1.

The parents of a child, age 6, who will palpating the toddler’s fontanels, what should
begin school in the fall ask the nurse for the nurse expects to find?
anticipatory guidance. The nurse should explain
that a child of this age: a. Closed anterior fontanel and open posterior
fontanel
a. Still depends on the parents b. Open anterior and fontanel and closed
b. Rebels against scheduled activities posterior fontanel
c. Is highly sensitive to criticism c. Closed anterior and posterior fontanels
d. Loves to tattle d. Open anterior and posterior fontanels

2. While preparing to discharge an 8-month- 7. Patrick, a healthy adolescent has meningitis

old infant who is recovering from gastroenteritis and is receiving I.V. and oral fluids. The nurse
and dehydration, the nurse teaches the parents should monitor this client’s fluid intake because
about their infant’s dietary and fluid fluid overload may cause:
requirements. The nurse should include which
other topic in the teaching session? a. Cerebral edema
b. Dehydration
a. Nursery schools c. Heart failure
b. Toilet Training d. Hypovolemic shock
c. Safety guidelines
d. Preparation for surgery 8. An infant is hospitalized for treatment of
nonorganic failure to thrive. Which nursing
3. Nurse Betina should begin screening for action is most appropriate for this infant?
lead poisoning when a child reaches which age?
a. Encouraging the infant to hold a bottle
a. 6 months b. Keeping the infant on bed rest to conserve
b. 12 months energy
c. 18 months c. Rotating caregivers to provide more
d. 24 months stimulation
d. Maintaining a consistent, structured
4. When caring for an 11-month-old infant environment
with dehydration and metabolic acidosis, the
nurse expects to see which of the following? 9. The mother of Gian, a preschooler with
spina bifida tells the nurse that her daughter
a. A reduced white blood cell count sneezes and gets a rash when playing with
b. A decreased platelet count brightly colored balloons, and that she recently
c. Shallow respirations had an allergic reaction after eating kiwifruit and
d. Tachypnea bananas. The nurse would suspect that the child
may have an allergy to:
5. After the nurse provides dietary restrictions
to the parents of a child with celiac disease, a. Bananas
which statement by the parents indicates b. Latex
effective teaching? c. Kiwifruit
d. Color dyes
a. “Well follow these instructions until our
child’s symptoms disappear.” 10. Cristina, a mother of a 4-year-old child
b. “Our child must maintain these dietary tells the nurse that her child is a very poor
restrictions until adulthood.” eater. What’s the nurse’s best recommendation
c. “Our child must maintain these dietary for helping the mother increase her child’s
restrictions lifelong.” nutritional intake?
d. “We’ll follow these instructions until our
child has completely grown and developed.” a. Allow the child to feed herself
b. Use specially designed dishes for children –
for example, a plate with the child’s favorite
6. A parent brings a toddler, age 19 months, cartoon character
to the clinic for a regular check-up. When c. Only serve the child’s favorite foods
d. Allow the child to eat at a small table and d. Emptying the trash cans in the assigned
chair by herself client room

11. Nurse Roy is administering total parental 16. Nurse Alice is providing cardiopulmonary
nutrition (TPN) through a peripheral I.V. line to resuscitation (CPR) to a child, age 4. the nurse
a school-age child. What’s the smallest amount should:
of glucose that’s considered safe and not caustic
to small veins, while also providing adequate a. Compress the sternum with both hands at a
TPN? depth of 1½ to 2” (4 to 5 cm)
b. Deliver 12 breaths/minute
a. 5% glucose c. Perform only two-person CPR
b. 10% glucose d. Use the heel of one hand for sternal
c. 15% glucose compressions
d. 17% glucose
17. A 4-month-old with meningococcal
12. David, age 15 months, is recovering from meningitis has just been admitted to the
surgery to remove Wilms’ tumor. Which findings pediatric unit. Which nursing intervention has
best indicates that the child is free from pain? the highest priority?

a. Decreased appetite a. Instituting droplet precautions

b. Increased heart rate b. Administering acetaminophen (Tylenol)
c. Decreased urine output c. Obtaining history information from the
d. Increased interest in play parents
d. Orienting the parents to the pediatric unit
13. When planning care for a 8-year-old boy
with Down syndrome, the nurse should: 18. Sheena, tells the nurse that she wants to
begin toilet training her 22-month-old child. The
a. Plan interventions according to the most important factor for the nurse to stress to
developmental level of a 7-year-old child the mother is:
because that’s the child’s age
b. Plan interventions according to the a. Developmental readiness of the child
developmental levels of a 5-year-old because b. Consistency in approach
the child will have developmental delays c. The mother’s positive attitude
c. Assess the child’s current developmental d. Developmental level of the child’s peers
level and plan care accordingly
d. Direct all teaching to the parents because 19. An infant who has been in foster care
the child can’t understand since birth requires a blood transfusion. Who is
authorized to give written, informed consent for
14. Nurse Victoria is teaching the parents of a the procedure?
school-age child. Which teaching topic should
take priority? a. The foster mother
b. The social worker who placed the infant in
a. Prevent accidents the foster home
b. Keeping a night light on to allay fears c. The registered nurse caring for the infant
c. Explaining normalcy of fears about body d. The nurse-manager
integrity
d. Encouraging the child to dress without help 20. A child is undergoing remission induction
therapy to treat leukemia. Allopurinol is included
15. The nurse is finishing her shift on the in the regimen. The main reason for
pediatric unit. Because her shift is ending, which administering allopurinol as part of the client’s
intervention takes top priority? chemotherapy regimen is to:

a. Changing the linens on the clients’ beds a. Prevent metabolic breakdown of xanthine
b. Restocking the bedside supplies needed for to uric acid
a dressing change on the upcoming shift b. Prevent uric acid from precipitating in the
c. Documenting the care provided during her ureters
shift
c. Enhance the production of uric acid to b. Call an ambulance immediately
ensure adequate excretion of urine c. Call the poison control center
d. Ensure that the chemotherapy doesn’t d. Punish the child for being bad
adversely affect the bone marrow
26. A child has third-degree burns of the
21. A 10-year-old client contracted severe hands, face, and chest. Which nursing diagnosis
acute respiratory syndrome (SARS) when takes priority?
traveling abroad with her parents. The nurse
knows she must put on personal protective a. Ineffective airway clearance related to
equipment to protect herself while providing edema
care. Based on the mode of SARS transmission, b. Disturbed body image related to physical
which personal protective should the nurse appearance
wear? c. Impaired urinary elimination related to fluid
loss
a. Gloves d. Risk for infection related to epidermal
b. Gown and gloves disruption
c. Gown, gloves, and mask
d. Gown, gloves, mask, and eye goggles or 27. A 3-year-old child is receiving dextrose 5%
eye shield in water and half-normal saline solution at 100
ml/hour. Which sign or symptom suggests
22. A tuberculosis intradermal skin test to excessive I.V. fluid intake?
detect tuberculosis infection is given to a high-
risk adolescent. How long after the test is a. Worsening dyspnea
administered should the result be evaluated? b. Gastric distension
c. Nausea and vomiting
a. Immediately d. Temperature of 102°F (38.9° C)
b. Within 24 hours
c. In 48 to 72 hours 28. Which finding would alert a nurse that a
d. After 5 days hospitalized 6-year-old child is at risk for a
severe asthma exacerbation?
23. Nurse Oliver s teaching a mother who
plans to discontinue breast-feeding after 5 a. Oxygen saturation of 95%
months. The nurse should advise her to include b. Mild work of breathing
which foods in her infant’s diet? c. Absence of intercostals or substernal
retractions
a. Iron-rich formula and baby food d. History of steroid-dependent asthma
b. Whole milk and baby food
c. Skim milk and baby food
d. Iron-rich formula only 29. Nurse Mariane is caring for an infant with
spina bifida. Which technique is most important
24. Gracie, the mother of a 3-month-old infant in recognizing possible hydrocephalus?
calls the clinic and states that her child has a
diaper rash. What should the nurse advise? a. Measuring head circumference
b. Obtaining skull X-ray
a. “Switch to cloth diapers until the rash is c. Performing a lumbar puncture
gone” d. Magnetic resonance imaging (MRI)
b. “Use baby wipes with each diaper change.”
c. “Leave the diaper off while the infant
sleeps.” 30. An adolescent who sustained a tibia
d. “Offer extra fluids to the infant until the fracture in a motor vehicle accident has a cast.
rash improves.” What should the nurse do to help relieve the
itching?
25. Nurse Kelly is teaching the parents of a
young child how to handle poisoning. If the child a. Apply cool air under the cast with a blow-
ingests poison, what should the parents do first? dryer
b. Use sterile applicators to scratch the itch
a. Administer ipecac syrup c. Apply cool water under the cast
d. Apply hydrocortisone cream under the cast symptoms will reappear if the patient
using sterile applicator.
eats prohibited foods.
6. Answer C. By age 18 months, the
anterior and posterior fontanels should
be closed. The diamond-shaped anterior
1. Answer C. In a 6-year-old child, a fontanel normally closes between ages 9
precarious sense of self causes and 18 months. The triangular posterior
overreaction to criticism and a sense of fontanel normally closes between ages 2
inferiority. By age 6, most children no and 3 months.
longer depend on the parents for daily 7. Answer A. Because of the inflammation
tasks and love the routine of a schedule. of the meninges, the client is vulnerable
Tattling is more common at age 4 to 5, to developing cerebral edema and
by age 6, the child wants to make increase intracranial pressure. Fluid
friends and be a friend. overload won’t cause dehydration. It
2. Answer C. The nurse always should would be unusual for an adolescent to
reinforce safety guidelines when develop heart failure unless the
teaching parents how to care for their overhydration is extreme. Hypovolemic
child. By giving anticipatory guidance shock would occur with an extreme loss
the nurse can help prevent many of fluid of blood.
accidental injuries. For parents of a 9- 8. Answer D. The nurse caring for an
month-old infant, it is too early to infant with nonorganic failure to thrive
discuss nursery schools or toilet training. should maintain a consistent, structured
Because surgery is not used environment that provides interaction
gastroenteritis, this topic is with the infant to promote growth and
inappropriate. development. Encouraging the infant to
3. Answer C. The nurse should start hold a bottle would reinforce an
screening a child for lead poisoning at uncaring feeding environment. The
age 18 months and perform repeat infant should receive social stimulation
screening at age 24, 30, and 36 months. rather than be confined to bed rest. The
High-risk infants, such as premature number of caregivers should be
infants and formula-fed infants not minimized to promote consistency of
receiving iron supplementation, should care.
be screened for iron-deficiency anemia 9. Answer B. Children with spina bifida
at 6 months. Regular dental visits often develop an allergy to latex and
should begin at age 24 months. shouldn’t be exposed to it. If a child is
4. Answer D. The body compensates for sensitive to bananas, kiwifruit, and
metabolic acidosis via the respiratory chestnuts, then she’s likely to be allergic
system, which tries to eliminate the to latex. Some children are allergic to
buffered acids by increasing alveolar dyes in foods and other products but
ventilation through deep, rapid dyes aren’t a factor in a latex allergy.
respirations, altered white blood cell or 10. Answer A. The best recommendation is
platelet counts are not specific signs of to allow the child to feed herself
metabolic imbalance. because the child’s stage of
5. Answer C. A patient with celiac disease development is the preschool period of
must maintain dietary restrictions initiative. Special dishes would enhance
lifelong to avoid recurrence of clinical the primary recommendation. The child
manifestations of the disease. The other should be offered new foods and
options are incorrect because signs and choices, not just served her favorite
 foods. Using a small table and chair 1½ “. The nurse should use the heels of
would also enhance the primary both hands clasped together and
recommendation. compress the sternum 1½ “to 2” for an
11. Answer B. The amount of glucose that’s adult. For a small child, two-person
considered safe for peripheral veins rescue may be inappropriate. For a
while still providing adequate parenteral child, the nurse should deliver 20
nutrition is 10%. Five percent glucose breaths/minute instead of 12.
isn’t sufficient nutritional replacement, 17. Answer A. Instituting droplet
although it’s sake for peripheral veins. precautions is a priority for a newly
Any amount above 10% must be admitted infant with meningococcal
administered via central venous access. meningitis. Acetaminophen may be
12. Answer D. One of the most valuable prescribed but administering it doesn’t
clues to pain is a behavior change: A take priority over instituting droplet
child who’s pain-free likes to play. A precautions. Obtaining history
child in pain is less likely to consume information and orienting the parents to
food or fluids. An increased heart rate the unit don’t take priority.
may indicate increased pain; decreased 18. Answer A. If the child isn’t
urine output may signify dehydration. developmentally ready, child and parent
13. Answer C. Nursing care plan should be will become frustrated. Consistency is
planned according to the developmental important once toilet training has
age of a child with Down syndrome, not already started. The mother’s positive
the chronological age. Because children attitude is important when the child is
with Down syndrome can vary from ready. Developmental levels of children
mildly to severely mentally challenged, are individualized and comparison to
each child should be individually peers isn’t useful.
assessed. A child with Down syndrome 19. Answer A. When children are minors
is capable of learning, especially a child and aren’t emancipated, their parents or
with mild limitations. designated legal guardians are
14. Answer A. Accidents are the major responsible for providing consent for
cause of death and disability during the medical procedures. Therefore, the
school-age years. Therefore, accident foster mother is authorized to give
prevention should take priority when consent for the blood transfusion. The
teaching parents of school-age children. social workers, the nurse, and the
Preschool (not school-age) children are nurse-manager have no legal rights to
afraid of the dark, have fears concerning give consent in this scenario.
body integrity, and should be 20. Answer A. The massive cell destruction
encouraged to dress without help (with resulting from chemotherapy may place
the exception of tying shoes). the client at risk for developing renal
15. Answer C. Documentation should take calculi; adding allopurinol decreases this
top priority. Documentation is the only risk by preventing the breakdown of
way the nurse can legally claim that xanthine to uric acid. Allopurinol doesn’t
interventions were performed. The other act in the manner described in the other
three options would be appreciated by options.
the nurses on the oncoming shift but 21. Answer D. The transmission of SARS
aren’t mandatory and don’t take priority isn’t fully understood. Therefore, all
over documentation. modes of transmission must be
16. Answer D. The nurse should use the considered possible, including airborne,
heel of one hand and compress 1” to droplet, and direct contact with the
 virus. For protection from contracting parts of burn management but aren’t
SARS, any health care worker providing the first priority.
care for a client with SARS should wear 27. Answer A. Dyspnea and other signs of
a gown, gloves, mask, and eye goggles respiratory distress signify fluid volume
or an eye shield. excess (overload), which can occur
22. Answer C. Tuberculin skin tests of quickly in a child as fluid shifts rapidly
delayed hypersensitivity. If the test between the intracellular and
results are positive, a reaction should extracellular compartments. Gastric
appear in 48 to 72 hours. Immediately distention may suggest excessive oral
after the test and within 24 hours are fluid intake or infection. Nausea and
both too soon to observe a reaction. vomiting or an elevated temperature
Waiting more than 5 days to evaluate may indicate a fluid volume deficit.
the test is too long because any reaction 28. Answer D. A history of steroid-
may no longer be visible. dependent asthma, a contributing factor
23. Answer D. The American Academy of to this client’s high-risk status, requires
Pediatrics recommends that infants at the nurse to treat the situation as a
age 5 months receive iron-rich formula severe exacerbation regardless of the
and that they shouldn’t receive solid severity of the current episode. An
food – even baby food – until age 6 oxygen saturation of 95%, mild work of
months. The Academy doesn’t breathing, and absence of intercostals
recommend whole milk until age 12 or substernal retractions are all normal
months, and skim milk until after age 2 findings.
years. 29. Answer A. Measuring head
24. Answer C. Leaving the diaper off while circumference is the most important
the infant sleeps helps to promote air assessment technique for recognizing
circulation to the area, improving the possible hydrocephalus, and is a key
condition. Switching to cloth diapers part of routine infant screening. Skull X-
isn’t necessary; in fact, that may make rays and MRI may be used to confirm
the rash worse. Baby wipes contain the diagnosis. A lumber puncture isn’t
alcohol, which may worsen the appropriate.
condition. Extra fluids won’t make the 30. Answer A. Itching underneath a cast can
rash better. be relieved by directing blow-dyer, set,
25. Answer C. Before interviewing in any on the cool setting, toward the itchy
way, the parents should call the poison area. Skin breakdown can occur if
control center for specific directions. anything is placed under the cast.
Ipecac syrup is no longer Therefore, the client should be
recommended. The parents may have to cautioned not to put any object down
call an ambulance after calling the the cast in an attempt to scratch.
poison control center. Punishment for
being bad isn’t appropriate because the
parents are responsible for making the
environment safe.
26. Answer A.Initially, when a preschool
client is admitted to the hospital for
burns, the primary focus is on assessing
and managing an effective airway. Body
image disturbance, impaired urinary
elimination, and infection are all integral