An ER nurse has recognized a mother who has frequently brought her 3-year-old in for vague symptoms of an undiagnosed neurological disorder and who has frequently requested specialist consultations. The child is brought in unconscious. A concern that the nurse may have is:

Physical abuse

Munchausen by proxy

Severe organic failure to thrive

Ingestion of a toxin

Answer and Explanation

The Correct Answer is B

A. Physical abuse typically presents with visible signs of injury, inconsistent explanations for trauma, or fearfulness around caregivers. While abuse may coexist, the pattern here involves medical fabrication rather than physical harm.
B. Munchausen by proxy (also known as factitious disorder imposed on another) occurs when a caregiver—usually a parent—exaggerates, fabricates, or induces illness in a child to gain attention or sympathy. The repeated vague complaints, specialist seeking, and now unconscious presentation strongly raise this concern.
C. Severe organic failure to thrive results from an underlying physical condition affecting growth and development, not from caregiver behavior. It also doesn't typically include extensive medical seeking behavior for vague, shifting symptoms.
D. Ingestion of a toxin is possible in any unconscious child, but in this context, without clear evidence of accidental exposure, it may actually be a result of the caregiver's actions in Munchausen by proxy. Thus, it is a potential symptom, not the root concern.

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Correct Answer is B

Explanation

A. Increased urine output is not typical in early congestive heart failure (CHF); in fact, decreased urine output can occur due to reduced kidney perfusion.
B. Tachypnea (rapid breathing) is an early and key sign of CHF in children. It occurs due to pulmonary congestion and decreased cardiac output, leading to poor oxygenation and compensatory increased respiratory rate.
C. Bradycardia is a late and often ominous sign of cardiac deterioration in children, not an early indicator.
D. Inability to sweat is not a recognized clinical indicator of CHF. On the contrary, diaphoresis (especially during feeding in infants) can be an early sign.

A. Kawasaki disease B. Rheumatoid heart disease C. Coarctation of the Aorta D. Dextro-transposition of the great arteries

Correct Answer is B

Explanation

A. Kawasaki disease typically presents with fever, conjunctivitis, rash, swollen hands/feet, and lymphadenopathy, not following strep throat or with joint pain as a primary feature.
B. Rheumatic heart disease is a complication of rheumatic fever, which can follow an untreated or inadequately treated streptococcal throat infection. The child’s symptoms—fever, shortness of breath (carditis), abdominal pain, and painful swollen joint (arthritis)—are classic signs of rheumatic fever, which can lead to long-term cardiac damage.
C. Coarctation of the aorta is a congenital condition involving narrowing of the aorta and typically presents with differential blood pressure between extremities, not joint swelling or post-streptococcal symptoms.
D. Dextro-transposition of the great arteries is a cyanotic congenital heart defect that presents in newborns, not older children with post-infectious symptoms.

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An ER nurse has recognized a mother who has frequently brought her 3-year-old in for vague symptoms of an undiagnosed neurological disorder and who has frequently requested specialist consultations. The child is brought in unconscious. A concern that the nurse may have is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is an early sign of congestive heart failure that the nurse should recognize?

Correct Answer is B

Explanation

A child with a history of strep throat presents with fever, shortness of breath, abdominal pain, and a very painful and swollen shoulder joint. Based on this history and presentation, what medical condition should be suspected?

Correct Answer is B

Explanation

The following is found during the assessment of a 1-month-old infant. Which of the following would lead the nurse to suspect a cardiac defect?

The parents of a child born with disabilities ask the nurse for advice about discipline. The nurse's response should be based on the knowledge that discipline is:

Cierra, a 10-year-old female weighing 36kg, is now NPO for surgery in the morning and needs _____ of maintenance fluids.

While teaching anticipatory guidance to a young couple with a child with Down syndrome, the nurse explains that one major physical characteristic of the child with Down syndrome is:

Of all the physical findings noticed on a child, which is most likely to indicate abuse?

A nurse in an emergency department is caring for a child who is experiencing an acute asthma attack. Which of the following medications should the nurse expect to administer first?

Which statement best describes a conductive hearing loss in a child?

For the child with transposition of the great vessels, which drug may be given to allow the Patent Ductus Arteriosus (PDA) to remain open until surgery?