Question Set A: Ten Items on Age, Development, and the Airway

INSTRUCTIONS. Answer without turning back. Circle the age in every stem before you read the options. Time the set at twelve minutes.

1. A nurse is performing developmental surveillance at a well-child visit. Which finding requires referral for further evaluation?

1. An 8-month-old who is not yet walking
2. A 15-month-old who is not yet using a spoon
3. A 3-month-old who does not smile in response to a caregiver's face
4. A 2-year-old who plays alongside other children rather than with them

2. A nurse must assess pain in a 9-month-old following abdominal surgery. Which tool is most appropriate?

1. A numeric rating scale from zero to ten
2. A faces scale on which the infant selects a picture
3. A behavioral observation scale scoring facial expression, leg position, activity, cry, and consolability
4. A verbal descriptor scale using the words mild, moderate, and severe

3. Select all that apply. A nurse reviews four children before immunization. Which situations are true contraindications to administering the scheduled vaccine?

1. A 4-month-old with a runny nose and a temperature of 99.8 °F
2. A 12-month-old receiving chemotherapy, scheduled for measles-mumps-rubella vaccine
3. A 2-month-old who is currently taking an oral antibiotic for otitis media
4. A 6-month-old whose sibling had a febrile seizure after a vaccine
5. A 4-month-old who had anaphylaxis after the 2-month dose of the same vaccine
6. A 2-month-old with a documented history of intussusception, scheduled for rotavirus vaccine

4. Place in order. A 10-month-old with tetralogy of Fallot becomes acutely cyanotic and irritable during a diaper change. Place the nurse's actions in the correct order.

1. Administer supplemental oxygen
2. Notify the provider and prepare for further intervention
3. Place the infant in a knee-to-chest position
4. Use a calm voice and allow the caregiver to hold the infant

5. A 4-year-old is brought in with a two-hour history of fever, refusal to swallow, and drooling. The child sits leaning forward with the chin thrust out and speaks in a muffled voice. There is no cough. Which action does the nurse take first?

1. Obtain a throat culture to identify the organism
2. Inspect the posterior pharynx with a tongue blade
3. Keep the child upright in the caregiver's lap and summon the airway team
4. Lay the child supine and start an intravenous line

6. A 4-year-old is scheduled for a cardiac catheterization this afternoon. Which approach to preparation is developmentally appropriate?

1. Explain the procedure a week in advance using a labeled anatomical diagram
2. A few minutes beforehand, let the child handle the equipment, describe what it will feel like, and state that it is not a punishment
3. Say nothing until the child is in the procedure room, to avoid distress
4. Ask the child to choose between two consent options and discuss the risks

7. A nurse teaches the caregiver of a 5-year-old newly diagnosed with cystic fibrosis. Which caregiver statement indicates correct understanding?

1. "I will give the enzymes only with his three main meals."
2. "I will give the enzymes with every meal and every snack he eats."
3. "I will give the enzymes at bedtime so they work overnight."
4. "I will stop the enzymes once he starts gaining weight again."

8. Hot spot. A nurse assesses a 4-month-old for signs of increased intracranial pressure. Referring to the figure, identify the region the nurse palpates to assess the anterior fontanel.

• Region A: the diamond-shaped area at the junction of the frontal and parietal bones, toward the front of the vault
• Region B: the triangular area toward the back of the vault
• Region C: the lateral area above the ear
• Region D: the midline suture running front to back

9. A 5-month-old is admitted with bronchiolitis. Respiratory rate 62, nasal flaring present, thick nasal secretions, and the infant took 2 oz of a 4 oz feed. Which nursing action is the priority?

1. Suction the nares before the next feeding attempt
2. Place the infant prone to improve oxygenation
3. Restrict all oral intake for the next twelve hours
4. Encourage the caregiver to hold the infant flat during feeds

10. A nurse provides anticipatory guidance to the caregiver of a 2-month-old. Which statement by the caregiver requires correction?

1. "She sleeps on her back in her crib with nothing else in it."
2. "Her car seat stays rear-facing in the back seat."
3. "I put a soft bumper pad and a small blanket in the crib so she doesn't get cold."
4. "I never leave her alone on the changing table."

SELF-SCORE: ☐1 ☐2 ☐3 ☐4 ☐5 ☐6 ☐7 ☐8 ☐9 ☐10

Margin notecircle the age first, every time.

Takeawaya candidate who marks the age before reading the options answers faster and changes fewer answers. → BOOK 13 · P13