PEDS EXAM 2

Question 1

A child with systemic lupus erythematosus (SLE) presents with fatigue, a butterfly-shaped rash, and joint pain. What is the most important lab to monitor?

A) Hemoglobin and hematocrit
B) Anti-nuclear antibodies (ANA)
C) Creatinine and urine protein
D) Platelet count

Answer 1

Answer: C) Creatinine and urine protein
Rationale: Kidney involvement is common in SLE. Monitoring renal function is critical for early detection of lupus nephritis.

Question 2

What is a priority nursing intervention for a child with systemic lupus erythematosus during an acute flare?

A) Administer corticosteroids as prescribed
B) Encourage participation in physical activities
C) Limit fluid intake
D) Administer antibiotics prophylactically

Answer 2

Answer: A) Administer corticosteroids as prescribed
Rationale: Corticosteroids help reduce inflammation during acute flares of SLE.

Question 3

Which teaching is appropriate for a family of a child with juvenile idiopathic arthritis (JIA)?

A) Apply ice packs to affected joints
B) Administer NSAIDs as prescribed
C) Avoid physical activity to prevent pain
D) Limit fluid intake

Answer 3

Answer: B) Administer NSAIDs as prescribed
Rationale: NSAIDs are the first line of treatment for inflammation and pain in JIA.

Question 4

Which complication is most concerning in a child with JIA starting methotrexate?

A) Weight gain
B) Photosensitivity
C) Risk for infection
D) Insomnia

Answer 4

Answer: C) Risk for infection
Rationale: Methotrexate suppresses the immune system, increasing the child’s susceptibility to infections.

Question 5

A child experiencing anaphylaxis after a bee sting has hypotension and stridor. What is the priority intervention?

A) Administer epinephrine IM
B) Start oxygen therapy
C) Place the child in a Trendelenburg position
D) Administer an antihistamine

Answer 5

Answer: A) Administer epinephrine IM
Rationale: Epinephrine is the first-line treatment for anaphylaxis as it reduces airway swelling and reverses hypotension.

Question 6

Which clinical manifestation is most indicative of leukemia in a child?

A) Generalized petechiae and fatigue
B) Bradycardia and weight gain
C) Hypertension and joint pain
D) Skin rash and blurred vision

Answer 6

Answer: A) Generalized petechiae and fatigue
Rationale: Petechiae indicate thrombocytopenia, and fatigue is common due to anemia, both hallmark findings in leukemia.

Question 7

What is the priority action for a child diagnosed with Disseminated Intravascular Coagulation (DIC)?

A) Administer fresh frozen plasma (FFP)
B) Encourage physical activity
C) Restrict fluids
D) Initiate broad-spectrum antibiotics

Answer 7

Answer: A) Administer fresh frozen plasma (FFP)
Rationale: FFP replaces clotting factors consumed in DIC.

Question 8

A child with immune thrombocytopenia (ITP) should avoid which activity?

A) Swimming
B) Contact sports
C) Watching TV
D) Eating citrus fruits

Answer 8

Answer: B) Contact sports
Rationale: Activities that increase the risk of bleeding should be avoided due to low platelet counts in ITP.

Question 9

Which lab result would the nurse anticipate in a child with von Willebrand’s disease?

A) Decreased white blood cell count
B) Prolonged activated partial thromboplastin time (aPTT)
C) Elevated D-dimer levels
D) Decreased hematocrit

Answer 9

Answer: B) Prolonged activated partial thromboplastin time (aPTT)
Rationale: von Willebrand’s disease affects clotting, leading to prolonged aPTT.

Question 10

What is the primary treatment for a bleeding episode in a child with hemophilia A?

A) Platelet transfusion
B) Desmopressin (DDAVP)
C) Factor VIII replacement therapy
D) Vitamin K injection

Answer 10

Answer: C) Factor VIII replacement therapy
Rationale: Hemophilia A results from a deficiency in factor VIII, which is replaced during bleeding episodes.

Question 11

A child with beta-thalassemia requires frequent blood transfusions. What complication should the nurse monitor for?

A) Hyperkalemia
B) Iron overload
C) Leukopenia
D) Dehydration

Answer 11

Answer: B) Iron overload
Rationale: Frequent transfusions can cause iron accumulation, requiring chelation therapy.

Question 12

Which clinical finding is consistent with aplastic anemia?

A) Elevated platelet count
B) Pancytopenia
C) Elevated reticulocyte count
D) Hemolysis

Answer 12

Answer: B) Pancytopenia
Rationale: Pancytopenia (low counts of all blood cells) is a hallmark of aplastic anemia.

Question 13

A child with sickle cell anemia presents with severe pain and swelling in the hands and feet. What is the priority intervention?

A) Administer IV fluids
B) Apply cold compresses
C) Restrict physical activity
D) Administer aspirin

Answer 13

Answer: A) Administer IV fluids
Rationale: IV fluids reduce blood viscosity and help alleviate symptoms of a vaso-occlusive crisis.

Question 14

What should the nurse teach parents about preventing vaso-occlusive crises in a child with sickle cell anemia?

A) Increase physical activity
B) Keep the child well-hydrated
C) Administer high-protein meals
D) Limit vaccinations

Answer 14

Answer: B) Keep the child well-hydrated
Rationale: Adequate hydration helps prevent sickling of red blood cells.

Question 15

What dietary recommendation is appropriate for a child with iron deficiency anemia?

A) Increase intake of calcium-rich foods
B) Provide vitamin C-rich foods with iron supplements
C) Avoid green leafy vegetables
D) Limit protein-rich foods

Answer 15

Answer: B) Provide vitamin C-rich foods with iron supplements
Rationale: Vitamin C enhances iron absorption.

Question 16

What is a hallmark early sign of increased intracranial pressure in an infant?

A) Sunken fontanel
B) High-pitched cry
C) Decreased respiratory rate
D) Hypertension

Answer 16

Answer: B) High-pitched cry
Rationale: A high-pitched cry is an early sign of increased intracranial pressure in infants due to the pressure on the brain.

Question 17

A child presents postoperatively after a ventriculoperitoneal (VP) shunt placement for hydrocephalus. What is the most important nursing assessment?

A) Monitor for nausea and vomiting
B) Assess for signs of shunt infection or malfunction
C) Measure blood glucose levels
D) Assess skin for rash

Answer 17

Answer: B) Assess for signs of shunt infection or malfunction
Rationale: Infection or malfunction of the VP shunt can lead to increased intracranial pressure and requires immediate attention.

Question 18

What is the priority nursing goal for a neonate diagnosed with myelomeningocele prior to surgery?

A) Prevent infection by keeping the sac moist and sterile
B) Monitor for signs of increased intracranial pressure
C) Encourage breastfeeding immediately after birth
D) Perform range-of-motion exercises

Answer 18

Answer: A) Prevent infection by keeping the sac moist and sterile
Rationale: Preventing infection is the primary goal before surgical closure of the myelomeningocele.

Question 19

A child with pyloric stenosis is experiencing excessive vomiting. What electrolyte imbalance should the nurse monitor for?

A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia

Answer 19

Answer: B) Hypokalemia
Rationale: Vomiting leads to the loss of potassium, resulting in hypokalemia.

Question 20

What is the classic symptom of intussusception in a child?

A) Currant jelly-like stools
B) Projectile vomiting
C) Severe constipation
D) Bilious vomiting

Answer 20

Answer: A) Currant jelly-like stools
Rationale: Currant jelly-like stools result from blood and mucus in the stool, a hallmark symptom of intussusception.

Question 21

A child with suspected appendicitis complains of pain in the lower right abdomen. The nurse knows to monitor for which life-threatening complication?

A) Intestinal obstruction
B) Peritonitis from a ruptured appendix
C) Internal hemorrhage
D) Sepsis from UTI

Answer 21

Answer: B) Peritonitis from a ruptured appendix
Rationale: A ruptured appendix can lead to peritonitis, which is a medical emergency.

Question 22

What is a common clinical manifestation of glomerulonephritis?

A) Polyuria and weight loss
B) Hematuria and periorbital edema
C) Proteinuria and hyperkalemia
D) Bradycardia and jaundice

Answer 22

Answer: B) Hematuria and periorbital edema
Rationale: Glomerulonephritis often presents with blood in the urine and facial swelling.

Question 23

In nephrotic syndrome, which laboratory finding would the nurse expect?

A) Decreased serum albumin
B) Increased hemoglobin
C) Elevated white blood cells
D) Increased platelet count

Answer 23

Answer: A) Decreased serum albumin
Rationale: Hypoalbuminemia is common due to significant protein loss in the urine.

Question 24

A 4-year-old child with bacterial meningitis is admitted to the pediatric unit. What is the priority intervention?

A) Administer prescribed antibiotics immediately
B) Place the child in a prone position
C) Initiate droplet precautions
D) Administer IV fluids

Answer 24

Rationale: Early antibiotic therapy is crucial in treating bacterial meningitis to prevent complications.

Question 25

A nurse assesses a child with suspected Wilms tumor. Which action is contraindicated? A) Auscultate bowel sounds B) Palpate the abdomen C) Obtain a urine sample D) Measure abdominal girth

Answer 25

Answer: B) Palpate the abdomen Rationale: Palpation of the abdomen is avoided in Wilms tumor to prevent rupture of the tumor.

Question 26

What is the first-line treatment for a toddler with severe dehydration? A) Oral rehydration therapy B) IV normal saline bolus C) Lactated Ringer's orally D) Pedialyte via a feeding tube

Answer 26

Answer: B) IV normal saline bolus Rationale: Severe dehydration is best treated with rapid IV fluid replacement.

Question 27

What is a late sign of increased intracranial pressure in a child? A) Irritability B) Fixed, dilated pupils C) High-pitched cry D) Increased head circumference

Answer 27

Answer: B) Fixed, dilated pupils Rationale: Fixed, dilated pupils indicate severe increased intracranial pressure and brain herniation.

Question 28

What is a major concern when assessing a child for possible child abuse? A) Consistent story between child and parent B) Vague or conflicting explanations for injuries C) Multiple healed fractures on imaging D) Frequent visits to the pediatrician

Answer 28

Answer: B) Vague or conflicting explanations for injuries Rationale: Inconsistent or vague explanations raise suspicion of child abuse.

Question 29

What clinical sign is associated with biliary atresia in an infant? A) Greenish vomit B) Clay-colored stools C) Severe abdominal pain D) Hematuria

Answer 29

Answer: B) Clay-colored stools Rationale: Clay-colored stools indicate bile flow obstruction, a hallmark of biliary atresia.

Question 30

A nurse suspects Hirschsprung’s disease in a newborn. Which symptom supports this diagnosis? A) Failure to pass meconium within 24-48 hours B) Frequent loose stools C) Projectile vomiting D) Severe dehydration

Answer 30

Answer: A) Failure to pass meconium within 24-48 hours Rationale: This symptom is indicative of a lack of innervation in the colon, as seen in Hirschsprung's disease.

Question 31

A child presents with an itchy, honey-colored crusted lesion on the face. What is the most likely diagnosis? A) Tinea corporis B) Impetigo C) Contact dermatitis D) Eczema

Answer 31

Answer: B) Impetigo Rationale: Impetigo is characterized by honey-colored crusted lesions, commonly caused by Staphylococcus aureus or Streptococcus pyogenes.

Question 32

A child experiences a tonic-clonic seizure in the hospital. What is the priority nursing intervention? A) Restrain the child to prevent injury B) Insert an oral airway to prevent tongue biting C) Turn the child onto their side and monitor the airway D) Administer prescribed antiseizure medications immediately

Answer 32

Answer: C) Turn the child onto their side and monitor the airway Rationale: Turning the child onto their side prevents aspiration and protects the airway during a seizure.

Question 33

What type of care is essential to meet the needs of a child with cerebral palsy? A) Provide a high-fat diet B) Use assistive devices to promote mobility C) Restrict physical activity to prevent injury D) Avoid interactions with peers to reduce anxiety

Answer 33

Answer: B) Use assistive devices to promote mobility Rationale: Assistive devices and therapies enhance the mobility and quality of life of children with cerebral palsy.

Question 34

What is a common predisposing factor for urinary tract infections in young girls? A) Drinking too much water B) Wiping from back to front C) Wearing loose clothing D) Frequent urination

Answer 34

Answer: B) Wiping from back to front Rationale: Wiping from back to front can introduce bacteria from the perianal area into the urethra, increasing the risk of UTIs.

Question 35

A 4-month-old infant presents with severe dehydration and sunken fontanels. Which rehydration method is most appropriate? A) Oral rehydration therapy B) Intravenous isotonic fluids C) Small, frequent sips of water D) Bolus of hypertonic fluids

Answer 35

Answer: B) Intravenous isotonic fluids Rationale: Severe dehydration requires rapid IV rehydration with isotonic fluids like normal saline or lactated Ringer’s.

Question 36

A nurse is teaching the parents of a child with aplastic anemia. What is an important topic to include? A) Administer iron supplements with milk B) Avoid live vaccines C) Encourage contact sports to improve stamina D) Provide a low-protein diet

Answer 36

Answer: B) Avoid live vaccines Rationale: Children with aplastic anemia have compromised immune systems and should avoid live vaccines.

Question 37

A nurse is reviewing a laboratory report for a child with iron deficiency anemia. What result would the nurse expect? A) Increased mean corpuscular volume (MCV) B) Decreased serum ferritin levels C) Increased platelet count D) Elevated reticulocyte count

Answer 37

Answer: B) Decreased serum ferritin levels Rationale: Low ferritin levels indicate decreased iron stores, which is common in iron deficiency anemia.

Question 38

A child with newly diagnosed type 1 diabetes mellitus is experiencing polyuria, polydipsia, and weight loss. What is the most appropriate initial intervention? A) Administer sliding-scale insulin B) Encourage high-carbohydrate meals C) Restrict fluid intake D) Provide oral antidiabetic medications

Answer 38

Answer: A) Administer sliding-scale insulin Rationale: Insulin therapy is essential to control blood glucose levels in type 1 diabetes.

Question 39

A child with suspected bacterial epiglottitis is admitted to the emergency department. What is the nurse's priority action? A) Assess the throat with a tongue depressor B) Prepare for endotracheal intubation C) Administer corticosteroids D) Apply a cool mist mask

Answer 39

Answer: B) Prepare for endotracheal intubation Rationale: Epiglottitis is a medical emergency due to the risk of airway obstruction; securing the airway is the top priority.

Question 40

The parent of a child with leukemia asks why their child is at risk for infections. Which is the best response? A) "The chemotherapy damages healthy tissues in the body." B) "Your child's white blood cell count is low due to the disease and treatment." C) "The disease causes the lymph nodes to stop working properly." D) "Your child’s anemia causes infections to occur frequently."

Answer 40

Answer: B) "Your child's white blood cell count is low due to the disease and treatment." Rationale: Leukemia and chemotherapy reduce white blood cell production, increasing the risk of infection.

Question 41

A 2-month-old infant presents with projectile vomiting and visible peristaltic waves. What condition is most likely? A) Intussusception B) Pyloric stenosis C) Gastroesophageal reflux D) Biliary atresia

Answer 41

Answer: B) Pyloric stenosis Rationale: Projectile vomiting and visible peristalsis are hallmark signs of pyloric stenosis.

Question 42

What is a primary nursing goal for a child recently diagnosed with Hirschsprung’s disease? A) Promote increased bowel motility B) Prevent infection of the surgical site C) Administer high-fiber meals D) Initiate toilet training

Answer 42

Answer: B) Prevent infection of the surgical site Rationale: Postoperative care for Hirschsprung’s disease focuses on preventing infection and monitoring bowel function.

Question 43

What finding indicates biliary atresia in an infant? A) Yellow sclera B) Blood-streaked stools C) Distended abdomen with rebound tenderness D) Increased urine output

Answer 43

Answer: A) Yellow sclera Rationale: Jaundice (yellow sclera and skin) is a hallmark of biliary atresia due to bile duct obstruction.

Question 44

A child presents to the ER after a head injury with loss of consciousness. What is the priority intervention? A) Assess airway, breathing, and circulation B) Perform a complete neurological exam C) Start IV fluids to maintain hydration D) Provide acetaminophen for pain

Answer 44

Answer: A) Assess airway, breathing, and circulation Rationale: In emergency care, ABCs (airway, breathing, circulation) are always the priority.

Question 45

A nurse is caring for a child with suspected bacterial meningitis. Which diagnostic test should be prioritized? A) Blood cultures B) Lumbar puncture C) CT scan of the brain D) CBC

Answer 45

Answer: B) Lumbar puncture Rationale: A lumbar puncture confirms the diagnosis of bacterial meningitis.

Question 46

A child with newly diagnosed systemic lupus erythematosus (SLE) asks why they need to avoid prolonged sun exposure. What is the best response by the nurse? A) "It can cause a painful skin rash to develop." B) "It can increase your risk for skin cancer." C) "It can cause fatigue and joint pain to worsen." D) "It can weaken your immune system."

Answer 46

Answer: C) "It can cause fatigue and joint pain to worsen." Rationale: Prolonged sun exposure can trigger SLE flares, exacerbating symptoms like fatigue and joint pain.

Question 47

A child with hemophilia is admitted for a bleeding episode. Which intervention should the nurse prioritize? A) Apply direct pressure and ice to the bleeding site B) Administer fresh frozen plasma immediately C) Encourage active range-of-motion exercises D) Place the child on strict bed rest

Answer 47

Answer: A) Apply direct pressure and ice to the bleeding site Rationale: Applying pressure and ice helps control bleeding while awaiting factor replacement therapy.

Question 48

Which clinical finding is an early indication of hydrocephalus in an infant? A) Increased appetite B) Bulging fontanels C) Decreased crying D) Narrowing sutures

Answer 48

Answer: B) Bulging fontanels Rationale: Bulging fontanels are an early sign of increased intracranial pressure associated with hydrocephalus.

Question 49

A child with suspected increased intracranial pressure shows bradycardia, irregular respirations, and widened pulse pressure. What should the nurse do first? A) Notify the provider immediately B) Administer an antipyretic C) Elevate the head of the bed to 30 degrees D) Initiate seizure precautions

Answer 49

Answer: A) Notify the provider immediately Rationale: These signs indicate Cushing’s triad, a late sign of increased intracranial pressure that requires immediate intervention.

Question 50

What is the nurse's priority intervention when caring for a child undergoing chemotherapy for leukemia who develops a fever? A) Administer prescribed antibiotics immediately B) Obtain a chest X-ray C) Begin a cooling blanket for hyperthermia D) Restrict visitors to prevent infection

Answer 50

Answer: A) Administer prescribed antibiotics immediately Rationale: Fever in a child undergoing chemotherapy is a medical emergency and may indicate neutropenic sepsis, requiring prompt antibiotic treatment.

Question 51

Case 1: Systemic Lupus Erythematosus (SLE) A 12-year-old female presents with fatigue, joint pain, and a butterfly-shaped rash on her cheeks. Labs reveal proteinuria, elevated ANA levels, and anemia. The patient is scheduled to start corticosteroid therapy. Question: What is the nurse’s priority intervention when teaching the patient and family about corticosteroid therapy? A) Take the medication on an empty stomach. B) Avoid live vaccines while on this medication. C) Decrease fluid intake to prevent fluid retention. D) Expect weight loss as a side effect.

Answer 51

Answer: B) Avoid live vaccines while on this medication. Rationale: Corticosteroids suppress the immune system, making the patient susceptible to infections. Live vaccines should be avoided.

Question 52

A 10-year-old child with JIA reports morning stiffness and joint swelling. The child’s treatment plan includes NSAIDs and physical therapy. The parents ask how they can help at home. Question: What should the nurse emphasize when educating the family about home care? A) Apply cold packs to the joints every morning. B) Administer NSAIDs with meals to minimize gastric irritation. C) Limit physical activity to avoid joint strain. D) Encourage the child to avoid naps to prevent stiffness.

Answer 52

Answer: B) Administer NSAIDs with meals to minimize gastric irritation. Rationale: NSAIDs can cause gastric irritation, so taking them with food is essential. Heat, not cold, is generally used to relieve stiffness in JIA.

Question 53

A 6-year-old child with a peanut allergy accidentally consumes a peanut-containing snack. The child develops hives, difficulty breathing, and swelling of the lips. Question: What is the nurse's first priority intervention? A) Administer diphenhydramine orally. B) Call the healthcare provider. C) Administer intramuscular epinephrine. D) Place the child in a supine position.

Answer 53

Answer: C) Administer intramuscular epinephrine. Rationale: Epinephrine is the first-line treatment for anaphylaxis and must be given immediately to reverse life-threatening symptoms.

Question 54

A 9-year-old child with acute lymphoblastic leukemia (ALL) develops a fever during chemotherapy. The child is neutropenic with a WBC count of 500 cells/mm³. Question: What is the nurse’s priority intervention? A) Administer prescribed antibiotics within 1 hour. B) Administer antipyretics for the fever. C) Place the child in reverse isolation. D) Start IV fluids to prevent dehydration.

Answer 54

Answer: A) Administer prescribed antibiotics within 1 hour. Rationale: Fever in a neutropenic child is a medical emergency due to the risk of sepsis. Prompt antibiotic administration is critical.

Question 55

Disseminated Intravascular Coagulation (DIC) A child with sepsis develops DIC and presents with petechiae, oozing at venipuncture sites, and a prolonged PT/INR. Question: What is the priority intervention? A) Administer vitamin K. B) Start fresh frozen plasma (FFP) transfusion. C) Initiate prophylactic antibiotics. D) Apply a tourniquet above the bleeding site.

Answer 55

Answer: B) Start fresh frozen plasma (FFP) transfusion. Rationale: FFP replaces clotting factors consumed in DIC, helping to manage the bleeding.

Question 56

A 5-year-old child with ITP presents with a platelet count of 20,000/mm³ and a history of recent viral illness. The family is concerned about the child’s activity level. Question: What activity should the nurse recommend the child avoid? A) Swimming with parental supervision. B) Playing video games. C) Riding a bicycle with a helmet. D) Playing soccer.

Answer 56

Answer: D) Playing soccer. Rationale: Contact sports like soccer should be avoided due to the risk of bleeding associated with low platelet counts.

Question 57

A child with vWD presents with recurrent nosebleeds and bruising. The healthcare provider prescribes desmopressin (DDAVP). Question: What should the nurse include in the family’s education? A) Limit the child’s fluid intake after receiving desmopressin. B) Administer desmopressin only during an active bleed. C) Avoid acetaminophen for pain management. D) Encourage contact sports to promote physical activity.

Answer 57

Answer: A) Limit the child’s fluid intake after receiving desmopressin. Rationale: Desmopressin can lead to water retention, so fluid intake should be restricted to prevent hyponatremia.

Question 58

An 8-year-old boy with hemophilia A presents with knee swelling and pain after a fall. The family has not administered any home treatment yet. Question: What is the nurse’s priority action? A) Apply ice and elevate the affected joint. B) Administer factor VIII replacement. C) Perform passive range-of-motion exercises. D) Provide nonsteroidal anti-inflammatory drugs (NSAIDs) for pain.

Answer 58

Answer: B) Administer factor VIII replacement. Rationale: The immediate treatment for bleeding in hemophilia is to replace the missing clotting factor.

Question 59

A child with beta thalassemia major is receiving regular blood transfusions. During a routine visit, the parents report that the child is lethargic and has darkened skin. Labs reveal elevated ferritin levels. Question: What is the most likely cause of the child’s symptoms? A) Iron overload from transfusions. B) Anemia due to disease progression. C) Low platelet count from treatment. D) Allergic reaction to transfusions.

Answer 59

Answer: A) Iron overload from transfusions. Rationale: Regular blood transfusions in beta thalassemia can lead to iron overload, requiring chelation therapy.

Question 60

A 7-year-old child with sickle cell anemia is admitted with severe pain in the hands and feet, fever, and dehydration. The provider orders IV fluids and pain management. Question: What is the nurse’s priority intervention? A) Administer IV fluids to improve hydration. B) Apply cold compresses to the painful areas. C) Start antibiotic therapy to treat infection. D) Encourage ambulation to relieve pain.

Answer 60

Answer: A) Administer IV fluids to improve hydration. Rationale: Hydration is critical in sickle cell crisis to reduce blood viscosity and prevent further vaso-occlusion.