Hematologyical & Immunological Dysfunction
Endocrine Dysfunction
Cerebral Dysfunction
Musculoskeletal Dysfunction
Neuromuscular Dysfunction
Child with Cancer
100
Which nursing intervention is most important in the care of a child with hemophilia?
A. Encourage participation in contact sports to strengthen joints
B. Administer aspirin for joint pain
C. Ensure a safe environment to prevent injury and bleeding
D. Give intramuscular injections to promote faster medication absorption
Answer: C
Rationale:
Hemophilia is a hereditary bleeding disorder (often X-linked recessive) characterized by clotting factor deficiencies. Because children are at high risk for bleeding, especially into joints or after head injury, the priority nursing intervention is ensuring a safe environment to prevent trauma and bleeding episodes.
100
A child arrives at the clinic with a blood glucose of 240 mg/dL and reports feeling “hot and thirsty.” He is diagnosed with hyperglycemia. What is the A1C goal for children with diabetes?
A. 6%
B. 7%
C. 8%
D. 8.5%
Answer: B
Rationale: The goal for children with diabetes is an A1C below 7%, indicating good blood sugar management and reduced risk for complications.
100
A child presents with lethargy and sluggish speech following a head injury. Which action is the priority?
A. Insert a nasogastric tube
B. Provide warm blankets to prevent shivering
C. Assess airway patency and prepare for possible airway support
D. Begin oral fluids to prevent dehydration
Answer: C
Rationale: As LOC decreases, airway reflexes diminish. Airway management is the primary concern, because cerebral hypoxia lasting >4 minutes can result in irreversible brain damage.
100
A 3-month-old infant is diagnosed with Developmental Dysplasia of the Hip. Which finding would the nurse expect?
A. Edema around the ankle
B. Restricted hip abduction
C. Bilateral equal leg lengths
D. Pain with passive flexion of the toes
Answer: B
Rationale: DDH symptoms follow SORT.
Shorter leg / Ortolani/Barlow (+) / Restricted abduction / Trendelenburg sign (+)
(Birth-6 months: Pavlik harness- splint for abduction of hips, worn continuously until hip is stable on both clinical and ultrasound)
100
Which finding is most consistent with cerebral palsy (CP)?
A. Early milestones with poor coordination
B. Persistent Moro and tonic neck reflexes beyond 6 months
C. Hypotonia and floppy baby syndrome beyond 6 months
D. Loss of deep tendon reflexes
Answer: B
Rationale: PALSy
P: Positive Moro & Tonic Neck > 6 mo
A: Abnormal posturing- rigid muscle = spasticity & tremors
L: Late Milestones
S: Stiff Arm & Legs = contractures
+ Babinski Reflex
•Baclofen via implanted intrathecal pump to ↓ spasticity, anti-seizure meds
100
A nurse is preparing a 5-year-old child for brain tumor surgery. Which intervention is most appropriate to reduce anxiety and promote understanding?
A. Provide a detailed explanation of the tumor pathology and surgical technique.
B. Tell the child that everything will be fine and avoid discussing postoperative changes.
C. Explain what the child will look like and feel like after surgery, including the size and shape of the dressing, and demonstrate on a doll.
D. Ask the parents to explain the surgery instead of the nurse.
Answer: C
Rationale:
Preschool-age children require explanations that are developmentally appropriate. At age 5, children benefit from concrete descriptions of what they will look like and feel like after surgery. Demonstrating the dressing’s size and shape on a doll supports understanding and reduces fear.
200
Which statement best describes anemia in children?
A. An increase in white blood cells that leads to infection
B. An overproduction of platelets that causes clotting problems
C. A decrease in red blood cells or hemoglobin resulting in reduced oxygen-carrying capacity
D. A disorder characterized primarily by enlarged lymph nodes
Answer: C
Rationale:
Anemia is the most common hematologic disorder of childhood and is defined by a decrease in red blood cells and/or hemoglobin, resulting in decreased oxygen-carrying capacity of the blood.
200
Which teaching point is most appropriate for an 8-year-old newly diagnosed with type 1 diabetes?
A. Urine testing only
B. Parent must give all injections
C. Beginning insulin injections with supervision
D. Child should manage all decisions independently
Answer: C
Rationale: Self-monitoring of BG has improved diabetes management and can be used successfully by children from the time of diagnosis with proper education. 8–10 years = insulin injections, with appropriate education and guidance.
200
Which assessment finding should the nurse recognize as the earliest indicator of changes in neurological status in a child?
A. Altered pupil size
B. Increased blood pressure
C. Posturing
D. Change in level of consciousness
Answer: D
Rationale: The slide states: “LOC is the earliest indicator of changes in neurological status.” Subtle LOC changes occur before vital signs, pupils, or motor abnormalities.
200
Which situation should cause the nurse to suspect possible child abuse when assessing a fracture?
A. Fracture in a teenager after a football injury
B. Spiral fracture in a toddler with a clear fall history
C. Distal forearm fracture in a non-ambulatory infant
D. Greenstick fracture in a school-aged child riding a bike
Answer: C
Rationale: Fractures are rare in infants and should raise suspicion for abuse—especially if the child is not walking. The distal forearm is the most frequently broken bone in childhood, but not in non-mobile infants.
200
Which maternal intervention helps prevent neural tube defects such as spina bifida?
A. Using topical antibiotics during pregnancy
B. Increasing calcium and zinc intake
C. Taking folic acid supplements before and during early pregnancy
D. Avoiding caffeine during the third trimester
Answer: C
Rationale:
Neural tube defects like spina bifida, anencephaly, and meningoceles are linked to inadequate folate. Prevention includes maternal folic acid supplementation before conception and in early pregnancy.
200
Which statement about acute leukemia indicates a correct understanding of its pathophysiology?
A. Acute leukemia results in excessive production of mature white blood cells that function normally.
B. Acute leukemia presents with unrestricted proliferation of immature white blood cells that decrease bone marrow production.
C. Acute leukemia primarily destroys red blood cells through autoimmune mechanisms.
D. Acute leukemia causes organ damage only when white blood cell counts are extremely elevated.
B is correct: unrestricted proliferation of immature white blood cells in the blood-forming tissues of the body. The cells decrease bone marrow production.
Results in anemia, infection/neutropenia, bleeding, weakened bones
300
A child receiving a blood transfusion develops crackles, distended neck veins, and hypertension. What is the nurse’s priority action?
A. Slow the transfusion rate and reassess in 15 minutes
B. Stop the transfusion, obtain vital signs, maintain a patent IV with normal saline, and notify the physician
C. Administer acetaminophen and continue the infusion as ordered
D. Elevate the head of the bed, continue the infusion, and document the findings
Answer: B
Rationale:
Signs such as distended neck veins, hypertension, and crackles indicate possible circulatory overload. The priority intervention for any suspected transfusion reaction is to stop the infusion immediately, assess vital signs, maintain IV access with normal saline, and notify the physician.
300
A child with SIADH is admitted with hyponatremia and decreased urine output (SG >1.032). Which intervention is most important?
A. Encourage oral fluids
B. Implement fluid restriction and monitor daily weights
C. Provide high-sodium snacks
D. Apply warm compresses for comfort
Answer: B
Rationale: SIADH causes excess water retention and hyponatremia. Priority care includes fluid restriction, strict I&Os, and daily weights.
300
The nurse is assessing four children. Which child should the nurse assess first?
A. A school-age child with a headache after a fall
B. A child with a head injury and decreasing LOC
C. A toddler in a persistent vegetative state with a low-grade fever
D. A child recovering from a concussion who is irritable
Answer: B
Rationale: A decreasing LOC is the most urgent finding because LOC is the earliest and most sensitive indicator of neurologic deterioration. The toddler in a persistent vegetative state is stable despite fever and is assessed next.
300
Which statement correctly identifies a spinal deformity?
A. Kyphosis is an abnormal convex curvature of the thoracic spine
B. Lordosis is a lateral curvature with spinal rotation
C. Scoliosis is excessive lumbar inward curvature
D. Kyphosis occurs only as a result of trauma
Answer: A
Rationale: Kyphosis = excessive thoracic convex curve
Lordosis = exaggerated lumbar inward curve
Scoliosis = lateral S-curve + rotation + rib asymmetry
300
Which treatment is most appropriate for improving mobility and function in a child with cerebral palsy?
A. Strict bedrest during growth spurts
B. Physical therapy, occupational therapy, and speech therapy
C. Avoidance of orthopedic surgery at all ages
D. Daily corticosteroid injections
Answer: B
Rationale:
CP treatment includes PT, OT, speech therapy, orthopedic surgery for contractures, baclofen pump for spasticity, seizure medications, and socialization.
300
A child is being evaluated for Hodgkin disease. Which assessment findings would the nurse expect?
A. Petechiae, bone pain, and frequent infections
B. Enlarged lymph nodes, fever, night sweats, and anorexia
C. Severe abdominal pain and bloody diarrhea
D. Persistent cough with wheezing and cyanosis
Answer: B
Rationale: Common symptoms of Hodgkin disease include enlarged lymph nodes, fever, night sweats, and anorexia.
A is incorrect: These findings are more consistent with leukemia.
C is incorrect: These symptoms are not characteristic of Hodgkin disease.
D is incorrect: Respiratory symptoms such as wheezing and cyanosis are not typical presenting signs.
400
Which statement best describes immune thrombocytopenia (ITP) in children?
A. A hereditary disorder caused by deficiency of clotting factor VIII
B. A condition caused by overproduction of platelets leading to clot formation
C. A bone marrow failure disorder resulting in decreased production of all blood cells
D. An acquired hemorrhagic disorder characterized by excessive destruction of platelets
Answer: D
Rationale:
Immune thrombocytopenia (ITP) is an acquired hemorrhagic disorder characterized by thrombocytopenia due to excessive destruction of platelets. Bone marrow function is typically normal, and the condition often follows a viral infection.
400
A child receiving growth hormone therapy asks when the medication should be given. Which response by the nurse is most accurate?
A. “Any time of day is fine.”
B. “Give the injections at night.”
C. “Give the medication with food in the morning.”
D. “They should be given once weekly.”
Answer: B
Rationale: Growth hormone is naturally released during sleep; therapy is most effective when administered intramuscularly at night.
400
A child diagnosed with Reye’s syndrome is being admitted. Which intervention is the priority?
A. Monitor intake and output closely and adjust fluids to prevent dehydration and cerebral edema
B. Limit fluid intake to reduce brain swelling
C. Encourage high protein intake
D. Administer aspirin for pain and fever control
Answer: A
Rationale: Reye’s syndrome requires accurate and frequent I&O monitoring and careful fluid adjustment to prevent dehydration and worsening cerebral edema. Aspirin is avoided due to association with the syndrome.
400
A child in traction begins to complain of pain in the unaffected leg. What is the priority nursing action?
A. Remove adhesive straps to check skin
B. Increase the weight of the traction
C. Assess for tightness or contractures in the uninvolved joints
D. Elevate both legs with pillows
Answer: C
Rationale: Traction RN implications include:
•Assess for tightness, weakness, contractures in uninvolved joints
•Movement is expected in children but must be properly aligned
•Adhesive straps are removed only when necessary
400
Which nursing teaching is most accurate for a family with a newly diagnosed child with Duchenne muscular dystrophy?
A. “Genetic counseling and testing are recommended for parents and female siblings.”
B. “Avoid all genetic testing because results are unreliable.”
C. “This condition is not inherited.”
D. “The disease typically resolves during adolescence.”
Answer: A
Rationale:
Genetic counseling: recommended for parents, female siblings, maternal aunts, and their female offspring.
DMD is X-linked and progressive.
400
The nurse is preparing a child with suspected increased intracranial pressure (ICP) for diagnostic testing related to a possible brain tumor. Which diagnostic procedure is contraindicated?
A. MRI with diffusion-weighted imaging
B. CT scan
C. Lumbar puncture
D. Brain biopsy
Answer: C
Rationale: A lumbar puncture is contraindicated in the presence of increased ICP because removal of cerebrospinal fluid can cause brain herniation.
500
Which statement best explains the pathophysiology of disseminated intravascular coagulation (DIC)?
A. Platelets are underproduced by the bone marrow, leading to isolated bleeding.
B. Excess thrombin production causes widespread microclot formation, consuming platelets and clotting factors and resulting in both clotting and bleeding.
C. A deficiency of factor VIII leads to prolonged bleeding episodes.
D. An autoimmune process destroys circulating platelets.
Answer: B
Rationale:
In DIC, the coagulation cascade becomes overactivated. Excess thrombin leads to widespread fibrin formation and microclots. As platelets and clotting factors are consumed, the child develops simultaneous clotting and bleeding.
500
Which finding is most consistent with diabetes insipidus?
A. Dehydration with urine specific gravity >1.01
B. Fluid overload with generalized edema
C. Low serum sodium with urine specific gravity >1.01
D. Polyuria with urine specific gravity <1.01
Answer: D
Rationale: DI causes massive water loss → dilute urine (SG <1.01), polyuria, polydipsia, dehydration, and hypernatremia.
500
A child with a head injury has clear drainage from the nose. Which finding confirms that this is cerebrospinal fluid (CSF)?
A. The fluid thickens when exposed to air
B. The child reports a salty taste
C. The drainage stops when the child leans forward
D. The fluid tests positive for glucose
Answer: D
Rationale: CSF leakage appears as clear fluid and tests positive for glucose. This finding indicates a dural tear and requires immediate provider notification.
500
Which metabolic change is most likely in a child experiencing prolonged immobility?
A. Increased protein synthesis and enhanced growth
B. Decreased calcium excretion into the bloodstream
C. Increased peristalsis and enhanced bowel motility
D. Decreased metabolic rate leading to reduced oxygen needs
Answer: D
Rationale: Immobility causes:
↓ metabolic rate
↓ O₂ needs
↓ food intake & energy requirements
↑ risk of negative nitrogen balance & catabolism
500
A child is admitted with suspected Guillain-Barré syndrome. Which assessment finding is most concerning and requires immediate intervention?
A. Muscle tenderness in the legs
B. Tingling in the hands and feet
C. Difficulty breathing due to intercostal or phrenic nerve involvement
D. Loss of deep tendon reflexes
Answer: C
Rationale:
GBS is an immune-mediated polyneuropathy with ascending paralysis. Involvement of the intercostal and phrenic nerves threatens ventilatory function and requires rapid respiratory support, making it the priority.
500
The nurse is preparing parents for their infant’s appearance after surgery for retinoblastoma. Which findings are expected? (SATA)
A. Facial edema or ecchymosis
B. Copious drainage from the affected socket
C. An eye pad dressing taped over the surgical site
D. Eyelids sutured shut for the first week
E. An implanted sphere covered with conjunctiva that resembles the lining of the mouth
Answer: A, C, E
Rationale:
After enucleation, facial edema or ecchymosis is expected; an eye pad dressing is applied, and an implanted sphere maintains orbital shape and is covered with conjunctiva, giving it a mucosal appearance. Copious drainage and sutured eyelids are not expected findings.