Pediatric NCLEX Review Carla Nye, MN, RN Doctoral Student University of South Florida

The nurse in an adolescent clinic is assessing the growth and development of the four following clients. Which of the four clients would require a referral? A 12-year old female who started her menses 6 months ago who is complaining of cramps. A 15-year old male with in Tanner stage 4 who is complaining of slight breast enlargement. A 16-year old female asking for birth control information. A 14-year old male in Tanner stage 1, who grew one inch last year. March 2007

Enterobius (pinworms) is diagnosed in a child Enterobius (pinworms) is diagnosed in a child. The treatment will most likely include which of the following pharmacological treatment plan? Mebendazole (Vermox) for all family members simultaneously Metronidazole (Flagyl) for all family members simultaneously Metronidazole (Flagyl) for the child only Mebendazole (Vermox) for the child only March 2007

The primary reason for screening of young children for lead poisoning is that Children with lead poisoning rarely have symptoms Lead is a hidden component of the U.S. water supply Children are exposed to lead through cigarette smoke Lead poisoning is the leading cause of mental retardation in the U.S. March 2007

A nurse is educating a mother on the care of her child with impetigo A nurse is educating a mother on the care of her child with impetigo. Which statement by the mother indicates that she needs further instructions? Impetigo can be caused by group A beta-hemolytic streptococcus Impetigo can be spread by scratching and direct skin-to-skin contact Impetigo pustules that rupture have a characteristic honey-colored crust Crusts should be allowed to dry and should not be removed. March 2007

Ten day course of oral amoxicillin Single IM injection of ceftriaxone The appropriate treatment for an initial acute otitis media may include all of the following except Ten day course of oral amoxicillin Single IM injection of ceftriaxone Wait and see prescription of an oral antibiotic Long term prophylactic antibiotics March 2007

Antipyretics for fever management Adequate fluid intake Discharge teaching for a child diagnosed with viral pneumonia include all of the following except Antipyretics for fever management Adequate fluid intake Antibiotic therapy Chest physiotherapy and postural drainage March 2007

An experienced nurse is discussing best practices for IV insertion and management in children with a new nurse. Which of the following statements by the new nurse “I should use a 24 gauge catheter when inserting an IV in an infant.” “Antecubital veins are the preferred veins to use for IV insertion in children.” “Scalp veins can be used in infants.” “I should start with the most distal site of an extremity vein.” March 2007

A mother expresses concern over how her 4-year old is responding to the death of the child’s father. Which of the following statement best describes how a preschooler comprehends death? A preschooler sees death as temporary and gradual, life and death can change places with one another understands that death is permanent, inevitable and universal responds well to logical explanations of death has a vague separation between fantasy and reality and therefore, has no concept of death. March 2007

A nurse is reviewing the immunizations that a 4-month-old will receive during a well baby visit. Which of the following is the correct list of immunizations for this infant? MMR, DTaP, Hib, IPV DTaP, Hib, IPV, PCV Varicella, DTaP, Hib, IPV, PCV Hepatitis A, DTaP, Hib, IPV, PCV DTaP – Diptheria, tetanus, pertussis Hib- Haemophilus influenzae B IPV – inactivated poliovirus PCV – Pneumococcal MMR – measles, mumps, rubella March 2007

Which of the following interventions would be most helpful in helping a family cope with the stress of the hospitalization of their child? Relating the health care teams plan for the child’s care. Explaining the daily schedule the child will follow in the hospital. Encouraging the family to go home at night in order to rest. Listening to the family’s concerns about the child’s progress March 2007

In working with children with cystic fibrosis, the nurse expects to provide teaching on which of the following treatment plans? Dietary modification including low protein, high fat, and low carbohydrate diet Daily range of motion exercises Renal dialysis and a strict intake and output Chest physiotherapy and postural drainage March 2007

General guidelines for medication management for children with asthma include: Use inhaled corticosteroids prophylactically before exercise Use inhaled B-adrenergic agonist prophylactically before exercise Use cromolyn sodium to treat acute exacerbations Use oral corticosteroids to treat acute exacerbations March 2007

A nurse is caring for a sleeping child who is post-op from abdominal surgery. The child’s pulse oximetry reading drops from 96% saturation to 89% saturation. What is the first thing the nurse should do? Call the doctor Prepare for intubation Have the child cough and deep breathe Assess for pain March 2007

A mother asks a nurse about the causes of juvenile rheumatoid arthritis (JRA). The most appropriate response would be “JRA is caused by a bacterial infection of the joint, often preceded by cellulitis or osteomyelitis.” “JRA is an inherited genetic disorder which is usually diagnosed in the first year of life.” “JRA is an autoimmune disease that occurs in a child with a genetic predisposition who is exposed to an environmental stimuli.” “ JRA is a skeletal disorder that appears during the growth spurt of puberty.” March 2007

In discussing the diagnosis of cerebral palsy with parents, a nurse informs the parents that Children with cerebral palsy have decreased intelligence. Cerebral palsy is a progressive neuromuscular disease Children with cerebral palsy are wheelchair dependent Children with cerebral palsy may have difficulties with speech. March 2007

Which of the following is a correct principle on which to base diabetic teaching for a school aged child? School aged children should be taught to self-administer their insulin injections. Use the same site for insulin injections in order to ensure stable absorption. Exercise makes the body less sensitive to insulin, and increases the insulin requirement. Follow a regimented diabetic diet from a known diabetic expert. March 2007

An infant arrives in the clinic to receive her 4 month DPT immunization. What is the appropriate method of administration? Oral Deltoid injection Vastus Lateralis injection Nasal March 2007

A 10 month old infant underwent a surgical repair of a cleft palate A 10 month old infant underwent a surgical repair of a cleft palate. What feeding strategies should the parent use for the first week post-operatively to feed the infant? Liquids from a cup Soft food from a spoon Liquid from a straw Soft finger foods March 2007

The nurse is monitoring a child who hit his head after a fall The nurse is monitoring a child who hit his head after a fall. Which of the following is a sign that requires immediate attention? A Glasgow Coma score of 15 Fluid leaking from the nose and ears A loss of consciousness for 2 minutes Severe headache and vomiting March 2007

Which of the following does NOT put an infant at risk for congenital heart disease? Family history of congenital heart disease Maternal Alcoholism Maternal Type 1 diabetes Maternal age less than 20 March 2007

The student will miss a lot of school and fall behind in school work. The school nurse encourages the parents of a student with a severe sore throat to take the child to a provider. The nurse is concerned because of which of the following? If strep tonsillitis is not treated with antibiotics it may lead to scarlet fever, otitis, or acute glomerulonephritis The student will miss a lot of school and fall behind in school work. Other children may also get sore throats if the child is not treated aggressively If untreated, strep may cause anemia, weight loss, and lethargy March 2007

The parents of a child hospitalized with acute glomerulonephritis asks the nurse why blood pressures readings are being taken so often. The nurse’s reply should be based on which of the following? Blood pressure fluctuations are a common side effect of antibiotic therapy Blood pressure fluctuations are a sign the condition has become chronic Acute hypertension must be anticipated and identified Hypotension leading to sudden shock can occur at any time. March 2007

After tonsillectomy surgery, a 4-year old child is brought to the recovery room. Which of the following actions should the nurse include in his plan of care? Institute measures to minimize crying. Perform postural drainage every two hours. Cough and deep breathe every hour. Give ice cream as tolerated. March 2007

A 12 year old is admitted to the ICU in diabetic ketoacidosis A 12 year old is admitted to the ICU in diabetic ketoacidosis. Her parents are in the waiting room and are frantic. Which of the nursing diagnosis is the highest priority? Risk for impaired skin integrity Interrupted family processes related to situational crisis Fluid volume deficit Risk for injury related to hypoglycemia March 2007

Which of the following symptoms would the RN expect to observe during the physical assessment of the adolescent girl anorexia nervosa? Dysmenorrhea Tachycardia Heat intolerance Decreased temperature March 2007

Place the patient in restraints. A 17 year-old adolescent is treated in the emergency room for acute alcohol intoxication. He is agitated and verbally abusive. His admission orders include chlordiazepoxide (Librium) 50mg IM or PO every 4-6 hours for agitation. The nurse should take which of the following precautions after Librium is administered? Place the patient in restraints. Leave the patient in a room by himself until the tranquilizer takes effect. Assign a practical nurse to stay with the patient. Ask the security guard to stay with the patient. March 2007

A 7 year-old boy with a compound fracture of the left femur is being admitted to a pediatric unit. Which of the following actions is best for the nurse to take? Ask the nursing assistant to obtain the child’s vital signs while the nurse obtains a history from the parents. Ask the LPN to assess the peripheral pulses of the child’s left leg while the nurse completes the admission forms. Ask the LPN to stay with the child and his parents while the nurse obtains phone orders from the physician. Ask the nursing assistant to obtain equipment for the child’s care while the nurse talks with the child and his parents. March 2007

A 5 year-old girl admitted after gastric lavage for Tylenol ingestion. Which of the following patients should the nurse on a pediatric unit assign to a LPN? A 3 year-old girl admitted yesterday with larnygotracheobronchitis who has a tracheostomy. A 5 year-old girl admitted after gastric lavage for Tylenol ingestion. A 6 year-old boy admitted for a fracture of the femur in balanced suspension traction. A 10 year-old boy admitted for observation after an acute asthmatic attack. March 2007