Pediatric Practice Online Exam 2023 B
Complete Practice & Revision Edition
1. Adolescent Post-Motor Vehicle Crash
• Nurses' Notes (2245): Found conscious, airbag deployed, wearing seat belt. HR
94/min, RR 20/min. 18-gauge IV in left antecubital.
• Nurses' Notes (2300): Sharp chest pain (6/10). Respirations fast and shallow.
Diminished breath sounds in left lung.
Which of the following interventions should the nurse plan to take? (Select all that
apply.)
• Apply Supplemental Oxygen
• Prepare for chest tube insertion
• Place adolescent in supine position
• Obtain consent for a paracentesis
• Administer a levalbuterol inhaler
Rationale:
• Apply Supplemental Oxygen: The client's chest pain, shallow rapid respirations,
diminished breath sounds, and potential pneumothorax point to escalating hypoxia.
Supplemental oxygen is indicated to support tissue oxygenation.
• Prepare for chest tube insertion: Diminished breath sounds on one side following
thoracic trauma strongly suggest a pneumothorax (air in the pleural cavity
preventing lung expansion). Placing a chest tube allows the removal of trapped
air/fluid and lets the lung re-expand.
,2. Lab Evaluation for Fatigue
A nurse is reviewing the laboratory report of a school-age child who is experiencing
fatigue. Which of the following findings should the nurse recognize as an indication of
anemia?
• A low hematocrit level
• An elevated BUN
• An increased neutrophil count
• A low uric acid level
Rationale: A low hematocrit level indicates a reduced proportion of red blood cells, which
decreases the oxygen-carrying capacity of the blood. This reduction in circulating oxygen
leads to common clinical manifestations of anemia, including fatigue, lightheadedness,
tachycardia, dyspnea, and pallor.
3. Asthma Prevention Education
A nurse is teaching the parent of a preschooler about ways to prevent acute asthma
attacks. Which of the following statements by the parent indicates an understanding
of the teaching?
• a. "I will use a humidifier in my child's room at night."
• b. "I will give my child a cough suppressant every 6 hours if he has a cough."
• c. "I should avoid using a wet mop on the floors when I am cleaning."
• d. "I should keep my child indoors when I mow the yard."
Rationale: Mowing the lawn kicks up grass, pollen, and mold, which are potent
environmental triggers for childhood asthma. Keeping the child indoors with windows
closed during lawn care minimizes exposure to these aeroallergens, reducing the risk of an
acute bronchospasm.
, 4. Hemophilia Joint Injury Management
A nurse on a pediatric unit is caring for a toddler with hemophilia who fell at home. The
toddler is irritable, crying (FLACC pain score of 8/10), grabbing their left knee, which is
ecchymotic and edematous. Classify the following interventions:
Intervention Anticipated Contraindicated
Administer factor VIII [X] []
Apply ice packs to the affected joints [X] []
Administer morphine PRN pain [X] []
Elevate the affected joints [X] []
Perform passive range-of-motion (ROM) exercises
[] [X]
during the first 12 hr
Rationale:
• Factor VIII & Joint Elevation/Ice: The toddler is experiencing hemarthrosis
(bleeding into the joint space). Administering replacement factor VIII halts internal
bleeding. Elevating the joint and applying ice cause local vasoconstriction, which
limits swelling and controls hemorrhage.
• Morphine: Severe pain (8/10) warrants opioid analgesia. Standard NSAIDs/aspirin
are avoided in hemophilia because they inhibit platelet aggregation and exacerbate
bleeding.
• Passive ROM (Contraindicated): Performing passive ROM within the first 48 hours
of an acute joint bleed can disrupt newly formed clots and restart active bleeding.
Passive movement should be avoided; the child should only move the joint as
tolerated.
Complete Practice & Revision Edition
1. Adolescent Post-Motor Vehicle Crash
• Nurses' Notes (2245): Found conscious, airbag deployed, wearing seat belt. HR
94/min, RR 20/min. 18-gauge IV in left antecubital.
• Nurses' Notes (2300): Sharp chest pain (6/10). Respirations fast and shallow.
Diminished breath sounds in left lung.
Which of the following interventions should the nurse plan to take? (Select all that
apply.)
• Apply Supplemental Oxygen
• Prepare for chest tube insertion
• Place adolescent in supine position
• Obtain consent for a paracentesis
• Administer a levalbuterol inhaler
Rationale:
• Apply Supplemental Oxygen: The client's chest pain, shallow rapid respirations,
diminished breath sounds, and potential pneumothorax point to escalating hypoxia.
Supplemental oxygen is indicated to support tissue oxygenation.
• Prepare for chest tube insertion: Diminished breath sounds on one side following
thoracic trauma strongly suggest a pneumothorax (air in the pleural cavity
preventing lung expansion). Placing a chest tube allows the removal of trapped
air/fluid and lets the lung re-expand.
,2. Lab Evaluation for Fatigue
A nurse is reviewing the laboratory report of a school-age child who is experiencing
fatigue. Which of the following findings should the nurse recognize as an indication of
anemia?
• A low hematocrit level
• An elevated BUN
• An increased neutrophil count
• A low uric acid level
Rationale: A low hematocrit level indicates a reduced proportion of red blood cells, which
decreases the oxygen-carrying capacity of the blood. This reduction in circulating oxygen
leads to common clinical manifestations of anemia, including fatigue, lightheadedness,
tachycardia, dyspnea, and pallor.
3. Asthma Prevention Education
A nurse is teaching the parent of a preschooler about ways to prevent acute asthma
attacks. Which of the following statements by the parent indicates an understanding
of the teaching?
• a. "I will use a humidifier in my child's room at night."
• b. "I will give my child a cough suppressant every 6 hours if he has a cough."
• c. "I should avoid using a wet mop on the floors when I am cleaning."
• d. "I should keep my child indoors when I mow the yard."
Rationale: Mowing the lawn kicks up grass, pollen, and mold, which are potent
environmental triggers for childhood asthma. Keeping the child indoors with windows
closed during lawn care minimizes exposure to these aeroallergens, reducing the risk of an
acute bronchospasm.
, 4. Hemophilia Joint Injury Management
A nurse on a pediatric unit is caring for a toddler with hemophilia who fell at home. The
toddler is irritable, crying (FLACC pain score of 8/10), grabbing their left knee, which is
ecchymotic and edematous. Classify the following interventions:
Intervention Anticipated Contraindicated
Administer factor VIII [X] []
Apply ice packs to the affected joints [X] []
Administer morphine PRN pain [X] []
Elevate the affected joints [X] []
Perform passive range-of-motion (ROM) exercises
[] [X]
during the first 12 hr
Rationale:
• Factor VIII & Joint Elevation/Ice: The toddler is experiencing hemarthrosis
(bleeding into the joint space). Administering replacement factor VIII halts internal
bleeding. Elevating the joint and applying ice cause local vasoconstriction, which
limits swelling and controls hemorrhage.
• Morphine: Severe pain (8/10) warrants opioid analgesia. Standard NSAIDs/aspirin
are avoided in hemophilia because they inhibit platelet aggregation and exacerbate
bleeding.
• Passive ROM (Contraindicated): Performing passive ROM within the first 48 hours
of an acute joint bleed can disrupt newly formed clots and restart active bleeding.
Passive movement should be avoided; the child should only move the joint as
tolerated.
