UWorld Pediatric Nursing.
Pediatric Nursing
Respiratory
Cystic Fibrosis - Pancreatic Enzymes
Test Id: 52270385
Question Id: 30371 (729561)
1 of 36
A A A
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
"I need to monitor the total amount of this medication that I give
1. to my child every day."
"I should give this medication with or just before my child has a
2. meal or snack."
3. "It is okay for my child to chew this medication."
"It is okay to open the capsule and sprinkle the medicine on a
4.
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
,UWorld Pediatric Nursing.
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)
2 of 36
,UWorld Pediatric Nursing.
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-year-old with ventriculoperitoneal shunt who has "lethargy" and
1. pulse of 78/min
3-year-old with history of meningocele who has unilateral ear pain
2. and urinary incontinence
6-year-old with muscular dystrophy who has "flu-like" symptoms
3. and temperature of 100.4 F (38 C)
8-year-old with history of cerebral palsy who has foot injury and
4. 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.
, UWorld Pediatric Nursing.
(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
Pediatric Nursing
Respiratory
Cystic Fibrosis - Pancreatic Enzymes
Test Id: 52270385
Question Id: 30371 (729561)
1 of 36
A A A
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
"I need to monitor the total amount of this medication that I give
1. to my child every day."
"I should give this medication with or just before my child has a
2. meal or snack."
3. "It is okay for my child to chew this medication."
"It is okay to open the capsule and sprinkle the medicine on a
4.
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
,UWorld Pediatric Nursing.
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)
2 of 36
,UWorld Pediatric Nursing.
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-year-old with ventriculoperitoneal shunt who has "lethargy" and
1. pulse of 78/min
3-year-old with history of meningocele who has unilateral ear pain
2. and urinary incontinence
6-year-old with muscular dystrophy who has "flu-like" symptoms
3. and temperature of 100.4 F (38 C)
8-year-old with history of cerebral palsy who has foot injury and
4. 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.
, UWorld Pediatric Nursing.
(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
