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1. A parent and 4-year-old child who recently emigrated from Colombia arrive at the pediatric clinic. The child has a temperature of 102° F, is irritable, and has a runny nose. Inspection reveals a rash and several small, red, irregularly shaped spots with blue-white centers in the mouth. What illness does the nurse suspect the child has?

• Measles
• Chickenpox
• Fifth disease
• Scarlet fever

2. A school nurse is teaching parents of school-age children about the importance of immunizations for the childhood communicable diseases. What preventable disease may cause the complication of encephalitis?

• Varicella
• Scarlet fever
• Poliomyelitis
• Whooping cough

3. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the health care provider prescribed 150 mg. What is the nurse’s best response to the parent?

• “The dose is close enough, and it doesn’t really matter which one is given.”
• “From your description, the medications are not necessary. They should be avoided at this age.”
• “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

4. A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and it was positive. She adds that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl if she has told this to anyone, she replies, “Yes, but my mother doesn’t believe me.” Legally, who should the nurse notify?

• Police concerning a possible sex crime
• Health care provider to confirm the pregnancy
• Child Protective Services for immediate intervention
• Girl’s mother about the pregnancy test’s positive result

5. During a nap, a 3-year-old hospitalized child wets the bed. How should the nurse respond?

• Ask the child to help with remaking the bed.
• Put clean sheets on the bed over a rubber sheet.
• Change the child’s clothes without discussing the incident.
• Explain that children should call the nurse when they need to go to the bathroom.

6. When teaching a group of parents in the daycare center about accident prevention, the nurse explains that young toddlers are prone to injuries from falls. When receiving feedback, the nurse identifies that more teaching is needed when one parent states, “I will:

• keep medications in a medicine cabinet.”
• have secured gates at entrances to staircases.”
• move our child to a regular bed by the age of 2J4.”
• buy shoes that close with Velcro rather than laces.”

7. After the nurse has completed an oral examination of a healthy 2-year-old child, the parent asks when the child should first be taken to the dentist. When is the most appropriate time in the child’s life for the nurse to suggest?

• Before starting school
• Within the next few months
• When the first deciduous teeth are lost
• At the next time a family member visits the dentist

8. A nurse on the pediatric unit is observing the developmental skills of several 2-year-old children in the playroom. Which child should the nurse continue to evaluate?

• Cannot stand on 1 foot
• Builds a tower of 7 blocks
• Uses echolalia when speaking
• Colors outside the lines of a picture

9. When the working mother of a toddler is preparing to take her child home after a prolonged hospitalization, she asks the nurse what type of behavior she should expect to be displayed. What is the nurse’s most appropriate description of her child’s probable behavior?

• Excessively demanding behavior
• Hostile attitude toward the mother
• Cheerful, with shallow attachment behaviors
• Withdrawn, without emotional ties to the mother

10. Where should the nurse manager place a 5-year-old child admitted with injuries that may be related to abuse?

• In a private room
• With an older, friendly child
• With a child of the same age
• In a room near the nurses’ desk

11. A nurse plans to talk to the parents of a toddler about toilet training. What should the nurse explain is the most important factor in the process of toilet training?

• Parents’ attitude about it
• Child’s desire to remain dry
• Child’s ability to sit still on the toilet
• Parents’ willingness to work at the toilet training

12. The parent of a 2-year-old child tells a nurse at the clinic, “Whenever I go to the store, my child has a screaming tantrum, demanding a toy or candy on the shelves. How can I deal with this situation?” What is the nurse’s best response?

• “Attempt to distract the child by offering the child a toy”
• “Say nothing and allow the tantrum to continue until it ends.”
• “Have a baby sitter stay with the child at home until the child outgrows this behavior.”
• “Give the child the item while in the store, and when the child loses interest, return the item to the shelf.”

13. A nurse is evaluating a 3-year-old child’s developmental progress. The inability to perform which task indicates to the nurse that there is a developmental delay?

• Copying a square
• Hopping on one foot
• Catching a ball reliably
• Using a spoon effectively

14. The parents of a 2-year-old child tell the nurse that they are having difficulty disciplining their child. What is the nurse’s most appropriate response?

• “This is a difficult age that your child is going through right now.”
• “Tell me more about your difficulty. I’m not sure what you mean by this.”
• “It’s important to be consistent with toddlers when they need disciplining.”
• “I can understand what you mean. That’s why this age is called the terrible twos.”

15. A nurse is assessing a child with the diagnosis of lead poisoning. What is the most harmful adverse effect that the nurse anticipates?

• Inadequate nutrition
• Delayed development
• Anemia and constipation
• Renal and skeletal damage

16. The nurse explains to the parent of a 2-year-old child that the toddler’s negativism is expected at this age. What need is this behavior meeting?

• Trust
• Attention
• Discipline
• Independence

17. A nurse is reviewing the immunization schedule of an 11-month-old infant. What immunizations does the nurse expect the infant to have previously received?

• Pertussis, tetanus, polio, and measles
• Diphtheria, pertussis, tetanus, and polio
• Rubella, polio, tuberculosis, and pertussis
• Measles, mumps, rubella, and tuberculosis

18. A parent asks a nurse how to tell the difference between measles (rubeola) and German measles (rubella). What should the nurse tell the parent about rubeola that is different from rubella?

• High fever and Koplik spots
• Rash on the trunk with pruritus
• Nausea, vomiting, and abdominal cramps
• Characteristics of a cold, followed by a rash

19. The parent of a child who has received all of the primary immunizations asks the nurse which ones the child should receive before starting kindergarten. The nurse tells the parent that her child should receive boosters of:

• IPV, HepB, Td.
• DTaP, HepB, Td
• MMR, DTaP, Hib.
• DTaP, IPV, MMR

20. A nurse is teaching the parents of a 2-year-old child the correct way to administer ear drops. After explaining that they position their child on the side, how should they move the pinna while instilling the drops?

• Forward
• Up and back
• Straight back
• Down and back

21. A 12-month-old infant has become immunosuppressed during a course of chemotherapy. When preparing the parents for the infant’s discharge, what information should the nurse give concerning the measles, mumps, and rubella (MMR) immunization?

• It should not be given until the infant reaches 2 years of age.
• Infants who are receiving chemotherapy should not be given these vaccines.
• It should be given to protect the infant from contracting any of these diseases.
• The parents should discuss this with their health care provider at the next visit.

22. A nurse is assessing a child with plumbism (lead poisoning). Which organ system is of most concern because of its irreversible side effects?

• Urinary
• Skeletal
• Nervous
• Hematologic

23. A 3-year-old child ingests a substance that may be a poison. The parent calls a neighbor who is a nurse and asks what to do. What should the nurse recommend the parent to do?

• Administer syrup of ipecac.
• Call the poison control center.
• Take the child to the emergency department.
• Give the child bread dipped in milk to absorb the poison.

24. What safety precautions should a nurse teach a child with diminished sensation in the legs because of cerebral palsy?

• Test the temperature of the water before a bath.
• Tighten brace straps securely before ambulating.
• Set the clock twice during the night to change position.
• Look down at the legs when crutch walking to determine how they are positioned.

25. A nurse talks with parents of a toddler with strabismus about why this condition should be treated in early childhood. What complication should the nurse explain can occur if it is not corrected?

• Cataracts
• Glaucoma
• Refractive errors
• Partial loss of sight

26. What type of play does a nurse expect when observing a toddler in a playroom with other children?

• Parallel
• Solitary
• Cooperative
• Competitive

27. What foods should a nurse order for a 30-month-old toddler on a regular diet?

• Hamburger with bun and grapes
• Chicken fingers and french fries
• Hot dog with bun and potato chips
• Macaroni and cheese and Cheerios

28. A nurse is teaching parents about why most children should be immunized against varicella (chickenpox) and why some receiving specific medications should not. Which medication should be included in the discussion?

• Insulin
• Steroids
• Antibiotics
• Anticonvulsants

29. What is one of the most important factors that a nurse must consider when parents of a toddler request to be present at a procedure occurring on the hospital unit?

• Type of procedure to be performed
• Individual assessment of the parents
• Whether the toddler wants the parents present
• Probable reaction to the toddler’s response to pain

30. A nurse is teaching a class about immunizations to members of a grammar school’s Parent-Teachers Association. Which childhood disease is the nurse discussing when explaining that it is a viral disease that starts with malaise and a highly pruritic rash that begins on the abdomen, spreads to the face and proximal extremities, and can result in grave complications?

• Rubella
• Rubeola
• Chickenpox
• Scarlet fever

31. During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, “I am pleased about the adjustment but somewhat concerned about my child’s reaction to me.” How should the nurse respond?

• The child is repressing feelings for the parent.
• Routines have been established and the child feels safe.
• The child has given up fighting and accepts the separation.
• Behavior has improved because the child feels better physically.

32. While assessing an 18-month-old child, a nurse observes that the toddler can crawl upstairs but needs assistance when climbing the stairs upright. What does this action indicate to the nurse?

• Presence of talipes equinovarus
• Reflective of neurologic damage
• Expected behavior in a toddler of this age
• Existence of developmental dysplasia of the hip

33. If a child cannot be given or is not responding to oral chelating agents, parenteral medication must be used. To effectively prepare a child to cope with this painful treatment, what is the priority nursing intervention?

• Rotating the injection sites and adding procaine to the chelating agent to lessen the discomfort
• Role-playing with puppets dressed as hospital personnel to minimize the child’s fear of unfamiliar adults
• Explaining the rationale for the injections so that the child does not view them as a punishment for bad behavior
• Therapeutic play using a needleless syringe and a doll before therapy is initiated and after receiving each injection

34. An 8-year-old child with cerebral palsy is admitted to the hospital for a tendon-lengthening procedure. After the surgery, the parents ask a nurse why their child must wear braces and shoes for at least 12 hours a day even while in bed. How should the nurse respond?

• “Ambulation can be encouraged as soon as possible.”
• “They maintain body alignment and help prevent footdrop.”
• “They stretch your child’s ligaments and strengthen muscle tone.”
• “It helps your child accept the physical constraints of the condition.”

35. A nurse encourages parents to have their young children’s eyes tested especially for monocular strabismus. What should the nurse explain can occur if it is not corrected early?

• Dyslexia will develop.
• Peripheral vision will disappear.
• Vision in both eyes will be diminished.
• Amblyopia will progress in the weak eye.

36. A parent asks the nurse what to do when their toddler has temper tantrums. What play materials should the nurse suggest to offer the child as another way of expressing anger?

• Ball and bat
• Wad of clay
• Punching bag
• Pegs and pounding board

37. A 15-month-old child with the diagnosis of hydrocephalus is to have a computed tomography (CT) scan. What should the nurse include when preparing the toddler for the CT scan?

• Shaving the head
• Starting the prescribed IV infusion
• Administering the prescribed sedative
• Giving the child a simple explanation of the procedure

38. At 2 years of age, a child is readmitted to the hospital for additional surgery. What is the most important factor in preparing the toddler for this experience?

• Gratification of the child’s wishes
• Previous experience of being hospitalized
• Avoidance of leaving the child with strangers
• Assurance of continuation of parental affection

39. A school nurse is teaching a group of teachers’ aides about the cause of lead poisoning in children. What is important to consider in terms of prevention?

• It is known to be caused by the ingestion of foods that are high in fat.
• It is attributed to an indigent and passive parent who fails to supervise the children.
• Environmental factors are involved because lead is available for ingestion and inhalation.
• Socioeconomic factors are involved, because inadequately maintained old buildings have more lead-based paint.

40. A nurse in the emergency department observes large welts and scars on the back of a child who has been admitted for an asthma attack. What additional information must be included in the nurse’s assessment?

• History of an injury
• Signs of child abuse
• Presence of food allergies
• Recent recovery from chickenpox

41. A 2-year-old child who was admitted to the hospital for further surgical repair of a clubfoot is standing in the crib, crying. The child refuses to be comforted and calls for the mother. As the nurse approaches the crib to provide morning care, the child screams louder. Knowing that this behavior is typical of the stage of protest, what is the most appropriate nursing intervention?

• Use comforting measures while holding the child.
• Fill the basin with water and proceed to bathe the child.
• Sit by the crib and bathe the child later when the anxiety decreases.
• Postpone the bath for a day because a child this upset should not be traumatized further.

42. On the third day of hospitalization the nurse observes that a 2-year-old toddler who had been screaming and crying inconsolably begins to regress and is now lying quietly in the crib with a blanket. What stage of separation anxiety has developed?

• Denial
• Despair
• Mistrust
• Rejection

43. During a vaccination drive at a well-child clinic, a nurse observes that a recently hired nurse is not wearing gloves. What should the nurse advise the newly hired nurse to do?

• Speak with the nurse manager regarding techniques.
• Put on gloves because standard precautions are required.
• Continue with the immunizations because gloves are not needed.
• Evaluate the child’s appearance to determine whether gloves are needed.

44. What behavior does a nurse expect from a toddler subjected to prolonged hospitalization with limited parental visits?

• Cheerful interactions with staff members
• Indications of sadness throughout the day
• Excessive crying when parents are not present
• Limited emotional response to the environment

45. A parent tells a nurse at the clinic, “Each morning I offer my 24-month-old child juice, and all I hear is ‘No.’ What should I do because I know my child needs fluid?” What strategy should the nurse suggest?

• Offer the child a choice of two juices.
• Distract the child with a favorite food.
• Offer the child the glass in a firm manner.
• Allow the child to see the parent getting angry.

46. The parents of an infant ask the nurse why their baby is scheduled to receive the intramuscular polio vaccine rather than the oral vaccine. What is the nurse’s best response?

• “The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.”
• "The consensus is that either can be used, since both produce the same results and are equally safe.”
• “The oral vaccine is more expensive, so the intramuscular vaccine is preferred unless it is contraindicated.”
• “The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.”

47. When planning long-term care for a child with cerebral palsy (CP), it is important for the nurse to consider that the:

• illness is not progressively degenerative.
• effects of cerebral palsy are unpredictable.
• child probably has some degree of mental retardation.
• child should have genetic counseling before planning a family.

48. A parent brings an 18-month-old toddler to the clinic. The parent states, “My child is so difficult to please, has temper tantrums, and annoys me by throwing food from the table.” What is the nurse’s best response?

• “Toddlers need discipline to prevent the development of antisocial behaviors.”
• “Toddlers are learning to assert independence, and this behavior is expected at this age.”
• “It is best to leave the toddler alone in the crib after calmly explaining why the behavior is unacceptable.”
• “This is the way a toddler expresses needs, and this behavior is acceptable during the initiative stage of development.”

49. A parent tearfully tells a nurse, “They think our child is developmentally delayed. We are thinking about investigating a preschool program for cognitively impaired children.” What is the nurse’s most appropriate response?

• Praise the parent for the decision and encourage the plan.
• Ask for more specific information related to the developmental delays.
• Advise the parent to have the health care provider help choose an appropriate program.
• Explain that this may be a premature action and the developmental delays could disappear.

50. A major developmental milestone of a toddler is the achievement of autonomy. What should the nurse instruct the parents to do to enhance their toddler’s need for autonomy?

• Teach the child to share with others.
• Help the child to learn society’s roles.
• Teach the child to accept external limits.
• Help the child to develop internal controls.
  
  

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145 questions