Deck 21: Caring for the Child in the Hospital,The Community,and Across Care Settings

Question 1

A 1-week-old infant is in the pediatric clinic.The birth weight was 8 lb,1 oz (3.65 kg).Today the infant weighs 7 lb (3.17 kg).The mother breastfeeds exclusively.What action by the nurse is best?

A)Assess the mother's breastfeeding technique.
B)Document the finding and alert the provider.
C)Reassure the woman that weight loss is normal.
D)Refer the mother to a lactation consultant.

Answer 1

Document the finding and alert the provider.

Question 2

A nurse is weighing a 2-month-old infant in the clinic.To ensure safety,which action is most appropriate?

A)Have the parent hold the child while standing on an adult scale.
B)Place the baby in the scale and place one hand on top of the baby.
C)Place the baby in the scale and hold one hand just over the baby.
D)Prop the infant sitting up in the scale,then weigh the prop separately.

Answer 2

Place the baby in the scale and hold one hand just over the baby.

Question 3

The pediatric nurse clarifies the history of a child who is brought to the emergency room with abdominal pain.The nurse uses the mnemonic OLD CAT to ask the appropriate questions,including which of the following?

A)Activity
B)Diet
C)Output
D)Timing

Answer 3

Timing

Question 4

A parent of a teething child asks for guidance on nonpharmacological treatments for gum pain.What herbal preparation can the nurse suggest?

A)Aloe vera
B)Chamomile
C)Echinacea
D)Tea tree oil

Question 5

On physical assessment of the skin of a patient,the nurse documents cyanosis.What other related assessment should the nurse perform?

A)Ask the parent about yellow and orange vegetable intake.
B)Draw blood for hemoglobin,hematocrit,and liver function studies.
C)Palpate all the child's lymph nodes,assessing for enlargement.
D)Take the child's vital signs,including blood pressure and pulse.

Question 6

A nurse is providing nutritional information to a parent group.Which information is most appropriate?

A)At least 35% of calories should come from protein.
B)Limit carbohydrates to 10-15% of daily calories.
C)Saturated fats are the healthiest fat choice.
D)Use whole milk until your child is 2 years old.

Question 7

A nursing manager is concerned about frequent errors on the pediatric unit and wants to decrease them.What action by the manager is best?

A)Have two nurses verify all new orders when they are written.
B)Institute a standardized handoff format at shift change.
C)Provide remedial education to nurses who make errors.
D)Require charge nurses to verify care plans with staff nurses.

Question 8

A nurse is assessing a school-age child in the clinic with an earache and fever.Using the SODA mnemonic,what question by the nurse best relates to "S"?

A)"Does it keep you from sleeping?"
B)"Has this affected your schoolwork?"
C)"How long have you been sick?"
D)"How sore is your ear today?"

Question 9

A middle-aged woman has brought a fussy baby to the pediatric clinic.After placing the woman and child in an exam room,which of the following questions should the nurse ask first?

A)"Have you taken the baby's temperature?"
B)"How are you related to the baby?"
C)"How long has the baby been so fussy?"
D)"What brings you to the office today?"

Question 10

A nurse is assessing a school-age child who complains of stomach aches after eating.Which question is appropriate for the "D" component of the OLD CAT mnemonic?

A)"Can you describe how your tummy pain feels?"
B)"Have you tried any over-the-counter drugs?"
C)"How long does the pain last after you eat?"
D)"What day did you first notice the pain?"

Question 11

The pediatric nurse is assessing a 5-year-old for developmental milestones.Which assessment tool should the nurse use?

A)CHEOPS scale
B)Denver II screening tool
C)FLACC scale
D)OLD CAT questions

Question 12

A nurse is explaining to a nursing student that a patient experienced a sentinel event during a previous hospitalization.What does the student understand about this event?

A)Experienced an unusual event that is rare in the literature
B)Had an unexpected response to treatment or nursing care
C)Meeting a major milestone in treatment for an illness
D)Unexpected event resulting in serious injury (or death)

Question 13

A nurse is attempting to assess a toddler,who is being uncooperative.What action by the nurse would be best to accomplish this task?

A)Get on the floor while assessing the child.
B)Give the child toys to play with.
C)Have the parent restrain the toddler.
D)Visit with the parent for a short while.

Question 14

The pediatric nurse working in a hospital setting uses both standard precautions and transmission-based precautions for patients.Which patient requires only standard precautions?

A)Infectious diarrhea
B)Staphylococcal infection
C)Tonsillitis
D)Tuberculosis

Question 15

The pediatric nurse assessing a patient for breath sounds documents a loud,high-pitched sound heard only over the trachea.The nurse should document this finding as which of the following?

A)Adventitious breath sound
B)Bronchial breath sound
C)Bronchovesicular breath sound
D)Vesicular breath sound

Question 16

A nurse is assessing a 10-month-old baby's anterior fontanel and finds it slightly depressed;the fontanel measures 2 inches (5.08 cm).What conclusion and action are most appropriate?

A)Delayed closing;alert health-care provider.
B)Fontanel is closing;document findings.
C)Large for age;assess for Down's syndrome.
D)Sign of dehydration;assess fluid status.

Question 17

A teenager is in the family practice clinic for a school physical.When the parent leaves the room,the teen admits to "cutting myself" after a relative "touched me in my private area." What action by the nurse is most appropriate?

A)Document the statements and alert the provider.
B)Explain that this information must be shared.
C)Have the secretary call the police department.
D)Reassure the teen of confidentiality rules.

Question 18

A pediatric nurse needs to administer acetaminophen (Children's Tylenol)to patients in the intensive care unit (ICU).Which dose,based on age,is correct?

A)0 to 3 months,40 mg
B)4 to 11 months,220 mg
C)2 to 3 years,120 mg
D)4 to 5 years,100 mg

Question 19

The pediatric nurse takes a comprehensive health history of a 10-year-old patient and asks the parents about their use of herbal products or home remedies.What information does the nurse know regarding herbal products?

A)Aloe vera can affect clotting time by decreasing platelets.
B)Bilberry can cause hypersensitivity in patients with allergies to plants.
C)Echinacea is contraindicated for patients with autoimmune disorders.
D)Fennel is contraindicated in patients with diabetes,hypertension,or liver disease.

Question 20

The pediatric nurse performs a health assessment on a 9-year-old girl who weighs 23 kg and is 132 cm tall.How does the nurse document the patient's BMI?

A)13.20
B)13.82
C)14.25
D)14.68

Question 21

A nurse is caring for a 5-year-old who broke his arm and is complaining of pain.What statement by the nurse to the child would be most helpful?

A)"I bet your arm will stop hurting really soon."
B)"You don't have to stand pain;I can give you medicine."
C)"You didn't do anything wrong that caused the hurt."
D)"Wait until you see the cool cast you are going to get."

Question 22

A mother brings her severely disabled child to the pediatric clinic with complaints that the child has his fourth upper respiratory infection in 3 months.The mother appears disheveled and fatigued.What action by the nurse is best?

A)Ask the mother when the last time she ate or bathed was.
B)Inquire as to the whereabouts of the child's father.
C)Make a referral to the visiting nurses for a home evaluation.
D)Offer the mother information on local respite care options.

Question 23

A new nurse caring for a toddler in pain after a procedure is reluctant to medicate the child for fear of causing a respiratory arrest.What action by the nurse's preceptor is best?

A)Agree about withholding medication and teach some distraction techniques.
B)Explain that pain has detrimental health effects and needs treatment.
C)Have the new nurse get naloxone (Narcan)and place it at the child's bedside.
D)Tell the new nurse to give the child analgesics and not worry about respiratory arrest.

Question 24

A nursing manager wants to decrease the amount of stress children have during hospitalization.What environmental change can the manager implement to best meet this goal?

A)Create a treatment room for procedures.
B)Have dim lighting installed in patient rooms.
C)Keep the play area unlocked and open at all hours.
D)Provide guest trays for parents staying in the room.

Question 25

A 66-lb child complains of mild pain after a procedure.What action by the nurse is best?

A)Administer 0.3 mg of naloxone (Narcan)every 4 hours orally if needed.
B)Administer 300 mg of acetaminophen (Tylenol)orally and provide a movie to watch.
C)Administer 450 mg of acetaminophen (Tylenol)orally every 3 hours as requested.
D)Administer morphine sulfate (Astromorph)9 mg orally every 4 hours if needed.

Question 26

A father is at the bedside of his hospitalized disabled child.He begins crying,saying he has lost his job and no longer has insurance,so he is unsure of how to pay for the child's medical bills.What action by the nurse would be most helpful?

A)Consult with a social worker who can discuss state and federal insurance programs.
B)Give the father written information on state health insurance options for children.
C)Listen to the father's concerns and tell him you understand how he must feel.
D)Tell the father not to worry;the health of his child is more important than money.

Question 27

A nurse is providing anticipatory guidance to the parents of a 4-year-old disabled child.What nutritional information should the nurse provide?

A)Feed the child as any other 4-year-old child.
B)Give child more than 70-90 kcal/kg/day.
C)Offer extra protein and vitamins daily.
D)Provide extra carbohydrates and fat intake.

Question 28

A student nurse on the pediatric floor finds a patient in pain and gives the child some toys to play with.The registered nurse asks why the student did not medicate the child.The student states that because the child was easily distracted,it did not appear that the child needed pain medication.What action by the registered nurse is most appropriate?

A)Give the child some pain medication.
B)Have the student reassess the child's pain.
C)Instruct the student to take the child's vital signs.
D)Thank the student for distracting the child.

Question 29

A nurse is listening to a school-age child's heart sounds and hears an abnormal noise after S? that is heard best when the child is lying in the left lateral position.What action by the nurse is most appropriate?

A)Arrange a cardiology consult.
B)Document the findings in the chart.
C)Notify the provider immediately.
D)Perform assessments for fluid balance.

Question 30

A 5-year-old child is having an acute asthma attack.How does the nurse position the child while waiting for a respiratory treatment?

A)Prone across the parent's lap
B)Semi-Fowler's position in bed
C)Upright in a hard-backed chair
D)Upright in the tripod position

Question 31

A visiting nurse is making a home visit on a male 2-month-old child who was born prematurely.The nurse notes that the child has not been circumcised.What action by the nurse is most important?

A)Assess the number of the baby's wet diapers per day.
B)Give parents a referral to have the child circumcised.
C)Instruct parents not to retract the foreskin until after age 1.
D)Teach parents to retract the foreskin for cleaning.

Question 32

A nurse has been asked to perform a Romberg test on a school-age child.What action does the nurse take to perform this assessment?

A)Ask the child to smile,frown,and make other faces.
B)Have the child touch a finger to the nose several times.
C)Instruct the child to walk across the room and back.
D)Tell the child to stand,close his or her eyes,and hold the arms out in front.

Question 33

A child needs hearing assessments.To assess air and bone conduction of sound,which assessment technique is most appropriate?

A)Have the child place a block into a box each time he or she hears a sound.
B)Place a probe into the ear canal and measure the amount of sound reflected.
C)Strike a tuning fork and place the handle against the back of the child's head.
D)Strike a tuning fork,place it on the mastoid process,then move it to within1 inch of the ear canal.

Question 34

A child will be hospitalized in the following week.In order to decrease the child's and parents' stress related to the hospitalization,which action by the clinic nurse would be most helpful?

A)Arrange for the family to visit the hospital and have a tour.
B)Give the family written information on visiting hours.
C)Introduce the family to another family whose child is hospitalized.
D)Suggest the family "take a break" and not stay with the child.

Question 35

A child has had eye testing.The nurse reads in the child's chart that the Hirschberg test demonstrated displacement of light reflection in one eye.What does this indicate to the nurse?

A)Color blindness
B)Normal ocular alignment
C)Presence of cataracts
D)Presence of strabismus

Question 36

A nurse reads in a child's chart that the child has pectus carinatum.What does the nurse understand this term to mean?

A)Barrel chest from chronic illness
B)Depression of the lower chest
C)Protrusion of the chest
D)Underdeveloped breast bone

Question 37

A child is in the emergency department following an overdose of acetaminophen (Tylenol).What medication does the nurse anticipate administering?

A)Activated charcoal
B)N-acetylcysteine (NAC)
C)Naloxone (Narcan)
D)Syrup of ipecac

Question 38

A toddler is brought to the clinic with a low-grade fever and the mother describes a grunting sound made by the child on expiration.The respiratory rate is 24 breaths/minute.What action by the nurse is most appropriate?

A)Assess nose and throat for foreign bodies.
B)Facilitate a stat chest x-ray.
C)Obtain an oxygen saturation;notify provider.
D)Weigh and measure child then calculate BMI.

Question 39

A child is in the clinic to follow up on a blood lead level of 7 µg/dL.What action by the nurse is best?

A)Call social work or Child Protective Services to evaluate home safety.
B)Instruct parents to have the child re-tested at the beginning of the school year.
C)Reassure parents that this is below the threshold for lead poisoning.
D)Teach parents to wet-mop surfaces instead of vacuuming the house.

Question 40

A school-age child with asthma came to the emergency department with a respiratory rate of 44 breaths/minute and wheezes heard throughout.After two breathing treatments,the nurse assesses a respiratory rate of 8 breaths/minute and hears no wheezing.The child is lying quietly on the bed.What action by the nurse is best?

A)Allow the child to rest undisturbed.
B)Call for another respiratory treatment.
C)Obtain oxygen saturation;notify provider.
D)Reassess the child in 30 minutes.

Question 41

A nurse needs to administer medication to a toddler.What action by the nurse is most likely to gain cooperation from the child?

A)Allow the child to negotiate a "reward."
B)Allow the parent to give the medication.
C)Explain that medicine is not a punishment.
D)Let the toddler self-administer the medicine.

Question 42

A nurse working on a pediatric unit teaches a student nurse that children may require intravenous fluids to be administered through one of several different venous access devices.The nurse tells the student that which of the following current patients are candidates for central venous access devices? (Select all that apply.)

A)Receiving blood product replacement after surgery
B)Receiving fluid maintenance prior to diagnostic testing
C)Requires long-term intravenous access for hydration
D)Will need regularly scheduled chemotherapy
E)With medication administration scheduled preoperatively

Question 43

The nurse conducts a seminar for new nurses about child safety in the hospital setting.Which of the following should be included? (Select all that apply.)

A)Asking children to state their names to ensure safe medication administration
B)Basing safety measures on the developmental level of the children
C)Keeping play areas in the hospital open at all times for children to visit
D)Providing age-appropriate transportation methods to other areas of the hospital
E)Storing toxic and nontoxic materials on the top shelf of a locked cabinet

Question 44

A 34-lb child needs acetaminophen (Tylenol).The correct dose range for this child is____________________ mg .

Question 45

The pediatric nurse is assessing a teenager's past medical history.Which information should the nurse inquire about? (Select all that apply.)

A)All acute illnesses
B)Any chronic illnesses
C)Apgar scores at birth
D)Birth weight
E)Neonatal feeding problems

Question 46

A child weighs 82 lb.The correct calculation for this child's 24-hour maintenance fluid requirements is ____________________ mL.

Question 47

A child weighs 8 lb.The correct calculation for this child's 24-hour maintenance fluid requirements is ____________________ mL.

Question 48

A child weighs 28 lb.The nurse prepares to administer intravenous (IV)morphine sulfate.The correct dose for this child is ____________________ mg.

Question 49

A family is raising a child with a serious disability,and the caregivers appear stressed and short tempered during well-child visits.What does the nurse understand about the emotional impact of this situation on the family? (Select all that apply.)

A)Caregiver fatigue is a constant threat due to ongoing medical needs.
B)Confusion and distress occur because they don't have the child they expected.
C)Family routine is disrupted by the constant needs of the disabled child.
D)Siblings adapt well to having a disabled child and enjoy helping out.
E)The family may worry about possible painful procedures and upsetting the child.

Question 50

A nurse has been asked to perform a HEENT assessment on a child.What areas does the nurse assess? (Select all that apply.)

A)Endocrine
B)Eyes
C)Head
D)Nose
E)Throat

Question 51

A child who weighs 35 lb needs chloral hydrate (Aquachloral)for sedation prior to a medical procedure.What dose should this child receive?

A)150 mg
B)450 mg
C)1,000 mg
D)1,500 mg

Question 52

The pediatric nurse caring for children with physical disabilities teaches the student nurse that coping mechanisms give rise to resiliency in children and their families.The nurse further notes that attributes of resilient children include which of the following? (Select all that apply.)

A)Dependence on family
B)Physical abilities
C)Problem-solving skills
D)Sense of purpose and future
E)Social competence

Question 53

A pediatric nurse reads in a chart that a female patient is in Tanner stage 3.Which of the following best describes this patient?

A)Breast buds and thick,curly pubic hair
B)Entire breast enlarged;pubic hair in inverted triangle
C)Has breast buds and sparse,straight pubic hair
D)Nipples protruded;pubic hair extending to medial thighs

Question 54

A nurse is providing a child safety class to a parent group.Which instructions are appropriate for the age group? (Select all that apply.)

A)Adolescent: Ride in the back seat of the car.
B)Infant: Never attach a pacifier to the infant's clothing.
C)Preschool: Teach stop,drop,and roll for fire.
D)School age: Keep toilet seats down and tubs empty.
E)Toddler: Never leave unattended in a walker.

Question 55

The nurse is providing discharge instructions to the parents of a 3-year-old going home after minor surgery.What information should the nurse include? (Select all that apply.)

A)Actions and side effects of prescribed medication
B)Activity that is expected and encouraged
C)How to take the child's rectal temperature
D)Signs and symptoms of infection
E)When the child can eat and drink again

Question 56

What does the pediatric nurse understand about the use of complementary and alternative medicine (CAM)? (Select all that apply.)

A)All CAM practices are the same within a cultural group.
B)CAM practices reflect ethnocultural health beliefs.
C)Only herbal remedies are considered CAM therapies.
D)Over half of the adults in America use CAM.
E)Very few doctors collaborate with CAM providers.

Question 57

The pediatric nurse performs a pain assessment on a 5-year-old girl who is admitted to the hospital for fractures following an accident.Depending on the assessment,the nurse could implement which of the following interventions? (Select all that apply.)

A)Manage mild pain with a combination of mild analgesics such as NSAIDs and distraction.
B)Manage mild pain with regularly timed analgesic administration of mild opioids.
C)Manage moderate pain with distraction plus regularly timed analgesic administration.
D)Manage severe pain with strong analgesics such as morphine sulfate (Astramorph).
E)Manage severe pain with strong analgesics (Astramorph)when distraction doesn't work.

Question 58

A preschool-age child is going to have a potentially painful procedure.What action by the nurse is best to prepare the child for this event?

A)Allow the child to decide if the parents stay or not.
B)Let the child touch and explore the equipment first.
C)Talk about it briefly for several days beforehand.
D)Use play to demonstrate the procedure to the child.

Question 59

The child development specialist explains to the nursing students that therapeutic play has several functions,including which of the following? (Select all that apply.)

A)Allows children to demonstrate their emotions
B)Decreases stress associated with hospitalization
C)Gives parents a break from watching their child
D)Helps correct children's misconceptions about care
E)May help child learn new coping skills

Question 60

A child who weighs 16 lb received an overdose of morphine sulfate and needs naloxone (Narcan).The safe dose for this child is ____________________ mg.