Question

A nurse is caring for an 11-year-old client who presents with abdominal pain and possible appendicitis. Which of the following manifestations should the nurse expect?

Answer 1

Correct Answers:

Pain in the right lower quadrant of the abdomen

Rationale :

✅ Appendicitis most commonly causes pain in the right lower quadrant (RLQ) because the appendix is located in the RLQ, near McBurney’s point.

✅ The pain often begins as vague periumbilical discomfort and then migrates to the RLQ as inflammation irritates the parietal peritoneum.

✅ RLQ pain is a key expected manifestation in children and is frequently accompanied by tenderness, guarding, and sometimes rebound pain.

✅ The nurse should expect the pain to worsen with movement, coughing, or walking, because these increase peritoneal irritation.

✅ Recognizing RLQ pain early is important because untreated appendicitis can progress to perforation and peritonitis, which are serious complications requiring urgent care.

Pain in the right upper quadrant of the abdomen

✅ RUQ pain is more typical of gallbladder or liver problems rather than appendicitis.

✅ Appendicitis pain classically localizes to the RLQ, not the RUQ.

Pain in both quadrants of the upper abdomen

✅ Upper abdominal pain is more consistent with gastric or hepatobiliary conditions than appendicitis.

✅ Appendicitis tends to become localized rather than causing broad bilateral upper abdominal pain.

Pain in the left lower quadrant of the abdomen

✅ LLQ pain is commonly associated with constipation or other lower intestinal conditions, not appendicitis.

✅ Appendiceal inflammation usually produces right-sided lower abdominal pain.

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Answer 2

Correct Answers:

"Your baby's foot is twisted to the side due to shortened tendons."

Rationale :

🟣 Clubfoot (talipes equinovarus) is a congenital deformity driven largely by shortened tendons/soft tissues that pull the foot into an abnormal position.

🟣 The typical position includes inversion and adduction of the forefoot with the heel turned inward (varus) and the ankle pointed downward (equinus).

🟣 Explaining shortened tendons helps the caregiver understand why treatment focuses on gradual stretching and repositioning rather than “waiting it out.”

🟣 It supports adherence to serial casting (Ponseti method) and later bracing, which work by slowly lengthening tight tissues and maintaining corrected alignment.

🟣 This teaching is also reassuring because it highlights that early intervention improves function and mobility and reduces long-term deformity.

“A bone development abnormality causes the foot to form incorrectly.”

🟣 Clubfoot is primarily related to soft tissue tightening and abnormal positioning, not a primary bone growth defect.

🟣 Bone alignment is affected secondarily, but the key driver is tight tendons/ligaments.

“Clubfoot is caused by a dislocated joint that causes the foot to turn inward.”

🟣 Clubfoot involves multiple joints and soft tissues, not a single “dislocated joint.”

🟣 Calling it a dislocation oversimplifies the condition and misguides expectations about treatment.

“Poor blood supply to the bone results in some of the tissue dying and affecting foot shape.”

🟣 This describes avascular necrosis, which is not the cause of congenital clubfoot.

🟣 Clubfoot is a structural congenital deformity, managed with casting and bracing rather than restoring blood supply.

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Answer 3

Correct Answers:

"l can participate in low impact activities such as bike riding, swimming, or yoga."

Rationale :

🔵 Beta thalassemia can cause chronic anemia, which reduces oxygen-carrying capacity and can lead to fatigue and exercise intolerance.

🔵 Low-impact activities support cardiovascular fitness while reducing the risk of overexertion and limiting stress on bones and joints.

🔵 Many clients with thalassemia also have risk for bone changes and, in some cases, splenomegaly, so avoiding high-contact sports helps prevent injury.

🔵 Choosing swimming, biking, or yoga demonstrates understanding of safe activity that can be paced with rest breaks and hydration.

🔵 This statement reflects effective learning because it balances activity participation with safety, energy conservation, and symptom monitoring.

“I can participate in any sport I would like, as long as I wear protective gear.”

🔵 Protective gear does not eliminate risks related to anemia-related fatigue or potential splenic injury with contact sports.

🔵 Activity choice should be guided by tolerance and risk level, not “any sport.”

“I cannot partake in any sports due to my diagnosis.”

🔵 Complete restriction is unnecessary; many adolescents can safely participate in appropriate activities.

🔵 Encouraging safe exercise helps overall conditioning and quality of life.

“I can participate in individual sports like track or cross country.”

🔵 These may be high-endurance and can trigger dyspnea and fatigue in anemia if intensity is not controlled.

🔵 While some may participate with provider guidance, the safest general teaching emphasizes low-impact options.

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Answer 4

Correct Answers:

Oral rehydration therapy (ORS) and continue feeding

Rationale :

🟢 Mild dehydration from viral gastroenteritis is best corrected with oral rehydration solution (ORS) because it provides the right balance of glucose and electrolytes to enhance intestinal absorption.

🟢 Continuing feeding supports gut healing and prevents worsening malnutrition; children should resume or continue age-appropriate diet as tolerated.

🟢 ORS is effective because it replaces ongoing stool losses and improves hydration without the risks of unnecessary IV therapy.

🟢 Early ORS reduces complications such as worsening dehydration, electrolyte imbalance, and need for hospitalization.

🟢 This approach matches evidence-based pediatric care for stable children who can drink and are not in shock.

NPO and antibiotics

🟢 Viral gastroenteritis does not improve with antibiotics and unnecessary antibiotics can worsen diarrhea.

🟢 NPO is not recommended for mild dehydration because it delays recovery and hydration.

Give only antidiarrheal agents

🟢 Antidiarrheals are generally avoided in children due to safety concerns and they do not correct dehydration.

🟢 The priority is fluid and electrolyte replacement with ORS.

IV fluids always

🟢 IV fluids are reserved for moderate to severe dehydration, inability to tolerate PO, or shock.

🟢 Mild dehydration is typically managed safely with oral therapy.

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Answer 5

Correct Answers:

Child life specialist

Rationale :

🟠 The child’s distress is triggered by separation/anxiety, leading to crying spells that worsen breathing and oxygenation.

🟠 A child life specialist is trained to reduce fear and anxiety through therapeutic play, coping strategies, and age-appropriate emotional support.

🟠 By decreasing crying and agitation, the child is less likely to develop episodes of tachypnea and oxygen desaturation.

🟠 Child life interventions can include structured activities, distraction, comfort routines, and family-connection support (e.g., videos/recordings).

🟠 This directly addresses the psychosocial trigger contributing to physiologic respiratory decline, improving overall stability.

Respiratory therapist

🟠 Helpful for airway clearance and oxygen delivery, but does not primarily address anxiety-driven crying episodes.

🟠 The main issue is emotional distress causing respiratory worsening.

Social worker

🟠 Social work helps with resources and family needs, but does not provide ongoing bedside coping/play interventions.

🟠 It’s supportive, but less direct for immediate anxiety-related distress.

Case manager

🟠 Case managers coordinate discharge planning and services rather than managing acute separation anxiety at the bedside.

🟠 This role is not the most targeted intervention for crying-induced desaturation.

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Answer 6

Correct Answers:

Face, Legs, Activity, Cry Consolability (FLACC)

Rationale :

🟡 A 6-month-old cannot reliably self-report pain, so an observational behavioral scale is required.

🟡 FLACC evaluates pain using five observable categories: face, legs, activity, cry, and consolability.

🟡 It is appropriate for infants and young children because it translates behavior into a consistent score for trending pain response.

🟡 FLACC supports safe analgesic decisions by documenting changes before and after interventions.

🟡 Using a validated tool improves accuracy and reduces under-treatment of pain in nonverbal patients.

Pain word scale

🟡 Requires the child to use words to describe pain, which a 6-month-old cannot do.

🟡 It is appropriate for older children who can verbalize.

FACES Pain Scale

🟡 Requires the child to point to a face that matches their pain, which is not developmentally appropriate at 6 months.

🟡 Best for children who can understand and choose a face representation.

Premature infant pain scale (PIPP-R)

🟡 PIPP-R is designed for premature/neonatal populations, especially in NICU settings.

🟡 A 6-month-old infant is better assessed with FLACC.

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Answer 7

Correct Answers:

The child will be discharged after 8 hours of observation.

Rationale :

⚫ After a submersion event with water aspiration, the priority risk is delayed respiratory complications such as bronchospasm or pulmonary edema.

⚫ A child who is conscious, stable, and without trauma is often managed with observation and serial respiratory assessments rather than immediate admission.

⚫ Observation allows monitoring for worsening work of breathing, cough, wheezing, or oxygen desaturation that can develop hours later.

⚫ If the child remains stable with normal oxygenation and no respiratory decline during the observation window, discharge is appropriate with strict return precautions.

⚫ This outcome matches safety-focused ED practice: monitor for delayed symptoms, then discharge if stable.

The child will be kept in the hospital for respiratory support.

⚫ Hospital respiratory support is needed if there are signs of deterioration (hypoxia, distress), which are not present here.

⚫ Stable children generally require observation first, not automatic admission.

The child will be moved to a rehabilitation facility for care.

⚫ Rehab is for ongoing functional deficits or injury recovery, not for a stable aspiration event without trauma.

⚫ There are no findings suggesting long-term rehab needs.

The child will be given CPR and monitored for response.

⚫ CPR is indicated for apnea, pulselessness, or unresponsiveness, which are not present.

⚫ The child is conscious and breathing, so CPR is not appropriate.

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Answer 8

Correct Answers:

Breastfeeding or IV dextrose

Rationale :

🔴 Newborn hypoglycemia is treated by restoring glucose to prevent neurologic injury; first-line management includes feeding (breastfeeding or formula) if the infant can safely feed.

🔴 If hypoglycemia is significant, symptomatic, or persistent, IV dextrose is used to rapidly correct low glucose levels.

🔴 This approach targets the core problem—low serum glucose—and helps stabilize the infant’s energy supply for the brain.

🔴 Ongoing monitoring is essential because newborns can have recurrent drops due to limited glycogen stores or endocrine/metabolic factors.

🔴 Feeding and/or IV dextrose are evidence-based interventions that directly correct hypoglycemia and reduce seizure risk.

Steroids

🔴 Steroids are not first-line for routine neonatal hypoglycemia and do not provide immediate glucose correction.

🔴 They are reserved for specific endocrine indications under provider direction.

Insulin

🔴 Insulin lowers blood glucose, so it would worsen hypoglycemia.

🔴 It is contraindicated in a hypoglycemic newborn.

Oral sucrose

🔴 Sucrose is mainly used for procedural comfort and does not reliably correct clinically significant hypoglycemia.

🔴 Hypoglycemia requires feeding or IV dextrose for effective treatment.

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Answer 9

Correct Answers:

"Males are two to three times more likely than females to experience nocturnal enuresis."

Rationale :

🔷 Nocturnal enuresis is more common in boys; stating males are more likely than females reflects accurate epidemiologic teaching.

🔷 This helps caregivers normalize the condition and reduces stigma by framing it as a common developmental issue.

🔷 Understanding prevalence supports realistic expectations and encourages consistent behavioral strategies rather than blame or punishment.

🔷 Accurate teaching also guides caregivers toward supportive interventions like scheduled voiding, limiting evening fluids, and positive reinforcement.

🔷 Recognizing risk patterns helps families understand that improvement often occurs over time with maturation.

“My child has secondary nocturnal enuresis and has never had bladder control.”

🔷 “Secondary” means the child previously had dryness and then began wetting again after a period of control.

🔷 “Never had bladder control” describes primary nocturnal enuresis.

“Up to 20% of children still wet the bed by age seven.”

🔷 This percentage is not accurate as stated; bedwetting rates generally decrease significantly with age and are typically lower around age 7.

🔷 Teaching should emphasize that prevalence declines as children mature, but exact rates must be correct.

“Children with this disorder will have it for the rest of their lives.”

🔷 Most children outgrow nocturnal enuresis as bladder capacity and nighttime hormonal control mature.

🔷 Presenting it as lifelong is misleading and increases caregiver anxiety.

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Answer 10

Correct Answers:

Osteosarcoma

Rationale :

🌟 Osteosarcoma is the most common primary malignant bone tumor in children and adolescents.

🌟 It typically occurs during periods of rapid growth and most often involves the metaphysis of long bones, especially around the knee (distal femur/proximal tibia).

🌟 A key expected presentation is progressive bone pain (often worse at night or with activity) and possible swelling or a palpable mass.

🌟 Teaching/recognition matters because osteosarcoma can metastasize (commonly to the lungs), so early evaluation of persistent pain is critical.

🌟 This diagnosis is strongly associated with radiographic findings such as sunburst pattern or Codman triangle, supporting why it stands out as the classic common pediatric primary bone cancer.

Chondrosarcoma

🌟 This tumor is more common in adults, not children.

🌟 It typically arises from cartilage and is less common as a pediatric primary bone malignancy.

Ewing

🌟 Ewing sarcoma is common in pediatrics, but it is generally second to osteosarcoma as the most common primary malignant bone tumor.

🌟 It more often affects the diaphysis of long bones or pelvis.

Multiple myeloma

🌟 Multiple myeloma is a plasma cell cancer primarily seen in older adults, not children.

🌟 It is not considered a typical pediatric primary bone tumor.

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Custom Brachwite Pediatric Final exam Nurs223 Section II

No.

1 :
A nurse is caring for an 11-year-old client who presents with abdominal pain and possible appendicitis. Which of the following manifestations should the nurse expect?

2 :
A nurse is providing teaching to the caregiver of an infant born with congenital talipes equinovarus (clubfoot). Which of the following statements should the nurse include in their teaching?

3 :
A nurse is providing education about physical activity to an adolescent who has beta thalassemia. Which of the following statements by the adolescent Indicates that the education was effective?

4 :
Most appropriate management for child with viral gastroenteritis and mild dehydration?

6 :
A nurse is assessing pain in a 6-month-old infant. Which of the following assessment tools should the nurse use?

7 :
A nurse is caring for a child who was brought to the emergency department after falling out of a boat. The child inhaled some water, is conscious, and shows no manifestations of trauma. Which of the following outcomes should the nurse expect?

8 :
Treatment for newborn hypoglycemia

9 :
A nurse is teaching a caregiver about nocturnal enuresis in school-age children who are 6 to 12 years old. Which of the following statements made by the caregiver demonstrates effective teaching?

10 :
Most common primary bone tumor in children

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Custom Brachwite Pediatric Final exam Nurs223 Section II

No.

1 : A nurse is caring for an 11-year-old client who presents with abdominal pain and possible appendicitis. Which of the following manifestations should the nurse expect?

2 : A nurse is providing teaching to the caregiver of an infant born with congenital talipes equinovarus (clubfoot). Which of the following statements should the nurse include in their teaching?

3 : A nurse is providing education about physical activity to an adolescent who has beta thalassemia. Which of the following statements by the adolescent Indicates that the education was effective?

4 : Most appropriate management for child with viral gastroenteritis and mild dehydration?

6 : A nurse is assessing pain in a 6-month-old infant. Which of the following assessment tools should the nurse use?

7 : A nurse is caring for a child who was brought to the emergency department after falling out of a boat. The child inhaled some water, is conscious, and shows no manifestations of trauma. Which of the following outcomes should the nurse expect?

8 : Treatment for newborn hypoglycemia

9 : A nurse is teaching a caregiver about nocturnal enuresis in school-age children who are 6 to 12 years old. Which of the following statements made by the caregiver demonstrates effective teaching?

10 : Most common primary bone tumor in children

1 :
A nurse is caring for an 11-year-old client who presents with abdominal pain and possible appendicitis. Which of the following manifestations should the nurse expect?

2 :
A nurse is providing teaching to the caregiver of an infant born with congenital talipes equinovarus (clubfoot). Which of the following statements should the nurse include in their teaching?

3 :
A nurse is providing education about physical activity to an adolescent who has beta thalassemia. Which of the following statements by the adolescent Indicates that the education was effective?

4 :
Most appropriate management for child with viral gastroenteritis and mild dehydration?

6 :
A nurse is assessing pain in a 6-month-old infant. Which of the following assessment tools should the nurse use?

7 :
A nurse is caring for a child who was brought to the emergency department after falling out of a boat. The child inhaled some water, is conscious, and shows no manifestations of trauma. Which of the following outcomes should the nurse expect?

8 :
Treatment for newborn hypoglycemia

9 :
A nurse is teaching a caregiver about nocturnal enuresis in school-age children who are 6 to 12 years old. Which of the following statements made by the caregiver demonstrates effective teaching?

10 :
Most common primary bone tumor in children