Pediatrics NUR 335 Exam Questions

Correct Answer: A) The presence of an extra chromosome

Trisomy conditions, such as Down syndrome, result from an extra chromosome in the set, leading to three copies of a particular chromosome instead of the usual two.

Why Other Options are Wrong:

B: Deletion refers to the loss of a portion of a chromosome, not an extra chromosome.

C: Chromosome rearrangements are characteristic of translocations, not trisomy.

D: A missing chromosome would be monosomy, not trisomy.

Summary:

Trisomy is characterized by the presence of an extra chromosome, whereas the other options describe other types of chromosomal abnormalities.

Correct Answer:

Manifestations that could indicate a sepsis infection

Long-term effects that result from a prolonged recovery

Explanation:

Manifestations that could indicate a sepsis infection:

Sepsis is a potential complication of bacterial meningitis. The nurse should monitor for signs of sepsis, such as fever, tachycardia, hypotension, altered mental status, and rapid breathing. Early recognition of sepsis is critical for timely treatment.

Long-term effects that result from a prolonged recovery:

Bacterial meningitis can lead to long-term effects such as neurological deficits, hearing loss, cognitive impairments, and developmental delays, especially if the infection was severe or treatment was delayed. Monitoring for these potential long-term effects is important.

Why Other Options are Wrong:

Blood pressure that could indicate hypertension:

While monitoring blood pressure is important in any child with a serious infection, bacterial meningitis is more commonly associated with hypotension (low blood pressure) due to sepsis rather than hypertension. The priority focus should be on maintaining adequate blood pressure to prevent shock.

Heart problems that result from cardiac dysfunction:

Cardiac dysfunction is not a common complication directly associated with bacterial meningitis. However, sepsis or shock associated with bacterial meningitis can affect cardiovascular stability. Monitoring for signs of circulatory issues due to sepsis would be more relevant.

A decrease in body temperature as a sign of bacterial meningitis progression:

A decrease in body temperature (hypothermia) can indicate severe progression of the infection or sepsis, which is a serious concern, but it is not a hallmark or common progression of bacterial meningitis itself. Fever is more typical early in the disease.

Summary:

The nurse should focus on monitoring for signs of sepsis (which can complicate bacterial meningitis) and long-term effects from the illness. Blood pressure should be monitored, but hypertension is not a typical finding in bacterial meningitis. Cardiac problems are not a common direct consequence, and a decrease in body temperature can signal a critical complication, but fever is more typical in the early stages of meningitis.

Correct Answer: C. 18 months.

Gastroesophageal reflux (GER) is common in infants, characterized by spitting up or "wet burps." GER occurs due to an underdeveloped lower esophageal sphincter, which allows stomach contents to flow back into the esophagus.

In most infants, this condition resolves as they grow and their digestive system matures. 95% of infants will outgrow GER by 18 months, as their digestive tract becomes more efficient and the esophageal sphincter strengthens, reducing reflux episodes.

Why the Other Options Are Incorrect:

A. 3 months: While many infants show improvement in GER symptoms by 3 months, not all will have fully resolved symptoms by this age. GER often persists beyond 3 months and typically resolves in a larger percentage of infants by 18 months, not just 3 months.

B. 9 months: By 9 months, many infants may see some improvement in GER, but not all will have completely outgrown it. The majority of infants with GER will have their symptoms significantly reduced or resolved by 18 months, not by 9 months.

D. 20 months: GER typically resolves by 18 months, so 20 months is beyond the typical age for resolution. If GER persists past this age, it may indicate an underlying condition that needs further medical evaluation.

Summary:

The correct answer is 18 months (C), as 95% of infants will experience resolution of gastroesophageal reflux by this age. While some infants may improve by 3 months or 9 months, full resolution typically occurs around 18 months. If symptoms persist beyond this age, it may suggest a need for further medical investigation.

Answer: b) Screen for esotropia or exotropia

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  Correct Answer: It is important to screen for esotropia or exotropia, which are types of strabismus (misalignment of the eyes).

  
  


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  These conditions can lead to vision problems if not addressed early.

  
  

Why the other options are incorrect:

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  a) Check for signs of astigmatism: While astigmatism is a common refractive error, it is not typically part of routine screenings during early well-child visits.

  
  

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  c) Test for color blindness: Color blindness screening is usually done at later stages, such as during school-age, rather than during early well-child visits.

  
  

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  d) Perform a vision acuity test using Snellen charts: Vision acuity testing is recommended for children at ages 4 and 5 years, but it is not the first priority in eye assessments during earlier well-child visits.

  
  

Correct Answer. B) 40%

40% is the correct figure based on long-term studies. Although OCD tends to persist into adulthood, early and appropriate treatment can help many children manage the condition effectively.

However, it's important to note that the remaining patients may experience varying degrees of ongoing symptoms or relapses, but with continued treatment, they can still improve.

Why the other options are incorrect:

10%: This figure underestimates the impact of treatment. Most patients benefit from therapy and/or medications.

60%: While recovery rates are fairly high, 60% is slightly overestimated based on the most recent research.

80%: This figure is too high, as not all patients fully recover, even with treatment.

Summary:

In pediatric OCD, 40% of patients will recover or significantly improve by early adulthood, given proper treatment.

Correct Answer: A) Abdominal MRI

A) Abdominal MRI (Correct): MRI is often preferred for staging Wilms tumors because it provides detailed images of the abdomen and kidneys, helping to assess the tumor's size, involvement with surrounding structures, and potential spread. It also allows for better visualization of lymph nodes and other distant organs.

Why Other Options are Wrong

B) Abdominal ultrasonography (Incorrect): Ultrasonography is often used as an initial screening tool to detect the presence of a mass or abnormality in the abdomen. However, it does not provide the detailed information needed for tumor staging and assessment of metastasis, which is why it is typically followed by CT or MRI.

C) Biopsy of the tumor (Incorrect): A biopsy of the Wilms tumor is generally not required for diagnosis because the diagnosis can often be confirmed by imaging studies and clinical presentation. In many cases, biopsy is avoided to reduce the risk of tumor spillage, especially in Wilms tumor, where surgical resection is often diagnostic.

D) Chest CT scan (Incorrect): A chest CT scan may be used to check for metastasis to the lungs, which is a common site of spread for Wilms tumor. However, it is not the primary diagnostic tool used to determine the extent of the tumor within the abdomen.

Summary:

The primary diagnostic study to assess the extent of a Wilms tumor and check for its spread is abdominal MRI. It provides detailed images of the tumor and surrounding organs, allowing for accurate staging and evaluation. Other imaging studies, such as ultrasound or CT, may also be used, but MRI is the preferred option for comprehensive assessment.

 

Correct Answer: C. Decompression with a nasogastric and rectal tube.

The patient is presenting with signs of toxic megacolon, a severe complication of Hirschsprung disease or inflammatory bowel disease (like ulcerative colitis).

Toxic megacolon is a life-threatening condition in which the colon becomes severely dilated, and the patient can experience abdominal distension, fever, and bowel obstruction.

The initial treatment of toxic megacolon typically involves:

1. Supportive care (fluid resuscitation and broad-spectrum antibiotics).

2. Decompression of the colon to reduce the distention and prevent further bowel perforation. This is achieved using a nasogastric tube to relieve gastric distension and a rectal tube to relieve colon distention.

Decompression is critical in managing toxic megacolon to avoid perforation, sepsis, or further complications.

Why the Other Options are Incorrect:

A. Colostomy proximal to the aganglionic segment:

Colostomy is used as part of surgical management for Hirschsprung disease or when surgical intervention is needed to bypass the aganglionic portion of the colon. However, this is not the initial management step for suspected toxic megacolon, as the patient needs to be stabilized and decompressed first.

B. Complete resection of the aganglionic segment of the colon:

Resection of the aganglionic segment is the definitive treatment for Hirschsprung disease but is usually not performed during the acute phase of toxic megacolon. Initial management focuses on decompression and stabilization rather than immediate surgery.

D. Saline enema:

Saline enemas may be used to help relieve constipation, but they are not appropriate in the management of toxic megacolon, which requires more urgent decompression and stabilization due to the risk of perforation and sepsis.

Summary:

In the case of a toxic megacolon, the priority is to decompress the colon and provide supportive care. This is best achieved by using a nasogastric tube and a rectal tube to relieve the distension. Surgical interventions like colostomy or resection are considered after initial stabilization.

Correct Answer: D) Atrial septal defect

Tetralogy of Fallot does not involve an atrial septal defect. The four key features of Tetralogy of Fallot are a large ventricular septal defect, right ventricular outflow tract obstruction (including pulmonic valve stenosis), right ventricular hypertrophy, and overriding of the aorta. An atrial septal defect is not part of this condition.

Why Other Options are Wrong:

A) Large ventricular septal defect:

This is one of the hallmark features of Tetralogy of Fallot, where a hole between the two ventricles allows oxygen-poor blood to mix with oxygen-rich blood.

B) Right ventricular outflow tract obstruction:

This is a characteristic feature of Tetralogy of Fallot, where there is narrowing or blockage of the pathway through which blood flows from the right ventricle to the lungs.

C) Pulmonary valve stenosis:

This is another defining feature of Tetralogy of Fallot, where the pulmonary valve is narrowed, further contributing to the right ventricular outflow tract obstruction.

Summary:

Tetralogy of Fallot is a congenital heart defect characterized by four main features: a large ventricular septal defect, right ventricular outflow tract obstruction (including pulmonary valve stenosis), right ventricular hypertrophy, and overriding of the aorta. An atrial septal defect is not part of the condition.

Correct Answer: D) Gene sequencing

Once screening tests indicate a potential metabolic disorder, gene sequencing is often used for definitive confirmation. This technique allows for the identification of specific genetic mutations that are responsible for inherited metabolic disorders. Since many metabolic disorders are caused by mutations in particular genes, gene sequencing provides precise and definitive information about the genetic cause of the disorder. Gene sequencing is particularly useful when enzyme studies have not provided clear results or when a genetic cause is strongly suspected based on clinical findings.

Why the Other Options Are Incorrect:

A) Biopsy (e.g., liver, muscle):

Biopsy is more invasive and typically used later in the diagnostic process when tissue-specific involvement (such as liver or muscle dysfunction) is suspected. While biopsies can help confirm certain metabolic disorders, they are not the first choice after screening tests suggest a disorder.

B) Enzyme studies:

Enzyme studies are crucial for diagnosing certain metabolic disorders, but they are not always definitive. In some cases, enzyme activity can be normal in some individuals, even when they have a genetic mutation. Gene sequencing provides a higher level of certainty, making it the preferred next step in many cases.

C) Fasting challenge tests:

Fasting challenge tests are used for specific metabolic disorders related to glucose and energy metabolism, like glycogen storage diseases or certain hypoglycemia disorders. However, these tests are not generally used as the first confirmatory step for diagnosing a metabolic disorder after screening.

Summary:

After initial screening suggests a metabolic disorder, gene sequencing is often the next confirmatory test because it directly identifies the genetic mutations causing the disorder. This approach provides a definitive diagnosis and is especially helpful when enzyme studies are inconclusive. Other methods like biopsy, enzyme studies, and fasting challenge tests have their place in the diagnostic process but are not typically the first step following screening.