You match developmental age, safety, and family teaching instead of treating the child as a small adult. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the LPN exams exam guide or more LPN exams practice questions.
Five pediatrics questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
You have a new patient consult in clinic this morning. The referral packet includes the newborn screen report, which is flagged abnormal hemoglobinopathy screen, F, A, Bart's, refer to hematology, and a complete blood count done at 4 years of age with a hemoglobin of 10 g/dL and an MCV of 68. The pediatrician has informed the parents the child has some form of alpha thalassemia. The older brother had the same newborn screen results but had a normal complete blood count when checked. The mother wants to know why her second child has an abnormal complete blood count when she and her husband do not have any blood problems. How would you respond to the child's mother?
A. The mother and father are both silent carriers and each passed a deleted alpha globin allele to their child. The child inherited a trans-deletion genotype alpha thalassemia trait.
B. The mother has cis deletion alpha thalassemia and the father has no alpha globin deletion, giving the child alpha thalassemia trait.
C. Neither parent has an alpha globin deletion; this was a new spontaneous mutation causing alpha thalassemia in the child.
D. Both parents carry cis deletions in the alpha globin gene cluster.
Show answer and rationale
Correct answer: A — The mother and father are both silent carriers and each passed a deleted alpha globin allele to their child. The child inherited a trans-deletion genotype alpha thalassemia trait.
Alpha globin deletions causing alpha thalassemia minor may be inherited in the cis (deletion on the same allele) or trans (deletion on both the maternal and paternal alleles). Option A is the correct answer because individuals with one deleted alpha globin are called silent carriers and will have no hematologic abnormalities on complete blood count. Hemoglobin Bart's is only detected at or near birth. If the offspring inherits both parental alleles with one missing alpha globin gene, the child will still inherit two functioning alpha globin, which is consistent with alpha thalassemia trait. Option B is incorrect because if the mother has a cis deletion, then she only has two functioning alpha globin, which would cause changes to her complete blood count, and she would have alpha thalassemia trait and not be a silent carrier. Option C is incorrect because the spontaneous loss of two alpha globin genes, one from each parental gamete, would be statistically unlikely, or the loss of two alpha globin on the same allele for one parental gamete. Option D is incorrect because (a) the parents would have abnormal blood counts, and (b) they have one child who had hemoglobin Bart's but now has a normal complete blood count.
Question 2
An otherwise healthy 18-year-old female is diagnosed with high-risk neuroblastoma after presenting with fatigue and bony pain. Imaging findings demonstrate a left adrenal mass with multiple osseous metastases. She successfully completes standard therapy for high-risk neuroblastoma, but experiences several episodes of disease recurrence and ultimately dies of her disease 10 years after her initial diagnosis. During her treatment, her tumor was sent for molecular analysis. Of the following, what molecular aberration was most likely to have been detected?
A. ETV6-NTRK3 gene fusion
B. PTPN11 mutation
C. ATRX mutation
D. MYCN amplification
Show answer and rationale
Correct answer: C — ATRX mutation
Inactivating mutations in the ATRX chromatin remodeling gene are found in 14% of patients with high-risk neuroblastoma and in 44% of adolescent and adult patients with metastatic neuroblastoma. In addition to the association with older age at diagnosis, this mutation is associated with an indolent disease course and poor overall survival, as is seen in this patient's case. ETV6-NTRK3 gene fusions are characteristic of infantile fibrosarcoma and cellular congenital mesoblastic nephroma. Although NTRK aberrations can be seen in neuroblastoma, this specific fusion product is not. PTPN11 mutations are seen in neuroblastoma, particularly in patients with a germline mutation and phenotypic evidence of Noonan's syndrome. These mutations are also not associated with older age or an indolent disease course. WT1 mutations are not associated with neuroblastoma. MYCN amplification is incorrect because the incidence of MYCN amplification is low in older patients with neuroblastoma (approximately 3%), whereas the incidence of ATRX mutations is higher. Of note, ATRX mutations are mutually exclusive of MYCN amplification in neuroblastoma.
Question 3
A 3-year-old nonsyndromic, well-appearing male with no significant past medical history presents with an abdominal mass palpated by his mother when giving him a bath. CT imaging reveals a 9-cm right renal mass without involvement of the inferior vena cava (IVC) and no evidence of tumor thrombus by ultrasound. The left kidney appears normal, and there is no imaging evidence of tumor rupture or adherence to surrounding organs. There are diffuse, bilateral pulmonary metastases from which he is asymptomatic with a normal respiratory rate and no supplemental oxygen requirement. Following the National Wilms Tumor Study Group (NWTS)/Children's Oncology Group (COG) approach to pediatric renal tumors, which of the following are appropriate next steps?
A. Core biopsy of the renal mass followed by three drug chemotherapy-vincristine, actinomycin, and doxorubicin
B. Nephrectomy with lymph node sampling followed by chemotherapy based on histology and stage
C. Fine-needle aspiration followed by three drug chemotherapy-vincristine, actinomycin, and doxorubicin
D. Neoadjuvant three drug chemotherapy - vincristine, actinomycin and doxorubicin-followed by nephrectomy at week 6
Show answer and rationale
Correct answer: B — Nephrectomy with lymph node sampling followed by chemotherapy based on histology and stage
By age and presentation, this patient most likely has favorable-histology Wilms' tumor (FHWT) with pulmonary metastases; however, this can only be confirmed by histologic diagnosis. With this presentation, other pediatric renal tumors remain in the differential, including diffuse anaplastic Wilms' tumor, clear cell sarcoma of the kidney, or malignant rhabdoid tumor. The National Wilms Tumor Study Group (NWTS)/Children's Oncology Group (COG) recommends upfront nephrectomy over biopsy for all patients (except bilateral or bilaterally predisposed) when feasible. Although the patient has pulmonary metastases, and her disease is therefore designated as overall stage IV, the local stage (kidney) may still be stage I or II. There is no evidence of tumor thrombus (extending to above the level of the hepatic veins), and the tumor is below the size at which risk of intraoperative rupture is increased (12-14 cm). If the diagnosis of this patient is FHWT, with upfront nephrectomy, depending upon intraoperative findings and lymph node status, this patient may be spared flank radiation if stage I or II for nephrectomy.
Question 4
A nurse is working with an active labor patient who is in preterm labor and has been designated as high risk. The patient is very apprehensive and asks the nurse, “Is everything going to be all right?†The nurse replies, “Yes, everything will be okay.†Following delivery via an emergency cesarean birth, the newborn undergoes resuscitation and does not survive. The patient is distraught over the outcome and blames the nurse for telling her that everything would be okay. Which ethical principle did the nurse violate?
A. Autonomy N R I G B.C M U S N T O
B. Fidelity
C. Beneficence
D. Accountability
Show answer and rationale
Correct answer: C — Beneficence
The correct answer is C: Beneficence. The nurse violated the ethical principle of beneficence by providing false reassurance to the patient, which ultimately led to a negative outcome. Beneficence means to do good and act in the best interest of the patient. By giving false hope, the nurse failed to provide truthful information that could have prepared the patient for potential complications.
A: Autonomy - This choice is not the correct answer because autonomy refers to respecting the patient's right to make their own decisions, which was not directly violated in this scenario.
B: Fidelity - This choice is not the correct answer because fidelity refers to being faithful and keeping promises to the patient, which is not the primary issue in this case.
D: Accountability - This choice is not the correct answer because accountability refers to taking responsibility for one's actions, which the nurse may need to do in this situation, but it is not the primary ethical principle violated.
In summary, the nurse violated the ethical
Question 5
A new mother and father are inspecting their baby after the nurse brings the infant to them. The mother wants to know why her baby has bruises on the buttocks area. Which statement should be made by the nurse?
A. Bruises are common after a traumatic delivery. I will ask the physician to come discuss the delivery.'
B. These areas are called blue/gray macules and are common in certain ethnic groups, but will disappear around 3 years of age.'
C. These are not bruises; these spots are birthmarks and are usually a permanent impairment.'
D. The previous nurse did not report these findings. Who else has been in the room with the baby?'
Show answer and rationale
Correct answer: B — These areas are called blue/gray macules and are common in certain ethnic groups, but will disappear around 3 years of age.'
The correct answer is B because blue/gray macules, also known as Mongolian spots, are common in certain ethnic groups, especially in babies with darker skin tones. These marks typically appear on the buttocks and lower back and usually fade away by around 3 years of age. This explanation reassures the parents that the marks are not bruises from trauma but rather a normal and harmless skin pigmentation variation.
Choices A, C, and D are incorrect because:
A: This statement implies a traumatic delivery, which may cause unnecessary worry for the parents. It also deflects responsibility by suggesting involving the physician without providing a clear explanation.
C: This statement misidentifies the marks as birthmarks, which are different from Mongolian spots. It also incorrectly suggests they are a permanent impairment, causing unnecessary concern.
D: This statement is confrontational and shifts the focus away from addressing the parents' concerns. It does not provide any explanation or reassurance about the baby's condition.
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Question 6
A 2-year-old girl has a diagnosis of overall stage IV favorable histology Wilms' tumor with pulmonary metastases and local stage III disease due to finding positive lymph nodes. After she completes 6 weeks of vincristine/dactinomycin/doxorubicin (DD4A) chemotherapy, restaging shows complete resolution of some but not all lung nodules. Tumor genetic testing reveals combined loss of heterozygosity for 1p and 16q. Which of the following would be the most appropriate treatment plan?
A. Continue chemotherapy with vincristine, doxorubicin, and dactinomycin to complete 25 weeks of therapy. Administer radiation to lungs and flank.
B. Continue chemotherapy with vincristine, doxorubicin and dactinomycin to complete 25 weeks of therapy. Radiation to flank only. No lung radiation.
C. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to flank only. No lung radiation.
D. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to lungs and flank.
Correct answer:
Choices A and B are incorrect as treatment with 5 drugs is superior to 3 drugs with lung radiation in patients with stage IV FHWT with either slow incomplete response, or pulmonary metastases, and/or in patients with combined loss of heterozygosity (LOH; 1p and 16q). Option C is incorrect because lung radiation therapy (RT) is indicated both for patients with LOH of 1p and 16q and for patients with slow incomplete response of pulmonary lesions. Option D is correct because the use of vincristine/dactinomycin/doxorubicin (DD4A) with the addition of cyclophosphamide and etoposide (Regimen M), along with lung radiation, was shown to improved event-free survival (EFS) and overall survival (OS) from treatment with DD4A and radiation therapy for patients with stage IV FHWT with slow incomplete response of pulmonary nodules, as well as for the group of patients with combined LOH of 1p and 16q. As this patient has both risk factors, Regimen M chemotherapy and appropriate radiotherapy fields would be the recommended therapy.
A nurse is entering information on the patient’s electronic health record (EHR) and is called to assist in an emergency situation with regard to another patient in the labor and birth suite. The nurse rushes to the scene to assist; however, she leaves the chart open on the computer screen. The emergent patient situation is resolved satisfactorily, and the nurse comes back to the computer entry screen to complete charting. At the end of the shift, the nurse manager asks to speak with the nurse and tells her that she is concerned with what happened today on the unit because there was a breach in confidentiality. Which response by the nurse indicates that she understands the nurse manager’s concerns?
A. The nurse acknowledges that she should have made sure that her patient was safe before assisting with the emergency.
B. The nurse states that she should have logged out of the EHR prior to attending to the emergency.
C. The nurse indicates that the unit was understaffed.
D. The nurse indicates that the she changed her password following the clinical emergency to maintain confidentiality.
Correct answer:
Step-by-step rationale:
1. The correct answer is B because logging out of the EHR prior to attending to the emergency is crucial to maintain patient confidentiality.
2. By leaving the EHR open, the nurse exposed sensitive patient information to potential unauthorized access.
3. This action violates patient privacy rights and is a breach of confidentiality.
4. Choice A is incorrect as it does not address the specific issue of breaching patient confidentiality by leaving the EHR open.
5. Choice C is irrelevant as understaffing does not excuse the breach of patient confidentiality.
6. Choice D is incorrect as changing the password after the breach does not rectify the initial mistake of leaving the EHR open.
Summary: Choice B is the correct response as it directly addresses the breach of confidentiality by acknowledging the importance of logging out of the EHR to protect patient information. Choices A, C, and D are incorrect as they do not effectively address the issue of breaching patient confidentiality.
Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year-old child with possible shock?
A. distal capillary refill
B. systolic blood pressure
C. skin color and temperature
D. presence of peripheral pulses
Correct answer:
Systolic blood pressure is the least reliable parameter when assessing the perfusion status of a 2-year-old child with possible shock. In pediatric patients, especially young children, blood pressure may not decrease until significant shock has already occurred, making it a late indicator of inadequate perfusion. Depending solely on systolic blood pressure to evaluate perfusion status in this age group can lead to a delay in appropriate interventions. Distal capillary refill time, skin color, and temperature changes, and the presence of peripheral pulses are more sensitive and early indicators of perfusion status in pediatric patients. Monitoring distal capillary refill provides information on peripheral perfusion, while changes in skin color and temperature can signal circulatory compromise. Evaluating the presence or absence of peripheral pulses offers insights into vascular perfusion. These parameters offer more reliable and prompt feedback on a child's perfusion status compared to systolic blood pressure.
The nurse is preparing for the discharge of a premature neonate to home with the parents. The nurse explains the neonate must be able to pass the infant car seat challenge before discharge. For which reason would the neonate be considered unsafe in a car seat?
A. Inability to remain at a 45-degree angle for a period of 1 hour
B. Reluctance of parents to use the car seat because of the small size of the baby
C. Inability to maintain adequate oxygenation, heart rate, and respiratory rate during trial
D. Inability to continue prescribed oxygen therapy for the neonate while in a car seat
Correct answer:
The correct answer is C because the infant car seat challenge is used to assess if the neonate can maintain adequate oxygenation, heart rate, and respiratory rate in a seated position. This is crucial as infants who are unable to maintain these vital signs while in a car seat are at risk of oxygen desaturation and apnea, which can lead to serious complications such as suffocation or sudden infant death syndrome. Therefore, if the neonate is unable to maintain adequate oxygenation, heart rate, and respiratory rate during the trial, it would be unsafe for them to travel in a car seat.
Choices A, B, and D are incorrect because they do not directly relate to the safety concerns associated with the infant car seat challenge. Choice A refers to the angle at which the neonate should be positioned in the car seat, which is important for proper positioning but not the primary concern during the car seat challenge. Choice B focuses on parental attitudes towards using the car seat, which is not a physiological
A client who is 6 hours postpartum and Rh-negative has an Rh-positive newborn. The client asks why an indirect Coombs test was ordered. Which of the following is an appropriate response by the healthcare provider?
A. It determines if kernicterus will occur in the newborn.
B. It detects Rh-negative antibodies in the newborn's blood.
C. It detects Rh-positive antibodies in the mother's blood.
D. It determines the presence of maternal antibodies in the newborn's blood.
Correct answer:
The correct answer is C because the indirect Coombs test is used to detect Rh-positive antibodies in the mother's blood. In this scenario, the mother is Rh-negative, so if she has been sensitized to Rh-positive blood during childbirth, her immune system may produce antibodies that could potentially harm future Rh-positive pregnancies. This test helps identify the presence of these antibodies early on so appropriate interventions can be initiated to prevent hemolytic disease of the newborn.
Choices A, B, and D are incorrect:
A: This test does not determine if kernicterus will occur in the newborn. Kernicterus is a severe complication of jaundice, which may result from hemolytic disease of the newborn if untreated.
B: The indirect Coombs test does not detect Rh-negative antibodies in the newborn's blood. It specifically looks for Rh-positive antibodies in the mother's blood.
D: The test does not determine the presence of maternal antibodies in the newborn's blood. It focuses on detecting antibodies in
The nurse is teaching a student nurse about some of the differences between a term and preterm infant. Which statement is most accurate?
A. Infants born at 32 weeks gestational age have sufficient alveolar stability to maintain adequate lung expansion.
B. Surfactant may need to be given to the infant born less than 34 to 36 weeks of age to assist with alveolar stability.
C. Women with gestational diabetes have larger babies; therefore, there are fewer issues with lung maturity when born preterm.
D. Mothers carrying multiples fetuses will increase the surfactant production naturally in utero.
Correct answer:
The correct answer is B because infants born before 34 to 36 weeks gestational age may not have fully developed surfactant production, which is crucial for alveolar stability and lung expansion. Surfactant reduces surface tension in the alveoli, preventing their collapse. Without sufficient surfactant, preterm infants are at risk of respiratory distress syndrome.
Choice A is incorrect because infants born at 32 weeks may still have underdeveloped alveoli and insufficient surfactant production, leading to potential lung expansion issues.
Choice C is incorrect because the presence of gestational diabetes does not guarantee sufficient lung maturity in preterm infants. Lung maturity is more closely related to gestational age and surfactant production.
Choice D is incorrect because while carrying multiple fetuses can slightly increase surfactant production, it may not be sufficient for preterm infants born before 34 to 36 weeks, necessitating the need for exogenous surfactant administration.
How should the nurse prepare the sibling of a near-drowning accident victim who wants to see his brother in the pediatric intensive care unit, considering the child was present during the accident?
A. Have the parents explain to the child why the sibling is so sick and inform the child that this could be the last time he sees his brother.
B. Reassure the sibling not to cry in the child's room to avoid upsetting the ill child.
C. If death is imminent, avoid informing the child about it and minimize involvement in care to protect the child from further trauma.
D. Cover tubes and wires with a sheet, wash off any existing blood, and prepare him for what he will see.
Correct answer:
When preparing a sibling to see their brother in the pediatric intensive care unit after a near-drowning accident, it is essential to cover tubes and wires with a sheet, wash off any existing blood, and explain what the sibling will see. This approach helps the sibling understand the situation better and prepares them emotionally for the encounter, reducing potential distress and trauma. By providing information and visual preparation, the sibling can have a more controlled and less overwhelming experience when visiting their brother in the intensive care unit. Choice A is incorrect as informing the child that this could be the last time he sees his sibling may cause unnecessary distress and anxiety. Choice B is incorrect as it dismisses the sibling's emotional response, which is essential to address in a supportive manner. Choice C is incorrect as honesty and appropriate information sharing are crucial, even in difficult situations, to help the child cope effectively with the circumstances.
Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem?
A. Group all care activities together to provide long periods of rest.
B. Keep charts on top of the incubator so the nurses can write on them ther
C. While giving a report to the next nurse, stand in front of the incubator and talk softly about how the infant responds to stimulation.
D. Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.
Correct answer:
The correct answer is D: Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.
Rationale:
1. Teaching parents signs of overstimulation empowers them to recognize and respond to their infant's cues effectively.
2. Parents can then modify the environment or interactions to reduce overstimulation, hence decreasing oxygen use.
3. This intervention promotes parental involvement in the care of the preterm infant, fostering a supportive and nurturing environment.
4. By educating parents, the nursing staff can work collaboratively with families to optimize the infant's care and well-being.
Summary:
A: Grouping care activities may help with rest but does not directly address overstimulation and increased oxygen use.
B: Keeping charts on top of the incubator is irrelevant to addressing overstimulation.
C: Providing a soft report does not directly address overstimulation or involve parents in recognizing signs.
A nurse concludes that the parent of a newborn is not showing positive indications of parent-infant bonding. The parent appears very anxious and nervous when asked to bring the newborn to the other parent. Which of the following actions should the nurse use to promote parent-infant bonding?
A. Hand the parent the newborn and suggest that they change the diaper.
B. Ask the parent why they are so anxious and nervous.
C. Tell the parent that they will grow accustomed to the newborn.
D. Provide reinforcement about infant care when the parent is present.
Correct answer:
The correct answer is D because providing reinforcement about infant care when the parent is present can help build the parent's confidence and competence in caring for the newborn, which can enhance parent-infant bonding. By offering support and guidance during interactions with the newborn, the parent can feel more comfortable and connected to the baby.
A: Handing the parent the newborn and suggesting they change the diaper may increase their anxiety and not address the underlying issue of bonding.
B: Asking the parent why they are anxious and nervous is important but may not directly promote bonding without providing concrete support.
C: Telling the parent they will grow accustomed to the newborn does not actively support bonding or address the parent's current concerns.
In summary, choice D is the best option as it provides practical assistance and positive reinforcement to help the parent feel more confident in caring for the newborn, ultimately fostering parent-infant bonding.
A client is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown after childbirth. Which of the following conditions is associated with these manifestations?
A. Postpartum fatigue
B. Postpartum psychosis
C. Letting-go phase
D. Postpartum blues
Correct answer:
The correct answer is D: Postpartum blues. This temporary condition occurs in the first few days after childbirth and is characterized by symptoms like tearfulness, insomnia, lack of appetite, and feeling letdown. Here's the rationale:
1. Postpartum blues are common and typically resolve within a few days to a week postpartum.
2. The symptoms mentioned align with the typical presentation of postpartum blues, which includes mood swings, irritability, and crying spells.
3. Postpartum fatigue (choice A) is a general symptom post-childbirth but does not specifically encompass the emotional and psychological symptoms described.
4. Postpartum psychosis (choice B) is a severe condition characterized by hallucinations, delusions, and disorganized thinking, which are not present in the client's presentation.
5. Letting-go phase (choice C) refers to the process of detachment from the pregnancy and accepting the reality of the newborn, but it does not encompass the specific symptoms described in
LPN exams pediatrics practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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