Shared Flashcard Set


NCLEX 3000 - Pre-schooler, School age
Pre-schooler, school age
Undergraduate 4

Additional Nursing Flashcards





A preschooler-age child refuses to take prescribed medication. Which nursing strategy would be most appropriate?


a. mixing the med in milk so the child isn't aware that its there

b. explaining the medication's effects in detail to ensure cooperation

c. making the child feel ashamed for not cooperating

d. showing trust in the child's ability to cooperate even with an unpleasant procedure


To gain a preschooler's cooperation, the nurse should show trust and express faith in the child's ability to cooperate even with an unpleasant procedure.

Hiding the meds in milk may foster mistrust. The nurse should provide a simple, not detailed explanation in terms the child can understand. shaming the child is inappropriate and may lead to feelings of guilt.


Before performing an otoscopic examination on a child, where should the nurse palpate for tenderness?


a. tragus, mastoid process, and helix

b. helix, umbo, and tragus

c. tragus, cochlea, and lobule

d. mastoid process, incus, and malleus

A. The nurse should palpate the child's external ear
The nurse is assessing whether the client has received all recommended immunizations for his age. Which immunization should he have received b/t ages 4 and 6?
DPT, MMR, and oral polio virus

A child, age 3, with lead poisoning is admitted to the facility for chelation therapy. The nurse must stay alert for which of the following adverse effects?


a. anaphylaxis

b. fever and chills

c. seizures

d. heart failure


C. Seizures


Chelation therapy removes lead by combining it with another substance to form a soluble compound that the kidneys can excrete. As lead is mobilized from bone and other tissues, the serum lead level rises rapidly, increasing the client's risk of seizures.


The nurse is providing care to a 5 y.o. with a fractured femur whose nursing dx is imbalanced nutrition r/t imparied physical mobility. Which of the following is most likely to occur with this condition?


a. decreased protein catabolism

b. increased calorie intake

c. increased digestive enzymes

d. increased carbohydrate need


D. Increased carbohydrate need


Carb need increases because healing and repair of tissue requires more carbohydrates.


A 5 y.o. has ALL and is to have induction chemotherapy consisting of vinicristine, asparaginase, and prednisone. when teaching the parents about the adverse effects of this regimen, the nurse should stress the importance of promptly reporting:


a. hair loss

b. moon face

c. constipation

d. bone pain


C. Neurotoxicity, the primary adverse effect of vinicristine, may manifest as constipation, a sign of paralytic ileus that must be reported STAT.


Hair loss and moon face are expected of chemo.


Bone pain is common in ALL patients.

The nurse is preparing to administer short-acting insulin to a child with DM. When should the nurse measure the child's blood glucose level?
1 hour after administering insulin

A 5 y.o. child is brought to the ER after being stung multiple times on the face by yellow jackets. Which of the following symptoms of anaphylaxis requires priority medical intervention?


a. pulse rate of 60 bpm

b. diffuse facial urticaria

c. respiratory rate of 20 bpm

d. BP of 90/50 mmHg

A. Bradycardia is an ominous sign in children. Older children initially demonstrate tachycardia in response to hypoxemia. When tachycardia can no longer maintain tissue O2, bradycardia follows. The development of cardiopulmonary arrest follows bradycardia!
How do you calculate BP in a child older than age 1?
80 mmHg + (age in years x 2)

To decrease the likelihood of bradyarrhythmias in children during endotracheal intubation, succinylcholine (Anectine) is used with which of the following agents?


a. epinephrine

b. isoproterenol

c. atropine

d. lidocaine


C. Atropine - succinylcholine 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.


Use lidocaine in adults ONLY.


The mother of a preschooler with spina bifida tells the nurse that her daughter sneezes and gets a rash when playing with brightly colored balloons and that recently she had an allergic reaction after eating kiwifruit and bananas. The nurse would suspect that the child may have an allergy to which of the following?


a. bananas

b. latex

c. kiwifruit

d. color dyes


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.


Parents repor that their daughter, age 4, resists going to bed at night. After instruction by the nurse, which statement by the parents indicates effective teaching?


a. "We'll let her fall asleep in our room, then move her to her own room."


b. "We'll lock her in her room if she gets up more than once."


c. "We'll play running games with her before bedtime to tire her out, and then she'll fall asleep easily."


d. "We'll read her a story and let her play quietly in her bed until she falls asleep."

D. Spending time with the parents and playing quietly are positive bedtime routines that provide security and prepare a child for sleep. the child should sleep in her own bed. Locking the door is frightening and may cause insecurity. Active play before bedtime stimulates the child and increases the time needed to settle down for sleep.

A 4 y.o., 40 lb/18 kg child is brought to the pediatrician's office. He has upper respiratory symptoms and has had fever for 2 days. He's dxed with a viral illness and the mother is instrcted to tx him with rest,fluids, and antipyretics. Which of the following would be the most appropriate medication dosage schedule?


a. acetaminophen 225 mg (10-15 mg/kg/dose) q4h w intermittent doses of ibuprofen 180 mg (10 mg/kg/dose) q6h for fever > 102.5'F.


b. aspirin 290 mg q6h with intermittent doses of acteminophen 225 mg q4h

c. acetaminophen 140 mg (5-10)


c. acetaminophen 225 mg (10-15 mg/kg/dose) q4h with intermittent doses of ibuprofen 90 mg (5 mg/kg/dose) q6h for a fever higher than 102.5'F


A. The correct dose schedule for acetaminophen is 10-15 mg/kg/dose q4h. Ibuprofen is 10 mg/kg/dose q6h for a fever higher than 102.5'F.


Never give aspirin to kids. Reye's syndrome is a risk.


Dose of 5-10 acetaminophen isn't correct nor is 5 mg/kg/dose for ibuprofen.


A mother complains to the nurse that her 4 y.o. son often "lies." What is the nurse's best response?


a. "Let the child know that he'll be punished for lying"

b. "Ask him why he isn't tellign the truth"

c. "It's probably due to his vivid imagination and creativity"

d. "Acknowledge him by saying, 'That's a pretent story.'"


D. It's important to acknowledge the child's imagination, while also letting him know in a nice way that what he said isn't real.


Punishment isn't appropriate for a child using their imagination, and accusing him of lying is a negative reinforcement. The child isn't truly lying in the adult sense. Imagination and creativity need to be acknowledged.


When giving TPN through IV to a school-age child, what is the lowest amount of glucose that is safe and not caustic to small veins that will also provide adequate TPN?


a. 5%

b. 10%

c. 15%

 d. 17%

B. 10% - The amount of glucose that is considered safe for peripheral veins while still providing adequate parenteral nutrition is 10%.

When administering morphien, the drug of choice for pediatric pain relief, to a school-age child, which symptom should cause the nurse to be concerned?

a. constipation

b. nausea and vomiting

c. pruritus

d. anemia


D. Anemia isn't a typical adverse effect of morphine and should be investigated if it's discovered during tx. Constipation, nausea and vomiting, and pruritus are all treatable adverse effects of morphine and don't necessitate cessation of the medication.

A child, age 6, is about to be discharged after tx for acute rheumatic fever. Which statement by the parents indicates effective discharge teaching?


a. "We'll keep our child in bed for at least a week."

b. "We'll give our child penicillin bid for 5 years."

c. "We'll measure our child's BP every day."

d. "We'll keep giving our child corticosteroids."

B. A child recovering from acute rheumatic fever must receive prophylactic penicillin for at least 5 years. Bed rest isn't indicated once the acute phase ends. Rheumatic fever doesn't call for blood pressure monitoring or corticosteroid therapy.

A child is admitted to the pediatric unit with a serum sodium level of 118 mEq/L. Which nursing action takes highest priority at this time?

a. replacing fluids slowly as ordered

b. instituting seizure precautions

c. administering diuretic therapy as prescribed

d. administering sodium bicarbonate as prescribed


B. a serum sodium level of 118 indicates severe hyponatremia, which places the client at risk for seizures. Fluid and sodium replacement should be done rapidly.

Diuretics may cause additional sodium loss. In a child with hyperkalemia, giving sodium bicarbonate would be appropriate b/c it promtes movement of potassium into the intracellular spaces.


A nurse suspects that an 8 y.o. client's chronic sinusitis and upper respiratory infections may be due to allergies. She orders an immunoglobulin assay. Which of the following would the nurse expect to find elevated? Immunoglobulin:


a. E

b. D

c. G

d. M


A. Immunoglobulin E is predominantly found in saliva and tears as well as intestinal and bronchial sections. Increased levels of IgE may be found in allergic disorders.


D's physical function is unknown. G's elevated in the presence of viral and bacterial infections. M's the f1st antibody activated after an antigen enters the body, especially effective against gram neg organisms

The nurse is giving instructions to instructions to parents of a school-age child dxed with sickle cell disease. The instructions should include to avoid what areas?

The child should avoid areas of low O2, such as high altitudes, because they may precipitate sickle cell crisis.


Apply a warm compress to reduce discomfort to affected areas. The child should be encouraged to rehydrate their cells by drinking fluids. Strenuous exercise may induce sickle cell crisis.


After a head injury, a child experiences enuresis, polydipsia, and weight loss. Based on these findings, the nurse should monitor closely for signs and symptosm of:

a. hypercalcemia

b. hyperglycemia

c. hyponatremia

d. hypokalemia

D. Enuresis, polydipsia, and weight loss suggest diabetes insipidus, a disorder that may result from a head injury that damages the neurohypophyseal structions. DI places the child at risk for fluid volume depletion and hypokalemia.

The nurse is caring for a school-age child with cerebral palsy. The child has difficulty eating using regular utensils and requires a lot of assistance. Which of the following referrals is most appropriate?

a. registered dietician

b. physical therapist

c. occupational therapist

d. nursing assistant

C. an occupational therapist helps physically disabled clients adapt to physical limitations and is most qualified to help a child with cerebral pasy eat and perform other activities of daily living. A physical therapist is trained to help a child with cerebral palsy gain function and prevent further disability but not to assit the child in performing activities of daily living.
What is terbutaline?
Terbutaline is a beta-adrenergic agonist bronchodilator
What is terbutaline used for in an asthmatic patient or a patient with bronchitis?
Terbutaline is indicated for the prevention and reversal of bronchospasm in patients 12 years of age and older with asthma and reversible bronchospasm associated with bronchitis and emphysema.
Adverse affects of terbutaline:
Seizures, angina, HTN or hypotension, tachycardia with rates up to 200 bpm, arrhythmias, nervousness, headache, tremor, dry mouth, palpitation, nausea, dizziness, fatigue, malaise, and insomnia. Hypokalemia may also occur.

The physician prescribes terbutaline 2.5 mg PO qid for a child with bronchitis. If the child receives an I.V. infusion of terbutaline, which serious adverse reaction is possible?

a. hypocalcemia

b. hypercalcemia

c. hypokalemia

d. hyperkalemia

C. hypokalemia - the nurse should monitor a client recieving terbutaline for hypokalemia, lactic acidosis, chest pain, arrhythmias, dyspnea, bloating, chills, or anaphylactic shock.
What is pancrelipase (pancreatic enzymes) used for?

needed for digestion of

fats, carbohydrates and proteins


The parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse would be most appropriate?


a. they promote absorption of nutrients and fat

b. they promote adequte rest

c. they prevent intestinal mucus accumulation

d. they help prevent meconium ileus

A. Pancreatic enzymes are given to a child with cystic fibrosis to aid fat and protein digestion. They don't promote rest or prevent mucus accumulation or meconium ileus.

What is protropin/somatrem?


What is it used for?


Protropin (somatrem) is a polypeptide hormone produced by recombinant DNA technology. It contains the identical sequence of amino acids constituting pituitary-derived human growth hormone.


It is indicated only for the long- term tx of children who have growth failure due to a lack of adequate endogenous growth hormone secretion.


A child is dxed with pituitary dwarfism. Which pituitary agent will the physcian probably prescribe to tx this condition?


a. corticotropin zinc hydroxide

b. somatrem

c. desmopressin acetate

d. vasopressin

B. Somatrem is used to tx linear growth failure stemming from hormonal deficiency. Corticotropin zinc hydroxide is used to tx adrenal insufficiency. DDAVP and vasopressin are used to tx diabetes insipidus.

When assessing a child with juvenile hypothryoidism, the nurse expects to which finding?


a. goiter

b. recent weight loss

c. insomnia

d. tachycardia

A. Jevenile hypothyroidism results in goiter, wt gain, sleepiness, and slow heart rate.

The nurse is interviewing the mother of a 7 y.o. Which of the following symptoms reported by the mother would most lead the nurse to suspect that the child has type 1 diabetes?


a. recent bed-wetting

b. poor appetite

c. wt gain

d. boundless energy

A. Polyuria is a hallmark sign of Type 1 DM. Parents often notice this symptom as bed-wetting in a chid previously toilet-trained. Polyphagia is also a hallmark sign of type 1 DM. A parent is likely to report that a child eats ecessively but seems to lose weight. Type 1 DM patients complain of fatigue.
Describe Type 1 DM Pathophysiology.

Type 1 DM is a catabolic disorder in which circulating insulin is very low or absent, plasma glucagon is elevated, and the pancreatic beta cells fail to respond to all insulin-secretory stimuli.


Patients need exogenous insulin to reverse this catabolic condition, prevent ketosis, decrease hyperglucagonemia, and normalize lipid and protein metabolism.

Describe the S/S seen in Type 1 DM

Polyuria and thirst

Polyphagia with weight loss

Fatigue and weakness

Muscle cramps

Nocturnal enuresis

Blurred vision

What are the signs and symptoms of impetigo?

Red sores that quickly rupture, ooze for a few days and then form a yellowish-brown crust




Painless, fluid-filled blisters


In the more serious form, painful fluid- or pus-filled sores that turn into deep ulcers

The school nurse is examining a student at an elementary school. What findings would lead the nurse to suspect impetigo?
Vesicular lesions that ooze, forming cruts on the face and extremities. Impetigo starts as a papulovesiicular lesion surrounded by redness. They become purulent and begin to ooze, forming crusts. They usually occur on the face and extremities.

What does Reye's Syndrome affect?


Reye's is a 2-phased syndrome illness, because it is almost always associated with:


affects all organs of the body, but most lethally the liver and the brain.


because it is almost always associated with a previous viral infection, such as influenza, cold, or chicken pox.



What are the s/s scene in stages I and II of Reye's?

Stage I:
Persistent or continuous vomiting

Signs of brain dysfunction: Listlessness , Loss of pep and energy, Drowsiness

Stage II:
Personality changes: Irritability, Aggressive behavior

Disorientation: Confusion , Irrational behavior, Combative

Delirium, convulsions, coma



A 6 y.o. child with a hx of varicella and aspirin intake is brought to the ER. The nurse suspects Reye's syndrome. Which assessment findings are consistent with this syndrome?


a. fever, decreased LOC, impaired liver fxn

b. jt inflammation, red macular rash, low-grade fever

c. peripheral edema, fever for more than 5 days, strawberry tongue

d. red, raised "bull's eye" rash, malaise, jt pain


A. Reye's syndrome occurs in children with a hx of viral infection, varicella, or influenza. It's often associated with the administration of aspirin. The child presents with fever and decreased LOC, which can lead to coma and death. As the disease progresses, the liver also develops impaired liver function.

  • A child with jt pain, a red macular rash with a clear center, and a low-grade fever probably has rheumatic fever.
  • a child presenting with peripheral edema, fiver for 5+ days, and a "strawberry tongue" probably has Kawasaki disease.
  • A child with a red, raised "bull's eye" rash, malaise, and jt pain should be tested for Lyme disease.

A pediatric ct with iron deficiency anemia is prescribed ferrous sulfate (Ferralyn). When teaching the child and parent how to administer this preparation, the nurse should provide which instruction?


a. administer with meals to prevent stomach upset

b. administer with milk to promote absorption

c. administer with fruit juice to promote absorption

d. administer with antacids to prevent stomach upset


Administering an oral iron supplement such as ferrous sulfate with fruit juice or another viatmin C source enhances absorption.


Preferably, doses should be administered bt meals bc gastric acidity and absense of food promote iron absorption.


Food, milk and antacids impair iron absorption.


An antibiotic is ordered for a child age 6, who has a URI. To avoid tooth discoloration, the nurse expects the physician to avoid prescribing which drug?


a. penicillin

b. erthyromycin

c. tetracycline

d. amoxicillin

C. Tetracycline should be avoided in kids under 8, because it may cause enamel hypoplasia and permanent yellowish gray to brownish tooth discoloration.
According to Erikson's theory of development, chronic illness can interfere with which stage of development in an 11 y.o.?
Industry vs. inferiority

A child is prescribed insulin regimen of insulin (Humulin R) and isophane insulin (Humulin N) administered subQ. How soon after administration can the nurse expect the regular insulin to begin to act?


a. 1/2 to 1 hour

b. 1 - 2 hours

c. 4 - 8 hours

d. 8 - 10 hours.

A. Regular insulin, a rapid-acting insulin, begins to act 1/2 to 1 hour, reaches peak concentration levels in 2-10 hours and has a duration of action 5 to 15 hours.

Regular has a _______ action, ________ duration


 NPH has a _______ action, ________ duration


human insulin are the _____________ preparations.



Regular: (rapid onset of action, short duration of action)


NPH: (slower onset of action, longer duration of action)


most commonly-used

Lente insulin is ______________ duration of action. It has an onset of action _________ after injection, a peak activity ______  after injection, and a duration of action of _________.

an intermediate


 onset: 2-4 hours

peak: 6-12 hours

duration: 18-26 hours

Ultralente insulin is a ___________with an onset of action ___________ after injection, a peak effect ____________ after injection, and a duration of action of more than__________.

a long-acting insulin


onset: 4-8 hours

peak: 10-30 hours

duration: 36 hours


Regular insulin has an onset of action (begins to reduce blood sugar) within __________ of injection, reaches a peak effect at _________, and has effects that last ________.



onset: within 30 minutes

peak: 1-3 hours

duration: 6-8 hours

NPH insulin is an insulin with an __________ duration of action. It has an onset of action starting about ________  following injection. It has a peak effect______ after injection, and a duration of action of ________.

intermediation duration


onset: 2 hours

peak: 4-12 hours

duration: 18-26 hours


An ultra rapid-acting insulin natural insulin. 


It reaches peak activity______ after injection. Therefore, insulin lispro should be injected ______ before a meal as compared to regular insulin which is injected 30-60 minutes before a meal.


Peak: 30 minutes - 2.5 hours

Injection: 15 minutes

What is rheumatic fever?
Rheumatic fever is an inflammatory disease that can develop as a complication of untreated or poorly treated strep throat. Strep throat is caused by infection with group A streptococcus bacteria.
What are the s/s of rheumatic fever?


Painful and tender joints

Pain in one joint that migrates to another joint

Red, hot or swollen joints

Small, painless nodules beneath the skin

Chest pain, Palpitations

Fatigue, Shortness of breath



After a child has a cardiopulmonary arrest, which of the following drugs would the nurse expect to administer during the initiral phase of tx?


a. dopamine

b. epinpehrine

c. sodium bicarbonate

d. atropine


A. After successful resuscitation, dopamine would be given as an infusion to increase cardiac output and maintain BP.


Epinephrine, sodium bicarbonate, and atropine are first-roudnd drugs in a cardiopulmonary arrest.

What is nephrotic syndrome?
Nephrotic syndrome is a kidney disorder that causes your body to excrete too much protein in your urine.
S/S of nephrotic syndrome

Edema, particularly around eyes and in ankles and feet


Foam in the toilet water(excess protein in your urine)


Weight gain due to excess fluid retention

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