Pediatric Nursing Exam 4

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Sample questions from Pediatric Nursing Exam 4

This material has 75 questions with answers and rationales. Here are the first 5.

1. 1.At a community clinic, a 6-year-old has a temperature of 39.4 C, cough, conjunctivitis, and a maculopapular rash that began at the hairline and is spreading downward. The parent reports a recent international trip and says the child has received no measles vaccine. Which action is most appropriate?

   • A.Apply topical antiparasitic medication and arrange a follow-up visit.
   • B.Place the child in an airborne infection isolation room and use an N95 respirator.
   • C.Place the child in a private room with contact precautions until the rash crusts.
   • D.Use droplet precautions and allow the child to wait in the general reception area.

   Rationale: The descending rash with cough, conjunctivitis, high fever, and absent immunization after travel is concerning for measles, which spreads through the airborne route. Airborne isolation and a fit-tested N95 respirator are indicated; the clinic should limit exposure to others while evaluation proceeds. Contact precautions until crusting are associated with varicella lesions, and droplet precautions alone are insufficient for measles. Antiparasitic treatment does not address this presentation.

2. 2.The parent of a 5-year-old reports that the child has intense itching, especially at night, and that two siblings have developed similar symptoms. Fine, wavy lines are visible between the child's fingers and at the wrists. Which instructions should the nurse include? Select all that apply.

   • A.Avoid sharing towels and clothing until treatment and household cleaning measures are completed.
   • B.Wash recently used clothing, towels, and bedding in hot water and dry them on high heat.
   • C.Treat household members and close contacts at the same time, as directed by the clinician.
   • D.Apply the prescribed scabicide as directed, including to the areas specified on the product instructions.
   • E.Expect itching to disappear immediately after the first treatment; repeat treatment is never needed.

   Rationale: Nocturnal itching, affected household contacts, and burrow-like lines are characteristic of scabies, which spreads through prolonged skin contact and may spread via recently used personal items. Scabicide use should follow the product or clinician instructions, and close contacts are commonly treated simultaneously to prevent reinfestation. Hot laundering and avoiding shared personal items help reduce transmission; itching can persist for several weeks after successful treatment, so immediate resolution is not expected. Repeat treatment may be prescribed, so it should not be ruled out.

3. 3.Which finding in a child with fever and a new rash most strongly supports roseola rather than measles?

   • A.A rash that appears as a high fever resolves and begins on the trunk.
   • B.A rough-textured rash with a prominent sore throat and strawberry tongue.
   • C.A rash of vesicles in different stages concentrated on the trunk and scalp.
   • D.A rash that begins on the face while cough and conjunctivitis are prominent.

   Rationale: Roseola commonly causes several days of high fever followed by a pink rash that appears as the fever resolves, often beginning on the trunk. Measles typically has a descending rash with respiratory symptoms and conjunctivitis. Varicella produces lesions in different stages, while a rough, sandpaper-like rash with pharyngitis suggests scarlet fever. The timing of the rash relative to the fever is a useful distinguishing clue.

4. 4.During a school health visit, a 9-year-old has honey-colored crusts around the nostrils and several small, moist sores on the chin. The child is afebrile and otherwise well. Which teaching is most appropriate?

   • A.Share towels only with family members because the infection spreads mainly through coughing.
   • B.Scrub the lesions vigorously to remove the crusts before applying any medication.
   • C.Keep the child home until every crust has detached, even if treatment has begun.
   • D.Use prescribed topical treatment, keep lesions covered when feasible, and follow local rules for return after treatment begins.

   Answer and rationale are in the full material.

5. 5.In the emergency department, a 3-month-old has episodes of repeated coughing followed by vomiting and brief pauses in breathing. The infant's caregiver reports that the cough has lasted 2 weeks, but the infant has had no audible whoop. Which interpretation should guide the nurse's next action?

   • A.The vomiting indicates a gastrointestinal infection; use contact precautions only.
   • B.Pertussis is unlikely without a whoop, so routine respiratory hygiene is sufficient.
   • C.The presentation is concerning for pertussis; institute droplet precautions and promptly notify the clinician.
   • D.The symptoms are typical of croup; place the infant in airborne isolation.

   Answer and rationale are in the full material.