CPNRE - Canadian Practical Nurse Registration Examination Pediatric and Child Health Nursing Questions and Answers Flashcards

A 3-year-old with known glucose-6-phosphate dehydrogenase (G6PD) deficiency is admitted with a urinary tract infection. Which antibiotic should the practical nurse flag as contraindicated and report to the physician before administration?

Answer: Nitrofurantoin

Nitrofurantoin is an oxidant drug that can trigger acute hemolytic anemia in patients with G6PD deficiency. G6PD is essential for protecting red blood cells from oxidative damage; without it, oxidant drugs cause rapid RBC destruction. Amoxicillin, cephalexin, and azithromycin are not classified as oxidant drugs and are generally safe in G6PD deficiency.

A 7-year-old post-operative patient following a tonsillectomy repeatedly swallows between assessments. Vital signs are stable and the child denies pain. What is the nurse's priority interpretation of this finding?

Answer: Possible occult hemorrhage with blood being swallowed

Frequent swallowing in a post-tonsillectomy patient is a classic and serious sign of occult hemorrhage — the child is swallowing blood pooling in the posterior pharynx. This can occur even with stable vital signs in the early stages. The nurse must inspect the oropharynx with a light and notify the physician immediately, as this is a surgical emergency. The other explanations are less urgent and do not match the clinical pattern.

A 10-month-old infant is brought in by parents concerned about developmental delay. On assessment, the nurse notes the infant cannot sit without support, does not transfer objects between hands, and has persistent asymmetric tonic neck reflex (ATNR). Which statement best reflects the nurse's clinical reasoning?

Answer: Persistent ATNR beyond 6 months may indicate central nervous system pathology and warrants urgent referral

The asymmetric tonic neck reflex (ATNR) is a primitive reflex that should be integrated (disappear) by 4–6 months of age. Persistence beyond 6 months is a red flag for central nervous system pathology, such as cerebral palsy. Combined with failure to sit independently (expected by 6–9 months) and failure to transfer objects (expected by 7 months), the cluster of findings represents significant neurodevelopmental delay requiring urgent specialist referral, not watchful waiting.

A 6-year-old with sickle cell disease presents to the emergency department with fever of 38.9°C, chest pain, decreased oxygen saturation (SpO2 88%), and new infiltrates on chest X-ray. The physician diagnoses acute chest syndrome. Which intervention is the highest priority?

Answer: Prepare for simple or exchange blood transfusion and administer supplemental oxygen

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease characterized by fever, respiratory symptoms, hypoxia, and new pulmonary infiltrates. Priority management includes supplemental oxygen to correct hypoxia and blood transfusion (simple or exchange) to dilute sickled hemoglobin and improve oxygen-carrying capacity. Incentive spirometry has a role in mild ACS prevention but is not the priority when SpO2 is 88%. Hydroxyurea is a preventive long-term therapy, not acute treatment. Oral hydration alone is insufficient for this severity.

A 14-year-old with anorexia nervosa is being re-fed on a structured nutrition plan. On day 3, the patient develops muscle weakness, paresthesias, and cardiac arrhythmia on the monitor. Which electrolyte abnormality is most likely responsible, and what nursing action is most appropriate?

Answer: Hypophosphatemia — recognize refeeding syndrome, hold the meal, and notify the physician immediately

Refeeding syndrome is a potentially fatal complication that occurs when nutrition is reintroduced too rapidly after starvation. Carbohydrate reintroduction causes insulin release, which drives phosphate, potassium, and magnesium into cells, causing severe hypophosphatemia. Hypophosphatemia manifests as muscle weakness, paresthesias, and life-threatening cardiac arrhythmias. The nurse must recognize this emergency, withhold further feeding, and immediately notify the physician for IV electrolyte replacement and cardiac monitoring. This is not a situation for dietary adjustment or reassessment delay.

A 2-year-old is admitted following ingestion of an unknown quantity of iron tablets from a parent's supplement bottle approximately 90 minutes ago. The child appears alert with mild nausea but no vomiting. Which nursing intervention reflects the most accurate understanding of iron poisoning management?

Answer: Prepare the child for whole bowel irrigation and anticipate administration of IV deferoxamine if serum iron is elevated

Iron poisoning is one of the leading causes of pediatric poisoning fatalities. Activated charcoal does NOT bind iron effectively and is not indicated. Ipecac syrup is no longer recommended in any poisoning. Iron toxicity progresses through five stages; early stability is deceptive. Whole bowel irrigation with polyethylene glycol is used to remove tablets from the GI tract, and IV deferoxamine (an iron chelator) is the specific antidote administered when serum iron levels are elevated or clinical toxicity is present. The nurse should anticipate these interventions and contact Poison Control and the physician promptly.