Toddler NCLEX, Toddler, Preschool-
passp Question and Answers
A boy, age 3, develops a fever and rash and is diagnosed with rubella. His mother has
just given birth to a baby girl. Which statement by the mother best indicates that she
understands the implications of rubella? - ANSWER 4. "I'll call my neighbor who's 2
months pregnant and tell her not to have contact with my son."
An emergency department nurse suspects neglect in a 3-year-old boy admitted for
failure to thrive. Signs of neglect in the child would include: - ANSWER 2. poor hygiene
and weight loss.
A 13-month-old client is admitted to the pediatric unit with a diagnosis of gastroenteritis.
The toddler has experienced vomiting and diarrhea for the past 3 days, and laboratory
tests reveal that he is dehydrated. Which nursing interventions are correct to prevent
further dehydration? - ANSWER 2. Give clear liquids in small amounts., 4. Encourage
the child to eat nonsalty soups and broths., 5. Monitor the I.V. solution per the
physician's order.
A toddler is diagnosed with a dislocated right shoulder and a simple fracture of the right
humerus. Which behavior most strongly suggests that the child's injuries stem from
abuse? - ANSWER 4. Not crying when moved
A parent calls the pediatric clinic to express concern over her toddler's eating habits.
She says the toddler eats very little and consumes only a single type of food for weeks
on end. The nurse knows that this behavior is characteristic of: - ANSWER 1. normal
toddler behavior.
The nurse is teaching parents about otitis media. When discussing why children are
predisposed to this disorder, the nurse should mention the significance of which
anatomical feature? - ANSWER 1. Eustachian tubes
A parent brings a toddler, age 19 months, to the clinic for a regular checkup. When
palpating the toddler's fontanels, what should the nurse expect to find? - ANSWER 3.
Closed anterior and posterior fontanels
For a child with a Wilms' tumor, which preoperative nursing intervention takes highest
priority? - ANSWER 3. Avoiding abdominal palpation
A 3-year-old client is admitted to the pediatric unit with pneumonia. He has a productive
cough and appears to have difficulty breathing. The parents tell the nurse that the
toddler hasn't been eating or drinking much and has been very inactive. Which
interventions to improve airway clearance should be included by the nurse in the care
plan? - ANSWER 2. Perform chest physiotherapy as ordered., 3. Encourage coughing
,and deep breathing., 5. Perform postural drainage., 6. Maintain humidification with a
cool mist humidifier.
The charge nurse overhears a nurse complaining that she has been assigned to a
toddler diagnosed with tetralogy of Fallot for the past 3 days and the mother is very
demanding. Which response by the charge nurse is best? - ANSWER 1. "It's important
for the child to have someone assigned to him who's familiar with his care."
A toddler is brought to the emergency department in cardiac arrest. The physician tries
three times to insert an I.V. catheter but is unsuccessful. By which alternate route can
the physician administer emergency medications? - ANSWER 4. Intraosseously
The nurse is caring for a toddler with Down syndrome. To help the toddler cope with
painful procedures, the nurse can: - ANSWER 3. hold and rock him and give him a
security object.
A 2-year-old child is brought to the emergency department with suspected croup. Which
data collection finding reflects increasing respiratory distress? - ANSWER 1. Intercostal
retractions
A 2-year-old child with a tracheostomy suddenly becomes diaphoretic and has an
increased heart rate, an increased respiratory rate, and a decreased oxygen saturation
level. Which of the following should be the nurse's first action? - ANSWER 1. Suction
the tracheostomy.
A 3-year-old child comes to the clinic for a wellness checkup. When the nurse weighs
the child, she notes a 10-lb weight gain since his last checkup 1 year ago. The nurse
recognizes that this weight gain is: - ANSWER 1. excessive for a toddler, requiring
further data collection.
A 14-month-old is undergoing bone marrow aspiration because leukemia is suspected.
A local anesthetic is administered, but the nurse anticipates that a nonpharmacologic
comfort measure will also be needed. Which measure is best for a toddler at this age? -
ANSWER 2. Reading the toddler a book during the procedure
Which desired outcome demonstrates effective parent teaching about disciplining a
toddler? - ANSWER 4. The parents will call immediate attention to undesirable
behavior.
A mother tells the nurse that she wants to begin toilet training her 22-month-old child.
The most important factor regarding toilet-training that the nurse should stress to her is:
- ANSWER 1. developmental readiness of the child.
A toddler is ordered 350 mg of amoxicillin and clavulanate (Augmentin) by mouth, four
times per day. The pharmacy sends a bottle with a concentration of 250 mg/5 ml. How
many milliliters should the nurse administer per dose? - ANSWER 7
, When caring for a 2-year-old child, the nurse should offer choices, when appropriate,
about some aspects of care. According to Erikson, doing this helps the child achieve : -
ANSWER 2. autonomy.
A 2 ½-year-old child, admitted with nephrotic syndrome, has been in the hospital for 24
hours. When the nurse makes her 8 a.m. rounds she notices that no care has been
documented for this child since 6 a.m. Which action by the nurse takes priority? -
ANSWER 1. Repositioning the child
A 2-year-old is brought to the clinic by his mother for his annual examination. Which
statement by the mother alerts the nurse to the toddler's risk for malnutrition? -
ANSWER 4. "He drinks a bottle of whole milk several times a day."
A nurse who's functioning as the team leader on the infant and toddler unit is working
with a licensed practical nurse (LPN) and a nursing assistant. The team leader notices
that the nursing assistant is sitting at the desk while the LPN is very busy with her
assignment and appears frustrated. What action should the team leader take? -
ANSWER 3. Ask the LPN why she's frustrated and ask the nursing assistant to help the
LPN with her work.
A nurse on the pediatric floor is caring for a toddler. The nurse should keep in mind that
toddlers: - ANSWER 1. express negativism.
A 2-year-old is admitted to the pediatric unit with fever, seizures, and vomiting. He's
awake and irritable. As the nurse is putting a gown on the child, the nurse notices
petechiae across the child's chest, abdomen, and back. The nurse should first: -
ANSWER 2. initiate droplet precautions.
A 3-year-old child with Down syndrome is admitted to the pediatric unit with asthma.
The child doesn't enunciate words well and holds onto furniture when he walks. The
nurse should ask the mother: - ANSWER 3. how the child's condition today differs from
his normal condition.
The nurse is caring for a child with a fractured leg. The child's mother becomes
concerned when she visits her son and notices him sucking his thumb, a behavior that
he had previously given up. What does this behavior indicate? - ANSWER 4. The child
is responding to stress.
A family of four involved in a house fire is brought to the hospital for treatment of burns.
The local media arrives at the hospital requesting information about the condition of the
family members. Which response by the nurse is most appropriate? - ANSWER 3. "I
need to obtain permission from the parents or their representative before I can release
any information."
passp Question and Answers
A boy, age 3, develops a fever and rash and is diagnosed with rubella. His mother has
just given birth to a baby girl. Which statement by the mother best indicates that she
understands the implications of rubella? - ANSWER 4. "I'll call my neighbor who's 2
months pregnant and tell her not to have contact with my son."
An emergency department nurse suspects neglect in a 3-year-old boy admitted for
failure to thrive. Signs of neglect in the child would include: - ANSWER 2. poor hygiene
and weight loss.
A 13-month-old client is admitted to the pediatric unit with a diagnosis of gastroenteritis.
The toddler has experienced vomiting and diarrhea for the past 3 days, and laboratory
tests reveal that he is dehydrated. Which nursing interventions are correct to prevent
further dehydration? - ANSWER 2. Give clear liquids in small amounts., 4. Encourage
the child to eat nonsalty soups and broths., 5. Monitor the I.V. solution per the
physician's order.
A toddler is diagnosed with a dislocated right shoulder and a simple fracture of the right
humerus. Which behavior most strongly suggests that the child's injuries stem from
abuse? - ANSWER 4. Not crying when moved
A parent calls the pediatric clinic to express concern over her toddler's eating habits.
She says the toddler eats very little and consumes only a single type of food for weeks
on end. The nurse knows that this behavior is characteristic of: - ANSWER 1. normal
toddler behavior.
The nurse is teaching parents about otitis media. When discussing why children are
predisposed to this disorder, the nurse should mention the significance of which
anatomical feature? - ANSWER 1. Eustachian tubes
A parent brings a toddler, age 19 months, to the clinic for a regular checkup. When
palpating the toddler's fontanels, what should the nurse expect to find? - ANSWER 3.
Closed anterior and posterior fontanels
For a child with a Wilms' tumor, which preoperative nursing intervention takes highest
priority? - ANSWER 3. Avoiding abdominal palpation
A 3-year-old client is admitted to the pediatric unit with pneumonia. He has a productive
cough and appears to have difficulty breathing. The parents tell the nurse that the
toddler hasn't been eating or drinking much and has been very inactive. Which
interventions to improve airway clearance should be included by the nurse in the care
plan? - ANSWER 2. Perform chest physiotherapy as ordered., 3. Encourage coughing
,and deep breathing., 5. Perform postural drainage., 6. Maintain humidification with a
cool mist humidifier.
The charge nurse overhears a nurse complaining that she has been assigned to a
toddler diagnosed with tetralogy of Fallot for the past 3 days and the mother is very
demanding. Which response by the charge nurse is best? - ANSWER 1. "It's important
for the child to have someone assigned to him who's familiar with his care."
A toddler is brought to the emergency department in cardiac arrest. The physician tries
three times to insert an I.V. catheter but is unsuccessful. By which alternate route can
the physician administer emergency medications? - ANSWER 4. Intraosseously
The nurse is caring for a toddler with Down syndrome. To help the toddler cope with
painful procedures, the nurse can: - ANSWER 3. hold and rock him and give him a
security object.
A 2-year-old child is brought to the emergency department with suspected croup. Which
data collection finding reflects increasing respiratory distress? - ANSWER 1. Intercostal
retractions
A 2-year-old child with a tracheostomy suddenly becomes diaphoretic and has an
increased heart rate, an increased respiratory rate, and a decreased oxygen saturation
level. Which of the following should be the nurse's first action? - ANSWER 1. Suction
the tracheostomy.
A 3-year-old child comes to the clinic for a wellness checkup. When the nurse weighs
the child, she notes a 10-lb weight gain since his last checkup 1 year ago. The nurse
recognizes that this weight gain is: - ANSWER 1. excessive for a toddler, requiring
further data collection.
A 14-month-old is undergoing bone marrow aspiration because leukemia is suspected.
A local anesthetic is administered, but the nurse anticipates that a nonpharmacologic
comfort measure will also be needed. Which measure is best for a toddler at this age? -
ANSWER 2. Reading the toddler a book during the procedure
Which desired outcome demonstrates effective parent teaching about disciplining a
toddler? - ANSWER 4. The parents will call immediate attention to undesirable
behavior.
A mother tells the nurse that she wants to begin toilet training her 22-month-old child.
The most important factor regarding toilet-training that the nurse should stress to her is:
- ANSWER 1. developmental readiness of the child.
A toddler is ordered 350 mg of amoxicillin and clavulanate (Augmentin) by mouth, four
times per day. The pharmacy sends a bottle with a concentration of 250 mg/5 ml. How
many milliliters should the nurse administer per dose? - ANSWER 7
, When caring for a 2-year-old child, the nurse should offer choices, when appropriate,
about some aspects of care. According to Erikson, doing this helps the child achieve : -
ANSWER 2. autonomy.
A 2 ½-year-old child, admitted with nephrotic syndrome, has been in the hospital for 24
hours. When the nurse makes her 8 a.m. rounds she notices that no care has been
documented for this child since 6 a.m. Which action by the nurse takes priority? -
ANSWER 1. Repositioning the child
A 2-year-old is brought to the clinic by his mother for his annual examination. Which
statement by the mother alerts the nurse to the toddler's risk for malnutrition? -
ANSWER 4. "He drinks a bottle of whole milk several times a day."
A nurse who's functioning as the team leader on the infant and toddler unit is working
with a licensed practical nurse (LPN) and a nursing assistant. The team leader notices
that the nursing assistant is sitting at the desk while the LPN is very busy with her
assignment and appears frustrated. What action should the team leader take? -
ANSWER 3. Ask the LPN why she's frustrated and ask the nursing assistant to help the
LPN with her work.
A nurse on the pediatric floor is caring for a toddler. The nurse should keep in mind that
toddlers: - ANSWER 1. express negativism.
A 2-year-old is admitted to the pediatric unit with fever, seizures, and vomiting. He's
awake and irritable. As the nurse is putting a gown on the child, the nurse notices
petechiae across the child's chest, abdomen, and back. The nurse should first: -
ANSWER 2. initiate droplet precautions.
A 3-year-old child with Down syndrome is admitted to the pediatric unit with asthma.
The child doesn't enunciate words well and holds onto furniture when he walks. The
nurse should ask the mother: - ANSWER 3. how the child's condition today differs from
his normal condition.
The nurse is caring for a child with a fractured leg. The child's mother becomes
concerned when she visits her son and notices him sucking his thumb, a behavior that
he had previously given up. What does this behavior indicate? - ANSWER 4. The child
is responding to stress.
A family of four involved in a house fire is brought to the hospital for treatment of burns.
The local media arrives at the hospital requesting information about the condition of the
family members. Which response by the nurse is most appropriate? - ANSWER 3. "I
need to obtain permission from the parents or their representative before I can release
any information."
