The nurse recommends to the family of a child with severe cerebral palsy that they
enroll their child in hippotherapy. The nurse would explain that hippotherapy includes:
1. Water exercises to increase muscular strength.
2. Use of braces and walkers to support walking.
3. Dietary therapy to maintain a normal weight.
4. Horseback riding, or hippotherapy, improves posture and balance and allows the
child to participate in a physical activity.
The 17-month-old infant is terminally ill with cancer and is in constant pain. The nurse
recognizes that the best way to control pain in this child would be for the physician to
order:
1. Patient-controlled analgesia with the parents controlling the button that administers
the dosage.
2. Intravenously administered opioids on a scheduled basis.
3. Intravenously administered opioids on a prn basis.
4. Parenteral administration controls pain more effectively than oral medication as oral
absorption may be modified by stomach activities. In addition, providing analgesics on
a scheduled basis is preferred over prn.
The nurse has been following the infant in the well-baby clinic and has checked the
child’s vision on every visit. At four months of age, the nurse will add the
cover-uncover test to check the child for:
1. Conjunctivitis.
2. Strabismus.
3. Amblyopia.
4. Cataracts.
In responding to the needs of pediatric patients in pain, the nurse has numerous
nonpharmacologic interventions available. These interventions include:
Standard Text: Select all that apply.
1. Regional nerve block.
2. Cutaneous stimulation.
3. Application of heat.
4. Electroanalgesia.
5. Use of EMLA cream.
During the hospital stay in the newborn nursery, the infant is tested for galactosemia.
When the test is positive, the parents are educated about treatment for galactosemia.
The infant will be placed on what type of infant feeding?
1. Goat’s milk formula
2. Breast milk
3. Cow’s milk-based formula
4. Meat-based formula such as Nutramigen
The nurse is assessing a newborn while the new parents watch. The nurse uses an
ophthalmoscope to examine the back of the eye (the retina) and notes a positive red
reflex. The nurse would explain to the parents that the red reflex indicates:
1. The absence of congenital cataracts.
2. The presence of intraocular hemorrhage.
3. The optic nerve has been traumatized during delivery.
4. Presence of amblyopia.
A two-year-old child with a fever is prescribed amoxicillin clavulanate 250 mg/5 ml
three times daily by mouth for ten days for otitis media. To guard against antibiotic
resistance, the nurse instructs the parent to:
1. Give the antibiotic for the full ten days.
2. Measure the prescribed dose in a household teaspoon.
3. Spread the dose evenly during daylight hours.
4. Stop the antibiotic when the child is afebrile.
Twenty-four hours after being transferred from the pediatric intensive care unit to the
regular pediatrics floor, the seven-year-old child is asked about his experience in the
PICU. The child says he was not in the PICU but came directly to the floor from the
ambulance ride. The nurse recognizes this is a coping behavior for the child known as:
1. Repression.
2. Regression.
3. Amnesia.
4. Developmental delay.
The nurse is teaching the kindergarten teacher about a five-year-old with cerebral palsy
who will be starting school. The child has a continuous baclofen pump. The nurse
informs the teacher of possible side effects of this drug, including:
1. Diarrhea.
2. Hypertonia.
3. Hypotonia.
4. Restlessness.
An adolescent has recently been diagnosed with type 1 diabetes mellitus and is on
dietary restrictions and daily insulin. The nurse is teaching the adolescent’s family
members about the disease and treatment. The nurse will warn the family that the
adolescent, upon returning to school, may:
1. Recognize that there is no difference between her and her classmates.
2. Not experience social stigma.
3. Acknowledge her condition to her classmates.
4. Not adhere to dietary recommendations.
A child has been hospitalized for an extended time period and is being discharged
home. This child requires complex, long-term care and will have a home health nurse
visit daily. In addition to a central line, the child is on oxygen by nasal cannula. What
should the nurse teach the family members?
1. How to insert an IV line
2. Nothing, the family is familiar with the care.
3. Instruction on oxygen administration
4. How to remove a central line
A school-age child with hemophilia falls on the playground and goes to the nurse’s
office with superficial bleeding above the knee. The nurse should:
1. Apply pressure to the area for at least 15 minutes.
2. Apply a warm, moist pack to the area.
3. Perform some passive range-of-motion to the affected leg.
4. Keep the affected extremity in a dependent position.
A child has been placed on an oral corticosteroid for a rash caused by graft-versus-host
disease. The nurse will monitor the child for the common side effects of corticosteroids
including:
1. Hyperglycemia.
2. Hepatic toxicity.
3. Seizures.
4. Renal toxicity.
A child is brought to the emergency department in a coma. The mother thinks the child
may have ingested a poison. The nurse will assess:
Standard Text: Select all that apply.
1. For burns around the mouth.
2. The child’s breath.
3. The child’s vomitus.
4. Hair samples.
5. Blood and urine toxicology screens.
A child is admitted to the hospital with pneumonia. The child’s oximetry reading is 88%
upon admission to the pediatric floor. The priority nursing activity for this child would
be to:
1. Begin administration of intravenous fluids.
2. Obtain a blood sample to send to the lab for electrolyte analysis.
3. Begin oxygen per nasal cannula at 1 liter.
4. Medicate for pain.
A child has cancer and has been treated with chemotherapy. The most recent lab value
indicates that the white blood cell count is very low. Based on this result, which would
the nurse expect to administer?
1. Epoetin alfa (Epogen)
2. Ondansetron (Zofran)
3. Oprelvekin (Neumega)
4. Filgrastim (Neupogen)
A school nurse is performing annual height and weight screening. The nurse notes that
three females who are close friends each lost 15 pounds over the past year. The priority
nursing action is to:
1. Obtain a nutritional history for each of these adolescents.
2. Refer these adolescents to the school psychologist.
3. Call the respective parents to discuss the eating patterns of each adolescent.
4. Speak with the girls in a group to discuss the problems associated with anorexia
nervosa.
An adolescent who is a vegetarian has been placed on iron supplementation secondary
to a diagnosis of iron-deficiency anemia. To increase the absorption of iron, the nurse
would instruct the teen to take the supplement with:
1. Orange juice.
2. Black or green tea.
3. Milk.
4. Tomato juice.
The nurse is providing information to a teenager newly diagnosed with diabetes and his
parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include:
Standard Text: Select all that apply.
1. Change in mental status.
2. Tachycardia.
3. Fruity breath odor.
4. Rapid, shallow respirations.
5. Abdominal pain.
The nurse is assessing an infant brought to the clinic because of diarrhea. The infant is
alert but has dry mucous membranes. Which other sign indicates the infant is still in the
early to moderate stage of dehydration?
1. Bradycardia
2. Tachycardia
3. Increased blood pressure
4. Normal fontanels
A nurse is planning care for a child with hyperkalemia. The nurse explains to the
parents that an adverse outcome of hyperkalemia is:
1. Hyperthermia
2. Respiratory distress
3. Seizures
4. Cardiac arrhythmias
A 16-year-old client has a long leg cast secondary to a fractured tibia. The child will
require a wheelchair for mobility. To effectively facilitate the adolescent’s return to
school, the school nurse should:
1. Meet with all of the other students prior to the student’s return to school to emphasize
the special needs of the injured teen.
2. Meet with teachers and administrators at the school to discuss modifications in the
student’s school routine.
3. Develop an individualized health plan (IHP) focusing on long-term needs of the
adolescent.
4. Meet with parents of the injured student to encourage homebound schooling until a
short leg cast is applied.
The nurse is caring for a child just admitted with diabetic ketoacidosis (DKA). Which
of the physician’s orders should the nurse question?
1. Neurological checks hourly
2. Insert urinary catheter and measure output hourly.
3. NPH insulin IV at 0.1 units/kg per hour
4. Stat serum electrolytes
The child has been admitted to the hospital unit newly diagnosed with retinoblastoma.
What would the nurse expect to see when examining the child’s eye?
1. A white reflex
2. Blue-tinged sclera
3. A red reflex
4. Yellow sclera
The nurse is caring for a young child with otitis media. The parent asks the nurse why
children seem to get otitis media frequently but adults do not. The nurse would explain
that younger children get otitis media more often because:
1. The eustachian tube is shorter, wider, and horizontal in younger children.
2. The eustachian tube is shorter, more narrow, and horizontal in younger children.
3. The eustachian tube is longer, wider, and vertical in younger children.
4. The eustachian tube is longer, more narrow, and vertical in younger children.
An adolescent is receiving methotrexate chemotherapy after undergoing limb-salvage
surgery for osteogenic sarcoma. The nurse knows the teen understands what to expect
for the schedule of administration for leucovorin therapy if the teen says:
1. “I don’t have any pain, so I won’t need to take the leucovorin this time.”
2. “I don’t have any nausea, so I won’t need the leucovorin.”
3. “I’m glad I only need one dose of the leucovorin.”
4. “It is important that I receive my leucovorin on time as it protects my body from the
methotrexate.”
A six-month-old infant has been hospitalized several times with diarrhea. The nurse
evaluates home care to determine the cause of the repeated illnesses. Which is the most
likely cause of the repeated gastroenteritis?
1. The infant is allowed to drink from her parents’ drinks at meal time.
2. If the infant doesn”t finish her bottle, the mother returns it to the refrigerator to be
used later in the day.
3. There are three school-age children in the family.
4. The infant often wears only a diaper around the house.
The child is receiving chemotherapy for acute lymphocytic leukemia. The nurse
recognizes that a potential oncological emergency for this child would be tumor lysis
syndrome. For which symptoms should the nurse monitor this child?
1. Respiratory distress and cyanosis
2. Thrombocytopenia and leukocytosis
3. Oliguria and altered levels of consciousness
4. Upper-extremity edema and neck vein distension
A child in renal failure has hyperkalemia. The nurse plans to instruct the child and her
parents to avoid which foods?
1. Carrots and green, leafy vegetables
2. Spaghetti and meat sauce with breadsticks
3. Hamburger on a bun and cherry gelatin
4. Chips, cold cuts, and canned foods
The nurse recommends to the mothers of toddlers and preschoolers that they limit
television to two hours a day. The nurse also discusses promoting physical activities
that are related to kinesthesia. Which activities would the nurse suggest?
Standard Text: Select all that apply.
1. Walking on a balance beam
2. Reading
3. Playing a memory game
4. Skipping
5. Giving up a pacifier
Two hours after admission for asthma exacerbation, the 10-year-old boy is lethargic
with mottled skin color. He has increased the use of accessory muscles and
demonstrates nasal flaring. He is unable to speak and his respiratory rate has increased.
The nurse would suspect:
1. Improvement in his condition is imminent.
2. Respiratory failure is imminent.
3. The medical diagnosis is incorrect and the child should be diagnosed with
pneumonia.
4. The child may be receiving too much oxygen, which is a respiratory depressant.
The nurse is preparing to administer a blood transfusion to a child with a severe anemia.
Which type of transfusion reaction may be within the nurse’s realm of prevention?
1. Allergic
2. Hemolytic
3. Febrile
4. Septic
A neonate has been diagnosed with a herpes simplex viral infection of the eye. Which
medication will the nurse prepare to administer?
1. Oral erythromycin
2. Fluoroquinolone eyedrops or ointment
3. Parenteral acyclovir (Zovirax) and vidarabine (VIRA-A) ophthalmic ointment
4. Intravenous penicillin
Based on physical findings, including a webbed neck and low hairline, the newborn
female infant is suspected of having Turner’s syndrome. The baby is in the newborn
nursery while preparations are made for further evaluation including karyotyping. The
nurse will want to monitor this baby for common associated conditions including:
1. Club foot (talipes equinovarus).
2. Congenital heart anomalies.
3. Hyperbilirubinemia due to liver abnormalities.
4. Diaphragmatic hernia.
The nurse is caring for a child who is dying. The parent asks that the child not be told
he is dying. The child asks the nurse if he is dying. Which of the following would be the
most appropriate action by the nurse at this time?
1. Ignore the child’s question and change the subject.
2. Offer to bring in the child life therapist.
3. Suggest the parents meet with the health care team.
4. Tell the child he is dying and offer to stay with him.
A child is being prepared for an invasive procedure in the presence of the child’s
babysitter. The single mother of the child has legal custody but is not present. After
details of the procedure are explained, the legal informed consent for treatment on
behalf of a minor child will be obtained from:
1. The divorced parent without custody.
2. The babysitter with written proxy consent.
3. A grandparent who lives in the home with the child.
4. The cohabitating unmarried boyfriend of the child’s mother.
Nursing care of the child with a snake bite involves assessment of the child for initial
and progressive signs of envenomation. Which is the priority nursing action at this
time?
1. Measure the circumference of the extremity containing the bite every 20 to 30
minutes.
2. Assess immunization status.
3. Assess the need for emergency breathing interventions.
4. Assess neurovascular status and vital signs.
5. Assess pain and the child’s response to pain medication.
During a well-child exam, the parents of a four-year-old child inform the nurse that they
are thinking of buying a television for their child’s bedroom and ask for advice as to
whether this is appropriate. The best response from the nurse would be:
1. “It is okay for children to have a television in their room as long as you limit the
amount of time they watch it to less than two hours per day.”
2. “Research has shown that watching educational television shows improves a child’s
performance in school.”
3. “Don’t buy a television for your child’s room; he is much too young for that.”
4. “Research has shown that children with a television in their bedroom spend
significantly less time playing outside than other children.”
Which of these aspects of developmental health supervision should be included in each
health care visit of young children?
1. Discussions of discipline with the parents
2. Toilet training guidelines
3. Referrals to community agencies
4. Patient and family education
The nurse works in a pediatric unit. In working with a parent who is suspected of
Munchausen syndrome by proxy, it is very important for the nurse to:
1. Try to keep the parent separated from the child as much as possible.
2. Explain to the child that the parent is causing the illness and that the health care team
will prevent the child from being harmed
3. Carefully document parent-child interactions.
4. Confront the parent with concerns of possible abuse.
After a routine vaginal delivery, the infant transitions with the mother in the recovery
room without difficulty. Prior to being discharged from the recovery room, it is noted
that the infant’s respiratory rate is 102 and the lungs are clear to auscultation. Based on
these findings, an appropriate transfer for this infant would be to:
1. The newborn nursery for the first bath.
2. The NICU and placed under an over-bed warmer for observation.
3. To the mother’s room to promote bonding with the parents.
4. The newborn nursery for its first feeding.
A child’s understanding of death changes as the child matures. When describing the
adolescent’s understanding of death, which of the following concepts puts the
adolescent at risk for driving under the influence (drunk driving) accidents?
1. A sense of invincibility
2. The idea that death is universal
3. The understanding that death is permanent
4. An understanding that death has an effect on survivors
A mother who is bottle-feeding her newborn requests to be discharged 24 hours
post-delivery, because the mother also has twin two-year-olds at home. The nurse
should schedule the follow-up visit for the newborn on which of these days?
1. Within 48 hours of discharge
2. When the infant is one month old
3. Within two weeks of discharge
4. Within one week of discharge
The telephone triage nurse receives a call from a parent who states that her
18-month-old is making a crowing sound when he breathes and is hard to wake up.
Which is the nurse’s priority action?
1. Advise the parent to hang up and call 911.
2. Reassure the parent and provide instructions on home care for the child.
3. Instruct the parent to make an appointment for the child to see the health care
provider.
4. Obtain the history of the illness from the parent.
The nurse is assessing a four-year-old child with a possible alteration in mental health.
Which findings indicate a need for further investigation?
Standard Text: Select all that apply.
1. Fails to make eye contact
2. Flinches when touched on the arm
3. History of limited prenatal care and precipitant delivery
4. Head circumference has not changed in over one year
5. Flat facial expressions
A nurse is giving instructions to a family whose first language is not English. In order
for the teaching to be effective, what type of discussion should the nurse have with the
family?
1. Give the family instruction booklets written in their first language.
2. Give verbal instruction in English and written instructions in the family’s first
language.
3. Obtain an interpreter to assist the nurse in presenting the instructions and verifying
the families’ understanding of the instructions.
4. Provide the instructions in English and ask the family to repeat the instructions to
you.
The nurse is administering packed red blood cells to a child with sickle-cell disease
(SCD). The nurse knows that a transfusion reaction will most likely occur:
1. Six hours after the transfusion is given.
2. At the end of the administration of the transfusion.
3. Within the first 20 minutes of administration of the transfusion.
4. Never; children with SCD do not have reactions.
During assessment of a child’s biological family history, it is especially important that
the nurse asking the mother for information uses the term “child’s father” instead of
“your husband” in the situation of a:
1. Traditional nuclear family.
2. Two-income nuclear family.
3. Traditional extended family.
4. Heterosexual cohabitating family.
An 18-month-old child is admitted to the hospital unit for weakness of the lower
extremities. Duchenne muscular dystrophy is suspected. Which assessment finding on
the admission history and physical is indicative of this disorder?
1. Infant was post-mature by almost two weeks.
2. The child seems very muscular.
3. The child walked early and without support at 10 months.
4. The child’s older sister developed scoliosis in the fourth grade.
During a summer healthy child visit, the mother tells the nurse that when school starts,
she will be going back to work. The mother expresses her concern that her child will be
a “latchkey” kid. Which suggestions will the nurse make to help maintain the child’s
safety and comfort?
Standard Text: Select all that apply.
1. “During the summer, leave the child home alone for short periods of time.”
2. “Ensure that an adult will always be available by phone.”
3. “Allow the child’s close friend to stay with the child so that he will not be alone.”
4. “Plan some activities that can serve as distractions for the child while alone.”
5. “Ensure that the child knows how and when to call 911.”
The mother of a six-year-old boy who has recently had surgery for the removal of his
tonsils and adenoids complains that he has begun sucking his thumb again. The nurse
caring for the child should assure the mother that this is a normal response for a child
who has undergone surgery and that it is a coping mechanism that children sometimes
use called:
1. Repression.
2. Rationalization.
3. Fantasy.
4. Regression.
A woman pregnant at term arrives at the small rural hospital in active labor. She has
received no prenatal care. At delivery, it is discovered that the newborn has a
gastroschisis defect. Immediate transfer to a pediatric hospital is planned. Nursing care
to prepare the infant for discharge would include:
1. Covering the exposed intestines with sterile moist gauze.
2. Wrapping the infant warmly in two or three blankets.
3. Providing a sterile water feeding to maintain hydration during transport.
4. Preventing the parents from seeing the infant prior to transfer to reduce their anxiety.