Pediatric Nursing MCQ Quiz - Objective Question with Answer for Pediatric Nursing - Download Free PDF

• An inguinal hernia occurs when a portion of the intestine or abdominal tissue protrudes through a weak spot in the abdominal muscles, specifically in the inguinal canal. This condition is relatively common in children, particularly in boys.
• The key clinical finding of an inguinal hernia in a child is a painless swelling or bulge in the groin area, which becomes more noticeable when the child cries, coughs, or strains. This happens because increased intra-abdominal pressure pushes the herniated tissue outward, making the bulge more visible.
• The swelling usually disappears or reduces when the child is calm or lying down, as the herniated tissue moves back into the abdominal cavity.
• Although inguinal hernias are typically painless, complications such as strangulation (when blood supply to the herniated tissue is cut off) can occur, leading to pain, redness, and other symptoms that require immediate medical attention.

• Rationale: Difficulty defecating is not a primary symptom of an inguinal hernia. While constipation can increase intra-abdominal pressure, which may exacerbate the visibility of a hernia, it is not a direct indicator of the condition. Difficulty defecating is more commonly associated with gastrointestinal issues such as constipation, anal fissures, or bowel obstruction.

• Rationale: A dribbling urinary stream is usually linked to urological conditions such as urinary tract infections, posterior urethral valves, or bladder dysfunction. It is not indicative of an inguinal hernia, as hernias do not typically affect the urinary system unless they are associated with other rare complications.

• Rationale: The absence of a testis within the scrotum is a characteristic finding of cryptorchidism (undescended testis), a separate condition. Although cryptorchidism and inguinal hernias can sometimes coexist in male children due to developmental abnormalities, the absence of a testis is not a direct indicator of an inguinal hernia.

• The most accurate clinical finding for an inguinal hernia in a child is painless groin swelling that becomes noticeable when the child cries or strains. Early identification and treatment are crucial to prevent complications such as incarceration or strangulation. Parents should seek medical evaluation if they notice any unusual swelling in the groin area of their child.

• Oesophageal atresia (EA) is a congenital condition where the oesophagus, the tube that carries food from the mouth to the stomach, does not develop properly. Instead of forming a continuous passage, the oesophagus ends in a blind pouch or is abnormally connected to the trachea. This defect prevents the normal passage of food and saliva.
• Continuous drooling is a hallmark sign of oesophageal atresia in newborns. Since the oesophagus is not properly connected to the stomach, any saliva produced by the infant cannot be swallowed and instead accumulates, leading to excessive and continuous drooling.
• In addition to drooling, newborns with oesophageal atresia may experience choking, coughing, or cyanosis (bluish discoloration of the skin) during feeding due to the inability to properly swallow or the misdirection of food into the airway.

• Rationale: While slowed reflexes may indicate neurological or developmental concerns, they are not specific to oesophageal atresia. Oesophageal atresia is primarily a structural defect of the oesophagus and does not directly impact reflexes.

• Rationale: Diaphragmatic breathing refers to breathing that primarily uses the diaphragm, which is normal for newborns. This is not indicative of oesophageal atresia. However, respiratory distress can occur in these infants due to aspiration or associated anomalies, but this is not the same as diaphragmatic breathing.

• Rationale: This symptom is unrelated to oesophageal atresia. Frothy stool might suggest gastrointestinal issues, but oesophageal atresia affects the upper digestive tract and does not directly cause changes in stool characteristics.

• Continuous drooling is the most specific and indicative sign of oesophageal atresia in a newborn. Early recognition of this condition is critical as it requires prompt medical intervention to prevent complications such as aspiration pneumonia and ensure proper feeding through alternative methods like a gastrostomy tube.

• The apex of the heart is the most reliable site for checking the pulse in a neonate. In neonates, their small size and unique physiology make the apex beat more prominent and easily identifiable compared to other pulse points.
• The apex beat is the point of maximal impulse, where the heart's contraction can be felt most clearly, typically located at the left side of the chest, near the fifth intercostal space and midclavicular line. In neonates, this position is adjusted slightly due to their smaller chest size.
• Using the apex of the heart ensures that healthcare providers can reliably assess the heart rate and rhythm, which are critical indicators of cardiovascular function in newborns.
• This method is non-invasive, straightforward, and avoids potential complications associated with palpating other pulse points, which may be less accessible in neonates.

• Rationale: The carotid pulse is a reliable pulse point in adults and older children but is not preferred in neonates. The carotid artery is located deep within the neck and may be difficult to palpate in a newborn due to their small anatomy and lack of defined musculature.
• Moreover, applying pressure near the carotid artery in neonates can pose risks, including potential compression of the airway or vagal stimulation, leading to bradycardia.

• Rationale: The femoral pulse is located in the groin area and may be used in emergency situations to assess circulation. However, it is less reliable for routine pulse assessment in neonates due to the difficulty in palpating the pulse accurately in this region.
• Additionally, the femoral pulse may be obscured by movement or positioning of the neonate, making it less practical for consistent pulse monitoring.

• Rationale: The brachial pulse is another viable option for pulse assessment in neonates and is often used during resuscitation. It can be palpated by gently pressing on the inner aspect of the upper arm, between the shoulder and elbow.
• However, the brachial pulse is less reliable than the apex of the heart for routine pulse checking, as it may require precise positioning and can sometimes be challenging to locate in a moving or restless neonate.

• Among the given options, the apex of the heart is the most reliable site for checking the pulse in neonates. It provides a clear and consistent assessment of heart rate and rhythm, which is essential for monitoring the neonate's cardiovascular status.
• Other pulse points, such as the carotid, femoral, and brachial, may be used in specific circumstances but are generally less practical or reliable for routine pulse assessment in neonates.

• A newborn's body temperature is an important indicator of their health status. The rectal temperature is considered the most accurate measurement of the core body temperature in infants. This is because the rectal method provides a direct reading of the body's internal temperature, unaffected by external factors like air temperature or clothing.
• The normal rectal temperature for a newborn is approximately 37.7 °C (99.9 °F). This value is slightly higher than the average adult temperature due to the newborn's metabolic activity and physiological processes.
• Maintaining an appropriate body temperature is crucial for newborns as they are less capable of regulating their temperature compared to adults. Deviations from the normal range could indicate underlying issues such as infection, hypothermia, or overheating.

• Rationale: Axillary (underarm) temperature is commonly used for newborns due to its ease and non-invasive nature. However, it tends to be less accurate than rectal measurements. The normal axillary temperature for a newborn is slightly lower, typically around 36.5 °C to 37 °C, making this option not the best representation of core body temperature.

• Rationale: Oral temperature measurement is not suitable for newborns because they are unable to hold a thermometer in their mouth properly. This method is more applicable to older children and adults. Therefore, this option is incorrect as it is not a recommended method for newborn temperature assessment.

• Rationale: While 36.8 °C could fall within the normal axillary temperature range for a newborn, it does not represent the core body temperature as accurately as the rectal method. Axillary readings can vary based on external conditions, making it less reliable for assessing a newborn's health.

• Among the given options, 37.7 °C (rectal) is the most accurate and reliable measurement of a newborn's core body temperature. Proper temperature assessment is critical for identifying potential health issues and ensuring the well-being of the infant.

• Play therapy is a psychotherapeutic approach specifically designed for children to help them express their emotions, thoughts, and experiences through play activities rather than verbal communication. This is particularly beneficial for children who prefer solitary activities or have difficulty expressing themselves verbally.
• Children who engage in solitary activities may use play as a safe and non-threatening medium to explore their emotions, work through their challenges, and develop social and emotional skills.
• The therapist observes the child's play behavior, interacts when appropriate, and uses these interactions to address the child's emotional and psychological needs in a supportive manner.
• Play therapy is effective in addressing a variety of issues, including anxiety, trauma, behavioral problems, and difficulty in social interaction, making it ideal for children who prefer being alone.

• Rationale: Family therapy focuses on improving communication, relationships, and dynamics within a family unit. While it can be beneficial for addressing family-wide issues, it is not specifically tailored to children who prefer solitary activities or struggle with individual emotional expression.

• Rationale: Art therapy involves using creative expression, such as drawing, painting, or sculpting, to explore emotions and experiences. While it can help children express themselves, it may not engage solitary children as effectively as play therapy, which uses a broader range of interactive activities tailored to their natural preferences.

• Rationale: CBT is a structured, goal-oriented form of therapy that focuses on identifying and changing negative thought patterns and behaviors. While it is highly effective for older children and adults, it relies heavily on verbal communication and cognitive skills, which may not be suitable for younger children or those who prefer solitary activities.

• Rationale: In the given question, there is no fifth option provided, so it does not apply to this explanation.

• Play therapy is the most suitable option for children who prefer being alone and engage in solitary activities. It provides a non-verbal, safe, and engaging way for children to express themselves and address emotional or psychological challenges.

Concept:

• Breast milk : Produced by the mammary glands of the lactating mother.
• Used to provide nutrition to the infant.
• Colostrum -> Provides important nutrients and elements of innate immunity to the infant -> Maternal antibodies.

Explanation:

• Breast milk can be stored at room temperature for 4 hours.
• Breast milk storage bags and food - grade containers -> Used to store breast milk.
• The storage time in a refrigerator is 4 days.
• Need -> Can be fed to the baby -> When he is hungry.

• The recommended compression-to-ventilation ratio for neonatal resuscitation is 3:1. This means that for every three chest compressions, one ventilation (breath) should be given.
• This ratio is designed to optimize both circulation and ventilation in the critical moments of neonatal resuscitation.
• The higher frequency of compressions relative to ventilations helps to ensure adequate cardiac output and perfusion, which is critical for the survival of a neonate in distress.
• This ratio is based on the specific physiological needs of neonates, who generally require more frequent ventilation support than older children and adults during resuscitation.

• Rationale: A 1:1 ratio would provide insufficient compressions relative to ventilations and does not meet the standard guidelines for neonatal resuscitation.

• Rationale: A 1:2 ratio is not recommended for neonates and would similarly provide an inappropriate balance of compressions and ventilations.

• Rationale: This ratio would be too heavily weighted toward compressions and provide insufficient ventilations for a neonate in distress.

• The correct compression-to-ventilation ratio for neonatal resuscitation is 3:1. This ratio ensures the appropriate balance of chest compressions and ventilations to support the physiological needs of neonates during resuscitation.

Concept:-

Examination of the newborn:

Complete physical examination should be done within 24 hours after birth. Including the following:

1. Vital signs
2. Physical examination
3. Neurological examination
4. Estimation of gestation age  

Newborn examination:

Concept:

• Birth weight of baby quadruples from 2 to 2 1/2 years of age (based on weight at birth).
• A newborn's normal weight is between 2.5 and 3.5 kg. If the weight of the baby is slightly more than 3.5 kg it is considered to be normal. If the baby weighs less than 2.5 kg, then the baby is said to have a low birth weight.

Additional Information

• The weight of newborn babies usually doubles by about 5 months of age. 
• Birth weight of the baby triples by 12 months of age.
• Height doubles between 3 and 4 years old.

Explanation:-

• The height doubles between the age of 4 years old. 

Additional Information

• Neonatal Height triples by 13 years old (based on height at birth).
• Physical growth is especially very fast during the first 2 years. Usually, an infant's birth weight generally doubles within 5 months and triples by the infant's first birthday.
• Also baby grows between 10 and 12 inches in length (or height), and the baby's proportions change during the first 2 years.
• A baby's length is measured usually from the top of their head to the bottom of one of their heels. It's the same as their height, but height is measured standing up, whereas length is measured when the baby is lying down.
• The average length at birth for a full-term baby is 19 to 20 inches or 50 cm.

Explanation

• Dehydration occurs when an infant or child loses so much body fluid that they are not able to maintain ordinary function. 
• Dehydration may happen because of vomiting, diarrhoea, fever or not drinking enough water. 

Some signs of dehydration in infants:

• Dry tongue and dry lips
• No tears when crying
• Depressed fontanelle
• Drowsiness
• Sunken eyes
• Dry and wrinkled skin
• Deep, rapid breathing
• Cool and blotchy hands and feel

 Important PointsDehydration can lead to serious complications, including:

• Heat injury
• Urinary and kidney problems
• Seizures
• Low blood volume shock (hypovolemic shock)

Additional Information ORT (Oral rehydration therapy) is the giving of fluid by mouth to prevent and/or correct the dehydration that is a result of diarrhoea.  As soon as diarrhoea begins, treatment using home remedies to prevent dehydration must be started. If adults or children have not been given extra drinks, or if in spite of this dehydration does occur, they must be treated with a special drink made with oral rehydration salts (ORS).

Dehydration can usually be treated at home, but severe cases may require hospitalization. Hospital care may include:

• Fluids are given intravenously (IV).
• Monitoring of electrolytes imbalance.
• Acetaminophen for fever.
• Rest.

Pneumonia: It is a lung infection caused by virus, bacteria and other micro-organisms.

causative organisms:

• Respiratory Syncytial Virus (most common); Streptococcus Aureus; Streptococcus Pneumoniae etc.

Clinical Manifestations:

• Tachypnea 
  • Respiratory Rate (RR) of 
    • RR > 60 breathes per minute in Neonate
    • RR > 50 bpm in infants 
    • RR > 40 bpm in children of 1 to 5 years of age
• Fever with chills
• Stridor i.e. horse noise on inspiration
• Grunting i.e. short and repetitve sound on expiration
• Nasal flaring
• In severe cases child may present with:
  • altered sensorium
  • Cynosis i.e. Spo2 < 90%

Diagnostic tests: 

• Blood test
• Sputum Culture
• Chest X ray
• Pulse Oximetry

Clinical Management: Broad spectrum antibiotics and symptomatic treatment

Booster Dose:

• Normal Respiratory Rate (RR)
  • Neonate:  30-60 breathes per minute (bpm)
  • Infants : 24-30 bpm
• Pneumonia is one of the leading cause of death among Children below the age of 5 years.
• Pneumonia can be prevented by immunization; adequate nutrition and modifying environmental factors.

Concept:

• Vitamin A is an over-the-counter vitamin that is naturally present in many foods.
• Vitamin A is important for normal vision, the immune system & reproduction.
• Vitamin A also helps the heart, lungs, kidneys and other organs work properly. 'There are two different types of Vitamin A, first preformed Vitamin A, is found in meat, poultry, fish, and dairy products.
• The second, Provitamin A, is found in fruits, vegetables & other plant-based products, most common type of provitamin is Beta-carotene.
• Vitamin A is available under the following different brand names: Retinol, Aquasol & Retinyl Palmitate.

Explanation:

• Vitamin A Supplementation Schedule  for Indian Children:
• Vitamin A ( 1st dose) at 9 completed months with measles- Rubella: 1 ml ( 1 lakh IU)  administered orally.
• Vitamin A ( 2nd dose) 16 to 18 months. Then one dose every 6 months up to the age of 5 years: 2ml ( 2lakh IU) is administered orally.

Additional Information

• The function of Vitamin A:
• Contributes to the production of retinal pigments.
• Required for the normal functioning of epithelial and glandular tissues.
• Supports growth, especially skeletal growth.
• It is anti-infective.
• Deficiency of Vitamin A leads to:
• Night blindness
• Conjunctival xerosis
• Bitot's spot
• Keratomalacia

Concept:

• Stunting is the impaired growth and development of the child.
• It is a disorder of malnutrition.

Explanation:

• Stunting -> low height-for-age.
• Causes:
  • Chronic or recurrent under-nutrition
  • Usually associated with poverty
  • Poor mental health and nutrition
  • Frequent illness and/or inappropriate feeding and care in early life.
• Stunting prevents children from reaching their physical and cognitive potential.
• Treatment:
  • Diet Planning
  • Antibiotics for infection
  • Anthelmintic drugs
  • Health education

Additional Information

• Rest of all options fall under underweight.
• An underweight person is a person whose body weight is considered too low to be healthy (BMI - less than 18.5).