NURS 6541 PEDS MIDTERM 3 LATEST VERSIONS (VERSION A, B
AND C) EXAM LATEST 2024 ACTUAL EXAM
While assessing an 18-month-old child a nurse observes that the toddler can crawl
up stairs but needs assistance when climbing the stairs upright. What does this
indicate to the nurse?
1 Presence of talipes equinovarus
2 Presence of neurologic damage
3 Expected behavior in a toddler of this age
4 Existence of developmental dysplasia of the hip - ANSWER: 3 Expected behavior in
a toddler of this age
Rationale
It is not until 2 years of age that toddlers are able to use their feet to walk up stairs
instead of crawling. Talipes equinovarus is identified with the use of other criteria. At
18 months of age the inability of the toddler to use the feet to go up stairs is not a
problem; it is expected. Developmental dysplasia of the hip is identified with the use
of other criteria.
A 10-year-old child who has sickle cell anemia is admitted to the hospital with a vaso-
occlusive painful episode. The nurse manager plans to place the child in the same
room as a child with the diagnosis of:
1 Pneumonia
2 Thalassemia
3 Acute pharyngitis
4 Chronic osteomyelitis - ANSWER: 2 Thalassemia
Rationale:
Thalassemia is a hemolytic anemia that is not communicable. Roommates with
infectious diseases should be avoided because a child with sickle cell anemia is
susceptible to infections. These childrens' spleens become infarcted and are
gradually replaced by fibrous tissue by 5 years of age. The spleen filters bacteria,
thereby triggering phagocytosis; without a functioning spleen and therefore this
trigger, these children are prone to infection. The child with sickle cell anemia is
susceptible to infection; pneumonia (lungs), pharyngitis (upper respiratory tract),
and chronic osteomyelitis (bone) are all types of infections.
A 15-month-old child is hospitalized after ingesting toilet bowl cleaner. The mother
confides that she feels guilty about leaving the cleaner where her child could get it.
What is the best response by the nurse?
1 "Anyone could make a mistake. Don't dwell on it."
2 "Let's not worry about the past. Your child is going to get better."
,3 "It was an accident, but you should consider special locks on your closets."
4 "That was careless of you. Please make sure that you poison-proof your house." -
ANSWER: 3 "It was an accident, but you should consider special locks on your
closets."
Describing the incident as an accident and recommending locks on closets accepts
the mother's statement and helps the mother express her guilt while providing
directions to safeguard her child. Poisoning is not an everyday occurrence; teaching
should be incorporated to protect the child. Telling the mother that the child will get
better is false reassurance; the child's condition is still in question. Calling the mother
careless only increases the mother's guilt and provides nothing more than a vague
suggestion of how to remedy the problem.
A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-
old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is
17 mEq/L. What complication does the nurse conclude has developed?
1 Metabolic acidosis
2 Metabolic alkalosis
3 Respiratory acidosis
4 Respiratory alkalosis - ANSWER: 1 Metabolic acidosis
The blood pH indicates acidosis; the bicarbonate (HCO3-) level is further from the
expected range than is the partial pressure of carbon dioxide (Pco2), indicating a
metabolic origin (losses from diarrhea). The blood pH indicates acidosis, not
alkalosis. The HCO3- level is farther from the expected range than the Pco2 level,
indicating a metabolic, not a respiratory, origin of the acidosis. The blood pH
indicates an acidic, not an alkalotic, state; also, it is of metabolic origin.
A 16-year-old single mother of a 1-month-old infant and the infant's grandmother
bring the baby to the emergency department and report that the infant accidentally
fell down the stairs. The nurse knows that a consent form for treatment should be
signed. Who has the responsibility for signing the consent?
1 The mother, despite her age
2 No one, because this is an emergency
3 The grandmother, because she is a relative
4 Family court, because the mother is a minor - ANSWER: 1 The mother, despite her
age
The client is an emancipated minor, meaning that she has adult status. In most states
the age of majority is 18 years; however, parents younger than 18 years are
considered emancipated minors and may sign consents for themselves and their
children. Consent always is needed when a parent is present and capable of
providing it. The grandmother does not have the legal right to give consent. Family
court is unnecessary.
, Methylphenidate (Ritalin SR) is ordered for a 6-year-old boy with the diagnosis of
attention deficit-hyperactivity disorder (ADHD). The nurse teaches the father about
the safe administration of the medication and concludes that the instructions have
been understood when the father says that he should administer it:
1 At bedtime
2 After breakfast
3 When the child gets hungry
4 When the child's behavior is out of control - ANSWER: 2 After breakfast
Methylphenidate (Ritalin SR) may cause nausea, anorexia, and dry mouth, which
interfere with appetite and adequate food intake; therefore it should be
administered after the child has eaten breakfast. Methylphenidate is a cerebral
stimulant that can interfere with sleep; it should not be administered within 6 hours
of bedtime. It should be taken exactly as prescribed, not on an as-needed basis.
During discharge planning the parents of an infant with spina bifida express concern
about skin care and ask the nurse what can be done to avoid problems. What is the
best response by the nurse?
1 Diapers should be changed at least every 4 hours.
2 Frequent diaper changes with cleansing are needed.
3 Medicated ointment should be applied six times a day.
4 Powder may be used in the perineal area when it becomes wet. - ANSWER: 2
Frequent diaper changes with cleansing are needed.
Infants with spina bifida often exhibit dribbling of urine; they need meticulous skin
care and frequent diaper changes to prevent skin breakdown. Changing diapers
every 4 hours is insufficient and may result in skin breakdown. Medicated ointments
are unnecessary; if a skin irritation develops and an ointment becomes necessary, it
should be prescribed by the health care provider. Powder will not keep the skin dry;
when powder mixes with urine, it forms a pastelike substance that promotes skin
breakdown. Also, powder is toxic if inhaled and should be avoided.
A nurse who works in a fertility clinic is discussing the inheritance pattern of sickle
cell disease with the parents of a school-aged child with the disease. The parents are
planning to have a second child. The nurse knows that the parental genotypic
makeup is:
1 Father heterozygous (sickle trait), mother heterozygous (sickle trait)
2 Mother homozygous (no sickle trait), father heterozygous (sickle trait)
3 Father homozygous (no sickle trait), mother heterozygous (sickle trait)
4 Mother homozygous (has sickle cell disease), father is homozygous (no sickle trait)
- ANSWER: 1 Father heterozygous (sickle trait), mother heterozygous (sickle trait)
Sickle cell disease is an autosomal recessive disorder; each parent contributes one
affected gene. All children with a mother who is homozygous (has sickle cell disease)
and a father who is homozygous (no sickle trait) will have the sickle cell trait but not
AND C) EXAM LATEST 2024 ACTUAL EXAM
While assessing an 18-month-old child a nurse observes that the toddler can crawl
up stairs but needs assistance when climbing the stairs upright. What does this
indicate to the nurse?
1 Presence of talipes equinovarus
2 Presence of neurologic damage
3 Expected behavior in a toddler of this age
4 Existence of developmental dysplasia of the hip - ANSWER: 3 Expected behavior in
a toddler of this age
Rationale
It is not until 2 years of age that toddlers are able to use their feet to walk up stairs
instead of crawling. Talipes equinovarus is identified with the use of other criteria. At
18 months of age the inability of the toddler to use the feet to go up stairs is not a
problem; it is expected. Developmental dysplasia of the hip is identified with the use
of other criteria.
A 10-year-old child who has sickle cell anemia is admitted to the hospital with a vaso-
occlusive painful episode. The nurse manager plans to place the child in the same
room as a child with the diagnosis of:
1 Pneumonia
2 Thalassemia
3 Acute pharyngitis
4 Chronic osteomyelitis - ANSWER: 2 Thalassemia
Rationale:
Thalassemia is a hemolytic anemia that is not communicable. Roommates with
infectious diseases should be avoided because a child with sickle cell anemia is
susceptible to infections. These childrens' spleens become infarcted and are
gradually replaced by fibrous tissue by 5 years of age. The spleen filters bacteria,
thereby triggering phagocytosis; without a functioning spleen and therefore this
trigger, these children are prone to infection. The child with sickle cell anemia is
susceptible to infection; pneumonia (lungs), pharyngitis (upper respiratory tract),
and chronic osteomyelitis (bone) are all types of infections.
A 15-month-old child is hospitalized after ingesting toilet bowl cleaner. The mother
confides that she feels guilty about leaving the cleaner where her child could get it.
What is the best response by the nurse?
1 "Anyone could make a mistake. Don't dwell on it."
2 "Let's not worry about the past. Your child is going to get better."
,3 "It was an accident, but you should consider special locks on your closets."
4 "That was careless of you. Please make sure that you poison-proof your house." -
ANSWER: 3 "It was an accident, but you should consider special locks on your
closets."
Describing the incident as an accident and recommending locks on closets accepts
the mother's statement and helps the mother express her guilt while providing
directions to safeguard her child. Poisoning is not an everyday occurrence; teaching
should be incorporated to protect the child. Telling the mother that the child will get
better is false reassurance; the child's condition is still in question. Calling the mother
careless only increases the mother's guilt and provides nothing more than a vague
suggestion of how to remedy the problem.
A specimen for arterial blood gases is obtained from a severely dehydrated 3-month-
old infant with a history of diarrhea. The pH is 7.30, Pco2 is 35 mm Hg, and HCO3- is
17 mEq/L. What complication does the nurse conclude has developed?
1 Metabolic acidosis
2 Metabolic alkalosis
3 Respiratory acidosis
4 Respiratory alkalosis - ANSWER: 1 Metabolic acidosis
The blood pH indicates acidosis; the bicarbonate (HCO3-) level is further from the
expected range than is the partial pressure of carbon dioxide (Pco2), indicating a
metabolic origin (losses from diarrhea). The blood pH indicates acidosis, not
alkalosis. The HCO3- level is farther from the expected range than the Pco2 level,
indicating a metabolic, not a respiratory, origin of the acidosis. The blood pH
indicates an acidic, not an alkalotic, state; also, it is of metabolic origin.
A 16-year-old single mother of a 1-month-old infant and the infant's grandmother
bring the baby to the emergency department and report that the infant accidentally
fell down the stairs. The nurse knows that a consent form for treatment should be
signed. Who has the responsibility for signing the consent?
1 The mother, despite her age
2 No one, because this is an emergency
3 The grandmother, because she is a relative
4 Family court, because the mother is a minor - ANSWER: 1 The mother, despite her
age
The client is an emancipated minor, meaning that she has adult status. In most states
the age of majority is 18 years; however, parents younger than 18 years are
considered emancipated minors and may sign consents for themselves and their
children. Consent always is needed when a parent is present and capable of
providing it. The grandmother does not have the legal right to give consent. Family
court is unnecessary.
, Methylphenidate (Ritalin SR) is ordered for a 6-year-old boy with the diagnosis of
attention deficit-hyperactivity disorder (ADHD). The nurse teaches the father about
the safe administration of the medication and concludes that the instructions have
been understood when the father says that he should administer it:
1 At bedtime
2 After breakfast
3 When the child gets hungry
4 When the child's behavior is out of control - ANSWER: 2 After breakfast
Methylphenidate (Ritalin SR) may cause nausea, anorexia, and dry mouth, which
interfere with appetite and adequate food intake; therefore it should be
administered after the child has eaten breakfast. Methylphenidate is a cerebral
stimulant that can interfere with sleep; it should not be administered within 6 hours
of bedtime. It should be taken exactly as prescribed, not on an as-needed basis.
During discharge planning the parents of an infant with spina bifida express concern
about skin care and ask the nurse what can be done to avoid problems. What is the
best response by the nurse?
1 Diapers should be changed at least every 4 hours.
2 Frequent diaper changes with cleansing are needed.
3 Medicated ointment should be applied six times a day.
4 Powder may be used in the perineal area when it becomes wet. - ANSWER: 2
Frequent diaper changes with cleansing are needed.
Infants with spina bifida often exhibit dribbling of urine; they need meticulous skin
care and frequent diaper changes to prevent skin breakdown. Changing diapers
every 4 hours is insufficient and may result in skin breakdown. Medicated ointments
are unnecessary; if a skin irritation develops and an ointment becomes necessary, it
should be prescribed by the health care provider. Powder will not keep the skin dry;
when powder mixes with urine, it forms a pastelike substance that promotes skin
breakdown. Also, powder is toxic if inhaled and should be avoided.
A nurse who works in a fertility clinic is discussing the inheritance pattern of sickle
cell disease with the parents of a school-aged child with the disease. The parents are
planning to have a second child. The nurse knows that the parental genotypic
makeup is:
1 Father heterozygous (sickle trait), mother heterozygous (sickle trait)
2 Mother homozygous (no sickle trait), father heterozygous (sickle trait)
3 Father homozygous (no sickle trait), mother heterozygous (sickle trait)
4 Mother homozygous (has sickle cell disease), father is homozygous (no sickle trait)
- ANSWER: 1 Father heterozygous (sickle trait), mother heterozygous (sickle trait)
Sickle cell disease is an autosomal recessive disorder; each parent contributes one
affected gene. All children with a mother who is homozygous (has sickle cell disease)
and a father who is homozygous (no sickle trait) will have the sickle cell trait but not
