CCRN Pediatric Practice Exam Questions from AACN with answers 2023, Exams of Nursing

Download CCRN Pediatric Practice Exam Questions from AACN with answers 2023 and more Exams Nursing in PDF only on Docsity! CCRN Pediatric Practice Exam Questions from AACN with answers 2023 A 1-month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant with the same symptoms who died at 2 months of age. Which additional assessment finding would cause the nurse to suspect an inborn error of metabolism? A) Micrognathia B) Microglossia C) Petite Facial Features 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 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In order to determine the discharge needs of the patient, the nurse should arrange for: A) Home nursing care for the first few days following discharge 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 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. 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 A child is admitted for colitis. Eight hours after admission the patient develops respiratory distress, abdominal distension, and capillary refill time greater than four seconds. The nurse should suspect: A) Intussusception B) Splenic Rupture C) Malrotation with Volvulus D) Bowel Perforation Answer: D) Bowel Perforation: This patient is demonstrating signs of bowel perforation with possible shock. Colitis can progress to the point of abdominal perforation. The patients abdominal distension is placing upward pressure on the diaphragm, resulting in decreased lung capacity and respiratory distress. Capillary refill time greater than four seconds is an indication of shock A) Intussusception: Symptoms of intussusception include acute paroxysmal abdominal pain during which the child may draw the knees to the chest and have increasing vomiting and red stools. The symptoms in thei scenario are not consistent with intussusception. B) Splenic rupture: Signs of splenic injury include tachycardia, hypotension, and abdominal tenderness The symptoms in this scenario are not consistent with a splenic rupture. C) Malrotation with volvulus: Symptoms of malrotation with volvulus include bilious emesis and bloody, mucous stools. The symptoms in this scenario are not consistent with malrotation with volvulus. 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. 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 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 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. 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. 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 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. A patient with bronchopulmonary dysplasia (BPD) is admitted with heart failure. the nurse can expect to perform interventions to: A) Decrease Preload B) Increase Afterload C) Decrease Heart Rate 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. A patient with end-stage pituitary adenoma is in the ICU being treated for aspiration pneumonia and diabetes insipidus. Despite knowing a plan for transpyloric tube feedings and nothing by mouth the mother is giving water and soft drinks to the patient. What is the nurse's best response to this situation? A) Ask the resident physician to change the diet order to include oral fluids. B) Notify the social worker that the mother is interfering with the medical plan. C) Ask the mother to explain why she is giving fluids to her son D) Ask security to restrict the mother's ability to visit the ICU Answer: C) Ask the mother to explain why she is giving fluids to her son: The nurse needs to understand the reasons for the mother's behavior before the nurse can advocate for the child's needs and the mother's goals for her son's care. A) Ask the resident physician to change the diet order to include oral fluids: A change in diet order may put the patient at risk for further aspiration and does not address the mother's concerns or care goals for her child. B) Notify the social worker that the mother is interfering with the medical plan: While the social worker may be able to help the mother identify personal resources, the nurse should first determine the mother's reasons for not following the medical plan and then help her articulate her goals for her son's care. D) Ask security to restrict the mother's ability to visit the ICU: Removing the mother from the unit does not address the mother's concerns or goals for her son's care and may create an adversarial relationship between the mother and the hospital staff. 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 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. 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 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. 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. 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 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 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 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. 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 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. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with: A) Tachypnea B) Cyanosis C) Confusion D) Hypotension Answer: C) Confusion: The patient with asphyxia from smoke inhalation will experience cerebral hypoxemia and demonstrate symptoms of neurologic dysfunction, including confusion A) Tachypnea: While the patient with smoke inhalation may experience tachypnea as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia B) Cyanosis: While the patient with smoke inhalation may experience cyanosis as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia D) Hypotension: While the patient with smoke inhalation and a burn injury may demonstrate hypotension from fluid shifts, this symptoms is not specific to asphyxia 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. 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 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. 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. B) Maintain current fluid rate: Maintaining the current fluid rate could result in fluid overload once the patient's urine output decreases following the administration of desmopressin (DDAVP) C) Increase sodium intake: Patients with diabetes insipidus are at risk for hypernatremia as a result of fluid shifts from very high urine output. Following the administration of desmopressin (DDAVP), urine output falls, correcting the fluid and sodium balance. Increasing the patient's sodium intake would contribute to inadvertent hypernatremia. D) Decrease glucose intake: Glucose levels and intake are an important consideration in diabetes mellitus, not diabetes insipidus. 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. Which of the following is a daily practice that should be a part of the bundle to reduce the incidence of central line-associated bloodstream infections? A) Review of antibiotics B) Replacement of the infusion tubing C) Replacement of the catheter D) Review of catheter necessity Answer: D) Review of catheter necessity: The Institute for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin antisepsis for children older than 2 months of age, along with a daily review of the line necessity. The consideration of catheter removal should be documented daily in the medical record. Unnecessary catheters should be removed promptly. A) Review of antibiotics: while it is important to review the patient's medication list daily, the Institute for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin 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. 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. 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 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