Paediatrics Exam 1
Total Questions : 100
Showing 25 questions, Sign in for moreA four-year-old patient has been diagnosed with leukemia. The patient's parents, who follow the Jehovah's Witness faith, inform the physician that they will not approve any type of blood transfusions. The pediatric nurse is aware that:
Explanation
Choice A reason: This choice is incorrect because the belief of Jehovah's Witnesses prohibits the acceptance of blood transfusions, regardless of the donor.
Choice B reason: This is the correct choice. Jehovah's Witnesses do not accept blood transfusions, even in life-threatening situations, as it is against their religious beliefs.
Choice C reason: This choice is incorrect. While a court order can override parental refusal in some jurisdictions, it does not change the fact that the parents will not approve of the transfusion.
Choice D reason: This choice is incorrect. While volume expanders can be used as an alternative to blood transfusions, the statement implies that blood products are not an option, which contradicts the correct answer.
A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 48, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is:
Explanation
Choice A reason: This is the correct choice. A respiratory rate of 48 is high for a 3-year-old, indicating that the croup is affecting his breathing.
Choice B reason: This choice is incorrect. A heart rate of 90 is within the normal range for a 3-year-old.
Choice C reason: This choice is incorrect. A blood pressure of 100/52 is within the normal range for a 3-year-old.
Choice D reason: This choice is incorrect. A temperature of 98.8°F (37.1°C) is within the normal range for a 3-year-old.
An 17-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to find out. The nurse's best response is:
Explanation
Choice A reason: This choice is incorrect. Confidentiality laws often protect the privacy of minors seeking treatment for sexually transmitted diseases.
Choice B reason: This is the correct choice. The law typically allows minors to receive confidential treatment for sexually transmitted diseases.
Choice C reason: This choice is incorrect. It suggests that someone else needs to be contacted, which is not necessary if the patient wishes for the visit to remain confidential.
Choice D reason: This choice is incorrect. Minors may consent to their own treatment for sexually transmitted diseases in many jurisdictions without parental consent.
In the pediatric emergency department, the nurse must prioritize patient care. Which patient should the nurse assess first?
Explanation
Choice A reason: While colic can be distressing, it is not life-threatening and does not require immediate assessment over more critical conditions.
Choice B reason: Suspicions of sexual activity in an adolescent are a concern but do not constitute an emergency that requires immediate assessment.
Choice C reason: A bite from another child, although potentially serious, is less urgent than a trauma case and can be assessed after more critical patients.
Choice D reason: This is the correct choice. A child hit by a car may have life-threatening injuries and requires immediate assessment and intervention.
A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is:
Explanation
Choice A reason: This is the correct choice. By 6 months, most infants have doubled their birth weight, and some may have tripled it.
Choice B reason: While it's true that each child grows at their own pace, there are general milestones for weight gain that can guide expectations.
Choice C reason: This choice is incorrect. A 10 lb increase is not a standard milestone for weight gain at 6 months.
Choice D reason: This choice is incorrect. Doubling the birth weight is expected by 6 months, but tripling may also be normal.
According to developmental theories, which important event is essential in the development of the toddler?
Explanation
Choice A reason: Developing friendships is important, but it is not as critical as walking in the early stages of a toddler's development.
Choice B reason: This is the correct choice. Walking is a significant developmental milestone for toddlers and is essential for their physical autonomy.
Choice C reason: Self-feeding is an important skill, but it typically develops after the child has learned to walk.
Choice D reason: Potty-training is a key milestone, but it usually occurs after the child has achieved the ability to walk.
When developing a plan of care for a hospitalized child, the nurse knows that children in which age group are most likely to view illness as a punishment for misdeeds?
Explanation
Choice A reason: Adolescents are capable of more complex thinking and are less likely to view illness as a punishment for misdeeds.
Choice B reason: Infants do not have the cognitive ability to associate illness with punishment.
Choice C reason: This is the correct choice. Preschool-age children often engage in magical thinking and may view illness as a punishment for misdeeds.
Choice D reason: School-age children are beginning to understand the biological causes of illness and are less likely to view it as a punishment.
A nurse is conducting developmental assessments on several children in the day-care setting. Which two children does the nurse identify as having developmental delays?
Explanation
Choice A reason: This choice is incorrect. It is not unusual for a 5-year-old to have difficulty with zippers.
Choice B reason: This choice is incorrect. Reciting a phone number is not expected of a 2-year-old.
Choice C reason: This is one of the correct choices. A 6-year-old should be able to sit still for a short story, and difficulty doing so may indicate a developmental delay.
Choice D reason: This choice is incorrect. A 2-year-old typically does not have the fine motor skills to cut with scissors.
Choice E reason: This is one of the correct choices. An 18-month-old should be starting to phrase simple sentences, and the inability to do so may indicate a developmental delay.
A mother brings her two-year-old child to the pediatric office for a sick visit. The child is seen regularly at the office and was last seen at her well-child visit two months ago. Based on this information, which is the most appropriate action by the nurse?
Explanation
Choice A reason: This choice is incorrect. There is no need for the mother to leave the room unless the child requests privacy.
Choice B reason: This choice is incorrect. While reviewing health promotion is important, it should not be the focus during a sick visit.
Choice C reason: This choice is incorrect. A comprehensive history is not necessary if the child is regularly seen and was recently assessed.
Choice D reason: This is the correct choice. The nurse should focus on the current illness reported by the mother, as the child has been regularly seen and assessed.
A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent would arouse suspicion of abuse?
Explanation
Choice A reason: This choice might not arouse suspicion as it could be a plausible accident involving siblings.
Choice B reason: This choice also might not arouse suspicion as accidents can happen when children are playing and not being watched closely.
Choice C reason: This choice is less likely to arouse suspicion as slipping on ice is a common accident.
Choice D reason: This is the correct choice. The statement may arouse suspicion because it suggests negligence, as the caregiver left the baby unattended in a potentially dangerous situation.
The nurse is giving a health promotion class to adolescents. The nurse will be sure to include information regarding the leading cause of death in adolescents aged 15 and up.
Explanation
Choice A reason: While drug overdose is a concern, it is not the leading cause of death among adolescents.
Choice B reason: Water safety and drowning are important, but they do not lead in causing deaths in this age group.
Choice C reason: This is the correct choice. Motor vehicle accidents are the leading cause of death among adolescents.
Choice D reason: Depression and suicide are significant issues, but they do not surpass motor vehicle accidents as the leading cause of death.
Which foods would the nurse recommend to the mother of a 2-year-old with anemia?
Explanation
Choice A reason: While apple or orange juice contains vitamin C, which can aid iron absorption, it is not sufficient on its own to address anemia.
Choice B reason: Excessive cow's milk can interfere with iron absorption and is not recommended for a child with anemia.
Choice C reason: This is the correct choice. Meats, eggs, and green vegetables are rich in iron, which is essential for treating anemia.
Choice D reason: Fruits, whole grains, and rice are healthy but are not the best sources of iron for addressing anemia in a child.
Which foods would the nurse recommend to the mother of a 2-year-old with anemia?
Explanation
Choice A reason: While vitamin C in juices can enhance iron absorption, they are not sufficient sources of iron by themselves.
Choice B reason: Cow's milk can interfere with iron absorption and is not recommended in high quantities for a child with anemia.
Choice C reason: This is the correct choice. These foods are rich in iron, which is essential for treating anemia.
Choice D reason: These are healthy options but do not provide the necessary iron content to effectively address anemia.
Which is the best nursing response to give a parent about contacting the physician regarding a 4-month-old infant with diarrhea?
Explanation
Choice A reason: Fever is a concern, but it is not the most immediate sign of dehydration.
Choice B reason: While loose stools are a symptom of diarrhea, the frequency mentioned does not necessarily indicate an emergency.
Choice C reason: This is the correct choice. Lack of a wet diaper for 8 hours can indicate dehydration, which is an emergency in infants.
Choice D reason: Longer naps may not be directly related to diarrhea and do not warrant immediate contact with a pediatrician.
A nurse is planning care for a child with hyponatremia. The nurse, delegating care of this child to a new RN on the pediatric unit, cautions the new nurse to be especially alert for which condition in the child?
Explanation
Choice A reason: Increased deep tendon reflexes are not typically associated with hyponatremia.
Choice B reason: Bradycardia is a concern but is not the most immediate complication of hyponatremia.
Choice C reason: Respiratory distress may occur, but it is not the primary concern with hyponatremia.
Choice D reason: This is the correct choice. Seizures can occur with severe hyponatremia and require immediate intervention. The nurse should monitor the child closely for any signs of neurological changes.
A 4-month-old is brought to the emergency department with severe dehydration. The heart rate is 198, and the blood pressure is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when the intravenous line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. Which action would the nurse expect to do immediately?
Explanation
Choice A reason: Administering a bolus of D10W is not the first-line treatment for severe dehydration and may not address the immediate fluid needs of the infant.
Choice B reason: Offering an oral rehydration solution is not appropriate for an infant with severe dehydration and a compromised ability to hold down fluids.
Choice C reason: Administering a bolus of hypertonic saline is not typically the initial treatment for dehydration and could potentially worsen the infant's condition.
Choice D reason: This is the correct choice. Administering a bolus of normal saline is the immediate action to treat severe dehydration and restore circulatory volume.
In planning care, the nurse recognizes that which child should have the most difficulty with separation from family during hospitalization?
Explanation
Choice A reason: A 7-year-old child may have some difficulty with separation but is typically able to understand the reason for hospitalization better than younger children.
Choice B reason: A 5-month-old infant may show signs of distress but does not have the same understanding of separation as an older child.
Choice C reason: This is the correct choice. A 4-year-old child is at a developmental stage where separation from family can cause significant distress and difficulty.
Choice D reason: A 15-month-old toddler may experience separation anxiety, but it is generally more intense in preschool-aged children.
A group of children on one hospital unit are all suffering from separation anxiety. Which child is experiencing the "despair" stage of separation anxiety?
Explanation
Choice A reason: Not crying if parents return and leave again may indicate the child has moved past the initial protest stage but does not necessarily indicate despair.
Choice B reason: This is the correct choice. Lying quietly in bed can be a sign of the despair stage, where the child has given up hope of the parents' return and appears withdrawn.
Choice C reason: Screaming and crying when parents leave is characteristic of the protest stage, not the despair stage.
Choice D reason: Appearing happy and content with staff may indicate the child has reached the detachment stage, which follows despair and involves the child forming new attachments.
In a pediatric surgical unit, when discussing patient-controlled analgesia (PCA) in a preoperative parental meeting, which client would be the most appropriate candidate for PCA?
Explanation
Choice A reason: This is the correct choice. An 8-year-old is typically capable of understanding and using PCA effectively, especially after a major surgery like spinal fusion.
Choice B reason: A 6-year-old may not fully understand how to use PCA and could be at risk for under or overdosing.
Choice C reason: While a 10-year-old could use PCA, the presence of a concussion may impair their ability to use it properly.
Choice D reason: A 16-year-old with Down Syndrome may have cognitive impairments that could hinder the safe use of PCA.
A parent asks the nurse if there is anything that can be done to reduce the pain that his 2-year-old experiences each morning when blood is drawn for lab studies. Which intervention is the best choice for the nurse to implement based on the parent's concern?
Explanation
Choice A reason: While distraction can be helpful, it may not be sufficient to reduce the pain of a needle stick for a 2-year-old.
Choice B reason: The vibrating device may distract from the pain, but it does not provide actual analgesia.
Choice C reason: Intravenous sedation is not practical or safe for daily blood draws in a 2-year-old.
Choice D reason: This is the correct choice. EMLA cream is a topical anesthetic that can effectively numb the skin and reduce pain from needle sticks.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must you, as the nurse, keep in mind when developing a care plan for the child?
Explanation
Choice A reason: This is the correct choice. Thick pulmonary secretions are a hallmark of cystic fibrosis and must be addressed in the care plan.
Choice B reason: While cystic fibrosis can affect various glands, the primary concern is the respiratory system.
Choice C reason: Elevated levels of chloride, not potassium, are found in the sweat of individuals with cystic fibrosis.
Choice D reason: Cystic fibrosis is an autosomal recessive disorder, not dominant. This is important for genetic counseling and understanding the inheritance pattern.
The nurse is providing care to a 4-month-old infant in the emergency department. Upon assessment, the infant is noted to be experiencing tachypnea, wheezing, retractions, and nasal flaring. The infant has large amounts of nasal drainage. The infant is irritable, and the pulse ox reading is currently at 85% on room air. The parents state the symptoms have been consistent for about two days, but they brought the child in due to concerns for dehydration with decreased milk intake. Which diagnosis does the nurse anticipate for this infant?
Explanation
Choice A reason: Pneumonia could present with these symptoms, but it is less likely in this case due to the specific combination of symptoms described.
Choice B reason: Active pulmonary tuberculosis is less common in infants and does not typically present with these acute symptoms.
Choice C reason: This is the correct choice. The symptoms described are characteristic of Respiratory Syncytial Virus (RSV), especially in infants.
Choice D reason: Croup could cause some of these symptoms, but it is more commonly associated with a distinctive barking cough and stridor.
Immunization of children with Haemophilus influenzae type B (Hib) vaccine decreases the incidence of which of the following conditions?
Explanation
Choice A reason: LTB, also known as croup, is not primarily caused by Haemophilus influenzae type B.
Choice B reason: Bronchiolitis is typically caused by viruses such as RSV, not Haemophilus influenzae type B.
Choice C reason: This is the correct choice. The Hib vaccine is effective in preventing epiglottitis, which can be caused by Haemophilus influenzae type B.
Choice D reason: While Hib can cause pneumonia, the vaccine is specifically known for its role in preventing invasive diseases like epiglottitis.
Which of the following are mild symptoms of respiratory distress? (Select the two responses that apply)
Explanation
Choice A reason: Tripod positioning is a more severe sign, indicating increased work of breathing.
Choice B reason: This is one of the correct choices. Nasal flaring is a mild symptom of respiratory distress, indicating increased effort to breathe.
Choice C reason: Confusion is a more severe symptom, suggesting hypoxia affecting brain function.
Choice D reason: Cyanosis is a severe sign of respiratory distress, indicating poor oxygenation.
Choice E reason: This is one of the correct choices. Tachypnea, or rapid breathing, is a mild symptom of respiratory distress.
A newborn is suspected of having cystic fibrosis. As the child is being prepared for transfer to a pediatric hospital, the mother asks the nurse which symptoms made the practitioner suspect cystic fibrosis. Which response by the nurse is the most appropriate?
Explanation
Choice A reason: Clubbed fingers are a sign of chronic hypoxia and may be seen in older children with cystic fibrosis, but they are not typically present at birth.
Choice B reason: This is the correct choice. Meconium ileus is a blockage of the intestines that occurs shortly after birth and is often the first sign of cystic fibrosis.
Choice C reason: A barrel chest is associated with chronic respiratory conditions and would not be present in a newborn.
Choice D reason: Steatorrheic stools, or fatty stools, may occur in cystic fibrosis but are not a primary indicator in a newborn.
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