Pediatric Nursing Exam 4 Eves Greater Lowell Technical School.
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An infant is admitted to the hospital with severe isotonic dehydration. In planning the infant's care, the nurse is aware the infant is at risk for shock. Which of the following are signs of shock in an infant?
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Tachycardia
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Hypertension
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Bradypnea
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Increased urination
Explanation
Correct Answer: (A) Tachycardia
Tachycardia is one of the earliest and most reliable signs of shock in an infant. When circulating blood volume is depleted due to severe dehydration, the heart compensates by increasing its rate to maintain adequate cardiac output and tissue perfusion. Recognizing tachycardia as an early warning sign of shock is critical for timely intervention.
Why the other options are incorrect:
B. Hypertension — Shock causes hypotension, not hypertension, as the loss of circulating volume leads to decreased vascular pressure. Hypotension in an infant is actually a late and ominous sign of decompensated shock.
C. Bradypnea — Shock triggers tachypnea as the body attempts to compensate for metabolic acidosis and decreased oxygen delivery. Bradypnea is not an expected finding and would indicate respiratory depression rather than a shock response.
D. Increased urination — Severe dehydration and shock cause oliguria or anuria due to decreased renal perfusion and activation of antidiuretic hormone. Increased urination is the opposite of what would be expected in a dehydrated infant approaching shock.
When teaching about general skin care measures that could help prevent acne, the nurse would include:
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Cleanse the skin routinely with mild soap.
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Scrub the skin with an exfoliating cleanser.
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Plan indoor activities to avoid sun exposure.
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Squeeze pimples when they occur to aid healing.
Explanation
Correct Answer: (A) Cleanse the skin routinely with mild soap.
Routine gentle cleansing with a mild, non-comedogenic soap removes excess oil, dirt, and bacteria from the skin surface without causing irritation. This is a foundational and evidence-based recommendation for acne prevention. Gentle cleansing twice daily helps keep pores clear and reduces the bacterial load of Cutibacterium acnes, the primary organism involved in acne pathogenesis.
Why the other options are incorrect:
B. Scrub the skin with an exfoliating cleanser — Aggressive scrubbing and exfoliating cleansers irritate and inflame the skin, disrupting the skin barrier and actually worsening acne. Harsh mechanical scrubbing can spread bacteria and cause microabrasions that increase the risk of infection and scarring.
C. Plan indoor activities to avoid sun exposure — While excessive sun exposure can damage the skin, moderate sun exposure is not a primary cause of acne. Completely avoiding outdoor activities is an unnecessary and impractical recommendation that does not reflect evidence-based acne prevention teaching.
D. Squeeze pimples when they occur to aid healing — Squeezing or popping pimples is strictly contraindicated in acne management. This practice ruptures the follicle wall, spreads bacteria and inflammatory contents into surrounding tissue, worsens inflammation, delays healing, and significantly increases the risk of permanent scarring.
A parent calls the school nurse because she wants to know what to do since a child in her son's class has head lice. What is the best response for the nurse to make?
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"Tell the child not to share or trade hats with his friends."
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"Do not worry. Boys rarely get head lice."
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"Apply vaseline to your son's hair before bed each night."
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"Treat your child's hair with Ridex."
Explanation
Correct Answer: (A) "Tell the child not to share or trade hats with his friends."
Head lice (Pediculosis capitis) spread primarily through direct head-to-head contact and through sharing personal items such as hats, combs, brushes, and hair accessories. Advising the parent to instruct their child not to share or trade hats is the most appropriate preventive measure since the child has not yet been identified as having lice and does not require treatment at this time.
Why Other Options are Incorrect:
B. "Do not worry. Boys rarely get head lice." — This is inaccurate and dismissive. Head lice infest children of all genders equally. Dismissing the parent's concern without providing preventive education is not appropriate nursing practice.
C. "Apply vaseline to your son's hair before bed each night." — Applying vaseline is not an evidence-based preventive measure for head lice. It is messy, difficult to remove, and not a recognized or recommended prophylactic treatment by public health or dermatological guidelines.
D. "Treat your child's hair with Ridex." — Pediculicide treatment should only be initiated when an active infestation has been confirmed by finding live lice or viable nits. Treating a child prophylactically with pediculicide when no infestation exists is not recommended due to the risk of unnecessary chemical exposure.
The parents bring a 4-year-old child with puffy skin around the eyes when waking in the morning, brown urine, and decreased urine output to the pediatrician. He has recently recovered from a streptococcal infection. Which of the following conditions does the nurse suspect?
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Dehydration
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Acute glomerulonephritis
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Urinary tract infection
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Nephrotic syndrome
Explanation
Correct Answer: (B) Acute glomerulonephritis
This clinical presentation is the classic picture of acute post-infection glomerulonephritis (APIGN). The child has periorbital edema (puffy skin around the eyes upon waking), brown or tea-colored urine indicating hematuria from glomerular inflammation, decreased urine output from impaired renal filtration, and a recent history of streptococcal infection. APIGN typically develops 1 to 3 weeks after a group A streptococcal infection of the throat or skin as immune complexes deposit in the glomeruli and trigger an inflammatory response.
Why the other options are incorrect:
A. Dehydration — Dehydration presents with decreased urine output but also causes dry mucous membranes, sunken fontanel, and decreased skin turgor. It does not cause periorbital edema or brown urine and has no association with prior streptococcal infection.
C. Urinary tract infection — UTI presents with dysuria, frequency, urgency, and possibly fever. It does not cause periorbital edema or the characteristic brown hematuria seen in glomerulonephritis, nor is it preceded by streptococcal infection.
D. Nephrotic syndrome — While nephrotic syndrome also causes periorbital edema and decreased urine output, it is characterized by massive proteinuria producing frothy urine, not brown hematuria. Nephrotic syndrome is not triggered by streptococcal infection and does not cause the tea-colored urine seen in this presentation.
Which of the following foods would be allowed in a gluten-free diet for a child with celiac disease?
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White rice
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Chicken nuggets from a fast food restaurant
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White bread
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Beef barley soup
Explanation
Correct Answer: (A) White rice
White rice is naturally gluten-free and is a safe food choice for a child with celiac disease. Celiac disease is an autoimmune condition triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. Rice contains no gluten and is one of the most commonly recommended grains for individuals following a strict gluten-free diet.
Why the other options are incorrect:
B. Chicken nuggets from a fast food restaurant — Fast food chicken nuggets are typically coated in wheat-based breading, making them a significant source of gluten. Cross-contamination during preparation is also a major concern in fast food environments.
C. White bread — White bread is made from wheat flour, which contains gluten. Despite being refined, it is completely contraindicated for a child with celiac disease.
D. Beef barley soup — Barley is one of the three primary gluten-containing grains. Beef barley soup contains gluten and must be strictly avoided by children with celiac disease.
The nurse is aware that rapid respirations are a possible cause of dehydration because they:
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Cause evaporation of fluid from the mucous membranes.
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Often lead to vomiting.
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Prevent the child from drinking.
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Increase circulation, thus increasing urine production.
Explanation
Correct Answer: (A) Cause evaporation of fluid from the mucous membranes.
Rapid respirations (tachypnea) increase insensible fluid losses through the respiratory tract. With each breath, moisture from the mucous membranes of the airways is exhaled. When respiratory rate is elevated, this evaporative loss increases significantly and can contribute to dehydration, particularly in infants and young children who have a higher respiratory rate baseline and a proportionally larger surface area relative to body weight.
Why the other options are incorrect:
B. Often lead to vomiting — Rapid respirations do not directly cause vomiting. Vomiting is a separate mechanism of fluid loss unrelated to respiratory rate. While some conditions cause both, tachypnea itself is not a cause of vomiting.
C. Prevent the child from drinking — While a severely tachypneic child may have difficulty feeding or drinking, this is not the primary mechanism by which rapid respirations cause dehydration. The direct insensible fluid loss through evaporation is the correct physiological explanation.
D. Increase circulation, thus increasing urine production — Tachypnea does not increase urine production. In dehydration, the body actually conserves water by reducing urine output through the action of antidiuretic hormone. Increased urine production would worsen, not cause, dehydration.
How would the nurse measure urine output of a toddler with nephrotic syndrome who is not yet toilet trained?
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Determine urine output by the number of diaper changes in each 24-hour period.
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Estimate output as small, moderate, or large and record on the child's chart.
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Subtract the weight of a dry diaper from a wet diaper and record this amount.
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Weigh each wet diaper and record the amount of urine output.
Explanation
The most accurate method for measuring urine output in a non-toilet-trained toddler is to weigh wet diapers and subtract the known dry weight of the same diaper. One gram of weight difference is equivalent to approximately one milliliter of urine. This method provides a quantitative and precise measurement of urine output, which is critical for monitoring fluid balance, disease progression, and response to treatment in a child with nephrotic syndrome.
Why the other options are incorrect:
A. Determine urine output by the number of diaper changes in each 24-hour period — Counting diaper changes does not account for the volume of urine in each diaper and provides no quantitative data. This method is inaccurate and insufficient for clinical monitoring of fluid balance in nephrotic syndrome.
B. Estimate output as small, moderate, or large and record on the child's chart — Subjective estimation is not an acceptable clinical measurement for urine output in a child requiring precise fluid balance monitoring. Nephrotic syndrome management demands accurate quantitative data, not estimations.
D. Weigh each wet diaper and record the amount of urine output — While weighing the wet diaper is part of the process, recording only the wet weight without subtracting the dry diaper weight produces an inaccurate measurement that overestimates actual urine output. The dry weight must be subtracted to obtain the true volume.
The statement made by a parent, indicating the need for further teaching about ways to control itching for the infant with eczema, is:
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"The baby's fingernails are kept short."
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"He will need to take prednisone until the itching resolves."
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"I should keep the skin well moisturized with products like Aquaphor or Vaseline after bathing."
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"I should avoid shampoos and use soap alternatives."
Explanation
Correct Answer: (B) "He will need to take prednisone until the itching resolves."
This statement indicates a need for further teaching because prednisone is a systemic corticosteroid that is not the standard first-line treatment for controlling itching in infant eczema. Eczema management in infants relies primarily on topical moisturizers, topical corticosteroids for flares, and trigger avoidance. Long-term or indiscriminate use of systemic prednisone in infants carries significant risks including immunosuppression, growth suppression, and adrenal insufficiency. The parent's statement reflects a misunderstanding of the appropriate treatment approach.
Why the other options are incorrect:
A. "The baby's fingernails are kept short." — This is correct and important teaching. Short fingernails minimize skin damage and prevent secondary infection from scratching, which is a primary concern in infants with eczema who cannot control the urge to scratch.
C. "I should keep the skin well moisturized with products like Aquaphor or Vaseline after bathing." — This is correct. Regular and generous application of emollients immediately after bathing helps lock in moisture, restore the skin barrier, and reduce the frequency and severity of eczema flares.
D. "I should avoid shampoos and use soap alternatives." — This is correct. Harsh soaps and shampoos strip the skin of natural oils and can trigger eczema flares. Fragrance-free, gentle soap alternatives and syndets are recommended for bathing infants with eczema.
A parent reports that her 2-year-old child passes hard, dry stools. Which of the following foods would the nurse recommend the mother include in the child's diet?
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Fish
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Fresh fruit
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Cheese
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Corn flakes
Explanation
Hard, dry stools indicate constipation, which is best addressed through increased dietary fiber and fluid intake. Fresh fruits such as pears, prunes, apples, and peaches are excellent sources of dietary fiber and natural sugars that draw water into the bowel, softening stools and promoting regular bowel movements. Fresh fruit is the most appropriate dietary recommendation for a constipated toddler.
Why the other options are incorrect:
A. Fish — Fish is a source of protein and healthy fats but contains no dietary fiber. It does not contribute to softening stools or relieving constipation and is not an appropriate dietary recommendation for this problem.
C. Cheese — Cheese is a dairy product that is low in fiber and high in fat and protein. Dairy products are known to worsen constipation in toddlers by slowing gastrointestinal motility. Cheese should be limited, not increased, in a constipated child.
D. Corn flakes — Corn flakes are a refined, low-fiber cereal that provides minimal benefit for constipation. Whole grain cereals with high fiber content would be more appropriate if recommending a grain-based food to address constipation.
The parent of a newborn male born with a hypospadias are requesting to speak with the physician about correcting the defect. The nurse understands that with this condition:
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Repairing the defect will increase the risk of testicular cancer.
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Routine circumcision is avoided in infants with hypospadias.
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Corrective surgery is usually delayed until the preschool period.
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Parents should hold the baby straddled on their hip postoperatively to prevent bleeding.
Explanation
In hypospadias, the urethral opening is located on the underside of the penis rather than at the tip. The foreskin in these infants is often incomplete and asymmetrical, and the remaining foreskin tissue is needed as a graft for the surgical repair of the urethra. Performing circumcision would remove this critical tissue and compromise the surgeon's ability to perform a successful corrective procedure.
Why the other options are incorrect:
A. Repairing the defect will increase the risk of testicular cancer. — Surgical repair of hypospadias does not increase the risk of testicular cancer. This statement is factually incorrect and not part of the counseling provided to families regarding hypospadias management.
C. Corrective surgery is usually delayed until the preschool period. — Surgical repair of hypospadias is typically performed between 6 and 18 months of age, well before the preschool period. Early correction is recommended to minimize psychological impact and allow normal urinary and sexual development.
D. Parents should hold the baby straddled on their hip postoperatively to prevent bleeding. — Straddling postoperatively is actually contraindicated as it places pressure on the surgical site and increases the risk of injury and bleeding. Parents are instructed to avoid positioning that puts pressure on the repair site.
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