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Uworld pediatrics Latest Practice Final Exam
With Correct Verified Questions and Answers
With Rationales
The clinic nurse supervises a graduate nurse who is teaching the parents of a 2-year-old with acute diarrhea about home management. The nurse would need to intervene when the graduate nurse provides which instruction?
"Do not administer antidiarrheal medications to your child."
"Follow the bananas, rice, applesauce, and toast diet for the next few days."
"Record the number of wet diapers and return to the clinic if you notice a decrease."
"Use a skin barrier cream such as zinc oxide in the diaper area until diarrhea subsides." - correct answer>>2. During bouts of acute diarrhea and dehydration, treatment focuses on maintaining adequate fluid and electrolyte balance. The first-line treatment is oral rehydration therapy, using oral rehydration solutions (ORSs) to increase reabsorption of water and sodium. Even if the diarrhea is accompanied by vomiting, ORS should still be offered in small amounts at frequent intervals. Continuing the child's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. The BRAT (bananas, rice, applesauce, and toast) diet is not recommended as it does not provide sufficient protein or energy. (Option 1) Use of antidiarrheal medications is discouraged as these have little effect in controlling diarrhea and may actually be harmful by prolonging some bacterial infections and causing fatal paralytic ileus in children. (Option 3) Parents should be taught to monitor their child for signs of dehydration by checking the amount of fluid intake, number of wet diapers, presence of sunken eyes, and the condition of the mucous membranes. (Option 4) Protecting the perineal skin from breakdown during bouts of diarrhea can be accomplished by using skin barrier creams (eg, petrolatum or zinc oxide). Educational objective: When a child is experiencing acute diarrhea, the priority is to monitor for dehydration. Treatment is accomplished with oral rehydration solutions and early reintroduction of the child's normal diet (usual foods).
The nurse is caring for an infant diagnosed with Hirschsprung disease who is awaiting surgery. Which assessment finding requires the nurse's immediate action?
Abdominal distension with no change in girth for 8 hours
Did not pass meconium or stool within 48 hours after birth
Episode of foul-smelling diarrhea and fever
Excessive crying and greenish vomiting - correct answer>>3. Hirschsprung disease (HD) occurs when a child is born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. As a result, there is no peristalsis and stool is not passed. These newborns exhibit symptoms of distal intestinal obstruction. They have a distended abdomen and will not pass meconium within the expected 24-48 hours. They also have difficulty feeding and often vomit green bile. Surgical removal of the defective section of bowel is necessary and colostomy may be required. A potentially fatal complication is Hirschsprung enterocolitis, an inflammation of the colon, which can lead to sepsis and death. Enterocolitis will present with fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension. (Option 1) Mild to moderate abdominal distension is an expected finding with a diagnosis of HD; however, increasing abdominal girth is a serious finding that must be reported. (Option 2) Failure to pass meconium or stool within 24-48 hours after birth is an expected finding of HD. (Option 4) Bilious vomiting and excessive crying are expected findings of HD. In enterocolitis, vomiting can occur more frequently and the client appears more ill. Educational objective: Enterocolitis, a potentially fatal complication of Hirschsprung disease, is characterized by explosive, foul-smelling diarrhea; fever; and worsening abdominal distension. A nurse is caring for a 3-month-old infant who has bacterial meningitis. Which clinical findings support this diagnosis? Select all that apply.
Depressed anterior fontanelle
Frequent seizures
"I will throw away stuffed animals and toys that cannot be washed." - correct answer>>1. Preventing the spread of pediculosis capitis (head lice) may be accomplished by using hot water to launder clothing, sheets, and towels in the washing machine; these items should then be placed in a hot dryer for 20 minutes. Treatment of head lice consists of the use of pediculicides and the removal of nits (eggs). (Option 2) Head lice are not spread by oral contact with eating utensils. Instead, they are spread by direct person-to-person contact or by nits that hatch in the environment and remain on clothing, combs, and pillows. (Option 3) Spraying insecticides around children and pets in the home is not recommended due to the risk of inhalation or skin contact. (Option 4) Items that cannot be washed or dry cleaned may be placed in sealed plastic bags for 14 days to kill active lice or lice that hatch from the nits in 7-10 days. Vacuuming of furniture, carpets, stuffed toys, rugs, and mattresses is also recommended to prevent the spread of lice and nits. Educational objective: Pediculosis capitis (head lice) is a common parasitic infestation of the scalp that is typically seen in school-aged children. It is spread by contact with personal items such as clothing, combs, and bedding. The clinic nurse is reviewing self-care management of acne vulgaris with an adolescent client. Which client statement indicates a need for further instruction?
"I have been scrubbing my face twice daily with antibacterial soap."
"I should buy skin care products that are labeled noncomedogenic."
"Maintaining a nutritious diet will help my skin heal."
"Picking or squeezing the lesions will worsen my acne." - correct answer>>1. Additional self-care measures include: Using noncomedogenic skin care products (ie, products that do not clog pores) to avoid creating new lesions (Option 2) Maintaining a healthy lifestyle (eg, moderate exercise, balanced diet, adequate sleep) to reduce stress and promote healing (Option 3)
Refraining from squeezing, picking, and vigorously scrubbing lesions to prevent additional inflammation and worsening the acne (Option 4) A client diagnosed with acute glomerulonephritis has pitting edema in both lower extremities, blood pressure of 170/80 mm Hg, and proteinuria. When developing a plan of care for this client, the nurse should include which most accurate indicator of fluid loss or gain?
Blood pressure measurements
Daily weight measurements
Intake and output measurements
Severity of pitting edema - correct answer>>2. The most accurate indicator of fluid loss or gain in an acutely ill client is weight, as accurate intake and output and assessment of insensible losses may be difficult (Option 3). A 2.2-lb (1-kg) weight gain is equal to 1,000 mL of retained fluid. (Option 1) Blood pressure measures the amount of pressure exerted on the arterial walls due to factors such as peripheral artery constriction or dilation, not just fluid volume status. (Option 4) Pitting edema is not an accurate indicator as the fluid may shift from intravascular to interstitial spaces without an overall change in fluid gain or loss throughout the body. Educational objective: The most accurate indicator of fluid loss or gain in an acutely ill client is daily weight. he nurse in a clinic is caring for an 8-month-old with a new diagnosis of bronchiolitis due to respiratory syncytial virus (RSV). Which instructions can the nurse anticipate reviewing with the parent?
Administering a cough suppressant and antihistamine
Prophylactic treatment of family members
Temporary cessation of breastfeeding
Use of saline drops and a bulb syringe to suction nares - correct answer>>4.
Minimize environmental stimuli
Place client in a room with negative-pressure air flow - correct answer>>1,2, Nursing care for a client with suspected meningococcal meningitis includes elevating the head of the bed at 30 degrees, implementing seizure precautions, and minimizing environmental stimuli. The nurse should implement droplet precautions that require the nurse (not the client) to wear a mask when caring for the client. The client wears the mask only if transported outside the room. Additional Information Physiological Adaptation NCSBN Client Need A 7-month-old infant is admitted to the unit with suspected bacterial meningitis after receiving an initial dose of antibiotics in the emergency department. Frequent assessment of which of the following is most important in the plan of care?
Babinski reflex
Fontanel assessment
Pulse pressure
Pupillary light response - correct answer>>2. Bacterial meningitis is inflammation of the meninges of the brain and spinal cord caused by infection. General manifestations in infants and children age <2 include fever, restlessness, and a high-pitched cry. One common acute complication of bacterial meningitis is hydrocephalus, an increase in intracranial pressure (ICP) resulting from obstruction of cerebrospinal fluid flow. Increased ICP can progress to permanent hearing loss, learning disabilities, and brain damage. Bulging/tense fontanels and increasing head circumference are important early indicators of increased ICP in children. Frequent assessment for developing complications is vital for any client with suspected bacterial meningitis. The nurse is assessing a 4-year-old boy in a pediatric clinic. Which behaviors by the client would concern the nurse for possible Duchenne muscular dystrophy? Select all that apply.
Frequently trips and falls at home
Has painful knees and elbows in the morning
Places hands on the thighs to push up to stand
Suddenly rigidly extends the arms and legs
Walks on tiptoes and has disproportionately large calves - correct answer>>1,3, Duchenne muscular dystrophy is an X-linked recessive disorder characterized by progressive replacement of muscle tissue with connective tissue. Classic signs include Gower sign/maneuver (placing hands on the thighs to push up to stand), enlarged calves, walking on tiptoes, and frequent tripping/falling. The parents of a hospitalized 3-month-old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that the teaching has been effective?
"At this age, my baby will not cry because we are leaving."
"I know my baby will feel abandoned when we leave."
"My baby is too young to sense my anxiety about leaving."
"My baby understands that we will return later in the day." - correct answer>>1. Separation or stranger anxiety occurs when the primary caregivers leave the child in the care of others who are not familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years. A 3-month-old can be soothed by any comforting voice (Option 1). (Option 2) A 3-month-old is not developmentally capable of fearing abandonment.
Oral bite prevention device
Oxygen delivery system
Padding on the bed siderails
Soft arm and leg restraints
Suction equipment - correct answer>>2,3, A nurse is teaching the parent of a 6-year-old with a urinary tract infection (UTI) how to avoid repeat infections. Which statements by the parent indicate that the teaching has been effective? Select all that apply.
"I just bought my child new nylon panties."
"I will make sure my child does not hold urine."
"I will not give my child any more bubble baths."
"I will teach my child to wipe from the front to the back."
"I will use antibacterial soap for bathing my child." - correct answer>>2,3, UTIs are one of the most common conditions in children, with a higher occurrence in girls (due to the short urethra and its close proximity to the vagina and anus). Girls should be taught to wipe from front to back; this will help minimize the chances of bacteria entering the urethra from the perianal area (Option 4).
- do not use antibacterials oap, bubble baths, or tught clothing bcuz this promots bacterial growht. The nurse has been providing care for the past month to a 7-year-old client recently diagnosed with type 1 diabetes mellitus. Initially, the family seemed devastated about the diagnosis and the client's parent stated, "Our lives will never be the same." Which statement made by the parent indicates that nursing interventions and education have been effective?
"Our child will not be able to participate in any sporting events."
"Our whole family will have to make sacrifices to deal with this disease."
"We are working to manage this disease so that it cannot control our child's life."
"We have set aside a place in the pantry for our child's special foods." - correct answer>>3. The diagnosis of a chronic illness (eg, diabetes) in a child will have an impact on the entire family. When parents see themselves and the child as capable of being independent and in control of the disease, there is an increased likelihood that the disease will be managed and controlled and the child can have an independent life. In the emergency department, a pediatric client is placed on mechanical ventilation by means of an endotracheal tube. Several hours later, the nurse enters the room and finds the client in respiratory distress. It is most important for the nurse to take which of these actions?
Assess the client for intercostal retractions
Assess the client's blood pressure in both arms
Auscultate the client's lung sounds
Observe the color of the client's fingernail beds - correct answer>>3. A client experiencing respiratory distress while receiving mechanical ventilation should be assessed for proper ventilation first. The nurse needs to determine if the mechanical ventilation equipment is still properly placed in the trachea. An endotracheal tube (ET) can become displaced with movement. By assessing the client's lung sounds, the nurse can quickly determine if ET placement has been compromised (Option 3). Airway is the priority for this client. By auscultating the client's lung sounds, the nurse can determine if the client has an open airway. The parent of a newborn is concerned about the possibility of the child developing hip dysplasia. Which intervention should the nurse encourage to help reduce the risk in this newborn?
Choose an infant carrier with a narrow seat
(Option 2) This infant is aspirating and in immediate distress, which should be addressed without delay. After suctioning the excess saliva and ensuring a clear airway, the nurse may perform further assessments. (Option 3) This infant's cyanosis is a result of aspirating secretions and does not indicate a circulatory problem. The knee-chest position is appropriate to increase pulmonary blood flow in infants with a cyanotic heart defect (eg, tetralogy of Fallot). Educational objective:The initial nursing action for a client experiencing cyanosis and excess oral secretions is oropharyngeal suctioning to ensure airway patency. Additional Information Physiological Adaptation NCSBN Client Need A nurse is caring for a child who is receiving oxygen at 2 L/min by nasal cannula and observes the current oxygen saturation and pulse plethysmographic waveform on the pulse oximeter. Which intervention should be the nurse's initial action? Click the exhibit button for additional information.
Auscultate the child's lung fields
Have the child take slow, deep breaths
Increase the oxygen flow rate to 3 L/min
Verify the position and integrity of the finger probe - correct answer>>4. The first action of the nursing process is assessment. The nurse should first evaluate the accuracy of the reading by evaluating the pulse plethysmographic waveform. Waveforms that are irregular or erratic may contain artifact caused by a loose, misapplied, or damaged pulse oximeter or by client movement (Option 4). After ensuring that the probe has been properly applied and positioned to provide an accurate reading, th The nurse assesses a pediatric client who was diagnosed with diarrhea caused by Escherichia coli. The nurse is most concerned with which finding?
Blood-streaked stools
Client drank fruit juice
Dry mucous membranes
Petechiae noted on the trunk - correct answer>>4. Hemolytic uremic syndrome (HUS) is a life-threatening complication of Escherichia coli diarrhea and results in red cell hemolysis, low platelets, and acute kidney injury. Hemolysis results in anemia, and low platelets manifest as petechiae or purpura. Therefore, the presence of petechiae in this client could indicate underlying HUS and needs further assessment. (Option 1) E coli bacteria infect people through contaminated food or water and attack the digestive system. Blood-streaked stool due to intestinal irritation is a common symptom associated with this illness. Treatment is aimed at preventing dehydration, and clients usually improve in about a week. (Option 2) Fruit juices are discouraged in acute diarrhea as they have high sugar (osmolality) and low electrolyte content. Continuing the client's normal diet (solid foods) is encouraged as it shortens the duration and severity of the diarrhea. (Option 3) Dry mucous membranes are a sign of dehydration, a common complication of any persistent diarrhea. Dehydration should be treated promptly, especially in children; however, as long as fluid is replenished, the condition is not life-threatening. Educational objective:Hemolytic uremic syndrome is a life-threatening complication of Escherichia coli diarrhea. Clinical features include anemia (pallor), low platelets (petechiae and purpura), and acute kidney injury (low urine output). what is hemolytic uremic syndrome and whatare 3 signs - correct answer>>life threatening complication of E coli diarrheaand results in red cell hemolysis, low platletes, and acute kidney injury.
- anemia, low platelets, petehciae or purpura and accuge kidney injury. A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs?
Appearance of upper lip hair
Increase in height
Presence of axillary hair
(Option 4) Pseudomenstruation is a physiological process and is not caused by trauma or abuse A nurse on a pediatric unit is admitting a school-aged child with suspected Reye syndrome. Which information obtained during the history taking is most consistent with this condition?
No history of varicella vaccine administration
Recent exposure to bats
Recent influenza infection
Recent use of acetaminophen for fever - correct answer>>3. Reye syndrome is characterized by fever, acute encephalopathy, and altered hepatic function. It often develops following a viral infection, especially varicella or influenza. The risk of developing Reye syndrome increases if aspirin therapy is used to treat fever. A nurse is teaching the parent of a child who has a new diagnosis of absence seizures. Which statement by the parent indicates understanding of the teaching?
"My child may experience incontinence." [2%]
"My child may seem confused afterwards." [8%]
"My child may stare and seem inattentive." [84%]
"My child will notice unusual odors prior to the event." [4%] - correct answer>>3. Absence seizures occur in children age 4-12 and usually disappear at puberty. Clinical manifestations include a brief loss of consciousness and an appearance of inattention or daydreaming (the absence attack) without loss of postural body tone. However, slight loss of tone may lead to dropping objects held in hands. Most absence seizures last less than 10 seconds and often go unrecognized. Following an attack, behavior and awareness return immediately to normal. The child does not experience a postictal period but usually has no recollection that a seizure has occurred. A child may have
multiple absence seizures each day. Treatment includes the use of anticonvulsant medication(s). (Options 1, 2, and 4) Altered sensory perceptions (eg, awareness of odors [aura]), postictal confusion, and incontinence are clinical manifestations of complex partial or tonic-clonic seizures. Educational objective: Absence seizures are characterized by a brief loss of consciousness and an appearance of inattention or daydreaming without loss of postural tone. Most absence seizures last less than 10 seconds. The seizures occur in children age 4-12, and multiple seizures may occur daily. The nurse is teaching a class on nutrition and feeding practices for young children. What should the nurse recommend as the best snack for a toddler?
½ cup orange juice
Dry, sweetened cereal
Raw carrot sticks
Slices of cheese - correct answer>>4. When choosing foods for a toddler (age 1-3 years), parents should consider the following factors: Safety: Small, hard, sticky, or slippery foods (eg, hot dogs, whole grapes, nuts, raw carrot sticks, popcorn, peanut butter, hard candy, fruit snacks) pose a choking risk and should not be offered. Nutrient density: Foods should contain valuable nutrients (eg, protein, vitamins) rather than just "empty calories" (eg, sugars). Potential for foodborne illness: Children are at a higher risk for developing food-related infections, especially if given raw, unpasteurized foods (eg, partially cooked eggs, raw fish, raw bean sprouts). Healthy snacks for a toddler include pieces of cheese, whole-wheat crackers, banana slices, yogurt, cooked vegetables, and cottage cheese with thinly sliced fruit (Option 4). (Option 1) Although orange juice is a source of vitamin C, it contains a large amount of sugar and lacks fiber. Toddlers should have no more than 4-6 oz of 100% fruit juice per day. (Option 2) Sweetened cereals, especially those marketed toward children, can be high in sugar and low in nutrients.
"Scoliosis screenings are typically performed between age 10 and 14." - correct answer>>3. n exaggerated inward curvature of the lumbar spine (ie, swayback) is lordosis, not scoliosis (Option 3). A 3-month-old child with developmental dysplasia of the hip (DDH) is being fitted for a Pavlik harness. Which statement made by the parent indicates a need for further instruction?
"I should leave the harness on during diaper changes." [14%]
"I will adjust the harness straps every 3-5 days." [67%]
"I will inspect the skin under the straps 2-3 times daily." [5%]
"The harness should keep my baby's legs bent and spread apart." [12%] - correct answer>>2. STRAPS ASSESSED EVERY 1 TO 2 WEEKS NOT DAILY. THIS SHOULD BE DONE BY HCP NOT PARENTS. Assess skin 2-3 times daily for redness or breakdown under the straps (Option 3) Dress the child in a shirt and knee socks under the harness to protect the skin Apply diapers underneath the straps to keep the harness clean and dry Leave the harness on at all times, unless otherwise indicated by the HCP (Option 1) The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply. The nurse plans care for a 3-year-old who was admitted with suspected pertussis infection. Which instructions will the nurse include in the plan of care? Select all that apply.
Institute droplet precautions
Monitor for signs of airway obstruction
Offer small amounts of fluids frequently
Place the child in a negative-pressure isolation room
Request an order for cough suppressant - correct answer>>1,2, known as whooping sound. reatment consists of antibiotics and supportive measures. Humidified oxygen and adequate fluids will help loosen the thick mucus. Suction as needed is important in infants. Respiratory status should be monitored for obstruction. The client should be positioned on the left side to prevent aspiration if vomiting occurs. Vaccination against whooping cough is available, but some individuals will still develop the disease, although in a milder form. Cough suppressants are not used as they are not very effective for pertussis. In addition, the child needs to cough up any mucus plugs that might develop to keep the airway clear. Educational objective:Pertussis can occur despite vaccination. Characteristic features include a cough lasting ≥2 weeks with ≥1 of the following: paroxysms of cough, inspiratory whooping sound, and posttussive vomiting. Clients need oral antibiotics, droplet precautions, and supportive measures (humidified oxygen and oral fluids). A nurse is discussing the concept of parallel play with parents of toddlers. Which statement should the nurse include to describe this type of play?
"Children play near other children but without significant interaction."
"Children playing together are strongly influenced by each other's choice of toy."
"The child primarily plays alone or with familiar people, such as parents."
"When playing in a group, one child will take on a follower role." - correct answer>>1. parellel play occurs 12-36 months cooperative play - correct answer>>school aged children (ages 6-12) may involve a formal game or task (eg, building a castle from blocks). solitary play - correct answer>>infants <
