1. A child with leukemia is being discharged after beginning chemotherapy.

Which of the following instructions will the nurse include when teaching the parents of this child? a) Provide a diet low in protein and high carbohydrates b) avoid fresh vegetables that are not cooked or peeled c) notify the doctor if the child's temperature exceeds 101 F (39C) d) increase the use of humidifiers throughout the house 2. A client with hemophilia has a very swollen knee after falling from bicycle riding. Which of the following is the first nursing action? a) initiate an IV site to begin administration of cryoprecipitate b) type and cross-match for possible transfusion c) monitor the client's vital signs for the first 5 minutes d) apply ice pack and compression dressings to the knee 3. An 8 year old child has been diagnosed to have iron deficiency anemia. Which of the following activities is most appropriate for the child to decrease oxygen demands on the body? a) Dancing b) playing video games c) reading a book d) riding a bicycle 4. A 16 month old child diagnosed with Kawasaki Disease (KD) is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. Which of the following would the nurse interpret as the priority? a) applying lotions to the hands and feet b) offering foods the toddler likes c) placing the toddler in a quiet environment d) encouraging the parents to get some rest 5. Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea? a. Notify the physician immediately b. Administer antidiarrheal medications c. Monitor child ever 30 minutes d. Nothing, this is characteristic of Hirschsprung disease 6. A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44 bpm. Which of the following actions would the nurse do first? a) obtain an order for sedation for the child b) assess for an irregular heart rate and rhythm c) explain to the child that it will only hurt for a short time d) place the child in knee-to-chest position 7. Which of the following would the nurse perform to help alleviate a child's joint pain associated with rheumatic fever? a) maintaining the joints in an extended position b) applying gentle traction to the child's affected joints c) supporting proper alignment with rolled pillows d) using a bed cradle to avoid the weight of bed lines on the joints

8. Which of the following health teachings regarding sickle cell crisis should be included by the nurse? a) it results from altered metabolism and dehydration b) tissue hypoxia and vascular occlusion cause the primary problems c) increased bilirubin levels will cause hypertension d) there are decreased clotting factors with an increase in white blood cells 9. Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease? a. Susceptibility to respiratory infection b. Bleeding tendencies c. Frequent vomiting and diarrhea d. Seizure disorder 10. When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions? a. Supine b. Prone c. In an infant seat d. On the side

11. Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)? a. Fluid volume deficit b. Risk for aspiration c. Altered nutrition: less than body requirements d. Altered oral mucous membranes 12. An adolescent with a history of surgical repair for undescended testes comes to the clinic for a physical exam. Anticipatory guidance for the parents and adolescent would focus on which of the following as most important? a) the adolescent sterility b) the adolescent future plans c) technique for monthly testicular self examinations d) need for a lot of psychosocial support 13. When developing the teaching plan for the parents of a 12 month old infant with hypospadias and chordee repair, which of the following would the nurse expect to include as most important? a) assisting the child to become familiar with his dressing so he will leave them alone b) encouraging the child to ambulate as soon as possible by using a favorite push toy c) forcing fluids to at least 250 ml/day by offering his favorite juices d) preventing the child from disrupting the catheter by using soft restraints 14. A school-aged client admitted to the hospital because of decreased urine output and periorbital edema is diagnosed with glomerulonephritis. Which of the following interventions would receive the highest priority? a) assessing vital signs every four hours b) monitoring intake and output every 12 hours c) obtaining daily weight measurements d) obtaining serum electrolyte levels daily 15. When assessing a 12 year old child with Wilm's tumor, the nurse should keep in mind that it most important to avoid which of the following?

a) measuring the child's chest circumference b) palpating the child's abdomen c) placing the child in an uprignt position d) measuring the child's occipitofrontal circumference 16. After talking with the parents of a child with Down Syndrome, which of the following would the nurse identify as an appropriate goal of care of the child? a) encouraging self-care skills in the child b) teaching the child something new each day c) encouraging more lenient behavior limits for the child d) achieving age-appropriate social skills 17. A hospitalized preschooler with meningitis who is to be discharged becomes angry when the discharge is delayed. Which of the following play activities would be most appropriate at this time? a) reading the child a story b) painting with water colors c) pounding on a pegboard d) stacking a tower of blocks

18. When assessing the development of a 15 month old child with cerebral palsy, which of the following milestones would the nurse expect a toddler of this age to have achieved? a) walking up steps b) using a spoon c) copying a circle d) putting a block in cup

19. Because of the risks associated with administration of factor VIII concentrate, the nurse would report which of the following? a) yellowing of the skin b) constipation c) abdominal distention d) puffiness around the eye 20. When the infant returns to the unit after imperforate anus repair, the nurse places the infant in which of the following position? a) on the abdomen, with legs pulled up under the body b) on the back, with legs extended straight out c) lying on the side with hips elevated d) lying on the back in a position of comfort 21. Which of the following statements is LEAST accurate concerning urinary tract infections (UTI) in children? A) negative urinalysis rules out UTI in children < 2 years of age. B) Children with multiple UTIs should be evaluated for abuse. C) Infants younger than 3 months of age with a UTI should be admitted for intravenous antibiotics. D) Neonatal boys are more prone to UTIs than girls. E) Well appearing children > 3 months old with pyelonephritis may be treated as outpatients. 22. Which of the following signs and symptoms would observe in a child diagnosed of laryngotracheobronchitis? a) predominant stridor on inspiration b) predominant expiratory wheeze c) high fever d) slow respiratory rate

23. What would cause the closure of the Foramen ovale after the baby had been delivered? a. Decreased blood flow b. Shifting of pressures from right side to the left side of the heart c. Increased PO2 d. Increased in oxygen saturation 24. A 13-year-old girl appears at your office at 5:05 PM for a 3:30 PM appointment scheduled for the day before. Her mother tells you that the girl has been limping for a couple of weeks and has much knee pain. She has been afebrile, does not recall being hit in the knee or leg, and has not had any illnesses recently. She has difficulty "moving her leg inward." Given the late hour and that the workup will be done in the emergency department, you impress the pediatric emergency department staff by telling them that the most likely diagnosis is one of the following: A. She twisted the leg trying to be on time for the appointment yesterday B. Septic arthritis of the hip C. Septic arthritis of the knee D. Aseptic necrosis of the hip E. Slipped capital femoral epiphysis 25. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? A: Slow pulse rate B: Weight gain C: Decreased systolic pressure D: Irregular WBC lab values

26. Who among the following pediatric client should be assessed first by the nurse? a) the child with 2 episodes of soft stools during the shift b) the child who had cough for the past three days, with clear nasal discharge and is irritable c) the child with 2 episodes of inconsolable crying while the knees are drawn over the abdomen and plays between the episodes d) the child with skin rashes on his face and trunk 27. The nurse is caring for several infants who are 2-day old. Who among these infants should be given highest priority by the nurse? a) a bottlefed infant who takes 1-ounce of milk every 3 to 5 hours b) a breastfed infant who lost 0.5 ounce of his weight c) a bottlefed infant who takes 2 to 3 ounces of milk every 2 to 4 hours d) a breastfed infant who feeds every 2 to 4 hours 28. Which of the following can indicate left sided heart failure in an infant? A: fever B: low appetite C: increased respiratory rate D: crying

29. While assessing a child with pyloric stenosis, the nurse is likely to note which of the following? a. Regurgitation b. Steatorrhea c. Projectile vomiting d. Currant jelly stools 30. The mother of a 3 year old with esophageal reflux asks the nurse what she can do to lessen the babys reflux. The nurse should tell the mother to:

a. Feed the baby only when he is hungry b. Burp the baby after feeding is completed c. Place the baby in supine with head elevated d. Burp the baby frequently throughout the feeding 31. The mother of a child with hemophilia asks the nurse which over the counter medication is suitable for her childs discomfort. a. Advil (Ibuprofen) b. Tylenol (Acetaminophen) c. Aspirin (acetylsalicytic acid) d. Naproxen (Naprosyn) 32. A 9-year old is admitted with suspected rheumatic fever. Which finding is suggested of polymigratory arthritis? a. Irregular movements of the extremities and facial grimacing b. Painless swelling over the extensor surfacesof the joints c. Faint areas of red demarcation ovet the back and abdomen d. Swelling, inflammation and effusion of the joints 33. A child with croup is placed in a cool, high-humidity tent connected to room air. The primary purpose of the tent is to: a. Prevent insensible water loss b. Provide a moist environment with oxygen at 30% c. Prevent dehydration and reduce fever d. Liquefy secretions and relieve laryngeal spasm 34. A 2-year old is hospitalized with suspected intussusception. Which finding is associated with intussusception? a. currant jelly stools b. Projectile vomiting c. ribbonlike stools d. Palpable mass over the flank 35. A 4-year old is admitted with acute leukemia. It will be most important to monitor the child for: a. Abdominal pain and anorexia b. Fatigue and bruising c. Bleeding and pallor d. Petichiae and mucosal ulcers 36. In a child with suspected coarctation of the aorta, the nurse would expect to find A) Strong pedal pulses B) Diminishing cartoid pulses C) Normal femoral pulses D) Bounding pulses in the arms

37. A client is admitted with the diagnosis of meningitis. Which finding would the nurse expect in assessing this client? A) Hyperextension of the neck with passive shoulder flexion B) Flexion of the hip and knees with passive flexion of the neck C) Flexion of the legs with rebound tenderness D) Hyperflexion of the neck with rebound flexion of the legs

38. Which of the actions suggested to the RN by the PN during a planning conference for a 10 month-old infant admitted 2 hours go with bacterial meningitis would be acceptable to add to the plan of care? A) Measure head circumference B) Place in airborne isolation C) Provide passive range of motion D) Provide an over-the-crib protective top 39. Agata, 2 years old is rushed to the ER due to cyanosis precipitated by crying. Her mother observed that after playing she gets tired. She was diagnosed with Tetralogy of Fallot. The goal of nursing care for Agata is to:

a. Prevent infection b. Promote normal growth and development c. Decrease hypoxic spells d. Hydrate adequately

40. Agata, who has tetralogy of fallot, was scheduled for a palliative surgery, which creates anastomosis of the subclavian artery to the pulmonary artery. This procedure is:

a. Waterston-Cooley b. Raskkind Procedure

c. Coronary artery bypass d. Blalock-Taussig

41. When assessing a newborn for developmental dysplasia of the hip, the nurse would expect to assess which of the following?

a. Symmetrical gluteal folds b. Trendelemburg sign

c. Ortolanis sign d. Characteristic limp

42. The Nurse is performing CPR on an infant. Where should the nurse assess for pulse? a. Brachial Pulse b. Carotid Pulse c. Radial Pulse d. femoral Pulse

43. A nurse is performing an admission assessment on a newborn infant with a diagnosis of spina bifida (myelomeningocele). A priority nursing assessment for this newborn is: a. Pulse rate b. Palpation of the abdomen c. Specific gravity of the urine d. Head circumference measurement 44. When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This findings is associated with: a. Otogenous tetanus b. Tracheoesophageal fistula c. Congenital heart defects d. Renal anomalies 45. Which of the following statements by the family of a child with asthma indicates a need for additional teaching?

a. We need to identify what things triggers his attacks b. He is to use bronchodilator inhaler before steroid inhaler c. Well make sure he avoids exercise to prevent asthma attacks d. he should increase his fluid intake regularly to thin secretions 46. When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following? a. A reduced white blood cell count b. A decreased platelet count c. Shallow respirations d. Tachypnea

47. A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the clients chemotherapy regimen is to: a. Prevent metabolic breakdown of xanthine to uric acid b. Prevent uric acid from precipitating in the ureters c. Enhance the production of uric acid to ensure adequate excretion of urine d. Ensure that the chemotherapy doesnt adversely affect the bone marrow

48. .Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first? a. Administer ipecac syrup b. Call an ambulance immediately c. Call the poison control center d. Punish the child for being bad

49. Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus? a. Measuring head circumference b. Obtaining skull X-ray c. Performing a lumbar puncture d. Magnetic resonance imaging (MRI)

50. A 1 year and 2-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the patients room, the nurse anticipates using which traction system? a. Bryants traction b. Bucks extension traction c. Overhead suspension traction d. 90-90 traction