, Question 1
A pediatric patient with acute lymphoblastic leukemia is receiving induction
chemotherapy. Which laboratory finding requires immediate nursing
intervention?
A. Absolute neutrophil count of 800/mm³
B. Platelet count of 50,000/mm³
C. Hemoglobin of 9.5 g/dL
D. Uric acid level of 5.2 mg/dL
Correct Answer: A - Absolute neutrophil count of 800/mm³
RATIONALE
An absolute neutrophil count (ANC) below 1,000/mm³ indicates
severe neutropenia and high infection risk, requiring immediate
protective isolation and possible growth factor administration. Platelet
count of 50,000/mm³ is low but not immediately life-threatening;
hemoglobin 9.5 g/dL is mildly low; uric acid 5.2 mg/dL is within
normal limits.
Question 2
Which assessment finding in a pediatric patient with nephrotic syndrome
indicates a complication requiring immediate intervention?
A. Periorbital edema upon waking
B. Abdominal distension with decreased urine output
C. Serum albumin of 2.8 g/dL
D. Blood pressure of 110/70 mm Hg
Correct Answer: B - Abdominal distension with decreased urine
output
Page 2
, RATIONALE
Abdominal distension with decreased urine output suggests ascites
and possible hypovolemia or renal impairment, which can progress to
shock. Periorbital edema and hypoalbuminemia are expected in
nephrotic syndrome; blood pressure of 110/70 is normal for many
children.
Question 3
A child with a ventricular septal defect (VSD) is prescribed digoxin. Which
assessment finding should the nurse report immediately?
A. Heart rate of 110 beats/min
B. Serum digoxin level of 1.8 ng/mL
C. Vomiting and poor feeding
D. Weight gain of 0.5 kg in 2 days
Correct Answer: C - Vomiting and poor feeding
RATIONALE
Vomiting and poor feeding are early signs of digoxin toxicity in
children, requiring immediate hold and notification. Heart rate 110 is
acceptable; digoxin level 1.8 ng/mL is within therapeutic range
(0.5-2.0 ng/mL); weight gain may indicate fluid retention but is not
the priority over toxicity signs.
Question 4
A pediatric patient is prescribed ceftriaxone 75 mg/kg/day IV divided every 12
hours. The patient weighs 22 lb. How many milligrams will the nurse
administer per dose?
A. 375 mg
B. 750 mg
C. 825 mg
D. 1500 mg
Page 3
, Correct Answer: A - 375 mg
RATIONALE
Convert weight: 22 lb ÷ 2.2 = 10 kg. Total daily dose = 75 mg × 10 kg
= 750 mg/day. Divided every 12 hours = 750 ÷ 2 = 375 mg per dose.
Options B, C, and D reflect calculation errors.
Question 5
Which statement by a parent of a child with sickle cell disease indicates correct
understanding of hydroxyurea therapy?
A. This medication will cure my child's sickle cell disease.
B. My child will need frequent blood counts to monitor for bone marrow
suppression.
C. We should stop the medication if my child has a fever.
D. This drug increases the risk of iron overload.
Correct Answer: B - My child will need frequent blood counts to
monitor for bone marrow suppression.
RATIONALE
Hydroxyurea increases fetal hemoglobin and reduces sickling but can
cause myelosuppression, requiring regular CBC monitoring. It is not
curative; fever requires evaluation but not stopping the drug; iron
overload is not a primary effect.
Question 6
A pediatric patient with severe dehydration from gastroenteritis is receiving IV
fluids. Which assessment finding indicates the need to increase the infusion
rate?
A. Urine output of 1 mL/kg/hr
B. Specific gravity of 1.030
C. Capillary refill of 2 seconds
D. Sunken fontanelle in an infant
Page 4
A pediatric patient with acute lymphoblastic leukemia is receiving induction
chemotherapy. Which laboratory finding requires immediate nursing
intervention?
A. Absolute neutrophil count of 800/mm³
B. Platelet count of 50,000/mm³
C. Hemoglobin of 9.5 g/dL
D. Uric acid level of 5.2 mg/dL
Correct Answer: A - Absolute neutrophil count of 800/mm³
RATIONALE
An absolute neutrophil count (ANC) below 1,000/mm³ indicates
severe neutropenia and high infection risk, requiring immediate
protective isolation and possible growth factor administration. Platelet
count of 50,000/mm³ is low but not immediately life-threatening;
hemoglobin 9.5 g/dL is mildly low; uric acid 5.2 mg/dL is within
normal limits.
Question 2
Which assessment finding in a pediatric patient with nephrotic syndrome
indicates a complication requiring immediate intervention?
A. Periorbital edema upon waking
B. Abdominal distension with decreased urine output
C. Serum albumin of 2.8 g/dL
D. Blood pressure of 110/70 mm Hg
Correct Answer: B - Abdominal distension with decreased urine
output
Page 2
, RATIONALE
Abdominal distension with decreased urine output suggests ascites
and possible hypovolemia or renal impairment, which can progress to
shock. Periorbital edema and hypoalbuminemia are expected in
nephrotic syndrome; blood pressure of 110/70 is normal for many
children.
Question 3
A child with a ventricular septal defect (VSD) is prescribed digoxin. Which
assessment finding should the nurse report immediately?
A. Heart rate of 110 beats/min
B. Serum digoxin level of 1.8 ng/mL
C. Vomiting and poor feeding
D. Weight gain of 0.5 kg in 2 days
Correct Answer: C - Vomiting and poor feeding
RATIONALE
Vomiting and poor feeding are early signs of digoxin toxicity in
children, requiring immediate hold and notification. Heart rate 110 is
acceptable; digoxin level 1.8 ng/mL is within therapeutic range
(0.5-2.0 ng/mL); weight gain may indicate fluid retention but is not
the priority over toxicity signs.
Question 4
A pediatric patient is prescribed ceftriaxone 75 mg/kg/day IV divided every 12
hours. The patient weighs 22 lb. How many milligrams will the nurse
administer per dose?
A. 375 mg
B. 750 mg
C. 825 mg
D. 1500 mg
Page 3
, Correct Answer: A - 375 mg
RATIONALE
Convert weight: 22 lb ÷ 2.2 = 10 kg. Total daily dose = 75 mg × 10 kg
= 750 mg/day. Divided every 12 hours = 750 ÷ 2 = 375 mg per dose.
Options B, C, and D reflect calculation errors.
Question 5
Which statement by a parent of a child with sickle cell disease indicates correct
understanding of hydroxyurea therapy?
A. This medication will cure my child's sickle cell disease.
B. My child will need frequent blood counts to monitor for bone marrow
suppression.
C. We should stop the medication if my child has a fever.
D. This drug increases the risk of iron overload.
Correct Answer: B - My child will need frequent blood counts to
monitor for bone marrow suppression.
RATIONALE
Hydroxyurea increases fetal hemoglobin and reduces sickling but can
cause myelosuppression, requiring regular CBC monitoring. It is not
curative; fever requires evaluation but not stopping the drug; iron
overload is not a primary effect.
Question 6
A pediatric patient with severe dehydration from gastroenteritis is receiving IV
fluids. Which assessment finding indicates the need to increase the infusion
rate?
A. Urine output of 1 mL/kg/hr
B. Specific gravity of 1.030
C. Capillary refill of 2 seconds
D. Sunken fontanelle in an infant
Page 4
