of right upper quadrant pain due to hepatic damage from glutathione

combining with the metabolite of acetaminophen being broken down.

(75)

37. Which of the following statements by

the mother of an 18 month old would

indicate to the nurse that the child needs

laboratory testing for lead levels?

a) my child does not always wash after playing outside

b) my child drinks 2 cups of milk everyday

c) my child has more temper tantrums than other kids

d) my child is smaller than other kids of the same age

(76)

Answer A

eating with dirty hands, especially after playing

outside, can lead to lead poisoning because lead is often present in soil surrounding homes. When

blood levels of lead reaches 15-19 mg/dL.., an investigation of the child's environment will be initiated. Oral chelation therapy is started when blood lead levels reached 45 mg/dL. When they reach 70 mg/dL, the child usually is hospitalized for intravenous chelation therapy.

(77)

38. Which of the following statements is

LEAST accurate concerning urinary tract

infections (UTI) in children?

A)A negative urinalysis rules out UTI in children < 2 years of age.        

B)B) Children with multiple UTIs should be evaluated for abuse. 

C) Infants younger than 3 months of age with a UTI should be admitted for intravenous antibiotics.

D) Neonatal boys are more prone to UTIs than girls. E) Well appearing children > 3 months old with

(78)

Answer A 

A negative urinalysis rules out UTI in children < 2 years of age. In children younger than 2-years-old, a negative urinalysis

does not rule out a urinary tract infection.  Up to 50% of

children with UTIs can have a false negative urinalysis. Nitrite and leukocyte esterase presence in urine dipstick have the

highest combined sensitivity for UTI. In addition, if both are positive, the false positive rate is less than 4%. Most consider young girls to be at the highest risk for UTI. This is in fact true except for the neonatal period, when neonatal boys

actually have a higher risk than girls. Children with UTIs are managed differently based on the age of the child. The very young are treated conservatively, and those under 3 months of age are generally admitted to the hospital for IV antibiotics. Pyelonephritis used to be commonly managed as an inpatient, but in well appearing children, this infection can be treated as an outpatient with oral antibiotics.

(79)

39. A 6-year-old boy is returned to his

room following a tonsillectomy. He remains

sleepy from the anesthesia but is easily

awakened. The nurse should place the child

in which of the following positions?

a. Sims’.

b. Side-lying. c. Supine.

(80)

Answer B.

Side-lying — CORRECT: most effective to facilitate drainage of secretions from the mouth and pharynx; reduces possibility of airway obstruction.

Supine — increased risk for aspiration, would not facilitate drainage of oral secretions

Prone — risk for airway obstruction and aspiration, unable to observe the child for signs of bleeding such as increased swallowing

Sims’ — on side with top knee flexed and thigh drawn up to chest and lower knee less sharply flexed: used for vaginal or rectal examination

(81)

40. Which of the following statements

indicate that the adolescent is having an

early sign of anorexia nervosa?

a) I have my menses every month b) I go out to eat with my friends

c) I run three times a day for a total of 5 hours per day

d) I try to maintain my weight around 115 lbs. for my height of 5 feet

(82)

Answer C

excessive exercise, consumption of very small

amounts of food and food rituals, amenorrhea, and excessive weight loss or weight is below normal, lanugo, dry skin, bradycardia, are all signs of anorexia nervosa.

(83)

41. Which of the following signs and

symptoms would observe in a child diagnosed

of laryngotracheobronchitis?

a) predominant stridor on inspiration b) predominant expiratory wheeze c) high fever

(84)

Answer A

Because croup cause upper airway obstruction,

(85)

42. A child discharged with slow

cerebrospinal fluid (CSF) leak 3 days after

a head injury was sustained. What will the

nurse include in the discharge plans?

a) avoid use of nonsteroidal anti-inflammatory drugs

b) turn from side to side only c) maintain complete bed rest

(86)

Answer C

most CSF leaks resolve spontaneously. The child

should be maintained on bed rest until CSF leak

stops. NSAID's may be used. The child may assume position of comfort. There are no dietary

(87)

43. What would cause the closure of the

Foramen ovale after the baby had been

delivered?

a. Decreased blood flow

b. Shifting of pressures from right side to the left side of the heart

c. Increased PO2

(88)

Answer B

During feto-placental circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is established, the

pressure will shift from the R to the L side, and will facilitate the closure of Foramen Ovale.

(Note: that is why you should position the NB in R side lying position to increase pressure in the L side of the heart.)

(89)

44. When assessing a newborn for

developmental dysplasia of the hip, the

nurse would expect to assess which of the

following?

a. Symmetrical gluteal folds b. Trendelemburg sign

c. Ortolani’s sign

(90)

Answer C

Ortolani’s sign is the abnormal clicking sound when the hips are abducted. The sound is produced when the femoral head enters the acetabulum. Letter A is wrong because its should be “asymmetrical gluteal fold”. Letter B and C are not applicable for newborns because they are seen in older children.

(91)

45. A newborn’s failure to pass meconium

within 24 hours after birth may indicate

which of the following?

a. Aganglionic Mega colon

b. Celiac disease

c. Intussusception

(92)

Answer A

Failure to pass meconium of Newborn during the first 24 hours of life may indicate Hirschsprung disease or Congenital Aganglionic Megacolon, an anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. B, C, and D are not associated in the failure to pass meconium of the newborn.

(93)

46. A 13-year-old girl appears at your office at 5:05 PM for a 3:30 PM appointment scheduled for the day before. Her mother tells you that the girl has been limping for a couple of weeks and has much knee pain. She has been afebrile, does not recall being hit in the knee or leg, and has not had any illnesses recently. She has difficulty

"moving her leg inward." Given the late hour and that the workup will be done in the emergency department, you

impress the pediatric emergency department staff by telling them that the most likely diagnosis is one of the following:

A. She twisted the leg trying to be on time for the appointment yesterday

B. Septic arthritis of the hip C. Septic arthritis of the knee D. Aseptic necrosis of the hip

(94)

Answer E

Slipped capital femoral epiphysis typically presents in girls aged 11 to 13 years and boys aged 13 to 15 years who are obese. It is most common in blacks. Although a slipped capital femoral epiphysis can produce pain localized to the groin area, it often presents as knee pain, especially on the board

examination. Internal rotation is difficult. If you were to suggest an x-ray, anteroposterior and frog lateral x-rays of the pelvis would be the way to go.

(95)

47. You are in your office late one cold winter evening, seeing a pair of siblings who have a cold and cough.

The mother and paternal grandmother are there. The grandmother notes that the best way to prevent the spread of colds is by wearing a wool hat at all times. What should you say?

A. Agree and pull out a cartoon with the

trademarked hats promoting your practice

B. Wearing a face mask and eye shields is the best method

C. Limiting exposure to other children to once weekly would help

D.Washing hands and all toys frequently would be fine

E. Isolating all children with colds is the best method

(96)

Answer D

Hand washing and cleaning toys that are shared by children are the most effective means of preventing the spread of colds and upper respiratory tract

infections during winter. If wearing a hat during cold weather prevented the spread of colds, then children in warm climates, would never get sick.

(97)

48. A 12-year-old boy who is at the 90th percentile for

weight complains of slight pain in the right thigh and knee for about a month. His complains are made worse by

physical activity and he has a mild limp. He has no history of recent infections or trauma. Physical examination

reveals a slight decrease in internal rotation of the right hip. There is mild right-sided metaphyseal osteopenia on radiograph.

Of the following, which would be the MOST likely diagnosis in this boy?

A) Transient synovitis B) Septic arthritis C) Osteomyelitis

D) Slipped capital femoral epiphysis E) Legg-Calve-Perthes disease

(98)

ANSWER  D

Slipped Capital Femoral Epiphysis occurs as the result of acute or repetitive microtrauma to a probable abnormal femoral growth plate. It is unilateral in 40%-80% of

cases and occurs during or just prior to the adolescent growth spurt (age 10 to 13 years). It is more commonly seen in boys and in very obese and/or very tall

adolescents. Onset prior to age 10 years may indicate an underlying endocrine problem such as hypothyroidism. The clinical presentation is a limp with pain related to the hip joint. There may be some shortening of the involved limb, and internal rotation is limited. Biplanar radiographs or computed tomographic scans will

establish the diagnosis. Mild demineralization of the metaphysis on the involved side is often associated.

(99)

49. A male infant weighing 3 kg is born via

spontaneous vaginal delivery at 37 weeks’

gestation. His Apgar score is 6/9 at 1 and 5

minutes. The patient is in no apparent distress.

Physical examination reveals no anus. What is

the most appropriate initial step in this

patient’s management?

(A)Colostomy

(B) Continued observation for 24 hours (C) Intubation and mechanical ventilation (D) Magnetic resonance imaging (MRI) of

the abdomen and pelvis

(100)

Answer B

Continued observation for 24 hours. The patient should be observed for delayed passage of meconium, as this can be normal up to 48 hours of life. If delayed beyond this period, meconium ileus, meconium plug, imperforate anus, or Hirschsprung’s disease should be considered. Evaluation of imperforate anus should include inspection for drainage of meconium through a fistula to the perineum or the urinary tract because this significantly alters treatment.1 Specifically, fistulae

occur with low termination of the colon/rectum, which can be managed definitively with anorectoplasty. Absence of a fistula significantly

increases the likelihood of a “high defect” imperforate anus, which can be managed with colostomy and subsequent contrast imaging of the distal colon/rectum, followed by definitive repair at a few months of age. Some surgeons obtain a cross-table lateral abdominal radiograph (not MRI) to determine where the terminal colon/rectum

lies in relation to the perineum, but this approach is unnecessary and is not widely practiced. Ultrasonography and radiography are required to rule out VACTERL association, but there is no need for MRI.

(101)

50. A previously healthy 5-year-old girl presents to the ED with her parents with a temperature of 100.8°F (38.2°C) and a 2-day history of decreased appetite and persistent vague abdominal pain

withtenderness in the mid-abdomen and right lower quadrant. Her

parents report that she has had no appetite and felt nauseous but has not vomited. Laboratory results are unremarkable except for a white blood cell count of 16,000 cells/mL (normal, 4500– 11,000 cells/mL). Ultrasound of the abdomen and pelvis is inconclusive, and the patient is admitted to the hospital for observation. Eighteen hours into her hospital stay, she passes copious amounts of bloody stool. She remains hemodynamically stable with normal vital signs and no change in her

abdominal pain. What is this patient’s most likely diagnosis? (A)Appendicitis

(B) Colonic arteriovenous malformation (C) Colonic diverticulitis

(D) Gastric stress ulcer (E) Meckel’s diverticulitis

(102)

Answer (E)

Meckel’s diverticulitis. Hemorrhage is the most

common complication of Meckel’s diverticulitis in

children; therefore, this condition should be considered in any child with abdominal pain of unclear

etiology associated with GI hemorrhage. Intestinal obstruction is another possible diagnosis but is more

common in adults. The diagnosis of Meckel’s diverticulitis can be confirmed by 99mTc-pertechnetate

scan, which detects heterotopic gastric mucosa or pancreatic tissue within the diverticulum. Meckel’s diverticula are usually completely asymptomatic, but resection is necessary when complications develop. Colonic arteriovenous malformations can cause GI hemorrhage in children but are much less common than Meckel’s diverticula. Appendicitis is common in children but very rarely causes hemorrhage. Colonic diverticulitis and gastric stress ulcers are exceedingly rare in children and are unlikely in this case.

(103)

51. A nurse has just started her rounds

delivering medication. A new patient on her

rounds is a 4 year-old boy who is

non-verbal. This child does not have on any

identification. What should the nurse do?

A: Contact the provider

B: Ask the child to write their name on paper.

C: Ask a co-worker about the identification of the child.

D: Ask the father who is in the room the child’s name.

(104)

Answer D

In this case you are able to determine the name of the child by the father’s statement. You should not withhold the medication from the child following identification.

(105)

52. A nurse is caring for an infant that has

recently been diagnosed with a congenital

heart defect. Which of the following

clinical signs would most likely be present?

A: Slow pulse rate B: Weight gain

C: Decreased systolic pressure D: Irregular WBC lab values

(106)

Answer B

Weight gain is associated with CHF and congenital heart deficits.

(107)

53. A mother has recently been informed

that her child has Down’s syndrome. You will

be assigned to care for the child at shift

change. Which of the following

characteristics is not associated with Down’s

syndrome?

A: Simian crease B: Brachycephaly C: Oily skin

(108)

Answer C

(109)

54. Who among the following pediatric client

should be assessed first by the nurse?

a) the child with 2 episodes of soft stools during the shift

b) the child who had cough for the past three days, with clear nasal discharge and is irritable

c) the child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays

between the episodes

(110)

Answer C

- this indicates appendicitis. The pattern of abdominal pain in appendicitis is as follows: pain occurs for 2 to 3 hours, pain is relieved in 2 to 3 hours, the n pain recurs and persists. During the time that pain subsides, it is when rupture of appendicitis may occur unnoticed.

(111)

55. The nurse is caring for several infants who

are 2-day old. Who among these infants should be

given highest priority by the nurse?

a) a bottlefed infant who takes 1-ounce of milk every 3 to 5 hours

b) a breastfed infant who lost 0.5 ounce of his weight

c) a bottlefed infant who takes 2 to 3 ounces of milk every 2 to 4 hours

(112)

Answer A

- the client experiences poor feeding (1 ounce = 30 ml) which indicates specific problems. The infant normally looses weight during the first week of life and he/she usually gains weight on the second week.

(113)

56. Which of the following can indicate

left-sided heart failure in an infant?

A: fever

B: low appetite

C: increased respiratory rate D: crying

(114)

. Answer C.

Shortness of breath and perspiration during

(115)

57. Which of the following is NOT part

of the triad of cystic fibrosis?

A: pancreatic enzyme deficiency B: fever

C: high concentration of sweat electrolytes

(116)

Answer B.

The triad of cystic fibrosis is COPD, pancreatic

enzyme deficiency, and a high concentration of

sweat electrolytes.

(117)

58. When assessing a child with a cleft

palate, the nurse is aware that the child is at

risk for more frequent episodes of otitis

media due to which of the following?

a. Lowered resistance from malnutrition

b. Ineffective functioning of the Eustachian tubes

c. Plugging of the Eustachian tubes with food particles

d. Associated congenital defects of the middle ear.

(118)

Answer  B 

Because of the structural defect, children with cleft palate may have ineffective functioning of their

Eustachian tubes creating frequent bouts of otitis media. Most children with cleft palate remain well-nourished and maintain adequate nutrition through the use of proper feeding techniques. Food particles do not pass through the cleft and into the

Eustachian tubes. There is no association between cleft palate and congenial ear deformities.

(119)

59. Which of the following should the nurse

expect to note as a frequent complication

for a child with congenital heart disease?

a. Susceptibility to respiratory infection

b. Bleeding tendencies

c. Frequent vomiting and diarrhea d. Seizure disorder

(120)

Answer A. 

Children with congenital heart disease are more prone to respiratory infections. Bleeding tendencies,

frequent vomiting, and diarrhea and seizure disorders are not associated with congenital heart disease.

(121)

60. Which of the following should the

nurse do first after noting that a child

with Hirschsprung disease has a fever

and watery explosive diarrhea?

a. Notify the physician immediately

b. Administer antidiarrheal medications c. Monitor child ever 30 minutes

d. Nothing, this is characteristic of Hirschsprung disease

(122)

Answer  A. 

For the child with Hirschsprung disease, fever and explosive diarrhea indicate enterocolitis, a

life-threatening situation. Therefore, the physician

should be notified immediately. Generally, because of the intestinal obstruction and inadequate

propulsive intestinal movement, antidiarrheals are not used to treat Hirschsprung disease. The child is acutely ill and requires intervention, with

monitoring more frequently than every 30

minutes. Hirschsprung disease typically presents with chronic constipation.

(123)

61. While assessing a child with pyloric

stenosis, the nurse is likely to note which

of the following?

a. Regurgitation b. Steatorrhea

c. Projectile vomiting d. “Currant jelly” stools

(124)

Answer C. 

Projectile vomiting is a key symptom of pyloric

stenosis. Regurgitation is seen more commonly with GER. Steatorrhea occurs in malabsorption

disorders such as celiac disease. “Currant jelly” stools are characteristic of intussusception.

(125)

62. Which of the following suggestions

should the nurse offer the parents of a

4-year-old boy who resists going to bed

at night?

a. “Allow him to fall asleep in your room, then move him to his own bed.”

b. “Tell him that you will lock him in his room if he gets out of bed one more time.”

c. “Encourage active play at bedtime to tire him out so he will fall asleep faster.”

d. “Read him a story and allow him to play quietly in his bed until he falls asleep.”

(126)

Answer D. 

Preschoolers commonly have fears of the dark, being left alone especially at bedtime, and ghosts, which may affect the child’s going to bed at night. Quiet play and time with parents is a positive

bedtime routine that provides security and also

readies the child for sleep. The child should sleep in his own bed. Telling the child about locking him in his room will viewed by the child as a threat.

Additionally, a locked door is frightening and

potentially hazardous. Vigorous activity at bedtime stirs up the child and makes more difficult to fall asleep.

(127)

63. The nurse is caring for a 4-year old

with cerebral palsy. Which nursing

intervention will help ready the child for

rehabilitative services?

a. Patching one of the eyes to strengthen the muscles

b. Providing suckers and pinwheels to strengthen tongue movement

c. Providing musical tapes to [provide auditory training

d. Encouraging play with a video game to improve muscle coordination

(128)

Answer B

The nurse can help ready the child with cerebral palsy for speech therapy by providing activities that help the child develop tongue control.

(129)

64. The mother of a 3 year old with

esophageal reflux asks the nurse what she

can do to lessen the baby’s reflux. The nurse

should tell the mother to:

a. Feed the baby only when he is hungry

b. Burp the baby after feeding is completed c. Place the baby in supine with head elevated d. Burp the baby frequently throughout the

(130)

Answer D

Burping the baby throughout the feeding will

help prevent gastric distention that contributes to esophageal reflux

(131)

65. The mother of a child with hemophilia

asks the nurse which over the counter

medication is suitable for her child’s

discomfort.

a. Advil (Ibuprofen)

b. Tylenol (Acetaminophen)

c. Aspirin (acetylsalicytic acid) d. Naproxen (Naprosyn)

(132)

Answer B

The nurse should recommend acetaminophen for the child’s joint discomfort because it will have no effect on the bleeding time.

(133)

66. The nurse is assessing an infant with

hirschspung’s disease. The nurse can expect

the infant to:

a. Weight less than expected for height and age b. Have infrequent bowel movements

c. Exhibit clubbing of fingers and toes

(134)

Answer B

The infant with hirschsprung’s disease will have infrequent bowel movements.

(135)

66. The nurse is to administer Digoxin

Elixir to a 6-month old with a congenital

heart defect. The nurse auscultates an

apical pulse rate of 100. the nurse should:

a. Record the heart rate and call the physician b. Record the heart rate and administer the

medication

c. Administer the medication and recheck the heart rate in 30 minutes

d. Hold the medication and recheck the heart rate in 30 minutes.

(136)

Answer B

The infant’s apical heart rate is within the accepted range for administering the

(137)

67. An 18-month old is scheduled for a

cleft palate repair. The usual type of

restraints for the child with cleft palate

repair are:

a. Elbow restraints b. Full arm restraints c. Wrist restraints d. Mummy restraints

(138)

Answer A

The least restrictive restraint for infant with a cleft lip and cleft palate repair is elbow restraint.

(139)

68. An infant with tetralogy of fallot is

discharged with a prescription of lanoxin

elixir. The nurse should instruct the mother

to:

a. Administer the medication using a nipple b. Administer the medication using a

calibrated dropper in the bottle

c. Administer the medication using a plastic baby spoon

d. Administer the medication in the baby bottle with 1oz of water

(140)

Answer B

The medication should be administered using a calibrated dropper that comes with the

medication. Other choices are not necessary

because a part or all of the medication could be lost during administration.

(141)

69. The nurse is caring for an infant

following a cleft lip repair. While comforting

the infant, the nurse should avoid:

a. Holding the infant b.Offering a pacifier c. Providing a mobile

(142)

Answer B

The nurse should avoid giving the infant a

pacifier or bottle because sucking is not

permitted.

(143)

70. A 5-year old with congestive heart

failure has been receiving Digoxin (Lanoxin).

Which finding indicated that the medication

is having a desired effect.

a. Increased urinary output

b.Stabilized weight

c. Improved appetite

(144)

Answer A

Lanoxin slows and strenghtens the contractions of the heart. An increase in urinary output shows that the medication is having a desired effect.

(145)

71. A 9-year old is admitted with suspected

rheumatic fever. Which finding is suggested

of polymigratory arthritis?

a. Irregular movements of the extremities and facial grimacing

b. Painless swelling over the extensor surfaces of the joints

c. Faint areas of red demarcation ovet the back and abdomen

d. Swelling, inflammation and effusion of the joints

(146)

Answer D

The child with poly migratory arthritis will exhibit a painful and swollen joints.

(147)

72. A child with croup is placed in a cool,

high-humidity tent connected to room air.

The primary purpose of the tent is to:

a. Prevent insensible water loss

b. Provide a moist environment with oxygen at 30%

c. Prevent dehydration and reduce fever d. Liquefy secretions and relieve laryngeal

(148)

Answer D

The primary reason for placing the child with croup under a mist tent is to liquefy secretions and

(149)

73. The nurse is caring for an 8-year old

following a routine tonsillectomy. Which

finding should be reported immediately?

a. Reluctance to swallow

b. Drooling of blood-tinged saliva c. An axillary temperature of 99F d. Respiratory stridor

(150)

Answer D

Respiratory stridor is a symptom of partail airway obstruction.choice A,B and C are expected with a tonsillectomy.

(151)

74. A 2-year old is hospitalized with

suspected intussusception. Which finding is

associated with intussusception?

a. “currant jelly” stools b. Projectile vomiting c. “ribbonlike” stools

(152)

Answer A

A child with intussusception has stools that

contain blood and mucus, which are described as “currant jelly” stools.

(153)

75. A 4-year old is admitted with acute

leukemia. It will be most important to

monitor the child for:

a. Abdominal pain and anorexia b. Fatigue and bruising

c. Bleeding and pallor

(154)

Answer C

A child with leukemia has low platelet cout which contributes to spontaneous bleeding.

(155)

76. A 6-month old client with ventral

septal defect is receiving digitalis for

regulation of his heart rate. Which finding

should be reported to the doctor?

a. Blood pressure of 126/80 b. Blood glucose of 110mg/dl c. Heart rate of 60 bpm

(156)

Answer C

A heart rate of 60 in the baby should be reported immediately. The dise should be held if the heart rate is blow 100bpm. The blood glucose, blood

pressure and respirations are within the normal limits.

(157)

77. A priority nursing diagnosis for a child

being admitted from a surgery following a

tonsillectomy is:

a. Altered nutrition

b. Impaired communication c. Risk for aspiration

(158)

Answer C

The first priority should be on airway, breathing and circulation.

(159)

78. An infant is admitted to the unit

with tetralogy of fallot. The nurse would

anticipate an order for which medication.

a. Digoxin

b. Epinephrine c. Aminophyline d. Atropine

(160)

Answer A

The infant with tetralogy of fallot has four heart defects. He will be treated with Digoxin to slow and strengthen the heart. Epinephrine,

aminophyline and atropine will speed the heart rate and will not used in this client.

(161)

79. In a child with suspected coarctation

of the aorta, the nurse would expect to

find

A)Strong pedal pulses

B) Diminishing cartoid pulses C) Normal femoral pulses

(162)

Answer D:

Bounding pulses in the arms

Coarctation of the aorta, a narrowing or

constriction of the descending aorta, causes increased flow to the upper extremities

(163)

80. A client is admitted with the

diagnosis of meningitis. Which finding

would the nurse expect in assessing this

client?

A)Hyperextension of the neck with passive shoulder flexion

B) Flexion of the hip and knees with passive flexion of the neck

C) Flexion of the legs with rebound tenderness

D) Hyperflexion of the neck with rebound flexion of the legs

(164)

Answer is B:

Flexion of the hip and knees with passive flexion of the neck. A positive Brudzinski’s sign—flexion of hip and knees with passive flexion of the neck; a positive Kernig’s sign—inability to extend the knee to more than 135 degrees, without pain behind the knee, while the hip is flexed usually establishes the diagnosis of meningitis

Figure

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References

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