Cystic Fibrosis Case Study
18. When should the second MMR be given to Darla? A. It should be administered as soon as possible B. The second MMR is given between 4-6 years of age C. I think the HCP will probably let you know D. It will not be given until 11-12 years of age
Answer: B
20. What laboratory result warrants immediate intervention? A. Serum potassium level of 3.7 mEq/L B. WBC is 20,000 mm3 C. Platelet count is 200,000 mm3 D. Darla has a serum chloride level of 101 mEq/L
Answer: B
23. What nursing tasks can be safely delegated to the UAP? A. Discontinue a PIV B. Empty foley bag C. Change the rate on an IV pump controller D. Complete an admission assessment
Answer: B
The HCP prescribes a sweat test to confirm Darla's diagnosis of CF 3. What information will the nurse include when teaching about the sweat test? A. Informed consent will be needed for this invasive, diagnostic test B. It will take 2 hours to obtain the sweat C. This procedure must be done twice a week for 3 weeks before confirming the diagnosis D. It is a simple, painless, reliable test that measures the chloride in sweat
Answer: D
On the day of Darla's discharge from the hospital, the nurse educator discusses routine immunizations with Pamela and Donald. 17. What is the nurse educator's responsibility when discussing immunizations? A. Explain that Darla should receive all routine childhood immunizations B. Instruct the parents to ask the pediatrician which immunizations Darla should get C. Discuss why immunizations are not given to children with chronic respiratory illnesses D. Teach Pamela and Donald that Darla's immunizations will be delayed due to the CF
Answer: A
The nurse educator refers Pamela and Donald to the local chapter of the CF Foundation (CFF). 16. What rationale best supports this referral? A. Community resources often provide support groups for parents of children with CF B. This foundation will provide health insurance for children with CF C. The CFF offers information on alternative therapy and treatment modalities D. Referrals for resources offer parents hope that a cure may one day be found
Answer: A
21. The HCP prescribes gentamicin 2.5 mg/kg Q8 hours IV to be infused over 30 minutes with a peak and a trough at the second dose for treatment of pneumonia. The pharmacy sends a 20 mL syringe containing 17 mL of medication labeled gentamicin 2 mg/mL. At what rate should the nurse set the infusion pump?
30 mL per hour (15 mL in 30 minutes)
12. Which instruction indicates to the nurse educator that the parents need more instruction about the respiratory care of the child with CF complications? A. Placing Darla in a prone position with she is having dyspneic episode B. Darla's chest percussions and postural drainage should be performed no sooner than 1 hour before meals or 1.5 hours after meals C. Encourage Darla's parents to have her participate in physical activities such as running, skipping and swimming D. Perform Darla's chest percussion and postural drainage after the administration of bronchodilators or nebulized medications as prescribed
Answer: A
22. Darla's IV antibiotic was given to another patient and she received someone else's antibiotic. Which action should the primary nurse implement first? A. Assess Darla and the child that received the wrong medication B. Administer the antibiotic to the correct clients C. Complete a medication incident report D. Notify the HCP immediately
Answer: A
10. Which statement by the nurse is correct about the secondary nursing care prevention for Darla? A. It is care such as the sweat test and DNA testing that Darla received B. It includes mainly teaching information about Darla's CF C. This is the nursing care we do when we are taking care of Darla here in the hospital D. It is care that includes giving Darla immunizations to prevent specific diseases
Answer: A
What are standards of care. 9. Which is the best explanation for the nurse to provide the student? A. Standards of care are published statements that describe the level of care that the client can expect from nurses B. Standards of care are laws mandated by the legislature of each state that ensure safe care for clients C. Standards of care are rules that help health care professionals deal with the ethical issues involved in the care of a client E. Standards of care for working with clients with CF or other diseases are outlined in the Nursing Practice Acts of each state.
Answer: A
13. What actions should the nurse educator take to address this? SATA A. Teach Darla to take a deep breath and then exhale while whispering the word "huff" B. Instruct the parents to perform chest physiotherapy (CPT) either 1 hour before meals or 2 hours after meals if possible C. Explain the importance of increasing fluid intake during acute exacerbations D. Discuss the use of short-term oral glucocorticoid steroid therapy E. Discuss the possibility of long-term oxygen administration to help with mobilizing secretions
Answer: A, B, C
11. Which statement by the parents indicates a correct understanding of a proper nutritional protocol of a client with CF? SATA. A. Darla's diet should consume more calories than an unaffected child B. Darla should use a salt substitute in place of regular table salt with her meals C. Darla should consume pancreatic enzymes one hour after consuming her meals D. Darla should take vitamin A, D, E, K supplementation along with her diet E. Her diet should consist of 3 meals/day of high fat, high protein and 2-3 snacks/day
Answer: A, D, E
The healthcare provider (HCP) reviews Darla's medical chart. 2. Which documentation further supports the diagnosis of CF? SATA. A. A history of frequent respiratory infections B. An elevated WBC C. Reports of episodic abdominal pain and crying D. A sweat chloride level of 35 mEq/L E. Reports of foul-smelling stools that have white streaks and are sticky
Answer: A, E
25. Darla's parents explain that they are looking forward to taking her to the beach this summer. How should the CF nurse educator respond? A. Wish them a happy vacation and tell them nothing special needs to be done B. Suggest that they add extra salt to Darla's diet and watch for dehydration C. Explain that the beach is not a good vacation place for Darla D. Encourage them to limit Darla's play time at the beach to 30 minutes a day
Answer: B
6. Based on her previous conversation with Pamela, what is the best response by the nurse? A. You are afraid your wife is going to leave you. Tell me more about what makes you think that B. I will sit with darla so you and your wife can talk. We have a quiet room you can use that is private and close by C. Ethically, I cannot discuss what your wife told me. Likewise, I cannot tell her what you say either D. Most parents are anxious during situations like this. Would you like me to set you up with a support group?
Answer: B
14. Which instruction should the nurse educator give Darla's parents concerning the use of pancreatic enzymes as an oral prescription? A. Administer pancreatic enzymes in the morning and at night B. Mix pancreatic enzymes with hot, starchy foods such as macaroni or pasta C. Open the capsule and mix the bead in a non protein food such as applesauce D. Ensure that Darla swallows the pancreatic enzyme capsule whole
Answer: C
15. While discussing pancreatic enzymes, te nurse educator explains that the dosage of the pancreatic enzyme is adjusted according to stool formation which indicates how well Darla is digesting her food. Which adjustment would the nurse anticipate will be required if darla has loose, fatty stools? A. The pancreatic enzymes would not be administered for 24 hours B. The amount of pancreatic enzymes would be decreased at each meal C. The pancreatic enzymes would be increased with each meal and snack D. No adjustment in the dosage would be made at this time
Answer: C
8. Which statement should the nurse record as the expected outcome for this nursing diagnosis? A. The child will maintain an O2 sat level greater than 95% B. The parents will list three symptoms that require the notification of the HCP C. The child will be able to remove mucus from the airway by coughing D. The child will rest comfortably and participate in age-appropriate activities
Answer: C
The nurse suspects that Darla may have Cystic Fibrosis (CF). Which statement by the mother supports the diagnosis of CF? A. My daughter went to bed feeling fine last night and woke up with a high fever and a sore throat B. Lately Darla's eyes appear to have a yellow discoloration C. When i kiss my daughter her skin tastes like salt D. I can hear her heart beating when I lay my head on her chest
Answer: C
19. A complication occurs, which interventions should the nurse implement first? A. Notify the CF educator to help support Darla's parents B. Administer IV ATB C. Insert a 24 gauge IV D. Administer O2 6L/min via simple face mask
Answer: D
24. Darla is in the therapy room with a play therapist and it is time for her vital signs. What action should the charge nurse take? A. Ask the play therapist to take the VS B. Interrupt the play therapist to take the VS C. Reprimand the primary nurse for delaying the VS D. Explain that play therapy is an intervention and should not be interrupted for VS
Answer: D
4. Donald and Pamela have been at Darla's bedside since she was admitted to the hospital. Donald asks to speak to the nurse outside in the hall. He tells the nurse that Pamela is telling everyone that Darla is going to be fine and that there has just been a mistake and everything will be all right as long as they pray. What action should the RN take first? A. Schedule and appointment for Pamela with the hospital's chaplain B. Suggest that donald and his wife sit down and talk about the situation C. Refer pamela to a professional counselor D. Make arrangements to meet with pamela privately at the first opportunity
Answer: D
5. What response reflects that the nurse values the principle of beneficence? A. No one ever knows when they will die. Darla could live for a long time B. This seems like an ethical dilemma to me. I'll refer it to the ethics committee. C. I think you probably should contact an attorney to discuss this if you are really serious D. Pamela, I know this has to be a very scary and difficult time for you. What can I do to help you?
Answer: D
7. Which nursing diagnosis has the highest priority? A. Anticipatory grieving related to a potentially fatal diagnosis B. Ineffective coping (family) related to chronic illness C. Risk for altered growth and development related to stress of illness and hospitalization D. Altered nutrition: less than body requirements related to poor intestinal absorption
Answer: D
