AND ANSWERS
A nurse in a clinic is preparing to administer pre-k-kindergarten vaccines to a 5 year old child whose
medical record indicates that his immunization are up to date which of the following vaccines should the
nurse plan to adminiser - -Mealsles, mumps, rubella (MMR)
-A nurse in a pediatric clinic is collecting data from a preschool age child who has suspected impetigo
contagiosa. Which of the following manifestations should the nurse expect to find with this skin
infection? - -Red macule with honey colored crusts
-A nurse in a provider's office is reinforcing teaching with a parent of a school age child who has
pediculosis capitis. Which of the following instructions should the nurse include in the teaching? - -Wash
all bed linens and dry them in a dryer for at least 20 min
-A nurse is a collecting data from an infant which of the following is a clinical manifestation of pyloric
stenosis?" - -Projectile Vomiting after feedings
-A nurse is an urgent care clinic is assisting with the care of a toddler who ingested 30 tablets of aspirin.
Which of the following substances should the nurse administer to the toddler? - -Activated charcoal (can
work with toxin, poison. Given through ng tube absorbs toxins)
-A nurse is assisting with the admission of a child who has pertussis. Which of the following actions
should the nurse take? - -Initiate droplet precautions
-A nurse is assisting with the admission of an infant who has resp. Syncytial Virus (RSV) which of the
following rooms should the nurse assign the infant? - -A private room with contact/droplet precautions
-A nurse is assisting with the care of a school age child who has respiratory failure due to pneumonia.
Which of the following positons should the nurse encourage to allow maximal lung expansions? - -
Upright (orthopnic positon, semi fowler, high fowler)
-A nurse is assiting with the care of a child with spina bifida. Which of the folloing precations should
nurse take while caring for this child? - -Latex Precautions
-A nurse is caring for a 2 week old infant who's mother requests additional information about sudden
infant death syndrome (SIDS). Which of the following responses should the nurse make? - -You should
place your baby on her back when sleeping to decrease the risk of SIDS
-A nurse is caring for a 3 year old client who has persistent otitis media. To help identify contributing
factors, the nurse should ask the parents which of the following questions? - -Does anyone smoke in the
same house as your daughter? (smoking can cause irritation, cause mucus in respiratory and causes
otitis media?) (otitis media is purulent color)
-A nurse is caring for a 4 year old child who has dehydration. Which of the following findings should the
nurse identify as the priority? - -Potassium 2.5 mEq/L
, -A nurse is caring for a 4 year old child who is 2 days postoperative following the insertion of a
ventriculoperitoneal shunt. Which of the following findings should the nurse identify as the priority .
(causes icp hydrocephalus) - -lethargy (high pitched cry, respiratory changes, bradycardia, wide pulse
pressure, irritability
-A nurse is caring for a 4-year old child who refuses to take his medication because of the bad taste.
Which of the following strategies should the nurse use to medication - -. Offer the child an ice pop prior
to administering the medication ( numb the tongue ...Nerves )
-A nurse is caring for a 6 month old child. The childs provider has ordered a diphtheria, tetanus, and
pertussis (DTAP) vaccine to be administered. Which of the following should cause the nurse to question
the administration of this vaccine? - -Temp of 40.5 C (104.9F) after last DTAP
-A nurse is caring for a 6-month-old infant who is postoperative following a myringotomy. Which of the
following pain assessment scales should the nurse use to determine the infants pain level? - -FLACC
-a nurse is caring for a child following an open reduction and internal fixation of a fractured femur and
application of a cast. The cast has a window cut in it for viewing of the incision. Which of the following
actions should the nurse take first? - -Perform neurovascular checks of the affected extremity (check for
infection, color, capillary refill, redness)
-A nurse is caring for a child who has a suspected diagnosis of bacterial meningitis. Which of the
following is the nurse's priority? - -Administer antibiotics when available
-A nurse is caring for a child who has acute diarrhea and reports that he is thirsty. Which of the following
fluids should the nurse give the child? - -Pedialyte
-A nurse is caring for a child who has acute glomerulonephritis. Which of the following actions is the
nurse's priority? - -Check the Childs weight daily
-A nurse is caring for a child who has atopic dermatitis. Which of the following findings should the nurse
expect? - -Rash with thick skin
-A nurse is caring for a child who has erythema infectiousm. Which of the following findings should the
nurse expect? - -Facial erythema
-A nurse is caring for a child who has juvenile rheumatoid arthritis. Which of the following actions should
the nurse take? - -Maintain night splints to the affected joint
-A nurse is caring for a child who has nosebleed. Which of the following actions should the nurse take? -
-Have the child sit with her head tilted forward and hold pressure on her nose for 10 mins (use ur fingers
pinching the nose)
-A nurse is caring for a child who has tinea pedis. The childs parents ask the nurse what this infection is
commonly called. The nurse should respond with which of the following common names - -Pinworms