Pediatric Nurse Chronic Conditions and Care Questions and Answers — Questions and Answers
Question 1: A school-aged child with a known diagnosis of asthma reports using their albuterol inhaler for shortness of breath 4-5 times per week and being awakened by coughing approximately once a week. According to the NHLBI guidelines, how should the nurse classify the child's current asthma severity?
- Intermittent
- Mild Persistent
- Moderate Persistent (Correct answer)
- Severe Persistent
Correct answer: Moderate Persistent
According to the National Heart, Lung, and Blood Institute (NHLBI) guidelines, moderate persistent asthma in children is characterized by daily symptoms of asthma or use of a short-acting beta-agonist (SABA) for symptom control, and nighttime awakenings more than once a week, but not nightly. This child's symptom frequency (SABA use nearly daily and weekly nighttime awakenings) fits the criteria for moderate persistent asthma.
Question 2: A nurse is providing nutritional counseling for the parents of a toddler newly diagnosed with cystic fibrosis. Which statement by the parents indicates a correct understanding of the dietary management?
- "We need to make sure our child follows a low-fat, low-calorie diet to prevent stomach upset."
- "We will give the pancreatic enzymes mixed in with a full glass of milk or in warm foods like soup."
- "Our child needs a high-calorie, high-protein diet, and we must give pancreatic enzymes with all meals and snacks." (Correct answer)
- "A gluten-free diet is the most important part of managing the digestive issues."
Correct answer: "Our child needs a high-calorie, high-protein diet, and we must give pancreatic enzymes with all meals and snacks."
The cornerstone of nutritional management in cystic fibrosis is a high-calorie, high-protein, high-fat diet to meet increased energy needs and support growth. [3, 10] Due to pancreatic insufficiency, exogenous pancreatic enzymes must be administered with every meal and snack to facilitate the digestion and absorption of nutrients, particularly fats and proteins. [3, 10] Enzymes should not be mixed with hot foods or milk products as this can inactivate them.
Question 3: A 10-year-old with type 1 diabetes is at the school nurse's office reporting feeling shaky and sweaty. A fingerstick glucose level is 60 mg/dL. The child is conscious and able to swallow. What is the nurse's priority action?
- Administer the child's prescribed dose of glargine (long-acting) insulin.
- Provide 15 grams of a fast-acting carbohydrate, such as 4 ounces of juice. (Correct answer)
- Call the child's parents to have them pick the child up immediately.
- Have the child lie down and recheck the blood glucose in one hour.
Correct answer: Provide 15 grams of a fast-acting carbohydrate, such as 4 ounces of juice.
The child is exhibiting symptoms of hypoglycemia with a confirmed low blood glucose reading. According to the "Rule of 15," the priority intervention for a conscious person with hypoglycemia is to administer 15 grams of a fast-acting carbohydrate. [5, 7, 9] After 15 minutes, the blood glucose should be rechecked. Administering insulin would further lower the blood sugar, and delaying treatment is unsafe.
Question 4: A 7-year-old with sickle cell disease is admitted to the pediatric unit with a vaso-occlusive crisis, reporting severe pain in the arms and legs. Which of the following physician orders should the nurse prioritize?
- Apply cold compresses to painful joints.
- Administer intravenous fluids and opioid analgesics. (Correct answer)
- Encourage active range-of-motion exercises.
- Obtain a complete blood count and reticulocyte count.
Correct answer: Administer intravenous fluids and opioid analgesics.
The highest priorities in managing a vaso-occlusive crisis (VOC) are aggressive pain management and intravenous hydration. [8, 13, 23] IV fluids help to reduce blood viscosity and reverse the sickling process, while opioid analgesics are necessary to control the severe ischemic pain. Cold compresses would cause vasoconstriction, worsening the crisis. [8] While lab work is important, it is not the immediate priority over treating pain and dehydration.
Question 5: When developing a plan of care for a preschooler with spastic cerebral palsy, which of the following is the most appropriate long-term goal for the nursing team to facilitate?
- Reversal of the underlying brain injury.
- Maximizing functional abilities and preventing musculoskeletal complications. (Correct answer)
- Discouraging the use of adaptive equipment to build strength.
- Achieving developmental milestones at the same pace as typically developing peers.
Correct answer: Maximizing functional abilities and preventing musculoskeletal complications.
Cerebral palsy is a non-progressive motor disorder; therefore, care is not curative but focuses on management. A primary goal is to maximize the child's functional independence and quality of life while preventing secondary complications like muscle contractures, which are common with spasticity. [1, 22] This is achieved through a multidisciplinary approach including physical therapy, bracing, and proper positioning. Adaptive equipment is crucial for promoting independence, not discouraging it.
Question 6: Which of the following nursing actions best exemplifies the core principles of family-centered care when managing a child's newly diagnosed chronic illness?
- Providing the family with a standardized information packet and a list of scheduled appointments.
- Collaborating with the parents and child to develop an individualized healthcare plan that aligns with their goals and daily routines. (Correct answer)
- Making decisions on behalf of the family to reduce their burden during a stressful time.
- Limiting communication to the primary physician to ensure a single, clear source of information.
Correct answer: Collaborating with the parents and child to develop an individualized healthcare plan that aligns with their goals and daily routines.
Family-centered care is an approach that recognizes the family as the constant in a child's life and views them as essential partners in care. [2, 6, 17] The core principles involve respect, information sharing, participation, and collaboration. [14, 16] Involving the family and child (as appropriate) in creating the care plan respects their expertise, empowers them, and tailors the plan to their specific needs and values, which is the essence of this philosophy. [17]
