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Pediatric Health Nursing-II
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Pediatric Health Nursing-II
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141. A 3-month-old infant is admitted with intussusception. The infant has sudden, severe, colicky abdominal pain, drawing knees to chest, and currant jelly stools. What is the urgent clinical intervention?
A.
Administering laxatives.
✓
B.
Preparing for a pneumatic or hydrostatic enema to reduce the intussusception, or surgical intervention if reduction fails.
✓
C.
Observing for spontaneous resolution.
✓
D.
Encouraging oral feeds.
✓
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Jun 6, 2026
142. A 6-year-old child with chronic kidney disease (CKD) is on a fluid restriction. What technical nursing intervention is critical for ensuring adherence?
A.
Allowing unlimited fluids.
✓
B.
Educating the child and family about the rationale for the restriction, providing measured amounts of fluid, and offering ice chips.
✓
C.
Ignoring fluid intake.
✓
D.
Encouraging sugary drinks.
✓
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Jun 6, 2026
143. A 13-year-old adolescent with a fractured femur is experiencing acute pain. What clinical nursing assessment is critical for effective pain management?
A.
Relying solely on parental reports.
✓
B.
Using an age-appropriate pain scale (e.g., FACES, Numeric Rating Scale) and assessing pain characteristics, intensity, and location.
✓
C.
Observing facial expressions only.
✓
D.
Asking if the pain is gone.
✓
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Jun 6, 2026
134. A 7-year-old child with acute glomerulonephritis is experiencing fluid overload. What critical situational nursing intervention is paramount?
A.
Encouraging high fluid intake.
✓
B.
Restricting sodium and fluid intake, monitoring for signs of worsening edema or respiratory distress.
✓
C.
Administering large volumes of IV fluids.
✓
D.
Providing sugary drinks.
✓
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Jun 6, 2026
135. A 15-year-old adolescent with a history of depression is refusing to take prescribed medications. What clinical nursing intervention is critical?
A.
Forcing the medication.
✓
B.
Exploring the adolescent's reasons for refusal, educating about the medication, addressing concerns, and involving the healthcare provider.
✓
C.
Telling the parents to force it.
✓
D.
Discharging the adolescent.
✓
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Jun 6, 2026
136. A 2-month-old infant is admitted with pertussis (whooping cough). What urgent clinical medicinal concern is paramount?
A.
Mild cough.
✓
B.
Severe paroxysmal coughing, potential for apnea, and the need for urgent antibiotic treatment and respiratory support.
✓
C.
Nasal congestion.
✓
D.
Increased appetite.
✓
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Jun 6, 2026
137. A 16-year-old adolescent is admitted after a motor vehicle accident with a traumatic brain injury. The nurse notes posturing. What technical pathophysiological sign does this indicate?
A.
Spinal cord injury.
✓
B.
Severe brain injury and increased intracranial pressure (ICP).
✓
C.
Peripheral nerve damage.
✓
D.
Muscle spasms.
✓
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Jun 6, 2026
138. A 4-year-old child with Down syndrome is hospitalized for a respiratory infection. What clinical nursing intervention is critical for providing family-centered care?
A.
Limiting parental visitation.
✓
B.
Involving parents in care planning, providing clear and concise information, and respecting family routines and preferences.
✓
C.
Making all decisions for the family.
✓
D.
Focusing only on the child's medical needs.
✓
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Jun 6, 2026
139. A 10-year-old child with leukemia is experiencing chemotherapy-induced nausea. What medicinal nursing consideration is critical for effective antiemetic administration?
A.
Administering antiemetics after vomiting begins.
✓
B.
Administering antiemetics routinely before chemotherapy and on a schedule as prescribed to prevent nausea.
✓
C.
Giving small doses of antiemetics.
✓
D.
Withholding antiemetics if the child is not eating.
✓
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Jun 6, 2026
140. A 8-year-old child with a new diagnosis of Type 1 Diabetes Mellitus is learning about sick day management. What critical situational advice should the nurse provide regarding insulin and blood glucose monitoring?
A.
Stop insulin and avoid monitoring.
✓
B.
Continue insulin (do not omit doses), monitor blood glucose and ketones frequently, and ensure adequate fluid intake.
✓
C.
Increase food intake significantly.
✓
D.
Rely only on oral medications.
✓
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Jun 6, 2026
128. A 16-year-old adolescent with cystic fibrosis is transitioning to adult care. What clinical nursing intervention is critical for promoting self-management?
A.
Taking over all aspects of care.
✓
B.
Empowering the adolescent to take increasing responsibility for their medications, treatments, and appointments, and connecting them with adult CF resources.
✓
C.
Limiting their involvement in care decisions.
✓
D.
Treating them like a child.
✓
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Jun 6, 2026
129. A 3-month-old infant is admitted with bronchiolitis and is experiencing increasing respiratory distress. The nurse notes retractions, nasal flaring, and grunting. What technical nursing assessment is critical for detecting worsening respiratory status?
A.
Only monitoring oxygen saturation.
✓
B.
Continuous monitoring of respiratory rate, effort, breath sounds, and color, and assessing for signs of fatigue.
✓
C.
Only monitoring heart rate.
✓
D.
Checking temperature.
✓
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Jun 6, 2026
130. A 8-year-old child with a new diagnosis of Type 1 Diabetes Mellitus is learning about insulin injection sites. What technical instruction is critical for the nurse to provide regarding site selection?
A.
Use the same site every time.
✓
B.
Rotate injection sites regularly to prevent lipohypertrophy and ensure consistent absorption.
✓
C.
Only inject into the abdomen.
✓
D.
Inject into muscles.
✓
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Jun 6, 2026
131. A 5-year-old child is in the PACU after a minor surgical procedure. The child is awake but disoriented. What clinical nursing intervention is critical?
A.
Leaving the child alone to rest.
✓
B.
Reorienting the child gently, providing a calm environment, and ensuring parental presence if possible.
✓
C.
Speaking loudly to the child.
✓
D.
Administering sedatives.
✓
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Jun 6, 2026
132. A 1-year-old infant is admitted with severe dehydration and metabolic acidosis. What medicinal intervention might be considered for metabolic acidosis?
A.
Oral rehydration solution.
✓
B.
Sodium bicarbonate (IV) if acidosis is severe and persists despite fluid resuscitation.
✓
C.
Antiemetics.
✓
D.
Antipyretics.
✓
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Jun 6, 2026
133. A 12-year-old child with cerebral palsy uses a feeding tube. What technical nursing consideration is critical to prevent clogged tubes?
A.
Flushing with soda.
✓
B.
Flushing the tube with water before and after medication administration and feedings.
✓
C.
Not flushing the tube.
✓
D.
Using cold water for flushing.
✓
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Jun 6, 2026
119. A 8-year-old child with severe asthma is prescribed a new inhaled corticosteroid. What medicinal education is critical for the nurse to provide to ensure optimal delivery?
A.
Inhale quickly and deeply.
✓
B.
Use a spacer device to improve drug delivery to the lungs and reduce systemic absorption.
✓
C.
Hold breath for 1 second.
✓
D.
Exhale immediately after inhalation.
✓
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Jun 6, 2026
120. A 3-year-old child is admitted with signs of poisoning. The child is lethargic and hypotensive. What is the urgent critical nursing priority?
A.
Inducing vomiting.
✓
B.
Assessing airway, breathing, circulation (ABC's), and identifying the substance ingested to guide urgent decontamination/antidote administration.
✓
C.
Administering activated charcoal without knowing the substance.
✓
D.
Waiting for lab results.
✓
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Jun 6, 2026
121. A 6-month-old infant is admitted with congestive heart failure. The infant is experiencing tachypnea, grunting, and nasal flaring. What technical nursing intervention is critical to reduce cardiac workload?
A.
Encouraging vigorous play.
✓
B.
Maintaining a neutral thermal environment, elevating the head of the bed, and clustering nursing care to promote rest.
✓
C.
Administering large feedings rapidly.
✓
D.
Restricting oxygen administration.
✓
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Jun 6, 2026
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