Deck 25: The Pediatric Patient

Question 1

If a 2-year-old child received a caution on the Denver II,this would indicate that the child

A) attempted but did not successfully complete one of the tasks.
B) failed to perform a task that has been achieved by 75%-90% of children the same age.
C) failed to perform a task that has been achieved by 100% of children the same age.
D) refused to perform one of the critical tasks.

Answer 1

failed to perform a task that has been achieved by 75%-90% of children the same age.

Question 2

General guidelines for conducting a pediatric physical examination include which of the following?

A) Allow younger children to sit on their caregiver's lap during as much of the examination as possible.
B) Always interview children of all ages in the presence of the caregiver.
C) Establish eye contact with toddlers and preschoolers early to lessen anxiety.
D) Perform procedures such as inspecting the ears while the child is sleeping, if possible, to avoid discomfort and crying.

Answer 2

Allow younger children to sit on their caregiver's lap during as much of the examination as possible.

Question 3

In an assessment of home safety using the acronym GUNS,what question should you ask related to the letter U?

A) "Are the guns kept unloaded?"
B) "Are there users of alcohol or other drugs in the home?"
C) "Do you understand the danger of keeping guns in the home?"
D) "Is there an urgency to protect yourself?"

Answer 3

"Are there users of alcohol or other drugs in the home?"

Question 4

Normal average head growth during the first year is

A) 0.5-0.75 cm per month.
B) 0.75-1 cm per month.
C) 1-1.5 cm per month.
D) 1.5-2 cm per month.

Question 5

Compared with an adult's,the eustachian tube of a child is

A) narrower and longer.
B) more horizontal, shorter, and wider.
C) shorter and more crooked.
D) wider, longer, and more vertical.

Question 6

In males,the appearance of facial hair during puberty typically occurs

A) as the first sign of sexual development.
B) 6 months after the appearance of pubic hair.
C) 6 months after the appearance of axillary hair.
D) within 1 year after testicular enlargement.

Question 7

Children in which age group typically gain 3 to 6 pounds and grow 1 to 2 inches (2.5-5 cm)per year?

A) 12-24 months
B) 2-6 years
C) 6-12 years
D) 13-18 years

Question 8

The nurse is teaching a new mother about prevention of sudden infant death syndrome (SIDS).Which of the following recommendations about sleeping should be included?

A) Place the infant on the abdomen (prone) without the head of the bed elevated while sleeping.
B) Include soft materials in the infant's sleeping environment (e.g., pillows, quilts, stuffed animals).
C) Place the infant on the back (supine) while sleeping.
D) Allow the infant to sleep in the bed with the mother.

Question 9

During the first year of life,neurons become myelinated following a certain sequence ending with which part of the body?

A) extremities
B) head
C) neck
D) trunk

Question 10

A measuring board is typically used to determine the recumbent length of a child who is under the age of

A) 1 year.
B) 2 years.
C) 3 years.
D) 4 years.

Question 11

Apgar scores are taken at 1 minute after birth and again at

A) 3 minutes.
B) 5 minutes.
C) 10 minutes.
D) 15 minutes.

Question 12

Which of the following typically occurs between 5 and 7 months of age?

A) closure of the posterior fontanel
B) development of the frontal sinus
C) eruption of the first lower central incisors
D) salivation and production of tears

Question 13

An infant weighing 6 pounds at birth should weigh at least

A) 12 pounds at 6 months.
B) 15 pounds at 12 months.
C) 18 pounds at 18 months.
D) 30 pounds at 2.5 years.

Question 14

A 2-year-old child received no delays and one caution on the Denver II.The nurse would record these results as which of the following?

A) Normal
B) The child should be retested in 1 to 2 weeks.
C) The child should be retested in 1 month.
D) The child has a developmental disability.

Question 15

Infants are at risk for hypothermia,bradycardia,and acidosis because they

A) are totally dependent upon breathing through their noses.
B) cannot shiver when exposed to lowered temperatures.
C) have a cardiac output of only 1 L per minute, whereas their circulating blood volume is around 85 cc/kg.
D) have a high ratio of body surface area to body surface mass.

Question 16

Strategies for increasing patient cooperation include all of the following,EXCEPT

A) demonstrating procedures on a doll, stuffed toy, or the caregiver.
B) humming, whistling, or using small toys to distract the child.
C) playing games to decrease anxiety and establish trust.
D) insisting on the patient's obedience.

Question 17

You are administering the Denver II during your examination of a 2-year-old child.The Denver II is a commonly used tool for assessing neuromuscular development of the child from birth through

A) 3 years of age.
B) 4 years of age.
C) 6 years of age.
D) 10 years of age.

Question 18

Hydrocephalus is suspected when the circumference of the head of an infant measures above the

A) 75th percentile.
B) 85th percentile.
C) 90th percentile.
D) 95th percentile.

Question 19

Normal systolic blood pressure (BP)for a 4-year-old child is approximately

A) 72 mm Hg.
B) 84 mm Hg.
C) 88 mm Hg.
D) 92 mm Hg.

Question 20

A rectal thermometer should be inserted into the rectum of a preschooler

A) 1/4 inch.
B) 1/2 inch.
C) 1 inch.
D) 1 1/2 inches.

Question 21

Flat,deep,irregular pink localized areas on the back of the neck,upper eyelids,upper lip,and lower occiput of light-skinned children are known as

A) eczema.
B) erythema toxicum.
C) milia.
D) telangiectatic nevi.

Question 22

When inspecting the ear of a 2-year-old child with suspected otitis media,you should do all of the following,EXCEPT

A) ask the child where it hurts.
B) pull the lower auricle down and out to straighten the canal.
C) insert the speculum about 1/4 inch to 1/2 inch.
D) introduce air into the canal by gently squeezing the bulb attachment.

Question 23

Swelling over the occipitoparietal region of the skull of a newborn is known as

A) caput succedaneum.
B) cephalhematoma.
C) craniosynostosis.
D) craniotabes.

Question 24

When you palpate a 5-year-old's neck,you identify small,movable,cool,nontender lymph nodes.Your findings would most likely indicate which of the following?

A) benign "shotty" nodes with no clinical significance
B) malignant and require further assessment immediately
C) related to lymphadenitis
D) related to an acute upper respiratory infection

Question 25

You would expect to locate the apical impulse on 2-year-old Joseph's chest at the

A) fourth intercostal space just left of the midclavicular line.
B) fourth intercostal space just right of the midclavicular line.
C) fifth intercostal space just left of the midclavicular line.
D) fifth intercostal space just right of the midclavicular line.

Question 26

Many children with Down syndrome have an associated atrioventricular canal malformation that involves

A) aortic stenosis, ventricular aneurysm, and atrioventricular block.
B) atrial hypoplasia, ventricular hypertrophy, and anomalous aortic valve.
C) atrial septal defect, ventricular septal defect, and a common atrioventricular valve.
D) coarctation of the aorta, ventricular hypoplasia, and patent ductus arteriosus.

Question 27

You completed an Apgar score on a newborn baby.The newborn's score was 7 at 5 minutes after birth.These results indicates he is

A) in good condition.
B) mildly depressed.
C) moderately depressed.
D) severely depressed and needs immediate resuscitation.

Question 28

Which of the following are characteristic findings in a child with Down syndrome?

A) a portion of the sclera seen above the iris
B) optical blink reflex
C) brushfield spots
D) infantile esotropia

Question 29

The nurse would examine a child with low-set ears for anomalies in which organ that formed at the same time as the ears in embryonic development?

A) heart
B) kidneys
C) liver
D) lungs

Question 30

Which finding from your examination of a 2-year-old child's thorax and lungs is abnormal?

A) barrel chest
B) bronchovesicular sounds heard throughout the peripheral lung fields
C) cough and wheezing
D) diaphragmatic excursion of two intercostal spaces

Question 31

Which of the following findings from an examination of a 12-month-old infant's mouth would the nurse record as abnormal?

A) absence of deciduous teeth
B) light pink tonsils, grade 2+
C) roof of the mouth is continuous and has a slight arch
D) small, white palpable nodules on the hard palate and gum margins

Question 32

The nurse is doing vision screenings on 3-year-olds using the Allen test.A child would be referred to an ophthalmologist if both eyes score less than 15/30 or scores for the right and left eye differ by how many feet?

A) 2 feet
B) 3 feet
C) 4 feet
D) 5 feet

Question 33

The nurse performs a transillumination of an infant's head in order to

A) assess for swelling or masses.
B) assess closure of the anterior and posterior fontanels.
C) ascertain if the suture lines are open, untied, or overlapping.
D) rule out anencephaly.

Question 34

When examining a 3 year old,you determine that the anterior fontanel measures 2 cm and is soft and flat.This finding most likely indicates

A) dehydration.
B) meningitis.
C) normal finding.
D) rickets.

Question 35

Pathological jaundice caused by a deficiency or inactivity of bilirubin glucuronyl transferase in the newborn occurs

A) within the first 24 hours of life.
B) the second or third day of life.
C) the fourth or fifth day of life.
D) within the first 2 weeks of life.

Question 36

Which finding indicates the presence of a retinoblastoma?

A) absent red reflex
B) bleeding into the optic nerve sheath
C) dark reddish color of the retina
D) yellowish or white light reflex

Question 37

Which of the following is most appropriate to use in screening the vision of a 2-year-old child?

A) Allen test
B) Hirschberg test
C) Snellen's E chart
D) Snellen's chart

Question 38

When assessing a small child for a thrill,you palpate as for the adult or use the alternative method,which requires the use of the

A) distal one-third of your fingers.
B) fingertips of your dominant hand.
C) palm of your hand.
D) proximal one-third of your fingers.

Question 39

Findings of excessive salivation,along with reports of choking and coughing during the newborn's feeding,may indicate which of the following?

A) early signs of viral infection
B) hypertrophic pyloric stenosis
C) milk allergy
D) tracheoesophageal fistula

Question 40

Mongolian spots,which commonly occur over the lumbar and sacral areas of the spine,buttocks,upper back,or shoulders in newborns of African,Latino,or Asian descent,are characterized by

A) a deep blue pigmentation.
B) erythematous maculopapular lesions.
C) inflammation of the epidermis and superficial dermis.
D) ruddy skin color.

Question 41

A six-month-old infant has femoral pulses that are weaker than the brachial pulses on palpation.This most likely indicates

A) a physiological brachial-femoral lag that should resolve in 3-4 years.
B) aortic valve stenosis.
C) coarctation of the aorta.
D) a normal finding.

Question 42

Assessing the rooting or sucking reflexes in the infant also tests which cranial nerve(s)?

A) CN III, IV, and VI
B) CN V
C) CN VIII
D) CN IX and X

Question 43

Which reflex is normally present in a 7-month-old infant?

A) palmar grasp
B) rooting
C) sucking
D) tonic neck

Question 44

Which finding from palpating the abdomen of a young child indicates pyloric stenosis?

A) abdominal distention, palpable stool over the abdomen, and absence of stool in the rectum
B) olive-shaped mass palpated in the right epigastric area
C) sausage-shaped mass with intermittent pain on palpation of the upper abdomen
D) soft, rounded mass in the left upper abdomen

Question 45

While examining the hips of a 1-month-old baby,you hear an audible clunk as you abduct the left leg and again when you adduct the same leg.This finding is

A) associated with metatarsus varus.
B) Gower's sign associated with muscular dystrophy.
C) normal in infants under 12 months.
D) Ortolani's sign associated with dislocation of the hip.

Question 46

Your examination of a 5-year-old child reveals limited abduction and internal rotation of the child's right hip accompanied by muscle spasm,proximal thigh atrophy,and a painless limp.These findings indicate

A) dislocated hip.
B) Duchenne muscular dystrophy.
C) juvenile rheumatoid arthritis.
D) Legg-Calvé-Perthes disease.

Question 47

To assess a male child for a hernia,you would palpate his inguinal area with

A) your little finger.
B) your index finger.
C) two fingers.
D) three fingers.

Question 48

The condition in which an infant has extra fingers or toes is called

A) adactyly.
B) dactylion.
C) polydactyly.
D) syndactyly.

Question 49

Suspending a 3-month-old infant in a prone position while supporting the chest with your hand will normally result in extension of the head,trunk,and hips,which is referred to as which of the following reflexes?

A) Galant
B) Landau
C) Moro
D) placing

Question 50

To assess the Babinski's reflex of a 12-month-old infant,you stroke the plantar surface of the foot with the tip of your thumbnail from the lateral heel upward.A normal response is

A) all toes curling down.
B) toes curling down and dorsiflexion of the great toe.
C) toes fanning outward with dorsiflexion of the great toe.
D) toes fanning outward with plantar flexion of the great toe.

Question 51

Which of the following is a normal finding from palpating the liver in a young child?

A) A firm liver edge is palpable 3 cm below the right costal margin.
B) A soft liver edge is palpable 1-2 cm below the right costal margin.
C) The surface of the liver is nodular with a firm, sharp border.
D) The surface of the liver is soft, smooth, and tender.

Question 52

The recommended technique for palpating the liver in a toddler is to use the

A) ulnar surface of the hand to press down and then upward at the right upper quadrant.
B) tips of two fingers to press inward along the right costal margin.
C) outer edge of the right thumb to press down and scoop up at the right upper quadrant.
D) palmar surface of your right hand placed parallel to the right costal margin.

Question 53

To examine the genitalia of a 2-year-old female,position her

A) in a froglike position on her caregiver's lap.
B) in a semilithotomy position on the examining table without feet in stirrups.
C) on her back with legs raised on her caregiver's lap.
D) on her side on the examining table.

Question 54

To assess the tonic neck reflex of a 3-month-old infant in a supine position,you rotate the infant's head to the right side and hold the jaw parallel to the shoulder.A normal response is for the infant to

A) extend both arms.
B) extend the left arm and leg.
C) flex both legs.
D) flex the left arm and leg.

Question 55

You are caring for a 5-year-old male patient and determine that the child's urethral meatus is located on the dorsal surface of the penis.This location is

A) a normal finding.
B) epispadias.
C) hypospadias.
D) phimosis.

Question 56

The nurse should examines a child admitted with a diagnosis of slipped capital femoral epiphysis for which of the following additional health problems?

A) developmental delays
B) emaciated appearance
C) nutritional anemia
D) obesity

Question 57

A child who displays the characteristics of genu varum has a distance between the two medial condyles of

A) less than 2 inches.
B) more than 2 inches.
C) less than 1 inch.
D) more than 1 inch.

Question 58

Cranial nerve VII can be assessed in the older child by asking the child to

A) close the eyes and identify the smell of peanut butter and chocolate.
B) identify the objects on Allen cards.
C) indicate if he hears a bell that is rung out of his line of vision.
D) raise the eyebrows, frown, puff the cheeks out, and close the eyes tightly.

Question 59

In the assessment of peripheral pulses of a child,which pair should not be palpated simultaneously?

A) brachial pulses
B) carotid pulses
C) femoral pulses
D) popliteal pulses

Question 60

Children with a ventricular septal defect (VSD)frequently have which abnormal heart sounds?

A) S₄
B) split S₂
C) S₃ and pansystolic murmur
D) soft, musical, systolic murmur heard while the patient is sitting

Question 61

The startle reflex in an infant under 4 months is normal.Which of the following are manifestations of the startle reflex? Select all that apply.

A) Flexing arms and legs
B) Extending and then flexing arms
C) Flexing the toes
D) Thumb and index fingers form a C
E) Arching of the back
F) Rolling of the eyes

Question 62

Which of the following can cause microcephaly? Select all that apply.

A) Syphilis
B) Rubella
C) Genetic defects
D) Bacterial meningitis
E) Intrauterine infections
F) Drug or alcohol ingestion during pregnancy

Question 63

A cleft palate that involves the uvula,soft palate,hard palate,or a combination,is classified as a(n)____________________ malformation.

Question 64

Which of the following are symptoms of mononucleosis? Select all that apply.

A) Sore throat
B) Fever
C) Apnea
D) Otitis media
E) Splenomegaly Apnea
F) Cervical adenitis

Question 65

The nurse is preparing to perform a well child examination on a 3-year-old child.The child is clinging to his mother and screaming.Which of the following measures would most allay his fears?

A) Allow him to stay on the exam table with his mother in the room.
B) Suggest that the mother reschedule the exam.
C) Allow the mother to hold him on her lap during the exam.
D) Use distraction techniques such as talking about a favorite television character.

Question 66

Which of the following can cause diaper dermatitis? Select all that apply.

A) Molds
B) Candida
C) Cleansing agents
D) Irritated skin
E) Poor nutrition
F) Coxsackievirus A16

Question 67

Your patient is found to have cryptorchidism.This means that he has

A) an enlargement of the scrotum.
B) one testis that is not palpable.
C) a bulge in the inguinal area.
D) an epididymal enlargement.

Question 68

Your 5-year-old male patient has an absent anal reflex along with anorectal tears and ecchymosis,which are most likely caused by

A) cancer of the anus.
B) a congenital disorder.
C) sexual abuse.
D) a spinal cord lesion.

Question 69

Rapid growth in an adolescent is called a(n)____________________.

Question 70

You are conducting a health history for 6-year-old child from his mother.Which fact obtained from the mother is most likely to prompt you to examine the child closely for current related health problems?

A) His older sister died of pneumonia.
B) His older brother has attention-deficit hyperactivity disorder.
C) His mother gained 35 pounds during her pregnancy with the child.
D) He attends an after-school program each day until she picks him up at around 5:30 p.m.

Question 71

Seborrheic dermatitis,also known as ____________________,is a result of increased epidermal tissue growth.

Question 72

Neonates normally lose ____________________ of birth weight by the third or fourth day after birth.

Question 73

A nurse preceptor asked a new graduate,"What did the American Academy of Pediatrics (AAP)recommend regarding sleep positioning in 2011?" Which response by the new graduate would indicate that further clarification is needed? Select all that apply.

A) Bottle feeding
B) Routine immunizations
C) Use a soft sleep surface
D) Consider use of a pacifier
E) Provide cereal in a bottle at bedtime
F) Room-sharing without bed-sharing