Pediatric Success: NCLEX®-Style Q&A Review (Q & a Success) Third Edition by Beth Richardson

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Pediatric Success: NCLEX ®-Style Q&A Review is designed to help you, the student, complete your nursing program as well as succeed on the NCLEX-RN® examination. This book applies critical-thinking ... skills primarily to multiple choice questions and to some alternate test items. It provides practice test questions and test-taking hints to help you analyze each item and choose the correct response. Another book in the Success series, Fundamentals Success by Nugent and Vitale, explains critical thinking and the RACE Model, which are used in each book in the series. This information will help you answer questions on tests in your nursing courses and on the NCLEX-RN® examination. The key to successful studying is knowing the material that will be covered on the examinations. Course notes should be studied every night and cor- responding readings done before class. This will help you learn the material and retain it longer. Once you know the material, it is important for you to be able to answer primarily multiple choice questions correctly. The RACE Model will help you succeed with answer- ing questions. HOW TO USE THIS REVIEW BOOK The book contains 14 chapters, a final comprehensive examination, and practice questions online. Test-taking hints are included with each question. This chapter, Chapter 1, provides guidelines for course test preparation and includes an example of how to use the RACE Model. Chapter 2 focuses on pharmacology and has been included because of the expressed need of students for extra testing in this area. In the NCLEX-RN® test plan (www. ncsbn.org), pharmacology and management of care have a large number of test items. This chapter includes questions centered on what the student nurse caring for children of all ages needs to know about administering medications, drug actions, dosages, expected effects, adverse effects, and teaching families. Chapter 3 covers growth and development of children from infancy through adolescence. Chapter 4 covers material on issues related to pediatric health. Chapters 5 through 13 follow pediatric health problems through each of the body systems. Each chapter contains practice questions, answers, and rationales for the correct answer, including test-taking hints, keywords, and abbreviations. Chapter 14, “Leadership and Management,” relates to pediatric nursing. Graduates need to have a working knowledge of issues in these areas. Chapter 15 is a final 100-ques- tion comprehensive examination. There are also questions available online that you can access free for 30 days. Questions in this book are written primarily at the application and analysis level and are either multiple choice, with four response choices, or alternate item format. Nursing faculty members write tests in these formats to familiarize students with the NCLEX-RN® examination style. Test Preparation One of the most important strategies for you is to study your course materials thoroughly and know the assigned concepts for each examination in your class. It is best to study daily 1 2 PEDIATRIC SUCCESS so that you really learn the material. Don’t wait and try to learn it all at once. The more time you spend studying the topic, the better you will retain the material. After you feel confident that you know the material, choose the chapter(s) in this book that correspond(s) with the assigned test material in your nursing course. Answer the prac- tice questions to determine your level of knowledge about the topic. Carefully review the questions you miss, making sure you read and understand the rationale for choosing the wrong distracter and why the correct response is indeed correct. The rationales provide a great deal of information about the correct and incorrect options, which helps you under- stand the content more completely. The test-taking hints are strategies to help you logi- cally determine the correct response. If you still feel uncomfortable with the content area, review that chapter in your textbook for better understanding. This method of preparing for an examination will help you identify your strengths and areas to focus on as you con- tinue to study. You may want to start with Chapter 2, “Pharmacology,” because you will be admin- istering medications to children throughout your pediatric nursing course. This chapter will help you focus on teaching strategies for families of children receiving medications, differences in delivering drugs to children, and calculating dosages. RACE Model The RACE Model is a critical-thinking strategy to be used when answering multiple choice questions. The RACE Model helps you analyze the question stem and determine the correct response. For more detailed information about the RACE Model, see Test Success: Test-Taking Techniques for Beginning Nursing Students by Nugent and Vitale. The RACE Model comprises: R - Recognize the keywords in the stem. A - Ask what the question is asking the nurse to do. C - Critically analyze each option in relation to the information in the stem. E - Eliminate as many options as possible to narrow your choice to the correct response. Some students believe they know the material but have difficulty choosing the correct response when answering multiple choice questions. Using the RACE Model will greatly increase your chances of choosing the correct response. To use it effectively during timed tests, you need to practice. Using the RACE Model as you prepare yourself with the chapter tests will help you. Following is a sample question: 1. A 6-month-old is being seen in the clinic for a well-child checkup. The parents want to know about starting solid foods. How should the nurse counsel them? 1. “Since you started rice cereal from a spoon 2 months ago, you can add a new strained vegetable each week.” 2. “Introduce some mashed fruits first. After the infant is eating that well, start vegetables and rice cereal.” 3. “Infants do best eating solids if you spoon-feed a new strained vegetable every other day to see what their preferences are.” 4. “Add rice cereal to each bottle. Next you can add fruits and vegetables fed by spoon.” Using the RACE Model: R - The client in the stem is the parent. A - The parents want to know how to add solid foods to their infant’s diet. C - Infants start rice cereal between 4 and 6 months. This is fed to the infant by spoon unless there is an indication to place it in the bottle. That is not stated in the stem of this question. Either strained fruits or vegetables are added to the infant’s diet at about 6 months of age. The infant stays on that choice for several days to determine whether the infant is allergic. E - Now you can eliminate choices 2, 3, and 4 because they do not contain choices that you know are correct. The remaining choice is 1, the correct response. KEYWORDS The following words include English vocabulary, nursing/medical terminology, concepts, princi- ples, or information relevant to content specifically addressed in the chapter or associated with topics presented in it. English dictionaries, your nursing textbooks, and medical dictionaries such as Taber’s Cyclopedic Medical Dictionary are resources that can be used to expand your knowl- edge and understanding of these words and related information. Acetaminophen (Tylenol) Albuterol (Proventil) Amoxicillin (Amoxil) Amoxicillin/clavulanate potassium (Augmentin) Amphotericin B Anticholinergic Baclofen Diphenhydramine (Benadryl) Benzoyl peroxide Carbamazepine (Tegretol) Chlorhexidine (Hibiclens) Ciprofloxacin (Cipro) Collagenase (Santyl) Cyclophosphamide (Cytoxan) Dexamethasone (Decadron) Diclofenac (Voltaren) Digoxin (Lanoxin) Diltiazem (Cardizem) Erythromycin Filgrastim (Neupogen) Gamma globulin Gentamicin (Garamycin) Growth hormone Ibuprofen (Advil, Motrin) Ifosfamide (Ifex) Indomethacin (Indocin) Intradermal Isotretinoin (Accutane) Levothyroxine (Synthroid) Lindane (Kwell, G-Well) Mesna (Mesnex) Metoclopramide (Reglan) Morphine sulfate (Duramorph) Nasal decongestant NPH insulin Oxybutynin (Ditropan) Pancreatic enzymes Penicillin Phenytoin (Dilantin) Prednisone Prostaglandin E Pyrantel pamoate (Antiminth) Ribavirin (Virazole) Rifampin (Rifadin) Salicylic acid Sympathomimetic Terbinafine (Lamisil) Trimethoprim/sulfamethoxazole (Septra, Bactrim) Vancomycin Vastus lateralis ABBREVIATIONS Cerebral palsy (CP) grain (gr) gram (g) milligram (mg) pound (lb) 3 4 PEDIATRIC SUCCESS CONVERSIONS 1 fl ounce = 30 mL (fluid volume) 1 g = 15 gr 1 g = 1000 mg 1 gr = 60 mg (or 65 mg for Tylenol or aspirin) 1 in = 2.54 cm 1 kg = 2.2 lb 1 L = 1000 mL 1 lb = 454 g 1 lb = 16 ounces 1 mg = 1000 mcg 1 ounce = 28 g (weight) QUESTIONS 1. A child is to receive phenytoin (Dilantin) 100 mg IV for seizure prophylaxis. Which intervention is appropriate when administering this drug? 1. Mix it in dextrose 5% in water and give over 1 hour. 2. Administer no faster than 2 mg/kg/min. 3. Do not use an inline filter. 4. Monitor temperature prior to and after administration. 2. The parent of a child who is being discharged from the clinic wants to know if there is a difference between Advil and ibuprofen, saying, “I can buy ibuprofen over the counter at a cheaper price than Advil.” What is the nurse’s best response? 1. “Advil and ibuprofen are two different drugs with similar effects.” 2. “There is no difference between the two medications, so you should use whichever one is cheaper.” 3. “Similarities exist between the drugs, but you need to consult the health-care provider about the specific order.” 4. “Ibuprofen is usually cheaper, so you should use it.” 3. What time would the nurse most likely see signs and symptoms of hypoglycemia after administering NPH insulin at 0730? 1. 0930 to 1030. 2. 1130 to 1430. 3. 1130 to 1930. 4. 1530 to 1930. 4. Morphine sulfate (Duramorph) 2 mg IV q2h prn for pain is ordered for a 12-year- old who has had abdominal surgery. Which is the most appropriate nursing action? 1. Administer the morphine sulfate (Duramorph) using a syringe pump over 1 hour. 2. Encourage the child to use incentive spirometer every hour during the day and when awake at night. 3. Ask the health-care provider to change the medication to meperidine (Demerol). 4. Administer the morphine sulfate (Duramorph) with Benadryl (diphenhydramine) to prevent itching. 5. The parent of a child who is being treated for Haemophilus influenzae meningitis tells the nurse that the family is being treated prophylactically with rifampin (Rifadin). Which should the nurse include in teaching about this medication? 1. “The drug will change the color of the urine to orange-red, and it will cause staining.” 2. “Adverse effects of the drug may cause urinary retention.” 3. “The drug is given to treat meningitis.” 4. “You will need to continue taking the drug for 7 days.” CHAPTER 2 PHARMACOLOGY 5 6. A 2-year-old child has been prescribed amoxicillin (Amoxil) bid for treatment of pharyngitis. Which statement indicates that the parent knows how to give the medication? 1. “If I miss giving my child a dose at breakfast, I will double up on the dose at night.” 2. “I will give the medication at breakfast and dinner.” 3. “I know that amoxicillin (Amoxil) is a pill, but sometimes my child will not take it.” 4. “I will continue giving the amoxicillin (Amoxil) for 10 days even after my child is better.” 7. A nurse is caring for a child who is receiving amphotericin B IV daily for a fungal infection. Prior to starting the therapy, which should the nurse review? 1. Aspartate aminotransferase and alanine aminotransferase serum levels. 2. Serum amphotericin level. 3. Serum protein and sodium levels. 4. Blood urea, nitrogen, and creatinine levels. 8. Which toxicity is specific to gentamicin (Garamycin)? 1. Hepatatoxicity. 2. Ototoxicity. 3. Myocardial toxicity. 4. Neurotoxicity. 9. A nurse is administrating vancomycin intravenously and sets the pump to infuse the medication over 90 minutes. Which adverse reaction is the nurse trying to prevent? 1. Vomiting. 2. Headache. 3. Flushing of the face, neck, and chest. 4. Hypertension. 10. The parents of an 8-year-old come to the clinic and ask the nurse if their child should receive growth hormone to boost short stature. Which is the nurse’s best response? 1. “Growth hormone only works if the child has short bones.” 2. “Can your child remember to take the pills every day?” 3. “Test results are required before growth hormone can be started in children.” 4. “How tall do you think your child should be?” 11. A child has been receiving prednisone for the past 3 weeks, and the parent wants to stop the medication. What is the nurse’s best response? 1. “There is no problem in stopping the medication since the child’s symptoms are gone.” 2. “It is dangerous for steroids to be stopped suddenly.” 3. “Your child may develop severe psychological symptoms when prednisone is stopped suddenly.” 4. “Stopping the prednisone will require blood work.” 12. A child who has been diagnosed with hypothyroidism is started on levothyroxine (Synthroid). Which should be included in the nurse’s teaching plan? 1. The child will have more energy the next day after starting the medication. 2. Optimal effectiveness of the medication may not occur for several weeks. 3. The medication should be taken once a day at any time. 4. The medication should be taken with milk. 6 PEDIATRIC SUCCESS 13. Which should the nurse include in the discharge teaching plan for a child beginning growth hormone therapy? 1. The child is expected to grow 3 to 5 inches during the first year of treatment. 2. The parents must measure the child’s weight and height weekly. 3. The child will need to continue the therapy until he or she is 21 years old. 4. There are no side effects from taking growth hormones. 14. The onset of Humalog insulin is: 1. 10 to 15 minutes. 2. 30 minutes to 1 hour. 3. 1 to 2 hours. 4. 2 to 4 hours. 15. Which should the nurse include in the teaching plan for a child started on metoclopramide (Reglan)? 1. The drug increases gastrointestinal motility. 2. The drug decreases tone in the lower esophageal sphincter. 3. The drug prevents diarrhea. 4. The drug induces the release of acetylcholine. 16. The nurse will monitor a child on high-dose prednisone for: 1. Diabetes. 2. Deep vein thrombosis. 3. Nephrotoxicity. 4. Hepatotoxicity. 17. A nurse is administering cyclophosphamide (Cytoxan) to a child with leukemia. Which action by the nurse would be appropriate? 1. Monitoring serum potassium levels. 2. Checking for hematuria. 3. Obtaining daily weights. 4. Obtaining neurological checks every 4 hours. 18. A nurse is giving ifosfamide (Ifex) as chemotherapy for a child who has leukemia. Mixed in with the ifosfamide (Ifex) is mesna (Mesnex). Mesna is given for which reason? 1. As combination chemotherapy. 2. As an antiarrhythmic. 3. To prevent hemorrhagic cystitis. 4. To increase absorption of the chemotherapy. 19. Which should a nurse anticipate be prescribed in chelation therapy for a child receiving frequent blood transfusions? 1. Dalteparin sodium (Fragmin). 2. Deferoxamine (Desferal). 3. Diclofenac (Voltaren). 4. Diltiazem (Cardizem). 20. Why is filgrastim (Neupogen) given to a child who has received chemotherapy? 1. Reduce fatigue level. 2. Prevent infection. 3. Reduce nausea and vomiting. 4. Increase mobilization of stem cells. 21. A child comes to the clinic for diphtheria, pertussis, and tetanus (DTaP) and inactivated poliovirus vaccines. The child does not appear ill but has a temperature of 101°F (38.3°C). The nurse should take which action? 1. Withhold the vaccines and reschedule when the child is afebrile. 2. Administer acetaminophen (Tylenol) and give the vaccines. 3. Give the vaccines and instruct the parent to give acetaminophen (Tylenol) every 4 hours as needed. 4. Have the health-care provider order an antibiotic and give the vaccine. CHAPTER 2 PHARMACOLOGY 7 22. Which of the following would the nurse instruct the parent about treating a pediculosis infestation? 1. Apply spinosad (Natroba) to the scalp, leave it in place for 4 minutes, and then add water. 2. Apply chlorhexidine (Hibiclens) to the scalp with sterile gloves and leave on overnight. 3. Apply terbinafine (Lamisil) as a thin layer to the scalp twice a day for 5 days. 4. Apply collagenase (Santyl) to the scalp with cotton applicator, leave in place overnight, then shampoo. 23. Amoxicillin (Amoxil) 250 mg PO twice a day is prescribed to treat strep throat in a child who weighs 42 lb. The desired dose is 50 mg/kg/day. The nurse determines that: 1. The prescribed dose is too low. 2. The prescribed dose is too high. 3. The prescribed dose is safe. 4. Not enough information is given to determine the safe dose. 24. A child with a heart defect is placed on a maintenance dose of digoxin (Lanoxin) elixir. The dose is 0.07 mg/kg/day, and the child’s weight is 16 lb. The medication is to be given two times a day. The nurse prepares how much digoxin (Lanoxin) for the morning dose? 1. 0.25 mg. 2. 0.37 mg. 3. 0.5 mg. 4. 2.5 mg. 25. Ciprofloxacin (Cipro) 300 mg daily is ordered for a child with a urinary tract infection. The medication comes 250 mg/5 mL. How much of the medication will the nurse prepare to give to the child? 1. 1.2 mL. 2. 3 mL. 3. 6 mL. 4. 12 mL. 26. A nurse is caring for a child with congenital heart disease who is being treated with digoxin (Lanoxin). Which is included in the family’s discharge teaching? 1. Make sure the medication is taken with food. 2. Repeat the dose if the child vomits. 3. Take the child’s pulse prior to administration. 4. Weigh the child daily. 27. Which medication is the most effective treatment for acne? 1. Salicylic acid. 2. Benzoyl peroxide. 3. Fluconazole (Diflucan). 4. Clotrimazole (Lotrimin). 28. Which would the nurse include when teaching an adolescent female beginning isotretinoin (Accutane) therapy? 1. Apply a thin layer to the affected skin twice a day. 2. Use Dove Sensitive Skin soap for added benefit. 3. A pregnancy test will be done prior to starting treatment. 4. Keep lips moistened to prevent inflammation. 29. Which medication is used for the treatment of spasticity in cerebral palsy (CP)? 1. Dexamethasone (Decadron). 2. Baclofen (Lioresal) 3. Diclofenac (Voltaren). 4. Carbamazepine (Tegretol). [Show More]

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