NR-328 Pediatric Nursing - Set 4 - Part 2

Correct Answer: The middle of the afternoon

Intermediate acting insulin peaks several hours after the dose, which puts the classic low in the middle of the afternoon and again overnight. Hypoglycemia is most likely when the insulin peaks. Option b is incorrect because no insulin is working yet before the morning dose is given. Glucose usually sits at its highest then, which is why the pre meal reading guides the dose. Option c is incorrect because the first hour belongs to the rapid acting insulin, which is peaking then alongside the breakfast the child just ate. The intermediate dose has barely started working. Option d is incorrect because glucose climbs after a meal rather than falling, and any evening low would follow an evening dose. Timing the watch to dinner misses the afternoon window entirely.

Correct Answer: Every care setting stays free of latex products

Repeated exposure during surgeries and catheterizations makes latex allergy common in these children, and reactions can reach anaphylaxis. A latex free environment is set up from birth rather than after a first reaction. Option a is incorrect because waiting for a reaction means waiting for possible anaphylaxis. Sensitization builds silently across years of gloves, catheters and tape, so avoidance begins at the very first hospital contact. Option b is incorrect because red rubber contains latex, which is precisely what these children must avoid. Silicone catheters are substituted for the clean intermittent catheterization that protects the kidneys. Option d is incorrect because balloons and rubber gloves are two of the classic triggers named for these families. Foods that cross react, including banana, avocado and kiwi, also get discussed at the visit.

Correct Answer: Check the child's blood glucose right away

A young child often shows only a behaviour change when glucose falls, so any sudden shift is checked. A finger stick takes seconds and tells the nurse whether fast acting sugar is needed. Option a is incorrect because crackers with cheese contain fat and protein that slow absorption, so glucose would rise too late. That combination belongs after a low has already been corrected. Option c is incorrect because calling the provider before gathering a glucose value gives the team nothing to act on. Minutes matter here, and the nurse can obtain the reading immediately at the bedside. Option d is incorrect because rest does nothing for a falling glucose and may let the toddler slip into deeper impairment unobserved. Sleepiness in this age group is itself a warning sign.

Correct Answer: "When he runs a fever we double or triple his hydrocortisone."

The damaged adrenal cannot raise cortisol during stress, so the family increases the glucocorticoid two or three times for fever, vomiting, injury, or surgery, then returns to the usual dose afterward. Option b is incorrect because stopping abruptly precipitates adrenal crisis within hours. Replacement continues every single day, well or ill, because the gland never makes cortisol on its own again. Option c is incorrect because a vomited dose is a missed dose, and waiting leaves the child unprotected. Families keep injectable hydrocortisone at home and are taught to give it intramuscularly. Option d is incorrect because medical identification stays on for life. Stable laboratory values change nothing about the danger during an accident, when responders must know that this child needs immediate steroid.

Correct Answer: Proportional short stature with a well nourished appearance

Growth hormone deficiency stunts height more than weight, so the child stays proportionally small and often looks well nourished or even chubby. Body segments remain in normal proportion because the whole skeleton grows slowly. Option a is incorrect because a wasted child whose weight falls before height describes failure to thrive or malnutrition. Good nutrition keeps these children well fleshed, and that appearance is exactly what separates the two. Option b is incorrect because disproportionately short limbs beside a normal trunk point toward a skeletal dysplasia such as achondroplasia. Pituitary shortness spares proportion, which is why the nurse measures segments before blaming hormones. Option d is incorrect because rapid growth with early breast or testicular development belongs to precocious puberty, the opposite pattern. Children lacking growth hormone enter puberty late, and their curve flattens rather than climbing.

Correct Answer: Give the ordered benzodiazepine and watch respirations

A seizure lasting five minutes or longer is status epilepticus, and a benzodiazepine is first line. Respiratory depression and hypotension follow the dose, so bag valve mask and suction stay at hand. Option a is incorrect because the five minute mark has already passed, and every additional minute of seizing adds hypoxia, acidosis and neuronal death. Waiting converts a treatable emergency into permanent injury. Option b is incorrect because tracing brain activity identifies a focus later, during the diagnostic workup. Stopping the discharge comes first, and arranging a study now steals time from the drug. Option c is incorrect because restraints belong nowhere in seizure care. Struggling against a strap tears muscle and breaks bone, and the child is guided rather than held while the medication works.

Correct Answer: Tuck a small diaper inside the cast edges

A smaller diaper tucked under the cast edges catches urine and stool before it wicks into the padding, and a larger diaper over the outside holds everything in place. Option b is incorrect because the abductor bar is a spacer, not a handle, and pulling on it can crack the cast or wrench the healing hip. Two people turn the child, supporting the whole cast. Option c is incorrect because a flat position invites reflux and makes swallowing harder inside a rigid cast. Feeding slightly upright protects the airway and helps the nurse watch for the distention of cast syndrome. Option d is incorrect because raw plaster around the perineal opening crumbles and abrades wet skin. Petaling those edges with smooth waterproof strips is what keeps the opening clean and comfortable for weeks.

Correct Answer: "Development pauses now and resumes when the injections are stopped."

Continuous agonist exposure shuts the pituitary axis down, so development halts or regresses and bone maturation slows. When therapy ends at the right bone age, puberty resumes and fertility is unaffected. Option a is incorrect because suppression is temporary and fertility is preserved. Families hear the word hormone and fear sterility, so the nurse states plainly that the axis restarts after treatment ends. Option b is incorrect because the drug is stopped at a bone age of roughly twelve years in girls, not continued indefinitely. Puberty then proceeds on its own at a normal pace. Option c is incorrect because slowing bone maturation is the point of therapy. Advancing bone age is what fuses the plates early and leaves a tall child as a short adult.

Correct Answer: "Type one comes from an immune attack on the pancreas, not diet"

Type one diabetes results from autoimmune destruction of the beta cells, so nothing the parents fed their child caused it. Naming that plainly relieves guilt and frees the family to learn the daily routine. Option a is incorrect because sugar intake does not trigger beta cell destruction and cannot change when symptoms appear. Confirming a false cause deepens the guilt these parents already carry into every meal. Option c is incorrect because brushing the feeling aside closes a conversation the family needs to have. Grief at diagnosis is expected, and parents work through it faster when someone listens. Option d is incorrect because predicting that guilt will fade offers false comfort and leaves the mistaken belief untouched. What corrects guilt here is accurate information about how the disease actually begins.

Correct Answer: Ketoacidosis needing a glucose check and insulin

Headache and confusion appear in both glucose extremes, so the discriminators decide it. Deep sighing Kussmaul breathing with fruity acetone breath and warm dry skin belong to ketoacidosis, where carbohydrate would be harmful. Option a is incorrect because a low glucose produces cool pale clammy skin and comes on within minutes. Giving sugar to a child in ketoacidosis adds to an already dangerous glucose load. Option b is incorrect because anxious hyperventilation is fast and shallow, and it does not scent the breath. The deep sighing pattern here is compensation for acid building up in the blood. Option d is incorrect because infection of the airway brings fever, cough and adventitious sounds rather than acetone on the breath. Nothing in this presentation points to the lungs as the source.

Correct Answer: Vomiting that continues with large urine ketones

Persistent vomiting with moderate or large ketones means the child cannot keep fluids down while fat breakdown accelerates. That combination heads toward ketoacidosis and needs the provider and probably intravenous treatment. Option b is incorrect because a glucose that responds to the correction dose shows the plan is working. The family keeps monitoring and follows the written sick day plan without an urgent call. Option c is incorrect because a single loose stool with a scratchy throat is a mild illness the family can manage at home, provided glucose and ketones are followed on schedule. Option d is incorrect because refusing solids while still taking fluids is exactly what sick day teaching anticipates. Carbohydrate containing sips substitute for meals, and the child stays hydrated meanwhile.

Correct Answer: Keep the boy from bearing any weight

Every step lets the femoral epiphysis slide farther through the growth plate and raises the risk of avascular necrosis. Crutches or a wheelchair come immediately, along with urgent orthopedic referral. Option a is incorrect because the knee is only where the pain is felt, not where the problem sits. Cooling a healthy joint treats nothing and leaves the boy walking on a slipping femoral head. Option c is incorrect because walking loads the very physis that is already giving way. A stable slip can turn unstable within hours of continued weight bearing, and that shift multiplies the chance of losing the blood supply. Option d is incorrect because imaging the knee would come back clean and delay the diagnosis further. Knee pain in a growing child sends the nurse to the hip, and both hips are filmed in two views.

Correct Answer: "Testing will define sex within days, so delay the announcement."

Karyotype, hormone levels, and ultrasound usually define sex within a few days, and retracting an announcement hurts far more than delaying one. Parents are encouraged to hold registration until results return. Option a is incorrect because guessing at sex from appearance is exactly what the team avoids. A virilized infant with this disorder is usually genetically female, but only testing can establish that. Option b is incorrect because framing the baby as defective feeds the guilt these parents already carry. The nurse states honestly that the genitals did not finish forming in the usual way. Option c is incorrect because a name humanizes the infant and keeps the family from resorting to impersonal words. Naming can proceed now; what waits is the public announcement and the certificate.

Correct Answer: Legg-Calve-Perthes disease of the hip

Avascular necrosis of the femoral head shows up in boys around four to ten years as an insidious limp with hip or referred knee pain, and abduction and internal rotation are the first motions lost. Option a is incorrect because joint infection makes a child look ill with a high fever and refuse to move the hip at all. This boy has walked on it for weeks and has no fever. Option b is incorrect because a slipped epiphysis belongs to the adolescent growth spurt, typically in a heavier eleven or twelve year old. Its hallmark is obligatory external rotation when the hip is passively flexed. Option d is incorrect because traction apophysitis produces a tender bony bump right over the tibial tubercle in an active teenager. Nothing about it restricts hip motion or explains a limp lasting weeks.

Correct Answer: Notify the provider about the findings immediately

These findings are compartment syndrome until proven otherwise, and the muscle dies within hours. The provider is told at once so the cast can be split and a fasciotomy arranged, while the nurse loosens constricting wraps. Option a is incorrect because more opioid masks the one symptom that is telling the truth here. Pain unrelieved by adequate dosing is the finding itself, and another dose only buys time the limb does not have. Option c is incorrect because raising a limb above the heart lowers arterial inflow into a compartment already short of perfusion. Once this syndrome is suspected the leg stays level with the heart, reversing the usual cast rule. Option d is incorrect because waiting an hour wastes the narrow window in which a fasciotomy still restores function. A pulse can stay palpable well into ischemia, so a normal recheck would falsely reassure the nurse.

Correct Answer: Measuring the daily weight and standing height

Routine measurement of weight and height is within assistive personnel scope. Those numbers matter here because cortisol excess produces weight gain with stalled linear growth, the pattern that separates it from ordinary obesity. Option a is incorrect because teaching is a nursing responsibility that requires judgment about what the family understands. Infection risk is blunted here, and explaining masked fever takes clinical reasoning the aide lacks. Option b is incorrect because skin assessment on fragile steroid thinned tissue calls for interpretation, not simple observation. The nurse decides whether new marks mean injury, bleeding risk, or ordinary play. Option c is incorrect because evaluation of a therapy belongs to the licensed nurse under every delegation framework. Judging how the child answers a slow taper cannot be handed to unlicensed staff.

Correct Answer: "I will give juice, wait fifteen minutes, then test again"

Fifteen grams of fast acting carbohydrate such as four ounces of juice raises glucose quickly, and rechecking after fifteen minutes shows whether a second dose is needed. This is the fifteen fifteen rule. Option a is incorrect because diet soda carries no sugar at all, so it cannot raise a falling glucose. Regular soda, juice or glucose tablets supply the carbohydrate this child actually needs. Option b is incorrect because waiting a full hour leaves the child unprotected while glucose may keep dropping toward seizure. The recheck belongs at fifteen minutes so a second treatment can follow. Option d is incorrect because insulin drives glucose lower still, which is exactly the wrong direction during a low. Sugar comes first, and insulin is held until the team reviews the dosing.

Correct Answer: Slow the fluid rate and notify the provider

These findings signal cerebral edema during treatment. Slowing the fluid rate and raising the head of the bed begin correction while the provider is alerted for mannitol or hypertonic saline. Option b is incorrect because stopping insulin lets ketone production restart and does nothing for swelling inside the skull. The insulin continues while the fluid rate and osmotic therapy address the brain. Option c is incorrect because imaging delays treatment, and a normal scan does not rule out cerebral edema. Therapy is started on the clinical picture, with the scan arranged afterward if needed. Option d is incorrect because vomiting here is a neurologic warning rather than an upset stomach. Masking it with an antiemetic while the same fluid rate continues would let the swelling advance unchecked.

Correct Answer: A high thyroid stimulating hormone with low thyroxine

Hashimoto thyroiditis destroys the gland, so thyroxine falls and the pituitary pushes thyroid stimulating hormone up. Positive antithyroid peroxidase antibodies complete the picture, and slowed growth with weight gain is the pediatric clue. Option a is incorrect because that combination describes Graves disease, where the child loses weight, tolerates heat poorly, and races through the day. Cold intolerance and weight gain point the other way. Option b is incorrect because celiac disease clusters with autoimmune thyroid disease but produces diarrhea, bloating, and poor weight gain. A goiter with a flat growth curve is not explained by normal studies. Option c is incorrect because both values falling together points to pituitary failure, an uncommon cause in this age group. When the gland itself fails, the pituitary signal climbs rather than drops.

Correct Answer: A missing enzyme blocks cortisol and diverts androgen production

Twenty one hydroxylase is missing, so cortisol cannot be made. Corticotropin rises without that feedback and enlarges the cortex, while blocked precursors pour down the androgen pathway and virilize the female fetus. Option a is incorrect because no tumor is present; the whole cortex thickens in response to relentless pituitary stimulation. The disorder is an inherited enzyme defect passed by both parents. Option b is incorrect because corticotropin output climbs rather than falls, driven by the empty cortisol signal. A pituitary that made too little would leave a small adrenal gland, not a hyperplastic one. Option d is incorrect because autoimmune destruction describes Addison disease in an older child. Here the gland is intact and overworked, and androgens are high instead of the low levels destruction would cause.