ESSENTIALS OF PEDIATRIC NURSING - 5TH
EDITION BY TERRI KYLE AND SUSAN CARMAN
| COMPLETE TEST BANK ALREADY GRADED
A+..
1. A pediatric nurse is assessing a child with suspected increased intracranial pressure (ICP).
Which of the following assessment findings is most indicative of Cushing's triad, indicating
impending brainstem herniation?
A. Bradycardia, hypertension, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Widening pulse pressure, bradycardia, and irregular respirations
D. Narrowing pulse pressure, tachycardia, and Cheyne-Stokes respirations
Answer: C
Rationale: Cushing's triad consists of widening pulse pressure, bradycardia, and irregular respirations
(often Cheyne-Stokes or ataxic). This reflects the body's attempt to maintain cerebral perfusion pressure
as ICP rises. Option A omits widening pulse pressure; B describes shock; D describes early
compensatory changes.
2. A school-age child with sickle cell disease is admitted with vaso-occlusive crisis. The nurse
receives an order for intravenous morphine 0.1 mg/kg every 2 hours PRN. The child weighs 30 kg.
Which of the following actions by the nurse is most appropriate?
A. Administer morphine 3 mg IV every 2 hours PRN as ordered
B. Question the order because morphine is contraindicated in sickle cell disease
C. Administer morphine 3 mg IV every 2 hours around the clock
D. Request a change to meperidine because it is safer for children
Answer: A
Rationale: The correct dose is 0.1 mg/kg × 30 kg = 3 mg. PRN administration is appropriate for pain
crisis; around-the-clock dosing may be needed but the order specifies PRN. Morphine is not
contraindicated; meperidine is avoided due to normeperidine accumulation and seizure risk.
3. A nurse is caring for a child with acute lymphoblastic leukemia (ALL) who is receiving
high-dose methotrexate. The nurse monitors for signs of methotrexate toxicity. Which laboratory
value is most critical to monitor during therapy?
A. Serum creatinine
B. Hemoglobin level
C. White blood cell count
D. Platelet count
Page 1
,Answer: A
Rationale: Methotrexate is primarily excreted renally; renal impairment leads to accumulation and
severe toxicity. Serum creatinine is the most critical lab to monitor. While myelosuppression occurs,
renal function is paramount for safe clearance.
4. A nurse is teaching a parent of a child with a new diagnosis of type 1 diabetes mellitus. Which of
the following statements by the parent indicates a correct understanding of managing
hypoglycemia?
A. I will give my child a snack of cheese and crackers before bedtime
B. If my child is unconscious, I will give glucagon intramuscularly
C. I will give my child orange juice if the blood glucose is 200 mg/dL
D. I will skip the insulin dose if my child is sick and not eating
Answer: B
Rationale: Glucagon IM is the correct treatment for severe hypoglycemia with altered consciousness.
Cheese and crackers are for prevention, not treatment. Orange juice is given for low blood glucose (<70
mg/dL), not 200 mg/dL. Insulin should never be skipped; sick-day management involves adjustments.
5. A nurse is assessing a child with suspected intussusception. Which of the following findings is
most consistent with this diagnosis?
A. Currant jelly stools, intermittent abdominal pain, and a sausage-shaped mass
B. Projectile vomiting, olive-shaped mass, and visible peristalsis
C. Watery diarrhea, perianal excoriation, and failure to thrive
D. Constipation, abdominal distension, and palpable fecal mass
Answer: A
Rationale: Intussusception presents with currant jelly stools (blood and mucus), colicky abdominal pain,
and a sausage-shaped mass on palpation. Option B describes pyloric stenosis; C is typical of chronic
diarrhea; D is constipation.
6. A nurse is caring for a child with nephrotic syndrome. Which of the following interventions
should the nurse prioritize?
A. Weigh the child daily and measure abdominal girth
B. Restrict fluids to 500 mL per day
C. Encourage a high-sodium diet to replace losses
D. Administer furosemide to reduce edema
Answer: A
Rationale: Daily weight and abdominal girth are key to monitoring fluid status. Fluid restriction is not
routine; sodium is restricted, not encouraged. Diuretics are used cautiously due to risk of hypovolemia;
albumin infusion may precede diuretics.
7. A nurse is assessing a child with suspected cystic fibrosis. Which of the following findings is most
indicative of pancreatic insufficiency?
A. Frequent, bulky, greasy stools
Page 2
,B. Hemoptysis and clubbing
C. Recurrent sinus infections
D. Meconium ileus at birth
Answer: A
Rationale: Pancreatic insufficiency leads to malabsorption, causing steatorrhea (bulky, greasy stools).
Hemoptysis and clubbing indicate advanced lung disease. Sinus infections and meconium ileus are
common but not specific to pancreatic insufficiency.
8. A child is admitted with a diagnosis of Kawasaki disease. The nurse anticipates that the most
serious complication is:
A. Coronary artery aneurysms
B. Stenosis of the mitral valve
C. Rheumatic heart disease
D. Myocarditis
Answer: A
Rationale: Kawasaki disease is a vasculitis that can lead to coronary artery aneurysms, the most serious
complication. Myocarditis can occur acutely but aneurysms are the primary concern. Mitral stenosis
and rheumatic heart disease are associated with rheumatic fever.
9. A nurse is evaluating a child's developmental milestones. Which of the following findings would
be most concerning for a developmental delay?
A. A 4-month-old infant does not roll from back to side
B. A 12-month-old child does not walk independently
C. An 18-month-old child does not use two-word phrases
D. A 24-month-old child does not kick a ball
Answer: C
Rationale: By 18 months, children typically use 10-20 words and begin combining two words. Lack of
two-word phrases at 18 months is a red flag for language delay. Rolling at 4 months is not yet expected;
walking at 12 months is variable; kicking a ball at 24 months is typical but not a critical milestone.
10. A nurse is preparing to administer immunizations to a 6-month-old infant. Which of the
following vaccines should the nurse anticipate administering?
A. Hepatitis B, DTaP, IPV, PCV13, and RV
B. DTaP, IPV, MMR, and Varicella
C. Hepatitis B, DTaP, IPV, and Hib
D. DTaP, IPV, PCV13, RV, and Influenza
Answer: A
Rationale: At 6 months, the recommended vaccines include Hepatitis B (third dose), DTaP (third dose),
IPV (third dose), PCV13 (third dose), and RV (third dose if Rotarix or second if RotaTeq). MMR and
Varicella are given at 12 months. Influenza is recommended annually starting at 6 months but is not part
of the routine 6-month schedule.
Page 3
, 11. A pediatric nurse is evaluating a child with suspected dehydration. The nurse calculates the
serum osmolality using the formula: 2(Na+) + (glucose/18) + (BUN/2.8). The laboratory results
show Na+ 150 mEq/L, glucose 90 mg/dL, and BUN 28 mg/dL. Which of the following best
describes the calculated osmolality and its clinical significance?
A. 310 mOsm/L; indicates hypertonic dehydration with free water deficit
B. 320 mOsm/L; indicates isotonic dehydration with equal water and solute loss
C. 300 mOsm/L; indicates hypotonic dehydration with hyponatremia
D. 315 mOsm/L; indicates hypertonic dehydration with hyperglycemia
Answer: A
Rationale: Calculating: 2(150) + (90/18) + (28/2.8) = 300 + 5 + 10 = 315 mOsm/L. A value >300
mOsm/L indicates hypertonic dehydration. The elevated Na+ (150 mEq/L) confirms free water deficit.
Option D is close but incorrectly attributes to hyperglycemia; glucose is normal. Options B and C are
incorrect values or types.
12. A nurse is caring for an infant with a congenital heart defect that results in increased
pulmonary blood flow. The nurse anticipates that which of the following compensatory
mechanisms is most likely to be activated initially?
A. Increased systemic vascular resistance to maintain cardiac output
B. Decreased heart rate to prolong ventricular filling time
C. Increased pulmonary vascular resistance to reduce shunt flow
D. Activation of the renin-angiotensin-aldosterone system to retain sodium and water
Answer: C
Rationale: In defects with increased pulmonary blood flow (e.g., VSD, PDA), the initial compensatory
response is pulmonary vasoconstriction, increasing pulmonary vascular resistance to limit excessive
flow. This is a local autoregulatory response. Option D occurs later with heart failure. Option A would
worsen the shunt. Option B is not compensatory; tachycardia is more common.
13. A child with acute lymphoblastic leukemia is receiving high-dose methotrexate. The nurse
monitors for signs of toxicity. Which laboratory finding would be most indicative of
methotrexate-induced nephrotoxicity?
A. Elevated serum creatinine and decreased urine output
B. Elevated liver enzymes and prolonged prothrombin time
C. Decreased platelet count and petechiae
D. Elevated uric acid and joint pain
Answer: A
Rationale: Methotrexate is excreted renally; high doses can cause acute kidney injury due to precipitation
in renal tubules. Elevated creatinine and oliguria are key indicators. Option B reflects hepatotoxicity,
option C myelosuppression, and option D tumor lysis syndrome, which can occur but is not specific to
methotrexate nephrotoxicity.
14. A nurse is assessing a toddler with suspected intussusception. The nurse understands that the
classic triad of symptoms includes which of the following?
Page 4
EDITION BY TERRI KYLE AND SUSAN CARMAN
| COMPLETE TEST BANK ALREADY GRADED
A+..
1. A pediatric nurse is assessing a child with suspected increased intracranial pressure (ICP).
Which of the following assessment findings is most indicative of Cushing's triad, indicating
impending brainstem herniation?
A. Bradycardia, hypertension, and irregular respirations
B. Tachycardia, hypotension, and tachypnea
C. Widening pulse pressure, bradycardia, and irregular respirations
D. Narrowing pulse pressure, tachycardia, and Cheyne-Stokes respirations
Answer: C
Rationale: Cushing's triad consists of widening pulse pressure, bradycardia, and irregular respirations
(often Cheyne-Stokes or ataxic). This reflects the body's attempt to maintain cerebral perfusion pressure
as ICP rises. Option A omits widening pulse pressure; B describes shock; D describes early
compensatory changes.
2. A school-age child with sickle cell disease is admitted with vaso-occlusive crisis. The nurse
receives an order for intravenous morphine 0.1 mg/kg every 2 hours PRN. The child weighs 30 kg.
Which of the following actions by the nurse is most appropriate?
A. Administer morphine 3 mg IV every 2 hours PRN as ordered
B. Question the order because morphine is contraindicated in sickle cell disease
C. Administer morphine 3 mg IV every 2 hours around the clock
D. Request a change to meperidine because it is safer for children
Answer: A
Rationale: The correct dose is 0.1 mg/kg × 30 kg = 3 mg. PRN administration is appropriate for pain
crisis; around-the-clock dosing may be needed but the order specifies PRN. Morphine is not
contraindicated; meperidine is avoided due to normeperidine accumulation and seizure risk.
3. A nurse is caring for a child with acute lymphoblastic leukemia (ALL) who is receiving
high-dose methotrexate. The nurse monitors for signs of methotrexate toxicity. Which laboratory
value is most critical to monitor during therapy?
A. Serum creatinine
B. Hemoglobin level
C. White blood cell count
D. Platelet count
Page 1
,Answer: A
Rationale: Methotrexate is primarily excreted renally; renal impairment leads to accumulation and
severe toxicity. Serum creatinine is the most critical lab to monitor. While myelosuppression occurs,
renal function is paramount for safe clearance.
4. A nurse is teaching a parent of a child with a new diagnosis of type 1 diabetes mellitus. Which of
the following statements by the parent indicates a correct understanding of managing
hypoglycemia?
A. I will give my child a snack of cheese and crackers before bedtime
B. If my child is unconscious, I will give glucagon intramuscularly
C. I will give my child orange juice if the blood glucose is 200 mg/dL
D. I will skip the insulin dose if my child is sick and not eating
Answer: B
Rationale: Glucagon IM is the correct treatment for severe hypoglycemia with altered consciousness.
Cheese and crackers are for prevention, not treatment. Orange juice is given for low blood glucose (<70
mg/dL), not 200 mg/dL. Insulin should never be skipped; sick-day management involves adjustments.
5. A nurse is assessing a child with suspected intussusception. Which of the following findings is
most consistent with this diagnosis?
A. Currant jelly stools, intermittent abdominal pain, and a sausage-shaped mass
B. Projectile vomiting, olive-shaped mass, and visible peristalsis
C. Watery diarrhea, perianal excoriation, and failure to thrive
D. Constipation, abdominal distension, and palpable fecal mass
Answer: A
Rationale: Intussusception presents with currant jelly stools (blood and mucus), colicky abdominal pain,
and a sausage-shaped mass on palpation. Option B describes pyloric stenosis; C is typical of chronic
diarrhea; D is constipation.
6. A nurse is caring for a child with nephrotic syndrome. Which of the following interventions
should the nurse prioritize?
A. Weigh the child daily and measure abdominal girth
B. Restrict fluids to 500 mL per day
C. Encourage a high-sodium diet to replace losses
D. Administer furosemide to reduce edema
Answer: A
Rationale: Daily weight and abdominal girth are key to monitoring fluid status. Fluid restriction is not
routine; sodium is restricted, not encouraged. Diuretics are used cautiously due to risk of hypovolemia;
albumin infusion may precede diuretics.
7. A nurse is assessing a child with suspected cystic fibrosis. Which of the following findings is most
indicative of pancreatic insufficiency?
A. Frequent, bulky, greasy stools
Page 2
,B. Hemoptysis and clubbing
C. Recurrent sinus infections
D. Meconium ileus at birth
Answer: A
Rationale: Pancreatic insufficiency leads to malabsorption, causing steatorrhea (bulky, greasy stools).
Hemoptysis and clubbing indicate advanced lung disease. Sinus infections and meconium ileus are
common but not specific to pancreatic insufficiency.
8. A child is admitted with a diagnosis of Kawasaki disease. The nurse anticipates that the most
serious complication is:
A. Coronary artery aneurysms
B. Stenosis of the mitral valve
C. Rheumatic heart disease
D. Myocarditis
Answer: A
Rationale: Kawasaki disease is a vasculitis that can lead to coronary artery aneurysms, the most serious
complication. Myocarditis can occur acutely but aneurysms are the primary concern. Mitral stenosis
and rheumatic heart disease are associated with rheumatic fever.
9. A nurse is evaluating a child's developmental milestones. Which of the following findings would
be most concerning for a developmental delay?
A. A 4-month-old infant does not roll from back to side
B. A 12-month-old child does not walk independently
C. An 18-month-old child does not use two-word phrases
D. A 24-month-old child does not kick a ball
Answer: C
Rationale: By 18 months, children typically use 10-20 words and begin combining two words. Lack of
two-word phrases at 18 months is a red flag for language delay. Rolling at 4 months is not yet expected;
walking at 12 months is variable; kicking a ball at 24 months is typical but not a critical milestone.
10. A nurse is preparing to administer immunizations to a 6-month-old infant. Which of the
following vaccines should the nurse anticipate administering?
A. Hepatitis B, DTaP, IPV, PCV13, and RV
B. DTaP, IPV, MMR, and Varicella
C. Hepatitis B, DTaP, IPV, and Hib
D. DTaP, IPV, PCV13, RV, and Influenza
Answer: A
Rationale: At 6 months, the recommended vaccines include Hepatitis B (third dose), DTaP (third dose),
IPV (third dose), PCV13 (third dose), and RV (third dose if Rotarix or second if RotaTeq). MMR and
Varicella are given at 12 months. Influenza is recommended annually starting at 6 months but is not part
of the routine 6-month schedule.
Page 3
, 11. A pediatric nurse is evaluating a child with suspected dehydration. The nurse calculates the
serum osmolality using the formula: 2(Na+) + (glucose/18) + (BUN/2.8). The laboratory results
show Na+ 150 mEq/L, glucose 90 mg/dL, and BUN 28 mg/dL. Which of the following best
describes the calculated osmolality and its clinical significance?
A. 310 mOsm/L; indicates hypertonic dehydration with free water deficit
B. 320 mOsm/L; indicates isotonic dehydration with equal water and solute loss
C. 300 mOsm/L; indicates hypotonic dehydration with hyponatremia
D. 315 mOsm/L; indicates hypertonic dehydration with hyperglycemia
Answer: A
Rationale: Calculating: 2(150) + (90/18) + (28/2.8) = 300 + 5 + 10 = 315 mOsm/L. A value >300
mOsm/L indicates hypertonic dehydration. The elevated Na+ (150 mEq/L) confirms free water deficit.
Option D is close but incorrectly attributes to hyperglycemia; glucose is normal. Options B and C are
incorrect values or types.
12. A nurse is caring for an infant with a congenital heart defect that results in increased
pulmonary blood flow. The nurse anticipates that which of the following compensatory
mechanisms is most likely to be activated initially?
A. Increased systemic vascular resistance to maintain cardiac output
B. Decreased heart rate to prolong ventricular filling time
C. Increased pulmonary vascular resistance to reduce shunt flow
D. Activation of the renin-angiotensin-aldosterone system to retain sodium and water
Answer: C
Rationale: In defects with increased pulmonary blood flow (e.g., VSD, PDA), the initial compensatory
response is pulmonary vasoconstriction, increasing pulmonary vascular resistance to limit excessive
flow. This is a local autoregulatory response. Option D occurs later with heart failure. Option A would
worsen the shunt. Option B is not compensatory; tachycardia is more common.
13. A child with acute lymphoblastic leukemia is receiving high-dose methotrexate. The nurse
monitors for signs of toxicity. Which laboratory finding would be most indicative of
methotrexate-induced nephrotoxicity?
A. Elevated serum creatinine and decreased urine output
B. Elevated liver enzymes and prolonged prothrombin time
C. Decreased platelet count and petechiae
D. Elevated uric acid and joint pain
Answer: A
Rationale: Methotrexate is excreted renally; high doses can cause acute kidney injury due to precipitation
in renal tubules. Elevated creatinine and oliguria are key indicators. Option B reflects hepatotoxicity,
option C myelosuppression, and option D tumor lysis syndrome, which can occur but is not specific to
methotrexate nephrotoxicity.
14. A nurse is assessing a toddler with suspected intussusception. The nurse understands that the
classic triad of symptoms includes which of the following?
Page 4
