Deck 14: Pediatric Assessment

Question 1

When infants are born prematurely, the chronological age on the growth chart:

A) is the same as for other children after 6 months
B) is not accurate, and a special chart for preemies must be used
C) must be corrected subtracting weeks or months of prematurity until age 18 months old
D) must be corrected until age 18, subtracting the period of prematurity from the age

Answer 1

must be corrected subtracting weeks or months of prematurity until age 18 months old

Question 2

When you are the nurse taking the health history of a child, the historian is most likely going to be an adult. Which of the following questions would be the most important to ask before admitting or treating the child?

A) "What is the birth date of the child?"
B) "Who is the legal guardian?"
C) "What is your relationship to the child?"
D) "What problems occurred during pregnancy?"

Answer 2

"Who is the legal guardian?"

Question 3

The nurse is talking with the caregivers about a child's developmental and health history. The child interrupts to add something and the caregivers direct the child to be quiet. The nurse's best course of action would be based mostly on which of the following ideas?

A) Caregivers have the right to govern their own children.
B) Children are not as accurate as caregivers in the recall of developmental and health histories.
C) Children need to be included in their own health care as much as possible, considering age and development.
D) The caregivers are the decision makers in terms of care and will be paying for the cost of the care.

Answer 3

Children need to be included in their own health care as much as possible, considering age and development.

Question 4

A mother tells you that her 4-year-old child has begun to have night waking and has started thumb sucking again. Otherwise the child seems very healthy. From this brief history, your immediate response is:

A) "It is normal for preschool-aged children to go through some short periods of regression."
B) "What changes have happened in your family or with your child?"
C) "Is there any possibility of pinforms or some other type of parasite that your child might have?"
D) "You need to call your pediatrician right away and get a complete physical on this child."

Question 5

When obtaining a child's past health history, the nurse would ask questions aimed at getting pertinent information, beginning with the:

A) Apgar score and birth itself
B) postnatal period
C) labor and delivery
D) prenatal period

Question 6

When taking the health history of a child whose family is at the poverty level and has no insurance, you discover that the child has been seen in the emergency room of the hospital ten times in the last 6 months. During the interview, you would first try to find out from the family if:

A) they use the emergency room for episodic health care or if the child has a regular health care provider
B) there is a history of child or spousal abuse or incestuous relationships in the family
C) the child has a chronic health problem with acute exacerbations presenting an emergency situation
D) the child is hyperactive or has a history of inattention to safety and suffers accidents on a regular basis

Question 7

Which of the following questions or statements is most important during the health history interview of the family seeking care for a toddler?

A) "What does your child prefer to eat?"
B) "When did your child say the first word?"
C) "Tell me about the toilet training and how that is going."
D) "Tell me how you have childproofed your home."

Question 8

A mother asks the nurse to tell her the normal amount of milk a bottle-feeding infant takes in per day in the first month after birth. The nurse's answer would be that an infant at this age would take up to:

A) 32 ounces
B) 46 ounces
C) 56 ounces
D) 64 ounces

Question 9

During a talk with the nurse, the mother of a 6-month-old baby says that she gets her to go to sleep by giving her a bottle of milk to suck on until she falls asleep. The nurse's best response would be:

A) "You need to be watching your baby on a monitor or there the baby cannot see you."
B) "Be sure you prop the bottle well and the baby's head is slightly elevated."
C) "Letting a child fall asleep with a bottle of milk or other liquid containing sugar will cause cavities."
D) "Your baby is old enough to hold her own bottle, and this builds independence and self-esteem."

Question 10

In the health history interview, the nurse asks the caregivers if they give their 4-month-old baby honey. If the answer is "yes," the nurse would do some teaching to:

A) reinforce the caregivers for supplying this added source of immunity
B) let the caregivers know that honey is helpful then the infant has vomiting and diarrhea
C) inform the caregivers of the dangers of botulism from honey until the infant is 1 year old
D) advise the caregivers not to give more than 4 ounces of honey per day

Question 11

A nurse is volunteering in a clinic in a developing country. The mother tells the nurse she is bottle-feeding with formula given to her by an earlier group of volunteers. The nurse will most want to check to be sure the mother has sufficient formula and that the formula contains:

A) zinc
B) magnesium
C) sodium
D) iron

Question 12

The nurse asks the caregivers how many wet diapers their infant has in 24 hours. The nurse is comparing the wet diapers of this infant against the norm, which is the equivalent of:

A) 2 saturated diapers
B) at least 6 very wet diapers
C) no less than 8 very wet diapers
D) 10 or more saturated diapers

Question 13

In teaching the caregivers about giving juice to their preschool-aged child, the nurse would advise the caregivers to give the child no more than how many ounces of juice per day?

A) 8-12
B) 16
C) 18-24
D) 28

Question 14

Children who are suspected of not having adequate calorie and protein intake might have which of the following laboratory tests ordered by their health care practitioner, which provide a picture of whether calorie or protein intake is sufficient or not?

A) serum sodium and potassium
B) cerebral spinal fluid analysis
C) arterial blood gases
D) serum albumin and prealbumin

Question 15

The most reliable indicator of body fat is:

A) skinfold thickness
B) weight
C) fit of clothing
D) comparison with peers

Question 16

The nurse administers the Denver Developmental Screening Test II to a child. The child fails to successfully complete a series of items. The nurse learns that the child has an infection, did not sleep well the night before, and is on antibiotics. Which of the following actions would be best on the part of the nurse?

A) Do nothing, as the test results are not affected by the child's condition.
B) Do not readminister the series that was failed or the entire test, as retakes are invalid.
C) Administer the test again in 1 month if the child is then well and sleeping well.
D) Wait at least 2 years to administer the test, moving up to the Denver III.

Question 17

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:

A) to provide a distraction to increase cooperativeness
B) to entertain and keep the nurse in a good mood to work with children
C) something that has little to do with the examination of the child
D) to keep the child focused so he or she won't get into things in the exam room

Question 18

Which of the following types of lighting would be best for the nurse to use during the pediatric physical assessment?

A) fluorescent
B) halogen
C) yellow
D) natural

Question 19

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

A) in a sequential manner
B) first
C) last
D) optional

Question 20

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

A) 10 months
B) 18 months
C) 3 years
D) 5 to 6 years or more

Question 21

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

A) oral
B) rectal
C) axillary
D) tympanic

Question 22

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?

A) The axilla is not sensitive to early temperature changes, and accuracy was critical in this case.
B) An oral temperature is much quicker to determine than an axillary temperature.
C) Locating an axillary thermometer might be more difficult than finding an oral one.
D) The oral temperature reading is easier and safer to get then compared to an axillary temperature.

Question 23

The nurse takes the temperature of a newborn and gets a reading of 37.7 degrees C (99.6 degrees F). The nurse interprets this temperature as:

A) very high for a newborn and calls the health care practitioner
B) high for an infant of this age and decides to retake it in 20 minutes
C) normal and proceeds to chart the temperature in the infant's record
D) below normal and adds a warmed blanket to the infant's crib

Question 24

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

A) 15 seconds, watching the chest
B) 30 seconds, watching the abdomen
C) 1 minute, watching the chest
D) 1 minute, watching the abdomen

Question 25

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?

A) radial pulse on all the children
B) radial on the two older children and apical on the 18-month-old and the child with a cardiac problem
C) apical on all children under 5
D) apical only on the child with a cardiac problem

Question 26

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

A) 40
B) 30
C) 20
D) 15

Question 27

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?

A) not being nourished any longer by the rich placenta
B) the exhaustion of the baby after the birth experience
C) the loss of extracellular fluid and meconium
D) the time it takes to learn to suckle adequately

Question 28

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

A) 40
B) 36
C) 32
D) 24

Question 29

A child's height must fall in what percentile range to be considered normal enough not to warrant further investigation?

A) 5% -95%
B) 10%-90%
C) 20%-80%
D) 25%-75%

Question 30

The mother of a 9-month-old infant is concerned that the head circumference of her baby is greater than the chest circumference. The best response by the nurse is:

A) "This is normal until the age of 1 year, and then the chest will be greater."
B) "Perhaps your baby was small for gestational age or premature."
C) "Let me ask you a few questions, and perhaps we can figure out the cause of this difference."
D) "These circumferences normally are the same, but in some babies this just differs."

Question 31

The nurse is assessing a newborn for jaundice. The nurse knows that jaundice is easiest to detect in the newborn in certain areas. Because of this knowledge, the nurse will assess which of the following?

A) the scapula, under the arm, and in the groin
B) under the chin and under the knee
C) under the scrotum or inside the labia
D) on the tip of nose, external ear, lips, hands, and feet

Question 32

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:

A) child abuse
B) ritual painting
C) lack of bathing
D) Mongolian spots

Question 33

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

A) normal and common
B) normal and rare
C) abnormal and may indicate spina bifida occulta
D) abnormal and may indicate cancer

Question 34

Atopic dermatitis (AD) is a skin lesion that is:

A) due to an allergy to the mother or father
B) common and involves the epidermis and superficial dermis
C) rarely seen outside the tropical climates
D) seen only in children over age 4

Question 35

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

A) sebum epithelium
B) epitheliosis
C) vernix caseosa
D) the third skin

Question 36

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

A) hydration
B) skin tension
C) excess fat
D) pain tracks

Question 37

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 then being pulled forward. Which of the following statements best represents the significance of this finding?

A) This is a normal finding, as the infant's head will not stay in line until after 8 months of age.
B) The nurse has not conducted the test correctly and must do it again using proper technique.
C) Significant head lag after the age of 6 months may indicate brain injury and needs further investigations.
D) Head lag should not be tested until the child is over 1 year of age.

Question 38

While working in a public health clinic, the nurse assesses a child who is 3 years old. The nurse finds an open and wide anterior fontanel. The nurse is aware that an open anterior fontanel at this age most likely is:

A) normal
B) a result of prolonged dehydration
C) due to disease, such as rickets
D) due to a congenital disorder

Question 39

While palpating the fontanels of a 1-month-old infant, the nurse finds the posterior fontanel to be 2 to 3 cm. The nurse is aware that this finding occurs with which of the following conditions or disorders?

A) diabetes
B) premature birth
C) cerebral palsy
D) congenital hypothyroidism

Question 40

Which of the following best defines craniosynostosis?

A) premature ossification of suture lines resulting in early fusion of the bones of the skull
B) sinus openings into the cranium allowing for changes in intracranial pressure
C) wider spaces than normal between the bones of the cranium
D) changes in the size and shape of the skull due to the absence of lymph and sinus openings

Question 41

While palpating the outer layer of the cranial bones behind and above the ears, the nurse finds a softening of this area and has the sensation of pressing on a table-tennis ball then palpating the area. The nurse knows this finding is indicative of:

A) shaken baby syndrome
B) skull fracture
C) craniotabes
D) crepitus

Question 42

The caregivers notice a swelling over the cranial bones of their newborn. The nurse examines the baby and tells the caregivers that this appears to be a cephalhematoma and will disappear with time. The nurse is reasonably certain this is a cephalhematoma and not some other abnormality because the:

A) mother had a forceps delivery
B) swelling does not cross suture lines
C) color is the same as a cephalhematoma
D) swelling is over a large area of the head

Question 43

Swelling over the occipitoparietal region of the skull is called by which of the following terms?

A) occipitocapus
B) caput succedaneum
C) edematous capitus
D) parietus sepitus

Question 44

When the nurse is doing vision screenings on young children, which of the following tests would be used on a child who is 6 years old and able to read the alphabet?

A) finger point
B) Snellen X
C) Snellen E
D) adult Snellen

Question 45

The nurse doing vision screenings on 3- to 4-year-old children would refer a child to the ophthalmologist if both eyes score less than 15/30 or scores for the child's right and left eye differ by how many feet?

A) 1
B) 2
C) 3
D) 5

Question 46

The nurse using the Hirschberg test would expect to find which of the following in a child with normal eyes?

A) the light reflected symmetrically in the center of both corneas
B) the light reflecting red on the optic nerve
C) arteries and veins in the proper proportion
D) no evidence of retinal detachment

Question 47

Which of the following statements best describes dacryocystitis?

A) a bladder infection brought about by wearing Dacron fabrics
B) an infection of the lacrimal sac caused by the obstruction of the lacrimal duct
C) repeated bladder infections that are resistant to antibiotics
D) eye infection secondary to a bladder infection

Question 48

In inspecting the eyes of a child, the nurse notes that there are some small white flecks around the perimeter of the iris. These white flecks are called:

A) cotton patches
B) Brushfield spots
C) snow spots
D) northern lights

Question 49

White flecks around the perimeter of the iris in children are:

A) normally found in 40% of children
B) found in a child with Down syndrome
C) seen in children with congenital cataracts
D) observed in children with retinal detachment

Question 50

The optical blink reflex occurs then the newborn's pupil reaction to light is assessed and a newborn blinks and:

A) flexes the head closer to the body
B) extends the chin away from the body
C) arches the back
D) throws up the hands in the air

Question 51

The nurse inspects a child's red reflex with an ophthalmoscope and finds black spots or opacities within the red reflex. The nurse knows these findings:

A) are normal in 95% of children
B) indicate congenital permanent blindness
C) suggest the child has experienced trauma
D) are abnormal and may indicate a cataract

Question 52

If the nurse finds a yellowish or white light reflex (cat's eye reflex) then inspecting the retina, he or she knows this may indicate:

A) retinoblastoma
B) albino characteristics
C) retrolental fibroplasia
D) retinitis pigmentosa

Question 53

The nurse inspecting the optic disc of a child with intracranial hemorrhage would find:

A) the disc to be edematous and larger than usual
B) the margins of the optic disc to be poorly defined (blurred)
C) a small-sized disc
D) the color of the disc to be bright red and darker than usual

Question 54

To assess the pinna position of the ears of a child, the nurse would draw an imaginary line from the outer canthus to the top of the ear. If the nurse finds that the ears are below the imaginary line, this means that:

A) the child is prone to heart problems and may have cardiac anomalies
B) the finding is abnormal and may be a sign of renal anomalies or Down syndrome
C) the child has inherited low-set ears that may run in the family of one or more parents
D) the child is prone to deafness and must be checked for hearing very carefully at intervals

Question 55

To look into the ear of a child younger than 3 years old, the nurse would position the ear by pulling the auricle:

A) down and out
B) back and up
C) in and forward
D) in and backward

Question 56

Patency of the nares must be determined at birth because:

A) of the possibility of polyps
B) mouth breathing will exhaust the newborn
C) the baby will have nasal flaring if not patent
D) newborns are nose breathers

Question 57

The most common causes of clubfoot include which of the following? Select all that apply.

A) abnormal intrauterine position of the fetal foot
B) maternal infection during the first trimester
C) genetics
D) lack of prenatal vitamins, especially in the first trimester