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1. To assess the effectiveness of an analgesic administered to a 4-year-old, what intervention is best for the nurse to implement?

A) Use a happy-face/sad-face pain scale. Feedback: CORRECT B) Ask the mother if she thinks the analgesic is working. Feedback: INCORRECT C) Assess for changes in the child's vital signs. Feedback: INCORRECT D) Teach the child to point to a numeric pain scale. Feedback: INCORRECT Feedback: CORRECT A 4-year-old can readily identify with simple pictures (A) to show the nurse how he/she is feeling. (B) could be used to validate what the child is telling the nurse via the "faces" pain scale, but it is best to elicit the child's assessment of his/her pain level. (C) may not accurately reflect the effectiveness of pain medication as they can also be affected by other variables, such as fear. (D) requires abstract number skills beyond the level of a 4-year-old.

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Correct Answer(s): A

2. Which behavior should the nurse expect a two-year-old child to exhibit? A) Build a house with blocks. Feedback: INCORRECT B) Ride a tricycle. Feedback: INCORRECT C) Display possessiveness of toys. Feedback: CORRECT D) Look at a picture book for 15 minutes. Feedback: INCORRECT Feedback: CORRECT Two-year-old children are egocentric and unable to share with other children. (A, B, and D) are behaviors of a preschooler.

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Correct Answer(s): C

3. A hospitalized 16-year-old male refuses all visits from his classmates because he is concerned about his distorted appearance. To increase the client's social interaction, what intervention is best for the nurse to initiate? A) Encourage the client to use a hand-held video game that is popular with all his friends. Feedback: INCORRECT B) Assign a 25-year-old female nursing student to offer support to the client. Feedback: INCORRECT C) Arrange for an Internet connection in the client's room for email communication. Feedback: CORRECT D) Encourage the client's mother to arrange a surprise get together in the cafeteria. Feedback: INCORRECT Feedback: CORRECT Body image and peer acceptance are key concerns for the adolescent. (C) allows for social interaction without face to face contact, thus protecting his self-image while also promoting social interaction. (A) does not promote social interaction. (B) does not encourage interaction with his own peer group, which is of greater importance. (D) does not respect the client's concern about his body image.

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Correct Answer(s): C

4. The parents of a 3-week-old infant report that the child eats well but vomits after each feeding. What information is most important for the nurse to obtain? A) Description of vomiting episodes in past 24 hours. Feedback: CORRECT B) Number of wet diapers in last 24 hours. Feedback: INCORRECT C) Feeding and sleep schedule. Feedback: INCORRECT

D) Amount of formula consumed during the past 24 hours. Feedback: INCORRECT Feedback: CORRECT A description of the vomiting episodes (A) will assist the nurse in determining the reason for the symptoms, which may be helpful in developing a plan of care for this infant. (B and C) provide related information but are not as helpful as (A). (D) may be related to the vomiting, but the nurse should first obtain a better description of the vomiting episodes.

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Correct Answer(s): A

5. A 6-year-old is admitted to the pediatric unit after falling off a bicycle. Which intervention should the nurse implement to assist the child's adjustment to hospitalization? A) Explain hospital schedules to the child, such as mealtimes. Feedback: CORRECT B) Use terms, such as "honey" and "dear," to show a caring attitude. Feedback: INCORRECT C) Provide a list of rules that limits visitation of siblings in the hospital. Feedback: INCORRECT D) Orient the parents to the hospital unit and refreshment areas. Feedback: INCORRECT Feedback: CORRECT Altered daily schedules and loss of rituals are upsetting to children and increase separation anxiety, and active sensitivity to the needs of children can minimize the negative effects of hospitalization. Explaining the hospital schedules (A) and establishing an individual schedule familiarizes the child to the hospital environment and decreases anxiety. (B) depersonalizes the child who should be addressed by name. Family and sibling visitation should be recommended and encouraged without limitation (C). Although (D) should be implemented, the direct involvement of the school-aged child incorporates the child's sense of initiate and cooperation.

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Correct Answer(s): A

6.

When evaluating the effectiveness of interventions to improve the nutritional status of an infant with gastro-esophageal reflux, which intervention is most important for the nurse to implement? A) Record weight daily. Feedback: CORRECT B) Assess for signs of anemia. Feedback: INCORRECT C) Document sleeping patterns. Feedback: INCORRECT D) Teach parenting skills. Feedback: INCORRECT Feedback: CORRECT The most definitive measure of improved nutrition in an infant is obtaining the child's daily weight (A). (B, C, and D) may also be useful, but they are not as definitive as a daily weight measurement.

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Correct Answer(s): A

7. A 4-year-old girl continues to interrupt her mother during a routine clinic visit. The mother appears irritated with the child and asks the nurse, "Is this normal behavior for a child this age?" The nurse's response should be based on which information? A) Children need to retain a sense of initiative without impinging on the rights and privileges of others. Feedback: CORRECT B) Negative feelings of doubt and shame are characteristic of 4-year-old children. Feedback: INCORRECT C) Role conflict is a common problem of children this age. She is just wondering where she fits into society. Feedback: INCORRECT D) At this age children compete and like to produce and carry through with tasks. She is just competing with her mother. Feedback: INCORRECT Feedback: CORRECT

Children aged 3 to 6 are in Erickson's "Initiative vs. Guilt" stage, which is characterized by vigorous, intrusive behavior, enterprise, and strong imagination. At this age, children develop a conscience and must learn to retain a sense of initiative without impinging on the rights of others (A). (B) describes the "Autonomy vs. Shame and Doubt," stage (1 to 3 years of age). (C) describes an adolescent (12 to 18 years of age), the "Identity vs. Role Confusion" stage. (D) describes a child 6 to 12 years of age, the "Industry vs. Inferiority" stage.

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Correct Answer(s): A

8. A 15-year-old girl tells the school nurse that all of her friends have started their periods and she feels abnormal because she has not. Which response is best for the nurse provide? A) Refer the adolescent to the healthcare provider for a pregnancy screen. Feedback: INCORRECT B) Schedule a conference with her parents to recommend hormone therapy. Feedback: INCORRECT C) Explain that menarche varies and occurs between the ages of 12 and 18 years. Feedback: CORRECT D) Suggest that she use diversions to help her not worry about delayed menarche. Feedback: INCORRECT Feedback: CORRECT The nurse should provide a factual and reassuring explanation that focuses on individual variations of menarche, which can normally occur between 12 and 18 years of age (C). (A) does not address the adolescent's concern and is judgmental. Menarche is influenced by hereditary, general health, and nutritional status, so (B) is not indicated. (D) dismisses the adolescent's concerns and does not offer factual information.

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Correct Answer(s): C

9. The nurse is planning care for school-aged children at a community care center. Which activity is best for the children? A) Building model airplanes. Feedback: INCORRECT B) Playing follow-the-leader. Feedback: CORRECT

C) Stringing large and small beads. Feedback: INCORRECT D) Playing with Playdough and clay. Feedback: INCORRECT Feedback: CORRECT School-aged children strive for independence and productivity (Erikson's Industry vs. Inferiority) and enjoy individual and group activities related to real-life situations, such as playing follow-the-leader (B). (A) is an individual activity that could contribute to feelings of inferiority and inadequacy if the task is too complex. Although school-aged children enjoy crafts, (C and D) are more appropriate for pre-school children.

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Correct Answer(s): B

10. A 14-year-old female client tells the nurse that she is concerned about the acne she has recently developed. Which recommendation should the nurse provide? A) Remove all blackheads and follow with an alcohol scrub. Feedback: INCORRECT B) Use medicated cosmetics only to help hide the blemishes. Feedback: INCORRECT C) Wash the hair and skin frequently with soap and hot water. Feedback: CORRECT D) Encourage her to see a dermatologist as soon as possible. Feedback: INCORRECT Feedback: CORRECT Washing the hair and skin with soap and hot water (C) removes oil and debris from the skin and helps prevent and treat acne. Oily skin is especially bothersome during adolescence when hormones cause enlargement of sebaceous glands and increased glandular secretions which predispose the teenager to acne. (A) is contraindicated. Cosmetics ("medicated" or not) should be used sparingly to avoid further blocking sebaceous gland ducts (B). (D) might be indicated at a later time, if healthcare recommendations are not successful.

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Correct Answer(s): C

11. A 6-month-old boy and his mother are at the healthcare provider's office for a well-baby check-up and routine immunizations. The healthcare provider recommends to the mother that the child receive an influenza vaccine. What medications should the nurse plan to administer today? A) The routine immunizations and schedule another appointment to administer the influenza vaccine. Feedback: INCORRECT B) All the immunizations with the influenza vaccine given at a separate site from any other injection. Feedback: CORRECT C) The influenza vaccine and schedule another appointment to administer the immunizations. Feedback: INCORRECT D) The influenza vaccine and the polio vaccine and schedule another appointment to administer the remaining immunizations. Feedback: INCORRECT Feedback: CORRECT At 6-months of age, the routine immunizations include Hepatitis B, DTaP, Hib (Haemophilus influenza type b), PCV (Pneumococcal), IPV (inactivated poliovirus) and influenza. The influenza vaccine should be given at a separate site from any other injection (B). Scheduling a return visit (A, B, or C) increases the risk that the mother will not bring the child back for the immunizations.

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Correct Answer(s): B

12. The mother of a 2-year-old boy consults the nurse about her son's increased temper tantrums. The mother states, "Yesterday he threw a fit in the grocery store, and I did not know what to do. I was so embarrassed. What can I do if this occurs again?" Which recommendation is best for the nurse to provide this mother? A) Paddle him gently as soon as the behavior is initiated. Feedback: INCORRECT B) Immediately put him in "time-out." Feedback: INCORRECT C) Quietly remind him that others are watching him. Feedback: INCORRECT

D) Walk away from him and ignore the behavior. Feedback: CORRECT Feedback: CORRECT The best approach for a toddler is to ignore the attention-seeking behavior (D). The parent should be somewhat nearby, within view of the child but should avoid reinforcing the behavior in any way. Tantrums can sometimes be avoided by talking to the child before the situation occurs. (A, B, and C) would all provide attention for the inappropriate behavior.

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Correct Answer(s): D

13. A 5-month-old is admitted to the hospital with vomiting and diarrhea. The pediatrician prescribes dextrose 5% and 0.25% normal saline with 2 mEq KCl/100 ml to be infused at 25 ml/hour. Prior to initiating the infusion, the nurse should obtain which assessment finding? A) Frequency of emesis in the last 8 hours. Feedback: INCORRECT B) Serum BUN and creatinine levels. Feedback: CORRECT C) Current blood sugar level. Feedback: INCORRECT D) Appearance of the stool. Feedback: INCORRECT Feedback: CORRECT Regardless of a client's age, adequate renal function must be present before adding potassium to IV fluids (B). (A) is important in determining the need for fluid replacement. (C) is not indicated. (D) is useful information, but will not impact administration of the prescribed IV solution.

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Correct Answer(s): B

14. When assessing a child with asthma, the nurse should expect intercostal retractions during A) inspiration. Feedback: CORRECT

B) coughing. Feedback: INCORRECT C) apneic episodes. Feedback: INCORRECT D) expiration. Feedback: INCORRECT Feedback: CORRECT Intercostal retractions result from respiratory effort to draw air into restricted airways (A).

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Correct Answer(s): A

15. Which restraint should be used for a toddler after a cleft palate repair? A) Clove hitch. Feedback: INCORRECT B) Mummy. Feedback: INCORRECT C) Elbow. Feedback: CORRECT D) Jacket. Feedback: INCORRECT Feedback: CORRECT Elbow restraints prevent children from bending their arms and bringing their hands to the oral surgical site. (A) restrains the hands, but the child can bend and bring their head to their hands. (B) is used during procedures. (D) restrains the body torso and is not appropriate.

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Correct Answer(s): C

16.

A full term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms are this newborn likely to exhibit? A) Choking, coughing, and cyanosis. Feedback: CORRECT B) Projectile vomiting and cyanosis. Feedback: INCORRECT C) Apneic spells and grunting. Feedback: INCORRECT D) Scaphoid abdomen and anorexia. Feedback: INCORRECT Feedback: CORRECT (A) includes the "3 Cs" of esophageal atresia caused by the overflow of secretions into the trachea. Projectile vomiting (B) is characteristic of pyloric stenosis in the infant. Apneic spells often occur with prematurity or sepsis, and grunting (C) is a sign of respiratory distress. A scaphoid abdomen (D) is characteristic of diaphragmatic hernia.

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Correct Answer(s): A

17. The nurse is assessing an 8-month-old child who has a medical diagnosis of Tetrology of Fallot. Which symptom is this client most likely to exhibit? A) Bradycardia. Feedback: INCORRECT B) Machinery murmur. Feedback: INCORRECT C) Weak pedal pulses. Feedback: INCORRECT D) Clubbed fingers. Feedback: CORRECT Feedback: CORRECT Tetrology of Fallot, a cyanotic heart defect, causes clubbing of fingers and toes (D) due to tissue hypoxia. Tachycardia, not (A), is a manifestation of congenital heart disease. (B) is a classic sign of ventricular septal defect. (C) is characteristic of coarctation of the aorta.

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Correct Answer(s): D

18. The nurse is preparing a health teaching program for parents of toddlers and preschoolers and plans to include information about prevention of accidental poisonings. It is most important for the nurse to include which instruction? A) Tell children they should not taste anything but food. Feedback: INCORRECT B) Store all toxic agents and medicines in locked cabinets. Feedback: CORRECT C) Provide special play areas in the house and restrict play in other areas. Feedback: INCORRECT D) Punish children if they open cabinets that contain household chemicals. Feedback: INCORRECT Feedback: CORRECT The only reliable way to prevent poisonings in young children is to make them inaccessible (B). Teaching children not to taste is important (A), but ineffective for young children. (C and D) will not control a child's curiosity.

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Correct Answer(s): B

19. The vital signs of a 4-year-old child with polyuria are: BP 80/40, Pulse 118, and Respirations 24. The child's pedal pulses are present with a volume of +1, and no edema is observed. What action should the nurse implement first? A) Insert an indwelling urinary catheter. Feedback: INCORRECT B) Start an IV infusion of normal saline. Feedback: CORRECT C) Send a specimen to the lab for urinalysis. Feedback: INCORRECT

D) Document the child's vital signs and pulses. Feedback: INCORRECT Feedback: CORRECT The current vital sign readings and the decreased peripheral pulse volume indicate that the child is experiencing fluid volume deficit due to the polyuria, so the priority action is to restore fluid volume (B). (A) is useful in obtaining a precise urine output measure, but is a lower priority than restoring fluid volume at this time. (C) is not indicated based on the current assessment data, and (D) does not recognize the need for immediate action to combat the fluid volume deficit.

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Correct Answer(s): B

20. Which action by the nurse is most helpful in communicating with a preschool-aged child? A) Speak clearly and directly to the child. Feedback: INCORRECT B) Use a doll to play and communicate. Feedback: CORRECT C) Approach when a parent is not present. Feedback: INCORRECT D) Play a board game with the child. Feedback: INCORRECT Feedback: CORRECT Communicating through play with a doll (B) or other toy gives time for the child to feel comfortable with a stranger. (A) may frighten some children and is usually not as effective as (B). To provide security and comfort, preschool-aged children should be approached when a parent is present, not (C). (D) is too advanced for a preschooler.

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Correct Answer(s): B

21. A 6-month-old infant with congestive heart failure (CHF) is receiving digoxin elixir. Which observation by the nurse warrants immediate intervention? A) Apical heart rate of 60. Feedback: CORRECT

B) Sweating across the forehead. Feedback: INCORRECT C) Doesn't suck well. Feedback: INCORRECT D) Respiratory rate of 30 breaths per minute. Feedback: INCORRECT Feedback: CORRECT A heart rate of 60 (A) is much lower than normal for a 6-month-old and warrants immediate intervention. The normal heart rate for a 6-month-old is 80 to 150 BPM when awake, and a rate of 70 while sleeping is considered within normal limits. (B and C) are expected symptoms of heart failure in an infant. (D) is within normal limits for an infant.

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Correct Answer(s): A

22. The nurse is developing a plan of care for a 3-year-old who is scheduled for a cardiac catheterization. To assist in decreasing anxiety for the child on the day of the procedure, which intervention is best for the nurse to implement? A) Reassure the parents that 3-year-olds are cooperative and therefore are less likely to be anxious. Feedback: INCORRECT B) Obtain a video film of a cardiac catheterization to show to the child prior to the procedure. Feedback: INCORRECT C) Give the child a ride on a gurney to visit the cardiac catheterization lab and meet a nurse who works there. Feedback: CORRECT D) Obtain a cardiac catheter and demonstrate the procedure by pretending to put the catheter in a doll or stuffed animal. Feedback: INCORRECT Feedback: CORRECT Familiarizing the child and mother with the department (C) will help decrease anxiety of the child and mother (who may have more anxiety than the child). Three is a difficult age to undergo a procedure that requires cooperation. Restraints and possibly sedation may be

required (A). At three, the child is too young to understand why this must be done, and (B) is not indicated. (D) is also not indicated because it is likely to be interpreted as painful.

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Correct Answer(s): C

23. A child falls on the playground and is brought to the school nurse with a small laceration on the forearm. Which action should the nurse implement first? A) Slowly pour hydrogen peroxide over the open wound. Feedback: INCORRECT B) Apply ice to the area before rinsing with cold water. Feedback: INCORRECT C) Wash the wound gently with mild soap and water. Feedback: CORRECT D) Gently cleanse with a sterile pad using povidone-iodine. Feedback: INCORRECT Feedback: CORRECT A small, superficial laceration to the skin should be washed gently with mild soap and water (C) for several minutes, followed by thorough rinsing. (A and D) are antiseptics that can be traumatic (painful) when cleaning fresh, open wounds. Applying ice (B) may reduce or prevent further edema, but the wound should be washed with mild soap and water first.

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Correct Answer(s): C

24. A female teenager is taking oral tetracycline HCL (Achromycin V) for acne vulgaris. What is the most important instruction for the nurse to include in this client's teaching plan? A) Use sunscreen when lying by the pool. Feedback: CORRECT B) Cleanse the skin at least 4 times a day. Feedback: INCORRECT C) Take the medication with a glass of milk. Feedback: INCORRECT

D) Menstrual periods may become irregular. Feedback: INCORRECT Feedback: CORRECT Photosensitivity is a common side effect of tetracycline HCL (Achromycin V) therapy. Severe sunburn can occur with minimal sun exposure and clients should be instructed to avoid sunlight and to use sunscreen (A). (B and D) are not related to tetracycline HCL (Achromycin V) therapy. (C) should be avoided because dairy products interfere with the absorption of tetracyclines.

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Correct Answer(s): A

25. As part of the physical assessment of children, the nurse observes and palpates the fontanels. Which child's fontanel finding should be reported to the healthcare provider? A) A 6-month-old with failure to thrive that has a closed anterior fontanel. Feedback: CORRECT B) A 24-month-old with gastroenteritis that has a closed posterior fontanel. Feedback: INCORRECT C) A 2-month-old with chickenpox that has an open posterior fontanel. Feedback: INCORRECT D) A 28-month-old with hydrocephalus that has an open anterior fontanel. Feedback: INCORRECT Feedback: CORRECT At six months of age the anterior fontanel should be open, and it should not be closed until approximately 18 months of age. (B and C) are normal findings. A child with hydrocephalus may have a delayed closing of the fontanel (D).

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Correct Answer(s): A

26. A 4-year-old boy was admitted to the emergency room with a fractured right ulna and a short arm cast is applied. When preparing the parents to take the child home, which discharge instruction has the highest priority? A) Call the healthcare provider immediately if his nail beds appear blue. Feedback: CORRECT

B) Check his fingers hourly for the first 48 hours to see that he is able to move them without pain. Feedback: INCORRECT C) Be sure his arm remains above his heart for the first 24 hours. Feedback: INCORRECT D) Take his temperature q4h for the next two days and call if an elevation is noted. Feedback: INCORRECT Feedback: CORRECT Cyanosis (A) indicates impaired circulation to fingers and should be reported immediately. Although the actions described in (B, C, and D) may be indicated, they are implemented rather excessively--and might tend to frighten the parents. It is not necessary to check the child's ability to move his fingers hourly for 2 days (B). Elevating the arm above the heart will help to decrease swelling but (C) is stated in a frightening way. It is not necessary to take the child's temperature q4h unless indicated by other symptoms.

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Correct Answer(s): A

27. The mother of a 6-month-old asks the nurse when her baby will get the first measles, mumps, and rubella (MMR) vaccine. Based on the recommended childhood immunization schedule published by the Centers for Disease Control, which response is accurate? A) 3 to 6 months. Feedback: INCORRECT B) 12 to 15 months. Feedback: CORRECT C) 18 to 24 months. Feedback: INCORRECT D) 4 to 6 years. Feedback: INCORRECT Feedback: CORRECT The first measles, mumps, and rubella (MMR) vaccine should be given no sooner than 12 months of age, and ideally between 12 and 15 months of age (B). (A) should not receive the MMR vaccine due to the presence of maternal antibodies. MMR is not routinely administered at (C), but other immunizations, such as DTaP and Hepatitis B may be given at that time. The second dose of MMR is routinely administered at (D), provided that at

least 4 weeks have elapsed since the first dose, and if both doses were administered beginning at or after 12 months.

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Correct Answer(s): B

28. When discussing discipline with the mother of a 4-year-old child, the nurse should include which guideline? A) Parental control should be consistent. Feedback: CORRECT B) Children as young as 4 years rarely need reprimand or punishment. Feedback: INCORRECT C) Withdrawal of approval is effective. Feedback: INCORRECT D) Parents should enforce rigid rules to be followed without question. Feedback: INCORRECT Feedback: CORRECT Discipline should be a positive and necessary component of childrearing that is started in infancy and should teach socially acceptable behavior, help children protect themselves from danger, and channel undesirable behavior into constructive activity. Misbehavior may result from inconsistent rules or messages, so parental attention should be clear, reasonable, and consistent (A). (B and C) are not helpful to the child. Children need boundaries that are firm but not rigid (D).

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Correct Answer(s): A

29. The nurse is teaching the parents of a 5-year-old with cystic fibrosis about respiratory treatments. Which statement indicates to the nurse that the parents understand? A) Perform postural drainage before starting aerosol therapy. Feedback: INCORRECT B) Give respiratory treatments when the child is coughing a lot. Feedback: INCORRECT C) Administer aerosol therapy followed by postural drainage before meals. Feedback: CORRECT

D) Ensure respiratory therapy is done daily during any respiratory infection. Feedback: INCORRECT Feedback: CORRECT Postural drainage for a child with cystic fibrosis is most effective when performed after nebulization and before meals (C) or at least 1 hour after eating to prevent nausea and vomiting. Postural drainage uses gravity to promote mucous removal after nebulization (A) treatments which open the airways. Pulmonary toileting or respiratory treatments should be given 3 to 4 times daily, not episodically (B and D).

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Correct Answer(s): C

30. An infant is born with a ventricular septal defect (VSD) and surgery is planned to correct the defect. The nurse recognizes that surgical correction is designed to achieve which outcome? A) Stop the flow of unoxygenated blood into systemic circulation. Feedback: INCORRECT B) Increase the flow of unoxygenated blood to the lungs. Feedback: INCORRECT C) Prevent the return of oxygenated blood to the lungs. Feedback: CORRECT D) Reduce peripheral tissue hypoxia and nailbed clubbing. Feedback: INCORRECT Feedback: CORRECT Closure of VSDs stops oxygenated blood from being shunted from the left ventricle to the right ventricle (C). VSDs are acyanotic defects, which means that no unoxygenated blood enters the systemic circulation (A and B). (D) is common with Tetrology of Fallot, which is a cyanotic defect.

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Correct Answer(s): C

31. A six-month-old returns from surgery with elbow restraints in place. What nursing care should be included when caring for any restrained child? A) Keep restraints on at all times. Feedback: INCORRECT

B) Remove restraints one at a time and provide range of motion exercises. Feedback: CORRECT C) Remove all restraints simultaneously and provide play activities. Feedback: INCORRECT D) Renew the healthcare provider's prescription for restraints every 72 hours. Feedback: INCORRECT Feedback: CORRECT Removing restraints one at a time (B) is safer than removing all of them at once (C). The child needs to exercise and should not be kept in restraints at all times (A). The renewal of the healthcare provider's prescription varies with hospitals (D), and it does not really answer the question.

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Correct Answer(s): B

32. A 3-month-old infant develops oral thrush. Which pharmacologic agent should the nurse plan to administer for treatment of this disorder? A) Nystatin (Mycostatin). Feedback: CORRECT B) Nitrofurantoin (Macrodantin). Feedback: INCORRECT C) Norfloxacin (Noroxin). Feedback: INCORRECT D) Neomycin sulfate (Mycifradin). Feedback: INCORRECT Feedback: CORRECT Nystatin (Mycostatin) (A) is an antifungal drug that is effective in treating thrush, an oral fungal infection. (B, C, and D) are not indicated for the treatment of oral thrush.

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Correct Answer(s): A

33.

During administration of a blood transfusion, a child complains of chills, headache, and nausea. Which action should the nurse implement? A) Start another IV of dextrose solution and stay with the child. Feedback: INCORRECT B) Continue the transfusion and monitor the childs vital signs. Feedback: INCORRECT C) Stop the infusion immediately and notify the healthcare provider. Feedback: CORRECT D) Slow the transfusion and assess for cessation of symptoms. Feedback: INCORRECT Feedback: CORRECT The child is exhibiting signs of a reaction to the blood transfusion. The blood transfusion should be stopped immediately and the healthcare provider notified (C). After the transfusion is discontinued, IV access should be maintained (A) with fluids that do not introduce any more cellular products. (B and D) place the child at risk for further blood reactions.

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Correct Answer(s): C

34. The mother of a 4-year-old child asks the nurse what she can do to help her other children cope with their siblings repeated hospitalizations. Which is the best response that the nurse should offer? A) Inform the parent that the child is too young to visit the hospital. Feedback: INCORRECT B) Suggest that the child visit a grandmother until the sibling returns home. Feedback: INCORRECT C) Ask the mother if the child asks when the sibling will be discharged. Feedback: INCORRECT D) Encourage the mother to have the children visit the hospitalized sibling. Feedback: CORRECT Feedback: CORRECT Needs of a sibling will be better met with factual information and contact with the ill child, so sibling visitation should be encouraged (D). Parents are experts on their children and

should determine when their children are old enough to visit (A) in the hospital. Separation from family and home (B) may intensify fear and anxiety. Children may have difficulty expressing questions (C), so the support of parents and other caregivers are needed to help alleviate their fears.

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Correct Answer(s): D

35. The nurse is assessing a 2-year-old. What behavior indicates that the child's language development is within normal limits? A) Is able to name four colors. Feedback: INCORRECT B) Can count five blocks. Feedback: INCORRECT C) Is capable of making a three word sentence. Feedback: INCORRECT D) Half of child's speech is understandable. Feedback: CORRECT Feedback: CORRECT Between approximately 15 and 24 months of age, a child's speech is only half understandable (D). (A and B) usually occur between 3 and 5 years of age. (C) is usually accomplished by 18 months of age.

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Correct Answer(s): D

36. The nurse is teaching a mother to give 4 ml of a liquid antibiotic to a 10-month-old infant. Which statement by the parent indicates a need for further teaching? A) I will give this antibiotic to my child until it is finished. Feedback: INCORRECT B) Using a teaspoon will help me measure this correctly. Feedback: CORRECT C) I will call the clinic if my child develops a rash or itching. Feedback: INCORRECT

D) My baby should begin to feel better within a few days. Feedback: INCORRECT Feedback: CORRECT The prescribed medication is 4 ml per dosage and is measured with the most accuracy using a syringe, so if the parent uses a teaspoon (B), which is equivalent to 5 ml, further teaching is indicated. (A, C, and D) indicate correct understanding and require no further intervention by the nurse.

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1.0/1.0

Correct Answer(s): B

37. A 2-year-old child with gastro-esophageal reflux has developed a fear of eating. What instruction should the nurse include in the parents' teaching plan? A) Invite other children home to share meals. Feedback: INCORRECT B) Accept that he will eat when he is hungry. Feedback: INCORRECT C) Reward the child with a nap after eating. Feedback: INCORRECT D) Consistently follow a set mealtime routine. Feedback: CORRECT Feedback: CORRECT A 2-year-old child is comforted by consistency (D). (A) is contraindicated because two-yearolds may participate in parallel activities with other children but are too young to feel comfort and support by the presence of other children when anxious or afraid. (B) may or may not be true and does not address the child's fears. The child with reflux should remain upright at least two hours after eating (C) to reduce symptoms.

Points Earned:

1.0/1.0

Correct Answer(s): D