Pediatric Nursing NCLEX Quiz 5

1. At the community center. the nurse leads an adolescent health information group. which often expands into other areas of discussion. She knows that these youths are trying to find out "who they are." and discussion often focuses on which directions they want to take in school and life. as well as peer relationships. According to Erikson. this stage is known as:

Identity vs. role confusion

Adolescent rebellion.

Career experimentation.

Relationship testing

For the child with iron deficiency anemia. the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia. decreased hemoglobin. decreased hematocrit and elevated total iron binding capacity.

Explanation

For the child with iron deficiency anemia. the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia. decreased hemoglobin. decreased hematocrit and elevated total iron binding capacity.

2. The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern?

The baby cannot say “mama” when he wants his mother

The mother has not given him finger foods.

The child does not sit unsupported.

The baby cries whenever the mother goes out.

The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.

Explanation

The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.

3. The nurse answers a call bell and finds a frightened mother whose child. the patient. is having a seizure. Which of these actions should the nurse take?

The nurse should help the mother restrain the child to prevent him from injuring himself

The nurse should call the operator to page for seizure assistance

The nurse should clear the area and position the client safely

Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH). a metabolic enzyme involved in the pentose phosphate pathway. especially important in red blood cell metabolism.

Explanation

Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH). a metabolic enzyme involved in the pentose phosphate pathway. especially important in red blood cell metabolism.

4. The adolescent patient has symptoms of meningitis: nuchal rigidity. fever. vomiting. and lethargy. The nurse knows to prepare for the following test:

Blood culture

Throat and ear culture

CAT scan

Lumbar puncture

The patient can lose vascular status without the nurse being aware if left for more than 4 hours. yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h. at which time the CSM checks can easily be performed.

Explanation

The patient can lose vascular status without the nurse being aware if left for more than 4 hours. yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h. at which time the CSM checks can easily be performed.

5. Buck's traction with a 10 lb. weight is securing a patient's leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation- sensation-movement:

Every shift

Every day

Every 4 hours

Every 15 minutes

By 12 months. 50 percent of children can walk well.

Explanation

By 12 months. 50 percent of children can walk well.

6. Sunshine. age 13. has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is:

Prone for two hours to prevent aspiration. should she vomit

Semi-Fowler’s so she can watch TV for five hours and be entertained

Supine for several hours. to prevent a headache.

On her right sides to encourage return of CSF

Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say “mama” in the sense that it refers to their mother at this time.

Explanation

Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say “mama” in the sense that it refers to their mother at this time.

7. Kim is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include:

Tachycardia. nausea. vomiting. heart palpitations. inability to sleep. restlessness. and seizures

Tachycardia. headache. dyspnea. temp. 101 F. and wheezing

Blurred vision. tachycardia. hypertension. headache. insomnia. and oliguria

Restlessness. insomnia. blurred vision. hypertension. chest pain. and muscle weakness

Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.

Explanation

Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.

8. The nurse is drawing blood from the diabetic patient for a glycosylated hemoglobin test. She explains to the woman that the test is used to determine:

The highest glucose level in the past week

Her insulin level

Glucose levels over the past several months

Her usual fasting glucose level

Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.

Explanation

Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.

9. Cherry. the mother of an 11-month-old girl. Elizabeth. is in the clinic for her daughter's immunizations. She expresses concern to the nurse that Elizabeth cannot yet walk. The nurse correctly replies that. according to the Denver Developmental Screen. the median age for walking is:

12 months

15 months

10 months

14 months

During this period. which lasts up to the age of 18-21 years. the individual develops a sense of “self.” Peers have a major big influence over behavior. and the major decision is to determine a vocational goal.

Explanation

During this period. which lasts up to the age of 18-21 years. the individual develops a sense of “self.” Peers have a major big influence over behavior. and the major decision is to determine a vocational goal.

10. The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted. the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except:

Capillary refill

Radial and ulnar pulse

Finger movement

Skin integrity

After a fracture is casted, the nurse must monitor circulation, sensation, and movement in the area distal to the injury to prevent complications like compartment syndrome. Checking capillary refill ensures proper blood flow. Assessing radial and ulnar pulses confirms adequate circulation, and testing finger movement ensures nerve and muscle function. Skin integrity, while important, is less critical immediately after casting compared to circulation and movement, as impaired blood flow or nerve damage can cause severe complications and require immediate action.

Explanation

After a fracture is casted, the nurse must monitor circulation, sensation, and movement in the area distal to the injury to prevent complications like compartment syndrome. Checking capillary refill ensures proper blood flow. Assessing radial and ulnar pulses confirms adequate circulation, and testing finger movement ensures nerve and muscle function. Skin integrity, while important, is less critical immediately after casting compared to circulation and movement, as impaired blood flow or nerve damage can cause severe complications and require immediate action.