Font size
WorksheetsNUR220 Test 4
Total questions: 151
Worksheet time: 1hrs 16mins
Which early clinical sign most reliably suggests dehydration in an infant during assessment?
Early tachycardia with dry mucosa
Late bradycardia with weak pulses
Hypertension with warm extremities
Generalized edema with weight gain
An infant with mild to moderate dehydration should receive which fluid plan over four hours?
Oral rehydration solution 50–100 mL/kg
Tap water 50–100 mL/kg by mouth
Undiluted fruit juice ad libitum
Normal saline maintenance only IV
A 6‑month‑old presents with vomiting and diarrhea. Which management step is most appropriate before etiology is confirmed?
Provide oral rehydration and skin care
Start broad‑spectrum antibiotics immediately
Give antimotility agents for diarrhea
Offer milk and broth for hydration
In pediatric gastroenteritis, which risk factor is most commonly implicated in causing the illness?
Rotavirus infection in young children
Chronic lactose intolerance history
Recent travel to high altitude
Prolonged exclusive breastfeeding
Which symptom cluster best supports a diagnosis of hypertrophic pyloric stenosis in an infant?
Projectile vomiting after feeds, RUQ olive mass
Bilious vomiting with severe diarrhea
Intermittent colicky pain with hematochezia
Constipation with abdominal distension only
An infant with hypertrophic pyloric stenosis has frequent emesis. Which metabolic disturbance is most expected?
Metabolic alkalosis with hypokalemia
Metabolic acidosis with hyperkalemia
Respiratory alkalosis with hyponatremia
Respiratory acidosis with hypernatremia
Which triad most strongly suggests intussusception in a toddler with intermittent abdominal pain?
Sausage-like mass, currant jelly stools, bilious vomiting
Rebound tenderness, fever, nonbilious vomiting
Projectile vomiting, olive-shaped mass, bloody diarrhea
Watery stools, diffuse tenderness, nonbilious emesis
A child with suspected intussusception has a palpable mid‑upper abdominal mass. What is the most appropriate immediate action?
Report bilious vomiting and prepare for air enema
Give oral fluids and observe for 24 hours
Administer antidiarrheals and schedule CT scan
Provide clear liquids and arrange outpatient ultrasound
Volvulus primarily threatens bowel viability by causing which pathophysiologic process?
Twisting that cuts off blood flow causing ischemia
Herniation that increases intraabdominal pressure only
Inflammation that narrows the lumen without ischemia
Perforation that leads to mild mucosal bleeding only
Which finding in a child with suspected volvulus most strongly indicates need for emergent surgery?
Bilious vomiting with shock signs and distention
Intermittent nonbilious emesis without tenderness
Occasional cramping relieved by defecation
Mild fever with localized right lower pain
McBurney’s point is best described as the location of maximal tenderness in appendicitis. Where is it found?
Two thirds from umbilicus to right anterior superior iliac spine
Midpoint between left costal margin and umbilicus
One third from xiphoid to the pubic symphysis
Two fingers below the left anterior superior iliac spine
Which change in pain best suggests appendiceal rupture in a patient with suspected appendicitis?
Sudden relief of pain followed by worsening signs
Gradual increase in pain over several days
Pain shifting from left to right lower quadrant
Persistent mild pain relieved by antacids
Postoperative care priority after cleft palate repair in an infant includes which action?
Use elbow restraints to protect sutures for two weeks
Place a hard nipple to stimulate vigorous sucking
Allow frequent crying to clear secretions safely
Brush sutures gently after each feeding daily
Which preoperative feeding strategy supports infants with cleft lip or palate?
Use special nipples and upright positioning during feeds
Delay feeds until surgery to reduce aspiration risk
Insert a nasogastric tube for all routine feedings
Offer thin liquids quickly with standard bottle nipples
Which sign most strongly suggests an incarcerated inguinal hernia requiring urgent evaluation?
Painful bulge with distention and no bowel movements
Intermittent bulge only with crying that reduces
Soft reducible bulge without skin changes
Small asymptomatic bulge that disappears when supine
Parents ask about an umbilical hernia in their infant. The best advice is:
Most close spontaneously; do not tape objects on it
Tape a coin over it to speed closure safely
Schedule elective repair within the first month
Begin abdominal crunches to strengthen muscles
Which immediate management step is critical for an omphalocele at birth?
Prevent hypothermia and fluid loss; protect the sac
Place infant prone and remove the external sac
Delay IV fluids to avoid edema of the sac
Routinely palpate and reposition abdominal organs
A neonate with frothy bubbles in the mouth, coughing, cyanosis, and regurgitation most likely has which condition?
Esophageal atresia with tracheoesophageal fistula
Pyloric stenosis with persistent nonbilious emesis
Duodenal atresia with double‑bubble sign only
Choanal atresia with improved oral feeding
Which immediate preoperative priority best reduces aspiration risk in an infant with esophageal atresia?
Elevate head 30–45 degrees with NPO
Provide frequent pacifier for comfort
Begin small oral feeds for hydration
Place flat and rotate every two hours
For congenital diaphragmatic hernia at birth, which action is most critical to prevent worsening respiratory compromise?
Avoid stimulating crying after delivery
Initiate vigorous bag-mask ventilation
Place supine with legs elevated
Delay oxygen and suction setup
Postoperative care for congenital diaphragmatic hernia includes which positioning strategy?
Position infant on affected side carefully
Place prone with head lower than chest
Keep head level with abdomen always
Maintain strict supine without supports
Which symptom cluster most strongly suggests infant GERD requiring medical management?
Chronic cough with poor weight gain
Isolated constipation without pain
Intermittent rash with normal growth
Fever with acute watery diarrhea
Which medication pairing reflects typical GERD therapy in infants and children?
Ranitidine or omeprazole mornings fasting
Amoxicillin and metformin after meals
Furosemide with albuterol before feeds
Levothyroxine at bedtime with milk
In Hirschsprung disease, which pathophysiologic defect leads to obstruction?
Absence of colonic ganglion cells causing aperistalsis
Hyperactive enteric neurons increasing peristalsis
Excess mucus secretion narrowing the lumen
Hypertrophy of smooth muscle increasing motility
Which neonatal assessment most strongly raises suspicion for Hirschsprung disease?
Failure to pass meconium with distention
Early passage of meconium without distention
Projectile nonbilious vomiting with hunger
Bloody stools with normal abdominal exam
Which long-term complication is most associated with untreated Hirschsprung disease?
Failure to gain weight with malnutrition
Recurrent nephrolithiasis with hematuria
Hyperthyroidism with heat intolerance
Increased bone density with fractures
Which foods must be excluded in a strict celiac disease diet?
Wheat, rye, barley, and oats
Rice, corn, millet, and sorghum
Eggs, dairy, fish, and poultry
Beans, nuts, fruits, and vegetables
Which deficiency pattern best matches celiac-associated malabsorption?
Iron, folate, calcium, ADEK, and B12
Sodium, chloride, iodine, and water
Uric acid, creatinine, lactate, and urea
Insulin, glucagon, cortisol, and TSH
Which clinical picture is most consistent with avoidant/restrictive food intake disorder in a toddler?
Persistent poor intake with weight below 5th percentile
Selective vegetarian diet with normal growth
Brief viral illness causing temporary poor appetite
Food allergies requiring elimination with catch-up growth
Which initial evaluation step is essential when assessing pediatric malnutrition or failure to thrive?
Obtain detailed dietary history with 24-hour recall
Start parenteral nutrition before assessment
Order endoscopy in all suspected cases
Restrict fluids to stimulate appetite
Which anatomical feature defines hypospadias in a newborn male?
Urethral opening on ventral penile surface
Urethral opening on dorsal penile surface
Urethral opening at bladder neck internally
Absent urethral opening requiring catheter
A child with epispadias is scheduled for repair. Which preoperative consideration is most appropriate?
Avoid circumcision until after repair
Begin tub baths to reduce swelling
Discontinue all antibiotics immediately
Tape stent flat against abdomen
Postoperative teaching after hypospadias repair should include which instruction to caregivers?
Expect red-tinged urine initially
Remove compression dressing day one
Allow straddling on parents’ hip
Begin voiding cystourethrogram daily
Which pathophysiology best describes vesicoureteral reflux (VUR)?
Urine flows backward up ureters
Urine leaks through abdominal wall
Urine bypasses kidneys entirely
Urine stagnates only in urethra
Which management step is emphasized for a child with recurrent VUR and UTIs?
Antibiotics in some cases with monitoring
Long-term diuretics to reduce pressure
Immediate nephrectomy for scar risk
Daily sitz baths as definitive therapy
Which finding most supports the diagnosis of bladder exstrophy in a neonate?
Everted bladder mucosa through abdominal wall
Hypertrophied urethral sphincter internally
Umbilical hernia with intact bladder
Patent urachus with clear drainage
Which statement about pediatric UTIs is most accurate?
Most result from ascending urethral bacteria
Most arise from hematogenous spread
They rarely involve the bladder mucosa
They are prevented by avoiding warm compresses
Which management plan aligns with uncomplicated pediatric UTI care?
Antibiotics, culture, fever management
Immediate IV fluids and bedrest
Surgical urethral dilation routinely
No antibiotics unless febrile seizures
Which definition correctly distinguishes primary from secondary enuresis?
Primary: never achieved control; Secondary: lost control
Primary: daytime only; Secondary: nighttime only
Primary: after age six; Secondary: before age two
Primary: due to infection; Secondary: congenital
Nocturnal enuresis is best described as which pattern?
Nighttime bedwetting usually subsiding by six
Daytime urgency with constant dribbling
Continuous leakage from birth to adulthood
Nighttime hematuria without incontinence
Which clinical feature most strongly suggests nephrotic syndrome in a child?
Foamy, frothy, dark yellow urine
Tea-colored urine with mild protein
Bloody diarrhea with pallor and HTN
Polyuria with low specific gravity
Loss of which protein in nephrotic syndrome most directly increases infection risk?
Immunoglobulins leaking into urine
Albumin leaking into urine
Transferrin leaking into urine
Fibrinogen leaking into urine
A key management priority for nephrotic syndrome when edema is present is to:
Consider fluid and sodium restrictions
Increase unrestricted oral fluids
Begin long-term broad antibiotics
Encourage high-potassium foods
Which finding best differentiates acute poststreptococcal glomerulonephritis from nephrotic syndrome?
Tea-colored urine with decreased GFR
Massive proteinuria with hypoalbumin
Periorbital edema with ascites
Hyperlipidemia with clotting risk
In acute poststreptococcal glomerulonephritis, a common complication necessitating monitoring is:
Uremia with elevated BUN and creatinine
DIC with low fibrinogen and platelets
Hepatic failure with high bilirubin
Hyperthyroidism with low TSH levels
Hemolytic uremic syndrome is characterized by the triad of hemolytic anemia, thrombocytopenia, and which complication?
Acute renal failure development
Chronic liver failure development
Pulmonary edema development
Adrenal crisis development
Which symptom profile most strongly signals hemolytic uremic syndrome and a medical emergency?
Bloody diarrhea, pallor, oliguria, HTN
Watery diarrhea, polyuria, bradycardia
Tea urine, peripheral neuropathy, rash
High fever, dry cough, limb edema
Priority monitoring during management of hemolytic uremic syndrome includes:
Blood pressure, electrolytes, and output
Peak flows, oxygen saturation, ABGs
Liver enzymes, ammonia, INR
Thyroid function, calcium, prolactin
A child with acute renal failure shows decreased urine output, tachypnea, and edema. Which initial action best addresses life-threatening electrolyte imbalance?
Administer polystyrene sulfonate as ordered
Increase IV hypotonic fluid boluses
Provide high-potassium nutritional supplements
Restrict sodium to zero immediately
Which lab pattern most aligns with acute renal failure in children?
Elevated BUN/creatinine with protein and blood in urine
Decreased BUN/creatinine with alkaline urine
Normal BUN/creatinine with glucose in urine
Elevated amylase/lipase with ketones in urine
For Wilms tumor, which nursing precaution is critical to prevent tumor seeding?
Do not palpate abdominal masses
Keep child NPO for 24 hours
Place in reverse isolation
Avoid all intramuscular injections
Most common age range for Wilms tumor occurrence is:
Two to five years of age
Birth to one year of age
Six to nine years of age
Ten to twelve years of age
A 15-year-old boy presents with sudden, severe scrotal pain and a blue-black discoloration of the scrotum. Which management is most appropriate to maximize testicular salvage?
Immediate analgesics and next-day ultrasound
Urgent manual detorsion and home observation
Emergent surgery within four to six hours
Ice packs and scrotal elevation for forty-eight hours
Antibiotics and outpatient urology follow-up
Which clinical feature most strongly suggests hydrocele rather than other scrotal pathology in an adolescent male?
Enlarged scrotum when lying, fluid-like feel
Sudden onset of intense scrotal pain
High fever with purulent scrotal drainage
Hard, irregular testicular mass on exam
Scrotal size decreases only with standing
In growth hormone deficiency of childhood, which combination is most typical?
Height below 3rd percentile with prominent forehead
Rapid linear growth with early puberty signs
Normal stature with markedly increased muscle mass
Tall stature with delayed bone age only
Obesity with deep voice and rapid hair growth
A newborn has protruding tongue, prolonged jaundice, slow reflexes, and a hoarse cry. What is the most critical long-term risk if treatment is delayed?
Intellectual disabilities that worsen with later therapy
Recurrent hyperthyroid storms in early childhood
Persistent short stature without cognitive impact
Infertility due to gonadal dysgenesis
Irreversible renal tubular acidosis in infancy
Which home management advice best supports a child started on levothyroxine for congenital hypothyroidism?
Take daily as prescribed to prevent cognitive harm
Use only during growth spurts to reduce dose
Stop during intercurrent illness to avoid side effects
Alternate days to mimic physiologic fluctuations
Reserve for nighttime only to improve absorption
A neonate with ambiguous genitalia is diagnosed with congenital adrenal hyperplasia. Which acute scenario requires immediate intervention during stress?
Vomiting with hypotension and tachycardia from cortisol deficit
Bradycardia with hypertension from aldosterone excess
Hyperglycemia with polyuria from excessive cortisol
Hypothermia with bradypnea from thyroid storm
Edema with bradycardia from vasopressin overdose
Which statement best distinguishes Type 1 from Type 2 diabetes mellitus?
Type 1 involves beta cell destruction and insulin deficiency
Type 1 is mainly insulin resistance in muscle and liver
Type 2 is autoimmune beta cell loss in childhood
Type 2 always presents with complete insulin absence
A patient with diabetic ketoacidosis is most likely to present with which combination of findings?
Kussmaul respirations, fruity breath, ketonuria
Bradycardia, hypertension, constricted pupils
High fever, productive cough, cyanosis
Peripheral edema, wheezing, frothy sputum
During DKA treatment, why must blood glucose declines be gradual rather than rapid?
Rapid drops increase risk of cerebral edema and hypoglycemia
Rapid drops lead to permanent beta cell regeneration
Slow drops cause severe hyperkalemia and arrhythmia
Slow drops prevent dehydration and increase urine output
Match the insulin class to its typical action profile timing.
Rapid-acting: onset about 15 minutes with meals
Short-acting: take 30–60 minutes before meals
Intermediate-acting NPH: covers roughly half a day
Long-acting glargine/detemir: provides full-day basal
Which nursing priority is most appropriate in initial management of DKA?
Begin IV fluids, monitor glucose hourly, replace potassium
Hold fluids, give subcutaneous insulin only, restrict potassium
Administer long-acting insulin first, avoid dextrose infusion
Delay labs until mental status improves, provide oral fluids
Which dietary advice is most appropriate for a child with phenylketonuria (PKU)?
Follow a low phenylalanine, low protein diet avoiding meat and milk
Increase high-protein foods including meat and dairy daily
Avoid tyrosine entirely and choose high-fat dairy products
Use a high phenylalanine diet to promote brain development
Which intervention is most appropriate before feeding an infant with copious nasal secretions to reduce aspiration risk?
Humidification with cool mist only
Suctioning of the nares gently
Positioning flat on the back
Avoiding chest physiotherapy
In infants, narrower bronchi and fewer alveoli primarily increase the risk for which problem?
Hyperventilation during crying episodes
Lower airway obstruction and hypoxemia
Excess dead space ventilation
Improved mucociliary clearance
Which description best characterizes wheezing on lung exam?
Low pitched sound heard on inspiration only
High pitched sound on inspiration or expiration
Brief clicks occurring with every heartbeat
Harsh sound produced by upper airway collapse
A term newborn develops cyanosis and respiratory distress that worsen during feeding with noisy respirations and copious nasal obstruction. Which condition is most consistent with these findings?
Tracheomalacia causing dynamic collapse
Choanal atresia with posterior bony occlusion
Bronchiolitis from viral infection
Laryngomalacia involving supraglottic tissue
Which is the most serious potential complication of untreated bacterial sinusitis in adolescents?
Otitis externa causing mild hearing loss
Orbital cellulitis with periorbital spread
Serous rhinitis with persistent sneezing
Tonsillitis leading to mild dehydration
A 7-year-old has several days of thin watery nasal discharge, low fever, fatigue, and watery eyes that later progress to thicker mucus. Which management approach is most appropriate?
Immediate broad-spectrum antibiotics course
Supportive care with humidity and saline washes
High dose systemic steroids for three days
No fluids to reduce nasal secretions
Which finding most specifically suggests streptococcal pharyngitis in a child with sore throat and fever?
Fine red sandpaper-like trunk rash
Productive green sputum with fever
Paroxysmal cough with posttussive emesis
Barking cough worse at night
A risk of untreated peritonsillar swelling in bacterial pharyngitis is the development of which complication?
Retropharyngeal abscess causing obstruction
Bronchospasm causing wheeze only
Pleural effusion causing dullness
Pulmonary embolism from deep veins
After tonsillectomy, which sign most strongly indicates postoperative hemorrhage?
Continuous swallowing with tachycardia
Mild throat pain with low fever
White exudate over tonsillar beds
Decreased appetite and fatigue
Which immediate nursing action is appropriate post-tonsillectomy to reduce complications?
Avoid citrus and offer cool fluids
Place supine with no head turn
Encourage coughing to clear clots
Use straws for easier sipping
Which symptom combination best characterizes viral croup?
Seal-bark cough with inspiratory stridor
Wet productive cough with rales
Dry cough with pleuritic chest pain
Whoop cough with apnea spells
A toddler with croup develops stridor at rest. The most appropriate home instruction is to
Bring child into steamy bathroom or cold air
Give oral fluids with a straw quickly
Use cough suppressants before sleeping
Perform chest percussion for secretions
Which triad is classic for epiglottitis?
Dysphagia, drooling, distress
Coughing, cyanosis, crackles
Rhinorrhea, retractions, rales
Wheezing, weakness, weight loss
In suspected epiglottitis, which action is contraindicated before securing the airway?
Inspecting the throat with a tongue depressor
Keeping the child in a position of comfort
Administering humidified oxygen via mask
Alerting anesthesia and ENT urgently
Which patient is most likely experiencing bronchiolitis due to RSV?
Infant with tachypnea, wheezing, and apnea
Teen with dry cough and chest pain
Adult with productive cough and fever
School-age child with whooping paroxysms
Primary management priority for bronchiolitis focuses on
Maintaining patent airway and gas exchange
Starting routine cough suppressants early
Empiric high-dose antibiotics promptly
Aggressive chest physiotherapy sessions
Which preventive therapy reduces severe RSV disease in high-risk infants?
Monthly palivizumab intramuscular injections
Annual live attenuated RSV vaccine dose
Daily oral oseltamivir prophylaxis course
Weekly inhaled corticosteroid preventive
Which clinical change in a tachypneic infant with bronchiolitis signals impending respiratory failure from fatigue?
Slowing breathing with rising CO2 levels
Increased crying with loud stridor
Persistent fever with improved appetite
Productive cough with thick green sputum
Which factor most increases a child’s risk for tuberculosis and warrants screening questions about recent travel?
Travel to a high-prevalence country
Attendance at a rural day camp
Recent dental cleaning appointment
Seasonal participation in sports
A patient has a positive TB test but no symptoms. Which management is most appropriate?
Start isoniazid for nine months
Begin four-drug therapy immediately
No treatment and repeat test yearly
Start corticosteroids for two weeks
Which initial action is recommended to control epistaxis in a stable adolescent?
Sit up and lean forward breathing through mouth
Lie flat with head tilted backward
Pack both nostrils with dry cotton balls
Apply warm compresses to nasal bridge
A toddler suddenly develops cough and inspiratory stridor while playing with small toys. Which complication is the greatest immediate concern?
Acute respiratory failure from obstruction
Development of chronic sinusitis
Progression to latent tuberculosis
Onset of allergic rhinitis symptoms
Which finding best supports a diagnosis of acute otitis media in a febrile child?
Bulging, inflamed tympanic membrane
Retracted, translucent tympanic membrane
Normal, pearly gray tympanic membrane
Perforated, draining tympanic membrane
Why are young children predisposed to acute otitis media compared with adults?
Eustachian tubes are shorter and more horizontal
Middle ear ossicles are more calcified
External canal is narrower and longer
Tympanic membrane is thicker and stiffer
Which medication is appropriate for quick relief of acute asthma symptoms?
Short-acting bronchodilator inhaler
Daily inhaled corticosteroid only
Oral antihistamine as needed
Long-acting beta-agonist alone
Which test primarily assesses the degree of asthma severity in a cooperative child older than five?
Pulmonary function tests values
Serial arterial blood gas results
Sputum culture for pathogens
Rapid antigen viral testing
Bronchopulmonary dysplasia in ex-premature infants primarily reflects which pathophysiologic change?
Fewer and larger alveoli with less surface area
Excess surfactant causing alveolar collapse
Hyperplastic alveoli with increased recoil
Mature capillary bed with robust perfusion
Which home management priority is emphasized for infants with bronchopulmonary dysplasia?
Reliable oxygen storage and safe use
Strict fluid boluses every evening
Daily peak flow meter recording
Routine ear irrigation after bathing
Which gastrointestinal manifestation is most characteristic of cystic fibrosis in infancy?
Meconium ileus with distention
Bloody stools with tenesmus
Painless jaundice and pruritus
Projectile nonbilious vomiting
Which statement best describes chest physiotherapy timing for cystic fibrosis airway clearance at home?
Perform several sessions daily before eating
Schedule once nightly right after dinner
Do only when wheezing becomes severe
Avoid during antibiotic treatment days
Which statement best distinguishes congenital from acquired heart disease?
Congenital involves structural anomalies present at birth
Congenital involves disorders developing after early childhood
Acquired consists only of genetic structural malformations
Acquired consists only of transient fetal shunts closing
Which is a risk factor specifically associated with congenital heart disease?
Maternal drug or alcohol use during pregnancy
Adult-onset hypertension in midlife
Organ transplant in adolescence
Obesity developing after childhood
What is the primary physiologic role of the foramen ovale in fetal circulation?
Shunts blood from right atrium to left atrium
Shunts blood from pulmonary artery to aorta
Connects umbilical vein to inferior vena cava
Directs blood from aorta to pulmonary artery
The ductus arteriosus normally allows which pathway in the fetus?
Flow from pulmonary artery to aorta, bypassing lungs
Flow from left atrium to right atrium, bypassing liver
Flow from umbilical vein to inferior vena cava
Flow from aorta back to pulmonary artery postnatally
Which description best matches the function of the ductus venosus?
Connects umbilical vein to inferior vena cava, bypassing liver
Allows flow from pulmonary artery to aorta, bypassing lungs
Permits mixing of atrial blood through septal opening
Increases pulmonary blood flow to oxygenate blood
Atrial septal defect often leads to increased pulmonary blood flow because already oxygenated blood re-enters circulation. Which consequence follows this physiology?
Increased blood volume and increased cardiac workload
Decreased systemic venous return and lower preload
Reduced pulmonary perfusion with right-to-left shunt
Immediate closure of fetal shunts after birth
In an atrial septal defect, the typical direction of shunting and its primary consequence are which of the following?
Left-to-right shunt causing pulmonary overcirculation
Right-to-left shunt causing systemic cyanosis
Bidirectional shunt causing balanced outputs
No shunt due to pressure equilibration
A child with a small atrial septal defect is most likely to have which finding on examination?
Midsystolic murmur with frequent respiratory infections
Diastolic rumble with bounding peripheral pulses
Continuous machinery murmur with widened pulse pressure
Harsh holosystolic murmur with failure to thrive
Post–ASD device closure, families should be advised that strenuous activities should be avoided for approximately how long?
Two weeks after septal occlusion
Three days after discharge
One month after occlusion
Six months after aspirin therapy
Ventricular septal defect pathophysiology is best described as which hemodynamic change?
Left-to-right shunt from ventricle to ventricle
Right-to-left shunt bypassing the lungs
Left-to-right shunt from atrium to atrium
Obstruction of left ventricular outflow
Which clinical pattern most strongly suggests symptomatic VSD in early infancy?
Adventitious lung sounds with heart failure signs
Intermittent cyanosis with clubbing of fingers
Widened pulse pressure with bounding pulses
Isolated hypertension limited to upper extremities
Optimal timing for surgical intervention in a large, symptomatic VSD generally aims for repair by what age?
By two years of age for large defects
After five years of age if asymptomatic
At birth regardless of size or symptoms
After adolescence to reduce recurrence
Patent ductus arteriosus most characteristically presents with which physical finding?
Continuous machinery murmur during systole and diastole
High-pitched click after the second heart sound
Loud holosystolic murmur at the apex
Fixed splitting of the second heart sound
Pharmacologic closure of a hemodynamically significant PDA is most directly achieved by which mechanism?
Inhibiting prostaglandin synthesis with NSAIDs
Increasing prostaglandin E1 infusion rate
Administering high-dose beta-blockers
Stimulating nitric oxide release continuously
In coarctation of the aorta, which blood pressure pattern is expected on examination?
Higher pressure in upper extremities than lower extremities
Higher pressure in lower extremities than upper extremities
Equal pressures in all extremities at rest
Labile pressures with higher diastolic in legs
A neonate with critical coarctation is given an infusion before surgery primarily to maintain ductal patency. Which agent is indicated?
Prostaglandin E1 infusion in the ICU
Intravenous indomethacin infusion
High-dose dopamine infusion
Sublingual nitroglycerin therapy
Aortic stenosis in children primarily threatens systemic circulation by which mechanism?
Narrowed aortic valve reducing forward blood flow
Fibrotic mitral valve reducing left atrial preload
Stiff pulmonary valve increasing right preload
Septal defect increasing pulmonary resistance
Which auscultatory finding most strongly suggests pulmonary stenosis in a symptomatic child?
High-pitched click after S2 with systolic ejection murmur
Continuous murmur radiating to the back and clavicle
Low-pitched diastolic rumble with opening snap
Holosystolic apex murmur with mid-diastolic rumble
Which combination correctly lists the four anatomical defects in Tetralogy of Fallot?
Pulmonary stenosis, VSD, overriding aorta, RV hypertrophy
ASD, PDA, coarctation, LV hypertrophy
Mitral stenosis, ASD, PDA, overriding aorta
Tricuspid atresia, VSD, PDA, RV hypertrophy
Pulmonary atresia, ASD, overriding aorta, LV hypertrophy
In Tetralogy of Fallot, what primarily allows unoxygenated blood to enter systemic circulation?
Overriding aorta over the VSD
Patent ductus arteriosus only
Atrial septal defect alone
Hypertrophied left ventricle
Mitral valve regurgitation
A toddler with TOF suddenly becomes extremely cyanotic and irritable during play. What is the most appropriate immediate action?
Knee-to-chest position and oxygen administration
Place supine and start rapid fluids
Ambulate to relieve venous pooling
Administer diuretics and restrict fluids
Apply ice packs to reduce metabolism
Which sign is most characteristic of a hypercyanotic (tet) spell in TOF?
Sudden tachypnea with worsening cyanosis
Bradycardia with pink mucous membranes
Hypertension with bounding pulses
Afebrile pallor without cyanosis
Loud continuous machinery murmur
Following a Blalock–Taussig shunt, which nursing action is most appropriate regarding the affected arm?
Avoid blood pressure and venipuncture on that side
Encourage frequent arterial blood draws there
Use the arm for central line placement
Apply tourniquet for stronger pulses
Monitor palpable radial pulse enhancement
Tricuspid atresia is best described by which pathophysiology?
Absent tricuspid valve with hypoplastic right ventricle
Narrowed mitral valve with enlarged left ventricle
Wide tricuspid valve causing right-to-left shunt
Overriding pulmonary artery over an ASD
Isolated VSD with increased pulmonary flow
In neonates with tricuspid atresia, why is prostaglandin E1 administered immediately after birth?
To maintain ductus arteriosus patency for pulmonary blood flow
To close the ductus arteriosus and improve systemic output
To increase myocardial contractility and heart rate
To treat arrhythmias from atrial reentry circuits
To reduce pulmonary edema by vasoconstriction
Which staged surgical approach redirects systemic venous return to the pulmonary arteries in tricuspid atresia?
Fontan procedure with earlier Glenn shunt
Ross procedure with later Norwood repair
Transcatheter PDA coil occlusion
Arterial switch with Lecompte maneuver
Maze procedure with mitral repair
Transposition of the Great Arteries primarily results in which circulation pattern?
Parallel circulations with deoxygenated blood to body
Series circulations with fully oxygenated systemic flow
Right-to-left shunt through the mitral valve
Increased mixing via normal foramen ovale
Complete obstruction of aortic outflow
A newborn with TGA is profoundly cyanotic without a murmur and has a loud second heart sound. Which immediate catheter-based intervention promotes survival before surgery?
Balloon atrial septostomy to increase mixing
Coarctation stent to improve afterload
Pulmonary valvotomy to reduce obstruction
VSD device closure to stop shunting
Coronary angioplasty to increase oxygen
Defining feature that makes TGA life-threatening in the first days of life is best stated as:
Reversed great arteries preventing oxygenated and systemic mixing
Overcirculation of lungs causing rapid heart failure
Severe mitral regurgitation reducing forward flow
Aortic coarctation decreasing renal perfusion
Patent ductus arteriosus raising pulmonary pressure
Which clinical cluster best matches congestive heart failure in infants due to congenital defects?
Tachypnea, poor feeding, pulmonary edema, hepatomegaly
Bradycardia, hyperactivity, dry cough, splenomegaly
Hypotension, polyuria, warm extremities, jaundice
Intermittent cyanosis only, normal growth, loud murmur
Seizures, photophobia, petechiae, hematuria
Which patient is at increased risk for infective endocarditis due to typical predisposing factors?
Teen with congenital valve defect and prior surgery
Runner with mild asthma controlled by inhalers
Child with seasonal allergies and eczema only
Adult with resolved viral cold last month
A new-onset heart murmur with low-grade fever, fatigue, and splenomegaly most strongly suggests which condition in a predisposed patient?
Infective endocarditis of damaged endocardium
Acute pericarditis from viral illness
Primary hypertension without complications
Stable congenital atrial septal defect
Which finding in an adolescent supports infective endocarditis rather than another rash illness?
Painful Osler nodes on fingers or toes
Target lesions on arms and legs
Sandpaper rash on trunk and neck
Vesicular rash in dermatomal band
The most appropriate initial treatment plan for confirmed infective endocarditis typically includes
Prolonged IV antibiotics for four to six weeks
Short oral antibiotics for three days
Immediate anticoagulation without antibiotics
Only fluids and antipyretics as supportive care
Acute rheumatic fever is best described as a delayed sequel of which infection?
Group A streptococcal pharyngitis
Staphylococcal skin abscess
Mycoplasma atypical pneumonia
Enteroviral gastrointestinal illness
Which combination of signs most strongly indicates acute rheumatic fever cardiac involvement?
New murmur, chest pain, and fever
Productive cough and wheezing only
Jaundice, pruritus, and dark urine
Polyuria, polydipsia, and weight loss
Which diagnostic approach helps confirm acute rheumatic fever in a febrile teen with joint pain?
Applying Jones criteria and echocardiogram
Ordering CT angiography of the brain
Scheduling colonoscopy with biopsies
Testing serum troponin every eight hours
First-line therapy to eradicate the inciting organism in acute rheumatic fever is
Penicillin therapy to clear strep infection
High-dose aspirin for antipyresis only
Broad antivirals for suspected influenza
Long-term antifungals to prevent relapse
Kawasaki disease pathophysiology primarily involves
Immune activation damaging arterial walls
Direct viral lysis of cardiac myocytes
Autoantibodies attacking red blood cells
Neurogenic inflammation of vagal pathways
During the acute febrile phase of Kawasaki disease, a hallmark clinical feature is
Fever for five days unresponsive to antipyretics
Bradycardia with hypothermia and rigors
Intermittent fever resolving within one day
Painless jaundice with clay-colored stools
Which set meets the clinical criteria for Kawasaki disease when fever exceeds five days?
Conjunctivitis, polymorphous rash, extremity changes, adenopathy
Photophobia only, mild cough only, isolated nausea only
Purulent otitis, periorbital edema, petechiae only
Hematuria, flank pain, costovertebral tenderness
The therapy that reduces coronary artery aneurysm risk in Kawasaki disease when given early is
Intravenous immunoglobulin over ten to twelve hours
Prophylactic anticoagulation with warfarin immediately
Daily high-dose corticosteroids alone for two weeks
Empiric broad-spectrum antibiotics for seven days
Which lab pattern most strongly supports iron deficiency anemia in a symptomatic adolescent?
Low hemoglobin with low ferritin levels
Low hemoglobin with high ferritin levels
Normal hemoglobin with low ferritin levels
High hemoglobin with low ferritin levels
A 6-month-old fed large volumes of cow’s milk presents with fatigue and pica. What is the most appropriate first-line therapy?
Start oral ferrous sulfate supplementation
Begin high-dose corticosteroid therapy
Administer prophylactic antibiotics
Order emergent platelet transfusion
Which clinical feature is most characteristic of thalassemia in children?
Pallor with hepatosplenomegaly present
Recurrent hemarthrosis predominates
Petechiae with mucosal bleeding
Pruritus with urticaria episodes
A child with sickle cell disease develops sudden severe anemia and splenomegaly. Which lab change is most expected during crisis?
Markedly elevated reticulocyte count
Profoundly decreased reticulocyte count
Thrombocytopenia with low platelets
Prolonged prothrombin time value
In idiopathic thrombocytopenic purpura, which statement is most accurate regarding routine labs?
Hemoglobin and RBC count are typically normal
PT and platelet count are both prolonged
Ferritin is characteristically very low
Reticulocyte count is consistently high
Hemophilia A is best described as a deficiency of which clotting factor and inheritance pattern?
Factor VIII, X-linked recessive
Factor IX, autosomal dominant
Factor VII, X-linked dominant
Factor VIII, autosomal recessive
Aplastic anemia primarily results from failure of which process?
Bone marrow production of blood cells
Splenic destruction of platelets alone
Autoimmune hemolysis of erythrocytes
Excess coagulation factor activation
Which management priority is most appropriate in a child with aplastic anemia and mucosal bleeding?
Prevent bleeding and monitor transfusions
Start iron fortification of formula
Encourage contact sports for fitness
Begin high-protein diet immediately
Which intervention best prevents vaso-occlusive crises in sickle cell disease during illness or stress?
Hydration, analgesia, and oxygenation
High-dose aspirin for pain control
Platelet transfusion for prophylaxis
Iron supplementation to raise Hgb
A child with ITP has platelets of 15,000/µL and minor petechiae. Which initial therapy is most appropriate?
Short course corticosteroids or IVIG
Immediate factor VIII infusion
Chronic iron chelation therapy
Empiric broad-spectrum antibiotics
Which statement best distinguishes hemophilia from platelet disorders during screening labs?
Normal platelet count and PT remain typical
Low platelet count with prolonged PT occurs
Normal hemoglobin with high ferritin occurs
Elevated ESR with thrombocytosis occurs
Which finding most specifically supports a diagnosis of Hodgkin lymphoma?
Diffuse B-cell proliferation without nodularity
Presence of Reed–Sternberg cells on biopsy
Elevated leukocyte alkaline phosphatase level
Generalized bone marrow fibrosis
Marked eosinophilia without lymphadenopathy
A child presents with fever, pallor, bruising, and bone pain. CBC shows decreased WBCs, hemoglobin, platelets, and RBCs. Which is the most appropriate next diagnostic step to confirm leukemia?
Order bone marrow aspiration and cytology
Repeat CBC in six weeks for trend
Start broad-spectrum antibiotics first
Perform lumbar puncture immediately
Obtain a peripheral blood smear only
Which management priority is most critical to reduce mortality in patients with leukemia during chemotherapy?
Aggressive diuresis to prevent hyperkalemia
Early detection and treatment of infections
Daily NSAIDs for bone pain control
Frequent intramuscular vaccinations
High-protein diet without central line care
What is osteomyelitis?
Bacterial infection of the bone and soft tissue surrounding the bone that can lead to necrosis once blood supply is disrupted
