Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 4 — Questions and Answers
Question 1: A nurse is assessing a 5-year-old with congenital heart disease who has a history of tetralogy of Fallot repair. The child suddenly squats during play. What does this behavior indicate?
- Normal fatigue from physical activity
- A hypercyanotic (Tet) spell requiring immediate intervention (Correct answer)
- Joint pain related to activity
- Hypoglycemia from exertion
Correct answer: A hypercyanotic (Tet) spell requiring immediate intervention
Squatting during a hypercyanotic spell increases systemic vascular resistance, reducing right-to-left shunting; it signals a Tet spell requiring immediate oxygen and knee-chest positioning.
Question 2: A 13-year-old with type 2 diabetes and obesity is counseled on lifestyle modifications. Which intervention has the strongest evidence for improving insulin sensitivity?
- Eliminating all carbohydrates from the diet
- 150 minutes per week of moderate aerobic exercise (Correct answer)
- Taking metformin twice daily without dietary changes
- Drinking at least 3 liters of water daily
Correct answer: 150 minutes per week of moderate aerobic exercise
Regular moderate aerobic exercise (150 min/week) improves insulin sensitivity and is a foundational intervention in pediatric type 2 diabetes management.
Question 3: A 2-year-old with sickle cell disease presents with painful swelling of both hands and feet. What is the most likely diagnosis?
- Rheumatoid arthritis flare
- Dactylitis (hand-foot syndrome) (Correct answer)
- Osteomyelitis from Salmonella infection
- Leukemic infiltration of bone
Correct answer: Dactylitis (hand-foot syndrome)
Dactylitis, or hand-foot syndrome, is the hallmark presenting vaso-occlusive crisis in young children with sickle cell disease, causing painful swelling of hands and feet.
Question 4: A 9-year-old with Crohn's disease has significantly delayed puberty and linear growth. Which intervention addresses this specific complication?
- Increase dietary fat intake
- Optimize disease control to reduce chronic inflammation (Correct answer)
- Administer growth hormone injections
- Restrict activity to conserve energy for growth
Correct answer: Optimize disease control to reduce chronic inflammation
Chronic inflammation in active Crohn's disease suppresses growth hormone signaling; controlling disease activity is the primary strategy for improving growth outcomes.
Question 5: A child with chronic kidney disease (CKD) stage 4 is on a renal diet. Which lab value is the most immediate concern requiring dietary adjustment?
- Serum sodium of 138 mEq/L
- Serum potassium of 6.2 mEq/L (Correct answer)
- BUN of 35 mg/dL
- Serum phosphorus of 5.0 mg/dL
Correct answer: Serum potassium of 6.2 mEq/L
A serum potassium of 6.2 mEq/L is dangerously elevated hyperkalemia in CKD, posing an immediate risk of life-threatening cardiac dysrhythmias requiring urgent dietary restriction and intervention.
Question 6: A 7-year-old with poorly controlled asthma is assessed. The nurse notes the child uses a long-acting beta-agonist (LABA) without inhaled corticosteroids (ICS). What action should the nurse take?
- Reassure the family that LABA alone is appropriate for the child's age
- Notify the provider, as LABA monotherapy is contraindicated in children (Correct answer)
- Teach the child to use LABA as a rescue inhaler during acute attacks
- Add an oral leukotriene modifier alongside the LABA
Correct answer: Notify the provider, as LABA monotherapy is contraindicated in children
LABA monotherapy without ICS is contraindicated in pediatric asthma due to increased risk of severe asthma exacerbations and death; the provider must be notified.
Question 7: A 15-year-old with hypothyroidism has been taking levothyroxine. The nurse is reviewing lab results: TSH is 8.2 mIU/L (elevated) and free T4 is low. Which question is most important to ask?
- Do you take the medication with calcium supplements?
- Have you been taking your medication consistently? (Correct answer)
- Are you following a gluten-free diet?
- Do you exercise within 30 minutes of taking the medication?
Correct answer: Have you been taking your medication consistently?
Elevated TSH with low T4 most commonly reflects non-adherence to levothyroxine; directly asking about medication consistency is the priority assessment.
Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 4
A nurse is assessing a 5-year-old with congenital heart disease who has a history of tetralogy of Fallot repair.
The child suddenly squats during play.
What does this behavior indicate?