NCLEX-PN pediatrics practice questions

Question 1

A 5-week-old infant is admitted with pyloric stenosis, sunken fontanels and a serum chloride of 88 mEq/L. A pyloromyotomy is planned. Which of the following interventions would the nurse expect to be included in the preoperative plan of care?

Accepted Answer

A: Keep the infant NPO; B: Infuse IV fluids, adding potassium once the infant is voiding; D: Weigh the infant daily on the same scale; E: Record intake and output, including vomitus and weighed diapers. Pyloric stenosis is a condition in young infants in which the muscle at the outlet of the stomach (the pylorus) thickens and narrows the opening into the small intestine.

The infant is kept NPO before surgery, because feedings only cause more vomiting and the infant must have an empty stomach for anesthesia. A nasogastric tube may be placed to decompress the stomach. IV fluids correct the dehydration and the hypochloremic metabolic alkalosis, and potassium is added only after the kidneys are shown to be working. Surgery is delayed until fluid and electrolyte values are normal. Daily weights and strict intake and output, with diapers weighed, show whether the fluid deficit is being corrected.

Question 2

A 13-year-old client has worn a Boston brace for 2 months. At a clinic visit, the client tells the nurse, "I take it off before school and put it back on at night. Everyone stares at it." Which response by the nurse is most appropriate?

Accepted Answer

C: "That sounds hard. Let's talk about clothes that fit over it and how others your age cope.". Body image and acceptance by peers are central concerns in early adolescence, and a brace that looks different is a common reason for poor adherence. The nurse first acknowledges the feeling, then works with the client on practical solutions, such as loose tops that hide the brace, a wearing schedule the client helps plan and contact with other adolescents who wear braces. Hours of wear are linked to how well the brace slows the curve, so solving the problem with the client is the goal. Involving the adolescent in decisions supports the need for control and makes adherence more likely.

Question 3

The nurse is giving prescribed ofloxacin otic drops to a 2-year-old child with otitis externa of the right ear. The bottle has been stored in the medication refrigerator. Which technique should the nurse use?

Accepted Answer

B: Gently pull the pinna down and back while instilling the drops. In a child younger than 3 years, the ear canal is short and angled upward, so pulling the pinna down and back straightens it and lets the drops reach the eardrum. Otic drops are given at room temperature, warmed in the hands if they were refrigerated, because cold fluid in the ear can cause pain, dizziness and nausea. The dropper is held just above the canal without touching it. The child then lies on the unaffected side with the treated ear up for about 5 minutes so the drops stay in the canal.

Question 4

During a well-child visit for a 2-month-old infant, the parent says that an unvaccinated child next door was hospitalized with epiglottitis. The health care provider explains the Haemophilus influenzae type b (Hib) vaccine to the parent. Which statement by the parent indicates a need for further teaching?

Accepted Answer

D: "The Hib vaccine will also protect my baby from strep and staph.". Epiglottitis is a serious infection that causes swelling of the epiglottis, the flap of tissue at the base of the tongue.

The Hib series starts at 2 months with further doses at 4 months and, for some vaccine brands, 6 months. A booster follows at 12 to 15 months. Routine Hib vaccination has made epiglottitis rare in children. The vaccine protects only against type b, however. Streptococcus, Staphylococcus and other strains of Haemophilus can still cause epiglottitis, so the parent should still seek emergency care for a sudden high fever with drooling, trouble swallowing or a muffled voice.

Question 5

At a well-baby visit, the nurse prepares routine immunizations for a 2-month-old male infant. The infant has severe hemophilia A, and several of the vaccines are given by intramuscular injection. The infant received a dose of factor VIII concentrate yesterday. Which action should the nurse take?

Accepted Answer

A: Use a 23- to 25-gauge needle for each intramuscular injection. Hemophilia A is an inherited bleeding disorder in which the blood lacks enough clotting factor VIII, so blood does not clot normally.

Infants with hemophilia should get all routine vaccines on schedule. The CDC advises that vaccines meant for the intramuscular route may be given that way to a person with a bleeding disorder, using a fine needle of 23 to 25 gauge (a higher gauge number means a finer needle), ideally soon after a factor dose. After each injection, firm pressure is held on the site for at least 2 minutes without rubbing to prevent a hematoma. The nurse reminds the parents to watch the site for swelling over the next day and to report a growing lump.

Question 6

A 5-week-old firstborn male infant is brought to the clinic by a parent who reports that the infant has vomited after most feedings for 4 days. Which of the following findings would the nurse recognize as consistent with pyloric stenosis?

Accepted Answer

A: Forceful vomiting that lands about 3 feet from the infant; C: Eagerness to feed again right after vomiting; D: A firm, olive-shaped mass in the right upper quadrant. Pyloric stenosis is a condition in young infants in which the muscle at the outlet of the stomach (the pylorus) thickens and narrows the opening into the small intestine.

In pyloric stenosis the muscle of the pylorus thickens and narrows the outlet of the stomach. Vomiting usually starts at 2 to 8 weeks of age, most often at 4 to 6 weeks, and becomes projectile. The infant stays hungry and wants to feed again right after vomiting. The thickened pylorus may be felt as an olive-shaped mass in the right upper quadrant, and peristaltic waves may be seen moving from left to right across the upper abdomen. Firstborn males are affected most often.

Question 7

A toilet-trained 3-year-old child has been hospitalized for 4 days and has begun wetting the bed and asking for a bottle. The parents are worried. Which response by the nurse is most appropriate?

Accepted Answer

B: "Going back to earlier behaviors is common in the hospital and usually stops at home.". Regression, returning to earlier behaviors such as bed-wetting, bottle use or thumb-sucking, is a common response to the stress of hospitalization in toddlers and preschoolers. It is the child's way of coping. Parents are reassured that it is temporary and encouraged not to scold, and the nurse keeps home routines where possible.

Question 8

At a pediatric clinic, a 2-year-old with iron deficiency anemia is prescribed ferrous sulfate liquid once daily. The nurse reinforces the teaching with the parent. Which statement by the parent indicates a correct understanding?

Accepted Answer

D: "I'll mix it with a little orange juice and give it through a straw.". Ferrous sulfate is an iron supplement used to treat or prevent iron-deficiency anemia.

Iron is absorbed best on an empty stomach and with vitamin C, which helps the gut take it up. Milk and dairy foods bind iron and block its absorption, so iron is never mixed with milk or given with dairy.

Liquid iron can stain the teeth, so it is given through a straw or with a dropper placed toward the back of the mouth, and the teeth are brushed afterward. Dark green or black stools are an expected effect of iron, not a reason to stop it. Too much milk, more than about 24 ounces (3 cups) a day in a toddler, is itself a common cause of iron deficiency, because it fills the child up and crowds out iron-rich foods.

Question 9

The nurse in a high school health office is reinforcing skin care teaching with a 15-year-old client who has moderate acne. Which statement by the adolescent indicates a need for further teaching?

Accepted Answer

C: "If I scrub my face harder, my acne should clear up faster.". Acne is a disorder in which blocked and inflamed hair follicles produce pimples, nodules and sometimes scarring.

Acne is driven by hormones, heredity and bacteria. Hormones at puberty make the sebaceous glands enlarge and produce more oil, the pores become blocked with oil and dead skin to form blackheads and whiteheads, and the bacterium Cutibacterium acnes, formerly called Propionibacterium acnes, multiplies in the blocked follicle and causes inflammation.

Dirt does not cause acne, and scrubbing harder actually makes it worse by irritating the skin and spreading inflammation. Chocolate and greasy food are not proven causes either, though a few people notice particular foods matter for them. So this adolescent is relying on a myth and needs the teaching reinforced, without dismissing how much the acne matters to the adolescent.

Question 10

The nurse at a pediatric cardiology clinic is reviewing the four defects that make up tetralogy of Fallot. Which of the following is one of them?

Accepted Answer

D: Pulmonary artery stenosis. Tetralogy means four, and the four spell the four defects. Pulmonary artery stenosis, Right ventricular hypertrophy, Overriding aorta, and a Ventricular septal defect.

The four fit together rather than being a random list. The pulmonary artery is narrowed, so blood struggles to get to the lungs and the right ventricle has to work harder against it, which is why it thickens. The aorta sits over the hole in the septum instead of over the left ventricle alone, so it picks up blood from both sides. And the ventricular septal defect is the hole that lets the unoxygenated blood across. Together they send blood past the lungs and out to the body, which is why the infant is blue.

For the exam you mostly need to recognize the four as answer choices rather than explain them, which is what the four defects is for.

NCLEX-PN pediatrics practice questions.