- A 3-year-old child is brought to the clinic with a fever of 38.9°C, irritability, and pulling at their ear. The nurse suspects otitis media. Which of the following should the nurse expect to find during an ear examination?
A) Clear tympanic membrane with good mobility
B) Red, bulging tympanic membrane with absent light reflex
C) Presence of earwax blocking the ear canal
D) Pearly grey tympanic membrane with a triangular light reflex
Answer: B) Red, bulging tympanic membrane with absent light reflex
Rationale: A red, bulging tympanic membrane without a light reflex is a classic sign of otitis media in children.
- When assessing the apical pulse of a 1-year-old child, the nurse should place the stethoscope:
A) At the second intercostal space
B) At the fourth intercostal space, right of the midline
C) At the fifth intercostal space, left of the midline
D) At the fourth intercostal space, left of the midline
Answer: D) At the fourth intercostal space, left of the midline
Rationale: In children under 7 years old, the apical pulse is best heard at the fourth intercostal space due to the position of their heart.
- A 7-year-old child with asthma is admitted for an acute exacerbation. Which of the following signs would indicate impending respiratory failure?
A) Coughing with expiratory wheezing
B) Use of accessory muscles with a respiratory rate of 30/min
C) Nasal flaring and cyanosis
D) SpO2 of 95% with increased coughing
Answer: C) Nasal flaring and cyanosis
Rationale: Nasal flaring and cyanosis are late signs of respiratory distress, indicating that the child is struggling to compensate, which can lead to respiratory failure.
- A nurse is teaching parents about the prevention of Sudden Infant Death Syndrome (SIDS). Which of the following is the most important instruction to give?
A) Place the infant on their stomach to sleep
B) Avoid using pacifiers during sleep time
C) Place the infant on their back to sleep
D) Use soft bedding to keep the infant comfortable
Answer: C) Place the infant on their back to sleep
Rationale: The “back to sleep” position has been shown to significantly reduce the risk of SIDS in infants.
- A nurse is preparing to give a 2-year-old child a dose of amoxicillin for an ear infection. The order is for 250 mg, and the medication is available as 125 mg/5 mL. How many mL should the nurse administer?
A) 10 mL
B) 5 mL
C) 7.5 mL
D) 15 mL
Answer: A) 10 mL
Rationale: 250 mg divided by 125 mg = 2, so the nurse should administer 10 mL.
- The nurse is caring for a 4-month-old infant who is scheduled to receive their first dose of rotavirus vaccine. The nurse knows that rotavirus is primarily responsible for which condition?
A) Respiratory infections
B) Otitis media
C) Gastroenteritis
D) Meningitis
Answer: C) Gastroenteritis
Rationale: Rotavirus is a leading cause of severe diarrhoea and gastroenteritis in infants and young children.
- Which of the following is a key indicator of dehydration in a child?
A) Bulging fontanels
B) Increased urine output
C) Dry mucous membranes
D) Increased skin turgor
Answer: C) Dry mucous membranes
Rationale: Dry mucous membranes are a classic sign of dehydration in children, along with decreased skin turgor and sunken fontanels.
- A child is diagnosed with bacterial meningitis. The nurse is reviewing laboratory results. Which of the following cerebrospinal fluid (CSF) findings is consistent with bacterial meningitis?
A) Increased glucose
B) Decreased protein
C) Cloudy appearance and increased WBC count
D) Clear appearance and decreased WBC count
Answer: C) Cloudy appearance and increased WBC count
Rationale: Bacterial meningitis typically presents with cloudy CSF due to increased WBCs and proteins, along with decreased glucose.
- Which developmental milestone should the nurse expect in a 9-month-old infant?
A) Sitting without support
B) Walking independently
C) Saying two-word sentences
D) Responding to simple commands
Answer: A) Sitting without support
Rationale: By 9 months of age, most infants can sit without support. Walking and two-word sentences occur closer to 12-18 months.
- A 6-year-old child with a history of leukaemia has a low platelet count. The nurse should take which of the following precautions?
A) Encourage the child to perform active range-of-motion exercises
B) Avoid intramuscular injections and perform frequent neuro checks
C) Administer aspirin for pain
D) Perform oral care with a stiff toothbrush
Answer: B) Avoid intramuscular injections and perform frequent neuro checks
Rationale: A low platelet count increases the risk of bleeding. IM injections and invasive procedures should be avoided to prevent bleeding complications.
- A nurse is performing a physical assessment on a toddler. Which of the following should be the last part of the examination?
A) Auscultating heart and lung sounds
B) Palpating the abdomen
C) Examining the ears and throat
D) Checking the skin for rashes
Answer: C) Examining the ears and throat
Rationale: In toddlers, invasive or uncomfortable procedures like ear and throat examinations should be left until the end of the assessment to avoid distressing the child early in the examination.
- A child is diagnosed with Tetralogy of Fallot. Which of the following symptoms is typically associated with this condition?
A) Frequent infections
B) Cyanosis during crying or feeding
C) High blood pressure
D) Bradycardia during activity
Answer: B) Cyanosis during crying or feeding
Rationale: Tetralogy of Fallot is a congenital heart defect that results in decreased oxygenation of the blood, leading to cyanosis, especially during periods of stress or exertion.
- Which of the following vaccines is contraindicated in a child who is immunocompromised?
A) Inactivated polio vaccine
B) Measles, Mumps, Rubella (MMR) vaccine
C) Diphtheria, Tetanus, Pertussis (DTaP) vaccine
D) Hepatitis B vaccine
Answer: B) Measles, Mumps, Rubella (MMR) vaccine
Rationale: The MMR vaccine is a live attenuated vaccine and is contraindicated in immunocompromised individuals due to the risk of severe infection.
- A nurse is teaching parents how to manage their child’s mild dehydration caused by diarrhoea. Which of the following instructions is most appropriate?
A) Offer the child fruit juices frequently
B) Administer an oral rehydration solution
C) Give the child sips of plain water only
D) Avoid giving the child any fluids for the first 12 hours
Answer: B) Administer an oral rehydration solution
Rationale: Oral rehydration solutions contain electrolytes and are the best method for managing mild dehydration in children.
- A child with sickle cell anaemia is admitted with severe pain. The nurse’s priority intervention is to:
A) Apply warm compresses to the painful areas
B) Administer high-flow oxygen via mask
C) Administer prescribed pain medication
D) Provide the child with fluids to prevent dehydration
Answer: C) Administer prescribed pain medication
Rationale: Pain management is the priority in a sickle cell crisis, followed by hydration and oxygen therapy.
- Which of the following interventions is most important when feeding a child with cerebral palsy?
A) Tilt the child’s head back while feeding
B) Provide high-calorie, low-protein meals
C) Place the child in an upright position
D) Encourage the child to eat quickly to avoid fatigue
Answer: C) Place the child in an upright position
Rationale: Children with cerebral palsy often have difficulty swallowing, and feeding in an upright position helps reduce the risk of aspiration.
- A 5-year-old child is admitted with suspected acute appendicitis. Which of the following findings would most likely indicate a ruptured appendix?
A) Sudden relief of pain
B) High fever
C) Nausea and vomiting
D) Rebound tenderness in the lower right quadrant
Answer: A) Sudden relief of pain
Rationale: Sudden relief of pain in appendicitis may indicate a ruptured appendix, which is a surgical emergency.
- A nurse is caring for a new-born diagnosed with jaundice. The most appropriate treatment to reduce bilirubin levels is:
A) Phototherapy
B) Increased formula feeding
C) Vitamin K administration
D) Administering iron supplements
Answer: A) Phototherapy
Rationale: Phototherapy is used to lower bilirubin levels by converting bilirubin into a water-soluble form that can be excreted in the urine.
Which assessment finding in an infant with pyloric stenosis is most characteristic?
A) Diarrhoea and dehydration
B) Frequent, projectile vomiting
C) Bilious vomiting after feeding
D) Abdominal distension with palpable liver
Answer: B) Frequent, projectile vomiting
Rationale: Pyloric stenosis causes obstruction of the stomach outlet, leading to forceful projectile vomiting, especially after feeding.
- A child is admitted with a diagnosis of acute glomerulonephritis. The nurse should expect to observe which of the following clinical manifestations?
A) Hypertension and dark urine
B) Polyuria and pale urine
C) Weight loss and oliguria
D) Hypotension and jaundice
Answer: A) Hypertension and dark urine
Rationale: Acute glomerulonephritis is characterized by hypertension, haematuria (causing dark urine), and oliguria (decreased urine output).
- A child is admitted to the hospital with a diagnosis of Kawasaki disease. Which of the following is a primary symptom of this condition?
A) Bradycardia
B) Conjunctivitis without discharge
C) A productive cough
D) Periorbital oedema
Answer: B) Conjunctivitis without discharge
Rationale: Kawasaki disease is characterized by fever, conjunctivitis without discharge, rash, and swelling of the hands and feet. It’s a systemic vasculitis that primarily affects young children.
- A nurse is assessing a child with croup. Which of the following sounds is most characteristic of this condition?
A) Wheezing
B) Barking cough
C) Rhonchi
D) Crackles
Answer: B) Barking cough
Rationale: Croup is characterized by a harsh, barking cough and inspiratory stridor due to upper airway inflammation and obstruction.
- A 2-year-old child is diagnosed with iron deficiency anaemia. Which of the following foods should the nurse recommend to increase the child’s iron intake?
A) Whole milk
B) Fortified cereals
C) Yogurt
D) Bananas
Answer: B) Fortified cereals
Rationale: Fortified cereals are high in iron and are commonly recommended to help treat iron deficiency anaemia in children.
- A nurse is caring for a 4-month-old infant with gastroesophageal reflux (GER). Which of the following nursing interventions is appropriate?
A) Feed the infant every 2 hours
B) Elevate the head of the bed after feedings
C) Give the infant cold formula
D) Place the infant in a prone position after feeding
Answer: B) Elevate the head of the bed after feedings
Rationale: Elevating the head of the bed after feedings helps prevent reflux of gastric contents into the oesophagus, which is a common intervention in infants with GER.
- Which of the following is the most appropriate toy for a 10-month-old infant?
A) Small rubber ball
B) Toy car with small parts
C) A set of building blocks
D) Stuffed animal
Answer: C) A set of building blocks
Rationale: A 10-month-old infant enjoys manipulating objects, and building blocks are appropriate for developing motor skills. Small objects should be avoided due to choking risks.
- A 3-year-old child with leukaemia is scheduled to undergo a lumbar puncture. Which of the following statements by the nurse would best explain the procedure to the child?
A) “We are going to take some of your blood to see how you’re feeling.”
B) “The doctor will use a special needle to get some fluid from your back.”
C) “You will lie very still, and it will be over quickly.”
D) “The doctor will put you to sleep so you won’t feel anything.”
Answer: C) “You will lie very still, and it will be over quickly.”
Rationale: Explaining procedures in simple, reassuring terms is essential for young children. The nurse’s statement is developmentally appropriate for a 3-year-old.
- A nurse is assessing a 5-year-old child with nephrotic syndrome. Which of the following findings is most likely?
A) Haematuria
B) Oedema around the eyes and ankles
C) Frequent urination
D) High blood pressure
Answer: B) Oedema around the eyes and ankles
Rationale: Nephrotic syndrome in children is characterized by proteinuria, hypoalbuminemia, and oedema, particularly around the eyes and lower extremities.
- A nurse is teaching the parents of a child with type 1 diabetes how to recognize signs of hypoglycaemia. Which of the following signs should be included?
A) Fruity breath odour
B) Increased thirst
C) Sweating and shakiness
D) Rapid, deep breathing
Answer: C) Sweating and shakiness
Rationale: Hypoglycaemia in children with type 1 diabetes is often characterized by symptoms such as sweating, shakiness, irritability, and confusion.
- The nurse is caring for a toddler who has been vomiting and having diarrhoea for 2 days. Which of the following assessments would indicate that the child is dehydrated?
A) Decreased skin turgor
B) Increased urine output
C) Bulging fontanel
D) Moist mucous membranes
Answer: A) Decreased skin turgor
Rationale: Decreased skin turgor, dry mucous membranes, and a sunken fontanel in infants are signs of dehydration.
- A nurse is reviewing safety guidelines with the parents of a 4-year-old child. Which of the following statements by the parents indicates a need for further teaching?
A) “We will keep all medicines out of reach.”
B) “We will make sure our child wears a helmet when riding a bike.”
C) “We can let our child sit in the front seat of the car if he’s in a booster seat.”
D) “We will teach our child to stay away from the stove while we are cooking.”
Answer: C) “We can let our child sit in the front seat of the car if he’s in a booster seat.”
Rationale: Children under 13 should not sit in the front seat of a car due to the risk of injury from airbags, even if they are in a booster seat.
- A nurse is caring for a child with a ventricular septal defect (VSD). Which of the following findings should the nurse expect to assess in this child?
A) Loud, harsh murmur
B) Weak peripheral pulses
C) Cyanosis during feeding
D) Bounding pulse in upper extremities
Answer: A) Loud, harsh murmur
Rationale: A ventricular septal defect (VSD) is a hole in the septum between the right and left ventricles, often causing a loud, harsh murmur due to turbulent blood flow between the ventricles.
- A child has been diagnosed with intussusception. Which of the following is the most characteristic symptom of this condition?
A) Constant, dull abdominal pain
B) Sudden, episodic abdominal pain
C) Vomiting immediately after eating
D) Abdominal distention with constipation
Answer: B) Sudden, episodic abdominal pain
Rationale: Intussusception occurs when a part of the intestine telescopes into another part, causing sudden episodes of severe abdominal pain, often with “currant jelly” stools.
- The nurse is planning care for a 6-year-old child with a new diagnosis of type 1 diabetes mellitus. Which of the following should be included in the care plan?
A) Administer oral hypoglycaemic agents
B) Instruct the child on using a glucometer
C) Monitor the child’s diet for high-fat content
D) Plan for daily insulin injections
Answer: D) Plan for daily insulin injections
Rationale: Children with type 1 diabetes require daily insulin injections because their bodies do not produce insulin. Oral hypoglycaemic agents are not used in type 1 diabetes.
- A nurse is caring for a 3-year-old child with acute epiglottitis. Which of the following interventions is the priority?
A) Place the child in a supine position
B) Prepare for intubation or tracheostomy
C) Administer a cough suppressant
D) Encourage oral fluids
Answer: B) Prepare for intubation or tracheostomy
Rationale: Acute epiglottitis is a life-threatening condition that can cause sudden airway obstruction, and the priority is to ensure a patent airway, which may require intubation.
- A nurse is caring for a 5-year-old child with varicella (chickenpox). Which of the following is the most appropriate action to relieve itching?
A) Apply hydrocortisone cream to the lesions
B) Give an oatmeal bath
C) Administer aspirin
D) Give the child warm baths every 4 hours
Answer: B) Give an oatmeal bath
Rationale: Oatmeal baths can soothe the skin and reduce itching associated with varicella. Aspirin is contraindicated due to the risk of Reye’s syndrome.
- A nurse is providing teaching to the parent of a 6-month-old infant who is receiving digoxin for a congenital heart defect. Which of the following instructions should the nurse include?
A) “Give the medication with meals.”
B) “Repeat the dose if the child vomits.”
C) “Measure the dose carefully using a syringe.”
D) “Mix the medication with formula to improve the taste.”
Answer: C) “Measure the dose carefully using a syringe.”
Rationale: Accurate dosing of digoxin is critical in infants, and a syringe ensures precision. The dose should not be repeated if the child vomits due to the risk of toxicity.
- A nurse is assessing a child with developmental dysplasia of the hip (DDH). Which of the following assessment findings is most indicative of DDH?
A) Symmetrical gluteal folds
B) Positive Ortolani sign
C) Limited abduction of the affected leg
D) Equal limb lengths
Answer: B) Positive Ortolani sign
Rationale: A positive Ortolani sign, a “clunk” heard when the hip is reduced into the acetabulum, is a key indicator of developmental dysplasia of the hip.
- A child with cystic fibrosis is prescribed pancrelipase. The nurse should teach the parents to administer the medication:
A) After meals and snacks
B) Only when the child is constipated
C) Before meals and snacks
D) With a glass of water
Answer: C) Before meals and snacks
Rationale: Pancrelipase aids in digestion and should be administered before meals and snacks to help the child absorb nutrients.
- A nurse is preparing to discharge a child with acute lymphoblastic leukaemia (ALL) who has a central venous catheter. Which of the following instructions should the nurse include regarding central line care?
A) Clean the site daily with sterile water
B) Avoid flushing the catheter unless instructed by a doctor
C) Use aseptic technique when handling the catheter
D) Keep the catheter site open to air for proper healing
Answer: C) Use aseptic technique when handling the catheter
Rationale: Aseptic technique is essential to prevent infections, which children with leukaemia are particularly susceptible to due to their immunocompromised state.
- A nurse is caring for a 6-year-old child with haemophilia. The nurse understands that haemophilia is characterized by which of the following?
A) Deficiency of platelets
B) Prolonged clotting time
C) Reduced red blood cell production
D) Decreased white blood cell count
Answer: B) Prolonged clotting time
Rationale: Haemophilia is a bleeding disorder caused by a deficiency in clotting factors, leading to prolonged clotting time and increased risk of bleeding.
- A nurse is preparing to administer an intramuscular (IM) injection to a 12-month-old infant. What is the most appropriate site for the injection?
A) Deltoid muscle
B) Vastus lateralis
C) Ventrogluteal muscle
D) Dorsogluteal muscle
Answer: B) Vastus lateralis
Rationale: The vastus lateralis is the preferred site for IM injections in infants under 2 years old due to its large muscle mass and minimal risk of nerve or vessel injury.
- A 2-year-old child is being evaluated for suspected meningitis. Which of the following signs would most likely indicate meningitis in this child?
A) Nuchal rigidity
B) Positive Babinski sign
C) High-pitched cry
D) Periorbital oedema
Answer: A) Nuchal rigidity
Rationale: Nuchal rigidity, or stiffness in the neck, is a common sign of meningitis in children. Other signs may include fever, headache, and irritability.
- The nurse is assessing an infant with bronchiolitis. Which of the following assessment findings is most characteristic of this condition?
A) Inspiratory wheezes
B) Crackles in the lower lung fields
C) Expiratory grunting
D) Nasal flaring and retractions
Answer: D) Nasal flaring and retractions
Rationale: Bronchiolitis, typically caused by the respiratory syncytial virus (RSV), often presents with nasal flaring, retractions, and other signs of respiratory distress in infants.
- A nurse is educating the parents of a child with atopic dermatitis (eczema). Which of the following statements should the nurse include in the teaching?
A) “Apply a topical corticosteroid only when there is severe itching.”
B) “Give the child a hot bath to soothe the skin.”
C) “Moisturize the child’s skin immediately after bathing.”
D) “Use antibacterial soap to prevent infections.”
Answer: C) “Moisturize the child’s skin immediately after bathing.”
Rationale: Moisturizing immediately after bathing helps lock in moisture and prevent drying, which is key in managing eczema. Hot baths and harsh soaps should be avoided as they can aggravate the condition.
- A child is brought to the emergency department with a suspected diagnosis of acute otitis media (AOM). Which of the following signs is most likely associated with AOM?
A) Clear nasal discharge
B) Decreased appetite
C) Tugging at the affected ear
D) Redness and swelling of the external ear canal
Answer: C) Tugging at the affected ear
Rationale: Acute otitis media is an infection of the middle ear, and children often tug at their ears in response to the pain and discomfort associated with the condition.
- A 6-year-old child is brought to the clinic with suspected mumps. Which of the following symptoms is most characteristic of this disease?
A) Swelling of the parotid glands
B) Rash on the trunk and limbs
C) Itchy blisters on the face
D) Sudden onset of cough and dyspnoea
Answer: A) Swelling of the parotid glands
Rationale: Mumps is a viral illness that primarily affects the salivary glands, causing swelling of the parotid glands, which is a hallmark symptom.
- A nurse is providing discharge instructions to the parents of a child who has been diagnosed with scabies. Which of the following should be included in the instructions?
A) “Give your child a cold bath every day to relieve itching.”
B) “Apply a thin layer of permethrin cream over the entire body.”
C) “The rash should disappear within 24 hours after treatment.”
D) “Wash only the clothes your child wore the day the rash appeared.”
Answer: B) “Apply a thin layer of permethrin cream over the entire body.”
Rationale: Permethrin cream is applied to the entire body from the neck down to treat scabies. It is important to treat all clothing, bedding, and personal items to prevent reinfestation.
- A nurse is caring for a child with leukaemia who is undergoing chemotherapy. Which of the following interventions is most important to prevent infection?
A) Encourage daily exercise
B) Administer live vaccines
C) Restrict visitors who are ill
D) Provide a high-protein diet
Answer: C) Restrict visitors who are ill
Rationale: Children receiving chemotherapy are immunocompromised and at increased risk of infection. Restricting visitors who may be ill helps reduce the risk of exposure to infectious agents.
- A nurse is caring for a 7-year-old child with acute glomerulonephritis. Which of the following interventions is most important to include in the plan of care?
A) Encourage increased fluid intake
B) Monitor the child’s blood pressure
C) Provide a high-protein diet
D) Restrict sodium in the child’s diet
Answer: B) Monitor the child’s blood pressure
Rationale: Acute glomerulonephritis often leads to hypertension due to impaired kidney function. Monitoring and managing blood pressure is a critical component of care.
- A 4-year-old child has been brought to the clinic with severe diarrhoea. Which of the following interventions is the nurse’s priority?
A) Administer antidiarrheal medications
B) Encourage the child to eat solid foods
C) Begin oral rehydration therapy
D) Keep the child on bed rest
Answer: C) Begin oral rehydration therapy
Rationale: Oral rehydration therapy is the priority for managing diarrhoea in children, as it helps replace lost fluids and prevent dehydration.
- A nurse is caring for an infant diagnosed with respiratory distress syndrome (RDS). Which of the following is a primary cause of RDS in infants?
A) Surfactant deficiency
B) Congenital heart defect
C) Airway obstruction
D) Bronchospasm
Answer: A) Surfactant deficiency
Rationale: Respiratory distress syndrome is caused by a lack of surfactant in the lungs, which leads to alveolar collapse and impaired gas exchange, particularly in premature infants.
- A child is diagnosed with pyloric stenosis. Which of the following symptoms would most likely be present?
A) Frequent, loose stools
B) Projectile vomiting after feeding
C) Abdominal pain relieved by eating
D) Vomiting that contains bile
Answer: B) Projectile vomiting after feeding
Rationale: Pyloric stenosis causes hypertrophy of the pyloric sphincter, leading to projectile vomiting, often immediately after feeding. The vomitus does not typically contain bile.
- A nurse is teaching parents of a child with sickle cell anaemia about preventing sickle cell crises. Which of the following should be included in the teaching?
A) “Increase your child’s physical activity.”
B) “Encourage your child to drink plenty of fluids.”
C) “Avoid giving your child iron supplements.”
D) “Administer antibiotics regularly.”
Answer: B) “Encourage your child to drink plenty of fluids.”
Rationale: Adequate hydration is crucial in preventing sickle cell crises, as dehydration can increase the risk of sickle cell formation and vaso-occlusion.
- A nurse is assessing a child with suspected appendicitis. Which of the following assessment findings is consistent with appendicitis?
A) Rebound tenderness at McBurney’s point
B) Abdominal pain relieved by movement
C) Diarrhoea and frequent bowel movements
D) Left lower quadrant pain
Answer: A) Rebound tenderness at McBurney’s point
Rationale: Rebound tenderness at McBurney’s point (located in the right lower quadrant) is a classic sign of appendicitis. Pain typically worsens with movement.
- The nurse is caring for a child diagnosed with Wilms’ tumour. Which of the following is the most important precaution to take when caring for this child?
A) Monitor for signs of infection
B) Avoid palpating the abdomen
C) Restrict fluid intake
D) Encourage a low-protein diet
Answer: B) Avoid palpating the abdomen
Rationale: Wilms’ tumour is a kidney tumour, and palpation of the abdomen should be avoided to prevent the risk of rupturing the tumour and causing metastasis.
- A nurse is caring for a child with rheumatic fever. Which of the following assessments is most important in detecting a complication of this condition?
A) Blood pressure monitoring
B) Assessment of heart sounds
C) Neurological assessment
D) Measurement of respiratory rate
Answer: B) Assessment of heart sounds
Rationale: Rheumatic fever can cause inflammation of the heart (rheumatic heart disease), so it is important to monitor for murmurs or other abnormal heart sounds that may indicate valve damage.
- A 9-month-old infant is brought to the clinic for a routine check-up. The nurse notes that the infant is not yet sitting without support. What is the most appropriate action?
A) Reassure the parents that development is normal
B) Recommend physical therapy immediately
C) Schedule a developmental screening
D) Suggest the parents give the infant more tummy time
Answer: C) Schedule a developmental screening
Rationale: By 9 months of age, most infants can sit without support. If an infant cannot do so, a developmental screening is recommended to assess for delays.
- A nurse is caring for a child with congenital heart disease. The child’s mother asks about ways to prevent bacterial endocarditis. Which of the following responses is most appropriate?
A) “Your child will need daily aspirin therapy.”
B) “Ensure your child gets prophylactic antibiotics before dental procedures.”
C) “Limit your child’s physical activity to prevent strain on the heart.”
D) “Your child should receive frequent vaccinations to prevent infections.”
Answer: B) “Ensure your child gets prophylactic antibiotics before dental procedures.”
Rationale: Children with congenital heart disease are at increased risk of bacterial endocarditis. Prophylactic antibiotics are given before dental and other invasive procedures to reduce the risk of infection.
- A child is hospitalized with nephrotic syndrome. Which of the following symptoms is the most typical of this condition?
A) Haematuria
B) Massive proteinuria
C) Hyperkalaemia
D) Hypoglycemia
Answer: B) Massive proteinuria
Rationale: Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and oedema due to increased permeability of the glomerular membrane.
- A nurse is providing preoperative teaching to the parents of a child scheduled for a tonsillectomy. Which of the following instructions should the nurse include?
A) “Give your child aspirin if they have any pain after surgery.”
B) “Your child should avoid coughing or clearing their throat after surgery.”
C) “Your child can have red or orange drinks immediately after surgery.”
D) “Allow your child to eat solid foods as soon as they feel ready.”
Answer: B) “Your child should avoid coughing or clearing their throat after surgery.”
Rationale: After a tonsillectomy, coughing or throat clearing can irritate the surgical site and increase the risk of bleeding. It’s important to avoid this behaviour.
- A nurse is caring for a child with Kawasaki disease. Which of the following treatments is most likely to be prescribed?
A) High-dose aspirin and intravenous immunoglobulin (IVIG)
B) Steroid therapy and oral antibiotics
C) Intravenous fluids and antipyretics
D) Low-dose aspirin and corticosteroids
Answer: A) High-dose aspirin and intravenous immunoglobulin (IVIG)
Rationale: The standard treatment for Kawasaki disease includes high-dose aspirin to reduce inflammation and prevent coronary artery aneurysms, as well as IVIG to decrease the risk of coronary artery disease.
- A nurse is assessing a 3-year-old child who is scheduled to undergo a cleft palate repair. Which of the following preoperative interventions is most appropriate?
A) Administer a sedative 1 hour before surgery
B) Teach the child to use a cup for drinking
C) Teach the child to blow their nose effectively
D) Allow the child to suck on a pacifier to calm them
Answer: B) Teach the child to use a cup for drinking
Rationale: Children with a cleft palate repair are encouraged to drink from a cup before surgery because sucking (e.g., on a bottle or pacifier) will need to be avoided postoperatively to prevent damage to the surgical site.
- A 5-year-old child has been diagnosed with type 1 diabetes mellitus. Which of the following statements by the parent indicates understanding of insulin administration?
A) “I will give the insulin injection in the same site each time.”
B) “I will inject the insulin at a 90-degree angle in my child’s abdomen.”
C) “I will skip the insulin dose if my child doesn’t eat.”
D) “I will give the insulin injection after my child eats.”
Answer: B) “I will inject the insulin at a 90-degree angle in my child’s abdomen.”
Rationale: Insulin is administered at a 90-degree angle into subcutaneous tissue, commonly in the abdomen. Rotating injection sites is important to prevent lipodystrophy.
- A nurse is educating the parents of an infant with gastroesophageal reflux (GER). Which of the following strategies should the nurse recommend to decrease the infant’s symptoms?
A) Thicken feedings with rice cereal
B) Place the infant in a prone position after feeding
C) Decrease the frequency of feedings
D) Burp the infant after the entire feeding
Answer: A) Thicken feedings with rice cereal
Rationale: Thickening formula with rice cereal can help decrease the occurrence of reflux in infants by making the feedings heavier and less likely to regurgitate.
- A child is diagnosed with iron-deficiency anaemia. Which of the following interventions is most appropriate for the nurse to include in the plan of care?
A) Administer iron supplements with milk
B) Give iron supplements with orange juice
C) Limit the child’s intake of red meat
D) Encourage a high-calcium diet
Answer: B) Give iron supplements with orange juice
Rationale: Iron supplements are best absorbed when taken with vitamin C, such as orange juice. Calcium (found in milk) can inhibit the absorption of iron.
- A 7-year-old child is hospitalized with acute asthma exacerbation. Which of the following interventions should the nurse prioritize?
A) Administer intravenous fluids
B) Teach the child how to use a peak flow meter
C) Administer a nebulized bronchodilator
D) Place the child in a semi-prone position
Answer: C) Administer a nebulized bronchodilator
Rationale: During an acute asthma exacerbation, administering a bronchodilator (such as albuterol) is the priority intervention to relieve bronchospasm and improve airflow.
- A nurse is caring for an infant with a diagnosis of failure to thrive. Which of the following is the most appropriate nursing intervention?
A) Restrict caloric intake to avoid obesity
B) Provide feedings on a strict schedule
C) Use a high-calorie formula
D) Encourage prolonged breastfeeding
Answer: C) Use a high-calorie formula
Rationale: Infants with failure to thrive may require high-calorie formulas to ensure they receive adequate nutrition to promote weight gain and proper growth.
- A nurse is caring for a child with suspected leukaemia. Which of the following diagnostic tests is most definitive in confirming the diagnosis?
A) Complete blood count
B) Bone marrow aspiration
C) Chest x-ray
D) Lumbar puncture
Answer: B) Bone marrow aspiration
Rationale: A bone marrow aspiration is the most definitive test for diagnosing leukaemia as it allows examination of bone marrow cells for abnormal proliferation of leukemic cells.
- The nurse is caring for a child with asthma. The child is prescribed montelukast (Singulair). The nurse should instruct the parents that this medication is used for:
A) Immediate relief of wheezing
B) Long-term control of asthma symptoms
C) Treating acute asthma attacks
D) Replacing inhaled corticosteroids
Answer: B) Long-term control of asthma symptoms
Rationale: Montelukast is a leukotriene receptor antagonist used for long-term control of asthma symptoms and to prevent exacerbations, but it is not used for acute asthma attacks.
- A nurse is teaching the parents of a child with celiac disease about dietary restrictions. Which of the following foods should the child avoid?
A) Corn
B) Rice
C) Oats
D) Wheat
Answer: D) Wheat
Rationale: Children with celiac disease must avoid gluten-containing foods such as wheat, barley, and rye, as these trigger an immune response that damages the small intestine.
- A nurse is assessing an infant who has developmental dysplasia of the hip (DDH). Which of the following findings would the nurse expect to observe?
A) Symmetrical gluteal folds
B) Limited abduction of the affected hip
C) Positive Babinski reflex
D) Shortening of the unaffected leg
Answer: B) Limited abduction of the affected hip
Rationale: Developmental dysplasia of the hip is often characterized by limited abduction on the affected side, asymmetry in the gluteal folds, and apparent shortening of the affected leg.
- A nurse is providing postoperative care for a child who had a myringotomy with the insertion of tympanostomy tubes. Which of the following instructions should be included in the discharge teaching?
A) “The tubes will remain in place for life.”
B) “Avoid getting water in the child’s ears during bathing or swimming.”
C) “Administer oral antibiotics for 10 days.”
D) “If the tubes fall out, contact the healthcare provider immediately.”
Answer: B) “Avoid getting water in the child’s ears during bathing or swimming.”
Rationale: After the insertion of tympanostomy tubes, it is important to keep the child’s ears dry to prevent water from entering the middle ear and causing infection.
- A child has been brought to the emergency department after ingesting a large amount of acetaminophen (Tylenol). Which of the following medications should the nurse prepare to administer?
A) Activated charcoal
B) Naloxone (Narcan)
C) Acetylcysteine (Mucomyst)
D) Vitamin K
Answer: C) Acetylcysteine (Mucomyst)
Rationale: Acetylcysteine is the antidote for acetaminophen overdose and is administered to prevent liver damage.
- A nurse is caring for a child with suspected bacterial meningitis. Which of the following is the priority intervention?
A) Initiate seizure precautions
B) Administer antibiotics as prescribed
C) Restrict fluid intake
D) Perform passive range-of-motion exercises
Answer: B) Administer antibiotics as prescribed
Rationale: Bacterial meningitis requires prompt administration of antibiotics to prevent serious complications like brain damage or death. Seizure precautions may be necessary, but they are not the priority.
- A child is hospitalized with dehydration due to gastroenteritis. Which of the following assessments would indicate that rehydration therapy has been effective?
A) Decrease in heart rate
B) Dry mucous membranes
C) Capillary refill of 4 seconds
D) Weight loss since admission
Answer: A) Decrease in heart rate
Rationale: A decrease in heart rate is a sign that dehydration is improving, as tachycardia is often an early sign of dehydration in children. Moist mucous membranes and normal capillary refill are also positive indicators.
- A nurse is providing care for a 4-year-old child who has undergone a surgical repair for a ventricular septal defect (VSD). Which of the following assessments should the nurse prioritize postoperatively?
A) Neurological assessment
B) Blood pressure monitoring
C) Respiratory assessment
D) Pain assessment
Answer: C) Respiratory assessment
Rationale: Respiratory assessment is a priority in the postoperative period for a child with VSD repair because of the risk of pulmonary complications and the need to ensure adequate oxygenation.
- A nurse is assessing a 2-year-old child during a well-child visit. Which of the following milestones should the nurse expect the child to have achieved?
A) Riding a tricycle
B) Using 2-word sentences
C) Drawing a stick figure
D) Jumping rope
Answer: B) Using 2-word sentences
Rationale: By age 2, children typically use 2-word sentences, such as “want cookie.” Other milestones like riding a tricycle and drawing a stick figure come at later ages.
- A nurse is caring for a school-aged child with osteomyelitis. The nurse knows that osteomyelitis is an infection of the:
A) Bone
B) Joint
C) Muscle
D) Tendon
Answer: A) Bone
Rationale: Osteomyelitis is an infection of the bone, often caused by bacteria. It requires prompt antibiotic treatment to prevent serious complications like chronic bone damage.
- A 10-year-old child with asthma has been prescribed a corticosteroid inhaler for long-term management. Which of the following instructions should the nurse provide to the child and parents?
A) “Use the inhaler during an acute asthma attack.”
B) “Rinse your mouth after using the inhaler.”
C) “Administer the medication before using a bronchodilator.”
D) “Do not use the inhaler for more than 5 days.”
Answer: B) “Rinse your mouth after using the inhaler.”
Rationale: Rinsing the mouth after using a corticosteroid inhaler helps prevent oral fungal infections (thrush), a common side effect of inhaled corticosteroids.
- A nurse is teaching a group of parents about the prevention of sudden infant death syndrome (SIDS). Which of the following should the nurse include as a key preventive measure?
A) Place the infant on their stomach to sleep
B) Use thick blankets in the crib
C) Avoid using pacifiers during naps
D) Place the infant on their back to sleep
Answer: D) Place the infant on their back to sleep
Rationale: Placing infants on their backs to sleep significantly reduces the risk of SIDS. Other risk-reducing strategies include using a firm mattress and avoiding loose bedding.
- A nurse is teaching a parent about the treatment plan for their child who has been diagnosed with nephrotic syndrome. Which of the following statements should the nurse include?
A) “Your child will need to avoid all salt in their diet.”
B) “Steroid therapy will be used to reduce the swelling.”
C) “Your child should drink at least 8 glasses of water daily.”
D) “Nephrotic syndrome typically resolves without treatment.”
Answer: B) “Steroid therapy will be used to reduce the swelling.”
Rationale: Steroid therapy is the primary treatment for nephrotic syndrome to reduce inflammation, decrease protein loss in the urine, and improve kidney function.
- A nurse is assessing a 6-month-old infant. Which of the following should be reported to the healthcare provider as a possible developmental delay?
A) Unable to sit with support
B) Inability to roll from back to front
C) Inability to pick up small objects
D) Lack of stranger anxiety
Answer: B) Inability to roll from back to front
Rationale: By 6 months, an infant should be able to roll from back to front. Failure to achieve this milestone may indicate a developmental delay.
- A nurse is caring for a child with cystic fibrosis (CF). Which of the following interventions is most important to include in the child’s care plan?
A) Administer pancreatic enzymes with each meal
B) Restrict fluid intake to prevent pulmonary oedema
C) Provide a high-fibre diet to prevent constipation
D) Teach the parents to avoid giving high-calorie foods
Answer: A) Administer pancreatic enzymes with each meal
Rationale: Children with CF often have pancreatic insufficiency, so pancreatic enzymes must be taken with meals to aid digestion and promote proper nutrient absorption.
- A nurse is caring for a new-born with jaundice due to hyperbilirubinemia. Which of the following interventions should the nurse implement?
A) Offer water between feedings
B) Place the new-born under phototherapy lights
C) Withhold feedings until bilirubin levels decrease
D) Administer antibiotics
Answer: B) Place the new-born under phototherapy lights
Rationale: Phototherapy is the standard treatment for hyperbilirubinemia as it helps break down bilirubin in the skin, allowing it to be excreted by the body.
- A nurse is assessing a child with suspected pertussis (whooping cough). Which of the following symptoms is the nurse most likely to observe?
A) Severe, spasmodic cough followed by a whooping sound
B) Fever and a barking cough
C) Hoarseness and difficulty swallowing
D) Productive cough with thick green mucus
Answer: A) Severe, spasmodic cough followed by a whooping sound
Rationale: Pertussis is characterized by severe coughing fits followed by a “whooping” sound as the child breathes in. It is a highly contagious bacterial infection.
- A nurse is caring for an infant with tetralogy of Fallot. During a “tet spell” (hypercyanotic episode), what is the priority action?
A) Administer oxygen
B) Place the infant in the knee-chest position
C) Start intravenous fluids
D) Provide suction to clear secretions
Answer: B) Place the infant in the knee-chest position
Rationale: The knee-chest position helps increase systemic vascular resistance, which reduces the right-to-left shunting of blood in tetralogy of Fallot, improving oxygenation during a tet spell.
- A nurse is assessing an infant with Hirschsprung disease. Which of the following findings is most characteristic of this condition?
A) Projectile vomiting
B) Chronic diarrhoea
C) Ribbon-like stools
D) Frequent urination
Answer: C) Ribbon-like stools
Rationale: Hirschsprung disease is caused by a lack of nerve cells in the colon, leading to a blockage. This results in ribbon-like stools due to the narrowed intestinal passage.
- A child with Down syndrome is brought to the clinic for a check-up. Which of the following health problems is this child most at risk for?
A) Vision and hearing impairments
B) Diabetes mellitus
C) Rheumatic fever
D) Anaemia
Answer: A) Vision and hearing impairments
Rationale: Children with Down syndrome are at increased risk for several health issues, including vision and hearing impairments, due to anatomical and developmental differences.
- A nurse is caring for a child diagnosed with Henoch-Schönlein purpura (HSP). Which of the following complications should the nurse monitor for?
A) Nephrotic syndrome
B) Hemarthrosis
C) Gastrointestinal bleeding
D) Polycythaemia
Answer: C) Gastrointestinal bleeding
Rationale: HSP is a vasculitis that affects small blood vessels and can lead to complications such as gastrointestinal bleeding and nephritis.
- A nurse is teaching the parents of a child with eczema (atopic dermatitis) about skin care. Which of the following instructions should the nurse include?
A) “Bathe your child daily using hot water and mild soap.”
B) “Keep your child’s skin moisturized with emollient creams.”
C) “Avoid using any moisturizers on your child’s skin.”
D) “Apply topical antibiotics to all areas of rash.”
Answer: B) “Keep your child’s skin moisturized with emollient creams.”
Rationale: Keeping the skin moisturized with emollient creams helps to maintain skin hydration and reduce flare-ups of eczema.
- A child is brought to the emergency department with suspected intussusception. Which of the following findings is most consistent with this diagnosis?
A) Hard, rigid abdomen with no bowel sounds
B) Bright red blood in the stool
C) Currant jelly-like stools and abdominal pain
D) Painless abdominal distention
Answer: C) Currant jelly-like stools and abdominal pain
Rationale: Intussusception is a medical emergency where part of the intestine telescopes into itself. It is typically associated with severe abdominal pain and “currant jelly” stools, which contain blood and mucus.
- A nurse is preparing to administer an immunization to a 2-month-old infant. Which of the following vaccines is appropriate for this age?
A) MMR (measles, mumps, rubella)
B) Hepatitis B
C) Varicella
D) HPV (human papillomavirus)
Answer: B) Hepatitis B
Rationale: The Hepatitis B vaccine is part of the routine immunization schedule and is typically administered shortly after birth and at 1-2 months and 6 months of age. MMR, varicella, and HPV are given at older ages.
- A nurse is providing discharge teaching to the parents of a child who has undergone surgical repair for hypospadias. Which of the following instructions should the nurse include?
A) “Your child can resume normal bathing immediately.”
B) “Encourage your child to engage in contact sports.”
C) “Avoid tub baths until the stent is removed.”
D) “The catheter should be removed if your child has pain.”
Answer: C) “Avoid tub baths until the stent is removed.”
Rationale: After hypospadias repair, tub baths should be avoided until the stent or catheter is removed to prevent infection and irritation at the surgical site.
- A nurse is assessing a toddler with suspected otitis media. Which of the following symptoms is most commonly associated with this condition?
A) Excessive earwax
B) Tugging at the ear
C) Clear drainage from the ear
D) Swollen lymph nodes behind the ear
Answer: B) Tugging at the ear
Rationale: Ear tugging, irritability, and fever are common signs of otitis media (middle ear infection) in toddlers, indicating discomfort in the ear.
- A nurse is caring for a child with sickle cell anaemia who is experiencing a vaso-occlusive crisis. Which of the following interventions should the nurse prioritize?
A) Restrict fluid intake
B) Apply cold compresses to painful areas
C) Administer oxygen to maintain oxygen saturation
D) Administer intravenous fluids and pain medications
Answer: D) Administer intravenous fluids and pain medications
Rationale: Hydration and pain management are the primary treatments for a vaso-occlusive crisis in sickle cell anaemia. Adequate hydration helps reduce the sickling of red blood cells, while pain medication alleviates discomfort.
- A nurse is teaching the parents of an infant about home care following a pyloromyotomy for pyloric stenosis. Which of the following instructions should the nurse include?
A) “Your child may return to normal feedings right after surgery.”
B) “Call the doctor if your child has projectile vomiting.”
C) “Avoid giving your child solid foods for 2 months.”
D) “Place your child in the prone position after feedings.”
Answer: B) “Call the doctor if your child has projectile vomiting.”
Rationale: Postoperative vomiting can occur after a pyloromyotomy, but projectile vomiting may indicate a complication, and the healthcare provider should be notified.
- A nurse is caring for a child with bronchiolitis caused by respiratory syncytial virus (RSV). Which of the following interventions should the nurse implement?
A) Administer antibiotics
B) Provide frequent nasal suctioning
C) Restrict fluid intake
D) Place the child in isolation for 48 hours
Answer: B) Provide frequent nasal suctioning
Rationale: Frequent nasal suctioning is important to maintain airway patency in children with RSV. Antibiotics are not effective for viral infections like RSV, and isolation should be maintained for as long as the child is infectious.
- A nurse is caring for a child with a diagnosis of acute glomerulonephritis. Which of the following clinical manifestations should the nurse expect?
A) Hyperactivity and increased urination
B) Oedema and haematuria
C) Jaundice and diarrhoea
D) Petechiae and fever
Answer: B) Oedema and haematuria
Rationale: Acute glomerulonephritis often presents with symptoms of fluid retention (oedema), hypertension, and haematuria (blood in the urine) due to inflammation of the glomeruli in the kidneys.
- A nurse is teaching the parents of a child who has juvenile idiopathic arthritis (JIA). Which of the following statements should the nurse include?
A) “Your child should avoid all physical activity to prevent joint damage.”
B) “Administer nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed.”
C) “Your child should only be active during symptom-free periods.”
D) “Apply heat to painful joints before exercise.”
Answer: B) “Administer nonsteroidal anti-inflammatory drugs (NSAIDs) as prescribed.”
Rationale: NSAIDs are often prescribed to reduce inflammation and manage pain in children with JIA. Physical activity, including range-of-motion exercises, is encouraged to maintain joint function.
- A nurse is providing care to an infant with spina bifida. Which of the following interventions is most important for the nurse to implement before surgery?
A) Keep the infant in a prone position
B) Apply lotion to the sac to prevent dryness
C) Cover the sac with a dry, sterile dressing
D) Place the infant on their back for feeding
Answer: A) Keep the infant in a prone position
Rationale: Before surgical repair of spina bifida, the infant should be placed in the prone position to prevent trauma to the exposed spinal cord and sac. The sac should be covered with a moist, sterile dressing to prevent infection.
- A nurse is providing care to an infant with spinal bifida. Which of the following interventions is most important for the nurse to implement before surgery?
A) Keep the infant in a prone position
B) Apply lotion to the sac to prevent dryness
C) Cover the sac with a dry, sterile dressing
D) Place the infant on their back for feeding
Answer: A) Keep the infant in a prone position
Rationale: Before surgical repair of spinal bifida, the infant should be placed in the prone position to prevent trauma to the exposed spinal cord and sac. The sac should be covered with a moist, sterile dressing to prevent infection.
