NUR 227 PEDS TEST 1 Pediatric Nursing Interventions and
Skills Questions With Complete Solutions
A 1-month-old infant is admitted to the hospital. The infants
mother is 17 years old and single and lives with her parents.
Who signs the informed consent for the 1-month-old infant?
a. The infants mother
b. The maternal grandparents of the infant
c. The paternal grandparents of the infant
d. Both the infants mother and the maternal grandparents
Correct Answers ANS: A
An emancipated minor is one who is legally under the age of
majority but is recognized as having the legal capacity of an
adult under circumstances prescribed by state law, such as
pregnancy, marriage, high school graduation, independent
living, or military service.
A 10-year-old child requires daily medications for a chronic
illness. Her mother tells the nurse that the child continually
forgets to take the medicine unless reminded. What nursing
action is most appropriate to promote adherence to the
medication regimen?
a. Establish a contract with her, including rewards.
b. Suggest time-outs when she forgets her medicine.
c. Discuss with her mother the damaging effects of her rescuing
the child.
d. Ask the child to bring her medicine containers to each
appointment so they can be counted. Correct Answers ANS: A
Many factors can contribute to the childs not taking the
medication. The nurse should resolve those issues such as
unpleasant side effects, difficulty taking medicine, and time
,constraints before school. If these factors do not contribute to
the issue, then behavioral contracting is usually an effective
method to shape behaviors in children. Time-outs provide
negative reinforcement. If part of a contract, negative
consequences can work, but they need to be structured.
Discussing with her mother the damaging effects of her rescuing
the child is not the most appropriate action to encourage
compliance. For a school-age child, parents should refrain from
nagging and rescuing the child. This child is old enough to
partially assume responsibility for her own care. If the child
brings her medicine containers to each appointment so they can
be counted, this will help determine if the medications are being
taken, but it will not provide information about whether the
child is taking them by herself.
A 14-year-old adolescent is hospitalized with cystic fibrosis.
What nursing note entry represents best documentation of his
breakfast meal?
a. Tolerated breakfast well
b. Finished all of breakfast ordered
c. One pancake, eggs, and 240 ml OJ
d. No documentation is needed for this age child. Correct
Answers ANS: C
Specific information is necessary for hospitalized children. It is
essential to be able to identify caloric intake and eating patterns
for assessment and intervention purposes. That he tolerated
breakfast well only provides information that the child did not
become ill with the meal. Even if he finished all his breakfast, an
evaluation cannot be completed unless the quantity of food
ordered is known. Nutritional information is essential, especially
for children with chronic illnesses.
,A 16-year-old girl comes to the pediatric clinic for information
on birth control. The nurse knows that before this young woman
can be examined, consent must be obtained from which source?
a. Herself
b. Her mother
c. Court order
d. Legal guardian Correct Answers ANS: A
Contraceptive advice is one of the conditions that is considered
medically emancipated. The adolescent is able to provide her
own informed consent.
A 2-year-old child has to receive Rocephin IM injections every
12 hours. What nursing intervention should be implemented for
the child?
a. Hold the child while rocking in a chair after each injection.
b. Prepare the child several hours before the injection is given.
c. Allow the child to watch a younger child receive an injection.
d. Encourage the child to draw a picture of the pain experienced
when an injection is given. Correct Answers ANS: A
After the procedure, the child continues to need reassurance that
he or she performed well and is accepted and loved. The other
options are not appropriate for a toddler.
A 2-year-old child is being admitted to the hospital for possible
bacterial meningitis. When preparing for a lumbar puncture,
what should the nurse do?
a. Set up a tray with equipment the same size as for adults.
b. Apply EMLA to the puncture site 15 minutes before the
procedure.
, c. Prepare the child for conscious sedation being used for the
procedure.
d. Reassure the parents that the test is simple, painless, and risk
free. Correct Answers ANS: C
Because of the urgency of the childs condition, conscious
sedation should be used for the procedure. Pediatric spinal trays
have smaller needles than do adult trays. EMLA should be
applied approximately 60 minutes before the procedure; the
emergency nature of the spinal tap precludes its use. A spinal tap
is not a simple procedure and does have associated risks;
analgesia will be given for the pain.
A 4-year-old girl is admitted to outpatient surgery for removal of
a cyst on her back. Her mother puts the hospital gown on her,
but the child is crying because she wants to leave on her
underpants. What is the most appropriate nursing action at this
time??
a. Allow her to wear her underpants.
b. Discuss with her mother why this is important to the child.
c. Ask her mother to explain to her why she cannot wear them.
d. Explain in a kind, matter-of-fact manner that this is hospital
policy. Correct Answers ANS: A
It is appropriate for the child to leave her underpants on. If
necessary, the underpants can be removed after she has received
the initial medications for anesthesia. This allows her some
measure of control in this procedure. The mother should not be
required to make the child more upset. The child is too young to
understand what hospital policy means.
A 5-year-old child returns from the pediatric intensive care unit
after abdominal surgery. The orders state to monitor vital signs
Skills Questions With Complete Solutions
A 1-month-old infant is admitted to the hospital. The infants
mother is 17 years old and single and lives with her parents.
Who signs the informed consent for the 1-month-old infant?
a. The infants mother
b. The maternal grandparents of the infant
c. The paternal grandparents of the infant
d. Both the infants mother and the maternal grandparents
Correct Answers ANS: A
An emancipated minor is one who is legally under the age of
majority but is recognized as having the legal capacity of an
adult under circumstances prescribed by state law, such as
pregnancy, marriage, high school graduation, independent
living, or military service.
A 10-year-old child requires daily medications for a chronic
illness. Her mother tells the nurse that the child continually
forgets to take the medicine unless reminded. What nursing
action is most appropriate to promote adherence to the
medication regimen?
a. Establish a contract with her, including rewards.
b. Suggest time-outs when she forgets her medicine.
c. Discuss with her mother the damaging effects of her rescuing
the child.
d. Ask the child to bring her medicine containers to each
appointment so they can be counted. Correct Answers ANS: A
Many factors can contribute to the childs not taking the
medication. The nurse should resolve those issues such as
unpleasant side effects, difficulty taking medicine, and time
,constraints before school. If these factors do not contribute to
the issue, then behavioral contracting is usually an effective
method to shape behaviors in children. Time-outs provide
negative reinforcement. If part of a contract, negative
consequences can work, but they need to be structured.
Discussing with her mother the damaging effects of her rescuing
the child is not the most appropriate action to encourage
compliance. For a school-age child, parents should refrain from
nagging and rescuing the child. This child is old enough to
partially assume responsibility for her own care. If the child
brings her medicine containers to each appointment so they can
be counted, this will help determine if the medications are being
taken, but it will not provide information about whether the
child is taking them by herself.
A 14-year-old adolescent is hospitalized with cystic fibrosis.
What nursing note entry represents best documentation of his
breakfast meal?
a. Tolerated breakfast well
b. Finished all of breakfast ordered
c. One pancake, eggs, and 240 ml OJ
d. No documentation is needed for this age child. Correct
Answers ANS: C
Specific information is necessary for hospitalized children. It is
essential to be able to identify caloric intake and eating patterns
for assessment and intervention purposes. That he tolerated
breakfast well only provides information that the child did not
become ill with the meal. Even if he finished all his breakfast, an
evaluation cannot be completed unless the quantity of food
ordered is known. Nutritional information is essential, especially
for children with chronic illnesses.
,A 16-year-old girl comes to the pediatric clinic for information
on birth control. The nurse knows that before this young woman
can be examined, consent must be obtained from which source?
a. Herself
b. Her mother
c. Court order
d. Legal guardian Correct Answers ANS: A
Contraceptive advice is one of the conditions that is considered
medically emancipated. The adolescent is able to provide her
own informed consent.
A 2-year-old child has to receive Rocephin IM injections every
12 hours. What nursing intervention should be implemented for
the child?
a. Hold the child while rocking in a chair after each injection.
b. Prepare the child several hours before the injection is given.
c. Allow the child to watch a younger child receive an injection.
d. Encourage the child to draw a picture of the pain experienced
when an injection is given. Correct Answers ANS: A
After the procedure, the child continues to need reassurance that
he or she performed well and is accepted and loved. The other
options are not appropriate for a toddler.
A 2-year-old child is being admitted to the hospital for possible
bacterial meningitis. When preparing for a lumbar puncture,
what should the nurse do?
a. Set up a tray with equipment the same size as for adults.
b. Apply EMLA to the puncture site 15 minutes before the
procedure.
, c. Prepare the child for conscious sedation being used for the
procedure.
d. Reassure the parents that the test is simple, painless, and risk
free. Correct Answers ANS: C
Because of the urgency of the childs condition, conscious
sedation should be used for the procedure. Pediatric spinal trays
have smaller needles than do adult trays. EMLA should be
applied approximately 60 minutes before the procedure; the
emergency nature of the spinal tap precludes its use. A spinal tap
is not a simple procedure and does have associated risks;
analgesia will be given for the pain.
A 4-year-old girl is admitted to outpatient surgery for removal of
a cyst on her back. Her mother puts the hospital gown on her,
but the child is crying because she wants to leave on her
underpants. What is the most appropriate nursing action at this
time??
a. Allow her to wear her underpants.
b. Discuss with her mother why this is important to the child.
c. Ask her mother to explain to her why she cannot wear them.
d. Explain in a kind, matter-of-fact manner that this is hospital
policy. Correct Answers ANS: A
It is appropriate for the child to leave her underpants on. If
necessary, the underpants can be removed after she has received
the initial medications for anesthesia. This allows her some
measure of control in this procedure. The mother should not be
required to make the child more upset. The child is too young to
understand what hospital policy means.
A 5-year-old child returns from the pediatric intensive care unit
after abdominal surgery. The orders state to monitor vital signs
