Kaplan Pediatrics B Exam 2024
The nurse cares for the clients i the pediatric clinic. The nurse should investigate which child for a
possible speech impairment? – correct answer✔✔ A 5 year old who uses single words
The nurse counsels the parent of a 12 year old diagnosed with chickenpox about when the child can
return to school. The nurse determines that teaching is effective if the parent makes which statement? –
correct answer✔✔ My child can return to school when the lesions are crusted
The nurse anticipates that the child with a diagnosis of idiopathic hypothyroidism will be given which
hormone? – correct answer✔✔ growth hormone
The nurse knows which signs and symptoms of rubeola are exhibited before the appearance of the rash
- correct answer✔✔ Runny nose, sneezing, and coughing
When assessing the 9 month old child, the nurse expects which reflex to be present? – correct
answer✔✔ Babinski’s
The nurse is asked to explain the major difference between a clubfoot and a positional deformity to a
student nurse. Which statement, if made by the nurse is appropriate? – correct answer✔✔ A clubfoot is
corrected with surgery and casting, but a positional deformity can be passively corrected.
the 18 month old toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory
infection. The nurse should expect to see which characteristic feature of cystic fibrosis? – correct
answer✔✔ An altered viscosity of mucus
The 5 month old infant is brought to the clinic by a parent for a well- baby check up. The nurse expects
to make which observation? – correct answer✔✔ The infant puts their feet to their mouth when lying
supine
The nurse at the health department provides care for a 16- year-old client. The client is accompanied by another adolescent the client identified as a friend. The client is concerned about a foul-smelling vagin*l discharge which has been occurring for the past several days. The client has also been experiencing some pain during urination. The client denies any fever and denies any abdominal pain, flank pain, urinary urgency, or urinary frequency. Vital signs are stable. Client is afebrile. When questioned, the client admits to being sexually active for the past several months with three different partners. The client states, “My parents are very strict. They would kill me if they knew.” Client does not use oral contraceptives, and states that a condom has only been used a few times during sexual activity. The client’s menstrual periods are regular; the last menstrual period was 18 days ago.
Foul-Smelling vagin*l discharge, experiencing some pain during urination, admits to being sexually active, three different partners, My parents are very strict. They would kill me if they knew, client does not use oral contraceptives, a condom has only been used a few times during sexual activity. Rational: Foul-smelling vagin*l discharge is a symptom that is concerning for vagin*l infection. Painful urination can indicate a urinary tract infection (UTI), but without any other symptoms of UTI, can also be a symptom of a sexually transmitted infection (STI). The client is sexually active with various partners and is not consistently using any form of contraception. These behaviors increase the risk of STI and pregnancy. The nurse needs to explore the client’s relationship with the parents, and how the client feels they would react to the client being sexually active.
Case Study: Complete the following sentences by choosing from the list of options
The nurse is most concerned the client has developed a sexually transmitted infection STI. The client is also at high risk for an unintended pregnancy. The nurse will praise the client for seeking help. Rational:Adolescents who engage in risky behaviors, such as unprotected sex, are at high risk for STI and unintended pregnancy. It is very important for the nurse to encourage the client to seek treatment and guidance for sexual activity. The client’s symptoms are more suggestive of vagin*l infection than UTI or latex allergy. Depression and school difficulties are possible concerns for a teenage client, however, there is not enough information presented to determine the client is at risk for either of these issues. The client’s behavior places the client at highest risk for unintended pregnancy. The nurse in the health department does not need to notify the parents of a 16-year-old adolescent seeking medical help. The client is seeking assistance for a medical issue. The priority is not potential issues the client may or may not be having in school.
Case Study: Which is the priority action for the nurse to take
Assist in obtaining vagin*l swabs for chlamydia and gonorrhea. Rational:The priority for this adolescent client will be to determine if there is infection and, if so, the type of infection present so appropriate treatment can be initiated. At this point, there is no need for the client to present a list of sexual partners. If the client is positive for STI, the client will need to inform all sexual partners of potential infection and need for treatment. Appropriate hygiene when toileting can decrease the incidence of UTI, but is not a priority for the nurse to discuss at this time. A discussion about condom use will also be important, but can occur after determination of infection is made.
Case Study: In planning care for the adolescent client, the nurse knows which 3 additional tests will be included during the visit
Pregnancy test, Human immunodeficiency virus (HIV) antigen test, Papanicolaou (Pap) test. Rational: The adolescent having unprotected sex is at high risk for STI, HIV, and human papillomavirus (HPV) which can be detected with a Pap smear. Results of those test have a direct impact on the clients continuing plan of care.
Case Study: The nurse at the health department provides care for a 16- year-old client. Physician’s Order: Doxycycline 100 mg tablets. Take one tablet by mouth twice daily for 7 days The client’s chlamydia swab is positive and the nurse reviews the physician’s order. Which statement is important for the nurse to make during discharge teaching (Select all that apply.)
“It is extremely important for you to use condoms every time you have sexual intercourse.”,Having sex with multiple partners increases your risk of getting a sexually transmitted disease.” It is necessary to avoid all sexual activity until after you have all of this medication.” Rational: The nurse needs to emphasize the importance of taking precautions to avoid future STIs. The client needs to use a condom every time the client engages in sexual activity. The client also needs to be aware that having sex with multiple partners increases the risk of STI. Avoiding all sexual activity while being treated for chlamydia is important to avoid further spread of infection.
Cast Study: The client returns to the health department to obtain results of the HIV antibody test, which is negative. The client asks to speak with the nurse. For each client statement below, click to specify whether the statement indicates the client understands the information provided at the previous visit or if the client needs further instruction
Client Statement Understands “My partner doesn’t like using a condom, but I make sure we use one every time.” “I am wearing sunscreen and I need to stay out of the sun while taking the medicine. – Further Teaching needed for “I Know that when I am having my period I can’t get pregnant.” “I told my last partner about getting tested for chlamydia, but I dont need to tell the other two.” Rational: The client is indicating understanding by correctly stating that condom use must be consistent to be effective. The client is also accurately describing the necessary actions needed while taking doxycycline for the chlamydia infection.
A toddler diagnosed with cystic fibrosis is admitted to the hospital with a respiratory infection. The nurse expects to see which characteristic feature of cystic fibrosis
Increased viscosity of mucus. Rational:Cystic fibrosis is an autosomal recessive trait with generalized involvement of the exocrine glands, resulting in altered viscosity of mucus-secreting glands. Mucus becomes thick and tenacious.
The nurse teaches about early signs and symptoms of rubeola that may appear before the notable rash. Which are included in the instructions
Runny nose, sneezing, and coughing Rational:The client will likely exhibit respiratory symptoms such as runny nose, sneezing, and coughing before the rash appears. Rubeola is communicable during the prodromal phase. The client should be isolated until the fifth day after the rash appears, and should maintain bedrest during the first 3-4 days.
A preschool age client is diagnosed with idiopathic hypopituitarism. Which hormone is most commonly prescribed for a preschool client diagnosed with idiopathic hypopituitarism
Growth hormone. Rational:The most common hormone affected in children with hypopituitarism is growth hormone. Growth hormone promotes growth of bone and soft tissues, affects linear growth, and conserves carbohydrate utilization.
The office nurse receives a phone call from a parent of an infant client who received the DTaP vaccine 3 days ago. The nurse is most concerned if the parent makes which statement
“My baby is crying continuously Rational: High pitched, continuous crying is a serious adverse effect of the DTaP vaccine. Other serious adverse effects include convulsions, high fever, and loss of consciousness.”
The nurse provides care for an infant client diagnosed with a cyanotic congenital heart defect. The nurse understands that chronic hypoxia from this disorder can result in which finding
Polycythemia. Rational: In chronic hypoxia, the body tries to compensate by producing more red blood cells (polycythemia) to carry the limited amount of oxygen available to the tissues.
A parent of a preschool-aged client diagnosed with frequent acute otitis media asks the nurse why this keeps happening to the child. The nurse’s explanation is based on which is the correct information
Children have shorter eustachian tubes than adults Rational: The eustachian tubes of children are shorter, wider, and straighter than those of adults. The organism causing the infection travels from the pharynx via the eustachian tube to the middle ear.
The nurse instructs a parent about the appropriate way to instill ear drops in the right ear of a toddler client. The nurse determines teaching is effective if the parent makes which statement
“I should pull my child’s ear down and back.”Rational: In children younger than 3 years of age, the nurse would straighten the ear canal by pulling the pinna down and straight back. In children older than 3 years of age, the nurse should pull the pinna up and back.
A parent of a preschool-aged client calls the clinic to report that the child has been exposed to chickenpox. The nurse informs the parent the incubation period for chickenpox is which length of time
2-3 weeks. Rational: The incubation period for varicella zoster is about 10-21 days, approximately 2-3 weeks. Chickenpox is spread by direct contact, droplet, and via contaminated objects. A person with chickenpox is contagious beginning 1 to 2 days before rash onset until all the chickenpox lesions have crusted. Vaccinated people who get chickenpox may develop lesions that do not crust. Those individuals are considered contagious until no new lesions have appeared for 24 hours.”
When assessing the 9-month-old client, the nurse expects which reflex to be present
Babinski Rational: Babinski reflex disappears at 12 months to two years; stroking the outer sole of the foot upward from the heel across the ball of the foot causes the big toe to dorsiflex and the toes to hyperextend.”
The nurse prepares discharge teaching for parents of a toddler diagnosed with non-organic failure to thrive (NFTT). Which suggestion by the nurse is most appropriate to include about mealtimes with the parents
Develop a structured routine for all activities. Rational:Children respond better if activities of daily living are structured. An unstructured lifestyle will be reflected in the child’s unwillingness to eat. Bathing, dressing, playing, sleeping, and eating should occur in a structured routine.
The nurse is caring for several child clients. The nurse recognizes which child client is at greatest risk for ingesting a poison
A 2-year-old. Rational :A 2-year-old child is very curious and likes to explore. The toddler does not have the judgment necessary to avoid dangerous substances. A toddler is at the highest risk for poisoning.A 5-year-old child is more likely to be educated to leave dangerous liquids alone. This child is at a lower risk to ingest a poison.A 7-year-old child is educated about the hazards of dangerous liquids. This child is at low risk to ingest a poison.”
During a visit, the home care nurse observes a pre-school age client sitting near a fireplace. The client’s clothing catches fire and covers the client in flames. Which action does the nurse take first
Push the client to the ground and make the client roll. Rational: The nurse will smother the flames, and not let the child run because it will fan the flames. A pre-school age child can be taught to stop, drop, and roll in the event of fire. Another person can pull the child to the ground and roll the child until the flames are smothered.
Which immunizations does the nurse administer to an adolescent client who has never been immunized
Tdap, MMR, and polio. Rational:The tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine is given to persons after the age of 6 years. Nursing responsibilities include teaching the client/parent to observe for severe reactions of extremely high temperature and redness at the injection site. Fever may occur within 24-48 hours. Vaccine given intramuscularly (IM). The IPV (inactivated polio) vaccine is given at ages 2 months, 4 months, 18 months, and 4-6 years and reactions are very rare.”
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