Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 5 — Questions and Answers
Question 1: A 6-year-old with phenylketonuria (PKU) is hospitalized for an unrelated illness. Which dietary consideration is essential during hospitalization?
- Increase protein intake to support recovery
- Maintain a phenylalanine-restricted diet with medical formula (Correct answer)
- Switch to a standard pediatric diet temporarily
- Provide high-calorie, high-protein supplemental feeds
Correct answer: Maintain a phenylalanine-restricted diet with medical formula
Children with PKU must maintain phenylalanine restriction at all times, including during illness, to prevent neurotoxic accumulation regardless of hospitalization.
Question 2: A nurse is educating the parents of a child newly diagnosed with juvenile dermatomyositis (JDM). Which skin finding is characteristic of this condition?
- Butterfly rash across the nose and cheeks
- Heliotrope rash around the eyes and Gottron papules on knuckles (Correct answer)
- Malar flush with joint swelling
- Petechiae distributed across the trunk
Correct answer: Heliotrope rash around the eyes and Gottron papules on knuckles
Heliotrope rash (purple discoloration around the eyelids) and Gottron papules (raised lesions over knuckles) are pathognomonic skin findings in juvenile dermatomyositis.
Question 3: An 11-year-old with attention-deficit/hyperactivity disorder (ADHD) is prescribed methylphenidate. Which parameter requires routine monitoring at each visit?
- Renal function and electrolyte levels
- Height, weight, blood pressure, and heart rate (Correct answer)
- Liver function tests and CBC
- Blood glucose and HbA1c
Correct answer: Height, weight, blood pressure, and heart rate
Stimulant medications like methylphenidate can suppress appetite and growth, and may elevate blood pressure and heart rate, requiring monitoring at every visit.
Question 4: A 4-year-old with autism spectrum disorder (ASD) has extreme food selectivity and is at risk for nutritional deficiency. Which nutrient is most commonly deficient in children with ASD-related food restriction?
- Vitamin C
- Calcium and vitamin D (Correct answer)
- Niacin
- Potassium
Correct answer: Calcium and vitamin D
Children with ASD often avoid dairy and other calcium-rich foods, making calcium and vitamin D the most commonly deficient nutrients, increasing risk for poor bone density.
Question 5: A 16-year-old with chronic migraine is prescribed topiramate for prophylaxis. Which adverse effect should the nurse emphasize during teaching?
- Weight gain and increased appetite
- Cognitive dulling, word-finding difficulty, and kidney stones (Correct answer)
- Increased seizure threshold
- Photosensitivity and skin rash
Correct answer: Cognitive dulling, word-finding difficulty, and kidney stones
Topiramate commonly causes cognitive side effects including word-finding difficulty ('Dopamax') and increases risk of kidney stones due to carbonic anhydrase inhibition.
Question 6: A nurse is reviewing the care plan for a 3-year-old with biliary atresia post-Kasai procedure. Which nutritional intervention is most important for long-term outcomes?
- Standard infant formula without supplementation
- Fat-soluble vitamin supplementation (A, D, E, K) (Correct answer)
- High-sodium diet to support liver function
- Protein restriction to prevent hepatic encephalopathy
Correct answer: Fat-soluble vitamin supplementation (A, D, E, K)
Biliary atresia impairs bile excretion, leading to fat-soluble vitamin malabsorption; supplementation of vitamins A, D, E, and K is critical for preventing deficiency-related complications.
Question 7: A 10-year-old with HIV on antiretroviral therapy (ART) has an undetectable viral load and CD4 count of 750 cells/mm³. The school nurse asks what activities the child can participate in. What is the best response?
- The child should be restricted from contact sports to protect classmates
- The child can participate in all school activities without restriction (Correct answer)
- Swimming should be avoided due to infection risk from pool water
- Only non-contact activities are permitted to prevent injury-related blood exposure
Correct answer: The child can participate in all school activities without restriction
A child with well-controlled HIV (undetectable viral load, normal CD4) poses no transmission risk and can participate fully in all school activities without restriction.
Pediatric Nurse Exam Pediatric Nurse Chronic Conditions and Care 5
A 6-year-old with phenylketonuria (PKU) is hospitalized for an unrelated illness.
Which dietary consideration is essential during hospitalization?