NCLEX Practice Exam for Pediatric Nursing 1

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1. Which of the following would be inappropriate when administering chemotherapy to a child?

  1. Monitoring the child for both general and specific adverse effects
  2. Observing the child for 10 minutes to note for signs of anaphylaxis
  3. Administering medication through a free-flowing intravenous line
  4. Assessing for signs of infusion infiltration and irritation

2. Which of the following is the best method for performing a physical examination on a toddler

  1. From head to toe
  2. Distally to proximally
  3. From abdomen to toes, the to head
  4. From least to most intrusive

3. Which of the following organisms is responsible for the development of rheumatic fever?

  1. Streptococcal pneumonia
  2. Haemophilus influenza
  3. Group A β-hemolytic streptococcus
  4. Staphylococcus aureus

4. Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?

  1. Polycythemia
  2. Cardiomyopathy
  3. Endocarditis
  4. Low blood pressure

5. How does the nurse appropriately administer mycostatin suspension in an infant?

  1. Have the infant drink water, and then administer mycostatin in a syringe
  2. Place mycostatin on the nipple of the feeding bottle and have the infant suck it
  3. Mix mycostatin with formula
  4. Swab mycostatin on the affected areas

6. A mother tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother?

  1. make the child seat with the family in the dining room until he finishes his meal
  2. provide quiet environment for the child before meals
  3. do not give snacks to the child before meals
  4. put the child on a chair and feed him

7. The nurse is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn?

  1. uneven head shape
  2. respirations are irregular, abdominal, 30-60 bpm
  3. (+) moro reflex
  4. heart rate is 80 bpm

8. Which of the following situations increase risk of lead poisoning in children?

  1. playing in the park with heavy traffic and with many vehicles passing by
  2. playing sand in the park
  3. playing plastic balls with other children
  4. playing with stuffed toys at home

9. An inborn error of metabolism that causes premature destruction of RBC?

  1. G6PD
  2. Hemocystinuria
  3. Phenylketonuria
  4. Celiac Disease

10. Which of the following blood study results would the nurse expect as most likely when caring for the child with iron deficiency anemia?

  1. Increased hemoglobin
  2. Normal hematocrit
  3. Decreased mean corpuscular volume (MCV)
  4. Normal total iron-binding capacity (TIBC)

11. The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take?

  1. The nurse should insert a padded tongue blade in the patient’s mouth to prevent the child from swallowing or choking on his tongue.
  2. The nurse should help the mother restrain the child to prevent him from injuring himself.
  3. The nurse should call the operator to page for seizure assistance.
  4. The nurse should clear the area and position the client safely.

12. At the community center, the nurse leads an adolescent health information group, which often expands into other areas of discussion. She knows that these youths are trying to find out “who they are,” and discussion often focuses on which directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as:

  1. identity vs. role confusion.
  2. adolescent rebellion.
  3. career experimentation.
  4. relationship testing

13. The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern?

  1. The baby cannot say “mama” when he wants his mother.
  2. The mother has not given him finger foods.
  3. The child does not sit unsupported.
  4. The baby cries whenever the mother goes out.

14. Cheska, the mother of an 11-month-old girl, KC, is in the clinic for her daughter’s immunizations. She expresses concern to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is:

  1. 12 months.
  2. 15 months.
  3. 10 months.
  4. 14 months.

15. Sally Kent., age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is:

  1. prone for two hours to prevent aspiration, should she vomit.
  2. semi-fowler’s so she can watch TV for five hours and be entertained.
  3. supine for several hours, to prevent headache.
  4. on her right sides to encourage return of CSF

16. Buck’s traction with a 10 lb. weight is securing a patient’s leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation- sensation-movement:

  1. every shift.
  2. every day.
  3. every 4 hours.
  4. every 15 minutes.

17. Carol Smith is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include:

  1. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures.
  2. tachycardia, headache, dyspnea, temp . 101 F, and wheezing.
  3. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria.
  4. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.

18. The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test:

  1. blood culture.
  2. throat and ear culture.
  3. CAT scan.
  4. lumbar puncture.

19. The nurse is drawing blood from the diabetic patient for a glycosolated hemoglobin test. She explains to the woman that the test is used to determine:

  1. the highest glucose level in the past week.
  2. her insulin level.
  3. glucose levels over the past several months.
  4. her usual fasting glucose level.

20. The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except:

  1. capillary refill.
  2. radial and ulnar pulse.
  3. finger movement
  4. skin integrity
Answers and Rationales
  1. B. When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important.
  2. D. When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided. Proceeding from distal to proximal is inappropriate at any age.
  3. C. Rheumatic fever results as a delayed reaction to inadequately treated group A β-hemolytic streptococcal infection.
  4. A. The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation
  5. D. Mycostatin suspension is given as swab. Never mix medications with food and formula.
  6. C. If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a “busy toddler.” He/she will not able to keep still for a long time.
  7. D. Normal heart rate of the newborn is 120 to 160 bpm. Choices A, B, and C are normal assessment findings (uneven head shape is molding).
  8. A. Lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).
  9. A. Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.
  10. C. For the child with iron deficiency anemia, the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia, decreased hemoglobin, decreased hematocrit and elevated total iron binding capacity.
  11. D. The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.
  12. A. During this period, which lasts up to the age of 18-21 years, the individual develops a sense of “self.” Peers have a major big influence over behavior, and the major decision is to determine a vocational goal.
  13. C. Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say “mama” in the sense that it refers to their mother at this time.
  14. A. By 12 months, 50 percent of children can walk well.
  15. C. Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.
  16. C. The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.
  17. A. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.
  18. D. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.
  19. C. The glycosolated hemoglobin test measures glucose levels for the previous 3 to 4 months.
  20. D. Capillary refill, pulses, and skin temperature and color are indicative of intact circulation and absence of compartment syndrome. Skin integrity is less important.