NR-328 Pediatric Nursing - Set 4 - Part 3

Correct Answer: Give intravenous saline and hydrocortisone as ordered

This picture is a salt wasting crisis, a life threatening emergency of the first weeks. Volume expansion with isotonic saline plus intravenous hydrocortisone reverses the shock, and dextrose corrects the low glucose. Option a is incorrect because sepsis workup can proceed alongside treatment but never ahead of it. A collapsing newborn needs circulating volume and steroid first, and the culture costs time he does not have. Option c is incorrect because imaging confirms anatomy after the infant is stable. Waiting on a scan while sodium falls and potassium climbs invites arrhythmia and cardiac arrest in a baby already mottled. Option d is incorrect because a vomiting, lethargic infant cannot absorb oral fluid, and the deficit is far too large for sips. Intravenous access is part of the resuscitation, not an optional extra.

Correct Answer: Start the day with a warm bath

Heat loosens stiff joints, so a warm bath or shower on waking makes the first hour bearable and lets the child move. Movement itself is what clears the stiffness through the day. Option b is incorrect because cold tightens tissue and makes gelled joints harder to bend at the very hour they are worst. Ice has a place after a flare or an injury, not for morning stiffness. Option c is incorrect because lying still is exactly what produces the gelling in the first place. Staying in bed all morning would also cost the child school, friends, and the ordinary routine that treatment aims to protect. Option d is incorrect because exercise is treatment in this disease, not a threat to the joints. Swimming and cycling preserve range of motion without pounding them, and only a genuine flare calls for backing off.

Correct Answer: Place the child on droplet precautions

Droplet precautions come first, ahead of cultures and antibiotics, because the organism spreads through respiratory secretions and everyone in the room is exposed until the barrier is in place. Option a is incorrect because the blood culture is drawn early, before other specimens and before antibiotics, yet it follows isolation. Protecting staff and other clients takes only seconds and comes ahead of it. Option c is incorrect because the spinal tap is assisted after isolation, cultures and intravenous access are handled. Preparing equipment is also delegated work, while the barrier decision belongs to the nurse at the door. Option d is incorrect because antibiotics are given as soon as cultures are obtained, and in a critically ill child they are not delayed for them. Even so, isolation precedes the first dose.

Correct Answer: Compartment syndrome under the cast

Pain far beyond what the injury explains, unrelieved by opioids and sharply worse when the muscles are passively stretched, is the earliest signature of rising compartment pressure under a constricting cast. Option a is incorrect because spasm eases with analgesia, warmth, and repositioning rather than escalating through repeated opioid doses. Passive stretching of a spasming muscle is uncomfortable but does not produce screaming of this intensity. Option b is incorrect because a nerve torn at the moment of injury declares itself immediately with numbness and weakness, not with pain that builds hours later. The timing here points to pressure inside the limb. Option d is incorrect because a rubbing cast edge causes localized soreness at one rim of the cast. It would not produce deep, unrelenting forearm pain, and stretching the fingers would leave that surface irritation unchanged.

Correct Answer: A simple febrile seizure of early childhood

Febrile seizures occur between six months and five years with fever and no central nervous system infection. A generalized event lasting under fifteen minutes in a well appearing child is the simple form. Option a is incorrect because meningitis or encephalitis must be absent for this label to apply, and the seizure described was generalized rather than focal. Nothing in the history points to a brain infection. Option b is incorrect because absence spells are brief blank stares without a fall or a postictal phase, and they belong to the school age years. Fever is not their trigger. Option c is incorrect because infantile spasms come in clusters of sudden jackknife flexion on waking or falling asleep, usually starting before the first birthday. Developmental regression accompanies them, not a fever.

Correct Answer: "I put the diaper on underneath the harness straps."

Placing the diaper under the straps keeps urine and stool off the harness while the hips stay flexed and abducted. The harness stays on, so the femoral head remains seated in the socket. Option b is incorrect because removing the harness lets the hip slip out of the acetabulum, and repeated removals stretch out the treatment. Bathing happens around the harness unless the orthopedist has approved taking it off. Option c is incorrect because strap position sets the exact angle of hip flexion and abduction. Only the provider changes it, since over abduction can injure the femoral nerve or cut off blood supply to the femoral head. Option d is incorrect because oils and lotions soak into the fabric, cake against warm creases, and soften skin until it breaks down. Clean, dry skin with a thin cotton shirt underneath is what protects it.

Correct Answer: Roll head, shoulders, and hips as one unit

Log rolling keeps the fused spine in a straight line, because any twist between shoulders and pelvis strains the instrumentation and the healing bone graft. Two or three people and a draw sheet make that possible. Option a is incorrect because moving the upper body ahead of the pelvis creates the rotation that fusion cannot tolerate. Segments have to travel together, which is the entire reason extra hands are gathered. Option b is incorrect because hauling on the arms drags the trunk into flexion and shear across a fresh incision. It also puts the whole load on the shoulders instead of a supporting sheet under the body. Option d is incorrect because a steep head elevation bends the operated spine forward and does nothing to change the adolescent's position in bed. Head of bed limits are set by the surgeon after this operation.

Correct Answer: Refrigerate unopened vials and never freeze them

Unopened vials and pens keep in the refrigerator, never the freezer, while the vial in use may sit at room temperature for the labelled period. Insulin whose appearance changes is discarded. Option a is incorrect because freezing destroys the protein structure of insulin and the vial must then be thrown away. Refrigeration keeps it stable without ever letting it reach freezing. Option b is incorrect because a parked car swings from freezing to scorching within hours, and heat degrades insulin quickly. Supplies travel in an insulated pack and come indoors with the family. Option c is incorrect because hot water damages the drug, and no warming step is needed at all. A vial kept at room temperature is already comfortable enough for injection.

Correct Answer: A rapid pulse with tremor and weight loss

Too much levothyroxine produces a hyperthyroid picture of tachycardia, tremor, sweating, diarrhea, poor sleep, and weight loss. These findings prompt a dose review, since the drug is titrated against thyroid studies and growth. Option a is incorrect because excess hormone burns energy and takes weight off rather than adding it. A climbing weight with sluggish behavior would instead suggest the dose is too small. Option c is incorrect because a hoarse cry and coarse puffy features belong to untreated or under-treated disease. Those signs point the dose upward, which contradicts the irritability and diarrhea described. Option d is incorrect because a wide posterior fontanel and hypotonia are classic clues to hypothyroidism that was never treated. This baby is receiving hormone, and the symptoms run the opposite direction.

Correct Answer: "We will inject under the skin at bedtime and rotate the sites."

Somatropin goes into subcutaneous tissue at bedtime, matching the natural pulse that follows sleep onset, and rotating among abdomen, thigh, and arm prevents fatty tissue changes that make absorption erratic. Option b is incorrect because the drug goes into subcutaneous tissue, never into muscle. A morning dose also misses the physiologic surge that arrives within ninety minutes of the child falling asleep. Option c is incorrect because freezing destroys the hormone and vigorous shaking damages the protein. Vials belong in the refrigerator and reconstituted ones are rolled gently between the palms until mixed. Option d is incorrect because skipped doses blunt the growth response, and the schedule runs six or seven nights weekly. Tiredness is expected at bedtime and is not a reason to hold it.