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1. A child with acute lymphoid leukemia (ALL) is started on chemotherapy protocol that includes prednisone. What side effect of this medication does the nurse anticipate?

• Alopecia
• Anorexia
• Weight loss
• Mood changes

2. An adolescent sustains a sports-related fracture of the femur, and an open reduction and internal fixation with a rod insertion is performed. After the surgery, a nurse identifies that the adolescent is very upset. Considering the developmental level, what does the nurse conclude is the most likely explanation for this distress?

• The need to navigate in a wheelchair
• The perception that the rod is a body intrusion
• Inability to participate in sports for several years
• Relief of pain will necessitate medication until the bone heals

3. One principle to be followed for children with type 1 dia­betes is to provide for the variability of the child’s activity. What should the nurse teach the child about how to com­pensate for increased physical activity?

• Eat more food when planning to exercise more than usual.
• Take oral, not injectable insulin, on days of heavy exercise
• Take insulin in the morning when extra exercise is anticipated
• Eat foods that contain sugar to compensate for the extra exercise.

4. The parent of a child with hemophilia asks the nurse, “If my son hurts himself, is it all right if I give him two baby aspi­rins?” How should the nurse respond?

• “You seem concerned about giving drugs to your child.”
• “It is all right to give him baby aspirin when he hurts himself.”
• “Aspirin may cause more bleeding. Give him acetamino­phen instead.”
• “He should be given acetaminophen every day. It will prevent bleeding.”

5. When teaching an adolescent with type 1 diabetes about dietary management, what should the nurse include?

• Meals should be eaten at home.
• Foods should be weighed on a gram scale.
• Ready source of glucose should be available.
• Specific foods should be cooked for the adolescent.

6. A nurse is planning to discuss the importance of following the prescribed course of treatment with a group of adolescent clients. What should the nurse first consider about their approach to illness and treatment?

• They are in touch with their feelings and concerns.
• Their thinking is both concrete and reality oriented.
• They are involved more with the present than the future.
• Their developmental goal is striving for industry versus inferiority.

7. A 15-year-old adolescent who has type 1 diabetes arrives at the diabetic outpatient clinic with a parent. The adolescent sits back in the chair with arms folded, frowns, and displays an “I don’t care” attitude. The adolescent and parent argue in front of the nurse. What is the best approach for the nurse to use?

• Encourage the adolescent to take more interest in and responsibility for treatment.
• Speak separately with each of them, encouraging them to recognize and vent their anger.
• Try to persuade the two of them to work out their differences together before returning to the clinic.
• Ask the parent to stay in the waiting room while the adolescent meets with the clinics staff members.

8. At 7 AM, a nurse receives the information that an adolescent with diabetes has a 6:30 AM fasting blood glucose level of 180 mg/dL. What is the priority nursing action at this time?

• Encourage the adolescent to start exercising.
• Ask the adolescent to obtain an immediate glucometer reading.
• Inform the adolescent that a complex carbohydrate such as cheese should be eaten.
• Tell the adolescent that the prescribed dose of rapid acting insulin should be administered.

9. An adolescent with terminal cancer tells the home care nurse, “I would really like to get my high school equivalency diploma. Do you think this is possible?” What is the nurse’s best approach in response to the adolescent’s question?

• Refocus the conversation on things the adolescent has already accomplished in life.
• Try to help the adolescent understand that this wish is too taxing and slightly unrealistic.
• Arrange for a conference with the school and encourage the adolescent to prepare for the test.
• Suggest to the adolescent that this energy should be directed toward expressing feelings about the illness.

10. An adolescent arrives at the clinic reporting experiencing buzzing in the ears. What assessment data are essential for the nurse to obtain?

• Music preferences
• Childhood ear infections
• Recent emotional trauma
• Familial history of deafness

11. A 6-year-old child comes to the school nurse reporting a sore throat, and the nurse verifies that the child has a fever and a red, inflamed throat. When a parent of the child arrives at school to take the child home, the nurse urges the parent to seek treatment. The nurse is aware that the causative agent may be beta-hemolytic streptococcus, and the illness may progress to inflamed joints and an infection in the heart. What illness is of most concern to the nurse?

• Tetanus
• Influenza
• Scarlet fever
• Rheumatic fever

12. A 13-year-old adolescent is diagnosed as having idiopathic scoliosis. Because exercise and avoidance of fatigue are essential components of care, which sport should the nurse suggest will be most therapeutic for this preadolescent?

• Golf
• Bowling
• Swimming
• Badminton

13. An adolescent with a serious health problem refuses to wear a medical alert bracelet. How can a nurse foster wearing of the bracelet?

• Recommend hiding the bracelet under long-sleeved clothes.
• Suggest wearing the bracelet when engaging in contact sports.
• Encourage the teenager to ask friends to wear similar bracelets.
• Help the teenager select a bracelet that is similar to those worn by peers.

14. A child has been diagnosed with classic hemophilia. A nurse teaches the child’s parents how to administer the plasma component factor VIII through a venous port. It is to be given 3 times a week. What should the nurse tell them about when to administer this therapy?

• Whenever a bleed is suspected
• In the morning on scheduled days
• At bedtime while the child is lying quietly in bed
• On a regular schedule at the parents’ convenience

15. A nurse is planning an evening snack for a child receiving Novolin N insulin. What is the reason for this nursing action?

• It encourages the child to stay on the diet.
• Energy is needed for immediate utilization.
• Extra calories will help the child gain weight.
• Nourishment helps to counteract late insulin activity.

16. A nurse is explaining how hemophilia is inherited to the parents of a recently diagnosed child. What is the bestexplanation of the genetic factor that is involved?

• It follows the Mendelian law of inherited disorders.
• The mother is the carrier of the disorder, but is not affected by it.
• It is an autosomal dominant disorder in which the woman carries the trait.
• A carrier can be male or female, but it occurs in the sex opposite that of the carrier.

17. How can a nurse best accomplish therapeutic communication with an adolescent?

• Using teen language
• Relating on a peer level
• Establishing a relationship over time
• Interacting by using concrete concepts

18. After orthopedic surgery, a 15-year-old adolescent reports a pain rating of 5 on a scale of 0 to 10. A nurse administers the prescribed 5 mg of oxycodone every 3 hours prn. Two hours after having been given this medication, the adolescent reports a pain rating of 10 out of 10. What action should the nurse take?

• Administer another dose of oxycodone within 30 minutes.
• Report that the adolescent has an apparent idiosyncrasy to oxycodone.
• Tell the adolescent that additional medication cannot be given for 1 more hour.
• Request that the health care provider evaluate the need for additional medication.

19. A 13-year-old boy tells the school nurse that he is getting breasts. How should the nurse respond?

• “This is expected at your age; let’s talk about it.”
• “You should get a physical; I’ll talk with your parents about this.”
• “There is nothing to worry about; this happens to a lot of boys your age.”
• “Wear a tight undershirt inside a button-down shirt; that should hide them.”

20. An 8-year-old child is diagnosed with Legg-Calve-Perthe disease. The health care provider orders an abduction brace 23 hours a day and non-weight-bearing activity. What should the nurse teach the parents to do?

• Have the child transfer to a wheelchair using the unaf­fected leg
• Explain that kneeling, but not standing, on the affected leg is permitted.
• Perform range-of-motion exercises to the lower extre­mities twice a day.
• Crutches can be used as long as the four-point gait is used when walking.

21. A nurse on the adolescent unit is planning to discuss smoking prevention. What is the most effective approach for the nurse to use?

• Share personal experiences with a smoking cessation program.
• Show pictures of the effects of smoking on the cardiopulmonary system.
• Present information on how smoking affects appearance and odor of the breath.
• Cite statistics about the relationship between smoking and cardiopulmonary diseases.

22. A nurse is teaching growth and development to a group of parents. When discussing puberty, one parent asks at what age a girl will get her first period. How should the nurse respond?

• Before the pubic hair appears
• About the same time the breasts develop
• At the end of the prepubertal growth spurt
• Near the age the mother had her first period

23. To slow the progression of the curvature, the preadolescent with scoliosis is fitted with a brace. How should the nurse respond to the parents’ questions about when the brace will no longer be needed?

• After cessation of bone growth
• After the curvature has straightened
• When the iliac crests are at equal levels
• When pain-free after prolonged standing

24. A nurse is interviewing an adolescent who is to start on a chemotherapeutic drug regimen that includes vincristine. For which side effect is it most important for the nurse to prepare the adolescent?

• Alopecia
• Constipation
• Loss of appetite
• Peripheral neuropathy

25. A nurse is developing a teaching plan for an 8-year-old child who has recently been diagnosed with type 1 diabetes. What developmental characteristic of a child this age should the nurse consider?

• Child is in the abstract level of cognition.
• Child’s dependence on peer influence has reached its peak.
• Child will welcome opportunities for participation in self-care.
• Child’s developmental stage involves achieving a sense of identity.

26. Based on developmental norms for a 5-year-old child, a nurse decides to withhold a scheduled dose of digoxin (Lanoxin) elixir and notify the health care provider. Below what apical pulse did the nurse withhold the medication?

• 60 beats/min
• 70 beats/min
• 90 beats/min
• 100 beats/min

27. What medication does a nurse expect to administer to control bleeding in a child with hemophilia A?

• Albumin
• Fresh frozen plasma
• Factor VIII concentrate
• Factors II, VII, IX, X complex

28. What treatment should the nurse suggest to an adolescent with type 1 diabetes if an insulin reaction is experienced while at a basketball game?

• “Call your parents immediately.”
• “Buy a soda and hamburger to eat.”
• “Administer insulin as soon as possible.”
• “Leave the arena and rest until the symptoms subside.”

29. A nurse is teaching a group of parents about a developmental expectation that occurs in girls at about 10 years of age. What should the nurse explain about one of the earliest signs of sexual maturity?

• Interest in the opposite sex
• Paying attention to grooming
• The first menstrual period or menarche
• The appearance of axillary and pubic hair

30. A parent receives a note from school that a student in class has head lice. The parent calls the school nurse to ask how to check for head lice. What instructions should the nurse provide?

• “Ask the child where it itches."
• “Check to see if your dog has ear mites.”
• “Look along the scalp line for white dots.”
• “Observe between the fingers for red lines.”