NURSING 1600 Ati Pediatrics Practice Questions & Answers Already graded A+

NSG 440 Ati Pediatrics Practice Questions & Answers 1. A nurse is collecting data from a 9-month-old infant. Which of the following findings would require further intervention? A. Positive Babinski reflex Rationale: The Babinski reflex disappears after 1 year of age. Therefore, a 9-month-old infant with a positive Babinski reflex is a finding that does not require further intervention. B. Positive Moro reflex Rationale: The Moro reflex disappears approximately at 3-4 months of age. Therefore, a 9- month-old infant with a positive Moro reflex is a finding that requires further intervention C. Negative Doll’s eye reflex Rationale: A negative Doll’s eye reflex is a normal finding. Therefore, a 9-month-old infant with a negative Doll’s eye reflex is a finding that does not require further intervention. D. Negative Crawl reflex Rationale: A negative Crawl reflex disappears after 6 months of age. Therefore, a 9-month-old infant with a negative Crawl reflex is a finding that does not require further intervention. 2. A nurse is reinforcing teaching a parent of a child who has a fracture of the epiphyseal plate. Which of the following is an appropriate statement by the nurse? A. “The blood supply to the bone is disrupted.” Rationale: Children heal fractures in less time than adults because of the generous blood supply to the bone and the epiphyseal plate. B. “Normal bone growth can be affected.” Rationale: A fracture of the epiphyseal plate can affect growth in a child. Therefore, it needs to be detected and treated rapidly. C. “Bone marrow can be lost though the fracture.” Rationale: The epiphyseal plate is the cartilage growth plate. Therefore, bone marrow is not lost through this type of fracture. D. “The healing process will take longer.” Rationale: Children heal fractures in less time than adults because of the generous blood supply to the bone and the epiphyseal plate. 3. A nurse is planning to speak to a group of adolescents about toxic shock syndrome (TSS). The nurse knows that TSS is commonly associated with which of the following? A. High-absorbency tampons Rationale: Toxic shock syndrome, a severe disease caused by a toxin made by Staphylococcus aureus, is characterized by shock and multiple organ dysfunction. It most often affects menstruating women who use highly absorbent tampons. B. Mosquito bites Rationale: Mosquito bites are not associated with TSS. C. International travel Rationale: International travel is not associated with TSS. D. Multiple sexual partners Rationale: TSS is not associated with multiple sexual partners. 4. A nurse is collecting data from an infant. Which of the following is a clinical manifestation of pyloric stenosis? A. Absent bowel sounds Rationale: Visible gastric peristaltic waves moving from the left to the right are a clinical manifestation of pyloric stenosis. B. Increased sodium level Rationale: Vomiting causes a depletion of fluid and electrolytes, therefore a decrease in serum sodium levels is a clinical manifestation of pyloric stenosis. C. Projectile vomiting after feedings Rationale: Pyloric stenosis is a narrowing and thickening of the pyloric canal between the stomach and the duodenum resulting in projectile vomiting. D. Golf ball-sized mass over the left quadrant Rationale: An olive-shaped mass is palpable right of the umbilicus is a clinical manifestation of pyloric stenosis. 5. A nurse is planning care for a child who has juvenile rheumatoid arthritis. Which of the following is an appropriate action for the nurse to take? A. Administer opioids on a schedule. Rationale: NSAIDs are used to control pain. Therefore, administering opioids on a schedule is not an appropriate action for the nurse to take. B. Schedule prolonged periods of complete joint immobilization daily. Rationale: Physical mobility will assist in preserving function and maintaining mobility. Therefore, prolonged periods of complete joint immobilization is not an appropriate action for the nurse to take. C. Apply cool compresses for 20 minutes every hour. Rationale: Heat is beneficial for relieving pain and stiffness. Therefore, applying cool compresses for 20 minutes every hour is not an appropriate action for the nurse to take. D. Maintain night splints to the affected joint. Rationale: Maintaining night splints to the affected joints will assist in range of motion. Therefore, this is an appropriate action for the nurse to take. 6. A nurse is caring for a school-age child who has mild persistent asthma. Which of the following is an expected finding? (Select all that apply.) A. Symptoms are continuous throughout the day. B. Daytime symptoms occur more than twice a week. C. Nighttime symptoms occur approximately twice a month. D. Minor limitations occur with normal activity. E. Peak expiratory flow (PEF) is greater than or equal to 80% of the predicted value. Rationale: Symptoms are continuous throughout the day is incorrect. Continual asthma symptoms throughout the day are seen with severe persistent asthma. Daytime symptoms occur more than twice a week is correct. A child with mild persistent asthma will typically have daytime symptoms more than twice a week, but not daily. Nighttime symptoms occur approximately twice a month is incorrect. Nighttime symptoms occurring approximately twice a month are seen with intermittent asthma. Minor limitations occur with normal activity is correct. A child with mild persistent asthma will have some minor limitations with normal daily activities. Peak expiratory flow (PEF) is greater than or equal to 80% of the predicted value is correct. A child with mild persistent asthma will have a PEF greater than or equal to 80% of the predicted value. 7. A nurse working in a pediatric clinic is collecting data on a preschool-age child who has a rash on his arm. The mother reports that the child was recently exposed to impetigo contagiosa. Which of the following manifestations should the nurse expect to find with this skin infection? A. Scaling patches that are clear in the center. Rationale: This finding is associated with tinia corporis (ringworm), not impetigo. B. Honey-colored crusts caused by dried exudate. Rationale: This finding is associated with impetigo contagiosa. Honey-colored crusts develop when vesicles rupture and the exudate dries. C. Firm papules with a roughened, finely papillomatous texture. Rationale: This finding is associated with verruca (warts), not impetigo. D. Lines of small blisters surrounding one large blister. Rationale: This finding is associated with poison ivy, not impetigo. 8. During a routine well child check-up, a nurse is reinforcing teaching to a parent who reports having difficulty getting a preschool-age child to go to bed. Which of the following statements indicates to the nurse that the parent understands how to foster a consistent bedtime for the preschooler? A. "I will allow my child to cry himself to sleep each night.” Rationale: While crying for brief periods of time is not harmful to the child, it may promote a sense of fear and insecurity and discourage the child from going to sleep. B. "I will let my child fall asleep with me, and then move him to his own bed.” Rationale: Allowing the child to routinely come into the parent’s bed fosters the idea that this will be the norm. The child may then be unwilling to sleep alone. C. "I will make sure the room is dark when placing my child in bed.” Rationale: Darkened rooms may elicit fear in a preschooler. D. "I will encourage my child to fall sleep with his favorite toy.” Rationale: Transitional objects, such as a blanket or toy, will provide a sense of comfort and allow the child to fall asleep more quickly. 9. A nurse is collecting data about a 6-year-old client. Which statement by the client's parent should concern the nurse? A. "The teacher says my child has to squint to see the board." Rationale: Squinting to see the board may indicate a vision problem. It is essential to check children for hearing and vision problems. If not identified and corrected early, they lead to frustration and a decreased ability to learn. B. "My child has recently lost both front top teeth." Rationale: Children of this age begin to lose their deciduous teeth to accommodate the emergence of their permanent teeth. This is an expected finding. C. "My child often cheats when we play board games." Rationale: Children of this age often cheat to win at games because they feel winning is most important. This is an expected finding. D. "Sometimes my child acts bossy with his friends." Rationale: Children of this age are often bossy and are learning how to interact with peers. This is an expected finding. 10. A nurse working at a clinic speaks on the telephone with the parent of a 2-month-old infant. The parent tells the nurse that the infant has projectile vomiting followed by hunger after meals. Which of the following responses by the nurse is appropriate? A. "Bring your infant into the clinic today to be seen." Rationale: The manifestations of worsening projectile vomiting, which started at about 6 weeks of age, and the child acting hungry afterwards, are indicative of pyloric stenosis. The baby needs to be examined in the clinic as soon as possible by the provider. B. "Burp your child more frequently during feedings." Rationale: This is not an appropriate response by the nurse. C. "Give your infant an oral rehydrating solution." Rationale: This is not an appropriate response by the nurse. D. "You might want to try switching to different formula." Rationale: This is not an appropriate response by the nurse. 11. A parent expresses concern to the nurse about his 5-year-old child's stuttering. Which of the following statements is an appropriate nursing response? A. "Look directly at your son when he is speaking." Rationale: Taking time to listen attentively to a child who stutters is an appropriate recommendation. B. "Try encouraging your son to begin saying the word again." Rationale: This response is inappropriate, as it calls attention unnecessarily to the child's disfluent speech pattern. C. "Many children his age have problems with stuttering." Rationale: This response is inappropriate, because it dismisses the parent's concern without offering any recommendations for helping the child. D. "Be sure to correct the child's speech gently and without judgement." Rationale: This is an inappropriate response, because it calls attention to the child's problem and might reinforce feelings of inadequacy. 12. A nurse is reinforcing teaching with the parent of a child scheduled for the initial surgery to treat Hirschsprung's disease. The nurse knows that the parent understands the goal of the surgery when the parent states, A. "I'm glad that the ostomy is only temporary." Rationale: Hirschsprung's disease is characterized by an area of the large intestine without innervation. The child will probably require 2 surgeries over 18 months to 2 years before normal bowel function is achieved. The initial surgery is for the creation of an ostomy, which relieves the obstructed area and allows the bowel distal to the ostomy to rest. B. "I'm glad my child will have normal bowel movements now." Rationale: It will probably take 18 months to 2 years for the child to achieve normal bowel function. C. "I want to learn how to use the feeding tube as soon as possible." Rationale: Placement of a feeding tube is not a typical part of the treatment plan for Hirschsprung's disease. D. "The operation will straighten out the kink in the intestine." Rationale: This statement indicates a lack of understanding of the pathophysiology of this disease. 13. A nurse is talking to a parent who is concerned about her hospitalized 5-year-old child's behavior and asks the nurse if it is "normal." The nurse explains that regression is common in hospitalized children and may manifest by which of the following? A. Bedwetting several times a day Rationale: Bedwetting by a preschooler who does not usually do so is a sign of regression in preschoolers. B. Crying when the parent leaves Rationale: This behavior is expected with preschoolers and is not a sign of regression. C. Eating only food from home Rationale: Preschoolers are reluctant to make changes in their dietary habits when ill. This is not a sign of regression. D. Cuddling a threadbare blanket at bedtime Rationale: Transitional objects are helpful in any situation where a child feels anxiety or stress. This is not a sign of regression. 14. A nurse is planning care for a child with suspected epiglottitis. Which of the following is an appropriate action for the nurse to take? A. Obtain a throat culture Rationale: Obtaining a throat culture on a child with suspected epiglottitis could precipitate obstruction of the airway and should be avoided. B. Place client in an upright position Rationale: Placing the child in an upright position will assist in maintaining a patent airway and is an appropriate action for the nurse to take. C. Transfer for a throat x-ray Rationale: The airway of a child with suspected epiglottitis could become obstructed easily, therefore transferring for a throat x-ray is not an appropriate action for the nurse to take. D. Visualize the epiglottis with a tongue depressor Rationale: Visualizing the epiglottis with a tongue depressor on a child with suspected epiglottitis could precipitate obstruction of the airway and should be avoided. 15. A school nurse is screening an 11-year-old client for idiopathic scoliosis. Which of the following instructions should the nurse give the client for this examination? A. “Lie prone on the examination table.” Rationale: With the client in this position, the nurse might notice some asymmetry due to scoliosis. However, this position does not exaggerate the manifestations of this disorder and is not part of the standard scoliosis screening procedure. B. “Touch your chin to your chest and then look up at the ceiling.” Rationale: These movements might help the nurse test flexion and hyperextension of the neck to evaluate the cervical spine. They are not part of the standard scoliosis screening procedure. C. “Turn to the side and remain in a relaxed position.” Rationale: Scoliosis is a lateral curvature of the spine that the nurse might not detect from a side view. This position might help the nurse note kyphosis, a convex thoracic curvature of the thoracic spine, or lordosis, an abnormal lumbar curvature. D. “Bend forward from the waist with your head and arms downward.” Rationale: Called the Adams position, this posture will make any asymmetry of the ribs and flanks easier for the nurse to recognize. 16. A school nurse is talking with a 13-year-old female at her annual health screening visit. Which of the following client comments should concern the nurse? A. "My parents treat me like a baby sometimes." Rationale: This is an expected comment. Adolescence can be a time of great struggle between independence and dependence for both the child and the parents. B. "I haven't gotten my period yet, and all my friends have theirs." Rationale: Adolescents constantly compare themselves to their peers and feel very isolated if there are any differences. Onset of menses varies and this client is still within the appropriate time frame. C. "None of the kids at this school like me, and I don't like them either." Rationale: This statement should concern the nurse, as the peer group is critical to adolescent development and sense of self-esteem. This comment needs to be explored in greater depth. D. "There's a pimple on my face, and I worry that everyone will notice it." Rationale: Adolescents constantly compare themselves to their peers and feel very isolated if there are any differences. 17. The nurse is caring for a hospitalized adolescent. The nurse understands that which major developmental task is important during adolescence? A. Building a sense of trust Rationale: Building a sense of trust is not an appropriate developmental task of adolescence. B. Learning to utilize creative energies Rationale: Learning to utilize creative energies is not a developmental task of adolescence. C. Learning to defer gratification Rationale: Learning to defer gratification is not an appropriate developmental task of adolescence. D. Defining a sense of self Rationale: Establishing an identity or defining a sense of self is the major adolescent developmental task. 18. A nurse is talking to the parents of an 8-month-old who will be hospitalized for surgery. Which of the following actions should the nurse explain to the parents will help prepare the infant for the hospital? A. Buy a new toy and give it to the infant at the hospital. Rationale: This action could be an effective anxiety-reduction strategy with a preschooler or school-age child, as a new toy could provide the child with distraction. This is not an appropriate action to take for a hospitalized infant. B. Bring the infant’s favorite blanket to the hospital. Rationale: Infants of this age have separation anxiety and often need a transitional object, such as a blanket or toy, that brings them comfort. The transitional object is especially important when the child is in unfamiliar surroundings, or the parent is not there to provide comfort. Having the object will help to provide the infant with a sense of security. C. Purchase new loose-fitting, soft pajamas for the child. Rationale: This action could be an effective anxiety-reduction strategy with an older school-age child or adolescent, as new clothes could help with the child’s anxiety about body image. This is not an appropriate action to take for a hospitalized infant. D. Read the child a story about hospitalization. Rationale: This action could be an effective anxiety-reduction strategy with a preschooler or school-age child because it will help to prepare the child for a new, anxiety- producing experience. This is not an appropriate action to take for a hospitalized infant. 19. A nurse is planning care for a hospitalized 4-year-old child. The nurse should include providing a A. plastic stethoscope. Rationale: Preschool play centers on imitation of adults. Providing a stethoscope allows the child to imitate the staff and helps ease the fear of unfamiliar equipment. B. brightly colored mobile. Rationale: A brightly colored mobile is appropriate for a very young infant. It would not meet the activity needs of a preschooler. C. jigsaw puzzle. Rationale: A jigsaw puzzle is too difficult for most preschoolers and will frustrate rather than entertain the child. D. helium-filled latex balloon. Rationale: Helium balloons might entertain the child, but the rubber in a deflated latex balloon presents a choking hazard. 20. A nurse is caring for an infant with spinal bifida. Which of the following is an appropriate action for the nurse to take? A. Obtain rectal temperature Rationale: Rectal temperature could case rectal prolapse and should be avoided. B. Place in prone position Rationale: Placing the infant in prone position will assist in preventing trama to the lesion. C. Cover lesion with a dry cloth Rationale: The lesion should be covered with a moist cloth to prevent drying. D. Perform ROM to lower extremities Rationale: Movement of the lower extremities could cause tension on the lesion and should be avoided. 21. A school-age child is brought to the emergency department with a 2-day history of nausea, vomiting, and report of severe right lower quadrant pain. The child's WBC is 17,000/mm3 so appendicitis is suspected. Which of the following statements made by the child is most concerning to the nurse? A. “I am scared and I want to go home.” Rationale: Many children are frightened by the health care setting. Since this is not unexpected, this is not the most concerning statement to the nurse. B. “I am hungry and thirsty.” Rationale: A client with a 2-day history of nausea and vomiting might be dehydrated and feel both hungry and thirsty. Children may report feeling hungry right after vomiting. Since this is not unexpected, this is not the most concerning statement to the nurse. C. “I’m tired and want to take a nap.” Rationale: A client with a 2-day history of nausea and vomiting might be dehydrated and exhausted. Clients of all ages may sleep when they are ill or in pain. Since this is not unexpected, this is not the most concerning statement to the nurse. D. “My belly doesn’t hurt anymore.” Rationale: The nurse's findings of a 2-day history of nausea, vomiting, and severe right lower quadrant pain, along with the laboratory findings of an elevated white blood cell (WBC) count are highly suspicious of appendicitis. Sudden relief of pain may be an early indicator of appendix rupture which would be a surgical emergency. Since the greatest risk to the client is peritonitis secondary to a burst appendix, this statement by the child is most concerning to the nurse. 22. At the preoperative visit before an elective surgery, the nurse is planning to prepare a 9-year-old client for IV catheter insertion. When reinforcing teaching, the nurse will first A. explain to the client's parents what they can expect during and after IV insertion. Rationale: While this is both important and appropriate, this is not the first action the nurse should take. B. provide an opportunity for the client to see and touch IV tubing and supplies. Rationale: While this is important and appropriate, it is best initiated at the conclusion of the visit. C. describe the insertion procedure to the client, emphasizing sensory aspects. Rationale: While this is important and appropriate, it is not the first action the nurse should take. D. ask the client what he knows about having an IV infusion. Rationale: A key principle of teaching/learning theory is to first determine the learner's prior knowledge and readiness to learn. The child's perception of the anticipated experience illuminates any misconceptions that require clarification. In addition, it is possible that the child has had experience with IV therapy, and the nurse can build on this knowledge. 23. An assistive personnel (AP) on a pediatric unit brings to the attention of the nurse several client measurements obtained with the morning vital signs. Which of the following clients should the nurse plan to visit first? A. 7-year-old client with diabetes insipidus and a urine specific gravity of 1.002 Rationale: A specific gravity of 1.002 is much lower than the expected reference range (1.005 to 1.030) and indicates urine output that is extremely dilute. The client is losing excessive water and is in danger of hypovolemia. Therefore, the nurse should plan to visit this client first. B. 1-year-old client with roseola and a temperature of 39°C (102.2°F) Rationale: A fever of 39°C (102.2°F) is an expected finding in a child with roseola; therefore, this is not the client that the nurse should plan to visit first. C. 4-year-old client with status asthmaticus and a pulse oximetry of 95% Rationale: This value, 95%, is considered within the expected range; therefore, this is not the client that the nurse should plan to visit first. D. 10-year-old client with sickle cell anemia and a pain rating of 6 out of 10 Rationale: A pain level of 6 is not unexpected or life threatening. Therefore, this is not the client that the nurse should plan to visit first. 24. A nurse is collecting data from an infant. Which of the following is clinical manifestation of a large patent ductus arteriosus? A. Cyanosis with crying Rationale: A patent ductus arteriosus is failure of the artery connecting the aorta and pulmonary artery to close after birth causing a left-to-right shunt. Therefore, cyanosis is not a clinical manifestation of a large patent ductus arteriosus. B. Machinery-like murmur Rationale: A patent ductus arteriosus is failure of the artery connecting the aorta and pulmonary artery to close after birth causing a left-to-right shunt. A machinery-like murmur is a clinical manifestation found in infants with a large patent ductus arteriosus. C. Weak pulses Rationale: A patent ductus arteriosus is failure of the artery connecting the aorta and pulmonary artery to close after birth causing a left-to-right shunt. Therefore, bounding pulses are a clinical manifestation of a large patent ductus arteriosus. D. Chronic hypoxemia Rationale: A patent ductus arteriosus is failure of the artery connecting the aorta and pulmonary artery to close after birth causing a left-to-right shunt. Therefore, chronic hypoxemia is not a clinical manifestation of a large patent ductus arteriosus. 25. A nurse is caring for an infant who is dehydrated and requires therapy. The nurse should monitor the infant's response to therapy by A. weighing the infant at the same time every day. Rationale: Weight is the most sensitive indicator of hydration status for clients of all ages. Weight is the only measurement that reflects both measurable fluid balance changes and incidental fluid loss. B. taking the infant's vital signs every 2 hr. Rationale: Vital signs are not a reliable indicator of hydration status. C. measuring the infant's head circumference twice a day. Rationale: Measuring head circumference gives no useful information regarding the hydration status of the infant. D. counting the number of wet diapers every shift. Rationale: Counting wet diapers is inadequate to accurately determine the hydration status of the infant. End of Test *items are not administered in this order. 1. A nurse is caring for a pre-school age child who has a epiglottitis with a barking cough. Which of the following is an appropriate nursing action? A. Encourage coughing. Rationale: Encouraging the client to cough is not an appropriate nursing and precipitates a complete obstruction. B. Attempt to obtain a throat culture. Rationale: Attempting to obtain a throat culture is not an appropriate nursing action and may precipitate a complete obstruction. C. Visualize the back of the throat. Rationale: Trying to visualize the back of the throat is not an appropriate nursing action and may precipitate a complete obstruction. D. Apply oxygen. Rationale: Applying high-flow oxygen on the client and keeping the client calm is an appropriate action by the nurse to improve oxygenation. 2. A nurse is reinforcing teaching to the parents of a child who has cystic fibrosis and has a prescription for pancrelipase (Pancrease) capsules. Which of the following should the nurse include in the teaching? A. Administer the medication with meals and snacks. Rationale: Pancrelipase is a digestive enzyme that must be administered with all snacks or meals in order for the food to be properly digested. B. Capsules must be taken whole. Rationale: The medication maybe taken whole or the capsules may be opened up and the contents sprinkled on soft food. C. This medication may be discontinued when symptoms diminish. Rationale: Pancreatic enzymes will be needed throughout the child's life. D. This medication may cause a diarrhea. Rationale: With sufficient replacement of the pancreatic enzyme, the client should experience a decrease in the number of stools.