Which assessment finding would the nurse recognize as common in infant with Down syndrome?

Pediatric Nurse Exam Sample Questions

These sample questions apply to all exams taken on or after October 25, 2014.

The following sample questions are similar to those on the examination but do not represent the full range of content or levels of difficulty. The answers to the sample questions are provided after the last question. Please note: Taking these or any sample question(s) is not a requirement to sit for an actual certification examination. Completion of these or any other sample question(s) does not imply eligibility for certification or successful performance on any certification examination.

To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the "Evaluate" button at the bottom of the page. A new browser window will open, displaying your results, which you may print, if you wish.

This practice exam is not timed, and you may take it as many times as you wish. Good luck!

Which of these statements is a misconception related to iron-deficiency anemia?

“Milk is a perfect food, and babies should be able to have all the milk they want.”

The nurse is preparing a child for discharge following a sickle cell crisis. Which statement by the mother indicates a need for further teaching?

“She has been down, but playing in soccer camp will cheer her up.”

The nurse identifies a nursing diagnosis of impaired oral mucous membranes related to the effects of chemotherapy. What instructions would the nurse include in the child's plan of care? (3)

Have the child rinse the mouth with lukewarm water three times a day. Apply a lip balm or petroleum jelly to prevent cracking. Provide various soft and bland foods to minimize further irritation.

The nurse is teaching the parents of a 15-year-old boy who is being treated for acute myelogenous leukemia about the side effects of chemotherapy. For which symptoms should the parents seek medical care immediately?

Temperature of 101° F (38.3° C) or greater

A nurse in the emergency department is examining a 6-month-old with symmetrical swelling of the hands and feet. The nurse immediately suspects

The nurse caring for a 14-year-old scheduled for magnetic resonance imaging (MRI) explains how the test works to the family. Which response accurately describes this test?

"The MRI uses radio waves and magnets to produce a computerized image of the body."

A 14-year-old experiencing difficulty breathing is sent for a radiograph. The nurse knows that difficulty breathing may be indicative of

A 9-year-old boy will be undergoing a hematopoietic stem cell transplantation, with donor cells being provided by his 12-year-old sister. The nurse recognizes that this type of transplantation is

The nurse is instructing the parents of a child with sickle cell anemia on safety precautions. What should the nurse emphasize during this teaching?

Ensure a consistent and daily intake of adequate fluids to prevent dehydration.

The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure?

Which nursing diagnosis would be most appropriate for a child with idiopathic thrombocytopenic purpura?

Ineffective tissue perfusion related to poor platelet formation-- anti platelet 

The nurse is caring for a 2-year-old with sickle cell anemia and instructing the parents on the manifestions of the disease. Which statement by the mother indicates a need for further teaching?

"The acute manifestations, like splenic sequestration, are most often life-threatening."

A 4-year-old child diagnosed with Wilms tumor is admitted for surgery. What information would be most important for the nurse to include in the child's preoperative plan of care?

Avoiding further abdominal palpation

A 3-year-old boy has been brought to the doctor's office with symptoms of anorexia and abdominal pain. A blood test reveals a lead level of 20 μg/100 mL. The child is prescribed an oral chelating agent. On discharge, the nurse should counsel the parents regarding

removal or covering of flaking paint on the walls of the home

The nurse is evaluating the complete blood count of a 7-year-old child with a suspected hematological disorder. Which finding is associated with an elevated mean corpuscular volume (MCV)?

Macrocytic red blood cells (RBCs)-- looks at average size of RBCs

The child with thalassemia may be given which classification of medication to prevent one of the complications frequently seen with the treatment of this disorder?

Iron-chelating drugs-- hemosiderosis (excessive iron) is common complication

Which symptom would lead the nurse to suspect that a child is developing a common side effect of vincristine?

The child says the fingertips feel numb

The nurse is caring for a 10-year-old boy with hemophilia. He asks the nurse for suggestions about appropriate physical activities. Which activity would the nurse most likely recommend?

The nurse identifies the nursing diagnosis of risk for infection related to chemotherapy-induced immunosuppression. What would the nurse include in the teaching plan for the child and parents about reducing the child's risk? (2)

Having the child sleep in a single bed and room Encouraging frequent, thorough handwashing

A nurse is preparing a 7-year-old girl for bone marrow aspiration. Which site should she prepare?

To prevent further sickle cell crisis, the nurse would advise the parents of a child with sickle cell anemia to

notify a health care provider if the child develops an upper respiratory infection

What is one advantage of an implanted port (central venous access device) that the nurse will explain to an adolescent?

Body appearance changes very little

Which symptom should the nurse most expect as a result of excessive iron deposits?

The nurse is completing the health history of a 6-month-old infant with retinoblastoma with the child's parents. Which symptom should the nurse expect that the parents have observed?

The nurse is caring for a child with aplastic anemia. The nurse is reviewing the child’s blood work and notes the granulocyte count is about 500, platelet count is over 20,000, and the reticulocyte count is over 1%. The parents ask if these values have any significance. Which response by the nurse is appropriate?

“These values will help us monitor the disease.”

When explaining the procedure of bone marrow aspiration to a child with leukemia, what would be the best explanation?

“You will feel pressure on your hip from the needle.

Which nursing diagnosis should the nurse identify as being the most appropriate for a child with idiopathic thrombocytopenic purpura?

Risk for bleeding related to insufficient platelet formation

The nurse is providing preoperative care for a 7-year-old boy with a brain tumor and his parents. Which intervention is priority?

Assessing the child’s level of consciousness

The nurse is caring for a child with leukemia. Which nursing intervention would be the highest priority for this child?

Following guidelines for protective isolation

The nurse is administering meperidine as ordered for pain management for a 10-year-old boy in sickle cell crisis. The nurse would be alert for

The nurse is caring for a 3-year-old boy with suspected iron-deficiency anemia. Which test would the nurse expect to be ordered to confirm the diagnosis?

The nurse is planning care for a school-aged child recovering from being hit by a motor vehicle while riding a bicycle. For what will the nurse assess to determine the onset of disseminated intravascular coagulation in this child?

A diagnosis of hemophilia is confirmed. This child most likely has a deficiency of which blood factor?

The group demonstrates understanding of the information when they identify what location as an unlikely site for childhood cancer?

The toddler with a cancer diagnosis is seen for a well-child checkup. Which health maintenance activity will the nurse exclude?

Administering the measles, mumps, rubella (MMR) vaccine

How can the nurse most simply describe for distressed parents a rhabdomyosarcoma that has been found in their 5-year-old?

Call it a tumor of muscle tissue

The nurse is evaluating the effectiveness of teaching provided to the parents of a school-age child prescribed liquid ferrous sulfate for iron-deficiency anemia. Which observations indicate that teaching has been effective? (4)

Parent places medication in orange juice. Child consumes fresh raw fruit and drinks water. Parent provides liquid-prepared medication to the child with a straw. Child goes to the bathroom to brush teeth immediately after taking the medication.

A child with ALL is beginning treatment with methotrexate in an attempt to eradicate the leukemic cells. The stage of therapy represents the

The nurse is assessing a school-aged child with sickle-cell anemia. Which assessment finding is consistent with this child's diagnosis?

A nurse is providing dietary interventions for a 5-year-old with an iron deficiency. Which response indicates a need for further teaching?

“Red meat is a good option; he loves the hamburgers from the drive-thru.

A child is to receive an oral corticosteroid as part of the treatment regimen for leukemia. After teaching the child and family about this drug, the nurse determines the need for additional teaching when they state

"We should administer the drug on an empty stomach."

The nurse is admitting to an examination room a child with the diagnosis of "probable acute lymphoblastic leukemia." What will confirm this diagnosis?

The nurse is assessing a 3-year-old boy whose mother reports that he is listless and has been having trouble swallowing. Which finding suggests the child may have a brain tumor?

Observation reveals nystagmus and head tilt

What is the priority action the nurse should take when caring for a child newly diagnosed with Wilms tumor (nephroblastoma)?

Protect the abdomen from manipulation.

A nurse is providing care for a child with disseminated intravascular coagulation (DIC). What would alert the nurse to possible neurologic compromise?

Widely fluctuating blood pressure

Children with ALL may need periodic lumbar punctures. You would teach the mother this is done to assess for:

The nurse is reviewing the laboratory test results of a child with thalassemia. Which results would the nurse expect to find with the hemoglobin electrophoresis? (2)

Hemoglobin F Hemoglobin A2

A nurse is teaching the parents of a child with sickle cell disease about factors that predispose the child to a sickle cell crisis. The nurse determines that the teaching was successful when the parents identify what as a factor?

The nurse is reviewing the results of a clotting study for a healthy 6-year-old. What would the nurse document as a normal prothrombin finding?

The nurse is providing teaching about iron supplement administration to the parents of a 10-month-old child. It is critical that the nurse emphasize which teaching point to the parents?

“You must precisely measure the amount of iron.”

The child is prescribed liquid ferrous sulfate. The nurse should encourage the child to take which action immediately after each dose to best eliminate possible side effects?

The nurse recognizes that the child's seeming well-being and drastic change in behavior should be further investigated to determine if the child...

is planning to commit suicide 

Which child would be best characterized as having a separation anxiety disorder?

WRONG- A 7-year-old who withdraws from contact with all strangers
Correct response:
An 8-year-old who will not stay overnight at a friend's house

To feed lunch to a child with autism spectrum disorder (ASD), which action would be most important for the nurse to take?

Use a repetitive series of movements.

The nurse is assessing a 6-year-old with attention deficit/hyperactivity disorder (ADHD). The nurse observes the boy making repeated clicking noises and notes he has a slight grimace. The nurse recommends the boy receive further evaluation for

The nurse suspects that a school-age child has Tourette syndrome. What did the nurse most likely assess in this client?

A 15-year-old student has been referred by the homeroom teacher to the school nurse for evaluation. The teacher is concerned that the student may be suffering from major depression. Who should be the primary source of information to investigate the concerns about the student?

The nurse is preparing a plan to educate the parents of a 10-year-old boy with a learning disorder. What will be part of this plan?

Explain the child's strengths and weaknesses.

Which behavior typical of children with autism spectrum disorder (ASD) requires you to maintain special care to keep them safe?

A nurse is explaining the rights and responsibilities of a child with a developmental disorder to the parents of 7-year-old diagnosed with a learning disorder. The child is attending a public school. The parents demonstrate understanding when they make which statements? Select all that apply.

"Our child should have an individualized education plan for his education." "We have the right to review any of his records related to his schooling." "We should not have to pay for any of the services he receives."

A mother has presented with her 2 year old child. She states that the child was talking in earlier months but recently has "kind of withdrawn." The child does not interact with other children or adults much but does enjoy throwing a ball, retrieving it and throwing it again. The nurse realizes that the child needs further assessment for which disorder?

A mother is telling the school nurse about her concerns regarding her 13-year-old daughter, who is experiencing headaches. Her grades have dropped, and she is sleeping late and going to bed early every night. The nurse advises the mother that the first priority should be to...

schedule an immediate history and physical examination-- not psychotriststtststs

An adolescent comes to the school nurse and after being quiet for several minutes states, "I think the world will be better when I am gone." Which statement should be the nurse's first response to this adolescent?

"Have you made a plan to commit suicide?"

The nurse is caring for a 10-year-old girl with an anxiety disorder. During a physical examination, which physical finding would the nurse expect?

The mother of an 8-year-old boy is concerned that her son has attention-deficit/hyperactivity disorder. She describes the symptoms he demonstrates. Which behavior should the nurse recognize as an example of impulsiveness?

Jumping out of his seat in the middle of class and running to the bathroom without the teacher's permission

The mother of a school-age child is distraught over the ongoing oppositional behavior demonstrated by the child at home and at school. Which nursing diagnosis should the nurse select as appropriate for the child and family?

Interrupted family processes related to inability of child to follow instructions

Which sign or symptom suggests that a 5-year-old boy who does not maintain eye contact or speak may have autism spectrum disorder (ASD)?

The child constantly pats his legs - repetitive activity 

The nurse is caring for a 12-month-old with autism spectrum disorder (ASD). What description would you expect to elicit from his mother on history-taking?

He stares at a rotating wheel on his crib mobile.

The nurse is performing a physical assessment of 16-year-old girl who is intellectually disabled. This client attended her local public elementary school through fifth grade and has since been enrolled at a special education school where she has received social and vocational training. She plans on getting a job in the coming month and on living independently in a few years. The nurse recognizes this client's level of intellectual disability as:

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate hydrochloride. What should the nurse instruct the parents regarding an adverse effect of this medication?

The mother of a 10-year-old child reports ongoing struggles encountered by her child at school. She states her daughter needs assistance in the class and during mealtimes. What response by the nurse is appropriate?

"The school is required to work with you to ensure your child's needs are met during the school period."

Which sign is consistent with autism spectrum disorder (ASD) in a 2-year-old boy?

Performs repetitive activity with toys

The nurse is examining a child with fetal alcohol syndrome (FAS). Which assessment finding should the nurse expect?

Low nasal bridge with short upturned nose

The nursing educator has completed an educational program for new nurses on eating disorders in teenagers. Which statement by a participant would indicate a need for further education?

“If they refuse to eat, we need to sit with them and not let them leave the table until they do eat something.”

The nurse is talking with the parents of a child who has been identified as having a learning disability. The parents state that there child performs well on oral examinations but struggles otherwise on exams. The nurse is aware that the parents are describing which disorder?

The nurse is meeting with a family that has learned that their 11-year-old daughter has some intellectual disabilities. They tell the nurse that she is having trouble coping with different situations at school. What is the best response by the nurse?

"Coping and adaptation are often affected by intellectual disabilities."

The nurse is collecting data from the caregiver of an 8-year-old child who recently started soiling his underwear each day rather than using the toilet to defecate. How would the nurse document this in the medical record?

The client has regressed to encopresis.

When teaching parents of a child with encopresis, what would you stress?

Not punishing the child for encopresis

When can autistic behaviors first be noticed?

A nurse is assessing a child with suspected drug use. Which characteristics are related to an increased risk of substance use? Select all that apply.

Being a member of a family that has had another member who uses drugs Being a member of an abusive family Having behavioral problems Being a slow learner

The nurse is caring for a girl with anorexia who has been hospitalized with unstable vital signs and food refusal. The girl requires enteral nutrition. The nurse is alert for which complications that signal refeeding syndrome?

Cardiac arrhythmias, confusion, seizures

A 10-year-old girl with ADHD has been on methylphenidate for 6 months. The girl's mother calls and tells the nurse that the medication is ineffective and requests an immediate increase in the child's dosage. What should the nurse say?

“Let's set up an appointment as soon as possible.”

A group of nursing students are reviewing medications used to treat attention deficit/hyperactivity disorder (ADHD). The group demonstrates understanding of the information when they identify what as a nonstimulant norepinephrine reuptake inhibitor?

A nurse is working at a facility that provides care to children with developmental disabilities. Which role would be the nurse's most important?

The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. The nurse will anticipate the child will next be:

The nurse is discussing health concerns and issues with a group of caregivers of adolescents. Which statement made by a caregiver would indicate a need for follow-up by the nurse?

"Our daughter has never had any health problems, and now she has developed so many cavities."

After teaching the parents of a child with Tourette syndrome about motor and vocal tics, the nurse determines that the teaching was successful when the parents state:

"If we get him focused on an activity, the tics will be less pronounced."

A 17-year-old child has been admitted with complications of anorexia nervosa. What diagnostic tests can be anticipated in the plan of care/treatment? Select all that apply.

Complete blood cell count Metabolic panel

A nurse is assessing a neonate with sepsis. The nurse understands that most commonly the cause involves:

A nurse is assessing a child with a tick-borne disease. What finding would indicate to the nurse that the child has developed ehrlichiosis and not Rocky Mountain spotted fever?

The nurse is administering a chicken pox vaccination to a 12-month-old girl. Which concern is unique to varicella?

This disease can reactivate years later and cause shingles.

The pediatric nurse knows that there are a number of anatomic and physiologic differences between children and adults. Which statement about the immune systems of infants and young children is true?

Children have an immature immune response.

A 16-year-old is seen in the emergency department with symptoms including a high fever, chills, headache, nausea and vomiting, and painful joints. During the nursing history the teenager reports recently returning from a trip to a rain forest in South America. What infectious disease does the nurse suspect the client has contracted?

The nurse is caring for an adolescent diagnosed with genital herpes. The drug of choice for treating genital herpes is:

A child is brought to the emergency department by his parents. The parents report that he stepped on a rusty nail about a week and a half ago. The child is complaining of cramping in his jaw and some difficulty swallowing. The nurse suspects tetanus. When assessing the child, the nurse would be alert to which muscle groups being affected next?

A nurse is preparing a presentation for parents about common childhood infectious diseases. What conditions would the nurse include as being caused by a tick bite?

Rocky Mountain spotted fever Lyme disease

The father of a child with mononucleosis is concerned with his child's fever and cough. The father asks when antibiotic therapy will begin. What is the best response by the nurse?

"Mononucleosis is a viral infection so an antibiotic isn't used. We address the symptoms with appropriate therapy."

A child is diagnosed with scarlet fever. History reveals that the child has no known drug allergies. When preparing the child's plan of care, the nurse would anticipate administering which agent as the drug of choice?

A nursing instructor is describing the progression of signs and symptoms associated with varicella from earliest to latest. Place the signs and symptoms below in the sequence that the instructor would describe them.

Low-grade fever Macular rash Papular rash Vesicle formation Crusting

The nurse is preparing to administer acetaminophen to a 4-year-old girl to provide comfort to the child. Which precaution is specific to antipyretics?

Ensure proper dose and interval

The parents of a 4-month-old diagnosed with sepsis tell the nurse that the physician explained sepsis to them but they don't really understand it. The parents state, "Could you please explain it to us?" What is the best response by the nurse?

"The infection your child has causes the release of toxins into the system, which can lead to impaired function in the lungs, liver, and kidneys."

The mother of a child with pediculosis capitis infestation tells the nurse that she does not understand why her child still has the infestation. The mother states, "I used the prescribed treatment just like I was instructed." How should the nurse respond?

"After finding the infestation did you wash items that your child's head came into contact with, like bed linen?"

The appearance of which hallmark clinical manifestation occurs in measles?

An adolescent girl and her caregiver present at the pediatrician's office. The adolescent reports severe abdominal pain. A diagnosis of pelvic inflammatory disease (PID) is made. The nurse notes in the child's chart that this is the third time she has been treated for PID. Which action by the nurse would be most appropriate?

Take the child to a private room and interview her regarding her sexual history and partners.

The nurse is performing a physical examination for a 7-year-old girl who was bitten by a tick. What would alert the nurse to the possibility of early localized Lyme disease?

Bull's-eye rash around the bite

The nurse is caring for a child admitted to the pediatric medical unit with chickenpox who has infected vesicles. What personal protective equipment should the nurse use when measuring the child's vital signs?

Gloves Gown N95 respirator

What is the leading cause of neonatal sepsis and death?

A nurse practitioner suspects that a child has scarlet fever based on which assessment finding?

A young client in the clinic has a rash, cough, and fever that the mother says spiked on day 5 of the rash. The client also had conjunctivitis. What would the nurse expect the physician to tell the family that the child has?

When the physician looks in a child's mouth during a sick-visit exam, the mother exclaims: “Her tongue is bright red! It was not like that yesterday.” The physician would most likely order which medication based on the probable diagnosis of scarlet fever?

Penicillin to prevent acute glomerulonephritis

A 6-year-old child is brought to the clinic by his parents. The parents state, "He had a sore throat for a couple of days and now his temperature is over 102°F (38.9°C). He has this rash on his face and chest that looks like sunburn but feels really rough." What would the nurse suspect?

Parents bring their 9-year-old child to the clinic for a well-child visit. They are concerned because several children in the neighborhood have developed Lyme disease and ask for suggestions on what to do to reduce their child's risk. What would be appropriate for the nurse to suggest? Select all that apply.

Wearing protective clothing when playing in wooded areas. Inspecting the skin closely for ticks after the child plays in wooded areas. Contacting the health care provider if there is any area of inflammation that might be a bite

The nurse is obtaining a throat culture from a child with a fever of unknown origin. Which nursing actions demonstrate knowledge of the appropriate way to collect this specimen?

The nurse obtains the specimen before administration of antibiotics The nurse swabs the pharyngeal and tonsillar area The nurse avoids touching the lips when inserting the culturette

A 15-year-old boy visits his primary care physician's office with fever, headache, and malaise, along with complaints of pain on chewing and pain in the jawline just in front of the ear lobe. The boy asks his mother to leave the exam room for a minute and then tells the nurse that he is also experiencing testicular pain and swelling. The nurse recognizes that this client most likely has which condition?

The mother of a 10-year-old child diagnosed with rubella asks what can be done to help her child feel better during her illness. What information can be provided?

encourage rest and relaxation

The nurse is providing teaching to the parents of a child with varicella. Which statement indicates that the parents have understood the instructions?

“We need to make sure that he washes his hands frequently.”

A 7-year-old with an earache comes to the clinic. The child's mother reports that 1 day ago her child had a fever and headache and did not want to play. When the nurse asks where it hurts, the child points to the jawline in front of the earlobe. What does the nurse expect the diagnosis to be for this child?

The student nurse is discussing the plan of care for a child admitted to the hospital for treatment of an infection. Which action should be taken first?

A 9-month-old child has been admitted to rule out sepsis. Which finding offers the most support to the presence of this disorder?

The child has had 8 ounces of formula in the past 24 hours.

The nurse is caring for an adolescent diagnosed with syphilis. The drug of choice for treating syphilis is:

A parent calls the nurse to discuss a rash which the mother suspects as varicella. The nurse states that the rash possibly could be varicella when the parent describes rash characteristics as:

various stages of lesions present at the same time.

A chief danger of scarlet fever is that children may develop:

The nurse at an outpatient facility is obtaining a blood specimen from a 9-year-old girl. Which technique would most likely be used?

Puncturing a vein on the dorsal side of the hand

The nurse is caring for a 16-year-old child with a diagnosis of acquired immunodeficiency syndrome (AIDS). What treatment goal has the highest priority for this child?

Preventing spread of infection

The 6-year-old child has been diagnosed with Lyme disease. She is allergic to penicillin. Which medication will most likely be ordered for this client?

The nurse is caring for a child hospitalized with pertussis. Which nursing intervention would be the highest priority for this child?

After teaching a class to a group of nursing students about reporting infectious diseases to the Centers for Disease Control and Prevention, the instructor determines a need for additional discussion when the students identify which infection as being reportable:

The nurse is caring for a 7-year-old child in droplet precautions due to the diagnosis of pertussis. While visiting the child, which actions by the parents require the nurse to intervene? Select all that apply.

The parents state, "We should postpone immunizing our 5-year-old since there has been contact with the infection." The parents state, "We have been limiting our child's fluids to help decrease the amount of coughing."

The nurse is caring for a child who is suspected of having an early onset of scarlet fever. Which clinical manifestations support this diagnosis? Select all that apply.

Swollen cervical lymph nodes. Red swollen pharynx. Body aches.

Which assessment findings would the nurse recognize as common in infants with Down syndrome?

Which anatomic findings are characteristic of Down syndrome?

Which is an expected physical examination finding in the adolescent with Hodgkin disease?

Which finding is appropriate when identifying cognitive impairment children quizlet?