CCRN PEDS AACN questions with answers 2023, Exams of Nursing

Download CCRN PEDS AACN questions with answers 2023 and more Exams Nursing in PDF only on Docsity! CCRN PEDS AACN questions with answers 2023 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 B. decrease functional residual capacity C. increase venous return to the heart D. increase cardiac output ✔increase functional residual capacity An 8-month-old with bronchopulmonary dysplasia (BPD) is admitted with heart failure. Nursing interventions should be done to A. decrease preload. B. increase afterload. C. decrease heart rate. D. increase contractility. ✔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. ✔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 ✔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. C. the radiant warmer. D. sedation. ✔the radiant warmer 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. constrict the pulmonary vascular bed. ✔dilate the pulmonary vascular bed 31. A 26-week-gestation infant with multiple congenital abnormalities dies shortly after admission to the NICU. The parents saw the infant briefly in the delivery room, but decline to come to the NICU. The nurse should first A. Take the infant to the parents. B. Refer the parents to a genetic counselor. C. Prepare a memory box for the parents. D. Take an instant photo of the infant to the parents. ✔Take an instant photo of the infant to the parents. For an acetaminophen level of 140 mcg/mL, the treatment choice is A. activated charcoal. B. N-acetylcysteine (Acetadote). C. deferoxamine (Desferal). D. pralidoxime chloride (Protopam). ✔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 ✔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?" ✔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 ✔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 ✔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) ✔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 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 53. Prior to the administration of digoxin (Lanoxin), the nurse assesses the heart rate and rhythm, as well as the A. Serum calcium level and QRS duration B. Serum potassium level and PR interval C. Serum calcium level and QT interval D. Serum potassium level and ST segment ✔Serum potassium level and PR interval 54. Medications used in the medical management of a closure of a PDA include A. Prostaglandin (PGE1) B. Digoxin (Lanoxin) C. Indomethacin (Indocin) D. Lasix (Furosemide) ✔Indomethacin (Indocin) 55. A patient with receptive aphasia and dementia is to be enrolled in a clinical trial. How should the nurse proceed to ensure informed consent is ethically 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 ✔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) ✔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 ✔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 ✔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 ✔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 ✔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 ✔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 ✔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 ✔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 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 ✔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 ✔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 ✔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 ✔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 ✔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 ✔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?" ✔"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 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? A. Chronic subdural hematoma B. Subarachnoid hematoma C. Acute subdural hematoma D. Acute epidural hematoma ✔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 ✔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 ✔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