Pediatric Nursing Exam 2 8-11 Questions With Correct Answers

The nurse in a pediatric clinic is assessing the motor development of a 3-year-old patient. The nurse reviews the toddler's last assessment results prior to determining changes. Which new development does the nurse expect to find during assessment? 1. Climbs on furniture unassisted 2. Rides a bicycle with training wheels 3. Independently builds a tower of seven blocks 4. Climbs stairs while holding the railing - Answer 3. Independently builds a tower of seven blocks A toddler by age 3 is expected to build a tower with six blocks or more; a 2-year-old will build a tower of four blocks or more. The nurse is evaluating the language skills of a 2-year-old patient. Which assessment finding causes the nurse to suspect a developmental delay? 1. States, "Want mommy!" 2. Points to objects named by the nurse 3. Converses using two short sentences 4. Repeats sounds but not words said by the nurse - Answer 4. Repeats sounds but not words said by the nurse Toddlers like to repeat words that are overheard. The expectation is for the toddler at 2 years of age to repeat a single word spoken by the nurse. The inability to perform this action may cause the nurse to suspect a developmental delay or a hearing defect. During a routine pediatric visit the nurse evaluates the cognitive skills of a toddler. The nurse draws a circle on paper and places the crayon in the toddler's right hand. The toddler shifts the crayon to the left hand and draws a circle. Which advice does the nurse provide to the parent? 1. Respect the toddler's preference of one hand over another. 2. Watch the toddler's tendency to alternately use both hands. 3. Reassure the parent that hand preference is not established until age 5 years. 4. Gently insist drawing instruments be placed in the right hand. - Answer 1. Respect the toddler's preference of one hand over another. The nurse advises the parent to respect the toddler's preference of using one hand over the other. The nurse is evaluating the motor development of a preschooler at age 5 years. Which assessment finding is essential in order for the child to be considered ready for preschool? 1. Dress independently 2. Use the toilet without assistance 3. Draw stick figures with two or more body parts 4. Throw overhand and catch a bounced ball - Answer 2. Use the toilet without assistance Before entering preschool, the preschooler needs to be able to use the toilet without assistance. ****The nurse in a pediatric clinic is performing a routine assessment on a preschool child. The nurse plans to evaluate some of the child's growth and development by interacting directly with the child. Which level of language does the nurse expect if the child is 4 years of age? 1. Sate full name and address without prompting 2. Appropriately converse using two to three sentences 3. Answer questions consistently with a "yes" or "no" 4. Speak clearly enough to be understood - Answer 2. Appropriately converse using two to three sentences The nurse is involved in a clinic screening for the kindergarten readiness of preschoolers. Primarily the children being screened are between the ages of 4 and 5 years. Which child does the nurse recognize as being ready to attend school? - Answer 3. The 4-year-old who counts to 10, recalls part of a story, and asks questions about the screening. A 4-year-old who can count to 10, recall part of a story, and asks questions about the screening exhibits a readiness for school. The nurse is gathering assessment information from the parent of a 5-year-old child. The parent states, "I am very frustrated. She insists on doing things alone even if it is a struggle to do it right, and gets angry if I redo the task." Which information will the nurse share with the parent to promote greater understanding? 1. Assure the parent that the child will become more compliant as she matures. 2. Suggest how the parent can critique the child's actions without hurting feelings. 3. Encourage the parent to set aside time each week to teach the child the correct way to do things. 4. Explain the child's interest in new things, the need to be independent, and pride in her abilities. - Answer 4. Explain the child's interest in new things, the need to be independent, and pride in her abilities. The behavior of this preschooler reflects the milestones related to social and emotional development. The nurse should explain behaviors in a positive way and encourage the parent to support expected growth and development. A parent has brought a toddler to a new pediatric clinic for a routine visit. The nurse will obtain a health history from the parent. Which information is most important for the nurse to gather? 1. Chief complaint 2. Family medical history 3. Toddler medical history 4. Social history - Answer 3. Toddler medical history The most important health history information is the toddler's medical history, which will include childhood illnesses, hospitalizations, surgeries, immunizations, and results of vision/hearing/developmental screens. The nurse in a pediatric office is performing physical assessments on multiple patients. Which patient will the nurse specifically report to the physician because of physical assessment findings? 1. The 4-year-old patient with a blood pressure of 110/75 mm Hg, pulse of 98 beats/minute. 2. The 3-year-old patient with a history of prematurely closed fontanels who has a headache. 3. The 2-year-old patient with asthma who exhibits abdominal breathing at 26 breaths per minute. 4. The 3-year-old patient with a soiled diaper, at the 70th percentile of weight and height. - Answer 2. The 3-year-old patient with a history of prematurely closed fontanels who has a headache. The 3-year-old patient with a history of prematurely closed fontanels has a condition that will affect the growth of the head. The presence of a headache is an indicator of possible increased intracranial pressure. Because there is a potential for brain damage, the nurse will report this finding specifically (and immediately) to the physician. The nurse works in the pediatric unit of a hospital and is currently providing care for a 1-year-old patient. Which action by the nurse is most important for maintaining the safety of this patient? 1. Question about the presence of smoke and carbon monoxide detectors in the home. 2. Check the temperatures of water, food, and drinks in order to prevent burns. 3. Provide caregiver education on basic home, outdoor play, and car safety measures. 4. Regularly check equipment in the crib environment for potential safety hazards. - Answer 4. Regularly check equipment in the crib environment for potential safety hazards. The nurse in an acute care setting is most focused on safety during the hospitalization of a pediatric patient. The nurse needs to check equipment regularly, with special attention to wire and cord placement to minimize entanglement, suction availability at crib side, and minimal equipment and crib attachments to decrease choking and suffocation hazards. The nurse is providing care for a 5-year-old patient whose tonsils were removed this morning. The nurse identifies the patient is in pain but not willing to speak. The nurse uses the Wong-Baker FACES scale for pain evaluation. Which indicator does the nurse expect the patient to use to describe the level of pain? 1. The frowning face out of a series of faces 2. A number between 7 and 10 from a scale of 0 to 10 3. An intense red color on a range from pink to deep red 4. The word that identifies the degree of pain (i.e., ouch, hurts bad) - Answer 1. The frowning face out of a series of faces The Wong-Baker FACES pain scale is a self-reporting rating scale that assigns a number value to a facial expression that is chosen by a child. A 4-year-old patient is on a regular regimen of medications for a chronic condition. The parent expresses frustration because of the difficulty in administering the medications. Which advice will the nurse provide to the parent for managing the process? 1. Ask if the child wants pills or a liquid form of medicine. 2. Inquire if the child prefers the medication at a certain time. 3. Make sure the medicine is sweet and refer to it as candy. 4. Put the medication in juice or milk as preferred by the child. - Answer 1. Ask if the child wants pills or a liquid form of medicine. rationale: Allowing a 4-year-old to have some choices regarding medication is likely to foster some cooperation. When possible, the child can decide if the medication is desired in a pill or liquid form. The nurse is providing care for a preschooler who is 5 years of age. The patient is hospitalized for treatment of a broken femur from a fall. Which behavior by the caregiver is of most concern to the nurse? 1. Requests updates on and changes in the patient 2. Frequently asks questions and expresses concerns 3. Remains adamant about staying at the bedside 4. Insists in reviewing all changes in the plan of care - Answer 3. Remains adamant about staying at the bedside rationale: The nurse needs to remind caregivers to care for themselves—reassure them that it is fine to go home for a while, whether to relieve stress, take a shower, go to sleep, and/or take care of other responsibilities. The caretaker's insistence on staying at the bedside is of greatest concern to the nurse. The nurse is asking a parent of a toddler at age 18 months if there are any particular parenting challenges at this time. Which advice will the nurse offer if the parent shares issues with separation anxiety? 1. The parent needs to just leave quickly and ignore the toddler's protests. 2. The parent needs to keep reassuring the toddler that the parent will return. 3. The toddler is to be left only with family members until the fear subsides. 4. The parent needs to plan leaving times to coincide with the toddler's naps. - Answer 2. The parent needs to keep reassuring the toddler that the parent will return. rationale: The nurse will advise the parent to repeatedly reassure the toddler that the parent will be back. After the toddler is reassured, the parent needs to leave quickly. The nurse finishes a series of parenting classes on the topic of tantrums and discipline. Which comment by an attending parent causes the nurse concern? 1. "We have learned to ignore her and she stops." 2. "I will give snack and a nap if he is that grumpy." 3. "He plays and then suddenly screams for no reason." 4. "She is learning that a tantrum means a time-out alone." - Answer 3. "He plays and then suddenly screams for no reason." rationale: The nurse is aware that some tantrum triggers may indicate a problem related to mental, physical, or emotional issues. The child that is playing and suddenly screams for no reason will cause the nurse concern. The nurse is caring for a 1-year-old patient after surgery for an intracranial shunt replacement. The nurse selects the FLACC scale for assessment because of the toddler's inability to participate in pain evaluation. The nurse will recognize which assessment finding as an indication of some level of pain? Select all that apply. 1. Constantly frowns, clenched jaw, quivering chin 2. Squirms, shifting back and forth, tense 3. Cries steadily and loudly, sometimes screams or sobs 4. Legs are positioned normally and appear relaxed 5. Answers to name, sucks thumb, and holds toy - Answer 1. Constantly frowns, clenched jaw, quivering chin 2. Squirms, shifting back and forth, tense 3. Cries steadily and loudly, sometimes screams or sobs Rationale: 1)Constantly frowning, with clenched jaw and quivering chin are in the face category on the FLACC pain scale, and the score is 2. 2)Squirming, shifting back and forth, and appearing tense are in the activity category on the FLACC pain scale, and the score is 1. 3)Crying steadily and loudly, sometimes screaming or sobbing, are in the cry category on the FLACC pain scale, and the score is 2. A community center is offering classes taught by pediatric nurses on summer safety for toddlers and preschoolers. Which topics will the nurses include in the teaching plan? Select all that apply. 1. Safety near swimming areas 2. Dangers of toys being left in a pool 3. Safety related to flotation devices 4. Bicycle safety for riders or passengers 5. Safety during trampoline play - Answer 1. Safety near swimming areas 2. Dangers of toys being left in a pool 3. Safety related to flotation devices 4. Bicycle safety for riders or passengers Rationale: 1)Child-proof all swimming areas, including access to pools, ponds, and lakes. Never leave children unattended near swimming areas, even if they can swim. 2)Toys left in a pool are a dangerous temptation, because children may be tempted to retrieve them. 3)Use flotation devices specifically designed for child safety. Floating toys, rafts, and rings do not provide adequate safety. 4)Trampolines are a safety risk for children of all ages, but toddlers and preschoolers should not be permitted to play on trampolines. A parent tells the nurse a toddler is exhibiting signs of being ready to potty train. Which action by the parent will draw the nurse's approval? Select all that apply. 1. "I am initially teaching my son to urinate sitting down." 2. "He has to sit on the potty 10 minutes each hour." 3. "We are still using diapers in order to avoid messes." 4. "Accidents result in the loss of a favorite toy for the day." 5. "We are using treats, stickers, and new underwear as incentives." - Answer 1. "I am initially teaching my son to urinate sitting down." 5. "We are using treats, stickers, and new underwear as incentives." Rationale: 1)The nurse will approve of the parent initially teaching a boy to sit to urinate. Once mastered, then move on to standing. The parent or caregiver may use flushable toilet targets for teaching purposes. 5)Incentives are appropriate, and the nurse will approve of providing encouragement in the form of praise and celebration, along with rewards and incentives such as treats, stickers, and new underwear. The parent of a toddler at age 2 years and a preschooler at age 4 years is sharing a concern about sibling rivalry. The parent states, "It is so upsetting to see them fighting with each other. I am afraid one of them will hurt the other." Which interventions will the parent and nurse design together in a plan for management? Select all that apply. 1. Set rules defining acceptable behavior. 2. Separate them to opposite sides of the room. 3. Teach children to be kind to each other. 4. Recognize the toddler has increased risk for injury. 5. Assist with appropriate expression of feelings. - Answer 1. Set rules defining acceptable behavior. 3. Teach children to be kind to each other. 5. Assist with appropriate expression of feelings. rationale: 1)Together the nurse and parent develop a plan that will set the rules for acceptable behavior. Rules will cover such behaviors such as no name calling, no pushing, and no slamming things. 3)The nurse and parent will identify ways to teach the children to be kind to each other by encouraging apologizing, sharing, and comforting each other when hurt. This intervention will foster positive feelings and behaviors. 5)Children may be unable to express the proper feelings of anger and frustration. The nurse and parent will identify therapeutic methods designed for self-expression. The community pediatric nurses are making home visits to families who have children either above or below the normal ranges in weight and/or height. One nurse visits a home with three qualifying children under the age of 5 years who are all below the standards for their ages. Which interventions will the nurse introduce to the caretakers? Select all that apply. 1. Prepare food for a toddler to eat seven times a day. 2. Serve generous portions and insist on a clean plate. 3. Encourage grazing throughout the day. 4. Physically feed the children to assure better intake. 5. Serve a variety of foods to provide varied nutrients. - Answer 1. Prepare food for a toddler to eat seven times a day. 3. Encourage grazing throughout the day. rationale: 1) The nurse will suggest the caregivers make food available for toddlers to eat approximately seven times a day, consuming more meals than snacks. 3)Children should be allowed to graze throughout the day, as toddlers may not sit for three meals. The nurse in a pediatric clinic is gathering physical assessment information during a yearly visit on a 6-year-old child. Which finding does the nurse expect during the assessment? 1. A weight gain of 6-1/2 pounds 2. A height increase of 5 inches 3. A blood pressure of 108/72 mm Hg 4. A pulse rate of 85 beats per minute - Answer 1. A weight gain of 6-1/2 pounds Children in this age group should gain 3 kg/year in weight, which is comparable to 6.6 pounds. The nurse is examining a 10-year-old child brought to the clinic because of episodes of shortness of breath, headaches, and stomach upset. The nurse notices bruises in various stages of resolution on the upper arms and upper legs. Which additional information is most important for the nurse to obtain? 1. Ask about the duration of the presenting symptoms. 2. Ascertain if there is a change in school performance. 3. Notify the physician of physical or sexual abuse. 4. Seek information about the cause of the bruises. - Answer 4. Seek information about the cause of the bruises. The most important information for the nurse to obtain is the source of the bruising. The child may have a valid explanation, or the explanation may increase the nurse's concern. The nurse will evaluate the child's response and act accordingly.