AACN CCRN Pediatric Practice Exam 150 Questions & Answers RATIONALES., Exams of Nursing

Download AACN CCRN Pediatric Practice Exam 150 Questions & Answers RATIONALES. and more Exams Nursing in PDF only on Docsity! AACN CCRN Pediatric Practice Exam 150 Questions & Answers RATIONALES To promote effective grieving in a 6-year-old sibling following the death of an infant, the nurse should: A) Recommend that the sibling not attend the infant's memorial service B) Encourage the parents to minimize their expression of grief with the sibling C) Explain to the sibling that the infant went to heaven D) Explain to the sibling that thoughts and wishes did not cause the infant's death - ✔ Answer: D) Explain to the sibling that thoughts and wishes did not cause the infant's death: At age 6, children may take words literally and because of their egocentrism, they believe that thoughts are all-powerful. They may truly believe they caused the death of their sibling. A simple, honest explanation of why the sibling died is indicated. This intervention is consistent with Caring Processes. A) Recommend that the sibling not attend the infant's memorial service: This intervention is not a solution to the problem and will not promote effective grieving for the sibling. It is not consistent with Caring Processes. B) Encourage the parents to minimize their expression of grief with the sibling: This intervention will lead to ineffective grieving for the sibling and is not consistent with Caring Processes C) Explain to the sibling that the infant went to heaven: This intervention will not address the sibling's problem A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at four weeks of age is admitted with increased somnolence, decreased appetite, and increased complaints of headache. This morning the child vomited twice. The nurse should anticipate: A) The physician ordering lumbar puncture and blood and urine cultures B) the patient having a CT scan followed by possible shunt revision C) Administering mannitol or hypertonic saline D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) - ✔ Answer: B) The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. A) The physician ordering lumbar puncture and blood and urine cultures: These interventions will not address the most likely primary problem, which is suspected VP shunt malfunction. Additionally, lumbar puncture is contraindicated in the presence of increased intracranial pressure, because downward herniation of the brainstem can occur. C) Administering mannitol or hypertonic saline: These medication are indicated for the medical management of increased intracranial pressure, of which this patient has symptoms. However, they will not address the most likely primary problem, which is suspected VP shunt malfunction. D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most likely primary problem, which is suspected increased intracranial pressure as a result of VP shunt malfunction An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? A) Small Bowel Injury B) Cardiac Contusion C) Splenic Laceration D) Pulmonary Embolism - ✔ Answer: C) Splenic laceration: Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis A) Small bowel injury: Signs of small bowel injury may include progressive abdominal distension, not referred left shoulder pain. B) Cardiac Contusion: Signs of cardiac contusion include chest pain, arrhythmias, and other indicators of myocardial dysfunction, such as elevated cardiac isoenzymes. Upper quadrant abdominal pain with radiation to the left shoulder is not consistent with a cardiac contusion D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on exertion, not left shoulder pain An infant has been admitted with encephalitis. The nurse should first assess the patient's: A) Pupillary response B) Blood glucose level C) Level of consciousness D) Airway Patency - ✔ Answer: D) Airway Patency: The first priority after admitting an infant with encephalitis is to assess the patient's ability to maintain airway patency. Such patients can develop rapid neurologic deterioration, and the nurse must be prepared to support the airway, oxygenation, and ventilation as needed. A) Pupillary Response: The infant with encephalitis should be monitored for changes in neurologic status, including pupillary response. However, assessing the patient;s ability to maintain airway patency is the first priority. B) Blood Glucose Level: The infant with encephalitis will need blood glucose levels monitored, especially if unable to maintain adequate oral intake. However, assessing the patient's ability to maintain airway patency is the first priority. C) Level of consciousness: The infant with encephalitis should be monitored for changes in neurologic status, including assessment of the level of consciousness. However, assessing the patient's ability to maintain airway patency is the first priority. a schedule and known activities will provide a healing environment appropriate for an autistic patient with a possible head injury. A patient who does not speak or understand English is admitted. Guidelines for using a translator may include A) Having the translator ask questions that you don't feel comfortable asking B) Standing next to the translator and as close to the patient as possible C) Providing all of the information, then allowing translation and asking of questions D) Allowing time for the translator to decode the medical jargon used in the teaching. - ✔ Answer: B) Standing next to the translator and as close to the patient as possible: This response is consistent with high competency levels in Facilitation of Learning. It supports the patient through the process of obtaining the information required from a professional individual and the translator A) Having the translator ask questions that you don't feel comfortable asking: This response is not consistent with high competency levels in Facilitation of Learning. A translator should be used to obtain all pertinent patient information C) Providing all of the information, then allowing translation and asking of questions: This response is not consistent with high competency levels in Facilitation of Learning. Content may be accidentally omitted with the process described in this option. D) Allowing time for the translator to decode the medical jargon used in the teaching: This response is not consistent with high competency levels in Facilitation of Learning. Jargon should not have to be decoded by the translator. This can lead to errors by the translator, who might provide inaccurate information. Family members of a patient who has just died are crying and wailing loudly both inside and outside the patient's room. Staff are expressing frustration with the outbursts. The nurse's best response is to acknowledge the noise and A) Ask a security officer to remove the family from the unit B) Guide the family to a nearby room where they can express their emotions C) Tell the family they must quiet down, or they will have to leave the unit D) Tell the other staff they are being insensitive to the family's expression of grief - ✔ Answer: B) Guide the family to a nearby room where they can express their emotions: People from various cultures express grief and mourning in different ways. This expression may include loud, emotional responses. Providing the family a place close to the patient's room allows them privacy while minimizing disruption to other patients and staff in the area. A) Ask a security officer to remove the family from the unit: Removing the family is not a culturally sensitive way to allow the family to experience their grief and mourning C) Tell the family they must quiet down or they will have to leave the unit: Asking the family to be quiet or removing them from the unit are not culturally sensitive ways to allow the family toe experience their grief and mourning D) Tell the other staff they are being insensitive to the family's expression of grief: Telling other staff members that they are being insensitive does not promote cultural awareness and does not address the family's need to express their grief and mourning. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for: A) Heart Failure B) Air Emboli C) Hypoxemia D) Syncope - ✔ Answer: A) Heart Failure: Heart Failure is a common manifestation associated with increased pulmonary blood flow B) Air Emboli: Although air emboli are possible with a septal defect, it would be a rare occurrence. This may be seen later in life due to chronic increased pulmonary blood flow C) Hypoxemia: Hypoxemia is not usually associated with cardiac defects that result in increased pulmonary blood flow D) Syncope: Syncope is not associated with cardiac defects that result in increased pulmonary blood flow A nurse believes the number of hemolyzed blood samples that have been reported by the laboratory is excessive. The best action for the nurse would be to A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed B) Request a staff meeting to discuss the problem and ask for feedback C) Develop an educational in-service on the proper blood-sampling technique for the staff D) Create a poster and post-test demonstrating the proper method of drawing blood samples - ✔ Answer: A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed: Evidence-based practice is the use of available data to support care and address care concerns. The nurse currently has only an impression and no data to support the concern B) Request a staff meeting to discuss the problem and ask for feedback: this intervention will not address the need for data to validate the concern C) Develop an educational in-service on the proper blood-sampling technique for the staff: This intervention will not address the need for data to validate the concern D) Create a poster and post-test demonstrating the proper method of drawing blood samples: This intervention will not address the need for data to validate the concern Which ventilatory parameters should be weaned first in a patient with bronchopulmonary dysplasia (BPD)? A) Tidal Volume (VT) and oxygen (FiO2) B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV) C) Oxygen (FiO2) and intermittent mandatory ventilation (IMV) D) Oxygent (FiO2) and peak inspiratory pressure (PIP) - ✔ Answer: D) Oxygen (FiO2) and peak inspiratory pressure (PIP): FiO2 should be weaned as soon as oxygenation improves. PIP is weaned as lung compliance improves A) Tidal Volume (VT) and oxygen (FiO2): Patients with BPD are usually ventilated using a pressure cycled ventilator mode, as breaths delivered at a set volume to non compliant lungs may generate a pressure higher than the desired peak pressure. B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV): PIP is weaned as the lung compliance improves but IMV is a mode of ventilation, not a weanable parameter C) Oxygent (FiO2) and intermittent mandatory ventilation (IMV): FiO2 is weaned as oxygenation improves but IMV is a mode of ventilation, not a weanable parameter Which of the following interventions would be the most valuable in aiding management of a child requiring PEEP of 14 cm water? A) Extracorporeal membrane oxygenation (ECMO) B) Placement of a thoracostomy tube C) Placement of a pulmonary artery catheter D) High-frequency oscillatory ventilation (HFOV) - ✔ Answer: D) High-frequency oscillatory ventilation (HFOV): HFOV improves oxygenation through alveolar recruitment without the complications associated with high PEEP, which is also used to improve oxygenation A) Extracorporeal Membrane Oxygenation (ECMO): This is used to provide support to patients with reversible cardiac or respiratory failure B) Placement of a thoracostomy tube: Placement of a thoracostomy tube is not indicated in this situation. This procedure would be performed in the case of air leak syndrome C) Placement of a pulmonary artery catheter: Pulmonary artery catheters are rarely used in pediatric patients. Clinical manifestations observed in a child diagnosed with failure to thrive may include A) Avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development C) Distress when held of left alone D) No interest in surroundings - ✔ Answer: A) Avoidance of eye contact and delayed motor development: The clinical manifestations of failure to thrive may include growth failure, apathy, avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development: The child may have a history of excessive irritability and may cry during feedings. Delayed language development is not associated with failure to thrive. C) Distress when held of left alone: When held these children may protest briefly when being put down but are apathetic when left alone D) No interest in surroundings: These children may display intense interest in inanimate objects such as toys but are much less interested in social interactions A nursing unit needs to be able to place patients back on ventilator support, as ordered, while patients nap Due to staffing patters, the respiratory therapist is not always available on the unit to place patients on the ventilator. An appropriate response by the nurse would be to: A) Place the patient on the ventilator when needed, despite current policy B) Wait for the therapist to intervene. C) Ask the parent to be responsible for this task. B) Provide the patient with articles on the relationship of hospitalization and medication compliance: Parents and older children often need education about eh maintenance aspect of asthma management to be reinforced. D) Advise the parents to withhold privileges if the patient remains non-compliant: For most children, withholding privileges is not a motivator to promote compliance. Amrinone lactate (Inocor) is given for which desired effect? A) Vasodilation B) Phospholipid inhibition C) Decreased myocardial contractility D) Catecholamine antagonism - ✔ Answer: A) Vasodilation: Amrinone is a phosphodiesterase inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting in improved cardiac contractility and vasodilation. B) Phospholipid Inhibition: This is not an effect of amrinone administration C) Decreased myocardial contractility: This is not an effect of amrinone administration. D) Catecholamine antagonism: This is not an effect of amrinone administration A family meeting is planned to discuss the family's ethical concerns regarding continuing life support measures for a child with end-stage cancer. The nurse's role should be to: A) Provide the legal standpoint regarding end-of-life decisions for children. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy C) Coordinate the meeting to ensure that everyone has the opportunity to speak D) Assist the parents in articulating their questions and concerns. - ✔ Answer: D) Assist the parents in articulating their questions and concerns: The parents' thoughts and understanding are critical for making decisions about their child's care. Nurses act as advocates by assisting the parents in articulating their questions and concerns and empowering the family to speak for their child and themselves. A) Provide the legal standpoint regarding end-of-life decisions for children: This does not address the parents' concenrs. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy: This does not specifically address the parents' concerns regarding continued life support measures and is not consistent with Caring Practices. C) Coordinate the meeting to ensure that everyone has the opportunity to speak: This intervention is not consistent with Caring Practices or Advocacy and Moral Agency, as the nurse's opinions and decisions may be in conflict with those of the parents. A hypertensive crisis as evidenced by acidosis, hypothermia, and alveolar hypoxia may be demostrated in which of the following children? A) Those with reactive pulmonary vascular bed B) Those with systemic vascular disease. C) Those with increases in ventricular afterload. D)Those with sustained increases in afterload - ✔ Answer: A) Those with reactive pulmonary vascular bed: Children with pulmonary vascular disease are at risk for developing a pulmonary hypertensive crisis. B) Those with systemic vascular disease: Systemic vascular disease does not affect pulmonary pressure C) Those with increases in ventricular afterload: The pediatric ventricle adapts to increases in ventricular afterload, provided the increases are not severe or acute. D) Those with sustained increases in afterload: Acute increases in afterload are poorly tolerated. The nurse is providing patient education for a family whose child has cerebral palsy and will be receiving a baclofen (Lioresal) pump to control spasticity. Which of the following is most important for the nurse to include in the discussion? A) The durg acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA) B) Parents can be taught to regulate the dosage based on symptoms. C) The child will have a normal gait after insertion of the pump. D) Parents must bring the child back to the clinic to have medicine added to the pump. - ✔ Answer: D) Parents must bring the child back to the clinic to have medicine added to the pump: The intrathecal dose of baclofen delivered via implanted pump is adjusted in the outpatient clinic using a telemetry wand every three to six months. A) The drug acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA): Baclofen has the opposite effect described in this answer, as it is a GABA agonist. B) Parents can be taught to regulate the dosage based on symptoms: The intrathecal dose of baclofen is adjusted in the outpatient clinic using a telemetry wand. C) The child will have a normal gait after insertion of the pump: The child's gait may be improved due to relief of severe spasticity, but there is no guarantee of a normal gait with this therapy. Positive end-expiratory pressure (PEEP) is intended to do which of the following? A) Increase functional residual capacity B) Decrease functional residual capacity C) Increase venous return to the heart D) Increase cardiac output - ✔ Answer: A) Increase functional residual capacity: PEEP increases functional residual capacity (FRC) by keeping the alveoli open after expiration, increasing alveolar volume B) Decrease functional residual capacity: This is the opposite of what occurs when PEEP is used. C) Increase venous return to the heart: PEEP can impede systemic venous return D) Increase cardiac output: At high levels, PEEP may decrease cardiac output. A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration this venture is financially worthwhile is to: A) Present a report summarizing research relating developmental care to decrease length of stay. B) Request that the neonatoogist present the plan. C) Present case studies demonstrating favorable outcomes for developmental care. D) Invite members of administration to attend the classes. - ✔ Answer: A) Present a report summarizing research relating developmental care to decreased length of stay: Evidence-based practice is the use of available data to support care. A decrease in length of stay is a motivator to support practice. B) Request that the neonatologist present the plan: This intervention will not address the financial concerns of the administrators. C) Present case studies demonstrating favorable outcomes for developmental care: This intervention will not address the financial concerns of the administrators. D) Invite members of the administration to attend the classes: This intervention will not address the financial concerns of the administrators. A 2-year-old with left-sided ventricular heart failure and pulmonary edema is experiencing extreme dyspnea. Which of the following would the nurse suggest to improve the work of breathing and decrease the child's anxiety and agitation? A) Digoxin (Lanoxin) B) Morphine (Duramorph) C) Furosemide (Lasix) D) Dobutamine (Dobutrex) - ✔ Answer: B) Morphine (Duramorph): Morphine relaxes the smooth muscles in the bronchial tubes, making the work of breathing easier, and it helps to control associated anxiety and agitation. A) Digoxin (Lanoxin): Digoin is a cardiac glycoside, which improves cardiac contractility and may be indicated for this patient. However, digoxin is not specifically used to treat dyspnea or anxiety/agitation. C) Furosemide (Lasix): Furosemide, a diuretic that blocks reabsorption of sodium and water, may be indicated for this patient, but is not specifically used to treat dyspnea or anxiety/agitation. D) Dobutamine (Dobutrex): Dobutamine has selective beta-adrenergic effects, which increase cardiac contractility. Dobutamine may be indicated for this patient but is not specifically used to treat dyspnea or anxiety/agitation. Which of the following statements by staff would be most concerning to the nurse who is championing the reduction of catheter-associated urinary tract infections (CAUTI) in his/her unit? A) "The urinary catheter was placed last night in the emergency department during trauma resuscitation." B) "I found the catheter disconnected from the collection device during my hourly assessment." C) "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled." D) "It is so much easier to monitor hourly output with a catheter in place." - ✔ Answer: C) "The patient is transferring to the floor today. They can discontinue the urinary catheter once they get him settled.": Catheters should be removed as soon as possible to prevent infection related to urinary catheters. A) "The urinary catheter was placed last night in the emergency department during trauma resuscitation.": Because catheters placed in the ED during resuscitation may pose a higher risk for infection, it is important to strictly monitor output following resuscitation. C) Perihilar infiltrates D) An elevated diaphragm - ✔ Answer: A) Hyperinflation: Hyperinflation is the expected finding due to air trapping associated with asthma B) Lobar consolidation: Lobar consolidation is typically seen with pneumonia, not asthma. C) Perihilar infiltrates: Perihilar infiltrates are possible but not common. D) An elevated diaphragm: A flattened diaphragm is seen in patients with asthma and is associated with air trapping. A child with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, and dilated pupil, and is hyperreflexic. the plan of care would be to administer: A) Glucagon IM B) Naloxone (Narcan) IV C) 25% Dextrose IV D) Regular insulin SQ - ✔ Answer: C) 25% dextrose IV: The patient has signs of severe hypoglycemia, and administration of IV dextrose will quickly raise the blood glucose level. No more than 12.5% glucose should be given peripherally. A) Glucagon IM: Glucagon is administered for severe hypoglycemia. It requires 15 to 20 minutes to elevate the blood glucose. B) Naloxone (Narcan) IV: Naloxone, which reverses the effects of opioids, is not indicated for this patient. D) Regular Insulin SQ: Regular insulin, which will lower the patient's blood glucose level, is not indicated for this patient with severe hypoglycemia. A nurse is caring for a patient with type 1 diabetes mellitus who has had multiple admissions over the last year for diabetic ketoacidosis (DKA). Before discharge for this episode of DKA, it is most important that the nurse arranges: A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high. B) To teach the patient to avoid sugar and foods high in carbohydrates C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease. D) For the patient and family to join a diabetes support group. - ✔ Answer: C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease: At this point, after multiple admissions, the most important intervention is helping the patient and family navigate through the system to identify available resources that could be helpful in meeting the challenge of the disease. A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high: A patient with diabetes most likely knows how to administer sliding scale insulin, but reinforcing the concepts may be indicated. B) To teach the patient to avoid sugar and foods high in carbohydrates: A patient with diabetes most likely knows the effects of diet on blood glucose, but reinforcing the concepts may be indicated. D) For the patient and family to join a diabetes support group: This may be helpful if the family is willing, but it is not the most important intervention A 10-day-old infant is admitted with a suspected congenital heart defect, due to a history of poor feeding and sudden onsent of respiratory distress and cyanosis. Initial assessment shows: HR: 180 pH: 7.28 RR: 72 pCO2: 30 BP: 48/ Doppler pO2: 48 CRT: greater than 5 sec HCO3: 16 The patient is intubated and placed on mechanical ventilation. Settings are as follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: 100%. Subsequent ABG results show: pH: 7.27 pCO2: 28 pO2: 50 HCO3: 15 The most probably etiology off the patient's cardiopulmonary status is which of the following? A) Tetrology of Fallot B) Hypoplasia C) Coarctation of aorta D) Transposition of the great arteries - ✔ Answer: B) Hypoplasia: Ten days after birth, the ductus arteriosus has closed, increasing pulmonary blood flow, and aortic flow and ysstemic perfusion decreasing. This causes severe deterioration, including severe cyanosis, hypoxemia, acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration or mechanical ventilation. A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic spell ("tet" spell). This patient has lower than normal pCO2. C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding, tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not sudden onset of respiratory distress. D) Transposition of the great arteries: In patients with transposition of the great arteries, cyanosis will not improve with oxygen administration. But oxygen administration helps decrease pulmonary vascular resistance, leading to increased pulmonary blood flow, which improves mixing of systemic and venous blood and improves arterial oxygen saturation. A teenager post-cardiac arrest has a new diagnosis of hypertrophic cardiomyopathy. The parents are concerned about what to do if their son collapses again. The nurse's best response would be: A) "Now that your son has been diagnosed and treated, you need not worry." B) "Would teaching you CPR help ease your anxieties?" C) "Do you know how to access the EMS system?" D) "I will have your son's cardiologist speak with you." - ✔ Answer: B) "Would teaching you CPR help ease your anxieties?": This statement is consistent with Caring Practices and Facilitation of Learning. It identifies and clarifies the parents' concerns, which is a first step when providing information. It also shows support for the parents' concerns. A) "Now that your son has been diagnosed and treated, you need not worry.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. C) "Do you know how to access the EMS system?": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. D) "I will have your son's cardiologist speak with you.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. Referring the parents to another provider will delay getting answers. This issues is something the nurse should be able to address. Which of the following methods is the best to update a family that speaks primarily Spanish? A) Use hand gestures to point to key things, such as the patient and the surgeon. B) Have the patient's 12-year-old sibling provide interpretation for the family C) Utilize a medical interpreter either in person or on the telephone. D) Give the family the operative consent written in Spanish. - ✔ Answer: C) Utilize a medical interpreter either in person or on the telephone: An interpreter whose role is to provide medical interpretation from English to the patient's or family's primary language is the best option, especially when care decisions are being made. A) Use hand gestures to point to key things, such as the patient and the surgeon: Hand gestures are not an appropriate method for medical interpretation when a patient's or family's primary language is not English. B) Have the patient's 12-year-old sibling provide interpretation for the family: It is not appropriate to have a child or other family member provide medical interpretation when a patient's or family's primary language is not English. D) Give the family the operative consent written in Spanish: Providing documents in the patient's or family's primary language is useful, but this option alone does not allow for verbal medical interpretation. When treating a patient with hypovolemic shock due to prolonged vomiting, the first action by the nurse should be to: A) Administer oxygen B) Prepare equipment for intubation C) Prepare the patient for central venous line placement D) Increase intravenous fluid rate. - ✔ Answer: A) Administer oxygen: It is important to assure that circulating blood is saturated with oxygen B) A social worker to meet with the family and assess adequacy of the home environment C) An outreach educator to determine the learning needs of the family D) A multidisciplinary care conference before discharge - ✔ Answer: B) A social worker to meet with the family and assess adequacy of the home environment: The first predischarge priority for a technology-dependent child is to assess the adequacy of the home environemtn. Further discharge planning is then based on the needs of the patient and family. A) Home nursing care for the first few days following discharge: While home nursing care may be needed after discharge, the first predischarge priority in this scenario is to evaluate the home environment. From there, a determination can be made about nursing care that will be needed at home. The home may not be adequate for a safe transition for the infant. C) An outreach educator to determine the learning needs of the family: Education may be necessary before discharging a technology-dependent child, but that cannot be determined without further information about the patient's home environment and family needs. D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to prepare to meet the complex needs of the child at home. A child with a myelomeningocele is started on a bowel management plan. the nurse would recognize that more education is needed when the mother states, "My child: A) tends to be more prone to diarrhea." B) will be unable to control his bowel movements." C) will require more activity to increase bowel movements." D) needs to have a bowel movement every day." - ✔ Answer: A) tends to be more prone to diarrhea.": With Facilitation of Learning the nurse recognizes this mother does not yet understand that patients with a myelomeningocele are prone to constipation and impaction, rather than diarrhea. Additional education is needed to help the mother understand the bowel management plan. B) will be unable to control his bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. C) will require more activity to increase bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. D) needs to have a bowel movement every day.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. A newborn is admitted with transposition of the great arteries. The SpO2 equals 46%. No murmur is heard. Until a balloon septostomy can be performed, which of the following medications should the nurse anticipate being administered as a temporary measure? A) Alprostadil (PGE1) B) Tolazoline (Priscoline) C) Indomethacin (Indocin) D) Digoxin (Lanoxin) - ✔ Answer: A) Alprostadil (PGE1): The initial management of the patient with transposition of the great arteries involves maintaining adequate arterial oxygen saturation via intercirculatory mixing of blood Until a balloon septostomy can be performed, alprostadil (PGE1) infusion is used to maintain patency of the ductus arteriosus. Additionally, it lowers pulmonary and systemic vascular resistance. B) Tolazoline (Priscoline): Tolazoline (Priscoline) is a vasodilator and is indicated for the treatment of persistent pulmonary hypertension of the newbon. C) Indomethacin (Indocin): Indomethacin (Indocin) is a prostaglandin synthetase inhibitor that is used to promote closure of a patent ductus arteriosus. Closure of the ductus would be life threatening in the patient with transposition of the great arteries. D) Digoxin (lanoxin): Digoxin (Lanoxin) is an antiarrhythmic used to treat a variety of cardiac conditions including supraventricular tachycardia and other atrial tachycardias. A patient with receptive aphasia and delirium is to be enrolled in a clinical trial. How should the nurse proceed to ensure informed consent is properly obtained? A) Involve the patient's legal guardian in the consent process B) Ensure that the investigator is aware of the patient's condition C) Inform the institutional review board (IRB) of the potential risk to the patient D) Obtain a copy of the consent form to place in the patient's chart. - ✔ Answer: A) Involve the patient's legal guardian in the consent process: A legal guardian can assist in the consent process when the patient is unable B) Ensure that the investigator is aware of the patient's condition: While the investigator may need to be aware of the patient's condition, in order to ethically protect this patient's rights related to consenting to research, the patient's legal representative needs to be involved in the consent process to speak on the patient's behalf. C) Inform the Institutional review board (IRB) of the potential risk to the patient: The IRB would have already evaluated the risks and benefits, including subject recruitment and consent, before granting approval for the clinical trial to proceed. Further IRB involvement might be warranted for violations of the research protocol or patient complications D) Obtain a copy of the consent form to place in the patient's chart: Just placing a copy of the consent form on the patient's chart does not meet the need to ethically protect the patient's rights related to consenting to research. If the patient is incapacitated, the legal guardian should be involved in the consent process. A patient is intubated due to a sudden deterioration in respiratory status. Arterial blood gases (ABG) post intubation are as follows: pH: 7.31 pCO2: 50 pO2: 80 HCO3: 22 O2 Sat: 95% The ABGs reflect: A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Metabolic acidosis - ✔ Answer: A) Respiratory acidosis: The patient in this scenario demonstrates a pH2 less than 7.35 and CO2 greater than 45 mmHg, which reflects respiratory acidosis. B) Respiratory alkalosis: Respiratory alkalosis would be reflected by ABG results demonstrating a pH greater than 7.45 and CO2 less than 35 mmHg C) Metabolic Alkalosis: Metabolic Alkalosis would be reflected by ABG results demonstrating a pH greater than 7.45 and HCO3 greater than 28 meq/L. The HCO3 in this patient scenario is within normal range. D) Metabolic acidosis: Metabolic acidosis would be reflected by ABG results demonstrating a pH less than 7.35 and HCO3 less than 22 mEq/L. The HCO3 in this patient scenario is within normal range. A patient presents with recurrent episodes of intermittent palpitations associated with weakness. An ECG reveals a heart rate of 125, a shortened PR interval, and a slurred upstroke before each widened QRS complex. This slurred upstroke (Delta wave) can be explained by: A) Atrial pre-excitation B) Atrial depolarization C) Ventricular repolarization D) Ventricular pre-excitation - ✔ Answer: D) Ventricular pre-excitation: In ventricular pre-excitation, the initial portion of the QRS complex is prolonged, and this "initial slurring" appears as Delta waves on the ECG. The ventricular pre-excitation in a patient with Wolff-Parkinson-White results from an anomalous conduction pathway between the atrium and the ventricle. The resultant premature depolarization of the ventricle produces a Delta wave and a widened QRS. A) Atrial pre-excitation: A slurred upstroke (Delta wave) is not associated with atrial pre- excitation B) Atrial depolarization: A slurred upstroke (Delta wave) is not associated with atrial depolarization C) Ventricular repolarization: A slurred upstroke (Delta wave) is not associated with ventricular repolarization Which of the following physical assessment findings are seen in a patient with an acute asthma attack receiving albuterol (Proventil) inhalation treatments? A) Wheezing and agitation B) Coughing and grunting C) Pleural rub and wheezing D) Stridor and bronchospasm - ✔ Answer: A) Wheezing and agitation: Wheezing is usually present during an asthma attack, unless severely diminished air movement is present as a result of bronchospasm and inflammation. Agitation is an adverse effect of beta-2 receptor agonists, such as albuterol (Proventil) B) Coughing and grunting: While a cough is a common symptom of acute asthma attack, grunting is usually seen with patient sin severe respiratory distress