CCRN Pediatric Practice Exam Questions and Answers from AACN, Exams of Nursing

Download CCRN Pediatric Practice Exam Questions and Answers from AACN and more Exams Nursing in PDF only on Docsity! CCRN Pediatric Practice Exam Questions and Answers from AACN 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. D) Musty Urine Odor - Answer: D) Musty urine odor: This is a common indicator of a metabolic disorder, especially with a family history of siblings dying early A) Micrognathia: This is not associated with an inborn error of metabolism B) Microglossia: This is not associated with an inborn error of metabolism C) Petite Facial Features: This is not associated with an inborn error of metabolism A school-aged child with autism is admitted with a fractured femur and possible head injury. Which of the following is important to promote adjustment to the hospital setting? A) Assign a child life therapist per shift B) Encourage lots of visitors C) Adhere to a home schedule D) Initiate new activities to keep the patient occupied - Answer: C) Adhere to a home schedule: Autism spectrum disorders are a complex neurodevelopmental disorder of brain function accompanied by a broad range and severity of intellectual and behavioral deficits, which is best managed when adhering to a schedule and minimizing change, so adhering to a home schedule is optimal. The schedule allows the child and family to optimally cope. A) Assign a child life therapist per shift: The assignment of a child life therapist can be very beneficial to help facilitate patient and family understanding of the hospital environment and provide therapeutic coping interventions, but it is not realistic that a child life therapist would be assigned to an individual patient for every shift. B) Encourage lots of visitors: The management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. maintenance of a schedule and minimizing visitors will provide a healing environment appropriate for an autistic patient who has a possible head injury. D) Initiate new activities to keep the patient occupied: Management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. The introduction of new activities may be stressful and potentially harmful with a head injury, so maintenance of 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 D) Increase Contractility - Answer: A) Decrease Preload: Decreasing the preload for a patient with BPD will improve right-sided heart failure related to chronic lung disease B) Increase Afterload: Increasing afterload would impede ventricular ejection, making heart failure worse. C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x SV) which would worsen the patient's heart failure. D) Increase contractility: Although increasing contractility may help improve left- sided heart failure, patients with BPD usually have right-sided heart failure. Factors that impair the release of oxygen to tissues by negatively affecting oxyhemoglobin dissociation include: A) Hyperthermia B) Metabolic acidosis C) Respiratory Acidosis D) Hypothermia - Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot eh right, resulting in hemoglobin that has less affinity for oxygen C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen A 15 yo patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The patient is cool, diaphoretic, restless, mottled peripherally, with no pedal pulses and faint femoral pulses. Vital signs are: HR: 140 MAP: 60 mmHg CVP: 20 mmHg Cardiac Index: 2.3 L/min/m2 SVR: 2000 dynes/sec/cm-5 The nurse should suspect: A) A pulmonary embolus B) Cardiac Tamponade C) Cardiogenic Shock D) Hypovolemic Shock - Answer: C) Cardiogenic Shock: After the Fontan operation, low cardiac output is the most common and severe complication. It is often caused by inadequate blood flow into the pulmonary circulation that results from hypovolemia and inadequate systemic venous pressure, elevated pulmonary vascular resistance, obstruction at the surgical site, or pump failure. A) A pulmonary embolus: A pulmonary embolus (PE) is most commonly associated with a deep vein thrombus. Other risk factors bacterial endocarditis, sepsis, and hematologic/oncologic pathology. There is no mention of complaints of chest pain or dyspnea, which are primary indicators of a PE. B) Cardiac Tamponade: This is a sudden accumulation of fluid in the pericardial sac. Signs and symptoms are similar to shock, hypotension, tachycardia, high CVP, narrowing of pulse pressure and deteriorating systemic perfusion. D) Hypovolemic Shock: Although some of the classic signs of hypovolemic shock are present (cool, restless, decreased pulses, tachycardia) diaphoresis and elevated CVP would not be seen with hypovolemic shock. While performing an exchange transfusion for a patient with sickle cell disease, which of the following electrolyte abnormalities should the nurse anticipate? A) Hypocalcemia B) Hypercalcemia C) Hypokalemia D) Hypomagnesemia - Answer: A) Hypocalcemia: metabolic complications of blood transfusion include hypocalcemia B) Hypercalcemia: Hypocalcemia is a complication of blood transfusion. C) Hypokalemia: Hyperkalemia is a complication of blood transfusion. D) Hypomagnesemia: This is not a complication of blood transfusion An adolescent with a history of admission for chronic status asthmaticus is being prepared for discharge. The nurse determines that the patient has not been compliant with medications, because doing so "makes him feel too different" from his peers. The nurse should: A) Arrange for the patient's school nurse to monitor compliance B) Provide the patient with articles on the relationship of hospitalization and medication compliance. C) refer the patient to a support group for adolescents with asthma D) Advise the parents to withhold privileges if the patient remains non-compliant. - Answer: C) Refer the patient to a support group for adolescents with asthma: this intervention will help normalize the experience and increase compliance A) Arrange for the patient's school nurse to monitor compliance: This will not help with the issue causing noncompliance and may worsen the problem. 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. 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. B) "I found the catheter disconnected from the collection device during my hourly assessment.": This is a potential risk for introducing infection bacteria. However, if the nurse replaced the device and reported the incident to the provider, the risk is low. D) "It is so much easier to monitor hourly output with a catheter in place.": This is not an appropriate use of a urinary catheter. A child presents with a chief complaint of blood in her urine. A review of the medical records shows multiple admissions for the same symptom. No etiology has been found. The patient is symptomatic only when the mother is present. The nurse suspects that the diagnosis will be: A) Muchausen syndrome by proxy. B) Nonaccidental Trauma C) Physical Abuse D) Sexual Abuse - Answer: A) Munchausen syndrome by proxy: Also known as medical child abuse or factitious disorder by proxy. Munchausen syndrome by proxy is the diagnosis given when a caregiver deliberately exaggerates or fabricates a medical history and symptoms, or induces symptoms resulting in caregiver gratification. The child's condition does not match the history, and diagnostic evidence does not support the diagnosis suggested by the history. B) Nonaccidental Trauma: Nonaccidental trauma resulting in hematuria would leave visible signs of abuse, such as bruising. C) Physical Abuse: Physical abuse resulting in hematuria would leave visible signs of abuse, such as bruising. D) Sexual Abuse: Sexual abuse of a child often involves exposure of genitalia, touching/fondling and/or oral genital contact. Hematuria alone would not support this diagnosis. Respiratory therapists, physical therapists, occupational therapists and nurses are all responsible for discharge teaching, with each discipline currently documenting on its own flow sheet. The best way to coordinate teaching would be to have: A) Daily care conferences to review and discuss patient teaching and the flow sheets B) Each discipline distribute copies of its flow sheet to each team member. C) Nurses review the flow sheets of all disciplines during shift change. D) All disciplines document patient teaching on the same flow sheet. - Answer: D) All disciplines document patient teaching on the same flow sheet: This plan is consistent with Collaboration. It gives opportunities for all disciplines to see the contributes of other team members. A) Daily care conferences to review and discuss patient teaching and the flow sheets: This plan is consistent with Collaboration but would be difficult to accomplish. Thus, it is not the best option. B) Each discipline distribute copies of its flow sheet to each team member: This plan is not consistent with Collaboration, and not an effective use of time for each team member. C) Nurses review the flow sheets of all disciplines during shift change: This plan is not consistent with Collaboration. All team members should be involved in the teaching process. Which of the following rhythms is expected one day post-cardiac catheterization for repair of an atrial septal defect (ASD)? A) Premature atrial contraction B) Junctional ectopic tachycardia C) Sinus bradycardia D) Sinus tachycardia - Answer: A) Premature atrial contraction: this is cause by an irritation to the atria during the cardiac catheterization. B) Junctional ectopic tachycardia: this is caused by an irritation to the AV node. C) Sinus bradycardia: Sinus bradycardia is not an expected complication of cardiac catheterization for repair of an atrial septal defect. D) Sinus tachycardia: Sinus tachycardia may be seen with stress, pain, hypoxemia, and low cardiac output, which are not expected or managed during the post-procedure phase. Which of the following would lead to hypovolemia due to increased insensible fluid loss in an infant post-cardiac surgery? A) Decreased activity B) Hypothermia C) Radiant warmer use D) Sedation - Answer: C) Radiant warmer use: The radiant warmer increases the effects of evaporation, which increases insensible fluid loss. A) Decreased activity: Decreased activity would decrease insensible fluid loss. B) Hypothermia: Hypothermia would decreased insensible fluid loss. D) Sedation: Sedation would decrease insensible fluid loss. A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing assessment for early neurological deterioration is: A) Level of consciousness B) Pupillary response 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) Prepare equipment for intubation: Although the patient may require intubation, this will not be the first action C) Prepare the patient for central venous line placement: Although the patient may require a central venous line, this will not be the first action D) Increase intravenous fluid rate: Intravenous fluids used in pediatric patients generally are hypertonic and include dextrose and potassium, which would be dangerous to give at an increased rate. The primary objective in the treatment of an infant with persistent pulmonary hypertension is to: A) Maintain the pH level at less than 7.40 B) Dilate the pulmonary vascular bed C) Dilate the systemic vascular bed D) Maintain fetal pulmonary circulation - Answer: B) Dilate the pulmonary vascular bed: Pulmonary vasodilation helps maintain adequate systemic blood pressure, decreases pulmonary vascular resistance, and ensures oxygen release to tissues in patients with persistent pulmonary hypertension of the newborn A) Maintain the pH level at less than 7.40: Acidosis is a condition that will worsen pulmonary vasoconstriction, the opposite of what needs to occur in patients with persistent pulmonary hypertension of the newborn C) Dilate the systemic vascular bed: Systemic vasodilation will not correct persistent pulmonary hypertension of the newborn. D) Maintain fetal pulmonary circulation: Persistence of fetal circulation results in persistent pulmonary hypertension. Which of the following actions would be appropriate after the administration of desmopressin (DDAVP) to a patient with diabetes insipidus? A) Decrease IV fluid rate B) Maintain current fluid rate C) Increase sodium intake D) Decrease glucose intake - Answer: A) Decrease IV fluid rate: Diabetes insipidus results in very high urine output, necessitating large volumes of fluid replacement to prevent dehydration. Following the administration of desmopressin (DDAVP), urine output falls and the IV fluid rate must be adjusted accordingly. 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?