Pediatrics NUR 335 Exam Questions

Correct Answer: c) Place the infant on their back to sleep.

Place the infant on their back to sleep is the most important recommendation for reducing the risk of sudden infant death syndrome (SIDS). Research has consistently shown that placing infants on their back to sleep significantly reduces the risk of SIDS compared to placing them on their stomach or side. The supine (back) position is recommended for every sleep period, including naps and overnight sleep.

Why Other Options are Wrong:

a) Place the infant on their stomach to sleep:

This position is associated with an increased risk of SIDS. Infants placed on their stomach to sleep are more likely to re-breathe exhaled carbon dioxide, which can contribute to suffocation.

b) Use a soft blanket to keep the infant warm:

Soft bedding, including blankets, pillows, and stuffed animals, can pose a suffocation risk. It is recommended to dress the infant appropriately for sleep and avoid placing soft bedding in the crib.

d) Allow the infant to sleep with a stuffed animal for comfort:

Stuffed animals or any soft items in the crib increase the risk of suffocation. The sleep environment should be kept free of these items to promote safe sleep.

Summary:

To reduce the risk of SIDS, parents should be instructed to place the infant on their back for all sleep periods. This practice, along with a safe sleep environment that includes a firm mattress and no soft bedding, is the most effective way to protect infants from SIDS.

Correct Answer: A. Newborn

Babinski sign is considered normal in newborns up to about 2 years of age. It is a reflex in which the big toe extends upward (dorsiflexes) and the other toes fan out when the sole of the foot is stroked. This reflex is a sign of an immature nervous system in infants, which usually disappears as the child’s nervous system matures.

Why Other Options are Wrong:

B. Adolescents:

In adolescents, the Babinski sign should no longer be present. Its persistence in older children or adolescents may indicate a neurological disorder.

C. Youth:

Similar to adolescents, a Babinski sign is not considered normal in youths, as their nervous systems are fully developed by this stage.

D. Older adults:

A positive Babinski sign in older adults can indicate a neurological condition, such as a lesion in the corticospinal tract or a sign of central nervous system damage.

Summary:

The Babinski reflex is a normal finding in newborns due to their developing nervous system. It typically disappears as the child grows and the nervous system matures. Its presence in older individuals may signal an underlying neurological issue.

Correct Answer: Absolute neutrophil count (ANC)

The absolute neutrophil count (ANC) is the most critical laboratory value to assess infection-fighting capability during chemotherapy.

Neutrophils are a type of white blood cell essential for fighting infections. Chemotherapy often causes neutropenia (low neutrophil count), increasing infection risk.

If the ANC falls below 500 cells/mm³, the child is at significant risk for infection, and chemotherapy may be delayed until neutrophil recovery.

Why Other Options are Wrong:

Eosinophils: Eosinophils are involved in allergic reactions and responses to parasitic infections. They are not a key indicator of general infection-fighting ability during chemotherapy.

Red blood cell count (RBC): RBCs assess oxygen-carrying capacity rather than infection defense. Though chemotherapy can reduce RBCs, it is not a direct measure of infection risk.

Hemoglobin (Hgb): Hemoglobin indicates oxygen transport efficiency but does not reflect immune defense.

Summary: The ANC is the best measure of infection-fighting ability during chemotherapy for acute lymphoblastic leukemia. Monitoring ANC ensures timely identification of neutropenia and helps prevent life-threatening infections during treatment.

Correct Answer: A) Intellectual disability

Intellectual disability is the hallmark feature of Down syndrome, and it is present in all individuals with the condition, though the severity can vary.

Why Other Options are Wrong:

B: Individuals with Down syndrome typically have a smaller head circumference, not a larger one.

C: Short stature, not long limbs, is more common in individuals with Down syndrome.

D: The characteristic facial features of Down syndrome include a flat facial profile, small ears, and upward slanting eyes, but not typically wide-set eyes with a prominent forehead.

Summary:

Down syndrome is characterized by intellectual disability, short stature, and microcephaly, with distinct facial features. It is caused by an extra chromosome 21 and can be diagnosed through chromosomal analysis. Intellectual disability is one of the most consistent findings in affected individuals.

Correct Answer: B. Failure to pass meconium within 48 hours of life.

Hirschsprung disease is a congenital condition caused by absence of ganglion cells (nerve cells) in part of the colon, leading to a functional obstruction.

The absence of these ganglion cells means that the affected portion of the colon cannot relax, causing a blockage that prevents normal bowel movements.

In neonates, one of the most common initial signs of Hirschsprung disease is failure to pass meconium within the first 48 hours of life.

Meconium is the thick, dark green substance that is passed by newborns shortly after birth, and failure to do so suggests an intestinal obstruction.

Why the Other Options are Incorrect:

A. Empty rectum on digital rectal examination:

This finding can be present in Hirschsprung disease, but it is not the most prominent symptom or sign in neonates. An empty rectum is typically seen in cases with more severe or longstanding disease, but it is not the most common presenting sign in the neonatal period.

C. Lack of physiologic urge to defecate:

While the absence of ganglion cells can affect motility and function in Hirschsprung disease, lack of a physiologic urge to defecate is not typically the prominent or earliest presenting sign in neonates. The issue is more about obstruction and delayed passage of meconium rather than a lack of urge.

D. Mild constipation with intermittent bouts of mild diarrhea:

This presentation is more typical of chronic cases of Hirschsprung disease, often seen in older children or toddlers who might experience intermittent symptoms. In neonates, the presentation is more often severe and manifests as a failure to pass meconium early in life.

Summary:

The most prominent symptom or sign of Hirschsprung disease in neonates is failure to pass meconium within the first 48 hours of life. This occurs because the affected segment of the colon lacks nerve cells, causing a functional obstruction and delaying the passage of stool. Early recognition is crucial to prevent complications from the condition.

Correct Answer: b) Noninfectious bone growth disturbances affecting the epiphyses

Osteochondroses are noninfectious, noninflammatory bone growth disturbances that occur at various ossification centers, particularly during periods of intense developmental activity. These disturbances affect the epiphyses, which are the ends of the bones where growth occurs.

Why Other Options are Wrong:

a) Inflammatory bone disorders affecting the metaphysis:

This is incorrect because osteochondroses are noninflammatory conditions, and they primarily affect the epiphyses, not the metaphysis.

c) Infectious bone conditions affecting the diaphysis:

This is incorrect. Osteochondroses are noninfectious and affect the epiphyses, not the diaphysis (shaft of the bone).

d) Malignant tumors in the ossification centers:

This is incorrect. Osteochondroses are benign disturbances of bone growth, not malignant tumors.

Summary:

Osteochondroses refer to noninflammatory, noninfectious disturbances in bone growth that primarily affect the epiphyses. These conditions typically arise during periods of significant developmental activity, leading to growth derangements at the ossification centers of the bone.

Correct Answer: A 4 Years.

A neonate's height typically doubles by around 4 years of age.

By 4 years, the child’s height has often slightly exceeded double the birth length.

Height triples by adolescence, around 13 years old.

Why the Other Options Are Incorrect:

3 Years:

Growth milestones tend to be reached slightly earlier, with doubling usually completed by 3 years.

2 Years:

While weight quadruples by 2 years, height doubling occurs later, closer to 3 years.

1 Year:

Height typically increases by about 50% rather than doubling within the first year.

Summary:

Height doubles by 3 years and triples by 13 years.

Monitoring these milestones is important for assessing normal growth and development.

Answer: b) At age 9 to 12 months

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  Correct Answer: For term infants, hematocrit or hemoglobin levels should be checked to detect iron deficiency at 9 to 12 months of age.

  
  


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  This is when iron stores from birth begin to diminish, and iron deficiency can become apparent.

  
  

Why the other options are incorrect:

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  a) At age 6 to 8 months: This age range is too early for detecting iron deficiency. Iron deficiency screening is typically done at 9 to 12 months for term infants.

  
  

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  c) At age 5 to 6 months: This is the recommended screening age for preterm infants, not term infants.

  
  

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  d) At age 3 to 4 months: Iron deficiency is less likely to be detected at this age, and screening is typically done later.

  
  

Summary:

To detect iron deficiency, hematocrit or hemoglobin levels should be checked in term infants at 9 to 12 months of age, and in preterm infants, screening should occur at 5 to 6 months.

Correct answer: B) Scarlatiniform rash with low-grade fever, malaise, and lymphadenopathy

Rubella typically presents with a scarlatiniform rash (fine, red, and sandpaper-like), often accompanied by low-grade fever, malaise, conjunctivitis, and lymphadenopathy, especially in the suboccipital, postauricular, and posterior cervical nodes.

Why Other Options are Wrong:

A) A maculopapular rash with a high fever:

While rubella can present with a maculopapular rash, the fever is usually low-grade, not high.

C) A vesicular rash with pain and itching:

A vesicular rash with pain and itching is characteristic of chickenpox, not rubella.

D) A blanching, erythematous rash that spreads cephalocaudally:

This describes the rash of measles, not rubella. Measles also presents with a high fever and a more widespread rash pattern.

Summary:

Rubella typically presents with a scarlatiniform rash, low-grade fever, malaise, conjunctivitis, and characteristic lymphadenopathy in the suboccipital, postauricular, and posterior cervical nodes. It is important to differentiate rubella from other viral rashes, such as measles and chickenpox, based on these symptoms.