Online NCLEX Practice Test about
Pediatric Nursing I

1. A mother of a 1-month old infant expresses concern because one of the infant's eye appears to be crossed. The most appropriate and supportive response by the nurse is which of the following?

a) this is normal in the young infant but should not be present after about age 4 months
b) this condition is probably permanent
c) the infant will probably need surgery
d) it needs observation because this thing may happen to the other eye

2. When assessing a 2 year-old child brought by his mother to the clinic for a routine check-up, which of the following would the nurse expect the child to be able to do?

a) ride a tricycle
b) tie his shoelaces
c) kick a ball forward
d) use blunt scissors

3. After having blood sample drawn, a 5 year-old child insists that the site be covered with an adhesive bandage strip. When the mother tries to remove the bandage before leaving the office, the child screams that all the blood will come out. The nurse interprets this behavior as indicating a fear of which of the following?

a) injury
b) compromised body integrity
c) pain
d) loss of control

4. After teaching a group of mothers about temper tantrums, the nurse knows the teaching has been effective when one of the mothers states which of the following?

a) I will ignore the temper tantrums
b) I should pick up the child during the tantrums
c) I'll talk to my daughter during the tantrums
d) I would put my child in time out

5. After teaching the parents of a preschooler who has undergone T and A (Tonsillectomy and Adenoidectomy) about appropriate foods to give the child after discharge, which of the following, if stated by the parents as appropriate foods, indicates successful teaching?

a) meatloaf and uncooked carrots
b) pork and noodle casserole
c) cream of chicken soup and orange sherbet
d) hot dog and potato chips

6. When teaching the parents of an older infant with CF (cystic fibrosis) about the type of diet the child should consume, which of the following would be most appropriate?

a) low protein diet
b) high fat diet
c) low carbohydrate diet
d) high calorie diet

7. a school-age child with CF asks the nurse what sports she can be involved in as she becomes older. Which of the following activities would be most appropriate for the nurse to suggest?

a) swimming
b) track
c) baseball
d) javelin throwing

8. A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44 bpm. Which of the following actions would the nurse do first?

a) obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
d) place the child in knee-to-chest position

9. Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever?

a) maintaining the joints in an extended position
b) applying gentle traction to the child's affected joints
c) supporting proper alignment with rolled pillows
d) using a bed cradle to avoid the weight of bed lines on the joints

10. A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority?

a) applying lotions to the hands and feet
b) offering foods the toddler likes
c) placing the toddler in a quiet environment
d) encouraging the parents to get some rest

11. Which of the following foods would the nurse encourage the mother to offer to her child with iron-deficiency anemia?

a) rice cereal, whole milk, and yellow vegetables
b) potato, peas, and chicken
c) macaroni, cheese and ham
d) pudding, green vegetables and rice

12. Because of the risks associated with administration of factor VIII concentrate, the nurse would report which of the following?

a) yellowing of the skin
b) constipation
c) abdominal distention
d) puffiness around the eye

13. When teaching the mother of an infant who has undergone surgical repair of a cleft lip how to care for the suture line, the nurse demonstrates how to remove formula and drainage. Which of the following solutions would the nurse use?

a) mouthwash
b) providone - iodine (betadine) solution
c) a mild antiseptic solution
d) half-strength hydrogen peroxide

14. Which of the following nursing diagnosis would the nurse identify as a priority for the infant with tracheoesophageal fistula (TEF)?

a) impaired parenting related to newborn's illness
b) risk of injury related to increased potential for aspiration
c) ineffective nutrition: less than body requirements, related to poor sucking ability
d) ineffective breathing pattern related to a weak diaphragm

15. When the infant returns to the unit after imperforate anus repair, the nurse places the infant in which of the following position?

a) on the abdomen, with legs pulled up under the body
b) on the back, with legs extended straight out
c) lying on the side with hips elevated
d) lying on the back in a position of comfort

16. A child presents to the emergency room with the history of ingesting a large amount of acetaminophen. For which of the following would the nurse assess?

a) hypertension
b) frequent urination
c) right upper quadrant pain
d) headache

17. Which of the following statements by the mother of an !8 month old would indicate to the nurse that the child needs laboratory testing for lead levels?

a) my child does not always wash after playing outside
b) my child drinks 2 cups of milk everyday
c) my child has more temper tantrums than other kids
d) my child is smaller than other kids of the same age

18. An adolescent with a history of surgical repair for undescended testes comes to the clinic for a sport physical. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important?

a) the adolescent sterility
b) the adolescent future plans
c) technique for monthly testicular self-examinations
d) need for a lot of psychosocial support

19. When developing the teaching plan for the parents of a 12 month old infant with hypospadias and chordee repair, which of the following would the nurse expect to include as most important?

a) assisting the child to become familiar with his dressing so he will leave them alone
b) encouraging the child to ambulate as soon as possible by using a favorite push toy
c) forcing fluids to at least 250 ml/day by offering his favorite juices
d) preventing the child from disrupting the catheter by using soft restraints

20. A school-aged client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with glomerulonephritis. Which of the following interventions would receive the highest priority?

a) assessing vital signs every four hours
b) monitoring intake and output every 12 hours
c) obtaining daily weight measurements
d) obtaining serum electrolyte levels daily

21. When assessing a 12 year old child with Wilm's tumor, the nurse should keep in mind that it most important to avoid which of the following?

a) measuring the child's chest circumference
b) palpating the child's abdomen
c) placing the child in an uprignt position
d) measuring the child's occipitofrontal circumference

22. When positioning the neonate with an unrepaired myelomeningocele, which of the following positions would be most appropriate?

a) supine the hip at 90 degree flexion
b) right side-lying position with knees flexed
c) prone with hips in abduction
d) semi-fowler's position with chest and abdomen elevated

23. A 4 year old with hydrocephalus is scheduled to have a ventroperitoneal shunt in the right side of the head. When developing the child's postoperative plan of care, the nurse would expect to place the preschooler in which of the following positions immediately after surgery?

a) on the right side, with the foot of the bed elevated
b) on the left side, with the head of the bed elevated
c) prone with the head of the bed elevated
d) supine, with the head of the bed flat

24. After talking with the parents of a child with Down Syndrome, which of the following would the nurse identify as an appropriate goal of care of the child?

a) encouraging self-care skills in the child
b) teaching the child something new each day
c) encouraging more lenient behavior limits for the child
d) achieving age-appropriate social skills

25. When teaching an adolescent with a seizure disorder who is receiving Valproic acid (Depakene), which of the following would the nurse instruct the client to report the health care provider?

a) three episodes of diarrhea
b) loss of appetite
c) jaundice
d) sore throat

26. A hospitalized preschooler with meningitis who is to be discharged becomes angry when the discharge is delayed. Which of the following play activities would be most appropriate at this time?

a) reading the child a story
b) painting with water colors
c) pounding on a pegboard
d) stacking a tower of blocks

27. The parents of a child tell the nurse they feel guilty because their child almost drowned. Which of the following remarks by the nurse would be most appropriate?

a) I can understand why you feel guilty, but these things happen
b) tell me a bit more about your feelings of guilt
c) you should not have taken your eyes off your child
d) you really shouldn't fell guilty; you're lucky because your child will be alright

28. The nurse teaches the parents of an infant with developmental dysplasia of the hip how to handle their child in a Pavlik harness. Which of the following interventions would be most appropriate?

a) fitting the diaper under the straps
b) leaving the harness off while the infant sleeps
c) checking for the skin redness under straps every other day
d) putting powder on the skin under the straps every day

29. When assessing the development of a 15 month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved?

a) walking up steps
b) using a spoon
c) copying a circle
d) putting a block in cup

30. The nurse teaches the mother of a young child with Duchenne's muscular dystrophy about the disease and its management. Which of the following statements by the mother indicates successful teaching?

a) my son will probably be unable to walk independently by the time he is 9 to 11 years old
b) muscle relaxants are effective for some children; I hope they can help my son
c) when my son is a little bit older, he can have surgery to improve his ability to walk
d) I need to help my son be as active as possible to prevent progression of the disease

31. A 9 month infant is having severe diarrhea and is experiencing dehydration and metabolic acidosis. Which of the following signs and symptoms will the nurse assess?

a) reduced white blood cell count
b) reduced platelet count
c) shallow respiration
d) tachypnea

32. Which of the following behavior of a preschooler indicates that the child is in the stage of initiative?

a) the child wants to finish his game of Candyland before his dressing is changed
b) the child cries and has a temper tantrum when he is sent to bed to go to sleep
c) the child ignores his parents and continues to watch television with other child
d) the child talks to his friends on the telephone and arranges for them to visit

34. A 2 month old infant undergoes repair of a cleft lip. After surgery, which equipment should the nurse teach the parents to use to feed their infant?

a) cross-cut nipple
b) plastic spoon
c) paper cup
d) rubber dropper

35. A 7 month old child has had recurrent middle-ear infections since she was 4 months old. Which of the following is most important to assess?

a) how well the clients eats
b) the client's weight gain since her last visit
c) whether the client received all her prescribed antibiotics at the time of the last infection
d) the client's temperature

36. Which of the following is appropriate toy for an 8 month old infant?

a) finger paint
b) jack-in-the-box
c) small rubber ball
d) play gym strung across the crib

37. The nurse is teaching new parents before discharge to home. The nurse explains that the anterior fontanel closes between ages

a) 2 and 3 months
b) 12 and 18 months
c) 3 and 6 months
d) 1 and 9 months

38. Which of the following are characteristics of an adolescent? Select all that apply.

a) egocentricity
b) abstract thinking
c) high-risk behaviors
d) sense of morality
e) hand dominance development
f) secondary sex characteristics development

39. In which child would you suspect child abuse?

a) a 2 year old child with bruises on both shins
b) a 2 year old child who won't make eye contact with the nurse
c) a 3 year old child who acts withdrawn and has bruises on his back
d) a 10 year old child who comes to the emergency department with a broken wrist

40. Which drug is used as an antidote for acetaminophen poisoning?

a) vitamin K
b) acetylsalicylic acid (ASA)
c) acetylcysteine
d) ethlenediaminetetraacetic acid (EDTA)

41. Which of the following is expected finding in a child with idiophatic thrombocytopenic purpura?

a) petechiae
b) nose bleeding
c) dark, concentrated urine
d) fever

42. An 8 year old child has been diagnosed to have iron deficiency anemia. Which of the following activities is most appropriate for the child to decrease oxygen demands on the body?

a) dancing
b) playing video games
c) reading a book
d) riding a bicycle

43. Which of the following nursing actions are appropriate for a child with hemophilia who is bleeding? Select all that apply

a) apply pressure
b) apply warm packs on the site
c) administer aspirin for pain
d) apply cold compresses to the site
e) elevate the injured part
f) perform range-of-motion exercises to the injured area immediately after bleeding stops

44. Which of the following medications for allergic rhinitis will not cause sedation?

a) brompheniramine and pseudoephedrine (dimetapp)
b) diphenhydramine (benadryl)
c) pseudoephedrine (triaminic)
d) loratadine (claritin)

45. A 6 month old infant is diagnosed to have bacterial meningitis. Which of the following is not a sign of meningeal irritation?

a) marked irritability
b) nuchal rigidity
c) depressed anterior fontanel
d) vomiting

46. Which assessment finding would lead the nurse to suspect Down syndrome in a newborn?

a) prominent scalp veins and high-pitched cry
b) single palmar crease and hypotonia
c) flat maxillary area and short papebral tissues
d) microcephaly, persistent postnatal growth lag

47. Which of the following nutrients decreases the incidence of neural tube defects (NTD's)?

a) vitamin C
b) vitamin K
c) vitamin B12
d) folic acid

48. Which instructions about preventing sudden infant death syndrome (SIDS) should the nurse include when teaching parents of infants? Select all that apply

a) place the infant in prone position
b) place the infant in a firm mattress
c) place the infant on his back to sleep
d) bottle feed the infant instead of breastfeeding
e) use soft mattress for the infant during the night
f) encourage breastfeeding of the infant

49. The nurse is teaching the parents of a young client how to handle poisoning. If the client ingests poison, what should the parents do first?

a) administer ipecac syrup
b) call an ambulance immediately
c) call the poison control center
d) inspect the home foe other potential poisons

50. The nurse will administer an oral medication to a 3 year old client. What is the best way for the nurse to proceed?

a) it's time for you to take your medicine right now
b) if you take your medicine now, you'll go home sooner
c) here's your medicine. Would you like apple juice or grape drink after?
d) see how Jerome took his medicine? He's a good boy. Now, be a good boy too

51. The nurse performs Guthrie screening test by drawing blood from the heel of an infant. The screening test is done to diagnose which of the following inborn error of metabolism?

a) glucose-6-phosphate dehydrogenase deficiency
b) phenylketonuria
c) galactosemia
d) hypothyroidism

52. The nurse is giving health teachings to a mother of a child with diabetes on signs and symptoms of hypoglycemia. The nurse should inform the mother that which of the following are manifestations of hypoglycemia?

a) behavioral changes, increased heart rate, sweating and tremors
b) nausea, fruity breath odor, headache, and fatigue
c) polydipsia, polyuria, polyphagia, and weight loss
d) enlarged tongue, hypotonia, easy weight gain, and cool skin temperature.

53. Which of the following foods are allowed for a child with galactosemia? Select all that apply

a) instant potatoes
b) chicken
c) lima foods
d) whole wheat bread
e) apples
f) 2% cow's milk

54. Which of the following statements indicate that the adolescent is having an early sign of anorexia nervosa?

a) I have my menses every month
b) I go out to eat with my friends
c) I run three times a day for a total of 5 hours per day
d) I try to maintain my weight around 115 lbs. for my height of 5 feet

55. A client and her husband are positive for the sickle cell trait. The client asks the nurse about chances of her children having sickle cell disease. Which of the following is appropriate response by the nurse?

a) one of her children will have sickle cell disease
b) only the male children will be affected
c) each pregnancy carries a 25% chance of the child being affected
d) if she had four children, one of them would have the disease

56. Which of the following health teachings regarding sickle cell crisis should be included by the nurse?

a) it results from altered metabolism and dehydration
b) tissue hypoxia and vascular occlusion cause the primary problems
c) increased bilirubin levels will cause hypertension
d) there are decreased clotting factors with an increase in white blood cells

57. A child with leukemia is being discharged after beginning chemotherapy. Which of the following instructions will the nurse include when teaching the parents of this child?

a) provide a diet low in protein and high carbohydrates
b) avoid fresh vegetables that are not cooked or peeled
c) notify the doctor if the child's temperature exceeds 101 F (39C)
d) increase the use of humidifiers throughout the house

58. A client with hemophilia has a very swollen knee after falling from bicycle riding. Which of the following is the first nursing action?

a) initiate an IV site to begin administration of cryoprecipitate
b) type and cross-match for possible transfusion
c) monitor the client's vital signs for the first 5 minutes
d) apply ice pack and compression dressings to the knee

59. Which of the following signs and symptoms would observe in a child diagnosed of laryngotracheobronchitis?

a) predominant stridor on inspiration
b) predominant expiratory wheeze
c) high fever
d) slow respiratory rate

60. In preparing a pediatric client for appendectomy, which of the following are appropriate nursing actions? Select all that apply

a) obtain signed consent from parents
b) administer enemas until clear
c) administer 500 ml Ringer's lactate at 50 ml/hr as ordered
d) ambulate the client to increase passage of flatus to decrease distention before surgery
e) position on left side, apply a warm K-pad to the abdomen
f) position on side, legs flexed to the abdomen with the head slightly elevated

61. Which of the following diagnostic tests is conclusive of pyloric stenosis?

a) scout film of the abdomen
b) colonoscopy
c) an altered electrolyte balance
d) an upper GI series

62. A child discharged with slow cerebrospinal fluid (CSF) leak 3 days after a head injury was sustained. What will the nurse include in the discharge plans?

a) avoid use of nonsteroidal anti-inflammatory drugs
b) turn from side to side only
c) maintain complete bed rest
d) gradually increase diet to clear liquids

63. An 8-year-old girl is in the emergency department with a greenstick fracture of the ulna. Which of the following is appropriate explanation by the nurse to the parents?

a) the bone is broken obliquely
b) there is splintering of the bone on one side
c) there is break in the skin integrity with protrusion of bone ends
d) the bone is broken into several fragments

64. A 2-month old child is in a left hip spica cast. Which of the following measures should be included in the nursing care plan of the child?

a) palpate the left brachial artery and compare it with the right
b) check cast for tightness by inserting fingers between skin and cast
c) blanch the skin of areas proximal to the casted left leg
d) maintain constant traction on the affected left leg

65. Which concept of death a does a dying 4-year-old child have?

a) death is something that happens only to adults
b) death is temporary and reversible
c) death produces a void in their lives
d) death is something that they can evade

66. The mother of a 12-month old infant brings her child to the pediatric clinic for check-up. The infant falls below third percentile for height and weight. The nurse suspects that the child is suffering from

a) failure to thrive
b) munchausen syndrome by proxy
c) physical neglect
d) physical abuse

67. A mother of a 2-year old child is concerned about the child's behavior of saying "no" to everything. When scolded, the child becomes angry and starts crying loudly, but then immediately wants to be held. Which of the following is best interpretation of this behavior?

a) the child is not effectively coping with stress
b) the child's need for affection is not being met
c) this is normal behavior of a 2-year old child
d) this behavior indicates the need for counseling

68. Which of the following factors poses the most serious safety threat to a hospitalized 2-year old child and should be removed or changed?

a) crayons and paper
b) teddy bear in the crib
c) mobile hanging over the crib
d) siderails in the halfway position



ANSWERS AND RATIONALE

1) A - strabismus is normal in an infant and it normally resolves before age 4 months

2) C - Rationale: a 2 year old usually can kick a ball forward. Riding a tricycle is characteristic of a 3 year old. Tying a shoelaces is a behavior to be expected of a 5 year old. Using blunt scissors is characteristic of a 3 year old.

3) B - Rationale: the preschool child does not have an accurate concept of skin integrity and can view medical surgical treatments as hostile invasions that can destroy or damage the body. The child does not understand that exsanguination will not occur from an injection site. Fear of pain would be manifested if the child thought that bodily harm would occur. If the child thought that he would urinate in his pants, then he would be demonstrating fear of loss of control.

4) A - Rationale: children who have temper tantrums should be ignored as long as they are safe. They should not receive either positive or negative reinforcement to avoid perpetuating the behavior. Temper tantrums are a toddler's way of achieving independence.

5) C - Rationale: for the first few days after a T and A, liquids and soft foods are best tolerated by the child while the throat is sore. Avoid hard and scratchy foods until throat is healed.

6) D - Rationale: CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction, a moderate fat, high calorie diet is indicated.

7) A - Rationale: swimming would be the most appropriate suggestion because it coordinates breathing and movement of all muscle groups and can be done on an individual basis or as a team sport. Because track events, baseball and javelin throwing usually are performed outdoors, the child would be breathing in large amounts of dust and dirt, which would be irritating to her mucous membranes and pulmonary system. The strenuous activity and increased energy expenditure associated with track events, in conjunction with the dust and possible heat, would play a role in placing the child at risk for an URTI and compromising her respiratory function.

8) d - Rationale: the child is experiencing a "tet spell" or hypoxic episode. Therefore the nurse should place the child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower extremities and reduces the volume of blood being shunted through the interventricular septal defect and the overriding aorta in the child with tetralogy of fallot. As a result, the blood then entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing the legs also increases vascular resistance and pressure in the left ventricle. An infant often assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child may need sedative. Once the child is in this position, the nurse may assess for an irregular heart rate and rhythm. Explaining tho the child that it will only hurt for a short time does nothing to alleviate hypoxia.

9) D - Rationale: for a child with arthritis associated with rheumatic fever, the joints are usually so tender that even the weight of bed linens can cause pain. Use of the bed cradle is recommended to help remove the weight of the linens on painful joints. Joints need to be maintained in good alignment, not positioned in extension, to ensure that they remain functional. Applying gentle traction to the joints is not recommended because traction is usually used to relieve muscle spasms, not typically associated with rheumatic fever. Supporting the body in good alignment and changing the client's position are recommended, but these measures are not likely to relieve pain.

10) C - Rationale: one of the characteristics of children with KD is irritability. They are often inconsolable. Placing the child in a quiet environment may help quiet the child and reduce the workload of the heart. The child's irritability takes priority over peeling of the skin.

11) B - Rationale: potato, peas, chicken, green vegetables, and rice cereal contain significant amounts of iron and therefore would be recommended. Milk and yellow vegetables are not good iron sources. Rice, by itself also is not a good source of iron.

12) A - Rationale: because factor VIII concentrate is derived from large pools of human plasma, the risk of hepatitis is always present.

13) D - Rationale: half-strength hydrogen peroxide is recommended for cleansing the suture line after cleft lip repair. The bubbling action of the hydrogen peroxide is effective for removing debris. Normal saline also may be used. Mouthwashes frequently contain alcohol which can be irritating. Povidone-iodine solution is not used because iodine contained in the solution can be absorbed through the skin, leading to toxicity. A mild antiseptic solution has some antibacterial properties but is ineffective in removing suture-line debris.

14) B - Rationale: because the blind pouch associated with TEF fills quickly with fluids, the child is at risk for aspiration. Children with TEF usually develop aspiration pneumonia.

15) C - Rationale: after surgical repair for an imperforate anus, the infant should be positioned either supine with the legs suspended at 90-degree angle or on either side with the hips elevated to prevent pressure on the perineum. A neonate who is placed on the abdomen pulls the legs up under the body, which puts tension on the perineum, as does positioning the neonate with the legs extended straight out

16) C - Rationale: after ingesting a large amount of acetaminohen, the child would complain of right upper quadrant pain due to hepatic damage from glutathione combining with the metabolite of acetaminophrn being broken down.

17) A - Rationale: eating with dirty hands, especially after playing outside, can lead to lead poisoning because lead is often present in soil surrounding homes. When blood levels of lead reaches 15-19 mg/dL.., an investigation of the child's environment will be initiated. Oral chelation therapy is started when blood lead levels reached 45 mg/dL. When they reach 70 mg/dL, the child usually is hospitalized for intravenous chelation therapy.

18) C - Rationale: because the incidence of testicular cancer is increased in adulthood among children who have undescended testes. It is extremely important to teach the adolescent how to perform the testicular self-examination monthly.

19) D - Rationale: the most important consideration for a successful outcome of this surgery is maintenance of the catheters or stents. A 12 month old likes to explore his environment. Applying soft restraints will prevent the child from disrupting the catheter.

20) C - Rationale: the child will glomerulonephritis experiences a problem with renal function that ultimately affects fluid balance. Because weight is the best indicator of fluid balance, obtaining daily weights would be the highest priority.

21) B - Rationale: the abdomen of the child with Wilm's tumor should not be palpated because of the danger of disseminating tumor cells. The child with Wilm's tumor should always be handled gently and carefully

22) C - Rationale: before surgery, the infant is kept in the prone position to decrease tension on the sac. This allows for optimal positioning of the hips, knees, and feet because orthopedic problems are common. The supine position is unacceptable because it causes pressure on the defect

23) D - Rationale: for at least the first 24 hours after insertion of a ventriculoperitoneal shunt, the child is positioned supine with the head of the bed flat to prevent too rapid decrease in CSF pressure. A rapid reduction in the size of the ventricles can cause subdural hematoma. Positioning on the operative site is to be avoided because it places pressure on the shunt valve, possibly blocking desired drainage of CSF. With continued increased ICP, the child would be positioned with the head of bed elevated to allow gravity to aid drainage.

24) A - Rationale: the goal in working with mentally challenged children is to train them to be as independent as possible, focusing on the developmental skills. The child may not be capable of learning something new every day but needs to repeat what has been taught previously. Rather than encouraging more lenient behavior limits, the parents need to be strict and consistent when setting limits for the child. Most children with Down syndrome are unable to achieve age-appropriate social skills due to their mental retardation. Rather, they taught socially appropriate behaviors.

25) C - Rationale: a toxic effect of valproic acid (Depakene) is liver toxicity, which may manifest with jaundice and abdominal pain. If jaundice occurs, the client needs to notify the health care provider as soon as possible.

26) C - Rationale: the child is angry and needs a positive outlet for expression of feelings. An emotionally tense child with pent-up hostilities needs a physical activity that will release energy and frustration. Pounding on a pegboard offers the opportunity. Listening to a story does not allow child to express emotions. It also places the child in a passive role and does not allow the child to deal with feelings in a healthy and positive way. Activities such as paintings and stacking a tower of blocks require concentration and fine movements, which could add to frustration.

27) B - Rationale: guilt is a common parental response. The parents need to be allowed to express their feelings openly in a nonthreatening, nonjudgmental atmosphere.

28) A - Rationale: the Pavlik harness is worn over a diaper. Knee socks are also worn to prevent the straps and foot and leg pieces from rubbing directly on the skin. For maximum results, the infant needs to wear the harness continuously. The skin should be inspected several times a day, not every other day, for signs of redness or irritation. Lotions and powders are to be avoided because they can cake and irritate the skin. (Hip dysplasia is a condition in which the head of the femur is improperly rested in the acetabulum, or hip socket of the pelvis. The characteristic manifestations are as follows: asymmetry of the gluteal and thigh folds; limited hip abduction in the affected hip; apparent shortening of the femur on the affected side (Galeazzi sign and Allis sign); weight bearing causes titling of the pelvis downward on the unaffected side (Trendelenberg sign); Ortolani click (in infant under 4 weeks of age).

29) D - Rationale: delay in achieving developmental milestones is a characteristic of children with cerebral palsy. A 15 month old child can put a block in a cup. Walking up steps typically is accomplished at 18 to 24 months. A child usually is able to use a spoon at 18 months. The ability to copy a circle is achieved at approximately 3 to 4 years of age.

30) A - Rationale: muscular dystrophy is an X-linked recessive disorder. The gene is transmitted through female carriers to affected sons 50% of the time. Daughters have a 50% chance of being carriers. It is a progressive disease. Children who are affected by this disease usually are unable to walk independently by age 9-11 years. There is no effective treatment for the disease. A characteristic manifestation is Gower's sign -- the child walks the hands up the legs in an attempt to rise from sitting to standing position.

31) D - Rationale: the body compensates for metabolic acidosis through the lungs, which try to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respiration.

32) A - Rationale: a child who wants to finish his game of candyland before his dressing is changed is in the stage of initiative. During this stage, a child plays, works and lives to the fullest and feels a real sense of accomplishment and satisfaction in activities. Completing tasks becomes increasingly important. Temper tantrum is a characteristic behavior of a toddler.

34) D - Rationale: rubber dropper or Breck feeder prevents suture line trauma and promotes healing.

35) C - Rationale: if the client is not receiving her full course of antibiotic therapy, her ear infections will recur; permanent hearing loss or systemic infection may result. Parents may not understand this and may discontinue treatment when the neonate seems better.

36) B - Rationale: the cognitive development of an infant ( birth up to 2 years) according to Piaget's theory is sensorimotor. The child will look for an object once it disappears from the sight to develop the cognitive skill of permanence. Finger paint, small balls, and anything strung across a crib are safely hazards.

37) B - Rationale: the anterior fontanel stays open to allow for the rapid growth of brain tissue during the first year of life. It normally closes between ages 12 and 18 months.

38) B, C, and F - Rationale: during adolescence, abstract thinking and secondary sex characteristics are developed and high-risk behaviors are common. Egocentricity is a characteristic of toddlerhood. Hand dominance develops during the preschool years, and sense of morality develops during the school-age years.

39) C - Rationale: a 3 year old child who acts withdrawn and has bruises on his back may be the victim of child abuse. Three-year old children are usually social, not withdrawn.

40) C - Rationale: acetylcysteine prevents hepatotoxicity caused by acetaminophen poisoning. Vitamin K is antidote of Coumadin; ASA is analgesic and antiplatelet; and EDTA is chelating agent used for lead poisoning.

41) A - Rationale: the common symptoms of idiophatic thrombocytopenic purpura include easy bruising, petechiae, and bleeding from mucous membranes. Hemorrhage like nose bleeding is a rare physical finding. Dark-colored concentrated urine may indicate dehydration. Fever isn't always present with idiophatic thrombocytopenic purpura.

42) C - Rationale: reading a book is restful activity and can keep the child from becoming bored. Choices a, b, and d require too much energy for a child with anemia and can increase oxygen demands on the body.

43) A, D, and E - Rationale: applying pressure and cold compresses to the site and elevating the injured part are all interventions to control bleeding. Applying warm packs to the site, administering aspirin, and moving the injured area immediately after bleeding stops will further cause bleeding. To restore joint mobility, begin range-of-motion exercises at least 48 hours after the bleeding is controlled.

44) D - Rationale: loratadine is nonsedating antihistamine used for allergic symptoms. Choices no. 1, 2, and 3 cause drowsiness in more than 50% of people who take them.

45) C - Rationale: marked irritability, vomiting, bulging fontanels and seizures are commonly seen in bacterial meningitis. Depressed anterior fontanel is a sign of dehydration, not of meningeal irritation.

46) B - Rationale: a single palmar crease, called simian line and hypotonia are characteristics of Down's syndrome. Prominent scalp veins and high-pitched cry are signs of increased intracranial pressure. Flat maxilla, microcephaly and postnatal growth delays are signs of fetal alcohol sydrome (FAS).

47) D - Rationale: folic acid rich foods like spinach and other green leafy vegetables decrease the risk of NTD's

48) B, C, and F - Rationale: research has proven that use of firm mattress, placing the infant on his back to sleep and breastfeeding can help reduce the incidence of SIDS.

49) C - Rationale: the parents should call the poison control center first, for specific directions to treat the client. Ipecac syrup is not indicated in all types of poisoning because some ingested substances cause more damage if vomiting is induced.

50) C - Rationale: involving the child helps gain cooperation, and permitting the child to make choices gives a sense of control. Telling a child to take medicine "right now" may provoke a negative response. Promising that a child will go home sooner can destroy the child's trust in nurses and physicians. Comparing one child to another will not encourage cooperation.

51) B - Rationale: the Guthrie screening test is used to diagnose phenylketonuria. Bacillus subtilis, present in the culture medium, grows if the blood contains an excessive amount of phenylketonuria.

52) A - Rationale: the signs and symptoms of hypoglycemia are behavioral changes, increased heart rate, sweating, and tremors. Nausea, fruity breath odor, headache and fatigue are present in hyperglycemia. Polydipsia, polyuria, polyphagia, and weight loss are signs of diabetes. Enlarged tongue, hypotonia, easy weight gain, and cool skin temperature are associated with hypothyroidism.

53) B, D, E - Rationale: the child with galactosemia should have a lactose-free-diet. Foods that may be included in the diet of the child are as follows: fish and chicken, fresh fruits and vegetables (except for lima beans), and bread made from whole wheat. The child should avoid dairy products, such as 2% cow's milk, instant potatoes, and other lactose-containing foods.

54) C - Rationale: excessive exercise, consumption of very small amounts of food and food rituals, amenorrhea, and excessive weight loss or weight is below normal, lanugo, dry skin, bradycardia, are all signs of anorexia nervosa.

55) C - Rationale: in autosomal recessive traits, both parents are carriers. There is a 25% chance with each pregnancy that a child will have the disease.

56) B - Rationale: tissue hypoxia occurs as a result of the decreased oxygen-carrying capacity of the red blood cells. The sickled cells begin to clump together, which leads to vascular occlusion.

57) B - Rationale: fresh fruits and vegetables harbor microorganisms, which can cause infections in immune-compromised child. Fruits and vegetables should either be peeled or cooked. The physician should be notified of a temperature above 100F, a diet low in protein is not indicated, and humidifiers harbor fungi in the water containers.

58) D - Rationale: rest, ice, compression, and elevation (RICE) are the immediate treatments to reduce the swelling and bleeding into the joint. These are the priority actions for bleeding into the joint of a client with hemophilia.

59) A - Rationale: because croup cause upper airway obstruction, inspiratory stridor is predominant symptom

60) A, C, F - Rationale: the client is pediatric; therefore obtain signed consent form from parents. IV fluid infusion is necessary preop to prevent dehydration. The characteristic position of comfort for the client with appendicitis is on the side with legs flexed against the abdomen, the head slightly elevated to decrease the upward spread of infection in case the appendix ruptures - enema, laxative, heat application over the abdomen and ambulation are contraindicated among clients with appendicitis. These factors may cause perforation of appendicitis.

61) D - Rationale: an upper GI series will show delayed gastric emptying and an elongated pyloric channel.

62) C - Rationale: most CSF leaks resolve spontaneously. The child should be maintained on bed rest until CSF leak stops. NSAID's may be used. The child may assume position of comfort. There are no dietary restrictions.

63) B - Rationale: greenstick fracture involves splintering of the bone on one side; not a complete fracture. It is common fracture in children.

64) B - Rationale: check the cast to make sure it is not too tight and not constricting circulation. The child is not in traction; the arms are not part of the treatment; and the circulation is checked distal to the cast.

65) B - Rationale: preschoolers see death as a departure or type of sleep and believe death is temporary - school-age children view death as something that happens only to adults. Infants and toddlers view death as the loss of a person who cared for them or a void in their lives. Adolescents feel that they can evade death or may feel that they're immune to death.

66) A - Rationale: failure to thrive is chronic, potentially life-threatening condition characterized by failure to maintain weight and height above the 5th percentile on age-appropriate growth charts. This condition may have an organic cause such as heart disease, or a nonorganic cause such as failure to bond between child and primary caregiver. In munchausen syndrome by proxy, a parent repeatedly brings a child to a health care facility reporting symptoms of illness when a child is well. The neglected child may appear unwashed or be improperly dressed for the weather. The physically abused child may have peculiar lacerations or bruises such as curved imprints from belt buckle.

67) C - Rationale: negativism (saying "no" to everything) is a necessary assertion of self-control by a toddler. The child is attempting to achieve autonomy at this stage of growth and development.

68) D - Rationale: to prevent falls ( one of the common accidents in the hospitals), crib rails always should be raised and fastened securely unless an adult is at the bedside. Crayons and paper and a teddy bear are safe toys for a 2-year old client. A side rail that's positioned incorrectly poses a serious threat.

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