👶🏼FINAL👶🏼 Flashcards
1
Q
A nurse is assessing a 2-year-old child during a wellness check-up. Which of the following growth patterns should the nurse expect?
A. Rapid growth in height and weight similar to infancy.
B. Slower physical growth compared to infancy, with increased independence and mobility.
C. Loss of weight as metabolism increases significantly.
D. Complete closure of fontanelles and cessation of head growth.
A
Answer: B
Rationale: Growth slows in the toddler years, with increasing independence and motor development. Weight gain is steady but not as rapid as in infancy.
2
Q
Which of the following is the best indicator of adequate growth in an infant?
A. Head circumference remains unchanged from birth.
B. Weight and height follow a consistent percentile on the growth chart.
C. Infant doubles birth weight by 6 months and triples it by 1 year.
D. Length increases by 12 inches in the first year.
A
Answer: C
Rationale: A healthy infant typically doubles birth weight by 6 months and triples it by 1 year, which is an important indicator of growth.
3
Q
A mother asks about the best nutrition for her 5-month-old infant. Which response by the nurse is appropriate?
A. “You should introduce cow’s milk now to increase calcium intake.”
B. “Exclusive breastfeeding or iron-fortified formula is recommended until 6 months of age.”
C. “Begin solid foods such as rice cereal, fruits, and vegetables at 3 months.”
D. “Give honey with formula to prevent constipation.”
A
Answer: B
Rationale: Exclusive breastfeeding or formula feeding is recommended until 6 months of age, after which solids can be introduced.
4
Q
The nurse is providing education to a new mother about childhood immunizations. Which statement requires further teaching?
A. “My baby should receive the first dose of the hepatitis B vaccine before discharge from the hospital.”
B. “Live vaccines should not be given to immunocompromised children.”
C. “If my child has a mild fever, I should skip the next vaccine dose.”
D. “The vaccine schedule is designed to protect my baby against serious illnesses.”
A
Answer: C
Rationale: Mild illness is not a contraindication to immunization. Vaccines should be administered on schedule to provide protection.
5
Q
Which toy is most appropriate for a 2-year-old child?
A. Small building blocks with intricate pieces.
B. Ride-on push toy.
C. Board game with small dice.
D. Video game console.
A
Answer: B
Rationale: Toddlers benefit from toys that encourage movement and gross motor skill development, such as push toys.
6
Q
A nurse is educating new parents on safe sleep practices to prevent sudden infant death syndrome (SIDS). Which statement indicates the need for further teaching?
A. “We will place our baby on their back to sleep.”
B. “We should avoid soft bedding and stuffed animals in the crib.”
C. “Co-sleeping is a safe way to keep our baby close at night.”
D. “A firm mattress with a fitted sheet is best for sleep safety.”
A
Answer: C
Rationale: Co-sleeping increases the risk of SIDS. Infants should sleep in their own crib or bassinet.
7
Q
The nurse is assessing the vital signs of a 3-year-old child. Which of the following would be expected findings?
A. HR 60 bpm, RR 12, BP 110/70
B. HR 100 bpm, RR 24, BP 90/60
C. HR 50 bpm, RR 30, BP 80/40
D. HR 130 bpm, RR 10, BP 120/80
A
Answer: B
Rationale: Normal heart rate for a toddler is 80-120 bpm, respiratory rate 20-30, and BP approximately 90/60.
8
Q
A nurse is assessing a child with respiratory distress. Which finding is most concerning?
A. Mild wheezing on expiration.
B. Nasal flaring and intercostal retractions.
C. Occasional dry cough.
D. Slight tachypnea but no cyanosis.
A
Answer: B
Rationale: Nasal flaring and retractions indicate increased work of breathing and worsening distress.
9
Q
A nurse is assessing a child diagnosed with cystic fibrosis. Which finding is characteristic of this condition?
A. Decreased sodium levels in sweat.
B. Thin, watery respiratory secretions.
C. Frequent respiratory infections and thick mucus production.
D. Hyperactive immune system with increased infections.
A
Answer: C
Rationale: Cystic fibrosis causes thickened mucus secretions leading to frequent infections
10
Q
A child with asthma is prescribed albuterol. The nurse understands that this medication works by:
A. Decreasing inflammation in the lungs.
B. Stabilizing mast cells to prevent histamine release.
C. Relaxing bronchial smooth muscles to improve airflow.
D. Suppressing the immune system to reduce airway hypersensitivity.
A
Answer: C
Rationale: Albuterol is a bronchodilator that relaxes airway muscles, improving airflow during an asthma exacerbation.
11
Q
A child with sickle cell anemia is admitted for a vaso-occlusive crisis. Which clinical manifestation should the nurse expect?
A. Hypertension and bradycardia.
B. Frequent bruising and petechiae.
C. Pallor and prolonged bleeding.
D. Severe joint pain and swelling.
A
Answer: D
Rationale: Vaso-occlusive crises cause severe pain and swelling due to blocked blood flow.
12
Q
Which laboratory result is most consistent with hemophilia?
A. Increased platelet count.
B. Prolonged partial thromboplastin time (PTT).
C. Decreased hemoglobin.
D. Increased white blood cell count.
A
Answer: B
Rationale: Hemophilia is characterized by prolonged PTT due to a deficiency in clotting factors.
13
Q
A child is diagnosed with aplastic anemia. Which diagnostic test confirms this condition?
A. Bone marrow biopsy.
B. Hemoglobin electrophoresis.
C. Reticulocyte count.
D. Serum iron level.
A
Answer: A
Rationale: Aplastic anemia is confirmed through a bone marrow biopsy, which reveals decreased production of all blood cell types.
14
Q
A nurse is educating parents on preventing iron-deficiency anemia in their toddler. Which recommendation is appropriate?
A. Increase intake of whole milk.
B. Offer iron-rich foods such as lean meats and fortified cereals.
C. Provide a diet high in calcium and vitamin D.
D. Limit intake of green leafy vegetables.
A
Answer: B
Rationale: Iron-rich foods help prevent iron-deficiency anemia in children.
15
Q
Which clinical finding is most consistent with Tetralogy of Fallot?
A. Bounding pulses in all extremities.
B. Harsh systolic murmur and cyanosis.
C. Widened pulse pressure and pallor.
D. Hypotension and bradycardia.
A
Answer: B
Rationale: Tetralogy of Fallot presents with cyanosis and a harsh systolic murmur due to its four cardiac defects.
16
Q
A child with congenital heart disease is being assessed. Which of the following should the nurse monitor closely?
A. Urine output and capillary refill time.
B. Deep tendon reflexes and pupillary response.
C. Skin temperature and bowel sounds.
D. Muscle tone and head circumference.
A
Answer: A
Rationale: Monitoring perfusion (urine output, capillary refill) helps assess the severity of heart disease.
17
Q
A nurse observes a child with Tetralogy of Fallot experiencing a hypercyanotic spell. What is the priority intervention?
A. Place the child in a knee-chest position.
B. Administer IV fluids immediately.
C. Perform chest compressions.
D. Obtain a chest X-ray.
A
Answer: A
Rationale: The knee-chest position increases systemic vascular resistance, reducing the severity of the cyanotic spell.
18
Q
A nurse is assessing a dehydrated infant. Which of the following findings would indicate severe dehydration?
A. Mildly sunken fontanelle, normal pulse, moist mucous membranes.
B. Capillary refill of 3 seconds, slightly dry mucous membranes, and normal heart rate.
C. Sunken fontanelle, tachycardia, and no tears when crying.
D. Increased urine output, flushed skin, and excessive thirst.
A
Answer: C
Rationale: Severe dehydration presents with sunken fontanelles, tachycardia, and an absence of tears.
19
Q
Which statement about Crohn’s disease and ulcerative colitis is correct?
A. Ulcerative colitis affects the entire gastrointestinal tract.
B. Crohn’s disease affects only the rectum and large intestine.
C. Crohn’s disease can affect any part of the GI tract, whereas ulcerative colitis is limited to the large intestine and rectum.
D. Both conditions have the same symptoms and require the same treatment.
A
Answer: C
Rationale: Crohn’s disease can occur anywhere in the GI tract, while ulcerative colitis is limited to the colon and rectum.
20
Q
A 3-week-old infant presents with projectile vomiting and a palpable olive-shaped mass in the right upper quadrant. The nurse suspects:
A. Pyloric stenosis.
B. Hirschsprung disease.
C. Intussusception.
D. Esophageal atresia.
A
Answer: A
Rationale: Pyloric stenosis presents with projectile vomiting and a palpable olive-shaped mass.
21
Q
Hirschsprung disease is best described as:
A. An absence of ganglion cells in the affected portion of the colon, leading to a megacolon.
B. An abnormal narrowing of the pylorus.
C. A telescoping of the bowel into itself.
D. A defect in the esophageal connection to the stomach.
A
Answer: A
Rationale: Hirschsprung disease results from missing ganglion cells in the colon, leading to obstruction.
22
Q
A toddler presents with fever, irritability, and foul-smelling urine. What should the nurse suspect?
A. Dehydration.
B. Urinary tract infection (UTI).
C. Appendicitis.
D. Gastroenteritis.
A
Answer: B
Rationale: UTIs in young children may present with fever, irritability, and foul-smelling urine.
23
Q
What labs are important for nephrotic syndrome?
A child with nephrotic syndrome is expected to have which abnormal laboratory result?
A. Increased albumin levels.
B. Decreased white blood cells.
C. Increased proteinuria.
D. Increased hemoglobin.
A
Answer: C
Rationale: Nephrotic syndrome is characterized by significant proteinuria.
24
Q
Which of the following is the most common cause of acute glomerulonephritis in children?
A. E. coli infection
B. Post-streptococcal infection
C. Viral meningitis
D. Severe dehydration
A
Answer: B
Rationale: Acute glomerulonephritis most often follows a streptococcal infection.
25
A child is having a tonic-clonic seizure in the hospital. What is the nurse’s priority action?
A. Restrain the child to prevent injury.
B. Place the child in a side-lying position and maintain airway patency.
C. Insert a tongue blade to prevent choking.
D. Hold the child upright to prevent aspiration.
Answer: B
Rationale: Positioning the child on their side helps maintain an open airway and prevents aspiration.
26
A child who sustained a head injury begins to have irregular respirations, hypertension, and bradycardia. What condition should the nurse suspect?
A. Concussion
B. Increased intracranial pressure (ICP)
C. Seizure disorder
D. Meningitis
Answer: B
Rationale: Irregular respirations, hypertension, and bradycardia indicate increased ICP.
27
What is the best clinical therapy and plan of care for cerebral palsy?
A child with cerebral palsy benefits most from:
A. Strict bed rest to prevent muscle contractions.
B. A multidisciplinary approach including physical therapy.
C. Minimal intervention to allow natural progression.
D. Only pharmacologic therapy.
Answer: B
28
How would you manage care and support an ADHD patient?
Which of the following interventions is most effective for managing ADHD in a school-aged child?
A. Providing a structured routine and minimizing distractions.
B. Allowing the child to self-regulate behaviors.
C. Increasing unstructured free time.
D. Avoiding pharmacologic interventions.
Answer: A
Rationale: Children with ADHD benefit from structure and reduced distractions.
29
A nurse is assessing a teenager with a recent history of trauma. The child presents with flashbacks, nightmares, and hypervigilance. Which condition does the nurse suspect?
A. Major depressive disorder
B. Post-Traumatic Stress Disorder (PTSD)
C. Bipolar disorder
D. Generalized anxiety disorder
Answer: B
Rationale: PTSD symptoms include flashbacks, nightmares, and hypervigilance.
30
The nurse is caring for an infant with Down Syndrome. Which associated health condition is most concerning?
A. Hypotonia
B. Congenital heart defects
C. Delayed speech development
D. Flattened facial features
Answer: B
Rationale: Congenital heart defects are common in children with Down Syndrome and require early medical intervention.
31
What are signs of Developmental Dysplasia of the Hip?
Which of the following findings is indicative of developmental dysplasia of the hip (DDH)?
A. Symmetrical gluteal folds.
B. Positive Barlow and Ortolani tests.
C. Normal range of motion in the hips.
D. Hyperextended knees.
Answer: B
Rationale: Positive Barlow and Ortolani tests indicate hip instability.
32
A child in a cast complains of severe pain unrelieved by medication, and the nurse notes pallor and decreased pulses. What should the nurse suspect?
A. Compartment syndrome.B. Normal healing.C. Sprain.D. Dislocation.
Answer: A
Rationale: Compartment syndrome is a medical emergency requiring immediate intervention.
33
What is a Pavlik harness?
The nurse is teaching a parent how to care for their infant in a Pavlik harness. Which statement by the parent indicates a need for further teaching?
A. "I should keep my baby's legs in a flexed, abducted position."
B. "I can remove the harness whenever my baby is fussy."
C. "I will check my baby’s skin under the straps daily."
D. "The harness helps to keep the hip joint in proper alignment."
Answer: B
Rationale: The Pavlik harness must be worn continuously to keep the hip in proper alignment.
34
Which instruction should the nurse give to the parents of a child with osteogenesis imperfecta?
A. Encourage high-impact activities to strengthen bones.
B. Increase calcium intake to cure the disease.
C. Avoid all physical activity to prevent injury.
D. Handle the child gently to prevent fractures.
Answer: D
Rationale: Children with OI have fragile bones, requiring careful handling. (Source: Chapter 29 Slide on OI Management)
35
A school-aged child presents with polyuria, polydipsia, polyphagia, and recent weight loss. The nurse should suspect:
A. Type 1 diabetes mellitusB. HypothyroidismC. Cystic fibrosisD. Celiac disease
Answer: A
Rationale: Type 1 diabetes presents with polyuria, polydipsia, polyphagia, and weight loss due to insulin deficiency.
36
What is the priority nursing intervention for a child in diabetic ketoacidosis (DKA)?
A child is admitted with DKA. What is the nurse’s immediate priority intervention?
A. Administer IV regular insulin infusion.
B. Monitor urine output hourly.
C. Begin rehydration with IV fluids.
D. Provide carbohydrate-rich foods.
Answer: C
Rationale: Rehydration with IV fluids is the first priority in treating DKA to correct dehydration and electrolyte imbalances.
37
What is the recommended HbA1c target for pediatric patients with type 1 diabetes?
According to the American Diabetes Association, what is the target HbA1c level for pediatric patients?
A. Less than 6.5%
B. Less than 9%
C. Less than 8.5%
D. Less than 7.5%
Answer: D
Rationale: The ADA recommends a target HbA1c of <7.5% to balance good glucose control while minimizing hypoglycemia risks.
38
How does exercise affect blood glucose levels in children with type 1 diabetes?
The nurse is educating a family about the impact of exercise on blood glucose levels. What should the nurse include?
A. Exercise decreases insulin sensitivity.B. Exercise increases insulin sensitivity and can lead to hypoglycemia.C. Exercise has no effect on blood glucose levels.D. Exercise increases blood glucose due to stress hormones.
Answer: B
Rationale: Exercise increases insulin sensitivity and may cause hypoglycemia, requiring carbohydrate intake adjustments.
39
What are the types of tinea infections and their clinical manifestations?
A child presents with a circular, scaly lesion with a raised border on their scalp. The nurse suspects:
A. Tinea capitis
B. Tinea corporis
C. Tinea pedis
D. Impetigo
Answer: A
Rationale: Tinea capitis presents as scaly, circular patches with hair loss, while tinea corporis affects the body.
40
How are burns classified by depth?
The nurse is assessing a child with a burn injury. Which of the following is characteristic of a deep partial-thickness burn?
A. Redness, pain, and intact skinB. Blisters, wet appearance, and intense painC. White, leathery skin with no painD. Eschar formation with absent pulses
Answer: B
Rationale: Deep partial-thickness burns present with blisters, moist appearance, and pain.
41
What is the emergency management of a severe burn?
A child suffers a severe burn. What is the nurse’s priority intervention?
A. Apply antibiotic ointment to the burn.B. Cover the burn with a clean, dry dressing.C. Break blisters to reduce swelling.D. Apply ice packs to the affected area.
Answer: B
Rationale: Covering a burn with a dry, clean dressing prevents contamination and helps maintain thermoregulation. (Source: Chapter 31 on Burn Management)
42
A nurse is assessing a 6-month-old infant during a routine check-up. Which of the following vital sign findings would require further evaluation?
A. HR: 120 bpm, RR: 30, BP: 85/50
B. HR: 90 bpm, RR: 15, BP: 70/40
C. HR: 140 bpm, RR: 35, BP: 80/45
D. HR: 110 bpm, RR: 28, BP: 75/50
Answer: B
Rationale: A normal heart rate for a 6-month-old infant is 100-160 bpm, respiratory rate 30-50 breaths per minute, and blood pressure around 70-100/40-60 mmHg. A heart rate of 90 bpm and a respiratory rate of 15 indicate bradycardia and respiratory depression, requiring further evaluation.
43
Which respiratory rate is expected for a sleeping 2-year-old toddler?
A. 10 breaths per minute
B. 55 breaths per minute
C. 40 breaths per minute
D. 24 breaths per minute
Answer: D
Rationale: The normal respiratory rate for a toddler (1-3 years) is 22-37 breaths per minute. A respiratory rate of 10 is too low, while rates above 40-50 may indicate respiratory distress.
44
A 10-year-old child is admitted for dehydration. Which of the following heart rates is within the expected range for this age group?
A. 50 bpm
B. 150 bpm
C. 125 bpm
D. 75 bpm
Answer: D
Rationale: The normal heart rate for a school-aged child (6-12 years) is 70-120 bpm. A rate of 50 is too low, and 150 is too high.
45
A nurse is checking the blood pressure of a 4-year-old child. Which of the following BP readings is within the normal range?
A. 80/40 mmHg
B. 110/70 mmHg
C. 90/50 mmHg
D. 130/80 mmHg
Answer: C
Rationale: The normal blood pressure range for a preschooler (3-5 years old) is 89-112/46-72 mmHg. A BP of 130/80 is too high, and 80/40 is too low for this age group.
46
Which of the following respiratory rates is considered abnormal for a newborn?
A. 30 breaths per minute
B. 40 breaths per minute
C. 50 breaths per minute
D. 70 breaths per minute
Answer: D
Rationale: The normal respiratory rate for a newborn (0-28 days) is 30-60 breaths per minute. A rate of 70 breaths per minute is too high and may indicate respiratory distress.
47
A nurse is performing a vital signs check on a 5-year-old child. Which of the following would be concerning?
A. HR: 95 bpm, RR: 22, BP: 100/60
B. HR: 110 bpm, RR: 25, BP: 90/55
C. HR: 130 bpm, RR: 45, BP: 85/50
D. HR: 80 bpm, RR: 20, BP: 95/65
Answer: C
Rationale: A normal HR for a 5-year-old is 80-120 bpm, RR 20-30 breaths per minute, and BP around 89-112/46-72 mmHg. A heart rate of 130 and RR of 45 are too high, indicating possible fever, dehydration, or distress.
48
A 3-year-old child is brought to the emergency room with a fever and dehydration. The nurse expects the child's heart rate to be:
A. 50 bpm
B. 70 bpm
C. 140 bpm
D. 200 bpm
Answer: C
Rationale: The normal heart rate for a toddler (1-3 years) is 98-140 bpm. A rate of 50 or 70 is too low, and 200 is dangerously high.
49
Which of the following blood pressure readings is expected for a 10-year-old child?
A. 60/30 mmHg
B. 80/40 mmHg
C. 100/60 mmHg
D. 140/90 mmHg
Answer: C
Rationale: The normal blood pressure for a school-aged child (6-12 years) is 97-115/57-76 mmHg. A BP of 60/30 or 80/40 is too low, while 140/90 is hypertensive for this age.
50
The nurse is monitoring a newborn immediately after birth. Which vital sign finding should be reported immediately?
A. HR: 150 bpm, RR: 50, BP: 65/40
B. HR: 110 bpm, RR: 35, BP: 70/45
C. HR: 80 bpm, RR: 20, BP: 55/30
D. HR: 140 bpm, RR: 60, BP: 75/50
Answer: C
Rationale: The normal HR for a newborn is 120-160 bpm, RR 30-60, and BP 60-80/40-50 mmHg. A heart rate of 80 and RR of 20 indicate bradycardia and respiratory distress, requiring immediate intervention.
51
A pediatric patient with Crohn's disease is experiencing abdominal pain, weight loss, and diarrhea. Which symptom would be most concerning to report to the healthcare provider?
A. Poor appetite
B. Non-bloody diarrhea
C. Severe fatigue and fever
D. Mild abdominal distension
Answer: C. Severe fatigue and fever
Rationale: Severe fatigue and fever may indicate complications such as an abscess or systemic infection, which require immediate medical attention. Non-bloody diarrhea and mild abdominal pain are common symptoms of Crohn's disease.
52
A 12-year-old child with Crohn's disease presents with stunted growth. Which factor is most likely contributing to this symptom?
A. Reduced physical activity
B. Chronic inflammation
C. Poor hydration
D. Frequent vomiting
Answer: B. Chronic inflammation
Rationale: Chronic inflammation in Crohn's disease can interfere with nutrient absorption and growth. It also increases the metabolic demand on the body, affecting growth in children.
53
A pediatric patient is newly diagnosed with ulcerative colitis. Which clinical manifestation would the nurse expect to see?
A. Non-bloody diarrhea with mucus
B. Bloody diarrhea with abdominal cramping
C. Severe constipation with weight gain
D. Foul-smelling fatty stools
Answer: B. Bloody diarrhea with abdominal cramping
Rationale: Ulcerative colitis typically involves inflammation of the colon and rectum, leading to bloody diarrhea and abdominal cramping. Fatty stools are more indicative of malabsorption disorders like Crohn's disease.
54
A 10-year-old child with ulcerative colitis reports ten bloody stools per day. What is the nurse's priority assessment?
A. Monitoring hemoglobin and hematocrit levels
B. Assessing for abdominal distension
C. Reviewing the child’s weight history
D. Evaluating the child’s oral intake
Answer: A. Monitoring hemoglobin and hematocrit levels
Rationale: Frequent bloody stools can lead to significant blood loss, increasing the risk of anemia. Monitoring hemoglobin and hematocrit is essential to identify and address anemia promptly.
55
A school nurse is assessing a 7-year-old child who presents with patchy hair loss, scaly pustular bald areas with indistinct margins, and black dotted stubbed hairs. The child complains of mild itching. Which of the following is the most likely diagnosis?
A) Seborrheic dermatitis
B) Tinea capitis
C) Alopecia areata
D) Impetigo
Correct Answer: B) Tinea capitis
Rationale:
Tinea capitis is a fungal infection of the scalp characterized by scaly pustular bald areas, broken hairs with a black-dotted appearance, and mild itching. Seborrheic dermatitis (A) presents with greasy scales but does not cause broken hairs. Alopecia areata (C) causes smooth, round patches of hair loss without scaling or broken hairs. Impetigo (D) typically presents with honey-colored crusted lesions rather than scaly pustules and hair loss.
56
A 9-year-old child presents with a large, purulent, tender, boggy mass on the scalp with drainage. The child also has broken hairs and mild itching. The healthcare provider suspects tinea capitis with a secondary bacterial infection. What is the most appropriate next step?
A) Treat with oral antifungal therapy and add antibiotics
B) Prescribe topical ketoconazole shampoo only
C) Administer a single-dose antifungal injection
D) Recommend over-the-counter antifungal cream
Correct Answer: A) Treat with oral antifungal therapy and add antibiotics.
Rationale:
Tinea capitis is treated with oral antifungal agents such as griseofulvin or terbinafine. If a kerion (large boggy purulent mass) is present, secondary bacterial infection is suspected, and antibiotics should be added to the treatment regimen. Topical ketoconazole shampoo (A) is used to reduce spores but is not sufficient as monotherapy. A single-dose antifungal injection (C) is not a standard treatment for tinea capitis. Over-the-counter antifungal creams (D) are ineffective because tinea capitis requires systemic treatment.
57
A 5-year-old child has been diagnosed with tinea capitis. The nurse is educating the parents about the prescribed treatment plan. Which statement by the parent indicates a need for further teaching?
A) "My child will need to take oral griseofulvin for at least 8 weeks."
B) "I should apply antifungal cream directly to the scalp daily."
C) "Everyone in the household should use selenium sulfide shampoo 2–3 times a week."
D) "My child should take the oral antifungal medication with fatty foods to improve absorption."
Correct Answer: B) "I should apply antifungal cream directly to the scalp daily."
Rationale:
Tinea capitis requires systemic treatment with oral antifungals (e.g., griseofulvin for 8–12 weeks or terbinafine for 6 weeks in children over 4 years). Antifungal creams (B) are ineffective for scalp infections and are not part of the recommended therapy. Household members should use selenium sulfide shampoo to reduce fungal spores (C). Oral griseofulvin should be taken with fatty foods (D) to enhance absorption.
58
A 10-year-old child presents with a circular pink, scaly lesion with an expanding border and central clearing on the trunk. The nurse understands that the child most likely acquired this condition from:
A) A bacterial skin infection
B) An allergic reaction
C) Contact with an infected pet, person, or contaminated object
D) Poor hygiene
Correct Answer: C) Contact with an infected pet, person, or contaminated object
Rationale:
Tinea corporis (ringworm) is a fungal infection of the trunk often acquired through contact with an infected human, animal, or contaminated objects like hats or clothing. It presents as a circular, scaly lesion with an expanding border and central clearing. Bacterial infections (A) usually present with erythema and pus, not a scaly annular lesion. Allergic reactions (B) cause diffuse rashes rather than ring-like lesions. Poor hygiene (D) is not a primary cause of tinea corporis.
59
Which of the following findings would be most consistent with tinea corporis?
A) Erythematous patches with honey-colored crusting
B) Lichenification and excoriations from chronic itching
C) Vesicular lesions on the hands and feet
D) A pink, scaly, annular lesion with a raised border and central clearing
Correct Answer: D) A pink, scaly, annular lesion with a raised border and central clearing
Rationale:
Tinea corporis is characterized by a pink, scaly, circular lesion with a raised border and a central clearing. Honey-colored crusting (A) is associated with impetigo. Vesicular lesions on the hands and feet (C) may indicate hand-foot-mouth disease or dyshidrotic eczema. Lichenification and excoriations (D) occur in chronic skin conditions like atopic dermatitis.
60
The nurse is providing discharge instructions to a parent of a child diagnosed with tinea corporis. Which statement by the parent indicates a correct understanding of the treatment plan?
A) "I should apply the antifungal cream twice a day for at least 4 weeks, even if the rash looks better."
B) "A topical corticosteroid will help with the itching and speed up healing."
C) "My child should avoid bathing until the infection resolves completely."
D) "Oral antifungal medication is the first-line treatment for this condition."
Correct Answer: A) "I should apply the antifungal cream twice a day for at least 4 weeks, even if the rash looks better."
Rationale:
Tinea corporis is treated with topical antifungal agents (e.g., clotrimazole, miconazole, terbinafine) applied twice daily for 4–6 weeks. The treatment should continue even after the rash improves to prevent recurrence. Corticosteroids (B) should not be used as they can worsen fungal infections. Bathing (C) is not contraindicated; good hygiene is important. Oral antifungal medication (D) is only used for cases resistant to topical therapy.
61
A parent brings their 8-year-old child to the clinic for evaluation of a skin lesion. The nurse observes a pink, scaly circular patch with a slightly raised border and a clearing center on the child's arm. The parent reports that the child recently adopted a kitten. Based on these findings, which condition does the nurse suspect?
A) Eczema
B) Tinea corporis
C) Contact dermatitis
D) Psoriasis
Correct Answer: B) Tinea corporis
Rationale:
Tinea corporis presents as a pink, scaly, circular lesion with a raised border and central clearing, commonly transmitted through contact with infected animals, people, or contaminated objects. Eczema (A) causes dry, itchy skin without a defined ring. Contact dermatitis (C) is usually a localized allergic reaction without an annular shape. Psoriasis (D) is characterized by thick, silvery scales, not a clearing center.
62
The school nurse assesses a 7-year-old child with a new skin lesion on the trunk. The lesion is pink, scaly, annular with a raised border and central clearing. The child denies pain but states mild itching. Which of the following clinical signs is most indicative of tinea corporis?
A) A honey-colored crusted lesion
B) Thick, scaly plaques with silvery scales
C) A circular lesion with raised borders and central clearing
D) Red, maculopapular rash with blisters
Correct Answer: C) A circular lesion with raised borders and central clearing
Rationale:
Tinea corporis presents as an annular lesion with a raised, scaly border and a clearing center. A honey-colored crusted lesion (A) suggests impetigo. Thick, silvery scales (C) indicate psoriasis. A red maculopapular rash with blisters (D) is more characteristic of allergic reactions or viral exanthems.
63
A 13-year-old male presents with complaints of an itchy rash in his groin area that has spread to his upper thighs. On examination, the nurse notes erythematous, scaly, annular lesions with slightly elevated borders. The penis and scrotum are unaffected. What is the most likely diagnosis?
A) Contact dermatitis
B) Tinea cruris
C) Candidiasis
D) Psoriasis
Correct Answer: B) Tinea cruris
Rationale:
Tinea cruris (jock itch) is a fungal infection affecting the groin and inner thighs but typically sparing the penis and scrotum. Contact dermatitis (A) would present with well-defined erythema due to an irritant or allergen exposure. Candidiasis (C) is usually seen in moist, occluded areas and may involve the scrotum. Psoriasis (D) may affect the groin but typically presents as thick plaques with silvery scales.
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A high school athlete visits the clinic complaining of an itchy, red rash in the groin area for the past two weeks. The nurse observes scaly, erythematous annular lesions extending to the upper thighs but sparing the penis and scrotum. What symptom is the patient most likely to report?
A) Pruritus (itching)
B) Burning pain
C) Oozing blisters
D) Painful pustules
Correct Answer: A) Pruritus (itching)
Rationale:
Tinea cruris causes significant itching in the groin and upper thigh area. Burning pain (A) is more associated with irritant dermatitis. Oozing blisters (C) are not typical of tinea infections and suggest a different condition, such as impetigo or a bacterial infection. Painful pustules (D) are not a key feature of tinea cruris.
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A 15-year-old soccer player presents with red, scaly patches on the soles of both feet, along with fissures between the toes. The nurse knows that this type of fungal infection is most commonly contracted from:
A) Direct skin-to-skin contact
B) Walking barefoot in locker rooms and public showers
C) Exposure to contaminated soil
D) A diet high in sugar and carbohydrates
Correct Answer: B) Walking barefoot in locker rooms and public showers
Rationale:
Tinea pedis is commonly acquired from warm, moist environments such as locker rooms, public showers, and swimming pools. Direct skin-to-skin contact (A) is more relevant for tinea corporis. Exposure to contaminated soil (C) is a risk factor for certain fungal infections but not for athlete’s foot. A high-sugar diet (D) does not cause tinea pedis.
66
The nurse is assessing a child with suspected tinea pedis. Which of the following clinical signs is most characteristic of this condition?
A) Thickened, discolored toenails
B) Dry, scaly plaques with silvery scales on the soles
C) Honey-colored crusted lesions on the foot
D) Vesicles, fissures, and peeling between the toes
Correct Answer: D) Vesicles, fissures, and peeling between the toes
Rationale:
Tinea pedis presents with fissures, peeling, and vesicles in the web spaces of the toes. Thickened, discolored toenails (A) are indicative of onychomycosis (nail fungus). Honey-colored crusted lesions (C) are characteristic of impetigo. Dry, silvery plaques (D) suggest psoriasis rather than tinea pedis.
67
A pediatric nurse is assessing a 10-year-old child with suspected hypothyroidism. Which of the following clinical findings would the nurse expect to observe?
A) Tachycardia, weight loss, heat intolerance
B) Cold intolerance, bradycardia, constipation
C) Increased energy, frequent bowel movements, excessive sweating
D) Hypertension, exophthalmos, smooth skin
Correct Answer: B) Cold intolerance, bradycardia, constipation
Rationale:
Hypothyroidism is characterized by decreased thyroid hormone levels, leading to cold intolerance, bradycardia (slow heart rate), constipation, fatigue, weight gain, and dry skin due to a slowed metabolic rate.
67
A 12-year-old child presents with increased sweating, weight loss despite a good appetite, and difficulty sleeping. Upon assessment, the nurse notes tachycardia and exophthalmos. Which condition does the nurse suspect?
A) Hypothyroidism
B) Diabetes Mellitus
C) Hyperthyroidism
D) Cushing’s Syndrome
Correct Answer: C) Hyperthyroidism
Rationale:
Hyperthyroidism results from excessive thyroid hormone production, leading to tachycardia, weight loss, heat intolerance, irritability, hyperactivity, and exophthalmos (protruding eyes).
68
The nurse is educating parents of a child diagnosed with growth hormone deficiency (GHD). Which statement by the parents indicates an understanding of the treatment?
A) “Growth hormone therapy will help improve our child’s muscle coordination but will not affect height.”
B) “The treatment will only work if given in high doses for a short period of time.”
C) “Growth hormone therapy will promote normal height development if started early.”
D) “Once our child stops growing, we can restart growth hormone therapy later in adulthood.”
Correct Answer: C) “Growth hormone therapy will promote normal height development if started early.”
Rationale:
Growth hormone therapy is given to stimulate normal growth and development in children with GHD. Treatment is most effective when initiated early in childhood before the epiphyseal (growth) plates close.
69
A nurse is teaching a family about administering growth hormone injections to their child. Which of the following statements indicates a need for further teaching?
A) “We will give the injection subcutaneously at bedtime.”
B) “If our child skips a dose, we should double the next dose to catch up.”
C) “We understand that this medication will be needed for several years until growth is complete.”
D) “We should monitor our child for signs of headaches, joint pain, or problems with blood sugar.”
Correct Answer: B) “If our child skips a dose, we should double the next dose to catch up.”
Rationale:
Growth hormone therapy is administered subcutaneously at bedtime (A) to mimic natural hormone secretion. Treatment is long-term (C) and requires monitoring for side effects such as headaches, joint pain, or glucose intolerance (D). Doubling the dose (B) is incorrect because it can cause adverse effects and hormone imbalances. If a dose is missed, the child should continue with the regular schedule.
70
A nurse is reviewing the differences between diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone (SIADH) with a nursing student. Which of the following statements made by the student indicates a correct understanding?
A) “Both conditions cause excessive urination and dehydration.”
B) “In diabetes insipidus, there is decreased urine output and fluid retention.”
C) “SIADH leads to excessive water retention, causing dilutional hyponatremia.”
D) “Diabetes insipidus is caused by an overproduction of antidiuretic hormone (ADH).”
Correct Answer: C) “SIADH leads to excessive water retention, causing dilutional hyponatremia.”
Rationale:
SIADH (syndrome of inappropriate antidiuretic hormone) causes excessive secretion of ADH, leading to water retention, fluid overload, and dilutional hyponatremia. Diabetes insipidus (DI) is the opposite, characterized by a deficiency of ADH, leading to excessive urination (polyuria) and dehydration.
71
A nurse is caring for two pediatric patients—one with diabetes insipidus (DI) and one with syndrome of inappropriate antidiuretic hormone (SIADH). Which clinical findings would the nurse expect to observe in each condition?
A) DI: High urine output, hypernatremia; SIADH: Low urine output, hyponatremia
B) DI: Low urine output, hyponatremia; SIADH: High urine output, hypernatremia
C) DI: Fluid overload, hyponatremia; SIADH: Dehydration, hypernatremia
D) DI: Edema, increased thirst; SIADH: Low urine osmolality, hypernatremia
Correct Answer: A) DI: High urine output, hypernatremia; SIADH: Low urine output, hyponatremia
Rationale:
Diabetes insipidus (DI) causes high urine output (polyuria), dehydration, and hypernatremia because the kidneys cannot retain water due to low ADH levels.
SIADH causes low urine output, water retention, and dilutional hyponatremia due to excessive ADH secretion.
Choices B, C, and D contain incorrect pairings. DI does not cause low urine output (B), fluid overload (C), or edema (D).
72
A 2-month-old infant is diagnosed with Tetralogy of Fallot (TOF). The mother reports that the baby turns blue when crying or feeding.
Question 5: Hypercyanotic Spells
What should the nurse do first when the baby has a "tet spell"?
A) Place the baby in a knee-chest position
B) Start high-flow oxygen via non-rebreather mask
C) Administer IV fluids immediately
D) Call for emergency intubation
Correct Answer: A) Place the baby in a knee-chest position
Rationale:
A hypercyanotic spell ("tet spell") causes severe hypoxia. The knee-chest position increases systemic vascular resistance, reducing right-to-left shunting. High-flow oxygen (B) is helpful but not the first step. IV fluids (C) help but are not immediate. Intubation (D) is only needed if cyanosis does not improve.
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Weight: 14.5 lbs (birth weight was 7 lbs)
Length: 26 inches
Head circumference: 17 inches
The parent states, “I’ve been introducing some solid foods, but I still mostly breastfeed.”
Question 1: Growth Patterns
Which of the following statements by the nurse accurately reflects the expected growth pattern for a 6-month-old infant?
A) "Your baby’s weight gain is concerning, as it should be much lower than this."
B) "It is normal for infants to triple their birth weight by 6 months."
C) "Your baby's growth is appropriate, as infants typically double their birth weight by 6 months."
D) "At this age, weight gain slows down significantly, and your baby should only gain a few pounds in the first year."
Correct Answer: C) "Your baby's growth is appropriate, as infants typically double their birth weight by 6 months."
Rationale:
By 6 months, an infant should double their birth weight. By 12 months, they should triple their birth weight.
72
A 5-year-old child with a history of asthma is brought to the ER with tachypnea, nasal flaring, and intercostal retractions. The child is speaking in short phrases and has an oxygen saturation of 89%. The parent states that the child’s inhaler has not been effective.
Question 3: Recognizing Respiratory Distress
What is the priority nursing intervention?
A) Administer albuterol via metered-dose inhaler (MDI) with a spacer
B) Apply a cool mist humidifier and encourage fluids
C) Administer nebulized albuterol and systemic corticosteroids
D) Obtain a chest X-ray before initiating treatment
Correct Answer: C) Administer nebulized albuterol and systemic corticosteroids
Rationale:
The child is showing severe respiratory distress (nasal flaring, intercostal retractions, low O2 saturation, and difficulty speaking). Nebulized albuterol (bronchodilator) and corticosteroids (reduce inflammation) are the priority treatments.
73
The parent asks the nurse about introducing new foods. Which response by the nurse is most appropriate?
A) "You should start giving your baby whole cow’s milk now."
B) "Continue breastfeeding, but start introducing iron-fortified cereals and pureed vegetables."
C) "At this age, you should start introducing honey and peanut butter."
D) "You can introduce any solid foods now, as long as they are soft."
Correct Answer: B) "Continue breastfeeding, but start introducing iron-fortified cereals and pureed vegetables."
Rationale:
Breastfeeding should continue while introducing iron-fortified cereals and pureed fruits/vegetables at 6 months. Whole cow’s milk (A) should not be introduced until after 12 months due to risk of anemia. Honey (C) should be avoided due to botulism risk. Soft foods (D) are not appropriate without considering potential allergens and choking hazards.
73
The nurse educates the parent about asthma medications. Which statement indicates correct understanding?
A) "I should give albuterol every day to prevent asthma attacks."
B) "My child should rinse their mouth after using a corticosteroid inhaler."
C) "A peak flow meter is not necessary unless my child is in the hospital."
D) "Oral corticosteroids should be used before exercise to prevent symptoms."
Correct Answer: B) "My child should rinse their mouth after using a corticosteroid inhaler."
Rationale:
Inhaled corticosteroids (e.g., fluticasone) can cause oral thrush; rinsing the mouth prevents this. Albuterol (A) is a rescue medication, not for daily use. A peak flow meter (C) should be used at home to monitor asthma control. Oral corticosteroids (D) are for acute exacerbations, not prevention.
74
Which clinical manifestations would the nurse expect in an infant with Tetralogy of Fallot?
A) Bounding peripheral pulses and hypertension
B) Weak pulses and cold extremities
C) Cyanosis, clubbing, and systolic murmur
D) Wide pulse pressure and bradycardia
Correct Answer: C) Cyanosis, clubbing, and systolic murmur
Rationale:
TOF consists of four defects: pulmonary stenosis, right ventricular hypertrophy, overriding aorta, and VSD. Cyanosis, clubbing (late sign), and a harsh systolic murmur are expected. Bounding pulses (A) suggest PDA, and weak pulses (B) suggest coarctation of the aorta. Wide pulse pressure (D) occurs with aortic insufficiency.
75
The nurse is educating the family on ways to prevent sickle cell crises. Which statement by the parent indicates a need for further teaching?
A) "We will ensure our child drinks plenty of fluids daily."
B) "It’s okay for my child to play sports in cold weather as long as they rest often."
C) "We should avoid high-altitude travel to prevent complications."
D) "Our child should receive all routine vaccinations, including the pneumococcal vaccine."
Correct Answer: B) "It’s okay for my child to play sports in cold weather as long as they rest often."
Rationale:
Children with sickle cell disease should avoid cold exposure because it can trigger vaso-occlusion and a crisis.
76
A 4-week-old infant is brought to the clinic with projectile vomiting after feedings, weight loss, and decreased urine output. The nurse palpates a firm, olive-shaped mass in the right upper quadrant.
Question 11: Recognizing Pyloric Stenosis
What additional finding would the nurse expect in this infant?
A) Bloody stools and severe diarrhea
B) Metabolic alkalosis and hypokalemia
C) Increased urine output and fever
D) Hyperactive bowel sounds and diarrhea
Correct Answer: B) Metabolic alkalosis and hypokalemia
Rationale:
Pyloric stenosis leads to severe vomiting, causing loss of stomach acid, resulting in metabolic alkalosis and hypokalemia (low potassium).
77
The child receives insulin therapy for DKA. Later, the nurse notices the child is diaphoretic, shaky, and confused. What should the nurse do first?
A) Administer 15g of oral glucose (juice or glucose gel)
B) Give an immediate IV push of dextrose 50%
C) Encourage the child to take deep breaths
D) Notify the provider before intervening
Correct Answer: A) Administer 15g of oral glucose (juice or glucose gel)
Rationale:
The child is experiencing hypoglycemia (diaphoresis, shaking, confusion). Oral glucose (A) is the first-line treatment if the child is conscious. IV dextrose (B) is reserved for severe cases or unconscious patients. Deep breaths (C) do not address the cause. Delaying intervention (D) can worsen hypoglycemia.
77
A 14-year-old with type 1 diabetes arrives at the ER with deep, rapid breathing (Kussmaul respirations), fruity breath odor, and altered mental status. Labs show blood glucose of 550 mg/dL and pH of 7.1.
Question 15: Priority Treatment for DKA
What is the first nursing intervention?
A) Administer IV normal saline (0.9% NaCl) bolus
B) Administer IV insulin immediately
C) Give an oral glucose solution
D) Place the child in Trendelenburg position
Correct Answer: A) Administer IV normal saline (0.9% NaCl) bolus
Rationale:
The priority in DKA is fluid resuscitation (IV normal saline) to correct dehydration. IV insulin (B) is started after fluid replacement to prevent cerebral edema. Oral glucose (C) is not used in hyperglycemia. Trendelenburg position (D) is not appropriate.
78
A 2-year-old girl is brought to the clinic by her mother with complaints of fever, irritability, and foul-smelling urine. The mother reports that the child has been urinating more frequently and crying during diaper changes.
Question 17: Recognizing UTI Symptoms in Pediatrics
Which additional finding would most concern the nurse?
A) Abdominal tenderness and vomiting
B) Slightly decreased urine output but no other symptoms
C) Fever of 99.5°F and a mild rash
D) A history of recent constipation
Correct Answer: A) Abdominal tenderness and vomiting
Rationale:
Abdominal tenderness and vomiting suggest pyelonephritis (kidney infection), a severe UTI complication. UTIs in young children often present with fever, irritability, and foul-smelling urine.
79
A 4-month-old infant is brought in for a routine well-baby checkup. During the assessment, the nurse notices asymmetric gluteal folds and a positive Ortolani test (a "clunk" when the hip is reduced into the socket).
Question 19: Expected Findings in DDH
Which additional finding would the nurse expect in an infant with developmental dysplasia of the hip (DDH)?
A) Toe-walking and in-toeing gait
B) Limited hip abduction and leg length discrepancy
C) Hyperflexibility of all joints
D) Bowed legs that resolve with age
Correct Answer: B) Limited hip abduction and leg length discrepancy
Rationale:
DDH is characterized by limited hip abduction, leg length discrepancy, and asymmetrical gluteal folds. Toe-walking (A) occurs with neuromuscular disorders. Hyperflexibility (C) is more common in connective tissue disorders like Ehlers-Danlos. Bowed legs (D) are normal in infants but not related to DDH.
80
Which intervention is most appropriate for a 4-month-old with confirmed DDH?
A) Pavlik harness
B) Serial casting
C) Surgical open reduction
D) Bracing until age 3
Rationale:
The Pavlik harness is the first-line treatment for infants under 6 months with DDH, keeping the hips in abduction. Serial casting (B) is used for clubfoot. Surgical reduction (C) is reserved for severe or older cases (over 6 months). Bracing (D) is not standard DDH treatment.
81
A 3-year-old is being evaluated for persistent high blood pressure. Upon assessment, the nurse notes bounding pulses in the upper extremities and weak femoral pulses in the lower extremities.
Question 21: Recognizing Coarctation of the Aorta (COA)
Which additional finding would the nurse expect?
A) Continuous "machine-like" murmur
B) Cyanosis of the lips and fingers
C) Decreased blood pressure in the legs
D) Splenomegaly and jaundice
Correct Answer: C) Decreased blood pressure in the legs
Rationale:
COA is a narrowing of the aorta that leads to higher BP in the upper body and lower BP in the legs. A machine-like murmur (A) is seen in PDA. Cyanosis (B) suggests a different congenital defect like TOF. Splenomegaly and jaundice (D) are seen in hematologic disorders.
82
The child undergoes surgical repair for COA. What is the priority nursing intervention postoperatively?
A) Encourage early ambulation
B) Monitor blood pressure closely
C) Limit fluid intake
D) Teach parents about a lifelong low-sodium diet
Correct Answer: B) Monitor blood pressure closely
Rationale:
Postoperative hypertension is common after COA repair. BP monitoring (B) is critical. Early ambulation (A) is important but not the priority. Fluid restriction (C) is not usually required. A low-sodium diet (D) is not lifelong but may be recommended for hypertension management.
83
A 4-year-old child is brought to a developmental specialist due to lack of eye contact, minimal speech, and repetitive hand flapping. The parent reports the child becomes distressed by changes in routine.
Question 23: Recognizing Autism Spectrum Disorder (ASD)
Which intervention is most appropriate when providing care for this child?
A) Encourage participation in large group activities
B) Use a structured routine and minimize environmental changes
C) Punish self-stimulatory behaviors (e.g., hand flapping)
D) Engage the child in forced eye contact during communication
Correct Answer: B) Use a structured routine and minimize environmental changes
Rationale:
Children with ASD benefit from structured routines and low-stimulation environments. Large groups (A) may overwhelm them. Punishing self-stimulatory behaviors (C) is inappropriate. Forcing eye contact (D) may cause distress.
84
The parent asks about improving communication with their child. What should the nurse recommend?
A) Speaking loudly and using long sentences
B) Using picture communication or sign language
C) Encouraging the child to respond in full sentences
D) Isolating the child to reduce sensory triggers
Rationale:
Children with ASD often benefit from alternative communication methods, such as picture boards or sign language. Loud speech (A) may be distressing. Full sentences (C) may be difficult. Isolation (D) is not appropriate.
