Child Evolve Exam

Pediatric Evolve Test
1. A childs mother tells the nurse that during a seizure the child has a blank expression and exhibits eyelid fluttering lasting
just 5 to 10 seconds. The nurse determines that the child is experiencing:
A. Atonic seizures
B. Absence seizures Correct
C. Myoclonic seizures
D. Tonic-clonic seizures
Rationale: Absence seizures, formerly called petit mal seizures, are characterized by brief episodes of altered
consciousness. There is no muscle activity except for eyelid fluttering, twitching, or head bobbing, and the child has a blank
expression. Absence seizures last only 5 to 10 seconds but may occur one after another, several times a day. Atonic
seizures are marked by an abrupt loss of postural tone, impairment of consciousness, confusion, lethargy, and sleep.
Myoclonic seizures are brief, random contractions of a muscle group that may occur on both sides of the body and may
occur singly or in clusters. Tonic-clonic seizures, formerly called grand mal seizures, consist of a tonic phase (a sustained,
generalized stiffening of muscles lasting a few seconds) and a clonic phase (symmetric and rhythmic, consisting of
alternating contraction and relaxation of major muscle groups).

Test-Taking Strategy: Use the process of elimination and focus on the data in the question. Recalling the characteristics of
the various types of seizures will direct you to the correct option. Also note the relationship of the words blank expression
in the question and the correct option. Review the various types of seizures if you had difficulty with this question.
2. The nurse is caring for a 3-year-old with leukemia. The child is not eating and is losing weight as a result of nausea and
mucositis stemming from the chemotherapy. Which interventions are appropriate? Select all that apply.
A. Providing small, frequent high-protein foods Correct
B. Administering oral viscous lidocaine before meals
C. Having the parents bring in the childs favorite foods
D. Providing cool liquids and soft foods at room temperature Correct
E. Applying a solution of Benadryl (diphenhydramine) and Maalox as prescribed to the mouth Correct
Rationale: High-protein, high-calorie foods should be given to the child. Protein promotes tissue healing, and calories are
needed for growth. Small, frequent meals are easier for a child to handle. Viscous lidocaine is not recommended for young
children, because it may depress the gag reflex and increase the risk of aspiration. Local anesthetics without alcohol, such
as a solution of diphenhydramine (Benadryl) and Maalox, may be recommended. Favorite foods should not be given to a
child who is nauseated, because the child will associate these foods with being sick. Cool liquids are soothing and reduce
the risk of burning fragile mucosa. Soft foods are gentler on inflamed mucosa.

Test-Taking Strategy: Note that the child is experiencing nausea and mucositis. Read each option carefully and think about
the effect of the intervention on the clients problems. This will help you answer correctly. Review the interventions for a
child with nausea and mucositis if you had difficulty with this question.
3. The nurse assesses a child with suspected meningitis for the presence of the Kernig sign. Which finding is the Kernig sign?
A. Calf pain on dorsiflexion of the foot
B. Pain with extension of the leg and knee Correct
C. Flexion of the hips and knees when the head is flexed
D. Calf pain when the calf muscle is squeezed against the tibia
Rationale: The Kernig sign is pain that occurs with extension of the leg and knee. The Brudzinski sign is flexion of the hips
and knees when the head is flexed. Both the Kernig and Brudzinski signs are noted in meningitis. Calf pain that occurs with
dorsiflexion of the foot or when the calf muscle is squeezed against the tibia are not manifestations of meningitis.

Test-Taking Strategy: Use the process of elimination. Eliminate first the options that are comparable or alike and relate to
calf pain. From the remaining options it is necessary to know the characteristics of the Kernig sign. Remember that the
Kernig sign is present if pain occurs with extension of the leg and knee. Review the characteristics of both the Kernig and
Brudzinski signs if you had difficulty with this question.
4. A nurse provides information to new parents about measures to reduce the risk of sudden infant death syndrome (SIDS).
The nurse tells the parents to:
A. Obtain a soft crib mattress and soft bedding
B. Place the infant in a supine position for sleep Correct
C. Place the infant in a face-down position for sleep
D. Be sure that the infant sleeps in a crib in the parents room until the age of 12 months
Rationale: As a means of reducing the risk of SIDS, the infant should be positioned on his or her back rather than in the
prone (face-down) position to sleep. The use of soft bedding is also a risk factor. Infants may suffocate by rebreathing
carbon dioxideladen expired air when sleeping face down on soft bedding. SIDS occurs most frequently between the
second and fourth months of life, with most of cases occurring before the age of 2 to 3 months.

Test-Taking Strategy: Use the process of elimination. Think about the risk factors associated with SIDS and visualize each
of the options. This will direct you to the correct option. Review the risk factors associated with SIDS if you had difficulty with
this question.
5. A lumbar puncture is performed on a child with suspected bacterial meningitis, and the cerebrospinal fluid (CSF) obtained
for analysis. The nurse determines that the diagnosis is confirmed if which findings are noted?
A. Cloudy CSF Correct
B. High glucose level
C. Decreased CSF pressure
D. Low protein concentration
Rationale: The diagnosis of meningitis is made by testing CSF obtained by lumbar puncture. Findings usually include cloudy
CSF (in the case of bacterial meningitis), a low glucose level, increased CSF pressure, and a high protein concentration.

Test-Taking Strategy: Use the process of elimination and focus on the suspected diagnosis, bacterial meningitis. Recalling
that CSF is normally clear will direct you to the correct option. Review findings in bacterial meningitis if you had difficulty with
this question.
6. A nurse provides home care instructions to the mother of a child with pediculosis capitis (head lice). Which statement by the
mother indicates a need for further instruction?
A. I need to wash her clothes and bedding in hot water and dry them on a hot setting.
B. I need to use an antilice spray on her and on anything that shes been in contact with. Correct
C. I need to boil or soak her combs and brushes in antilice shampoo or hot water for at least 10 minutes.
D. I can get the lice and nits off her eyelashes by applying petrolatum to the eyelashes twice a day for 8 days.
Rationale: Antilice sprays should be used on furniture and other environmental objects but are never used on a child. Also,
floors, play areas, and furniture should be vacuumed to remove any hairs carrying live nits. The childs clothing and bedding
should be washed in hot water and dried on a hot setting. Items that cannot be washed should be dry cleaned or sealed in
plastic bags and kept in a warm place for 2 to 3 weeks. Combs and brushes must be boiled or soaked in antilice shampoo
or hot water for at least 10 minutes. Lice and nits may be removed from the childs eyelashes with the application of
petrolatum to the eyelashes twice a day for 8 days.

Test-Taking Strategy: Use the process of elimination and note the strategic words need for further instruction, which
indicate a negative event query and the need to select the incorrect statement. Recall that antilice sprays should never be
sprayed on the child. This will direct you to the correct option. Review home care instructions for the child with lice if you
had difficulty with this question.
7. A physician prescribes oral amoxicillin (Amoxil) 60 mg 3 times daily for a child who weighs 12.5 lb. The safe pediatric
dosage is 20 to 40 mg/kg/day in 3 equal doses. The medication label reads, "Amoxicillin 125 mg/5 mL." How many milliliters
will the nurse administer per dose?
Correct Responses: "2.4"
8. The mother of a child admitted to the hospital with Kawasaki disease asks the nurse about the disease. The nurse responds
that it is:
A. A common communicable disease
B. Caused by exposure to an individual with rheumatic fever
C. A disease that affects the smooth muscle cells of the vascular walls Correct
D. A disease that most often occurs in the summer after swimming in a lake
Rationale: Kawasaki disease, also called mucocutaneous lymph node syndrome, is an acute febrile exanthematous illness
of children with a generalized vasculitis of unknown origin. A generalized immune response affects the smooth muscle cells
of the vascular walls. It is not a communicable disease and is not caused by exposure to an individual with rheumatic fever.
Kawasaki disease is diagnosed most often in late winter and early spring. It is not associated with swimming.

Test-Taking Strategy: Knowledge regarding the characteristics of Kawasaki disease is required to answer this question.
Eliminate the options that are comparable or alike in that they indicate that Kawasaki disease is communicable. To select
from the remaining options it is necessary to know that the disease affects the smooth muscle cells of the vascular walls. If
you are unfamiliar with this disorder, review this content.
9. A nurse provides instructions on the administration of oral iron to the mother of a child with iron-deficiency anemia. The
nurse determines that the mother understands the instructions if the mother states that she will administer the iron with:
A. Milk
B. Cereal
C. Formula
D. Orange juice Correct
Rationale: Oral iron is administered with a vitamin Crich food to aid its absorption. Milk, cereal, and formula are avoided
with the administration of iron because these foods may impede absorption.

Test-Taking Strategy: Use the process of elimination. Recalling that vitamin C aids in the absorption of iron will direct you to
the correct option. Review the procedure for administering iron if you had difficulty with this question.
10. A nurse is preparing a child admitted from the emergency department with a diagnosis of acute appendicitis for an
appendectomy, to be performed in an hour. The child tells the nurse that the acute abdominal pain has suddenly subsided.
The priority nursing intervention is to:
A. Contact the physician Correct
B. Document the findings
C. Tell the parents that the pain was probably a result of gastroenteritis
D. Inform the operating room that the surgery will probably be canceled
Rationale: In appendicitis, sudden relief of pain may indicate that the appendix has ruptured. The temporary relief from pain
is followed by an increase in pain, a rigid abdomen, and early shock symptoms. If a ruptured appendix is suspected, the
nurse must immediately contact the physician. The nurse would document the findings but would contact the physician first,
because a ruptured appendix is an emergency. The surgery will not be canceled. This manifestation is not a result of
gastroenteritis.

Test-Taking Strategy: Use the process of elimination, note the strategic word priority, and focus on the data in the
question. Recalling that rupture is a concern in a child with acute appendicitis and recalling the manifestations of
appendiceal rupture will direct you to the correct option. Review the complications of acute appendicitis if you had difficulty
with this question.
11. A nurse is monitoring a child for complications after spinal fusion for scoliosis. The nurse suspects the presence of superior
mesenteric artery syndrome if the child:
A. Becomes lethargic
B. Complains of pain
C. Complains of a headache and has a fever
D. Vomits and exhibits abdominal distension Correct
Rationale: One complication of the surgical treatment of scoliosis is superior mesenteric artery syndrome, the result of
mechanical changes in the position of the clients abdominal contents caused by lengthening of the body. It results in a
syndrome of emesis and abdominal distention. Therefore postoperative vomiting warrants attention. Lethargy and headache
with fever are not symptoms of superior mesenteric artery syndrome. The nurse would need more information about the
clients pain to determine whether it is the result of superior mesenteric artery syndrome. Additionally, pain is expected in
the postoperative period.

Test-Taking Strategy: Use the process of elimination and focus on the subject, superior mesenteric artery syndrome.
Recalling the location of the superior mesenteric artery (peritoneum) will direct you to the correct option. Review this
complication of the surgical treatment of scoliosis if you had difficulty with this question.
12. A nurse provides instructions to the parents of an infant with bronchopulmonary dysplasia about the safe use of oxygen at
home. Which statement by a parent indicates a need for further instruction?
A. We need to keep the oxygen tank upright.
B. We should have a fire extinguisher close at hand.
C. We can put petroleum jelly on her lips to relieve the dryness. Correct
D. We need to keep the oxygen tank at least 5 feet from electrical devices.
Rationale: If oxygen is being used at home, the parents are instructed to avoid using alcohol-based substances or oil, which
are flammable and increase the risk for fire, around the infants mouth. Products that should be avoided include petroleum
jelly, vitamin A and D ointment, and baby oil. The remaining statements reflect correct use of oxygen at home.

indicate a negative event query and the need to select the incorrect statement. Focusing on the subject, the safe use of
oxygen, and recalling that oxygen is flammable will direct you to the correct option. Review these home care instructions if
you had difficulty with this question.
13. Intravenous potassium chloride in 0.9% sodium chloride solution has been prescribed for a child who is severely
dehydrated. Before administering the solution, the nurse must:
A. Check urine output Correct
B. Evaluate skin turgor
C. Measure capillary refill
D. Obtain the childs blood pressure
Rationale: Potassium chloride is not administered if the urine output is not adequate. If the child is anuric, potassium will be
retained, causing an increased potassium level. Although skin turgor, capillary refill, and blood pressure may be checked,
they are not essential assessments in this situation.

Test-Taking Strategy: Use the process of elimination and note the strategic word must. Eliminate the options that refer to
clinical signs of dehydration skin turgor and capillary refill. Focus on what the question is asking about the administration
of a particular solution. Review nursing interventions in the administration of IV potassium chloride if you had difficulty with
this question.
14. A nurse provides home care instructions to the parents of a child with acute spasmodic croup. The nurse should tell the
parents that if stridor at rest occurs, they should:
A. Administer an analgesic
B. Take the child to the emergency department Correct
C. Place a cool-mist humidifier in the childs room
D. Provide mist from steam produced by hot running water in a closed bathroom
Rationale: Children who experience stridor at rest, cyanosis, severe agitation or fatigue, or moderate to severe retractions
and children who are unable to take oral fluids should be seen in the emergency department, because these manifestations
may indicate airway obstruction. An analgesic will not alleviate the stridor. Although a cool-mist humidifier and steam
produced by hot running water are measures used to treat acute spasmodic croup, they are not useful in this situation,
which involves stridor, indicating airway obstruction and representing a medical emergency.

Test-Taking Strategy: Use the process of elimination. Recalling that stridor is an indication of airway obstruction will direct
you to the correct option. Review the complications associated with acute spasmodic croup if you had difficulty with this
question.
15. Hydrostatic reduction is performed in a hospitalized child with a diagnosis of intussusception. Which outcome indicates that
the procedure was successful?
A. Passage of barium in the stool
B. Passage of stool without blood Correct
C. Visible peristalsis across the abdomen
D. Presence of a sausage-shaped abdominal mass
Rationale: Intussusception is an invagination of a section of the intestines into the distal bowel that results in bowel
obstruction. In children, this condition most often occurs as a section of the terminal ileum telescopes into the ascending
colon through the ileocecal valve. The goal of treatment is to restore the bowel to its normal position and function as quickly
as possible. In children who do not show symptoms of shock or sepsis, attempts at hydrostatic reduction are made with the
use of a barium or air enema until a free flow of barium into the terminal ileum is evident. The passage of stool without blood
is a successful outcome. The nurse watches for the passage of barium after this procedure, but it does not indicate a
successful procedure. Visible peristalsis across the abdomen is a manifestation of Hirschprungs disease. Presence of a
sausage-shaped abdominal mass is a sign of intussusception.

Test-Taking Strategy: Use the process of elimination and note the words successful outcome. Recalling the signs of
intussusception and the purpose of hydrostatic reduction will direct you to the correct option. Review this procedure if you
16. A child is admitted to the hospital with suspected infective endocarditis. List in order of priority how the nurse will carry out
the physicians prescriptions for the child, with 1 being the first prescription to be carried out and 4 the last.
The correct order is:
1. Obtaining blood for cultures
2. Starting an IV line
3. Administering intravenous (IV) antibiotics
4. Scheduling an echocardiogram
Rationale: The diagnosis of infective endocarditis is established primarily on the basis of blood cultures that yield the
causative organism. The nurse would prepare to obtain blood cultures first so that the diagnosis could be confirmed. An IV
line would then be initiated and the antibiotics started. The echocardiogram should be scheduled once the antibiotics have
been started. The visualization of a vegetation (an abnormal growth of infected tissue) on echocardiographic studies helps
establish the diagnosis.

Test-Taking Strategy: Note that the client has suspected infective endocarditis. Therefore the diagnosis needs to be
confirmed. The only way to confirm the diagnosis is blood culture. Use your knowledge of general medication guidelines to
determine that antibiotics are not initiated until cultures have been performed. Also note that IV antibiotics cannot be started
until an IV line has been inserted. Recalling these facts should help you determine the correct order of action. Review the
therapeutic management of the child with suspected infective endocarditis if you had difficulty with this question.
17. A nurse is providing instructions on the use of a metered-dose inhaler (MDI) to an adolescent with asthma. Which
statements by the adolescent indicates an understanding of the instructions?Select all that apply.
. I need to shake the inhaler well before I use it. Correct
A. I really need to use the spacer when I inhale the corticosteroid. Correct
B. After I breathe the medication in, I should hold my breath for 1 or 2 seconds.
C. I have to put my lips tightly around the mouthpiece, press down on the inhaler, and breathe in
slowly. Correct
D. The doctor has prescribed two inhalations, so I need to breathe in the second inhalation immediately after
the first.
Rationale: If the physician has prescribed two inhalations, the nurse teaches the adolescent to wait at least 2 minutes after
the first inhalation before taking the second. The adolescent is also taught to shake the inhaler before repeating the dose.
The client should hold his or her breath for as long as possible, at least 5 to10 seconds, to allow the medicine to penetrate
deep into the lungs. A spacer must be utilized with the MDI when corticosteroids are being inhaled to prevent yeast infection
of the mouth.

Test-Taking Strategy: Use the process of elimination and note the strategic words understands the instructions. Visualize
each option and think about the purpose and use of this device. This will direct you to the correct option. Review the use of
this device if you had difficulty with this question.
18. A pediatric community health nurse is conducting a screening program to identify children at risk for a hematologic disorder.
The nurse determines that the child at most risk for beta-thalassemia is the child:
. Of Mediterranean descent Correct
A. Whose dietary intake of iron is poor
B. Who has a known factor VIII deficiency
C. Whose parent is known to have abnormal hemoglobin S (HbS)
Rationale: The thalassemias are a group of inherited disorders characterized by an abnormality in hemoglobin synthesis
that results from a reduction in or absence of one of the chains found in normal hemoglobin. They are primarily found
among people of Mediterranean descent. Beta-thalassemia, also known as thalassemia major or Cooleys anemia, is the
most common and severe form of thalassemia. Poor dietary intake of iron is associated with iron-deficiency anemia. Factor
VIII deficiency is associated with hemophilia. An abnormal HbS trait is associated with sickle cell disease.

Test-Taking Strategy: Use the process of elimination and knowledge regarding the various types of anemias to assist in
directing you to the correct option. Remember that the thalassemias are primarily found in people of Mediterranean descent.
Review the characteristics of beta- thalassemia if you had difficulty with this question.
19. A nurse is preparing to administer digoxin (Lanoxin) to an infant. The nurse notes that the infants heart rate is 110
beats/min. The appropriate response on the part of the nurse is to:
. Contact the healthcare provider
A. Administer the prescribed dose Correct
B. Obtain a blood sample to check the digoxin level
C. Withhold the dose and reassess the heart rate in 1 hour
Rationale: Before administering digoxin, the nurse counts the infants heart rate for 1 full minute. The nurse would withhold
the dose and contact the physician if the heart rate were slower than 100 beats/min in an infant. Therefore the appropriate
action on the part of the nurse would be to administer the prescribed dose. Contacting the physician, obtaining a blood
sample to check the digoxin level, and withholding the dose and reassessing the heart rate in 1 hour are incorrect on the
basis of the information in the question.

Test-Taking Strategy: Focus on the data in the question and recall the parameters for safe administration of digoxin. Noting
that the client of the question is an infant and recalling that the heart rate is 110 beats/min will direct you to the correct
option. Review the procedure for administering digoxin if you had difficulty with this question.
20. Oral nystatin suspension is prescribed for an infant with thrush (oral candidiasis). The nurse should instruct the mother to:
. Avoid breastfeeding the infant
A. Apply the suspension before feeding the infant
B. Apply the suspension with a cotton-tipped applicator
C. Rub the suspension onto the mucous membranes with a gloved finger Correct
Rationale: Thrush is a superficial fungal infection of the oral mucous membranes. It occurs as a result of overgrowth
of Candida albicans . Cotton-tipped applicators tend to absorb the medication; a more effective method of administration is
to rub the suspension onto the mucous membranes, using a gloved finger. To increase the amount of time the medication is
in contact with the mucous membranes, nystatin should be applied after feedings. Breastfeeding does not need to be
avoided. If the infant is breastfed, the mothers breasts should also be treated with nystatin.

Test-Taking Strategy: Use the process of elimination. Focus on the diagnosis and think about the intended effect of the
medication. This will direct you to the correct option. Review the procedure for applying this medication if you had difficulty
with this question.
21. A nurse is admitting a child with respiratory syncytial virus (RSV) infection to the hospital. The nurse tells the parents that
the best way to prevent the spread of the infection is:
. Restricting visitors
A. Wearing goggles and a mask
B. Washing the hands meticulously Correct
C. Wearing goggles and a protective gown
Rationale: RSV infection, which is easily communicable, is acquired mainly through contact with contaminated surfaces.
RSV can live on skin or paper for as long as 1 hour and on cribs and other nonporous surfaces for as long as 6 hours. It is
usually transferred on inadequately washed hands. Meticulous handwashing decreases the spread of organisms.
Maintaining contact precautions (e.g., wearing a gown and gloves) reduces nosocomial transmission of RSV. RSV infection
is not airborne, so goggles and masks are unnecessary. Restriction of visitors is not necessary.

Test-Taking Strategy: Use the process of elimination and note the strategic word best. Recalling the basic principles of
standard precautions and remembering that RSV is acquired mainly through contact with contaminated surfaces will direct
you to the correct option. Review this infection if you had difficulty with this question.
22. What discharge instructions are important to provide the parents after their child undergoes cardiac catheterization? Select
all that apply.
. A fever is normal after the procedure.
A. Some bleeding from the catheter insertion site is expected.
B. The child may play in a tub bath 1 day after the procedure.
C. Contact sports should be avoided for 1 week after the procedure. Correct
D. Acetaminophen or ibuprofen may be given to ease pain or discomfort. Correct
Rationale: The parents are instructed that the physician must be notified if a fever higher than 38C (101F) develops, if
bleeding or drainage (pus) from the catheter insertion site is noted, or if the child exhibits pallor, coolness, or numbness of
the affected extremity. Acetaminophen or ibuprofen is recommended for mild pain as needed. Bathing should be limited to a
shower, sponge bath, or brief tub bath (no soaking) for the first 1 to 3 days. The parents are also instructed to keep the child
from engaging in strenuous exercise (e.g., climbing trees, swimming, contact sports) for 1 week after the procedure.

Test-Taking Strategy: Note that the child has undergone cardiac catheterization and read each option carefully. Thinking
about the procedure and recalling the complications that may occur after this procedure will direct you to the correct options.
Review these home care instructions if you had difficulty with this question..
23. A nurse is caring for several children who have been fitted with a variety of traction devices. Which child should be
monitored most closely for signs and symptoms of osteomyelitis?
.
A. Correct
B.
C.
Rationale: The most serious complication associated with skeletal traction is osteomyelitis, an infection involving the bone.
Organisms gain access to the bone systemically or through the opening created by the metal pins or wires used for traction.
Osteomyelitis may occur with any open fracture. Clinical manifestations include localized pain, swelling, warmth,
tenderness, and unusual odor. An increased temperature may accompany the symptoms. Balanced suspension traction
may be used with or without skin and skeletal traction. When it is used with skeletal traction, however, the client is at risk for
osteomyelitis. Bucks extension and Russell traction are types of skin traction. Crutchfield tongs are inserted in the skull and
as a result are less likely to give rise to osteomyelitis.

Test-Taking Strategy: Focus on the subject, signs and symptoms of osteomyelitis. Recall that osteomyelitis is an infection of
the bone. From this point, use the process of elimination and note the words skeletal traction in the correct option. Review
the various types of traction if you had difficulty with this question.
24. A nurse is monitoring a school-age child who is being treated for dehydration. The nurse notes that the childs urine output
has been 1 mL/kg/hr over the past 3 hours and that the specific gravity of the urine is 1.020. The appropriate nursing action
is to:
. Contact the physician
A. Document the findings Correct
B. Encourage the child to drink more fluids
C. Increase the rate of flow of the intravenous (IV) solution
Rationale: Urine output of less than 2 to 3 mL/kg/hr in infants and toddlers, 1 to 2 mL/kg/hr in preschoolers and young
school-age children, and 0.5 to 1 mL/kg/hr in school-age children or adolescents indicates dehydration. A specific gravity of
the urine above 1.020 may indicate dehydration. The nurse would document the findings, because they are normal.

Test-Taking Strategy: Use the process of elimination. Eliminate the options that indicate the need to implement additional
treatment. Additionally, note that these options indicate increasing fluid intake. Remember also that the nurse would not
increase the rate of IV fluids without a physicians prescription to do so. Review normal findings related to urine output and
specific gravity in a school-age child if you had difficulty with this question.
25. A nurse, providing information to the mother of a child with irritable bowel syndrome tells the mother that:
. There is no cure
A. Fiber must be eliminated from the diet
B. Treatment is aimed at relieving the symptoms Correct
C. Surgery and creation of a permanent colostomy will be necessary
Rationale: There is no definitive treatment for irritable bowel syndrome. Instead, treatment is aimed at relieving the
symptoms. The primary nursing intervention is reassurance that irritable bowel syndrome is a self-limiting, intermittent
problem. Unless lactose intolerance is suspected, a healthy, well-balanced, moderate-fiber diet should be followed. The
child is encouraged to eat slowly. Surgery and creation of a permanent colostomy are not necessary.

Test-Taking Strategy: Use the process of elimination and your knowledge regarding treatment for this syndrome. Eliminate
the options containing the closed-ended words no, must, and permanent. Review this syndrome if you had difficulty
with this question.
26. A nurse is providing home care instructions to the mother of a child with sinusitis. Which statement by the mother indicates
a need for further instruction?
. Tylenol can help relieve the discomfort.
A. I need to encourage him to drink clear liquids.
B. Breathing cool, moist air will help drain his sinuses. Correct
C. I can put warm, moist compresses over his sinuses to make him feel better.
Rationale: Breathing warm (not cool) mist in a shower can help liquefy and mobilize nasal mucus. Acetaminophen (Tylenol)
is given to reduce fever and alleviate discomfort. Sinus drainage is facilitated by increasing the childs intake of clear fluids.
Warm, moist compresses applied two or three times a day help ease swelling and pain.

Test-Taking Strategy: Note the strategic words need for further instruction, which indicate a negative event query and the
need to select the incorrect statement. Recalling the effects of warm and cool treatments will direct you to the correct option.
Review home care instructions for the child with sinusitis if you had difficulty with this question.
27. A nurse is performing an assessment of a school-age child admitted with acute poststreptococcal glomerulonephritis. Which
question would help determine the cause of this acute condition?
. Have you fallen off your bicycle recently?
A. Did you have a sore throat a few weeks ago? Correct
B. Have you had chickenpox in the last 2 months?
C. Have you eaten any shrimp or crab in the last 7 to 10 days?
Rationale: Glomerulonephritis refers to a group of kidney disorders characterized by inflammatory injury in the glomerulus.
Acute poststreptococcal glomerulonephritis, the most common type, is characterized by hematuria, proteinuria, edema, and
renal insufficiency. It occurs as an immune reaction to a group A beta-hemolytic streptococcal infection of the throat or skin.
Falling off a bicycle, contracting chickenpox, and eating shellfish are not causes of acute glomerulonephritis.

Test-Taking Strategy: Use the process of elimination and focus on the subject, the origin of this disorder. Note the
relationship between the word poststreptococcal in the clients diagnosis and the correct option. Review the cause of this
disorder if you had difficulty with this question.
28. A nurse provides instruction to an adolescent client with exercise-induced asthma. Which statement by the adolescent
indicates a need for further instruction?
. I should use the bronchodilator after I finish working out. Correct
A. The symptoms usually begin after 5 to 10 minutes of exercise.
B. I should use progressive muscle-relaxation techniques to keep from hyperventilating.
C. When I exercise in cold weather, I should warm cover my nose and mouth with a scarf to warm up the air Im
breathing.
Rationale: Exercise-induced asthma may be triggered by the rapid breathing of large volumes of cool, dry air, such as that
taken in with mouth breathing during exercise. The symptoms of exercise-induced asthma usually begin after 5 to 10
minutes of exercise and often last 30 to 60 minutes. Measures to prevent exercise-induced asthma include warming the air
by breathing through the nose or covering the mouth and nose with a scarf when exercising in cold weather, using an
inhaled bronchodilator before exercise, and practicing techniques to decrease hyperventilation, such as progressive muscle
relaxation and diaphragmatic breathing.

indicate a negative event query and the need to select the incorrect statement. Note the subject, exercise-induced asthma,
as well as the words after I finish working out in the correct option. Review content on exercise-induced asthma if you had
difficulty with this question.
29. A nurse is caring for an infant with hypospadias. The nurse makes a priority of assessing the infants:
. Blood pressure
A. Urinary output Correct
B. Level of consciousness
C. Gastrointestinal function
Rationale: Hypospadias is a congenital anomaly in which the actual opening of the urethral meatus is below the normal
placement on the glans of the penis. The nurse would make a priority of assessing urinary function in the infant. Blood
pressure, level of consciousness, and gastrointestinal function are unrelated to this disorder.

Test-Taking Strategy: Use the process of elimination. Recalling the pathophysiology of hypospadias will direct you to the
correct option. Review this disorder if you had difficulty with this question.
30. A child with a history of sickle cell disease is seen in the emergency department, where acute sequestration crisis is
diagnosed. The nurse should immediately prepare to:
. Administer pain medication
A. Start an intravenous (IV) line Correct
B. Obtain informed consent for a splenectomy
C. Place a cold pack on the abdomen over the area of the spleen
Rationale: Acute sequestration crisis is a complication of sickle cell disease. It is characterized by pooling of blood in the
spleen, resulting in splenic enlargement. Acute sequestration crisis is a life-threatening condition if hypovolemic shock
occurs. Emergency treatment involves restoring circulating blood volume with a crystalloid and colloid (blood) infusion.
Therefore an IV line is needed immediately. Pain is not a priority concern with this type of crisis. Splenectomy may be
necessary in cases in which the condition recurs frequently. Placing a cold pack on the abdomen over the area of the
spleen will not stop the pooling of blood and might cause more discomfort for the child, so this is not an appropriate
measure.

Test-Taking Strategy: Use the process of elimination and note the strategic word immediately. Focus on the name of the
crisis and recall that this type of crisis can lead to hypovolemic shock. This will direct you to the correct option. Review the
immediate treatment for acute sequestration crisis if you had difficulty with this question.
31. Which test result specifically indicates that a child with an immunosuppressive condition has been exposed to tuberculosis?
. A positive ELISA result
A. A positive result on the Western blot immunoassay
B. A white blood cell (WBC) count of 13,500 cells/mm
3

C. A 7-mm area of induration after administration of a Mantoux skin test Correct
Rationale: The Mantoux test is administered as a screen for tuberculosis. Purified protein derivative (PPD) is administered
by way of intradermal injection and the skin reaction is read by a professional 48 to 72 hours after administration. An
induration measuring 5 mm or larger is considered a positive finding in the highest-risk groups, such as children with
immunosuppressive conditions or HIV infection. The ELISA and Western blot are used to diagnose HIV. An increased WBC
count occurs with infections in general but is not specific to tuberculosis.

Test-Taking Strategy: Use the process of elimination and focus on the subject, exposure to tuberculosis. Eliminate the
ELISA and Western blot, which are comparable or alike in that both are used to diagnose HIV. To select from the remaining
options, note that the child has an immunosuppressive condition and focus on the subject to find the correct option. Review
the procedure for interpreting the results of this test if you had difficulty with this question.
32. A nurse is providing home care instructions to the mother of a child who has undergone cleft lip repair. Which statements by
the mother indicate an understanding of these instructions? Select all that apply.
. I should put her on her stomach to sleep.
A. I shouldnt brush her teeth for 1 to 2 weeks. Correct
B. I should rinse her mouth with water after feeding her. Correct
C. I should watch signs of infection like drainage or fever. Correct
D. I should never use a bulb syringe to clear secretions from her mouth.
Rationale: I shouldnt brush her teeth for 1 to 2 weeks, I should rinse her mouth with water after feeding her, and I
should watch for signs of infection like drainage or fever are all accurate statements. Gentle aspiration of oral secretions
may be needed to prevent respiratory complications, and bulb syringes are often sent home with the family for removal of
these secretions. After cleft lip repair the child should be kept supine, on the side opposite the repair, or in an infant seat.
The prone position could result in contact of the suture line with the bed linens, leading to disruption of the suture line.

Test-Taking Strategy: Use the process of elimination and note the strategic words indicate an understanding. Consider the
safety issues related to oral surgery and positioning and wound care. Visualize each of the options to answer correctly.
Review care after cleft lip repair if you had difficulty with this question.
33. An immunocompromised child who never had chickenpox is exposed to a child with varicella. The nurse should tell the
mother of the immunocompromised child that:
. The child will receive varicella zoster immune globulin Correct
A. There is no need to be concerned about the exposure to varicella
B. The child will be hospitalized and placed in respiratory isolation
C. The child should be monitored closely for early signs of chickenpox
Rationale: Immunocompromised children are unable to fight varicella adequately. If a child who has not had chickenpox is
exposed to someone with varicella, the child should receive the varicella zoster immune globulin within 96 hours of
exposure. Stating that there is no need to be concerned about exposure to varicella, placing the child on respiratory
isolation, and monitoring for signs chickenpox are all incorrect.

Test-Taking Strategy: Use the process of elimination. Noting that the child is immunocompromised will assist you in
eliminating the options that would delay treatment. The only option that helps the client is the one involving the
administration of varicella zoster immune globulin. Review care of the immunocompromised child if you had difficulty with
this question.
34. An HIV-positive woman delivers an infant. The physician prescribes testing for the newborn, and the nurse prepares to:
. Ask the laboratory to perform virologic testing Correct
A. Obtain blood from the umbilical cord to send to the laboratory
B. Perform a heelstick to obtain a specimen for a Western blot assay
C. Perform a fingerstick to obtain a specimen for an enzyme-linked immunosorbent assay (ELISA)
Rationale: Traditional HIV antibody measurement by ELISA or Western-blot assay is not accurate in infants younger than
18 months because of the persistence of maternal antibodies. Because of the potential for maternal contamination during
delivery, umbilical cord blood should not be used for testing. HIV-exposed infants should undergo virologic testing within 48
hours of birth and follow-up testing, depending on the initial results.

Test-Taking Strategy: Use the process and focus on the subject, a newborn infant exposed to HIV. Recalling that the ELISA
and Western blot assay are not accurate in an infant younger than 18 months will assist you in eliminating these options.
Next eliminate the option involving cord blood, knowing that such blood could be contaminated. Review the tests to detect
HIV in a newborn infant if you had difficulty with this question.
35. A nurse is reviewing the physicians preoperative prescriptions for a child who is scheduled for an appendectomy. Which
prescription should the nurse question?
. Check vital signs every hour.
A. Insert an intravenous (IV) line.
B. Administer a Fleet enema before surgery. Correct
C. Apply a cold pack to the abdomen as needed for comfort.
Rationale: Enemas or laxatives are not administered to the client with appendicitis because of the risk of rupturing the
appendix. IV fluid therapy is started to prepare the child for surgery and correct any fluid or electrolyte imbalance related to
vomiting and diarrhea. Vital signs are taken as a means of monitoring the child for sepsis or shock. Comfort measures,
including topical cold application, pain medication, encouragement of positions of comfort, are instituted. Heat is not applied
to the abdomen, because vasodilation increases the risk of perforation.

Test-Taking Strategy: Note the words which prescription should the nurse question? Recalling that the risk associated with
acute appendicitis is rupture will direct you to the correct option. Review care of the child with acute appendicitis if you had
36. A nurse reviews the physicians prescriptions for the care of a child who has just undergone tonsillectomy. Which
prescription should the nurse question?
. Suction every 2 hours. Correct
A. Position the child on his side.
B. Use an ice collar as needed for comfort.
C. Provide clear, cool liquids when the child is fully awake.
Rationale: After tonsillectomy, suction equipment should be available for emergency use. The child is not suctioned unless
there is an airway obstruction, because suctioning may disrupt the surgical site, leading to bleeding. The child is positioned
on the side to facilitate drainage of secretions. Clear, cool liquids are offered once the child is awake. An ice collar can
alleviate discomfort.

Test-Taking Strategy: Use the process of elimination and focus on the subject, the prescription that the nurse would
question. Visualizing the anatomical location of the surgical procedure and recalling that bleeding is a concern will direct you
to the correct option. Review care of the child who has undergone tonsillectomy if you had difficulty with this question.
37. A nurse reviews a childs record and notes documentation that the child is obtunded. On the basis of this documentation,
which of the following findings would the nurse expect to note while conducting a neurological assessment?
. The child requires considerable stimulation to be aroused.
A. The child awakens easily but exhibits limited responsiveness.
B. The child is awake, alert, oriented, and interacts with the environment.
C. The child sleeps unless aroused and, once aroused, has limited interaction with the environment. Correct
Rationale: A child is considered obtunded when he or she sleeps unless aroused and, once aroused, has limited interaction
with the environment. A lethargic child awakens easily but demonstrates limited responsiveness. A child in a stupor requires
considerable stimulation to be aroused. A child who is awake, alert, oriented and interacts with the environment is fully
conscious.

Test-Taking Strategy: Specific knowledge regarding the standard terms used to describe various levels of consciousness is
needed to answer this question. It is necessary to know that obtunded is a term that describes a child who sleeps unless
aroused and, once aroused, has limited interaction with the environment. Review these terms if you had difficulty with this
question..
38. A nurse provides instructions to the mother of a child with cystic fibrosis (CF) on the correct procedure for administering
pancrelipase (Viokase). The nurse tells the childs mother that the medication may be administered with:
. Oatmeal
A. Hot milk
B. Applesauce Correct
C. Mashed potatoes
Rationale: Pancrelipase is a pancreatic enzyme preparation used to reduce fat in the stool and to aid the digestion of
protein, carbohydrates, and fat. Because these enzymes may be inactivated by heat, the preparation should not be
administered with hot foods.

Test-Taking Strategy: Use the process of elimination. Eliminate first the option containing the word hot. Next eliminate the
options that are comparable or alike in that they are they are prepared and served with a warm or hot temperature. Review
the procedures for administering pancreatic enzyme preparations if you had difficulty with this question.
39. Which medication is essential for the nurse to have available before administering an allergy injection to a child?
. Immune globulin
A. Ibuprofen (Motrin)
B. Epinephrine (Adrenalin) Correct
C. Acetaminophen (Tylenol)
Rationale: Emergency epinephrine should be available, when allergy injections are being administered, to treat a
hypersensitivity reaction if one occurs. Immune globulin is an immune serum used to provide passive immunity or prevent
acute infection in immunocompromised clients. Ibuprofen is a nonsteroidal antiinflammatory drug, and acetaminophen is an
analgesic; neither is an appropriate treatment for a hypersensitivity reaction.

Test-Taking Strategy: Use the process of elimination and your knowledge of the actions of the medications listed in the
options. Recalling that a hypersensitivity reaction may occur when allergy injections are administered and recalling the
classification and uses of each medication in the options will direct you to the correct option. Review the actions of these
medications if you had difficulty with this question.
40. A nurse is assigned to care for a child with diarrhea. Which intervention should the nurse avoid in caring for the child?
. Wearing clean gloves
A. Turning the child every 2 hours
B. Using protective moisture barriers
C. Taking a rectal temperature every 4 hours Correct
Rationale: Rectal temperatures are avoided in the child with diarrhea because inserting a thermometer in the rectum
stimulates peristalsis and may damage excoriated tissue. Gloves are worn when caring for the child. Clean gloves are
sufficient; sterile gloves are not necessary in this situation. The child is turned every 2 hours to reduce pressure on irritated
skin and to prevent skin breakdown. Protective moisture barriers, such as creams or ointments, are useful in protecting the
skin from diarrhea stools.

Test-Taking Strategy: Use the process of elimination and note the strategic word avoids, which indicates a negative event
query and the need to select the incorrect intervention. Focusing on the childs diagnosis and recalling that peristalsis would
aggravate the condition will direct you to the correct option. Review nursing interventions in the care of a child with diarrhea
if you had difficulty with this question.
41. A nurse is caring for an infant with Hirschsprungs disease. Which manifestation of the disease should the nurse expect to
see?
. Non-bilious projectile vomiting
A. Foul-smelling, ribbon-like stools Correct
B. A sausage-shaped abdominal mass
C. Bloody, mucousy currant jelly stools
Rationale: The child with Hirschsprungs disease will have constipation that has been present since the neonatal period and
the frequent passage of foul-smelling, ribbon-like or pellet stools. Non-bilious projectile vomiting is a manifestation of pyloric
stenosis. Bloody, mucousy currant jelly stools and a sausage-shaped abdominal mass are manifestations of
intussusception.

Test-Taking Strategy: Specific knowledge regarding the manifestations of Hirschsprungs disease is needed to answer this
question. Recalling that Hirschsprungs disease is characterized by the absence of ganglionic cells will direct you to the
correct option. Review the manifestations of Hirschsprungs disease if you had difficulty with this question.
42. A nurse provides home care instructions to the parents of a child who has undergone heart surgery. The nurse should tell
the parents to:
. Apply lotion to the incision line twice a day
A. Restrict fluid intake to prevent fluid retention
B. Contact the physician if the childs appetite decreases Correct
C. Allow the child to resume activities as tolerated by the child
Rationale: After discharge, the childs appetite normally will improve, so the nurse instructs the parents to contact the
physician if the childs appetite decreases. The parents should also notify the physician if the childs breathing becomes
faster and harder than normal at rest; if the temperature rises above 100F (37.7C); if new or frequent coughing develops;
if the child becomes cyanotic; if redness, swelling, or drainage at the incision site occurs; if the child experiences frequent
vomiting or diarrhea; or if the childs pain increases. The use of creams, lotions, and powders on the incision line are
avoided until the incision is completely healed and without scabs. Adequate fluid intake is encouraged. The child should
avoid outside play and activities in which falls are a risk for several weeks.

Test-Taking Strategy: Use the process of elimination and your knowledge of general postoperative home care instructions
to answer the question. Noting that the child has undergone heart surgery will direct you to the correct option. Review these
home-care instructions if you had difficulty with this question.
43. A nurse is assigned to care for an infant with congenital diaphragmatic hernia (CDH). Which clinical finding supports this
diagnosis?
. Presence of an anal membrane
A. Failure to pass meconium stool
B. Viscera located outside the abdominal cavity
C. Auscultation of cardiac sounds on the right side of the chest Correct
Rationale: CDH is an opening in the diaphragm through which abdominal contents herniate into the thoracic cavity during
prenatal development. Clinical findings depend on the severity of the defect but may include the presence of abdominal
organs in the chest (revealed by fetal ultrasonography), diminished breath sounds or an absence of such sounds on the
affected side, auscultation of bowel sounds over the chest, auscultation of cardiac sounds on the right side of the chest,
respiratory distress, and a scaphoid abdomen. The presence of an anal membrane and failure to pass meconium stool are
findings noted in imperforate anus. The presence of viscera outside the abdominal cavity is noted in gastroschisis.

Test-Taking Strategy: Use the process of elimination. Eliminate first the options that are comparable or alike in that they are
related to an imperforate anus. To select from the remaining options, focus on the name of the disorder and use your
knowledge of the pathophysiology of CDH to find the correct option. Review the manifestations of CDH if you had difficulty
with this question.
44. A nurse is assessing a child after tonsillectomy. Which finding is indicative of postoperative bleeding?
. Slowed pulse rate
A. Frequent swallowing Correct
B. Complaints of throat pain
C. An increase in blood pressure
Rationale: Monitoring the child for postoperative bleeding is most important. Because the operative site in this procedure is
not as readily visible as other surgical sites, the nurse must be alert to excessive or frequent swallowing, an increased pulse
and decreasing blood pressure, signs of fresh bleeding in the back of the throat, vomiting of bright-red blood, and
restlessness that does not seem to be associated with pain. Pain is not an indication of postoperative bleeding.

Test-Taking Strategy: Use the process of elimination and focus on the subject, signs of postoperative bleeding. Throat pain
would be expected in the postoperative period, so eliminate this option. Thinking about the physiological response that
occurs with blood loss will assist you in eliminating a slowed pulse rate and an increased blood pressure. Review the
indicators of postoperative bleeding after tonsillectomy if you had difficulty with this question.
45. A nurse is reviewing the chart of a child with a brain tumor. Which symptom would the nurse expect to note in the history
and physical?
. Nausea that occurs at bedtime
A. Fatigue that occurs after activity
B. Dizziness that occurs late in the day
C. Headache and morning vomiting related to the child's getting out of bed Correct
Rationale: Manifestations of brain tumors vary with tumor location and the age and development of the child, but the
hallmark symptoms of a brain tumor in a child are headache and morning vomiting related to the child's getting out of bed.
The sudden increase in intracranial pressure that occurs with the change of position causes the vomiting. Nausea at
bedtime, dizziness that occurs late in the day, and fatigue after activity are not symptoms specifically associated with brain
tumors.

Test-Taking Strategy: Use the process of elimination. Note the relationship of the clients diagnosis, brain tumor, and the
word headache in the correct option. Review the manifestations of a brain tumor if you had difficulty with this question.
46. The mother of a child with hemophilia calls the clinic nurse and reports that her child has hit his knee on the corner of a
coffee table and that the joint appears swollen. The nurse should tell the mother immediately to:
. Immobilize the affected joint Correct
A. Take the child to the emergency department
B. Elevate the affected joint and apply a heating pad
C. Bring the child to his primary healthcare provider
Rationale: If a muscle or joint injury occurs in the child with hemophilia, the affected part is immobilized, elevated, and
treated with ice and compression. Initial immobilization will help prevent further injury until the bleeding resolves. There is no
information in the question indicating that bringing the child to the emergency department is necessary. Heat will increase
circulation to the site and increase bleeding. The physician should be notified if a blunt injury, especially that involving a
joint, occurs, but it is not necessary to immediately bring the child to the primary healthcare provider.

Test-Taking Strategy: Use the process of elimination and note the strategic word immediately. Focusing on the data in the
question will assist you in eliminating the options that are comparable or alike (i.e., bringing the child to the emergency
department or primary healthcare provider). To select from the remaining options, recall the effects of heat, which will help
you eliminate this option. Review care of the child with hemophilia if you had difficulty with this question.
47. A nurse is performing an assessment of a child admitted to the hospital with suspected rheumatic fever. About which recent
occurrence should the nurse ask the parents as a means of eliciting data relevant to the cause of illness?
. A sore throat Correct
A. Blunt chest injury
B. A swollen knee joint
C. Recent loss of appetite
Rationale: Rheumatic fever characteristically appears 2 to 6 weeks after an untreated or partially treated group A beta-
hemolytic streptococcal infection of the upper respiratory tract. Therefore the nurse would ask the parents about the recent
occurrence of a sore throat in the child. A blunt chest injury is not associated with rheumatic fever. A swollen knee joint and
loss of appetite may be manifestations of this disorder but are not the cause.

Test-Taking Strategy: Use the process of elimination and focus on the subject, the origin of rheumatic fever. Because a
swollen knee joint and loss of appetite may be manifestations, rather than causes, of this disorder, these options are
eliminated first. To select from the remaining options, note the name of the disorder, which will assist you in identifying the
correct option. Review the cause of rheumatic fever if you had difficulty with this question.
48. A child has been in the hospital for several days for treatment of severe vomiting related his HIV-positive status. Which
assessment finding is the best indication that the childs condition is improving?
. No lesions in the mouth and throat
A. Weight increase of 1 lb over 3 days Correct
B. Temperature change from 100.2F to 99.2F
C. Capillary refill slowing from 2 seconds to 3 seconds
Rationale: Vomiting results in fluid volume deficit. The most accurate method of evaluating fluid volume increase (the
desired outcome) is weight. A temperature decrease is not reflective of fluid volume increase. Increasing capillary refill time
is indicative of a fluid volume decrease, not an increase. The absence of mouth ulcers would allow the child to drink without
pain but does not reflect a fluid volume increase.

Test-Taking Strategy: Note the data in the question and remember that the child is experiencing severe vomiting. Use the
process of elimination and focus on the subject, an assessment finding indicating fluid volume increase. The correct option
is the only one that related to fluid volume. Review the findings that indicate a positive outcome in a child with severe
vomiting if you had difficulty with this question.
49. A child is admitted to the hospital, where Wilms tumor is diagnosed. The primary nursing intervention is:
. Keeping the room dark and avoiding overstimulation
A. Posting a sign over the bed reading, Do not palpate abdomen Correct
B. Take the blood pressure once per day to avoid irritating the child
C. Maintaining the client in a high Fowler position when she is not sleeping
Rationale: Wilms tumor, or nephroblastoma, is the most common renal tumor in children. The most common clinical
presentation is an asymptomatic, mobile abdominal mass. The tumor mass should not be palpated because of the high risk
of rupturing the protective capsule. Excessive manipulation may result in seeding of the tumor. The nurse places a sign in
the childs room warning against palpating the abdomen. Hypertension may occur as a result of increased production of
renin by the kidneys; therefore the blood pressure needs to be checked regularly (more frequently than once a day). Placing
the child in a high Fowler position and keeping the room dark are not interventions specific to Wilms tumor.

Test-Taking Strategy: Use the process of elimination. Recalling that this type of tumor presents as an abdominal mass and
involves the kidney will direct you to the correct option. Review care of the child with Wilms tumor if you had difficulty with
this question.
50. A physician prescribes the following interventions for a child with suspected meningitis. Prioritize these interventions by
numbering them in the order in which they should be performed, with 1 as the first prescription to be carried out and 4 as
the last.
The correct order is:
0. Respiratory isolation
1. Lumbar puncture
2. Administer antibiotics
3. Continued neurologic assessments every 2 hours
Rationale: It is important that nurses protect themselves and others from possible infection, so the child should immediately
be placed in isolation if meningitis is suspected. The next priority is setting up for the lumbar puncture so that specimens for
culture may be obtained. Once this is done, antibiotics are administered. Antibiotics given before lumbar puncture has been
performed and cultures have been obtained could kill the causative bacteria and lead to a misdiagnosis. A neurological
assessment is conducted every 2 hours and should have been part of the admission criteria. It is the lowest priority of the
four options based on the timeframe identified in the question.

Test-Taking Strategy: Specific knowledge regarding meningitis is required to answer this question. Use your knowledge of
prioritization to answer this question. Also, keep in mind that specimen for diagnostic tests typically must be obtained before
the initiation of antibiotic therapy. Review care of the child with suspected meningitis if you had difficulty with this question.
51. A nurse is assigned to care for a child with a severe burn injury. The nurse plans care, remembering that:
. A childs skin is thicker than an adults
A. A child has a lower proportion of body fluid to body mass than does an adult
B. A child is at lower risk for protein and calorie deficiencies than an adult is
C. A child has a larger body surface area than an adult and is therefore at increased risk for fluid and heat
loss Correct
Rationale: A child has a larger body surface area than an adult and is therefore at increased risk for fluid and heat loss.
Children are also at increased risk for dehydration and metabolic acidosis stemming from diarrhea, evaporative water loss,
and increased fluid requirements. A childs skin is thinner than an adults; therefore lower burn temperatures and shorter
exposure to heat or chemicals can result in a more severe burn. The higher proportion of body fluid to mass in children
increases the risk of cardiovascular problems because of the less effective cardiovascular response to changing
intravascular volume. Children are at increased risk for protein and calorie deficiency because they have smaller muscle
mass and lower body fat than do adults.

Test-Taking Strategy: Knowledge regarding the physiological differences between children and adults and the effects of a
burn injury is needed to answer this question. Read each option carefully, thinking about the anatomy and physiology of a
child. Review these differences if you had difficulty with this question.
52. A nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be
admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement:
. Enteric precautions
A. Contact precautions
B. Droplet precautions Correct
C. Neutropenic precautions
Rationale: The child is also placed in a private room, with droplet-transmission precautions, for at least 24 hours after
antibiotics are given. Enteric, contact, and neutropenic precautions are not implemented to prevent the spread of meningitis.
Enteric precautions are instituted when the mode of transmission involves the gastrointestinal tract. Contact precautions are
instituted when contact with infectious items or materials is likely. Neutropenic precautions are instituted when a child has a
low neutrophil count.

Test-Taking Strategy: Use the process of elimination and knowledge regarding the mode of transmission of meningitis.
Thinking about the route of transmission should easily direct you to the correct option. If you had difficulty with this question,
review the mode of transmission of meningitis.
53. A nurse is providing information to the mother of a child with newly diagnosed celiac disease. What piece of information
should the nurse include?
. An infection can precipitate a celiac crisis. Correct
A. The disease can be cured with medication.
B. Pasta is an appropriate part of the childs diet.
C. Temporary dietary modifications may be necessary to heal the gastrointestinal tract.
Rationale: Celiac disease is the result of an inability to digest fully the gliadin, or protein, part of wheat, barley, rye, and oats.
This lifelong deficiency requires dietary modifications to prevent chronic maldigestion and malabsorption; dietary
management is the mainstay of treatment. All wheat, barley, rye, and oats (i.e., pasta, baked products, and many breakfast
cereals) should be eliminated from the diet and replaced with corn and rice. Celiac crisis is marked by profuse, watery
diarrhea and vomiting and can quickly lead to severe dehydration and metabolic acidosis.

Test-Taking Strategy: Knowledge regarding the characteristics of celiac disease is required to answer this question.
Knowing that the disease cannot be cured and remembering that lifelong dietary management, which includes the
elimination of wheat, barley, rye, and oats, is the primary treatment will direct you to the correct option. Review celiac
disease and celiac crisis if you had difficulty with this question.
54. A nurse is monitoring a 3-year-old with diarrhea for signs of dehydration. The child now weighs 42 lb, a decrease from his
weight of 44 lb 24 hours ago. In addition to dry mucous membranes and lack of tears, what assessment finding would the
nurse find?
. Decreased heart rate
A. Bilateral 1+ pedal pulses Correct
B. Increased blood pressure
C. Urine output of 80 mL in the last 3 hours
Rationale: The minimum urine output for a child is 1 mL/kg/hour. The child weighs 42 lb, or 19 kg, so 80 mL in the last 4
hours is within the minimum range. A child with dehydration will have a rapid, weak, thready pulse. Blood pressure may be
decreased in moderate and severe dehydration, but it is a late sign of hypovolemia. A child with dehydration will exhibit 1+
pedal pulses: difficult to palpate, weak, and thready.

Test-Taking Strategy: Use the process of elimination and focus on the subject, signs of dehydration. Thinking about the
pathophysiology of dehydration will direct you to the correct option. Review the signs of dehydration in a child if you had
Level of Cognitive Ability: Analyzing
55. Which pediatric client is at least risk for otitis media?
. A breastfed infant Correct
A. A bottle-fed infant
B. A child who attends a daycare center
C. A child exposed to environmental smoke
Rationale: Breastfeeding offers some protection against ear infection by providing maternal antibodies and by decreasing
the incidence of allergy. Also, the more upright the position of the infant during nursing, the greater the protection against
ear infection. Bottle feeding contributes to ear infection because of the position of the infant during feeding. Also, reflux of
formula into the eustachian tube from the nasopharynx may occur when the infant swallows while in a supine position.
Attendance at a daycare center predisposes a child to otitis media. Exposure to environmental smoke is a risk factor.

Test-Taking Strategy: Use the process of elimination and note the strategic words least risk. Recalling that breast milk
provides maternal antibodies will direct you to the correct option. Review the origin of otitis media if you had difficulty with
this question.
56. A nurse has provided dietary instructions to the mother of a child with Crohns disease. Which statements by the mother
indicate an understanding of the instructions? Select all that apply.
. Its important to include meat in his diet.
A. I wont give him high-fiber vegetables like corn. Correct
B. Snacks such as nuts will help provide the extra protein he needs. Correct
C. I should give him ice cream every day to be sure that he gets his calcium.
D. Ill make sure that he takes a multivitamin and iron supplement every day. Correct
Rationale: A well-balanced, high-protein, high-calorie diet is recommended in Crohns disease; a multivitamin and iron
supplement should also be taken. Meat is high in protein and necessary for optimal growth and development. High-fiber
foods such as corn, nuts, and seeds can produce obstructions in children with intestinal strictures and should be avoided.
Ice cream is a milk product and should be avoided.

Test-Taking Strategy: Focus on the childs diagnosis. Recalling that Crohns disease is an inflammatory bowel disease will
direct you to the correct options. Review the dietary measures for this bowel disorder if you had difficulty with this question.
Level of Cognitive Ability: Evaluating
57. The nurse should contact the healthcare provider with concerns about a prescription for valproic acid (Depakene) for an
adolescent who has a history of:
. Hepatitis Correct
A. Diabetes mellitus
B. Migraine headaches
C. Tonic-clonic seizures
Rationale: Valproic acid, an anticonvulsant used to treat seizures, is principally used as an adjunct to other anticonvulsant
agents. It is also used as prophylaxis against migraine headaches. Valproic acid is contraindicated in hepatic disease and
used with caution in persons with a history of hepatic disease or bleeding abnormalities. It is not contraindicated in clients
with diabetes mellitus.

Test-Taking Strategy: Use the process of elimination and focus on the name of the medication. Recalling that this
medication is an anticonvulsant will help you eliminate tonic-clonic seizures. To select from the remaining options, recall that
valproic acid is hepatotoxic, which will help you answer correct. Review this medication if you had difficulty with this
question.
58. A nurse provides home care instructions to the mother of an infant with gastroesophageal reflux disease (GERD). Which
statement by the mother indicates a need for further instruction?
. I shouldnt give the baby a pacifier. Correct
A. I should thicken feedings with rice cereal.
B. I should put the baby on her right side with her head raised.
C. I need to give the baby small, frequent feedings and use a predigested formula.
Rationale: Small, frequent feedings of a predigested formula will reduce the amount of formula in the stomach, ease
distension, and minimize reflux. These smaller, more frequent feedings with frequent burping are often tried as the first line
of treatment. Thickened feedings tend to decrease the chances of reflux, vomiting, and aspiration. Placing the affected
infant in a 30-degree head-elevated prone or right-sidelying position helps prevent reflux. The use of a pacifier allows the
infant to practice swallowing. Pacifier use also decreases the incidence of crying and reflux episodes and may increase
clearance of reflux stomach contents.

Test-Taking Strategy: Use the process of elimination and note the strategic words need for further instruction. These
words indicate a negative event query and the need to select the incorrect statement. Think about the pathophysiology
associated with this disorder to assist in directing you to the correct option. Review home care instructions for the infant with
GERD if you had difficulty with this question.
59. 5A newborn is found to have esophageal atresia (EA) with tracheoesophageal fistula (TEF). In which position does the
nurse immediately place the infant?
. Trendelenburg
A. Flat and side-lying
B. Prone, with the head of the bed flat
C. Supine, with the head of the bed elevated Correct
Rationale: EA and TEF are congenital malformations in which the esophagus terminates before it reaches the stomach, a
fistula forms an unnatural connection with the trachea, or both. Keeping the infant supine, with the head of the bed elevated,
decreases the likelihood that gastric secretions will enter the lungs. Placing the child in the Trendelenburg position, flat and
side-lying, or prone with the head of the bed flat is incorrect; any of these positions could result in the aspiration of gastric
secretions.

Test-Taking Strategy: Use the process of elimination and recall the pathophysiology of this disorder. Recalling that the
primary concern is aspiration of gastric secretions will direct you to the correct option. Review care of the infant with EA and
TEF if you had difficulty with this question.
Level of Cognitive Ability: Applying
60. A nurse is monitoring a child who sustained a head injury. Which assessment finding is an early sign of increased
intracranial pressure (ICP)?
. Bradycardia
A. Change in behavior Correct
B. Widened pulse pressure
C. Change in respiratory rate and pattern
Rationale: A change in the childs normal behavior is an important early sign of increased ICP. The Cushing response
which consists of an increased systolic blood pressure with widening pulse pressure, bradycardia, and a change in
respiratory rate and pattern, usually apparent just before or at the time of brainstem herniation is a late sign of increased
ICP.

Test-Taking Strategy: Use the process of elimination and note the strategic word early. Eliminate the options that are
comparable or alike in that they involve vital signs. Review the early signs of increased ICP if you had difficulty with this
question.
61. What manifestation of hypertrophic pyloric stenosis should the nurse reviewing the record of an infant with this disorder
expect to see documented?
. Fever
A. Profuse diarrhea
B. Alternating constipation and diarrhea and fecal impaction
C. Olive-shaped mass palpated in the right upper abdominal quadrant Correct
Rationale: Progressive non-bilious projectile vomiting in a previously healthy infant is the major manifestation of pyloric
stenosis. The vomitus may become blood-tinged if esophageal irritation occurs. A movable, palpable, firm, olive-shaped
mass is felt in the right upper quadrant. This mass is most easily palpated when the stomach is empty and the infant is
relaxed. Deep gastric peristaltic waves from the left upper quadrant to the right upper quadrant may be visible immediately
before vomiting commences. If the condition progresses, the infant may become dehydrated and experience metabolic
alkalosis. Fever, profuse diarrhea, and alternating constipation and diarrhea and fecal impaction are not manifestations of
this disorder.

Test-Taking Strategy: Use the process of elimination. First, eliminate the options that involve diarrhea. To select from the
remaining options, note that the diagnosis involves the gastrointestinal system; this will direct you to the correct option.
Review the manifestations of this disorder if you had difficulty with this question.
62. A 9-year-old is found to have type 1 diabetes mellitus. The nurse discusses with the childs parents the self-care tasks that
may be delegated to the child. In light of the developmental characteristics of the school-age child, which task does the
nurse tell the mother may be delegated to the child as long as she is supervised?
. Drawing up insulin
A. Recognizing when to test for ketones
B. Looking for patterns in the blood glucose level
C. Choosing the injection site in accordance with the rotation schedule Correct
Rationale: The school-age child is beginning to develop a self-concept. Appropriate self-care tasks include choosing the
injection site in accordance with a rotation schedule, performing fingersticks and blood glucose testing, pushing the plunger
on the insulin syringe after the needle has been inserted by a parent or administering one's own injection, and performing
ketone testing. Drawing up insulin is a task appropriate for a client in early adolescence. Recognizing when to test for
ketones and looking for patterns in the blood glucose level are also tasks for the adolescent.

Test-Taking Strategy: Use your knowledge of the concepts of growth and development to answer the question. Focusing on
the client of the question, a 9-year old, will direct you to the correct option. Review the developmental characteristics of the
school-age child if you had difficulty with this question.
63. The use of a Pavlik harness has been prescribed for an infant with developmental dysplasia of the hip, and the nurse
provides instructions to the mother about the use of the harness. Which statement by the mother indicates the need for
further instruction?
. The diaper is put on under the harness.
A. The harness is placed against the skin to provide support. Correct
B. I need to support her hips and buttocks when the harness is off.
C. The harness straps should be secure enough to keep her hips flexed but not tight.
Rationale: When the infant is in a Pavlik harness, the skin under the harness must be protected. The parents are instructed
to place a shirt and socks on the infant under the harness to reduce rubbing. The diaper should go on under the harness as
well. The harness straps should be secure enough to keep the childs hips flexed but not tight. The harness should be worn
23 hours a day and should be removed only in accordance with the physicians recommendation. The infants hips and
buttocks should be carefully supported whenever the infant is out of the harness.

Test-Taking Strategy: Focus on the strategic words need for further instruction, which indicate a negative event query and
the need to select the incorrect intervention. Note the words placed against the skin in the correct option for this question.
Review home care instructions for an infant in a Pavlik harness if you had difficulty with this question.
64. A nurse is conducting an assessment of a 12-year-old with Osgood-Schlatter disease. Which question does the nurse ask
the child to elicit data regarding the cause of the disease?
. Do you participate in sports? Correct
A. Did you fall off your bicycle?
B. Have you ever fallen and hit your head?
C. Does anyone else in your family have this disease?
Rationale: Osgood-Schlatter disease is believed to result from repetitive stress in sports, combined with overuse of
immature muscles and tendons over an extended period, and an imbalance in the strength of the quadriceps muscle during
adolescent growth. The classic picture is bilateral knee pain that is exacerbated by running, jumping, or climbing stairs in a
very active boy or girl who is involved in sports. The child will point to the tibial tubercle as the site of pain. The disease
occurs in boys and girls between the ages of 8 and 16 years, although it is more common in boys. Usually both knees are
involved. The assessment questions noted in the remaining options are unrelated to the cause of this disease.

Test-Taking Strategy: Use the process of elimination. Eliminate the options that are comparable or alike in that the child is
asked about sustaining an injury (i.e., fall off the bicycle, hitting the head in a fall). To select from the remaining options, it is
necessary to know that the cause of this disease is sports related. Review the origins of Osgood-Schlatter disease if you
65. The nurse is assigned a child who has been admitted to the hospital with suspected cystic fibrosis (CF). Which of the
following tests does the nurse anticipate will be prescribed to diagnosis CF?Select all that apply.
. Chest x-ray Correct
A. Barium swallow
B. Intestinal biopsy
C. Sweat chloride assay Correct
D. Stool examination for ova and parasites
The diagnosis of CF is established with the use of several tests findings: a quantitative sweat chloride test result of more
than 60 mEq/L, a chest x-ray showing patchy atelectasis, and a stool analysis revealing fat. The barium swallow is used to
diagnosis gastrointestional disorders such as pyloric stenosis but not CF. Intestinal biopsy is not used to diagnose CF. Stool
examination for ova and parasites is used to diagnose parasitic infestation; CF is not caused by a parasite.

Test-Taking Strategy: Use the process of elimination. Eliminate that the options that are comparable or alike in that they are
specific for gastrointestinal problems (i.e., barium swallow, intestinal biopsy, stool examination for ova and parasites).
Review the diagnostic findings in CF if you had difficulty with this question.
66. A nurse is providing information to the parents of a child with suspected Hirschsprungs disease. The nurse informs the
parents that diagnosis is definitively confirmed by the findings of:
. Blood tests
A. Rectal biopsy Correct
B. Barium enema
C. Rectal examination
Rationale: The definitive diagnosis of Hirschsprungs disease is made by means of rectal biopsy. During biopsy, a small
core or punch sample that contains all layers of the bowel mucosa is removed. Absence of ganglionic cells in the sample
confirms the diagnosis of Hirschsprungs disease. Blood tests are not used to diagnose the disease. A barium enema and a
rectal examination will detect significant characteristics of the disease but will not confirm the diagnosis.

Test-Taking Strategy: Use the process of elimination and focus on the word confirmed. Recalling the pathophysiology of
this disease and remembering that a biopsy will identify the characteristics of tissues will direct you to the correct option.
Review this disease if you had difficulty with this question.
Level of Cognitive Ability: Applying.
67. A child has been found to have pharyngitis. The most reliable method of determining whether the infection is bacterial or
viral in origin is:
. Throat culture Correct
A. The rapid streptococcal antigen test
B. Monitoring for complaints of a sore throat
C. Collecting data regarding the childs signs and symptoms
Rationale: Although signs and symptoms differ between viral and bacterial pharyngitis, the only reliable means of
determining whether a case of pharyngitis is viral or bacterial in origin is a throat culture. Not all children with pharyngitis
complain of a sore throat, particularly if they are of preschool age. Instead, the child may complain of a stomachache or
simply refuse to eat. Although a rapid streptococcal antigen test can be used to screen for group A streptococcal infection, it
is not the most reliable means of determining whether a case of pharyngitis is viral or bacterial in origin. This test has an
approximately 20% incidence of false-negative results.

Test-Taking Strategy: Use the process of elimination. Eliminate the options that are comparable or alike in that they involve
signs or symptoms. To select from the remaining options, note the strategic words most reliable method, which should
direct you to the correct option. Review diagnostic tests for this infection if you had difficulty with this question.
68. A nurse is caring for an infant scheduled for a pyloromyotomy. In which position should the nurse place the infant for the
preoperative period?
. Prone
A. Supine
B. Head elevated Correct
C. Trendelenburg
Rationale: In the preoperative period, the infants head of the bed is elevated to reduce the risk of aspiration. The nurse
would use blankets or towel rolls to maintain this position. Prone, supine, and Trendelenburg are incorrect positions
because they increase the risk of aspiration.

Test-Taking Strategy: Use the process of elimination. First eliminate the options that are comparable or alike in that the
head of the bed is flat. Next, recall that aspiration is a concern; this will direct you to the correct option. Review preoperative
care for pyloromyotomy if you had difficulty with this question.
69. A nurse is developing a plan of care for a child at risk for seizures. Which interventions should be carried out if a seizure
occurs? Select all that apply.
. Turning the child on her side Correct
A. Monitoring the childs movements Correct
B. Restraining the childs arms and legs
C. Loosening the clothing around the childs neck Correct
D. Gently inserting a padded tongue blade between the childs upper and lower teeth
Rationale: When a seizure begins, it is important to note the childs movements and keep track how long the seizure lasts.
This information will help the physician treat the seizure. Positioning the child on the side will help prevent aspiration
because saliva will drain from the childs mouth. Clothing around the childs neck is loosened to help maintain a patent
airway. The nurse would not restrain the childs arms or legs, because this could cause injury. The nurse would not insert
any object into the childs mouth. Forcing an object into the childs mouth may cause injury to the childs mouth, gums, or
teeth.

Test-Taking Strategy: Note that the question addresses actions to be taken during a seizure. Visualize this occurrence to
answer correctly. Also, read each option carefully and eliminate those that could cause harm to the child. Remember, do not
restrain the child experiencing a seizure or place anything in the childs mouth. Review nursing interventions during a
seizure if you had difficulty with this question.
70. What instruction should the nurse provide to a parent regarding the prevention of urinary tract infection in his child?
. Wrap the diaper tightly on the child
A. Avoid giving the child bubble baths Correct
B. Use underwear made of a synthetic fabric
C. Encourage the child to hold the urine to avoid frequent voiding
Rationale: Bubble baths should be avoided because they may irritate the urinary tract and lead to urinary tract infections.
Tight clothing or diapers are avoided, and cotton underwear, rather than a synthetic fabric, should be used to prevent
irritation that could lead to infection. The child should be encouraged to avoid holding urine and to urinate at least four times
per day, emptying the bladder completely.

Test-Taking Strategy: Use the process of elimination. Focusing on the subject, preventing a urinary tract infection, and
recalling the causes of a urinary tract infection will direct you to the correct option. Review these preventive measures if you
71. A nurse providing home care instructions to a mother of a HIV-positive child discusses measures to prevent transmission of
the virus. Which statement by the mother indicates a need for further instruction?
. I wont let my children share toothbrushes.
A. Ill wash up blood spills with soap and hot water and allow them to air dry. Correct
B. Ill wash my hands with soap and water if I touch any blood from my child.
C. Ill rinse bloodstained clothing with hydrogen peroxide and then wash it as usual.
Rationale: The correct method of cleaning up blood spills is to wash the area with soap and water, rinse with bleach, and let
the area air dry. The remaining statements by the mother reflect correct measures to prevent transmission of the virus.

Test-Taking Strategy: Note the strategic words need for further instruction, which indicate a negative event query and the
need to select the incorrect statement. Recalling that blood spills must be cleaned with a 1:10 bleach/water solution will
direct you to the correct option. Review these home care measures if you had difficulty with this question.
72. A nurse is conducting a neurovascular assessment of a child who has just had a cast applied to her leg. The nurse notes
that the capillary refill time distal to the cast is 4 seconds. In light of this finding, which action by the nurse is appropriate?
. Documenting the findings
A. Contacting the healthcare provider Correct
B. Removing any pillows that were placed under the leg
C. Continuing neurovascular assessments every 1 to 2 hours
Rationale: To assess capillary refill time, the nurse would apply pressure to the childs nail bed and count how long it takes
for the color to return (should be no longer than 2 seconds). A sluggish capillary refill time indicates neurovascular
impairment; if such impairment is suspected, the physician is notified. Although the nurse would document the findings and
continue the assessments, it would be most important to contact the physician. Elevation of the extremity on pillows helps
prevent edema at the fracture site and subsequent neurovascular impairment.

Test-Taking Strategy: Use the process of elimination and focus on the data in the question. Recalling that the normal
capillary refill time is 2 seconds or less and that a sluggish capillary refill indicates neurovascular impairment will direct you
to the correct option. Review the signs of neurovascular impairment if you had difficulty with this question.
73. The nurse is providing home care instructions to the parents of a child with immune thrombocytopenic purpura (ITP) whose
platelet count is 19,500 cells/mm
3
. Which statements by the parents indicate that they understand the instructions? Select
all that apply.
. Well use Motrin if he has a fever.
A. Its all right to let him ride his bike.
B. We need to avoid giving him aspirin. Correct
C. He should use an extra-soft toothbrush. Correct
D. We need to watch for signs of bleeding. Correct
Rationale: Immune thrombocytopenic purpura is a hematologic disorder resulting in the reduction and destruction of
platelets. A decreased platelet count places the child at risk for bleeding. The normal platelet count is 150,000 to 400,000
cells/mm
3
. If the platelet count falls below 20,000 cells/mm
3
, high-risk activities such as contact sports, bicycle riding, roller
skating, and diving are avoided. The child should also use an extra-soft toothbrush to prevent mucosal trauma. Parents are
instructed to monitor the child for signs of bleeding. Medications that may affect platelet function, such as aspirin and
nonsteroidal antiinflammatory drugs (NSAIDs, e.g., iboprophen [Motrin]), are avoided. Tylenol is an acceptable alternative to
aspirin and NSAIDs.

Test-Taking Strategy: Focus on the data in the question and note the platelet count. Recalling that a low platelet count
increases the risk for bleeding will direct you to the correct options. Review this disorder and the normal platelet count if you
74. A nurse is performing an assessment of a child with nephrotic syndrome. Which manifestation would the nurse most likely
note?
. Periorbital edema Correct
A. Weight loss of 1.5 kg
B. Temperature of 99.2F
C. Blood pressure of 128/86 mm Hg
Rationale: Nephrotic syndrome is a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema.
Manifestations include edema (first noted in the periorbital spaces and dependent areas of the body), anorexia, fatigue,
abdominal pain, respiratory infection, and increased weight. The child with nephrotic syndrome usually has a normal blood
pressure. Fever may occur if an infection is present.

Test-Taking Strategy: Use the process of elimination and note the strategic words most likely. Recalling that nephrotic
syndrome is a kidney disorder characterized by proteinuria, hypoalbuminemia, and edema will direct you to the correct
option. Review the manifestations of this disorder if you had difficulty with this question.
75. In which position should the nurse place the child who has just undergone tonsillectomy to facilitate drainage?
. Prone Correct
A. Supine
B. High Fowler
C. Semi-Fowler
Rationale: After tonsillectomy, the child should be placed in a prone or side-lying position to facilitate drainage. The supine,
high Fowler and semi-Fowler positions will not facilitate drainage and may, in fact, increase the risk for aspiration.

Test-Taking Strategy: Use the process of elimination and focus on the subject, a way to facilitate drainage. Visualize each
of the positions identified in the options to determine which will facilitate drainage. This will direct you to the correct option.
Review care of the child who has undergone tonsillectomy if you had difficulty with this question.
76. A nurse is conducting an assessment on a child admitted with suspected von Willebrands disease (VWD). Which question
does the nurse ask to elicit information specific to the manifestations associated with this disease?
. Does it hurt to urinate?
A. Are you always thirsty?
B. Do you have frequent headaches?
C. How many times have you had a nosebleed? Correct
Rationale: VWD is an inherited bleeding disorder. In the child with VWD, von Willebrand protein is either underproduced or
dysfunctional. The von Willebrand protein is the carrier protein for coagulation factor VIII, and it is also a cofactor for the
binding of platelets to damaged endothelial cells. The clinical manifestations of VWD include a history of epistaxis, bleeding
from the gums, prolonged bleeding from cuts, excessive bleeding after surgery or trauma, and menorrhagia (excessive
menstrual bleeding) in females. Urinary problems, thirst, and headaches are not clinical manifestations of VWD.

Test-Taking Strategy: Focus on the data in the question. Recalling that VWD is a bleeding disorder will direct you to the
correct option. Review this disorder if you had difficulty with this question.
77. Which high-calcium food does the nurse direct the parents of a child with lactose intolerance to include in the childs diet?
. Yogurt
A. Raisins
B. Broccoli Correct
C. Ice cream
Rationale: Yogurt, ice cream, and broccoli are high in calcium, but the child with lactose intolerance should avoid all high-
lactose foods, such as milk, yogurt, and ice cream. Foods that are high in calcium and will be tolerated by a child with
lactose intolerance include egg yolk, dried beans, cauliflower, and molasses. Raisins are high in magnesium and
phosphorus.

Test-Taking Strategy: Use the process of elimination. Noting the subject, foods high in calcium, will assist you in eliminating
raisins. To select from the remaining options, focus on the childs diagnosis and recall that yogurt and ice cream are high in
lactose; this will direct you to the correct option. Review dietary measures for the child with lactose intolerance if you had
78. A nurse is providing home care instructions to the mother of an infant who has just been found to have hemophilia. The
nurse should tell the mother to:
. Pad crib rails and table corners Correct
A. Use baby aspirin for pain relief
B. Use a soft toothbrush for dental hygiene
C. Use a generous amount of lubricant when taking the childs temperature rectally
Rationale: Establishment of an age-appropriate safe environment is of paramount importance for the hemophiliac client.
Providing a safe environment for an infant includes padding table corners and crib rails, providing extra joint padding in
clothes, and keeping items that could be pulled down onto the infant out of reach. The use of a soft toothbrush is an
appropriate measure for a child with hemophilia but is not typically necessary for an infant. Rectal temperature
measurements and the use of aspirin are contraindicated in hemophilia because of the risk of bleeding.

Test-Taking Strategy: Use the process of elimination. Focus on the words "infant" and "hemophilia." Remembering that a
toothbrush is not needed for an infant will help you eliminate this option. Recalling that aspirin should not be administered
will assist you in eliminating this option. Rectal temperature measurements are contraindicated in hemophilia, so this option
may easily be eliminated as well. Additionally, the words "generous amount" should serve as a clue that this is an incorrect
option. Review the care of the infant with hemophilia if you had difficulty with this question.
79. A child being seen in the clinic is found to have rubeola (measles), and the father asks the nurse how to care for the child.
The nurse should tell the father that he should:
. Keep the child in a room with dim lights Correct
A. Give the child warm baths to help prevent itching
B. Allow the child to play outdoors, because sunlight will help heal the rash
C. Take the child's temperature every 4 hours and administer 1 baby aspirin for fever
Rationale: One nursing consideration in rubeola is eye care. The affected child usually has photophobia, so the nurse
should suggest that the parent keep the child out of brightly lit areas. Children with viral infections are not to be given aspirin
because of the risk of Reye syndrome. Warm baths and sunlight will aggravate itching. Additionally, the child needs rest.

Test-Taking Strategy: Use the process of elimination. Eliminate the options that involve warmth, which will aggravate the
condition. Recalling that aspirin should not be administered will help you answer correctly. To select from the remaining
options, recall that photophobia may develop in children with rubeola. Review nursing care of the child with rubeola if you
80. A nurse is planning diversional activities for a school-age child hospitalized with acute febrile rheumatic fever. Which activity
is most appropriate?
. Board games Correct
A. Twice-daily visits to the playroom
B. Frequent visits from the childs friends
C. Visits from other children who are hospitalized
Rationale: A child with rheumatic fever requires bed rest during the acute febrile stage of the illness. When the childs
activities are restricted, the nurse and family should limit visitors and arrange for quiet yet enjoyable activities based on the
childs age and developmental level. Visits to the playroom are also restricted during the acute stage of the illness. Board
and computer games, movies, puzzles, and crafts are all appropriate for the school-age child.

Test-Taking Strategy: Use the process of elimination and note the word acute in the diagnosis. Eliminate the options that
are comparable or alike in that they are stimulating activities. Review care of the child hospitalized with acute febrile
rheumatic fever if you had difficulty with this question.
81. The mother of a child with iron-deficiency anemia who is receiving an oral iron supplement calls the nurse and reports that
the child is having black stools. Which response by the nurse is appropriate?
. Its nothing to worry about.
A. You need to bring the child to the emergency department and have this checked.
B. Black, tarry stools are a normal finding when oral iron supplements are being administered. Correct
C. You need to obtain a stool specimen and bring it to the physicians office so that we can check it for blood.
Rationale: Black, tarry stools are a harmless side effect of the administration of iron supplements. The child does not need
to be brought to the emergency department, and it is not necessary to obtain a stool specimen to check for blood. It is
inappropriate to tell the mother not to worry. It is appropriate to provide an accurate explanation for the mothers concern.

Test-Taking Strategy: Use your knowledge of therapeutic communication techniques to eliminate the option in which the
nurse tells the mother not to worry. Next eliminate the options that are comparable or alike in that they indicate a need to
have the child checked. Remember that black, tarry stools occur as a harmless side effect of the use of iron supplements.
Review the effects of iron supplements if you had difficulty with this question.
82. Which laboratory result would the nurse expect to see in a child admitted to the hospital with acute glomerulonephritis?
. Hematocrit of 38%
A. 2+ protein in the urine Correct
B. Serum potassium of 3.8 mg/dL
C. White blood cell (WBC) count of 9800 cells/mm
3

Rationale: History, presenting symptoms, and laboratory results can establish the diagnosis of acute poststreptococcal
glomerulonephritis. Urinalysis reveals macroscopic or microscopic hematuria with red cast cells, which indicate glomerular
injury. Proteinuria is also present. Blood chemistry values are usually within the normal ranges. If renal insufficiency is
severe, however, the blood urea nitrogen and creatinine levels are increased. The complete blood count usually
demonstrates normal a WBC count and mild anemia. The lower hemoglobin and hematocrit values reflect the dilutional
effect of extra fluid in the blood, a result of decreased glomerular filtration. Electrolyte disturbances such as a high serum
potassium level and low serum bicarbonate level may result from inadequate glomerular filtration. All laboratory values
identified in the options are normal, with the exception of the urinary protein level.

Test-Taking Strategy: Use the process of elimination. Recalling the pathophysiology of acute glomerulonephritis and
recalling normal laboratory findings will direct you to the correct option. Review the laboratory findings of this disorder if you
83. Hemosiderosis develops in a child with beta-thalassemia as a result of long-term transfusion therapy. The child is being
treated with deferoxamine (Desferal). The nurse assesses the effectiveness of this therapy by monitoring the childs:
. Lung sounds
A. Blood pressure
B. Serum iron level Correct
C. Serum erythrocyte level
Rationale: One major complication of long-term transfusion therapy is hemosiderosis, the deposition of hemosiderin, an
iron-containing pigment, in the organs. As a means of preventing iron overloadinduced organ damage, chelation therapy
with deferoxamine (administered subcutaneously or intravenously) is instituted. The nurse would assess the effectiveness
of therapy by monitoring the serum iron level. Therapy is continued until the iron level returns to an acceptable level. Lung
sounds, blood pressure, and the serum erythrocyte level not indicators of the effectiveness of this therapy.

Test-Taking Strategy: Use the process of elimination. Recalling that hemosiderosis is the deposition of an iron-containing
pigment in body organs will direct you to the correct option. Review the purpose of this medication if you had difficulty with
this question.
84. A nurse reviews the prescriptions for a child with Kawasaki disease and notes that the physician has prescribed intravenous
immune globulin (IVIG). The nurse should tell the childs mother that this medication has been prescribed to:
. Reduce the childs fever
A. Prevent coronary artery damage Correct
B. Alleviate pain from joint inflammation
C. Prevent the transmission of the infection to others
Rationale: Therapeutic management of Kawasaki disease is directed at preventing or reducing the coronary artery damage
that may occur. High-dose IVIG has been shown to reduce the prevalence of coronary artery abnormalities when given
within 10 days of fever onset. IVIG is not specifically administered to reduce a fever or to alleviate pain. Kawasaki disease is
not communicable.

Test-Taking Strategy: Use the process of elimination. Recalling that this disease affects the smooth muscle cells of the
vascular walls will direct you to the correct option. Review the purpose of administering IVIG to the child with Kawasaki
disease if you had difficulty with this question.
85. A nurse is providing home care instructions to the mother of a child with juvenile idiopathic arthritis. Which action should the
nurse tell the parents to take during a painful exacerbation?
. Splinting the painful joints and avoiding any joint movement
A. Encouraging the child to perform simple isometric exercises Correct
B. Alternating splinting of the painful joints with joint exercises every hour
C. Encouraging the child to perform the prescribed joint exercises to maintain muscle and joint integrity
Rationale: During an exacerbation of the disease, the childs natural reaction is to rest the painful joint, but such inactivity
could lead to muscle wasting and flexion deformity. Therefore it is important for the child to perform simple isometric
exercises. These exercises are appropriate during exacerbations of the disease because they do not involve joint
movement. Exercises that involve joint movement are avoided during an exacerbation of the disease.

Test-Taking Strategy: Use the process of elimination and focus on the subject, exercise during an acute exacerbation of
juvenile idiopathic arthritis. Eliminate the option using the words avoiding any joint movement. To select from the
remaining options, note the word simple in the correct one. Review home care measures during painful exacerbations of
juvenile idiopathic arthritis if you had difficulty with this question.
86. A nurse provides home care instructions to the mother of a child with impetigo. Which statement by the mother indicates the
need for further instruction?
. Its OK for him to go to school tomorrow. Correct
A. I need to wear gloves while Im taking care of him.
B. My husband and I shouldnt share towels or utensils with him.
C. I need to soak the crusts and then wash them off with a warm, soapy washcloth three times a day.
Rationale: Impetigo is an extremely contagious bacterial skin infection, and close contact contributes to its spread. The child
should not attend school or daycare for 24 hours after treatment with antibiotics is started. Gloves should be worn by
anyone caring for the child. Towels or eating utensils used by the child should not be shared with anyone else. The crusts
should be soaked and then washed off with a warm, soapy washcloth three times a day. Additionally, the child should be
bathed daily with an antibacterial soap. The childs fingernails should be kept short, and the hands should be washed
frequently with an antibacterial soap to help prevent cross-contamination.

Test-Taking Strategy: Use the process of elimination and note the strategic words need for further instructions, which
indicate a negative event query and the need to select the incorrect statement. Recalling that impetigo is extremely
contagious will direct you to the correct option. Remember that the child should not attend school or daycare for 24 hours
after starting treatment with antibiotics. Review home care instructions for this skin infection if you had difficulty with this
question.
87. A nurse is providing discharge dietary instructions to the mother of a child who has undergone tonsillectomy. Which of the
following items should the nurse tell the mother that it is safe to give the child? Select all that apply.
. Water Correct
A. Dark toast
B. Cherry gelatin
C. Scrambled eggs Correct
D. Mashed potatoes Correct
Rationale: Adequate fluid and food intake promotes healing and maintains hydration. Clear, cool liquids are encouraged.
Water will maintain hydration. Red liquids and foods, such as cherry gelatin, are avoided because they will give the
appearance of blood if the child vomits. Rough foods such as toast could irritate the throat. Soft foods such as mashed
potatoes and scrambled eggs will not irritate the throat.

Test-Taking Strategy: Visualizing the anatomical location of the surgical procedure and recall that foods that are rough will
irritate the throat. Also remember that red liquids and foods are avoided in the postoperative period. Review care of the child
who has undergone tonsillectomy if you had difficulty with this question.
88. A child who is experiencing wheezing during an acute asthma episode is brought to the emergency department by the
parents. Which intervention does the nurse implement first?
. A chest x-ray
A. Administration of a corticosteroid
B. Administration of a bronchodilator Correct
C. Insertion of an intravenous (IV) catheter
Rationale: A child who is experiencing an episode of wheezing along with other symptoms of an acute asthma attack will
first receive a bronchodilator by way of nebulizer or metered-dose inhaler. If the symptoms do not improve, a dose of an oral
corticosteroid is usually prescribed. If the childs condition still does not improve, hospitalization may be necessary. Once
the child is hospitalized, humidified oxygen is administered to keep the oxygen saturation at 95% or greater. An IV line is
initiated to deliver fluids and provide venous access for parenteral medications as prescribed. Chest radiography, arterial
blood gas determinations, or pulse oximetry may be performed as a means of further evaluating the childs oxygenation
status.

Test-Taking Strategy: Note the strategic words wheezing and first. Use your knowledge of the ABCs (airway, breathing,
and circulation). This will direct you to the correct option. Remember, a bronchodilator will dilate the airways. Review
immediate care of the child experiencing wheezing during an acute asthma episode if you had difficulty with this question.
89. A nurse provides home care instructions to the mother of a child who has undergone myringotomy with the insertion of
tympanostomy tubes. Which statement by the mother indicates a need for further instruction?
. A fever is normal after this procedure. Correct
A. I need to call the doctor if the tubes fall out.
B. I need to keep his ears dry while hes taking a bath.
C. I should keep him from blowing his nose for 7 to 10 days.
Rationale: The mother should be instructed to report any fever or increased pain, which could indicate a postoperative
infection. It is not an emergency if the tubes fall out, but the physician should be notified. Nose-blowing should be avoided
for 7 to 10 days after the procedure. The childs ears need to be kept dry during baths and showers. The usual
recommendation is to place ear plugs or cotton balls covered with petroleum jelly in the ears during baths and showers.

indicate a negative event query and the need to select the incorrect statement. Recalling that fever is an indication of an
infection will direct you to the correct option. Review home care instructions after this procedure if you had difficulty with this
question.
90. A nurse is caring for a child scheduled for a tonsillectomy. To reduce the risk of aspiration during surgery the nurse should
assess the child for:
. Loose teeth Correct
A. Throat redness
B. Signs of active infection
C. Exudate in the tonsillar area
Rationale: In the preoperative period, the child is checked for loose teeth to reduce the risk of aspiration during surgery.
Throat redness and exudate in the tonsillar area are signs of active infection. Other signs of active infection include fever
and an increased white blood cell count.

Test-Taking Strategy: Use the process of elimination and focus on the subject, reducing the risk of aspiration. Note the
options that are comparable or alike. Throat redness and exudate in the tonsillar area are signs of active infection. Review
preoperative care for the child scheduled for tonsillectomy if you had difficulty with this question.
91. A nurse is reviewing the results of an infants serum digoxin test. The digoxin level is 1.5 ng/mL. In light of this finding, which
action should the nurse take?
. Administering the prescribed dose because the level is within the therapeutic range Correct
A. Calling the healthcare provider with the results and asking for further prescriptions
B. Giving the prescribed dose and notifying the healthcare provider of the low digoxin level
C. Holding the dose and immediately notifying the healthcare provider of the toxic digoxin level
Rationale: Digoxin is a cardiac glycoside that increases cardiac output and improves cardiac contractility. The effectiveness
of digoxin depends on achieving and maintaining a therapeutic serum drug level. The difference between a therapeutic and
a toxic level is narrow, the therapeutic range being 1.0 to 2.0 ng/mL. A digoxin level of 1.5 ng/dL is therapeutic. A level
greater than 2.0 ng/mL exceeds the therapeutic range and indicates toxicity. Therefore the nurse should administer the
prescribed dose. The remaining options are incorrect actions.

Test-Taking Strategy: Use the process of elimination. Eliminate the options that are comparable or alike in that they indicate
that the digoxin level is outside the therapeutic range. Review the therapeutic digoxin range if you had difficulty with this
question.
92. A girl with systemic lupus erythematosus (SLE) wants to go to the beach with her friends on the day after their junior prom.
The girl asks the nurse for guidance regarding sun exposure. The nurse should tell the client:
. She cannot be exposed to any sunlight at all
A. She must bring a beach umbrella and remain under it all day
B. Waterproof sunscreen with a minimum sun protection factor (SPF) of 15 is a necessity Correct
C. It is all right to go to the beach as long as she wears sunglasses, a sun hat, and clothes that cover her entire
body
Rationale: SLE, a chronic multi-system autoimmune disease characterized by inflammation of the connective tissue, varies
in severity and is marked by remissions and exacerbations. Although the origin of SLE is not known, genetic, environmental,
hormonal, and immune response factors are likely responsible. These factors include exposure to sun and other UV light,
stress, fatigue, viruses, bacteria, certain medications, and some food additives. Avoiding triggers that set off exacerbation is
essential, so wearing appropriate sunscreen is a necessity. The sunscreen should contain an SPF higher than 15 and
should be waterproof. The remaining options present incorrect information.

Test-Taking Strategy: Use the process of elimination and eliminate the options that are comparable or alike in that they
indicate that exposure to sunlight must be avoided. Also, noting the close-ended words cannot and must will help you
eliminate these options. Review measures that will help prevent an exacerbation of SLE if you had difficulty with this
question.
93. A child with severe respiratory distress is seen in the emergency department and treated for an acute asthmatic episode.
Which assessment finding indicates that the childs condition is improving?
. Stridor
A. Shortness of breath
B. Increased wheezing Correct
C. Dyspnea on exertion
Rationale: A child in severe respiratory distress may not demonstrate wheezing during an acute asthma attack because of
decreased air movement. Decreased wheezing in a child who is not improving clinically may signal an inability to move air.
This is referred to as a "silent chest" and is an ominous sign during an asthma episode. With treatment, increased wheezing
may actually signal that the childs condition is improving. Shortness of breath, dyspnea on exertion, and stridor are
manifestations of an asthmatic episode that indicate airway obstruction.

Test-Taking Strategy: Use the process of elimination and focus on the subject, a finding that indicates that the childs
condition is improving. Recalling the pathophysiology of an asthma episode will direct you to the correct option. Review the
expected findings after treatment for an asthma episode if you had difficulty with this question.
94. A cardiac catheterization is performed on an infant. After the procedure, the nurse should tell the mother that the infant:
. Needs to remain in the crib for 6 hours
A. Can be held in a prone position on the mothers lap Correct
B. Needs to have the affected leg restrained for 8 hours
C. Will have to remain in a 20-degree head-elevated position for several hours
Rationale: After cardiac catheterization, the affected leg is kept straight for 4 to 6 hours. Keeping the infant in the crib does
not ensure that the affected leg will remain in a straight position. The infant may be held prone on a parents lap. Older
children remain in bed, with the head of the bed raised just 20 degrees.

Test-Taking Strategy: Use the process of elimination and note that the client of the question is an infant. Visualize each of
the options and recall that the affected leg must remain straight. This will direct you to the correct option. Review care after
this procedure if you had difficulty with this question.
95. A nurse is providing information to parents about the transmission of hepatitis. The nurse should tell the parents that
hepatitis A virus (HAV) is primarily transmitted:
. During birth
A. By way of sexual contact
B. In blood and blood products
C. In contaminated food or water Correct
Rationale: HAV is transmitted by way of the fecal-oral route and in food or water contaminated with HAV. Hepatitis B virus is
transmitted by way of blood, blood products, and secretions; prenatally or perinatally; during sexual contact; and in breast
milk. Hepatitis C virus is transmitted perinatally or through blood and blood products.

Test-Taking Strategy: Knowledge regarding the transmission of HAV is needed to answer this question. Remember that
HAV is transmitted by way of the fecal-oral route and in HAV-contaminated food or water. If you are unfamiliar with the
routes of transmission of the various types of hepatitis, review this information.
96. A nurse is providing home care instructions to the parents of a child with bacterial conjunctivitis. The nurse should tell the
parents:
. That the child may attend school if antibiotics have been started
A. To save any unused eye medication in case a sibling gets the eye infection
B. That the child's towels and washcloths should not be used by other members of the household Correct
C. To wipe any crusted material from the eye with a cotton ball soaked in warm water, starting at the outer
aspect of the eye and moving toward the inner aspect
Rationale: Bacterial conjunctivitis is highly contagious, and infection control measures should be taught. These include
practicing good handwashing and not sharing towels and washcloths with others. The child should be kept home from
school until 24 hours after antibiotics have been started. Bottles of eye medication should never be shared with others.
Crusted material may be wiped from the eye with a cotton ball soaked in warm water, starting at the inner aspect of the eye
and moving toward the outer aspect.

Test-Taking Strategy: Use the process of elimination. Recalling that bacterial conjunctivitis is highly contagious will direct
you to the correct option. If you had difficulty with this question, review infection-control measures for bacterial
conjunctivitis.
97. The nurse is discharging a child with primary nocturnal enuresis. Which statements by the parents indicate that they
understand the techniques used to manage this disorder? Select all that apply.
. An alarm system might help prevent the bedwetting. Correct
A. We need to limit her fluid intake throughout the day.
B. We need to be sure that she urinates just before bedtime. Correct
C. Weve already developed a reward system for when she stays dry for a certain number of consecutive
nights. Correct
D. Well teach her to perform Kegel or pelvic muscle exercises and encourage her to do them every hour of the
day.
Rationale: Treatment of primary nocturnal enuresis includes limiting fluids after supper (not throughout the day) and
encouraging the child to urinate before bedtime. A reward system of some type may be helpful, and the child and parents
can decide on a special reward when the child has achieved a certain number of consecutive dry nights. Behavioral
conditioning with the use of alarms may be helpful. One such alarm system includes a device worn on the childs pajamas
that contains a moisture-sensitive alarm. As the child starts to void, the alarm goes off, awakening the child. Kegel or pelvic
muscle exercises may be helpful for daytime enuresis but are not useful in preventing nocturnal enuresis.

Test-Taking Strategy: Read each option carefully. Remembering that fluid intake is not normally limited in children because
dehydration is likely to develop and understanding that performing Kegel or pelvic muscle exercises 24 hours a day will
disrupt sleep will assist you in answering correctly. Review the treatment measures for this disorder if you had difficulty with
this question.
98. The mother of a child who underwent myringotomy with the insertion of tympanostomy tubes 1 day ago calls the physicians
office and reports to the nurse that the child has a small amount of reddish drainage coming from the ears. The nurse
should tell the mother to:
. Irrigate the ears gently with warm water
A. Bring the child to the physicians office to be checked
B. Carefully push the tubes a little farther into the ear canal
C. Continue to monitor the drainage, because this is a normal finding Correct
Rationale: After myringotomy with insertion of tympanostomy tubes, the child is monitored for ear drainage. A small amount
of reddish drainage is normal for the first few days after surgery, but the mother should report any heavier bleeding or
bleeding that occurs after 3 days. Having the physician check the child is unnecessary. Irrigating the ears with warm water
and pushing the tubes further into the ear canal are inappropriate and could cause harm to the child.

Test-Taking Strategy: Use the process of elimination. Focusing on the type of surgical procedure identified in the question
will assist you in eliminating the options that involve irrigating the ear and pushing the tubes farther in. To select from the
remaining options, note the words small amount in the question, which should direct you to the correct option. Review the
expected findings after this procedure if you had difficulty with this question.
99. A pancreatic enzyme preparation is prescribed for a child with cystic fibrosis (CF). The nurse instructs the childs mother to
administer the pancreatic enzyme:
. At noon only
A. With meals and snacks Correct
B. 2 hours after breakfast and dinner
C. At bedtime and in the morning when the child awakens
Rationale: Pancreatic enzyme preparations are administered to ease the steatorrhea that occurs in CF as a result of
digestive system involvement. These preparations are administered with every meal and snack to supplement and replace
pancreatic enzymes and aid digestion.

Test-Taking Strategy: Use the process of elimination. Eliminate the option containing the closed-ended word only. To
select from the remaining options, recall the purpose of administering these preparations, which should direct you to the
correct option. Review the procedure for administering pancreatic enzyme preparations if you had difficulty with this
question.
100. A child has a plaster of Paris cast applied to his arm after fracturing the arm in a fall. The nurse should tell the mother that
the cast:
. Is water resistant
A. Is very lightweight
B. Will quickly dry if it gets wet
C. Takes 24 hours or more to dry Correct
Rationale: Plaster of Paris is a heavy material that molds easily to the extremity and is less expensive than synthetic cast
materials. It takes 24 hours or longer to dry. Plaster of Paris is not water resistant; when wet, a cast made of plaster will
begin to disintegrate.

Test-Taking Strategy: Use the process of elimination. Focusing on the word plaster will help you answer the question. A
cast made of plaster would not be lightweight or water resistant and would not dry quickly if it became wet. Review the
characteristics of a plaster of Paris cast if you had difficulty with this question.

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