A 17-year-old female with a history of cystic fibrosis presents to the emergency room at 0100 with right upper quadrant pain radiating to the right shoulder. Per the patient, she has moderate nausea and states, “I think it is the fried chicken and french fries I ate for dinner.” On exam, there is right upper quadrant tenderness on palpation and a pear-shaped mass noted. Which of the following is the most likely diagnosis on the patient presentation?

1.Appendicitis

2.Gallstones

3.Kidney stones

4.Pancreatitis

2.Gallstones

A 13-year-old is admitted to the hospital with a diagnosis of acute slipped capital femoral epiphysis (SCFE). The child is awaiting surgical correction. Which of the following is allowed when providing care to the child?

1.Assistance with ambulation to the bathroom

2.Regular range of motion exercises

4.Manual reduction of the hip

4.Split Russell’s traction

4.Split Russell’s traction

A student nurse is learning about the different types of traction. Which of the following statements indicates the nurse needs further teaching? Select all that apply.

1.“Russell’s traction is used on children younger than 2 to 3 years of age and less than 26.4 pounds.”

2.“Bryant’s traction uses pull in only one direction.”

3.“Modified diapering should be used for a child with Bryant’s traction.”

4.“Skeletal traction is used after open reduction of a fracture to keep the bones in proper position.”

5.“When Crutchfield tongs are used as traction, the child should only be moved by log-rolling.”

1.“Russell’s traction is used on children younger than 2 to 3 years of age and less than 26.4 pounds.”

4.“Skeletal traction is used after open reduction of a fracture to keep the bones in proper position.”

A nurse caring for an older child with suspected Hirschsprung’s disease would expect which of the following to be part of the child’s history? Select all that apply.

1.Diarrhea

2.Delayed passage of first meconium

3.Failure to thrive

4.Male

5.UTIs

2.Delayed passage of first meconium

3.Failure to thrive

4.Male

A nurse is educating parents about the Pavlik harness for their 6-month-old infant with developmental dysplasia of the hip. Which of the following parent statements indicates understanding of the teaching? Select all that apply.

1.“The brace should be applied and worn every night while the child sleeps.”

2.“As the hips have more ROM, we will adjust the harness as needed.”

3.“Frequent skin checks are important.”

4.“The diaper should be applied under the straps.”

5.“Cradling the infant should be minimized to not put pressure on the hips while harnessed.”

3.“Frequent skin checks are important.”

4.“The diaper should be applied under the straps.”

The ER nurse is caring for a 4-year-old girl diagnosed with a fractured ulna. The child is crying, fearful, and resistant to having the cast applied. What is the most appropriate statement for the nurse to make to the child?

1.“Don’t be scared; I’ll let you pick out the color for the cast.”

2.“Don’t worry; applying the cast will not hurt.”

3.“I will give you some medicine if you are in pain.”

4.“Let’s turn on some cartoons; what is your favorite show?”

4.“Let’s turn on some cartoons; what is your favorite show?”

A student nurse is learning about pediatric fractures and the healing process. Which of the following indicate understanding? Select all that apply.

1.Fractures cause an inflammatory response.

2.Callus formation takes up to a year.

3.Osteoblasts activate within 24 hours of the fracture occurring.

4.There are five types of diaphysis fractures.

5.To heal correctly, the bones need to be perfectly aligned.

1.Fractures cause an inflammatory response.

3.Osteoblasts activate within 24 hours of the fracture occurring.

Upon assessment of an infant, the condition in the figure is noted. The nurse caring for the infant knows all of the following are true regarding the condition except which of the following?

1.This defect usually begins at the end of the first trimester in utero.

2.It is more common in African American children.

3.Most will spontaneously resolve.

4.This defect is caused by a protrusion of bowel through the inguinal canal.

4.This defect is caused by a protrusion of bowel through the inguinal canal.

The nurse is speaking with a caregiver of a child just diagnosed with failure to thrive. The caregiver asks what the best treatment is. What is the nurse’s best response?

1.“First, the cause of the failure to thrive needs to be identified.”

2.“Small frequent meals will aid in gaining adequate weight.”

3.“Supplementation is needed optimize caloric intake.”

4.“Offer healthy food choices and the child will eat when they are hungry enough.”

1.“First, the cause of the failure to thrive needs to be identified.”

A student nurse is reviewing the chart of a child diagnosed with irritable bowel syndrome. The chart states the child has hematochezia. The student nurse knows this means the child has:

1.Tarry stools

2.Stools with red blood

3.Blood in the urine

4.Vomit containing blood

2.Stools with red blood

A nurse is teaching a child’s caregiver about spica cast care at home. Which of the following responses from the caregiver indicates further teaching is needed? Select all that apply.

1.“If the cast gets wet, I should use a hair dryer to quickly dry the cast.”

2.“Small dents in the cast may happen, especially the longer the child has the cast.

3.“Bivalving the cast will help prevent soiling of the cast in the perineal area.”

4.“I should place my child on their abdomen to promote their independence in feeding themselves.”

5.“If itching occurs under the cast, they should be sure to use a long device, so it does not get stuck under the cast.”

1.“If the cast gets wet, I should use a hair dryer to quickly dry the cast.”

2.“Small dents in the cast may happen, especially the longer the child has the cast.

5.“If itching occurs under the cast, they should be sure to use a long device, so it does not get stuck under the cast.”

Which assessment finding in a child is concerning after a cast is applied for an elbow fracture? Select all that apply.

1.Unrelieved pain

2.Weakness

3.Paresthesia

4.Pale in color

5.Range of motion

1.Unrelieved pain

3.Paresthesia

4.Pale in color

A 4-week-old male infant is brought to the emergency room by his parent due to new onset of projectile nonbilious vomiting immediately after feedings. On exam, an ‘olive-like’ mass is palpated on the edge of the upper right quadrant. Surgical intervention is performed to correct the condition. What information should the nurse include in postsurgical teaching? Select all that apply.

1.“Save any wet diapers.”

2.“Notify the health-care provider about any vomiting immediately after surgery.”

3.“Even if bowel sounds are not present, feedings will begin 6 hours postoperatively.”

4“Feedings will start with Pedialyte.”

5.“Short bowel syndrome may be a complication of the surgical intervention.”

1.“Save any wet diapers.”

3.“Even if bowel sounds are not present, feedings will begin 6 hours postoperatively.”

4“Feedings will start with Pedialyte.”

When preparing a presentation for student nurses regarding pediatric peptic ulcer diseases (PUD), the instructor should include which of the following as risk factors? Select all that apply.

1.Stress

2.Nonsteroidal anti-inflammatory drugs (NSAIDs)

3.Helicobacter pylori infection

4.Sodium supplements

5.Bisphosphonates

1.Stress

2.Nonsteroidal anti-inflammatory drugs (NSAIDs)

3.Helicobacter pylori infection

5.Bisphosphonates

When evaluating a child for possible appendicitis, the most reliable diagnosis is the following symptoms occurring in what order?

• Right lower quadrant pain
• Periumbilical pain
• High fever
• Abdominal pain subsides

Upon assessment immediately after birth, a newborn has decreased breath sounds with signs of respiratory distress. Upon further testing, the newborn is found to have abdominal organs within the chest cavity. The nurse knows the correct diagnosis for this condition is:

1.Diaphragmatic hernia

2.Umbilical hernia

3.Inguinal hernia

4.Epigastric hernia

1.Diaphragmatic hernia

A nurse caring for a 5-year-old boy notes he has symptoms consistent with Legg-Calvé-Perthes disease (LCPD). Which of the following would support this diagnosis?

1.Pain that persists with rest

2.Limited adduction and external hip rotation

3.Stiff joints throughout body

4.Muscle wasting in quadriceps and buttocks

4.Muscle wasting in quadriceps and buttocks

A nurse is caring for a child with a diagnosis of Meckel’s diverticulum. Which of the following symptoms would the nurse expect to note in this child? Select all that apply.

1.Age less than 2 years

2.“Currant-jelly” stools

3.Diverticula seen on abdominal x-ray

4.Anemia

5.Periumbilical pain

1.Age less than 2 years

2.“Currant-jelly” stools

4.Anemia

5.Periumbilical pain

During a routine fetal ultrasound, the mother is informed that her fetus will be born with a cleft lip and palate. When explaining the expected course of treatment to the mother, what should not be included?

1.Surgical repair of the cleft lip is usually at or before 3 months of age.

2.Surgical repair of the palate will occur at the same time as the cleft lip repair.

3.Delay in surgical correction of the soft palate could cause interference with speech.

4.The infant will need to use a special nipple when feeding until surgical correction is possible.

2.Surgical repair of the palate will occur at the same time as the cleft lip repair.

The type of traction applied in the figure for a femur fracture is an example of which type of traction?

1.Russell’s traction

2.Bryant’s traction

3.Buck’s traction

4.Crutchfield tong traction

1.Russell’s traction

A parent brings their 3-year-old child to the health-care provider’s office for complaints of no bowel movement in last 5 days with the previous bowel movement being hard and causing straining to pass. The child has just started toilet training within the last month. On assessment, the child is growing well, has a normal diet with adequate intake, and has no signs or symptoms of illness. When considering the best outcomes for this family, what should the nurse include in teaching about constipation? Select all that apply.

1.Ensure adequate hydration.

2.Restriction of refined carbohydrates.

3.Establishment of regular toilet time and sitting on the toilet for 5-10 minutes at a time.

4.Daily bowel cleansing medication.

5.Steps for administering an enema.

1.Ensure adequate hydration.

2.Restriction of refined carbohydrates.

3.Establishment of regular toilet time and sitting on the toilet for 5-10 minutes at a time.

A newly diagnosed 7-year-old child with Hirschsprung’s disease develops a low-grade fever and acute onset of abdominal distention with diarrhea. What is the nurse’s priority intervention?

1.Administer an antidiarrheal medication.

2.Administer an antipyretic.

3.Notify the physician of the child’s status.

4.Nothing, as these symptoms are characteristic of Hirschsprung’s disease.

3.Notify the physician of the child’s status.

A parent brings an 8-year-old to the health-care provider’s office with concerns of areas of thickened, dark, velvety discoloration in the child’s body folds and creases. The nurse knows this condition is most commonly associated with:

1.Insulin resistance

2.Nonalcoholic fatty liver disease (NAFLD)

3.Extrahepatic biliary atresia (EHBA)

4.Portal hypertension

1.Insulin resistance

The nurse knows priority prevention against gastroenteritis is achieved by:

1.Proper handwashing.

2.Thorough washing of all fruits and vegetables.

3.Reduction in intake of fruit juices.

4.Proper hydration.

1.Proper handwashing.

A caregiver brings a 4-year-old child to the health-care provider’s office with complaints of acute diarrhea. What history information should the nurse gather before starting the physical exam? Select all that apply.

1.Number of wet diapers in the last 24 hours

2.What other symptoms are present

3.Recent travel

4.Known food allergies

5.Presence of pica

1.Number of wet diapers in the last 24 hours

2.What other sWhen the parent of a newly diagnosed child with Crohn’s disease asks the symptoms are present

3.Recent travel

4.Known food allergies

5.Presence of pica

A nurse teaching nutrition to a group of newly diagnosed adolescents with celiac disease should include which foods in the list of restricted items? Select all that apply.

1.Millet

2.Wheat

3.Oat

4.Hydrolyzed vegetable protein

5.Corn

2.Wheat

3.Oat

4.Hydrolyzed vegetable protein

A nurse is caring for a child in the hospital who receives lansoprazole (Prevacid) twice a day for GERD. The child weighs 27 pounds. The ordered dose is 1 mg/kg/day. How many milligrams will the nurse administer at the 0900 dose? Round to the whole number. Enter numeral only.

6

An older child is diagnosed with hepatitis A. All of the following symptoms are indicative of the icteric stage of the disease in this child except:

1.Diarrhea

2.Jaundice

3.Hepatomegaly

4.Clay-colored stool

1.Diarrhea

A 4-month-old boy has been diagnosed with gastroesophageal reflux (GER). Which of the following statements by the parent indicates an understanding of teaching provided? Select all that apply.

1.“I will burp him with every ounce.”

2.“If I add infant cereal to his bottle, his fluid intake will be less.”

3.“Lying on his left-side at night will help with symptoms.”

4“Holding him upright after feeding is recommended.”

5.“He will probably outgrow the GER by 1 year of age.”

1.“I will burp him with every ounce.”

2.“If I add infant cereal to his bottle, his fluid intake will be less.”

4“Holding him upright after feeding is recommended.”

5.“He will probably outgrow the GER by 1 year of age.”

A student nurse learning about assessment findings consistent with a diagnosis of intussusception needs further instruction when stating which of the following are associated with this condition? Select all that apply.

1.Episodic abdominal pain with vomiting

2.Crying and drawing up of legs to the abdomen

3.Palpable ‘olive-shape’ abdominal mass

4.Ribbon-like stools

5.Dehydration

3.Palpable ‘olive-shape’ abdominal mass

4.Ribbon-like stools

An oncoming nurse is obtaining report from the outgoing nurse for a 3-week-old infant with suspected volvulus. The nurse taking over care of the infant knows which of the following signs and symptoms are consistent with volvulus? Select all that apply.

1.Intermittent green vomiting

2.Palpable epigastric mass

3.Bloody stool

4.A ‘bird’s beak’ appearance seen on barium enema

5.Recent upper respiratory infection

1.Intermittent green vomiting

2.Palpable epigastric mass

3.Bloody stool

4.A ‘bird’s beak’ appearance seen on barium enema

A student nurse correctly understands the functions of the small intestine based on which statements? Select all that apply.

1.“Fat breakdown occurs mainly in the duodenum.”

2.“The small intestine is primarily responsible for carbohydrates, fats, proteins, minerals, and vitamins.

3.“The ileum absorbs bile salts, vitamins, and chloride.”

4.“Amylase and ptyalin in the small intestine break down starches into disaccharides.”

5.“The small intestine converts disaccharides to monosaccharides.”

2.“The small intestine is primarily responsible for carbohydrates, fats, proteins, minerals, and vitamins.

3.“The ileum absorbs bile salts, vitamins, and chloride.”

A child presents to the emergency room with a temperature of 102.1^oF, swollen abdomen, epigastric pain radiating to the back, nausea and vomiting, and elevated amylase. The child is diagnosed with severe pancreatitis. The nurse should prepare for which nursing interventions? Select all that apply.

1.Antibiotic administration

2.NG tube insertion

3.Pain medication administration

4.IV fluid replacement

5.Frequent vital signs.

1.Antibiotic administration

2.NG tube insertion

3.Pain medication administration

4.IV fluid replacement

5.Frequent vital signs.

A nurse caring for a child post-op from a volvulus teaches the caregiver about which potential long-term complication?

1.Short bowel syndrome

2.Vomiting

3.Feeding intolerance

4.Constipation

1.Short bowel syndrome

A child with recent placement of a temporary colostomy after surgical correction of Hirschsprung’s disease is being discharged home. Signs of complication from stricture to be taught to the caregivers should include: Select all that apply.

1.Constipation

2.Vomiting

3.Diarrhea

4.Abdominal distention

5.Fever

1.Constipation

2.Vomiting

3.Diarrhea

When reviewing a child’s food diary, the nurse identifies all of the following as possible triggers for the child’s IBS except:

1.Broccoli

2.Diet Soda

3.Yogurt

4.Bran cereal

4.Bran cereal