Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 4 — Questions and Answers
Question 1: A nurse is caring for a 6-week-old with pyloric stenosis who has been vomiting for 2 weeks. Which electrolyte imbalance is most expected?
- Hyperkalemic metabolic acidosis
- Hypochloremic hypokalemic metabolic alkalosis (Correct answer)
- Hypernatremic metabolic acidosis
- Dilutional hyponatremia with metabolic acidosis
Correct answer: Hypochloremic hypokalemic metabolic alkalosis
Repeated vomiting of gastric contents causes loss of HCl, resulting in hypochloremic, hypokalemic metabolic alkalosis.
Question 2: A 7-year-old with nephrotic syndrome is admitted with severe edema and ascites. Which dietary instruction is most important?
- High-protein, high-sodium diet
- Low-sodium diet with adequate protein intake (Correct answer)
- High-fat diet to replace urinary losses
- Fluid restriction below 200 mL per day
Correct answer: Low-sodium diet with adequate protein intake
Sodium restriction reduces fluid retention while adequate protein intake helps replace urinary protein losses in nephrotic syndrome.
Question 3: A 4-year-old swallowed a button battery 2 hours ago. X-ray shows it is in the esophagus. What is the priority action?
- Observe and repeat X-ray in 24 hours
- Arrange emergent endoscopic removal (Correct answer)
- Give magnet therapy to retrieve it
- Administer a cathartic to speed transit
Correct answer: Arrange emergent endoscopic removal
Esophageal button batteries cause rapid tissue liquefactive necrosis and require emergent endoscopic removal within 2 hours.
Question 4: A 10-year-old with type 1 diabetes presents with polyuria, polydipsia, and a blood glucose of 320 mg/dL but no ketones and a normal pH. Which management is most appropriate?
- Administer IV insulin infusion and admit for DKA protocol
- Give correction dose of subcutaneous insulin and increase hydration (Correct answer)
- Send home with instructions to increase basal insulin permanently
- Withhold insulin and recheck glucose in 4 hours
Correct answer: Give correction dose of subcutaneous insulin and increase hydration
Without acidosis or significant ketosis, hyperglycemia can be managed with subcutaneous correction insulin and oral hydration.
Question 5: A 3-year-old with severe anaphylaxis receives epinephrine IM. After 5 minutes, symptoms persist. What should the nurse do next?
- Switch to subcutaneous epinephrine
- Administer a second dose of IM epinephrine (Correct answer)
- Give oral diphenhydramine and wait
- Apply an ice pack to the injection site
Correct answer: Administer a second dose of IM epinephrine
A second dose of IM epinephrine is indicated if anaphylaxis symptoms persist or recur 5–15 minutes after the first dose.
Question 6: Which finding in a toddler with acute otitis media (AOM) indicates the need for immediate referral rather than watchful waiting?
- Mild ear pain for 24 hours
- Bulging tympanic membrane with severe otalgia and fever >39°C (Correct answer)
- Slightly red tympanic membrane without fever
- Ear tugging without other symptoms
Correct answer: Bulging tympanic membrane with severe otalgia and fever >39°C
Severe AOM with bulging tympanic membrane, severe pain, and high fever requires prompt antibiotic treatment rather than watchful waiting.
Question 7: A 12-year-old is admitted with acute pancreatitis secondary to blunt abdominal trauma. Which nursing intervention is the priority in the first 24 hours?
- Begin high-fat enteral feedings immediately
- Provide aggressive IV fluid resuscitation and pain management (Correct answer)
- Administer prophylactic broad-spectrum antibiotics
- Insert nasogastric tube for decompression in all cases
Correct answer: Provide aggressive IV fluid resuscitation and pain management
Adequate IV fluid resuscitation prevents pancreatic necrosis and systemic complications, and pain control is essential in acute pancreatitis management.
Pediatric Nurse Exam Pediatric Nurse Management of Acute Illness 4
A nurse is caring for a 6-week-old with pyloric stenosis who has been vomiting for 2 weeks.
Which electrolyte imbalance is most expected?