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Pediatric Comprehensive Exam 2 Evolve Exam Questions with
Answers
1.1. A parent whose 12-year-old child has been inhaling paint fumes asks the nurse, "Can he become addicted to paint fumes?" What is the best response for the nurse to provide? A. Any time you use an illegal substance, you are abusing drugs. B. Tell me what you think may have caused him to start inhaling paint fumes. C. Only hard drugs like cocaine and heroin can cause problems with addiction. D. Abuse of any of the inhalants can eventually lead to addiction.: D. Abuse of any of the inhalants can eventually lead to addiction. Any inhalant can become addictive. Any substance that is used to alter perception can be addictive and is not limited to the common street drugs. 2.2. A young adult female is brought to the emergency room by family mem- bers who report that she ingested a large quantity of acetaminophen (Tylenol). The nurse should prepare for which treatment to be implemented? A. Gastric lavage with normal saline. B. IV administration of Narcan. C. Syrup of ipecac per nasogastric tube. D. Acetylcysteine (Mucomyst) 140 mg/kg.: - Acetylcysteine (Mucomyst) 140 mg/kg. Mucomyst (D) is the antidote for acute acetaminophen (Tylenol) poisoning and is the treatment of choice for an overdose. (B) is used for an overdose of narcotics. (C) is used for ingestion of non-corrosive products such as iron tablets. (A) might also be implemented, depending on the amount of drugs ingested and the time elapsed since ingestion. 3.3. An 8-year-old male client with nephrotic syndrome is in remission follow- ing treatment with prednisone (Deltasone). The nurse should teach the child to check his urine for which finding? A. Ketones. B. Protein. C. White blood cells. D. Glucose.: B. Protein.
2 / 99 Children should be taught to check for protein (albumin) (B) in the urine daily, because a positive reading for protein in the urine is often the only indicator of a relapse of nephrotic syndrome. (C) is an indication of infection. (A and D) should be assessed while the child is receiving corticosteroid therapy, since corticosteroids increase blood glucose. 4.4. When making a home visit to a family with a teething 4-month-old, what information is most important for the nurse to provide the parents? A. No action is required for the common symptoms associated with teething, which include drooling, irritability, and poor sleeping. B. A slight fever is often associated with teething, but a fever lasting more than three days requires medical attention. C. Though child development is characterized by individual differences, first teeth usually erupt during the seventh month. D. Providing cooled teething toys can help decrease the discomfort associat- ed with tooth eruption.: B. A slight fever is often associated with teething, but a fever lasting more than three days requires medical attention. A slight fever that persists longer than three days is likely to be associated with a pathological process, not teething, and the parents should seek the attention of their healthcare provider if it occurs (B). (A, C, and D) provide useful information about teething, but do not have the priority of (B). 5.5. To treat cystitis, a 14-day course of treatment with cephalexin (Ceclor) is prescribed for a client residing in a long-term care facility. Which action is most important for the nurse to take prior to administering the first dose of this medication? A.Take the client's vital signs prior to the first dose and once daily for 14 days. B. Determine if the client has ever had a hypersensitivity reaction to peni- cillins. C. Review the client's fasting blood glucose levels for a hyperglycemic trend. D. Restrict the use of dairy products in the client's diet for the next 3 weeks.: B. Determine if the client has ever had a hypersensitivity reaction to penicillins. Most individuals who have an allergy to penicillins (B) are at risk of
4 / 99 8.8. A client at 13-weeks' gestation is scheduled for an amniocentesis in one week. The nurse knows that the primary reason for conducting this procedure is to obtain what information? A. Quantification of alpha-fetoprotein levels. B. Level of fetal lung maturity. C. Presence of genetic disorders. D. Determination of gestational age.: C. Presence of genetic disorders. Amniocentesis is done at 14 to 16 weeks' gestation to determine chromosomal, genetic, and metabolic disorders (C). Amniocentesis in the third trimester assesses
5 / 99 fetal lung maturity (B) by evaluating the lecithin/sphingomyelin (L/S) ratio and the presence of phosphatidylglycerol (PG). Amniocentesis is performed to quantify alpha-fetoprotein levels (A) after abnormal maternal serum alpha-fetoprotein levels (done at 15 to 18 weeks) are found. While specific levels of creatinine, bilirubin, and lipid cells are present in amniotic fluid only after 35 to 36 weeks' gestation, gestational age (D) is commonly evaluated by ultrasound. 9.9. A hospitalized 5-year-old boy recovering from surgery refuses to drink fluids. Which intervention is best for the nurse to implement? A. Ask the parents to participate in encouraging the child's fluid intake. B. Offer the child a popsicle and allow him to pick the flavor he prefers. C. Tell the child he can go outside after he drinks a full glass of water. D. Make a game of seeing who can finish a glass of water first--the nurse or the child.: B. Offer the child a popsicle and allow him to pick the flavor he prefers. Fluids in popsicle form (B) are an excellent choice for a child, and small children react best when they are provided with possible choices, such as choosing a flavor. (D) is a good intervention, but (B) is better. (C) is manipulative and the nurse must be careful not to make promises that may not be possible. Although (A) may be useful, it may also be manipulative and is not as likely as (B) to obtain the ultimate goal of increasing fluids. 10.10. An overweight adolescent girl has been to the school nurse three times in the last two months complaining of vaginal and urinary tract infections. What action should the nurse take first? A. Counsel the girl regarding hygiene. B. Ask if she is going to the bathroom frequently. C. Teach the girl the importance of practicing safe sex. D. Encourage the girl to see the school counselor.: B. Ask if she is going to the bathroom frequently. All actions might be implemented, depending on further assessment findings. How- ever, based on the data presented, the nurse should ask questions directed toward symptoms of diabetes (B). Recurrent vaginal and urinary tract infections are often an early sign of IDDM. (A, C, and D) require further assessment data to support their implementation.
7 / 99 Based on these assessment findings, which food is best for the nurse to encourage the child to eat? A. A piece of bubble gum. B. Peanut butter crackers. C. A chocolate bar. D. A soft drink.: B. Peanut butter crackers. Peanut butter crackers (B) provide a complex carbohydrate, plus protein and fat. This child is exhibiting signs and symptoms of mild to moderate hypoglycemia and needs to eat about 15 grams of carbohydrates to increase the blood sugar level. Complex carbohydrates are broken down more slowly and are slower acting than simple sugars, so they prevent the blood glucose level from peaking and then dropping precipitously. (A, C, and D) contain only simple sugars. 12.12. When examining the wound of a client who had abdominal surgery yesterday, the nurse finds that the wound edges are close together, there is no sign of redness, and there is a slight amount of bright red blood oozing from the incision. What action should the nurse take? A. Observe closely for possible dehiscence. B. Increase the IV fluid rate and encourage the client to eat more ice chips. C. Notify the healthcare provider that the client's wound is producing a san- guineous drainage. D. Record these findings in the client's record.: D. Record these findings in the client's record. These are normal findings for one-day postoperative and indicate that the wound is healing by primary intention (D). Dehiscence (A) is separation of a surgical incision, and there is no indication that this is a possibility at this time. Serosanguineous drainage is thin and red and is composed of serum and blood, and this client is not exhibiting this finding, and even if the wound was producing this drainage, the finding does not warrant (C). There is no indication of dehydration, so (B) is not indicated at this time. 13.13. When culturing a wound, the nurse should obtain the sample from which part of the wound? A. Any particularly painful area of the wound.
8 / 99 B. All necrotic sections of the wound. C. Areas containing purulent or pooled exudates.
10 / 99 longer maintains the delusion.
11 / 99 16.16. A newborn is brought to the admissions nursery by the nurse and the father of the baby. The baby weighs 9 pounds 3 ounces and measures 21 inches head to toe. Which description is a correct assessment of this infant? A. Above average in weight but below average in length. B. Above average in weight but average in length. C. Macrosomia with an average length. D. Above average in weight and length.: B. Above average in weight but average in length. The baby is definitely above the average weight of 7 1/2 pounds. The average newborn length ranges from 18 to 21 inches, so the baby is in the upper limit of average length (B). (A and D) are both incorrect. (C) is a term used to describe neonates of poorly controlled diabetic mothers and refers to a large body size and birth weight of 4000 g or more. Since this infant is above average in weight but is high average in length, he is most likely a normal, large infant. Determining how large the parents are provides additional worthwhile assessment data. 17.17. A client has a precipitous delivery attended only by the nurse. What nursing intervention has the highest priority? A. Massage the uterine fundus until it is firm. B. Assess for signs of placental detachment. C. Clamp and cut the umbilical cord. D. Ensure an adequate airway in the newborn.: D. Ensure an adequate airway in the newborn. Ensuring an adequate airway in the newborn (D) is the priority. (A, B and C) can be delayed until this is accomplished. 18.18. A new mother asks the nurse why her infant son has yellow liquid coming out of his eyes. Which explanation is correct? A. Most infants have drainage from their eyes which usually resolves within 2 to 3 days of life. B. This type of question should be discussed with your pediatrician. C. Conjunctivitis neonatorum is common in newborns. D. An antibiotic ointment is placed in each newborn's eyes to prevent infec- tion.: D. An antibiotic ointment is placed in each newborn's eyes to
13 / 99 junctiva of each eye to prevent chlamydia and gonorrhea (D). (C) is not a common finding in newborns. (B) is dismissing the mother's questions and may alarm the family because the nurse appears unwilling to discuss the condition. An infant may have yellow drainage related to administration of an antibiotic ointment, but it should be resolved as soon as the infant is bathed (A). 19.19. A client with severe preeclampsia is receiving magnesium sulfate 2 grams IV hourly. The nurse assesses the client and finds: blood pressure 140/90, pulse 100, respirations 10, deep tendon reflexes 1+, and urinary output 130 mL in 4 hours. The nurse will discontinue the magnesium infusion based on which assessment finding? A. Deep tendon reflexes 1+. B. Respirations of 10. C. Urinary output of 130 mL in 4 hours. D. Blood pressure of 140/90.: B. Respirations of 10. With respirations less than 12 (B), the client is at risk for developing respiratory arrest and the magnesium sulfate should be discontinued. Other cardinal signs of magnesium toxicity include urinary output 20.20. A male client, who has a 3-year history of Type 2 diabetes that is con- trolled by diet, is being discharged postmyocardial infarction with a prescrip- tion of nitroglycerin tablets for chest pain and regular insulin for treatment of his diabetes. Following teaching, the client tells the nurse that he will make sure he keeps his nitroglycerin bottle in his pants pocket at all times, that he eats and drinks a snack before going to bed, and that he checks his blood glucose before eating in the morning. This client requires further teaching on which subject? A. Blood glucose monitoring. B. Storing nitroglycerin. C. Fluid intake. D. Diabetic diet.: B. Storing nitroglycerin. Nitroglycerin must be kept in the original dark-tinted, glass, screw-top bottle so that contact with air can be avoided, and keeping it in a pants pocket exposes it to body heat (B), which can reduce its effectiveness. The client should keep the medication in a jacket pocket, which would reduce direct body contact with the bottle. He should also check the
14 / 99 expiration date on the bottle (it is good for 3 months and tingling in the mouth indicates that the drug is fresh). Some people experience a headache when
16 / 99 C. Participates in one social or recreational activity each morning and afternoon. Participation in social/recreational activities (C) is an expected outcome of treatment
17 / 99 for a client with impaired social interaction because it indicates that the client is no longer totally immersed in obsessive thoughts and compulsive rituals. (A and B) are outcomes related to disturbed thought processes, rather than social interaction. (D) does not suggest progress since many clients have this understanding but are powerless to change their behavior.
- While conducting a routine health assessment of a woman who recently immigrated to the U.S. from China, the nurse notes that the client makes little direct eye contact, is deferential to healthcare personnel, and avoids sharing her personal thoughts and feelings. What action should the nurse take? A. Determine if there is a family history of emotional disorders. B. Refer the client to a psychiatric outpatient clinic. C. Continue the interview process and record the findings. D. Encourage the woman to attend citizenship classes.: C. Continue the inter- view process and record the findings. The nurse should accept these behaviors as culturally determined and continue with the interview (C). These behaviors are common in the Chinese culture where people are members of strong, cohesive groups that focus on the group rather than the individual. These behaviors are not related to a psychiatric disorder (A and B). Citizenship (D) is an individual choice, while cultural behaviors evolve over time. 25.25. After the sudden death of a severely injured client while in transport by helicopter, the flight nurse discovers that the oxygen tank that was attached to the oxygen supply was empty during the transport. What action should the flight nurse take? A. Replace the empty tank without reporting the situation to any members of the agency. B. Send an anonymous letter explaining the situation to the family of the client. C. Advise the flight crew of the situation, then suggest that no further discus- sion be held. D. Complete an adverse occurrence report and submit it to the nurse- manag- er.: D. Complete an adverse occurrence report and submit it to the nurse-manager. A medication error occurred, so an adverse occurrence report should be
19 / 99 26.26. A client has a living will and an advance directive specifying no intu- bation or CPR. The client's spouse and children tell the nurse privately that they want the client resuscitated, if the need arises. How should the nurse respond? A. Nurses use their best judgment based on the client's condition. B. Every effort must be made to honor the family's wishes about their loved one. C. The healthcare team must honor the written wishes of the client. D. Notify the healthcare provider of the family's wishes, so a decision can be made.: C. The healthcare team must honor the written wishes of the client. The client should be the ultimate decision-maker regarding treatment or refusal of treatment. The client's ethical right to autonomy and legal right to give informed consent for treatment are recognized in both legally created special directives and living wills. Although family members are very important in the care and support of the client, the nurse, and healthcare provider must respect the legal document that the client created to direct the course of treatment. 27.27. The charge nurse observes that a demographic screen has been left open on a hallway computer by a nurse who is responding to a call light because the unlicensed assistive personnel (UAP) is involved in a personal phone call. Which action should the charge nurse take first? A. Send a UAP into the client's room to relieve the nurse. B. Page the unit manager to address the situation. C. Instruct the UAP to end the phone call immediately. D. Close the demographic screen on the computer.: D. Close the demographic screen on the computer. The greatest priority is for the charge nurse to close the computer screen (D), because health information stored in computerized systems is considered to be Protected Health Information (PHI) under HIPAA (Health Insurance Portability and Accountability Act). (A, B, and C) may be indicated, but are of less priority than (D). 28.28. A high school senior is complaining of a persistent cough and admits to smoking 10 to 15 cigarettes daily for the past year. He is convinced that he is hopelessly addicted to tobacco since he tried unsuccessfully to quit
20 / 99 smoking last week. Which intervention is best for the nurse to implement? A. Provide the student with the latest research data describing the long-term
