Pediatrics Final Exam
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 answersAnswer: 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?
5. Feeding their infant with a formula that is not iron fortified
6. Starting iron-fortified infant cereal at 4 to 6 months of age
7. Introducing cow's milk at 6 months of age
8. Limiting vitamin C consumption after 1 year of age correct
answersAnswer: 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?
9. "Both the mother and the father have the sickle cell trait."
10."The mother has the trait, but the father doesn't."
11."The father has the trait, but the mother doesn't."
12."The mother has sickle cell disease, but the father doesn't have the
disease or the trait." correct answersAnswer: 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 answersAnswer: 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?
5. Morphine sulfate
6. Meperidine
7. Acetaminophen
8. Ibuprofen correct answersAnswer: 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.
9. Fever
10.Dehydration
11.Regular exercise
,4. Altitude
5. Increased fluid intake correct answersAnswer: 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?
6. Six hours after the transfusion is given
7. Within the first 20 minutes of administration of the transfusion
8. At the end of the administration of the transfusion
9.Never; children with SCD do not have reactions. correct
answersAnswer: 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?
10.It prevents blood transfusion reactions.
11.It stimulates RBC production.
12.It provides vitamin supplementation.
13.It prevents iron overload. correct answersAnswer: 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?
14.Referrals to support groups and social services
15.Short-term support
, 3. Genetic counseling
4. Nutrition counseling correct answersAnswer: 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?
5. Apply a warm, moist pack to the area.
6. Perform some passive range of motion to the affected leg.
7. Apply pressure to the area for at least 15 minutes.
8. Keep the affected extremity in a dependent position. correct
answersAnswer: 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?
9. Consider a swim club instead of the bicycling club.
10.Wear kneepads, elbow pads, and a helmet while bicycling.
11.Participate only in the social activities of the club.
12.Not join the club. correct answersAnswer: 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 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 answersAnswer: 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?
5. Feeding their infant with a formula that is not iron fortified
6. Starting iron-fortified infant cereal at 4 to 6 months of age
7. Introducing cow's milk at 6 months of age
8. Limiting vitamin C consumption after 1 year of age correct
answersAnswer: 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?
9. "Both the mother and the father have the sickle cell trait."
10."The mother has the trait, but the father doesn't."
11."The father has the trait, but the mother doesn't."
12."The mother has sickle cell disease, but the father doesn't have the
disease or the trait." correct answersAnswer: 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 answersAnswer: 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?
5. Morphine sulfate
6. Meperidine
7. Acetaminophen
8. Ibuprofen correct answersAnswer: 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.
9. Fever
10.Dehydration
11.Regular exercise
,4. Altitude
5. Increased fluid intake correct answersAnswer: 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?
6. Six hours after the transfusion is given
7. Within the first 20 minutes of administration of the transfusion
8. At the end of the administration of the transfusion
9.Never; children with SCD do not have reactions. correct
answersAnswer: 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?
10.It prevents blood transfusion reactions.
11.It stimulates RBC production.
12.It provides vitamin supplementation.
13.It prevents iron overload. correct answersAnswer: 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?
14.Referrals to support groups and social services
15.Short-term support
, 3. Genetic counseling
4. Nutrition counseling correct answersAnswer: 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?
5. Apply a warm, moist pack to the area.
6. Perform some passive range of motion to the affected leg.
7. Apply pressure to the area for at least 15 minutes.
8. Keep the affected extremity in a dependent position. correct
answersAnswer: 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?
9. Consider a swim club instead of the bicycling club.
10.Wear kneepads, elbow pads, and a helmet while bicycling.
11.Participate only in the social activities of the club.
12.Not join the club. correct answersAnswer: 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
