Term
The RN’s assessment findings of the 2-year-old with meningitis include an altered level of consciousness, decreased urine output, and temperature of 103.4°F (39.7°C). The LPN who works on an adult oncology unit arrives to assist in “any way possible.” Which task should the RN delegate to the LPN?
a. Notifying the health care provider
b. Checking the size of the child’s pupils
c. Administering an acetaminophen suppository
d. Removing the child’s extra blankets and clothing |
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Definition
| d. Removing the child’s extra blankets and clothing |
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Term
The child has an asthma attack and is treated with epinephrine while in the ED. Despite receiving epinephrine, the child is still agitated, sweating profusely, and has an oxygen saturation of 89% and a RR of 30 bpm. Breath sounds are diminished, and wheezing is absent. Based on this information, the nurse should anticipate interventions to treat which acid-base imbalance?
a. Respiratory acidosis
b. Respiratory alkalosis
c. Metabolic alkalosis
d. Metabolic acidosis |
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Definition
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Term
The 15-month-old toddler with acute laryngotracheobronchitis (croup) is placed in a prescribed mist oxygen tent. When assessing the toddler 2 hours later, the RN obtains an increased HR of 122 bpm and a respiratory rate of 58 breaths per minute. Which action should the nurse take next?
a. Notify the health care provider immediately of the child’s vital signs
b. Ask the PCA to obtain a blood pressure while calling the charge nurse
c. With the assistance of the PCA, remove the child from the oxygen tent
d. Ask the PCA to obtain an oximeter to check the toddler’s oxygen saturation level |
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Definition
| d. Ask the PCA to obtain an oximeter to check the toddler’s oxygen saturation level |
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Term
The client with asthma has pronounced wheezing and signs of a possible impending asthma attack. Which intervention should the nurse implement first?
a. Have the client cough and deep breathe.
b. Prepare the client for possible intubation.
c. Give an inhaled beta-2 adrenergic agonist.
d. Notify the client’s health care provider. |
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Definition
| c. Give an inhaled beta-2 adrenergic agonist. |
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Term
The client with interstitial pulmonary disease is experiencing dyspnea and fatigue. Which recommendation by the nurse will be most helpful to this client?
a. Use energy conservation measures
b. Use oxygen therapy while at home
c. Remain in an upright position
d. Use controlled coughing for airway clearance |
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Definition
| a. Use energy conservation measures |
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Term
The nurse completes an assessment for a 6-kg infant following surgery to correct a VSD. In what order should the nurse address the assessment findings? Place the assessment findings in the order of priority. 1. Hemoglobin level of 25 g/dL 2. Chest tube drainage of 15 mL/kg in one hour 3. Pulse oximeter reading of 90% 4. Urine output of 20 mL over the past 2 hours
a. 3, 1, 2, 4
b. 4, 3, 2, 1
c. 4, 3, 1, 2
d. 3, 2, 4, 1 |
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Definition
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Term
The ED nurse is assessing the pediatric client with a tentative diagnosis of acute pericarditis. Which assessment finding should the nurse conclude supports acute pericarditis?
a. Bilateral lower-extremity pain
b. Pain on expiration
c. Pleural friction rub
d. Pericardial friction rub |
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Definition
| d. Pericardial friction rub |
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Term
The nurse is reviewing orders for the 10-yearold about to undergo a cardiac catheterization in two hours. Which prescription should the nurse question with the HCP?
a. Clear liquid diet
b. Obtain CBC now
c. Obtain height and weight
d. Place IV and saline lock |
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Definition
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Term
The nurse administers a calcium channel blocker to the 10-year-old experiencing fatigue and dependent edema from HF. The child’s baseline BP is 108/65 mm Hg. Which finding best indicates that the medication has had the desired therapeutic effect?
a. The child voids 300 mL one hour after administration.
b. The child’s blood pressure decreases to 90/52 mm Hg.
c. The child is able to complete physical therapy without fatigue.
d. The child’s clubbing in the extremities begins to disappear. |
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Definition
| c. The child is able to complete physical therapy without fatigue. |
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Term
The nurse is taking the history from the parent of the infant with Hirschsprung’s disease. Which statement is the parent most likely to make?
a. “My baby has ribbonlike stools that have a foul smell.”
b. “My baby has projectile vomiting and swollen arms and legs.”
c. “My baby has gained weight faster than my other children.”
d. “My baby cries every evening and has leg and fist clenching.” |
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Definition
| a. “My baby has ribbonlike stools that have a foul smell.” |
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Term
The experienced nurse overhears a conversation between the mother of the 12-year-old newly diagnosed with Crohn’s disease and the new nurse (See exhibit). The mother has just been told by the HCP, in the presence of the new nurse, that her child does not require surgery but will need long-term therapy. Which is the most important conclusion that the experienced nurse should make about this conversation?
Questions New Nurse “The doctor was just in the room. Do you have any questions?”
Client “No. Andy will be well again in a short time. I am so thankful.”
New Nurse “You seem relieved that your son is improving. Tell me what you understand about your child’s treatment plan.”
Client “Andy’s intestines are healing just fine; I just need to take Andy for frequent checkups.”
New Nurse “Do you mean that your son doesn’t need parenteral nutrition anymore?”
Client “He doesn’t need anything. Not even surgery. This will soon be over.”
New Nurse “That’s wonderful. Your son is very lucky.”
a. The new nurse used appropriate therapeutic communication skills.
b. The new nurse acknowledged the client’s feelings and offered support.
c. The new nurse failed to address the son by name in the conversation.
d. The new nurse failed to provide the client with accurate information. |
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Definition
| d. The new nurse failed to provide the client with accurate information. |
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Term
The nurse is planning care for the 18-month-old with iron-deficiency anemia. Which intervention should the nurse implement?
a. Review the laboratory report for macrocytic RBCs.
b. Limit milk intake to no more than 1 liter per day.
c. Give prescribed iron with foods high in vitamin D.
d. Inform the HCP if stools are hard and black-colored. |
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Definition
| b. Limit milk intake to no more than 1 liter per day. |
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Term
1991. The nurse is caring for the 4-year-old hospitalized with complications from chicken pox. Which type of precautions should the nurse plan?
a. Airborne and droplet precautions with negative airflow room
b. Airborne and droplet precautions with positive airflow room
c. Contact and droplet precautions with negative airflow room
d. Standard precautions with reverse isolation and positive-airflow room |
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Definition
| a. Airborne and droplet precautions with negative airflow room |
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Term
The 8-year-old is being seen in the clinic with contact dermatitis on the legs from poison ivy. Which instructions should the nurse not include when teaching the child’s parent?
a. Apply dressings moistened with either saline or water.
b. Apply a thick paste made with baking soda and water.
c. Inspect the yard for plants with shiny, pointed oval leaflets.
d. Give OTC oral diphenhydramine to help relieve the itching. |
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Definition
| b. Apply a thick paste made with baking soda and water. |
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Term
The child with a tentative diagnosis of otitis externa (OE) is to be evaluated in the clinic. The nurse requires further instructions if they anticipate preparing the child for which procedure?.
a. A complete otoscopic examination 3
b. A culture of the external auditory canal
c. X-rays of the face, maxilla, and skull
d. Instillation of ear drops such as ciprofloxacin |
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Definition
| c. X-rays of the face, maxilla, and skull |
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Term
The nurse is administering multiple anticonvulsant medications to children. The nurse should inform the parents about ensuring that their child has good oral care to prevent gingival hyperplasia when teaching about which medication?
a. Phenytoin
b. Valproic acid
c. Carbamazepine
d. Phenobarbital sodium |
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Definition
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Term
The nurse is preparing to teach the child who has CP. What is the most important factor for the nurse to consider when teaching the child?
a. Current age
b. Type of cerebral palsy
c. Prior illness experience
d. Developmental level |
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Definition
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Term
The pregnant client tells the nurse that she smokes two packs per day (PPD) of cigarettes, has smoked in other pregnancies, and has never had any problems. What is the nurse’s best response?
a. “I’m glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking.”
b. “You need to stop smoking for the baby’s sake. You could have a spontaneous abortion with this pregnancy if you continue to smoke.”
c. “Smoking can lead to having a large baby, which can make delivery difficult. You may even need a cesarean section.”
d. “Smoking less would eliminate the risk for your baby, and you would feel |
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Definition
| a. “I’m glad that your other pregnancies went well. Smoking can cause both maternal and fetal problems, and it is best if you could quit smoking.” |
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Term
The nurse is using a picture to educate the parents of the child with a congenital murmur about the etiology of the condition. Which location should the nurse identify to the child’s parents for a murmur occurring at the tricuspid valve?
a. A
b. B
c. C
d. D |
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Definition
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Term
The nurse is caring for the pediatric client with congenital heart disease. The nurse should monitor the client for which specific complications?
a. Congestive heart failure and pulmonary hypotension
b. Congestive heart failure and hypoxemia
c. Hypoxemia and pulmonary hypotension
d. Pulmonary hypotension and cyanosis |
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Definition
| b. Congestive heart failure and hypoxemia |
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Term
The nurse is taking a history on the adolescent client who has new-onset hypertension. The nurse is aware that a history of substance abuse may contribute to this condition and questions the adolescent. Which abused substances acknowledged by the adolescent would not contribute to hypertension?
a. Amphetamines
b. Cocaine
c. Hallucinogens
d. Alcohol |
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Definition
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Term
The nurse is explaining the reason for counting the child’s grams of carbohydrate intake to the mother of the child who has type 1 DM. Which statement is most accurate?
a. “Carbohydrate counting helps to have lower blood glucose levels.”
b. “Carbohydrate counting ensures sufficient energy for growth and development.”
c. “Carbohydrate counting ensures consistent glucose levels to prevent hypoglycemia.”
d. “Carbohydrate counting helps attain metabolic control of glucose and lipid levels.” |
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Definition
| d. “Carbohydrate counting helps attain metabolic control of glucose and lipid levels.” |
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Term
The nurse is planning teaching about bacterial meningitis for a group of parents. Which statement should the nurse include when teaching the parents?
a. Symptoms of meningitis often develop over time, making it easier to diagnose than other infections.
b. Having a seizure associated with a high temperature usually indicates a problem other than meningitis.
c. High-risk children 2 to 10 years and other children 11 years and older should receive the meningococcal conjugate vaccine (MCV4).
d. Intravenous antibiotics are administered to family members who may have been in close contact with the child. |
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Definition
| c. High-risk children 2 to 10 years and other children 11 years and older should receive the meningococcal conjugate vaccine (MCV4). |
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Term
What is a major nursing care goal of muscular dystrophy for children?
a. Increasing motility
b. prevention of skin breakdown
c. addressing psychological trauma from a chronic disease
d. prevention of respiratory infections. |
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Definition
| d. prevention of respiratory infections. |
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Term
Which one of the following children is most likely to be hospitalized for treatment of croup?
a. The 2-year-old child whose croupy cough worsens at night
b. The 5-year-old child whose croupy cough worsens at night
c. The 2-year-old child using the accessory muscles to breathe
d. The 2-year-old child with inspiratory stridor when upright and supine |
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Definition
| d. The 2-year-old child with inspiratory stridor when upright and supine |
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Term
What is the fluid compartment that constitutes over half of the total body water at birth?
a. Intracellular fluid
b. Extracellular fluid
c. Cytoplasm
d. Sodium chloride |
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Definition
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Term
When observing the parent instilling prescribed ear drops prescribed twice a day for a 2-year-old, the nurse decides that the teaching about positioning of the pinna for instillation of the drops is effective when the parent pulls the toddler’s pinna in which direction?
a. up and forward
b. up and backward
c. down and forward 4
d. down and backward |
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Definition
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Term
The nurse is teaching an adolescent with asthma how to use an inhaler. In which order should the nurse instruct the client to follow the steps from first to last? All options must be used.
1. Put the inhaler in your mouth.
2. Breathe out.
3. Depress the top of the inhaler.
4. Begin to slowly breath in.
5. Hold the breath 5 to 10 seconds.
6. Shake the inhaler.
a. 6, 2, 1, 3, 4, 5
b. 3, 1, 6, 4, 2, 5
c. 6, 2 ,1 ,4 ,3 ,5
d. 6, 1, 2, 3, 4, 5 |
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Definition
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Term
A mother has heard that several children have been diagnosed with mononucleosis. She asks the nurse what precautions should be taken to prevent this from occurring in her child. The nurse should instruct the mother to:
a. take no particular precautionary measures.
b. sterilize the child’s eating utensils before they are reused.
c. wash the child’s linens separately in hot, soapy water.
d. have the child vaccinated. |
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Definition
| a. take no particular precautionary measures. |
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Term
Which of the following choices most accurately describes dehydration or fluid loss in infants and young children?
a. As a percentage
b. In milliliters per kilogram of body weight
c. By the amount of edema present
d. By the degree of skin elasticity |
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Definition
| b. In milliliters per kilogram of body weight |
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Term
After a tonsillectomy and adenoidectomy, which finding should alert the nurse to suspect early hemorrhage in a 5-year-old child?
a. drooling of bright red secretions
b. pulse rate of 95 bpm
c. vomiting of 25 mL of dark brown emesis
d. blood pressure of 95/ 56 mm Hg |
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Definition
| a. drooling of bright red secretions |
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Term
The father of a 2-year-old phones the emergency department on a Sunday evening and informs the nurse that his son put a bead in his nose. What is the most appropriate recommendation made by the nurse?
a. “Try to remove the bead at home as soon as possible; you might try using a pair of tweezers.”
b. “Be sure to take your child to the pediatrician in the morning so the pediatrician can remove the bead in the office.”
c. “You should bring your child to the emergency department tonight so the bead can be removed as soon as possible.”
d. “Ask your child to blow his nose several times; this should dislodge the bead.” |
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Definition
| c. “You should bring your child to the emergency department tonight so the bead can be removed as soon as possible.” |
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Term
A 3-year-old is brought into the emergency department in her parent’s arms. The child’s mouth is open, and she is drooling and lethargic. The parent states that the child became ill suddenly within the past 2 hours. What should the nurse do first?
a. Draw blood cultures for complete blood count.
b. Start an intravenous line.
c. Inspect the child’s throat with a tongue blade.
d. Maintain the child in an undisturbed, upright position. |
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Definition
| d. Maintain the child in an undisturbed, upright position. |
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Term
What is the most serious form of spina bifida?
a. Myelomeningocele
b. Meningocele
c. Spina bifida occulta
d. Kyphosis |
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Definition
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Term
A child has developed a urinary tract infection, and is at risk for urosepsis. What is not signs or symptoms should the nurse monitor?
a. Decreased temperature
b. Increased heart rate
c. Decreased urinary output
d. Increased respiratory rate |
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Definition
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Term
A child has tested positive for sickle cell trait. The parent is requesting information on this condition. What is the nurse’s most appropriate response?
a. “ Your child has sickle cell disease.”
b. “ Your child is a carrier of the disorder but doesn’t have sickle cell disease.”
c. “ Your child is a carrier of the disease and will pass the disease to all offspring.”
d. “ Your child doesn’t currently have the disease, but may show evidence as he gets older.” |
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Definition
| b. “ Your child is a carrier of the disorder |
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Term
The nurse is assessing a client for decerebrate posturing. The nurse should assess the client for:
a. internal rotation and adduction of arms with flexion of elbows, wrists, and fingers.
b. back hunched over and rigid flexion of all four extremities with supination of arms and plantar flexion of feet.
c. supination of arms and dorsiflexion of the feet.
d. back arched and rigid extension of all four extremities. |
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Definition
| d. back arched and rigid extension of all four extremities. |
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Term
A toddler with the smell of smoke on his clothes presented to the emergency room in an acute asthmaticus. Arterial blood gas (ABG) was drawn. The nurse would expect the results to be...
a. Respiratory alkalosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Metabolic alkalosis |
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Definition
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Term
A 3-month-old infant with meningococcal meningitis has just been admitted to the pediatric unit. Which nursing intervention has the highest priority?
a. instituting droplet precautions
b. administering acetaminophen
c. obtaining history information from the parents
d. orienting the parents to the pediatric unit |
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Definition
| a. instituting droplet precautions |
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Term
The healthcare provider (HCP) prescribes carbamazepine extended release for a client with a cerebral palsy who also has a seizure disorder. The client has a gastrostomy feeding tube, and carbamazepine is on the hospital’s “no crush” list. In order to administer the medication, the nurse should:
a. cut the medication into four pieces that can be placed in the feeding tube.
b. dissolve the medication in 30 mL of juice.
c. ask the pharmacist for an oral suspension.
d. contact the HCP to change the prescription. |
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Definition
| d. contact the HCP to change the prescription. |
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Term
The nurse is explaining the nature of the fracture to the parents of a 10-year-old who has a greenstick fracture. Which drawing should the nurse choose to explain the fracture to the parents?
A. 1st from left
B. 2nd from left
C. 3rd from left
D. 4th from left |
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Definition
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Term
While assessing a neonate at 4 hours after birth, the nurse observes an indentation with a small tuft of hair at the base of the neonate’s spine. The nurse should document this as what finding?
a. spina bifida cystica
b. spina bifida occulta
c. meningocele
d. myelomeningocele |
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Definition
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Term
A child with sickle cell crisis is being discharged. As part of discharge teaching to prevent further crisis, what should the nurse advise the parent to do?
a. Encourage the child to drink lots of liquids.
b. Take the child’s temperature every morning.
c. Weigh the child every day.
d. Offer the child a high-protein diet. |
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Definition
| a. Encourage the child to drink lots of liquids. |
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Term
The nurse is caring for a client who has been diagnosed with pernicious anemia. Which statement by the client indicates an understanding of the treatment of pernicious anemia?
a. “I will need to increase my dietary intake of foods that are high in vitamin B12.”
b. “I will receive my first injection of vitamin B12 tomorrow, and I will return for a follow-up injection in 1 month.”
c. “I understand that the oral form of vitamin B12 is preferred because it is safer and less expensive than the injection form.”
d. “I will need to take vitamin B12 replacements for the rest of my life.” |
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Definition
| d. “I will need to take vitamin B12 replacements for the rest of my life.” |
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Term
The nurse is obtaining a nursing history of a client suspected of having hepatitis C. The nurse should ask the client if the client has:
a. drunk contaminated water.
b. traveled to India.
c. had a tattoo.
d. eaten shellfish. |
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Definition
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Term
A 15 year old male present to the emergency room with ronchi in the right lower lung fields.
Height 68 inches
Weight 148 pounds
HR 112
Blood pressure 85/45 mmHg
SpO2 90% Room air
Oxygen to keep SpO2 >/= 92%
IV Access x 2
3 liters of NS @ 500 ml/hour IV
Labs: CMP, CBC, UA/Cx
WBC 27,000
Hemoglobin 11
Hemocrit 34
NA 132
Cl 99
K 3.4
Mg 1.8
Piperacillin-tazobactram (Zosyn) 3.375 gram / 50 ml NS IV q 6 hours was order over four hour.
Replace Mg if needed 2 grams/50 ml IV x 1 @ 1 gram/hour
Replace K if needed 40 mEq KCL/ 500 ml IV x 1 @ 10 mEq KCL /hour
After the boluses, if MAP< 60 mmHg, start norepinephrine quad strength 16 mg/250 ml NS IV @ 0.2 mcq/kg/min.
What was his admitting diagnosis?
a. UTI
b. Influenza
c. Pneumonia
d. Dehydration |
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Definition
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