Pediatric Nursing Exam 4 Eves Greater Lowell Technical School.
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Free Pediatric Nursing Exam 4 Eves Greater Lowell Technical School. Questions
1. The nurse is speaking to the parent of a 3-year-old child who has mild diarrhea. What advice will the nurse give to the parent about diet?
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Offer high protein foods such as spaghetti and meatballs.
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Reduce the intake of solid foods to allow the intestine to rest.
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Offer the child ginger ale or other coca cola.
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Offer orange juice with pulp.
Explanation
Explanation
Correct Answer: (B) Reduce the intake of solid foods to allow the intestine to rest.
For a child with mild diarrhea, reducing solid food intake temporarily allows the gastrointestinal tract to rest and recover. The current evidence-based approach encourages offering bland, easy-to-digest foods and maintaining hydration while avoiding foods that can worsen intestinal motility or irritation. Allowing the gut to rest reduces the stimulation of peristalsis and helps resolve diarrhea more quickly.
Why Other Options are Incorrect:
A. Offer high protein foods such as spaghetti and meatballs — Heavy, high-protein and high-fat meals stimulate gastrointestinal motility and can worsen diarrhea. These foods are too harsh for an irritated gut and are not appropriate during acute diarrhea.
C. Offer the child ginger ale or other coca cola — Carbonated beverages and sodas contain high amounts of sugar and gas that can worsen diarrhea and cause abdominal cramping. They do not provide adequate electrolyte replacement and are not recommended for managing childhood diarrhea.
D. Offer orange juice with pulp — Orange juice is high in sugar and acidity, which can irritate the intestinal lining and worsen diarrhea. The high fructose content acts as an osmotic agent, drawing water into the bowel and increasing stool frequency.
Correct Answer: (B) Reduce the intake of solid foods to allow the intestine to rest.
For a child with mild diarrhea, reducing solid food intake temporarily allows the gastrointestinal tract to rest and recover. The current evidence-based approach encourages offering bland, easy-to-digest foods and maintaining hydration while avoiding foods that can worsen intestinal motility or irritation. Allowing the gut to rest reduces the stimulation of peristalsis and helps resolve diarrhea more quickly.
Why Other Options are Incorrect:
A. Offer high protein foods such as spaghetti and meatballs — Heavy, high-protein and high-fat meals stimulate gastrointestinal motility and can worsen diarrhea. These foods are too harsh for an irritated gut and are not appropriate during acute diarrhea.
C. Offer the child ginger ale or other coca cola — Carbonated beverages and sodas contain high amounts of sugar and gas that can worsen diarrhea and cause abdominal cramping. They do not provide adequate electrolyte replacement and are not recommended for managing childhood diarrhea.
D. Offer orange juice with pulp — Orange juice is high in sugar and acidity, which can irritate the intestinal lining and worsen diarrhea. The high fructose content acts as an osmotic agent, drawing water into the bowel and increasing stool frequency.
2. The nurse is teaching parents of a 3-year-old with Wilms tumor. Which of the following statements by the parent indicates the need for further teaching?
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"I should massage his abdomen with baby oil daily."
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"He should avoid contact sports after treatment."
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"The tumor may cause hypertension."
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"He will need to have surgery to remove the tumor."
Explanation
Explanation
Correct Answer: (A) "I should massage his abdomen with baby oil daily."
This statement indicates a need for further teaching because abdominal massage is strictly contraindicated in a child with Wilms tumor. The tumor is encapsulated and massaging the abdomen risks rupturing the capsule, causing cancer cells to spread throughout the peritoneal cavity and leading to metastasis. Parents must be explicitly instructed never to palpate or massage the child's abdomen.
Why Other Options are Incorrect:
B. "He should avoid contact sports after treatment." — This is correct. Children treated for Wilms tumor, especially those who undergo nephrectomy, must avoid contact sports to protect the remaining kidney from injury. This statement reflects appropriate understanding.
C. "The tumor may cause hypertension." — This is correct. Wilms tumor can compress the renal vasculature and trigger the renin-angiotensin system, leading to hypertension. The parent correctly understands this complication.
D. "He will need to have surgery to remove the tumor." — This is correct. Surgical resection (nephrectomy) is the primary treatment for Wilms tumor, typically followed by chemotherapy and sometimes radiation. This statement reflects accurate knowledge of the treatment plan.
Correct Answer: (A) "I should massage his abdomen with baby oil daily."
This statement indicates a need for further teaching because abdominal massage is strictly contraindicated in a child with Wilms tumor. The tumor is encapsulated and massaging the abdomen risks rupturing the capsule, causing cancer cells to spread throughout the peritoneal cavity and leading to metastasis. Parents must be explicitly instructed never to palpate or massage the child's abdomen.
Why Other Options are Incorrect:
B. "He should avoid contact sports after treatment." — This is correct. Children treated for Wilms tumor, especially those who undergo nephrectomy, must avoid contact sports to protect the remaining kidney from injury. This statement reflects appropriate understanding.
C. "The tumor may cause hypertension." — This is correct. Wilms tumor can compress the renal vasculature and trigger the renin-angiotensin system, leading to hypertension. The parent correctly understands this complication.
D. "He will need to have surgery to remove the tumor." — This is correct. Surgical resection (nephrectomy) is the primary treatment for Wilms tumor, typically followed by chemotherapy and sometimes radiation. This statement reflects accurate knowledge of the treatment plan.
3. The nurse would expect a child admitted to the hospital for non-organic failure to thrive to:
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Weigh in the 50th percentile for age.
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Have a defect in the intestine preventing absorption of nutrients.
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May have a genetic cardiac defect.
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May have a parent that fails to bond with the child.
Explanation
Explanation
Correct Answer: (D) May have a parent that fails to bond with the child.
Non-organic failure to thrive (NOFTT) is caused by psychosocial and environmental factors rather than an underlying medical condition. It is most commonly associated with inadequate caloric intake due to caregiver neglect, poverty, feeding difficulties, or a disrupted parent-child attachment. A parent who fails to bond with the child may not respond appropriately to the infant's hunger cues, may not offer adequate feedings, or may create an environment of emotional deprivation that contributes to growth failure.
Why the other options are incorrect:
A. Weigh in the 50th percentile for age — A child with failure to thrive by definition falls below the 3rd to 5th percentile for weight or has demonstrated a significant downward crossing of weight percentiles over time. Weighing at the 50th percentile is inconsistent with this diagnosis.
B. Have a defect in the intestine preventing absorption of nutrients — Intestinal malabsorption describes organic failure to thrive, where a physical pathology such as celiac disease or short bowel syndrome impairs nutrient absorption. This is the opposite of non-organic failure to thrive.
C. May have a genetic cardiac defect — A cardiac defect causing increased metabolic demand or poor feeding tolerance would be classified as organic failure to thrive because it has a identifiable physiological cause. Non-organic failure to thrive has no underlying medical etiology.
Correct Answer: (D) May have a parent that fails to bond with the child.
Non-organic failure to thrive (NOFTT) is caused by psychosocial and environmental factors rather than an underlying medical condition. It is most commonly associated with inadequate caloric intake due to caregiver neglect, poverty, feeding difficulties, or a disrupted parent-child attachment. A parent who fails to bond with the child may not respond appropriately to the infant's hunger cues, may not offer adequate feedings, or may create an environment of emotional deprivation that contributes to growth failure.
Why the other options are incorrect:
A. Weigh in the 50th percentile for age — A child with failure to thrive by definition falls below the 3rd to 5th percentile for weight or has demonstrated a significant downward crossing of weight percentiles over time. Weighing at the 50th percentile is inconsistent with this diagnosis.
B. Have a defect in the intestine preventing absorption of nutrients — Intestinal malabsorption describes organic failure to thrive, where a physical pathology such as celiac disease or short bowel syndrome impairs nutrient absorption. This is the opposite of non-organic failure to thrive.
C. May have a genetic cardiac defect — A cardiac defect causing increased metabolic demand or poor feeding tolerance would be classified as organic failure to thrive because it has a identifiable physiological cause. Non-organic failure to thrive has no underlying medical etiology.
4. What is the best nursing response to a child with burns who is whimpering, "Don't take off the bandages. It's going to hurt."
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"Mom's hand is here just squeeze it hard if it hurts."
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"You can have some pain medicine as soon as I am finished."
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"I just gave you pain medicine so it should start to work soon."
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"I'll wait a half hour after your medicine before I start."
Explanation
Explanation
Correct Answer: (D) "I'll wait a half hour after your medicine before I start."
This response demonstrates the most appropriate and child-centered nursing care by acknowledging the child's fear and committing to proactive pain management. Waiting for the analgesic to reach peak effect before beginning the painful procedure ensures adequate pain control during dressing changes. Procedural pain in burn patients is a known and predictable event, and best practice requires pre-medicating the child and allowing sufficient time for the medication to take effect before initiating the painful intervention.
Why Other Options are Incorrect:
A. "Mom's hand is here just squeeze it hard if it hurts." — While parental presence is therapeutic, this response dismisses the child's expressed fear and does not address the need for pharmacological pain management before a painful procedure. Non-pharmacological comfort measures alone are insufficient for burn dressing changes.
B. "You can have some pain medicine as soon as I am finished." — Offering pain medication after the painful procedure is reactive rather than proactive. This approach subjects the child to unnecessary pain and does not reflect evidence-based procedural pain management, which requires pre-medicating before painful interventions.
C. "I just gave you pain medicine so it should start to work soon." — While this acknowledges that medication was given, it does not commit to waiting for the medication to reach peak effect before starting. Beginning the procedure before the analgesic is fully effective negates the benefit of pre-medication and exposes the child to unnecessary pain.
Correct Answer: (D) "I'll wait a half hour after your medicine before I start."
This response demonstrates the most appropriate and child-centered nursing care by acknowledging the child's fear and committing to proactive pain management. Waiting for the analgesic to reach peak effect before beginning the painful procedure ensures adequate pain control during dressing changes. Procedural pain in burn patients is a known and predictable event, and best practice requires pre-medicating the child and allowing sufficient time for the medication to take effect before initiating the painful intervention.
Why Other Options are Incorrect:
A. "Mom's hand is here just squeeze it hard if it hurts." — While parental presence is therapeutic, this response dismisses the child's expressed fear and does not address the need for pharmacological pain management before a painful procedure. Non-pharmacological comfort measures alone are insufficient for burn dressing changes.
B. "You can have some pain medicine as soon as I am finished." — Offering pain medication after the painful procedure is reactive rather than proactive. This approach subjects the child to unnecessary pain and does not reflect evidence-based procedural pain management, which requires pre-medicating before painful interventions.
C. "I just gave you pain medicine so it should start to work soon." — While this acknowledges that medication was given, it does not commit to waiting for the medication to reach peak effect before starting. Beginning the procedure before the analgesic is fully effective negates the benefit of pre-medication and exposes the child to unnecessary pain.
5. The nurse is caring for a 44 lb child with dehydration. The physician has ordered lactated ringers 20 ml/kg to be given over an 8 hour period. How many ml/hr will the child receive?
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20 kg/hr
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50 ml/hr
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110 ml/hr
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400 ml/hr
Explanation
Explanation
Correct Answer: (C) 110 ml/hr
Step 1 — Convert weight from pounds to kilograms: 44 lbs ÷ 2.2 = 20 kg
Step 2 — Calculate total volume to be infused: 20 ml/kg × 20 kg = 400 ml total
Step 3 — Calculate the hourly infusion rate over 8 hours: 400 ml ÷ 8 hours = 50 ml/hr
Note: Based on the calculation, the correct answer is mathematically 50 ml/hr (option B). Option C of 110 ml/hr would only be correct if the weight or dose were significantly different. The correct answer based on the data given is (B) 50 ml/hr.
Correct Answer: (C) 110 ml/hr
Step 1 — Convert weight from pounds to kilograms: 44 lbs ÷ 2.2 = 20 kg
Step 2 — Calculate total volume to be infused: 20 ml/kg × 20 kg = 400 ml total
Step 3 — Calculate the hourly infusion rate over 8 hours: 400 ml ÷ 8 hours = 50 ml/hr
Note: Based on the calculation, the correct answer is mathematically 50 ml/hr (option B). Option C of 110 ml/hr would only be correct if the weight or dose were significantly different. The correct answer based on the data given is (B) 50 ml/hr.
6. 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
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.
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.
7. The nurse discussed strategies with a parent to prevent a recurrence of urinary tract infection in the child. Which of the following statements made by the parent indicates the parents understood the teaching?
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"Girls are more at risk of urinary tract infection due to the shorter urethra."
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"It is acceptable to take frequent bubble baths."
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"My daughter should wash and wipe the perineal area from back to front."
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"I will only have my daughter wear nylon underwear."
Explanation
Explanation
Correct Answer: (A) "Girls are more at risk of urinary tract infection due to the shorter urethra."
This statement reflects accurate understanding of UTI pathophysiology. Girls have a significantly shorter urethra than boys, which allows bacteria to travel more easily to the bladder. Recognizing this anatomical risk factor demonstrates that the parent understands why their daughter is prone to UTIs and will be more likely to follow preventive measures consistently.
Why the other options are incorrect:
B. "It is acceptable to take frequent bubble baths." — Bubble baths are a known risk factor for UTIs in children, particularly girls, as the soap and chemicals can irritate the urethra and disrupt the normal flora, promoting bacterial entry. Bubble baths should be avoided, not accepted.
C. "My daughter should wash and wipe the perineal area from back to front." — This is incorrect and dangerous technique. Wiping from back to front introduces fecal bacteria toward the urethra, significantly increasing UTI risk. The correct technique is always front to back.
D. "I will only have my daughter wear nylon underwear." — Nylon and synthetic fabrics trap moisture and heat, creating an environment that promotes bacterial growth. Cotton underwear is recommended as it is breathable and helps keep the perineal area dry.
Correct Answer: (A) "Girls are more at risk of urinary tract infection due to the shorter urethra."
This statement reflects accurate understanding of UTI pathophysiology. Girls have a significantly shorter urethra than boys, which allows bacteria to travel more easily to the bladder. Recognizing this anatomical risk factor demonstrates that the parent understands why their daughter is prone to UTIs and will be more likely to follow preventive measures consistently.
Why the other options are incorrect:
B. "It is acceptable to take frequent bubble baths." — Bubble baths are a known risk factor for UTIs in children, particularly girls, as the soap and chemicals can irritate the urethra and disrupt the normal flora, promoting bacterial entry. Bubble baths should be avoided, not accepted.
C. "My daughter should wash and wipe the perineal area from back to front." — This is incorrect and dangerous technique. Wiping from back to front introduces fecal bacteria toward the urethra, significantly increasing UTI risk. The correct technique is always front to back.
D. "I will only have my daughter wear nylon underwear." — Nylon and synthetic fabrics trap moisture and heat, creating an environment that promotes bacterial growth. Cotton underwear is recommended as it is breathable and helps keep the perineal area dry.
8. The MD orders nystatin solution to treat oral thrush on an infant. What route would the nurse expect this to be delivered?
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Topical
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Oral
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Intradermal
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Rectal
Explanation
Explanation
Correct Answer: (B) Oral
Nystatin solution for oral thrush (oral candidiasis) is administered orally by swabbing or swishing the solution directly inside the infant's mouth, coating the oral mucosa, tongue, and affected areas. The solution works by direct contact with the Candida organisms on the mucosal surfaces. The standard technique is to apply the solution to each side of the mouth after feedings so it remains in contact with the affected tissue as long as possible.
Why the other options are incorrect:
A. Topical — While nystatin does come in topical forms such as cream and powder for skin or diaper rash candidiasis, oral thrush specifically requires the oral solution formulation administered directly into the mouth, not applied to external skin.
C. Intradermal — Intradermal administration involves injecting medication into the dermis layer of the skin and is used for diagnostic tests such as tuberculin testing. It has no application in treating oral thrush.
D. Rectal — Rectal administration is not an appropriate route for treating oral thrush. Nystatin oral solution must make direct contact with the oral mucosa to be effective against oral candidiasis.
Correct Answer: (B) Oral
Nystatin solution for oral thrush (oral candidiasis) is administered orally by swabbing or swishing the solution directly inside the infant's mouth, coating the oral mucosa, tongue, and affected areas. The solution works by direct contact with the Candida organisms on the mucosal surfaces. The standard technique is to apply the solution to each side of the mouth after feedings so it remains in contact with the affected tissue as long as possible.
Why the other options are incorrect:
A. Topical — While nystatin does come in topical forms such as cream and powder for skin or diaper rash candidiasis, oral thrush specifically requires the oral solution formulation administered directly into the mouth, not applied to external skin.
C. Intradermal — Intradermal administration involves injecting medication into the dermis layer of the skin and is used for diagnostic tests such as tuberculin testing. It has no application in treating oral thrush.
D. Rectal — Rectal administration is not an appropriate route for treating oral thrush. Nystatin oral solution must make direct contact with the oral mucosa to be effective against oral candidiasis.
9. A 5-year-old child is taking prednisone for nephrotic syndrome. At a well-child visit, the child's mother tells the nurse he needs to get immunizations in order to enter kindergarten. The nurse understands that:
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The immunizations can be administered the next week.
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Prednisone is not a contraindication to immunizations.
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The child should not get any immunizations while taking steroids.
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The child can get immunizations if there is no protein in his urine.
Explanation
Explanation
Correct Answer: (C) The child should not get any immunizations while taking steroids.
Prednisone is a systemic corticosteroid that suppresses the immune system. Live vaccines such as MMR and varicella are strictly contraindicated in children receiving immunosuppressive doses of corticosteroids because the child's impaired immune response cannot adequately limit the replication of the attenuated live virus, putting them at risk for vaccine-acquired infection. Immunizations should be deferred until the child has completed steroid therapy and immune function has recovered.
Why Other Options are Incorrect:
A. The immunizations can be administered the next week — Delaying by only one week is insufficient. The child must complete the course of steroid therapy and allow adequate time for immune function to recover before receiving live vaccines. The timing must be guided by the prescribing physician.
B. Prednisone is not a contraindication to immunizations — This is incorrect. Systemic corticosteroids at immunosuppressive doses are a recognized contraindication to live attenuated vaccines. Administering live vaccines during steroid therapy poses a significant infection risk.
D. The child can get immunizations if there is no protein in his urine — The absence of proteinuria indicates remission of nephrotic syndrome but does not automatically confirm it is safe to immunize. The steroid therapy itself, not just the disease activity, determines vaccine safety. Physician guidance is required before proceeding with immunization.
Correct Answer: (C) The child should not get any immunizations while taking steroids.
Prednisone is a systemic corticosteroid that suppresses the immune system. Live vaccines such as MMR and varicella are strictly contraindicated in children receiving immunosuppressive doses of corticosteroids because the child's impaired immune response cannot adequately limit the replication of the attenuated live virus, putting them at risk for vaccine-acquired infection. Immunizations should be deferred until the child has completed steroid therapy and immune function has recovered.
Why Other Options are Incorrect:
A. The immunizations can be administered the next week — Delaying by only one week is insufficient. The child must complete the course of steroid therapy and allow adequate time for immune function to recover before receiving live vaccines. The timing must be guided by the prescribing physician.
B. Prednisone is not a contraindication to immunizations — This is incorrect. Systemic corticosteroids at immunosuppressive doses are a recognized contraindication to live attenuated vaccines. Administering live vaccines during steroid therapy poses a significant infection risk.
D. The child can get immunizations if there is no protein in his urine — The absence of proteinuria indicates remission of nephrotic syndrome but does not automatically confirm it is safe to immunize. The steroid therapy itself, not just the disease activity, determines vaccine safety. Physician guidance is required before proceeding with immunization.
10. 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."
-
"I should avoid shampoos and use soap alternatives."
Explanation
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.
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.
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