PEDs Exam 2 (resp, immune, cardiac, neuro)
RN teaching parents of child w/ rheumatic fever. Which statement by a parents indicates an understanding of the teaching?
"my child may take aspirin for his joint pain"
child w/ bacterial endocarditis. The child is scheduled to receive moderate-term abx therapy and requires a PICC. What teaching statement should the RN make to the parent?
"the PICC line will last for several weeks w/ proper care"
RN teaching school-age child with asthma how to use a metered-dose inhaler. In which order should the Rn instruct the child to perform the steps and evaluate return demonstration?
1. shake the inhaler while holding it upright 2. position the mouthpiece in the mouth 3. slowly inhale the med 4. hold breath for 5-10sec
RN assessing a preschooler who has HIV. Which of the following manifestations should the RN expect? a. generalized petechiae b. jaundice c. obesity d. chronic diarrhea
d. chronic diarrhea Failure to thrive and weight loss are expected
RN caring for child w/ epistaxis. Which action should the RN perform? a. apply a warm cloth to the bridge of nose b. tilt head back c. apply cont pressure to the nose for at least 10 min d. admin asprin for pain
c. apply cont pressure to the nose for at least 10 min
school-aged child who had an arm cast applied 8 hr ago. Which finding should alert the RN to a complication r/t the casting? a. child report pain 5 out of 10 b. child's hands are cool bilaterally c. child reports tightness at the wrist d. child's grasp is weak
c. child reports tightness at the wrist
Rn teaching a newly hired RN about caring of an infant who's PO myelomeningocele repair. What should the RN teach to monitor for which complication? a. hydrocephalus b. congenitial hypotonia c. otitis media d. osteomyelitis
a. hydrocephalus
RN providing dietary teaching to parents of a kid w/ cystic fibrosis. Which dietary recommendation should the RN make? a. increase protein intake b. decrease calorie intake c. increase fiber intake d. decrease salt intake
a. increase protein intake these children require up to 150% of the recommended daily allowance to meet their nutritional needs
Rn assessing 12 MO male infant VS. He's in the 90th% for height. Which of the following findings should the RN report to the provider? a. HR 175/min b. RR 26/min c. BP 88/40 d. temp 37.6c (99.7f)
a. HR 175/min tachypnea for a 12 MO
RN is assessing a school-aged child after a ventriculoperitoneal (VP) shunt replacement. Which of the following findings indicates a complication of this procedure? a. abdominal distension b. unequal peripheral pulses c. pinpoint pupils d. frontal bossing
a. abdominal distension VP shunt allows excess CSF from the ventricles to drain into the peritoneal cavity and be reabsorbed. Abdom distention can indicate the presence of peritonitis due to the draining CSF or a postop ileus. Unequal peripher pluses: cardiac cath The inability of the shunt to drain due to blockage will increase ICP --> pressure on the oculomotor nerve --> dilation of pupils Frontal bossing: infants with hydrocephalus (open cranial sutures allow for excess CFS to cause head enlargement)
RN admitting a child who has a UTI and a hx of myelomeningocele. After completing the admission hx, which of the following actions should the RN plan to take? a. attach a latex allergy alert identification band b. initiate contact precautions c. post signs in the pt's bathroom to strain the urine d. administer folic acid with meals
a. attach a latex allergy alert identification band Myelomeningocele, a serious complication of spina bifida, is a neural tube defect in which the spinal cord and meninges are in a cerebrospinal fluid-filled sac at birth. Pts who have neural tube defects are at risk for latex allergy; so RN should avoid the use of common medical products containing latex (like latex gloves)
A nurse is providing teaching to the parent of a child who has cystic fibrosis and a prolapsed rectum. The RN should identify that which of the following is a cause of this complication? a. bulky stools b. weakened rectal sphincter c. elevated pancreatic enzymes d. decreased intra-abdominal pressure
a. bulky stools
RN assessing a 6 MO infant who has a cardiac cath w/ R femoral entry to dx a possible congenital heart defect. Which of the following findings should the RN report to the provider? a. cool toes on the R foot b. weak pedal pulses on both feet c. positive Babinski reflex on both feet d. Erythema on the R foot
a. cool toes on the R foot Rn should monitor the temp of the R extremity and report any indication of coolness distal to the entry sight bc can indicate an obstruction of an artery
Rn teaching parents of an infant about food allergens. Which of the following is the most common food allergy in children? a. cow's milk b. wheat bread c. corn syrup d. Eggs
a. cow's milk Some kids are sensitive to the protein casein found in cow's milk. They have difficulty metabolizing casein, are are therefore allergic
18 MO infant has pneumocystis carinii pneumonia. Results of enzyme-linked immunosorbent assay (ELISA) testing indicate that she is HIV pos. When planning care, the Rn should consider which factor? a. infant's mother is likely HIV pos b. infant's ELISA test result is prob a false pos for HIV c. antiretroviral meds are inappropriate for infants and children who have HIV d. HIV pos status is a contraindication for MMR immunizations
a. infant's mother is likely HIV pos
RN preparing to assess a 3 MO infant during a well-child visit. Which observation should the RN expect? a. looks at his hands b. has a pincer grasp c. has no head lag when pulled to a sitting position d. can independently roll from back to abdom
a. looks at his hands
RN caring for a 2 day old infant who has myelomeningocele. Which action should the RN take? a. monitor the infant's head circumference b. position the infant supine c. place the infant under a radiant warmer d. Tape a piece of plastic over the protruding membranes
a. monitor the infant's head circumference (bc this disorder has an increased risk of hydrocephalus)
RN performing a neurological exam on a 15 MO toddler. Which finding should the RN expect? a. neg babinski reflex b. presence of the moro reflex c. absence of corneal reflexes d. pos palmar grasp
a. neg babinski reflex
RN planning care for a 10 MO infant who has suspected failure to thrive (FTT). Which interventions should the RN include in the plan of care? (SATA) a. observe parent's actions when feeding the child b. maintain a detailed record of food and fluid intake c. follow the child's cues to time food and fluids d. sit beside the child's high chair for feedings e. play music videos during scheduled meal times
a. observe parent's actions when feeding the child b. maintain a detailed record of food and fluid intake
RN teaching parents of a child w/ strabismus. Which instructions should the RN include to prevent the development of amblyopia? a. patch the unaffected side b. administer mydriatic eye drops daily c. obtain prescription eyeglasses d. administer antihistamines
a. patch the unaffected side (to strengthen the weak eye muscles) amblyopia: unilateral central blindness occurs as a result of another problem such as strabismus. Strabismus: muscle weakness (lazy eye), allows the eye to wander so that the child cannot focus on an object with both eyes at the same time. This confusion can cause the brain to ignore the signals from the weak eye in favor of the strong eye --> central blindness if no tx by 6 YO. Mydriatic eyedrops: for eye exams
Rn caring for a 4 MO infant who has tetralogy of Fallot and experiences a hypercyanotic spell. Which action should the RN take? a. place infant in knee-chest postion b. begin CPR c. prepare to intubate the infant d. administer IV adenosine
a. place infant in knee-chest postion
RN providing dietary teaching to parents of a kid w/ cystic fibrosis. Which instruction should the RN include? a. provide a high-fat diet for the toddler b. limit the toddler's daily intake of Na c. increase the toddler's intake of foods high in folic acid d. allow the toddler to skip meals when he is not hungry
a. provide a high-fat diet for the toddler Kids w/ cystic fibrosis have impaired intestinal absorption of fate.
RN in a provider's office receives a phone call from the guardian of an infant who just vomited after the admin of digoxin. Which of the following actions should the nurse take first? a. tell them that a repeat dose of med should not be given b. verify the rx med regimen c. determine if the infant has been exposed to others who are ill d. ask them about the infant's UOP
a. tell them that a repeat dose of med should not be given (= greater risk for digoxin toxicity)
RN assessing an infant who develops resp distress, absence of breath sounds on one side, and deviation of the trachea away from the affected side. Based on these manifestations, which of the following conditions is the infant experiencing? a. tension pneumothorax b. flail chest c. pulmonary contusion d. fractured rib
a. tension pneumothorax (might also become cyanotic and show asymmetry of the thorax) Flail chest: pullling of the traumatized rib area inward during inspiration and outward during expiration pulmonary contusion: decreased breath sounds, tachycardia, tachypnea, blood-tinged secretions Fractured rib: pain and ecchymosis in the area of trauma, swelling, and muscle spasms
RN teaching parents of an infant about tx options for profound sensorineural hearing loss. The RN should include which of the following pieces of info about the function of cochlear implants? a. they provide direct stimulation of auditory nerve fiber b. they conduct sound waves through the mastoid bone to the cochlea c. they process digital sound to amplify several sound frequencies d. they convert vibrations in the ear's structures to electrical signals
a. they provide direct stimulation of auditory nerve fiber
RN is caring for a group of infants with congenital heart defects. For which of the following defects should the RN expect to observe cyanosis? a. transposition of the great arteries b. ventricular septal defect c. coarctation of the aorta d. patent ductus arteriosus
a. transposition of the great arteries (will have severe cyanosis bc reversal of the anatomical position of the aorta and pulmonary artery allows venous blood to enter the systemic circulation w/o oxygenation. ventricular septal defect (VSD): hole in the septal wall between the ventricles; can have increased pulmonary vascular resistance. Coarctation of aorta: constricted segment of the aorta that obstructs blood flow to the body. Left ventricle must generate higher than normal pressures for adequate stoke volume, but oxygenation of blood remains adequate for systemic circulation patent ductus arteriosus (PAD): will have blood vessels connecting the pulmonary artery to the aorta. Infant can have increased pulmonary vascular resistance
RN assessing 2 MO infant w/ ventricular septal defect (VSD). Which of the following findings should the RN report to the MD? a. weight gain of 1.8kg (4lb) b. HR 125/min c. soft, flat fontanel d. systemic murmur
a. weight gain of 1.8kg (4lb) indicated increased fluid and worsening of the child's HF. The rest is expected for a 2 MO
RN is providing teaching to the parents of an infant who has HF and a new rx for digoxin elixir. Which information should the RN include? a. withhold the med if the infant's HR is less than 110/min b. mix the med in 120 mL (4oz) of infant formula c. expect the infant to vomit frequently while taking this med d. double the dose if the infant has increased edema
a. withhold the med if the infant's HR is less than 110/min dont mix the med with any liquids, including formula. Notify MD if infant vomits frequently bc it's a manifestation of med toxicity. Dont double doses bc this could cause toxicity.
RN teaching adolescent about managing asthma and using a peak expiratory flow meter. Which of the following statements by the pt demonstrates an understanding of the teaching? a. "I will use my peak flow meter whenever I feel SOB" b. "I will continue to take my med when my peak flow rate is in the green zone" c. "I need to use the average of 3 readings when I measure my flow rate" d. "my asthma is being controlled if my flow rate is in the yellow zone"
b. "I will continue to take my med when my peak flow rate is in the green zone" should obtain 3 readings and write down the highest of the 3; rather than the average Flow rate in yellow zone indicated inadequate control of asthma
RN is assessing a preschooler who has recurrent and persistent otitis media. When obtaining the child's history from her parents, which of the following questions should the RN ask? a. "does ur child wear a har outdoors in cold weather?" b. "does anyone smoke around or in the same house as ur child?" c. "have u given ur child any aspirin recently?" d. "is ur child's diet high in gluten?"
b. "does anyone smoke around or in the same house as ur child?" Otitis media is an infection of the middle ear. Passive smoking promotes adherence of resp pathogens to the lining of the middle ear space and prolongs inflam and impedes drainage from the ear. OM is not caused by exposure to cold weather. Aspirin has some implications for Reye's syndrome if taken during a viral illness.
RN is providing teaching about immunizations to the parents of a severely immunocompromised child who has HIV. Which statement should the RN include? a. "ur child's immunizations today will be half-doses" b. "the pneumococcal and influenza vaccines are recommended for ur child" c. "immunizations will be delayed until ur child tests HIV-neg" d. "ur child will need to restart the immunization schedule once ur child's lab values are within the RR"
b. "the pneumococcal and influenza vaccines are recommended for ur child"
RN is teaching the parents of a 3 YO who has persistent otitis media about prevention. Which of the following statements by the parents indicates an understanding of the teaching? a. "my child shouldn't play around others who have ear infections" b. "we should not smoke around our child" c. "my child should not swim this summer" d. "I will encourage my child to blow his nose forcefully when he has a cold"
b. "we should not smoke around our child" Preventing exposure to tobacco smoke at home can prevent further episodes of ear infections bc it can cause inflam of the resp tract Ear infections is not contagious Kid with recurrent ear infections can skin; wearing earplugs may decrease the risk of infection
RN is providing discharge teaching to parents whose infant had a VP shunt placement for the tx of hydrocephalus. Which of the following statements by the parents indicates an understanding of the teaching? a. "we will check his abdom daily for signs of fluid accumulation" b. "we will notify the doctor right away if he has a fever" c. "we should keep a helmet on him when he's awake." d. "we can expect him to have occasional seizure episodes'
b. "we will notify the doctor right away if he has a fever" (infection risk after VP shunt insertion; esp 1-2 months after placement) - parents should report fevers, vomiting, seizure activity, and decreased responsiveness (bc indicates infection)
6YO began tx for pneumococccal pneumonia 4 days ago. Which finding indicates tx is effective? a. dullness w/ chest percussion b. HR 118/min c. conjunctival discharge d. RR 28/min
b. HR 118/min dullness w/ chest percussion = consolidation of infection
Rn is caring for a child with an exacerbation of cystic fibrosis. Which lab findings should the RN report to the provider immediately? a. blood glucose 140 mg/dL b. SpO2 85% c. RBC 3.2 million/uL d. serum Na 156 mEq/L
b. SpO2 85%
RN is caring for a child who has paralytic poliomyelitis. Which of the following actions should the RN take? a. implement droplet precautions b. administer oral analgesics prior to exercises c. use humidified O2 to thin secretions d. initiate seizure precautions
b. administer oral analgesics prior to exercises Paralytic poliomyelitis presents with pain and stiffness in the back, neck, and legs followed by signs of CNS system paralysis. ROM exercises are necessary to prevent contractures, but they can cause the child discomfort. Contact precautions- virus spread by direct contact with feces and oropharyngeal secretions Resp complications are due to paralysis of resp muscles. RN should assess for signs of weak resp effort (difficulty talking, ineffective coughing, and shallow and rapid respirations) Seizures are not an expected complication
RN is reviewing the risk factors for the development of congenital heart disease w/ a client who is planning to conceive. Which of the following conditions should the RN include as a maternal risk factor? a. preeclampsia b. alcohol consumption c. placenta previa d. late prenatal care
b. alcohol consumption
Rn is planning care for an infant who has heart failure. Which of the following interventions should the RN include in the plan to meet the nutritional needs of the infant? (SATA) a. offer the infant a feeding Q2hr b. allow 30 min to complete each feeding c. gradually increase the caloric density of the formula d. position the infant semi-upright during feedings e. provide gavage feeding if respiratory rate exceeds 80/min
b. allow 30 min to complete each feeding c. gradually increase the caloric density of the formula d. position the infant semi-upright during feedings e. provide gavage feeding if respiratory rate exceeds 80/min RR 80-100/min = tachypnea, indicator of infant stress Feedings Q3hr: allows infant to get adequate rest between feedings while keeping the volume of feeding at a tolerable level
RN is caring for a child who has been in a Buck's traction for 2 days. Which of the following actions should the RN take to prevent complications? a. manually move the weights to the floor when the child is experiencing pain b. check for pulses in the affected leg Q4hr c. cleanse the pins Q12hr d. inform parents to discourage visitors for the child
b. check for pulses in the affected leg Q4hr (traction might lead to neurovascular compromise. RN should assess for edema, pulses, pain, color, and temp Q4hr) Rn should not move or adjust the weight to ensure proper alignment and correct healing. Buck's traction is skin traction, which works w/o the use of pins
ED RN caring for 2 YO who was found by parents crying and holding a container of toilet bowl cleaner. The lips are edematous and inflamed, and he's drooling. Which is the priority RN action? a. remove the child's contaminated clothing b. check the child's resp staus c. administer an antidote to the child d. establish IV access for the child
b. check the child's resp staus
School-aged child who begins having a tonic-clonic seizure when leaving the bathroom. Which action should the RN take first? a. obtain a portable suction machine and suction tubing b. ease the child to the floor in Sims' position c. time the length of the seizure d. notify the child's parents
b. ease the child to the floor in Sims' position (and turn to L side) if greater than 5 mins: administer benzodiazepine for status epilepticus
RN developing a plan of care for a school-age child who underwent a surgical procedure that resulted in a temporary loss of vision. Which of the following interventions should the RN include? a. assign an assistive personnel to feed the child b. explain the sounds the child is hearing c. have the child use a cane when ambulating d. rotate nurses caring for the child
b. explain the sounds the child is hearing
RN caring for 3 YO w/ cyanotic cardiac defect. Child cries when parents leave room, worsening her cyanosis and dyspnea. Which position should the RN place the child to improve these manifestations? a. orthopneic b. keen-chest c. sims' d. semi-fowler's
b. knee-chest It's similar to squatting, facilitates oxygenation of the lungs. Orthopneic postions: can help pts with resp difficulties Sims': when exposure of the rectal area is required Semi-fowler's: does promote lung expansion, but the pts difficulty is cardiac in nature, not resp.
RN is planning care for a preschooler who is immediately PO VP shunt. Which intervention should the RN include in the plan? a. monitor the preschooler's pupils Q8hr b. lay the preschooler on the nonoperative side c. keep the head of the bed elevated to 30 degrees d. check bowel sounds once per day
b. lay the preschooler on the nonoperative side (to avoid putting pressure on the shunt or surgical site) monitor pupillary response Q15-30 min immediately following neurological surgery. Increased ICP can put pressure on the oculomotor nerve causing unilateral pupil dilation. Flat position: to avoid rapid draining of ICF through the shunt should check bowel sound frequently bc peritonitis or an ileus can be a PO complication
Rn teaching parents of an infant who has acute OM about how to admin abx eardrops. Which instruction should the RN include? a. chill the med prior to administration b. massage the anterior area of the infant's ear following administration c. hyperextend the infant's neck during admin d. pull the auricle up and back during med admin
b. massage the anterior area of the infant's ear following administration (to facilitate instillation of the med) Otic solution should be warm/room temp Hyperextending the neck is for nasal med <3 YO: auricle down and straight back
RN caring for an infant who is PO myelomeningocele repair. Which is the priority action the RN should take? a. measure I&O b. measure head circumference c. check lower extremity function d. monitor BP
b. measure head circumference
RN is assessing a child who has a ventricular septal defect (VAP). Which of the following findings should the RN expect? a. diastolic murmur b. murmur at the L sternal border c. cyanosis that increases with crying d. widened pulse pressure
b. murmur at the L sternal border VAP is an acyanotic heart defect. a systolic murmur can be heard best at the LL sternal border. The sound is transmitted in the direction of blood flow, so any backflow of blood from the L to the R ventricle through the septal defect is best heard in this area. diastolic murmur: atrial septal defect (ASD) cyanosis that increases w/ crying: atrioventricular canal defect widened pulse pressure: patent ductus arteriosus
A school RN is assessing a child who has been stung by a bee. The child's hand is swelling, and the RN notes that the child is allergic to insect stings. Which of the following should the RN expect if the child develops anaphylaxis (SATA)? a. bradycardia b. nausea c. hypertension d. urticaria e. stridor
b. nausea d. urticaria e. stridor Common GI response to excessive histamine release is nausea. Common skin manifestation is hives (urticaria). A serious, life-treatening response is airway narrowing (which presents as dyspnea and stridor) Histamine is a potent vasodilator = tachycardia and hypotension
RN reviewing lab reports of a 2 YO kid w/ diarrhea and has been vomiting for 24 hr. Which of the following findings should the RN report to the provider? a. Hct 40% b. potassium 2.5 mEq/L c. Serum creatinine 0.4 mg/dL d. BUN 6 mg/dL
b. potassium 2.5 mEq/L hypokalemia, which can cause arrhythmias or even cardiac arrest. All others are in the expected RR
RN assessing school-aged child who is 30 min PO following cardiac cath using the L femoral artery. Which of the following findings should the RN identify as the priority to report to the provider? a. the child rouses to verbal stimuli b. pulse strength of the child's L popliteal artery site is decreased c. RR is 20/min d. rates pain at the cath insertion site at a 7 out of 10
b. pulse strength of the child's L popliteal artery site is decreased
RN is assessing a child who is PO. Which of the following findings should the RN identify as an indication that naloxone should be administered? a. crackles in the lung bases b. respiratory depression c. nausea and vomiting d. Tachycardia
b. respiratory depression
RN caring for a 6 week old infant following a pyloromyotomy. Which forms of feedings should the RN anticipate for the infant 6 hr after the procedure? a. bottle feed w/ added protein b. small, frequent bottle feedings of electrolyte solution c. cont. nasoduodenal tube feedings d. bolus feedings via gastrostomy tube
b. small, frequent bottle feedings of electrolyte solution (or sterile water; Feedings begin 4-6hr after the surgical procedure.) small, incremental formula feedings will resume 24 hr after if small, frequent feedings of electrolyte solution are retained by the infant nasoduodenal tube feed: children who have brain injuries or are on mechanical ventilation Gtube feed: kids that can;'t have any food/fluids PO, or the passage of a tube through the esophagus is contraindicated
RN caring for adolescent following a lumbar puncture. Which action should the RN take? a. initiate NPO status b. supine postion c. place moist, warm pack on lower back d. apply a eutectic mixture of local anesthetics (EMLA) to the puncture site
b. supine position (for 30 min-1hr after to decrease the risk of post-dural puncture headache) encourage adolescent to consume fluids (promotes replacement of CSF) EMLA at least 1 hr prior to procedure.
RN assessing a child who sustained a head injury. During the assessment, RN observes clear drainage leaking from the child's nose. Which action should the RN take? a. perform nasotracheal suctioning b. test the nasal secretions for glucose c. maintain direct lighting on the child d. lower the HOB
b. test the nasal secretions for glucose (w/ reagent strip to determine if the secretions are a leakage of CSF = skull fracture) avoid nasotracheal suctioning: contraindicated bc risk of injury to the brain if skull is fractured avoid bright lights bc risk of increased ICP. (so decrease stimulation) HOB elevated and midline: to assist w/ preventing increased ICP
3 YO 1 day PO tonsillectomy. Which method should the RN determine if the child is experiencing pain? a. ask the parents b. use the FACES scale c. use the numeric rating scale d. check the child's temp
b. use the FACES scale
RN performing a physical assessment on a 6 MO infant. Which reflex should the Rn expect to find?
babinski
RN teaching guardian of 18 MO toddler about otic med admin. Which statement should the RN make. a. "admin the drops immediately after removing the med from the fridge" b. "place the child in a seated position with the head tilted to the side for admin" c. "gently pull the ear cartilage down and back when administering the med" d. "position the med bottle so the drops dont touch the side of the ear canal"
c. "gently pull the ear cartilage down and back when administering the med" Room temp/slightly warm to prevent pain and vertigo during admin Prone or supine w/ head turned to side. Should remain in this position for 2-3 min after admin Position the bottle so the drops fall against the side of the ear canal to avoid placing it onto the tympanic membrane
RN giving teaching to parents of a toddler who is undergoing insertion of tympanostomy tubes. Which statement should the RN include? a. "the MD will replace the tubes routinely about Q2years" b. "if ur child gets water in ears it will not cause further problems" c. "the tubes should stay in place until they fall out on their own" d. "Now that the tubes are in place, she should not have any further problems with hearing"
c. "the tubes should stay in place until they fall out on their own" (usually fall out within 6-12 months after insertion) Tympanostomy tubes allow drainage from and ventilation to the middle ear. most kids dont need the tubes for more than a year. Should wear earplugs whenever there's a possibility of getting contaminated or soapy water inside the ear. hearing impairment is common w/ recurrent OM and can continue after tubes are in place
RN providing teaching about disease management strategies to a 9 YO pt w/ cystic fibrosis. Which of the following statements should the RN include? a. "Thorough and effective pulmonary clearance can help prevent the need for a lung transplant when u get older" b. "u should eat these kinds of foods bc they will help u grow big and strong" c. "ur mucus is thick bc cystic fibrosis interferes w/ how ur glands work" d. "ur med follows a certain schedule to help u sleep better"
c. "ur mucus is thick bc cystic fibrosis interferes w/ how ur glands work"
Rn caring for a 4 MO child who has acute otitis media and a fever of 38.3c (101f). Which med should the RN administer? a. diphenhydramine b. Furosemide c. Amoxicillin d. ibuprofen
c. Amoxicillin should take abx to help alleviate the infection Kids <6 MO should not take ibuprofen, they should take acetaminophen.
RN is assessing a 6 MO infant following a cardiac cath. Which of the following findings should the RN report to the provider? a. temp 37.5c (99.5f) b. apical pulse rate 140/min c. BP 86/40 mmHg d. RR 32/min
c. BP 86/40 mmHg is indicative of hypotension and bleeding in a 6MO infant, should report to the provider
Rn is assessing a 6 MO infant following a cardiac cath. Which of the following findings should the RN report to the provider? a. temp 37.5c (99.5f) b. apical pulse rate 140/min c. BP 86/40 mmHg d. RR 32/min
c. BP 86/40 mmHg (hypotension and bleeding in 6MO infant) the rest is within RR
ED RN caring for a toddler who's in acute resp distress. Which of the following findings should alert the RN to the possibility of epiglottitis? a. lethargy b. spontaneous coughing c. drooling d. hoarseness
c. drooling Epiglottitis: respults in rapid swelling of the epiglottis which can obstruct breathing. Drooling is expected bc inability to swallow saliva. other s/s: restless, appears anxious. absence of spontaneous coughing bc inflam. Hoarseness: for acute spasmodic laryngitis
RN assessing preschooler w/ influenza and reports new onset of a sore throat and difficulty swallowing. Which of the following findings is the priority for the RN to report to the provider? a. temp 39c (102f) b. skin is sallow c. drooling d. hoarse voice
c. drooling (=epiglottitis, a medical emergency. Left untreated --> can develop a complete respiratory obstruction) all correct, but this is priority
RN caring for toddler w/ asthma. Parents are concerned about the toddler's rx to hospitalization. Which of the following actions should the Rn take to decrease the child's anxiety? a. provide privacy b. give the child a thorough examination before providing care c. encourage rooming-in d. tell the child you will help fix her
c. encourage rooming-in
RN reviewing the medical record of a client who has a new rx for a benzodiazepine. For which of the following findings should the RN question the provider's rx? a. skeletal muscle injury b. hx of status epilecticus c. hypotension d. insomnia
c. hypotension (can cause severe hypotension and increase the pt's risk of cardiac arrest)
RN caring for a preschooler immediately PO brainstem tumor. Which action should the RN take? a. have the child deep-breathe and cough Qhr b. offer the child clear liquids 4 hr after the procedure c. monitor the child's temp Q30 min d. place the child in Trendelenburg position
c. monitor the child's temp Q30 min (Q15-30 min bc surgery on brainstem can cause hyperthermia) avoid coughing bc increases ICP NPO for at least 24 hr after. Gag and swallow reflex are depressed (aspiration risk) Trendelenburg: increases ICP and risk of PO hemorrhage
Infant w/ laryngotracheobronchitis. Which finding should u report as an indication of impending airway obstruction? a. bradycardia b. resp depression c. nasal flaring d. barking cough
c. nasal flaring
RN is providing teaching to the parents of a toddler who has bacterial conjunctivitis. Which instructions should the RN include? a. clean secretions from the infected eye by wiping from the outer canthus toward the inner canthus and upward b. keep the infected eye covered w/ warm compresses for the 1st 24-48hr c. notify provider immediately if the sclera becomes inflamed d. apply pressure to the outer canthus of the eye for 1 min after admin eyedrops
c. notify provider immediately if the sclera becomes inflamed
RN is planning care for an infant with an unrepaired myelomeningocele. Which action should the RN take? a. fasten the diaper loosely b. cleanse the meningeal sac w/ iodine daily c. palpate the abdom for bladder distension d. cover the sac w/ a dry, sterile gauze dressing
c. palpate the abdom for bladder distension (bc neurogenic bladder is a common complication of myelomeningocele) dont put diaper on until after the defect has been repaired and healed bc risk of tearing the sac. Should place padding under the infant to absorb urine and stool, w/ frequent skin care Povidone-iodine is neurotoxic Should keep the sac from drying: sterile nonadherent dressing moistened w/ NS Q2-4 hr.
Rn carring for a 18 MO infant w/ chronic otitis media. The RN should recognize that chronic otitis media will affect which of the following? a. olfaction b. visual activity c. speech patterns d. hand-eye coordination
c. speech patterns OM can result in hearing loss, which can affect speech development
RN assessing 6 MO admitted w/ acute vomiting and diarrhea. Which finding indicates the infant has moderate dehydration? a. bulging anterior fontanel b. bradycardia c. tachypnea d. polyuria
c. tachypnea and will have flat or sunken fontanel, slight tachycardia, and decreased UOP.
RN providing preop education for a 8 YO child prior to cardiac surgery. Which of the following actions should the RN take> a. provide education for the child immediately before surgery b. plan a teaching session that will last no longer than 60 min c. use a doll w/ tubes and an incision to explain the surgery d. discuss methods to cover the scar once healing has occurred.
c. use a doll w/ tubes and an incision to explain the surgery
RN is planning preop teaching for a school-age child who is scheduled for cardiac surgery. Which of the following actions should the RN plan to take when teaching the child? a. limit teaching sessions to 10 mins b. use simple, concrete terms when giving explanations c. use photographs to help explain the procedure d. conduct the teaching session 2 days before the procedure
c. use photographs to help explain the procedure
ED RN assessing infant who recently started taking digoxin to tx a supraventricular arrhythmia. Which of the following findings should the RN identify as an indication of digoxin toxicity? a. irritability b. diaphoresis c. vomitting d. tachycardis
c. vomitting
A nurse is teaching a school-age child who is to undergo a bone marrow aspiration. Which of the following statements should the RN make? a. "I will give u an abx b4 ur procedure" b. "I will place u on ur side during the procedure" c. "u might have a headache following the procedure" d. "I will place a pressure dressing over the area following the procedure"
d. "I will place a pressure dressing over the area following the procedure" (helps prevent bleeding from the site) no abx b4 bone marrow biopsy bc it might skew the results Should be in prone position bc the provider will obtain the specimen from the iliac crest Bone marrow aspiration will not affect the brain or its fluids. Lumbar puncture are likely to cause headaches
RN teaching an adolescent w/ asthma about how to use a peak expiratory flow meter (PEFM). Which response by the adolescent indicated an understanding of the teaching? a. "I will breath in through the mouthpiece, hold my breath for 5 sec, and then exhale" b. "if I get a reading in the green zone, I will tell my parents immediately so they can call the MD" c. "I will slowly exhale through the mouthpiece over a 10 sec interval" d. "I will record the highest reading of 3 attempts"
d. "I will record the highest reading of 3 attempts" instruct the pt to take a deep breath, place the lips around the mouthpiece, and then blow into the mouthpiece as hard and fast as possible. values in the green zone = 80-100% of the child personal best
RN teaching parents of a toddler who had an anaphylactic rx to PB about administering injectable epinephrine. Which instruction should the nurse include. a. "common sites for an injection of epi are the fatty tissue found in the upper arm and in the lower abdom" b. "administer epi prior to giving ur child PB products in the future" c. "no further tx is needed after injecting the epi" d. "u will need to increase the dosage as ur child gains weight"
d. "u will need to increase the dosage as ur child gains weight" (bc epi is weight based) IM injection administered into the vastus lateralis muscle of the thigh oral immunotherapy might be attempted (small amouts to increase tolerance to the food, but done under medical supervision)
RN is assessing an adolescent who is receiving fentanyl via epidural. Which of the following assessments should the RN identify as the priority? a. skin around the catheter site b. BP c. pain level d. Oxygen saturation
d. Oxygen saturation ABCs. By monitoring the SpO2 and Resp status, the RN can identify if the pt has developed opioid-induced respiratory depression
RN caring for a toddler who has OM and a temp of 39.1c(102.4f). Which action should the RN take first? a. reduce the temp of the room b. redress the child in minimal clothing c. apply cool compresses to the forehead d. administer an antipyretic to the child
d. administer an antipyretic to the child reducing temp, minimal clothing, cool compress: about 1 hr after admin of antipyretic
Which med should the nurse give to a child experiencing an acute asthma attack? a. Zafirlukast b. budesonide c. montelukast d. albuterol
d. albuterol (rescue med, rapid onset of action) Zafirlukast: leukotriene modifier; for asthma prophylaxis and maintenance therapy and to prevent exercise induced bronchospasm budesonide: glucocorticoid used for long-term control and prophylaxis of chronic asthma montelukast: most commonly rx leukotriene modifier used for prophylaxis and maintenance therapy for asthma and to prevent exercise-induced bronchospasm
RN caring for a child who has epistaxis. Which action should the RN take? a. administer aspirin b. tilt the child's head back and apply pressure c. have the child lie down and rest d. apply cont pressure to the lower part of the child's nose
d. apply cont pressure to the lower part of the child's nose with the child sitting up and breathing through mouth, RN should apply cont pressure w/ the thumb and forefinger to the soft lower area of the nose for 10 mins.
Rn caring for a 2 YO who has cystic fibrosis. The RN is planning to take the child to the playroom. Which of the following activities would be appropriate for this child? a. cutting figures from colored paper b. drawing stick figures using crayons c. riding a tricycle d. building towers with blocks
d. building towers with blocks
RN is assessing a toddler who has AIDS. Which finding is an indication of an opportunistic infection? a. koplik spots b. peripheral neuopathy c. chancre d. candidiasis
d. candidiasis Thrush is often the intial opportunistic infection in a HIV + child who is developing AIDS
child w/ autism spectrum disorder. Which action should the RN take? a. provide activities to stimulate the child's interest in the environment b. make frequent eye contact when talking to the child c. offer the child choices when scheduling planned care d. ensure that staff visits w/ child are kept short
d. ensure that staff visits w/ child are kept short (esp w/ new staff)
RN caring for a child with cystic fibrosis who has a pulmonary infection. Which of the following findings is the Rn's priority? a. blood streaking of the sputum b. dry mucous membranes c. constipation d. inability to clear secretions
d. inability to clear secretions ALL are correct tho
RN is caring for a toddler who has a fever, high-pitched cry, irritability, and vomiting. Which actions should the RN take? a. administer 81mg aspirin b. give toddler a cold bath c. place toddler in supine position d. pad the rails of the toddler's bed
d. pad the rails of the toddler's bed manifestations of bacterial meningitis--> seizure precautions toddler with fever = acetaminophen (not aspirin bc it's associated with development of Reye syndrome)
RN teaching a group of parents about otitis media. Which is a risk factor? a. summer months b. breastfeeding c. ages 7-10 YO d. passive smoking
d. passive smoking 6YO and younger. (most common during first 2-3 years of life and at 4-6 when kid starts going to school) Winter and spring months (resp infections are common during this time, and OM commonly occurs after this type of infection) bottle feeding is a risk factor
RN on a ped unit has just received reports for 4 newly admitted pts. For which of the following children should the RN plan to initiate droplet precautions? a. rocky mountain spotted fever b. roseola d. Molluscum contagiosum d. pertussis
d. pertussis whooping cough: bacterial infection that's transmitted via exposure or direct contact with the resp secretions of an infected person. manifestations include: fever, sneezing, and a severe productive cough that generally becomes worse before getting better.
RN is reviewing the morning labs of an infant who is receiving digoxin and furosemide for the tx of heart failure. Which of the following findings should the RN report to the provider? a. sodium 140 mEq/L b. calcium 10.2 mg/dL c. chloride 100 mEq/L d. potassium 3.2 mEq/L
d. potassium 3.2 mEq/L (potassium for an infant 4.1-5.3)
RN admitting a child who has a hx of tonic-clonic seizures. Which of the following items is the priority to have in the child's room? a. pulse ox b. oxygen therapy c. bag valve mask d. suction equipment
d. suction equipment
ED RN assessing school-aged child who is experiencing an acute asthma exacerbation. Which of the following findings is the priority for the RN to report to the provider? a. excessively prolonged expiration b. increased diaphoresis c. increased production of frothy sputum d. sudden decrease in wheezing
d. sudden decrease in wheezing (indicated child experiencing decreased air movement) (silent chest = ventilatory failure and imminent resp arrest)
Preschooler has impetigo. What is the parent teachings
wash child's clothes in hot water. Keep them separate from others in the household impetigo: bacterial infection of skin caused by staph or strep spread through direct contact, contagious from the time of initial appearance of lesion - when they have healed
