ANSWERS WITH EXPLANATIONS 2024-2025 LATEST GRADED A+
A nurse is caring for an 18 yo who is up to date on immunizations and planning to attend college. The
nurse should inform the client that he should receive which of the following immunizations prior to
moving into a campus dorm? - answer-Meningococcal Polysaccharide
"Prevents against infection by certain groups of meningococcal bacteria. It can cause life threatening
illnesses, such as maningococcal meningitis, which affects the brain, and meningococcemia, which
affects the blood. Both conditions can be fatal. College freshman living in dorms are at an increased
risk."
A nurse is assessing a 9-month-old infant during a well-child visit. Which of the following findings
indicates that the infant has a developmental delay? - answer-Inability to vocalize vowel sounds
"The infant should begin vocalizing vowel sounds at the age of 7 months, and by the age of 10 months,
be able to say at least one word."
A nurse is caring for preschool-age child who is dying. Which of the following findings is an age-
appropriate reaction to death by the child? (Select all that apply.) - answer-The child views death as
similar to sleep.
The child believes his thoughts can cause death.
The child thinks death is a punishment.
A nurse is caring for an adolescent who is receiving pain medication via a PCA pump. When the nurse
assesses the client's pain at 0800, the client describes pain as a 3 on a scale of 1 to 10. At 1000, the client
describes the pain as a 5. The nurse discovers the client has not pushed the button to deliver medication
in the past 2 hours. Which of the following actions should the nurse take? - answer-Reinforce teaching
with the client about how to push the button to deliver the medication.
"The appropriate action at this time is to reinforce client teaching about the PCA. The nurse should
remind the client about the availability of the medication, verify that the client knows how to use the
equipment, and emphasize the importance of using it regularly to manage pain effectively."
A nurse at a peds clinic is assessing a toddler at a well-child visit. Which of the following actions should
the nurse take? - answer-Minimize physical contact with the child initially.
,"The nurse should initially minimize physical contact with the toddler, and then progress from the least
traumatic to the most traumatic procedures."
A nurse on a pediatric unit is admitting a 4 yo child. Which of the following toys should the nurse plan to
provide for the child to engage in independent play? - answer-Plastic stethoscope
"Preschool play centers on imitative activities. Providing a stethoscope allows the child an opportunity
for therapeutic play and imitating HCPs helps to ease the fear of unfamiliar equipment."
A nurse is caring for a 2 yo child with cystic fibrosis. The nurse is planning to take the child to the
playroom. Which of the following activities would be appropriate for the child? - answer-Building towers
of blocks
"This is an appropriate activity for a 2 yo. It promotes fine motor development, and knocking blocks
down provides a means of dealing w stress of hospitalization."
A nurse is providing anticipatory guidance about accidental ingestion of a toxic substance to the parents
of a toddler. The nurse should instruct the parents to take which of the following actions if the child
ingests a hazardous substance? - answer-Call the poison control center.
A nurse in a peds clinic is caring for a 3 yo child who has a blood lead level of 3 mcg/dL. When teaching
the parents about the correlation of nutrition with lead poisoning, which of the following information is
appropriate for the nurse to include in teaching? - answer-Ensure that the child's dietary intake of
calcium and iron is adequate.
"A child with an elevated blood lead level should have an adequate intake of calcium and iron to reduce
the absorption and effects of lead. Milk is a good source of calcium."
A nurse is caring for a 10 month old infant who has suspected FTT. Which interventions should be
included in the POC? (select all that apply) - answer-Observing the parents's actions when feeding the
child-- inappropriate feeding techniques and meal patterns by parents can contribute to the child's
growth failure.
Maintaining a detailed record of food anf fluid intake-- a nurtritional goal with a child with FTT is to
correct nutritional deficiencies, which can be identified by recording food and fluid intake.
**sitting beside the child's high chair is NOT correct- caregivers should sit directly in front of the child to
promote eye contact and encourage feeding.
, A nurse in the ED is caring for a 2yo child who was found by his parents crying and holding a container of
toilet bowl cleaner. The child's lips are edematous and inflamed, and he is drooling. What is the priority
action of the nurse? - answer-Check the child's respiratory status
"Use the ABCs framework. An alteration is airway and circulating O2 is a threat to life and that makes it
the nurses priority. This child's lips are edematous and inflamed and he is drooling- these findings
indicate that the child might have swelling of the oral cavity and pharynx, which can lead to a
compromised airway. Airway is always the highest priority, breathing the second highest, and circulation
the thirs highest."
A nurse is providing education to the parent of a toddler who is about to receive her first dose of the
MMR vaccine. Which statement by the parent indicated understanding of the teaching? - answer-I can
give my child acetaminophen for discomfort associated with the immunization
"Parents can give acetaminophen for minor discomforts such as low-grade fever and local tenderness."
Your child has just received the MMR vaccine, when should they get the varicalla vaccine? - answer-
Either in the same visit or at least 1 month apart.
A nurse is teaching the parent of a 12 month old infant about nutrition. Which statement by the parent
indicates need for further teaching? - answer-My infant drinks at least 2 quarts of skim milk each day
"As the infant transitions into toddlerhood, whole milk intake should average 24 to 30 oz per day. Too
much milk can affect intake of solid foods and result in iron deficiency anemia. Skim milk is not
recommended until after the age of 2 since it lacks the essential fatty acids needed for growth and
development."
A nurse is assisting a provider during a femoral venipuncture on a toddler. The nurse should place the
child in which position? - answer-Supine
"Supine position with the legs in a frog position."
A nurse is teaching about promoting sleep with the parent of a 3 yo toddler. Which info should the
nurse include? - answer-follow a nightly routine and established bedtime
"Preschool age children test limits, consistency is very important."
A nurse is assessing a 3 yo child who is 1 day post-op following a tonsillectomy. Which method should
the nurse use to determine if the child is experiencing pain? - answer-Use the FACES scale