1. Answer C. In a 6-year-old child, a precarious sense of self causes overreaction to criticism and a sense of inferiority. By age 6, most children no longer depend on the parents for daily tasks and love the routine of a schedule. Tattling is more common at age 4 to 5, by age 6, the child wants to make friends and be a friend.
2. Answer C. The nurse always should reinforce safety guidelines when teaching parents how to care for their child. By giving anticipatory guidance the nurse can help prevent many accidental injuries. For parents of a 9-month-old infant, it is too early to discuss nursery schools or toilet training. Because surgery is not used gastroenteritis, this topic is inappropriate.
3. Answer C. The nurse should start screening a child for lead poisoning at age 18 months and perform repeat screening at age 24, 30, and 36 months. High-risk infants, such as premature infants and formula-fed infants not receiving iron supplementation, should be screened for iron-deficiency anemia at 6 months. Regular dental visits should begin at age 24 months.
4. Answer D. The body compensates for metabolic acidosis via the respiratory system, which tries to eliminate the buffered acids by increasing alveolar ventilation through deep, rapid respirations, altered white blood cell or platelet counts are not specific signs of metabolic imbalance.
5. Answer C. A patient with celiac disease must maintain dietary restrictions lifelong to avoid recurrence of clinical manifestations of the disease. The other options are incorrect because signs and symptoms will reappear if the patient eats prohibited foods.
6. Answer C. By age 18 months, the anterior and posterior fontanels should be closed. The diamond-shaped anterior fontanel normally closes between ages 9 and 18 months. The triangular posterior fontanel normally closes between ages 2 and 3 months.
7. Answer A. Because of the inflammation of the meninges, the client is vulnerable to developing cerebral edema and increase intracranial pressure. Fluid overload won’t cause dehydration. It would be unusual for an adolescent to develop heart failure unless the overhydration is extreme. Hypovolemic shock would occur with an extreme loss of fluid of blood.
8. Answer D. The nurse caring for an infant with nonorganic failure to thrive should maintain a consistent, structured environment that provides interaction with the infant to promote growth and development. Encouraging the infant to hold a bottle would reinforce an uncaring feeding environment. The infant should receive social stimulation rather than be confined to bed rest. The number of caregivers should be minimized to promote consistency of care.
9. Answer B. Children with spina bifida often develop an allergy to latex and shouldn’t be exposed to it. If a child is sensitive to bananas, kiwifruit, and chestnuts, then she’s likely to be allergic to latex. Some children are allergic to dyes in foods and other products but dyes aren’t a factor in a latex allergy.
10. Answer A. The best recommendation is to allow the child to feed herself because the child’s stage of development is the preschool period of initiative. Special dishes would enhance the primary recommendation. The child should be offered new foods and choices, not just served her favorite foods. Using a small table and chair would also enhance the primary recommendation.
11. Answer B. The amount of glucose that’s considered safe for peripheral veins while still providing adequate parenteral nutrition is 10%. Five percent glucose isn’t sufficient nutritional replacement, although it’s sake for peripheral veins. Any amount above 10% must be administered via central venous access.
12. Answer D. One of the most valuable clues to pain is a behavior change: A child who’s pain-free likes to play. A child in pain is less likely to consume food or fluids. An increased heart rate may indicate increased pain; decreased urine output may signify dehydration.
13. Answer C. Nursing care plan should be planned according to the developmental age of a child with Down syndrome, not the chronological age. Because children with Down syndrome can vary from mildly to severely mentally challenged, each child should be individually assessed. A child with Down syndrome is capable of learning, especially a child with mild limitations.
14. Answer A. Accidents are the major cause of death and disability during the school-age years. Therefore, accident prevention should take priority when teaching parents of school-age children. Preschool (not school-age) children are afraid of the dark, have fears concerning body integrity, and should be encouraged to dress without help (with the exception of tying shoes).
15. Answer C. Documentation should take top priority. Documentation is the only way the nurse can legally claim that interventions were performed. The other three options would be appreciated by the nurses on the oncoming shift but aren’t mandatory and don’t take priority over documentation.
16. Answer D. The nurse should use the heel of one hand and compress 1” to 1½ “. The nurse should use the heels of both hands clasped together and compress the sternum 1½ “to 2” for an adult. For a small child, two-person rescue may be inappropriate. For a child, the nurse should deliver 20 breaths/minute instead of 12.
17. Answer A. Instituting droplet precautions is a priority for a newly admitted infant with meningococcal meningitis. Acetaminophen may be prescribed but administering it doesn’t take priority over instituting droplet precautions. Obtaining history information and orienting the parents to the unit don’t take priority.
18. Answer A. If the child isn’t developmentally ready, child and parent will become frustrated. Consistency is important once toilet training has already started. The mother’s positive attitude is important when the child is ready. Developmental levels of children are individualized and comparison to peers isn’t useful.
19. Answer A. When children are minors and aren’t emancipated, their parents or designated legal guardians are responsible for providing consent for medical procedures. Therefore, the foster mother is authorized to give consent for the blood transfusion. The social workers, the nurse, and the nurse-manager have no legal rights to give consent in this scenario.
20. Answer A. The massive cell destruction resulting from chemotherapy may place the client at risk for developing renal calculi; adding allopurinol decreases this risk by preventing the breakdown of xanthine to uric acid. Allopurinol doesn’t act in the manner described in the other options.
21. Answer D. The transmission of SARS isn’t fully understood. Therefore, all modes of transmission must be considered possible, including airborne, droplet, and direct contact with the virus. For protection from contracting SARS, any health care worker providing care for a client with SARS should wear a gown, gloves, mask, and eye goggles or an eye shield.
22. Answer C. Tuberculin skin tests of delayed hypersensitivity. If the test results are positive, a reaction should appear in 48 to 72 hours. Immediately after the test and within 24 hours are both too soon to observe a reaction. Waiting more than 5 days to evaluate the test is too long because any reaction may no longer be visible.
23. Answer D. The American Academy of Pediatrics recommends that infants at age 5 months receive iron-rich formula and that they shouldn’t receive solid food – even baby food – until age 6 months. The Academy doesn’t recommend whole milk until age 12 months, and skim milk until after age 2 years.
24. Answer C. Leaving the diaper off while the infant sleeps helps to promote air circulation to the area, improving the condition. Switching to cloth diapers isn’t necessary; in fact, that may make the rash worse. Baby wipes contain alcohol, which may worsen the condition. Extra fluids won’t make the rash better.
25. Answer C. Before interviewing in any way, the parents should call the poison control center for specific directions. Ipecac syrup is no longer recommended. The parents may have to call an ambulance after calling the poison control center. Punishment for being bad isn’t appropriate because the parents are responsible for making the environment safe.
26. Answer A.Initially, when a preschool client is admitted to the hospital for burns, the primary focus is on assessing and managing an effective airway. Body image disturbance, impaired urinary elimination, and infection are all integral parts of burn management but aren’t the first priority.
27. Answer A. Dyspnea and other signs of respiratory distress signify fluid volume excess (overload), which can occur quickly in a child as fluid shifts rapidly between the intracellular and extracellular compartments. Gastric distention may suggest excessive oral fluid intake or infection. Nausea and vomiting or an elevated temperature may indicate a fluid volume deficit.
28. Answer D. A history of steroid-dependent asthma, a contributing factor to this client’s high-risk status, requires the nurse to treat the situation as a severe exacerbation regardless of the severity of the current episode. An oxygen saturation of 95%, mild work of breathing, and absence of intercostals or substernal retractions are all normal findings.
29. Answer A. Measuring head circumference is the most important assessment technique for recognizing possible hydrocephalus, and is a key part of routine infant screening. Skull X-rays and MRI may be used to confirm the diagnosis. A lumber puncture isn’t appropriate.
30. Answer A. Itching underneath a cast can be relieved by directing blow-dyer, set, on the cool setting, toward the itchy area. Skin breakdown can occur if anything is placed under the cast. Therefore, the client should be cautioned not to put any object down the cast in an attempt to scratch.

How to pass the NCLEX

2.    While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and dehydration, the nurse teaches the parents about their infant’s dietary and fluid requirements. The nurse should include which other topic in the teaching session?
a.    Nursery schools
b.    Toilet Training
c.    Safety guidelines
d.    Preparation for surgery

3.    Nurse Betina should begin screening for lead poisoning when a child reaches which age?
a.    6 months
b.    12 months
c.    18 months
d.    24 months

4.    When caring for an 11-month-old infant with dehydration and metabolic acidosis, the nurse expects to see which of the following?
a.    A reduced white blood cell count
b.    A decreased platelet count
c.    Shallow respirations
d.    Tachypnea

5.    After the nurse provides dietary restrictions to the parents of a child with celiac disease, which statement by the parents indicates effective teaching?
a.    “Well follow these instructions until our child’s symptoms disappear.”
b.    “Our child must maintain these dietary restrictions until adulthood.”
c.    “Our child must maintain these dietary restrictions lifelong.”
d.    “We’ll follow these instructions until our child has completely grown and developed.”

6.    A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the toddler’s fontanels, what should the nurse expects to find?
a.    Closed anterior fontanel and open posterior fontanel
b.    Open anterior and fontanel and closed posterior fontanel
c.    Closed anterior and posterior fontanels
d.    Open anterior and posterior fontanels

7.    Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should monitor this client’s fluid intake because fluid overload may cause:
a.    Cerebral edema
b.    Dehydration
c.    Heart failure
d.    Hypovolemic shock

8.    An infant is hospitalized for treatment of nonorganic failure to thrive. Which nursing action is most appropriate for this infant?
a.    Encouraging the infant to hold a bottle
b.    Keeping the infant on bed rest to conserve energy
c.    Rotating caregivers to provide more stimulation
d.    Maintaining a consistent, structured environment

9.    The mother of Gian, a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons, and that she recently had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to:
a.    Bananas
b.    Latex
c.    Kiwifruit
d.    Color dyes

10.    Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What’s the nurse’s best recommendation for helping the mother increase her child’s nutritional intake?
a.    Allow the child to feed herself
b.    Use specially designed dishes for children – for example, a plate with the child’s favorite cartoon character
c.    Only serve the child’s favorite foods
d.    Allow the child to eat at a small table and chair by herself

11.    Nurse Roy is administering total parental nutrition (TPN) through a peripheral I.V. line to a school-age child. What’s the smallest amount of glucose that’s considered safe and not caustic to small veins, while also providing adequate TPN?
a.    5% glucose
b.    10% glucose
c.    15% glucose
d.    17% glucose

12.    David, age 15 months, is recovering from surgery to remove Wilms’ tumor. Which findings best indicates that the child is free from pain?
a.    Decreased appetite
b.    Increased heart rate
c.    Decreased urine output
d.    Increased interest in play

13.    When planning care for a 8-year-old boy with Down syndrome, the nurse should:
a.    Plan interventions according to the developmental level of a 7-year-old child because that’s the child’s age
b.    Plan interventions according to the developmental levels of a 5-year-old because the child will have developmental delays
c.    Assess the child’s current developmental level and plan care accordingly
d.    Direct all teaching to the parents because the child can’t understand

14.    Nurse Victoria is teaching the parents of a school-age child. Which teaching topic should take priority?
a.    Prevent accidents
b.    Keeping a night light on to allay fears
c.    Explaining normalcy of fears about body integrity
d.    Encouraging the child to dress without help

15.    The nurse is finishing her shift on the pediatric unit. Because her shift is ending, which intervention takes top priority?
a.    Changing the linens on the clients’ beds
b.    Restocking the bedside supplies needed for a dressing change on the upcoming shift
c.    Documenting the care provided during her shift
d.    Emptying the trash cans in the assigned client room

16.    Nurse Alice is providing cardiopulmonary resuscitation (CPR) to a child, age 4. the nurse should:
a.    Compress the sternum with both hands at a depth of 1½ to 2” (4 to 5 cm)
b.    Deliver 12 breaths/minute
c.    Perform only two-person CPR
d.    Use the heel of one hand for sternal compressions

17.    A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority?
a.    Instituting droplet precautions
b.    Administering acetaminophen (Tylenol)
c.    Obtaining history information from the parents
d.    Orienting the parents to the pediatric unit

18.    Sheena, tells the nurse that she wants to begin toilet training her 22-month-old child. The most important factor for the nurse to stress to the mother is:
a.    Developmental readiness of the child
b.    Consistency in approach
c.    The mother’s positive attitude
d.    Developmental level of the child’s peers

19.    An infant who has been in foster care since birth requires a blood transfusion. Who is authorized to give written, informed consent for the procedure?
a.    The foster mother
b.    The social worker who placed the infant in the foster home
c.    The registered nurse caring for the infant
d.    The nurse-manager

20.    A child is undergoing remission induction therapy to treat leukemia. Allopurinol is included in the regimen. The main reason for administering allopurinol as part of the client’s chemotherapy regimen is to:
a.    Prevent metabolic breakdown of xanthine to uric acid
b.    Prevent uric acid from precipitating in the ureters
c.    Enhance the production of uric acid to ensure adequate excretion of urine
d.    Ensure that the chemotherapy doesn’t adversely affect the bone marrow

21.    A 10-year-old client contracted severe acute respiratory syndrome (SARS) when traveling abroad with her parents. The nurse knows she must put on personal protective equipment to protect herself while providing care. Based on the mode of SARS transmission, which personal protective should the nurse wear?
a.    Gloves
b.    Gown and gloves
c.    Gown, gloves, and mask
d.    Gown, gloves, mask, and eye goggles or eye shield

22.    A tuberculosis intradermal skin test to detect tuberculosis infection is given to a high-risk adolescent. How long after the test is administered should the result be evaluated?
a.    Immediately
b.    Within 24 hours
c.    In 48 to 72 hours
d.    After 5 days

23.    Nurse Oliver s teaching a mother who plans to discontinue breast-feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?
a.    Iron-rich formula and baby food
b.    Whole milk and baby food
c.    Skim milk and baby food
d.    Iron-rich formula only

24.    Gracie, the mother of a 3-month-old infant calls the clinic and states that her child has a diaper rash. What should the nurse advise?
a.    “Switch to cloth diapers until the rash is gone”
b.    “Use baby wipes with each diaper change.”
c.    “Leave the diaper off while the infant sleeps.”
d.    “Offer extra fluids to the infant until the rash improves.”

25.    Nurse Kelly is teaching the parents of a young child how to handle poisoning. If the child ingests poison, what should the parents do first?
a.    Administer ipecac syrup
b.    Call an ambulance immediately
c.    Call the poison control center
d.    Punish the child for being bad

26.    A child has third-degree burns of the hands, face, and chest. Which nursing diagnosis takes priority?
a.    Ineffective airway clearance related to edema
b.    Disturbed body image related to physical appearance
c.    Impaired urinary elimination related to fluid loss
d.    Risk for infection related to epidermal disruption

27.    A 3-year-old child is receiving dextrose 5% in water and half-normal saline solution at 100 ml/hour. Which sign or symptom suggests excessive I.V. fluid intake?
a.    Worsening dyspnea
b.    Gastric distension
c.    Nausea and vomiting
d.    Temperature of 102°F (38.9° C)

28.    Which finding would alert a nurse that a hospitalized 6-year-old child is at risk for a severe asthma exacerbation?
a.    Oxygen saturation of 95%
b.    Mild work of breathing
c.    Absence of intercostals or substernal retractions
d.    History of steroid-dependent asthma

29.    Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus?
a.    Measuring head circumference
b.    Obtaining skull X-ray
c.    Performing a lumbar puncture
d.    Magnetic resonance imaging (MRI)

30.    An adolescent who sustained a tibia fracture in a motor vehicle accident has a cast. What should the nurse do to help relieve the itching?
a.    Apply cool air under the cast with a blow-dryer
b.    Use sterile applicators to scratch the itch
c.    Apply cool water under the cast
d.    Apply hydrocortisone cream under the cast using sterile applicator.

Answers and Rationale will be posted soon…

More NCLEX REVIEW soon…

1. Answer C. A recent episode of pharyngitis is the most important factor in establishing the diagnosis of rheumatic fever. Although the child may have a history of fever or vomiting or lack interest in food, these findings are not specific to rheumatic fever.
2. Answer C. In an emergency, intraosseous drug administration is typically used when a child is critically ill and under age 3.
3. Answer D. A family’s behavioral patterns and values are passed from one generation to the next. Cultural background commonly plays a major role in determining a family’s health practices. Physical characteristics do not indicate a child’s culture. Although heritage plays a role in culture, it does not dictate a group’s shared values and its effect on culture is weaker than that of behavioral patterns.
4. Answer A. Because the anterior fontanel normally closes between ages 12 and 18 months, the nurse should notify the doctor promptly of this finding. An open fontanel does not indicate abuse and is not associated with Tay-Sachs disease.
5. Answer B. Ulcerative colitis causes profuse diarrhea, intense abdominal cramps, anal fissures, and abdominal distentions are more common in Crohn’s disease.
6. Answer D. The recommended injection site for an infant is the vastus lateralis or rectus femoris muscles. The deltoid is inappropriate. The dorsogluteal and ventrogluteal sites can be used only in toddlers who have been walking for about 1 year.
7. Answer C. A negative nitrogen balance may result from inadequate protein intake and is best detected by measuring the total protein level. Measuring total iron-bi8nding capacity, hemoglobin, and serum transferring levels would help detect iron-deficiency anemia, not a negative nitrogen balance.
8. Answer B. According to Erikson, the primary psychosocial task during adolescence is to establish a personal identity confusion. The adolescent attempts to establish a group identity by seeking acceptance and approval from peers, and strives to attain a personal identity by becoming more independent form the family. Becoming industrious is the developmental task of the school-age child, achieving intimacy is the task of the young adult, and developing initiative is the task of the preschooler.
9. Answer B. Preschool-age children are most likely to view illness as a punishment for misdeeds. Separation anxiety, although seen in all age group, is most common in older infants. Fear of death is typical of older school-age children and adolescents. Adolescents also fear mutilation.
10. Answer C. The nurse should obtain objective information about the child’s nutritional intake, such as by asking about what the child ate for a specific meal. The other options ask for subjective replies that would be open to interpretation.

1. Answer A. The most important data to obtain on a child’s arrival in the emergency department are vital sign measurements. The nurse should gather the other data later.
2. Answer D. The stress of starting nursery school may trigger a return to a level of successful behavior from earlier stages of development. A child’s skills remain intact, although increased stress may prevent the child from using these skills. Growth occurs when the child does not regress. Parents rarely desire less mature behaviors.
3. Answer D. A child’s poor progress in school may indicate a visual disturbance. The other options are more appropriate questions to ask when assessing vision in a geriatric patient.
4. Answer C. Rice cereal is the first solid food an infant should receive because it is easy to digest and is associated with few allergies. Next, the infant can receive pureed fruits, such as bananas, applesauce, and pears, followed by pureed vegetables, egg yolks, cheese, yogurt, and finally, meat. Egg whites should not be given until age 9 months because they may trigger a food allergy.
5. Answer C. Succinycholine is an ultra-short-acting depolarizing agent used for rapid-sequence intubation. Bradycardia can occur, especially in children. Atropine is the drug of choice in treating succinylcholine-induced bradycardia. Lidocaine is used in adults only. Epineprine bolus and isoproterenol are not used in rapid-sequence intubation because of their profound cardiac effects.
6. Answer A. Bryant’s traction is used to treat femoral fractures of congenital hip dislocation in children under age 2 who weigh less than 30 lb (13.6 kg). Buck’s extension traction is skin traction used for short-term immobilization or to correct bone deformities or contractures; overhead suspension traction is used to treat fractures of the humerus; and 90-90 traction is used to treat femoral fracture in children over age 2.
7. Answer D. Because adolescents absorb less information through reading, providing age-appropriate reading materials is the least effective way to teach parenting skills to an adolescent. The other options engage more than one of the senses and therefore serve as effective teaching strategies.
8. Answer D. Normally the top of the ear aligns with an imaginary line drawn across the inner and outer canthus of the eye. Ears set below this line are associated with renal anomalies or mental retardation. Low-set ears do not accompany otogenous tetanus, tracheoesophageal fistula, or congenital heart defects.
9. Answer A. At age 3, gross motor development and refinement in eye-hand coordination enable a child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills requires for roller-skating and jumping rope develop around age 5.
10. Answer A. In a child, Eustachian tubes are short and lie in a horizontal plane, promoting entry of nasopharyngeal secretions into the tubes and thus setting the stage for otitis media. The nosopharynx, tympanic membrane, external ear canal have no unusual features that would predispose a child to otitis media.
11. Answer A. Increased urine output, a sign of improving kidney function, typically is the first sign that a child with acute poststreptoccocal glomerulonephritis (APSGN) is improving. Increased appetite, an increased energy level, and decreased diarrhea are not specific to APSGN.
12. Answer C. The primary purpose of administering corticosteroids to a child with nephritic syndrome is to decrease proteinuria. Corticosteroids have no effect on blood pressure. Although they help reduce inflammation, this is not the reason for their use in patients with nephritic syndrome. Corticosteroids may predispose a patient to infection.
13. Answer A. In an infant, signs of fluid volume deficit (dehydration) include sunken fontanels, increased pulse rate, and decreased blood pressure. They occur when the body can no longer maintain sufficient intravascular fluid volume. When this happens, the kidneys conserve water to minimize fluid loss, which results in concentrated urine with a high specific gravity.
14. Answer C. The nurse should shake a suspension before administration to dispersed drug particles uniformly. Diluting the suspension and crushing particles are not recommended for this drug form.
15. Answer A. Fluid volume replacement must be calculated to the child’s weight to avoid over-hydration. Initial fluid bolus is administered at 20 ml/kg, followed by another 20 ml/kg bolus if there is no improvement in fluid status.
16. Answer B. According to the American Association on Mental Deficiency, a person with an intelligence quotient (IQ) between 50 and 70 is classified as mildly mentally retarded but educable. One with an IQ between 35 and 50 is classified as moderately retarded but trainable. One with an IQ below 36 is severely and profoundly impaired, requiring custodial care.
17. Answer C. Role and relationship patterns focus on body image and the patient’s relationship with others, which commonly interrelated with food intake. Questions about activities and food preferences elicit information about health promotion and health protection behaviors. Questions about food allergies elicit information about health and illness patterns.
18. Answer B. SIDS can occur any time between 1 week and 1 year of age. The incidence peaks at 2 to 4 months of age.
19. Answer D. An adolescent who demonstrates a preoccupation with death (such as by talking about death frequently) should be considered at high risk for suicide. Although depression, excessive sleepiness, and a history of cocaine use may occur in suicidal adolescents, they also occur in adolescents who are not suicidal.
20. Answer D. The most common sign of Wilms’ tumor is a painless, palpable abdominal mass, sometimes accompanied by an increase in abdominal girth. Gross hematuria is uncommon, although microscopic hematuria may be present. Dysuria is not associated with Wilms’ tumor. Nausea and vomiting are rare in children with Wilms’ tumor.

More NCLEX Questions soon…

2.    Nurse Liza is administering a medication via the intraosseous route to a child. Intraosseous drug administration is typically used when a child is:
a.    Under age 3
b.    Over age 3
c.    Critically ill and under age 3
d.    Critically ill and over age 3

3.    When assessing a child’s cultural background, the nurse in charge should keep in mind that:
a.    Cultural background usually has little bearing on a family’s health practices
b.    Physical characteristics mark the child as part of a particular culture
c.    Heritage dictates a group’s shared values
d.    Behavioral patterns are passed from one generation to the next

4.    While examining a 2-year-old child, the nurse in charge sees that the anterior fontanel is open. The nurse should:
a.    Notify the doctor
b.    Look for other signs of abuse
c.    Recognize this as a normal finding
d.    Ask about a family history of Tay-Sachs disease

5.    The nurse is aware that  the most common assessment finding in a child with ulcerative colitis is:
a.    Intense abdominal cramps
b.    Profuse diarrhea
c.    Anal fissures
d.    Abdominal distention

6.    When administering an I.M. injection to an infant, the nurse in charge should use which site?
a.    Deltoid
b.    Dorsogluteal
c.    Ventrogluteal
d.    Vastus lateralis

7.    A child with a poor nutritional status and weight loss is at risk for a negative nitrogen balance. To help diagnose this problem, the nurse in charge anticipates that the doctor will order which laboratory test?
a.    Total iron-binding capacity
b.    Hemoglobin
c.    Total protein
d.    Serum transferring

8.    When developing a plan of care for a male adolescent, the nurse considers the child’s psychosocial needs. During adolescence, psychosocial development focuses on:
a.    Becoming industrious
b.    Establishing an identity
c.    Achieving intimacy
d.    Developing initiative

9.    When developing a plan care for a hospitalized child, nurse Mica knows that children in which age group are most likely to view illness as a punishment for misdeeds?
a.    Infancy
b.    Preschool age
c.    Scholl age
d.    Adolescence

10.    Nurse Taylor suspects that a child, age 4, is being neglected physically. To best assess the child’s nutritional status, the nurse should ask the parents which question?
a.    “Has your child always been so thin?”
b.    “Is your child a picky eater?”
c.    “What did your child eat for breakfast?”
d.    “Do you think your child eats enough?”

11.    A female child, age 2, is brought to the emergency department after ingesting an unknown number of aspirin tablets about 30 minutes earlier. On entering the examination room, the child is crying and clinging to the mother. Which data should the nurse obtain first?
a.    Heart rate, respiratory rate, and blood pressure
b.    Recent exposure to communicable diseases
c.    Number of immunizations received
d.    Height and weight

12.    A mother asks the nurse how to handle her 5-year-old child, who recently started wetting the pants after being completely toilet trained. The child just started attending nursery school 2 days a week. Which principle should guide the nurse’s response?
a.    The child forgets previously learned skills
b.    The child experiences growth while regressing, regrouping, and then progressing
c.    The parents may refer less mature behaviors
d.    The child returns to a level of behavior that increases the sense of security.

13.    A female child, age 6, is brought to the health clinic for a routine checkup. To assess the child’s vision, the nurse should ask:
a.    “Do you have any problems seeing different colors?”
b.    “Do you have trouble seeing at night?”
c.    “Do you have problems with glare?”
d.    “How are you doing in school?”

14.    During a well-baby visit, Jenny asks the nurse when she should start giving her infant solid foods. The nurse should instruct her to introduce which solid food first?
a.    Applesauce
b.    Egg whites
c.    Rice cereal
d.    Yogurt

15.    To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which of the following agents?
a.    Epinephrine (Adrenalin)
b.    Isoproterenol (Isuprel)
c.    Atropine sulfate
d.    Lidocaine hydrochloride (Xylocaine)

16.    A 1 year and 2-month-old child weighing 26 lb (11.8 kg) is admitted for traction to treat congenital hip dislocation. When preparing the patient’s room, the nurse anticipates using which traction system?
a.    Bryant’s traction
b.    Buck’s extension traction
c.    Overhead suspension traction
d.    90-90 traction

17.    Mandy, age 12, is 7 months pregnant. When teaching parenting skills to an adolescent, the nurse knows that which teaching strategy is least effective?
a.    Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model
b.    Initiating a teenage parent support group with first – and – second-time mothers
c.    Using audiovisual aids that show discussions of feelings and skills
d.    Providing age-appropriate reading materials

18.    When performing a physical examination on an infant, the nurse in charge notes abnormally low-set ears. This findings is associated with:
a.    Otogenous tetanus
b.    Tracheoesophageal fistula
c.    Congenital heart defects
d.    Renal anomalies

19.    Nurse Raven should expect a 3-year-old child to be able to perform which action?
a.    Ride a tricycle
b.    Tie the shoelaces
c.    Roller-skates
d.    Jump rope

20.    Nurse Betina is teaching a group of parents about otitis media. When discussing why children are predisposed to this disorder, the nurse should mention the significance of which anatomical feature?
a.    Eustachian tubes
b.    Nasopharynx
c.    Tympanic membrane
d.    External ear canal

21.    The nurse is evaluating a female child with acute poststreptoccocal glomerulonephritis for signs of improvement. Which finding typically is the earliest sign of improvement?
a.    Increased urine output
b.    Increased appetite
c.    Increased energy level
d.    Decreased diarrhea

22.    Dr. Smith prescribes corticosteroids for a child with nephritic syndrome. What is the primary purpose of administering corticosteroids to this child?
a.    To increase blood pressure
b.    To reduce inflammation
c.    To decrease proteinuria
d.    To prevent infection

23.    Parents bring their infant to the clinic, seeking treatment for vomiting and diarrhea that has lasted for 2 days. On assessment, the nurse in charge detects dry mucous membranes and lethargy. What other findings suggests a fluid volume deficit?
a.    A sunken fontanel
b.    Decreased pulse rate
c.    Increased blood pressure
d.    Low urine specific gravity

24.    How should the nurse May prepare a suspension before administration?
a.    By diluting it with normal saline solution
b.    By diluting it with 5% dextrose solution
c.    By shaking it so that all the drug particles are dispersed uniformly
d.    By crushing remaining particles with a mortar and pestle

25.    What should be the initial bolus of crystalloid fluid replacement for a pediatric patient in shock?
a.    20 ml/kg
b.    10 ml/kg
c.    30 ml/kg
d.    15 ml/kg

26.    Becky, age 5, with intelligence quotient of 65 is admitted to the hospital for evaluation. When planning care, the nurse should keep in mind that this child is:
a.    Within the lower range of normal intelligence
b.    Mildly retarded but educable
c.    Moderately retarded but trainable
d.    Completely dependent on others for care

27.    Maureen, age 12, is brought to the clinic for evaluation for a suspected eating disorder. To best assess the effects of role and relationship patterns on the child’s nutritional intake, the nurse should ask:
a.    “What activities do you engage in during the day?”
b.    “Do you have any allergies to foods?”
c.    “Do you like yourself physically?”
d.    “What kinds of food do you like to eat?”

28.    Sudden infant death syndrome (SIDS) is one of the most common causes of death in infants. At what age is the diagnosis of SIDS most likely?
a.    At 1 to 2 years of age
b.    At I week to 1 year of age, peaking at 2 to 4 months
c.    At 6 months to 1 year of age, peaking at 10 months
d.    At 6 to 8 weeks of age

29.    When evaluating a severely depressed adolescent, the nurse knows that one indicator of a high risk for suicide is:
a.    Depression
b.    Excessive sleepiness
c.    A history of cocaine use
d.    A preoccupation with death

30.    A child is diagnosed with Wilms’ tumor. During assessment, the nurse  in charge expects to detect:
a.    Gross hematuria
b.    Dysuria
c.    Nausea and vomiting
d.    An abdominal mass

Answers and Rationale

Tips on How to Pass NCLEX

1. B. When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important.

2. D. When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided. Proceeding from distal to proximal is inappropriate at any age.

3. C. Rheumatic fever results as a delayed reaction to inadequately treated group A β-hemolytic streptococcal infection.

4. A. The child with congenital heart disease develops polycythemia resulting from an inadequate mechanism to compensate for decreased oxygen saturation

5. D. Mycostatin suspension is given as swab. Never mix medications with food and formula.

6. C. If the child is hungry he/she more likely would finish his meals. Therefore, the mother should be advised not to give snacks to the child. The child is a “busy toddler.” He/she will not able to keep still for a long time.

7. D. Normal heart rate of the newborn is 120 to 160 bpm. Choices A, B, and C are normal assessment findings (uneven head shape is molding).

8. A. Lead poisoning may be caused by inhalation of dusk and smoke from leaded gas. It may also be caused by lead-based paint, soil, water (especially from plumbings of old houses).

9. A. Glucose-6-phosphate dehydrogenase deficiency (G6PD) is an X-linked recessive hereditary disease characterised by abnormally low levels of glucose-6-phosphate dehydrogenase (abbreviated G6PD or G6PDH), a metabolic enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.

10. C. For the child with iron deficiency anemia, the blood study results most likely would reveal decreased mean corpuscular volume (MCV) which demonstrates microcytic anemia, decreased hemoglobin, decreased hematocrit and elevated total iron binding capacity.

11. D. The primary role of the nurse when a patient has a seizure is to protect the patient from harming him or herself.

12. A. During this period, which lasts up to the age of 18-21 years, the individual develops a sense of “self.” Peers have a major big influence over behavior, and the major decision is to determine a vocational goal.

13. C. Over 90% percent of babies can sit unsupported by nine months. Most babies cannot say “mama” in the sense that it refers to their mother at this time.

14. A. By 12 months, 50 percent of children can walk well.

15. C. Lying flat keeps the patient from having a “spinal headache.” Increasing the fluid intake will assist in replenishing the lost fluid during this time.

16. C. The patient can lose vascular status without the nurse being aware if left for more than 4 hours, yet checks should not be so frequent that the patient becomes anxious. Vital signs are generally checked q4h, at which time the CSM checks can easily be performed.

17. A. Bronchodilators can produce the side effects listed in answer choice (A) for a short time after the patient begins using them.

18. D. Meningitis is an infection of the meninges, the outer membrane of the brain. Since it is surrounded by cerebrospinal fluid, a lumbar puncture will help to identify the organism involved.

19. C. The glycosolated hemoglobin test measures glucose levels for the previous 3 to 4 months.

20. D. Capillary refill, pulses, and skin temperature and color are indicative of intact circulation and absence of compartment syndrome. Skin integrity is less important.

a. Monitoring the child for both general and specific adverse effects

b. Observing the child for 10 minutes to note for signs of anaphylaxis

c. Administering medication through a free-flowing intravenous line

d. Assessing for signs of infusion infiltration and irritation

2. Which of the following is the best method for performing a physical examination on a toddler

a. From head to toe

b. Distally to proximally

c. From abdomen to toes, the to head

d. From least to most intrusive

3. Which of the following organisms is responsible for the development of rheumatic fever?

a. Streptococcal pneumonia

b. Haemophilus influenza

c. Group A β-hemolytic streptococcus

d. Staphylococcus aureus

4. Which of the following is most likely associated with a cerebrovascular accident (CVA) resulting from congenital heart disease?

a. Polycythemia

b. Cardiomyopathy

c. Endocarditis

d. Low blood pressure

5. How does the nurse appropriately administer mycostatin suspension in an infant?

a. Have the infant drink water, and then administer mycostatin in a syringe

b. Place mycostatin on the nipple of the feeding bottle and have the infant suck it

c. Mix mycostatin with formula

d. Swab mycostatin on the affected areas

6. A mother tells the nurse that she is very worried because her 2-year old child does not finish his meals. What should the nurse advise the mother?

a. make the child seat with the family in the dining room until he finishes his meal

b. provide quiet environment for the child before meals

c. do not give snacks to the child before meals

d. put the child on a chair and feed him

7. The nurse is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn?

a. uneven head shape

b. respirations are irregular, abdominal, 30-60 bpm

c. (+) moro reflex

d. heart rate is 80 bpm

8. Which of the following situations increase risk of lead poisoning in children?

a. playing in the park with heavy traffic and with many vehicles passing by

b. playing sand in the park

c. playing plastic balls with other children

d. playing with stuffed toys at home

9. An inborn error of metabolism that causes premature destruction of RBC?

a. G6PD

b. Hemocystinuria

c. Phenylketonuria

d. Celiac Disease

10. Which of the following blood study results would the nurse expect as most likely when caring for the child with iron deficiency anemia?

a. Increased hemoglobin

b. Normal hematocrit

c. Decreased mean corpuscular volume (MCV)

d. Normal total iron-binding capacity (TIBC)

11. The nurse answers a call bell and finds a frightened mother whose child, the patient, is having a seizure. Which of these actions should the nurse take?

a. The nurse should insert a padded tongue blade in the patient’s mouth to prevent the child from swallowing or choking on his tongue.

b. The nurse should help the mother restrain the child to prevent him from injuring himself.

c. The nurse should call the operator to page for seizure assistance.

d. The nurse should clear the area and position the client safely.

12. At the community center, the nurse leads an adolescent health information group, which often expands into other areas of discussion. She knows that these youths are trying to find out “who they are,” and discussion often focuses on which directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as:

a. identity vs. role confusion.

b. adolescent rebellion.

c. career experimentation.

d. relationship testing

13. The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern?

a. The baby cannot say “mama” when he wants his mother.

b. The mother has not given him finger foods.

c. The child does not sit unsupported.

d. The baby cries whenever the mother goes out.

14. Cheska, the mother of an 11-month-old girl, KC, is in the clinic for her daughter’s immunizations. She expresses concern to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is:

a. 12 months.

b. 15 months.

c. 10 months.

d. 14 months.

15. Sally Kent., age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is:

a. prone for two hours to prevent aspiration, should she vomit.

b. semi-fowler’s so she can watch TV for five hours and be entertained.

c. supine for several hours, to prevent headache.

d. on her right sides to encourage return of CSF

16. Buck’s traction with a 10 lb. weight is securing a patient’s leg while she is waiting for surgery to repair a hip fracture. It is important to check circulation- sensation-movement:

a. every shift.

b. every day.

c. every 4 hours.

d. every 15 minutes.

17. Carol Smith is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include:

a. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures.

b. tachycardia, headache, dyspnea, temp . 101 F, and wheezing.

c. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria.

d. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness.

18. The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test:

a. blood culture.

b. throat and ear culture.

c. CAT scan.

d. lumbar puncture.

19. The nurse is drawing blood from the diabetic patient for a glycosolated hemoglobin test. She explains to the woman that the test is used to determine:

a. the highest glucose level in the past week.

b. her insulin level.

c. glucose levels over the past several months.

d. her usual fasting glucose level.

20. The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except:

a. capillary refill.

b. radial and ulnar pulse.

c. finger movement

d. skin integrity

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