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WorksheetsPediatric Exam 2
Total questions: 100
Worksheet time: 2hrs 40mins
A child with nephrotic syndrome is admitted with severe periorbital edema. Which provider order should the nurse question?
Daily weights
IV albumin infusion
Sodium-restricted diet
High-sodium snacks to stimulate appetite
Which finding is most concerning in a child with nephrotic syndrome?
Frothy urine
2+ pitting edema in the ankles
Fever of 101.8°F (38.8°C)
Fatigue after walking
The nurse is educating the parents of a child with nephrotic syndrome about prednisone therapy. Which statement indicates understanding?
We will stop the medication when the swelling goes away.
We should not give any live vaccines while our child is on steroids.
We should double the dose if protein is found in the urine.
We can give the medication at different times each day.
A child with nephrotic syndrome is receiving diuretics. What is the most important nursing action?
Monitoring blood pressure hourly
Strict intake and output
Administering with milk
Assessing for cough and wheezing
Which lab result would the nurse expect in nephrotic syndrome?
Elevated serum albumin
Decreased serum cholesterol
Hypoalbuminemia
Hypernatremia
A child with acute post-streptococcal glomerulonephritis (APSGN) presents with cola-colored urine and hypertension. Which nursing intervention is a priority?
Encourage oral fluids
Monitor for seizures
Provide high-sodium diet
Place child in contact isolation
Which assessment finding supports the diagnosis of APSGN?
Generalized petechiae
Recent sore throat
Weight loss
Diarrhea
A nurse prepares to give antibiotics to a child with APSGN. Which is the best rationale?
To prevent hematuria
To treat the underlying streptococcal infection
To prevent seizures
To decrease blood pressure
Which complication is the nurse most concerned about in APSGN?
Hypotension
Seizures due to hypertension
Dehydration
Hypoglycemia
Which finding should the nurse expect in a child with APSGN?
Hematuria and proteinuria
Hypotension and tachycardia
Increased urine output
Polyuria with clear urine
Which diet order is most appropriate for a child with APSGN?
High-sodium, high-fluid
Low-protein, high-carbohydrate
Low-sodium, fluid restriction
High-fat, high-calorie
The nurse is providing discharge teaching for a child recovering from APSGN. Which statement indicates further teaching is needed?
We should monitor our child’s blood pressure at home.
Our child can return to full activity within 1–2 weeks.
We should limit salty snacks until cleared by the provider.
We need to follow up with urine tests after discharge.
A child with nephrotic syndrome has generalized edema. Which nursing intervention is most appropriate?
Elevate the child’s legs on pillows
Restrict protein intake
Which diagnostic test confirms APSGN?
Positive throat culture for group A strep
Elevated antistreptolysin O (ASO) titer
Decreased BUN and creatinine
Normal urinalysis
Which symptom should the nurse expect in nephrotic syndrome but NOT in APSGN?
Proteinuria
Hematuria
Hypoalbuminemia
Severe generalized edema
A nurse notices that a child with nephrotic syndrome has gained 3 pounds in 24 hours. What is the priority action?
Inform the provider
Restrict physical activity
Administer diuretic early
Increase oral fluid intake
Which nursing intervention is most important in the acute phase of APSGN?
Provide oxygen therapy
Monitor and control blood pressure
Encourage large fluid intake
Encourage high-protein diet
A child with nephrotic syndrome is prescribed IV albumin. Which outcome indicates effectiveness?
Increased edema
Increased urine output
Decreased blood pressure
Elevated temperature
The nurse is caring for a child with nephrotic syndrome receiving corticosteroid therapy. Which complication should be closely monitored?
Hypoglycemia
Infection
Hypertension
Hypokalemia
The nurse is reinforcing teaching with the parents of a child with APSGN. Which statement requires correction?
We will keep track of urine output daily.
We should expect some cola-colored urine at first.
We should give extra fluids to flush the kidneys.
We will avoid adding salt to meals.
A child with sickle cell crisis is admitted with severe pain and dehydration. Which intervention should the nurse implement first?
Administer prescribed opioid analgesics
Encourage high-calorie meals
Begin IV fluid therapy
Apply warm compresses to painful areas
Which finding indicates a vaso-occlusive crisis in sickle cell disease?
Jaundice and hepatomegaly
Severe limb pain and swelling
Increased urine output
Polycythemia
Which instruction is appropriate for the parents of a child with sickle cell disease?
Avoid cold environments.
Encourage your child to fast when ill.
Give aspirin for pain control.
Restrict oral fluids during crisis.
A nurse is reviewing labs for a child with sickle cell anemia. Which result should be expected?
Increased hemoglobin
Decreased reticulocyte count
Elevated bilirubin
Increased platelet count
A nurse is caring for a child with sickle cell crisis. Which nursing intervention is most effective in preventing further sickling?
Providing supplemental oxygen
Maintaining adequate hydration
Administering antibiotics
Encouraging bed rest
The nurse administers hydroxyurea to a child with sickle cell disease. What is the primary purpose of this medication?
Stimulate red blood cell production
Increase fetal hemoglobin (HbF) production
Decrease iron absorption
Replace missing clotting factors
A school nurse notices a child with hemophilia has bruising and swelling in the knee after a fall. What is the nurse’s priority action?
Apply warm compresses
Immobilize the joint and apply ice
Encourage ambulation
Administer oral acetaminophen only
Which intervention should be included in the plan of care for a child with hemophilia?
Avoid giving immunizations
Administer IM injections with small needles
Encourage participation in contact sports
Use a soft-bristled toothbrush
Which medication is contraindicated for a child with hemophilia?
Acetaminophen
Amoxicillin
Ibuprofen
Factor VIII concentrate
A child with hemophilia A is prescribed desmopressin (DDAVP). What is the purpose of this medication?
Stimulates production of factor IX
Stimulates release of factor VIII
Stimulates red blood cell production
Stimulates platelet formation
A nurse is teaching parents of a child with hemophilia about home care. Which statement shows understanding?
We will keep factor replacement medication at home.
We should use aspirin for joint pain.
We should encourage football to keep joints strong.
We can give intramuscular vitamin K if bleeding occurs.
Which clinical sign is most specific to hemophilia?
Fatigue
Nosebleeds
Hemarthrosis
Bruising
A toddler with iron deficiency anemia is prescribed oral iron supplements. Which teaching should the nurse include?
Administer with milk for best absorption
Give with orange juice to enhance absorption
Stop supplement if stools turn black
Expect pale conjunctiva as a normal finding
Which dietary change would best improve iron deficiency anemia?
Increasing milk intake
Encouraging leafy green vegetables and red meat
Adding more refined grains
Limiting vitamin C-rich foods
Which lab value is expected in iron deficiency anemia?
Increased mean corpuscular volume (MCV)
Decreased mean corpuscular volume (MCV)
Increased hemoglobin
Increased hematocrit
A nurse is caring for a child with anemia. Which finding would indicate worsening condition?
Pale skin and fatigue
Increased urine output
Bradycardia
Tachycardia and shortness of breath
A child presents with frequent nosebleeds. Which action should the nurse take first?
Tilt the head back and pinch the nose
Tilt the head forward and apply pressure to nares
Apply heat packs
Encourage nose blowing to clear clots
A parent asks how to prevent recurrent epistaxis in their child. Which teaching is correct?
Use a humidifier in the child’s room
Avoid using saline nasal sprays
Encourage frequent nose picking
Limit fluids before bedtime
Which medication may be prescribed for recurrent epistaxis?
Topical vasoconstrictors
Antihistamines
Oral iron supplements
Anticoagulants
A nurse is monitoring a child after an episode of epistaxis. Which complication should the nurse assess for?
Hypokalemia
Anemia from blood loss
Hyperglycemia
Hypertension
A child receiving chemotherapy develops a fever of 101.9°F (38.8°C). What is the nurse’s priority action?
Administer acetaminophen
Place child in reverse isolation
Notify the provider immediately
Apply cool compresses
Which lab result is most concerning for a child receiving chemotherapy?
WBC 2,000/mm³
Hematocrit 36%
Platelets 180,000/mm³
Hemoglobin 12 g/dL
Which nursing intervention best prevents infection in a child receiving chemotherapy?
Encouraging large crowds to maintain normal socialization
Avoiding fresh flowers and raw fruits/vegetables
Encouraging daily rectal temperature checks
Using the same central line dressing for 1 week
A child receiving chemotherapy reports painful mouth sores. Which nursing intervention is most appropriate?
Use lemon-glycerin swabs
Encourage soft, bland foods
Use alcohol-based mouthwash
Brush teeth vigorously
A child on chemotherapy is experiencing nausea and vomiting. When should the nurse administer ondansetron?
Only if the child vomits
After chemotherapy is completed
30 minutes before chemotherapy
At bedtime
Which finding indicates tumor lysis syndrome?
Hypokalemia
Hyperkalemia and hyperphosphatemia
Decreased uric acid
Metabolic alkalosis
Which intervention is priority in tumor lysis syndrome?
Administer oral iron supplements
Start IV fluids to promote excretion
Place child in Trendelenburg position
Restrict fluids to prevent overload
Which medication may be prescribed to prevent complications of tumor lysis syndrome?
Allopurinol
Hydroxyurea
Prednisone
Vincristine
A child with ALL presents with bone pain, fever, and petechiae. Which is the best explanation for these symptoms?
Increased WBC production
Bone marrow failure
Decreased immune response to viruses
Liver dysfunction
Which nursing intervention is most important for a child with ALL?
Encourage outdoor play for vitamin D
Strict infection prevention measures
Avoid use of pain medications
Provide high-sodium diet
Which medication combination is commonly used to treat ALL?
A child with ALL is neutropenic. Which activity is most appropriate?
Visiting with friends who have mild colds
Eating fresh strawberries from the garden
Playing board games with family
Attending large social gatherings
Which finding suggests spinal cord compression in a child with cancer?
Severe headache and vomiting
Weakness and paralysis of legs
Hypertension and tachycardia
Polyuria and dehydration
Which sign indicates septic shock in a child receiving chemotherapy?
Warm, flushed skin and stable vitals
Hypotension, tachycardia, altered LOC
Increased urine output
Bradycardia with hypertension
The nurse is preparing to care for a child with Wilms tumor. Which action is most important?
Palpate the abdomen for tumor size
Avoid abdominal palpation
Place the child on a high-sodium diet
Encourage contact sports
Which assessment finding is expected in a child with Wilms tumor?
Painful abdominal swelling
Painless abdominal mass
Constipation and diarrhea
Cyanosis of the lips
The nurse is teaching parents about post-op care following Wilms tumor removal. Which statement requires further teaching?
We should monitor blood pressure regularly.
We should report any signs of infection.
We will allow rough play to build strength.
We should encourage deep breathing and coughing.
Which chemo complication is related to bone marrow suppression?
A. Alopecia
B. Pancytopenia
C. Constipation
D. Dysphagia
Which nursing action is most appropriate for a child at risk for bleeding due to chemotherapy?
Use an electric razor for shaving
Administer aspirin for pain
Use rectal thermometers
Encourage contact sports for mobility
Which clinical finding is most concerning for a child with ALL?
Low-grade fever
Nosebleed and gum bleeding
Hair loss
Decreased appetite
A nurse is caring for an infant with suspected bacterial meningitis. Which action should the nurse take first?
Initiate droplet isolation
Insert a urinary catheter
Provide a warm blanket
Encourage oral fluids
Which finding is consistent with bacterial meningitis in a 6-month-old infant?
Sunken fontanel
Bulging fontanel
Decreased head circumference
Bradycardia
A nurse is preparing a child for lumbar puncture to rule out meningitis. Which action is appropriate?
Place child in prone position
Place child in side-lying position with knees flexed
Place child supine with legs extended
Place child in Trendelenburg
Which cerebrospinal fluid (CSF) finding is consistent with bacterial meningitis?
Clear CSF, normal glucose
Cloudy CSF, low glucose, high protein
Clear CSF, high glucose
Cloudy CSF, high glucose, low protein
The nurse is teaching parents about prevention of Reye’s syndrome. Which statement demonstrates understanding?
We should not give aspirin to children with viral infections.
Acetaminophen should be avoided in children.
We should give aspirin to prevent fevers.
Ibuprofen always causes liver damage.
Which finding would the nurse expect in a child with Reye’s syndrome?
Hyperactivity and euphoria
Confusion, seizures, elevated ammonia
Bradycardia and hypotension
Increased urine output
Which medication may be used to reduce intracranial pressure in Reye’s syndrome?
Mannitol
Acetaminophen
Prednisone
Hydroxyurea
A child with a seizure disorder is placed on seizure precautions. Which item is most important to keep at the bedside?
Tongue blade
Oxygen and suction equipment
Blood pressure cuff
Cardiac monitor
During a tonic-clonic seizure, what is the nurse’s priority action?
Insert an oral airway
Hold the child down to prevent injury
Place the child on their side
Administer acetaminophen
Which medication is commonly prescribed for seizure control in children?
Hydroxyurea
Phenytoin
Factor VIII
Allopurinol
A parent states, “My child always sleeps for hours after a seizure.” The nurse should respond:
A. “This is an expected postictal finding.”
B. “Your child may have brain damage.”
C. “This means your child’s seizure was not real.”
D. “This indicates medication toxicity.”
Which nursing action is most appropriate when documenting a seizure?
Describe length, type of movements, and recovery
Record that the child was unconscious
Note only the time it ended
Avoid documenting observations to protect privacy
Which type of seizure is characterized by brief staring episodes?
Tonic-clonic
Absence seizure
Which action is appropriate during the recovery phase of a seizure?
Insert a nasogastric tube
Place child supine with head flat
Provide a quiet environment and allow rest
Ambulate child quickly to reorient
A newborn is diagnosed with spina bifida myelomeningocele. Which nursing action is priority?
Keep the sac covered with a sterile, moist dressing
Place the infant on the abdomen
Clean the sac with alcohol
Apply powder to keep the area dry
Which complication is most associated with spina bifida?
Hypertension
Latex allergy
Diabetes mellitus
Asthma
Which clinical finding would be expected in a newborn with spina bifida myelomeningocele?
Protruding sac at spine, bowel/bladder dysfunction
Projectile vomiting and olive-shaped mass
Hypotension and bradycardia
Clear lungs and no neurological deficits
The nurse is teaching parents about long-term care for a child with spina bifida. Which is most important?
Monitoring for signs of increased intracranial pressure
Administering hydroxyurea daily
Increasing protein in diet
Restricting oral fluids
Which statement indicates correct parent understanding of spina bifida care?
We must use latex-free products.
We can allow our child to lie on the sac.
We will bathe our child daily by submerging in warm water.
We can use talcum powder on the sac.
The nurse is caring for a child with suspected meningitis. Which intervention should be avoided before antibiotics are started?
Collecting cerebrospinal fluid for culture
Monitoring neurological status
Placing child on droplet precautions
Administering corticosteroids
A child with Legg-Calvé-Perthes disease is admitted. Which symptom should the nurse expect?
Projectile vomiting
Hip pain and limping
Severe headache
Red, swollen joints
Which intervention is appropriate for a child with Legg-Calvé-Perthes disease?
Encourage contact sports to maintain strength
Maintain activity restriction and possible traction
Provide high-sodium diet
Encourage daily running exercises
Which medication is most appropriate to relieve discomfort in Legg-Calvé-Perthes disease?
Corticosteroids
NSAIDs
Chemotherapy agents
Diuretics
The school nurse suspects scoliosis in a 12-year-old. Which finding supports this?
Equal leg lengths
One shoulder higher than the other
Flat spinal alignment
Symmetrical hip level
A child is being evaluated for scoliosis. Which diagnostic test is most commonly used to confirm the condition?
X-ray of the spine
CT scan of the head
Echocardiogram
MRI of the brain
Which intervention is most appropriate for a child with mild scoliosis?
Immediate spinal fusion surgery
Physical therapy and bracing
Complete bed rest
Opioid pain control
A nurse is providing post-op care for a child after spinal fusion for scoliosis. Which finding should be reported immediately?
Pain at the incision site
Decreased sensation and movement in legs
Limited appetite
Low-grade fever
Which intervention should be included in post-op scoliosis spinal fusion care?
Encourage early ambulation without support
Log-roll when repositioning
Restrict deep breathing exercises
Place child prone at all times
The nurse is caring for a child in traction. Which nursing intervention is most important?
A child in a leg cast reports numbness and tingling in the toes. What should the nurse do first?
Reassure the child this is normal
Elevate the extremity and reassess
Notify the provider immediately
Apply warm compress
Which sign suggests compartment syndrome in a child with a cast?
Mild pain relieved by elevation
Severe pain unrelieved by medication
Pink, warm skin
Strong pedal pulses
Which action should the nurse take if compartment syndrome is suspected?
Elevate the limb above the heart
Loosen or bivalve the cast per order
Apply ice packs directly to the cast
Restrict IV fluids
Which classic assessment finding supports developmental dysplasia of the hip (DDH) in a newborn?
Positive Ortolani or Barlow test
Hyperactive deep tendon reflexes
Bilateral leg edema
Wide symmetrical gluteal folds
Which nursing intervention is most appropriate for an infant in a Pavlik harness for DDH?
Remove harness daily for 12 hours
Keep harness on continuously as prescribed
Use powder under straps
Place infant prone for sleep
A parent asks how to care for their infant in a Pavlik harness. Which response is correct?
We should check skin under straps daily.
We can adjust straps ourselves at home.
We should only use the harness at night.
We can remove the harness for baths.
Which finding indicates improvement in DDH treatment with Pavlik harness?
Normal hip abduction and symmetric leg lengths
Persistent leg length discrepancy
Continued hip clicking
Increased hip instability
A nurse is assessing a child with a cast. Which finding requires immediate intervention?
Capillary refill of 2 seconds
Toes are cool and pale
Reports mild itching under cast
Minimal swelling around edges
Which nursing intervention is appropriate for cast care?
Use fingertips to handle wet cast
Elevate extremity on pillows
Insert a pencil to scratch under cast
Cover cast with plastic wrap continuously
Which symptom is part of the “6 Ps” of compartment syndrome?
F. Paralysis
A. Pain out of proportion
B. Pallor
D. Paresthesia
C. Pulselessness
Which is the priority action for a child who develops severe pain and absent pulses in the limb with a cast?
Reassess in 30 minutes
Notify the provider immediately
Apply an elastic bandage
Elevate the extremity above heart level
