NR-328 Pediatric Nursing - Set 5 - Part 1

Correct Answer: Chronic sorrow reactivated by a missed milestone

Chronic sorrow is grief that recurs whenever a milestone the child will not reach comes into view. Seeing peers ride bicycles reactivates the loss, and this pattern is expected rather than pathological. Option b is incorrect because depression and chronic sorrow can coexist, yet grief triggered by a specific reminder and settling afterward does not meet the criteria for a mood disorder. Screening continues, but referral is not automatic. Option c is incorrect because denial belongs to the shock phase soon after diagnosis and shows as disbelief or second opinions. This mother names the loss accurately; she is grieving what she already accepts. Option d is incorrect because families who have adapted still grieve. Renewed sadness at a birthday, a first school day or a sibling passing the child by signals ongoing loss, not a breakdown in coping.

Correct Answer: "Low muscle tone and a large tongue weaken the latch."

Generalized hypotonia together with a protruding tongue and small oral cavity weakens suck, so feeds take longer. Naming that mechanism relieves maternal guilt and opens the way to upright positioning, chin and cheek support and lactation referral. Option a is incorrect because blaming maternal technique for a physiologic feeding problem deepens the guilt these mothers already carry. The weak suck comes from the infant's tone and oral anatomy, not from how the mother holds her baby. Option b is incorrect because a bottle does not correct hypotonia. Breast milk remains preferred, and the same slow tiring pattern appears with any nipple, so the answer is positioning, jaw support and smaller more frequent feeds. Option c is incorrect because these infants need full caloric intake to grow, and short intake is a red flag rather than a normal variation. Growth must be plotted at every visit and lactation support arranged promptly.

Correct Answer: Each son faces a one in two risk

A son inherits one X from his mother, so a carrier mother gives each son an even chance of disease. Daughters have a second normal X and become carriers rather than bleeders. Option a is incorrect because a daughter who receives the altered X still holds a normal copy on her other X. That backup produces enough factor, so she carries the gene without significant bleeding. Option b is incorrect because an affected father passes his X only to daughters, making them obligate carriers while his sons receive the Y and escape entirely. Carrier mothers transmit the gene as well. Option d is incorrect because equal involvement of males and females describes an autosomal dominant disorder such as von Willebrand disease. Hemophilia sits on the X chromosome, so boys carry nearly all of the burden.

Correct Answer: "We will bring his weighted blanket and keep his usual bedtime."

Familiar comfort objects and the home routine are protective for an autistic child in an unfamiliar place. Keeping sleep, meals and rituals as close to normal as possible reduces distress and lowers the chance of a crisis. Option b is incorrect because removing the comfort item takes away the child's main self regulation tool. Personal objects can be cleaned, and losing them costs far more in distress than the small infection risk they carry. Option c is incorrect because surprise is the opposite of what helps. Predictability calms an autistic child, so photographs, social stories and a visual schedule are shown ahead of time and the same sequence is followed each day. Option d is incorrect because procedures and meals are scheduled around the child's routine rather than the ward's convenience. Food preferences and textures matter enormously here, and a shifting timetable is a common trigger for escalation.

Correct Answer: Give an intravenous opioid before the change

Burned tissue perfuses unpredictably, so opioids are given intravenously and timed to peak as the dressing comes off. Scheduled analgesia around the clock plus distraction keeps procedural pain from building between changes. Option a is incorrect because intramuscular absorption is erratic when perfusion is damaged, so the dose may arrive late or not at all. The intravenous route is the standard for burn pain in children. Option b is incorrect because distraction and child life support work alongside medication rather than replacing it. Dressing changes rank among the most painful procedures in pediatrics, and no play technique covers that alone. Option d is incorrect because chasing pain after it peaks leaves the child frightened and harder to settle at the next change. Premedication before the dressing comes off is what keeps the cycle from starting.

Correct Answer: Explain that this dip is a normal developmental change

Hemoglobin falls to its lowest point around two to three months as fetal cells break down and production pauses. This physiologic anemia of infancy resolves on its own and needs no iron. Option b is incorrect because supplementing a healthy term infant at this age treats a laboratory value rather than a problem. Maternal stores still cover the infant, and routine iron is added closer to four months. Option c is incorrect because transfusion is reserved for symptomatic or severe anemia. This infant feeds eagerly, gains weight, and shows no tachycardia, so exposing him to blood products carries risk without benefit. Option d is incorrect because structural hemoglobin disorders such as sickle cell disease stay quiet until fetal hemoglobin fades near six months. Newborn screening already covers them, so a fresh workup adds nothing here.

Correct Answer: Arrange respite care and a social work referral

Sleep deprivation, lost income and isolation are the known consequences of home care by an untrained unpaid caregiver. Respite and early social work referral relieve exhaustion, and families rarely ask for either unprompted. Option a is incorrect because a child on continuous technology needs monitoring, suctioning or feeds through the night, so there is no protected sleep window. The advice sounds supportive yet changes nothing about the workload. Option b is incorrect because normalising exhaustion dismisses a warning sign. Caregiver breakdown at this level threatens the marriage, the siblings and, in extreme cases, the safety of the child being cared for. Option c is incorrect because the barrier is not poor scheduling. Twenty four hour skilled nursing performed by one parent cannot be reorganised into a manageable day, so the answer is another pair of hands.

Correct Answer: True strabismus needing referral to ophthalmology

Facial folds can mimic a turned eye, but the corneal light reflex stays symmetric in that harmless picture. An off-center reflection means genuine misalignment, and any constant deviation after about four months needs referral. Option b is incorrect because epicanthal folds create only the appearance of crossing, and the light reflection then lands identically on both corneas. This infant fails that test, which rules the benign explanation out. Option c is incorrect because wandering eye movements are tolerated only in the first weeks of life. By six months alignment should be steady, and a deviation at this age carries a real risk of amblyopia. Option d is incorrect because a refractive error is identified by acuity or photoscreening rather than by an uneven light reflex. Glasses may be part of later care, but the misalignment itself still needs an eye specialist.

Correct Answer: An infant not yet rolling who has cheek bruising

Bruising in a child who is not yet mobile is a recognised red flag, and cheek bruising in an infant sits squarely in the pattern that prompts a report. Those who do not cruise rarely bruise. Option a is incorrect because shins are bony prominences on the front of the body, exactly where a running toddler collects accidental marks. The location and the history match each other well. Option b is incorrect because a scraped elbow is ordinary skating damage in an active child of that age. Nothing about the site, the pattern or the account given is out of keeping with the story. Option c is incorrect because forehead bruising from a fall is common once a child walks and runs. A mobile preschooler explains the finding, and the mechanism fits both the site and the developmental stage.

Correct Answer: Give intravenous fluids, oxygen and scheduled analgesia

Dilute blood flows through narrowed vessels, oxygen interrupts further sickling, and analgesia given on a schedule keeps ahead of pain. Hydration, oxygenation and pain control drive care during the crisis. Option a is incorrect because limiting fluid thickens the blood and drives more cells into the sickled shape. Intake is usually raised above maintenance during a crisis, not held back to watch output. Option b is incorrect because cold triggers vasoconstriction, which slows flow through vessels already plugged with rigid cells. Warm compresses are applied instead so that dilated vessels carry blood past the obstruction. Option d is incorrect because exertion raises oxygen demand at the moment tissue is already starved. Rest in a position of comfort lowers that demand, and gentle movement waits until the pain settles.

Correct Answer: Add iron-fortified cereal and pureed meats daily

Maternal iron stores are exhausted by about six months, so a breastfed infant needs iron from food. Fortified cereal and pureed meats supply heme and non-heme iron the marrow can use. Option a is incorrect because cow milk is poor in iron, displaces iron-rich foods, and can cause slow intestinal blood loss. It belongs after the first birthday and even then in limited amounts. Option c is incorrect because withholding solids past this age removes the very source the infant now depends on. Complementary foods start around six months precisely because stored iron has run out. Option d is incorrect because a vitamin preparation lacking iron cannot correct an iron shortage. The deficiency is specific, so the supplement or the diet must supply elemental iron rather than general micronutrients.

Correct Answer: "Palliative care works alongside the treatment aimed at curing your child's illness."

Palliative care begins at diagnosis of any serious illness, needs no prognosis, and runs alongside cure directed therapy. Naming that clearly answers the parents' fear that consulting the service means treatment has ended. Option a is incorrect because waiting for curative therapy to fail describes the commonest misconception about this service. Referral at diagnosis gives the family symptom control and goals of care support for years. Option b is incorrect because comfort focused care confined to the last weeks describes hospice, which generally requires a prognosis of about six months. Palliative care carries no prognostic requirement at all. Option d is incorrect because nothing is withdrawn when this team joins. Symptom management, psychosocial support and coordination are added to whatever disease directed therapy continues, so the child receives both at once.

Correct Answer: Stay with her and alert the team immediately

Safety comes first, so the nurse does not leave her alone and calls the provider and mental health team without delay. One to one observation begins, potential means are removed, and caregivers are informed because risk overrides confidentiality. Option b is incorrect because secrecy cannot be promised when a teen may be harmed. Limits on confidentiality are stated before the sensitive questions, and this disclosure is exactly the situation those limits were designed to cover. Option c is incorrect because leaving the room means leaving an at risk adolescent unobserved. The mother does need to be involved, yet someone else brings her in while the nurse remains at the bedside. Option d is incorrect because minimizing feelings shuts down a disclosure that took courage to make. Telling a teen that others feel the same suggests her situation is ordinary, and the assessment of intent and safety never happens.

Correct Answer: Pallor, recurrent infection and easy bruising

Immature blasts fill the marrow and squeeze out normal production, so red cells, neutrophils and platelets all fall. Pallor, persistent infection and unexplained bruising are the visible result of that crowding. Option a is incorrect because a marrow packed with blasts produces fewer red cells and fewer platelets, not more. Rising counts of both would point away from leukemia toward an entirely different process. Option b is incorrect because clotting factors come from the liver, not the marrow, and leukemia leaves them largely untouched. Bleeding in this child stems from too few platelets rather than thickened blood. Option c is incorrect because tumor lysis pushes uric acid up and calcium down, the reverse of this pairing. Neither value describes what happens when blasts displace the three normal cell lines.

Correct Answer: "I will give it with orange juice through a straw."

Vitamin C in orange juice converts iron into the form the gut absorbs best, and delivering the dose through a straw carries it past the teeth, so temporary staining is avoided. Option b is incorrect because milk and other dairy bind iron in the gut and block absorption. Doses are separated from milk by an hour before or two hours afterward, never mixed into it. Option c is incorrect because improved color arrives long before the depleted stores refill. Therapy continues two to three months after the hemoglobin normalizes, and families who stop early watch the anemia return. Option d is incorrect because iron tablets and liquid look like candy to a young child, and overdose is a leading cause of poisoning death. Storage must be locked away and well out of reach.

Correct Answer: Explain that itch can persist for weeks

Itching after successful scabies treatment reflects hypersensitivity to dead mites and commonly lasts two to four weeks. Without fresh burrows there is no evidence of failure, so reassurance and symptom relief fit here. Option a is incorrect because household treatment already happened at the first round and repeating it now exposes everyone to needless medication. A second application is scheduled one to two weeks after the first, not later. Option b is incorrect because urgent retreatment is reserved for burrows appearing beyond four weeks, which signals live mites. Sending this child in today treats a hypersensitivity itch with a scabicide that has nothing left to kill. Option d is incorrect because antibiotics belong with honey-colored crusting, pus, or warmth from scratched-open skin, none of which appear here. Night itch alone after treatment does not point toward a bacterial complication.

Correct Answer: "We will call right away if he has a fever."

Neutropenia strips away the redness and pus that usually announce infection, so a rising temperature is the family's one reliable alarm. They telephone at once rather than medicating at home. Option a is incorrect because a thermometer placed rectally tears fragile mucosa and pushes gut bacteria straight into the blood. Axillary or oral readings are used, along with no suppositories and no enemas. Option b is incorrect because live preparations contain weakened organisms that an immunosuppressed child cannot contain. Those vaccines are withheld during therapy and restarted only after immune recovery, on the oncology team's timetable. Option c is incorrect because crowded indoor places multiply exposure exactly when the counts bottom out. Celebrations are moved home with a few healthy, screened guests so the child keeps his social life safely.

Correct Answer: Tell the sibling nothing he did caused this

Preschool siblings believe an angry wish or bad behaviour made the child ill, so correcting magical thinking directly is the priority. Saying nothing he did, said or wished caused this relieves hidden guilt. Option a is incorrect because dropping age appropriate rules and chores tells the sibling that the family has stopped functioning normally. Continued expectations are reassuring, and normal routines steady a young child during upheaval. Option c is incorrect because exclusion feeds the fantasy that the hospital is worse than it is. Visitation is encouraged so the sibling sees the child, gets a role, and stays part of the family. Option d is incorrect because rewarding invisibility creates the parentified child whose own needs disappear. Siblings need permission for jealousy and anger, protected time alone with a parent, and their own activities kept going.

Correct Answer: Assisting the child with a daily bath

Daily bathing is standard hygiene within the scope of assistive personnel, who report what they observe. Teaching, assessment and screening decisions stay with the nurse because each requires clinical judgment. Option b is incorrect because instructing a family is a nursing responsibility that cannot be handed off. The nurse tailors mouth care to this child's mucositis risk and confirms that the parents can carry it out. Option c is incorrect because inspecting mucosa is an assessment, and interpreting a new ulcer against the child's chemotherapy schedule takes nursing knowledge. Unlicensed staff may report soreness but cannot evaluate it. Option d is incorrect because screening who enters the room means judging whether a person carries a fever, cough or rash. That gatekeeping protects a child with no defenses and belongs to the nurse.

Correct Answer: These findings can represent depression in childhood

Children show depression through irritability rather than stated sadness, along with somatic complaints, falling school performance, withdrawal and loss of interest in play. The diagnostic criteria allow irritable mood in place of depressed mood for this age. Option a is incorrect because requiring a child to name sadness sets a bar most cannot reach. Adults describe low mood in words, while children of this age communicate distress through the body and through behavior at home and school. Option b is incorrect because abdominal pain here travels with mood change, social withdrawal and academic decline, which no bowel disorder explains. A medical cause is ruled out once, and repeated testing then reinforces the sick role. Option c is incorrect because a school age child is normally deep in friendships, activities and industry. Two months of withdrawal, irritability and slipping grades marks a change from that baseline and calls for mental health screening.