1 :

School-age child admitted, diagnosed with cystic fibrosis at 3 months of age, has experienced failure to thrive, and has chronic obstructive pulmonary disease. The child presents with wheezing, rhonchi, paroxysmal cough, and dyspnea. The parent reports large, frothy, foul- smelling stools. The child has deficient levels of vitamin At D, E, and K.

Barrel-shaped chest

Clubbing of the fingers bilaterally

Respiratory rate 40/min with wheezing and rhonchi noted bilaterally

dyspnea

paroxysmal cough

Temperature 38.4Β° C (101.1Β° F) 

Heart rate 100/min 

Respiratory rate 40/min

Blood pressure 100/57 mm Hg

Sputum culture positive for Pseudomonas aeruginosa

Stool analysis positive for presence of fat and enzymes

Chest x-ray indicates obstructive emphysema 

WBC count 207000/mm3 (5,000 to 10,000/mm3)


A nurse is reviewing the child's medical record. Which of the following medications should the nurse expect the provider to prescribe or reconcile from the child's home medication list? Select all that apply.


Answer Options

Hint : 🧬Think about the consequences of enzyme deficiency and thick mucus in this condition.

Correct Answers:

  • Water-soluble vitamins
  • Dornase alfa
  • Pancreatic lipase


Rationale :

πŸ§ͺCystic fibrosis impairs the absorption of fat-soluble vitamins (A, D, E, K) due to pancreatic insufficiency, so water-soluble forms of these vitamins are required to enhance absorption.

🌬️Dornase alfa is a mucolytic agent that reduces the viscosity of pulmonary secretions, improving airway clearance and respiratory function in children with chronic obstructive pulmonary disease caused by CF.

🍽️Pancreatic lipase is essential for children with CF who have pancreatic enzyme deficiency. Supplementation with enzymes helps with the digestion of fats and proteins, improving nutrient absorption and weight gain.

🧴Medications like acetaminophen and meperidine are not specific to CF management and do not address the underlying disease complications like malabsorption or thickened mucus.


πŸ“Œcore message

Children with cystic fibrosis often require vitamin supplementation, mucolytics, and pancreatic enzymes to manage malabsorption and pulmonary complications.

2 :

A 15-yeardd adolescent is admitted for a crisis. The parent reports that the adolescent has a low-grade fever and has vomited for 3 days. The adolescent reports having right- sided and low back pain. They also report hands and right knee are painful and swollen. The client reports pain as 8 on a scale of 0 to 10.

Temperature 37Β°C (100Β° F)

Heart rate 100/min

Blood pressure 110/72 mm Hg

Respiratory rate 20/min

Oxygen saturation 95% on room air

Awake, alert, and oriented x 3

Yellow sclera of eyes noted bilaterally

Right upper quadrant tender to palpation

Hands painful to touch and swollen bilaterally

Right knee is swollen, warm to palpation, and the client reports pain as 8 on a scale of 0 to 10.

Client is tearful and grimacing during the examination.


The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include.


Answer Options

Hint : 🧬Focus on interventions that reduce sickling and support oxygenation and cell production.

Correct Answers:

  • Instruct the parent to ensure the pneumococcal vaccine is current.
  • Administer folic acid as prescribed.
  • Monitor oxygen saturation continuously.
  • Place the client on strict bed rest.
  • Give oral hydroxyurea.


Rationale :

🦠Pneumococcal vaccination is critical for individuals with sickle cell disease due to their increased infection risk from splenic dysfunction.

πŸ’ŠFolic acid supplementation supports red blood cell production and counters chronic hemolysis.

πŸ“ˆContinuous oxygen monitoring is necessary during a vaso-occlusive crisis because hypoxia can worsen sickling.

πŸ§ͺHydroxyurea is a disease-modifying therapy that increases fetal hemoglobin and reduces the frequency of crises.

πŸ›ŒStrict bed rest is recommended to decrease oxygen demand and prevent further sickling episodes during acute crises.


πŸ“Œcore message

Management of vaso-occlusive crisis in sickle cell includes hydration, rest, oxygen monitoring, folic acid, and preventive immunizations.

3 :

Hint : 🧫This condition uses up clotting components and platelets abnormally.

Correct Answers:

  • Decreased platelet count


Rationale :

🩸Disseminated intravascular coagulation (DIC) is a condition involving widespread clotting and subsequent bleeding due to consumption of platelets and clotting factors.

πŸ”¬A decreased platelet count (thrombocytopenia) is a hallmark laboratory feature, reflecting excessive use during abnormal clot formation.

⚠️Other findings include elevated PT, aPTT, D-dimer, and decreased fibrinogen, not increased Hgb or RBCs.

🧫The drop in platelets contributes to increased bleeding risk, which is a critical concern in DIC.


πŸ“Œcore message

DIC is marked by decreased platelet count due to consumption during abnormal systemic clotting.

4 :

Hint : πŸ”Check which value falls significantly below the normal range for that age.

Correct Answers:

  • An 18-month-old toddler who has a heart rate of 68/min


Rationale :

❀️The normal heart rate for an 18-month-old ranges between 80 to 130 beats per minute. A heart rate of 68/min is bradycardic and abnormal.

πŸ›‘This finding could indicate hypoxia, increased intracranial pressure, or cardiac dysfunction, requiring immediate evaluation.

🌑️A temperature of 37.3°C, a BP of 132/82 in an adolescent, and a respiratory rate of 30/min in a 3-month-old are all within normal parameters for their respective age groups.

πŸ“žBradycardia in toddlers is a priority reportable finding due to the potential for rapid decompensation.


πŸ“Œcore message

A heart rate of 68/min is abnormally low in a toddler and may indicate cardiac or systemic compromise.

5 :

Hint : 🎯Focus on items that can easily become choking hazards when detached.

Correct Answers:

  • Check clothing for loose buttons.


Rationale :

🧡Toddlers are at high risk for choking, and loose buttons on clothing pose a hazard if detached and ingested.

🚫Safety measures should prioritize prevention of aspiration and choking, making button checks an important intervention.

πŸ”₯Setting the water heater to 54Β°C (129.2Β°F) is too high and increases the risk of burn injuriesβ€”it should be set no higher than 49Β°C (120Β°F).

🎈Balloons are also a known choking hazard for toddlers and should be avoided.

πŸ‘‰Screens on windows can prevent insect entry but do not reliably prevent falls, thus not a primary injury prevention method.


πŸ“Œcore message

Choking prevention in toddlers includes checking for small removable objects like buttons.

6 :

Hint : πŸ‘€Watch for subtle signs that indicate hidden internal bleeding.

Correct Answers:

  • "Notify the provider if your child is swallowing frequently."


Rationale :

🩸Frequent swallowing after a tonsillectomy can be an early sign of postoperative bleeding, even if no visible blood is present.

πŸ§ƒUsing a straw or encouraging throat clearing increases the risk of irritating the surgical site, which can dislodge clots and promote bleeding.

🧼Dark brown blood may be old, but active bleeding often presents subtly, hence any signs should be reported promptly.

πŸ“žEarly recognition of complications like bleeding is crucial for preventing hemorrhage in pediatric post-tonsillectomy patients.


πŸ“Œcore message

Frequent swallowing after tonsillectomy may signal bleeding and should be reported immediately.

7 :

Hint : πŸ›‘Consider how to minimize fear in young children during short, noninvasive tests.

Correct Answers:

  • "Your child can rest on your lap during the procedure."


Rationale :

πŸ‘©β€πŸ‘§Allowing the toddler to sit in the parent's lap promotes security and cooperation during the ECG, aligning with atraumatic care principles.

πŸ“‰ECGs are painless and noninvasive, so comfort positioning is preferred to avoid unnecessary distress.

🩺ECG leads are placed on the chest, arms, and legs, not on the back, and no alarms will sound during the testβ€”it simply records electrical activity.

⏱️The procedure takes only a few minutes, not 30, making a brief, comforting setup ideal.

πŸ“Œcore message

ECGs are noninvasive, and using parental presence enhances comfort during the procedure.

8 :

Hint : πŸ”Always confirm location before you proceed with any feeding.

Correct Answers:

  • Check the pH of the gastric secretions.


Rationale :

πŸ§ͺVerifying NG tube placement is the priority before administering any enteral feeding to prevent the risk of aspiration or misplacement.

πŸ“‰Gastric aspirate should have a pH of 1 to 5, confirming stomach placement.

🚫Attaching tubing or flushing before checking placement can deliver fluids or feeds into the lungs if the tube is misplaced.

βœ…Checking tube placement is a critical safety step in all types of enteral feeding.


πŸ“Œcore message

Checking gastric pH is essential to verify NG tube placement before feeding.

9 :

Hint : πŸ”§Think about safe design features that prevent parts from breaking off.

Correct Answers:

  • Provide an infant with a one-piece pacifier for non-nutritive sucking.


Rationale :

πŸ‘ΆA one-piece pacifier minimizes the risk of choking or aspiration compared to multi-piece designs that could separate.

πŸͺ‘Feeding a 5-month-old in a high chair is unsafe because they lack adequate trunk and head control.

πŸ›οΈInfants should sleep on a firm mattress, not a soft one, to prevent SIDS.

πŸš—Car seats should never be placed behind active airbags, which can cause fatal injury in an accident.


πŸ“Œcore message

A one-piece pacifier ensures safe soothing and minimizes choking risk in infants.

10 :

Hint : 🧯Think about what could save the child’s life if they stop breathing suddenly.

Correct Answers:

  • Place intubation equipment at the bedside.


Rationale :

πŸ—£οΈEpiglottitis is a life-threatening emergency marked by sudden airway obstruction, so preparation for intubation or tracheostomy is the highest priority.

⚠️Any agitation or invasive procedures like x-rays can worsen airway obstruction, so airway management preparation comes first.

πŸ›‘IV antibiotics and precautions are important but are secondary to securing the airway.

🚨Placing emergency equipment readily available ensures rapid intervention if airway compromise occurs.


πŸ“Œcore message

In epiglottitis, the top priority is securing the airway, so intubation readiness is critical.

Total Questions: 10

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