For which complication(s) should the nurse observe during administration of Factor
VIII to a child with hemophilia?
1. Fever and chills
2. Fat emboli
3. Nausea and vomiting
4. Congestive heart failure
The mother of a toddler asks the nurse: “Now that my child has outgrown his infant car
seat, what should I do when we are in the car?” Which is the best response by the
nurse?
1. “Place him in a booster chair on the seat beside you so you can watch him.”
2. “Be sure to select a car seat according to his weight and height, and make sure it
contains shoulder harnesses.”
3. “Your child should remain in the rear-facing car seat until he reaches 40 pounds.”
4. “The child can now be buckled safely into the regular car seat belts.”
The nurse finds that an infant has stronger pulses in the upper extremities than in the
lower extremities and higher blood pressure readings in the arms than in the legs. This
could be indicative of what heart defect?
1. Transposition of the great vessels
2. Patent ductus arteriosus
3. Coarctation of the aorta
4. Atrial septal defect
The mother of a dying three-year-old child posts on Facebook: “Family and friends.
Michael’s heart is giving out. Looks like it will be tonight. He is surrounded by family
and not in pain. I treasure every minute of being his mother. Pray for us.” The nurse
who has worked with the family recognizes that Michael’s mother is in which stage of
grieving according to Kubler-Ross?
1. Denial
2. Acceptance
3. Bargaining
4. Depression
The nurse is caring for a client in the pediatric intensive care unit. The parents have
expressed anger over the nursing care their child is receiving. The nursing intervention
most appropriate for these parents would be to:
1. Explain to the parents that their anger is affecting their child, and they will not be
allowed to visit the child until they calm down.
2. Ask the physician to talk with the family.
3. Acknowledge the parents’ concerns and collaborate with them regarding the care of
their child.
4. Call the chaplain to sit with the family.
A very concerned 14-year-old boy presents to the clinic because of an enlargement of
his left breast. Except for the breast enlargement, the client’s history and physical are
normal. The most appropriate intervention for the nurse to implement next would be to
inform the child that:
1. This is a normal finding in adolescent males and that the breast tissue generally
regresses by the time of full sexual maturity.
2. His condition is related to a high-fat diet and that limiting fat intake usually will
resolve the enlargement over a period of a couple of months.
3. A pediatric endocrine consult is being arranged.
4. The healthcare provider is arranging a surgical consult for him.
Despite the availability of the Children’s Health Insurance Program (CHIP), families
often fail to obtain coverage for eligible children because:
1. They do not see the importance of insurance coverage.
2. Families do not have adequate time to complete the enrollment process.
3. They do not know their child is eligible.
4. Parents do not value medical interventions for their children.
A mother of a three-year-old tells the nurse that her child often puts small toys in his
mouth and she is concerned about choking. She asks the nurse what she should do if the
child chokes. In addition to recommending the mother take a CPR course, the best
response by the nurse would be to:
1. Show the mother how to do cardiac compressions and rescue breathing.
2. Recommend the mother perform back blows and chest thrusts.
3. Teach the mother how to perform abdominal thrusts.
4. Tell the mother to do nothing until the child loses consciousness.
The nurse stops at the scene of an accident and finds a child conscious but with a
sucking wound of the chest. The immediate action by the nurse would be to:
1. Place the child in trendelenburg.
2. Begin rescue breathing.
3. Begin cardiac resuscitation.
4. Cover the wound with an air occlusive dressing.
The nursing supervisor is observing the staff on the pediatric unit. Which nurse is
providing family-centered care?
1. The nurse who delays morning care until after the family has visited the child
2. The nurse who suggests the mother take a break and get breakfast while the nurse
changes the child’s dressings
3. While admitting a new client, the nurse explains the visitation rules of the unit to the
parents and grandparents.
4. During discharge planning, the nurse recognizes the mother is unable to perform
wound care on the client, so the nurse works with the family to determine which family
member will be available to meet this child’s health care needs.
A five-year-old with a history of being treated for hypopituitarism comes to the
physician with complaints of right hip and leg pain. The nurse understands that this
symptom might be related to which medication that is used to treat hypopituitarism?
1. Daily growth hormone
2. Insulin before meals and bedtime
3. DDAVP (desmopressin acetate) at HS
4. Cortisone injections
A nurse is reviewing the charts of children in the pediatric units to determine which
parents would benefit from referral to the genetics clinic. The nurse recognizes that the
parents of children with genetic and chromosomal disorders would benefit most from
this referral. Therefore, the nurse refers the parents of the:
Standard Text: Select all that apply.
1. Neonate born at 28 weeks with respiratory distress syndrome.
2. Two-year-old child who is terminally ill with a brain tumor.
3. Child diagnosed at age six with cystic fibrosis.
4. Four-year-old child with nephrotic syndrome.
5. Child with Duchenne muscular dystrophy being treated for respiratory symptoms.
The nurse is preparing to perform a heel stick on a neonate. The most appropriate
complementary therapy for the nurse to plan to use in the neonate to decrease pain
during this quick but painful procedure is:
1. Holding the infant.
2. Sucrose pacifier.
3. Massage.
4. Swaddling.
The home health nurse is observing the home environment for safety issues to discuss
with the mother. Which observation creates a risk of injury for the toddler?
1. The mother fills the mop bucket and places it on the floor. She then leaves the room
to obtain the mop.
2. When cooking, the mother only uses the back burners of the stove.
3. The mother straps her child into the high chair.
4. The mother has child-proof latches only on the cabinets containing household
chemicals, medications, and poisons.
The ten-year-old child was diagnosed with a medulloblastoma; following surgery the
child is started on chemotherapy by intrathecal injection. While preparing the family for
the start of chemotherapy, the nurse will explain that intrathecal administration was
chosen because:
1. It reduces side effects.
2. It does not require the child being ‘stuck.”
3. Many chemotherapy drugs do not cross the blood-brain barrier.
4. Intrathecal administration is less expensive than intravenous administration.
A new patient is admitted to the pediatric clinic. The nurse wants to partner with the
parents in creating a health care home. The first step for the nurse in becoming an
effective partner with the parents would be to:
1. Develop a relationship with the parents with open supportive communication and
display an interest and a concern for the family’s goals.
2. Determine the family’s financial stability and identify community resources.
3. Provide the parents with the nurse’s home phone number so the parents can call when
they need information.
4. Remind the parents that it is necessary for the child to receive health supervision on a
regular basis.