RN Learning System Nursing Care of Children Practice Quiz

A nurse is teaching the parent of a preschool-age child about the treatment for pinworms. Which of the following statements by the parent indicates an understanding of the teaching?

“I will give my child a dose of albendazole today and again in 2 weeks.”

–The nurse should instruct the parent to repeat the dose of albendazole in 2 weeks to completely eradicate the parasite and prevent reinfection.

A nurse is assessing a child who has a ventricular septal defect. Which of the following findings should the nurse expect?

Murmur at the left sternal border.

–A ventricular septal defect, a hole in the septal wall between the ventricles, is an acyanotic heart defect. A systolic murmur can be best heard at the lower left sternal border. Sound is transmitted in the direction of blood flow, so any backflow of blood from the left to the right ventricle through the septal defect is best heard in this area.

A nurse is teaching an adolescent who has asthma about how to use a peak expiratory flow meter (PEFM). Which of the following responses by the adolescent indicates an understanding of the teaching?

“I will record the highest reading of three attempts.”

–Once the client establishes a personal best, she should routinely check the PEFM by performing three attempts and recording the highest reading of the three.

A nurse is providing teaching to the parents of an infant who has acute otitis media about how to administer antibiotic eardrops. Which of the following instructions should the nurse include?

Massage the anterior area of the infant’s ear following administration.

–The nurse should instruct the parents to massage the anterior area of the ear following administration of eardrops to facilitate instillation of the medication.

A nurse is providing teaching to the parent of a 2-year-old toddler about nutrition. Which of the following statements by the parent indicates an understanding of the teaching?

“My child should consume 1,000 calories per day.”

–Toddlers who are 2 years old should consume 1,000 calories daily.

A nurse is providing teaching about immunizations to the parents of a severely immunocompromised child who has human immunodeficiency virus (HIV). Which of the following statements should the nurse include in the teaching?

“The pneumococcal and influenza vaccines are recommended for your child.”

–Immunization against common childhood illnesses, including the influenza and pneumococcal disease, is recommended for all children exposed to and infected with HIV.

A nurse in an emergency department is caring for a 4-year-old child who has burns to the neck and face following a house fire. Which of the following actions should the nurse take first?

Determine the child’s breathing pattern.

–The nurse should apply the ABC priority setting framework. This framework emphasizes the basic core of human functioning: having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body’s organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse’s priority concern. When applying the ABC priority setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second highest priority in the ABC priority setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Determining the child’s breathing pattern is the first action the nurse should take. Circulation is the third highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them.

A nurse is providing discharge teaching to the parents of a child who has nephrotic syndrome. Which of the following instructions should the nurse include in the teaching?

Keep the child away from people who have an infection.

–Children who have nephrotic syndrome are at increased risk for infection and should avoid contact with people who have infections.

A nurse is providing nutritional teaching to an adolescent client who has celiac disease. Which of the following breakfast foods should the nurse recommend?

Scrambled eggs

–The client who has celiac disease should be on a low-gluten diet and should avoid foods containing barley, oat, rye, and wheat; therefore, scrambled eggs are an appropriate breakfast item for the nurse to recommend to the client.

A clinic nurse is providing teaching to the parent of a 1-month-old infant who has gastroesophageal reflux. Which of the following statements by the parent indicates an understanding of the teaching?

“I will add rick cereal to my baby’s feedings.”

–The mother should add 1 tsp to 1 tbsp of rice cereal per ounce of formula or expressed breast milk to thicken the feedings because this will decrease the number of vomiting episodes.

A nurse is assessing a 2-month-old infant who has a ventricular septal defect. Which of the following findings should the nurse report to the provider?

Weight gain of 1.8 kg (4 lb)

–A 4 lb weight gain indicates increased fluid and worsening of the child’s heart failure; therefore, the nurse should report this finding to the provider.

A nurse is creating a plan of care for a child who has leukopenia secondary to chemotherapy. Which of the following interventions should the nurse include in the plan?

Monitor the child for increased temperature.

–Leukopenia places the child at risk for infection; therefore, the nurse should monitor the child for a fever.

A nurse is providing dietary teaching to the parent of a child who has cystic fibrosis. Which of the following dietary recommendations should the nurse make?

Increase the child’s protein intake.

–The nurse should recommend an increase in protein intake for the child who has cystic fibrosis. These children require up to 150% of the recommended daily allowances to meet their nutritional needs.

A nurse is assessing a 6-month-old infant following a cardiac catheterization. Which of the following findings should the nurse report to the provider?

BP 86/40 mm Hg

–A BP of 86/40 mm Hg is indicative of hypotension and bleeding in a 6-month-old infant and should be immediately reported to the provider.

A nurse is caring for a child who is postoperative following a tonsillectomy. Which of the following findings is the nurse’s priority?

Frequent swallowing

–The nurse should apply the urgent versus non-urgent priority-setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose more of a threat to the client. Frequent swallowing can be an indication of bleeding, therefore is the nursing priority finding to address. The nurse may also need to use Maslow’s hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which finding is the most urgent.

A nurse is teaching about clinical manifestations of tracheomalacia to a parent of an infant who had tracheoesophageal fistula repair as a newborn. Which of the following findings should the nurse include in the teaching?

Barking cough

–Infants who have tracheomalacia have a weakened trachea, which leads to collapse. Clinical manifestations of tracheomalacia include barking cough, stridor, wheezing cyanosis, and apnea.

A nurse is reviewing the laboratory results of a child who has experienced diarrhea for the past 24 hr. Which of the following values for urine specific gravity should the nurse expect?

1.035

–1.035 is a concentrated specific gravity, which is an expected value for a child who is dehydrated; therefore, this is an expected urine specific gravity for a child who has experienced diarrhea for 24 hr.

A nurse is providing teaching to an adolescent who has a fiberglass arm cast. Which of the following instructions should the nurse include in the teaching?

Place a plastic bag over the cast when showering.

–The nurse should instruct the adolescent to keep the cast dry by placing a plastic bag over it while showering. Although water will not damage the fiberglass cast, water can enter the openings of the cast and result in maceration of the skin.

A home health nurse is developing a plan of care for the parents of a toddler who has hemophilia. Which of the following instructions should the nurse include in the plan?

Inspect the toddler’s toys for sharp edges.

–The nurse should instruct the parents to inspect the toddler’s toys for sharp edges or parts because this decreases the risk of injury and bleeding to the toddler.

A nurse is providing teaching to the parents of a school-age child who has type 1 diabetes mellitus about management of hypoglycemia. Which of the following responses by the parents indicates an understanding of the teaching?

“I will make sure my child drinks 240 mL (8 oz) of milk as soon as possible.”

–Giving the child 10 to 15 g of simple carbohydrates, such as 240 mL (8 oz) of milk, will elevate the blood glucose level and alleviate the hypoglycemia.

A nurse is teaching a newly hired nurse about the care of an infant who is postoperative following myelomeningocele repair. The nurse should teach the newly hired nurse to monitor the infant for which of the following complications?

Hydrocephalus

–In the surgical repair of the myelomeningocele, the pathway for the cerebral spinal fluid is altered; therefore, the infant is at risk for hydrocephalus and the nurse should monitor the infant for this condition.

A nurse is preparing to obtain an antistreptolysin O (ASO) titer from a child who has acute glomerulonephritis. The child’s parent asks the nurse to explain the purpose of the test. Which of the following responses should the nurse make?

“The test shows us if your child had a recent strep infection.”

–An ASO titer indicates that the child has had a recent strep infection. In determining a definitive diagnosis for acute glomerulonephritis, this must be documented as it is usually the result of this type of infection.

A nurse is caring for an infant following surgical repair of a cleft lip and palate. Which of the following actions should the nurse take?

Use a suction catheter to gently remove the infant’s oral secretions PRN.

–The nurse should use a suction catheter to gently remove the infant’s oral secretions to prevent aspiration and maintain a patent airway.

A nurse is providing teaching to an adolescent who has scoliosis and a new prescription for a Boston brace. Which of the following responses by the adolescent indicates an understanding of the teaching?

“I can take my brace off for about an hour daily to shower.”

–The nurse should instruct the child to wear the brace for 23 hr each day and to only remove it for showering or participating in physical therapy.

A nurse is caring for a child who is in skeletal traction. Which of the following actions is the nurse’s priority?

Encourage the child to use an incentive spirometer.

–The nurse should apply the ABC priority-setting framework. This framework emphasizes the basic core of human functioning – having an open airway, being able to breathe in adequate amounts of oxygen, and circulating oxygen to the body’s organs via the blood. An alteration in any of these can indicate a threat to life, and is therefore the nurse’s priority concern. When applying the ABC priority setting framework, airway is always the highest priority because the airway must be clear and open for oxygen exchange to occur. Breathing is the second highest priority in the ABC priority setting framework because adequate ventilatory effort is essential in order for oxygen exchange to occur. Encouraging the child to use an incentive spirometer will assist the child in adequate oxygenation and is the priority nursing action. Circulation is the third highest priority in the ABC priority setting framework because delivery of oxygen to critical organs only occurs if the heart and blood vessels are capable of efficiently carrying oxygen to them.

A nurse in an emergency department is caring for a toddler who is in acute respiratory distress. Which of the following findings should alert the nurse to the possibility of epiglottitis?

Drooling

–Epiglottitis is a disorder caused by an inflammation of the epiglottis. It results in rapid swelling of the epiglottis, which can obstruct breathing. Drooling is common finding due to the toddler’s inability to swallow saliva.

A nurse is teaching a school-age child and his parents how to self-administer insulin. Which of the following actions should the nurse take first?

Demonstrate the injection technique on an orange.

–The nurse should apply the safety and risk reduction priority setting framework. This framework assigns priority to the factor or situation posing the greatest safety risk to the client. When there are several risks to client safety, the one posing the greatest threat is the highest priority. Demonstrating the injection technique on an orange poses no risk to the client and is therefore the first action the nurse should take. The nurse should use Maslow’s hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which risk poses the greatest threat to the client.

A nurse is caring for an 8-year-old who has acute glomerulonephritis. Which of the following findings should the nurse expect?

Periorbital edema

–Periorbital edema is an expected finding in a child who has glomerulonephritis.

A nurse in an emergency department is assessing a school-age child who is experiencing an acute asthma exacerbation. Which of the following findings is the priority for the nurse to report to the provider?

Sudden decrease in wheezing

–The nurse should apply the urgent versus nonurgent priority setting framework. Using this framework, the nurse should consider urgent needs the priority need because they pose a larger risk to the client. A sudden decrease in wheezing can be an indication that the child is experiencing decreased air movement and should be reported to the provider. The nurse might also need to use Maslow’s hierarchy of needs, the ABC priority setting framework, or nursing knowledge to identify which finding is the most urgent. A sudden decrease in wheezing (silent chest) indicates ventilator failure and an imminent respiratory arrest.

A nurse is admitting a child who has Wilms’ tumor. Which of the following actions should the nurse take?

Put a “no abdominal palpation” sign over the child’s bed.

–The nurse should place a sign over the child’s bed reading “no abdominal palpation” because palpation is not necessary to confirm diagnosis and could aid in metastasis.

A nurse is caring for a 12-month-old infant following surgical repair of a cleft palate. The nurse should plan to feed the infant using which of the following instruments?

Cup

–The infant should be fed clear liquids using a cup for 7 to 10 days following a cleft palate repair to prevent trauma and injury to the suture line.

A nurse is reviewing changes in healthcare delivery and funding for pediatric populations. Which current trend in the pediatric setting should the nurse expect to find?

a.	Increased hospitalization of children
b.	Decreased number of uninsured children
c.	An increase in ambulatory care
d.	Decreased use of managed care

ANS: C

One effect of managed care is that pediatric healthcare delivery has shifted dramatically from the acute care setting to the ambulatory setting. The number of hospital beds being used has decreased as more care is provided in outpatient and home settings. The number of uninsured children in the United States continues to grow. One of the biggest changes in healthcare has been the growth of managed care.

A nurse is referring a low-income family with three children under the age of 5 years to a program that assists with supplemental food supplies. Which program should the nurse refer this family to?

a.	Medicaid
b.	Medicare
c.	Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program
d.	Women, Infants, and Children (WIC) program

ANS: D

WIC is a federal program that provides supplemental food supplies to low-income women who are pregnant or breast-feeding and to their children until the age of 5 years. Medicaid and the Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program provides for well-child examinations and related treatment of medical problems. Children in the WIC program are often referred for immunizations, but that is not the primary focus of the program. Public Law 99-457 provides financial incentives to states to establish comprehensive early intervention services for infants and toddlers with, or at risk for, developmental disabilities. Medicare is the program for Senior Citizens.

In most states, adolescents who are not emancipated minors must have parental permission before:

a.	treatment for drug abuse.
b.	treatment for sexually transmitted diseases (STDs).
c.	obtaining birth control.
d.	surgery.

ANS: D

An emancipated minor is a minor child who has the legal competence of an adult. Legal counsel may be consulted to verify the status of the emancipated minor for consent purposes. Most states allow minors to obtain treatment for drug or alcohol abuse and STDs and allow access to birth control without parental consent.

A nurse is completing a clinical pathway for a child admitted to the hospital with pneumonia. Which characteristic of a clinical pathway is correct?

a.	Developed and implemented by nurses
b.	Used primarily in the pediatric setting
c.	Specific time lines for sequencing interventions
d.	One of the steps in the nursing process

ANS: C

Clinical pathways measure outcomes of client care and are developed by multiple healthcare professionals. Each pathway outlines specific time lines for sequencing interventions and reflects interdisciplinary interventions. Clinical pathways are used in multiple settings and for clients throughout the life span. The steps of the nursing process are assessment, diagnosis, planning, implementation, and evaluation.

When planning a parenting class, the nurse should explain that the leading cause of death in children 1 to 4 years of age in the United States is:

a.	premature birth.
b.	congenital anomalies.
c.	accidental death.
d.	respiratory tract illness.

ANS: C

Accidents are the leading cause of death in children ages 1 to 19 years. Disorders of short gestation and unspecified low birth weight make up one of the leading causes of death in neonates. One of the leading causes of infant death after the first month of life is congenital anomalies. Respiratory tract illnesses are a major cause of morbidity in children.

Which statement is true regarding the “quality assurance” or “incident” report?

a.	The report assures the legal department that there is no problem.
b.	Reports are a permanent part of the client’s chart.
c.	The nurse’s notes should contain the following: “Incident report filed and copy placed in chart.”
d.	This report is a form of documentation of an event that may result in legal action.

ANS: D

An incident report is a warning to the legal department to be prepared for potential legal action; it is not a part of the client’s chart or nurse documentation.

. Which client situation fails to meet the first requirement of informed consent?

a.	The parent does not understand the physician’s explanations.
b.	The physician gives the parent only a partial list of possible side effects and complications.
c.	No parent is available and the physician asks the adolescent to sign the consent form.
d.	The infant’s teenage mother signs a consent form because her parent tells her to.

ANS: C

The first requirement of informed consent is that the person giving consent must be competent. Minors are not allowed to give consent. An understanding of information, full disclosure, and voluntary consent are requirements of informed consent, but none of these is the first requirement.

A nurse assigned to a child does not know how to perform a treatment that has been prescribed for the child. What should the nurse’s first action be?

a.	Delay the treatment until another nurse can do it.
b.	Make the child’s parents aware of the situation.
c.	Inform the nursing supervisor of the problem.
d.	Arrange to have the child transferred to another unit.

ANS: C

If a nurse is not competent to perform a particular nursing task, the nurse must immediately communicate this fact to the nursing supervisor or physician. The nurse could endanger the child by delaying the intervention until another nurse is available. Telling the child’s parents would most likely increase their anxiety and will not resolve the difficulty. Transfer to another unit delays needed treatment and would create unnecessary disruption for the child and family.

A nurse is completing a care plan for a child and is finishing the assessment phase. Which activity is not part of a nursing assessment?

a.	Writing nursing diagnoses
b.	Reviewing diagnostic reports
c.	Collecting data
d.	Setting priorities

ANS: D

Setting priorities is a part of planning. Writing nursing diagnoses, reviewing diagnostic reports, and collecting data are parts of assessment.

A nurse is reviewing the nursing care plan for a hospitalized child. Which statements are collaborative problems? Select all that apply.

a.	Risk for injury
b.	Potential complication of seizure disorder
c.	Altered nutrition: Less than body requirements
d.	Fluid volume deficit
e.	Potential complication of respiratory acidosis

ANS: B, E

In addition to nursing diagnoses, which describe problems that respond to independent nursing functions, nurses must also deal with problems that are beyond the scope of independent nursing practice. These are sometimes termedcollaborative problems—physiological complications that usually occur in association with a specific pathological condition or treatment. The potential complications of seizure disorder and respiratory acidosis are physiological complications that will require physician collaboration to treat. Risk for injury, altered nutrition, and fluid volume deficit will respond to independent nursing functions.

Which nursing activities do not meet the standard of care? Select all that apply.

a.	Failure to notify a physician about a child’s worsening condition
b.	Calling the supervisor about staffing concerns
c.	Delegating assessment of a new admit to the Unlicensed Assistive Personnel (UAP)
d.	Asking the Unlicensed Assistive Personnel (UAP) to take vital signs
e.	Documenting that a physician was unavailable and the nursing supervisor was notified

ANS: A, C

A nurse who fails to notify a physician about a child’s worsening condition and delegating the assessment of a new admit to a UAP do not meet the standard of care. Calling the supervisor about staffing concerns, asking the UAP to take vital signs, and documenting that a physician could not be reached and the nursing supervisor was notified all meet the standard of care.