Clinical manifestations of increased ICP in children include all of the following except:

1
Clinical manifestations of increased ICP in
children include all of the following except

1. Headache
2. Vomiting, w/ or w/o nausea
3. Seizures
4. Setting-sun sign

2
FYI late signs of incd ICP

• Decd LOC
• Decd motor response to command
• Decd sensory response to painful stimuli
• Alterations in pupil size reactivity
• Papilledema (optic nerve swelling)
• Cheyne-Stokes repsirations
• Decerebrate or decorticate posturing

3
Nurse caring for 8yo w/ dx of basilar skull
fracture. Which order would nurse question?

1. Clear liquid intake
2. Maintain patent IV line
3. Daily weight
4. Suction as needed

4
Nurse monitoring child for bleeding post brain
tumor resection. Checks head dressing notes
colorless drainage on back of dressing. Which
would be most appropriate intervention?

1. Circle area of drainage continue to monitor
2. Reinforce dressing
3. Notify physician
4. Document findings continue to monitor

5
Post op removal of brain tumor, physician order
to maintain child in flat position. Nurse
monitoring notes child is restless, pulse rate is
elevated BP has dropped significantly from
baseline. Suspects shock. Which would be most
appropriate nursing action?

1. Place child in Trendelenburgs position
2. Elevate head of bed
3. Increase IV fluids
4. Notify physician

6
Lumbar puncture performed on child w/ suspected
bacterial meningitis. Which of the following CSF
results would verify dx?

1. Cloudy CSF, decd protein, decd glucose
2. Cloudy CSF, incd protein, decd glucose
3. Clear CSF, incd protein, decd glucose
4. Clear CSF, decd pressure, elevated protein

7
Which statement regarding meningitis is true?

1. Both viral bacterial meningitis may have an
   associated fever
2. Stiff neck is the most common symptom in infants
   w/ bacterial meningitis
3. Headaches only occur w/ bacterial meningitis
4. Viral meningitis is more easily detected than
   bacterial meningitis is children

8
Which of the following vaccine(s) protects
infants from bacterial meningitis (there may be
more than one)?

1. IPV (polio)
2. PCV (pneumococcal)
3. DTaP (diptheria, tetanus, pertussis)
4. Hib (haemophilus influenzae type b)

9
Which of the following positions is the most
effective in preventing a further increase in ICP?

1. Left side lying, head flexed, knees drawn up
2. Trendelenburg position
3. Fowlers position
4. Supine w/ 30o head elevation

10
Adolescent discharged w/ prescription for
phenytoin (Dilantin). Which of the following by
father indicates discharge teaching has been
effective?

1. I need to admin her medicine in the morning
   evening
2. I will keep the annual appt for f/u on her med
3. I will be sure to encourage good oral care
   regular dental visits
4. I can allow her to stop taking the med after
   6wks, as long as there are no seizures

11
Parent of 9yo w/ GH deficiency asks nurse how
long son will need to take injections for his
growth problem. Which is most appropriate?

1. Injections are usually contd until age 10 for
   girls 12 for boys
2. Injections need to continue until child reaches
   the 5th percentile on the growth chart
3. Injections should be contd until bone maturation
   is complete, usually between 14-16yrs
4. The injections will need to be administered
   throughout the childs entire life.

12
During which of the following periods of growth
devt should a nurse anticipate behavioral
problems form a child w/ untreated GH deficiency?

1. Infant
2. Preschooler
3. School-age
4. Adolescent

13
When providing health teaching to group of
adolescents w/ type 1 d.m., a nurse instructs
them that a hypoglycemic reaction can occur b/c
of

1. Too much glucose in the body
2. Eating too much junk food
3. Exercising strenuously
4. Not enough insulin in the body

14
Nurse caring for child w/ type 1 d.m. who has
been taking insulin for 3 mos. Which diagnostic
study will provider likely order to determine how
well childs diabetes is being managed?

1. Morning faster blood glucose
2. 2hr oral glucose tolerance test
3. Hb1Ac
4. Diary of childs daily blood glucoses

15
Place the following steps in order when treating
hypoglycemia

• Recheck blood glucose
• Treat w/ 15g carbs
• If still low, give 15g more carbs
• Stop activity sit down
• Recheck blood glucose

16
Child brought by parents to ER w/ 1st degree
burns to shoulders from sun exposure. Which
interventions are indicated?

1. Start IV of NS
2. Apply cool, wet compresses
3. Scrub area w/ soft-bristle brush
4. Admin morphine sulfate for pain relief

17
Child experiences 3rd degree burns to both legs
after they were immersed in boiling water. Which
nursing diagnoses will receive priority during
the first 24 hours?

1. Deficient fluid volume
2. Imbalanced nutrition less than body requirements
3. Impaired breathing pattern
4. Disturbed body image

18
Mother of 3yo arrives at clinic tells nurse
that child has been scratching the skin
continuously has developed a rash. Nurse
assess suspects scabies. Nurse bases this
suspicion on which finding

1. Clusters of fluid filled vesicles
2. Fine, threadlike lines
3. Purple-colored lesions
4. Thick, honey colored crusts

19
Which of the following orders should a nurse
implement first for a child w/ a UTI?

1. Ampicillin 250mg IV q 12hr
2. Blood urine cultures
3. Sitz bath prn for pain
4. Voiding cystourethrogram (VCUG)

20
3yo being admitted w/ nephrotic syndrome. Best
roommate is

1. 16yo recovering post-op from ruptured appendix
2. 8yo w/ leukemia
3. Another toddler w/ rheumatic fever
4. No roommate because isolation is required

21
Admission assessment on 2yo who has been dxd w/
nephrotic syndrome. Nurse knows that most common
characteristic assocd w/ it is?

1. Generalized edema
2. Frank bright red blood in urine
3. Incd urinary output
4. hypertension

22
Parents of child w/ glomerulonephritis concerned
about activity restrictions after discharge.
Nurse bases response on the fact that urinary
findings are near normal.

1. Activity must be limited for 1 mo
2. Child must not play active games
3. Child must remain in bed for 2 wks
4. Activity does not affect course of disease

23
Which nursing intervention has highest priority
when caring for child w/ acute glomerulonephritis?

1. Assess for dysuria
2. Monitor BP
3. Monitor temp
4. Assess for jaundice

24

• A child is admitted w/ glomerulonephritis. Nurse
  should expect to see a recent _______ infection
  in the history given by the mother.

25
Failure to repair hypospadias can lead to
testicular cancer later in life.

1. True
2. False

26
To prevent swelling of casted extremity, elevate
the extremity above heart level apply ice to
cast.

1. True
2. False

27
Which of the following is an early sign of
impaired neurovascular function in a child w/ an
arm cast?

1. Cool, cold fingers
2. Pain
3. Inability to detect a pulse distal to cast
4. Inability to move distal extremity

28
Choose the most appropriate roommate for a 16yo
in a full body cast.

1. 12 yo w/ inguinal hernia repair
2. 9 yo w/ gastroenteritis
3. 6 yo w/ fractured femur
4. 15 yo w/ pneumonia

29
When caring for child in Bryants traction, nurse
should be aware that this traction is

1. Skin traction to the affected leg
2. Attached to a pin placed in the affected femur
3. Used to allow child to turn from side to side
4. Skin traction elevates hips slightly from bed

30
Nurse detects a positive Ortolani sign in a
newborn. What is the nurse assessing?

1. Broadening of perineum
2. Shortening of one leg
3. Audible click on hip manipulation
4. Unilateral droop of hip

31
13mo old dxd w/ L hip dysplasia scheduled for
surgery spica cast. Childs mother questions
why a pavlik harness is not being used.
Appropriate response is

1. Pavlik harness is used for children w/ scoliosis,
   not hip dysplasia
2. Pavlik harness is used for school-age children
3. Your childs condition is too severe for a pavlik
   harness
4. Pavlik harness is only used for infants lt6mos

32
Mother brings 2wk old to clinic for tx following
dx of clubfoot made at time of birth. Which
statements, indicates need for further teaching?

1. I need to bring my infant back to clinic in 1 mo
   for a new cast
2. Tx needs to be started as soon as possible
3. I need to come to clinic every week w/ my infant
   for casting
4. I realize my infant will require follow-up care
   until full grown

33
Nurse providing instructions to parents of child
w/ scoliosis regarding use of a brace. Which
statement indicated need for further instructions?

1. I should apply lotion under the brace to prevent
   skin breakdown
2. I should avoid the use of powder b/c it will cake
   under the brace
3. I will have my child wear soft fabric clothing
   under the brace
4. I will encourage my child to perform prescribed
   exercises

34
To prevent loss of joint fxn in a child w/ JRA,
nurse should teach parents to avoid letting child

1. Ride a bike
2. Walk to school
3. Do frequent isometric exercises
4. Watch TV for prolonged periods

35
Child scheduled for debridement of leg wounds.
In what order should nurse perform procedures?

1. Remove dressing
2. Medicate for pain
3. Pour water on dressing to loosen it
4. Assess need for dressing supplies

36
Which of the following are manifestations of
scabies? (all that apply)

1. Nits present
2. Threadlike rash between fingers other moist
   areas
3. Circular rash on extremities
4. Pruritus
5. Eczematous eruption in infants

37
Match skin disorder w/ cause

1. Impetigo contagiosa
2. Scabies
3. Lyme disease
4. Cold sore, fever blister
5. ringworm

1. Fungal infection
2. Bacterial infection
3. Viral infection
4. Caused by spirochete
5. Caused by burrowing mite

38
Match type of dermatitis w/ its description

1. Diaper dermatitis
2. Infantile eczema
3. Acne
4. Seborrheic dermatitis

1. Weeping, red vesicles papules
2. Comedones pustules
3. Red, inflamed skin
4. Thick, yellow scaly areas

39
Which of the following meds can be used for
children w/ eczema? (all that apply)

1. Corticosteroids
2. Accutane
3. Peroxide
4. Antihistamines
5. Calamine lotion

40
Diaper dermatitis can be largely prevented by
changing an infants diapers frequently keeping
the diaper area clean dry.

• True
• False

41
Eczema usually appears on cheeks of a 4yo child.

1. True
2. False

42
A complication that may occur w/ acne most
types of dermatits is cellulitis.

• True
• False

43
Nurse reviewing sick day mangement w/ parent of a
child w/ type 1 diabetes. Which of following
should be included in teaching? (all that apply)

1. Monitor blood glucose every 4 hr
2. Discontinue taking insulin until feeling better
3. Drink 8 oz fruit juice every hour
4. Test urine for ketones
5. Call PCP if blood glucose is gt250mg/dL

44
Providing health teaching to group of adolescents
w/ D.M., nurse teaches them to observe for s/s of
hypoglycemia. Which of following should be
included? (all that apply)

1. Frequent urination
2. Incd energy level
3. Nausea
4. Nervousness irritability
5. Sweating pallor
6. Deep, rapid labored respirations

45
Hypoglycemic rx can occurs b/c of

1. Too much glucose in body
2. Eating too much junk food
3. Exercising strenuously
4. Not enough insulin in body

46
Child w/ type 1 D.M. on insulin for 3 months.
Which of the following diagnostic studies will
provider order to how well childs D.M. is being
managed?

1. Morning fasting blood glucose
2. 2hr oral glucose tolerance test
3. Hb1Ac
4. Diary of childs daily blood glucoses

47
When teaching child w/ newly dxd type 1 D.M.,
priority should be placed on

1. Wt loss measures
2. Self-monitoring of blood glucose
3. Need to reduce physical activity
4. Elimination of sugar from diet

48
During scheduled exam, childs HbA1c level is 9.
Child has had type 1 D.M. for 1 yr. Which of
the following actions should nurse take?

1. Assess signs of infection childs intake for
   past 24hr
2. Explore childs general dietary patterns for past
   3 mos
3. Review parents understanding of diabetic foot
   care
4. Immediately admin childs rapid acting insulin
   dose.

49
Nurse asks 12yo w/ GH deficiency to draw a pic
off herself playing w/ children on a
playground-potential characteristics that might
represent positive and negative self-esteem

• Positive

• Negative

• Child playing w/ other children
• Child smiling
• Interaction between children
• True height discrepancy
• Bright, colorful picture

• Child standing off to side while other children
  are playing
• Drawing indicates teasing /or ridicule
• Child appears much smaller than others
• Dark picture that is scribbled

50
Match diagnostic test w/ findings r/t growth
disorders.

1. X-rays of wrist hand
2. IGF-1
3. MRI
4. GH stimulation/ suppression test

1. Determines GH level
2. Ids pituitary gland tumor
3. Determines bone age
4. Measures effect of glucose on GH

51
6yo who has been bladder trained w/o enuresis
since age 4 has begun having accidents both at
night occasionally during the day. Which of
the following should be ruled out as possible
causes? (all that apply)

1. Glomerulonephritis
2. UTI
3. New onset D.M.
4. Epispadias
5. Bladder exstrophy

52
Match structural GU disorder w/ definition

1. Hypospadias
2. Epispadias
3. Phimosis
4. Bladder exstrophy
5. Cryptorchidism
6. Chordee
7. Hydrocele

1. Ventral curvature of penis
2. Narrowed opening in urinary meatus preventing
   retraction of foreskin over glans penis
3. Failure of 1 or both testicles to descend into
   scrotum
4. Collection of fluid in scrotal sac
5. Urethral meatus is located on ventral side of
   glans penis
6. Eversion of bladder through lower abd wall
7. Urethral meatus located on dorsal side of glans
   penis

53
Multiple surgeries will be required for child w/
bladder exstrophy to repair damage to bladder
pelvic area.

1. True
2. False

54
6yo admitted to acute care w/ dx of possible UTI.
Which of following should nurse expect to find?

1. Dysuria, thirst, light colored urine, ammonia
   odor in urine
2. Dysuria, L sided pain, foul odor to urine, dark
   color to urine
3. Polyuria, lower abd pain, yellow urine, sweet
   odor to urine
4. Oliguria, epigastric pain, yellow skin tones,
   ammonia odor to breath

55
Nurse preparing discharge teaching for mother of
6yo girl who had severe UTI. Which instructions
are beneficial? (all that apply)

1. Avoid bubble baths
2. Change childs bathing suit immediately after
   swimming
3. Encourage child to go to BR q6hr
4. Have child wear cotton underpants rather than
   nylon
5. Observe child wiping back to front after voiding

56
Child admitted w/ glomerulonephritis. Which of
following indicates need to call PCP?

1. Specific gravity decrease from 1.022 to 1.020
2. Crackles in bases bilaterally
3. Absence of S3 on auscultation
4. Wt gain of 0.91kg overnight

57
Child admitted w/ nephrotic syndrome. Which of
following classic symptoms should nurse observe
for?

1. HTN, hypoNa, hemoconcentration
2. hyperNa, hypoalbuminenia, hyperlipidemia
3. Hematuria, hypoaldosteronemia, hyperNa
4. Hemodilution, hyperalbuminemia, hypoproteinemia

58
Parent of child w/ excess fluid vol weeping
skin tells nurse he would like to be more
involved in cares. Which should nurse encourage?

1. Admin IV Lasix under supervision of nurse
2. Read to child from bedside chair
3. Reposition child q30min
4. Assist in changing linens as they become wet

59
Toddler w/ nephrotic syndrome has plt count of
700,000mm3. For which s/s should nurse monitor?

1. Thrombosis
2. Bruising
3. Pulm congestion
4. Cardiac enlargement

60
3 yo w/ meningitis is documented as having
photophobia. Which of following interventions is
most effective in minimizing this symptom?

1. Avoid using the TV
2. Keep volume down on radio
3. Bandage both eyes temporarily
4. Elevate HOB

61
Child admitted w/ possible Reye syndrome. Which
factors in health history might be supportive of
this dx?

1. Recent h/o UTI
2. Recent h/o bacterial otitis media
3. Recent episode of gastroenteritis
4. Recent episode of haemophilus influenzae
   meningitis

62
Which manifestations are indicative of Stage II
of Reye syndrome? (all that apply)

1. Coma
2. Fixed pupils
3. Hyperventilation
4. Combativeness
5. Hyperactive deep tendon reflexes

63
Lack of which is a warning sign of palsy in 3mo
old infant?

1. Crawling
2. Sitting up w/o assistance
3. Hold head upright
4. Babbling simple words

64
Match type of CP w/ correct description

1. Will cause child to experience difficulty w/
   quick or precise mvmts (writing, buttoning)
2. Causes slow uncontrollable writhing mvmts of
   hands, feet, arms, /or legs
3. Delays ability to walk in children (may walk on
   tips of toes b/c of tight heel tendon)
4. Tightness in certain leg muscles makes legs move
   like arms of scissor (scissor walking)
5. Will interfere w/ childs ability to speak (child
   often hard to understand)

1. Hemiplegia/ hemiparesis
2. Diplegia/ diparesis
3. Quadriplegia/quadriparesis
4. Dyskinetic/ athetoid
5. ataxic

65
Child w/ spina bifida should be instructed in
intermittent bladder catheterization using clean
latex catheter.

1. True
2. False

66
Priority nursing dx for child who sits in
wheelchair all day is risk for impaired skin
integrity.

1. True
2. False

67
School-age child w/ spina bifida has shunt in
place for hydrocephalus. Which s/s are
manifestations of incd ICP? (all that apply)

1. Fever
2. Hypotension
3. Headache
4. Lethargy
5. Bulging anterior fontanel
6. Seizures
7. Change in school performance

68
Match each type of seizure below w/ its
definition.

1. Tonic-clonic
2. Absence seizure
3. Febrile seizure
4. Complex partial seizure

1. Occurs w/ temp gt 38.8 (101.8)
2. Generalized mvmt of all extremities
3. Decd consciousness w/ staring, lip smacking,
   chewing during seizure
4. 5-10sec loss of consciousness that looks like
   daydreaming

69
A single seizure lasting gt10mins or a series of
seizures lasting 20-30mins is called ________.
70
Which vitals is indicative of Cushings reflex
in a 6yo?

1. Temp 37.2 (99), pulse 100, RR 22, BP 100/70
2. Temp 37.9 (100.2), pulse 140, RR 26, BP 60/30
3. Temp 35.6 (96), pulse 50, RR 18, BP 80/50
4. Temp 37.8 (100), pulse 64, RR 20, BP 140/40

71
Child w/ concussion being discharged home w/
parent. Which statement indicates need for
further teaching?

1. I will keep him awake all night to make sure
   there is no change
2. I should call the hospital if I cannot arouse him
3. His pupils should remain equal get smaller when
   I shine a light into them
4. I should call the doctor if he starts to vomit

72
6mo old infant admitted to critical care w/
basilar skull fracture. Which findings should
nurse expect? (all that apply)

1. Two black eyes
2. Nuchal rigidity
3. Split cranial sutures
4. Bruising of neck posterior to infants ear
5. Nosebleed

73
Which are priority assessments for adolescent
postop for insertion of Harrington rod secondary
to scoliosis?

1. Ability to eat a balanced diet
2. BP pulse
3. O2 sat
4. Assess for body image disturbance
5. Neurvascular assessment
6. Pain assessment
7. Assess for wound infection

74
8 yr old R femur fracture after falling off
skateboard. After 3 wks traction w/ pin, casted
discharged. Teaching instructions include
(all that apply)

1. Wash cast carefully if it becomes soiled
2. Allow cast to remain uncovered until it dries
   completely
3. Support wet cast carefully avoid denting it
4. Make sure nothing is placed inside cast
5. Check leg frequently for signs of swelling

75
Incd pain, erythema fever are 3 signs that
compartment syndrome is occurring w/in casted
extremity.

• True
• False

76
Adolescent w/ rheumatoid arthritis reports severe
pain during PT exercises states she doesnt
want to go back to PT again. Intervention to
solve this problem

1. Medicate w/ morphine sulfate before PT
2. Use ice packs before PT to dec inflammation
3. Take warm bath or use warm packs before PT
4. Perform passive ROM for adolescent before PT

77
What measures can be taken to dec pain prevent
deformity during sleep for child w/ RA?

• Splinting of knees, wrists, hands
• Sleeping on firm matterss w/o pillows under knees
  may help dec pain prevent flexion deformities

78
5 yo child unable to sit through meals, easily
distracted. At night, gets up while family is
sleeping wanders about house. Doing poorly in
kindergarten d/t inability to concentrate on
work. Which should child be evaluated for?

1. Mental retardation
2. Down syndrome
3. ADHD
4. Autism

79
Nurse is discussing w/ parents of 3mo w/ Down
syndrome ways to help prevent recurrent resp
infections. Which interventions should nurse
discuss? (all that apply)

1. Practice frequent handwashing
2. Keep infant in Fowlers position most of time to
   prevent choking
3. Use bulb syringe to remove nasal mucus
4. Keep infants mouth moist by rinsing frequently
   w/ water

80
Nurse assessing 4yo for autism. Should be alert
for

1. Constant talking impulsive behavior
2. Poor language interpersonal skills
3. Frequent resp UTIs
4. Constant clinging to parents wanting to be
   cuddled

81
9yo w/ autism continually hits head on desk.
During planning w/ teachers, school nurse has
devised one outcome for the problem, which states
child will develop self-control measures to
prevent behavior. Nurse should evaluate this
outcome to be met when child

1. Wears his helmet continually to prevent injury
2. Begins cutting his arm instead of banging his
   head
3. Seeks out a staff member instead of head banging
4. Is placed in seat w/o desk to prevent this
   unacceptable behavior

82
3mo old FTT being bottle fed. Following
techniques nurse should teach mom (all that
apply)

1. Simulate feeding environment in common dining
   room
2. Maintain eye contact w/ infant during feeding
3. Burp infant frequently during feeding
4. Give infant as much formula as she can hold
   during each feeding
5. Develop structured feeding routine

83
Nurse evaluating family in which child abuse has
occurred. Which is best indicator that parents
are making progress toward resolution of violence?

1. Parents plan weekly outings to park
2. Parents are attending parenting classes
3. Parents report high expectations for their
   children
4. Parents relate an understanding of normal growth
   development

84
Nurse assessing family of child brought in for
severe injuries. Which behaviors by parents
indicates probable abuse?

1. Delay in seeking treatment for childs injuries
2. Detailed description of events prior to injuries
3. Anxious, concerned attitude
4. Encouraging child to explain injuries