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

A 4-year-old is admitted with nephrotic syndrome and severe peripheral edema. The nurse notes the child's urine output is 15 mL/hour and the child weighs 18 kg. Serum albumin is 1.4 g/dL. Which intervention takes priority?

Answer: Administer IV albumin as ordered, followed by furosemide

In nephrotic syndrome, massive proteinuria leads to hypoalbuminemia and oncotic pressure collapse, causing third-spacing and effective hypovolemia despite edema. IV albumin temporarily restores oncotic pressure and intravascular volume, and must precede furosemide — giving a diuretic alone to an already volume-depleted child risks circulatory collapse. Fluid restriction is secondary, sodium should be restricted (not increased), and supine positioning does not address the underlying oncotic deficit.

A 10-month-old with a known peanut allergy receives their first dose of MMR vaccine. Fifteen minutes later, the nurse observes urticaria, inspiratory stridor, and a heart rate of 178 bpm. The child weighs 9 kg. What is the correct epinephrine dose and route?

Answer: 0.09 mg IM of 1:1,000 concentration into the anterolateral thigh

Epinephrine for anaphylaxis is dosed at 0.01 mg/kg using the 1:1,000 (1 mg/mL) concentration given IM. For a 9 kg infant: 9 × 0.01 = 0.09 mg. The anterolateral thigh (vastus lateralis) is the preferred IM site for fastest absorption. IV epinephrine 1:10,000 is reserved for cardiac arrest scenarios and carries severe dysrhythmia risk. The subcutaneous route has slower, less reliable absorption during anaphylaxis. The deltoid has inadequate muscle mass in infants.

A 7-year-old with newly diagnosed Type 1 diabetes mellitus has a blood glucose of 22 mmol/L, serum bicarbonate of 10 mEq/L, and is breathing rapidly with fruity-smelling breath. An IV of 0.9% NaCl is running. The family asks why potassium is being added to the IV despite the child's serum potassium being 5.2 mEq/L. The nurse's best response is:

Answer: Once insulin is started, potassium will shift back into cells and serum levels will drop, sometimes dangerously

In diabetic ketoacidosis (DKA), acidosis and insulin deficiency cause potassium to shift out of cells, so serum K⁺ appears normal or high even though total body potassium is depleted. When insulin therapy is initiated, potassium rapidly re-enters cells and serum K⁺ can fall precipitously, causing life-threatening hypokalemia and cardiac dysrhythmias. Potassium is added prophylactically once serum K⁺ is below 5.5 mEq/L and urine output is confirmed. The other options are physiologically incorrect.

A 13-year-old with Crohn's disease is on long-term prednisone therapy. The school nurse calls concerned about behavioral changes, including euphoria and insomnia. The adolescent's parent asks if these symptoms indicate the disease is worsening. The most accurate nursing response is:

Answer: These are recognized neuropsychiatric adverse effects of corticosteroid therapy, not signs of disease progression

Corticosteroids, including prednisone, have well-documented neuropsychiatric adverse effects including euphoria, mood lability, insomnia, and in severe cases, psychosis — collectively called steroid-induced psychiatric syndromes. These are dose-dependent and unrelated to disease activity. Adrenal suppression presents with fatigue, weakness, and hypotension — not euphoria. Crohn's disease does not directly affect the CNS. Misinterpreting these as a flare could lead to an inappropriate dose increase.

A 2-year-old is brought to the emergency department after ingesting an unknown quantity of iron tablets belonging to a grandparent. The child is currently asymptomatic and the ingestion occurred 45 minutes ago. Serum iron level is pending. Which statement best guides the nurse's immediate priority assessment?

Answer: An asymptomatic presentation in the first 6 hours may be a deceptive latent phase before severe systemic toxicity develops

Iron poisoning follows a classic five-stage course. Stage I (0–6 hours) involves GI symptoms; Stage II (6–24 hours) is a deceptive apparent recovery (latent phase) where the child may seem well; Stage III brings severe systemic toxicity (shock, metabolic acidosis, hepatotoxicity). An asymptomatic child at 45 minutes must not be falsely reassured — the latent phase is a well-known feature of iron toxicity. The nurse must treat this as a potentially serious ingestion pending serum iron and clinical staging, not reassure or discharge.

A nurse is caring for a 6-week-old infant with bronchiolitis caused by RSV. The infant's SpO₂ is 91% on room air, respiratory rate is 68/min, and there is moderate subcostal retracting. The physician orders nebulized epinephrine. The nurse should recognize that:

Answer: Evidence does not support routine use of epinephrine in bronchiolitis; its benefit is temporary and does not alter the disease course or reduce hospitalization

Current evidence-based guidelines (including the Canadian Paediatric Society) do not support routine use of bronchodilators — including epinephrine or salbutamol — for bronchiolitis, as they do not improve oxygenation, reduce hospital admissions, or shorten illness duration. While epinephrine may produce short-term symptomatic improvement through vasoconstriction and bronchodilation, this effect is transient and has not been shown to change outcomes. Supportive care (oxygen, hydration, suctioning) remains the mainstay. The nurse should be aware of this evidence gap even when administering the ordered medication.