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1. An infant has a plaster cast applied for clubfoot correction. What nursing intervention will hasten drying of the cast?

• Using a blow dryer
• Opening the window
• Exposing the casted extremity
• Covering the cast with a light sheet

2. What should a nurse teach the parents of a toddler newly diagnosed with cystic fibrosis about the administration of vitamins A, D, E, and K?

• Offer them in a water-miscible form.
• Give them during meals and snack time.
• Calibrate them based on height and weight.
• Present them with fruit juice rather than milk.

3. The parents of a 4-year-old child are concerned about the effects of hospitalization on their child. Which behavior should the nurse expect the child to exhibit?

• Refuse to cooperate with the nurses when the parents are absent
• Demonstrate despair if the parents do not visit at least once a day
• Cry when the parents leave and return but not during their absence
• Be unable to relate to children in the playroom if other parents are present

4. When is the most appropriate time for the nurse to plan for chest percussion and postural drainage for a toddler with cystic fibrosis?

• After suctioning
• Before aerosol therapy
• One hour before meals
• Fifteen minutes after meals

5. A nurse is obtaining a health history from the parents of a child with celiac disease. What characteristic does the nurse expect when the parents describe their child’s stools?

• Small, pale, mucoid
• Large, frothy, green
• Large, pale, foul-smelling
• Moderate, green, foul-smelling

6. A nurse is caring for a child with sickle cell anemia. What is the priority nursing intervention to prevent thrombus formation in capillaries and the stasis and clotting of blood that occur in the sickling process?

• Encourage fluids.
• Encourage bed rest.
• Administer oxygen.
• Administer prescribed anticoagulants.

7. A 4-year-old child with nephrotic syndrome is being treated with corticosteroid therapy. A nurse reviews the laboratory reports of the child’s urine to evaluate if the treatment has been effective. Which of the following should decrease?

• Polyuria
• Hematuria
• Glycosuria
• Proteinuria

8. A child receives a gastrostomy tube feeding every 4 hours. What is the priority nursing intervention for this child?

• Open the tube one hour before feeding.
• Keep the child lying flat during the feeding.
• Flush the tube with normal saline after feeding.
• Position the child on the right side after feeding.

9. A 3-year-old child is admitted with partial- and full-thickness burns over 30% of the body. What significant adverse outcome during the first 48 hours should the nurse attempt to prevent?

• Shock
• Pneumonia
• Contractures
• Hypertension

10. During a well-child visit the parents tell a nurse, “Our 3-year-old child does not listen to us when we speak and ignores us.” After an auditory screening, it is determined that the child has a mild hearing loss. What should the nurse explain to the parents about a mild hearing loss?

• A severe hearing deficit may develop.
• It will not interfere with progress in school.
• An immediate follow-up visit is not necessary.
• Speech therapy in addition to hearing aids may be required.

11. A child with 3-thalassemia (Cooley anemia) is admitted to the ambulatory care unit for a transfusion. What instruc tions should the nurse include in the discharge plan?

• Encourage fluids.
• Restrict activities.
• Protect from infections.
• Offer small meals frequently.

12. An unconscious child requires intermittent nasogastric feedings. When should the nurse check placement of the tube?

• Once a day
• Before each feeding
• At every shift change
• During the night shift

13. What should the nurse teach parents is the major influence on the eating habits of early school-age children?

• Smell and appearance of food
• Availability of food selections
• Food preferences of the peer group
• Example of parents and siblings at mealtimes

14. The parent of a 14-month-old toddler asks the nurse about how to proceed with bowel training. What should the nurse recommend to optimize success?

• Place the child on the toilet every 2 hours.
• Start by having the child sit on a potty chair.
• Avoid bowel training until the child is 2 years old.
• Begin before the child’s diet consists mainly of solid foods.

15. A child with cystic fibrosis has recurrent episodes of bronchitis and the parents ask the nurse why this happens. What reason should the nurse include in the reply?

• Associated heart defects cause heart failure and respiratory depression.
• Neuromuscular irritability causes spasm and constriction of the bronchi.
• Tenacious secretions that obstruct the respiratory tract provide a favorable medium for growth of bacteria.
• Elevated salt content in saliva irritates the mucous membranes, resulting in inflammation of the nasopharynx.

16. A nurse working at a summer camp is informed of an outbreak of scabies. For what clinical indicator should the nurse screen the children?

• Pruritic, threadlike lesions in skin folds
• Grayish white particles adhering to hair shafts
• Central necrotic ulcer surrounded by petechiae
• Reddened, round areas of alopecia over the scalp

17. Mebendazole (Vermox) is prescribed for a child with pinworms. For whom should this medication also be prescribed?

• The child’s infant brother
• People using the same toilet facilities as the child
• Members of the child’s family after they test positive
• The child’s immediate family members even if they are symptom-free

18. What nursing care to prevent a crisis is the same for children with sickle cell anemia and celiac disease?

• Limit activity.
• Protect from infection.
• Document color and consistency of stools.
• Offer a low-carbohydrate, high-protein, low-fat diet.

19. A nurse can assist in confirming a suspected diagnosis of intestinal infestation with pinworms in a 6-year-old child by:

• teaching the mother the procedure for an anal cellophanetape test.
• asking the mother to collect stools for 3 consecutive days for culture.
• having the mother bring in the child’s stools for visual examination for 3 days.
• assisting the mother to schedule a hypersensitivity test of the child’s blood serum.

20. When a nurse brings a dinner tray to a 4-year-old child hospitalized with pneumonia, the child says, “I’m too sick to feed myself.” How should the nurse respond?

• “Try to eat as much as you can.”
• “You can eat later when you feel better.”
• “Wait a few minutes, and I will be back to help you.”
• “You’re really not that sick, and I’m sure you can feed yourself.”

21. A child with cystic fibrosis has been hospitalized with bacterial pneumonia. The nurse determines that the child has no known allergies. What does the nurse conclude about the reason the health care provider selected a specific antibiotic?

• Tolerance of the child
• Sensitivity of the bacteria
• Selectivity of the bacteria
• Preference of the health care provider

22. A nurse is performing health screening of toddlers in a culturally diverse neighborhood. Which child should the nurse consider at risk for 3-thalassemia (Cooley anemia)?

• Two-year-old child of Greek descent with a large abdomen
• Eighteen-month-old child of Irish descent with very pale skin color
• Three-year-old child of Spanish descent with an increased hematocrit
• Twenty-month-old child of Asian descent with edematous knee joints

23. A child with sickle cell disease has a sequestration crisis. The parents ask how it differs from a painful episode (vasoocclusive crisis). What should the nurse consider before responding?

• There is peripheral ischemia along with the pain.
• There is decreased blood volume and signs of shock.
• Red blood cell production diminishes with severe anemia.
• Red blood cell destruction is accelerated and jaundice appears.

24. A nurse teaches a 5-year-old child with cystic fibrosis how to use an inhaler. What is the most appropriate way to evaluate understanding of the technique?

• Asking questions about using the inhaler
• Showing the nurse how to use the inhaler
• Explaining how the inhaler will be used at home
• Telling the nurse about the technique that was learned

25. A child is to receive a blood transfusion. What should the nurse do first if an allergic reaction to the blood occurs?

• Shut off the infusion.
• Slow the rate of flow.
• Administer an antihistamine.
• Call the health care provider.

26. The parents of a child newly diagnosed with cystic fibrosis ask a nurse what causes the problems related to this disorder. What should the nurse consider about the primary pathology before responding?

• Hyperactivity of the eccrine (sweat) glands
• Hypoactivity of the autonomic nervous system
• Mechanical obstruction of mucus-secreting glands
• Atrophic changes in the mucosal lining of the intestines

27. The parents of a 6-year-old child with celiac disease tell the school nurse that their child becomes dejected because of not being able to eat “snack” food like the rest of the children. What snack can the nurse recommend that is safe for the child to eat?

• Pretzels
• Tortilla chips
• Oatmeal cookies
• Peanut butter crackers

28. A nurse is assessing a school-age child with cystic fibrosis. What complication of frequent stools and tenacious mucus does the nurse anticipate?

• Anal fissures
• Rectal prolapse
• Intussusception
• Meconium ileus

29. What is a nurse’s best approach when preparing a 4-year-old child for an otoscopic examination?

• “This tube will feel like a pencil in your ear.”
• “You can help by holding this tube while I get ready.”
• “Please try to sit very still while I’m looking through the tube.”
• “It won’t hurt a bit when I look into your ear through this tube.”

30. The parents of a child newly diagnosed with cystic fibrosis ask a nurse what causes the foul-smelling, frothy stool. What should be included in the nurses answer?

• Undigested fat
• Sodium and chloride
• Lipase, trypsin, and amylase
• Partially digested carbohydrates

31. A pale, lethargic 1-year-old infant weighs 12.6 kg (28 lb) and has a hemoglobin level of 9 g/dL. The parent tells the nurse that the infant refuses solid food when it is offered by spoon and drinks between four and six full bottles of milk per day. What should the nurse recommend?

• Begin the weaning process immediately.
• Take the infant to the metabolic clinic for an examination.
• Give the infant finger foods such as dry cereal and chopped meat.
• Puncture a large hole in the nipple and add pureed baby foods to the milk.

32. A 6-year-old child has partial-thickness burns of the face and upper chest. What is the priority nursing assessment for the first 24 hours?

• Wound sepsis
• Pulmonary distress
• Fear and separation anxiety
• Fluid and electrolyte imbalance

33. A 4-year-old child is diagnosed with acute lymphoblastic leukemia (ALL). One of the parents tells the nurse, “We just had a discussion with our pediatrician about induction che­motherapy, consolidation therapy, and radiation therapy. We are so confused and don’t know what to do. We want to do what is best for our child, but we don’t want any unnecessary suffering.” What is the nurse’s best response?

• “The new treatment protocols have shown to have excel­lent results."
• “There are support groups for parents with children who have leukemia.”
• “Let me get you the telephone number of the Leukemia Society, where you can get some advice.”
• “Maybe you could talk with your health care provider about getting a second opinion from a specialist in leukemia.”

34. The nurse observes that a 6-month-old infant is startled by a loud noise but does not turn in the direction of the sound. How should the nurse interpret this response?

• Effect of vision deficits
• Evidence of hearing loss
• Low-normal hearing range
• Developmentally appropriate

35. After many episodes of otitis media, a 3-year-old child is to have a myringotomy with tubes implanted surgically. What should the nurse include in the discharge preparation for this family?

• Keep the child at home for one week.
• Insert earplugs during the child’s bath.
• Apply an ointment to the ear canal daily.
• Use cotton swabs to clean the inner ears.

36. A child in sickle cell crisis (painful episode) reports right knee pain. What should the nurse anticipate the health care provider will order?

• Wrap the knee in a cold pack.
• Apply a warm soak to the knee.
• Administer 0.5 mg of morphine.
• Decrease the amount of IV fluids.

37. The parents of a child newly diagnosed with cystic fibrosis tell a nurse that even though they were told it is an inherited disorder there is no history of cystic fibrosis in the family. How can the nurse clarify the way it was inherited?

• It is a mutated gene.
• It involves an X-linked gene.
• The inheritance is autosomal recessive.
• The inheritance is autosomal dominant.

38. What is the best way for a nurse to meet a 3-year-old child sitting in the waiting room of the pediatric clinic?

• Walk into the waiting room to greet the child.
• Call the child by name at the waiting room door.
• Ask the receptionist to bring the child into the examining room.
• Stand at the examining room door while the child walks down the hall.

39. A nurse teaches a parent how to perform a cellophane-tape test for pinworms. At what time should the nurse teach the parent to perform the test?

• Immediately after meals
• Following a bowel movement
• At bedtime before the child’s bath
• Early morning before the child gets up

40. A nurse is caring for a preschooler who is being prepared for surgery. What does the nurse expect to have the most influ­ence on the child’s response to hospitalization?

• Fear of separation
• Fear of bodily harm
• Belief in death’s finality
• Belief in the supernatural

41. The health care provider prescribes mebendazole (Vermox) for a 4-year-old child with pinworms. What should the nurse prepare the parents to expect when they observe the child’s stool?

• Blood
• Constipation
• Yellow color
• Passage of worms

42. A child is admitted to the pediatric unit with a hemoglobin level of 6.4 g/dL. What should be the nurse’s priority assessment?

• Manifestations of shock
• Increased white cell count
• Presence of hemoglobinuria
• Signs of cardiac decompensation

43. A 4-year-old child is brought to the emergency department after falling on the handlebars of a tricycle. The child is guarding the abdomen, crying, and not allowing any physi­cal contact with the staff. Which action best enables the nurse to initiate the assessment process?

• Medicate the child for pain before proceeding.
• Allow the child to guide the examiner’s hand to the area that hurts
• Have the parents restrain the child while the abdomen is auscultated
• Suggest the health care provider order a computed tomography of the child’s abdomen.

44. When counseling the parents of a child with anemia related to an inadequate diet, a nurse explains that several different nutrients are involved. These nutrients include protein, iron, and vitamin B12. What other nutrient should the nurse include?

• Calcium
• Thiamine
• Folic acid
• Riboflavin

45. What is an important nursing intervention during the care of a hospitalized child with cystic fibrosis?

• Discourage coughing.
• Perform postural drainage.
• Encourage active exercise.
• Provide small, frequent feedings.

46. Pinworms cause a number of symptoms besides anal itching. A complication of pinworm infestation, although rare, that the nurse should be aware of is:

• hepatitis.
• stomatitis.
• pneumonitis.
• appendicitis.

47. A child with nephrotic syndrome has repeated relapses. As the child gets older, what is most important for the nurse to help the child develop?

• A positive body image
• The ability to test urine
• Fine muscle coordination
• Acceptance of possible sterility

48. A young child with a leg fracture of suspicious origin is brought into the emergency department by the mother and the mother’s boyfriend. It is the child’s first visit to this hospital. After assessing the child, a nurse anticipates that the health care provider will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool?

• The exact location and extent of the fracture will be pinpointed.
• It is the first step toward a complete assessment before a CT scan and an MRI are done.
• Three separate x-ray films of the leg and hip should be ordered, making it more cost effective.
• The skeletal history of the current fracture and any previous healing or healed fractures are identified.

49. A nurse is planning for the discharge of a child after a sickle cell vaso-occlusive crisis (pain episode). What is most important for the nurse to emphasize?

• A high-calorie diet
• A rigorous exercise regimen
• An increased intake of fluids
• An increase in the hours spent sleeping

50. A 4-year-old child being admitted for surgery arrives on the ambulatory surgical unit crying and pulling at the hospital gown while clutching a teddy bear. What is the nurse’s bestresponse?

• “Please stop crying. Nobody will hurt you.”
• “Hello, I’m your nurse. Let’s go and see your room.”
• “I know you feel scared. This must be your special teddy bear.”
• “We want you to be happy here. Let’s go to the playroom and play.”