Care of the child with Neurologic Problem

1. When assessing a toddler, age 18 months, the nurse should interpret which reflex as a sign of a neurologic
dysfunction?
a. Positive gag reflex
b. Positive tonic neck reflex
c. Positive Babinski's reflex
d. Positive corneal reflex

2. When developing a care plan for a toddler with a seizure disorder, which of the following would be inappropriate?
a. Padded side rails
b. Oxygen mask and bag system at bedside
c. Arm restraints while asleep
d. Cardiorespiratory monitoring

3. A 6-year-old child with a history of varicella and aspirin intake is brought to the emergency department. The nurse
suspects Reye's syndrome. Which assessment findings are consistent with this syndrome?
a. Fever, decreased level of consciousness (LOC), and impaired liver function
b. Joint inflammation, red macular rash with a clear center, and low-grade fever
c. Peripheral edema, fever for 5 or more days, and "strawberry tongue"
d. Red, raised "bull's eye" rash, malaise, and joint pain

4. After a series of tests, a 6-year-old client weighing 50 lb (22.7 kg) is diagnosed with complex partial seizures. The
physician prescribes phenytoin (Dilantin), 125 mg by mouth twice per day. After the nurse administers phenytoin, where is
the drug metabolized?
a. Pancreas
b. Kidneys
c. Stomach
d. Liver

5. An 8-year-old child is suspected of having meningitis. Signs of meningitis include which of the following?
a. Cullen's sign
b. Koplik's spots
c. Kernig's sign
d. Chvostek's sign

6. When caring for an adolescent who's at risk for injury related to intracranial pathology, which action would maintain
stable intracranial pressure (ICP)?
a. Turn the client's head from side to side frequently.
b. Keep the head in midline position while raising the head of the bed 15 to 30 degrees.
c. Hyperextend the client's head with a blanket roll.
d. Suction frequently to maintain a clear airway.

7. A 3-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention
has the highest priority?
a. Instituting droplet precautions
b. Administering acetaminophen (Tylenol)
c. Obtaining history information from the parents
d. Orienting the parents to the pediatric unit

8. The nurse is assessing an infant for signs of increased intracranial pressure (ICP). What is the earliest sign of
increased ICP in an infant?
a. Vomiting
b. Papilledema
c. Headache
d. Increased head circumference

9. A nurse on the pediatric floor is caring for a toddler who has neurologic problem. The nurse should keep in mind that
toddlers:
a. express negativism.
b. have reliable verbal responses to pain.
c. have a good concept of danger.
d. have little fear.

10. While examining a 2-year-old child, the nurse sees that the anterior fontanel is open. The nurse should:
a. notify the physician.
b. look for other signs of abuse.
c. recognize this as a normal finding.
d. ask about a family history of Tay-Sachs disease.
Care of the child with Respiratory Problem

11. When planning care for a child with epiglottitis, the nurse should assign highest priority to:
a. providing psychological support.
b. ensuring airway patency.
c. instituting infection control.
d. administering prescribed drug therapy.

12. When a toddler with croup is admitted to the facility, the physician orders treatment with a mist tent. As the parent
attempts to put the toddler in the crib, the toddler cries and clings to the parent. What is the nurse's best approach
for gaining the child's cooperation with the treatment?
a. Turn off the mist so the noise doesn't frighten the toddler.
b. Let the toddler sit on the parent's lap next to the mist tent.
c. Encourage the parent to stand next to the crib and stay with the child.
d. Put the side rail down so the toddler can get into and out of the crib unaided.

13. A 2-year-old child is brought to the emergency department with a history of upper airway infection that has worsened
over the last 2 days. The nurse suspects the child has croup. Signs of croup include a hoarse voice, inspiratory
stridor, and:
a. a barking cough.
b. a high fever.
c. sudden onset.
d. dysphagia.

14. Which assessment finding would the nurse identify as abnormal for a 4-month-old?
a. The abdominal wall is rising with inspiration.
b. The respiratory rate is between 30 and 35 breaths/minute.
c. The infant's skin is mottled during examination.
d. The spaces between the ribs (intercostal) are delineated during inspiration.

15. A child with asthma is receiving theophylline. The nurse knows that theophylline is administered primarily to:
a. decrease coughing induced by postnasal drip.
b. dilate the bronchioles.
c. reduce airway inflammation.
d. eradicate the infection.

16. When developing a care plan for a hospitalized child, the nurse knows that children in which age-group are most
likely to view illness as a punishment for misdeeds?
a. Infancy
b. Preschool age
c. School age
d. Adolescence

17. When assessing a child with bronchiolitis, which finding does the nurse expect?
a. Clubbed fingers
b. Barrel chest
c. Barking cough and stridor
d. Productive cough

18. A mist tent contains a nebulizer that creates a cool, moist environment for an infant with an upper respiratory tract
infection. The cool humidity helps the infant breathe by:
a. decreasing respiratory tract edema.
b. avoiding anxiety.
c. drying secretions.
d. increasing fluid intake.

19. A baby undergoes surgery to correct an esophageal atresia and tracheoesophageal fistula. Which nursing diagnosis
has the highest priority during the first 24 hours postoperatively?
a. Ineffective airway clearance
b. Imbalanced nutrition: Less than body requirements
c. Interrupted breast-feeding
d. Hypothermia

20. When caring for a toddler with epiglottitis, the nurse should first:
a. examine his throat.
b. Keep a tracheotomy tray at the bedside.
c. administer I.V. fluids.
d. administer antibiotics.
Care of the child with Gastrointestinal Problem

21. A child, age 9, is admitted to the emergency department with pain in the right lower abdominal quadrant, suggesting
appendicitis. To further assess for pain associated with appendicitis, the nurse should examine which region?
a. Left lower abdominal quadrant
b. Right upper abdominal quadrant
c. Left upper abdominal quadrant
d. Umbilical area

22. Which intervention takes priority when admitting an infant with acute gastroenteritis?
a. Obtaining a stool specimen
b. Weighing the infant
c. Offering the infant clear liquids
d. Obtaining a history of the illness

23. A neonate born several hours ago shows signs of a tracheoesophageal fistula (TEF). During the initial assessment,
what does the nurse expect to find?
a. Continuous drooling
b. Diaphragmatic breathing
c. A slow response to stimuli
d. Passage of frothy meconium

24. Which technique is most effective in preventing nosocomial infection transmission when caring for a preschooler?
a. Client isolation
b. Standard precautions
c. Hand washing
d. Needleless syringe system

25. The nurse is teaching accident prevention to the parents of a toddler. Which instruction is appropriate for the nurse to
tell the parents?
a. The toddler should wear a helmet when roller blading.
b. Place locks on cabinets containing toxic substances.
c. Teach the toddler water safety.
d. Don't allow the toddler to use pillows when sleeping.

26. Twenty-four hours after birth, a neonate hasn't passed meconium. The nurse suspects which condition?
a. Hirschsprung's disease
b. Celiac disease
c. Intussusception
d. Abdominal wall defect

27. The nurse prepares to administer the Denver Developmental Screening Test to a 6-month-old infant during a well-
baby checkup. This test assesses the child's:
a. intelligence quotient (IQ).
b. psychological development.
c. social, motor, and language development.
d. vision and eye muscle coordination

28. The nurse is assessing a 6 years old patient who is suspected for having pyloric stenosis. Upon assessment the nurse
expects that the patient will have:
a. Palpable sausage-shaped mass
b. Projectile vomiting
c. Currant jelly-like stool
d. Olive-shaped upon auscultation

Care of the child with Sensory Problem

29. Before performing an otoscopic examination on a child, where should the nurse palpate for tenderness?
a. Tragus, mastoid process, and helix
b. Helix, umbo, and tragus
c. Tragus, cochlea, and lobule
d. Mastoid process, incus, and malleus

30. The nurse is teaching the parents of a 5-year-old child how to respond in case of poisoning. If poisoning occurs, what
should the parents' first response be?
a. Administer syrup of ipecac.
b. Call the poison control center.
c. Bring the child to the physician's office.
d. Monitor the child for adverse effects.
31. The nurse is teaching a parent how to administer antibiotics at home to a toddler with acute otitis media. Which
statement by the parent indicates that teaching has been successful?
a. "I'll give the antibiotics for the full 10-day course of treatment."
b. "I'll give the antibiotics until my child's ear pain is gone."
c. "Whenever my child is cranky or pulls on an ear, I'll give a dose of antibiotics."
d. "If the ear pain is gone, there's no need to see the physician for another examination of the ears."

Care of the patient with various pediatric problems

32. The nurse is caring for a 2½-year-old child with tetralogy of Fallot (TOF). Which abnormalities are associated with
TOF?
a. Aortic stenosis, atrial septal defect, overriding aorta, and left ventricular hypertrophy
b. Pulmonic stenosis, intraventricular septal defect, overriding aorta, and right ventricular hypertrophy
c. Pulmonic stenosis, patent ductus arteriosus, overriding aorta, and right ventricular hypertrophy
d. Transposition of the great vessels, intraventricular septal defect, right ventricular hypertrophy, and patent
ductus arteriosus

33. A 10-month-old infant with tetralogy of Fallot (TOF) experiences a cyanotic episode. To improve oxygenation during
such an episode, the nurse should place the infant in which position?
a. Knee-to-chest
b. Fowler's
c. Trendelenburg's
d. Prone

34. A child, age 4, is admitted with a tentative diagnosis of congenital heart disease. When assessment reveals a
bounding radial pulse coupled with a weak femoral pulse, the nurse suspects that the child has:
a. patent ductus arteriosus.
b. coarctation of the aorta.
c. aventricular septal defect.
d. truncus arteriosus.

35. A school-age child with fever and joint pain has just received a diagnosis of rheumatic fever. The child's parents ask
the nurse whether anything could have prevented this disorder. Which intervention is most effective in preventing
rheumatic fever?
a. Immunization with the hepatitis B vaccine
b. Isolation of individuals with rheumatic fever
c. Use of prophylactic antibiotics for invasive procedures
d. Early detection and treatment of streptococcal infections

36. Which assessment finding is an early sign of heart failure in a toddler?

a. Increased respiratory rate
b. Increased urine output
c. Decreased weight
d. Decreased heart rate

37. A preschool-age child with sickle cell anemia is admitted to the health care facility in vaso-occlusive crisis after
developing a fever and joint pain. What is the nurse's highest priority when caring for this child?
a. Providing fluids
b. Maintaining protective isolation
c. Applying cool compresses to affected joints
d. Administering antipyretics as prescribed

38. A pediatric client with iron deficiency anemia is prescribed ferrous sulfate (Ferralyn), an oral iron supplement. When
teaching the child and parent how to administer this preparation, the nurse should provide which instruction?
a. "Administer ferrous sulfate with meals to prevent stomach upset."
b. "Administer ferrous sulfate with milk to promote absorption."
c. "Administer ferrous sulfate with fruit juice to promote absorption."
d. "Administer ferrous sulfate with antacids to prevent stomach upset."

39. A child is diagnosed with nephrotic syndrome. When planning the child's care, the nurse understands that the
primary goal of treatment is to:
a. manage urinary changes by monitoring fluid intake and output and observing for hematuria.
b. reduce the excretion of urinary protein.
c. help prevent cardiac or renal failure by carefully monitoring fluid and electrolyte balance.
d. decrease edema and hypertension through bed rest and fluid restriction.

40. The nurse is developing a teaching plan for a child with acute poststreptococcal glomerulonephritis. What is the most
important point to address in this plan?
a. Infection control
b. Nutritional planning
c. Prevention of streptococcal pharyngitis
d. Blood pressure monitoring

41. In a pediatric client, what is an early sign of acute renal failure (ARF)?
a. Hypertension
b. Decreased urine output
c. Anemia
d. Hematuria

42. A 4-year-old girl has a urinary tract infection (UTI). When teaching the parents how to help her avoid recurrent UTIs,
the nurse should emphasize which preventive measure?
a. Wiping her perineum from back to front after she uses the toilet
b. Administering prophylactic antibiotics
c. Giving her a warm bath for 15 minutes daily
d. Making sure she avoids bubble baths

43. When assessing a child with juvenile hypothyroidism, the nurse expects which finding?
a. Goiter
b. Recent weight loss
c. Insomnia
d. Tachycardia

44. A child with diabetes insipidus receives desmopressin acetate (DDAVP). When evaluating for therapeutic
effectiveness, the nurse would interpret which finding as a positive response to this drug?
a. Decreased urine output
b. Increased urine glucose level
c. Decreased blood pressure
d. Relief of nausea

45. A child is diagnosed with pituitary dwarfism. Which pituitary agent will the physician probably prescribe to treat this
condition?
a. corticotropin zinc hydroxide (Cortrophin-Zinc)
b. somatrem (Protropin)
c. desmopressin acetate (DDAVP)
d. vasopressin (Pitressin)

46. When discharging a 5-month-old infant from the hospital, the nurse checks to see whether the parent's car restraint
system for the infant is appropriate. Which of the following restraint systems would be safest?
a. A front-facing convertible car seat in the middle of the back seat
b. A rear-facing infant safety seat in the front passenger seat
c. A rear-facing infant safety seat in the middle of the back seat
d. A front-facing convertible car seat in the back seat next to the window

47. A 12-month-old child fell down the stairs and a basilar skull fracture is suspected. The nurse should look for:
a. cerebrospinal fluid otorrhea.
b. deafness.
c. raccoon eyes.
d. Battle's sign.

48. The nurse is caring for an 8-year-old child with acute asthma exacerbation. Which of the following would be of
greatest concern to the nurse?
a. The child's respiratory rate is now 24 breaths/minute.
b. Recent blood gas analysis indicates an oxygen saturation of 95%.
c. Before a respiratory therapy treatment, wheezing isn't heard on auscultation.
d. The child's mother reports that the child sometimes forgets to take the inhalers.

49. When performing a physical assessment on a girl, age 10, the nurse keeps in mind that the first sign of sexual
maturity in girls is:
a. breast bud development.
b. pubic hair.
c. axillary hair.
d. menarche.

50. The parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic
enzymes. Which response by the nurse would be most appropriate?
a. "Pancreatic enzymes promote absorption of nutrients and fat."
b. "Pancreatic enzymes promote adequate rest."
c. "Pancreatic enzymes prevent intestinal mucus accumulation."
d. "Pancreatic enzymes help prevent meconium ileus."