Pediatrics NUR 335 Exam Questions

Correct Answer: D. Use the Glasgow Coma Scale (GCS)

Explanation:

The Glasgow Coma Scale (GCS) is the initial and most critical tool used to assess the cognitive status of a patient with a suspected head injury. The GCS evaluates a patient's level of consciousness based on their eye, verbal, and motor responses. This assessment helps determine the severity of the head injury and aids in making decisions about further interventions. It provides a quick, standardized way to assess the child’s neurological status.

Why Other Options are Wrong:

A. Have blood work done

Blood work might be required to assess metabolic issues or other conditions, but it does not provide an immediate assessment of the child's cognitive status. The GCS should be used first to evaluate neurological function.

B. Monitor intracranial pressure

While monitoring intracranial pressure (ICP) is important in head injuries, it is not the first action. Initial assessment of cognitive function should be done through the Glasgow Coma Scale before considering more invasive measures like ICP monitoring.

C. Recommend a CT scan

A CT scan might be necessary to assess structural damage after a head injury, but it does not immediately evaluate cognitive status. The GCS is the first step to assess consciousness and neurological function, which will guide further decisions like imaging studies.

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: Pain medications

Pain management is a priority intervention for clients experiencing a sickle cell crisis. The crisis causes severe pain due to vaso-occlusion, where sickled red blood cells block blood flow, leading to tissue ischemia.

Opioid analgesics, such as morphine, are commonly used to manage pain during a crisis.

Why Other Options are Wrong:

Laxatives:

Laxatives are not indicated for treating sickle cell crisis. However, they may be used later if opioid use leads to constipation.

Thyroid replacement medications:

Thyroid medications address hypothyroidism, not pain or complications of sickle cell disease.

Diuretics:

Diuretics can worsen dehydration, which is a common trigger for sickle cell crises. Hydration is crucial during a crisis to prevent further sickling.

Summary: The priority intervention for a client in sickle cell crisis is administering pain medications to manage severe vaso-occlusive pain. Other supportive measures, such as hydration and oxygen therapy, are also important but pain control remains the primary focus.

Correct Answer: A) Under 5 years

A) Under 5 years (Correct):

Wilms tumor most commonly affects children under the age of 5 years, with the peak incidence around 3 to 4 years of age. It is rare in older children or adults.

B) Ages 6 to 9 years (Incorrect):

While Wilms tumor can occur in children up to 9 years, it is not the most common age group for diagnosis. Most cases occur in younger children.

C) Ages 10 to 13 years (Incorrect):

Wilms tumor is much less common in this age range. It is typically diagnosed much earlier, with the peak incidence being before 5 years of age.

D) Ages 14 to 17 years (Incorrect):

Wilms tumor is very rare in adolescents and adults. It is generally diagnosed before the age of 5, making it highly unlikely in this age group.

Summary:

Wilms tumor most commonly affects children under 5 years old, with a peak incidence between 3 and 4 years of age. It is rare in older children or adolescents, making the other options incorrect. Early detection and treatment are crucial for a favorable prognosis, as Wilms tumor is treatable when diagnosed at an early stage.

Correct Answer: Constipation with foul-smelling, ribbon-like stool.

Hirschsprung's disease is a congenital condition caused by the absence of ganglion cells in the distal colon, leading to impaired peristalsis and obstruction.

The stool cannot pass effectively, resulting in chronic constipation and ribbon-like stools due to the narrowed segment of the colon. The stool may also be foul-smelling due to prolonged retention in the bowel.

Why Other Options are Wrong

"Currant jelly" stool: This describes stool associated with intussusception, not Hirschsprung's disease. It results from bowel telescoping, leading to mucosal injury and blood mixing with mucus.

Passage of foul-smelling, fatty stools: This describes steatorrhea, commonly seen in cystic fibrosis due to fat malabsorption, not Hirschsprung's disease.

Mucoid, bloody diarrhea: This could indicate infectious gastroenteritis or inflammatory bowel disease, not Hirschsprung's disease.

Summary:

In an infant with Hirschsprung's disease, the nurse would expect constipation with foul-smelling, ribbon-like stool due to the lack of proper bowel motility and obstruction of stool passage.

Correct Answer: B) Diabetes

Diabetes is a chronic condition where blood sugar regulation is impaired, requiring lifelong management.

Why Other Options are Wrong:

A: A sprained ankle is an acute injury and typically resolves with treatment within weeks.

C: A minor stomach virus is short-lived and is not a chronic condition.

D: Acute bronchitis is a short-term condition that generally resolves in a few weeks.

Summary:

Diabetes is a chronic condition, while the other conditions listed are typically acute and short-term.

Correct Answer: c) Blood accumulates between the periosteum and bone

Cephalhematoma occurs when blood accumulates between the periosteum and the bone, typically over the parietal bones or occasionally the occiput. It does not cross suture lines and usually becomes apparent after the soft tissue edema has subsided. It resolves gradually over several months.

Why Other Options are Wrong:

a) Swelling crosses suture lines:

This is incorrect. Cephalhematomas do not cross the suture lines; swelling caused by caput succedaneum (a different type of swelling) can cross suture lines.

b) Occurs immediately after birth:

While cephalhematomas may be visible shortly after birth, they are not evident immediately. They become apparent once soft-tissue edema begins to subside.

d) Typically resolves in a few days:

Cephalhematomas resolve over several months, not within a few days. They typically gradually decrease in size over time.

Summary:

Cephalhematomas are characterized by blood accumulation between the periosteum and bone, usually over the parietal bones or occiput. They do not cross suture lines and typically resolve gradually over several months after birth.

Correct Answer: C) A scissors gait

A scissors gait is a classic feature of spastic cerebral palsy, particularly in cases where the spasticity affects the muscles of the legs. In this gait, the legs cross over one another as the individual walks, resembling the action of scissors. This is due to tight adductors (inner thigh muscles) and a lack of coordination between the legs.

Spastic cerebral palsy is characterized by increased muscle tone (hypertonia) and exaggerated reflexes. The damage to the central nervous system (CNS) in spastic CP leads to abnormal muscle contraction patterns, resulting in stiffness and jerky movements.

Why Other Options are Wrong:

A) Athetoid movements:

Athetoid movements are characteristic of athetoid cerebral palsy, not spastic cerebral palsy. Athetoid CP involves involuntary, slow, writhing movements (often affecting the hands and feet). These movements are not a feature of spastic CP.

B) Intention tremor:

Intention tremor is typically associated with cerebellar damage, leading to tremors that occur during purposeful movement (e.g., reaching for an object). It is not characteristic of spastic cerebral palsy, which is more associated with hypertonia and stiffness rather than tremors.

D) A wide-based gait:

A wide-based gait is more commonly seen in individuals with ataxia or cerebellar disorders. It is characterized by a broad stance and difficulty maintaining balance. This is not typical of spastic CP, where the gait is more stiff and restricted due to muscle tightness.

Summary:

Spastic cerebral palsy, which occurs in over 70% of CP cases, is defined by muscle stiffness and exaggerated reflexes. A scissors gait, where the legs cross while walking, is a classic sign of spastic CP due to hypertonia in the leg muscles. The other options, such as athetoid movements, intention tremors, and a wide-based gait, are associated with different types of cerebral palsy or other neurological disorders.

Correct answer: C) Physical abuse

Physical abuse involves deliberate harm to a child's body, such as hitting, burning, or shaking.

Why Other Options are Wrong:

A: Neglect refers to the failure to provide for the child’s basic needs, such as food, shelter, and medical care.

B: Emotional abuse includes actions that harm a child's emotional or psychological well-being, such as verbal abuse or neglecting emotional needs.

D: Sexual abuse involves any sexual activity forced on or involving a child.

Summary:

Physical abuse is defined by the deliberate harm to a child’s body, while the other types of maltreatment involve different forms of harm or neglect.