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1. A nurse is preparing to administer an immunization to a 4-year-
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old child. Which of the following actions should the nurse plan to take?
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A. Place the child in a prone position for the immunization.
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B. Request that the child's caregiver leave the room during the immunization.
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C. Administer the immunization using a 24-gauge needle. 6 6 6 6 6 6
D. Inject the immunization slowly after aspirating for 3 seconds.: C. Administer
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the immunization using a 24-gauge needle.
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Rationale: The nurse should administer an immunization for a 4-year-
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old child using a 22 to 25-
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gauge needle to minimize the amount of pain the child experiences.
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2. A nurse is caring for a school-age child who has experienced a tonic-
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clonic seizure. Which of the following actions should the nurse take during th
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e immediate postictal period?
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A. Place the child in a side-lying position.
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B. Delay documentation until the child is fully alert.
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C. Give the child a high-carbohydrate snack.
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D. Administer an oral sedative to the child.: A. Place the child in a side-
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lying position. 6
Rationale: The nurse should place the child in a side-
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lying position to prevent aspiration.
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3. NGN* A nurse on a Peds unit is admitting a preschooler. Vital Signs (0715:) T
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38.3° C (100.9° F) HR 126/min RR 26/min O2 97%. Physical exam Pt has been tire
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d lately and has a sore throat and fever. Tolerating sips of liquids but is refusin
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g solids. UO dark yellow urine. Alert, responsive to verbal stim. MM dry, sticky. S
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kin turgor w/o tenting. Tonsils enlarged, erythematous. Resps regular and non-
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labored. No accessory muscle use. Lungs clear ant& post bilat. PMI in L mid-
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clavic line 4th ICS. HR regular w/o murmurs, gallops, rubs. Radial, pedal pulse
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2+ bilat. Cap refill >2 sec. Abd flat, non-
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distended. Bowel sounds active in all 4 quadS. Extrems warm and dry to touch
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. Mononucl rapid test: posit (neg)
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RN should identify that the child is at risk for developing what?
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Dropdown 1: Splenomegaly, Acute post- 6 6 6 6
16/653
, RN Pediatric Nursing Online Practice 2023 B
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streptococcal glomerulonephritis (APSGN), Dysrhythmias
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26/653
, RN Pediatric Nursing Online Practice 2023 B
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Dropdown 2: + mono rapid test, UO, Cardio assessment: 1. Splenomegaly Ratio
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nale: The child's positive mononucleosis rapid test result indicates the pres-
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ence of infectious mono, a condition caused by the Epstein-
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Barr virus.Therefore, the nurse should identify that the child is at risk for deve
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loping splenomegaly, a common complication of infectious mono.
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2. Positive mono rapid test 6 6 6
Rationale: The child's positive mononucleosis rapid test result indicates the p
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res- ence of infectious mono, a condition caused by the Epstein-
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Barr virus.Therefore, the nurse should identify that the child is at risk for deve
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loping splenomegaly, a common complication of infectious mono.
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4. ***A nurse is assessing an infant who has a ventricular septal defect. Which o
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f the following findings should the nurse expect?
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A. Loud, harsh murmur 6 6
B. Dysrhythmias
C. Weak femoral pulses 6 6
D. High blood pressure: A. Loud, harsh murmur
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Rationale: The nurse should expect to hear a loud, harsh murmur with a ventricula
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r septal defect due to the left-to-
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right shunting of blood, which contributes to hyper-
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trophy of the infant's heart muscle.
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Ventricular septal defect does not affect the electrical conduction of the hear
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t. Therefore, the nurse should not expect to hear dysrhythmias when assessing th
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is infant. The nurse should expect weak femoral pulses when assessing an infant wh
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o has coarctation of the aorta. The nurse should expect an elevated blood pressur
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e when assessing an infant who has coarctation of the aorta.
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5. A nurse is providing discharge teaching the guardians of a toddler with a lo
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wer leg cast applied 24 hours ago. The nurse should instruct the guardians to r
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eport which of the following findings to the provider?
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A. Capillary refill time < 2 seconds. 6 6 6 6 6
B. Restricted ability to move the toes. 6 6 6 6 6
C. Swelling of the casted foot when the leg is dependent. 6 6 6 6 6 6 6 6 6
D. Pedal pulse +3 bilateral.: B. Restricted ability to move the toes.
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36/653
, RN Pediatric Nursing Online Practice 2023 B
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Rationale:The nurse should inform the guardians that the restricted ability of th
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e tod- 6
dler to move their toes is an indication of neuromuscular compromise and require
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s
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