NCLEX RN Pediatric
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Question 1 of 5.
The nurse has identified a priority nursing diagnosis of Anxiety related to surgery for a 4-yearold preparing for a tonsillectomy. The nurse should tell the child:
A. You won't have so many sore throats after your tonsils are removed.
B. The doctor will put you to sleep so you don't feel anything.
C. Show me how to give the doll an I.V.
D. When it is done you will get to see your mommy and get a Popsicle.
Explanation: When preparing a child for a procedure the nurse should use neutral words, focus on sensory experiences, and emphasize the positive aspects at the end. Being reunited with parents and having an ice pop would be considered pleasurable events. Children this age fear bodily harm. To reduce anxiety, avoid the word 'removed' to describe what is being done to the tonsils. Using the terms 'put to sleep' and 'I.V.' may be threatening. Additionally, directing a play experience to focus on I.V. insertion may be counterproductive as the child may have little recollection of this aspect of the procedure.
Question 2 of 5.
Which of the following is appropriate language development for an 8-month-old? The child should be:
A. Saying 'dada' and 'mama' specifically ('dada' to father and 'mama' to mother).
B. Saying three other words besides 'mama' and 'dada.'
C. Saying 'dada' and 'mama' nonspecifically.
D. Saying 'ball' when parents point to a ball.
Explanation: At 8 months, infants typically say 'dada' and 'mama' nonspecifically, as specific use develops closer to 12 months.
Question 3 of 5.
The nurse assesses a 6-month-old for vaccination readiness. Which finding would most likely indicate the need to delay administering the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine?
A. A family history of sudden infant death syndrome (SIDS).
B. A fever of 38.5°C following the 4-month vaccinations.
C. An acute bilateral ear infection.
D. Living with a family member who is immunosuppressed.
Explanation: An acute infection is a contraindication for vaccination due to the risk of adverse reactions.
Question 4 of 5.
A mother states that she thinks her 9-month-old 'is developing slowly.' When assessing the infant's development, the nurse is also concerned because the infant should be demonstrating which of the following characteristics?
A. Vocalizing single syllables.
B. Standing alone.
C. Building a tower of two cubes.
D. Drinking from a cup with little spilling.
Explanation: Building a tower of two cubes is expected by 9 months; failure to do so suggests developmental delay.
Question 5 of 5.
When assessing a 2-year-old child brought by his mother to the clinic for a routine checkup, which of the following should the nurse expect the child to be able to do?
A. Ride a tricycle.
B. Tie his shoelaces.
C. Kick a ball forward.
D. Use blunt scissors.
Explanation: Kicking a ball forward is a gross motor skill expected at 2 years.
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