Question

A nurse is caring for a 12-year-old client who has sickle cell disease.

Answer 1

Correct Answers

Blank 1 Correct Option: IV hydromorphone
Blank 2 Correct Option: pain

Rationale :

IV hydromorphone

🔵 The child is in a vaso-occlusive crisis, which is characterized by severe pain due to blocked sickled red blood cells obstructing blood flow in the microvasculature.

🔵 At 1000, the child reports pain 10/10 in the right knee, indicating severe, unrelieved pain despite ongoing care and the passage of time.

🔵 In sickle cell vaso-occlusive crises, the priority intervention is administration of opioid analgesics, usually via the IV route for rapid onset and effective pain control.

🔵 IV hydromorphone is a strong opioid analgesic commonly used for severe acute pain in hospitalized pediatric clients when non-opioid and weaker analgesics are inadequate.

🔵 The child’s vital signs are stable and oxygen saturation is 96% on room air, so there is no immediate indication for fluid resuscitation or transfusion; managing the severe pain with IV opioids is the most appropriate anticipated prescription.

pain

🔵 The nurse’s note clearly states the child’s pain increased from 7/10 to 10/10, demonstrating worsening uncontrolled pain despite already being in the unit and assessed.

🔵 The affected knee is swollen, warm, and painful, consistent with localized vaso-occlusion and inflammation, which directly causes the severe pain requiring IV opioid management.

🔵 The child’s hemoglobin is 9 g/dL and hematocrit is 18%, which are low but not unusual in chronic sickle cell disease, and this mild/moderate anemia alone does not explain the need for IV hydromorphone.

🔵 The platelet count is 450,000/mm³, slightly elevated, which can occur as a reactive process in chronic disease, but elevated platelets are not treated with opioids.

🔵 The primary indication for ordering IV hydromorphone is the child’s severe, unrelenting pain, not the lab abnormalities, so “pain” correctly completes the sentence.

Fresh frozen plasma transfusion

🔵 Fresh frozen plasma (FFP) is used to replace clotting factors in conditions like coagulopathies, liver failure, or massive bleeding, not to treat vaso-occlusive pain.

🔵 This child has no evidence of active bleeding, coagulopathy, or hemodynamic instability, so FFP is not an appropriate anticipated prescription in this situation.

Factor VIII

🔵 Factor VIII is specifically indicated for hemophilia A or certain clotting factor deficiencies, where the client has prolonged bleeding or a known factor VIII deficiency.

🔵 The child has sickle cell disease, not hemophilia, and there are no signs of bleeding or factor deficiency, so factor VIII is not appropriate here.

Hemoglobin

🔵 Although the child’s hemoglobin is low (9 g/dL), mild to moderate anemia is chronic and expected in sickle cell disease and is not the reason for prescribing IV hydromorphone.

🔵 Opioid analgesics like hydromorphone are ordered to manage severe pain, not to correct hemoglobin levels, which would instead be addressed with transfusion or disease-modifying therapy if indicated.

Platelets

🔵 The child’s platelet count is elevated (450,000/mm³), which may reflect reactive thrombocytosis, but this is not treated with IV opioids and is not an indication for hydromorphone.

🔵 Platelet abnormalities are typically managed with hematology consultation and underlying disease control, not with pain medications, so “platelets” does not logically complete the sentence.

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Answer 2

Correct Answers:

Bowling

Rationale :

🟦 Bowling is a low-impact, non-contact sport, which greatly reduces the risk of trauma and bleeding for a child who has hemophilia.

🟦 Children with hemophilia are at high risk for joint bleeds and internal hemorrhage when exposed to collision or fall-prone activities.

🟦 Bowling involves controlled movements, typically using both hands and feet on a stable surface, which minimizes the chance of falls or direct blows.

🟦 The sport allows the child to participate socially and physically while maintaining necessary safety precautions for their bleeding disorder.

🟦 Encouraging safe physical activity like bowling promotes normal growth, self-esteem, and socialization, while still protecting the child from excessive bleeding risk.

🟦 Gymnastics involves jumping, flipping, and high-impact landings, which significantly increase the risk of joint injuries and internal bleeding for a child with hemophilia.

🟦 The use of equipment such as beams and bars creates multiple opportunities for direct trauma, making gymnastics unsafe for this condition.

🟦 Basketball is a contact sport with frequent collisions, falls, and rapid changes in direction, all of which can lead to serious bleeding episodes.

🟦 The competitive and fast-paced nature of basketball places excessive strain on joints and muscles, which is unsafe for a child with a bleeding disorder.

🟦 Soccer involves running, kicking, and bodily contact, making falls, collisions, and leg injuries very common.

🟦 These risks can trigger hemarthrosis (joint bleeding) and other internal bleeds, so soccer is not recommended for a child with hemophilia.

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Answer 3

Correct Answers:

Kerosene heater

Rationale :

✨ Carbon monoxide (CO) is produced by incomplete combustion of carbon-based fuels, such as kerosene, gas, or wood.

✨ A kerosene heater burns fuel and, in a poorly ventilated home, can release dangerous levels of CO into the air.

✨ CO is colorless, odorless, and tasteless, so families cannot detect it without CO detectors, increasing risk of poisoning.

✨ Symptoms such as headache, dizziness, nausea, and confusion are classic early manifestations of CO exposure.

✨ Identifying the kerosene heater as a CO source allows the nurse to teach about proper ventilation, safe use, and the need for CO detectors to prevent toxicity.

Refrigerator

✨ A standard household refrigerator runs on electricity, not fuel combustion, and does not normally produce carbon monoxide.

✨ Unless it is an older type using special fuels (rare in modern homes), it is not considered a typical CO source.

Washing machine

✨ A washing machine also uses electricity and does not burn fuel, so it does not generate CO during normal operation.

✨ It might pose other risks (e.g., electrical or water hazards) but is not a source of carbon monoxide poisoning.

Electric stove

✨ An electric stove does not burn gas or fuel, so it does not emit carbon monoxide.

✨ CO risk is associated with gas stoves or fuel-burning appliances, not standard electric stoves.

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Answer 4

Correct Answers:

Keep the affected extremity straight for at least 6 hr.

Rationale :

🌟 After arterial cardiac catheterization, the catheter insertion site (often in the femoral artery) is at risk for bleeding and hematoma formation.

🌟 Keeping the affected extremity straight and immobilized for at least 6 hours helps maintain pressure over the puncture site and supports clot formation.

🌟 Movement or flexion at the hip or knee can disrupt the clot, leading to significant bleeding or loss of perfusion to the limb.

🌟 Maintaining the leg straight and still also allows for accurate monitoring of distal pulses, color, temperature, and sensation, which are critical for detecting circulatory compromise.

🌟 This intervention is a priority safety measure to prevent postprocedural hemorrhage and ensure adequate vascular stability after catheter removal.

Remove the child's pressure dressing after the first 4 hr.

🌟 The pressure dressing helps maintain hemostasis at the insertion site and is typically left in place longer than 4 hours, per provider or facility protocol.

🌟 Removing it too early can increase the risk of bleeding and compromise site stability.

Monitor output using an indwelling urinary catheter for the first 24 hr.

🌟 An indwelling urinary catheter is not routinely required after cardiac catheterization and can increase risk of infection and discomfort.

🌟 Urine output can usually be monitored noninvasively unless there is a specific medical indication for catheterization.

Maintain the child's NPO status for 4 to 6 hr.

🌟 NPO status is generally required before the procedure to reduce aspiration risk under sedation, not routinely after the child is stable and awake.

🌟 Once vital signs are stable and gag reflex has returned, the child can usually resume oral intake as ordered.

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Answer 5

Correct Answers:

Establish a dally schedule with the toddler and their family.

Rationale :

💎 Children with heart failure fatigue easily due to decreased cardiac output, so they benefit from predictable routines that balance activity and rest.

💎 A daily schedule allows the nurse and family to plan quiet periods, naps, and low-energy play, preventing overexertion.

💎 Consistency in the routine reduces anxiety and stress, which can otherwise increase metabolic and cardiac workload.

💎 Involving the family in planning the schedule promotes family-centered care, improves adherence, and helps them recognize signs of fatigue that signal the need for rest.

💎 This structured approach optimizes the toddler’s energy conservation, supports growth and development, and helps manage the symptoms of heart failure effectively.

Allow the toddler to visit the playroom 30 min prior to bedtime.

💎 Visiting the playroom close to bedtime can cause stimulation and excitement, making it harder for the toddler to settle and rest.

💎 For a child with heart failure, this added activity before sleep can increase fatigue and cardiac workload, which is not restful.

Keep the television on in the toddler's room.

💎 A television running continuously can be overstimulating, disrupt sleep, and prevent the calm, quiet environment needed for rest.

💎 Background noise and light may interfere with the toddler’s ability to nap and achieve deep sleep, which is essential for recovery in heart failure.

Administer diuretics with the toddler's lunch.

💎 While diuretics are important in heart failure management, the time of administration is based on fluid balance and provider orders, not primarily to promote rest.

💎 Giving diuretics at lunch may increase urination soon after, possibly interrupting naps or rest periods, and does not directly support energy conservation planning.

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Answer 6

Correct Answers:

Increased abdominal girth

Rationale :

✨ Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema, especially generalized and dependent edema.

✨ Low serum albumin decreases plasma oncotic pressure, causing fluid to shift into the interstitial space, including the peritoneal cavity.

✨ This fluid accumulation in the abdomen leads to ascites, which is observed clinically as increased abdominal girth.

✨ Parents may report that the child’s clothes or waistband feel tighter and the abdomen appears swollen or distended.

✨ Recognizing increased abdominal girth as a key sign helps the nurse identify fluid retention and the need for further evaluation and treatment of nephrotic syndrome.

Constipation

✨ Constipation is not a defining feature of nephrotic syndrome; it may occur in many pediatric conditions or from diet or activity changes.

✨ It does not specifically reflect the protein loss, edema, or fluid shifts associated with nephrotic syndrome.

Increased urinary output

✨ In nephrotic syndrome, children often exhibit decreased urinary output (oliguria) due to fluid retention, not increased output.

✨ Increased urine, especially if clear and plentiful, would be more consistent with diuresis or other fluid-balance states, not nephrotic edema.

Irritability

✨ While irritability can occur in many illnesses, it is nonspecific and not a hallmark indicator of nephrotic syndrome.

✨ The nurse should prioritize more specific findings like edema, periorbital swelling, and increased abdominal girth when considering nephrotic syndrome.

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Answer 7

Correct Answers:

Irritability

Rationale :

🌟 Hydrocephalus with a malfunctioning VP shunt can cause increased intracranial pressure (ICP) due to impaired CSF drainage.

🌟 In infants, early signs of increased ICP are often behavioral, such as irritability, restlessness, and inconsolable crying.

🌟 The infant may be unable to verbalize pain or headache, so persistent irritability is a critical clue that pressure is building in the skull.

🌟 If untreated, increased ICP can progress to vomiting, lethargy, bulging fontanel, and changes in level of consciousness, making early recognition crucial.

🌟 Identifying irritability as a significant change prompts the nurse to notify the provider immediately to evaluate for shunt obstruction or malfunction and prevent neurologic damage.

Flat fontanel

🌟 A flat fontanel is usually a normal finding in a well-hydrated infant and does not indicate raised intracranial pressure.

🌟 Increased ICP is more typically associated with a bulging or tense fontanel, not a flat one.

Increased appetite

🌟 Increased appetite is not a typical sign of increased ICP; more often, children may have poor feeding or vomiting.

🌟 Appetite changes alone would not strongly suggest shunt malfunction compared with irritability or vomiting.

Tachycardia

🌟 Although vital signs can change with serious neurologic problems, tachycardia is a nonspecific sign and may relate to many other issues such as fever or pain.

🌟 More classic signs of increased ICP in infants are irritability, bulging fontanel, high-pitched cry, and changes in behavior or LOC.

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Answer 8

Correct Answers:

Decreased bone density

Rationale :

⭐ Prednisolone is a systemic corticosteroid that, with prolonged use, can interfere with bone formation and calcium metabolism.

⭐ It promotes bone resorption and decreases bone formation, leading to osteopenia and osteoporosis over time.

⭐ Children on long-term steroids are at increased risk for fragility fractures, delayed growth, and musculoskeletal complications.

⭐ Monitoring for bone pain, decreased height velocity, and fracture history is essential in pediatric clients on chronic prednisolone therapy.

⭐ Recognizing decreased bone density as an adverse effect helps the nurse advocate for bone health support, such as adequate calcium, vitamin D, weight-bearing activity, and appropriate dosing and duration.

Hypoglycemia

⭐ Corticosteroids like prednisolone typically cause hyperglycemia, not hypoglycemia, by increasing gluconeogenesis and decreasing cellular glucose uptake.

⭐ Thus, the nurse should be more concerned about elevated blood glucose rather than low blood sugar in a child on prednisolone.

Decreased intraocular pressure

⭐ Prednisolone can actually increase intraocular pressure, contributing to glaucoma risk with long-term use.

⭐ Decreased intraocular pressure is not associated with steroid therapy and would not be the expected adverse effect.

Weight loss

⭐ Corticosteroid therapy more commonly causes weight gain due to increased appetite, fluid retention, and fat redistribution.

⭐ Weight loss would not be typical and might suggest another underlying problem rather than prednisolone’s usual side effect profile.

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Answer 9

Correct Answers:

Increased respiratory rate

Rationale :

🔷 Patent ductus arteriosus (PDA) causes increased blood flow from the aorta to the pulmonary artery, leading to increased pulmonary circulation.

🔷 This excess blood in the lungs results in pulmonary congestion, making it harder for the infant to exchange oxygen effectively.

🔷 To compensate, the infant develops tachypnea (increased respiratory rate) as an early and prominent sign of respiratory distress.

🔷 Infants with PDA may also show retractions, nasal flaring, or feeding difficulty, but increased respiratory rate is a key expected finding.

🔷 Recognizing tachypnea as a primary manifestation helps the nurse monitor for worsening heart failure and respiratory compromise in PDA.

Decreased heart rate

🔷 Infants with PDA are more likely to develop tachycardia (increased heart rate) due to increased workload on the heart, not bradycardia.

🔷 Decreased heart rate would be more concerning for severe decompensation or conduction problems, not a typical early sign of PDA.

Increased temperature

🔷 Increased temperature suggests infection or inflammation, not specifically PDA.

🔷 PDA is a cardiac structural defect, and fever is not a classic expected finding unless another condition is present.

Decreased systolic blood pressure

🔷 In PDA, there may be a widened pulse pressure, but systolic blood pressure is often normal or even elevated, not specifically decreased.

🔷 Hypotension is more associated with severe decompensated heart failure or shock, not uncomplicated PDA.

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Answer 10

Correct Answers:

Check the wound sites for manifestations of infection.

Rationale :

💠 Clients with extensive burns are at very high risk for infection and sepsis because the skin barrier is destroyed.

💠 Infection is one of the leading causes of morbidity and mortality in burn clients, especially during the dressing change, when wounds are exposed.

💠 The nurse must closely assess for erythema, increased drainage, odor, swelling, and changes in pain, which indicate local or systemic infection.

💠 Early identification of infection signs allows for prompt interventions such as culture collection, antibiotic therapy, and adjusting wound care.

💠 Addressing the risk of infection during dressing changes directly targets the greatest life-threatening complication for burn clients.

Adjust the room temperature to 33° C (91.4° F).

💠 Keeping the room warm helps prevent hypothermia in burn clients, which is important but is generally a secondary concern compared to preventing infection and sepsis.

💠 While a warm environment reduces heat loss, it does not directly address the greatest risk, which is wound infection.

Apply tepid water to the old dressings before removal.

💠 Using tepid water can help loosen adherent dressings and decrease pain, but this is primarily a comfort and skin-protection measure.

💠 It does not directly address the most serious, life-threatening complication, which is development of infection.

Perform passive range-of-motion exercises during the dressing change.

💠 Passive range-of-motion exercises are important to prevent contractures and maintain joint mobility in burn clients.

💠 However, these exercises focus on long-term mobility, not on the immediate, greatest risk of infection and sepsis during dressing changes.

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RN Pediatric Nursing 2023 Dec 9

No.

1 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

Correct Answers

2 :
A nurse is providing teaching about participating in sports to a 12-year-old child who has hemophilia. Which of the following sports should the nurse recommend?

4 :
A nurse is providing postoperative care for a child following an arterial cardiac catheterization. Which of the following actions should the nurse take?

5 :
A nurse is caring for a 3-year-old toddler who has heart failure. Which of the following actions should the nurse take to promote rest for the toddler?

6 :
A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

7 :
A nurse is caring for an infant who has hydrocephalus and ventriculoperitoneal shunt malfunction. Which of the following assessment findings Indicates that the infant is experiencing increased Intracranial pressure?

8 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

9 :
A nurse is assessing an infant who has patent ductus arteriosus. Which of the following findings should the nurse expect?

10 :
A nurse is planning to complete dressing changes for an adolescent who has multiple burn injuries. Which of the following interventions addresses the greatest risk to the client?

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RN Pediatric Nursing 2023 Dec 9

No.

1 : A nurse is caring for a 12-year-old client who has sickle cell disease.

Correct Answers

2 : A nurse is providing teaching about participating in sports to a 12-year-old child who has hemophilia. Which of the following sports should the nurse recommend?

4 : A nurse is providing postoperative care for a child following an arterial cardiac catheterization. Which of the following actions should the nurse take?

5 : A nurse is caring for a 3-year-old toddler who has heart failure. Which of the following actions should the nurse take to promote rest for the toddler?

6 : A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

7 : A nurse is caring for an infant who has hydrocephalus and ventriculoperitoneal shunt malfunction. Which of the following assessment findings Indicates that the infant is experiencing increased Intracranial pressure?

8 : A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

9 : A nurse is assessing an infant who has patent ductus arteriosus. Which of the following findings should the nurse expect?

10 : A nurse is planning to complete dressing changes for an adolescent who has multiple burn injuries. Which of the following interventions addresses the greatest risk to the client?

1 :
A nurse is caring for a 12-year-old client who has sickle cell disease.

2 :
A nurse is providing teaching about participating in sports to a 12-year-old child who has hemophilia. Which of the following sports should the nurse recommend?

4 :
A nurse is providing postoperative care for a child following an arterial cardiac catheterization. Which of the following actions should the nurse take?

5 :
A nurse is caring for a 3-year-old toddler who has heart failure. Which of the following actions should the nurse take to promote rest for the toddler?

6 :
A nurse is assessing a toddler during a well-child visit. Which of the following findings should the nurse identify as an indication of nephrotic syndrome?

7 :
A nurse is caring for an infant who has hydrocephalus and ventriculoperitoneal shunt malfunction. Which of the following assessment findings Indicates that the infant is experiencing increased Intracranial pressure?

8 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

9 :
A nurse is assessing an infant who has patent ductus arteriosus. Which of the following findings should the nurse expect?

10 :
A nurse is planning to complete dressing changes for an adolescent who has multiple burn injuries. Which of the following interventions addresses the greatest risk to the client?