Peds Nclex exam questions with perfect Answers

Peds Nclex exam questions with perfect Answers Which of the following best describes why children have fewer respiratory tract infections as they grow older? a. The amount of lymphoid tissue decreases. b. Repeated exposure to organisms causes increased immunity. c. Viral organisms are less prevalent in the population. d. Secondary infections rarely occur after viral illnesses. - b. Repeated exposure to organisms causes increased immunity. Rationale: Children have increased immunity after exposure to a virus. Labored breathing is referred to as: a. dyspnea. b. tachypnea. c. hypopnea. d. orthopnea. - a. dyspnea. Rationale: Dyspnea is labored breathing. Why are cool-mist vaporizers rather than steam vaporizers recommended in home treatment of respiratory tract infections? a. They are safer. b. They are less expensive. c. Respiratory secretions are dried. d. A more comfortable environment is produced. - a. They are safer. Rationale: Cool-mist vaporizers are safer than steam vaporizers, and little evidence exists to show any advantages to steam. Decongestant nose drops are recommended for a 10-month-old infant with an upper respiratory tract infection. Instructions for nose drops should include which of the following? a. Avoid using for more than 3 days. b. Keep drops to use again for nasal congestion. c. Administer drops until nasal congestion subsides. d. Administer drops after feedings and at bedtime. - a. Avoid using for more than 3 days Rationale: Vasoconstrictive nose drops such as phenylephrine (Neo-Synephrine) should not be used for more than 3 days to avoid rebound congestion. What is an appropriate nursing intervention when caring for an infant with an upper respiratory tract infection and elevated temperature? a. Give tepid water baths to reduce fever. b. Encourage food intake to maintain caloric needs. c. Have child wear heavy clothing to prevent chilling. d. Give small amounts of favorite fluids frequently to prevent dehydration. - d. Give small amounts of favorite fluids frequently to prevent dehydration Rationale: Preventing dehydration by small frequent feedings is an important intervention in the febrile child. The parent of an infant with nasopharyngitis should be instructed to notify the health professional if the infant: a. becomes fussy. b. has a cough. c. has a fever over 99° F. d. shows signs of an earache. - d. Shows signs of an earache. Rationale: If an infant with nasopharyngitis shows signs of an earache, it may mean a secondary bacterial infection is present and should be referred to a practitioner for evaluation. It is generally recommended that a child with acute streptococcal pharyngitis can return to school: a. when sore throat is better. b. if no complications develop. c. after taking antibiotics for 24 hours. d. after taking antibiotics for 3 days. - c. After taking antibiotics for 24 hours. Rationale: After children have taken antibiotics for 24 hours, they are no longer contagious to other children. A child is diagnosed with influenza, probably type A disease. Management includes which of the following? a. Clear liquid diet for hydration b. Aspirin to control fever c. Amantadine hydrochloride to reduce symptoms d. Antibiotics to prevent bacterial infection - c. Amantadine hydrochloride to reduce symptoms Rationale: Amantadine may reduce symptoms related to influenza A if administered within 24 to 48 hours of onset. It is ineffective against type B or C. Chronic otitis media with effusion (OME) is differentiated from acute otitis media (AOM) because it is usually characterized by which of the following? a. Fever as high as 40° C (104° F) b. Severe pain in the ear c. Nausea and vomiting d. A feeling of fullness in the ear - d. A feeling of fullness in the ear Rationale: OME is characterized by feeling of fullness in ear or other nonspecific complaints. Which of the following statements is characteristic of AOM? a. The etiology is unknown. b. Permanent hearing loss often results. c. It can be treated by intramuscular (IM) antibiotics. d. It is treated with a broad range of antibiotics. - d. It is treated with a broad range of antibiotics Rationale: Historically AOM has been treated with a range of antibiotics. However, new research shows that antibiotics do not improve outcomes in children with uncomplicated AOM. An 18-month-old child is seen in the clinic with AOM. Trimethoprim-sulfamethoxazole (Bactrim) is prescribed. Which of the following statements made by the parent indicates a correct understanding of the instructions? a. "I should administer all of the prescribed medication." b. "I should continue medication until the symptoms subside." c. "I will immediately stop giving medication if I notice a change in hearing." d. "I will stop giving medication if fever is still present in 24 hours." - a. "I should administer all of the prescribed medication." Rationale: Antibiotics should be given for their full course to prevent recurrence of infection with resistant bacteria An infant's parents ask the nurse about preventing OM. Which of the following should be recommended? a. Avoid tobacco smoke. b. Use nasal decongestant. c. Avoid children with OM. d. Bottle-feed or breastfeed in supine position. - a. Avoid tobacco smoke. Rationale: Eliminating tobacco smoke from the child's environment is essential for preventing OM and other common childhood illnesses. The nurse is assessing a child with croup. Examining the child's throat by using a tongue depressor might precipitate which of the following? a. Inspiratory stridor b. Complete obstruction c. Sore throat d. Respiratory tract infection - b. Complete obstruction Rationale: If a child has acute epiglottitis, examination of the throat may cause complete obstruction and should be performed only when immediate intubation can take place Which of the following types of croup is always considered a medical emergency? a. Laryngitis b. Epiglottitis c. Spasmodic croup d. Laryngotracheobronchitis (LTB) - b. Epiglottitis Rationale: Epiglottitis is always a medical emergency needing antibiotics and airway support for treatment. The nurse encourages the mother of a toddler with acute LTB to stay at the bedside as much as possible. The nurse's rationale for this action is primarily which of the following? a. Mothers of hospitalized toddlers often experience guilt. b. The mother's presence will reduce anxiety and ease child's respiratory efforts. c. Separation from mother is a major developmental threat at this age. d. The mother can provide constant observations of the child's respiratory efforts. - b. The mother's presence will reduce anxiety and ease child's respiratory efforts. Rationale: The family's presence will decrease the child's distress. A school-age child had an upper respiratory tract infection for several days and then began having a persistent dry, hacking cough that was worse at night. The cough has become productive in the past 24 hours. This is most suggestive of which of the following? a. Bronchitis b. Bronchiolitis c. Viral-induced asthma d. Acute spasmodic laryngitis - a. Bronchitis Rationale: Bronchitis is characterized by these symptoms and occurs in children older than 6 years. Skin testing for tuberculosis (TB) (the Mantoux test) is recommended: a. every year for all children older than 2 years. b. every year for all children older than 10 years. c. every 2 years for all children starting at age 1 year. d. periodically for children who reside in high-prevalence regions. - d. periodically for children who reside in high-prevalence regions Rationale: Children who reside in high-prevalence regions for TB should be tested every 2 to 3 years. Which of the following is the most important consideration in managing TB in children? a. Skin testing b. Chemotherapy c. Adequate nutrition d. Adequate hydration - b. Chemotherapy Rationale: Drug therapy for TB includes isoniazid, rifampin, and pyrazinamide daily for 2 months and two or three times a week for the remaining 4 months. The mother of a toddler yells to the nurse, "Help! He is choking to death on his food." The nurse determines that lifesaving measures are necessary based on which of the following? a. Gagging b. Coughing c. Pulse over 100 beats/min d. Inability to speak - d. Inability to speak Rationale: The inability to speak is indicative of a foreign-body airway obstruction of the larynx. Abdominal thrusts are needed for treatment of the choking child. The nurse is caring for a child with acute respiratory distress syndrome (ARDS) associated with sepsis. Nursing actions should include which of the following? a. Force fluids. b. Monitor pulse oximetry. c. Institute seizure precautions. d. Encourage high-protein diet. - b. Monitor pulse oximet Rationale: Monitoring cardiopulmonary status is an important evaluation tool in the care of the child with ARDS. The nurse is caring for a child with carbon monoxide poisoning associated with smoke inhalation. Which of the following is essential in this child's care? a. Monitor pulse oximetry. b. Monitor arterial blood gases. c. Administer oxygen if respiratory distress develops. d. Administer oxygen if child's lips become bright, cherry red. - b. Monitor arterial blood gases. Rationale: Arterial blood gases are the best way to monitor carbon monoxide poisoning. Asthma in infants is usually triggered by: a. medications. b. a viral infection. c. exposure to cold air. d. allergy to dust or dust mites. - b. a viral infection. Rationale: Viral illnesses cause inflammation that causes increased airway reactivity in asthma. Which of the following statements is the most descriptive of bronchial asthma? a. There is heightened airway reactivity. b. There is decreased resistance in the airway. c. The single cause of asthma is an allergic hypersensitivity. d. It is inherited. - a. There is heightened airway reactivity. Rationale: In bronchial asthma, spasm of the smooth muscle of the bronchi and bronchioles causes constriction, producing impaired respiratory function. A child has a chronic, nonproductive cough and diffuse wheezing during the expiratory phase of respiration. This suggests which of the following? a. Asthma b. Pneumonia c. Bronchiolitis d. Foreign body in trachea - a. Asthma Rationale: Asthma may have these chronic symptoms. It is now recommended that children with asthma who are taking long-term inhaled steroids should be assessed frequently because which of the following may develop? a. Cough b. Osteoporosis c. Slowed growth d. Cushing syndrome - c. Slowed growth Rationale: The growth of children on long-term inhaled steroids should be assessed frequently to assess for systemic effects of these drugs. β-Adrenergic agonists and methylxanthines are often prescribed for a child with an asthma attack. What is their action? a. Liquefy secretions b. Dilate the bronchioles c. Reduce inflammation of the lungs d. Reduce infection - b. Dilate the bronchioles Rationale: These medications work to dilate the bronchioles in acute exacerbations. A parent whose two school-age children have asthma asks the nurse in what sports, if any, they can participate. The nurse should recommend which of the following? a. Soccer b. Running c. Swimming d. Basketball - c. Swimming Rationale: Swimming is well tolerated in children with asthma because they are breathing air fully saturated with moisture and because of the type of breathing required in swimming. Which of the following drugs is usually given first in the emergency treatment of an acute, severe asthma episode in a young child? a. Ephedrine b. Theophylline c. Aminophylline d. Short-acting β2-agonists - d. Short-acting β2-agonists Rationale: Short-acting β2 agonists are the first treatment in an acute asthma exacerbation. Which statement expresses accurately the genetic implications of cystic fibrosis (CF)? a. If it is present in a child, both parents are carriers of this defective gene. b. It is inherited as an autosomal dominant trait. c. It is a genetic defect found primarily in non-Caucasian population groups. d. There is a 50% chance that siblings of an affected child also will be affected. - a. If it is present in a child, both parents are carriers of this defective gene. Rationale: CF is an autosomal recessive gene inherited from both parents. What is the earliest recognizable clinical manifestation(s) of CF? a. Meconium ileus b. History of poor intestinal absorption c. Foul-smelling, frothy, greasy stools d. Recurrent pneumonia and lung infections - a. Meconium ileus Rationale: The earliest clinical manifestation of CF is a meconium ileus, which is found in about 10% of children with CF. Clinical manifestations include abdominal distention, vomiting, failure to pass stools, and rapid development of dehydration. Which of the following tests aid in the diagnosis of CF? a. Sweat chloride test, stool for fat, chest radiograph films b. Stool for fat, gastric contents for hydrochloride, chest radiograph films c. Sweat chloride test, bronchoscopy, duodenal fluid analysis d. Sweat chloride test, stool for trypsin, biopsy of intestinal mucosa - a. Sweat chloride test, stool for fat, chest radiograph films Rationale: A sweat test result of greater than 60 mEq/L is diagnostic of CF, a high level of fecal fat is a gastrointestinal (GI) manifestation of CF, and a chest radiograph showing patchy atelectasis and obstructive emphysema indicates CF. CF is suspected in a toddler. Which of the following tests is essential in establishing this diagnosis? a. Bronchoscopy b. Serum calcium c. Urine creatinine d. Sweat chloride test - d. Sweat chloride test Rationale: A sweat chloride test result greater than 60 mEq/L is diagnostic of CF. A child with CF receives aerosolized bronchodilator medication. This medication should be administered: a. before chest physiotherapy (CPT). b. after CPT. c. before receiving 100% oxygen. d. after receiving 100% oxygen. - a. before chest physiotherapy (CPT). Rationale: Bronchodilators should be given before CPT to open bronchi and make expectoration easier. A child with CF is receiving recombinant human deoxyribonuclease (rhDNase). This drug: a. may cause mucus to thicken. b. may cause voice alterations. c. is given subcutaneously. d. is not indicated for children younger than 12 years. - b. may cause voice alterations. Rationale: One of the only adverse effects of DNase is voice alterations and laryngitis. Pancreatic enzymes are administered to the child with CF. Nursing considerations should include which of the following? a. Do not administer pancreatic enzymes if child is receiving antibiotics. b. Decrease dose of pancreatic enzymes if child is having frequent, bulky stools. c. Administer pancreatic enzymes between meals if at all possible. d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. - d. Pancreatic enzymes can be swallowed whole or sprinkled on a small amount of food taken at the beginning of a meal. Rationale: Enzymes may be administered in a small amount of cereal or fruit at the beginning of a meal or swallowed whole. In providing nourishment for a child with CF, which of the following factors should the nurse keep in mind? a. Diet should be high in carbohydrates and protein. b. Diet should be high in easily digested carbohydrates and fats. c. Most fruits and vegetables are not well tolerated. d. Fats and proteins must be greatly curtailed. - a. Diet should be high in carbohydrates and protein. Rationale: Children with CF require a well-balanced, high-protein, high-calorie diet because of impaired intestinal absorption.