Pediatrics NUR 335 Exam Questions

Correct answer: C) Translocation

Translocation is a structural chromosomal abnormality in which a portion of a chromosome breaks off and attaches to another chromosome, causing rearrangement.

Why Other Options are Wrong:

A: Trisomy refers to a numerical abnormality where there is an extra chromosome.

B: Monosomy is a numerical abnormality where one chromosome is missing.

D: Down syndrome is a condition caused by trisomy 21, which is a numerical abnormality, not a structural one.

Summary:

Structural abnormalities involve changes to the structure of chromosomes, such as translocation, whereas trisomy and monosomy are numerical abnormalities.

Correct answer: B) Congenital rubella syndrome, which may include heart defects and deafness

Congenital rubella syndrome (CRS) occurs when a pregnant woman contracts rubella during pregnancy. The virus can be transmitted to the fetus, leading to a range of birth defects including heart defects, deafness, cataracts, and developmental delays.

Why Other Options are Wrong:

A) Development of a maculopapular rash in the fetus:

Although rubella infection typically causes a rash in the child, it does not manifest this way in the fetus. Instead, CRS can cause organ abnormalities and developmental issues.

C) Increased risk of preterm labor:

While rubella infection can have serious consequences for the fetus, it does not directly increase the risk of preterm labor.

D) Increased risk of low birth weight:

Rubella infection can cause congenital anomalies, but it is more directly linked to specific defects rather than a general risk of low birth weight.

Summary:

If a pregnant woman contracts rubella, particularly in the first trimester, it can lead to congenital rubella syndrome, which can cause severe complications such as heart defects, deafness, and other developmental disorders in the fetus. Prevention through vaccination before pregnancy is key.

Correct Answer d: Bone marrow biopsy and aspiration

The most definitive diagnostic test for leukemia is a bone marrow biopsy and aspiration. This procedure involves taking a small sample of bone marrow (usually from the hip bone) to examine under a microscope. Leukemia is a type of cancer that originates in the bone marrow, and the biopsy allows the healthcare team to assess the bone marrow for the presence of abnormal or immature blood cells, which are characteristic of leukemia. It also helps determine the specific type of leukemia (e.g., acute lymphoblastic leukemia or acute myeloid leukemia).

Why Other Options are Wrong:

Chest X-ray:

While a chest X-ray may be used to evaluate for potential complications of leukemia, such as lung involvement or mediastinal mass, it is not a definitive diagnostic test for leukemia. It may be part of the initial assessment but is not used to diagnose leukemia itself.

Urinalysis:

A urinalysis may be conducted to check for signs of kidney involvement or other complications, but it is not useful for diagnosing leukemia. Leukemia diagnosis depends on blood and bone marrow findings, not urine analysis.

Complete blood count (CBC):

A CBC is one of the first tests often done when leukemia is suspected because it can reveal abnormal levels of white blood cells, red blood cells, and platelets, which are common in leukemia. However, a CBC cannot definitively diagnose leukemia—it may suggest the need for further testing, such as a bone marrow biopsy, to confirm the diagnosis.

Summary:

A bone marrow biopsy and aspiration is considered the most definitive test for diagnosing leukemia, as it directly evaluates the bone marrow, where leukemia originates. While a CBC and other tests may indicate the presence of leukemia or complications, they cannot confirm the diagnosis without further testing such as a biopsy.

Correct Answer: b) It results in localized changes in vertebral bodies, leading to back pain and kyphosis.

Scheuermann disease is an osteochondrosis affecting the vertebral bodies and causing back pain and kyphosis. The disease typically leads to localized changes in the vertebrae, and kyphosis (excessive curvature of the spine) is a key characteristic. Back pain often accompanies these changes, particularly in adolescents.

Why Other Options are Wrong:

a) It causes a lateral curvature of the spine, most often in the thoracic region, with a Cobb angle greater than 40 degrees:

This description refers to scoliosis, not Scheuermann disease. Scheuermann disease causes kyphosis (forward curvature), not lateral curvature.

c) It is an inflammatory condition that causes painful swelling in the lower back and is usually seen in adolescents:

This is incorrect because Scheuermann disease is non-inflammatory and does not cause swelling. It involves changes in the vertebral bodies and leads to kyphosis, not inflammation.

d) It involves pain and swelling in the sacral region with a flat back posture and is more common in girls:

This is incorrect because Scheuermann disease typically affects the thoracic or thoracolumbar spine, leading to kyphosis, not a flat back posture. The condition is more common in boys, not girls.

Summary:

Scheuermann disease is a type of osteochondrosis that primarily affects the vertebral bodies and leads to back pain and kyphosis. The condition causes localized changes in the vertebrae, often resulting in a forward curvature of the spine (kyphosis). It is commonly diagnosed in adolescents, with symptoms worsening during periods of rapid growth. The condition typically does not involve swelling or inflammation, making it distinct from other spine disorders.

Correct answer: C) Translocation

Translocation occurs when a part of one chromosome is transferred to another chromosome, leading to structural rearrangements.

Why Other Options are Wrong:

A: Trisomy involves an extra chromosome, not rearrangement.

B: Monosomy involves the loss of a chromosome, not rearrangement.

D: Duplication is a type of structural abnormality where part of a chromosome is repeated, but it does not involve rearrangement between chromosomes.

Summary:

Translocation refers to the movement of chromosome parts between chromosomes, while trisomy, monosomy, and duplication are different types of chromosomal abnormalities.

Correct Answer: Upper leg

Rhabdomyosarcoma is a type of cancer that arises from the striated (skeletal) muscles, which can be found in various parts of the body. The most common sites of rhabdomyosarcoma in children include the head and neck, genitourinary tract, and extremities, particularly the upper leg. The tumor can form in the muscles of the limbs, and the upper leg is one of the most common areas where rhabdomyosarcoma occurs.

Why Other Options are Wrong

Ribs: While rhabdomyosarcoma can occur in various areas, the ribs are not one of the most common sites for this type of cancer. Rhabdomyosarcoma is more frequently found in areas with abundant skeletal muscle, such as the upper leg and head/neck region.

Head: Although rhabdomyosarcoma can occur in the head and neck region, especially in the orbital (eye socket) and nasopharyngeal areas, the upper leg is still more commonly affected than the head. However, it's important to recognize that tumors can form in multiple locations.

Spine: The spine is an uncommon location for rhabdomyosarcoma. Tumors arising from the spine typically involve the bone (e.g., Ewing's sarcoma) rather than the soft tissue, which is the primary tissue involved in rhabdomyosarcoma.

Summary:

Rhabdomyosarcoma is most commonly present in the upper leg of pediatric clients, although it can also occur in other areas such as the head and neck region. The nurse should be particularly vigilant in assessing for a mass or tumor in the upper leg, as it is a common site for this type of cancer in children.

Correct answer : D) All of the above

Different forms of maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect, often overlap and can occur simultaneously in a child’s life.

Why Other Options are Wrong:

A, B, and C: Each of these forms of maltreatment can exist independently but frequently co-occur with other forms of abuse.

Summary:

All forms of child maltreatment can coexist, and it is not uncommon for a child to experience multiple forms of abuse simultaneously.

Correct Answer: b) If the child has been exposed to someone with tuberculosis or has traveled to a high-risk country

A tuberculosis (TB) screening test should be conducted when there are risk factors such as exposure to someone with tuberculosis, living with individuals who have been incarcerated, or having recently traveled to a high-risk country (outside of the United States, Canada, Australia, New Zealand, or Western/North European countries). TB screening tests (such as the tuberculin skin test or IGRA) help identify children who may have been exposed to the bacteria, even in the absence of symptoms. IGRA is preferred in some cases to avoid false positives, particularly for those who have received the BCG vaccine.

Why Other Options are Wrong:

a) Only if the child shows symptoms of tuberculosis:

TB screening tests are not based solely on symptoms. Even if a child shows no symptoms, screening is important if there are known exposure risks or if they have traveled to or lived in high-risk areas.

c) Only if the child is at risk due to a family member being incarcerated:

While incarceration can be a risk factor, TB screening should not be restricted only to children with incarcerated family members. The screening should also include other exposure risks such as travel to high-risk countries or living with someone who has tuberculosis.

d) Only if the child has a positive family history of tuberculosis:

A positive family history alone is not an indicator for TB testing. The screening is more dependent on exposure to someone with active TB or travel to high-risk regions, not merely family history.

Summary:

A tuberculosis screening test should be conducted if a child has been exposed to someone with tuberculosis, has traveled to a high-risk country, or has family members who are recent immigrants from high-risk countries or have been incarcerated. The test can be either a tuberculin skin test or IGRA, with IGRA being preferred in certain cases, such as when the child has received the BCG vaccine.

Correct Answer: B) 50 to 70 mm Hg

For preterm infants receiving oxygen therapy, the target PaO2 (partial pressure of oxygen) range is 50 to 70 mm Hg. This range is recommended to maintain adequate oxygenation while minimizing the risks of complications such as retinopathy of prematurity and bronchopulmonary dysplasia, which can occur with excessive oxygenation.

Why Other Options are Wrong:

A) 60 to 90 mm Hg

This range is too high for preterm infants, increasing the risk of conditions like retinopathy of prematurity.

C) 70 to 90 mm Hg

Although this range might be acceptable for term infants, it is too high for preterm infants. Preterm infants require a lower PaO2 range (50 to 70 mm Hg) to avoid complications.

D) 80 to 100 mm Hg

This range is too high for preterm infants and can increase the likelihood of bronchopulmonary dysplasia and other oxygen-related complications.

Summary:

For oxygen therapy in neonates and infants, preterm infants should have a PaO2 range of 50 to 70 mm Hg and term infants should have a PaO2 range of 50 to 80 mm Hg. Oxygen should be delivered via humidified and warmed devices to prevent drying and bronchospasm. The goal is to maintain appropriate oxygen saturation while avoiding the risks of conditions such as retinopathy of prematurity and bronchopulmonary dysplasia.