Pediatrics Final Exam Questions And Answers #22 2025
The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency
anemia. Which finding indicates that the infant is not tolerating activity?
1. Heart rate of 138
2. Increased alertness
3. Respiratory rate less than 40 with activity
4. Muscle weakness - correct answer Answer: 4
Explanation: Iron deficiency anemia can result in less oxygen reaching the cells and
tissues, causing activity intolerance. An indication that a 9-month-old child is not
tolerating activity and that iron deficiency anemia is worsening would be the presence of
muscle weakness during activity. A heart rate of 138, increased alertness, and a
respiratory rate of less than 40 with activity are all signs that iron deficiency anemia is
resolving and activity tolerance is improving.
Page Ref: 592
Which action by the parents demonstrates an understanding of the nurse's teaching
with regard to prevention of iron-deficient anemia?
1. Feeding their infant with a formula that is not iron fortified
2. Starting iron-fortified infant cereal at 4 to 6 months of age
3. Introducing cow's milk at 6 months of age
4. Limiting vitamin C consumption after 1 year of age - correct answer Answer: 2
Explanation: Starting iron-fortified infant cereal at 4 to 6 months of age is recommended
for prevention of iron deficiency in children. Infants who are not breast-fed should get
iron-fortified formula. Cow's milk should not be introduced until 12 months of age.
Vitamin C should be started at 6 to 9 months of age and continued, because foods rich
in vitamin C improve iron absorption.
Page Ref: 593
A child is diagnosed with sickle cell disease. The parents are unsure how their child
contracted the disease. Which explanation by the nurse is the most appropriate?
1. "Both the mother and the father have the sickle cell trait."
2. "The mother has the trait, but the father doesn't."
3. "The father has the trait, but the mother doesn't."
4. "The mother has sickle cell disease, but the father doesn't have the disease or the
trait." - correct answer Answer: 1
Explanation: 1. Sickle cell disease is an autosomal recessive disorder; both parents
must have the trait in order for a child to have the disease.
,Page Ref: 594
The charge nurse on a pediatric unit is making a room assignment for a school-age
child diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which
room assignment is most appropriate for this client?
1. Semiprivate room
2. Reverse-isolation room
3. Contact-isolation room
4. Private room - correct answer Answer: 4
Explanation: Splenic sequestration can be life-threatening, and there is profound
anemia. The child does not need an isolation room but should not be placed in a room
with any child who may have an infectious illness. The private room is appropriate for
this child.
Page Ref: 596
The nurse is providing care for an adolescent client who is experiencing pain related to
a sickle cell crisis. Which medication does the nurse prepare to administer to this client?
1. Morphine sulfate
2. Meperidine
3. Acetaminophen
4. Ibuprofen - correct answer Answer: 1
Explanation: The pain during a sickling crisis is severe, and morphine is needed for pain
control around the clock or by patient-controlled analgesia (PCA). Meperidine is not
used for pain control for clients with sickle cell pain crisis because it could cause
seizures. Acetaminophen or ibuprofen is used for mild pain and would not be effective
for the severe pain experienced by a child in sickle cell pain crisis.
Page Ref: 598
The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle
cell disease. Which precipitating factors to a sickle cell crisis will the nurse include in the
explanation?
Select all that apply.
1. Fever
2. Dehydration
3. Regular exercise
4. Altitude
5. Increased fluid intake - correct answer Answer: 1, 2, 4
,Explanation: Fever, dehydration, and altitude are precipitating factors contributing to a
sickle cell crisis. Regular exercise and increased fluid intake are recommended
activities for a child with sickle cell disease and will not contribute to a sickle cell crisis.
Page Ref: 598
The nurse is administering packed rbcs to a child with sickle cell disease (SCD). The
nurse is monitoring for a transfusion reaction and knows it is most likely to occur during
which time frame?
1. Six hours after the transfusion is given
2. Within the first 20 minutes of administration of the transfusion
3. At the end of the administration of the transfusion
4. Never; children with SCD do not have reactions. - correct answer Answer: 2
Explanation: Blood reactions can occur as soon as the blood transfusion begins or
within the first 20 minutes. The nurse should remain with the child for the first 20
minutes of the transfusion.
Page Ref: 598
A child who has beta-thalassemia is receiving numerous blood transfusions. The child is
also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine
will help their child. Which rationale does the nurse use when responding to the
parents?
1. It prevents blood transfusion reactions.
2. It stimulates RBC production.
3. It provides vitamin supplementation.
4. It prevents iron overload. - correct answer Answer: 4
Explanation: Iron overload can be a side effect of a hypertransfusion therapy.
Deferoxamine (Desferal) is an iron-chelating drug, which binds excess iron so it can be
excreted by the kidneys. It does not prevent blood-transfusion reactions, stimulate RBC
production, or provide vitamin supplementation.
Page Ref: 602
A child recently diagnosed with aplastic anemia is being prepared for discharge. When
planning support for the family, which service should the nurse plan to include in the
discharge plan?
1. Referrals to support groups and social services
2. Short-term support
3. Genetic counseling
4. Nutrition counseling - correct answer Answer: 1
, Explanation: Families require support in dealing with a child who has a life-threatening
disease. They should be referred to support groups for counseling, if indicated, and to
social services. The support will be long term in nature. Aplastic anemia is not a
genetically transmitted disease. Nutrition counseling is not a priority and may or may not
be needed with aplastic anemia.
Page Ref: 603
A school-age child with hemophilia falls on the playground and goes to the nurse's office
with superficial bleeding above the knee. Which action by the nurse is the most
appropriate?
1. Apply a warm, moist pack to the area.
2. Perform some passive range of motion to the affected leg.
3. Apply pressure to the area for at least 15 minutes.
4. Keep the affected extremity in a dependent position. - correct answer Answer: 3
Explanation: If a hemophiliac child experiences a bleeding episode, superficial bleeding
should be controlled by applying pressure to the area for at least 15 minutes. Ice should
be applied, not heat. The extremity should be immobilized and elevated, so passive
range of motion and keeping the extremity in a dependent position would not be
appropriate interventions at this time.
Page Ref: 604
A child diagnosed with hemophilia plans on participating in a bicycling club. Which
recommendation by the nurse is the most appropriate?
1. Consider a swim club instead of the bicycling club.
2. Wear kneepads, elbow pads, and a helmet while bicycling.
3. Participate only in the social activities of the club.
4. Not join the club. - correct answer Answer: 2
Explanation: Children with hemophilia should be encouraged to participate in
noncontact sports activities. Bicycling is an excellent option and is recommended along
with swimming. The child should always use kneepads, elbow pads, and a helmet when
participating in a physical sport. Participating only in the social aspects of the club would
not encourage physical activity. Discouraging a child from joining a club would not foster
growth and development.
Page Ref: 604-605
The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which
nursing intervention is a priority for this child?
1. Frequent ambulation
The nurse is evaluating the activity tolerance of a 9-month-old with iron deficiency
anemia. Which finding indicates that the infant is not tolerating activity?
1. Heart rate of 138
2. Increased alertness
3. Respiratory rate less than 40 with activity
4. Muscle weakness - correct answer Answer: 4
Explanation: Iron deficiency anemia can result in less oxygen reaching the cells and
tissues, causing activity intolerance. An indication that a 9-month-old child is not
tolerating activity and that iron deficiency anemia is worsening would be the presence of
muscle weakness during activity. A heart rate of 138, increased alertness, and a
respiratory rate of less than 40 with activity are all signs that iron deficiency anemia is
resolving and activity tolerance is improving.
Page Ref: 592
Which action by the parents demonstrates an understanding of the nurse's teaching
with regard to prevention of iron-deficient anemia?
1. Feeding their infant with a formula that is not iron fortified
2. Starting iron-fortified infant cereal at 4 to 6 months of age
3. Introducing cow's milk at 6 months of age
4. Limiting vitamin C consumption after 1 year of age - correct answer Answer: 2
Explanation: Starting iron-fortified infant cereal at 4 to 6 months of age is recommended
for prevention of iron deficiency in children. Infants who are not breast-fed should get
iron-fortified formula. Cow's milk should not be introduced until 12 months of age.
Vitamin C should be started at 6 to 9 months of age and continued, because foods rich
in vitamin C improve iron absorption.
Page Ref: 593
A child is diagnosed with sickle cell disease. The parents are unsure how their child
contracted the disease. Which explanation by the nurse is the most appropriate?
1. "Both the mother and the father have the sickle cell trait."
2. "The mother has the trait, but the father doesn't."
3. "The father has the trait, but the mother doesn't."
4. "The mother has sickle cell disease, but the father doesn't have the disease or the
trait." - correct answer Answer: 1
Explanation: 1. Sickle cell disease is an autosomal recessive disorder; both parents
must have the trait in order for a child to have the disease.
,Page Ref: 594
The charge nurse on a pediatric unit is making a room assignment for a school-age
child diagnosed with sickle cell disease, who is in splenic sequestration crisis. Which
room assignment is most appropriate for this client?
1. Semiprivate room
2. Reverse-isolation room
3. Contact-isolation room
4. Private room - correct answer Answer: 4
Explanation: Splenic sequestration can be life-threatening, and there is profound
anemia. The child does not need an isolation room but should not be placed in a room
with any child who may have an infectious illness. The private room is appropriate for
this child.
Page Ref: 596
The nurse is providing care for an adolescent client who is experiencing pain related to
a sickle cell crisis. Which medication does the nurse prepare to administer to this client?
1. Morphine sulfate
2. Meperidine
3. Acetaminophen
4. Ibuprofen - correct answer Answer: 1
Explanation: The pain during a sickling crisis is severe, and morphine is needed for pain
control around the clock or by patient-controlled analgesia (PCA). Meperidine is not
used for pain control for clients with sickle cell pain crisis because it could cause
seizures. Acetaminophen or ibuprofen is used for mild pain and would not be effective
for the severe pain experienced by a child in sickle cell pain crisis.
Page Ref: 598
The nurse is teaching parents how to prevent a sickle cell crisis in the child with sickle
cell disease. Which precipitating factors to a sickle cell crisis will the nurse include in the
explanation?
Select all that apply.
1. Fever
2. Dehydration
3. Regular exercise
4. Altitude
5. Increased fluid intake - correct answer Answer: 1, 2, 4
,Explanation: Fever, dehydration, and altitude are precipitating factors contributing to a
sickle cell crisis. Regular exercise and increased fluid intake are recommended
activities for a child with sickle cell disease and will not contribute to a sickle cell crisis.
Page Ref: 598
The nurse is administering packed rbcs to a child with sickle cell disease (SCD). The
nurse is monitoring for a transfusion reaction and knows it is most likely to occur during
which time frame?
1. Six hours after the transfusion is given
2. Within the first 20 minutes of administration of the transfusion
3. At the end of the administration of the transfusion
4. Never; children with SCD do not have reactions. - correct answer Answer: 2
Explanation: Blood reactions can occur as soon as the blood transfusion begins or
within the first 20 minutes. The nurse should remain with the child for the first 20
minutes of the transfusion.
Page Ref: 598
A child who has beta-thalassemia is receiving numerous blood transfusions. The child is
also receiving deferoxamine (Desferal) therapy. The parents ask how the deferoxamine
will help their child. Which rationale does the nurse use when responding to the
parents?
1. It prevents blood transfusion reactions.
2. It stimulates RBC production.
3. It provides vitamin supplementation.
4. It prevents iron overload. - correct answer Answer: 4
Explanation: Iron overload can be a side effect of a hypertransfusion therapy.
Deferoxamine (Desferal) is an iron-chelating drug, which binds excess iron so it can be
excreted by the kidneys. It does not prevent blood-transfusion reactions, stimulate RBC
production, or provide vitamin supplementation.
Page Ref: 602
A child recently diagnosed with aplastic anemia is being prepared for discharge. When
planning support for the family, which service should the nurse plan to include in the
discharge plan?
1. Referrals to support groups and social services
2. Short-term support
3. Genetic counseling
4. Nutrition counseling - correct answer Answer: 1
, Explanation: Families require support in dealing with a child who has a life-threatening
disease. They should be referred to support groups for counseling, if indicated, and to
social services. The support will be long term in nature. Aplastic anemia is not a
genetically transmitted disease. Nutrition counseling is not a priority and may or may not
be needed with aplastic anemia.
Page Ref: 603
A school-age child with hemophilia falls on the playground and goes to the nurse's office
with superficial bleeding above the knee. Which action by the nurse is the most
appropriate?
1. Apply a warm, moist pack to the area.
2. Perform some passive range of motion to the affected leg.
3. Apply pressure to the area for at least 15 minutes.
4. Keep the affected extremity in a dependent position. - correct answer Answer: 3
Explanation: If a hemophiliac child experiences a bleeding episode, superficial bleeding
should be controlled by applying pressure to the area for at least 15 minutes. Ice should
be applied, not heat. The extremity should be immobilized and elevated, so passive
range of motion and keeping the extremity in a dependent position would not be
appropriate interventions at this time.
Page Ref: 604
A child diagnosed with hemophilia plans on participating in a bicycling club. Which
recommendation by the nurse is the most appropriate?
1. Consider a swim club instead of the bicycling club.
2. Wear kneepads, elbow pads, and a helmet while bicycling.
3. Participate only in the social activities of the club.
4. Not join the club. - correct answer Answer: 2
Explanation: Children with hemophilia should be encouraged to participate in
noncontact sports activities. Bicycling is an excellent option and is recommended along
with swimming. The child should always use kneepads, elbow pads, and a helmet when
participating in a physical sport. Participating only in the social aspects of the club would
not encourage physical activity. Discouraging a child from joining a club would not foster
growth and development.
Page Ref: 604-605
The nurse is caring for a child with disseminated intravascular coagulation (DIC). Which
nursing intervention is a priority for this child?
1. Frequent ambulation
