1. A 3-year-old child who has acute lymphoblastic leukemia (ALL) is scheduled to receive cranial radiation. The nurse should explain to the parents that radiation will:
avoid the need for chemotherapy.
reduce the risk for systemic infection.
limit metastasis to the lymphatic system.
prevent central nervous system involvement.
2. When planning discharge teaching for the parents of a child with asthma, what information should the nurse include?
Avoid foods high in fat.
Stay at home for two weeks.
Increase the protein and calorie intake.
Minimize exertion and exposure to cold.
3. A 10-year-old child is diagnosed with lymphocytic thyroid itis (Hashimoto disease). What should the nurse explain to the parents and child about this condition?
It is chronic.
Treatment is difficult.
It is an inherited disorder.
Regression occurs spontaneously.
4. The nurse observes that a 4-year-old child is having difficulty relating with some of the children in the playroom. What does the nurse identify is the reason that this problem is not unexpected with preschoolers?
At this age they engage only in parallel play.
At this age they are extremely dependent on their parents.
Fierce temper tantrums and negativism are typical behaviors.
Exaggerating and boasting to impress others are typical behaviors.
5. An 8-year-old child who has been receiving chemotherapy will soon return to school after a prolonged absence. Classmates are aware that the child is being treated for cancer. How should the school nurse prepare the class for the child’s return to school?
Encourage the students to think about how they feel toward their classmate.
Explain to the students why it is important to tolerate those who are different.
Ask the students not to make fun of their classmate because of lost weight and having no hair.
Initiate a discussion with the students about cancer treatments and the side effects of chemotherapy.
6. 7-year-old child develops a urinary tract infection. A sulfonamide preparation is prescribed. What is a major nursing responsibility when administering this drug?
Weigh the child daily.
Give the medication with milk.
Monitor the child’s temperature frequently.
Administer the drug at the prescribed times.
7. A nurse is attempting to involve a hospitalized preschooler in therapeutic play. Why is this so important?
The child can work out ways of coping with fears.
It provides an opportunity to accept the hospital situation.
The child can forget the reality of the situation for a little while.
It provides an opportunity to meet other children on the pediatric unit.
8. A 7-year-old child has recently been diagnosed with juvenile idiopathic arthritis (JIA). The parents are concerned about the lifelong effects of the disorder and are investigating other therapies to use with the medications. What referral should the nurse recommend?
Physical therapy
Special education
Nutritional therapy
Herbal supplements
9. Obesity in children is an ever-increasing problem. What should a nurse consider before confronting the problem with individual children?
Enjoyment of specific foods is inherited.
Childhood obesity is not usually a predictor of adult obesity.
Children with obese parents and siblings are destined for obesity.
Familial and cultural influences are deciding factors in eating habits.
10. What nursing intervention is most effective in alleviating the fretfulness of a hospitalized 5-year-old child?
Reading a story to the child
Giving a jigsaw puzzle to the child
Supplying the child with videos to watch
Offering the child crayons with drawing paper
11. A health care provider lists orders for a young child with a tentative diagnosis of Wilms tumor. Which order should the nurse question?
MRI
CT scan
Renal biopsy
Abdominal ultrasound
12. What nursing intervention will be most effective to help relieve the anxiety of a young school-age child during the postoperative period?
Encouraging the child to talk about feelings
Having the child and a parent room together
Telling the child a story about a child with similar surgery
Providing the child with sterile dressing equipment and a doll
13. A 5-year-old child is admitted to the pediatric intensive care unit with a diagnosis of acute asthma. A blood sample is obtained to measure the child’s arterial blood gases. What finding does the nurse expect?
High oxygen level
Elevated alkalinity
Decreased bicarbonate
Increased carbon dioxide level
14. Two second-graders are brought to the school health office after a fight during gym class. What should the school nurse say to the children?
“Why did you do this?”
“Tell me what happened.”
“You are both in a lot of trouble.”
“How many fights have you two had?”
15. A combination of drugs, including vincristine and prednisone, is prescribed for a child with leukemia. For what adverse effect should the nurse assess the child that indicates vincristine toxicity?
Hemolytic anemia
Irreversible alopecia
Gastrointestinal problems
Neurologic complications
16. A child has a tonsillectomy and adenoidectomy for numer ous recurrent respiratory tract infections. Postoperatively what should the nurse teach the parents to do?
Offer ice chips on which to suck.
Encourage the intake of ice cream.
Keep the child in the supine position.
Gargle with a diluted mouthwash solution.
17. A nurse is caring for a child with acute lymphoid leukemia who is receiving chemotherapy. The parents ask why the child needs prednisone. How should the nurse respond?
It decreases inflammation.
Production of lymphocytes is suppressed.
It increases appetite and a sense of well-being.
Irradiation skin irritation and edema are reduced.
18. A 4-year-old child newly diagnosed with leukemia is admitted for chemotherapy. While assisting with morning care, the nurse observes bloody expectorant after the child has brushed the teeth. How should the nurse respond to this occurrence?
Secure a smaller toothbrush for the child to use.
Document the incident without alarming the child.
Tell the child to be more careful when brushing the teeth.
Rinse the child’s mouth with half-strength hydrogen peroxide.
19. A nurse is planning a teaching program for a child who has recently been diagnosed with type 1 diabetes. What is the nurse’s first concern relating to the child and parents?
Exploring their feelings about diabetes
Needing to restrict the child’s activities
Learning to monitor blood glucose levels
Practicing administering insulin injections
20. A nurse is planning to teach about self-administration of insulin to a school-age child newly diagnosed with diabetes mellitus. What is the nurse’s first action?
Assess the child’s developmental level.
Determine the family’s understanding of the procedure.
Discuss community resources for the child in the future.
Collaborate with the school nurse for ensuring continuity of care in school.
21. An 11-year-old child with juvenile idiopathic arthritis (JIA) will be receiving continued nonsteroidal antiinflammatory drug (NSAID) therapy at home. Which important toxic effect of NSAIDs must be included in the nurse’s discharge instructions to the child and family?
Diarrhea
Hypothermia
Blood in the urine
Increased irritability
22. A child with nephrotic syndrome visits the clinic for a follow-up visit. During the visit the parent states that the child is always tired and has no appetite. The nurse observes that the child has a muddy, pale complexion. What problem does the nurse suspect?
Impending renal failure
Being too active in school
Developing a viral infection
Refusing the prescribed medications
23. The school nurse is planning to teach a class about nutrition. Which age group will be most receptive to this information?
6-year-old children
8-year-old children
11-year-old children
15-year-old children
24. The parents of a child with acute post streptococcal glomerulonephritis (APSGN) ask a nurse why their child is being weighed every morning. What is the nurse’s best response?
“It is the best way to measure your child’s fluid balance.”
“It provides a measure of how much protein is being lost.”
“The disease process usually is over when weight loss stops.”
“Plans for the daily caloric intake are made according to the daily weight change.”
25. A child recovering from a severe asthma attack is given prednisone 15 mg po twice daily. What is the priority nursing intervention?
Prevent exposing the child to infection.
Have the child rest as much as possible.
Check the child’s eosinophil count daily.
Offer nothing by mouth to the child except oral medications.
26. Which fifth-grader who needs help with social inter action should the school nurse appoint as a health office monitor?
One who is reserved, although strong academically
The child who has been identified as the class clown
One who comes to the health office daily for medication
The child who participates in a wide variety of school- related activities
27. A nurse is teaching a class of nursing assistants about the differences in providing care among various age groups. Which age group of children does the nurse explain makes the provision of nursing care the most challenging?
From 1 to 4 years of age
Between 6 and 8 years old
Between 6 and 12 months old
From birth to 6 months of age
28. A nurse is teaching a 12-year-old child with type 1 diabetes about the effects of Novolin N insulin. If the child receives the insulin at 7:30 AM, what time of day is an insulin reaction likely to occur?
8:30 PM
2:30 PM
9:30 AM
1:30 AM
29. After a tonsillectomy, which finding alerts the nurse to suspect the initial stage of hemorrhage?
Noisy snoring
Asking for water
Frequent swallowing
Gradual onset of pallor
30. A 4-year-old child is diagnosed with mucocutaneous lymph node syndrome (Kawasaki disease). The child is admitted to the pediatric unit and the nurse performs an initial assessment. What clinical finding supports this diagnosis?
Strawberry tongue
Copious discharges from the eyes
Insidious onset of low-grade fever
Maculopapular rash on the extremities
31. What toy should a nurse offer two 6-year-old children in the playroom?
Clay
Checkers
Board game
Building set
32. The parents of a 12-year-old child with juvenile idiopathic arthritis (JIA) ask a nurse why their child is not receiving steroid therapy because it is so effective for adults with rheumatoid arthritis. The nurse responds that it is not used as the first-choice drug for a preadolescent. On what aspect of the child’s development should the nurse explain it will have an adverse effect?
Growth
Sexuality
Emotions
Body image
33. A nurse is caring for a preschooler on the pediatric unit. What does the nurse identify as the child’s greatest fear at this age?
Death
Mutilation
Painful procedures
Isolation from peers
34. A 7-year-old child is expressing fear concerning an uncomfortable sterile dressing change. What should the nurse say to be most therapeutic?
“Do you want some medicine so it won’t hurt?”
“Will you help hold the package of bandages for me?
“This won’t hurt if you try to relax while closing your eyes.”
“I’ll put on television so you can watch it while I change the bandage.”
35. The parents of a child with acute post streptococcal glomerulonephritis (APSGN) tell the nurse that they are concerned about activity restrictions after discharge. How should the nurse respond?
Activity must be limited for 1 month.
The child should not play active games.
The child must remain in bed for 2 weeks.
Activity does not affect the course of the illness.
36. The nurse is providing instruction to a parent of a child with influenza. Which statement by the parent indicates the need for further instruction?
“I will manage the fever with baby aspirin.”
“We will make sure to get a flu shot next season.”
“Providing fluids will help relieve the symptoms.”
“Staying home from school will prevent transmission.”
37. A 7-year-old child is admitted for surgery. What is an essential preoperative nursing intervention?
Allow a favorite toy to remain with the child.
Document the child’s ASO titer and C-reactive protein level.
Inspect the child’s mouth for loose teeth and report the findings.
Encourage a parent to stay until the child leaves for the operating room.
38. What is the most important nursing intervention for a 3-year-old child with a diagnosis of nephrotic syndrome?
Regulating diet
Encouraging fluids
Preventing infection
Maintaining bed rest
39. Range-of-motion exercises are prescribed for a child with juvenile idiopathic arthritis (JIA). What criterion should the nurse use to evaluate the effectiveness of the exercises?
Pain is relieved.
Affected joints can flex and extend.
Pedal and radial pulses are diminished.
Subcutaneous nodules at the joints recede.
40. A nurse in the child life center encourages preschool children to engage in role-playing. The nurse considers this an important part of socialization because it:
helps children think about careers.
teaches children about stereotypes.
encourages expression of concerns.
provides guidelines for adult behavior.
41. A child has been admitted to the pediatric unit with a severe asthma attack. What type of acid-base imbalance should the nurse expect the child to develop?
Metabolic alkalosis caused by excessive production of acid metabolites
Respiratory alkalosis caused by accelerated respirations and loss of carbon dioxide
Respiratory acidosis caused by impaired respirations and increased formation of carbonic acid
Metabolic acidosis caused by the kidneys’ inability to compensate for increased carbonic acid formation
42. A peripheral central venous catheter has just been inserted in the arm of a 7-year-old child on the pediatric unit. A peripheral IV line is still in place. An antibiotic is to be administered immediately. Which intravenous access line should the nurse use for the antibiotic infusion and why?
Central venous catheter, because this will help determine its patency
Peripheral line, because the central venous catheter is reserved for fluids
Central venous catheter, because the antibiotic must be given systemically as quickly as possible
Peripheral line, because the central venous catheter placement has not been confirmed by radiograph
43. 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
44. An 11-year-old child has gained weight. The mother tells a nurse that she is concerned that her child, who loves sports, may become obese. What is the nurse’s most appropriate response?
Suggest an increase in activity.
Encourage a decreased caloric intake.
Explain this is expected during preadolescence.
Discuss the influence of genetics on weight gain.
45. What should be a school nurse’s first action when a child tells the nurse of a sore throat?
Examine the throat.
Have the child sent home.
Take the child’s temperature.
Secure a prescription for an oral analgesic.
46. A 3-year-old preschooler has been hospitalized with nephrotic syndrome. What is the best way for the nurse to evaluate fluid retention or loss?
Weigh daily at the same time.
Have the child urinate in a bedpan.
Measure the abdominal girth daily.
Test the child’s urine for proteinuria.
47. A young child with acute nonlymphoid leukemia is admitted to the pediatric unit with a fever and neutropenia. What are the most appropriate nursing interventions to minimize the complications associated with neutropenia?
Placing the child in a private room, restricting ill visitors, and using strict handwashing techniques
Encouraging a well-balanced diet, including iron-rich foods, and helping the child avoid overexertion
Avoiding rectal temperatures, limiting injections, and applying direct pressure for five minutes after venipuncture
Offering a moist, bland, soft diet; using toothettes rather than a toothbrush; and providing frequent saline mouthwashes
48. When planning nursing care for a 5-year-old child with acute post streptococcal glomerulonephritis (APSGN), what should the nurse emphasize that the child and family maintain?
A bland diet high in protein
Bed rest for at least four weeks
Isolation from children with infections
A daily intramuscular dose of penicillin
49. A 6-year-old child begins thumb-sucking after surgery. This was not the child’s behavior preoperatively. What is the best action for the nurse to take?
Accept the thumb-sucking.
Distract the child by playing checkers.
Report this behavior to the health care provider.
Tell the child that thumb-sucking causes buckteeth.
50. Parents express concerns to the nurse that their 4-year-old child is spending a large amount of time playing with an imaginary playmate. How should the nurse respond?
“Perhaps your child needs more interaction with friends.”
“You have reason to be concerned. This is not typical behavior.”
“Imaginary playmates are an important part of a young child’s life.”
“This is a sign of social immaturity. I recommend psychological counseling.”