Pediatric Conditions - NCLEX-PN
Card 1 of 440
What specific enzyme deficiency accounts for 95% of all cases of congenital adrenal hyperplasia?
What specific enzyme deficiency accounts for 95% of all cases of congenital adrenal hyperplasia?
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In 21-hydroxylase deficiency, cortisol production is reduced, which in turn causes adrenocorticotropic hormone (ACTH) to increase. The precursors for the cortisol are then shunted into androgen production since these are steroids, and are thus derived from cholesterol.
In 21-hydroxylase deficiency, cortisol production is reduced, which in turn causes adrenocorticotropic hormone (ACTH) to increase. The precursors for the cortisol are then shunted into androgen production since these are steroids, and are thus derived from cholesterol.
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The postpartum nurse is caring for a family and their new baby, a two day old infant. The baby is "spitting up" following every formula feeding. The nurse may suggest .
The postpartum nurse is caring for a family and their new baby, a two day old infant. The baby is "spitting up" following every formula feeding. The nurse may suggest .
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Typically, the digestive system of a 2-day-old infant can only accommodate 15-30 milliliters of formula comfortably. The infant's stomach will grow considerably over the coming weeks. Frequent spitting up could be due to overfeeding. Before switching formula brands, try decreasing the amount fed at each feeding. Increasing the frequency of feedings may add to this problem. Another possibility, that the infant is feeding too fast, may be corrected by using a "slow-flow" instead of a "soft" or "standard" nipple. "Soft" nipples may be helpful in infants with poor suck or latch. While feeding and directly afterwards, it is advised to keep the infant in a semi-upright position.
Typically, the digestive system of a 2-day-old infant can only accommodate 15-30 milliliters of formula comfortably. The infant's stomach will grow considerably over the coming weeks. Frequent spitting up could be due to overfeeding. Before switching formula brands, try decreasing the amount fed at each feeding. Increasing the frequency of feedings may add to this problem. Another possibility, that the infant is feeding too fast, may be corrected by using a "slow-flow" instead of a "soft" or "standard" nipple. "Soft" nipples may be helpful in infants with poor suck or latch. While feeding and directly afterwards, it is advised to keep the infant in a semi-upright position.
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The community health nurse knows that teaching has been effective when the father of a newborn states .
The community health nurse knows that teaching has been effective when the father of a newborn states .
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Newborns should be placed on their back, in their crib, with nothing else when put to sleep. The crib may contain a fitted sheet or a light blanket. Crib pads, pillows, and stuffed animals are not advised because they may interfere with the child's ability to breathe.
Newborns should be placed on their back, in their crib, with nothing else when put to sleep. The crib may contain a fitted sheet or a light blanket. Crib pads, pillows, and stuffed animals are not advised because they may interfere with the child's ability to breathe.
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Hippotherapy has the ability to positively impact children who are cognitively, socially, emotionally, or physically challenged. Which of the following therapies is most closely related to hippotherapy?
Hippotherapy has the ability to positively impact children who are cognitively, socially, emotionally, or physically challenged. Which of the following therapies is most closely related to hippotherapy?
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Hippotherapy is therapeutic horseback riding for the handicapped. The motion of the horse can help the child develop flexibility and balance. Working with others and animals can help the child cross social and emotional boundaries. A therapy involving animals (pet therapy) is most similar to hippotherapy.
Hippotherapy is therapeutic horseback riding for the handicapped. The motion of the horse can help the child develop flexibility and balance. Working with others and animals can help the child cross social and emotional boundaries. A therapy involving animals (pet therapy) is most similar to hippotherapy.
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Jennifer is a 14-year-old patient who has been diagnosed with diphtheria and subsequently, myocarditis. The nurse implements all of the following except .
Jennifer is a 14-year-old patient who has been diagnosed with diphtheria and subsequently, myocarditis. The nurse implements all of the following except .
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Diphtheria is an illness caused by bacteria (Corynebacterium diphtheriae). It is spread through droplets, requiring droplet precautions. Standard precautions should also be used, as with any patient. Delivery of antitoxin and antibiotics are important to a patient's recovery. Enforcing bedrest is important after a patient has developed myocarditis (inflammation of the heart).
Diphtheria is an illness caused by bacteria (Corynebacterium diphtheriae). It is spread through droplets, requiring droplet precautions. Standard precautions should also be used, as with any patient. Delivery of antitoxin and antibiotics are important to a patient's recovery. Enforcing bedrest is important after a patient has developed myocarditis (inflammation of the heart).
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A community health nurse is giving a presentation on pertussis (whooping cough). He tells his audience that which population is most at risk?
A community health nurse is giving a presentation on pertussis (whooping cough). He tells his audience that which population is most at risk?
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Children under 4 years of age hold the greatest risk of contracting Pertussis and developing serious complications, including death. Pertussis vaccines are recommended for all age groups. Children can start a vaccination series as early as 2 months of age. New parents are encouraged to become vaccinated before their baby arrives to prevent transmission before the infant is eligible for immunization.
Children under 4 years of age hold the greatest risk of contracting Pertussis and developing serious complications, including death. Pertussis vaccines are recommended for all age groups. Children can start a vaccination series as early as 2 months of age. New parents are encouraged to become vaccinated before their baby arrives to prevent transmission before the infant is eligible for immunization.
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A room designed to accommodate a child with the measles should include which of the following?
A room designed to accommodate a child with the measles should include which of the following?
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Measles is an airborne illness. For that reason, air pressure devices are necessary to prevent the spread of infection. Negative air pressure devices will adequately contain the measles virus because air will flow in to the room as opposed to out. Conversely, positive air pressure devices may be used to create an air flow out of a room in severely immunocompromised patients.
Measles is an airborne illness. For that reason, air pressure devices are necessary to prevent the spread of infection. Negative air pressure devices will adequately contain the measles virus because air will flow in to the room as opposed to out. Conversely, positive air pressure devices may be used to create an air flow out of a room in severely immunocompromised patients.
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The school nurse is approached by a 9-year-old boy who is complaining of severe scalp pruritus. Upon closer examination, the nurse concludes that he has a case of head lice (P_ediculosis capitis_). She knows all of the following to be true except .
The school nurse is approached by a 9-year-old boy who is complaining of severe scalp pruritus. Upon closer examination, the nurse concludes that he has a case of head lice (P_ediculosis capitis_). She knows all of the following to be true except .
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Children and adults with exceptional personal hygiene are equally affected by head lice. The same applies to people of all socioeconomic groups, genders, and nationalities. All of the other options are true nursing interventions for head lice.
Children and adults with exceptional personal hygiene are equally affected by head lice. The same applies to people of all socioeconomic groups, genders, and nationalities. All of the other options are true nursing interventions for head lice.
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A school nurse is holding a question and answer meeting for parents following a recent outbreak of scarlet fever. Which of the following would the nurse confirm as false?
A school nurse is holding a question and answer meeting for parents following a recent outbreak of scarlet fever. Which of the following would the nurse confirm as false?
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Scarlet fever is a bacterial infection caused by group A S_treptococcus_ that is transmitted through the air. Children who are sensitive to the bacterial toxin may develop a rash, although some will not. Infants and toddlers under the age of two are rarely seen with the disease.
Scarlet fever is a bacterial infection caused by group A S_treptococcus_ that is transmitted through the air. Children who are sensitive to the bacterial toxin may develop a rash, although some will not. Infants and toddlers under the age of two are rarely seen with the disease.
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A 3-day-old infant is diagnosed with hyperbilirubinemia. A bilirubin test is required by capillary heel puncture. The nurse does all of the following except .
A 3-day-old infant is diagnosed with hyperbilirubinemia. A bilirubin test is required by capillary heel puncture. The nurse does all of the following except .
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Avoid squeezing the infant's heel if possible. Squeezing causes hemolysis of the specimen. Too much pressure may also result in damage to the tissue. Turning off the bilirubin treatment lights is also important because exposure to the light may alter the bilirubin in the sample. Cleansing the site of puncture is important, and warming the area will increase the capillary blood flow.
Avoid squeezing the infant's heel if possible. Squeezing causes hemolysis of the specimen. Too much pressure may also result in damage to the tissue. Turning off the bilirubin treatment lights is also important because exposure to the light may alter the bilirubin in the sample. Cleansing the site of puncture is important, and warming the area will increase the capillary blood flow.
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Parotid gland enlargement, fever, myalgia, and tender salivary glands would indicate which of the following conditions?
Parotid gland enlargement, fever, myalgia, and tender salivary glands would indicate which of the following conditions?
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Parotid gland enlargement, fever, myalgia, and tender salivary glands are all indicative of infection with the mumps virus. Symptoms typically last for 7-10 days, though sequelae such as hearing damage and testicular disorders can be long-lasting or even permanent.
Parotid gland enlargement, fever, myalgia, and tender salivary glands are all indicative of infection with the mumps virus. Symptoms typically last for 7-10 days, though sequelae such as hearing damage and testicular disorders can be long-lasting or even permanent.
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A mother brings her child in for paroxysmal bouts of 10-15 coughs followed by 1-2 deep gasping breaths. It started as a simple cold and cough, which seemed to be getting better before the gasping paroxysmal coughing started. The coughing is severe enough that he has vomited several times. What is the most likely diagnosis?
A mother brings her child in for paroxysmal bouts of 10-15 coughs followed by 1-2 deep gasping breaths. It started as a simple cold and cough, which seemed to be getting better before the gasping paroxysmal coughing started. The coughing is severe enough that he has vomited several times. What is the most likely diagnosis?
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The most likely diagnosis in this case is pertussis, also known as whooping cough. This is caused by Bordetella pertussis, a gram-negative encapsulated coccobacillus. It begins as a seemingly normal upper respiratory infection, which progresses two weeks after onset into paroxysms of 5-15 violent coughs followed by a forceful inspiratory gasp, often described as a "whoop." Coughing is often forceful enough to induce vomiting, nosebleeds, or subconjunctival hemorrhage. Croup, pneumonia, and bronchitis are all conditions that include cough, though none of them will generally present with this degree of gasping, vomiting, or blood vessel damage due to cough.
The most likely diagnosis in this case is pertussis, also known as whooping cough. This is caused by Bordetella pertussis, a gram-negative encapsulated coccobacillus. It begins as a seemingly normal upper respiratory infection, which progresses two weeks after onset into paroxysms of 5-15 violent coughs followed by a forceful inspiratory gasp, often described as a "whoop." Coughing is often forceful enough to induce vomiting, nosebleeds, or subconjunctival hemorrhage. Croup, pneumonia, and bronchitis are all conditions that include cough, though none of them will generally present with this degree of gasping, vomiting, or blood vessel damage due to cough.
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Strawberry tongue and maculopapular ("sandpaper") rash are commonly seen in what childhood exanthem?
Strawberry tongue and maculopapular ("sandpaper") rash are commonly seen in what childhood exanthem?
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Strawberry tongue (glossitis) and maculopapular ("sandpaper") rash are commonly seen in scarlet fever, a condition caused by group A Streptococcus bacteria, often after a bout of strep throat. The other exanthems listed can all cause erythematous rash, though none are associated with glossitis.
Strawberry tongue (glossitis) and maculopapular ("sandpaper") rash are commonly seen in scarlet fever, a condition caused by group A Streptococcus bacteria, often after a bout of strep throat. The other exanthems listed can all cause erythematous rash, though none are associated with glossitis.
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A nurse working in labor and delivery is responsible to assessing a newborn according to the APGAR scale. The newborn infant is noted to have a vigorous good cry, a heart rate of 97, with good reflexes, and acrocyanosis.
What is the newborn's APGAR scale according to these findings?
A nurse working in labor and delivery is responsible to assessing a newborn according to the APGAR scale. The newborn infant is noted to have a vigorous good cry, a heart rate of 97, with good reflexes, and acrocyanosis.
What is the newborn's APGAR scale according to these findings?
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The APGAR score is 8, the child has received a score of 2 under respiration for good cry, a score of 2 under cry reflex for vigorous crying, a score of 2 under reflexes for good reflexes, a score of 1 for heart rate of 97 (under 100 bpm), and and score of 1 for color for acrocyanosis (blue limbs, pink body).
The APGAR score is 8, the child has received a score of 2 under respiration for good cry, a score of 2 under cry reflex for vigorous crying, a score of 2 under reflexes for good reflexes, a score of 1 for heart rate of 97 (under 100 bpm), and and score of 1 for color for acrocyanosis (blue limbs, pink body).
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You are the nurse taking care of a 19-year old patient at a primary care clinic who complains of fever, tonsillar exudates, tender anterior cervical lymph nodes, and a sore throat without a cough. How many of the Centor criteria for streptococcal pharyngitis does this patient exhibit?
You are the nurse taking care of a 19-year old patient at a primary care clinic who complains of fever, tonsillar exudates, tender anterior cervical lymph nodes, and a sore throat without a cough. How many of the Centor criteria for streptococcal pharyngitis does this patient exhibit?
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The correct answer is "4." This is correct because the patient exhibits four out of the four Centor criteria for streptococcal pharyngitis. The Centor criteria are as follows:
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Tonsillar exudates
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Lack of cough
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Fever
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Tender anterior cervical lymphadenopathy
The Centor criteria are used to generate a score based upon the patient's age and number of positive criteria. This score can then be used to assess the likelihood that the patient's condition is due to streptococcal pharyngitis, and therefore to guide the decision of whether or not to treat with antibiotics for streptococcal pharyngitis. In this patient's case, since they are older than 14 and younger than 45, they do not gain or lose points for their age. They get four points total for having all of the positive criteria. Therefore, it is highly likely that they are infected with streptococcal pharyngitis and should be treated empirically with antibiotics.
The correct answer is "4." This is correct because the patient exhibits four out of the four Centor criteria for streptococcal pharyngitis. The Centor criteria are as follows:
-
Tonsillar exudates
-
Lack of cough
-
Fever
-
Tender anterior cervical lymphadenopathy
The Centor criteria are used to generate a score based upon the patient's age and number of positive criteria. This score can then be used to assess the likelihood that the patient's condition is due to streptococcal pharyngitis, and therefore to guide the decision of whether or not to treat with antibiotics for streptococcal pharyngitis. In this patient's case, since they are older than 14 and younger than 45, they do not gain or lose points for their age. They get four points total for having all of the positive criteria. Therefore, it is highly likely that they are infected with streptococcal pharyngitis and should be treated empirically with antibiotics.
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Which of the following is considered a late sign of hunger in the newborn?
Which of the following is considered a late sign of hunger in the newborn?
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Crying is considered a late sign of hunger. By the time the infant cries, they may be more difficult to console or to feed, especially if breastfeeding. Feed on cue when the infant is rooting, making sucking motions, or when they are frequently bringing their hands to their face or mouth.
Crying is considered a late sign of hunger. By the time the infant cries, they may be more difficult to console or to feed, especially if breastfeeding. Feed on cue when the infant is rooting, making sucking motions, or when they are frequently bringing their hands to their face or mouth.
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Which of the following terms describes the congenital abnormality of the forebrain in which an infant is born with a diminished brain size?
Which of the following terms describes the congenital abnormality of the forebrain in which an infant is born with a diminished brain size?
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Microcephaly denotes a congenital abnormality of the forebrain in which an infant is born with a diminished brain size. Potential causes include fetal alcohol syndrome, congenital rubella, and trisomy 18.
The other answers are all examples of congenital forebrain birth defects:
- Anencephaly is the complete absence of major portions of the brain, skull, and scalp.
- Agyri is the absence of gyri.
- Polymicrogyri is a condition in which gyri are too many, too small, and very shallow.
Microcephaly denotes a congenital abnormality of the forebrain in which an infant is born with a diminished brain size. Potential causes include fetal alcohol syndrome, congenital rubella, and trisomy 18.
The other answers are all examples of congenital forebrain birth defects:
- Anencephaly is the complete absence of major portions of the brain, skull, and scalp.
- Agyri is the absence of gyri.
- Polymicrogyri is a condition in which gyri are too many, too small, and very shallow.
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Anencephaly and other neural tube defects have been linked to maternal deficiency of what nutrient?
Anencephaly and other neural tube defects have been linked to maternal deficiency of what nutrient?
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Anencephaly and other neural tube defects have been linked to maternal deficiency of folate. This is most likely due to folate's role in methylation and nucleic acid synthesis. The other nutrients listed are all important to maternal health but have no known correlation with neural tube defects such as anencephaly.
Anencephaly and other neural tube defects have been linked to maternal deficiency of folate. This is most likely due to folate's role in methylation and nucleic acid synthesis. The other nutrients listed are all important to maternal health but have no known correlation with neural tube defects such as anencephaly.
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Periventricular leukomalacia (PVL) is the most common finding on autopsy of newborns with what condition?
Periventricular leukomalacia (PVL) is the most common finding on autopsy of newborns with what condition?
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Periventricular leukomalacia is the most common finding on autopsy of newborns with cerebral palsy. PVL involves the softening of the brain tissue and subsequent death of the white matter. This is caused by lack of blood flow to the periventricular area of the brain, which results in necrosis and gliosis of brain tissue. Neonates born with PVL are likely to have mental impairment, motor disorders, and compromised vision and hearing. PVL is usually diagnosed with ultrasound of the head. None of the other conditions listed typically present with this finding.
Periventricular leukomalacia is the most common finding on autopsy of newborns with cerebral palsy. PVL involves the softening of the brain tissue and subsequent death of the white matter. This is caused by lack of blood flow to the periventricular area of the brain, which results in necrosis and gliosis of brain tissue. Neonates born with PVL are likely to have mental impairment, motor disorders, and compromised vision and hearing. PVL is usually diagnosed with ultrasound of the head. None of the other conditions listed typically present with this finding.
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A mother one hour post birth expresses concern because her baby's head looks slightly cone shaped. The nurse tells the mother that .
A mother one hour post birth expresses concern because her baby's head looks slightly cone shaped. The nurse tells the mother that .
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It is normal for a child's head to be slightly misshapen immediately following birth. The infant's skull is composed of bony plates connected by membranes (fontanelles), allowing for accommodation of the baby's growing brain. Caput succedaneum (swelling of the scalp) can also be found following a long delivery. A misshapen head usually resolves on its own and is normal but does not require any medical intervention.
It is normal for a child's head to be slightly misshapen immediately following birth. The infant's skull is composed of bony plates connected by membranes (fontanelles), allowing for accommodation of the baby's growing brain. Caput succedaneum (swelling of the scalp) can also be found following a long delivery. A misshapen head usually resolves on its own and is normal but does not require any medical intervention.
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