Hematology
A child with sickle cell disease is experiencing a Vaso-occlusive crisis. What is the nurse’s priority intervention?
A. Apply cold packs to painful joints
B. Increase IV fluid administration
C. Restrict activity
D. Administer oral iron
B
Rationale: Hydration decreases blood viscosity and reduces further sickling. Cold causes vasoconstriction and worsens the crisis
A nurse assesses a toddler with suspected neuroblastoma. Which finding is most characteristic of this malignancy?
A. Painless swelling of the knee
B. Abdominal mass that crosses the midline
C. Leukocoria
D. Nighttime bone pain relieved by rest
B
Rationale: Neuroblastoma commonly presents as a firm, irregular abdominal mass that crosses the midline, often with metastasis.
A child with a ventriculoperitoneal (VP) shunt returns from surgery. Which assessment finding requires immediate intervention?
A. Mild headache
B. Clear fluid leaking from the incision
C. Decreased appetite
D. Low-grade fever
B
Rationale: Clear fluid leakage may indicate CSF shunt malfunction or infection and is an emergency.
Which finding indicates hypoglycemia in a school-age child with diabetes?
A. Fruity breath
B. Deep, rapid respirations
C. Pallor, tremors, and diaphoresis
D. Polyuria and polydipsia
C
Rationale: Hypoglycemia causes adrenergic symptoms such as tremors, sweating, pallor, and confusion. Fruity breath and Kussmaul respirations indicate hyperglycemia/DKA.
A child is diagnosed with pediculosis capitis. Which nursing instruction is most important for the parents?
A. Wash the hair daily for 2 weeks
B. Apply permethrin and repeat in 7–10 days
C. Shave the child’s head
D. Isolate the child for 2 weeks
B
Rationale: Permethrin is repeated in 7–10 days to kill newly hatched lice. Shaving and prolonged isolation are unnecessary.
A child with a fractured femur in a cast suddenly reports severe pain, numbness, and tingling in the affected leg. What is the nurse’s priority action?
A. Elevate the extremity
B. Apply ice to the cast
C. Loosen restraints
D. Notify the provider immediately
D
Rationale: These are early signs of compartment syndrome, a medical emergency requiring immediate provider notification.
A child taking oral iron supplements should be instructed to:
A. Take the medication with milk
B. Take the medication with orange juice
C. Take medicine at bedtime only
D. Avoid vitamin C
B
Rationale: Vitamin C enhances iron absorption. Milk decreases absorption.
The nurse teaches the parents of a child with retinoblastoma. Which statement indicates a need for further teaching?
A. “My child’s eye may have to be surgically removed.”
B. “White pupils can be an early sign of this cancer.”
C. “This cancer can be hereditary.”
D. “Vision is usually unaffected after treatment.”
D
Rationale: Vision is often affected, especially if enucleation is required. The statement is incorrect.
A newborn with myelomeningocele is admitted to the NICU. What is the nurse’s priority intervention?
A. Apply a sterile, moist dressing to the sac
B. Assess feeding ability
C. Measure head circumference
D. Place the infant supine
A
Rationale: The sac must be kept moist and sterile to prevent rupture and meningitis. Prone positioning.
Which assessment finding is most consistent with congenital hypothyroidism in an infant?
A. Tachycardia and weight loss
B. Poor feeding, constipation, and hypotonia
C. Excessive sweating and irritability
D. Hyperactivity and diarrhea
B
Rationale: Hypothyroidism causes slowed metabolism, leading to poor feeding, constipation, hypotonia, and lethargy.
A toddler with atopic dermatitis has severe pruritus. Which nursing intervention is the highest priority?
A. Apply topical corticosteroids daily
B. Keep the child’s fingernails short
C. Bathe the child twice daily
D. Use scented lotions
B
Rationale: Scratching increases skin breakdown and infection risk. Nail trimming is a key safety priority.
Parents of an infant in a Pavlik harness for DDH ask about care. Which instruction is most important?
A. Remove the harness during sleep
B. Adjust the straps as the infant grows
C. Do not remove the harness unless directed
D. Apply lotion under the straps daily
C
Rationale: The harness must remain in place at all times for proper hip positioning unless the provider directs otherwise.
Which trigger most commonly precipitates a sickle cell crisis in children?
A. Hyperglycemia
B. Dehydration
C. Iron deficiency
D. Hypertension
B
Rationale: Dehydration, infection, hypoxia, stress, and cold exposure are common triggers.
A child diagnosed with osteosarcoma complains of increasing leg pain at night. Which explanation should the nurse give the parents?
A. “This pain is caused by anemia.”
B. “Tumor growth increases pressure within the bone.”
C. “This is a normal response to physical activity.”
D. “The pain occurs due to infection.”
B
Rationale: Osteosarcoma causes bone destruction and increased intraosseous pressure, leading to severe pain, often worse at night.
A child is admitted with suspected bacterial meningitis. Which intervention is the highest priority?
A. Administer IV antibiotics
B. Reduce environmental stimuli
C. Obtain blood cultures
D. Control fever
A
Rationale: Early antibiotic administration is life-saving and should not be delayed.
A nurse is teaching parents how to prevent diabetic ketoacidosis (DKA). Which instruction is most important?
A. Withhold insulin if the child is not eating
B. Check urine or blood ketones during illness
C. Increase insulin only when blood glucose exceeds 300 mg/dL
D. Restrict fluids during sick days
B
Rationale: Sick-day management and ketone monitoring are essential to detect early DKA. Insulin is never withheld during illness.
Which parent statement about eczema indicates a need for further teaching?
A. “We should moisturize immediately after bathing.”
B. “We should avoid triggering allergens.”
C. “Hot baths help reduce itching.”
D. “Cotton clothing is best for my child.
C
Rationale: Hot water worsens itching and dries the skin. Lukewarm baths are recommended
Which statement by parents of a newborn with clubfoot shows correct understanding of treatment?
A. “Surgery is always required immediately.”
B. “Casting usually begins within the first few weeks of life.”
C. “Treatment starts when the child begins to walk.”
D. “The condition will correct itself without intervention.”
B
Rationale: Early serial casting is the first-line treatment and improves outcomes.
Which intervention is most important in preventing iron-deficiency anemia in infants?
A. Giving cow’s milk before 12 months
B. Introducing iron-fortified cereal at 6 months
C. Using only breast milk until 2 years
D. Avoiding vitamin C-rich foods
B
Rationale: Iron stores decline by 4–6 months. Iron-fortified foods prevent deficiency
Which symptom is most concerning for increased intracranial pressure in a child with neuroblastoma?
A. Vomiting without nausea
B. Fatigue
C. Weight loss
D. Decreased appetite
A
Rationale: Projectile vomiting without nausea is a classic sign of increased intracranial pressure (ICP).
A child with meningitis develops a seizure. What is the nurse’s priority action?
A. Insert a tongue blade
B. Place the child on the side
C. Restrain the child
D. Obtain IV access
B
Rationale: Side-lying positioning protects the airway and prevents aspiration.
A newborn has a positive screening test for PKU. What is the nurse’s priority intervention?
A. Administer IV glucose
B. Begin a low-phenylalanine diet immediately
C. Start corticosteroid therapy
D. Restrict all protein
B
Rationale: PKU requires early dietary restriction of phenylalanine to prevent irreversible intellectual disability.
A nurse assesses an infant with erythema, skin breakdown, and satellite lesions in the diaper area. Which intervention is most appropriate?
A. Apply petroleum jelly only
B. Apply topical antifungal cream
C. Switch to cloth diapers
D. Limit fluid intake
B
Rationale: Satellite lesions indicate candidal diaper rash, which requires antifungal treatment.
Which screening finding most strongly suggests scoliosis in an adolescent?
A. Back pain after exercise
B. Uneven shoulder height
C. Limited hip rotation
D. Decreased leg strength
B
Rationale: Uneven shoulders, rib hump, and asymmetrical waistline are classic scoliosis findings.
Which statement by the parents of a child with hemophilia indicates correct understanding of home care?
A. “My child should avoid all physical activity.”
B. “We will give aspirin for pain.”
C. “We will use protective gear during play.”
D. “We should massage swollen joints.”
C
Rationale: Protective gear prevents injury. Aspirin and joint massage increase bleeding risk
A child with leukemia is admitted with a platelet count of 18,000/mm³. Which nursing action is the priority?
A. Encourage ambulation
B. Institute bleeding precautions
C. Administer acetaminophen
D. Restrict oral fluids
B
Rationale: A platelet count under 20,000 places the child at high risk for spontaneous bleeding.
A child is rescued after a near-drowning episode and arrives at the emergency department with spontaneous breathing. What is the nurse’s priority action?
A. Obtain a chest X-ray
B. Administer prophylactic antibiotics
C. Assess airway and oxygen saturation
D. Insert a urinary catheter
C
Rationale: Airway and oxygenation are the highest priorities due to risk of hypoxia and aspiration.
Which parent statement indicates a need for further teaching about hypothyroidism?
A. “My child may grow more slowly without treatment.”
B. “My child will need routine thyroid blood tests.”
C. “Once symptoms improve, the medication can be stopped.”
D. “The medication replaces a hormone my child lacks.”
C
Rationale: Levothyroxine is lifelong therapy. Stopping medication can cause developmental and metabolic complications
A child presents with a dog bite to the forearm. What is the priority nursing action?
A. Suture the wound immediately
B. Cleanse the wound thoroughly with soap and water
C. Apply antibiotic ointment only
D. Cover with an occlusive dressing
B
Rationale: Immediate and thorough cleansing reduces infection risk more than any other action.
A child with juvenile idiopathic arthritis has morning stiffness and swollen joints. Which nursing intervention is most appropriate?
A. Encourage bed rest throughout the day
B. Apply cold packs in the morning
C. Encourage warm baths and gentle exercise
D. Restrict all physical activity
C
Rationale: Warmth and gentle activity reduce stiffness and maintain joint mobility