UWorld Pediatric Nursing
Pediatric Nursing
Respiratory
Cystic Fibrosis - Pancreatic Enzymes
Test Id: 52270385
Question Id: 30371 (729561)
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The mother of a 6-year-old child with cystic fibrosis (CF) has received instruction on the
use of pancreatic enzymes. Which statement made by the mother indicates a need for
further teaching?
Unordered Options Ordered Response
1. "I need to monitor the total amount of this medication that I give
to my child every day."
2. "I should give this medication with or just before my child has a
meal or snack."
3. "It is okay for my child to chew this medication."
4. "It is okay to open the capsule and sprinkle the medicine on a
tablespoon of applesauce."
You answered this question incorrectly.
Time Spent: 74 Seconds
62% of people answered this question correctly.
Last Updated: 10/31/2015
Explanation
In CF, unusually thick mucus obstructs the pancreatic ducts, preventing pancreatic
enzymes (amylase, trypsin, and lipase) from reaching the small intestine. The result is
malabsorption of carbohydrates, fats, and proteins; the inability to absorb fat-soluble
vitamins (A, D, E, and K) is of particular concern. Gastrointestinal signs and symptoms
of CF include flatulence, abdominal cramping, ongoing diarrhea, and/or steatorrhea.
Nutritional therapy includes the administration pancreatic enzyme supplements with or
just before every meal or snack (Option 2). These enzymes are enteric-coated
beads designed to dissolve only in an alkaline environment similar to that of the small
intestine. They must not be mixed with a substance that would cause them to dissolve
prior to reaching the jejunum. Capsule contents may be sprinkled on applesauce,
yogurt, or acidic, soft, room-temperature foods with pH <4.5. Capsules should be
swallowed whole and not crushed or chewed; chewing the capsules could cause
irritation of the oral mucosa. Excessive intake of pancreatic enzymes can result in
fibrosing colonopathy (Option 1).
(Option 4) This is a true statement; some children have difficulty taking a whole
capsule. Capsule contents can be sprinkled in acidic substances such as applesauce.
Capsules should not be taken with milk as they can cause it to curdle.
Educational objective:
Pancreatic enzyme supplements are used to aid the absorption of carbohydrates, fats,
and proteins in a child with CF. They are taken with or just before every meal (not as
needed); should be swallowed whole or sprinkled on an acidic food; and should not be
crushed or chewed. They should not be taken with milk. Excessive intake could result
in fibrosing colonopathy.
Neurologic
Priority Peds Clogged Shunt
Test Id: 52270385
Question Id: 32143 (729561)
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A A A
The emergency department triage nurse is assessing 4 pediatric clients. Which client is
a priority for further diagnostic workup and definitive care?
Unordered Options Ordered Response
1. 1-year-old with ventriculoperitoneal shunt who has "lethargy" and
pulse of 78/min
2. 3-year-old with history of meningocele who has unilateral ear pain
and urinary incontinence
3. 6-year-old with muscular dystrophy who has "flu-like" symptoms
and temperature of 100.4 F (38 C)
4. 8-year-old with history of cerebral palsy who has foot injury and
spastic clonus
You answered this question correctly.
Time Spent: 183 Seconds
72% of people answered this question correctly.
Last Updated: 8/31/2015
Explanation
A ventriculoperitoneal shunt is used to treat hydrocephalus and is usually placed at age
3-4 months. Blockage and infection are complications of shunt placement. Blockage
results in signs of increased intracranial pressure (ICP). The normal pulse range for a
1-year-old is 100-160/min. A pulse of 78/min is considered bradycardia, a part of
Cushing's triad (bradycardia, slowed respiration, widened pulse pressure).
(Option 2) Meningocele is a saclike protrusion through a bony defect that contains
meninges and cerebrospinal fluid; it is corrected with surgery. In some children,
residual bowel and bladder incontinence can result despite surgery. If bowel and
bladder control is obtained but incontinence reoccurs, the child should be evaluated for
infection (a common complication). Although the child with ear pain (eg, otitis media)
may need antibiotics, this is not urgent and the client with neurological signs is the
priority.
(Option 3) Muscular dystrophy is an inherited condition of muscle fiber degeneration
and muscle wasting. Respiratory and cardiac problems are the leading causes of
mortality. These clients should take precautions to prevent respiratory infections (eg,
pneumococcal and influenza vaccination, avoiding contact with infected individuals).
This client is the second priority after the client with increased ICP and possible brain
herniation.
(Option 4) Cerebral palsy is a permanent disorder of movement, with abnormal muscle
tone, lack of physical coordination, spasticity, and compromised posture development
causing activity limitation. Clonus is a series of involuntary, rhythmic, muscular
contractions and relaxations. Spasticity/clonus is an expected finding in a client with
cerebral palsy. Foot injury in this client is not a priority.
Educational objective:
A ventriculoperitoneal shunt is used to treat hydrocephalus. Complications include
blockage (with signs of increased intracranial pressure [ICP]) and infection. The normal
pulse range for a 1-year-old is 100-160/min; bradycardia can be a sign of increased ICP.
Gastrointestinal/Nutrition
Infant Feeding – Most Concerning – Honey
Test Id: 52270385
Question Id: 32403 (729561)
3 of 36
A A A
The clinic nurse interviews the parents of a 6-month-old about the child's diet and
feeding schedule. Which parent statement causes the nurse the most concern?
Unordered Options Ordered Response
1. "Apples are a healthy food, so we often make apple pie for our
child."
2. "Chopped pears are one of our child's favorite foods."
3. "Oatmeal with fresh honey is our child's favorite breakfast."
4. "We have found TV dinners to be convenient as they have both
meat and vegetables."
You answered this question correctly.
Time Spent: 178 Seconds
57% of people answered this question correctly.
Last Updated: 8/28/2015
Explanation
Although more than one of these parent comments are concerning, the most concerning
is feeding honey to a child under age 1 year. Honey (especially raw or wild) is not
recommended for children under age 1 due to the risk for infant botulism. An infant
under age 1 has an immature gut system that can allow Clostridium botulinum spores
contaminated in honey to colonize the gastrointestinal tract and release toxin that
causes botulism.
Botulinum toxin produces muscle paralysis by inhibiting the release of acetylcholine at
the neuromuscular junction. Infants often present with constipation, diminished deep
tendon reflexes, and generalized weakness. Additional symptoms are lack of head
control, difficulty in feeding, and decreased gag reflex, which can progress to
respiratory failure. Isolation of the organism from the child's stool can take several
days; therefore, diagnosis is usually made by history, and treatment with botulism
immune globulin is started before laboratory results are known.
(Option 1) Apple pie is not the best way to serve apples to a 6-month-old as the other
ingredients add too much fat and sugar. This would need to be addressed but is not a
priority over the use of honey.
(Option 2) Raw fruits are appropriate for a 6-month-old.
(Option 4) Although TV dinners contain meat and vegetables, they are not the best
source of food for an infant due to the high sodium content. This would need to be
addressed after the use of honey is addressed.
Educational objective:
Due to the risk of infant botulism, honey should not be given to children under age 1
year.
Infectious Disease
Preschool Psychosocial Integrity
Test Id: 52270385
Question Id: 33431 (729561)
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A A A
The nurse is caring for a 4-year-old who was hospitalized with influenza. Which nursing
action would be most effective to maintain psychosocial integrity?
Unordered Options Ordered Response
1. Encouraging use of puzzles for play
2. Offering the child stacking blocks for diversion
3. Providing crayons to draw noses on facemasks
4. Suggesting that playmates visit the child
You answered this question correctly.
Time Spent: 18 Seconds
54% of people answered this question correctly.
Last Updated: 11/16/2015
Explanation
Clients with influenza are maintained on droplet precautions, and anyone entering the
room must wear a facemask. Medical play during the preschool period (age 3-6 years)
facilitates psychosocial integrity. Crayons are age-appropriate toys. Drawing noses on
facemasks will help the child feel more comfortable with procedures and provides a
developmentally appropriate diversion.
(Option 1) Puzzles would be more appropriate for the school-age child (6-12 years).
(Option 2) Stacking blocks would be more appropriate for the toddler (age 1-3 years).
(Option 4) Maintaining contact with peers would be more appropriate for the
adolescent (age 12-19 years).
Educational objective:
Maintaining psychosocial integrity is a priority when a child is hospitalized. This is
achieved by integrating age-appropriate diversions (eg, medical play for a preschooler)
in the nursing care.
Hematological/Oncological
Leukemia - Infection Precautions
Test Id: 52270385
Question Id: 30904 (729561)
5 of 36
A A A
A nurse is admitting a child who has leukemia. Several rooms are available on the
pediatric unit. Which client could share a room with this child?
Unordered Options Ordered Response
1. A client recovering from a ruptured appendix
2. A client with cystic fibrosis
3. A client with minimal change nephrotic syndrome
4. A client with rheumatic fever
You answered this question correctly.
Time Spent: 7 Seconds
46% of people answered this question correctly.
Last Updated: 1/22/2016
Explanation
Leukemia is characterized by unrestricted proliferation of abnormal white blood cells
(lymphoblasts), resulting in depression of normal bone marrow activity. This disorder is
the most common form of childhood cancer. Infection is a major concern due to
neutropenia. In addition, anemia occurs due to decreased red blood cell production,
and bleeding is common as a result of decreased platelet production.
It would be appropriate for this client with leukemia to share a room with a client with
minimal change nephrotic syndrome (MCNS). MCNS is a non-infectious condition of
the glomeruli and poses no risk to a client with leukemia.
(Option 1) Appendicitis is a result of viral or infectious processes and can lead to
rupture of the appendix. A client recovering from a ruptured appendix poses a threat of
infection to the child who has leukemia.
(Option 2) A client with cystic fibrosis has pulmonary complications due to thick mucus
that traps bacteria. The tracheobronchial tree is colonized with bacteria and respiratory
infections are a lifelong problem. This client poses a threat of infection to the child with
leukemia.
(Option 4) Rheumatic fever occurs following pharyngitis caused by group A β-hemolytic
Streptococcus. A client with this condition poses a threat of infection to the child with
leukemia.
Educational objective:
Leukemia is a cancer of the blood and organs involved in hematologic function. Due to
myelosuppression, clients are at risk for problems related to infection, anemia, and
bleeding.
Cardiovascular
Pedi Heart Failure
Test Id: 52270385
Question Id: 31564 (729561)
6 of 36
A A A
The home health nurse is visiting an infant who recently had surgery to repair tetralogy
of Fallot. The nurse should teach the parents to report which findings indicative of heart
failure to the health care provider (HCP)? Select all that apply.
Unordered Options Ordered Response
1. Cool extremities
2. Increase in appetite
3. Puffiness around the eyes
4. Reduction in nu [Show Less]