Question

A nurse is caring for an adolescent who is admitted with a vaso- occlusive crisis.

Answer 1

Correct Answers:

Give oral hydroxyurea.
Instructing the parent to ensure the pneumococcal vaccine is current
Monitor oxygen saturation
Apply warm compresses to painful joints
Encourage increased fluid intake

Rationale :

📌 B. Give oral hydroxyurea

📌 Hydroxyurea is a disease-modifying agent that increases fetal hemoglobin (HbF), which helps prevent sickling of red blood cells.

📌 It reduces the frequency and severity of vaso-occlusive crises in clients with sickle cell disease.

📌 Long-term use decreases hospital admissions, transfusion needs, and pain episodes, making it a cornerstone of medical management.

📌 It is appropriate even during crisis episodes, especially if the child is on a chronic regimen.

🎯 D. Instruct the parent to ensure the pneumococcal vaccine is current

🎯 Children with sickle cell disease are at high risk for infections, especially with encapsulated organisms like Streptococcus pneumoniae.

🎯 Pneumococcal vaccination is essential for infection prevention, which is also a trigger for vaso-occlusive crises.

🎯 Up-to-date immunizations significantly reduce morbidity and the risk of overwhelming sepsis, which can be life-threatening.

🎯 This intervention is part of long-term preventive care and education.

📌 E. Monitor oxygen saturation

📌 Hypoxia can exacerbate red blood cell sickling, leading to worsening of vaso-occlusion.

📌 Continuous monitoring allows for early detection of oxygen desaturation, which requires prompt intervention.

📌 Ensuring adequate oxygenation prevents complications such as acute chest syndrome, a severe complication of sickle cell crisis.

📌 It also helps evaluate the effectiveness of therapies and the child’s respiratory stability.

🎯 F. Apply warm compresses to painful joints

🎯 Warmth promotes vasodilation, which helps improve blood flow and relieves the ischemic pain caused by blocked sickled cells.

🎯 It provides non-pharmacologic pain relief, especially useful for localized joint and muscle discomfort.

🎯 Cold applications should be avoided, as they cause vasoconstriction and worsen sickling.

🎯 This is a safe and supportive comfort measure in managing vaso-occlusive pain.

📌 G. Encourage increased fluid intake

📌 Hydration reduces blood viscosity, making red blood cells less likely to clump and sickle.

📌 Adequate fluid intake helps flush out sickled cells, decreasing the chance of further vascular occlusion.

📌 This intervention is critical for both acute crisis management and long-term prevention of recurrences.

📌 Oral or IV fluids are prioritized depending on the client’s ability to tolerate fluids and severity of dehydration.

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Answer 2

Correct Answers:

"Your child should walk the bicycle through intersections."

Rationale :

🎯 Walking a bicycle through intersections is a key safety strategy to prevent accidents in areas with high vehicle movement.

🎯 It improves visibility, gives the child more time to assess traffic, and reduces the risk of being struck by a vehicle.

🎯 Teaching this to school-age children is developmentally appropriate, as they are learning road awareness and judgment.

🎯 This behavior is endorsed by pediatric safety guidelines and significantly reduces the chance of injury during street crossings.

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Answer 3

Correct Answers:

A toddler who has seasonal influenza

Rationale :

💠 Seasonal influenza is spread via droplet transmission, meaning it can spread through coughing, sneezing, or talking.

💠 Children with influenza require droplet precautions, which include wearing a mask, using gloves and gowns, and separating the patient from others.

💠 These precautions are essential to prevent the rapid spread of flu viruses, particularly in pediatric units with immunocompromised patients.

💠 Flu is a highly contagious respiratory illness, making this protective measure non-negotiable in a clinical setting.

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Answer 4

Correct Answers:

12.5

Rationale :

📌 Step 1: Convert child’s weight to kg

📌 55 lb ÷ 2.2 = 25 kg

📌 Step 2: Calculate required dose

📌 10 mg × 25 kg = 250 mg needed

📌 Step 3: Use available concentration

📌 100 mg in 5 mL → (250 mg ÷ 100 mg) × 5 mL = 12.5 mL

📌 The nurse should administer 12.5 mL of ibuprofen to deliver the correct weight-based dose.

📌 Always round to the nearest tenth as directed and use a leading zero if needed, no trailing zero.

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Answer 5

Correct Answers:

Pancreatic lipase
Water-soluble vitamins
Dornase alfa

Rationale :

⭐ A. Pancreatic lipase

⭐ Children with cystic fibrosis (CF) commonly have pancreatic insufficiency, leading to malabsorption of fats and fat-soluble vitamins.

⭐ Pancreatic enzyme replacement therapy (PERT) with pancreatic lipase aids digestion by breaking down fats, proteins, and carbohydrates.

⭐ This reduces steatorrhea (large, frothy, foul-smelling stools), improves nutrient absorption, and supports growth and development.

⭐ It should be administered with all meals and snacks to mimic normal pancreatic function.

⭐ C. Water-soluble vitamins

⭐ In CF, children often have malabsorption of fat-soluble vitamins A, D, E, and K due to impaired pancreatic enzyme activity.

⭐ Providers typically prescribe fat-soluble vitamins in water-miscible (water-soluble) form, which allows for better gastrointestinal absorption.

⭐ Supplementation helps prevent complications like night blindness (vitamin A), bone issues (vitamin D), neurologic symptoms (vitamin E), and bleeding disorders (vitamin K).

⭐ These vitamins are essential for long-term health maintenance in CF.

⭐ E. Dornase alfa

⭐ Dornase alfa (Pulmozyme) is a recombinant human DNase used to thin pulmonary secretions in CF patients.

⭐ It breaks down DNA in mucus, reducing its viscosity and improving airway clearance and pulmonary function.

⭐ This medication is administered via nebulization and is a cornerstone therapy for managing chronic lung disease in CF.

⭐ Dornase alfa helps decrease infection risk and reduce the frequency of hospitalizations.

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Answer 6

Correct Answers:

Prolonged wound healing

Rationale :

🔹 Prednisolone, a corticosteroid, suppresses the immune response and inflammatory processes, which can impair tissue repair.

🔹 This leads to delayed wound healing, putting children at higher risk for infection or complications post-injury or surgery.

🔹 The nurse should monitor for slow or non-healing wounds, as this can signal excessive corticosteroid effect.

🔹 Other signs may include thinning skin or easy bruising, also related to collagen breakdown.

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Answer 7

Correct Answers:

A decrease in peripheral edema

Rationale :

🟣 Furosemide is a loop diuretic used in children with heart failure to remove excess fluid and reduce workload on the heart.

🟣 A reduction in edema indicates that the medication is effectively promoting diuresis and relieving fluid overload.

🟣 Decreased peripheral swelling leads to improved comfort, mobility, and cardiac efficiency.

🟣 This is one of the primary therapeutic goals in pediatric heart failure treatment.

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Answer 8

Correct Answers:

Facial twitching

Rationale :

🟥 Facial twitching in a child with sickle cell anemia may indicate hypocalcemia or neurologic involvement, including stroke, which is a medical emergency.

🟥 Children with sickle cell disease are at increased risk for cerebrovascular events due to sickled cells occluding cerebral vessels.

🟥 Neurologic symptoms such as twitching, weakness, or slurred speech must be immediately reported and evaluated.

🟥 Early intervention is critical to prevent permanent damage or progression of neurologic injury.

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Answer 9

Correct Answers:

Oral electrolyte solution

Rationale :

🟢 In infants with acute diarrhea, oral rehydration therapy (ORT) with an oral electrolyte solution is the first-line treatment.

🟢 It restores fluid and electrolyte balance safely without worsening diarrhea.

🟢 Foods and drinks high in sugar, such as juice, can worsen diarrhea and are not recommended.

🟢 ORT prevents dehydration-related complications and supports ongoing recovery.

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Answer 10

Correct Answers:

Provide a pacifier coated with an oral sucrose solution prior to the injections.

Rationale :

💠 Oral sucrose provides non-pharmacological pain relief in infants and is supported by evidence for use during procedures.

💠 When combined with sucking (like on a pacifier), it helps trigger endogenous opioid release, reducing procedural pain perception.

💠 This is a key principle of atraumatic care for infants undergoing painful procedures like immunizations.

💠 It helps ensure the child has a comforting, low-stress experience during vaccinations.

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RN Paediatric Nursing 2023

No.

1 :
A nurse is caring for an adolescent who is admitted with a vaso- occlusive crisis.

Answer Options

2 :
A nurse is teaching the parent of a school-age child about bicycle safety. Which of the following instructions should the nurse include in the teaching?

3 :
A nurse on a pediatric unit is caring for four children. The nurse should use droplet precautions for which of the following children?

4 :
A nurse is preparing to administer ibuprofen 10 mg/kg PO to a child. The child weighs 55 lb. Available is ibuprofen 100 mg/5 mL solution. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

5 :
A nurse is caring for a school-age child who has cystic fibrosis.

Answer Options

6 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

7 :
A nurse is assessing a school-age child who has heart failure and is taking furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

8 :
A nurse is caring for a child who has sickle cell anemia. Which of the following findings is the priority for the nurse to report to the provider?

9 :
A nurse is providing teaching to the guardian of an II-month-old infant who has acute diarrhea. Which of the following food items should the nurse instruct the parent to provide to the infant?

10 :
A nurse is preparing to administer immunizations to a 3-month- old infant. Which of the following is an appropriate action for the nurse to take to deliver atraumatic care?

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RN Paediatric Nursing 2023

No.

1 : A nurse is caring for an adolescent who is admitted with a vaso- occlusive crisis.

Answer Options

2 : A nurse is teaching the parent of a school-age child about bicycle safety. Which of the following instructions should the nurse include in the teaching?

3 : A nurse on a pediatric unit is caring for four children. The nurse should use droplet precautions for which of the following children?

4 : A nurse is preparing to administer ibuprofen 10 mg/kg PO to a child. The child weighs 55 lb. Available is ibuprofen 100 mg/5 mL solution. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

5 : A nurse is caring for a school-age child who has cystic fibrosis.

Answer Options

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

7 : A nurse is assessing a school-age child who has heart failure and is taking furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

8 : A nurse is caring for a child who has sickle cell anemia. Which of the following findings is the priority for the nurse to report to the provider?

9 : A nurse is providing teaching to the guardian of an II-month-old infant who has acute diarrhea. Which of the following food items should the nurse instruct the parent to provide to the infant?

10 : A nurse is preparing to administer immunizations to a 3-month- old infant. Which of the following is an appropriate action for the nurse to take to deliver atraumatic care?

1 :
A nurse is caring for an adolescent who is admitted with a vaso- occlusive crisis.

2 :
A nurse is teaching the parent of a school-age child about bicycle safety. Which of the following instructions should the nurse include in the teaching?

3 :
A nurse on a pediatric unit is caring for four children. The nurse should use droplet precautions for which of the following children?

4 :
A nurse is preparing to administer ibuprofen 10 mg/kg PO to a child. The child weighs 55 lb. Available is ibuprofen 100 mg/5 mL solution. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

5 :
A nurse is caring for a school-age child who has cystic fibrosis.

6 :
A nurse is assessing a school-age child who is receiving prednisolone. For which of the following adverse effects should the nurse monitor?

7 :
A nurse is assessing a school-age child who has heart failure and is taking furosemide. Which of the following findings should the nurse identify as an indication that the medication is effective?

8 :
A nurse is caring for a child who has sickle cell anemia. Which of the following findings is the priority for the nurse to report to the provider?

9 :
A nurse is providing teaching to the guardian of an II-month-old infant who has acute diarrhea. Which of the following food items should the nurse instruct the parent to provide to the infant?

10 :
A nurse is preparing to administer immunizations to a 3-month- old infant. Which of the following is an appropriate action for the nurse to take to deliver atraumatic care?