Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 3 — Questions and Answers
Question 1: A nurse is evaluating a 6-year-old with nephrotic syndrome. Which assessment finding indicates a worsening condition requiring immediate notification of the provider?
- Mild periorbital edema in the morning
- Urine output of 0.3 mL/kg/hr over 4 hours (Correct answer)
- Albumin level of 3.0 g/dL
- Weight gain of 0.5 kg over 48 hours
Correct answer: Urine output of 0.3 mL/kg/hr over 4 hours
Urine output below 0.5 mL/kg/hr indicates oliguria, signaling potential acute kidney injury in a child with nephrotic syndrome and requires immediate provider notification.
Question 2: A 4-year-old with spina bifida (myelomeningocele) is admitted for a urinary tract infection. Which bladder management strategy is standard of care?
- Encouraging voluntary voiding every 4 hours
- Indwelling urinary catheter placement
- Clean intermittent catheterization (CIC) schedule (Correct answer)
- Suprapubic catheter as first-line management
Correct answer: Clean intermittent catheterization (CIC) schedule
Clean intermittent catheterization is the gold standard for neurogenic bladder management in spina bifida, reducing infection risk better than indwelling catheters.
Question 3: An 8-year-old with hemophilia A requires a dental extraction. Which pre-procedure nursing preparation is essential?
- Administer aspirin for pain management pre-procedure
- Ensure factor VIII replacement therapy is given before the procedure (Correct answer)
- Apply firm direct pressure for 5 minutes post-extraction
- Schedule the procedure in the afternoon for best clotting activity
Correct answer: Ensure factor VIII replacement therapy is given before the procedure
Factor VIII concentrate must be administered before any invasive procedure in hemophilia A to achieve adequate clotting factor levels and prevent excessive bleeding.
Question 4: A 14-year-old with lupus (SLE) is started on hydroxychloroquine. What specific monitoring is required for this medication?
- Monthly liver function tests
- Baseline and annual ophthalmology exams (Correct answer)
- Daily blood glucose monitoring
- Weekly complete blood count
Correct answer: Baseline and annual ophthalmology exams
Hydroxychloroquine can cause retinal toxicity, so baseline and annual ophthalmologic screening is required to detect early changes and prevent vision loss.
Question 5: A nurse is caring for a 3-year-old with Hirschsprung disease who underwent surgical repair. Which postoperative stool characteristic indicates a complication?
- Loose stools for the first week postoperatively
- Small, ribbon-like stools with straining (Correct answer)
- Two to three stools per day of soft consistency
- Mild perianal skin irritation from frequent stools
Correct answer: Small, ribbon-like stools with straining
Ribbon-like stools after Hirschsprung repair suggest anastomotic stricture or incomplete resection, requiring prompt evaluation.
Question 6: A child with Duchenne muscular dystrophy (DMD) develops dysphagia. Which dietary modification is the priority nursing recommendation?
- Switch to a low-calorie diet to prevent obesity
- Introduce thickened liquids and soft, moist foods (Correct answer)
- Restrict protein intake to reduce muscle workload
- Encourage carbonated beverages to ease swallowing
Correct answer: Introduce thickened liquids and soft, moist foods
Thickened liquids and soft, moist foods reduce aspiration risk in DMD-related dysphagia while maintaining adequate nutritional intake.
Question 7: A nurse is developing a care plan for a 10-year-old with celiac disease. Which goal is the highest priority?
- Achieve ideal body weight within 6 months
- Maintain strict lifelong gluten-free diet (Correct answer)
- Take vitamin D supplements daily
- Participate in school meal programs
Correct answer: Maintain strict lifelong gluten-free diet
Strict lifelong adherence to a gluten-free diet is the cornerstone of celiac disease management to prevent intestinal damage and associated complications.
Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 3
A nurse is evaluating a 6-year-old with nephrotic syndrome.
Which assessment finding indicates a worsening condition requiring immediate notification of the provider?