NCLEX Practice Exam for Pediatric Nursing 2

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1. Andrea with suspected rheumatic fever is admitted to the pediatric unit. When obtaining the child’s history, the nurse considers which information to be most important?

  1. A fever that started 3 days ago
  2. Lack of interest in food
  3. A recent episode of pharyngitis
  4. Vomiting for 2 days

2. Nurse Liza is administering a medication via the intraosseous route to a child. Intraosseous drug administration is typically used when a child is:

  1. Under age 3
  2. Over age 3
  3. Critically ill and under age 3
  4. Critically ill and over age 3

3. When assessing a child’s cultural background, the nurse in charge should keep in mind that:

  1. Cultural background usually has little bearing on a family’s health practices
  2. Physical characteristics mark the child as part of a particular culture
  3. Heritage dictates a group’s shared values
  4. Behavioral patterns are passed from one generation to the next

4. While examining a 2-year-old child, the nurse in charge sees that the anterior fontanel is open. The nurse should:

  1. Notify the doctor
  2. Look for other signs of abuse
  3. Recognize this as a normal finding
  4. Ask about a family history of Tay-Sachs disease

5. The nurse is aware that the most common assessment finding in a child with ulcerative colitis is:

  1. Intense abdominal cramps
  2. Profuse diarrhea
  3. Anal fissures
  4. Abdominal distention

6. When administering an I.M. injection to an infant, the nurse in charge should use which site?

  1. Deltoid
  2. Dorsogluteal
  3. Ventrogluteal
  4. Vastus lateralis

7. A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse in charge anticipates that the doctor will order which laboratory test?

  1. Total iron-binding capacity
  2. Hemoglobin
  3. Total protein
  4. Serum transferring

8. When developing a plan of care for a male adolescent, the nurse considers the child’s psychosocial needs. During adolescence, psychosocial development focuses on:

  1. Becoming industrious
  2. Establishing an identity
  3. Achieving intimacy
  4. Developing initiative

9. When developing a plan care for a hospitalized child, nurse Mica knows that children in which age group are most likely to view illness as a punishment for misdeeds?

  1. Infancy
  2. Preschool age
  3. School age
  4. Adolescence

10. Nurse Taylor suspects that a child, age 4, is being neglected physically. To best assess the child’s nutritional status, the nurse should ask the parents which question?

  1. “Has your child always been so thin?”
  2. “Is your child a picky eater?”
  3. “What did your child eat for breakfast?”
  4. “Do you think your child eats enough?”

11. A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?

  1. Heart rate, respiratory rate, and blood pressure
  2. Recent exposure to communicable diseases
  3. Number of immunizations received
  4. Height and weight

12. A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse’s response?

  1. The child forgets previously learned skills
  2. The child experiences growth while regressing, regrouping, and then progressing
  3. The parents may refer less mature behaviors
  4. The child returns to a level of behavior that increases the sense of security.

13. A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child’s vision, the nurse should ask:

  1. “Do you have any problems seeing different colors?”
  2. “Do you have trouble seeing at night?”
  3. “Do you have problems with glare?”
  4. “How are you doing in school?”

14. During a well-baby visit, Jenny asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first?

  1. Applesauce
  2. Egg whites
  3. Rice cereal
  4. Yogurt

15. To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which of the following agents?

  1. Epinephrine (Adrenalin)
  2. Isoproterenol (Isuprel)
  3. Atropine sulfate
  4. Lidocaine hydrochloride (Xylocaine)

16. A 1 year and 2-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the patient’s room, the nurse anticipates using which traction system?

  1. Bryant’s traction
  2. Buck’s extension traction
  3. Overhead suspension traction
  4. 90-90 traction

17. Mandy, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective?

  1. Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model
  2. Initiating a teenage parent support group with first – and – second-time mothers
  3. Using audiovisual aids that show discussions of feelings and skills
  4. Providing age-appropriate reading materials

18. When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This findings is associated with:

  1. Otogenous tetanus
  2. Tracheoesophageal fistula
  3. Congenital heart defects
  4. Renal anomalies

19. Nurse Raven should expect a 3-year-old child to be able to perform which action?

  1. Ride a tricycle
  2. Tie the shoelaces
  3. Roller-skates
  4. Jump rope

20. Nurse Betina is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?

  1. Eustachian tubes
  2. Nasopharynx
  3. Tympanic membrane
  4. External ear canal

21. The nurse is evaluating a female child with acute poststreptoccocal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?

  1. Increased urine output
  2. Increased appetite
  3. Increased energy level
  4. Decreased diarrhea

22. Dr. Smith prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child?

  1. To increase blood pressure
  2. To reduce inflammation
  3. To decrease proteinuria
  4. To prevent infection

23. Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggests a fluid volume deficit?

  1. A sunken fontanel
  2. Decreased pulse rate
  3. Increased blood pressure
  4. Low urine specific gravity

24. How should the nurse May prepare a suspension before administration?

  1. By diluting it with normal saline solution
  2. By diluting it with 5% dextrose solution
  3. By shaking it so that all the drug particles are dispersed uniformly
  4. By crushing remaining particles with a mortar and pestle

25. What should be the initial bolus of crystalloid fluid replacement for a pediatric patient in shock?

  1. 20 ml/kg
  2. 10 ml/kg
  3. 30 ml/kg
  4. 15 ml/kg

26. Becky, age 5, with intelligence quotient of 65 is admitted to the hospital for evaluation. When planning care, the nurse should keep in mind that this child is:

  1. Within the lower range of normal intelligence
  2. Mildly retarded but educable
  3. Moderately retarded but trainable
  4. Completely dependent on others for care

27. Maureen, age 12, is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the child’s nutritional intake, the nurse should ask:

  1. “What activities do you engage in during the day?”
  2. “Do you have any allergies to foods?”
  3. “Do you like yourself physically?”
  4. “What kinds of food do you like to eat?”

28. Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely?

  1. At 1 to 2 years of age
  2. At I week to 1 year of age, peaking at 2 to 4 months
  3. At 6 months to 1 year of age, peaking at 10 months
  4. At 6 to 8 weeks of age

29. When evaluating a severely depressed adolescent, the nurse knows that one indicator of a high risk for suicide is:

  1. Depression
  2. Excessive sleepiness
  3. A history of cocaine use
  4. A preoccupation with death

30. A child is diagnosed with Wilms’ tumor. During assessment, the nurse in charge expects to detect:

  1. Gross hematuria
  2. Dysuria
  3. Nausea and vomiting
  4. An abdominal mass
Answers and Rationales
  1. Answer C. A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever.
  2. Answer C. In an emergency, intraosseous drug administration is typically used when a child is critically ill and under age 3.
  3. Answer D. A family’s behavioral patterns and values are passed from one generation to the next. Cultural background commonly plays a major role in determining a family’s health practices. Physical characteristics do not indicate a child’s culture. Although heritage plays a role in culture, it does not dictate a group’s shared values and its effect on culture is weaker than that of behavioral patterns.
  4. Answer A. Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the doctor promptly of this finding. An open fontanel does not indicate abuse and is not associated with Tay-Sachs disease.
  5. Answer B. Ulcerative colitis causes profuse diarrhea, intense abdominal cramps, anal fissures, and abdominal distentions are more common in Crohn’s disease.
  6. Answer D. The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. The deltoid is inappropriate. The dorsogluteal and ventrogluteal sites can be used only in toddlers who have been walking for about 1 year.
  7. Answer C. A negative nitrogen balance may result from inadequate protein intake and is best detected by measuring the total protein level. Measuring total iron-bi8nding capacity, hemoglobin, and serum transferring levels would help detect iron-deficiency anemia, not a negativenitrogen balance.
  8. Answer B. According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers, and strives to attain a personal identity by becoming more independent form the family. Becoming industrious is the developmental task of the school-age child, achieving intimacy is the task of the young adult, and developing initiative is the task of the preschooler.
  9. Answer B. Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age group, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation.
  10. Answer C. The nurse should obtain objective information about the child’s nutritional intake, such as by asking about what the child ate for a specific meal. The other options ask for subjective replies that would be open to interpretation.
  11. Answer A. The most important data to obtain on a child’s arrival in the emergency department are vital sign measurements. The nurse should gather the other data later.
  12. Answer D. The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child’s skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors.
  13. Answer D. A child’s poor progress in school may indicate a visual disturbance. The other options are more appropriate questions to ask when assessing vision in a geriatric patient.
  14. Answer C. Rice cereal is the first solid food an infant should receive because it is easy to digest and is associated with few allergies. Next, the infant can receive pureed fruits, such as bananas, applesauce, and pears, followed by pureed vegetables, egg yolks, cheese, yogurt, and finally, meat. Egg whites should not be given until age 9 months because they may trigger a food allergy.
  15. Answer C. Succinycholine is an ultra-short-acting depolarizing agent used for rapid-sequence intubation. Bradycardia can occur, especially in children. Atropine is the drug of choice in treating succinylcholine-induced bradycardia. Lidocaine is used in adults only. Epineprine bolus and isoproterenol are not used in rapid-sequence intubation because of their profound cardiac effects.
  16. Answer A. Bryant’s traction is used to treat femoral fractures of congenital hip dislocation in children under age 2 who weigh less than 30 lb (13.6 kg). Buck’s extension traction is skin traction used for short-term immobilization or to correct bone deformities or contractures; overhead suspension traction is used to treat fractures of the humerus; and 90-90 traction is used to treat femoral fracture in children over age 2.
  17. Answer D. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The other options engage more than one of the senses and therefore serve as effective teaching strategies.
  18. Answer D. Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. Low-set ears do not accompany otogenous tetanus, tracheoesophageal fistula, or congenital heart defects.
  19. Answer A. At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills requires for roller-skating and jumping rope develop around age 5.
  20. Answer A. In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nosopharynx, tympanic membrane, external ear canal have no unusual features that would predispose a child to otitis media.
  21. Answer A. Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute poststreptoccocal glomerulonephritis (APSGN) is improving. Increased appetite, an increased energy level, and decreased diarrhea are not specific to APSGN.
  22. Answer C. The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. Corticosteroids have no effect on blood pressure. Although they help reduce inflammation, this is not the reason for their use in patients with nephritic syndrome. Corticosteroids may predispose a patient to infection.
  23. Answer A. In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with a high specific gravity.
  24. Answer C. The nurse should shake a suspension before administration to dispersed drug particles uniformly. Diluting the suspension and crushing particles are not recommended for this drug form.
  25. Answer A. Fluid volume replacement must be calculated to the child’s weight to avoid over-hydration. Initial fluid bolus is administered at 20 ml/kg, followed by another 20 ml/kg bolus if there is no improvement in fluid status.
  26. Answer B. According to the American Association on Mental Deficiency, a person with an intelligence quotient (IQ) between 50 and 70 is classified as mildly mentally retarded but educable. One with an IQ between 35 and 50 is classified as moderately retarded but trainable. One with an IQ below 36 is severely and profoundly impaired, requiring custodial care.
  27. Answer C. Role and relationship patterns focus on body image and the patient’s relationship with others, which commonly interrelated with food intake. Questions about activities and food preferences elicit information about health promotion and health protection behaviors. Questions about food allergies elicit information about health and illness patterns.
  28. Answer B. SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age.
  29. Answer D. An adolescent who demonstrates a preoccupation with death (such as by talking about death frequently) should be considered at high risk for suicide. Although depression, excessive sleepiness, and a history of cocaine use may occur in suicidal adolescents, they also occur in adolescents who are not suicidal.
  30. Answer D. The most common sign of Wilms’ tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms’ tumor. Nausea and vomiting are rare in children with Wilms’ tumor.