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NCLEX RN Questions and Answer with Rationale 25th Edition (Child Health)
1. Which of the following precautions will the nurse specifically take during the administration of ribavirin (Virazole) to a child with respiratory syncytial virus (RSV)?
A. Hand washing before administration
B. Wearing goggles
C. Wearing a gown
D. Wearing a gown and a mask
Answer: B. Wearing goggles
Rationale: Some caregivers experience headaches, burning nasal passages and eyes, and crystallization of soft contact lenses as a result of administration of ribavirin. Specific to this medication is the use of goggles. A mask may be worn. Hand washing is to be performed before and after any child contact. A gown is not necessary.
Test-Taking Strategy: Note the key word specifically. Recalling that this medication is administered via hood, facemask, or oxygen tent will direct you to the correct option. Review this medication if you had difficulty with this question.
Level of Cognitive Ability: Application Client Needs: Safe, Effective Care Environment Integrated Process: Nursing Process/Implementation Content Area: Child Health References:
deWit, S. (2005). Fundamental concepts and skills for nursing, Philadelphia: W.B. Saunders, p. 212.
Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 598.
McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1214.
2. A 10-year-old child with asthma is treated for acute exacerbation. Which finding would indicate that the condition is worsening?
A. Increased wheezing
B. Decreased wheezing
C. Warm, dry skin
D. A pulse rate of 90 beats per minute
Answer: B. Decreased wheezing
Rationale: Decreased wheezing in a child who is not improving clinically may be incorrectly interpreted as a positive sign when, in fact, it may signal an inability to move air. A “silent chest” is an ominous sign during an asthma episode. With treatment, increased wheezing may actually signal that the child’s condition is improving. The normal pulse rate in a 10-year-old is 70 to 110 beats per minute. Warm, dry skin indicates an improvement in the condition because the child is normally diaphoretic during exacerbation.
Test-Taking Strategy: Use the process of elimination. Noting the key word worsening will assist in eliminating options 3 and D. From the remaining options, it is necessary to know the signs of improvement in a child treated for asthma. Remember, decreased wheezing may signal an inability to move air. Review these clinical manifestations if you had difficulty with this question.
Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Child Health References:
McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, pp. 1224-1225.
Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 294.
3. A mother arrives at the clinic with her 3-year-old child. The mother tells the nurse that the child has had a fever and a cough for the past 2 days, and this morning the child began to wheeze. Viral pneumonia is diagnosed. Which of the following would the nurse anticipate to be a component of the treatment plan?
A. Oral antibiotics
B. Hospitalization and antibiotics
C. Supportive treatment
D. Intravenous (IV) fluid administration
Answer: C. Supportive treatment
Rationale: With viral pneumonia, treatment is supportive. More severely ill children may be hospitalized and given oxygen, chest physiotherapy, and IV fluids. Antibiotics are not given. Bacterial pneumonia, however, is treated with antibiotic therapy.
Test-Taking Strategy: Use the process of elimination and note the key word viral in the question. Recalling that antibiotics are not effective in treating viruses will assist in eliminating options 1 and B. There are no data in the question to support the need for IV fluid administration. This leaves option 3 as the correct answer. It is also the umbrella (global) option. Review care to the child with viral pneumonia if you had difficulty with this question.
Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Planning Content Area: Child Health Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, pp. 1217-1218.
4. A mother of an 8-year-old child being treated for right lower lobe pneumonia at home calls the clinic nurse. The mother tells the nurse that the child has discomfort on the right side and that the acetaminophen (Tylenol) is not very effective. The appropriate suggestion by the nurse would be to:
A. Increase the dose of acetaminophen
B. Increase the frequency of acetaminophen administration
C. Encourage the child to lie on the right side
D. Encourage the child to lie on the left side
Answer: C. Encourage the child to lie on the right side
Rationale: Splinting of the affected side by lying on that side may decrease discomfort. It is inappropriate to advise the mother to increase the dose or frequency of the acetaminophen. Lying on the left side will not be helpful in alleviating discomfort.
Test-Taking Strategy: Use the process of elimination. Options 1 and 2 can be eliminated first because the nurse would not provide pharmacological instructions. Recalling the principles related to splinting an incision in the postoperative client will assist in directing you to option 3 from the remaining options. Review care to the child with pneumonia if you had difficulty with this question.
Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Child Health Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 192.
5. A nurse is reviewing the health record of an infant with a diagnosis of gastroesophageal reflux. Which clinical manifestation of this disorder would the nurse expect to note documented in the record?
A. Excessive oral secretions
B. Coughing, wheezing, and short periods of apnea
C. Bowel sounds heard over the chest
D. Hiccupping and spitting up after a meal
Answer: D. Hiccupping and spitting up after a meal
Rationale: Clinical manifestations of all types of gastroesophageal reflux include vomiting (spitting up) after a meal, hiccupping, and recurrent otitis media related to pooled secretions in the nasopharynx during sleep. Option 1 is a clinical manifestation of esophageal atresia and tracheoesophageal fistula. Option 2 is a clinical manifestation of hiatal hernia. Option 3 is a clinical manifestation of congenital diaphragmatic hernia.
Test-Taking Strategy: Knowledge of the clinical manifestations associated with gastroesophageal reflux will easily direct you to the correct option. Note the word “reflux” in the question and the relation to “hiccupping and spitting up after a meal.” If you had difficulty with this question, review the manifestations of this disorder.
Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Child Health Reference: Leifer, G. (2003). Introduction to maternity & pediatric nursing (4th ed.). Philadelphia: W.B. Saunders, p. 665.
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