Peds Unit 6
1. The nurse is conducting a physical examination of a toddler with suspected lead
poisoning. Lab results indicate blood lead level 52 µg/dL. Which action would the nurse
expect to happen next?
A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered
B) Repeat testing within 1 week with education to decrease lead exposure
C) Confirm with repeat testing in 1 month and referral to local health department
D) Prepare to admit child to begin chelation therapy - ANSA. Repeat testing within 2 days
and prepare to begin chelation therapy as ordered.
The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a
repeat laboratory test within 2 days and educate the parents to decreased lead exposure.
She should also expect to begin chelation therapy as ordered and refer the case to the local
health department for investigation of home lead reduction with referrals for support
services. Repeat testing in 1 week with parent education is appropriate for lead levels
between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate
for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy
immediately would be appropriate for lead levels greater than 70 mcg/dL
2. A nurse is conducting a physical examination of a 5-year-old with suspected iron
deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?
A) "Open your mouth so I can look inside your cheeks and lips."
B) "Do you have any bruises on your feet or shins?"
C) "Will you show me how you walk across the room?"
D) "Let me see the palms of your hands and soles of your feet." - ANSC. "Will you show me
how you walk across the room?"
Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit,
stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the
hands and feet provide information about signs of petechiae, purpura, or pallor.
3. The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is
providing discharge instructions about home care and safety recommendations to the boy
and his parents. Which response indicates a need for further teaching?
A) "We should avoid aspirin and drugs like ibuprofen."
B) "He can resume participation in football in 2 weeks."
C) "Swimming would be a great activity."
D) "Our son cannot take any antihistamines." - ANSB. "He can resume participation in
football in 2 weeks."
The nurse must emphasize to the parents that they need to prevent trauma to their son by
avoiding activities that may cause injury. Participation in contact sports like football is not
recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be
avoided because they could precipitate anemia. Swimming, a noncontact sport, is an
appropriate choice.
, 4. The nurse is assessing a child with suspected thalassemia. Which of the following would
the nurse expect to assess?
A) Dactylitis
B) Frontal bossing
C) Presence of clubbing
D) Presence of spooning - ANSB. Frontal bossing
The nurse would expect to find skeletal deformities such as frontal or maxillary bossing.
Dactylitis is associated with sickle cell anemia. Clubbing and spooning are associated with
chronic decreases in oxygen supply.
5. The nurse is caring for a child recently diagnosed with glucose-6-phosphate
dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that
may result in oxidative stress. Which of the following responses indicates a need for further
teaching?
A) "I doubt he will ever eat fava beans, but they could trigger hemolysis."
B) "He must avoid exposure to naphthalene, an agent found in mothballs."
C) "He must never take methylene blue for a urinary tract infection."
D) "My son can never take penicillin for an infection." - ANSD. "My son can never take
penicillin for an infection."
The nurse should emphasize that penicillin is not a known trigger that may result in oxidative
stress and hemolysis. Fava beans, naphthalene, and methylene blue can trigger oxidative
stress.
6. The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the
adolescent and her parents about this disorder and care, which response by the parents
indicates a need for additional teaching?
A) "We need to administer Stimate prior to dental work."
B) "We should be aware that she may suffer from menorrhagia."
C) "We should administer desmopressin as often as needed."
D) "We understand that she may have frequent nosebleeds." - ANSC. "We should administer
desmopressin as often as needed."
The parents need to know that desmopressin spray Stimate is used for controlling bleeding;
the other brands are used for homeostasis and enuresis. Additionally, Stimate should only
be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent
use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.
7. The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the
following would the nurse do first to provide adequate pain management?
A) Administer a nonsteroidal anti-inflammatory drug as ordered.
B) Use guided imagery and therapeutic touch.
C) Administer meperidine as ordered.
D) Initiate pain assessment with a standardized pain scale. - ANSD. Initiate pain assessment
with a standardized pain scale.
1. The nurse is conducting a physical examination of a toddler with suspected lead
poisoning. Lab results indicate blood lead level 52 µg/dL. Which action would the nurse
expect to happen next?
A) Repeat testing within 2 days and prepare to begin chelation therapy as ordered
B) Repeat testing within 1 week with education to decrease lead exposure
C) Confirm with repeat testing in 1 month and referral to local health department
D) Prepare to admit child to begin chelation therapy - ANSA. Repeat testing within 2 days
and prepare to begin chelation therapy as ordered.
The recommendation for blood lead levels of 45 to 69 mcg/dL is to confirm the level with a
repeat laboratory test within 2 days and educate the parents to decreased lead exposure.
She should also expect to begin chelation therapy as ordered and refer the case to the local
health department for investigation of home lead reduction with referrals for support
services. Repeat testing in 1 week with parent education is appropriate for lead levels
between 20 and 44 mcg/dL. Repeat testing in 1 month and education would be appropriate
for levels between 15 and 19 mcg/dL. Preparing to admit the child to begin chelation therapy
immediately would be appropriate for lead levels greater than 70 mcg/dL
2. A nurse is conducting a physical examination of a 5-year-old with suspected iron
deficiency anemia. How would the nurse evaluate for changes in neurologic functioning?
A) "Open your mouth so I can look inside your cheeks and lips."
B) "Do you have any bruises on your feet or shins?"
C) "Will you show me how you walk across the room?"
D) "Let me see the palms of your hands and soles of your feet." - ANSC. "Will you show me
how you walk across the room?"
Neurologic effects of iron deficiency may be demonstrated when the child's ability to sit,
stand, and walk are impaired. Inspecting the mouth, looking for bruises, and checking the
hands and feet provide information about signs of petechiae, purpura, or pallor.
3. The nurse is caring for a 12-year-old boy with idiopathic thrombocytopenia. The nurse is
providing discharge instructions about home care and safety recommendations to the boy
and his parents. Which response indicates a need for further teaching?
A) "We should avoid aspirin and drugs like ibuprofen."
B) "He can resume participation in football in 2 weeks."
C) "Swimming would be a great activity."
D) "Our son cannot take any antihistamines." - ANSB. "He can resume participation in
football in 2 weeks."
The nurse must emphasize to the parents that they need to prevent trauma to their son by
avoiding activities that may cause injury. Participation in contact sports like football is not
recommended. Aspirin, nonsteroidal anti-inflammatory drugs, and antihistamines should be
avoided because they could precipitate anemia. Swimming, a noncontact sport, is an
appropriate choice.
, 4. The nurse is assessing a child with suspected thalassemia. Which of the following would
the nurse expect to assess?
A) Dactylitis
B) Frontal bossing
C) Presence of clubbing
D) Presence of spooning - ANSB. Frontal bossing
The nurse would expect to find skeletal deformities such as frontal or maxillary bossing.
Dactylitis is associated with sickle cell anemia. Clubbing and spooning are associated with
chronic decreases in oxygen supply.
5. The nurse is caring for a child recently diagnosed with glucose-6-phosphate
dehydrogenase (G6PD) deficiency. The nurse is teaching the parents about triggers that
may result in oxidative stress. Which of the following responses indicates a need for further
teaching?
A) "I doubt he will ever eat fava beans, but they could trigger hemolysis."
B) "He must avoid exposure to naphthalene, an agent found in mothballs."
C) "He must never take methylene blue for a urinary tract infection."
D) "My son can never take penicillin for an infection." - ANSD. "My son can never take
penicillin for an infection."
The nurse should emphasize that penicillin is not a known trigger that may result in oxidative
stress and hemolysis. Fava beans, naphthalene, and methylene blue can trigger oxidative
stress.
6. The nurse is caring for a 13-year-old girl with von Willebrand disease. After teaching the
adolescent and her parents about this disorder and care, which response by the parents
indicates a need for additional teaching?
A) "We need to administer Stimate prior to dental work."
B) "We should be aware that she may suffer from menorrhagia."
C) "We should administer desmopressin as often as needed."
D) "We understand that she may have frequent nosebleeds." - ANSC. "We should administer
desmopressin as often as needed."
The parents need to know that desmopressin spray Stimate is used for controlling bleeding;
the other brands are used for homeostasis and enuresis. Additionally, Stimate should only
be used 3 days in a row as lessening of the response (tachyphylaxis) occurs with frequent
use. Stimate should be used before dental work. Menorrhagia and nosebleeds may occur.
7. The nurse is caring for a child who has been admitted for a sickle cell crisis. Which of the
following would the nurse do first to provide adequate pain management?
A) Administer a nonsteroidal anti-inflammatory drug as ordered.
B) Use guided imagery and therapeutic touch.
C) Administer meperidine as ordered.
D) Initiate pain assessment with a standardized pain scale. - ANSD. Initiate pain assessment
with a standardized pain scale.
