Pediatrics CCRN Exam with All Questions from AACN and 100% Correct Answers and Rationale, Exams of Nursing

Download Pediatrics CCRN Exam with All Questions from AACN and 100% Correct Answers and Rationale and more Exams Nursing in PDF only on Docsity! Pediatrics CCRN Exam with All Questions from AACN and 100% Correct Answers and Rationale Latest Version Updated 2024-2025 An adolescent with a history of admission for chronic status asthmaticus is being prepared for discharge. The nurse determines that the patient has not been compliant with medications, because doing so "makes him feel too different" from his peers. The nurse should: A) Arrange for the patient's school nurse to monitor compliance B) Provide the patient with articles on the relationship of hospitalization and medication compliance. C) refer the patient to a support group for adolescents with asthma D) Advise the parents to withhold privileges if the patient remains non-compliant. --------- -- Correct Answer ------------ Answer: C) Refer the patient to a support group for adolescents with asthma: this intervention will help normalize the experience and increase compliance A) Arrange for the patient's school nurse to monitor compliance: This will not help with the issue causing noncompliance and may worsen the problem. B) Provide the patient with articles on the relationship of hospitalization and medication compliance: Parents and older children often need education about eh maintenance aspect of asthma management to be reinforced. D) Advise the parents to withhold privileges if the patient remains non-compliant: For most children, withholding privileges is not a motivator to promote compliance. Amrinone lactate (Inocor) is given for which desired effect? A) Vasodilation B) Phospholipid inhibition C) Decreased myocardial contractility D) Catecholamine antagonism ----------- Correct Answer ------------ Answer: A) Vasodilation: Amrinone is a phosphodiesterase inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting in improved cardiac contractility and vasodilation. B) Phospholipid Inhibition: This is not an effect of amrinone administration C) Decreased myocardial contractility: This is not an effect of amrinone administration. D) Catecholamine antagonism: This is not an effect of amrinone administration A family meeting is planned to discuss the family's ethical concerns regarding continuing life support measures for a child with end-stage cancer. The nurse's role should be to: A) Provide the legal standpoint regarding end-of-life decisions for children. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy C) Coordinate the meeting to ensure that everyone has the opportunity to speak D) Assist the parents in articulating their questions and concerns. ----------- Correct Answer ------------ Answer: D) Assist the parents in articulating their questions and concerns: The parents' thoughts and understanding are critical for making decisions about their child's care. Nurses act as advocates by assisting the parents in articulating their questions and concerns and empowering the family to speak for their child and themselves. A) Provide the legal standpoint regarding end-of-life decisions for children: This does not address the parents' concenrs. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy: This does not specifically address the parents' concerns regarding continued life support measures and is not consistent with Caring Practices. C) Coordinate the meeting to ensure that everyone has the opportunity to speak: This intervention is not consistent with Caring Practices or Advocacy and Moral Agency, as the nurse's opinions and decisions may be in conflict with those of the parents. A hypertensive crisis as evidenced by acidosis, hypothermia, and alveolar hypoxia may be demostrated in which of the following children? A) Those with reactive pulmonary vascular bed B) Those with systemic vascular disease. C) Those with increases in ventricular afterload. D)Those with sustained increases in afterload ----------- Correct Answer ------------ Answer: A) Those with reactive pulmonary vascular bed: Children with pulmonary vascular disease are at risk for developing a pulmonary hypertensive crisis. B) Those with systemic vascular disease: Systemic vascular disease does not affect pulmonary pressure C) Those with increases in ventricular afterload: The pediatric ventricle adapts to increases in ventricular afterload, provided the increases are not severe or acute. D) Those with sustained increases in afterload: Acute increases in afterload are poorly tolerated. The nurse is providing patient education for a family whose child has cerebral palsy and will be receiving a baclofen (Lioresal) pump to control spasticity. Which of the following is most important for the nurse to include in the discussion? A) The durg acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA) B) Parents can be taught to regulate the dosage based on symptoms. C) The child will have a normal gait after insertion of the pump. D) Parents must bring the child back to the clinic to have medicine added to the pump. - ---------- Correct Answer ------------ Answer: D) Parents must bring the child back to the clinic to have medicine added to the pump: The intrathecal dose of baclofen delivered via implanted pump is adjusted in the outpatient clinic using a telemetry wand every three to six months. A) The drug acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA): Baclofen has the opposite effect described in this answer, as it is a GABA agonist. B) Parents can be taught to regulate the dosage based on symptoms: The intrathecal dose of baclofen is adjusted in the outpatient clinic using a telemetry wand. C) The child will have a normal gait after insertion of the pump: The child's gait may be improved due to relief of severe spasticity, but there is no guarantee of a normal gait with this therapy. D) Sexual Abuse: Sexual abuse of a child often involves exposure of genitalia, touching/fondling and/or oral genital contact. Hematuria alone would not support this diagnosis. Respiratory therapists, physical therapists, occupational therapists and nurses are all responsible for discharge teaching, with each discipline currently documenting on its own flow sheet. The best way to coordinate teaching would be to have: A) Daily care conferences to review and discuss patient teaching and the flow sheets B) Each discipline distribute copies of its flow sheet to each team member. C) Nurses review the flow sheets of all disciplines during shift change. D) All disciplines document patient teaching on the same flow sheet. ----------- Correct Answer ------------ Answer: D) All disciplines document patient teaching on the same flow sheet: This plan is consistent with Collaboration. It gives opportunities for all disciplines to see the contributes of other team members. A) Daily care conferences to review and discuss patient teaching and the flow sheets: This plan is consistent with Collaboration but would be difficult to accomplish. Thus, it is not the best option. B) Each discipline distribute copies of its flow sheet to each team member: This plan is not consistent with Collaboration, and not an effective use of time for each team member. C) Nurses review the flow sheets of all disciplines during shift change: This plan is not consistent with Collaboration. All team members should be involved in the teaching process. Which of the following rhythms is expected one day post-cardiac catheterization for repair of an atrial septal defect (ASD)? A) Premature atrial contraction B) Junctional ectopic tachycardia C) Sinus bradycardia D) Sinus tachycardia ----------- Correct Answer ------------ Answer: A) Premature atrial contraction: this is cause by an irritation to the atria during the cardiac catheterization. B) Junctional ectopic tachycardia: this is caused by an irritation to the AV node. C) Sinus bradycardia: Sinus bradycardia is not an expected complication of cardiac catheterization for repair of an atrial septal defect. D) Sinus tachycardia: Sinus tachycardia may be seen with stress, pain, hypoxemia, and low cardiac output, which are not expected or managed during the post-procedure phase. Which of the following would lead to hypovolemia due to increased insensible fluid loss in an infant post-cardiac surgery? A) Decreased activity B) Hypothermia C) Radiant warmer use D) Sedation ----------- Correct Answer ------------ Answer: C) Radiant warmer use: The radiant warmer increases the effects of evaporation, which increases insensible fluid loss. A) Decreased activity: Decreased activity would decrease insensible fluid loss. B) Hypothermia: Hypothermia would decreased insensible fluid loss. D) Sedation: Sedation would decrease insensible fluid loss. A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing assessment for early neurological deterioration is: A) Level of consciousness B) Pupillary response C) Motor response D) Cranial nerve assessment ----------- Correct Answer ------------ Answer: A) Level of consciousness: Level of consciousness is the earliest indicator of improvement or deterioration in neurological status. B) Pupillary response: Alterations in pupil size and reactivity are a late sign of neurological deterioration and may be affected by medications, trauma, and poisons. C) Motor response: Changes in motor response are a late sign of neurological deterioration and are assessed as part of the Glasgow Coma Score. D) Cranial nerve assessment: While it is important to note changes, cranial nerve assessment is not the most important aspect of a nurse's ongoing neurological assessment. The chest x-ray of a patient with status asthmaticus will most commonly reveal which of the following? A) Hyperinflation B) Lobar consolidation C) Perihilar infiltrates D) An elevated diaphragm ----------- Correct Answer ------------ Answer: A) Hyperinflation: Hyperinflation is the expected finding due to air trapping associated with asthma B) Lobar consolidation: Lobar consolidation is typically seen with pneumonia, not asthma. C) Perihilar infiltrates: Perihilar infiltrates are possible but not common. D) An elevated diaphragm: A flattened diaphragm is seen in patients with asthma and is associated with air trapping. A child with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, and dilated pupil, and is hyperreflexic. the plan of care would be to administer: A) Glucagon IM B) Naloxone (Narcan) IV C) 25% Dextrose IV D) Regular insulin SQ ----------- Correct Answer ------------ Answer: C) 25% dextrose IV: The patient has signs of severe hypoglycemia, and administration of IV dextrose will quickly raise the blood glucose level. No more than 12.5% glucose should be given peripherally. A) Glucagon IM: Glucagon is administered for severe hypoglycemia. It requires 15 to 20 minutes to elevate the blood glucose. B) Naloxone (Narcan) IV: Naloxone, which reverses the effects of opioids, is not indicated for this patient. D) Regular Insulin SQ: Regular insulin, which will lower the patient's blood glucose level, is not indicated for this patient with severe hypoglycemia. A nurse is caring for a patient with type 1 diabetes mellitus who has had multiple admissions over the last year for diabetic ketoacidosis (DKA). Before discharge for this episode of DKA, it is most important that the nurse arranges: A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high. B) To teach the patient to avoid sugar and foods high in carbohydrates C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease. D) For the patient and family to join a diabetes support group. ----------- Correct Answer - ----------- Answer: C) For the patient and family to meet with social worker to discuss challenges they face with management of the disease: At this point, after multiple admissions, the most important intervention is helping the patient and family navigate through the system to identify available resources that could be helpful in meeting the challenge of the disease. A) To teach the patient how to administer sliding scale insulin when blood glucose levels are high: A patient with diabetes most likely knows how to administer sliding scale insulin, but reinforcing the concepts may be indicated. B) To teach the patient to avoid sugar and foods high in carbohydrates: A patient with diabetes most likely knows the effects of diet on blood glucose, but reinforcing the concepts may be indicated. D) For the patient and family to join a diabetes support group: This may be helpful if the family is willing, but it is not the most important intervention A 10-day-old infant is admitted with a suspected congenital heart defect, due to a history of poor feeding and sudden onsent 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. Settings are as follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: 100%. Subsequent ABG results show: pH: 7.27 pCO2: 28 D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most likely primary problem, which is suspected increased intracranial pressure as a result of VP shunt malfunction An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? A) Small Bowel Injury B) Cardiac Contusion C) Splenic Laceration D) Pulmonary Embolism ----------- Correct Answer ------------ Answer: C) Splenic laceration: Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis A) Small bowel injury: Signs of small bowel injury may include progressive abdominal distension, not referred left shoulder pain. B) Cardiac Contusion: Signs of cardiac contusion include chest pain, arrhythmias, and other indicators of myocardial dysfunction, such as elevated cardiac isoenzymes. Upper quadrant abdominal pain with radiation to the left shoulder is not consistent with a cardiac contusion D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on exertion, not left shoulder pain An infant has been admitted with encephalitis. The nurse should first assess the patient's: A) Pupillary response B) Blood glucose level C) Level of consciousness D) Airway Patency ----------- Correct Answer ------------ Answer: D) Airway Patency: The first priority after admitting an infant with encephalitis is to assess the patient's ability to maintain airway patency. Such patients can develop rapid neurologic deterioration, and the nurse must be prepared to support the airway, oxygenation, and ventilation as needed. A) Pupillary Response: The infant with encephalitis should be monitored for changes in neurologic status, including pupillary response. However, assessing the patient;s ability to maintain airway patency is the first priority. B) Blood Glucose Level: The infant with encephalitis will need blood glucose levels monitored, especially if unable to maintain adequate oral intake. However, assessing the patient's ability to maintain airway patency is the first priority. C) Level of consciousness: The infant with encephalitis should be monitored for changes in neurologic status, including assessment of the level of consciousness. However, assessing the patient's ability to maintain airway patency is the first priority. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with: A) Tachypnea B) Cyanosis C) Confusion D) Hypotension ----------- Correct Answer ------------ Answer: C) Confusion: The patient with asphyxia from smoke inhalation will experience cerebral hypoxemia and demonstrate symptoms of neurologic dysfunction, including confusion A) Tachypnea: While the patient with smoke inhalation may experience tachypnea as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia B) Cyanosis: While the patient with smoke inhalation may experience cyanosis as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia D) Hypotension: While the patient with smoke inhalation and a burn injury may demonstrate hypotension from fluid shifts, this symptoms is not specific to asphyxia 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 is the most useful resource for a nurse caring for this infant? A) Classes conducted by the primary nurse as the need arises B) An interpreter who is proficient in the parents' language C) Information about the cultural backgrounds represented in the community D) Ongoing classes addressing the cultural needs of the community ----------- Correct Answer ------------ Answer: B) An interpreter who is proficient in the parents' language: This intervention is consistent with Response to Diversity. Providing an interpreter may facilitate communication by the parents. Trained interpreters can improve outcomes by helping to ensure effective communication between the healthcare team and the patient/family A) Classes conducted by the primary nurse as the need arises: This intervention is not consistent with Response to Diversity. It will not help in this situation. While addressing needs as they arise is important, the parents are not communicating these needs at present. C) Information about the cultural backgrounds represented in the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents' needs during this stressful time. D) Ongoing classes addressing the cultural needs of the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents; needs during this stressful time. A toddler with a history of unrepaired tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. The most appropriate nursing intervention would be to: A) Administer A pre-medication before attempting the IV B) Apply a face mask with oxygen C) Transfuse red blood cells D) Place the child in knee-chest position ----------- Correct Answer ------------ Answer: D) Place the child in knee-chest position: This maneuver aids blood return to the heart, thus alleviating cyanotic spells A) Administer a pre-medication before attempting the IV: This may be appropriate if it helps the infant to experience minimal pain, and thus cry less during the IV start. B) Apply a face mask with oxygen: Administering oxygen is helpful to minimize the hypoxia, but the mask may cause even more distress. C) Transfuse red blood cells: If other measures do not alleviate the spells, volume in the form of packed red blood cells may be ordered to maintain the hematocrit greater than or equal to 45% A 1-month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant with the same symptoms who died at 2 months of age. Which additional assessment finding would cause the nurse to suspect an inborn error of metabolism? A) Micrognathia B) Microglossia C) Petite Facial Features D) Musty Urine Odor ----------- Correct Answer ------------ Answer: D) Musty urine odor: This is a common indicator of a metabolic disorder, especially with a family history of siblings dying early A) Micrognathia: This is not associated with an inborn error of metabolism B) Microglossia: This is not associated with an inborn error of metabolism C) Petite Facial Features: This is not associated with an inborn error of metabolism A school-aged child with autism is admitted with a fractured femur and possible head injury. Which of the following is important to promote adjustment to the hospital setting? A) Assign a child life therapist per shift B) Encourage lots of visitors C) Adhere to a home schedule D) Initiate new activities to keep the patient occupied ----------- Correct Answer ------------ Answer: C) Adhere to a home schedule: Autism spectrum disorders are a complex neurodevelopmental disorder of brain function accompanied by a broad range and severity of intellectual and behavioral deficits, which is best managed when adhering to a schedule and minimizing change, so adhering to a home schedule is optimal. The schedule allows the child and family to optimally cope. A) Assign a child life therapist per shift: The assignment of a child life therapist can be very beneficial to help facilitate patient and family understanding of the hospital environment and provide therapeutic coping interventions, but it is not realistic that a child life therapist would be assigned to an individual patient for every shift. B) Encourage lots of visitors: The management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. maintenance of a schedule and minimizing visitors will provide a healing environment appropriate for an autistic patient who has a possible head injury. D) Initiate new activities to keep the patient occupied: Management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. The introduction of new activities may be stressful and potentially harmful with a head injury, so maintenance of B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV): PIP is weaned as the lung compliance improves but IMV is a mode of ventilation, not a weanable parameter C) Oxygent (FiO2) and intermittent mandatory ventilation (IMV): FiO2 is weaned as oxygenation improves but IMV is a mode of ventilation, not a weanable parameter Which of the following interventions would be the most valuable in aiding management of a child requiring PEEP of 14 cm water? A) Extracorporeal membrane oxygenation (ECMO) B) Placement of a thoracostomy tube C) Placement of a pulmonary artery catheter D) High-frequency oscillatory ventilation (HFOV) ----------- Correct Answer ------------ Answer: D) High-frequency oscillatory ventilation (HFOV): HFOV improves oxygenation through alveolar recruitment without the complications associated with high PEEP, which is also used to improve oxygenation A) Extracorporeal Membrane Oxygenation (ECMO): This is used to provide support to patients with reversible cardiac or respiratory failure B) Placement of a thoracostomy tube: Placement of a thoracostomy tube is not indicated in this situation. This procedure would be performed in the case of air leak syndrome C) Placement of a pulmonary artery catheter: Pulmonary artery catheters are rarely used in pediatric patients. Clinical manifestations observed in a child diagnosed with failure to thrive may include A) Avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development C) Distress when held of left alone D) No interest in surroundings ----------- Correct Answer ------------ Answer: A) Avoidance of eye contact and delayed motor development: The clinical manifestations of failure to thrive may include growth failure, apathy, avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development: The child may have a history of excessive irritability and may cry during feedings. Delayed language development is not associated with failure to thrive. C) Distress when held of left alone: When held these children may protest briefly when being put down but are apathetic when left alone D) No interest in surroundings: These children may display intense interest in inanimate objects such as toys but are much less interested in social interactions A nursing unit needs to be able to place patients back on ventilator support, as ordered, while patients nap Due to staffing patters, the respiratory therapist is not always available on the unit to place patients on the ventilator. An appropriate response by the nurse would be to: A) Place the patient on the ventilator when needed, despite current policy B) Wait for the therapist to intervene. C) Ask the parent to be responsible for this task. D) Question the current policy that only respiratory therapists can manage the ventilator. ----------- Correct Answer ------------ Answer: D) Question the current policy that only respiratory therapists can manage the ventilator: Clinical Inquiry is questioning the appropriateness of policies, guidelines, and current practices to improve patient care A) Place the patient on the ventilator when needed, despite current policy: This is not a Caring Practice as the RN may not have the knowledge to perform this task safely B) Wait for the therapist to intervene: This may not be satisfactory if the patient hypoventilates during sleep. C) Ask the parent to be responsible for this task: This response is not a safe or Caring Practice A patient with bronchopulmonary dysplasia (BPD) is admitted with heart failure. the nurse can expect to perform interventions to: A) Decrease Preload B) Increase Afterload C) Decrease Heart Rate D) Increase Contractility ----------- Correct Answer ------------ Answer: A) Decrease Preload: Decreasing the preload for a patient with BPD will improve right-sided heart failure related to chronic lung disease B) Increase Afterload: Increasing afterload would impede ventricular ejection, making heart failure worse. C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x SV) which would worsen the patient's heart failure. D) Increase contractility: Although increasing contractility may help improve left-sided heart failure, patients with BPD usually have right-sided heart failure. Factors that impair the release of oxygen to tissues by negatively affecting oxyhemoglobin dissociation include: A) Hyperthermia B) Metabolic acidosis C) Respiratory Acidosis D) Hypothermia ----------- Correct Answer ------------ Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot eh right, resulting in hemoglobin that has less affinity for oxygen C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen A 15 yo patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The patient is cool, diaphoretic, restless, mottled peripherally, with no pedal pulses and faint femoral pulses. Vital signs are: HR: 140 MAP: 60 mmHg CVP: 20 mmHg Cardiac Index: 2.3 L/min/m2 SVR: 2000 dynes/sec/cm-5 The nurse should suspect: A) A pulmonary embolus B) Cardiac Tamponade C) Cardiogenic Shock D) Hypovolemic Shock ----------- Correct Answer ------------ Answer: C) Cardiogenic Shock: After the Fontan operation, low cardiac output is the most common and severe complication. It is often caused by inadequate blood flow into the pulmonary circulation that results from hypovolemia and inadequate systemic venous pressure, elevated pulmonary vascular resistance, obstruction at the surgical site, or pump failure. A) A pulmonary embolus: A pulmonary embolus (PE) is most commonly associated with a deep vein thrombus. Other risk factors bacterial endocarditis, sepsis, and hematologic/oncologic pathology. There is no mention of complaints of chest pain or dyspnea, which are primary indicators of a PE. B) Cardiac Tamponade: This is a sudden accumulation of fluid in the pericardial sac. Signs and symptoms are similar to shock, hypotension, tachycardia, high CVP, narrowing of pulse pressure and deteriorating systemic perfusion. D) Hypovolemic Shock: Although some of the classic signs of hypovolemic shock are present (cool, restless, decreased pulses, tachycardia) diaphoresis and elevated CVP would not be seen with hypovolemic shock. While performing an exchange transfusion for a patient with sickle cell disease, which of the following electrolyte abnormalities should the nurse anticipate? A) Hypocalcemia B) Hypercalcemia C) Hypokalemia D) Hypomagnesemia ----------- Correct Answer ------------ Answer: A) Hypocalcemia: metabolic complications of blood transfusion include hypocalcemia B) Hypercalcemia: Hypocalcemia is a complication of blood transfusion. C) Hypokalemia: Hyperkalemia is a complication of blood transfusion. D) Hypomagnesemia: This is not a complication of blood transfusion Which of the following methods is the best to update a family that speaks primarily Spanish? A) Use hand gestures to point to key things, such as the patient and the surgeon. B) Have the patient's 12-year-old sibling provide interpretation for the family C) Utilize a medical interpreter either in person or on the telephone. D) Give the family the operative consent written in Spanish. ----------- Correct Answer ---- -------- Answer: C) Utilize a medical interpreter either in person or on the telephone: An interpreter whose role is to provide medical interpretation from English to the patient's or family's primary language is the best option, especially when care decisions are being made. D) Ask security to restrict the mother's ability to visit the ICU ----------- Correct Answer --- --------- Answer: C) Ask the mother to explain why she is giving fluids to her son: The nurse needs to understand the reasons for the mother's behavior before the nurse can advocate for the child's needs and the mother's goals for her son's care. A) Ask the resident physician to change the diet order to include oral fluids: A change in diet order may put the patient at risk for further aspiration and does not address the mother's concerns or care goals for her child. B) Notify the social worker that the mother is interfering with the medical plan: While the social worker may be able to help the mother identify personal resources, the nurse should first determine the mother's reasons for not following the medical plan and then help her articulate her goals for her son's care. D) Ask security to restrict the mother's ability to visit the ICU: Removing the mother from the unit does not address the mother's concerns or goals for her son's care and may create an adversarial relationship between the mother and the hospital staff. A 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In order to determine the discharge needs of the patient, the nurse should arrange for: A) Home nursing care for the first few days following discharge B) A social worker to meet with the family and assess adequacy of the home environment C) An outreach educator to determine the learning needs of the family D) A multidisciplinary care conference before discharge ----------- Correct Answer --------- --- Answer: B) A social worker to meet with the family and assess adequacy of the home environment: The first predischarge priority for a technology-dependent child is to assess the adequacy of the home environemtn. Further discharge planning is then based on the needs of the patient and family. A) Home nursing care for the first few days following discharge: While home nursing care may be needed after discharge, the first predischarge priority in this scenario is to evaluate the home environment. From there, a determination can be made about nursing care that will be needed at home. The home may not be adequate for a safe transition for the infant. C) An outreach educator to determine the learning needs of the family: Education may be necessary before discharging a technology-dependent child, but that cannot be determined without further information about the patient's home environment and family needs. D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to prepare to meet the complex needs of the child at home. A child with a myelomeningocele is started on a bowel management plan. the nurse would recognize that more education is needed when the mother states, "My child: A) tends to be more prone to diarrhea." B) will be unable to control his bowel movements." C) will require more activity to increase bowel movements." D) needs to have a bowel movement every day." ----------- Correct Answer ------------ Answer: A) tends to be more prone to diarrhea.": With Facilitation of Learning the nurse recognizes this mother does not yet understand that patients with a myelomeningocele are prone to constipation and impaction, rather than diarrhea. Additional education is needed to help the mother understand the bowel management plan. B) will be unable to control his bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. C) will require more activity to increase bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. D) needs to have a bowel movement every day.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. A newborn is admitted with transposition of the great arteries. The SpO2 equals 46%. No murmur is heard. Until a balloon septostomy can be performed, which of the following medications should the nurse anticipate being administered as a temporary measure? A) Alprostadil (PGE1) B) Tolazoline (Priscoline) C) Indomethacin (Indocin) D) Digoxin (Lanoxin) ----------- Correct Answer ------------ Answer: A) Alprostadil (PGE1): The initial management of the patient with transposition of the great arteries involves maintaining adequate arterial oxygen saturation via intercirculatory mixing of blood Until a balloon septostomy can be performed, alprostadil (PGE1) infusion is used to maintain patency of the ductus arteriosus. Additionally, it lowers pulmonary and systemic vascular resistance. B) Tolazoline (Priscoline): Tolazoline (Priscoline) is a vasodilator and is indicated for the treatment of persistent pulmonary hypertension of the newbon. C) Indomethacin (Indocin): Indomethacin (Indocin) is a prostaglandin synthetase inhibitor that is used to promote closure of a patent ductus arteriosus. Closure of the ductus would be life threatening in the patient with transposition of the great arteries. D) Digoxin (lanoxin): Digoxin (Lanoxin) is an antiarrhythmic used to treat a variety of cardiac conditions including supraventricular tachycardia and other atrial tachycardias. A patient with receptive aphasia and delirium is to be enrolled in a clinical trial. How should the nurse proceed to ensure informed consent is properly obtained? A) Involve the patient's legal guardian in the consent process B) Ensure that the investigator is aware of the patient's condition C) Inform the institutional review board (IRB) of the potential risk to the patient D) Obtain a copy of the consent form to place in the patient's chart. ----------- Correct Answer ------------ Answer: A) Involve the patient's legal guardian in the consent process: A legal guardian can assist in the consent process when the patient is unable B) Ensure that the investigator is aware of the patient's condition: While the investigator may need to be aware of the patient's condition, in order to ethically protect this patient's rights related to consenting to research, the patient's legal representative needs to be involved in the consent process to speak on the patient's behalf. C) Inform the Institutional review board (IRB) of the potential risk to the patient: The IRB would have already evaluated the risks and benefits, including subject recruitment and consent, before granting approval for the clinical trial to proceed. Further IRB involvement might be warranted for violations of the research protocol or patient complications D) Obtain a copy of the consent form to place in the patient's chart: Just placing a copy of the consent form on the patient's chart does not meet the need to ethically protect the patient's rights related to consenting to research. If the patient is incapacitated, the legal guardian should be involved in the consent process. A patient is intubated due to a sudden deterioration in respiratory status. Arterial blood gases (ABG) post intubation are as follows: pH: 7.31 pCO2: 50 pO2: 80 HCO3: 22 O2 Sat: 95% The ABGs reflect: A) Respiratory acidosis B) Respiratory alkalosis C) Metabolic alkalosis D) Metabolic acidosis ----------- Correct Answer ------------ Answer: A) Respiratory acidosis: The patient in this scenario demonstrates a pH2 less than 7.35 and CO2 greater than 45 mmHg, which reflects respiratory acidosis. B) Respiratory alkalosis: Respiratory alkalosis would be reflected by ABG results demonstrating a pH greater than 7.45 and CO2 less than 35 mmHg C) Metabolic Alkalosis: Metabolic Alkalosis would be reflected by ABG results demonstrating a pH greater than 7.45 and HCO3 greater than 28 meq/L. The HCO3 in this patient scenario is within normal range. D) Metabolic acidosis: Metabolic acidosis would be reflected by ABG results demonstrating a pH less than 7.35 and HCO3 less than 22 mEq/L. The HCO3 in this patient scenario is within normal range. A patient presents with recurrent episodes of intermittent palpitations associated with weakness. An ECG reveals a heart rate of 125, a shortened PR interval, and a slurred upstroke before each widened QRS complex. This slurred upstroke (Delta wave) can be explained by: A) Atrial pre-excitation B) Atrial depolarization C) Ventricular repolarization D) Ventricular pre-excitation ----------- Correct Answer ------------ Answer: D) Ventricular pre-excitation: In ventricular pre-excitation, the initial portion of the QRS complex is prolonged, and this "initial slurring" appears as Delta waves on the ECG. The ventricular B) Splenic rupture: Signs of splenic injury include tachycardia, hypotension, and abdominal tenderness The symptoms in this scenario are not consistent with a splenic rupture. C) Malrotation with volvulus: Symptoms of malrotation with volvulus include bilious emesis and bloody, mucous stools. The symptoms in this scenario are not consistent with malrotation with volvulus. PEEP is intended to do which of the following? A. Improve ventilation/perfusion matching B. Decrease functional residual capacity C. Increased venous return to the heart D. Increased cardiac output ---------- Correct Answer ----------- A. Improve ventilation/perfusion matching - PEEP increases alveolar volume, thereby improving ventilation/perfusion matching and increasing functional residual capacity. - A detrimental effect of PEEP (especially at high levels) is a decrease in venous return to the heart and a subsequent decrease in cardiac output. In an infant with sepsis, 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 ----------- D. Hypothermia - To answer this question, you must consider the factors that would cause a left shift of the oxyhemoglobin curve. - Hypothermia, decreased CO2, and increased pH (alkalosis) would all cause a left shift. - Hyperthermia and acidosis would cause a right shift of the curve In which condition might you observe a decreased V/Q ratio (<0.8)? A. Status asthmaticus B. Sepsis C. Pulmonary emboli D. Tricuspid atresia ---------- Correct Answer ----------- A. Status asthmaticus - A V/Q ratio of <0.8 is indicative of perfusion exceeding ventilation. Air trapping from diseases such as asthma is a common cause of this scenario Factors such as small nostrils, larger tongue, and narrower airways in an infant.... A. Decrease airway resistance B. Make intubation easier C. Increase airway resistance D. Improve airway obstruction ---------- Correct Answer ----------- C. Increase airway resistance - There are a number of factors that increase airway resistance and obstruction in young infants, including their larger heads and tongues, smaller nostrils, decreased muscle tone, and narrower airways. - Intubation is more difficult because of an anterior larynx and narrow cricoid ring. Indications that a patient is ready to wean from mechanical ventilation include: A. Hemodynamic instability B. Adequate cough and gag reflexes C. Persistent coma D. PEEP > 8 ---------- Correct Answer ----------- B. Adequate cough and gag reflexes - Before being extubated, a child needs to have an adequate level of consciousness to protect his or her airway. This includes having an adequate cough and gag; hemodynamic stability (not instability); and a PEEP <5, with an oxygen requirement generally less than an FiO2 of 0.4. A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190. These findings suggest: A. Aspiration pneumonia B. Viral pneumonia C. Acute respiratory distress syndrome D. Pneumothorax ---------- Correct Answer ----------- C. Acute respiratory distress syndrome - This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things. - Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for this question. - The symptoms described are not consistent with a pneumothorax. An infant with bronchiolitis is intubated due to an acute respiratory failure. Post- intubation ABG results demonstrate: pH 7.22 PaCO2 62 PaO2 75 HCO3 22 O2 sat 90% This blood gas reflects: A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis ---------- Correct Answer ----------- B. Respiratory acidosis This child's blood gas results include a decreased pH and an increase in PaCO2 — both of which indicate a state of respiratory acidosis. An intubated, mechanically ventilated patient has a sudden decrease in SpO2 from 95% to 78%, and the ventilator is alarming high peak pressures. Your first intervention is to: A. Increase the FiO2 and ventilator rate B. Assess the patency of the endotracheal tube C. Administer a neuromuscular blocking agent D. Prepare to reposition the endotracheal tube ---------- Correct Answer ----------- B. Assess the patency of the endotracheal tube - Your first priority is assessing the patency of the ETT. - Once you have confirmed whether the tube is or is not patent, that will help to direct your next interventions. - The alarms for high peak pressure may indicate that the ETT is kinked or blocked with secretions. The most important intervention when caring for the patient with epiglottitis and who is in significant respiratory distress is to: A. Keep the child quiet and comfortable B. Administer racemic epinephrine C. Place the child in a supine position D. Administer antibiotics ---------- Correct Answer ----------- A. Keep the child quiet and comfortable - The goal is to keep the child quiet, comfortable, and in whatever position that allows them to maintain their own airway until a skilled provider who can control the airway is present and ready to do so. - Racemic epinephrine might be helpful for the patient with croup - Although the patient with epiglottitis needs antibiotics, that's not the priority intervention until the airway is secure. B. Increased fluid requirements C. Decreased pulmonary vascular resistance D. Increased caloric needs ---------- Correct Answer ----------- D. Increased caloric needs -Infants with BPD have increased caloric needs because of the chronic increased work of breathing distress. -They require diuretics and generally do not tolerate fluid overload. -And, they experience increased pulmonary vascular resistance and resultant right-sided heart failure. Cerebrospinal fluid is produced by the: A. Choroid plexus B. Cerebral ventricles C. Arachnoid villi D. Pia mater ---------- Correct Answer ----------- A. Choroid plexus Cerebrospinal fluid is formed in the choroid plexus and reabsorbed in the arachnoid villi. Problems with CSF production or absorption can result in hydrocephalus. A child is admitted after falling off a golf cart. The child was initially awake and alert, but now is unresponsive. The nurse should suspect which condition? A. Hydrocephalus B. Epidural hematoma C. Subdural hematoma D. Diffuse axonal injury ---------- Correct Answer ----------- B. Epidural hematoma Epidural hematomas result from hemorrhage into the extradural space, usually from a tear in the middle meningeal artery. With the classic presentation, the child is initially awake and alert, but as the bleeding continues, the hematoma gets larger and the child can become unresponsive. An infant with a ventriculoperitoneal shunt is irritable with a high-pitched cry and setting-sun sign. The nurse should be concerned this child may have: A. Diabetes insipidus B. Stroke C. New-onset seizures D. Shunt malfunction ---------- Correct Answer ----------- D. Shunt malfunction This child is demonstrating symptoms of hydrocephalus and increased ICP. The most common cause of this in a child with a VP shunt is shunt malfunction. This needs further investigation with medical imaging and the child may require surgery to correct the problem. A traumatically injured 8-year-old is being cared for in the ICU. The nurse notes the child has an ICP of 18 mmHg, arterial blood pressure of 112/72 mmHg, with MAP of 86 mmHg and central venous pressure of 7 mmHg. The nurse calculates the cerebral perfusion pressure and anticipates which intervention? A. MRI evaluation B. Ongoing monitoring C. Emergent surgery D. Fluid bolus ---------- Correct Answer ----------- B. Ongoing monitoring -This child has age-appropriate values for blood pressure, MAP, and CVP. The calculated CPP is 68 mmHg (MAP minus ICP). -Based on the information given in this scenario, there is no indication for additional brain imaging, surgical intervention, or fluid bolus. -The nurse should continue monitoring the patient and supporting vital functions. The priority management strategy for an epidural hematoma is: A. Surgery B. ICP monitoring C. Steroids D. Pain control ---------- Correct Answer ----------- A. Surgery - Large epidural hematomas are treated with surgery. - Depending on the child's condition, ICP monitoring may be indicated, but surgical removal is the priority. - Steroids are not indicated in this scenario. - The child will need pain assessed and treated in the postoperative period. Which is the initial independent nursing intervention to maintain cerebral perfusion? A. Hypertonic saline administration B. Maintain head midline C. Initiate blood transfusion D. Administer sedation ---------- Correct Answer ----------- B. Maintain head midline -This question asks about the initial independent nursing intervention. -Of the choices offered, maintaining the head midline is the only independent nursing action. This will help to promote venous drainage, which can improve cerebral perfusion. A patient presents with agitation, nuchal rigidity, and a positive Brudzinski sign. The priority intervention is: A. ICP monitoring B. Medical restraints C. Antibiotic administration D. Intraventricular catheter ---------- Correct Answer ----------- C. Antibiotic administration -This patient is demonstrating signs of meningitis. Initial treatment includes antibiotic administration. -ICP monitoring and placement of an intraventricular catheter are not indicated in this scenario. -Restraints may be needed, but they could further agitation. A child is admitted to the ICU following a motor vehicle collision in which he was an unrestrained passenger. He is complaining of numbness and tingling in his legs and feet, and has decreased sensation. Preliminary imaging studies are normal. The nurse anticipates: A. Removal of the cervical collar B. Discontinuation of log rolling C. Administration of anti-anxiety medications D. Ongoing spinal cord protective measures ---------- Correct Answer ----------- D. Ongoing spinal cord protective measures. -This patient's clinical picture is consistent with spinal cord injury, even though there were no findings on imaging studies. He may have Spinal Cord Injury Without Radiograph Abnormality (SCIWORA). -The patient should have spinal cord protective measures in place (eg, log rolling, cervical collar) at this point. Which is a required element of the exam for brain death determination? A. Apnea test B. EEG C. MRI D. Spinal cord reflexes ---------- Correct Answer ----------- A. Apnea test -Brain death determination requires two exams separated by an observation period based on the child's age. Apnea testing must occur with each exam, unless the patient's condition prevents it. -In that case, an ancillary test such as four-vessel cerebral angiography or EEG is needed. -MRI and testing of spinal cord reflexes are not part of the brain death exam. A patient is admitted with status epilepticus. After arrival, the SpO2 decreases to 85%. The priority response is: A. Oxygen administration intervention choice that will have the most immediate effect is the administration of insulin and glucose. This will help to shift potassium back into the cells and decrease the serum potassium levels. -Additionally, calcium chloride or calcium gluconate should be administered first in order to protect the heart A young child is admitted with hemolytic uremic syndrome. The preferred mode of dialysis in this patient is: A.Peritoneal dialysis B. Hemodialysis C. CVVH D. Dialysis is not indicated ---------- Correct Answer ----------- A. Peritoneal dialysis Peritoneal dialysis (PD) is the preferred mode for the patient with HUS. These patients are usually of a younger age, which makes PD a good choice. A recently admitted child has muscle weakness and a tall, peaked T. wave was observed on electrocardiogram. Which intervention do you anticipate? A. Administration of hypertonic saline B. Administration of potassium replacement C. Emergent cardioversion D. Removal of potassium from all IV fluids ---------- Correct Answer ----------- D. Removal of potassium from all IV fluids -This patient is demonstrating signs of hyperkalemia. The only option listed that would begin to address this is the removal of potassium from all IV fluids. -Depending on the serum potassium level, the nurse should anticipate administering calcium, insulin/glucose, sodium bicarbonate, and kayexalate. -Hypertonic saline and cardioversion are not indicated and administering potassium in this situation is contraindicated. The nurse is caring for a child with liver failure and who is experiencing profound abdominal distention. What is the primary concern? A. Renal insufficiency B. Biliary atresia C. Intestinal perforation D. Respiratory failure ---------- Correct Answer ----------- D. Respiratory failure -Children with liver failure can experience profound abdominal ascites and distention. This process pushes up on the diaphragm and can result in respiratory distress, which can lead to respiratory failure. -Increased pressure in the abdomen can compromise perfusion to other abdominal organs, like the kidney. But in this scenario, respiratory distress is the primary concern. The nurse caring for a child who was injured in a motor vehicle crash notes positive Cullen's sign in the right abdomen around the umbilicus. This is indicative of: A. Impending disseminated intravascular coagulopathy B. Necrotic bowel process C. Sepsis D. Intra-abdominal bleeding ---------- Correct Answer ----------- D. Intra-abdominal bleeding In cases of severe intra-abdominal bleeding, Cullen's sign (bluish discoloration around the periumbilical area) may be seen. The nurse should be concerned that the child has severe injuries and may need surgical exploration or repair. The primary concern for a child diagnosed with intussusception is: A. Dehydration B. Bowel infarction C. Infection D. Pain ---------- Correct Answer ----------- B. Bowel infarction -When intussusception occurs, part of the bowel telescopes inside itself. This can result in decreased arterial blood flow to the area and resultant bowel infarction. -Intervention to correct the telescoping bowel needs to be initiated immediately. -The child may experience severe paroxysmal pain, is at risk for dehydration, and can develop an infection if perforation occurs. You are caring for an adolescent with multiple traumatic injuries sustained in a motor vehicle collision. Upon assessment, you notice that the patient has developed shallow, rapid respirations and abdominal distention; is now complaining of pain in the area of the right shoulder; and whose BP has also dropped to 80/50 mmHg. You suspect that this patient has sustained a traumatic injury to the: A. Spleen B. Liver C. Kidneys D. Clavicle ---------- Correct Answer ----------- B. Liver Abdominal distention and rapid, shallow respirations may be seen with many abdominal injuries. -Pain that radiates to the right shoulder is consistent with hepatic injury. -Additionally, the patient is showing signs of shock, which can be associated with bleeding from a lacerated liver. Which would be an indication for urgent surgical intervention in the child with a gastrointestinal hemorrhage? A. Presence of free air on abdominal radiograph B. Weakness and faintness C. Age <3 months D. Unknown etiology of the gastrointestinal hemorrhage ---------- Correct Answer --------- -- A. Presence of free air on abdominal radiograph -Indications for urgent surgical intervention include the presence of free air on abdominal radiograph (sign of possible intestinal perforation) or severe hemorrhage that is unresponsive to blood component therapy. -Less invasive measures can be used to determine the cause of the Gl bleed. Which finding is most concerning for necrotizing enterocolitis (NEC)? A. Sausage-shaped mass in the RUQ B. Apnea and bradycardia C. Pneumatosis intestinalis D. Hyperbilirubinemia ---------- Correct Answer ----------- C. Pneumatosis intestinalis -Pneumatosis intestinalis is a specific finding on abdominal x-ray that is indicative of NEC in a patient at risk for this condition. -Apnea and bradycardia are nonspecific symptoms associated with many neonatal conditions. -A sausage-shaped mass in the RUQ is associated with intussusception. Potential complications of blood component administration include: A. Anaphylaxis B. Thrombocytopenia C. Anemia D. Vaso-occlusive crisis ---------- Correct Answer ----------- A. Anaphylaxis -Symptomatic anemia is an indication for blood component therapy, not a complication. -Anaphylaxis is a potential complication of blood component therapy caused by antigen antibody complexes. -The patient may experience bronchospasm, cough, respiratory distress, and hypotension. -Thrombocytopenia is a low platelet count, and vaso-occlusive crisis is a risk for patients with sickle cell disease A child having a seizure has a serum sodium level of 125 mEq/L and a decreased urine output. What disease process is most likely? A. Diabetes mellitus (DM) B. Syndrome of inappropriate antidiuretic hormone (SIADH) C. Diabetes insipidus (DI) D. Diabetic ketoacidosis (DKA) ---------- Correct Answer ----------- B. Syndrome of inappropriate antidiuretic hormone (SIADH) -The symptoms of SIADH include hyponatremia and decreased urine output. -The child is likely having a seizure because of the low serum sodium. -A child with DI would have an increased serum sodium level and a significantly increased urine output. -Diabetes mellitus and DKA are disorders of glucose control. Which parameters signal the development of SIADH? A. Decreased serum sodium, decreased serum osmolality B. Increased serum sodium, increased serum osmolality C. Decreased serum sodium, increased serum osmolality D. Increased serum sodium, decreased serum osmolality ---------- Correct Answer -------- --- A. Decreased serum sodium; decreased serum osmolality -In SIADH, an increase in the production of ADH results in retention of fluid, hyponatremia, and hypo-osmolality. -Hypernatremia and hyperosmolality would be clinical manifestations of DI, not SIADH. -Under most circumstances, sodium levels are the primary determinant of osmolality. In a patient being treated for SIADH, which one of the following sodium levels would indicate reversal of this syndrome? A. 119 mEg/L B. 128 mEq/L C. 135 mEq/L D. 152 mEq/L ---------- Correct Answer ----------- C. 135 mEq/L -A sodium level of 135 mEq/L would indicate that Na+ levels are returning to normal and SIADH is reversed. -Answers A and B would relate to a patient who is having ongoing issues with hyponatremia, an indication that SIADH has not been reversed. -Answer D indicates hypernatremia, which also is not an indication of reversal of SIADH. Which of the following findings is indicative of Diabetes Insipidus? A.Serum sodium 150 mEq/L B. Urine-specific gravity 1.012 C. CVP 15 mmHg D. Serum osmolality 280 mOsm/L ---------- Correct Answer ----------- A. Serum sodium 150 mEq/L -DI is associated with hypovolemia, hypernatremia, and hyper-osmolality. -Among the possible answers to this question, a sodium level of 150 mEq/L (hypernatremia) would be your best choice. A child with a closed head injury has developed SIADH. Which of the following laboratory results would this patient exhibit? A. Serum Na+ 122 mEg/L; serum Osm 262 mOsm/L B. Serum Na+ 134 mEq/L; serum Osm 280 mOsm/L C. Serum Na+ 144 mEq/L; serum Osm 282 mOsm/L D. Serum Na+ 158 mEq/L; serum Osm 295 mOsm/L ---------- Correct Answer ----------- A. Serum Na+ 122 mEq/L; serum Osm 262 mOsm/L -You know that patients with SIADH have hyponatremia and hypo-osmolality, you know that answer "A" is the best response. A child experiencing Diabetes Insipidus (DI) has a urine output >4 mL/kg/hr and a serum sodium of 158 mEq/L. The nurse should expect the patient will need: A. Hypotonic intravenous fluids and urine output replacement B. Vasopressin administration and urine output replacement C. Hypertonic saline administration and 75% maintenance intravenous fluid D. Vasopressin and hypertonic saline administration ---------- Correct Answer ----------- B. Vasopressin and urine output replacement -Immediate treatment for a patient with symptomatic DI is ADH replacement and urine output replacement to keep the patient from progressing to profound hypovolemic shock. -Hypotonic fluids and hypertonic saline administration are contraindicated in this situation. -Fluid restriction to 75% of maintenance needs is a treatment for SIADH. Which of the following actions would be appropriate after the administration of Desmopressin (DDAVP) to a patient with DI? A. Decreasing fluids B. Increasing fluids C. Increasing sodium intake D. Decreasing sodium intake ---------- Correct Answer ----------- A. Decreasing fluids -Administration of DDAVP should result in renal retention of water and a subsequent increase in intravascular volume. -If those things occur, the nurse could anticipate that intravenous fluids would be decreased. A child being treated for DKA becomes more lethargic, is difficult to arouse, and has vomited twice in the past hour. These symptoms could be interpreted as indications of: A. Exhaustion due to lack of sleep B. The development of hypoglycemia C. Decreased intestinal motility D. Cerebral edema and increased ICP ---------- Correct Answer ----------- D. Cerebral edema and increased ICP -These symptoms are indications that the child may be developing cerebral edema and an increased ICP. -Nurses must recognize that children with DKA are at a higher risk for the development of cerebral edema and must monitor closely for any changes in neurological status. A child in DKA has a glucose of 350 mg/dL. One hour later the glucose is 250 mg/dL. The nurse would anticipate the administration of: A. Potassium chloride B. Sodium bicarbonate C. Dextrose solution D. Subcutaneous insulin ---------- Correct Answer ----------- C. Dextrose solution -As the glucose decreases to 250 mg/dL, it will become necessary to administer glucose in addition to the insulin infusion that this patient is likely already receiving. -The child in DKA will not receive SQ insulin, as she will not be able to utilize that as effectively as IV insulin. -You have no information to suggest that this patient requires electrolyte supplementation. -Sodium bicarbonate is not appropriate An adolescent is admitted with an unstable pelvic fracture. The nurse should anticipate the patient may need which intervention because of this injury? A. Frequent pupillary assessment B. Incentive spirometry C. Long-bone casting D. Leg-length monitoring ---------- Correct Answer ----------- B. Incentive spirometry D. Repeat a fluid bolus of 20 mL/kg ---------- Correct Answer ----------- D. Repeat a fluid bolus of 20 mL/kg -Children with septic shock typically have very large fluid deficits. -Most children require at least 40-60 mL/kg, but some may require as much as 200 mL/kg. -There is no indication that ventilator settings need to be adjusted. -The other two interventions (epinephrine and cooling) may be indicated, as well, but fluid resuscitation is the first priority. Lactic acid production occurs when there is: A. Improved cellular function B. Anaerobic metabolism C. Alteration in body temperature D. Aerobic metabolism ---------- Correct Answer ----------- B. Anaerobic metabolism -As shock progresses to an uncompensated state, metabolism shifts from aerobic to anaerobic, resulting in increased production of lactic acid. The following blood gas results are consistent with which condition? pH 7.25 PaC02 61 mmHg Pa02 58 mmHg HCO3 24 mmHg A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic acidosis D. Metabolic alkalosis ---------- Correct Answer ----------- A. Respiratory acidosis This blood gas result reveals a low pH, elevated CO2, low 02, and normal HCO3. We would expect to see a child with this blood gas in respiratory distress. A 4-month-old arrives with a 24-hour history of vomiting and diarrhea. The patient is lethargic, pale, cool, and clammy. Weak peripheral pulses can be palpated and her capillary refill time is >4 seconds. The child is in: A. Hypovolemic shock B. Septic shock C. Anaphylactic shock D. Cardiogenic shock ---------- Correct Answer ----------- A. Hypovolemic shock -This patient's history and clinical exam are consistent with hypovolemic shock. -Gastroenteritis is a common cause of fluid loss in an infant, which can result in significant hypovolemia. The child is placed on high-flow oxygen and an IV is inserted. An initial fluid bolus is ordered. The child weighs 7 kg. Which of the following is the most appropriate fluid to administer to this infant? A. D1OW B. 0.9% normal saline C. Packed red blood cells D. Hypertonic saline ---------- Correct Answer ----------- B. 0.9% normal saline -The initial fluid bolus for a child in hypovolemic shock from gastroenteritis should be an isotonic crystalloid solution, usually 0.9% normal saline. -D10W contains glucose and is not isotonic; therefore, it should not be used as a fluid bolus. -Packed red blood cells and hypertonic saline are not indicated in this patient scenario. The parents of a 15-month-old state that she has a high fever and vomiting and is now extremely irritable. The mother states there are "bruises" and a spotty rash on the child's legs, but she has no history of recent trauma. The child's vital signs are HR 160, RR 38, BP 74/52, and rectal temperature of 41°C. This child is most likely experiencing: A. Hypovolemic shock B. Cardiogenic shock C. Septic shock D. Anaphylactic shock. ---------- Correct Answer ----------- C. Septic shock -The child's history and clinical presentation are suggestive of sepsis and septic shock. She quickly needs an IV fluid bolus and antibiotics An adolescent intentionally ingested acetaminophen and has a toxic level. In addition to fluid hydration, the patient should receive: A. Hemodialysis B. N-acetylcysteine C. Sodium bicarbonate D. Ipecac syrup ---------- Correct Answer ----------- B. N-acetylcysteine -The antidote for acetaminophen ingestion is N-acetylcysteine, given as an intravenous infusion. -Hemodialysis and sodium bicarbonate are not indicated in this scenario, but might be appropriate for salicylate overdose. -Ipecac syrup is not recommended. -This child may also benefit from psychosocial support and mental health care A toddler is hospitalized after ingesting her older sister's clonidine. Which is an essential intervention to prevent future occurrences? A. Tell the parents the child protective team will be notified next time B. Ensure parents store the medication in their bedroom C. Ask the pediatrician to discontinue the sister's medication D. Ensure parents use a lock box to store medication ---------- Correct Answer ----------- D. Ensure parents use a lock box to store medication -Medication should be kept in a lockbox so young children are unable to access it accidentally. -Part of the process of investigating a child's accidental ingestion includes a psychosocial and safety assessment, which may involve the social worker or the child protective team. Which of the following is likely to be most successful in reducing an ICU's CLABSI rate? A. Using clean technique during catheter insertion B. Exclusively using central catheters in all patients C. Implementing a bundle of effective strategies D. Reinforcing loose catheter dressings ---------- Correct Answer ----------- C. Implementing a bundle of effective strategies -Our goal is to prevent CLABSI from occurring by bundling care practices as they pertain to insertion of the catheter, maintenance of the catheter, and early removal. -Sterile technique and maximum barrier precautions should be used during insertion, not clean technique. -Catheters should be placed only when truly indicated and removed as soon as possible. -Loose dressing should be changed, not reinforced. Complications of organ transplant include rejection and: A. Infection B. Malignant hyperthermia C. Osteopenia D. Developmental delay ---------- Correct Answer ----------- A. Infection -A patient who receives a transplant will receive immunotherapy and thus will have a lifelong risk of infection. -Other potential post-transplant complications include bleeding, delayed graft functioning postoperatively, and potential challenges with medical compliance. The risk for drowning increases with: A. Swimming lessons exercise, and fever all increase oxygen demand. A patient with congestive heart failure would most likely exhibit all of the following clinical manifestations except: A. Increased urine output B. Decreased cardiac output C. Hepatomegaly D. Cardiomegaly ---------- Correct Answer ----------- A. Increased urine output -Patients with congestive heart failure typically exhibit increased heart size, fluid volume overload with decreased urine output, and hepatomegaly-not increased urine output. A child is admitted in a hypertensive crisis and vasodilators are ordered. The nurse understands that the intention is to improve cardiac function through: A. Increasing SVR B. Inotropic and chronotropic actions C. Decreasing afterload D. Improving renal function ---------- Correct Answer ----------- C. Decreasing afterload -Introducing vasodilators into this child's medical management will allow for reduction of systemic vascular pressures, thereby reducing afterload. -Medications that increase SVR or have inotropic and chronotropic actions would worsen this situation. A 16-year-old crashes her car into a wooden fence and is impaled through the chest by a fence post. She presents with significant shortness of breath. You are unable to auscultate breath sounds on the right side and you palpate crepitus throughout the right side of the chest. Her HR is 146 and you are unable to obtain a blood pressure. She is most likely experiencing: A. Cardiomyopathy B. Cardiogenic shock C. Hypertensive crisis D. Cardiogenic/obstructive shock ---------- Correct Answer ----------- D. Cardiogenic/obstructive shock -Cardiogenic/obstructive shock occurs when cardiac output is obstructed and there is an inability to provide adequate tissue perfusion despite normal intravascular volume and myocardial function. -Causes include trauma to the great vessels, tamponade, pulmonary embolism, valvular stenosis, and coarctation of the aorta A child experiences sudden cardiac death after playing soccer. The most likely etiology is: A. Restrictive cardiomyopathy B. Hypertrophic cardiomyopathy C. Dilated cardiomyopathy D. Kawasaki disease ---------- Correct Answer ----------- B. Hypertrophic cardiomyopathy -Hypertrophic cardiomyopathy involves thickening of the heart muscles, which can obstruct blood flow out of the left ventricle. -Intense exercise can worsen the outflow obstruction, which makes this type of cardiomyopathy the most common cause of sudden cardiac death in people younger than age 35 and in athletes. A patient with a subclavian central venous catheter develops facial swelling, headache, dyspnea, and jugular vein fullness. The nurse suspects the patient has: A. Deep vein thrombosis B. Pulmonary embolism C. Superior vena cava syndrome D. Catheter infection ---------- Correct Answer ----------- C. Superior vena cava syndrome -The main problem in superior vena cava syndrome is impaired return of venous blood from drainage areas like the head and neck, upper extremities, and upper thorax because of some sort of obstruction (In this case, a central venous catheter obstruction) -Symptoms occur due to back-up of blood and include facial swelling, dyspnea, cough, arm edema, and headache, full jugular veins, and engorgement of collateral veins. Twelve hours after cardiac surgery, a patient develops hypotension, tachycardia, and increased central venous and left atrial pressures. There are clots in the chest tube. What is the next likely intervention? A. Chest x-ray B. Pericardiocentesis C. Fluid administration D. Increase in inotropic infusions ---------- Correct Answer ----------- B. Pericardiocentesis -This patient is showing signs of cardiac tamponade, a complication that can develop after cardiac surgery, especially if the chest tubes stop draining due to clotting. -The appropriate intervention to relieve the building pressure and improve cardiac output is a pericardiocentesis. -A chest x-ray, fluid administration, and/or increasing the inotropes would not alleviate this emergency. Which intervention would not be appropriate for an infant with Tetralogy of Fallot who is experiencing a "tet" spell? A. Placing the baby in knee-to-chest position B. Morphine administration C. Decreasing the concentration of oxygen administration D. Fluid administration ---------- Correct Answer ----------- C. Decreasing the concentration of oxygen administration -In a "tet" spell, the infant experiences obstruction to the outflow tract, which increases right-to-left shunting and decreases pulmonary blood flow. -Interventions such as placing the baby in a knee-to-chest position and administering morphine and fluids will help relieve this shunting. -Oxygen concentration should actually be increased, not decreased, during a "tet" spell because it is a potent pulmonary vasodilator, which can improve pulmonary blood flow. The nurse should anticipate which patient will need a balloon septostomy? A. Baby with small ventricular septal defect B. Toddler with infectious pericarditis C. Infant with a large atrial septal defect D. Newborn with transposition of the great arteries ---------- Correct Answer ----------- D. Newborn with transposition of the great arteries -A baby born with transposition of the great arteries has parallel pulmonary and systemic circulations and is dependent on some type of shunt to survive. -A balloon septostomy may be used to create an atrial septal defect until surgical repair is made. -This procedure is not indicated for a VSD or ASD, or for pericarditis. A child recently underwent a diagnostic cardiac catheterization. The nurse notes the patient's distal foot is cool, with poor perfusion and an absent pulse, and should suspect what? A. Post-procedure bleeding B. This is a normal finding C. Hematoma D. Heart failure ---------- Correct Answer ----------- C. Hematoma -Post-procedure monitoring after cardiac catheterization includes observing for bleeding and perfusion. -A hematoma can form, which may require intervention if distal perfusion is significantly compromised, and this is not a normal finding. -The assessment findings described in this question do not indicate there is bleeding or heart failure. When is there a particular risk for arrhythmias? A. Post atrial balloon septostomy C. Convene a staff meeting to discuss the problem D. Develop a poster demonstrating the correct procedure ---------- Correct Answer -------- --- B. Track the actual blood culture contamination rate -The first step of analyzing a potential problem is to collect actual data to determine whether or not the problem truly exists. -In this scenario, the blood culture contamination rate would be determined by evaluating the number of blood cultures drawn as compared to the number that are reported as contaminated. -Once that assessment is done, appropriate next steps such as direct observations or education can be determined. The parents of a toddler who is transferring out of the ICU state, "We want to stay one more day and then be discharged from the ICU." Which is the most appropriate response? A. "Aren't you glad there are sicker patients who needs this bed?" B. "You sound concerned about leaving the ICU" C. "They have great nurses in his new unit" D." We have to move him once he doesn't meet ICU criteria" ---------- Correct Answer --- -------- B. "You sound concerned about leaving the ICU" -Transfer from the ICU environment can be stressful for both the patient and family. This is particularly true after a long ICU stay, or when the child has been very ill. -Providing the parents with an opportunity to voice their concerns will allow the nurse to understand their questions and anxiety. With this knowledge, the nurse can better address the situation. The mother of a recently admitted, technology-dependent child tells the nurse that she has missed several clinic appointments. How can the nurse best help in this situation? A. Inform the social worker about the medical neglect B. Assess the mother's access to tangible resources C. Notify the clinic physician that the child is admitted D. Reassure the mother that she is doing her best ---------- Correct Answer ----------- B. Assess the mother's access to tangible resources -The nurse's first response should be to further assess the mother's situation and determine why she has missed appointments. -Assessing tangible resources, like transportation, may better elicit the mother's needs and the nurse can then best respond from a systems thinking perspective. Parents need education and training to care for their child's new gastrostomy tube. 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 parents' current knowledge and skills D. Establish a deadline for completing the training ---------- Correct Answer ----------- C. Assess the parents' current knowledge and skills The first thing the nurse needs to do is assess the parents' current understanding of the gastrostomy tube. Following that assessment, a teaching plan can be developed. Numerous consultants are involved in a patient's care and are ordering conflicting therapies. The nurse should: A. Ask consultants to collaborate before ordering therapies B. Prioritize and complete therapies in order of importance C.Balance the conflicting therapies as able D. Request a care conference and include the consulting services ---------- Correct Answer ----------- D. Request a care conference and include the consulting services -Multidisciplinary team members must collaborate to meet the patient's care needs. The best way to facilitate collaboration is through a care conference where all consulting services and the primary care team can jointly develop the patient's plan of care. A family of Middle Eastern descent requests that no male caregivers enter the room when the mother is there alone at night. What's the best response? A. Notify the social worker that the family is interfering with care B. Assign male caregivers if necessary to meet the unit's staffing needs C. Transfer the patient to a larger intensive care unit D. Document the request and include the information in the handoff report ---------- Correct Answer ----------- D. Document the request and include the information in the handoff report -An appropriate response to diversity is to honor this family's request. -Of the options listed, documenting and including the information in the handoff report is the best way to communicate the request. -It would be important for the nurse to talk with the family about emergency scenarios where it might not be possible to honor this while still meeting the urgent needs of the child. -A plan for this scenario could then be articulated with the family's agreement. Nurses return from a national conference excited to start using a new wound care dressing. What should be their first step? A. Review current literature related to the product and its intended uses B. Arrange a product demonstration by a company representative C. Prepare a research protocol to study resulting improvements in care D. Obtain the support of the intensive care unit's medical director ---------- Correct Answer ----------- A. Review current literature related to the product and its intended uses -Before making a change in care practices or using new products, the first step is to review available scientific literature related to the product and the condition it is designed to impact. -After synthesizing the literature, the unit team can consider appropriate next steps, such as a product demonstration or the development of a protocol. -Key stakeholders should be identified and may include the unit's medical director and others. An adolescent with a terminal condition tells the nurse that she no longer wants aggressive treatment. Her father agrees, but her mother is adamantly opposed. The parents are divorced, but share custody. The most appropriate nursing response is to: A. Tell the parents to respect their child's wishes B. Ask the parents to speak privately and seek resolution C. Explain that the mother's wishes take priority D. Contact the social worker to begin conflict resolution ---------- Correct Answer ---------- - D. Contact the social worker to begin conflict resolution -This sensitive situation calls for expertise on the part of the healthcare providers. The unit's social worker (or equivalent) is in the best position to begin the process of exploring the family's emotional needs and desires. -The next step may be a family meeting or care conference with the team. -The other options listed do not adequately move the process toward resolution. During a cardiopulmonary resuscitation event, the nurse notices the child's parents standing together in the corner of the room crying. What's the nurse's best response? A. Gently escort them to the family waiting area B. Stand near them and explain what is happening C. Notify them that family cannot be present during CPR D. Ask the nurse manager to intervene ---------- Correct Answer ----------- B. Stand near them and explain what is happening -The nurse's best option in this scenario is to be a supportive presence. -After explaining what is happening, the nurse can offer the parents the option of staying in the room, or close by if they choose. -Parents may need "permission" that it's okay to stay or step away if they are overwhelmed. -Family support should be an assigned role during any resuscitation, just like compressions or airway management.