Before you start these questions, let me say this to you. These questions have been developed to help you learn the Pediatric content that often shows up on the NCLEX. Take the time to know the content in this questions by paying attention to the rationales and to the right answers.
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A 2-hour-old newborn with no significant risk factors
Neurologic: Crying neonate with bulging anterior fontanelle and a soft triangular spot on the back of the head.
Cardiac: Acrocyanosis. Heart rate 180 regular. All peripheral pulses palpable.
Respiratory: Respiratory rate 65 with abdominal retractions and mild nasal flaring
Temperature: 98 F
BP: Deferred
Heart rate: 180 bpm
Respiratory rate: 65 breaths/minute
The nurse reviews the medical record of a newborn. Based on the assessment findings and vital signs, which of the following requires immediate follow up?
The nurse is caring for a infant who has been diagnosed with a coarctation of the aorta. Which of the following assessment findings does the nurse anticipate?
The nurse is caring for a child with currant jelly-like stools (blood and mucus in the stool). The nurse recognizes that the condition that this client is most likely experiencing is which of the following?
The nurse is preparing to administer ear drops to a 2-year-old child. Which of the following actions should the nurse perform?
The neonatal intensive care unit nurse admits a neonate with gastroschisis. The nurse recognizes that the priority action for this neonate is which of the following?
The nurse admits a 10-month-old infant with pyloric stenosis. Which of the following clinical manifestations should the nurse anticipate?
The nurse is caring for a 5-year-old client with a history of tetralogy of Fallot who has clubbed fingers. The nurse recognizes that this is a sign of which of the following?
The nurse is caring for an infant with suspected tracheoesophageal fistula (TEF). Which of the following clinical manifestations should the nurse anticipate? Type an “X” to specify whether the clinical manifestation is anticipated or not ancipated.
Clinical Manifestation | Anticipated | Not Anticipated |
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Cyanosis | ||
Constant drooling | ||
Bilious emesis | ||
Choking with feedings | ||
Coughing with feedings | ||
Clay-colored stools | ||
Epigastric olive-shaped mass | ||
Dry Mouth |
The nurse is assessing a 5-year-old client with a casted left leg due to a femur fracture. Which of the following assessment findings indicate infection?
The community health nurse is developing a plan for a child with Down’s syndrome. What is the main goal for this child?
The clinic nurse is assessing a client with recurrent otitis media. Which of the following is a priority assessment?
The nurse is caring for a 4-year-old with a recent viral infection. The mother managed the child’s fever with aspirin and the child developed Reye’s Syndrome. Which of the following manifestations of Reye’s syndrome should the nurse anticipate? Type an “X” to choose your response.
Clinical Manifestation | Anticipated | Not Anticipated |
---|---|---|
Increased intracranial pressure | ||
Seizures | ||
↓ Level of Consciousness | ||
Lethargy | ||
Elevated lipase and amylase | ||
Elevated liver enzymes | ||
Decreased ammonia level | ||
Decreased prothrombin time |
The school nurse is preparing a presentation for a group of high school students about testicular cancer. Which of the following points should the nurse include? Select all that apply.
The nurse is a caring for a child post-ventriculoperitoneal shunt placement. Which of the following is the best position for this child?
A 9-week-old newborn has been diagnosed with a patent ductus arteriosus. Which of the following clinical findings does the nurse anticipate? Select all that apply.
The nurse is caring for a 12-year-old with diabetes type I. Upon initial assessment, the child appears confused with cold clammy skin. What is the priority action by the nurse?
The nurse is developing a teaching plan for the parents of a child with a cleft lip/cleft palate repair. Which of the following teaching points should the nurse include? Select all that apply.
The nurse is caring for a mother who just had a baby with a cleft lip and palate. The nurse recognizes that it is important to focus on which of the following due to the appearance of the baby?
The nurse is caring for a child with persistent jaundice (> 4 weeks), dark urine, clay-colored stools, and hepatomegaly. The nurse recognizes that the condition that this child is likely experiencing is which of the following?
The nurse is caring for an infant with Hirschsprung’s Disease (Congenital Aganglionic Megacolon). Which of the following clinical manifestations does the nurse expect in this infant? Select all that apply.
The nurse provides education to the parents of an infant with Hirschsprung’s Disease. Which of the following statements by the parents demonstrates understanding of the teaching?
The nurse is caring for an infant who was diagnosed with a tracheoesophogeal fistula after several episodes of choking, coughing, and cyanosis. Which of the following of the nursing interventions are indicated and which are contraindicated/Unnecessary? Type an “X” to specify your answer.
Nursing Intervention | Indicated | Contraindicated/Unnecessary |
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Monitor Lung Sounds | ||
Place catheter to low intermittent suction to esophageal pouch prior to surgical correction | ||
Keep infant upright | ||
Small, frequent meals prior to surgical correction | ||
As prescribed, provide Gastrostomy feedings postoperatively until esophageal anastomosis heals. | ||
After anastomosis heals, start oral feedings with sterile water per MD order |
The nurse is caring for a neonate with a tracheoesophageal fistula. What is the priority concern for this infant?
The nurse is caring for an infant who has been diagnosed with intussusception. Which of the following clinical manifestations should the nurse anticipate? Select all that apply.
The nurse is assessing an infant with a history of forceful vomiting and notices visible peristaltic waves and an olive-shaped mass in the right upper quadrant. Which of the following conditions should the nurse suspect?
The nurse is caring for a child with rheumatic fever, an autoimmune response to Group A beta hemolytic streptococcal infection. Which of the followings clinical manifestations should the nurse anticipate? Select all that apply.
The nurse anticipates which of the following abnormal laboratory results in a client with rheumatic fever? Select all that apply.
The experienced neonatal intensive care nurse is teaching the new graduate nurse about the nursing care of newborns with spina bifida. Which of the following teaching points should the experienced NICU nurse include? Select all that apply.
The nurse is caring for a newborn who had a spina bifida repair (myelomeningocele). Which of the following is the best position for this newborn?
The nurse is caring for a newborn with a myelomeningocele. Which of the following is a priority assessment?
The nurse is preparing a teaching plan for the parents of a child with iron deficiency anemia. Which of the following foods should the nurse include as good sources of iron? Select 2 that apply.
The nurse educates the client with iron deficiency anemia to take iron supplements with which of the following foods in order to promote better absorption?
The nurse is caring for a client with iron poisoning. The physician has ordered deferoxamine mesylate IV. During the administration, the client complains of itchiness and his face turns red. The client’s blood pressure is 69/45 and heart rate is 125. What should the nurse do first?
The nurse is caring for a 6-year-old client with acute lymphocytic leukemia who is receiving chemotherapy. Which of the following is the nurse’s priority concern for this client?
Which of the following pediatric clients should have a sign “DO NOT PALPATE THE ABDOMEN” sign on the bed?
The nurse is assessing adolescents for scoliosis, a lateral curvature of the spine with rotation of the vertebrae. Which of the following should the nurse asses for? Select all that apply.
The nurse provides education to a mother who had a baby with clubfeet. Which of the following statements by the mother demonstrates understanding of the teaching? Select all that apply.
The pediatric nurse is admitting a 4-year-old with poorly-managed and complicated congenital heart disease with a right-to-left shunt. The nurse anticipates which of the following clinical manifestations? Select all that apply.
Match the congenital heart defect with the clinical manifestations.
Coarctation of the Aorta
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Tetralogy of Fallot
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Patent Ductus Arteriosus
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The pediatric nurse is caring for a child with Tetralogy of Fallot who had a palliative shunt (Blalock-Taussig procedure) to increase blood flow to the lungs. The child starts to cry and becomes cyanotic. What is the priority action for this child?
The home health nurse visits a child with celiac disease. What is the most important information that the nurse should teach the parents of this child?
The nurse provides education to a mother with a child who has been diagnosed with Celiac disease. Which of the following statements by the mother requires follow up? Select all that apply.
The pediatric nurse is caring for a child diagnosed with severe gastroenteritis. The child has severe diarrhea and signs and symptoms of fluid volume deficit. The child develops hypokalemia and the physician orders potassium replacement. What assessment is most important before administering the potassium replacement?
The nurse will be admitting an infant with bronchiolitis due to respiratory syncytial virus (RSV). Which interventions should the nurse plan to implement? Select all that apply.
A 16-year-old client with a history of cystic fibrosis is admitted to the medical floor with increased respiratory secretions and oxygen saturations of 92%.
Neuro: Alert and oriented. Answers questions appropriately.
Respiratory: Crackles to right lower lobe. Oxygen saturation 96% on 3 L Nasal Cannula. No respiratory distress at this time.
Cardiac: Skin warm and dry. All peripheral pulses palpable.
GI: Bowel sounds active x 4 quadrants. Had a regular brown and fatty bowel movement.
Temperature: 99.9 °F
Blood Pressure: 110/50
Heart rate: 98 bpm
Respiratory rate: 22 breaths/minute regular unlabored.
Oxygen Saturation 96% on 3L Nasal Cannula
Pain: Denies
Chest X-Ray: Right lower lobe infiltration consistent with pneumonia
Intervention | Indicated | Contraindicated |
---|---|---|
Contact Precautions. May share room with another CF client. | ||
Antibiotics as prescribed | ||
Oxygen to keep Saturations > 95% | ||
Chest PT with Huff coughing | ||
Pancreatic enzyme therapy | ||
May have high sodium foods | ||
Flutter valve or Acapella Device | ||
Cough suppressants |
The nurse assesses a 4-year-old client who is complaining of constant ear pain x 3 days. The child has a fever of 102°F, poor appetite, and vomited x 1 this am. The child attends day care. The mother reports that no one else has similar symptoms at home.
For each client finding, specify by typing an “X” whether the findings point to otitis media or otitis externa.
Findings | Otitis Media | Otitis Externa |
---|---|---|
Likes to swim | ||
Ear Pain | ||
Fever | ||
No sick contacts | ||
Attends day care | ||
Vomiting |
The nurse obtained a Guthrie test (PKU test) by performing a heel stick on a 2-day-old newborn. The child had ingested several feedings prior to the test. The test came back positive and, even after receiving extensive education by the physician, the parents have a lot of questions regarding the results of the test. Which of the following are acceptable responses by the nurse? Select all that apply.
A 5-year-old is admitted with a sore throat, excessive drooling, muffled phonation, and inspiratory stridor. The child prefers to sit in a tripod position. Upon inspection, the physician notices a cherry red epigottis and diagnoses the child with acute epiglottitis. Which of the following nursing interventions does the nurse anticipate? Select all that apply.
The nurse admits a 5-year-old child with irritability, noticeable horseness, brassy cough, low-grade fever, and mild inspiratory stridor. The nurse anticipates which of the following physician orders? Select all that apply.
Match the treatment
Kawasaki's disease
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Iron overdose
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Lead poisoning
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Otitis Media
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Aspirin overdose
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Aceminophen overdose
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Keep PDA open
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Close PDA
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The nurse is giving a presentation on osteosarcoma, the most common type of bone cancer in children. Which of the following points should the nurse include? Select all that apply.
A child has been diagnosed with chickenpox at the clinic. The nurse should instruct the parents to do which of the following?
A 5-year-old child of low socioeconomic status who lives in a home that was constructed in the 1940’s comes to the clinic for a physical. The child exhibits impulsivity, hyperactivity and developmental delays. The mother states that the child appeared to have a seizure in the morning, but stopped and now the child is back to normal. Which of the following is the priority intervention for this child?
An 8-year-old child has been diagnosed wiht Legg-Calve-Perthes Disease (Coxa Plana) and will be discharged home. Which of the following instructions should be part of the discharge teaching?
The nurse is caring for a 9-year-old client with Duchenne muscular dystrophy. The nurse notices that the client places his hands on his knees and moves his hands up his legs until standing erect. What other clinical manifestations does the nurse expect in this client? Type an “X” to specify.
Characteristics | Anticipated | Not Anticipated |
---|---|---|
Muscle atrophy and weakness | ||
The client is male | ||
Unknown cause | ||
Wide-based waddling gait | ||
Hypertrophied leg muscles | ||
Gower’s Maneuver to stand erect | ||
Swimming best exercise | ||
Weight lifting is best exercise |
A 2-year-old child is admitted with a high fever x 5 days unresponsive to acetaminophen. The child exhibits conjunctival redness, inflammation of the pharynx and oral mucosa, a strawberry-looking tongue, and red, swollen hands and feet.
Based on the clinical note, the nurse anticipates which of the following laboratory findings in this client? Select all that apply.
The nurse is caring for a newborn who was born with a myelomeningocele. Which of the following interventions should the nurse include in the plan of care? Select all that apply.
The nurse admits a 4-month-old infant with acute diarrhea of unknown etiology and dehydration. The nurse should include which of the following interventions in the plan of care?
Match the age of the child and the immunization.
Knowing the immunization schedule is essential. I have provided the most basic schedule here. Some vaccines require an extra dose not included, but if you can remember this, you will be just fine.
Hepatitis B
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Rotavirus, DTap, Hib, Pneumococcal, IPV (polio)
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Hib, Pneumococcal, IPV, MMR (measles, mumps, rubella) and Varicella.
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TDap, IPV, MMR, Varicella
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HPV (Human Papilloma Virus)
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The nurse provides education to the parents of a child with asthma. Which of the following statements by the parents requires follow up? Select all that apply.
The mother of a 2-year-old child who has been newly-diagnosed with Hirschsprung’s disease asks the nurse about the treatment of choice for this disease. What is the nurse’s best response?
The nurse reviews the assessment data as documented in the medical record of a child with nephrotic syndrome who is being treated with corticosteroids. Select one finding that requires immediate follow-up?
The client is a 5-week-old infant with a history of mild regurgitation that progressed to projectile vomiting. Emesis only contains gastric contents (undigested milk) and no bile. Infant is dehydrated and has gained minimal weight since birth.
Infant is irritable and hungry. Peristaltic waves visible across epigastrium. Olive-shaped mass is palpated just right to the umbilicus.
Peripheral IV started to the right hand and IV fluid started per MD order. Pt will have pyoloromyotomy tomorrow am. Informed consent in chart.
Temperature 98.5 °F, BP 79/45, HR 135 bpm, RR 40 breahs/minute, Oxygen Saturation 98% on room air.
Weight 3.99 kg
Which of the following is a post-surgical expected outcome for this infant?
Which of the following pediatric clients would be an inappropriate assignment for a pregnant nurse?
A 2-weak-old infant is brought to the clinic with poor weight gain, chronic constipation, foul-smelling, ribbon-like stools, and abdominal distention. Full-term infant born via vaginal delivery without complications.
General: Sleepy infant with obvious evidence of failure to thrive.
Cardiac: S1 S2 heart tones without murmurs. All peripheral pulses palpable. Skin warm and dry.
Respiratory: Respiratory rate 45, regular and unlabored. Lungs clear to auscultation bilaterally
GI: Abdominal distention with palpable mass in the left lower quadrant. Bowel sounds hypoactive. +anal patency. No fistula.
Temperature: 98 °F
BP: 78/43
Heart rate: 125 bpm
Respiratory rate: 35 breaths/minute
Oxygen Saturation 98 % on room air
Weight: 3.4 kg (birth weight 3.6 kg)
The nurse recognizes that the condition that this infant is most likely experiencing is which of the following?
The nurse educates a mother of a child with a suspected ventricular septal defect about the indications of a cardiac catheterization. Which of the following should the nurse include in the teaching plan?
The pediatric nurse admits a child who had a cardiac catheterization to further evaluate a ventricular septal defect. Which of the following is the nurse’s priority concern?
The nurse is caring for a child with hydrocephalus who had a ventriculoperitoneal shunt. Which of the following clinical manifestations indicate VP shunt failure?
The nurse is caring for a newborn with physiologic jaundice on phototherapy. The nurse recognizes that which of the following are the priority concerns for this newborn? Select all that apply.
Which of the following clients should be on reverse or neutropenic isolation?
A child with a history of recurrent otitis media has developed hearing loss. Despite the fact the fact that recurrent otitis media can lead to hearing loss, the physician asserts that the most likely cause was antibiotic therapy. Which of the following antibiotics causes ototoxicity?
A child with recurrent tonsillitis had a tonsillectomy 12 hours ago. Which of the following foods is acceptable for this child?
The nurse is caring for a child with nephrotic syndrome who has developed anasarca. Which of the following laboratory findings does the nurse expect in this client?
The nurse is admitting a 2-year-old child with acute epiglottitis. Which of the following nursing interventions has the highest priority?
The parents of a child with cystic fibrosis ask the nurse, “Why does my child need to take supplemental vitamins?” What is the best response by the nurse?
The nurse is caring for a child with a ventriculoperitoneal shunt. While assessing the abdominal dressing, the nurse notices clear drainage. Which of the following should be the nurse’s first action?
The nurse is assessing a newborn with a translucent swelling of the scrotum that cannot be reduced. Which of the following conditions is the newborn most likely experiencing?
A mother brings her 5-year-old child who has a history of Celiac disease to the pediatric clinic. The child has had chronic diarrhea, increased gas, foul-smelling stool, and weight loss over the past month. The nurse assesses whether the child has been following a gluten-free diet. The mother demonstrates understanding of a gluten-free diet when she states that she gives which of the following snacks to the child?
A 10-year-old is brought to the pediatric clinic for a complete physical. Upon assessment of developmental milestones, the mother states that the child is behind in school and 2 weeks ago was diagnosed with attention deficit hyperactivity disorder by a specialist. The nurse expects that the child will exhibit which of the following signs and symptoms of this disorder? Select all that apply.
A mother brings a 2-month old infant to the pediatric health care clinic. The mother tells the nurse that the infant appears yellow and has very dark urine. The nurse suspects biliary atresia and assesses the infant for which of the following additional signs and symptoms?
The nurse is assessing an infant with congenital hip dysplasia. Which of the following findings should the nurse expect?
The pediatric nurse is caring for a 5-year-old who starts to have a generalized seizures. What is the nurse’s priority action?
The clinic nurse is assessing a child with suspected chickenpox. What nurse expects to see which of the following characteristics of the chickenpox rash?
A 6-year-old child with sickle cell anemia is admitted with fever, chest pain and shortness of breath. The nurse should prioritize which intervention?
The pediatric nurse receives report on 4 clients. Which client should the nurse see first?
Which of the following is suggestive of meningitis in a 3-month-old infant?
Which of the following developmental milestones is expected in a 6-month-old infant?
The nurse is caring for a 6-year-old child with strep throat who has been prescribed antibiotics. The nurse anticipates that the doctor will order which of the following routes to administer the antibiotics?
The nurse provides education to the parents of a child who has been diagnosed with rheumatic fever. Which of the following statements by the parents demonstrates understanding of the teaching provided?
The nurse admits a child with suspected kawasaki disease. The nurse expects which of the following criteria will be used to diagnosed Kawasaki disease?
The nurse is caring for a child with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) who is taking methylphenidate (Ritalin). Which of the following adverse effects is associated with this medication?
A 4-year-old child was prescribed amoxicillin for an ear infection. The nurse should teach the parents to watch for which of the following possible adverse effects?
A 6-year-old child with asthma is prescribed albuterol and inhaled corticosteroid therapy. The parents should be educated to administer medication in which order?
A nurse is caring for a 12-year-old girl with type 1 diabetes. Which of the following statements by the patient would indicate a correct understanding of diabetes management?
A child with congenital heart disease is undergoing cardiac catheterization. Which of the following interventions is necessary post-procedure to prevent complications?
The nurse is providing education to the parents of a child with a cleft lip and palate. Which of the following statements by the parents indicates a need for further teaching?
The nurse is caring for a child with meningitis who has been admitted to the hospital. Which of the following interventions would be appropriate?
The nurse is caring for a 1-month old child with pneumonia who is receiving oxygen therapy. Which of the following findings would indicate that the child is experiencing respiratory distress?
The nurse is assessing a 4-year-old child who has been experiencing frequent episodes of diarrhea that contain blood. Which laboratory test is most important in helping to diagnose the cause of the diarrhea?
A nursing is performing a well-child examination on a 5-year-old child. Which question should the nurse ask to assess the child’s cognitive development?
. The nurse is caring for a 2-year-old patient who has been diagnosed with intussusception. Which intervention should the nurse prioritize?
A 12-year-old patient is scheduled for an appendectomy. Which preoperative teaching intervention should the nurse include in the care plan?
A 4-year-old child with a history of congenital heart disease is admitted to the hospital with symptoms of heart failure. What assessment findings should the nurse anticipate? Select all that apply.
A 6-year-old child with a history of asthma is admitted to the hospital with a severe asthma exacerbation. The child is receiving continuous albuterol nebulization and high-dose intravenous (IV) steroids. What potential side effects of the IV steroids should the nurse monitor for? Select all that apply.
The nurse is caring for a pediatric client with varicella. The nurse should implement which of the following infection control precautions?
The nurse is caring for an 10-year-old client who came in for child abuse. Which of the following interventions should the nurse implement?