Pediatric Nursing Exam 4 Eves Greater Lowell Technical School.
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Free Pediatric Nursing Exam 4 Eves Greater Lowell Technical School. Questions
The nurse is teaching the parents about dietary interventions to treat scurvy (vitamin C deficiency). Which of the following statements by the parents indicates that they understand the teaching?
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"We give him healthy fats to make sure he absorbs the vitamin C."
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"We give him whole wheat toast daily."
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"Vitamin C is not stored in the body and daily intake is necessary."
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"Orange juice given to toddlers should be boiled first."
Explanation
Correct Answer: (C) "Vitamin C is not stored in the body and daily intake is necessary."
Vitamin C is a water-soluble vitamin, meaning it is not stored in body tissues and is continuously excreted. This means consistent daily dietary intake is essential to maintain adequate levels and prevent deficiency. This statement demonstrates a clear and accurate understanding of vitamin C metabolism and the importance of ongoing dietary compliance to treat and prevent scurvy.
Why Other Options are Incorrect:
A. "We give him healthy fats to make sure he absorbs the vitamin C." — Fat-soluble vitamins such as A, D, E, and K require fat for absorption. Vitamin C is water-soluble and does not require fat for absorption. This statement reflects a fundamental misunderstanding of vitamin C metabolism.
B. "We give him whole wheat toast daily." — Whole wheat toast is not a meaningful source of vitamin C. Vitamin C is found in fresh fruits and vegetables such as citrus fruits, strawberries, kiwi, bell peppers, and broccoli. This dietary choice would not effectively treat scurvy.
D. "Orange juice given to toddlers should be boiled first." — Boiling destroys vitamin C due to its heat-sensitive nature. This intervention would eliminate the very nutrient needed to treat scurvy and reflects dangerous misinformation.
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.
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.
Which of the following treatments for intussusception on a 4-month-old infant is the treatment of choice?
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Repeated tap water enemas until resolved.
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No treatment is needed, it is not an emergency.
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Ultrasound guided air enema.
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Surgical bowel resection.
Explanation
Correct Answer: (C) Ultrasound guided air enema.
An ultrasound-guided air enema (pneumatic reduction) is the first-line, non-surgical treatment of choice for intussusception in infants and children when there are no signs of peritonitis or bowel perforation. Air is introduced into the colon under fluoroscopic or ultrasound guidance to hydrostatically reduce the telescoped bowel segment. This approach is effective in the majority of cases and avoids the need for surgery.
Why the other options are incorrect:
A. Repeated tap water enemas until resolved — Tap water enemas are contraindicated in intussusception as they are ineffective for reducing the telescoped bowel and carry a risk of water intoxication in infants. They are not a recognized treatment for intussusception.
B. No treatment is needed, it is not an emergency — Intussusception is a true pediatric emergency. Left untreated, the telescoped bowel becomes ischemic, leading to necrosis, perforation, peritonitis, sepsis, and death. Immediate intervention is mandatory.
D. Surgical bowel resection — Surgery is reserved for cases where air enema reduction fails, or when the child presents with signs of bowel perforation or peritonitis. It is not the first-line treatment of choice when non-surgical reduction is still possible.
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.
A child is brought to the emergency room because he ingested an unknown quantity of Tylenol. If this child is not treated promptly, what complications should the nurse expect?
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Kidney damage.
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Intellectual disability.
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Bleeding.
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Liver damage.
Explanation
Correct Answer: (D) Liver damage.
Acetaminophen (Tylenol) overdose is the leading cause of acute liver failure in children and adults. When ingested in toxic quantities, the normal hepatic metabolic pathways become saturated and a toxic metabolite called NAPQI (N-acetyl-p-benzoquinone imine) accumulates in the liver. Without prompt treatment with N-acetylcysteine (NAC), NAPQI causes massive hepatocellular necrosis, progressing to acute liver failure, coagulopathy, encephalopathy, and potentially death.
Why the other options are incorrect:
A. Kidney damage — While renal toxicity can occur in severe acetaminophen overdose, it is a secondary and less common complication. Hepatotoxicity is the primary and most significant concern and is the defining complication of acetaminophen overdose.
B. Intellectual disability — Acetaminophen overdose does not cause direct neurological damage leading to intellectual disability. Encephalopathy that occurs in severe cases is a consequence of liver failure, not direct brain toxicity from the drug.
C. Bleeding — Coagulopathy and bleeding can occur as a late complication of acetaminophen-induced liver failure, since the liver produces clotting factors. However, bleeding is a secondary consequence of liver damage, not a primary direct complication of the acetaminophen toxicity itself.
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 nurse is teaching parents about postoperative care for a 3-week-old infant who has been diagnosed with pyloric stenosis and will have surgical repair. Which of the following statements by the parents would indicate the teaching has been effective?
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"I should avoid burping her until two weeks after surgery."
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"I should move her around after feedings to help the formula go down."
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"She will need to have a nasogastric tube after surgery."
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"I will burp her before and during feedings and lay her on her right side after."
Explanation
This statement reflects accurate understanding of postoperative feeding management following pyloromyotomy for pyloric stenosis. Burping before and during feedings reduces air accumulation and minimizes vomiting. Positioning the infant on the right side after feedings uses gravity to promote gastric emptying through the pylorus into the duodenum, reducing the risk of regurgitation and aspiration in the postoperative period.
Why the other options are incorrect:
A. "I should avoid burping her until two weeks after surgery." — Burping is actually encouraged before and during feedings after pyloromyotomy. Avoiding burping would allow air to accumulate in the stomach, increasing discomfort and the likelihood of postoperative vomiting.
B. "I should move her around after feedings to help the formula go down." — Moving or jostling an infant after feeding increases the risk of regurgitation and vomiting, which is particularly dangerous in a postoperative infant who is at risk for aspiration. The infant should be kept still and positioned on the right side after feedings.
C. "She will need to have a nasogastric tube after surgery." — A nasogastric tube is not a standard component of postoperative care following pyloromyotomy. Feedings are typically reintroduced orally within hours of surgery using a graduated feeding protocol. This statement reflects an inaccurate understanding of postoperative care.
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.
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.
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