CCRN PEDS AACN Questions & Answers, Exams of Nursing

Download CCRN PEDS AACN Questions & Answers and more Exams Nursing in PDF only on Docsity! CCRN PEDS AACN Questions & Answers 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 - ✔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. - ✔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." - ✔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 - ✔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 - ✔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 - ✔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 - ✔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 - ✔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 another infant with the same symptoms who died at 2 months of age. Which finding would cause the nurse to suspect an inborn error of metabolism? A. micrognathia B. microglossia C. petite facial features D. abnormal urine odor - ✔abnormal urine odor 2. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for A. heart failure. D. residual right ventricular outflow obstruction - ✔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. - ✔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. - ✔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. - ✔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. - ✔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 - ✔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. - ✔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. - ✔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 - ✔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. - ✔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 HCO3 15 The most probable etiology of the patient's cardiopulmonary status is A. Tetralogy of Fallot. B. hypoplastic left heart syndrome. C. persistent pulmonary hypertension. D. diaphragmatic hernia. - ✔hypoplastic left heart syndrome 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 talk to you." - ✔"Would teaching you CPR help ease your anxieties?" A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing neurological assessment is A. level of consciousness. B. papillary response. C. motor response. D. assessment of the cranial nerves. - ✔level of consciousness A survey reveals that all of a hospital's nurses feel that the routine 4 a.m. chest x-rays cause an interruption in children's sleep patterns. The best strategy for addressing this issue would be to A. Assemble a work group to discuss the current hospital policy. B. Reschedule all non-emergent 4 a.m. chest x-rays during daytime hours. C. Request an in-service for the radiology department on the effects of sleep deprivation in children. D. Send the results of the survey to the hospital administrator. - ✔Assemble a work group to discuss the current hospital policy The chest x-ray of a patient with status asthmaticus will reveal ✔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) - ✔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 - ✔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 - ✔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 - ✔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 - ✔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 - ✔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 - ✔Information about Vietnamese culture 45. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with A. Tachypnea B. Cyanosis C. Confusion D. Hypertension - ✔Confusion 46. A child with 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 more prone to diarrhea B. Will be unable to control his stools C. Will require more activity to increase stools D. Needs to have a stool every day - ✔Tends to more prone to diarrhea 47. A 3-month-old 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. Ability to maintain airway - ✔Ability to maintain airway 48. A 15-year-old trauma patient admitted for evaluation is complaining of left upper quadrant abdominal pain radiating to the left shoulder. BP has dropped to 80/50. Which condition is indicated? A. Small bowel injury B. Cardiac contusion C. Splenic laceration D. Pulmonary embolism - ✔Splenic laceration 49. A newborn is admitted with transposition of the great arteries. The SaO2 equals 46%. No murmur is heard. Until a balloon septostomy can be performed, which one of the following should be administered as a temporary measure? A. Alprostadil (PGE1) B. Tolazoline (Priscoline) C. Indomethacin (Indocin) D. Digoxin (Lanoxin) - ✔Alprostadil (PGE1) 50. To promote effective grieving in a 6-year-old sibling following the death of a neonate, 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 when 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 - ✔Explain to the sibling that thoughts and wishes did not cause the infant's death 51. A patient admitted with multiple trauma develops flank pain, hematuria and costovertebral-angle tenderness. The nurse would suspect the child has experienced injury to the A. Pancreas B. Kidney C. Liver D. Bladder - ✔Kidney 52. Common laboratory findings associated with acute renal failure include an increase in the blood urea nitrogen (BUN) level, as well as which of the following changes in the concentrations of potassium and creatinine? Potassium Creatinine A. increased increased B. decreased increased C. increased decreased D. decreased decreased - ✔increased increased 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 - ✔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 - ✔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 - ✔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 - ✔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 - ✔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 - ✔Cor-pulmonale 70. Which one of the following cerebrospinal fluid results is indicative of bacterial neningitis? A. WBCs 200/mm3 B. RBCs 3/mm3 C. Protein 120 mg/dL D. Glucose 90 mg/dL - ✔Protein 120 mg/dL 71. A patient transferring out of the ICU says, "Why can't I just stay a few days longer? I don't feel strong enough." Which of the following is the most appropriate response? A. "There's a very sick patient who needs the bed." B. "You sound concerned about leaving the ICU." C. "Most people do just fine after transfer." D. "Your insurance limits the time you can stay in the ICU." - ✔"You sound concerned about leaving the ICU." 72. A 9-month-old born at 26-weeks has grunting, tachypnea and cool extremities. The following ABG findings are obtained on room air: pH 7.07 PO2 50 PCO2 80 HCO3 7 These blood gas results indicate A. Uncompensated respiratory acidosis B. Compensated metabolic acidosis C. Alveolar hypoventilation D. Alveolar hyperventilation - ✔Alveolar hypoventilation 73. Which of the following conditions occurs at the renal tubular cell to initiate acute tubular necrosis? A. Azotemia B. Hyperphosphatemia C. Ischemia D. Hyperkalemia - ✔Ischemia 74. A 2-year-old is admitted with a diagnosis of hemolytic uremic syndrome. The child presents with petechial rash, bloody stools and oliguria. In addition to an increased BUN and creatinine, expected laboratory values should be Hgb HCT Platelets K+ A. 7.1 19.5 90,000 5.5 B. 3.1 36.7 117,000 4.5 C. 7.5 19.8 200,000 5.2 D. 14.4 44.7 47,000 3.8 - ✔7.1 19.5 90,000 5.5 75. A 10-month-old is admitted to the hospital due to abdominal distention and poor weight gain. The nurse should be concerned if the infant A. Stopped an action in response to being told "no." B. Turned the head when name was called C. Cried when a nurse entered the room D. Avoided eye contact with the nurse - ✔Avoided eye contact with the nurse 76. Which complication is most common in infants with congenital diaphragmatic hernia? A. Alveolar-arterial ratio mismatch B. Inhibition of surfactant delivery C. Left-to-right shunting through patent ductus arteriosus D. Sever pulmonary hypertension - ✔Sever pulmonary hypertension 77. The parent of a mechanically ventilated patient is to be taught how to suction. When developing a teaching plan, the nurse must first A. Obtain written information about the procedure B. Determine a schedule for demonstrating the technique C. Assess the knowledge and skills the parent needs to learn D. Encourage the parent to observe the procedure on other patients - ✔Assess the knowledge and skills the parent needs to learn 78. Which of the following findings is indicative of diabetes insipidus (DI)? Serum Na+ Urine Specific Gravity A. 155 1.002 B. 140 1.005 C. 130 1.015 D. 12 1.030 - ✔A. 155 1.002 79. A 2-month-old born with spina bifida is admitted with dehydration and sepsis. Before the infant was discharged from the hospital a month ago the parents had been instructed on the proper technique and importance of performing catheterization every six hours. While interviewing the parents, the nurse learns this was not done consistently for the past two weeks. Interventions at this point should include A. Involving social services B. Notifying law enforcement C. Demonstrating catheterization technique D. Eliminating parental visitation - ✔Involving social services 80. In patients with dilated cardiomyopathy, which of the following intracardiac pressure changes would be seen? Left Atrial Pressure Right Atrial Pressure A. Increased Increased B. Decreased Decreased C. Decreased Increased D. Increased Decreased - D. Hypotension, bradycardia and nausea/vomiting - ✔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 B. Viral infection C. Bacterial infection D. Normal count - ✔Bacterial infection 93. The pathophysiology of asthma can best be explained by A. Airway narrowing and T-lymphocyte activation B. Mast cell migration, V/Q mismatch and mucosal drying C. Bronchospasm, mucosal edema and tenacious secretions D. Cilliary paralysis and prolonged inspiratory phase - ✔Bronchospasm, mucosal edema and tenacious secretions 94. To verify a diagnosis of DIC, a significant laboratory findings is an elevation in A. Fibrin split products B. Prothrombin C. Fibrinogen D. Platelets - ✔Fibrin split products 95. Children with acute renal failure run the risk of developing acute uremic encephalopathy. The first sign of cerebral dysfunction is often A. Confusion B. Tetany C. Asterixis D. Hemiparesis - ✔Confusion 96. In a patient with herpes simplex encephalitis, anticipated findings would include normal serum glucose and which of the following CSF values? Protein Glucose A. 70 mg/dL 60 mg/dL B. 70 mg/dL 240 mg/dL C. 150 mg/dL 120 mg/dL D. 150 mg/dL 180 mg/dL - ✔70 mg/dL 60 mg/dL 97. Initially unconscious, post motor vehicle crash, a child is admitted awake and responsive. The child develops a severe localized headache and shows signs of rapid deterioration. The most likely cause would be A. Acute subdural hematoma B. Epidural hematoma C. Subacute subdural hematoma D. Cerebral contusion - ✔Epidural hematoma 98. A child is diagnosed with Guillain-Barre syndrome. It would be imperative for the nurse to inform the physician after observing which of the following? A. Increasing hoarseness B. Tingling in the hands C. Weak muscle tone in feet D. Weak muscle tone in legs - ✔Increasing hoarseness 99. The nurse is caring for a patient experiencing a fourth episode of heart failure. The patient states, "I cannot take it anymore. I wish I could end all of this." A priority when caring for this patient's response to stress is to A. Place the patient in a hospital gown or pajamas B. Explore suicidal intent with the patient C. Manage the patient in a restrictive environment for the first 48 hours D. Allow the patient to have only short periods alone in a safe environment - ✔Explore suicidal intent with the patient 100. A 12-year-old is admitted after being struck by a speeding car. During the initial evaluation, the nurse notes increasing respiratory distress and displacement of a segment of the chest wall inward during inspiration. The nurse should suspect A. Open pneumothorax B. Flail chest C. Traumatic asphyxia D. Cardiac tamponade - ✔Flail chest 101. A 17-year-old patient is received from the operating room following insertion of a ventriculoperitoneal shunt. The patient is receiving propofol (Diprivan) intravenously for assistance with ventilation and reduction of oxygen consumption. The nurse recognizes that the following lab values need to be reported immediately: pH PCO2 HCO3 PO2 A. 7.2 50 30 75 B. 7.2 35 19 95 C. 7.6 45 30 95 D. 7.6 30 19 95 - ✔7.2 35 19 95 102. A 10-year-old is admitted after an accidental shooting to the femur and pelvis. Significant blood loss has occurred. Following adequate fluid resuscitation, perfusion remains poor, and oxygen requirements and work of breathing are increasing. The nurse should suspect A. Acute systemic inflammatory response syndrome (SIRS). B. Severe anemia related to blood loss C. Compartment syndrome D. Fat embolism syndrome - ✔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 - ✔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 - ✔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 - ✔Tachycardia 106. A 6-year-old is admitted with a temporal lobe skull fracture. Which type of bleed is suspected? C. Transfuse one unit of PRBCs D. Adjust the settings on the PCA pump - ✔Adjust the settings on the PCA pump 118. Which of the following clinical manifestations is an indication of the need for an artificial airway in a 2-year-old with laryngotracheo-bronchitis? A. Respiratory alkalosis B. Increased production of mucus C. Metabolic acidosis D. Persistent agitation/lethargy - ✔Persistent agitation/lethargy 119. Medical management of Phenobarbital (Luminal) overdose includes A. Forced dieresis B. Fluid restriction C. Nitroprusside (Nitropress) infusion D. Naloxone (Narcan) administration - ✔Forced dieresis 120. An adolescent with a history of admissions 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 - ✔Refer the patient to a support group for adolescents with asthma 121. A 5-year-old with a new diagnosis of status asthmaticus is admitted. Initial assessment reveals severe wheezing and use of accessory muscles. Initial management of this patient should be A. Administration of inhaled corticosteroid B. Administration of nebulized albuterol C. Intubation and mechanical ventilation D. Observation and administration of oxygen to keep O2 concentration at 90% - ✔Administration of nebulized albuterol 122. To determine whether a child is hypocalcemic, it is important to obtain not only a total Ca++ serum level, but also an ionized Ca++ serum level, because ionized Ca++ is A. Approximately 80% of the total plasma calcium B. The biologically active form of calcium C. Not filtered into the glomerular filtrate D. Deposited in bone - ✔The biologically active form of calcium 123. A 22-month-old is admitted with meningococcemia. Which of the following is associated with this diagnosis? A. Purpura fulminans B. Gram-positive bacteria C. Hypertension D. CBC count 20,000 mm3 - ✔Purpura fulminans 124. A 7-year-old is admitted following a bike versus motor vehicle crash. The patient complains of LUQ abdominal pain. The child has positive Kehr's sign and ecchymosis in the left upper quadrant. Amylase is 60 units/L, AST is 22 units/L, and PT is 12 seconds. Injury to which of the following organs is suspected? A. Spleen B. Liver C. Pancreas D. Kidney - ✔Spleen 125. The most important objective in caring for the patient with epiglottitis is to A. Keep the child quiet and comfortable B. Administer racemic epinephrine C. Place the child in a supine position D. Administer antibiotics - ✔Keep the child quiet and comfortable 126. A 5-year-old with a history of frequent urinary tract infections is admitted with influenza type A sepsis. On admission blood pressure was 70/30 and capillary refill was greater than 4 seconds with weak central pulses. On day two the patient develops oliguria. BUN is 54 and creatinine is 2.1. Which type of renal failure is this patient experiencing? A. Intrarenal B. Pre-renal C. Post-renal D. Chronic renal - ✔Pre-renal 127. A patient is admitted to the PICU with nausea, vomiting and diarrhea. The nurse would call the physician immediately with which of the following venous lab results? K+ Na+ Cl- A. 5.4 132 100 B. 6.5 125 95 C. 3.0 160 90 D. 3.5 145 92 - ✔6.5 125 95 128. A 6-month-old cries with diaper changes and does not interact with the mother or staff. The infant appears thin for height and has bruises on the lower arms. X-ray reveals a tibial fracture. The nurse suspects maltreatment. The most important portion of the workup and documentation would be the A. CT scan B. History given by the mother C. Growth chart from previous visits D. Complete blood count - ✔History given by the mother 129. A 10-year-old non-English-speaking patient has arrived to the unit postoperatively. The nurse recognizes pain control will be a priority nursing intervention. The best tool for pain assessment would be A. Numeric pain scale B. Richmond agitation scale C. Visual analog scales D. FACES pain scale - ✔FACES pain scale 130. A nurse notices that there seems to be an increase in medication errors when medication infusions are started. The nurse's best course of action would be to A. Ask the nurse manager to remind all staff to be careful when hanging and checking medication infusions B. Keep a list of all nurses who have made errors and give it to the nurse manager C. Review the medication error rate, then offer to help revise the unit policy for checking medication drips D. Be more careful when hanging and checking medication infusions - ✔Review the medication error rate, then offer to help revise the unit policy for checking medication drips