CCRN PEDS AACN exam questions with suitable answers latest updated., Exams of Nursing

Download CCRN PEDS AACN exam questions with suitable answers latest updated. and more Exams Nursing in PDF only on Docsity! CCRN PEDS AACN exam questions with suitable answers latest updated. 1. In caring for a patient with salicylate intoxication, the critical care nurse would anticipate which of the following as a primary treatment measure? A. Administration of protamine sulfate B. Administration of glucose C. Transfusion of packed RBCs D. Replacement of fluid and electrolytes - Correct answer D. Replacement of fluid and electrolytes 2. An adolescent with the developmental age of a 4-year-old requires placement of a chest tube. The best way to prepare the patient for this procedure is to A. Use short simple sentences and limit descriptions to concrete explanations. B. Show the patient a chest tube and explain how it will feel. C. Explain in detail why a chest tube is needed and how it works. D. Tell the parents what will be done so they can explain it to their child. - Correct answer Use short simple sentences and limit descriptions to concrete explanations. 3. A child admitted with a gunshot wound to the head, accidentally inflicted by an older sibling. The parents are overcome with grief and appear to be ignoring the following statements made by the older sibling: "It was an accident; I didn't mean to do it; I'm sorry!" Which of the following actions by the nurse would be most appropriate? A. Discuss the importance of gun safety with the older sibling while the parents are at the bedside. B. Seek additional support for the parents for ways they can assist the older sibling C. Tell the parents that they need to provide support for the older sibling D. Tell the older sibling, "Accidents happen; I know you didn't mean to do it." - Correct answer Seek additional support for the parents for ways they can assist the older sibling 4. Which of the following laboratory findings is indicative of the syndrome of inappropriate ADH secretion (SIADH)? A. Serum sodium = 148 mEq/L B. Decreased serum osmolality C. Blood urea nitrogen (BUN) = 28 mg/dl D. Serum potassium = 5.1 mEq/L - Correct answer Decreased serum osmolality 5. A 3-year-old is admitted to the ICU with a 10-hour history of an acute-onset asthma attack. Initial assessment reveals the following HR 160 pH 7.25 RR 48 pCO2 35 BP 112/76 pO2 40 T 32*C HCO3 22 A. Administration of NaHCO3 B. Fluid resuscitation C. Racemic epinephrine D. Intubation - Correct answer Intubation 6. A 2-year-old is experiencing manifestations of digoxin (Lanoxin) toxicity. BP is 94/60, capillary refill time is 2 seconds and the electrocardiogram reveals AV block with a heart rate of 60. The critical care nurse would anticipate which of the following interventions? A. Performance of cardioversion B. Administration of Atropine C. Performance of vasovagal maneuvers D. Monitoring of HR and rhythm and perfusion status - Correct answer Monitoring of HR and rhythm and perfusion status 7. An adolescent with asthma is readmitted just a week after discharge from the hospital. On questioning, the nurse learns that the patient refuses to use the inhalers at school. The nurse should A. Talk to the teen about long-term consequences of the disease if the treatment plan is not followed B. Talk to the school nurse to find out why they are not monitoring the medications at school C. Help the parents set up a disciplinary contract with the teen D. Arrange for the teen to attend an asthma support group - Correct answer Arrange for the teen to attend an asthma support group 8. An unconscious 5-month-old is admitted. The parent reports the baby fell off the table during a diaper change by an older sibling. What findings would indicate further inquiry of the history? A. A reddened or bruised are on the skull B. Poorly reactive pupils C. Retinal hemorrhage D. A linear skull fracture - Correct answer Retinal hemorrhage 1. A 1-month-old infant presents with poor feeding, vomiting and diarrhea since birth. The infant is lethargic and in mild respiratory distress. The mother reports having D. increase contractility. - Correct answer decrease preload 11. A 2-month-old with a history of unrepaired Tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. Nursing interventions are aimed at A. Increasing pulmonary flow and relaxing the infundibulum. B. Decreasing systemic flow and increasing pulmonary vascular resistance. C. Decreasing pulmonary flow and increasing systemic vascular resistance (SVR). D. Increasing systemic flow and relaxing the left ventricular outflow tract. - Correct answer Increasing pulmonary flow and relaxing the infundibulum. During surgery on a 2-month-old with Tetralogy of Fallot, a trans-thoracic PA catheter was placed. Upon removal of this line, the PA pressure is 29 mm Hg systolic. As the line is 'pulled back' into the right ventricle, the pressure measures 72 mm Hg systolic. RA Sat=72, PA Sat=72. This change in measurement may indicate a/an A. right bundle branch block. B. residual VSD. C. incompetent pulmonic valve. D. residual right ventricular outflow obstruction - Correct answer residual right ventricular outflow obstruction A 4-year-old has been admitted twice in the past six months for status asthmaticus. The parents smell of smoke when they come to the hospital, but state they don't smoke in the house. The most appropriate discharge planning intervention would be to A. discuss with the parents how to avoid asthma triggers at home. B. give the parents literature about smoking cessation treatment and support groups. C. call Child Protective Services to report a medically unsafe home environment. D. remind parents they shouldn't smoke around the child. - Correct answer give the parents literature about smoking cessation treatment and support groups. A 4-year-old 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 most appropriate diagnosis for this patient would be A. Munchausen syndrome by proxy. B. non-accidental trauma. C. physical abuse D. sexual abuse. - Correct answer Munchausen syndrome by proxy A 13-year-old male with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, dilated pupils, and is hyperreflexic. The plan of care would be to administer A. glucagon IM. B. naloxone (Narcan IV). C. 50% dextrose IV. D. regular insulin SQ. - Correct answer 50% dextrose IV. The initial therapy for children at risk for pulmonary embolus related to venous thromboembolism from a central venous line (CVL) is A. placement of an inferior vena cava filter. B. administration of anticoagulants. C. immediate removal of the CVL. D. thrombectomy by a surgeon. - Correct answer administration of anticoagulants In an infant with bronchopulmonary dysplasia (BPD), factors that impair the release of oxygen by negatively affecting oxyhemoglobin dissociation include A. hyperthermia. B. metabolic acidosis C. respiratory acidosis D. hypothermia - Correct answer hypothermia When inhaled nitric oxide (iNO) is administered to infants with congenital heart disease complicated by pulmonary artery hypertension, the desired result is A. smooth muscle relaxation. B. pulmonary vasoconstriction. C. pulmonary vasodilation. D. systemic vasodilation. - Correct answer pulmonary vasodilation 19. A patient with hypovolemic shock is receiving fluid resuscitation. Dopamine (Intropin) is started at 3 mcg/kg/min for A. hypotension. B. decreased cardiac contractility. C. decreased heart rate. D. renal perfusion. - Correct answer renal perfusion 20. A patient admitted following an acute asthma attack has been given multiple albuterol (Proventil) inhalation treatments. The following measurements are obtained: BP 130/78 HR 160 RR 48 FiO2 60% (by non-rebreather mask) O2 Sat 88% Physical findings could include which of the following? A. wheezing and agitation B. coughing and grunting C. pleural rub and wheezing D. stridor and bronchospasm - Correct answer wheezing and agitation 21. 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 sheets 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. - Correct answer all disciplines document patient teaching on the same flow sheet A 10-day-old infant is admitted with a suspected congenital heart defect, a history of poor feeding, and sudden onset 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 at a rate of 20; PIP/PEEP=24/4 cm water; FiO2=100%. Subsequent ABG results show: pH 7.27 pCO2 28 pO2 50 A. activated charcoal. B. N-acetylcysteine (Acetadote). C. deferoxamine (Desferal). D. pralidoxime chloride (Protopam). - Correct answer N-acetylcysteine (Acetadote). 33. Which of the following actions would be appropriate after the administration of desmopressin (DDAVP) to a patient with diabetes insipidus? A. Decreasing IV fluid rate B. Maintaining current fluid rate C. Increasing sodium intake D. Decreasing glucose intake - Correct answer Decreasing IV fluid rate 34. A 15-year-old with acute myelogenous leukemia has undergone multiple rounds of chemotherapy. One night, the patient tells the nurse, "I'm tired of all the chemo and I want to stop." The nurse should A. Explain the adolescent patients cannot legally make healthcare decisions B. Encourage the patient to, "express these feelings to your parents." C. Arrange for the patient to discuss the treatment plan with the physicians D. Ask the patient, "Do you realize you could die if you stop chemotherapy?" - Correct answer Encourage the patient to, "express these feelings to your parents." 35. A 9-year-old presents with recurrent episodes of intermittent palpitations associated with weakness. Physical examination is unremarkable. An ECG reveals a heart rate of 125 beats per minute, a shortened PR interval and a slurred upstroke prior to 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 - Correct answer Ventricular pre-excitation 36. A patient with end-stage liver failure secondary to Hepatitis C virus has been declared brain dead. The parents decide to discontinue feedings and donate their daughter's organs. In response to the parents' request, the most appropriate action by the nurse would be to A. Contact the organ procurement agency B. Convene a multidisciplinary care conference C. Tell the parents that their daughter's condition precludes organ donation D. Discontinue feedings per the parents' request - Correct answer Contact the organ procurement agency 37. Which of the following tests will confirm brain death in a 6-month-old? A. Absence of spontaneous breathing when PaCO2 goes above 60 mmHg B. Eyes deviate toward the right when ice water is injected into the ears C. Radionuclide scan shows cerebral arterial blood flow into the brain stem D. Low voltage amplitude observed on electroencephalogram (EEG) - Correct answer Absence of spontaneous breathing when PaCO2 goes above 60 mmHg 38. The acute treatment of esophageal varices includes A. Placement of a large NGT to low intermittent suction B. Immediate surgical intervention C. Administration of vasopressin (Pitressin) or octreotide (Sandostatin) D. Placement of a central venous line for hyperalimentation (TPN) - Correct answer Administration of vasopressin (Pitressin) or octreotide (Sandostatin) 39. A 1-year-old who in ventilator dependent has been hospitalized since birth. He is now being discharged home with a tracheostomy and a gastrostomy. In order to determine the discharge needs of the patient, the 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 the adequacy of the home environment C. An outreach educator to determine the learning needs of the family D. A multidisciplinary care conference prior to discharge - Correct answer A multidisciplinary care conference prior to discharge 40. A 10-year old patient is intubated due to a sudden deterioration in respiratory status. ABGs post intubation are as follows: pH 7.31 pCO2 50 pO2 80 HCO3 22 O2 Sat 95% The blood gases reflect A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis - Correct answer Respiratory acidosis 41. A 4-year-old has been admitted following repair of coarctation of the aorta. The child's vital signs are: HR 80 BP 150/80 RR 20 CVP 10 The arterial blood gas results are: pH 7.32 pCO2 42 pO2 96 HCO3 23 The child is comfortable and resting quietly. The most likely cause of the hypertension is A. Expected physiologic response to an aortic incision B. Excessive volume expansion during the surgical period C. Diminished baroreflex sensitivity to changes in arterial pressure D. Inadequate pain control following a thoracotomy - Correct answer Diminished baroreflex sensitivity to changes in arterial pressure 42. A 10-year-old is admitted for colitis. Eight hours after admission the patient develops respiratory distress, abdominal distension and capillary refill time greater than 4 seconds. The nurse should suspect A. Aspiration pneumonia B. Malabsorption syndrome C. Adhesions D. Bowel perforation - Correct answer Bowel perforation 43. A hospital's current policy states that medication drips should be changed within 24 hours after surgery. Nurses note that many postoperative cardiac patients develop blood pressure instability after inotrope syringes are changed. The best approach to solving this problem is to A. Notify the physician of a patient's blood pressure instability B. Disregard the policy and wait for the syringes to empty C. Form a committee to examine the problem and look for solutions D. Give a bolus of inotrope immediately prior to changing a drip - Correct answer Form a committee to examine the problem and look for solutions 44. An acutely ill infant is born to a Vietnamese family. The father asks few questions about the infant's condition and the mother asks none. Both parents appear to be proficient in English. Which of the following would be the most useful resource for a nurse caring for this patient? A. Classes conducted by the primary nurse as the need arises B. An interpreter proficient in the parents' language C. Information about Vietnamese culture D. Ongoing classes addressing the cultural needs of the local community - Correct answer Information about Vietnamese culture 45. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with D. Obtain a copy of the consent form to place in the patient's chart - Correct answer Involve the patient's legal guardian in the consent process 56. A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at 4 weeks of age is admitted. Over the last two days the child has been sleeping more, appetite has decreased and complains of a 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 getting a CT scan followed by possible shunt revision C. Administering mannitol or hypertonic saline D. Administering a loading dose of phenytoin (Dilantin) - Correct answer The patient getting a CT scan followed by possible shunt revision 57. A 2-month-old is admitted to the PICU status post surgical repair of a malrotation. Twenty-four hours later the patient has absent bowel sounds and increased drainage from the nasogastric tube. The most likely cause is A. Intestinal ileus B. Recurrent malrotation C. Postoperative infection D. Small bowel obstruction - Correct answer Intestinal ileus 58. Signs and symptoms that indicate occlusion of the blalock-Taussig shunt are decreased oxygen saturation, as well as A. Decreased capillary refill and respiratory alkalosis B. Decreased capillary refill and metabolic alkalosis C. Increased cyanosis and respiratory acidosis D. Decreased cyanosis and metabolic acidosis - Correct answer Increased cyanosis and respiratory acidosis 59. The best explanation for a patient's esophageal/gastrointestinal hemorrhage is A. Gastric ulcerations B. Systemic hypertension C. Portal hypertension D. Increased ammonia levels - Correct answer Portal hypertension 60. Which of the following are expected findings in a child admitted in the early stage of septic shock A. Flushed skin, bounding pulses and wide pulse pressure B. Flushed skin, weak pulses and narrow pulse pressure C. Pale and mottled skin, bounding pulses and wide pulse pressure D. Pale and mottled skin, weak pulses and narrow pulse pressure - Correct answer Flushed skin, bounding pulses and wide pulse pressure 61. In the patient with distributive shock and low systemic vascular resistance (SVR), the nurse would expect which early physical findings? A. Decreased urine output, hypotension, decreased level of consciousness and prolonged capillary refill B. Hypotension, hyperthermia, respiratory distress, and hypoxemia C. Hyperthermia, warm, pink flushed extremities, capillary refill time less than 2 seconds and hypotension D. Brisk capillary refill, increased urine output, hypoxemia and hyperthermia - Correct answer Hyperthermia, warm, pink flushed extremities, capillary refill time less than 2 seconds and hypotension 62. In the pediatric patient with severe trauma, the progression of multiple organ dysfunction syndrome (MODS) is typically A. Respiratory failure, cardiovascular collapse, pulmonary embolism, liver failure and infection B. Circulatory collapse, renal failure, respiratory failure, GI tract and liver failure, and infection. C. Respiratory arrest, hepatic failure, renal failure, cardiac arrest and disseminated intravascular coagulation (DIC). D. Circulatory collapse, respiratory failure, GI tract and liver failure, renal failure and neurological dysfunction - Correct answer Circulatory collapse, respiratory failure, GI tract and liver failure, renal failure and neurological dysfunction 63. A 5-year-old has been admitted after a motor vehicle crash. The child is tachypneic, pale and hypotensive; nailbeds are dusky. Paradoxical chest movement is observed. These signs and symptoms are most indicative of a A. Compound rib fracture B. Fractured sternum C. Flail chest D. Ruptured diaphragm - Correct answer Flail chest 64. The purpose of administering mannitol (Osmitrol) to a patient with a head injury is to A. Deplete water from the intravascular space B. Raise the patient's serum osmolality C. Decrease the patient's serum osmolality D. Increase the patient's cerebral blood flow - Correct answer Raise the patient's serum osmolality 65. Following bronchoscopy for removal of a foreign body, the patient becomes dyspneic, with retractions and stridor. This is most likely due to A. Hypoxia B. edema C. anxiety D. atelectasis - Correct answer edema 66. Which of the following cardiovascular complications is an expected finding during the initial stage of spinal shock following a spinal cord injury? A. Tachycardia B. Hypertension C. Hyperthermia D. Hypotension - Correct answer Hypotension 67. A major trauma patient is transported from a rural hospital. The patient died before arrival of the family to the ICU. The nurse would best prepare for the arrival of the family by planning to A. Give them information about the local bereavement support group B. Escort them to the waiting room to await the physician's arrival C. Provide them with information about the care the patient received prior to death D. Accompany them to the morgue to see the patient - Correct answer Provide them with information about the care the patient received prior to death 68. An 8-year-old 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 different nurses every shift B. Encourage lots of visitors C. Adhere to a home schedule D. Initiate new activities to keep occupied - Correct answer Adhere to a home schedule 69. A long-term complication for a child with bronchopulmonary dysplasia (BPD) is A. Cor-pulmonale B. Barotraumas C. Cystic fibrosis D. Cardiomyopathy - Correct answer Cor-pulmonale 70. Which one of the following cerebrospinal fluid results is indicative of bacterial neningitis? A. WBCs 200/mm3 B. RBCs 3/mm3 Left Atrial Pressure Right Atrial Pressure A. Increased Increased B. Decreased Decreased C. Decreased Increased D. Increased Decreased - Correct answer Increased Increased 81. A patient with a closed-head injury has developed SIADH. Which of the following laboratory results would this patient exhibit? Serum Na+ Serum Osmolality A. 122 262 B. 134 280 C. 144 282 D. 158 295 - Correct answer 122 262 82. An infant with respiratory distress syndrome (RDS) requiring mechanical ventilation (PIP=34 cm water, PEEP=10 cm water) suddenly desaturates and becomes bradycardic. The most likely explanation is which of the following? A. Pneumomediastinum B. Hemothorax C. Pleural effusions D. Pneumothorax - Correct answer Pneumothorax 83. The ECG of a child requiring VVI pacing demonstrates pacer spikes and ventricular depolarization. The patient's intrinsic rate is greater than the demand rate set on the pulse generator. This discrepancy is due to A. Understanding B. Loss of capture C. Excessive capture D. Oversensing - Correct answer Understanding 84. A child being treated for diabetic ketoacidosis (DKA) becomes lethargic, is difficult to arouse and has vomited twice in the past hour. These occurrences could be interpreted as indications of A. Exhaustion due to lack of sleep B. The development of hypoglycemia C. Decreased intestinal motility D. Increased ICP - Correct answer Increased ICP 85. When planning care for an infant who presents in status epilepticus, it is important for the nurse to understand that A. Most seizures are a symptom of a problem, not a disease entity B. A focal seizure cannot progress to a generalized tonic-clonic seizure. C. Child abuse should be considered a causative factor of seizures only if no obvious signs of trauma are noted D. Prolonged seizures do not result in brain damage - Correct answer Most seizures are a symptom of a problem, not a disease entity 86. A patient's family expresses anxiety regarding the meaning of numbers on the patient's monitor and asks the nurse for clarification. The nurse's most appropriate response should be A. "The numbers indicate when the patient is having problems." B. "The numbers help us determine the best treatment." C. "Which numbers on the monitor concern you?" D. "What don't you understand about the monitor?" - Correct answer "Which numbers on the monitor concern you?" 87. A child presents with fever, tachycardia, BP 60/42, weak pulses, warm and flushed skin. The first intervention should be A. 20 mL/kg normal saline fluid bolus B. Epinephrine infusion at 0.05 mcg/kg/min C. Oxygen via endotracheal tube D. Dopamine (Inotrope) infusion at 3 mcg/kg/min - Correct answer 20 mL/kg normal saline fluid bolus 88. A neutropenic patient is admitted showing signs of respiratory infection. Blood and sputum cultures are obtained. The nurse should anticipated A. Beginning antibiotics immediately B. Immediate placement in strict isolation C. No intervention until the causative organism is identified D. Transbronchial biopsy - Correct answer Beginning antibiotics immediately 89. A child weighing 15 kg is admitted with chronic renal failure. Which of the following assessment findings should be reported immediately? A. Urine output of 2-5 mL/hr B. Elevated BUN, elevated creatinine C. Hyperalbuminemia D. Headache, nausea and vomiting - Correct answer Urine output of 2-5 mL/hr 90. A 4-month-old born at 26-weeks is admitted with respiratory distress. The patient was discharged from the NICU with minimal O2 and an apnea monitor. Three weeks after admission the patient fails extubation for the third time, and it is determined that a tracheostomy and home ventilator will be needed. The nurse should A. Involve the discharge coordinator in obtaining home care and needed equipment B. Reassure the family that the tracheostomy can probably be removed in a year or so C. Begin tracheostomy teaching care with the mother and explain that the child will probably need a gastrostomy tube also D. Wait until after the tracheostomy is completely healed to start the process of home ventilator teaching - Correct answer Involve the discharge coordinator in obtaining home care and needed equipment 91. A 2-year-old ingested several unidentified pills. Which symptoms would indicate a tricyclic antidepressant overdose? A. Dry mouth, lethargy and hypotension B. Hypertension, agitation and nystagmus C. Slurred speech, bradycardia and ataxia D. Hypotension, bradycardia and nausea/vomiting - Correct answer Dry mouth, lethargy and hypotension 92. A 2-year-old currently being treated for acute lymphocytic leukemia (ALL) is admitted with nausea, vomiting and neutropenia. Cultures obtained from a blood sample and the Hickman catheter site insertion are positive. Vital Signs are: T 101.8*F (38.8*C) HR 92 RR 30 BP 94/60 A CBC and differential yield the following results: Hgb 8.1 g/dL HCT 29% Platelets 30,000/mL Differential: Band neutrophils 6% Segmented neutrophils 72% Lymphocytes 16% Monocytes 3% Eosinophils 2% Basophils 1% The patient's differential indicates a A. Leukemic relapse C. Compartment syndrome D. Fat embolism syndrome - Correct answer Acute systemic inflammatory response syndrome (SIRS). 103. While performing an exchange transfusion for a sickle cell patient, which of the following electrolyte abnormalities should the nurse anticipate? A. Hypocalcemia B. Hypercalcemia C. Hypoglycemia D. Hyperglycemia - Correct answer Hypocalcemia 104. The nurse is caring for a 14-year-old patient who is day one status post resection of a brain tumor. The nurse would report the following assessment finding immediately: A. CPP 40 B. SBP 120-130 C. ETCO2 35 D. MAP 65 - Correct answer CPP 40 105. An infant is admitted after unsuccessful reduction of an intussception. Further assessment reveals abdominal distention, fever and hypoactive bowel sounds. The nurse should immediately notify the surgeon if the patient has A. Abdominal erythema B. Hypertension C. Tachycardia D. White stools - Correct answer Tachycardia 106. A 6-year-old is admitted with a temporal lobe skull fracture. Which type of bleed is suspected? A. Chronic subdural hematoma B. Subarachnoid hematoma C. Acute subdural hematoma D. Acute epidural hematoma - Correct answer Acute epidural hematoma 107. A child is admitted with a tricyclic antidepressant overdose. The most common arrhythmias seen are A. Atrial B. Sinus C. Heart blocks D. Ventricular - Correct answer Ventricular 108. A 4-year-old with sickle cell disease is admitted with confusion, aphasia and complaints of "head hurting." An order for IVF and one unit of PRBCs is to be administered prior to MRI with contrast. The nurse explains to the mother that this is done because can A. Cause cerebral hemorrhage B. Increase sickling of hemoglobin C. Cause severe allergic reaction D. Decrease circulation to the brain - Correct answer Increase sickling of hemoglobin 109. Which one of the following is the first action to take in the case of a patient with a suspected tension pneumothorax? A. Administer a NaCl fluid bolus B. Assist with intubation C. Call for a chest radiograph D. Prepare for a needle thoracostomy - Correct answer Prepare for a needle thoracostomy 110. A 3-year-old is admitted after being found in the family swimming pool. The family does not know how long he was in the pool before they found him. He is intubated on mechanical ventilation with no spontaneous respirations and does not respond to painful stimuli. The most likely reason for this is A. Temporary depletion of ATP B. Reversible failure of the sodium potassium C. Concurrent head injury when he fell into the pool D. Sever cerebral injury with neuronal death due to hypoxemia - Correct answer Sever cerebral injury with neuronal death due to hypoxemia 111. A 1-month-old is admitted with failure to thrive. The mother states that the baby has been taking Similac with iron, 4 ounces about every four hours. Bright red blood is noted in the stool. The nurse should suspect A. Parental neglect B. Vitamin K deficiency C. Milk protein allergy D. Gastritis - Correct answer Milk protein allergy 112. A child has the following physical findings: decrease in tissue perfusion, lethargy, acidosis and oliguria. The patient's hemodynamic status remains unstable after three fluid boluses. The next intervention should be A. Use of inotropic agents to increase myocardial contractility B. Administration of diuretics for vascular congestion C. Use of vasodilators to decrease afterload D. Administration of NaHCO3 - Correct answer Use of inotropic agents to increase myocardial contractility 113. A 9.6 kg toddler is admitted after vomiting 250 mL of frank blood in the emergency department. The history is significant for end-stage liver failure. The assessment would be expected to reveal A. Tachycardia with bounding pulse B. Tachycardia with weak peripheral pulses C. Normal heart rate with weak pulses D. Normal heart rate with bounding pulses - Correct answer Tachycardia with weak peripheral pulses 114. A 3-year-old presents following ingestion of an unknown substance. Symptoms displayed include nstagmus, ataxia, seizures, respiratory depression, prolonged PT/PTT and hyponatremia. It is suspected the toddler ingested A. Carbamazepine (Tegretol) B. Phenobarbital (Luminal) C. Clonidine (Catapres) D. Theophylline (Accurbron) - Correct answer Carbamazepine (Tegretol) 115. On the second day following tracheoosophageal fistula repair, an infant develops a temperature of 102*F (39*C), a respiratory rate of 75 and frothy chest tube drainage. The signs/symptoms indicate A. Ventilator-associated pneumonia B. Anastomosis site leakage C. Pneumothorax D. Chylothorax - Correct answer Anastomosis site leakage 116. The best medication to improve gastric motility is A. Ranitidine (Zantac) B. Famotidine (Pepcid) C. Sucralfate (Carafate) D. Metoclopramide (Reglan) - Correct answer Metoclopramide (Reglan) 117. The nurse finds a 12-year-old postoperative spinal fusion patient restless and diaphoretic with HR 120, BP 110/80 and O2 Sat of 90%. Lab results reveal Hgb is 11.8 and Hemotocrit is 32.9. Primary intervention for this patient would be to A. Increase FiO2 via nasal cannula B. Obtain capillary blood gas C. Transfuse one unit of PRBCs