AACN CCRN PEDIATRICS EXAM NEWEST ACTUAL EXAM & PRACTICE EXAM QUESTIONS & CORRECT ANSWERS, Exams of Nursing

Download AACN CCRN PEDIATRICS EXAM NEWEST ACTUAL EXAM & PRACTICE EXAM QUESTIONS & CORRECT ANSWERS and more Exams Nursing in PDF only on Docsity! AACN CCRN PEDIATRICS EXAM NEWEST ACTUAL EXAM & PRACTICE EXAM QUESTIONS AND DETAILED CORRECT ANSWERS WITH RATIONALES | VERIFIED A+ GRADE 2024-2025 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. B) the patient having a CT scan followed by possible shunt revision C) Administering mannitol or hypertonic saline D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) Correct Answer Answer: B) The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. A) The physician ordering lumbar puncture and blood and urine cultures: These interventions will not address the most likely primary problem, which is suspected VP shunt malfunction. Additionally, lumbar puncture is contraindicated in the presence of increased intracranial pressure, because downward herniation of the brainstem can occur. C) Administering mannitol or hypertonic saline: These medication are indicated for the medical management of increased intracranial pressure, of which this patient has symptoms. However, they will not address the most likely primary problem, which is suspected VP shunt malfunction. D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most 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 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 a schedule and known activities will provide a healing environment appropriate for an autistic patient with a possible head injury. A patient who does not speak or understand English is admitted. Guidelines for using a translator may include A) Having the translator ask questions that you don't feel comfortable asking B) Standing next to the translator and as close to the patient as possible C) Providing all of the information, then allowing translation and asking of questions D) Allowing time for the translator to decode the medical jargon used in the teaching. Correct Answer Answer: B) Standing next to the translator and as close to the patient as possible: This response is consistent with high competency levels in Facilitation of Learning. It supports the patient through the process of obtaining the information required from a professional individual and the translator A) Having the translator ask questions that you don't feel comfortable asking: This response is not consistent with high competency levels in Facilitation of Learning. A translator should be used to obtain all pertinent patient information C) Providing all of the information, then allowing translation and asking of questions: This response is not consistent with high competency levels in Facilitation of Learning. Content may be accidentally omitted with the process described in this option. D) Allowing time for the translator to decode the medical jargon used in the teaching: This response is not consistent with high competency levels in Facilitation of Learning. Jargon should not have to be decoded by the translator. This can lead to errors by the translator, who might provide inaccurate information. Family members of a patient who has just died are crying and wailing loudly both inside and outside the patient's room. Staff are expressing frustration with the outbursts. The nurse's best response is to acknowledge the noise and A) Ask a security officer to remove the family from the unit B) Guide the family to a nearby room where they can express their emotions C) Tell the family they must quiet down, or they will have to leave the unit D) Tell the other staff they are being insensitive to the family's expression of grief Correct Answer Answer: B) Guide the family to a nearby room where they can express their emotions: People from various cultures express grief and mourning in different ways. This expression may include loud, emotional responses. Providing the family a place close to the patient's room allows them privacy while minimizing disruption to other patients and staff in the area. A) Ask a security officer to remove the family from the unit: Removing the family is not a culturally sensitive way to allow the family to experience their grief and mourning C) Tell the family they must quiet down or they will have to leave the unit: Asking the family to be quiet or removing them from the unit are not culturally sensitive ways to allow the family toe experience their grief and mourning D) Tell the other staff they are being insensitive to the family's expression of grief: Telling other staff members that they are being insensitive does not promote cultural awareness and does not address the family's need to express their grief and mourning. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for: A) Heart Failure B) Air Emboli C) Hypoxemia D) Syncope Correct Answer Answer: A) Heart Failure: Heart Failure is a common manifestation associated with increased pulmonary blood flow B) Air Emboli: Although air emboli are possible with a septal defect, it would be a rare occurrence. This may be seen later in life due to chronic increased pulmonary blood flow C) Hypoxemia: Hypoxemia is not usually associated with cardiac defects that result in increased pulmonary blood flow D) Syncope: Syncope is not associated with cardiac defects that result in increased pulmonary blood flow A nurse believes the number of hemolyzed blood samples that have been reported by the laboratory is excessive. The best action for the nurse would be to A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed 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. 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. Positive end-expiratory pressure (PEEP) is intended to do which of the following? A) Increase functional residual capacity B) Decrease functional residual capacity C) Increase venous return to the heart D) Increase cardiac output Correct Answer Answer: A) Increase functional residual capacity: PEEP increases functional residual capacity (FRC) by keeping the alveoli open after expiration, increasing alveolar volume B) Decrease functional residual capacity: This is the opposite of what occurs when PEEP is used. C) Increase venous return to the heart: PEEP can impede systemic venous return D) Increase cardiac output: At high levels, PEEP may decrease cardiac output. A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration this venture is financially worthwhile is to: A) Present a report summarizing research relating developmental care to decrease length of stay. B) Request that the neonatoogist present the plan. C) Present case studies demonstrating favorable outcomes for developmental care. D) Invite members of administration to attend the classes. Correct Answer Answer: A) Present a report summarizing research relating developmental care to decreased length of stay: Evidence-based practice is the use of available data to support care. A decrease in length of stay is a motivator to support practice. B) Request that the neonatologist present the plan: This intervention will not address the financial concerns of the administrators. C) Present case studies demonstrating favorable outcomes for developmental care: This intervention will not address the financial concerns of the administrators. D) Invite members of the administration to attend the classes: This intervention will not address the financial concerns of the administrators. A 2-year-old with left-sided ventricular heart failure and pulmonary edema is experiencing extreme dyspnea. Which of the following would the nurse suggest to improve the work of breathing and decrease the child's anxiety and agitation? A) Digoxin (Lanoxin) 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. including severe cyanosis, hypoxemia, acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration or mechanical ventilation. A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic spell ("tet" spell). This patient has lower than normal pCO2. C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding, tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not sudden onset of respiratory distress. D) Transposition of the great arteries: In patients with transposition of the great arteries, cyanosis will not improve with oxygen administration. But oxygen administration helps decrease pulmonary vascular resistance, leading to increased pulmonary blood flow, which improves mixing of systemic and venous blood and improves arterial oxygen saturation. A teenager post-cardiac arrest has a new diagnosis of hypertrophic cardiomyopathy. The parents are concerned about what to do if their son collapses again. The nurse's best response would be: A) "Now that your son has been diagnosed and treated, you need not worry." B) "Would teaching you CPR help ease your anxieties?" C) "Do you know how to access the EMS system?" D) "I will have your son's cardiologist speak with you." Correct Answer Answer: B) "Would teaching you CPR help ease your anxieties?": This statement is consistent with Caring Practices and Facilitation of Learning. It identifies and clarifies the parents' concerns, which is a first step when providing information. It also shows support for the parents' concerns. A) "Now that your son has been diagnosed and treated, you need not worry.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. C) "Do you know how to access the EMS system?": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. D) "I will have your son's cardiologist speak with you.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. Referring the parents to another provider will delay getting answers. This issues is something the nurse should be able to address. 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. A) Use hand gestures to point to key things, such as the patient and the surgeon: Hand gestures are not an appropriate method for medical interpretation when a patient's or family's primary language is not English. B) Have the patient's 12-year-old sibling provide interpretation for the family: It is not appropriate to have a child or other family member provide medical interpretation when a patient's or family's primary language is not English. D) Give the family the operative consent written in Spanish: Providing documents in the patient's or family's primary language is useful, but this option alone does not allow for verbal medical interpretation. When treating a patient with hypovolemic shock due to prolonged vomiting, the first action by the nurse should be to: A) Administer oxygen B) Prepare equipment for intubation C) Prepare the patient for central venous line placement D) Increase intravenous fluid rate. Correct Answer Answer: A) Administer oxygen: It is important to assure that circulating blood is saturated with oxygen B) Prepare equipment for intubation: Although the patient may require intubation, this will not be the first action C) Prepare the patient for central venous line placement: Although the patient may require a central venous line, this will not be the first action D) Increase intravenous fluid rate: Intravenous fluids used in pediatric patients generally are hypertonic and include dextrose and potassium, which would be dangerous to give at an increased rate. The primary objective in the treatment of an infant with persistent pulmonary hypertension is to: A) Maintain the pH level at less than 7.40 B) Dilate the pulmonary vascular bed C) Dilate the systemic vascular bed D) Maintain fetal pulmonary circulation Correct Answer Answer: B) Dilate the pulmonary vascular bed: Pulmonary vasodilation helps maintain adequate systemic blood pressure, decreases pulmonary vascular resistance, and ensures oxygen release to tissues in patients with persistent pulmonary hypertension of the newborn A) Maintain the pH level at less than 7.40: Acidosis is a condition that will worsen pulmonary vasoconstriction, the opposite of what C) Ask the mother to explain why she is giving fluids to her son D) Ask security to restrict the mother's ability to visit the ICU 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. excitation in a patient with Wolff-Parkinson-White results from an anomalous conduction pathway between the atrium and the ventricle. The resultant premature depolarization of the ventricle produces a Delta wave and a widened QRS. A) Atrial pre-excitation: A slurred upstroke (Delta wave) is not associated with atrial pre-excitation B) Atrial depolarization: A slurred upstroke (Delta wave) is not associated with atrial depolarization C) Ventricular repolarization: A slurred upstroke (Delta wave) is not associated with ventricular repolarization Which of the following physical assessment findings are seen in a patient with an acute asthma attack receiving albuterol (Proventil) inhalation treatments? A) Wheezing and agitation B) Coughing and grunting C) Pleural rub and wheezing D) Stridor and bronchospasm Correct Answer Answer: A) Wheezing and agitation: Wheezing is usually present during an asthma attack, unless severely diminished air movement is present as a result of bronchospasm and inflammation. Agitation is an adverse effect of beta-2 receptor agonists, such as albuterol (Proventil) B) Coughing and grunting: While a cough is a common symptom of acute asthma attack, grunting is usually seen with patient sin severe respiratory distress C) Pleural rub and wheezing: Wheezing may be present at this time, but a pleural rub is not associated with asthma D) Stridor and bronchospasm: Bronchospasm may be present at this time but stridor is not associated with asthma Which of the following observations is consistent with the diagnosis of brain death in a 6-month-old? A) Absence of spontaneous breathing when PaCO2 goes above 60 mmHg B) Eyes deviate toward the right when ice water is injected into the ears. C) Radionuclide scan shows cerebral arterial blood flow into the brain stem D) Low-voltage amplitude observed on electroencephalogram (EEG) Correct Answer Answer: A) Absence of spontaneous breathing when PaCo2 goes above 60 mmHg: The patient's apnea test is consistent with the diagnosis of brain death when the PaCo2 is above 60 mmHg, and there are no spontaneous respirations B) Eyes deviate to the right when ice water is injected into the ears: eye deviation toward the right side demonstrates an abnormal oculovestibular reflex (cold water calorics) test, but that response is not consistent with the diagnosis of brain death C) Radionuclide scan shows cerebral arterial blood flow into the brain stem: Evidence of blood flow to any part of the brain or brain stem during a radionuclide scan is not consistent with the diagnosis of brain death D) Low-voltage amplitude observed on electroencephalogram (EEG): To be consistent with the diagnosis of brain death, the electroencephalogram (EEG) must demonstrate 30 minutes of electrocerebral silence, not low-voltage amplitude The acute treatment of bleeding esophageal varices includes: A) Placement of a large NGT to low intermittent suction B) Immediate surgical intervention C) Administration of octreotide (Sandostatin) D) Placement of a central venous line for hyperalimentation (TPN) Correct Answer Answer: C) Administration of octreotide (Sandostatin): Drug treatment for acute esophageal bleeding varices includes either octreotide (Sandostatin) or vasopressin (DDAVP) A) Placement of a large NGT to low intermittent suction: The patient may acutely require saline lavage through a large NGT, not intermittent suction B) Immediate surgical intervention: Surgical intervention may be needed, but not until the acute bleeding is controlled. D) Placement of a central venous line for hyperalimentation (TPN): Hyperalimentation is not an acute treatment for esophageal varices The attitude that one's own ethnic group is superior to others and that one's values, beliefs and perceptions are the correct ones is called: A) Ethnicity B) Ethnocentrism C) Racism D) Stereotyping Correct Answer Answer: B) Ethnocentrism: Ethnocentrism is the emotional attitude that one's own ethnic group is superior to others, including that one's own values, beliefs, and perceptions are the correct ones; and that the group's ways of living and behaving are the best A) Ethnicity: Ethnicity is the classification or affiliation with a group or division of humans differentiated by customs, characteristics, language or other distinguishing features C) Racism: Racism is the belief that certain races of people are by birth or nature superior to others D) Stereotyping: Stereotyping is attributing values, beliefs and attitudes based upon a person's ethnicity A child is admitted for colitis. Eight hours after admission the patient develops respiratory distress, abdominal distension, and capillary refill time greater than four seconds. The nurse should suspect: A) Intussusception B) Splenic Rupture C) Malrotation with Volvulus D) Bowel Perforation Correct Answer Answer: D) Bowel Perforation: This patient is demonstrating signs of bowel perforation with possible shock. Colitis can progress to the point 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. Which of the following is the first action to take in the case of a patient with a suspected tension pneumothorax? A. Assess blood pressure B. Prepare for intubation C. Obtain a chest radiograph D. Prepare for needle thoracostomy Correct Answer D. Prepare for needle thoracostomy Tension pneumothorax is an emergency requiring needle decompression. The child will require monitoring of vital signs pulmonary vascular resistance through dilation of the pulmonary bed. Patients at risk for pulmonary embolus include those with an inherited hypercoagulable state and: A. Sickle cell disease B. Diabetes C. Asthma D. Pneumonia Correct Answer A. Sickle cell disease Patients with sickle cell disease are at risk for developing a pulmonary embolus. Sickling of the RBCs within the small blood vessels of the lung and other organs leads to small vessel occlusion and, ultimately, infarction of areas of the pulmonary parenchyma. A baby with BPD will have: A. Left-sided heart failure 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. A. Oxygen administration B. Anticonvulsant administration C. Intubation D. Bite block insertion Correct Answer A. Oxygen administration Hypoxia is a complication of seizures, and the therapeutic priority in the management of a seizure is to maintain oxygenation and ventilation. A nasogastric tube should not be inserted in the child with which injury? A. Linear skull fracture B. Basilar skull fracture C. Depressed skull fracture D. Diffuse axonal injury Correct Answer B. Basilar skull fracture -Nasogastric tubes should not be inserted in patients with suspected basilar skull fractures because the tube could go up through the fracture into the brain. -These patients need an orogastric tube placed through the mouth Interventions for a child experiencing delirium include identifying and treating the underlying cause and: A. Hourly neurologic exams B. Medical restraints C. Benzodiazepine administration D. Sleep promotion Correct Answer D. Sleep promotion -Children who have delirium often experience sleep disturbances. -Strategies to promote sleep include turning down the lights at night, preventing noise, and allowing the child uninterrupted times for sleeping. -Hourly neurologic exams would not be indicated in this scenario and would interfere with the goal of sleep promotion. -Benzodiazepine administration and medical restraint use can worsen the symptoms of delirium In prerenal AKI, oliguria is the body's compensatory mechanism to: A. Conserve bicarbonate to alter the acid-base balance B. Increase the glomerular filtration rate C. Restore the intravascular volume to increase tissue perfusion D. Excrete potassium to maintain electrolyte balance Correct Answer C. Restore the intravascular volume to increase tissue perfusion. -Oliguria (a significant decrease in urine output) is the body's compensatory mechanism to retain more fluid, increase intravascular volume, and thereby improve tissue perfusion. Common laboratory findings associated with AKI include an increase in the BUN level, as well as which of the following changes in the concentrations of potassium and creatinine? A. Increased potassium and increased creatinine B. Decreased potassium and increased creatinine C. Increased potassium and decreased creatinine D. Decreased potassium and decreased creatinine Correct Answer A. Increased potassium and increased creatinine -In AKI, there is an accumulation of nitrogenous waste products (BUN and creatinine). Additionally, many patients develop hyperkalemia as the result of injury to the distal tubules. -Hypokalemia and/or a decreased serum creatinine are not commonly seen in AKI. Which is a potential result of a significant, sudden occurrence of hyponatremia? A. Respiratory failure B. Cerebral edema C. Hypotension D. Hyperkalemia Correct Answer B. Cerebral edema -A significant, sudden decrease in serum Na+ levels will result in a sudden decrease in serum osmolality. This, in turn, will lead to a shift of fluid into the intracellular space. -When there is a significant decrease in serum Na over a short period of time, this can result in cerebral edema and increased ICP. Classic signs of hemolytic uremic syndrome (HUS) include: A. Chronic kidney disease, oliguria, and pernicious anemia B. Chronic kidney disease, leukopenia, and hemolytic anemia C. Thrombocytopenia, hemolytic anemia, and acute kidney injury D. Acute kidney injury, positive Coombs test, and anemia Correct Answer C. Thrombocytopenia, hemolytic anemia, and acute kidney injury. The priority intervention for symptomatic hyperkalemia is: A. Initiation of CVVH B. Administration of 20 mL/kg fluid bolus C. Administration of sodium polystyrene 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 Twenty minutes after initiation of a PRBC transfusion, your patient develops a fever; becomes hypotensive, anxious, and dyspneic; and begins to shake uncontrollably. You suspect which of the following is occurring? A. Citrate toxicity B. Acute hemolytic transfusion reaction C. Acute nonhemolytic transfusion reaction D. Transfusion-related acute lung injury (TRALI) Correct Answer B. Acute hemolytic transfusion reaction -The purpose of hydration is to maximize renal excretion of potassium, phosphate, and uric acid. -It would be contraindicated to administer potassium or phosphate to this patient. -An additional goal is to decrease the uric acid level, not increase production. A toddler was extubated 2 days ago after 10 days of mechanical ventilation for viral bronchiolitis. With your initial assessment, you note bleeding from the patient's nares and two large bruises on the chest, with petechiae on all extremities. Lab results demonstrate a normal PT/PTT and D-dimer, but the platelet count is significantly decreased. What do you suspect? A. Disseminated intravascular coagulopathy B. Thrombotic thrombocytopenic purpura C. Idiopathic thrombocytopenic purpura D. Hemolytic uremic syndrome Correct Answer C. Idiopathic thrombocytopenic purpura -ITP is an immune-mediated decrease in platelet count. -It often occurs following a viral infection. -Diagnostic studies will reveal a low platelet count, but normal PT/PTT and D-dimer. 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. Frequent pupillary assessment B. Incentive spirometry C. Long-bone casting D. Leg-length monitoring Correct Answer B. Incentive spirometry -Patients with unstable pelvic fractures are likely to need prolonged bedrest and are at risk for atelectasis; thus, meticulous pulmonary toilet is important, which includes incentive spirometry. -Other nursing interventions include neurovascular monitoring of the distal extremities and measures to prevent skin breakdown. What is the priority intervention for compartment syndrome? A. Neurovascular monitoring B. Elevating the extremity C. Fasciotomy D. Pain management Correct Answer C. Fasciotomy -The priority intervention to relieve the effects of compartment syndrome and prevent further damage is a fasciotomy. -It is important to continue neurovascular monitoring and ensure the child receives adequate pain management. The nurse should be concerned for which electrolyte imbalance after a fasciotomy is performed to manage compartment syndrome? A. Hyperkalemia B. Hypernatremia C. Hypophosphatemia D. Hypercalcemia Correct Answer A. Hyperkalemia -The child who requires a fasciotomy for compartment syndrome is at risk for rhabdomyolysis after the damaged skeletal muscle cells release myoglobin, potassium, phosphate, and lactate into the circulation. -The result is hyperkalemia, hypocalcemia, hyperphosphatemia, and acidosis. Which is a risk factor for the development of a pressure injury? A. Adequate nutrition B. Hyperperfusion C. Immobility D. Dry skin Correct Answer C. Immobility -Immobility puts a patient at risk for the development of a pressure injury. -Other risk factors include poor nutrition, moisture problems, and shearing forces. A critically ill patient is hypotensive with pale, mottled, and cool extremities. The nurse should be concerned for: A. Skin failure B. Bacterial colonization C. Over hydration D. Dehydration Correct Answer A. Skin failure -Skin failure can occur when blood is shunted away from the skin to other vital organs in a critically ill patient. -It is also associated with impaired temperature control and metabolic conditions. -Skin failure and the injuries it causes may not be preventable. Pressure injuries may be prevented by ensuring the patient has: A. Appropriate antibiotics B. Adequate hemoglobin C. Frequent repositioning D. A wound care consult Correct Answer C. Frequent repositioning -Frequent repositioning of the patient helps relieve pressure to bony prominences. -Other strategies to prevent pressure injuries include performing a thorough skin assessment on admission and every shift, ensuring adequate nutrition, and keeping the skin clean and dry. You are caring for a patient in hypovolemic shock. You would expect which of the following hemodynamic findings? A. Decreased HR B. Increased pulmonary occlusion pressure C. Decreased mean arterial pressure D. Increased systemic vascular resistance Correct Answer D. Increased systemic vascular resistance -Children in hypovolemic shock will initially respond with an increase in systemic vascular resistance (eg, cool extremities, vasoconstriction, etc.). -A decreased HR and decreased mean arterial pressure would be seen as no longer being able to compensate You are caring for a patient with septic shock. The patient is intubated and mechanically ventilated with normal ABG results. The patient has received a total of 20 mL/kg of isotonic fluids for persistent hypotension without improvement and remains febrile, with a temperature of 40.3°C rectally. You anticipate the next intervention will be: -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 B. Adequate adult supervision C. The winter season D. Overestimating swimming ability Correct Answer D. Overestimating swimming ability -There is an increased risk for drowning when the swimmer overestimates his or her swimming skills and abilities. -The risk is decreased with adequate adult supervision. -Swimming lessons may improve skills, but do not replace supervision. A 5-month-old arrives unconscious with a history of falling from a changing table. Head CT reveals a subdural hematoma. Which additional assessment finding is concerning for abusive head trauma? A. Forehead bruising -As you review the choices, A and B don't make sense physiologically; decreasing stroke volume will decrease, not increase blood pressure so you should be able to eliminate those quickly. -Now consider the role of the sympathetic nervous system ("fight or flight"). -Increasing stroke volume and HR would happen when the sympathetic nervous system is activated. A slowing down of the conduction system would not. Which of these will likely decrease myocardial oxygen demand? A. Pain control B. Arrhythmias C. Exercise D. Fever Correct Answer A. Pain control Of the items listed, only improving pain control will decrease a patient's myocardial oxygen demand. Things like arrhythmias, 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. 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 B. After large ventricular septal defect (VSD) repair C. With indomethacin therapy for patent ductus closure D. Whenever there is right to left shunting of blood Correct Answer B. After large ventricular septal defect (VSD) repair -Surgical repair for a large VSD occurs around the AV conduction system, placing the patient at risk for arrhythmias. -The risk is not as high for atrial repairs or during indomethacin therapy for closing a patent ductus arteriosus. The nurse should be concerned for postoperative bleeding when the chest tube drainage: A. Increases to 8 mL/kg in 1 hour B. Decreases and develops clots C. Risk manager D. Patient safety advocate Correct Answer A. Ethics committee -The nurse may be experiencing moral distress in this situation. Of the options listed, the ethics committee is the best resource to clarify the concept of double effect, where a legitimate act, such as relieving pain at the end of life, causes an undesired effect, such as oversedation or a slightly shortened life. -It is ethically acceptable in this situation to use higher than normal dosages of pain and anxiety relieving medications. A nurse manager feels that the number of blood culture samples reported by the laboratory as "contaminated" is excessive. The most appropriate action for the nurse manager would be to: A. Observe the staff as they obtain blood culture samples B. Track the actual blood culture contamination rate 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 adolescent is admitted after an intentional medication overdose. Although assigned female gender at birth, the patient identifies as male. How should the nurse respond? A. Refer to the patient as "her" or "she" B. Refer to the patient as "him" or "he" C. Assess the genitalia and notify the provider D. Assess the genitalia and notify the social worker Correct Answer B. Refer to the patient as "him" or "he" -Gender assignment at birth and gender identity are two different things. The nurse's best response in this scenario is to respect the patient's identity preference and use the pronouns "him" or "he." -While the provider and social worker will need information regarding the patient's preference, it is not appropriate to assess the genitalia specifically to determine gender identity in this scenario. A patient with a newly diagnosed condition is being discharged. The mother goes to the pharmacy to pick up the child's medications and returns to the unit without them after being told the insurance provider doesn't cover them. What is the nurse's best response? A. Tell the mother to follow up with the primary care provider B. Obtain today's doses of the medication and give to the mother C. Notify the social worker or case manager of the situation D. Suggest the mother return to the pharmacy and pay in cash Correct Answer C. Notify the social worker or case manager of the situation -The unit's social worker or case manager should have the expertise to ensure the patient has what is needed to manage care at home, including prescription medications. -In this scenario, the nurse's best response is to seek assistance from those who can help the family navigate the system. A child has just died. What's the nurse's best response to the parents? A." You can always have other children" B. "She's in a better place now" C. "I'm so sorry for your loss" D. "It's God's will when children die". Correct Answer C. "I'm so sorry for your loss" -The loss of a child is unimaginable for parents. -Being a quiet, supportive presence and offering a simple condolence, such as "I'm sorry," is a good initial response in this scenario. -The other options minimize the parents' emotions and do not give them a space to grieve A large pediatric/adult hospital is implementing a new continuous renal replacement therapy. Crucial considerations in the process include identifying equipment, financial resources and: A. Key stakeholders B. Staff educators C. Appropriate patients D. Attending physicians Correct Answer A. Key stakeholders -From a systems thinking perspective, key stakeholder identification is vital in the early stages of a major planned change. -Stakeholders from both pediatric and adult areas may include nurses, physicians, educators, and others who will be impacted by the change. Decision- making and planning should include everyone's input. The mother of a child experiencing delirium is worried about her child's condition. How can the nurse best support the mother? A. Give the mother written information about delirium B. Have the physician talk with the mother about delirium C. Assess the mother's understanding of delirium D. Have the mother of another delirious child speak with her Correct Answer C. Assess the mother's understanding of delirium -Parents of a delirious child may be fearful that the condition is permanent. -In this scenario, the nurse should first explore the mother's understanding of her child's condition and the expected course. -With this knowledge, the nurse can then plan appropriate interventions to support the mother. -These may include giving the mother written information or having a provider answer her additional questions.