Nuero
A child is prescribed long-term phenytoin (Dilantin). Which teaching is most important?
A. Avoid dairy products
B. Perform meticulous oral hygiene
C. Restrict physical activity
D. Increase sodium intake
B. Perform meticulous oral hygiene
A child has Tetralogy of Fallot. Which combination correctly identifies the four cardiac defects?
PROVe
P = Pulmonary stenosis
R = Right ventricular hypertrophy
O = Overriding aorta
V = Ventricular septal defect
A nurse is caring for a child in Buck's traction. Which interventions are appropriate to maintain effective traction?
A. Keep the weights hanging freely.
B. Remove the weights during repositioning.
C. Ensure the ropes move freely through the pulleys.
D. Allow the weights to rest on the floor.
Both A and C are true, but A is the priority because if the weights are not hanging freely, the traction is ineffective.
A nurse is reviewing the medical records of two pediatric patients.
Which diagnosis is most likely?
A. Patient 1—Ewing sarcoma; Patient 2—Osteosarcoma
B. Patient 1—Osteosarcoma; Patient 2—Ewing sarcoma
C. Both patients have osteosarcoma.
D. Both patients have Ewing sarcoma.
B. Patient 1—Osteosarcoma; Patient 2—Ewing sarcoma
Osteosarcoma Around the knee, adolescent growth spurt, metaphysis, localized pain/swelling
Ewing sarcoma Pelvis or shaft of long bones, younger child, fever + bone pain (can mimic infection)
A nurse evaluates two children with skin infections. Which finding most strongly suggests cellulitis rather than impetigo?
A. Honey-colored crusts
B. Superficial lesions limited to the epidermis
C. Diffuse redness, warmth, and swelling extending into deeper tissues
D. Lesions confined around the mouth
C. Diffuse redness, warmth, and swelling extending into deeper tissues
The parents report their child with epilepsy has been sleeping much longer than usual after seizures and the seizures are occurring more frequently. What should concern the nurse most?
A. Increased appetite
B. Increased lethargy and more frequent seizures
C. Mild headache
D. Occasional dizziness
B. Increased lethargy and more frequent seizures
A 4-year-old child with Tetralogy of Fallot suddenly becomes cyanotic while crying. What is the nurse's priority intervention?
A. Lay the child flat in bed.
B. Place the child in the knee-chest position.
C. Encourage the child to walk around.
D. Give the child oral fluids.
B. Place the child in the knee-chest position.
The nurse is assessing a child who had a cast applied 2 hours ago. Which finding should the nurse recognize as the earliest sign of neurovascular compromise?
A. Paralysis
B. Pulselessness
C. Pain that is severe and not relieved by medication
D. Cool skin
C. Pain that is severe and not relieved by medication
Rationale// by the time pulses are absent, the extremity is in serious danger. Pain out of proportion to the injury, especially pain with passive movement, is one of the earliest signs of compartment syndrome.
A 4-year-old is brought to the clinic because the parents noticed a large abdominal mass while bathing the child. The child has no complaints of pain. Which condition should the nurse suspect?
A. Neuroblastoma
B. Wilms tumor
C. Appendicitis
D. Intussusception
B. Wilms tumor
A child has an annular lesion with central clearing on the arm. Which diagnosis is most likely?
A. Tinea capitis
B. Tinea corporis
C. Impetigo
D. Contact dermatitis
B. Tinea corporis
A 6-month-old infant has a ventriculoperitoneal (VP) shunt. Which assessment finding requires the nurse to contact the provider first?
A. Sleeping 30 minutes longer after feeding
B. Bulging anterior fontanel when the infant is calm
C. Two episodes of spit-up after feeding
D. Temperature of 99.5°F (37.5°C)
B. Bulging anterior fontanel when the infant is calm
A child with sickle cell disease reports severe pain in the arms and legs. Which complication is most likely occurring?
A. Iron-deficiency anemia
B. Vaso-occlusive crisis
C. Aplastic crisis
D. Splenic sequestration crisis
B. Vaso-occlusive crisis
The nurse is caring for four children. Which child should be assessed first?
A. Child with osteosarcoma reporting increasing pain despite scheduled analgesics.
B. Child with juvenile idiopathic arthritis who has pain when they participate in physical therapy.
C. Child with a newly applied cast who cannot wiggle the fingers of the affected hand.
D. Child with scoliosis whose parent has questions about brace wear.
C. Child with a newly applied cast who cannot wiggle the fingers of the affected hand.
Inability to move the fingers after a newly applied cast is a red flag for neurovascular compromise or compartment syndrome.
A child has a firm, painless mass in the thigh. Imaging shows the tumor originated in skeletal muscle. Which diagnosis is most likely?
A. Osteosarcoma
B. Ewing sarcoma
C. Rhabdomyosarcoma
D. Neuroblastoma
C. Rhabdomyosarcoma
Key// Skeletal muscle
A nurse assesses an infant with white patches on the tongue and inner cheeks that cannot be wiped away. Which medication should the nurse expect to administer?
A. Mupirocin
B. Nystatin suspension
C. Acyclovir
D. Amoxicillin
B. Nystatin suspension
A nurse is caring for a child with suspected bacterial meningitis. Which provider prescription should the nurse implement first?
A. Obtain blood cultures.
B. Administer IV ceftriaxone.
C. Administer acetaminophen.
D. Start maintenance IV fluids.
B. Administer IV ceftriaxone.
administering IV antibiotics as soon as they are available. Although cultures are ideally obtained first, treatment should not be delayed in a critically ill child.
A child with Tetralogy of Fallot is having a hypercyanotic ("Tet") spell. Why does placing the child in the knee-chest position improve oxygenation?
A. It decreases pulmonary vascular resistance.
B. It increases systemic vascular resistance, reducing the right-to-left shunt.
C. It increases cardiac output.
D. It slows the heart rate.
B. It increases systemic vascular resistance, reducing the right-to-left shunt
The nurse is caring for an adolescent with progressive scoliosis. Which assessment finding is the highest priority?
A. One shoulder is higher than the other.
B. The adolescent reports embarrassment about wearing a back brace.
C. The adolescent becomes short of breath while walking to class.
D. The adolescent reports mild back discomfort after sitting in class.
C
Rationale: While all of these findings may occur with scoliosis, shortness of breath suggests the spinal curvature may be affecting chest expansion and lung function, making it the highest priority assessment.
A nurse is reviewing four pediatric patients. Which child should the nurse suspect has rhabdomyosarcoma?
A. A 3-year-old with leukocoria (white pupillary reflex)
B. A 5-year-old with painless cervical lymphadenopathy and Reed-Sternberg cells
C. A 6-year-old with a rapidly enlarging painless mass near the orbit causing the eye to bulge
D. A 4-year-old with a smooth abdominal mass and hypertension
C. A 6-year-old with a rapidly enlarging painless mass near the orbit causing the eye to bulge
A parent asks why the provider prescribed a medication for tinea capitis. What is the best response?
A. "Creams are too expensive."
B. "The fungus infects the hair follicles, so oral medication is needed."
C. "Children can't tolerate oral antifungals."
D. "The medication prevents bacterial infection."
B. "The fungus infects the hair follicles, so oral medication is needed."
A nurse is caring for four pediatric patients. Which child should the nurse assess first?
A. Child with bacterial meningitis who is recieving antibotics and reports photophobia
B. Child with a seizure disorder who is sleeping after a 1-minute seizure.
C. Child with a VP shunt who is difficult to arouse and has repeated vomiting.
D. Child with a brain tumor who reports a headache rated 6/10.
C. Child with a VP shunt who is difficult to arouse and has repeated vomiting.
A child who is deteriorating, not which diagnosis is more dangerous. A child with meningitis who only has photophobia has an expected symptom. The child with the VP shunt has new neurologic changes (decreased LOC + vomiting), suggesting acute increased ICP and impending herniation.
A child presents with migratory joint pain and a new heart murmur. Which question is most important for the nurse to ask?
A. Has your child had chickenpox?
B. Has your child recently had a sore throat?
C. Has your child had diarrhea?
D. Has your child traveled recently?
B. Has your child recently had a sore throat?
A nurse is evaluating parent teaching for an infant wearing a Pavlik harness. Which parent statement requires immediate follow-up?
The nurse is teaching the parents of an infant wearing a Pavlik harness. Which parent statement indicates the need for further teaching?
A. "I will check my baby's toes to make sure they stay warm and pink."
B. "I will keep the harness on as prescribed"
C. "I will keep my baby's legs straight because that will help the hips heal faster."
D. "I will place the diaper underneath the harness."
C
Keeping the legs straight is exactly what the Pavlik harness is designed to prevent. The harness keeps the hips flexed and abducted, allowing the femoral head to remain properly positioned in the hip socket so the joint can develop normally.
A 7-year-old is diagnosed with leukemia. Which assessment finding is most suggestive of acute myeloid leukemia (AML) rather than acute lymphoblastic leukemia (ALL)?
A. Bone pain and limp
B. Petechiae and recurrent infections
C. Gingival swelling and bleeding
D. Fatigue and pallor
C. bleeding gums
Rationale: AML arises from immature myeloid cells, which have a tendency to infiltrate tissues outside the bone marrow. This extramedullary infiltration commonly affects the gingiva, leading to gingival hyperplasia (swollen gums) and bleeding.
An infant is diagnosed with oral thrush and is breastfeeding. Which instruction should the nurse include in the teaching plan?
A. Continue breastfeeding, and treat both the infant and the mother's nipples as prescribed.
B. Stop breastfeeding until the white patches have completely resolved.
C. Switch to formula until the infection is gone.
D. continue breastfeeding clean the infant's mouth with Nyastin after each feeding.
A
Rationale: Oral thrush is caused by Candida albicans. Breastfeeding should continue, but both the infant and the breastfeeding mother should be treated