paediatric nursing MCQ

1. Which of the following statements concerning children with attention deficit hyperactivity disorder (ADHD) is TRUE?

a)      Children with ADHD are more academically able than those without ADHD

b)      Children with ADHD are more likely to be girls than boys

c)      Children with ADHD are up to 25% more likely to sustain a traumatic head injury than those without ADHD

2. At what body mass index (BMI) is obesity currently defined?

a)      25

b)      30

c)      35

3. Which of the following statements about childhood obesity is FALSE?

a)      Obese children are more likely to come from poorer families

b)      Obese children are more likely to have obese parents

c)      Obese children are more likely to suffer from ADHD

d)     Obese children are more likely to suffer isolation and bullying at school 

4. There are many short and long term complications of obesity in childhood. They include all of the following EXCEPT:

a)      Slipped femoral epiphysis

b)      Hypertension

c)      Low self-esteem

d)     Skin disease

5. Fathers who are not married to the Mother of their children do not have automatic parental responsibility for these children. They may however gain responsibility by doing any of the following EXCEPT:

a)      Registering the birth with the Mother

b)      By agreement of the Mother

c)      By living with the Mother

d)     By obtaining a court order

6. Which act governs principles of consent in children of 16 and 17 years of age?

a)      The Family Law Reform Act

b)      The Children Act

c)      The Fraser Act

7. In taking a history from a child and their family it is important to begin the consultation with:

a)      Closed questions

b)      Open questions

c)      Leading questions

8. The following are all important considerations in the clinical examination of children EXCEPT:

a)      To consider the child’s previous experience of healthcare settings

b)      To consider the interaction of the child with parents or carers

c)      To consider aspects of your approach to the child that may appear threatening

d)     To consider the child’s needs and not that of parents or carers

9. At what age would you expect stranger anxiety and separation anxiety to be most acute?

a)      Adolescence

b)      6-9 years

c)      12 months

10. Diagnostic decision making is an increasingly important part of many nurse’s role. The following are all strategies to aid diagnosis EXCEPT:

a)      Pattern recognition

b)      Decision analysis theory and differential diagnosis

c)      Documentation

d)     Intuition

11. Which of the following statements about children’s bones is UNTRUE?

a)      Children’s bones are softer and more pliable than adult’s bones

b)      Children’s bones have growth plates that fuse at about 18 years of age

c)      Children’s bones break more easily than adult’s bones

d)     Children’s bones have sometimes different fracture patterns than adult’s bones

12. All of the following features of a young child’s head make it more likely to suffer a head injury EXCEPT:

a)      The head is relatively larger than in the adult

b)      In young children the parachute reflex may not be fully developed

c)      Young children have patent fontanelles

d)     Young children have immature psychomotor skills

13. Which of the following injuries would you LEAST EXPECT to see in a 4 year old that has fallen onto an outstretched hand?

a)      Supracondylar fracture of the humerus

b)      Fracture of the mid-third of the clavicle

c)      Fracture of the neck of the humerus

d)     Buckle fracture of the distal radius

14. Which of the following statements describes a Salter-Harris type 5 fracture of the growth plate?

a)      A fracture through the metaphysis that does not involve the epiphysis

b)      A fracture through the epiphysis that does not involve the metaphysis

c)      A fracture through the metaphysis and epiphysis

d)     A crush injury of the growth plate

15. Which of the following Salter-Harris growth plate injuries is LEAST LIKELY to cause post injury arthritis and growth abnormalities?

a)      Salter Harris type 4 injury

b)      Salter Harris type 2 injury

c)      Salter-Harris type 3 injury

16. The following are all signs of respiratory distress in children EXCEPT:

a)      Nasal flaring

b)      Recession of intercostal muscles

c)      Capillary refill time of 2 seconds

d)     Expiratory grunting

 17. The following are all reliable means of estimating how well or unwell a child is EXCEPT:

a)      Checking capillary refill time

b)      Checking the respiratory rate

c)      Checking blood pressure

d)     Checking for non-blanching rashes

18. The following are early signs of meningococcal disease in children EXCEPT:

a)      Hypotension

b)      Prolonged capillary refill time

c)      Tachycardia

d)     Cool peripheries

e)      Abnormal interaction with parents or carers

19. Which of the following is an acceptable way to estimate the weight of a child when it is impossible to weigh them formally?

a)      (Age in years + 2) X 4

b)      (Age in years + 4) x 2

c)      (Age in months + 4) x 3

20. Which of the following findings is diagnostic of a bony injury in an x-ray of a child’s elbow?

a)      An undisplaced anterior fat pad

b)      The presence of an accessory ossicle

c)      A posterior fat pad

21. Why is a pulled elbow an uncommon presentation after the age of 5 or 6 years?

a)      At this age the radial head matures and is held more securely in the annular ligament

b)      At this age the annular ligament becomes fibrosed and holds the radial head more securely

c)      At this age children’s bones begin to ossify

22. The following are all signs of life threatening asthma in children EXCEPT:

a)      Silent chest

b)      Bradypnoea

c)      An expiratory wheeze on auscultation of the chest

23. The British Thoracic society define life threatening asthma as being when peak expiratory flow recordings are:

a)      <75% of predicted

b)      <33% of predicted

c)      <20% of predicted

d)     <50% of predicted

24. Which one of the following is indicated as a treatment in mild dehydration secondary to gastroenteritis in a child?

a)      Broad spectrum antibiotic

b)      Anti-motility drugs

c)      Oral rehydration therapy

d)     IV fluid replacement

25. All of the following are signs of an acute abdomen with peritonitis EXCEPT:

a)      Abdominal guarding

b)      Rebound tenderness

c)      Abdominal distension

d)     Pain on passing urine

26. Which of the following would you expect to be the LEAST LIKELY cause of an acute abdomen in a child?

a)      Perforated appendix

b)      Volvulus

c)      Pancreatitis

d)     Intussusception

27. Which of the following statements about impetigo skin infection is UNTRUE?

a)      It is a staphylococcal or streptococcal infection

b)      It is most commonly found on the face and trunk

c)      It is highly contagious

d)     It does not generally need to be treated with antibiotics

28. Herpes simplex is commonly seen in children and adolescents. Which of the following statements is UNTRUE?

a)      It is characterised by vesicular lesions

b)      Recurrence is often associated with trigger factors in individuals

c)      It is characterised by macular lesions

d)     It is contagious 

  

29. The NICE (2007) guidelines for the management of feverish illness in children in children less than 5 years of age recommend that:

a)      Paracetamol be alternated with Ibuprofen in the management of fever

b)      Antipyretics should not be given in a child with fever who is otherwise well

c)      Antipyretics be given to avoid febrile convulsion

30. According to NICE the following signs and symptoms are the 3 main causes of parental anxiety in their children:

a)      Fever, cough and the possibility of meningococcal disease

b)      Fever, diarrhoea and the possibility of meningococcal disease

c)      Fever, weight loss and the possibility of meningococcal disease

Paediatric Multiple Choice Questionnaire                          Answers

1	C	Children with ADHD are more often boys and sometimes face difficulties in academic achievement. Hyperactivity associated with ADHD leads to an increased risk of many sorts of injury including head injury
2	B	Being overweight is currently defined as a body mass index over 25 whilst obesity is defined as a body mass index greater than 30
3	C	Obesity in children is disproportionately evident in lower socio-economic groups and obese children may have obese parents. Bullying and intimidation at school and a limited peer network are features of obesity in children also
4	D	Low self-esteem secondary to isolation and intimidation is more prevalent amongst obese children. Hypertension is a long term risk associated with obesity whilst slipped femoral epiphysis is seen in adolescent boys more than girls and has an association with obesity
5	C	Since 2002 fathers not married to the mother may acquire parental responsibility by registering the birth jointly. They may also do so by agreement of the Mother or secondary to a court order in their favour.
6	A	The Family Law reform act of 1969 allows 16 and 17 year olds to consent to certain treatments but decisions to refuse treatment may be overturned by courts. Fraser competence also has to be taken into account in this age group
7	B	Closed and leading questions might be usefully employed later in the consultation when diagnosis is being considered and the practitioner wishes to focus the information from the patient. Open questions at the start of the consultation will yield more information to base diagnosis on and is a part of actively listening to the patient. Closed or leading questions at the start of a consultation may lead the patient to think that they are not being listened to or are being rushed
8	D	Children should be treated as part of a family unit and this is particularly important in young children where anxiety about separation from parents is also prevalent. Previous experience of healthcare settings may influence the present consultation especially if this is recollected as a bad experience. Aspects of how we approach children and the environment we do this in should also be considered.
9	C	Anxiety about being separated from parents begins when the child is less than 1 year old and is most prevalent in this very young age group. A degree of independence and being comfortable for short periods away from parents will become evident at around 2 or 3 years of age
10	C	Documentation is an important part of the consultation but does not help in diagnosis. Pattern recognition and differential analysis are recognised decision making techniques and certain authors also argue that intuitive processes inform diagnosis
11	C	Being softer and more pliable it generally requires more force to break a child’s bone than an adult’s as the bone will absorb a certain amount of force without fracturing. If fractured children’s bones may show characteristic fracture patterns such as buckle and greenstick deformities. Growth plates fully fuse at approximately 18 years
12	C	The greater relative size of the young child’s head, immature psychomotor skills and an immature parachute reflex (the action of putting out an outstretched hand when falling) all make children more likely to sustain head injury. Patent fontanelles below the age of about 18 months mean that classical symptoms of rising intracranial pressure may be evident at a later stage in this age group as the fontanelles compensate for a certain level of rising pressure
13	C	A fall onto an outstretched hand is a common mechanism of injury and may produce differing injuries according to the age of the patient. In older patients Colles fractures of the wrist and fractures of the neck of the humerus are common whilst children are more likely to sustain supracondylar fractures in the elbow, fractures of the clavicle and buckle fractures of the wrist
14	D	Growth plate injuries in children are classified according to the Salter Harris system. Salter Harris 5 type fractures are associated with falls from height in children and are crush injuries  - in adults fractures of the calcaneum may result from similar mechanism of injury
15	B	Salter Harris fractures that involve the epiphysis itself are associated with growth and development problems and arthritic processes, Salter Harris 3,4,and 5 fractures all involve the epiphysis whereas Salter Harris type 1 and 2 fractures do not
16	C	Respiratory distress in children may be evidenced by nasal flaring and recession of the intercostal muscles of the chest wall secondary to increased respiratory effort. An expiratory grunt in children is secondary to forced closure of the glottis in an effort to increase positive end pressure in the airway. A capillary refill time of 2 seconds is a normal finding
17	C	Children compensate very well for circulatory failure by maintaining a normal blood pressure for a longer period of time than many adults. A normal blood pressure in a child should not therefore be allowed to reassure the practitioner that the child is not unwell. Earlier signs of circulatory problems include a prolonged capillary refill time and an increased respiratory rate
18	A	Hypotension is a late marker of major illness or injury in children. In meningococcal disease with septicaemia a prolonged capillary refill time, cool peripheries and tachycardia may all indicate peripheral shutdown and peripheral circulatory damage. The importance of listening to parental reports of abnormal behaviour cannot be over-emphasised as they are obviously far more able to gauge this than the healthcare professional
19	B	(Age in years + 4) x 2 is an acceptable means of estimating weight in kilograms in children with BMI within normal limits. So a 4 year old would weigh 16 kilograms using this formula (4+4 = 8 x 2 = 16)
20	C	Bony injuries of the elbow in children may be particularly difficult to identify on x-ray. On a lateral film of the elbow an undisplaced fat pad on the anterior aspect of the elbow can be seen normally – if it is displaced away from it’s position following the curve of the elbow then this is indicative of a bloody effusion after a fracture. The posterior fat pad of the elbow should not be visible on a lateral view of the elbow as it lies within the olecranon fossa – this is therefore always an abnormal finding
21	A	The notched appearance of the radial head becomes evident at about the age of 5 years and this holds the radial head more firmly within the annular ligament making pulled elbow much less likely.
22	C	An expiratory wheeze on auscultation of the chest would be expected in asthma whether mild, moderate, severe or life threatening. A silent chest and decreased respiratory rate are signs of exhaustion in the child after a period of compensation  - they are ominous pre-terminal signs
23	B	The British Thoracic Society define mild asthma as 75% or more of expected peak flow, moderate as between 50% and 75%, severe as 33%-50% and life threatening as less than 33%
24	C	Antibiotics are not indicated in uncomplicated gastroenteritis in children as the majority are viral in nature and self-limiting. They may also exacerbate diarrhoea. IV fluid replacement is not indicated in mild (<5%) dehydration and anti-motility drugs such as loperamide are not indicated in children or adults unless symptoms are socially debilitating
25	D	Dysuria is not associated with an acute abdomen and peritonitis. Guarding or being protective of the abdomen, rebound tenderness of the peritoneum on palpation and distension of the abdomen are features of an acute abdomen
26	C	Volvulus and intussusception are seen in very young children and infants and appendicitis is the most common surgical cause of abdominal pain in children. Pancreatitis is seen far more frequently in adults
27	D	As impetigo is highly contagious and seen more commonly in young children antibiotic administration is generally necessary. Impetigo is a staphylococcal or streptococcal infection that most often occurs on the face around the mouth and nose
28	C	Herpes simplex is characterised by vesicular lesions - raised and fluid filled.  They often recur associated with different trigger factors such as stress and sunlight in individuals. It is contagious at 1-4 days. A macular rash is a flat rash that involves a change in colour of the skin usually to red or pink and is seen in diseases such as measles
29	B	The NICE guidelines of May 2007 concerning feverish illness in the under 5’s recommend that antipyretics should not be given solely to reduce fever in children who are otherwise well as fever is a therapeutic response to illness. They specifically discourage the routine alternation of paracetamol and ibuprofen to manage fever and advise that administration of antipyretics does not prevent febrile convulsions
30	A	The NICE feverish illness guidelines estimate that fever, cough and the possibility of meningitis are the 3 main causes of parental anxiety