1 :

2 weeks ago:

Parent brought in a 4-week-old infant who was born vaginally at 39 weeks of gestation. Birth was without complications. The parent reports an increase in "spitting up" after feedings over the past few days. Infant is awake and alert, heart rate regular, lung sounds clear, bowel sounds active, abdomen soft and nondistended. Weight: 3.4 kg (7 lb 9 oz), length: 50.2 cm (19.75 in).

Today:

6-week-old infant accompanied by parent. Parent reports infant has been spitting up more frequently. Parent states the infant "throws up pretty hard after most feedings. It looks like most of the feeding comes out like a fountain." The parent reports that the infant seems hungry after vomiting and wonders if "we need to change to a different formula." Weight: 3.5 kg (7 lb 11 oz), length: 51.4 cm (20.25 in).

2 weeks ago:

Heart rate: 132/min

Respiratory rate: 40/min

Temperature: 36.2Β°C (97.7Β°F) axillary

Oxygen saturation: 99% on room air

Today:

Heart rate: 140/min

Respiratory rate: 38/min

Temperature: 36.5Β°C (97.7Β°F) axillary

Oxygen saturation: 99% on room air

Today:

Infant with recurrent episodes of vomiting post-feeding, per parent's report. Abdomen slightly distended in the epigastric area with a small, palpable mass in the right upper quadrant. Will obtain an abdominal ultrasound and laboratory tests. Plan of care discussed with parent, who voiced understanding.


Drag words from the choices below to fill in each blank in the following sentence. The infant is at risk for developingand.


Hint : 🧠Consider which complications occur when an infant repeatedly loses most of each feeding through forceful vomiting.

Correct Answers

  • Blank 1 Correct Option: Dehydration
  • Blank 2 Correct Option: Failure to thrive

Rationale :

🧴The infant’s forceful projectile vomiting, persistent hunger after vomiting, and palpable right upper quadrant mass are classic findings associated with hypertrophic pyloric stenosis.

πŸ’§Repeated vomiting causes substantial loss of fluid and electrolytes, placing the infant at significant risk for dehydration.

πŸ“‰The minimal weight gain over 2 weeks suggests inadequate nutritional retention and increasing risk for failure to thrive.

⚠️Persistent gastric outlet obstruction can worsen nutritional deficiency, dehydration, and electrolyte abnormalities if untreated.


πŸ“ŒCore Message

Persistent projectile vomiting from suspected pyloric stenosis places an infant at major risk for dehydration and failure to thrive because fluids and nutrients cannot be adequately retained.

2 :

Hint : πŸ‘€Look for an injury with an unusual pattern and protected location that would be difficult to explain through normal toddler activity.

Correct Answers:

  • Circular burns on the soles of the toddler's feet


Rationale :

πŸ”₯Circular or patterned burns in unusual locations are highly suspicious for deliberately inflicted injuries and possible child maltreatment.

πŸ‘£The soles of the feet are normally protected from accidental contact burns, making injuries in this location particularly concerning.

🩺Intentional burns often demonstrate recognizable shapes, patterns, or sharply defined borders that reflect the causative object or method.

πŸ›‘οΈThe nurse should recognize suspicious injuries promptly because identifying nonaccidental trauma is essential for protecting the child from further harm.


πŸ“ŒCore Message

A patterned burn on a normally protected body surface such as the soles strongly suggests nonaccidental injury and requires evaluation for child maltreatment.

3 :

Hint : 🧠After neurosurgery, prioritize any finding showing a deterioration in neurological status or consciousness.

Correct Answers:

  • Lethargy


Rationale :

🧠New lethargy after ventriculoperitoneal shunt placement can indicate increased intracranial pressure caused by shunt obstruction or malfunction.

⚠️Changes in level of consciousness are high-priority neurological findings because they can signal worsening cerebral dysfunction.

πŸ’§A malfunctioning shunt can prevent adequate drainage of cerebrospinal fluid, causing intracranial pressure to rise rapidly.

🚨Because neurological deterioration can become life-threatening, lethargy requires immediate assessment and provider notification.


πŸ“ŒCore Message

Postoperative lethargy following VP shunt insertion can signal increasing intracranial pressure from shunt malfunction and requires immediate intervention.

4 :

Hint : 🦿During the earliest postoperative period, consider which intervention helps control swelling before long-term contracture-prevention strategies become the focus.

Correct Answers:

  • Elevate the child's residual limb for 48 hr.


Rationale :

🦿Immediately after amputation, elevating the residual limb helps reduce postoperative edema and promotes venous return.

πŸ’§Swelling is expected after surgery, so short-term elevation helps control tissue edema during the early postoperative period.

⏱️Elevation should be limited to the initial postoperative period because prolonged flexion can eventually contribute to joint contractures.

πŸ’β€β™‚οΈAfter the initial period, positioning and exercises should emphasize prevention of hip and knee flexion contractures while maintaining mobility.


πŸ“ŒCore Message

Short-term elevation of the residual limb after amputation helps minimize postoperative edema, while prolonged elevation should later be avoided to prevent contractures.

5 :

Hint : 🧸Recall which primitive infant reflex normally disappears as voluntary hand control begins to emerge.

Correct Answers:

  • The infant has an absent grasp reflex.


Rationale :

πŸ‘ΆThe primitive palmar grasp reflex normally disappears at approximately 3 to 4 months of age as voluntary motor control develops.

🧠Loss of primitive reflexes at the expected age demonstrates normal maturation of the infant's central nervous system.

πŸ™ˆStranger anxiety generally develops later in infancy, commonly around 6 to 8 months rather than at 4 months.

πŸ”„Rolling completely from the back to the abdomen generally develops later than 4 months, although infants may begin rolling in one direction around this period.


πŸ“ŒCore Message

At approximately 4 months, disappearance of the palmar grasp reflex reflects expected neurological maturation and increasing voluntary motor control.

6 :

Hint : ⚠️Before implementing enteral nutrition, determine whether the prescribed delivery method is physiologically appropriate for the tube's location.

Correct Answers:

  • Clarify the feeding prescription with the provider.


Rationale :

🩺A nasojejunal tube delivers feeding directly into the small intestine rather than allowing food to enter the stomach.

⏳The small intestine cannot accommodate a large volume suddenly, so jejunal feedings should generally be delivered continuously rather than as bolus feedings.

⚠️A prescription for bolus nasojejunal feeding therefore creates a potential safety concern that must be clarified before implementation.

πŸ“žThe nurse must resolve an unsafe or questionable provider prescription before performing subsequent feeding-related interventions.


πŸ“ŒCore Message

Because jejunal feeding normally requires controlled continuous administration, a prescription for a bolus feeding should be clarified before implementation.

7 :

24-month-old toddler here for wellness visit with guardian. Reports that the toddler is active in a playgroup and able to run and kick and throw a ball. The toddler feeds themselves with finger foods as well as small toddler-sized utensils. The toddler is starting to work on toilet training and has some success with telling the guallian during the day that they need to use the toilet. The toddler uses several words together such as "want go home now.

Weight 21 kg (46 lb)

Height 87 cm (344 in

 BMI 28

Diet Recall

24 hr food recall Guardian reports the following approximate history of the toddler's diet:

Morning Snack

8 oz whole milk

Breakfast

3 blueberries

1 slice of white toast with 1 tsp peanut butter

6 oz 100% apple juice

Late Morning snack

4 oz whole milk with chocolate syrup

1Β½ cup marshmallow oat cereal

Lunch

1 small banana

1 cup macaroni and cheese (1 oz)

1 oz chopped ham

6 oz 100% apple juice

Afternoon Snack

8 oz whole milk

2 sandwich cookies

Dinner

2 broccoli spears

8 grapes

4 oz fried chicken

8 oz 1% milk


A nurse is caring for a toddler in a pediatric clinic. Which of the following referrals should the nurse make?


Answer Options

Hint : 🍎Compare the child's growth measurements and dietary intake with the developmental skills described in the wellness assessment.

Correct Answers:

  • Nutritionist


Rationale :

βš–οΈThe toddler has a BMI of 28, indicating a significant weight-for-height concern that warrants focused nutritional evaluation.

πŸ₯›The dietary recall shows excessive consumption of milk, juice, refined carbohydrates, and calorie-dense foods, contributing to excessive caloric intake.

πŸ₯¦A nutritionist or dietitian can assess portion sizes, nutrient balance, beverage intake, and age-appropriate dietary modifications for healthy growth.

πŸƒThe toddler's reported gross motor, fine motor, language, and toileting development are generally appropriate, making developmental therapy referrals less indicated.


πŸ“ŒCore Message

The toddler's excessive weight relative to height and calorie-dense dietary pattern indicate the need for a nutrition referral rather than developmental therapy.

8 :

Hint : 🧬Consider how thick gastrointestinal secretions can affect bowel elimination in a child with cystic fibrosis.

Correct Answers:

  • "I will give my child stool softeners for constipation."


Rationale :

🧬Children with cystic fibrosis produce abnormally thick secretions that can contribute to intestinal obstruction and constipation.

🚽Prescribed stool softeners or osmotic agents can be used to promote bowel elimination and reduce complications related to thick intestinal contents.

🍽️Children with cystic fibrosis generally require a high-calorie, high-protein diet rather than restriction of fat and carbohydrates because energy requirements are increased.

πŸ’ŠPancreatic enzyme capsules should be swallowed or their granules sprinkled on appropriate acidic foods rather than chewed because chewing can damage the protective coating.


πŸ“ŒCore Message

Children with cystic fibrosis can develop constipation from thick intestinal secretions, while adequate nutrition, pancreatic enzyme therapy, and regular physical activity remain important components of home care.

9 :

Hint : πŸƒFocus on how illness and physical activity change fluid needs and glucose utilization in a child receiving insulin.

Correct Answers:

  • "I should increase my intake of sugar-free fluids when I am sick."
  • "I should eat a snack 30 minutes before my baseball game starts."
  • "I should eat extra food on busy days when I am more active."


Rationale :

πŸ’§During illness, children with type 1 diabetes should maintain adequate hydration by increasing intake of sugar-free fluids when blood glucose is not low.

⚾Eating a carbohydrate-containing snack before prolonged exercise helps prevent exercise-induced hypoglycemia caused by increased glucose utilization.

πŸƒOn days of increased physical activity, additional carbohydrate intake may be necessary to maintain appropriate blood glucose levels.

🩸Balancing insulin, carbohydrate intake, activity, and illness management is essential for preventing both hypoglycemia and hyperglycemia.


πŸ“ŒCore Message

Effective type 1 diabetes management requires adequate sugar-free hydration during illness and appropriate carbohydrate adjustments around increased physical activity to reduce glucose instability.

10 :

Hint : 🧠Prioritize interventions that identify internal bleeding and correct the child's specific coagulation deficiency.

Correct Answers:

  • Assess for changes in level of consciousness.
  • Administer factor VIII.


Rationale :

🩸A child with hemophilia A has a deficiency of clotting factor VIII, which creates a high risk for prolonged or internal bleeding after significant trauma.

🧠Assessing for changes in level of consciousness is important following a motor vehicle crash because neurological deterioration can indicate intracranial bleeding associated with trauma.

πŸ’‰Administration of factor VIII concentrate replaces the deficient coagulation factor and promotes effective clot formation to control or prevent hemorrhage.

🚨Because abdominal trauma can cause occult internal hemorrhage, rapid assessment and replacement of the deficient factor are critical components of emergency management.


πŸ“ŒCore Message

A child with hemophilia A who experiences major trauma requires immediate assessment for internal hemorrhage and replacement of factor VIII to promote adequate coagulation.

Total Questions: 10

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