Chapter 44
A child has a new cast placed for a fractured arm. Which finding requires the nurse’s immediate action?
A. Warm feeling inside the cast
B. Mild itching under the cast
C. Unrelenting pain not relieved by usual measures
D. Need to elevate the limb for 48 hours
Correct answer: C. Unrelenting pain not relieved by usual measures
Rationale:
This is a classic sign of compartment syndrome, which can occur after a cast is applied if swelling continues and pressure builds inside the cast. This is an emergency, and the cast may need to be removed immediately. A warm feeling inside a drying cast and elevation for 48 hours are expected. Mild itching can occur, but severe pain is the red flag.
A nurse is assessing an infant with a skin disorder. Which statement best explains why infants are at higher risk for dehydration and skin breakdown than adults?
A. Infant skin is thicker and less permeable
B. Infant skin contains more water and the epidermis is loosely bound to the dermis
C. Infants have more subcutaneous fat than adults
D. Infant skin is more resistant to friction injury
Correct answer: B. Infant skin contains more water and the epidermis is loosely bound to the dermis
Rationale:
Infant skin is thinner, contains more water, and the epidermis is loosely attached to the dermis, which makes it easier to blister, break down, and lose fluid. This is one of the most important pediatric skin differences to remember.
A nurse is reviewing lab work for a child with suspected iron deficiency anemia. Which test is the most sensitive indicator of total iron stores?
A. Reticulocyte count
B. Ferritin
C. PT
D. Hemoglobin electrophoresis
Correct answer: B. Ferritin
Rationale:
Ferritin is the most sensitive serum test for total iron stores and is commonly used to identify iron-deficiency anemia. Reticulocyte count reflects marrow response, PT is for clotting, and hemoglobin electrophoresis helps identify hemoglobin disorders like sickle cell disease.
A child with a fracture is prescribed ibuprofen for pain. Which instruction should the nurse include?
A. Give on an empty stomach for best absorption
B. Administer with water or food to decrease GI upset
C. Monitor for urinary retention
D. Expect severe respiratory depression
Correct answer: B. Administer with water or food to decrease GI upset
Rationale:
NSAIDs such as ibuprofen are used for mild to moderate pain, and the nurse should give them with water or food to reduce GI upset. The notes also highlight monitoring for nausea, vomiting, diarrhea, and constipation.
A child with Duchenne muscular dystrophy is taking corticosteroids. Which statement by the parent shows correct understanding?
A. “I can stop the medication once my child looks stronger.”
B. “I should give the medication with food.”
C. “This medication should be taken only on an empty stomach.”
D. “This medicine cannot affect signs of infection.”
Correct answer: B. “I should give the medication with food.”
Rationale:
In Chapter 44, corticosteroids are used for conditions such as Duchenne muscular dystrophy, and nursing teaching includes giving them with food to decrease GI upset. The nurse should also teach that steroids may mask signs of infection and should not be stopped abruptly.
Which intervention should the nurse teach the family of a child with a sprain?
A. Apply heat continuously for the first 24 hours
B. Use RICE therapy, including ice for 20 to 30 minutes at a time
C. Encourage full weight-bearing as soon as possible
D. Massage the injured area vigorously every hour
Correct answer: B. Use RICE therapy, including ice for 20 to 30 minutes at a time
Rationale:
For sprains and strains, the most important intervention is RICE: rest, ice, compression, and elevation. Ice is applied for 20 to 30 minutes, removed for about an hour, and repeated for up to 48 hours to reduce swelling and pain. Heat and vigorous massage are not appropriate in the acute phase.
A child has impetigo around the nose and mouth. Which assessment finding is most consistent with this diagnosis?
A. Silvery scales with distinct borders
B. Thick yellow-brown crusted lesions
C. Annular rash with central clearing
D. Red, raised welts of varying size
Correct answer: B. Thick yellow-brown crusted lesions
Rationale:
Impetigo is a contagious bacterial skin infection that commonly causes thick yellow-brown crusting, especially around the nose and mouth. Silvery plaques suggest psoriasis, annular lesions suggest tinea corporis, and welts suggest urticaria.
A child is diagnosed with idiopathic thrombocytopenic purpura (ITP) after a recent viral illness. Which assessment finding would the nurse expect?
A. Honey-colored crusted lesions
B. Petechiae and purpura
C. Cola-colored urine
D. Productive cough with fever
Correct answer: B. Petechiae and purpura
Rationale:
ITP is an immune-related platelet disorder, often occurring after a viral illness, and commonly presents with petechiae and purpura due to low platelets. These are classic bleeding signs. The other options point to unrelated disorders.
A child with cerebral palsy is receiving baclofen. Which nursing assessment is the priority?
A. Monitor for decreased spasticity and changes in mental status
B. Assess for bleeding gums
C. Watch for severe hypertension
D. Check for ring-shaped skin lesions
Correct answer: A. Monitor for decreased spasticity and changes in mental status
Rationale:
Baclofen is used to reduce painful spasms and spasticity in children with conditions such as cerebral palsy and spinal cord injury. Nursing care includes assessing motor function, monitoring for decreased spasticity, and observing for mental confusion, depression, or hallucinations.
A child has atopic dermatitis with severe itching. Which medication class would the nurse expect to help reduce itching?
A. Oral antihistamines
B. Iron chelators
C. Prothrombin inhibitors
D. Vasodilators
Correct answer: A. Oral antihistamines
Rationale:
For atopic dermatitis, the notes list management that includes good skin hygiene, emollients, topical corticosteroids, oral antihistamines, and antibiotics if there is a secondary infection. Oral antihistamines are commonly used to help with itching.
A nurse is assessing an infant for developmental dysplasia of the hip. Which finding is most concerning?
A. A high-pitched click with movement
B. Symmetric thigh folds
C. A distinct “clunk” with Barlow or Ortolani maneuver
D. Full hip abduction
Correct answer: C. A distinct “clunk” with Barlow or Ortolani maneuver
Rationale:
A distinct clunk during the Barlow or Ortolani maneuver is an abnormal finding and suggests developmental dysplasia of the hip. A high-pitched click is considered benign and normal. Symmetric folds and full abduction are reassuring findings.
A child is brought to the emergency department after a house fire. Which finding is the strongest indicator of inhalation injury?
A. Red painful blisters on the arm
B. Carbonaceous sputum and hoarseness
C. Peeling skin on the legs
D. Complaints of thirst and anxiety
Correct answer: B. Carbonaceous sputum and hoarseness
Rationale:
In a burned child, carbonaceous sputum, hoarseness, stridor, and burns around the mouth, nose, or eyes strongly suggest inhalation injury and possible airway compromise. Airway always comes first with burn assessment.
A nurse is caring for a child with sickle cell disease. Which statement about screening is correct?
A. It is only tested if symptoms appear later in childhood
B. It is routinely tested on newborn screening
C. It is diagnosed only by PT and INR
D. It is most common in children of Asian descent
Correct answer: B. It is routinely tested on newborn screening
Rationale:
Sickle cell disease and sickle cell trait are routinely screened at birth on newborn screening, and your notes also state it is repeated again at 2 weeks, with NICU babies possibly screened 3 times. This is a very testable pediatric point.
A nurse is preparing discharge teaching for a child taking baclofen at home. Which parent statement indicates a need for further teaching?
A. “I will watch for changes in my child’s muscle tightness.”
B. “I will stop the medication right away if my child seems better.”
C. “I will call if I notice confusion or unusual behavior.”
D. “I know this medication is used to reduce spasms.”
Correct answer: B. “I will stop the medication right away if my child seems better.”
Rationale:
Baclofen must be tapered before discontinuation because withdrawal symptoms may occur. This makes abrupt stopping unsafe. The other statements reflect correct understanding.
A nurse is teaching a family about treatment for tinea corporis (ringworm). Which medication should the nurse expect to be prescribed?
A. Ketoconazole cream
B. Nystatin cream
C. Cephalexin
D. IV oxacillin
Correct answer: A. Ketoconazole cream
Rationale:
Tinea corporis is a fungal infection with an annular, ring-like lesion. The chapter specifically notes treatment with ketoconazole cream. Nystatin is associated more with Candida, while cephalexin and oxacillin are antibacterial agents.
A 13-year-old adolescent with obesity reports sudden hip pain and is unable to bear weight. Which condition should the nurse suspect first?
A. Torticollis
B. Slipped capital femoral epiphysis
C. Scoliosis
D. Metatarsus adductus
Correct answer: B. Slipped capital femoral epiphysis
Rationale:
Slipped capital femoral epiphysis is a high-yield pediatric ortho disorder commonly seen in children ages 9 to 16, especially with obesity, sedentary lifestyle, and growth spurts. The hallmark is sudden hip pain with inability to bear weight. The other conditions do not match this presentation.
A nurse is caring for a child with a significant burn injury. Which urine output would indicate that fluid resuscitation is currently adequate?
A. 0.2 mL/kg/hr
B. 0.5 mL/kg/hr
C. 1 mL/kg/hr
D. 3 mL/kg/hr
Correct answer: C. 1 mL/kg/hr
Rationale:
For pediatric burn patients, the minimum expected urine output is 1 mL/kg/hr. This is a major high-yield point because urine output is one of the best ways to evaluate whether fluid resuscitation is effective.
A critically ill child is suspected of developing disseminated intravascular coagulation (DIC). Which lab pattern would the nurse expect?
A. Increased platelets and decreased D-dimer
B. Decreased fibrinogen and increased D-dimer
C. Decreased PT and decreased PTT
D. Increased clotting factors and decreased bleeding risk
Correct answer: B. Decreased fibrinogen and increased D-dimer
Rationale:
DIC is a life-threatening condition involving widespread clotting followed by bleeding because clotting factors and platelets become consumed. Expected lab findings include decreased fibrinogen, decreased platelets, prolonged PT/PTT, and positive D-dimers.
A child in traction is receiving diazepam for skeletal muscle spasms. Which adverse effect should the nurse monitor for most closely?
A. Sedation and dizziness
B. Hypertension and bradycardia
C. Severe diarrhea and rash
D. Photosensitivity and edema
Correct answer: A. Sedation and dizziness
Rationale:
Benzodiazepines such as diazepam are used adjunctively for skeletal muscle spasms. Nursing implications include monitoring the sedation level, recognizing that dizziness may occur, and being aware of possible paradoxical excitement.
A child is being treated for iron toxicity. Which medication should the nurse anticipate?
A. Deferoxamine
B. Prednisone
C. Baclofen
D. Hydralazine
Correct answer: A. Deferoxamine
Rationale:
In Chapter 46, treatment for iron toxicity includes deferoxamine given IV or subcutaneously, and deferasirox for chronic use. These medications bind iron so it can be removed from the body.
A nurse is caring for a child with Duchenne muscular dystrophy. Which nursing intervention is most important to help delay respiratory complications?
A. Restrict fluids to prevent aspiration
B. Keep the child flat in bed for chest expansion
C. Encourage upright positioning, coughing, and deep-breathing exercises
D. Avoid movement to reduce muscle fatigue
Correct answer: C. Encourage upright positioning, coughing, and deep-breathing exercises
Rationale:
A major complication of Duchenne muscular dystrophy is progressive weakness of the respiratory muscles. High-yield nursing care includes upright positioning to promote chest expansion, along with coughing and deep-breathing exercises to keep the airway clear and support ventilation. Keeping the child flat would make breathing harder, and total avoidance of movement is not appropriate.
Which burn finding is most suspicious for child abuse and should prompt further investigation?
A. Irregular splash burns on the forearm
B. Burn with blistering after hot soup spilled
C. Uniform glove-like burn pattern with delayed care seeking
D. Redness and pain after touching a hot pan
Correct answer: C. Uniform glove-like burn pattern with delayed care seeking
Rationale:
Burns suspicious for abuse often have a uniform appearance, such as stocking or glove patterns, a history that does not fit the injury, and a delay in seeking treatment. Irregular splash patterns are more consistent with accidental injury. This is a classic NCLEX safety question.
A child is receiving a blood transfusion. Which information is most important for the nurse to verify before administration?
A. Whether the child ate breakfast
B. ABO blood group, Rh factor, and crossmatch compatibility
C. The child’s most recent ferritin level
D. Whether the child has had a bowel movement today
Correct answer: B. ABO blood group, Rh factor, and crossmatch compatibility
Rationale:
Before a blood transfusion, the priority is to verify blood type, Rh factor, and compatibility through crossmatching to prevent a potentially life-threatening transfusion reaction. This is one of the most classic NCLEX safety priorities in hematology.
A child is prescribed an opioid analgesic after an orthopedic procedure. Which nursing action is most important?
A. Assess respiratory rate before and after administration
B. Restrict fluids to prevent nausea
C. Give the medication only if the child has a fever
D. Encourage the child to ambulate immediately after the dose
Correct answer: A. Assess respiratory rate before and after administration
Rationale:
For narcotic analgesics, the nurse should assess pain carefully, but one of the most important safety checks is the respiratory rate before and after administration. Sedation, nausea, vomiting, constipation, and pupil constriction can also occur.
A nurse is caring for a child with idiopathic thrombocytopenic purpura (ITP) and very low platelets. Which medication would the nurse expect to administer?
A. IVIG
B. Ketoconazole
C. Mupirocin
D. Deferasirox
Correct answer: A. IVIG
Rationale:
For ITP, the notes state that the condition is often self-limiting, but corticosteroids may be given when platelet counts are low, and IVIG is used to boost IgG. This is one of the most commonly tested medication points for pediatric bleeding disorders.