NCLEX Practice Exam for Pediatric Nursing 3

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1.    The parents of a child, age 6, who will begin school in the fall ask the nurse for anticipatory guidance. The nurse should explain that a child of this age:

  1. Still depends on the parents
  2. Rebels against scheduled activities
  3. Is highly sensitive to criticism
  4. Loves to tattle

2.    While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and dehydration, the nurse teaches the parents about their infant’s dietary and fluid requirements. The nurse should include which other topic in the teaching session?

  1. Nursery schools
  2. Toilet Training
  3. Safety guidelines
  4. Preparation for surgery

3.    Nurse Betina should begin screening for lead poisoning when a child reaches which age?

  1. 6 months
  2. 12 months
  3. 18 months
  4. 24 months

4.    When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following?

  1. A reduced white blood cell count
  2. A decreased platelet count
  3. Shallow respirations
  4. Tachypnea

5.    After the nurse provides dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching?

  1. “Well follow these instructions until our child’s symptoms disappear.”
  2. “Our child must maintain these dietary restrictions until adulthood.”
  3. “Our child must maintain these dietary restrictions lifelong.”
  4. “We’ll follow these instructions until our child has completely grown and developed.”

6.    A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the toddler’s fontanels, what should the nurse expects to find?

  1. Closed anterior fontanel and open posterior fontanel
  2. Open anterior and fontanel and closed posterior fontanel
  3. Closed anterior and posterior fontanels
  4. Open anterior and posterior fontanels

7.    Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client’s fluid intake because fluid overload may cause:

  1. Cerebral edema
  2. Dehydration
  3. Heart failure
  4. Hypovolemic shock

8.    An infant is hospitalized for treatment of nonorganic failure to thrive. Which nursing action is most appropriate for this infant?

  1. Encouraging the infant to hold a bottle
  2. Keeping the infant on bed rest to conserve energy
  3. Rotating caregivers to provide more stimulation
  4. Maintaining a consistent, structured environment

9.    The mother of Gian, a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons, and that she recently had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to:

  1. Bananas
  2. Latex
  3. Kiwifruit
  4. Color dyes

10.    Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What’s the nurse’s best recommendation for helping the mother increase her child’s nutritional intake?

  1. Allow the child to feed herself
  2. Use specially designed dishes for children – for example, a plate with the child’s favorite cartoon character
  3. Only serve the child’s favorite foods
  4. Allow the child to eat at a small table and chair by herself

11.    Nurse Roy is administering total parental nutrition (TPN) through a peripheral I.V. line to a school-age child. What’s the smallest amount of glucose that’s considered safe and not caustic to small veins, while also providing adequate TPN?

  1. 5% glucose
  2. 10% glucose
  3. 15% glucose
  4. 17% glucose

12.    David, age 15 months, is recovering from surgery to remove Wilms’ tumor. Which findings best indicates that the child is free from pain?

  1. Decreased appetite
  2. Increased heart rate
  3. Decreased urine output
  4. Increased interest in play

13.    When planning care for a 8-year-old boy with Down syndrome, the nurse should:

  1. Plan interventions according to the developmental level of a 7-year-old child because that’s the child’s age
  2. Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays
  3. Assess the child’s current developmental level and plan care accordingly
  4. Direct all teaching to the parents because the child can’t understand

14.    Nurse Victoria is teaching the parents of a school-age child. Which teaching topic should take priority?

  1. Prevent accidents
  2. Keeping a night light on to allay fears
  3. Explaining normalcy of fears about body integrity
  4. Encouraging the child to dress without help

15.    The nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority?

  1. Changing the linens on the clients’ beds
  2. Restocking the bedside supplies needed for a dressing change on the upcoming shift
  3. Documenting the care provided during her shift
  4. Emptying the trash cans in the assigned client room

16.    Nurse Alice is providing cardiopulmonary resuscitation (CPR) to a child, age 4. the nurse should:

  1. Compress the sternum with both hands at a depth of 1½ to 2” (4 to 5 cm)
  2. Deliver 12 breaths/minute
  3. Perform only two-person CPR
  4. Use the heel of one hand for sternal compressions

17.    A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority?

  1. Instituting droplet precautions
  2. Administering acetaminophen (Tylenol)
  3. Obtaining history information from the parents
  4. Orienting the parents to the pediatric unit

18.    Sheena, tells the nurse that she wants to begin toilet training her 22-month-old child. The most important factor for the nurse to stress to the mother is:

  1. Developmental readiness of the child
  2. Consistency in approach
  3. The mother’s positive attitude
  4. Developmental level of the child’s peers

19.    An infant who has been in foster care since birth requires a blood transfusion. Who is authorized to give written, informed consent for the procedure?

  1. The foster mother
  2. The social worker who placed the infant in the foster home
  3. The registered nurse caring for the infant
  4. The nurse-manager

20.    A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client’s chemotherapy regimen is to:

  1. Prevent metabolic breakdown of xanthine to uric acid
  2. Prevent uric acid from precipitating in the ureters
  3. Enhance the production of uric acid to ensure adequate excretion of urine
  4. Ensure that the chemotherapy doesn’t adversely affect the bone marrow

21.    A 10-year-old client contracted severe acute respiratory syndrome (SARS) when traveling abroad with her parents. The nurse knows she must put on personal protective equipment to protect herself while providing care. Based on the mode of SARS transmission, which personal protective should the nurse wear?

  1. Gloves
  2. Gown and gloves
  3. Gown, gloves, and mask
  4. Gown, gloves, mask, and eye goggles or eye shield

22.    A tuberculosis intradermal skin test to detect tuberculosis infection is given to a high-risk adolescent. How long after the test is administered should the result be evaluated?

  1. Immediately
  2. Within 24 hours
  3. In 48 to 72 hours
  4. After 5 days

23.    Nurse Oliver s teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?

  1. Iron-rich formula and baby food
  2. Whole milk and baby food
  3. Skim milk and baby food
  4. Iron-rich formula only

24.    Gracie, the mother of a 3-month-old infant calls the clinic and states that her child has a diaper rash. What should the nurse advise?

  1. “Switch to cloth diapers until the rash is gone”
  2. “Use baby wipes with each diaper change.”
  3. “Leave the diaper off while the infant sleeps.”
  4. “Offer extra fluids to the infant until the rash improves.”

25.    Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first?

  1. Administer ipecac syrup
  2. Call an ambulance immediately
  3. Call the poison control center
  4. Punish the child for being bad

26.    A child has third-degree burns of the hands, face, and chest. Which nursing diagnosis takes priority?

  1. Ineffective airway clearance related to edema
  2. Disturbed body image related to physical appearance
  3. Impaired urinary elimination related to fluid loss
  4. Risk for infection related to epidermal disruption

27.    A 3-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. Which sign or symptom suggests excessive I.V. fluid intake?

  1. Worsening dyspnea
  2. Gastric distension
  3. Nausea and vomiting
  4. Temperature of 102°F (38.9° C)

28.    Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation?

  1. Oxygen saturation of 95%
  2. Mild work of breathing
  3. Absence of intercostals or substernal retractions
  4. History of steroid-dependent asthma

29.    Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus?

  1. Measuring head circumference
  2. Obtaining skull X-ray
  3. Performing a lumbar puncture
  4. Magnetic resonance imaging (MRI)

30.    An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching?

  1. Apply cool air under the cast with a blow-dryer
  2. Use sterile applicators to scratch the itch
  3. Apply cool water under the cast
  4. Apply hydrocortisone cream under the cast using sterile applicator.
Answers and Rationales
  1. Answer C. In a 6-year-old child, a precarious sense of self causes overreaction to criticism and a sense of inferiority. By age 6, most children no longer depend on the parents for daily tasks and love the routine of a schedule. Tattling is more common at age 4 to 5, by age 6, the child wants to make friends and be a friend.
  2. Answer C. The nurse always should reinforce safety guidelines when teaching parents how to care for their child. By giving anticipatory guidance the nurse can help prevent many accidental injuries. For parents of a 9-month-old infant, it is too early to discuss nursery schools or toilet training. Because surgery is not used gastroenteritis, this topic is inappropriate.
  3. Answer C. The nurse should start screening a child for lead poisoning at age 18 months and perform repeat screening at age 24, 30, and 36 months. High-risk infants, such as premature infants and formula-fed infants not receiving iron supplementation, should be screened for iron-deficiency anemia at 6 months. Regular dental visits should begin at age 24 months.
  4. Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.
  5. Answer C. A patient with celiac disease must maintain dietary restrictions lifelong to avoid recurrence of clinical manifestations of the disease. The other options are incorrect because signs and symptoms will reappear if the patient eats prohibited foods.
  6. Answer C. By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.
  7. Answer A. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increase intracranial pressure. Fluid overload won’t cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration is extreme. Hypovolemic shock would occur with an extreme loss of fluid of blood.
  8. Answer D. The nurse caring for an infant with nonorganic failure to thrive should maintain a consistent, structured environment that provides interaction with the infant to promote growth and development. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.
  9. Answer B. Children with spina bifida often develop an allergy to latex and shouldn’t be exposed to it. If a child is sensitive to bananas, kiwifruit, and chestnuts, then she’s likely to be allergic to latex. Some children are allergic to dyes in foods and other products but dyes aren’t a factor in a latex allergy.
  10. Answer A. The best recommendation is to allow the child to feed herself because the child’s stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation. The child should be offered new foods and choices, not just served her favorite foods. Using a small table and chair would also enhance the primary recommendation.
  11. Answer B. The amount of glucose that’s considered safe for peripheral veins while still providing adequate parenteral nutrition is 10%. Five percent glucose isn’t sufficient nutritional replacement, although it’s sake for peripheral veins. Any amount above 10% must be administered via central venous access.
  12. Answer D. One of the most valuable clues to pain is a behavior change: A child who’s pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration.
  13. Answer C. Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age. Because children with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed. A child with Down syndrome is capable of learning, especially a child with mild limitations.
  14. Answer A. Accidents are the major cause of death and disability during the school-age years. Therefore, accident prevention should take priority when teaching parents of school-age children. Preschool (not school-age) children are afraid of the dark, have fears concerning body integrity, and should be encouraged to dress without help (with the exception of tying shoes).
  15. Answer C. Documentation should take top priority. Documentation is the only way the nurse can legally claim that interventions were performed. The other three options would be appreciated by the nurses on the oncoming shift but aren’t mandatory and don’t take priority over documentation.
  16. Answer D. The nurse should use the heel of one hand and compress 1” to 1½ “. The nurse should use the heels of both hands clasped together and compress the sternum 1½ “to 2” for an adult. For a small child, two-person rescue may be inappropriate. For a child, the nurse should deliver 20 breaths/minute instead of 12.
  17. Answer A. Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be prescribed but administering it doesn’t take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit don’t take priority.
  18. Answer A. If the child isn’t developmentally ready, child and parent will become frustrated. Consistency is important once toilet training has already started. The mother’s positive attitude is important when the child is ready. Developmental levels of children are individualized and comparison to peers isn’t useful.
  19. Answer A. When children are minors and aren’t emancipated, their parents or designated legal guardians are responsible for providing consent for medical procedures. Therefore, the foster mother is authorized to give consent for the blood transfusion. The social workers, the nurse, and the nurse-manager have no legal rights to give consent in this scenario.
  20. Answer A. The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn’t act in the manner described in the other options.
  21. Answer D. The transmission of SARS isn’t fully understood. Therefore, all modes of transmission must be considered possible, including airborne, droplet, and direct contact with the virus. For protection from contracting SARS, any health care worker providing care for a client with SARS should wear a gown, gloves, mask, and eye goggles or an eye shield.
  22. Answer C. Tuberculin skin tests of delayed hypersensitivity. If the test results are positive, a reaction should appear in 48 to 72 hours. Immediately after the test and within 24 hours are both too soon to observe a reaction. Waiting more than 5 days to evaluate the test is too long because any reaction may no longer be visible.
  23. Answer D. The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn’t receive solid food – even baby food – until age 6 months. The Academy doesn’t recommend whole milk until age 12 months, and skim milk until after age 2 years.
  24. Answer C. Leaving the diaper off while the infant sleeps helps to promote air circulation to the area, improving the condition. Switching to cloth diapers isn’t necessary; in fact, that may make the rash worse. Baby wipes contain alcohol, which may worsen the condition. Extra fluids won’t make the rash better.
  25. Answer C. Before interviewing in any way, the parents should call the poison control center for specific directions. Ipecac syrup is no longer recommended. The parents may have to call an ambulance after calling the poison control center. Punishment for being bad isn’t appropriate because the parents are responsible for making the environment safe.
  26. Answer A.Initially, when a preschool client is admitted to the hospital for burns, the primary focus is on assessing and managing an effective airway. Body image disturbance, impaired urinary elimination, and infection are all integral parts of burn management but aren’t the first priority.
  27. Answer A. Dyspnea and other signs of respiratory distress signify fluid volume excess (overload), which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention may suggest excessive oral fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit.
  28. Answer D. A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.
  29. Answer A. Measuring head circumference is the most important assessment technique for recognizing possible hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis. A lumber puncture isn’t appropriate.
  30. Answer A. Itching underneath a cast can be relieved by directing blow-dyer, set, on the cool setting, toward the itchy area. Skin breakdown can occur if anything is placed under the cast. Therefore, the client should be cautioned not to put any object down the cast in an attempt to scratch.