NR-328 Pediatric Nursing - Set 3 - Part 2

Correct Answer: Glomerulonephritis following a streptococcal infection

Puffy eyes on waking, tea or cola coloured urine and hypertension appearing one to two weeks after streptococcal pharyngitis are the classic nephritic triad of immune complex glomerular inflammation. Option a is incorrect because minimal change disease produces frothy urine loaded with protein, generalised swelling and a normal or low blood pressure. Gross bloody urine and hypertension point away from that diagnosis entirely. Option c is incorrect because kidney infection brings high fever, chills, flank tenderness and vomiting, with bacteria growing on culture. This child has no fever pattern like that, and the urine culture in glomerulonephritis stays negative. Option d is incorrect because scarring from years of refluxed infected urine develops slowly and shows up as growth failure and persistent hypertension. An abrupt onset days after a throat infection does not fit that timeline.

Correct Answer: Metabolic acidosis from bicarbonate loss

Stool is rich in bicarbonate, so prolonged diarrhea produces metabolic acidosis. The infant blows off carbon dioxide to pull the pH back up, which is why deep rapid breathing appears with clear lungs. Option a is incorrect because retained carbon dioxide follows hypoventilation in croup, bronchiolitis, or sedative overdose. This infant is moving more air, not less, and the lungs are clear on examination. Option b is incorrect because a high bicarbonate belongs to the infant who vomits gastric acid repeatedly, producing an alkalotic picture. Losses from the lower gut move bicarbonate in the opposite direction entirely. Option d is incorrect because hyperventilation driven by fear or discomfort lowers carbon dioxide without any underlying acid load. Nothing in this history points to anxiety, and the deep pattern here is compensation for a metabolic problem.

Correct Answer: Offer smaller feedings with frequent burping

Conservative feeding changes come before anything else in a thriving infant. Smaller volumes with frequent burping keep the stomach from overfilling, and most infants outgrow the reflux as the sphincter matures near a year. Option a is incorrect because acid suppression is reserved for infants with complications such as poor growth, esophagitis or apnea. Medicating a comfortable baby who is gaining well adds risk without a target. Option c is incorrect because a formula change is considered only when cow milk protein allergy is suspected, and then an extensively hydrolyzed product is chosen. Nothing here points toward an allergic cause. Option d is incorrect because the slumped car seat position raises pressure inside the abdomen and pushes stomach contents upward. Upright time after feeds means held against the shoulder or carried, not seated.

Correct Answer: Bottled soy sauce used for stir fry

Soy sauce is brewed with wheat, which puts it on the hidden gluten list along with gravies, marinades and salad dressings. Families are taught to check every bottled sauce label before use. Option b is incorrect because plain dairy carries no gluten at all; milk and yogurt sit among the naturally safe foods. Only flavored versions with added cookie pieces or malt would need a label check. Option c is incorrect because whole fruit needs no processing and therefore no wheat, barley or rye ever touches it. Produce is one of the few aisles a newly diagnosed family can shop without worry. Option d is incorrect because corn is an approved grain and pasta made from it replaces wheat pasta directly. The teaching point for boxed foods is the starch source, and this box names a safe one.

Correct Answer: Observe the caregiver feeding the infant

Watching an actual feeding is the single most informative assessment in failure to thrive. It shows the infant's cues and suck, how the caregiver reads and responds to them, and how much milk truly goes in. Option a is incorrect because diaper weights track output rather than intake, and this infant is not losing fluid. Urine volume will look ordinary while the calorie problem behind the poor growth stays hidden. Option b is incorrect because routine vital signs are already normal and will stay that way in an infant who is simply underfed. They cannot show why the weight curve flattened. Option c is incorrect because head circumference is measured, though not daily; it changes last and slowest in undernutrition. Weight falls first, then length, so a daily head measurement adds little early on.

Correct Answer: Weigh the child each morning before breakfast

Weighing is a standardized measurement that assistive personnel perform safely, and daily weight on the same scale is the most accurate account of fluid lost and replaced. Assessment, teaching and clinical judgment stay with the nurse. Option a is incorrect because judging turgor means interpreting what the skin shows about volume status. Assessment of that kind belongs to the registered nurse and cannot be handed to unlicensed staff. Option b is incorrect because parent education requires evaluating what the family already understands and adapting the message. Teaching is a nursing responsibility, and delegating it would leave gaps nobody notices until the child returns. Option d is incorrect because titrating fluid is clinical judgment resting on assessment findings and prescriber orders. No part of that decision can move to assistive personnel, whatever their experience on the unit.

Correct Answer: "I take the binder about two hours after eating."

A binder works by trapping phosphorus from food inside the gut, so it must be swallowed with meals. Taken hours afterward there is nothing left to bind, and the serum phosphorus keeps climbing. Option a is incorrect because iron is given alongside erythropoiesis stimulating agents to correct the anaemia of kidney disease. Swallowing it with juice aids uptake, so this practice needs praise rather than correction. Option b is incorrect because those two levels drive the whole bone problem in kidney disease. Regular checks let the team adjust binders and vitamin D before parathyroid hormone climbs and bone begins to weaken. Option c is incorrect because dairy, dark colas and nuts are the foods highest in phosphorus. Cutting them back supports the same goal the binder serves, so this adolescent has understood the dietary side well.

Correct Answer: Acetylcysteine after a four-hour serum level

A level drawn at four hours or later can be plotted against time to decide on treatment, and acetylcysteine restores glutathione. The quiet early phase is exactly when the liver is being injured. Option b is incorrect because deferoxamine chelates iron and has no effect on the metabolite that destroys liver cells here. Its classic marker is urine turning a reddish-brown shade during the infusion. Option c is incorrect because naloxone reverses opioid receptor binding in a child with pinpoint pupils and shallow respirations. Breathing is unaffected in this ingestion, so the drug would accomplish nothing at all. Option d is incorrect because charcoal helps most within the first hour after ingestion, and this child arrived well past that point. Repeated dosing also risks vomiting of the oral antidote that matters most.

Correct Answer: "We will keep him off gluten even when he feels well."

Symptoms fade within weeks, yet the immune reaction to gluten is permanent. Staying with the diet during good stretches is what protects the villi, keeps growth on track and prevents later complications. Option a is incorrect because returning wheat to the plate restarts the same injury that caused the fatigue and poor growth. Feeling better is the earliest sign the diet works, not permission to stop it. Option c is incorrect because falling antibody levels measure adherence rather than cure. The tissue transglutaminase result drops precisely because gluten is gone, and it would climb again if the food returned. Option d is incorrect because barley belongs on the excluded list with wheat, rye and triticale, and ordinary oats are avoided for milling contamination. Only certified gluten free oats are considered safe for this child.

Correct Answer: Weight that has fallen across two percentile lines

Reflux earns the label of disease when it causes complications, and faltering growth is the clearest one. An infant crossing percentile lines downward is losing more calories than the spitting up would suggest. Option a is incorrect because timing alone says nothing about severity; reflux normally follows feeds while the sphincter is immature. The nurse looks past the spitting itself to growth, comfort and breathing. Option b is incorrect because a settled baby after feeds is reassuring, describing the happy spitter rather than a child in pain. Irritability and arching would be the worrying counterpart to this finding. Option d is incorrect because laundry volume measures nothing clinical. Parents of thriving spitters go through many cloths every day, and the nurse weighs the infant instead of counting them.

Correct Answer: Call the poison control center right away

With the airway and breathing intact, contacting poison control is the single most useful next step. That center identifies the agent, estimates the dose, and directs decontamination and where the child should be seen. Option a is incorrect because induced vomiting has been abandoned. Ipecac fails to remove enough toxin, brings a risk of aspiration, and causes the child to vomit up charcoal or an oral antidote given later. Option c is incorrect because milk, water and home neutralizers are given only when poison control directs it. Adding fluid can dilute an oral antidote later, and it delays the call that actually shapes treatment. Option d is incorrect because several adult drugs are lethal to a toddler in a single tablet, and some poisons stay silent for hours. Waiting for symptoms wastes the window when treatment still works.

Correct Answer: Hold the fluid and notify the prescriber

Potassium is never added until urine output is established, because output proves the kidney is perfused and able to excrete it. With no wet diaper, the nurse holds the fluid and contacts the prescriber. Option a is incorrect because monitoring does not undo the hazard of infusing potassium into an anuric infant. Serum levels can climb to arrest before a rhythm change gives the nurse any useful warning. Option b is incorrect because dilution addresses vein irritation and infusion rate, not the absent renal clearance that makes this order unsafe. Changing a prescribed concentration also sits outside independent nursing practice. Option d is incorrect because potassium given as an intravenous push causes cardiac arrest in any child, whatever the urine output. The drug is always diluted and delivered by infusion pump with cardiac monitoring.

Correct Answer: Oral rehydration solution in small amounts

Oral rehydration solution is first line for mild and moderate dehydration. Glucose and sodium co-transport keeps working in an inflamed gut, and the therapy is safer, cheaper and less painful than an intravenous line. Option a is incorrect because intravenous fluid is reserved for severe deficit, shock, intractable vomiting, or a child who cannot drink. This toddler is alert and drinking, so a needle adds pain without benefit. Option b is incorrect because juice carries a heavy sugar load with almost no sodium. The osmotic pull of that sugar draws water into the bowel and makes the diarrhea worse rather than better. Option c is incorrect because sports drinks were designed for sweating athletes, not for stool losses. Their sodium content is far too low to replace what the gut is losing, and the sugar concentration is too high.

Correct Answer: A virus such as norovirus

Viruses cause most childhood gastroenteritis, with rotavirus and norovirus leading the list. Norovirus in particular spreads explosively through daycare rooms, producing vomiting and watery stools in several children over a short span. Option b is incorrect because giardia and cryptosporidium follow camping trips, untreated water and long daycare exposure, and they tend to cause drawn out symptoms. An abrupt cluster over two days fits a viral pattern. Option c is incorrect because bacterial illness is suspected with bloody stools, high fever, severe pain or recent antibiotics. Nothing in this outbreak carries those markers, and bacterial cases rarely sweep a room this quickly. Option d is incorrect because yeast overgrowth after antibiotics shows up as thrush or a diaper rash rather than an outbreak of vomiting. No shared antibiotic exposure links these children anyway.

Correct Answer: Acknowledge her worry and review formula preparation

Most failure to thrive is mixed in origin, and blame shuts a caregiver down. Naming her effort, then walking through correct measuring and mixing with a return demonstration, fixes the calorie deficit and keeps her engaged. Option a is incorrect because charting the problem without correcting it leaves the infant on watered down formula for another day. Documentation records care; it is not a substitute for teaching that changes the feeding. Option b is incorrect because a promise of quick weight gain is not the nurse's to make, and it skips over the reason growth stalled. False comfort also leaves the mixing error uncorrected at home. Option c is incorrect because the dietitian belongs on the team, yet this mother needs an answer now from the nurse standing with her. Shared care works best when bedside teaching starts immediately and continues afterward.

Correct Answer: Inflammation runs through the full bowel wall

Skip lesions, right sided pain and perianal disease describe Crohn, where inflammation is transmural. Full thickness involvement is what produces fistulas, abscesses and strictures, and it explains why resection does not end the disease. Option a is incorrect because colectomy cures the intestinal disease of ulcerative colitis, which is confined to the colon. Crohn recurs at the anastomosis after resection, so surgery is used for complications only. Option c is incorrect because bloody diarrhea with mucus marks ulcerative colitis. Rectal bleeding happens less often in Crohn, where diarrhea, fatty stools, growth failure and abdominal pain dominate the picture instead. Option d is incorrect because continuous spread starting at the rectum is the ulcerative colitis pattern. The endoscopy here found normal tissue between diseased segments, which is the opposite of a continuous lesion.

Correct Answer: Holding and rocking the infant between feedings

Comfort measures such as holding and rocking sit well within the assistive role and reduce crying that would strain the repair. Suture line care, assessment and teaching stay with the nurse. Option b is incorrect because cleaning a fresh incision calls for sterile technique and judgment about crusting, drainage and dehiscence. That combination of skill and evaluation belongs to a licensed nurse. Option c is incorrect because assessment cannot be handed off under any delegation rule. Deciding whether the wound edges are separating or bleeding requires nursing judgment that assistive staff are not licensed to exercise. Option d is incorrect because parent education is a nursing responsibility that also demands evaluation of what the family understood. Assistive personnel may reinforce a message already given, never deliver the instruction itself.

Correct Answer: Metabolic alkalosis with low chloride and potassium

Repeated loss of gastric contents strips hydrogen, chloride and potassium from the body. The result is a hypochloremic, hypokalemic metabolic alkalosis with a rising pH and bicarbonate, the classic pyloric stenosis chemistry. Option a is incorrect because acidosis with retained potassium develops when bicarbonate is lost low in the gut, as in prolonged diarrhea. Vomiting removes acid instead, driving the blood in the opposite direction. Option b is incorrect because hyperventilation blows off carbon dioxide and produces that pattern; this infant breathes normally. Calcium is not the electrolyte emptied by gastric losses, so the pairing does not fit. Option d is incorrect because retained carbon dioxide from hypoventilation causes that acid base state, which belongs to respiratory failure. Chloride actually falls here, since it leaves the body with every projectile emesis.

Correct Answer: Hospital-acquired hyponatremia with cerebral edema

Hypotonic maintenance fluid is a known cause of hospital-acquired hyponatremia in children. Water moves into brain cells as serum sodium falls, producing headache, irritability, and seizures, which is why isotonic maintenance solutions are now standard. Option a is incorrect because a dilute solution lowers serum sodium rather than raising it. Hypernatremia in children follows insufficient intake, concentrated formula, or large insensible losses, none of which fits this hospitalized child. Option c is incorrect because rising potassium announces itself through muscle weakness, paresthesias, bradycardia and peaked T waves. Seizure activity is not part of that presentation, and the tonicity of the fluid is the clue here. Option d is incorrect because low calcium produces tetany, carpopedal spasm, stridor and a prolonged interval, usually after thyroid surgery or in kidney disease. Ordinary maintenance fluid does not strip calcium from the circulation.

Correct Answer: Keep the toddler NPO and notify the provider

Fever with explosive foul diarrhea and distension in Hirschsprung disease signals enterocolitis, which can progress to sepsis and shock. The toddler is kept NPO while the nurse alerts the provider for urgent fluids and antibiotics. Option a is incorrect because feeding a child with a possibly obstructed, inflamed colon adds volume the bowel cannot move. Enteral intake is stopped, and hydration is given through a vein until the crisis settles. Option b is incorrect because this diarrhea is not the blockage clearing itself. Mistaking enterocolitis for improvement delays antibiotics and decompression in a child who can slide into septic shock within hours. Option d is incorrect because collecting a specimen is a reasonable later step that treats nothing. Laboratory work can wait a few minutes; halting intake and reaching the provider protects the toddler right now.