NR-328 Pediatric Nursing - Set 4 - Part 1

Correct Answer: Trained staff keep glucagon and fast sugar accessible

A written management plan makes accommodations binding, and hypoglycemia can happen anywhere in the building. Fast acting sugar and glucagon must be reachable, with staff trained to treat when the nurse is away. Option b is incorrect because sending a symptomatic child down a corridor to test wastes minutes that matter. The plan permits checking and treating in the classroom or wherever the child happens to be. Option c is incorrect because restricting fluids and toileting works directly against a child whose glucose may be running high. Unrestricted access is one of the standard accommodations written into the plan. Option d is incorrect because exclusion from trips, sport and camp isolates a child who can participate fully with trained supervision. Diabetes camps in particular reduce isolation better than any classroom lecture.

Correct Answer: Wear a snug cotton shirt under the brace

A seamless cotton shirt sits between plastic and skin, soaking up sweat and taking the rubbing that would otherwise redden pressure points. Skin is checked at every removal for redness that lingers. Option a is incorrect because creams leave skin soft and damp under an airtight shell, and softened skin blisters where the brace presses. Bathing belongs in out of brace time, with skin dried completely first. Option b is incorrect because a brace holds a curve in check only in proportion to the hours it is worn. School hours alone fall far short of the eighteen or more hours these prescriptions call for. Option d is incorrect because trunk muscles weaken fast inside a rigid orthosis. Prescribed strengthening during the hours the brace is off keeps her conditioned, and it comes off for showering and sport as specified.

Correct Answer: Give a snack with carbohydrate and protein

Fast acting sugar wears off quickly, so once the reading recovers the child needs longer lasting fuel. Crackers with cheese, milk or half a sandwich hold glucose steady until the next meal arrives. Option b is incorrect because repeating gel is reserved for a recheck that still sits below seventy. This reading has already recovered, so more simple sugar would only push glucose upward. Option c is incorrect because two hours without food invites a second drop once the juice is metabolised. Waiting for the tray ignores how briefly simple carbohydrate supports the glucose level. Option d is incorrect because rapid acting insulin belongs with the meal it covers, not with a snack given to steady a recent low. Giving it now would drive glucose down again.

Correct Answer: Start intravenous fluids with dextrose and hydrocortisone

Adrenal crisis is treated immediately with intravenous isotonic fluid containing dextrose and intravenous hydrocortisone, while the cortisol sample is drawn alongside. Cardiac monitoring follows because potassium climbs as aldosterone fails. Option a is incorrect because waiting on a laboratory value while perfusion fails costs the child his life. The sample goes to the laboratory at the same moment the steroid is pushed. Option b is incorrect because a vomiting child in shock absorbs almost nothing from the gut. The parenteral route is the only reliable way to deliver steroid in this situation. Option d is incorrect because restriction worsens a volume depleted circulation. Hyponatremia here comes from aldosterone loss with real fluid deficit, so the child needs salt containing fluid rather than less of it.

Correct Answer: Those signs are late; act on the pain

Arterial inflow keeps running while pressure climbs, so pallor and a missing pulse arrive only after muscle and nerve have begun to die. Escalating pain and paresthesia come first and drive the response. Option b is incorrect because treating pallor and pulselessness as early markers is the error that costs children limbs. By the time either appears, the window for a fasciotomy to restore full function has usually closed. Option c is incorrect because numbness and tingling in the toes show up well ahead of any color or pulse change. Paresthesia is the first of the classic warning signs to declare itself. Option d is incorrect because a foot that looks pink with a strong pulse proves nothing about compartment pressure. Blood keeps entering the limb long after the tissue inside has lost the perfusion it needs.

Correct Answer: Asymmetric thigh folds with limited hip abduction

Uneven thigh and gluteal folds appear because the dislocated femoral head rides higher on that side, and the tight adductor muscles limit how far the flexed hip can be abducted. Option a is incorrect because even skin creases and a hip that abducts fully describe a normally seated femoral head. Nothing in that picture would prompt an ultrasound or a referral to the orthopedic team. Option b is incorrect because equal leg length rules against the shortening that dysplasia produces. Vigorous symmetric kicking is a reassuring motor finding, and the affected infant more often shows reduced movement on the involved side. Option d is incorrect because unrestricted rotation and level knees are exactly what the Galeazzi maneuver looks for and fails to find in dysplasia. One knee sitting lower marks the shortened femur.

Correct Answer: Hold the child curled with knees drawn up

Curling the spine opens the spaces between vertebrae so the needle can pass. The child is held securely but never so tightly that breathing is restricted, and topical anesthetic goes on ahead of time. Option a is incorrect because straightening the back closes the very gaps the needle must enter. Flexion of the neck and hips, or sitting and leaning forward, is what opens them. Option b is incorrect because the child lies flat for the ordered time, commonly about an hour, to limit the headache that follows fluid removal. Sitting up early invites that complication. Option c is incorrect because fluids are encouraged rather than restricted once the tap is finished, since replacing volume helps the headache settle. Restriction has no role in recovery from this procedure.

Correct Answer: Offer small frequent sips of carbohydrate containing fluids

A child who cannot eat still needs carbohydrate to cover the insulin and prevent ketosis, so regular soda, gelatin, popsicles or sports drinks go in small frequent amounts that a sick stomach tolerates. Option a is incorrect because withholding fluid speeds dehydration in a child already losing water through vomiting and fever. Small sips are usually tolerated even when a full drink is not. Option b is incorrect because plain water replaces volume without supplying the glucose this child is missing at every meal. Insulin continues during illness, so carbohydrate has to come from somewhere. Option d is incorrect because a large volume of milk at once is likely to come straight back up during a stomach virus. Sick day fluids work best in small measured amounts.

Correct Answer: A growth hormone stimulation test

Growth hormone is released in pulses, so provocative agents are given and serial samples drawn. A low peak response confirms the deficiency, which is why this test settles the diagnosis. Option a is incorrect because one random draw can land between pulses and read low in a perfectly normal child. That unpredictable secretion pattern makes the isolated value useless for diagnosis. Option b is incorrect because a bone age film answers how much growing potential remains rather than whether the pituitary secretes enough. Delayed bone age appears in several conditions besides pituitary disease. Option c is incorrect because imaging of the brain excludes a tumor and maps pituitary anatomy, a necessary step that still measures no hormone. It supports the workup without proving deficient secretion.

Correct Answer: A bulging fontanelle with a high pitched cry

Open fontanelles and unfused sutures let the infant skull expand, so pressure first shows as a bulging tense fontanelle, a shrill high pitched cry, irritability and poor feeding rather than the adult picture. Option b is incorrect because a sunken fontanelle with dry mucous membranes points to fluid volume deficit from vomiting or poor intake. Dehydration lowers intracranial volume instead of raising it. Option c is incorrect because a swollen optic disc takes time to develop and belongs to the older child whose fused skull cannot expand. Infants rarely show papilledema early. Option d is incorrect because generalized flaccidity with a weak cry appears late, once deepening coma has erased spontaneous movement. The nurse would already have seen fontanelle changes and irritability well before that.

Correct Answer: "He can eat fruit and the low protein cupcake."

Fruits, vegetables, and specially made low protein foods are allowed freely alongside the phenylalanine free formula. Planning a safe treat lets the child join the party without loading him with phenylalanine. Option a is incorrect because cheese is dairy protein, one of the heaviest phenylalanine sources on the table. Meat, eggs, nuts, and legumes sit in the same restricted group with it. Option b is incorrect because sugar free drinks are usually sweetened with aspartame, which breaks down into phenylalanine directly. Labels carry a warning line, and families learn to read every one. Option d is incorrect because the restriction lasts for life, and levels are monitored the whole time. Adolescents drift off the diet, which is why the nurse anticipates that struggle early.

Correct Answer: Thick yellow drainage around a loose pin

Purulent drainage together with a pin that has loosened points to infection tracking along the pin into bone. Both findings go to the provider, since osteomyelitis follows quickly if they are ignored. Option a is incorrect because a scant clear or serous ooze is the expected tissue response to a pin passing through skin. The nurse documents it and continues sterile cleaning from the pin outward. Option b is incorrect because light crusting forms normally where serum dries at the skin opening. It is cleaned with the prescribed solution using a fresh applicator for each pin and needs no notification. Option c is incorrect because brisk capillary refill in the surrounding skin is a reassuring perfusion finding. It tells the nurse blood flow past the traction is intact and gives no evidence of a pin infection.

Correct Answer: Precocious puberty for a girl under eight

Secondary sexual characteristics before age eight in a girl, or before age nine in a boy, define precocious puberty. Breast tissue plus pubic hair at seven meets that threshold and needs evaluation. Option a is incorrect because typical breast budding begins between about eight and thirteen years in girls. Arriving a year or more ahead of that window is what prompts the referral. Option c is incorrect because delayed puberty means no breast development by thirteen, the reverse of this picture. Replacement hormones would push development further along when it is already running early. Option d is incorrect because adrenarche describes pubic or axillary hair and body odor appearing alone, with no breast tissue. This child has both, which places her outside that benign variant.

Correct Answer: Headache with blurred vision and vomiting

Headache, vision change and vomiting in a shunted child mean the shunt has stopped draining and pressure is rising again. That combination goes to the emergency department rather than into a scheduled appointment. Option b is incorrect because a scraped knee is ordinary childhood injury handled with soap, water and a dressing at home. It says nothing about the valve or the tubing. Option c is incorrect because generalized soreness after a long day is common and self limiting. Redness, swelling or tenderness following the shunt tract with fever would instead point toward infection. Option d is incorrect because extra weekend sleep in a healthy school age child is unremarkable. Lethargy that cannot be interrupted, or a child who will not wake for meals, is the version that alarms.

Correct Answer: Central diabetes insipidus after the head injury

Too little antidiuretic hormone lets water pour out, so the urine stays dilute while the serum sodium rises and weight falls. New bedwetting with constant thirst after head trauma is the classic clue. Option a is incorrect because that syndrome traps water instead of losing it, giving scant concentrated urine, a falling sodium, and weight gain. Its treatment is fluid restriction, which would be dangerous here. Option c is incorrect because failing adrenal hormones drop the serum sodium and raise potassium, with hypotension and salt craving. Rising sodium alongside enormous dilute urine points at the pituitary instead. Option d is incorrect because too much free water dilutes the blood and drives sodium down, not up. This child is losing fluid faster than he can drink, which is why his weight dropped.

Correct Answer: Elevation drains fluid too fast and risks bleeding

The infant lies flat until the surgeon orders otherwise, because sudden decompression pulls the brain away from the dura and tears bridging veins. Head elevation is introduced gradually and only as ordered. Option a is incorrect because infection risk comes from the surgical wound and organisms on the skin, not from the angle of the mattress. It shows up as fever with tenderness along the tubing. Option b is incorrect because pressure on the valve is avoided by keeping the infant off the operated side, which is a separate rule about turning rather than about the height of the bed. Option c is incorrect because the tape measure works at any bed angle. Daily circumference checks continue after surgery to show whether the shunt is moving fluid, and positioning does not affect them.

Correct Answer: Setting up the meal tray and water

Setting out food and drink is routine, needs no clinical judgment, and sits well within an assistive role. The order restricting ambulation and every neurologic assessment stay with the nurse and therapist. Option b is incorrect because the written order names who may take this adolescent out of bed, and an assistive person is not on that list. Handing over the walk would breach the order outright. Option c is incorrect because movement, sensation, and strength in all four limbs form a nursing assessment after fusion. New weakness can mean cord compromise, and interpreting that finding is not within an assistive scope. Option d is incorrect because deciding whether analgesia is adequate before mobility calls for evaluation the nurse owns. Assistive staff may report what the adolescent says about pain, but the judgment that follows belongs to licensed staff.

Correct Answer: The pattern points to rising intracranial pressure

Once the sutures fuse, a child shows pressure as headache that peaks on waking after lying flat overnight, with vomiting that often arrives without nausea. Both are early warning signs. Option a is incorrect because gastroenteritis brings cramping, diarrhea and nausea that precedes each episode of emesis. Neither the morning timing nor the absence of nausea fits an intestinal infection. Option b is incorrect because uneventful recovery means the child feels better each day. Cerebral edema peaks one to three days after injury, so worsening headache and emesis mark deterioration rather than healing. Option d is incorrect because a migraine after concussion would not reliably cluster in the early morning, and vomiting without nausea is not its signature. Naming it a migraine delays urgent imaging.

Correct Answer: The weights hang freely above the floor

Traction only pulls when gravity acts on suspended weights. Once a weight touches the floor, the bed, or a chair, the pulling force stops and the fracture fragments drift out of alignment. Option a is incorrect because a weight leaning on the frame carries part of its own load. The pull reaching the femur drops below what was prescribed, and the fragments lose the alignment the traction was set to hold. Option c is incorrect because countertraction depends on the child staying centered and in line with the pull. A body angled toward the footboard changes that line, and the nurse repositions the child rather than the weights. Option d is incorrect because a knot jammed at the pulley stops the rope from running in its groove. Ropes must move freely for the force to transfer, so the nurse frees the knot before anything else.

Correct Answer: Confirm the reading with a finger stick

Sensors read interstitial fluid, which lags behind blood, so a rapidly falling glucose still shows an acceptable number. Whenever the reading and the symptoms disagree, a finger stick settles it before treatment. Option a is incorrect because trusting the sensor over the symptoms can leave a real low untreated. Adrenergic warning signs like these deserve a blood value, not reassurance about the device. Option b is incorrect because swapping hardware takes time this student does not have and may not fix anything. The immediate question is what the blood glucose actually reads right now. Option c is incorrect because rest does not raise a falling glucose, and symptoms that pass on their own were never the point. Untreated lows progress toward confusion, seizure and loss of consciousness.