Special Needs
A nurse tells a child with cognitive impairment, “Let’s get ready like a superhero getting their armor on!” The child appears confused. What should the nurse do instead?
A. Repeat the same statement louder
B. Use a simple, direct instruction
C. Ask the parent to explain
D. Skip the task
B. Use a simple, direct instruction
A child with diabetes feels shaky during soccer practice. What is the BEST immediate action?
A. Give insulin
B. Give water
C. Provide a fast-acting carbohydrate
D. Stop activity and wait
C. Provide a fast-acting carbohydrate (4 oz juice, hard candy, 4 oz soda, glucose tablets)
Let's go further: What can you pair with a fast-acting carb?
A child with Kawasaki disease is afebrile but irritable with peeling skin. What is the nurse’s primary concern?
A. Infection
B. Coronary artery involvement
C. Dehydration
D. Pain
B. Coronary artery involvement
A student nurse adjusts traction weights so they don’t touch the floor. What is the priority issue with this?
A. It doesn't increase patient comfort and relaxation
B. It disrupts the traction force
C. There's no issue; it improves alignment
D. There's no issue; it reduces pain
B. It disrupts the traction force
A child is pale, sweaty, and confused with a family hx of DM1 and SLE. What is the FIRST action?
A. Check blood glucose
B. Give insulin
C. Check temperature
D. Monitor
A. Check blood sugar
A 10-month-old does not respond to their name but smiles and makes eye contact. What is the nurse’s best next concern?
A. Vision impairment
B. Hearing impairment
C. Autism spectrum disorder
D. Normal development
B. Hearing impairment
A child with diabetes is vomiting and has high blood glucose. Which finding would MOST concern the nurse?
A. Increased appetite
B. Presence of ketones
C. Warm skin
D. Mild fatigue
B. Presence of ketones
A child receiving digoxin vomits after a dose. What should the nurse do?
A. Give another dose
B. Hold the medication and assess
C. Give anti-nausea medication
D. Continue as scheduled
B. Hold the medication and assess
A child in traction reports increasing pain despite medication. What is the nurse’s priority?
A. Reposition the child
B. Assess neurovascular status
C. Increase medication
D. Apply heat
B. Assess neurovascular status
A child with sepsis has delayed cap refill and tachycardia. What is priority?
A. Antibiotics
B. Oxygen
C. Fluids
D. Labs
C. Fluids
Let's go further: What type of fluids?
A hospitalized child with autism becomes increasingly agitated when multiple staff enter the room. What is the BEST nursing adjustment?
Reduce stimulation, limit staff, maintain routine
Acceptable Alternatives:
Why is giving insulin first in DKA potentially dangerous?
It can worsen hypovolemia and cause rapid fluid shifts before circulation is restored
Acceptable Alternatives:
Why is long-term antibiotic therapy required after rheumatic fever?
To prevent recurrence and further heart damage.
Acceptable Alternatives:
Why must Pavlik harness positioning be maintained continuously?
To keep the hip properly aligned for correct development.
Acceptable Alternatives:
Why is hypotension a late sign in pediatric shock?
Children compensate with vasoconstriction and tachycardia until collapse.
Acceptable Alternatives:
Parents of a newly diagnosed child say, “This is our fault.” What is the BEST response?
A. “That’s not true, don’t think that way.”
B. “Why would you think that?”
C. “Many parents feel this way—tell me more.”
D. “You shouldn’t feel guilty.”
C. “Many parents feel this way—tell me more.”
Which parent statement shows correct understanding of steroid use in CAH?
A. “We can stop the medication when symptoms improve.”
B. “We increase the dose during illness.”
C. “This medication is only needed short-term.”
D. “Missing doses is okay occasionally.”
B. “We increase the dose during illness.”
In early septic shock, why is the skin warm?
A. Decreased cardiac output
B. Vasoconstriction
C. Vasodilation
D. Fluid overload
C. Vasodilation
Which finding suggests compartment syndrome?
A. Warm skin
B. Mild swelling
C. Severe unrelieved pain
D. Improved movement
C. Severe unrelieved pain
A child with Kawasaki disease is admitted. What is the FIRST priority?
A. Pain control
B. IVIG
C. Fluids
D. Labs
B. IVIG
Why are peer interactions prioritized over independent play for children with cognitive impairment?
They promote social skill development and communication growth
Acceptable Alternatives:
Why does untreated precocious puberty lead to short adult height?
Early closure of growth plates due to early hormone exposure
Acceptable Alternatives:
Why does Kawasaki disease specifically affect coronary arteries?
It causes systemic vasculitis with a predilection for medium-sized arteries, including coronary vessels.
Acceptable Alternatives:
Why are children with OI often misdiagnosed as abuse cases?
Frequent fractures occur with minimal trauma
Acceptable Alternatives:
Let's go further: What are other 'expected' complications?
A child presents with tachycardia, cool skin, and normal BP. What is happening physiologically?
Compensated shock with vasoconstriction, maintaining blood pressure.
Acceptable Alternatives: