The nurse working in the clinic includes an adolescent history in every client intake
interview. Which of these issues should the nurse address when the parents are not
present?
1. The adolescent’s role in the family
2. Teen job responsibilities
3. Possible domestic violence
4. Activities done as a family
A child has been comatose in the PICU for three days. The parents have been at the
child’s bedside or in the waiting room the entire time. Which statement by the nurse
would be most helpful in promoting the parents to take a break?
1. “You”ve been here three days. It is time for you to go home and take a shower.”
2. “Your child isn”t aware you are here anyway, so why don”t you take a break?”
3. “I”ll be with your child, so go home and get a good nap.”
4. “I know you are concerned and afraid to leave. If you”d like to take a short walk, you
can leave me your cell phone number and I”ll call you if there are any changes.”
Despite the availability of Children’s Health Insurance Programs (CHIP), many eligible
children are not enrolled. The nursing intervention that can best help eligible children to
become enrolled is:
1. Educating the family about the need for keeping regular well-child visit
appointments.
2. Assessing details of the family’s income and expenditures.
3. Limiting costly, unnecessary duplication of services through case management.
4. Advocating for the child by encouraging the family to investigate CHIP eligibility.
A nurse is performing a developmental assessment on several children in a clinic
setting. Which children exhibit a delay in meeting developmental milestones?
Standard Text: Select all that apply.
1. An 18-month-old toddler who is unable to speak in sentences
2. A two-year-old who is unable to cut with scissors
3. A two-year-old who cannot recite her phone number
4. A six-year-old who is unable to sit still for a short story
5. A five-year-old who is unable to button his shirt
The nurse is teaching a group of parents about car safety. Which statement by a parent
requires additional teaching?
1. “The safest place in the car for the baby is the middle of the back seat.”
2. “I will use a rear facing car seat for my baby.”
3. “I will take the car seat to the local police station for them to check placement and
safety.”
4. “For the trip home from the birth hospital, I will bucket myself in the back seat and
hold the baby carefully. I am borrowing a car seat and should have it by my next trip
out.”
The nurse is conducting an educational program for parents of children with chronic
conditions. Which statement by a parent requires additional nursing interventions?
1. “I know my child will get better and not have to take any more medication.”
2. “I know my child will need assistance with activities of daily living.”
3. “I know my child may need specialized education.”
4. “I know my child will have to stay on a special diet.”
The nurse in a pediatric acute care unit is assigned the following tasks. Based on
recognition that the action defined requires training beyond the preparation of a
registered nurse, the nurse would refuse to:
1. Diagnose a six-year-old with diversional activity deficit related to placement in
isolation.
2. Listen to the concerns of an adolescent about being out of school for a lengthy
surgical recovery.
3. Diagnose an eight-year-old with acute otitis media and prescribe an antibiotic.
4. Provide information to a mother of a newly diagnosed four-year-old diabetic about
local support group options.
The nurse is preparing to administer a vaccine to a 14-month-old infant. Which finding
would require that the nurse delay the vaccination until the next well-child visit?
1. The child is allergic to a substance in the vaccine.
2. The child has a low-grade fever and a runny nose.
3. The child received a dose of immune globulin two months ago.
4. The child is on antibiotics.
A child who is dependent on a ventilator is being discharged from the hospital. Prior to
discharge, the home health nurse discusses development of an emergency plan of care
with the family. Which is the most essential part of the plan?
1. Provision for an alternate heating source if power is lost
2. Notifying the power company that the child is on life support
3. Designation of an emergency shelter site
4. Acquisition of a backup generator
During a well-child visit, the nurse questions the mother about a toddler’s food habits.
The mother expresses concern that her child, who used to be a good eater and would eat
all types of vegetables, now refuses all but three types of vegetables. Which is the
appropriate response for the nurse to make to the mother?
1. “This is a serious concern, and we need to address this with the physician.”
2. “Toddlers often go on food jags. Just continue to offer all types of vegetables without
making it an issue.”
3. “Don”t make an issue over it. Just stop offering those favorite vegetables and the
child will start eating other vegetables.”
4. “Have you thought about adding a multivitamin to the child’s daily routine?”
The nurse is monitoring the urine specific gravity and pH on a child receiving
chemotherapy. The nurse will try to maintain the urine values at what levels?
1. Specific gravity 1.030 and pH 7.5
2. Specific gravity 1.005 and pH 6
3. Specific gravity 1.030 and pH 6
4. Specific gravity 1.005 and pH 7.5
The nurse in the newborn nursery is admitting a neonate. In order to determine the
health and development of the newborn, what will the nurse assess?
Standard Text: Select all that apply.
1. Head and chest circumference
2. Weight and length
3. Body fat determination
4. Presence of newborn reflexes
5. Gestational age of the infant
A family actively participates in school functions with all their children, one of whom is
paraplegic and requires a wheelchair for mobility. The nurse evaluates this family to be
working on the process of:
1. Stagnation.
2. Isolation.
3. Normalization.
4. Interaction.
A nurse is preparing to perform a physical assessment on a toddler. Which of these
actions should the nurse take?
1. Explain each part of the examination to the child before performing it.
2. Ask the mother to tell the child not to be afraid.
3. Perform the assessment from head to toe.
4. Leave intrusive procedures, such as ear and eye examinations, until the end.
The nurse caring for a nine-year-old child with extensive burns needs to prepare the
child for going to whirlpool therapy for the first time. The most effective response to
promote communication with this child would be:
1. “Have you been to the playroom yet? Maybe when you get back from whirlpool we
can check it out together.”
2. “Before you leave for whirlpool, I will give you a shot that will relax you, and you
probably won’t even remember going downstairs at all.”
3. “I am going to be taking you downstairs to whirlpool. Do you have any questions?”
4. “Some of the children I have worked with have told me that they worried about the
whirlpool hurting them.”