NR-328 Pediatric Nursing - Set 3 - Part 1

Correct Answer: Appendicitis with early luminal obstruction

Periumbilical pain that migrates to McBurney point, followed by nausea and fever, is the textbook appendicitis sequence. The order matters, because pain arriving before vomiting is what points toward the inflamed appendix. Option a is incorrect because telescoped bowel belongs to infants and young toddlers and produces screaming spells that come and go. Pain there never migrates in a fixed direction across the abdomen. Option b is incorrect because retained stool causes crampy discomfort without fever, and it does not move from the navel to one quadrant. Bowel habits, not migrating pain, define that problem. Option d is incorrect because aganglionic bowel is nearly always identified in infancy, with lifelong constipation and ribbon like stools. A sudden day of pain moving to one quadrant does not fit.

Correct Answer: Give the dose thirty minutes before a feeding

Proton pump inhibitors work on pumps that activate with a meal, so the dose is given about half an hour before a feed. Giving it with or after food blunts the effect. Option b is incorrect because burying the drug in a bottle leaves the dose incomplete whenever the feeding is not finished. Delayed release forms are also damaged by mixing, so accuracy is lost twice. Option c is incorrect because acid is already pouring out by the end of a feeding, and the drug arrives too late to block it. Timing before the meal is what makes these agents effective. Option d is incorrect because these medicines control esophageal injury over weeks and are dosed daily, not as symptoms come and go. Skipping doses on quiet days lets the mucosa keep breaking down.

Correct Answer: Begin rescue breathing with airway support

Drowning injures through hypoxia, and the path to arrest is respiratory. Ventilation comes first, so the nurse opens the airway and delivers rescue breaths, protecting the cervical spine if the event was unwitnessed. Option a is incorrect because wet clothing does need removing and the child does need warming, yet neither restores oxygen. Rewarming follows once breaths are being delivered and a pulse has been checked. Option b is incorrect because attempts to drain water from the lungs are useless and dangerous. They delay ventilation, risk vomiting with aspiration, and move a spine that may already be injured. Option d is incorrect because glucose is checked during the assessment of any collapsed child, though it never precedes airway and breathing. A normal reading would not change what this toddler needs right now.

Correct Answer: Set the thermostat to one hundred twenty degrees

A water heater set at one hundred twenty degrees Fahrenheit or lower buys several minutes before a serious scald, while hotter water burns a child's thin skin within seconds. Scalds are the leading burn mechanism under age five. Option b is incorrect because water at that temperature produces a serious burn within seconds. A toddler cannot move away fast enough, and the thin dermis lets heat reach deep tissue almost immediately. Option c is incorrect because factory settings are often higher than the safe ceiling for a household with young children. Parents are taught to check the dial themselves and adjust it rather than assume. Option d is incorrect because raising the temperature trades one hazard for a far likelier one. Scald injury from tap water sends many young children to burn centers each year, and prevention outweighs that concern.

Correct Answer: Avoid rectal temperatures and rectal suppositories

Nothing goes into the rectum after a pull through unless the surgeon orders it, because the new anastomosis sits low and tears easily. Axillary temperatures are used until that restriction is lifted. Option a is incorrect because a thermometer placed in the rectum can disrupt the fresh join between healthy bowel and the anal canal. Axillary readings give the same information without that danger. Option b is incorrect because pushing a tube past a new suture line risks perforation and bleeding. Distension after this surgery is reported to the surgeon, who decides whether decompression is safe. Option c is incorrect because soap suds solutions are never used in small children; they irritate the mucosa and hypotonic absorption can bring on water intoxication and seizures. Isotonic saline is the only choice.

Correct Answer: A larger share of body water is extracellular

Roughly half of an infant's body water sits in the extracellular compartment, close to forty-five percent of body weight. Vomiting, diarrhea and fever drain that compartment first, so circulating volume falls quickly. Option b is incorrect because total body water is higher in a child, not lower. A newborn is roughly seventy-five percent water against sixty percent in an adult, and that proportion falls gradually toward adult values. Option c is incorrect because the intracellular reserve an adult draws on during illness is exactly what the infant lacks. Adults buffer losses from that store, while the infant empties a shallow extracellular pool instead. Option d is incorrect because that distribution describes the adult, whose body water is weighted toward the intracellular space at about twenty percent extracellular. Describing an infant this way reverses the compartment proportions that matter clinically.

Correct Answer: A sunken anterior fontanelle

Loss of fluid volume lets the anterior fontanelle sink below the skull margin, and it is one of the earliest visible markers of dehydration in an infant whose fontanelle has not yet closed. Option a is incorrect because a fontanelle that bulges reflects rising pressure inside the skull, seen with meningitis, hydrocephalus or crying. Volume depletion pulls the soft spot inward instead of pushing it outward. Option b is incorrect because refill under two seconds tells the nurse that peripheral perfusion is intact. A dehydrated infant shows sluggish refill, cool skin and mottling as the body protects the core. Option d is incorrect because well-hydrated tissue keeps the mouth wet and shiny. Dryness, tacky gums and absent tears are what the nurse charts when the extracellular compartment has been drained by illness.

Correct Answer: "Bedwetting is not deliberate, so consequences should not be used."

Wetting during sleep is not willful, and punishment deepens shame without producing dry nights. The nurse normalises the problem, explains that maturation usually resolves it, and steers the family toward reward based routines. Option b is incorrect because daytime fluids are kept adequate, with limits applied only after the evening meal. Cutting drinks from midday leaves the child thirsty at school and does nothing about nighttime arousal. Option c is incorrect because shame delays nothing and heals nothing. Children who feel humiliated hide the wetting, withdraw from sleepovers and camp, and become harder to help, which is why blame is never part of the plan. Option d is incorrect because responsibility and punishment are not the same thing. Having the child help strip the bed as an ordinary routine is reasonable, but framing it as a penalty turns a maturational delay into a moral failing.

Correct Answer: Fewer wet diapers than usual

Falling urine output is an early and sensitive marker of fluid deficit, and a parent can count diapers at home. Fewer wet diapers means the kidney is already conserving water. Option a is incorrect because a falling pressure arrives late in a child, long after compensation has failed. Waiting for that number at home would delay care until the toddler is already in decompensated shock. Option b is incorrect because mottling and cool limbs appear once perfusion is compromised, which places the toddler well past the early window. This finding demands emergency evaluation rather than telephone monitoring. Option c is incorrect because unresponsiveness marks severe, advanced depletion and is an emergency, not an early warning. Parents should certainly report it, yet by then the chance to rehydrate by mouth has passed.

Correct Answer: "I will give the tablet with food and follow the taper."

Prednisone is given with food to protect the stomach and is tapered rather than stopped, since abrupt withdrawal is dangerous. Following the ordered schedule exactly is the central medication message for families. Option a is incorrect because ending steroids the moment swelling clears invites relapse and adrenal crisis. The course runs several weeks at full dose and then tapers slowly, regardless of how well the child looks. Option b is incorrect because live vaccines are withheld while a child takes high dose corticosteroids. Immunisations are kept current before therapy starts or after it ends, and giving one now could cause the illness itself. Option d is incorrect because the moon face, big appetite and mood swings fade once the drug is withdrawn. Calling those changes permanent would frighten a family unnecessarily and misrepresents what happens after the taper finishes.

Correct Answer: Wash hands with soap and water afterward

Alcohol rubs work poorly against norovirus, so hands are washed with soap and running water after every diaper change. Gloves and gowns supplement that washing, and they never replace it. Option b is incorrect because the alcohol product leaves this virus largely intact on the hands, which is how it sweeps through daycare rooms and units. Friction under running water is what removes it. Option c is incorrect because spread here happens by the fecal oral route rather than through the air. Contact precautions with gloves, gown and dedicated equipment fit the organism; airborne gear belongs to a different set of infections. Option d is incorrect because withholding food prolongs the illness and adds malnutrition to fluid loss. Age appropriate feeding continues during gastroenteritis, and assistive personnel should be told to offer meals as usual.

Correct Answer: Clean the outside gently and avoid forcing it

A foreskin that will not retract is normal in infancy and separates on its own over years. Forced retraction tears tissue and causes scarring, so families are taught gentle external cleaning only. Option a is incorrect because gradual stretching is still forcing. Small tears heal into scar tissue that makes the opening tighter, turning a normal developmental finding into a genuine problem needing treatment. Option b is incorrect because steady traction risks trapping the foreskin behind the glans. That trapped and swollen state is a urological emergency, which is exactly what routine handling of an infant should never create. Option d is incorrect because surgery is reserved for the child who has ballooning, painful voiding or repeated inflammation. None of that appears here, and topical corticosteroid treatment would be tried first anyway.

Correct Answer: Prepare for early intubation and give oxygen

Soot, a hoarse cry and facial burns point to inhalation injury. Airway edema builds over hours until intubation becomes impossible, so early elective intubation with high-flow oxygen protects this small airway. Option a is incorrect because ice deepens a burn and drops the core temperature of a child who already loses heat fast. Wound care of any kind waits until the airway has been secured. Option c is incorrect because the adult chart gives the head far too little weight in a young child, so a head burn is badly underestimated. Sizing the burn matters for fluid orders, though it never precedes airway management. Option d is incorrect because stridor announces an airway that has already narrowed dangerously. Waiting for that sound in a child with a small airway leaves the team trying to intubate through swollen tissue.

Correct Answer: "I will store medicines locked up and out of reach."

Medications, cleaners and vitamins belong locked, up and away in their original labeled containers. Storage that a toddler cannot reach or open is the measure that prevents the exposure in the first place. Option a is incorrect because families are told to discard any syrup of ipecac they still own. Making a child vomit is no longer part of poisoning care at home or in the emergency department. Option b is incorrect because child-resistant is not the same as childproof. Those caps slow a determined toddler down, and plenty of two-year-olds open them, which is why the container still has to be locked away. Option c is incorrect because calling medicine candy teaches a toddler that pills are a treat worth hunting for. Nurses tell families to name the medicine honestly and never to bargain with that word.

Correct Answer: Side lying with the head supported

Side lying lets blood and saliva run out of the mouth instead of pooling near the fresh repair. It also keeps the suture line off the bedding while the infant recovers from anesthesia. Option a is incorrect because lying face down presses the new palate work against the mattress and hides the mouth from view. Most surgeons forbid it, and it makes early bleeding easy to miss. Option c is incorrect because a supine infant recovering from anesthesia can pool secretions at the back of the throat. Drainage needs somewhere to go, and flexing the knees does nothing for the airway. Option d is incorrect because an infant just out of the operating room needs a flat surface and close observation, not a moving seat. Swing straps also press near the face and interfere with monitoring.

Correct Answer: An order for intravenous fluids and electrolytes

Pyloric stenosis is a metabolic emergency, not a surgical one. Anesthesia given to a dehydrated, alkalotic, hypokalemic infant invites arrhythmias and apnea, so intravenous fluid and electrolyte repair comes before the pyloromyotomy. Option b is incorrect because anything swallowed will be vomited straight back through the obstructed pylorus. This infant stays NPO with a nasogastric tube, and the deficit is replaced through a vein. Option c is incorrect because drugs cannot open a hypertrophied muscle, and suppressing emesis leaves the blockage untouched. The vomiting stops when the pylorus is divided surgically, not when nausea is masked. Option d is incorrect because paperwork is required yet never outranks perfusion. Consent can be witnessed once the fluid is running; a dry, alkalotic infant who goes to the operating room first is the one at risk.

Correct Answer: Notify the provider and prepare for surgery

Pain that vanishes abruptly in appendicitis means the appendix has perforated and pressure inside it has fallen. Pallor and rapid shallow breathing fit early peritonitis, so the provider is called and surgery prepared. Option a is incorrect because charting relief treats a rupture as good news. The quiet interval lasts only until peritonitis spreads, and a child left unattended during it can deteriorate into shock. Option b is incorrect because anything swallowed jeopardizes anesthesia and worsens spillage into the peritoneum. This child stays NPO, receives intravenous fluids and antibiotics, and goes to the operating room. Option c is incorrect because heat widens local blood vessels and speeds rupture, which is why it is forbidden with suspected appendicitis. Enemas and laxatives are withheld for the same reason.

Correct Answer: A latent phase precedes shock and acidosis

Iron moves through a deceptive quiet interval after the early gastrointestinal phase. Shock, high anion gap acidosis, coagulopathy and liver failure can follow, so the child stays for observation rather than going home. Option a is incorrect because feeling better says nothing about how much iron crossed the gut wall. An abdominal film may still show radiopaque tablets, and absorbed iron is already circulating toward the liver. Option b is incorrect because charcoal does not adsorb iron at all, along with lithium, alcohols and heavy metals. Deferoxamine is the chelating agent used when toxicity is moderate or severe. Option d is incorrect because bleeding shows corrosive injury to the stomach lining, which is the first stage rather than proof of safety. Systemic absorption is happening at the same time the mucosa bleeds.

Correct Answer: "Some vomiting is expected while the surgical site is swollen."

Edema at the myotomy site makes some emesis normal for the first day or two after surgery. Feeds continue in small amounts and advance, so this parent needs reassurance rather than a change in plan. Option a is incorrect because two episodes of spitting on the first postoperative day do not indicate a failed pyloromyotomy. Alarming the family invents a complication where ordinary healing swelling explains what happened. Option b is incorrect because withholding oral intake reverses the recovery plan. Clear feeds begun within hours of surgery are advanced steadily, and returning to intravenous nutrition would delay discharge without treating anything. Option c is incorrect because blaming the formula points the parent toward an allergy workup that no finding supports. Swelling at the cut muscle, not the milk itself, accounts for these early episodes.

Correct Answer: Keep the child NPO and support the airway

Detergent pods are alkaline caustics that burn tissue deeply. The child stays NPO with airway support and intravenous fluid while endoscopy is arranged, since esophageal injury occurs even when the mouth looks nearly normal. Option b is incorrect because charcoal coats the mucosa and obscures the view during endoscopy, which is the study that grades the burn. It also fails to bind caustic agents in any useful way. Option c is incorrect because mixing an acid with an alkali releases heat inside injured tissue. That exothermic reaction deepens the damage, so neutralizing agents are never given after a caustic exposure. Option d is incorrect because bringing the product back up drags it across the esophagus a second time. Vomiting doubles the burn and adds an aspiration hazard, which is why emesis is never induced.