Pediatric Exam Neurology, Hematology, Oncology

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Sample questions from Pediatric Exam Neurology, Hematology, Oncology

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.During discharge teaching for a 2-day-old newborn with myelomeningocele, which explanation best describes the purpose of early developmental follow-up?

   • A.Restricted movement prevents the need for physical therapy.
   • B.Developmental screening should wait until the child begins school.
   • C.Motor development may require individualized support because of lower-extremity weakness.
   • D.All developmental domains will be delayed to the same degree.

   Rationale: Myelomeningocele can impair lower-extremity strength and mobility, making early individualized developmental support important. Motor impairment does not establish that language, social, and cognitive development will be equally delayed. Waiting until school misses opportunities for early intervention, and restricting movement does not replace physical therapy. Developmental planning should build on the child's abilities rather than assume global disability.

2. 2.At a well-child visit, the parent of a 3-month-old infant asks which finding should be reported for further developmental assessment. Which finding is most concerning?

   • A.The infant does not smile in response to a caregiver.
   • B.The infant does not sit without support.
   • C.The infant has not developed a pincer grasp.
   • D.The infant does not use recognizable words.

   Rationale: A social smile is generally present by about 2 months, so its absence at 3 months warrants further assessment. Independent sitting, a pincer grasp, and recognizable words develop later in infancy. These later skills are not expected in this client. Developmental screening compares findings with age-appropriate milestones rather than with milestones from later stages.

3. 3.Refer to the client's chart. Which nursing actions are appropriate while awaiting urgent neurosurgical evaluation? Select all that apply.

   • A.Offer a full bottle to assess feeding coordination.
   • B.Continue frequent neurologic assessments.
   • C.Apply firm pressure over the shunt reservoir repeatedly.
   • D.Elevate the head of the bed approximately 30 degrees and maintain neutral head alignment.
   • E.Notify the neurosurgical team about the change in responsiveness.

   Rationale: The progression from irritability to difficulty arousing, repeated vomiting, and a tense fontanel suggests rising intracranial pressure and possible shunt malfunction. Neutral head alignment with modest elevation supports venous drainage, and the neurosurgical team needs immediate notification of the deterioration. Frequent neurologic reassessment is necessary to identify further decline. Feeding increases aspiration risk in this less responsive infant, and the shunt reservoir should not be manipulated without specific direction.

4. 4.During a home visit, an 11-month-old infant consistently reaches with the right hand while keeping the left hand tightly fisted. Which response is most appropriate?

   • A.Recommend restricting the right hand without an evaluation.
   • B.Arrange prompt evaluation for asymmetric motor development.
   • C.Wait until age 3 years before assessing handedness.
   • D.Document normal establishment of hand dominance.

   Answer and rationale are in the full material.

5. 5.The parent of a 16-month-old toddler with iron-deficiency anemia reports that the child drinks 36 oz of cow's milk daily and eats little solid food. Which teaching is most appropriate?

   • A.Stop all dietary fat to increase interest in solid foods.
   • B.Replace meals with additional milk until the hemoglobin improves.
   • C.Give the prescribed iron supplement with a full cup of milk.
   • D.Limit milk to the recommended daily amount and offer iron-rich foods.

   Answer and rationale are in the full material.