GU & Renal
A child presents with periorbital edema and proteinuria. Which condition is most likely?
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Urinary tract infection
D. Hypospadias
Answer: B. Nephrotic syndrome
Rationale: Nephrotic syndrome is characterized by massive protein loss in urine, hypoalbuminemia, and edema, especially periorbital edema that is often most noticeable in the morning. Acute glomerulonephritis instead typically presents with hematuria (tea or cola-colored urine), hypertension, and mild edema due to inflammation of the glomeruli. A urinary tract infection usually presents with fever, dysuria, urgency, or abdominal pain, not severe edema. Hypospadias is a congenital structural abnormality of the urethra and would not cause edema or proteinuria.
A child is diagnosed with Wilms tumor. Which nursing action is the highest priority?
A. Palpate the abdomen every shift
B. Place a sign above the bed stating “Do Not Palpate Abdomen”
C. Encourage the child to lie prone
D. Apply warm compresses to the abdomen
Answer: B. Place a sign stating “Do Not Palpate Abdomen.”
Rationale: Wilms tumor is a kidney tumor that forms a fragile abdominal mass, and palpation can cause tumor rupture and spread of cancer cells, which significantly worsens prognosis. Therefore, placing a sign to remind staff not to palpate the abdomen is a critical safety intervention. Palpating the abdomen frequently would increase the risk of rupture. Positioning the child prone or applying warm compresses does not address the primary risk associated with the tumor and would not be priority interventions.
A nurse is assessing pain in a 6-month-old infant following surgery. Which pain scale should the nurse use?
A. Numeric Rating Scale
B. FLACC scale
C. Wong-Baker Faces scale
D. Visual Analog Scale
Answer: B
Rationale: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is designed for infants and young children who cannot verbally communicate their pain level. It allows the nurse to assess pain through observable behaviors. The Numeric Rating Scale and Visual Analog Scale require the patient to understand numbers or abstract measurement concepts, which infants cannot do. The Wong-Baker Faces scale is appropriate for children who can point to pictures and identify feelings, usually around age 3 or older, making it inappropriate for a 6-month-old infant.
A child with immune thrombocytopenia (ITP) is most likely to present with which symptom?
A. Petechiae and bruising
B. Severe joint pain
C. Abdominal mass
D. Hypertension
Answer: A. Petechiae and bruising
Rationale: ITP is an autoimmune disorder in which antibodies destroy platelets, resulting in low platelet counts and increased bleeding risk. Children commonly present with petechiae, bruising, nosebleeds, or bleeding gums. Joint pain is more characteristic of autoimmune joint disorders such as juvenile idiopathic arthritis. An abdominal mass suggests tumors like neuroblastoma or Wilms tumor. Hypertension is unrelated to platelet destruction.
Which finding is most characteristic of increased ICP in infants?
A. Bulging fontanel
B. Sunken fontanel
C. Increased appetite
D. Dry mucous membranes
Answer: A. Bulging fontanel
Rationale: Infants have open fontanels that allow pressure changes to become visible. Increased ICP may cause a bulging or tense fontanel, irritability, vomiting, and increased head circumference. A sunken fontanel usually indicates dehydration. Appetite changes and dry mucous membranes are not indicators of increased intracranial pressure.
A child with acute glomerulonephritis has dark “tea-colored” urine. What is the underlying cause?
A. Excess protein in urine
B. Presence of blood in urine
C. High glucose levels
D. Bacterial infection
Answer: B. Presence of blood in urine
Rationale: The tea-colored urine seen in acute glomerulonephritis results from hematuria caused by inflammation and damage to the glomeruli, allowing red blood cells to leak into urine. Excess protein in urine is more characteristic of nephrotic syndrome, where protein loss leads to edema. High glucose levels in urine occur in diabetes mellitus, not glomerulonephritis. While infections (such as streptococcal infections) can trigger glomerulonephritis, the dark urine itself results specifically from blood in the urine, not bacteria.
A child with neuroblastoma most commonly presents with which finding?
A. Abdominal mass that crosses the midline
B. Severe joint pain
C. Petechiae
D. Enlarged tonsils
Answer: A. Abdominal mass crossing the midline
Rationale: Neuroblastoma is a tumor of the sympathetic nervous system, most often arising in the adrenal glands, and frequently presents as a firm abdominal mass that may cross the midline. This helps distinguish it from Wilms tumor, which typically does not cross the midline. Joint pain is more commonly associated with leukemia or inflammatory disorders. Petechiae usually suggest platelet abnormalities or hematologic conditions such as leukemia or ITP. Enlarged tonsils are unrelated to neuroblastoma.
Which behavioral sign most strongly indicates pain in a neonate?
A. High-pitched cry
B. Decreased movement
C. Hypotonia
D. Weak cry
Answer: A. High pitched cry
Rationale: Neonates express pain through behavioral cues such as high-pitched crying, irritability, facial grimacing, and difficulty being consoled. A high-pitched cry is a classic indicator of distress or pain. Decreased movement and hypotonia suggest neurologic or systemic concerns rather than typical pain responses, as infants in pain usually become tense and restless. A weak cry may indicate fatigue or illness but is less specific for pain than a high-pitched cry.
Which symptom is most characteristic of systemic lupus erythematosus (SLE)?
A. Butterfly rash across the cheeks
B. Honey-colored skin lesions
C. Persistent cough
D. Severe abdominal pain
Answer: A. Butterfly rash across the cheeks
Rationale: SLE is an autoimmune disease that can affect multiple organs. A hallmark feature is the malar or butterfly rash across the cheeks and nose, often worsened by sunlight. Honey-colored lesions are characteristic of impetigo. Persistent cough suggests respiratory illness. Abdominal pain is nonspecific and not a defining feature of lupus.
Which sign indicates a late and life-threatening stage of increased ICP?
A. Irritability
B. Vomiting
C. Cushing’s triad
D. Headache
Answer: C. Cushing’s triad
Rationale: Cushing’s triad—bradycardia, hypertension with widened pulse pressure, and irregular respirations—is a late and dangerous sign indicating severe increased ICP and possible brain herniation. Irritability, headache, and vomiting are earlier signs that occur before severe neurologic deterioration.
A newborn is diagnosed with hypospadias. What should the nurse anticipate?
A. Immediate circumcision
B. Delayed circumcision until surgical repair
C. No treatment needed
D. Removal of the foreskin
Answer: B. Delayed circumcision
Rationale: In hypospadias, the urethral opening is located on the underside of the penis, and the foreskin is often needed later for surgical reconstruction of the urethra, so circumcision is delayed. Immediate circumcision or foreskin removal would eliminate tissue needed for the repair. The condition does require surgical correction, so stating no treatment is needed would be incorrect.
A child undergoing chemotherapy develops tumor lysis syndrome. Which laboratory finding is most concerning?
A. Hyperkalemia
B. Low uric acid
C. Hypocalcemia correction
D. Elevated hemoglobin
Answer: A. Hyperkalemia
Rationale: Tumor lysis syndrome occurs when large numbers of cancer cells break down rapidly, releasing intracellular substances into the bloodstream. This causes hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia. Hyperkalemia is especially dangerous because it can cause life-threatening cardiac dysrhythmias, making it the most urgent finding. Low uric acid would not occur; uric acid levels typically increase. Elevated hemoglobin is unrelated to tumor lysis syndrome, and while hypocalcemia occurs, potassium abnormalities pose the greatest immediate cardiac risk.
A child receiving morphine becomes difficult to arouse with respirations of 8/min. What is the nurse’s priority action?
A. Reassess in 30 minutes
B. Administer naloxone
C. Encourage deep breathing
D. Raise the head of the bed
Answer: B Administer Naloxone
Rationale: Respiratory depression is the most serious complication of opioid therapy. Naloxone is an opioid antagonistthat rapidly reverses the effects of opioids and is the priority treatment. Reassessing later delays care in a life-threatening situation. Encouraging deep breathing or repositioning may help temporarily but does not treat the underlying opioid toxicity.
Which symptom is characteristic of juvenile idiopathic arthritis (JIA)?
A. Morning joint stiffness
B. Severe headaches
C. Hematuria
D. Persistent cough
Answer: A. Morning joint stiffness
Rationale: JIA causes chronic inflammation of the joints, resulting in swelling, pain, and morning stiffness that improves with activity. Headaches, hematuria, and cough are unrelated to inflammatory joint disease.
Which finding is typical in spastic cerebral palsy?
A. Increased muscle tone and stiffness
B. Flaccid muscles
C. Normal movement patterns
D. Decreased reflexes
Answer: A. Increased muscle tone
Rationale: Spastic cerebral palsy is the most common type and is characterized by increased muscle tone, stiffness, and difficulty with voluntary movement. Flaccid muscles and decreased reflexes suggest other neurologic disorders. Normal movement patterns would not be present in cerebral palsy.
Which symptom is most common in infants with a urinary tract infection?
A. Dysuria
B. Fever and irritability
C. Flank pain
D. Urinary urgency
Answer: B. Fever and irritability
Rationale: Infants often show nonspecific symptoms of infection, such as fever, irritability, poor feeding, or vomiting. Dysuria, urgency, and flank pain are more typical symptoms in older children and adults who can communicate urinary discomfort.
A child with sickle cell disease is experiencing a vaso-occlusive crisis. What is the priority nursing intervention?
A. Administer pain medication
B. Restrict fluids
C. Apply cold packs
D. Encourage strenuous activity
Answer: A. Administer pain medication
Rationale: A vaso-occlusive crisis occurs when sickle-shaped red blood cells block blood flow, causing severe ischemic pain. Pain control is a priority nursing intervention, typically using opioid analgesics. Hydration and oxygen may also be important supportive measures. Restricting fluids would worsen blood viscosity and increase sickling. Cold packs cause vasoconstriction and may wo
Which non-pharmacologic intervention can help reduce pediatric pain?
A. Distraction with toys or games
B. Restrict parental presence
C. Reduce fluid intake
D. Enforce strict bed rest
Answer: A. Distraction with toys or games
Rationale: Distraction techniques help children focus attention away from painful stimuli and are widely used in pediatric care. Parental presence usually reduces anxiety and pain perception. Fluid restriction and strict bed rest do not directly reduce pain and may worsen discomfort.
Which situation most strongly suggests child neglect?
A. A child with a fractured arm from a fall at school
B. A child with poor hygiene and untreated medical conditions
C. A child who refuses to eat vegetables
D. A child with seasonal allergies
Answer: B. Poor hygiene and untreated medical conditions
Rationale: Neglect occurs when caregivers fail to meet a child’s basic needs, including hygiene, nutrition, supervision, or medical care. Poor hygiene, malnutrition, or untreated illnesses may indicate neglect. Injuries from accidents at school are common and not necessarily signs of neglect. Refusing vegetables is typical child behavior and does not indicate caregiver failure. Seasonal allergies are common medical conditions and not related to neglect.
Which symptom may indicate a pediatric brain tumor?
A. Morning vomiting with headache
B. Increased appetite
C. Weight gain
D. Skin rash
Answer: A. Morning vomiting with headache
Rationale: Brain tumors often increase intracranial pressure, causing headaches and vomiting that are frequently worse in the morning due to pressure changes after lying flat overnight. Increased appetite and weight gain are not typical symptoms of brain tumors. Skin rashes are unrelated to intracranial tumors.
Which assessment finding requires immediate reporting in a child with acute glomerulonephritis?
A. Mild edema
B. Decreased appetite
C. Hypertension
D. Fatigue
Answer: C. Hypertension
Rationale: Hypertension is a serious complication of acute glomerulonephritis because fluid retention and impaired kidney function increase blood pressure, which can lead to seizures, stroke, or hypertensive crisis. Mild edema is expected due to fluid retention and is monitored but not immediately life-threatening. Decreased appetite and fatigue are common general symptoms in many illnesses and are not urgent findings. However, elevated blood pressure requires prompt intervention to prevent neurologic complications.
Which assessment finding may indicate leukemia in a child?
A. Frequent infections and bruising
B. Increased appetite
C. Rapid weight gain
D. Elevated blood pressure
Answer: A. Frequent infections and bruising
Rationale: Leukemia disrupts normal bone marrow function, reducing production of white blood cells, red blood cells, and platelets. This leads to frequent infections, fatigue, pallor, and bruising or bleeding. Increased appetite and rapid weight gain are not typical symptoms. Elevated blood pressure is not a hallmark finding of leukemia.
Untreated pain in children can lead to which complication?
A. Improved immune function
B. Delayed healing
C. Increased appetite
D. Improved sleep
Answer: B. Delayed healing
Rationale: Persistent pain activates stress responses that release hormones such as cortisol, which can suppress immune function and delay healing. Children experiencing pain may also have decreased appetite and sleep disturbances. Therefore, improved immune function, appetite, or sleep would not occur with untreated pain.
A nurse suspects child abuse while assessing a patient. What is the nurse’s legal responsibility?
A. Confirm abuse before reporting
B. Report the suspicion to child protective services
C. Confront the parents immediately
D. Wait until another provider confirms the suspicion
Answer: B. Report the suspicion to child protective services
Rationale: Nurses are mandatory reporters, meaning they are legally required to report suspected abuse, not just confirmed abuse. Waiting for proof or confirmation may delay protection for the child. Confronting parents directly may escalate the situation and is not the nurse’s role. The responsibility is to report concerns so trained investigators can assess the situation.
Which condition is commonly associated with a neurogenic bladder in children?
A. Spina bifida
B. Asthma
C. Diabetes mellitus
D. Pneumonia
Answer: A. Spina bifida
Rationale: Neurogenic bladder occurs when nerve damage interferes with bladder control. This frequently occurs in children with spina bifida because the spinal cord and nerves that control bladder function may be affected. Asthma and pneumonia are respiratory conditions unrelated to bladder nerve control. Diabetes mellitus may affect nerves over time but is not the most common cause in children.