Paediatrics Exam 1

Question 1: View

A four-year-old patient has been diagnosed with leukemia. The patient's parents, who follow the Jehovah's Witness faith, inform the physician that they will not approve any type of blood transfusions. The pediatric nurse is aware that:

A. The patient can only receive blood that has been donated by family members. B. Under no circumstances will the patient receive blood products. C. In an emergency, a court order can be obtained for the patient to receive blood transfusions. D. The patient can receive volume expanders.

Explanation

The correct answer is: c. In an emergency, a court order can be obtained for the patient to receive blood transfusions.

Choice A: The patient can only receive blood that has been donated by family members.

Jehovah’s Witnesses refuse blood transfusions, including those from family members, due to their religious beliefs. They believe that both the Old and New Testaments command them to abstain from blood (Genesis 9:4; Leviticus 17:10; Deuteronomy 12:23; Acts 15:28, 29). Therefore, this option is incorrect.

Choice B: Under no circumstances will the patient receive blood products.

While Jehovah’s Witnesses generally refuse blood transfusions, there are exceptional circumstances where medical professionals can seek a court order to administer blood transfusions, especially in life-threatening situations involving minors. Thus, this statement is not entirely accurate.

Choice C: In an emergency, a court order can be obtained for the patient to receive blood transfusions.

In life-threatening emergencies, especially involving minors, courts can intervene and issue orders to administer necessary medical treatments, including blood transfusions, despite parental objections based on religious beliefs. This ensures the child’s right to life and health is protected. Therefore, this is the correct answer.

Choice D: The patient can receive volume expanders.

Volume expanders can be used to increase blood volume and maintain circulation, but they do not carry oxygen or replace lost blood cells. While they are an option for managing blood loss, they are not a substitute for blood transfusions in severe cases of anemia or blood loss, which are common in leukemia patients. Thus, this option is not entirely correct.

Question 2: View

A 3-year-old admitted to the hospital with croup has the following vital signs: heart rate 90, respiratory rate 48, blood pressure 100/52, and temperature 98.8°F (37.1°C). The parents ask the nurse if these vital signs are normal. The nurse's best response is:

A. "Your son's respiratory rate is elevated, but the other vital signs are within the normal range." B. "Your son's heart rate is elevated, but the other vital signs are within the normal range." C. "Your son's blood pressure is elevated, but the other vital signs are within the normal range." D. "Your son's temperature is elevated, but the other vital signs are within the normal range."

Explanation

Choice A reason: This is the correct choice. A respiratory rate of 48 is high for a 3-year-old, indicating that the croup is affecting his breathing.
Choice B reason: This choice is incorrect. A heart rate of 90 is within the normal range for a 3-year-old.
Choice C reason: This choice is incorrect. A blood pressure of 100/52 is within the normal range for a 3-year-old.
Choice D reason: This choice is incorrect. A temperature of 98.8°F (37.1°C) is within the normal range for a 3-year-old.

Question 3: View

An 17-year-old with a rash and itching in the groin area is concerned that he has contracted a sexually transmitted disease and does not want his parents to find out. The nurse's best response is:

A. "We cannot promise that the hospital will not contact your parents surrounding the details of this visit, including billing." B. "We will not contact your parents regarding this visit." C. "Who would you like us to contact about your visit here today?" D. "We will need to contact your parents for consent to prescribe medications."

Explanation

Choice A reason: This choice is incorrect. Confidentiality laws often protect the privacy of minors seeking treatment for sexually transmitted diseases.
Choice B reason: This is the correct choice. The law typically allows minors to receive confidential treatment for sexually transmitted diseases.
Choice C reason: This choice is incorrect. It suggests that someone else needs to be contacted, which is not necessary if the patient wishes for the visit to remain confidential.
Choice D reason: This choice is incorrect. Minors may consent to their own treatment for sexually transmitted diseases in many jurisdictions without parental consent.

Question 4: View

In the pediatric emergency department, the nurse must prioritize patient care. Which patient should the nurse assess first?

A. The 1-month-old infant who has developed colic and is crying. B. The 14-year-old adolescent whose mother suspects her child is sexually active. C. The 2-year-old toddler who was bitten by another child at the day-care center. D. The 6-year-old school-aged child who was hit by a car while riding a bicycle.

Explanation

Choice A reason: While colic can be distressing, it is not life-threatening and does not require immediate assessment over more critical conditions.
Choice B reason: Suspicions of sexual activity in an adolescent are a concern but do not constitute an emergency that requires immediate assessment.
Choice C reason: A bite from another child, although potentially serious, is less urgent than a trauma case and can be assessed after more critical patients.
Choice D reason: This is the correct choice. A child hit by a car may have life-threatening injuries and requires immediate assessment and intervention.

Question 5: View

A 6-month-old male is at his well-child checkup. The nurse weighs him, and his mother asks if his weight is normal for his age. The nurse's best response is:

A. "At 6 months, his weight should be approximately three times his birth weight." B. "Each child gains weight at his or her own pace." C. "At 6 months, a child should weigh about 10 lb more than his or her birth weight." D. "At 6 months, his weight should be approximately twice his birth weight."

Explanation

Choice A reason: This is the correct choice. By 6 months, most infants have doubled their birth weight, and some may have tripled it.
Choice B reason: While it's true that each child grows at their own pace, there are general milestones for weight gain that can guide expectations.
Choice C reason: This choice is incorrect. A 10 lb increase is not a standard milestone for weight gain at 6 months.
Choice D reason: This choice is incorrect. Doubling the birth weight is expected by 6 months, but tripling may also be normal.

Question 6: View

According to developmental theories, which important event is essential in the development of the toddler?

A. The child develops friendships. B. The child learns to walk. C. The child learns to feed self. D. The child begins potty-training.

Explanation

Choice A reason: Developing friendships is important, but it is not as critical as walking in the early stages of a toddler's development.
Choice B reason: This is the correct choice. Walking is a significant developmental milestone for toddlers and is essential for their physical autonomy.
Choice C reason: Self-feeding is an important skill, but it typically develops after the child has learned to walk.
Choice D reason: Potty-training is a key milestone, but it usually occurs after the child has achieved the ability to walk.

Question 7: View

When developing a plan of care for a hospitalized child, the nurse knows that children in which age group are most likely to view illness as a punishment for misdeeds?

A. Adolescence B. Infant C. Preschool-age D. School-age

Explanation

Choice A reason: Adolescents are capable of more complex thinking and are less likely to view illness as a punishment for misdeeds.

Choice B reason: Infants do not have the cognitive ability to associate illness with punishment.

Choice C reason: This is the correct choice. Preschool-age children often engage in magical thinking and may view illness as a punishment for misdeeds.

Choice D reason: School-age children are beginning to understand the biological causes of illness and are less likely to view it as a punishment.

Question 8: View

A nurse is conducting developmental assessments on several children in the day-care setting. Which two children does the nurse identify as having developmental delays?

A. A 5-year-old who is unable to zip his own jacket. B. A 2-year-old who cannot recite her phone number. C. A 6-year-old who is unable to sit still for a short story. D. A 2-year-old who is unable to cut with scissors. E. An 18-month-old toddler who is unable to phrase sentences.

Explanation

Choice A reason: This choice is incorrect. It is not unusual for a 5-year-old to have difficulty with zippers.
Choice B reason: This choice is incorrect. Reciting a phone number is not expected of a 2-year-old.
Choice C reason: This is one of the correct choices. A 6-year-old should be able to sit still for a short story, and difficulty doing so may indicate a developmental delay.
Choice D reason: This choice is incorrect. A 2-year-old typically does not have the fine motor skills to cut with scissors.
Choice E reason: This is one of the correct choices. An 18-month-old should be starting to phrase simple sentences, and the inability to do so may indicate a developmental delay.

Question 9: View

A mother brings her two-year-old child to the pediatric office for a sick visit. The child is seen regularly at the office and was last seen at her well-child visit two months ago. Based on this information, which is the most appropriate action by the nurse?

A. Asking the mother to leave the room after obtaining the history. B. Reviewing health promotion and maintenance activities. C. Obtaining a comprehensive history, including sociodemographic data. D. Focusing exclusively on the reported illness.

Explanation

Choice A reason: This choice is incorrect. There is no need for the mother to leave the room unless the child requests privacy.

Choice B reason: This choice is incorrect. While reviewing health promotion is important, it should not be the focus during a sick visit.

Choice C reason: This choice is incorrect. A comprehensive history is not necessary if the child is regularly seen and was recently assessed.

Choice D reason: This is the correct choice. The nurse should focus on the current illness reported by the mother, as the child has been regularly seen and assessed.

Question 10: View

A child is admitted to the hospital unit with physical injuries. The nurse is taking the child's history. Which statement by the parent would arouse suspicion of abuse?

A. "The baby's 18-month-old brother was trying to pull the baby out of the crib and dropped the baby on the floor." B. "I placed the baby in the infant swing. His 6-year-old brother was running through the house and tripped over the swing, causing it to fall." C. "I was walking up the steps and slipped on the ice, falling while carrying my baby." D. "I did not realize that my baby was able to roll over yet, and I was just gone a minute to check on dinner when the baby rolled off of the couch and onto our tile floor."

Explanation

Choice A reason: This choice might not arouse suspicion as it could be a plausible accident involving siblings.

Choice B reason: This choice also might not arouse suspicion as accidents can happen when children are playing and not being watched closely.

Choice C reason: This choice is less likely to arouse suspicion as slipping on ice is a common accident.

Choice D reason: This is the correct choice. The statement may arouse suspicion because it suggests negligence, as the caregiver left the baby unattended in a potentially dangerous situation.