Pediatrics

1. A 15-year-old adolescent suffering from prolonged malnutrition shoes up crying in the emergency room with a clean wet towel around his left arm. His mother quickly explains the situation to the LPN attending to them. The patient was handling a container of boiling water left on the counter and all of its contents fell on his arm. When the LPN removes the towel from the patient’s arm, she sees that the epidermis has completely disappeared. The LPN quickly informs the nurse, who is nearby. Second to third degree burns are extending from the left arm to the joints. The patient’s arm is hypersensitive to air, and his face is very pale. The patient’s vital signs are as follows: BP at 76/50, pulse at 140 bpm, resp. at 44 bpm, SpO2 at 92% in room air, and rectal temp at 37. The patient is almost unresponsive to speech, and his dressings are rapidly being soaked thought by his bodily fluids. The physician asked the LPN to install an IV infusion and begin a Lactated Ringers solution afterwards. Which intervention should take priority in this situation? *
2. A young woman arrives at the emergency room for a puncture wound. She was bitten on the calf by a marmot. The animal ran towards her while she was on a bike path. A portion of her skin and external gemellus muscle was removed by the animal’s teeth. The patient is very worried about getting infected. The young woman’s condition is evaluated by the doctor as well as the nurse. The LPN begins cleaning the wound. In accordance with the nurse’s instructions and the collective prescription, the LPN administers 500 mg 2 co. PO analgesic (acetaminophen). The physician prescribes an anti-rabies vaccine prophylaxis. The patient also receives a first dose of anti-rabies immunoglobulin around and in the wound. Which intervention should take priority in this situation? *
3. A 4-year-old boy is brought to the clinic because he has been crying, irritable, and refusing to sleep. His mother reports that he has been tugging at his right ear for the past 24 hours and had a fever overnight. During the assessment, the LPN notices that the child becomes more upset when laid flat. Otoscopic inspection reveals a red, bulging tympanic membrane. What should the LPN prioritize? *
4. A 7-year-old boy with known asthma arrives at the emergency department after experiencing shortness of breath during soccer practice. He is anxious, using accessory muscles, has audible wheezing, and his oxygen saturation is 91% on room air. He is unable to speak in full sentences. What is the most appropriate first action for the LPN? *
5. A 10-year-old girl hospitalized for suspected appendicitis has been vomiting for 12 hours and appears dehydrated. She now says her “belly hurts less suddenly.” The LPN observes tachycardia, pale skin, and delayed capillary refill. Which finding requires immediate reporting? *
6. A 3-year-old boy is brought to the pediatric unit after three days of fever, poor appetite, and a worsening cough. His mother says he has been breathing “faster than normal” and refuses to lie flat because it “makes it harder to breathe.” On assessment, the LPN notes nasal flaring, mild intercostal retractions, a respiratory rate of 44/min, temperature 38.9°C, and crackles in the right lower lobe. The child clings to his mother and becomes irritable when positioned for auscultation. The physician orders a chest X-ray, humidified oxygen PRN, and IV antibiotics. Which finding indicates the child's respiratory status is worsening? *
7. A 2-year-old girl is admitted for vomiting and diarrhea that began 24 hours ago. Her mother reports that she has refused most fluids and had only one wet diaper today. The LPN notes dry mucous membranes, crying without tears, lethargy between interactions, and a capillary refill of 4 seconds. Vital signs: HR 158/min, RR 32/min, T 37.6°C. The physician orders ORS (oral rehydration solution) in small frequent sips and close monitoring of intake and output. Which sign indicates moderate to severe dehydration? *
8. A 4-year-old boy is brought to the clinic with persistent ear pain, especially at night. His mother reports low-grade fever and recent irritability. The child pulls at his right ear and becomes tearful during assessment. The LPN observes redness behind the ear and tenderness on palpation. The physician diagnoses acute otitis media and prescribes amoxicillin and analgesics PRN. Which intervention will provide the most immediate pain relief? *
9. A 20-month-old toddler arrives at the emergency department at night after developing a barking cough and noisy breathing. His parents say symptoms worsened suddenly. The LPN notes inspiratory stridor, mild retractions, and hoarse voice. The child is frightened and clings to his father. The physician orders humidified air, dexamethasone, and monitoring of airway patency. Which observation requires immediate intervention? *
10. A 6-year-old girl with a history of asthma presents with wheezing, persistent cough, and difficulty playing because she becomes short of breath. Her mother reports that symptoms worsened after the child visited a friend's home with a cat. Vital signs: RR 36/min, HR 142/min, O₂ sat 93% on room air. The physician orders a bronchodilator nebulizer treatment. Which assessment finding shows the treatment is effective? *
11. An 8-year-old child with cystic fibrosis is admitted for poor weight gain and increased mucus production. The mother explains that the child often has bulky, foul-smelling stools. The LPN notes a thin appearance despite a good appetite. The physician orders pancreatic enzyme supplements with all meals and snacks. Which teaching is most important for enzyme administration? *
12. A 2-year-old is brought to the unit with fever 39.8°C, irritability, and decreased appetite. He has no seizure history. The parents are anxious and fear the fever will cause brain damage. The physician orders antipyretics and monitoring. Which statement is correct teaching for the parents? *
13. A 10-year-old with type 1 diabetes becomes pale and shaky during recess. Teachers bring him to the LPN’s office. He reports dizziness and says he skipped breakfast. Fingerstick glucose is 2.8 mmol/L. The physician's standing orders include fast-acting glucose for hypoglycemia. What is the priority action? *
14. A 7-year-old with sickle cell disease is admitted for severe pain in the lower back and legs. He is crying and guarding his limbs. His mother says he has had poor hydration for two days due to a viral illness. The physician orders IV fluids, analgesics, and oxygen PRN. Which intervention is priority? *
15. A 5-month-old infant presents with coughing, wheezing, and difficulty feeding. Parents note decreased wet diapers. Vital signs: RR 58/min, HR 168/min, O₂ sat 92%. The physician suspects RSV and orders nasal suctioning PRN and oxygen as needed. Which finding requires urgent intervention? *
16. A 6-year-old child arrives with fever, cough, conjunctivitis, and a maculopapular rash. Koplik spots are seen inside the cheeks. The physician diagnoses measles and orders airborne precautions. Which action must the LPN perform first? *
17. A 12-year-old arrives with abdominal pain that started near the umbilicus and moved to the right lower quadrant. The LPN notes rebound tenderness, low-grade fever, and decreased appetite. The child is guarding the abdomen. The physician orders NPO status, IV fluids, and surgery consult. Which finding suggests a possible rupture? *
18. A 9-year-old girl presents with fatigue, pallor, and difficulty concentrating at school. Her diet consists mostly of milk, bread, and cereal. The physician orders iron supplements and nutritional counseling. Which food should the LPN recommend to increase iron? *
19. A 4-year-old has had a fever for five days, swollen hands and feet, cracked lips, and conjunctivitis. The physician suspects Kawasaki disease and orders IVIG and aspirin. Which complication is the greatest concern? *
20. A 6-year-old child with chronic diarrhea and poor growth is diagnosed with celiac disease. Parents need teaching before discharge. Which food must be avoided? *
21. A 3-year-old with influenza has fever, chills, cough, and decreased appetite. The LPN notes dry lips and reduced urine output. The physician orders antipyretics and encourages hydration. Which sign indicates improving hydration? *
22. A 7-year-old boy is admitted with fever, headache, photophobia, and neck stiffness. He becomes increasingly irritable and has difficulty focusing during assessment. The physician orders lumbar puncture, antibiotics, and neuro checks q1h. Which change is most concerning? *