CCRN PEDS AACN
125. The most important objective in caring for the patient with epiglottitis is to A. Keep the child quiet and comfortable B. Administer racemic epinephrine C. Place the child in a supine position D. Administer antibiotics
Keep the child quiet and comfortable
51. A patient admitted with multiple trauma develops flank pain, hematuria and costovertebral-angle tenderness. The nurse would suspect the child has experienced injury to the A. Pancreas B. Kidney C. Liver D. Bladder
Kidney
58. Signs and symptoms that indicate occlusion of the blalock-Taussig shunt are decreased oxygen saturation, as well as A. Decreased capillary refill and respiratory alkalosis B. Decreased capillary refill and metabolic alkalosis C. Increased cyanosis and respiratory acidosis D. Decreased cyanosis and metabolic acidosis
Increased cyanosis and respiratory acidosis
86. A patient's family expresses anxiety regarding the meaning of numbers on the patient's monitor and asks the nurse for clarification. The nurse's most appropriate response should be A. "The numbers indicate when the patient is having problems." B. "The numbers help us determine the best treatment." C. "Which numbers on the monitor concern you?" D. "What don't you understand about the monitor?"
"Which numbers on the monitor concern you?"
A teenager post cardiac arrest has a new diagnosis of hypertrophic cardiomyopathy. The parents are concerned about what to do if their son collapses again. The nurse's best response would be A. "Now that your son has been diagnosed and treated, you need not worry." B. "Would teaching you CPR help ease your anxieties?" C. "Do you know how to access the EMS system?" D. "I will have your son's cardiologist talk to you."
"Would teaching you CPR help ease your anxieties?"
71. A patient transferring out of the ICU says, "Why can't I just stay a few days longer? I don't feel strong enough." Which of the following is the most appropriate response? A. "There's a very sick patient who needs the bed." B. "You sound concerned about leaving the ICU." C. "Most people do just fine after transfer." D. "Your insurance limits the time you can stay in the ICU."
"You sound concerned about leaving the ICU."
66. Which of the following cardiovascular complications is an expected finding during the initial stage of spinal shock following a spinal cord injury? A. Tachycardia B. Hypertension C. Hyperthermia D. Hypotension
Hypotension
81. A patient with a closed-head injury has developed SIADH. Which of the following laboratory results would this patient exhibit? Serum Na+ Serum Osmolality A. 122 262 B. 134 280 C. 144 282 D. 158 295
122 262
87. A child presents with fever, tachycardia, BP 60/42, weak pulses, warm and flushed skin. The first intervention should be A. 20 mL/kg normal saline fluid bolus B. Epinephrine infusion at 0.05 mcg/kg/min C. Oxygen via endotracheal tube D. Dopamine (Inotrope) infusion at 3 mcg/kg/min
20 mL/kg normal saline fluid bolus
114. A 3-year-old presents following ingestion of an unknown substance. Symptoms displayed include nstagmus, ataxia, seizures, respiratory depression, prolonged PT/PTT and hyponatremia. It is suspected the toddler ingested A. Carbamazepine (Tegretol) B. Phenobarbital (Luminal) C. Clonidine (Catapres) D. Theophylline (Accurbron)
Carbamazepine (Tegretol)
A 13-year-old male with diabetes is admitted after collapsing in class. On admission, he is tachycardic, has shallow respirations, dilated pupils, and is hyperreflexic. The plan of care would be to administer A. glucagon IM. B. naloxone (Narcan IV). C. 50% dextrose IV. D. regular insulin SQ.
50% dextrose IV.
127. A patient is admitted to the PICU with nausea, vomiting and diarrhea. The nurse would call the physician immediately with which of the following venous lab results? K+ Na+ Cl- A. 5.4 132 100 B. 6.5 125 95 C. 3.0 160 90 D. 3.5 145 92
6.5 125 95
74. A 2-year-old is admitted with a diagnosis of hemolytic uremic syndrome. The child presents with petechial rash, bloody stools and oliguria. In addition to an increased BUN and creatinine, expected laboratory values should be Hgb HCT Platelets K+ A. 7.1 19.5 90,000 5.5 B. 3.1 36.7 117,000 4.5 C. 7.5 19.8 200,000 5.2 D. 14.4 44.7 47,000 3.8
7.1 19.5 90,000 5.5
101. A 17-year-old patient is received from the operating room following insertion of a ventriculoperitoneal shunt. The patient is receiving propofol (Diprivan) intravenously for assistance with ventilation and reduction of oxygen consumption. The nurse recognizes that the following lab values need to be reported immediately: pH PCO2 HCO3 PO2 A. 7.2 50 30 75 B. 7.2 35 19 95 C. 7.6 45 30 95 D. 7.6 30 19 95
7.2 35 19 95
96. In a patient with herpes simplex encephalitis, anticipated findings would include normal serum glucose and which of the following CSF values? Protein Glucose A. 70 mg/dL 60 mg/dL B. 70 mg/dL 240 mg/dL C. 150 mg/dL 120 mg/dL D. 150 mg/dL 180 mg/dL
70 mg/dL 60 mg/dL
39. A 1-year-old who in ventilator dependent has been hospitalized since birth. He is now being discharged home with a tracheostomy and a gastrostomy. In order to determine the discharge needs of the patient, the should arrange for A. Home nursing care for the first few days following discharge B. A social worker to meet with the family and assess the adequacy of the home environment C. An outreach educator to determine the learning needs of the family D. A multidisciplinary care conference prior to discharge
A multidisciplinary care conference prior to discharge
78. Which of the following findings is indicative of diabetes insipidus (DI)? Serum Na+ Urine Specific Gravity A. 155 1.002 B. 140 1.005 C. 130 1.015 D. 12 1.030
A. 155 1.002
47. A 3-month-old infant has been admitted with encephalitis. The nurse should first assess the patient's A. Pupillary response B. Blood glucose level C. Level of consciousness D. Ability to maintain airway
Ability to maintain airway
37. Which of the following tests will confirm brain death in a 6-month-old? A. Absence of spontaneous breathing when PaCO2 goes above 60 mmHg B. Eyes deviate toward the right when ice water is injected into the ears C. Radionuclide scan shows cerebral arterial blood flow into the brain stem D. Low voltage amplitude observed on electroencephalogram (EEG)
Absence of spontaneous breathing when PaCO2 goes above 60 mmHg
106. A 6-year-old is admitted with a temporal lobe skull fracture. Which type of bleed is suspected? A. Chronic subdural hematoma B. Subarachnoid hematoma C. Acute subdural hematoma D. Acute epidural hematoma
Acute epidural hematoma
102. A 10-year-old is admitted after an accidental shooting to the femur and pelvis. Significant blood loss has occurred. Following adequate fluid resuscitation, perfusion remains poor, and oxygen requirements and work of breathing are increasing. The nurse should suspect A. Acute systemic inflammatory response syndrome (SIRS). B. Severe anemia related to blood loss C. Compartment syndrome D. Fat embolism syndrome
Acute systemic inflammatory response syndrome (SIRS).
68. An 8-year-old with autism is admitted with a fractured femur and possible head injury. Which of the following is important to promote adjustment to the hospital setting? A. Assign different nurses every shift B. Encourage lots of visitors C. Adhere to a home schedule D. Initiate new activities to keep occupied
Adhere to a home schedule
117. The nurse finds a 12-year-old postoperative spinal fusion patient restless and diaphoretic with HR 120, BP 110/80 and O2 Sat of 90%. Lab results reveal Hgb is 11.8 and Hemotocrit is 32.9. Primary intervention for this patient would be to A. Increase FiO2 via nasal cannula B. Obtain capillary blood gas C. Transfuse one unit of PRBCs D. Adjust the settings on the PCA pump
Adjust the settings on the PCA pump
121. A 5-year-old with a new diagnosis of status asthmaticus is admitted. Initial assessment reveals severe wheezing and use of accessory muscles. Initial management of this patient should be A. Administration of inhaled corticosteroid B. Administration of nebulized albuterol C. Intubation and mechanical ventilation D. Observation and administration of oxygen to keep O2 concentration at 90%
Administration of nebulized albuterol
38. The acute treatment of esophageal varices includes A. Placement of a large NGT to low intermittent suction B. Immediate surgical intervention C. Administration of vasopressin (Pitressin) or octreotide (Sandostatin) D. Placement of a central venous line for hyperalimentation (TPN)
Administration of vasopressin (Pitressin) or octreotide (Sandostatin)
49. A newborn is admitted with transposition of the great arteries. The SaO2 equals 46%. No murmur is heard. Until a balloon septostomy can be performed, which one of the following should be administered as a temporary measure? A. Alprostadil (PGE1) B. Tolazoline (Priscoline) C. Indomethacin (Indocin) D. Digoxin (Lanoxin)
Alprostadil (PGE1)
72. A 9-month-old born at 26-weeks has grunting, tachypnea and cool extremities. The following ABG findings are obtained on room air: pH 7.07 PO2 50 PCO2 80 HCO3 7 These blood gas results indicate A. Uncompensated respiratory acidosis B. Compensated metabolic acidosis C. Alveolar hypoventilation D. Alveolar hyperventilation
Alveolar hypoventilation
115. On the second day following tracheoosophageal fistula repair, an infant develops a temperature of 102*F (39*C), a respiratory rate of 75 and frothy chest tube drainage. The signs/symptoms indicate A. Ventilator-associated pneumonia B. Anastomosis site leakage C. Pneumothorax D. Chylothorax
Anastomosis site leakage
77. The parent of a mechanically ventilated patient is to be taught how to suction. When developing a teaching plan, the nurse must first A. Obtain written information about the procedure B. Determine a schedule for demonstrating the technique C. Assess the knowledge and skills the parent needs to learn D. Encourage the parent to observe the procedure on other patients
Assess the knowledge and skills the parent needs to learn
A survey reveals that all of a hospital's nurses feel that the routine 4 a.m. chest x-rays cause an interruption in children's sleep patterns. The best strategy for addressing this issue would be to A. Assemble a work group to discuss the current hospital policy. B. Reschedule all non-emergent 4 a.m. chest x-rays during daytime hours. C. Request an in-service for the radiology department on the effects of sleep deprivation in children. D. Send the results of the survey to the hospital administrator.
Assemble a work group to discuss the current hospital policy
7. An adolescent with asthma is readmitted just a week after discharge from the hospital. On questioning, the nurse learns that the patient refuses to use the inhalers at school. The nurse should A. Talk to the teen about long-term consequences of the disease if the treatment plan is not followed B. Talk to the school nurse to find out why they are not monitoring the medications at school C. Help the parents set up a disciplinary contract with the teen D. Arrange for the teen to attend an asthma support group
Arrange for the teen to attend an asthma support group
75. A 10-month-old is admitted to the hospital due to abdominal distention and poor weight gain. The nurse should be concerned if the infant A. Stopped an action in response to being told "no." B. Turned the head when name was called C. Cried when a nurse entered the room D. Avoided eye contact with the nurse
Avoided eye contact with the nurse
92. A 2-year-old currently being treated for acute lymphocytic leukemia (ALL) is admitted with nausea, vomiting and neutropenia. Cultures obtained from a blood sample and the Hickman catheter site insertion are positive. Vital Signs are: T 101.8*F (38.8*C) HR 92 RR 30 BP 94/60 A CBC and differential yield the following results: Hgb 8.1 g/dL HCT 29% Platelets 30,000/mL Differential: Band neutrophils 6% Segmented neutrophils 72% Lymphocytes 16% Monocytes 3% Eosinophils 2% Basophils 1% The patient's differential indicates a A. Leukemic relapse B. Viral infection C. Bacterial infection D. Normal count
Bacterial infection
88. A neutropenic patient is admitted showing signs of respiratory infection. Blood and sputum cultures are obtained. The nurse should anticipated A. Beginning antibiotics immediately B. Immediate placement in strict isolation C. No intervention until the causative organism is identified D. Transbronchial biopsy
Beginning antibiotics immediately
42. A 10-year-old is admitted for colitis. Eight hours after admission the patient develops respiratory distress, abdominal distension and capillary refill time greater than 4 seconds. The nurse should suspect A. Aspiration pneumonia B. Malabsorption syndrome C. Adhesions D. Bowel perforation
Bowel perforation
93. The pathophysiology of asthma can best be explained by A. Airway narrowing and T-lymphocyte activation B. Mast cell migration, V/Q mismatch and mucosal drying C. Bronchospasm, mucosal edema and tenacious secretions D. Cilliary paralysis and prolonged inspiratory phase
Bronchospasm, mucosal edema and tenacious secretions
104. The nurse is caring for a 14-year-old patient who is day one status post resection of a brain tumor. The nurse would report the following assessment finding immediately: A. CPP 40 B. SBP 120-130 C. ETCO2 35 D. MAP 65
CPP 40
62. In the pediatric patient with severe trauma, the progression of multiple organ dysfunction syndrome (MODS) is typically A. Respiratory failure, cardiovascular collapse, pulmonary embolism, liver failure and infection B. Circulatory collapse, renal failure, respiratory failure, GI tract and liver failure, and infection. C. Respiratory arrest, hepatic failure, renal failure, cardiac arrest and disseminated intravascular coagulation (DIC). D. Circulatory collapse, respiratory failure, GI tract and liver failure, renal failure and neurological dysfunction
Circulatory collapse, respiratory failure, GI tract and liver failure, renal failure and neurological dysfunction
45. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with A. Tachypnea B. Cyanosis C. Confusion D. Hypertension
Confusion
95. Children with acute renal failure run the risk of developing acute uremic encephalopathy. The first sign of cerebral dysfunction is often A. Confusion B. Tetany C. Asterixis D. Hemiparesis
Confusion
36. A patient with end-stage liver failure secondary to Hepatitis C virus has been declared brain dead. The parents decide to discontinue feedings and donate their daughter's organs. In response to the parents' request, the most appropriate action by the nurse would be to A. Contact the organ procurement agency B. Convene a multidisciplinary care conference C. Tell the parents that their daughter's condition precludes organ donation D. Discontinue feedings per the parents' request
Contact the organ procurement agency
69. A long-term complication for a child with bronchopulmonary dysplasia (BPD) is A. Cor-pulmonale B. Barotraumas C. Cystic fibrosis D. Cardiomyopathy
Cor-pulmonale
1. In caring for a patient with salicylate intoxication, the critical care nurse would anticipate which of the following as a primary treatment measure? A. Administration of protamine sulfate B. Administration of glucose C. Transfusion of packed RBCs D. Replacement of fluid and electrolytes
D. Replacement of fluid and electrolytes
4. Which of the following laboratory findings is indicative of the syndrome of inappropriate ADH secretion (SIADH)? A. Serum sodium = 148 mEq/L B. Decreased serum osmolality C. Blood urea nitrogen (BUN) = 28 mg/dl D. Serum potassium = 5.1 mEq/L
Decreased serum osmolality
33. Which of the following actions would be appropriate after the administration of desmopressin (DDAVP) to a patient with diabetes insipidus? A. Decreasing IV fluid rate B. Maintaining current fluid rate C. Increasing sodium intake D. Decreasing glucose intake
Decreasing IV fluid rate
41. A 4-year-old has been admitted following repair of coarctation of the aorta. The child's vital signs are: HR 80 BP 150/80 RR 20 CVP 10 The arterial blood gas results are: pH 7.32 pCO2 42 pO2 96 HCO3 23 The child is comfortable and resting quietly. The most likely cause of the hypertension is A. Expected physiologic response to an aortic incision B. Excessive volume expansion during the surgical period C. Diminished baroreflex sensitivity to changes in arterial pressure D. Inadequate pain control following a thoracotomy
Diminished baroreflex sensitivity to changes in arterial pressure
91. A 2-year-old ingested several unidentified pills. Which symptoms would indicate a tricyclic antidepressant overdose? A. Dry mouth, lethargy and hypotension B. Hypertension, agitation and nystagmus C. Slurred speech, bradycardia and ataxia D. Hypotension, bradycardia and nausea/vomiting
Dry mouth, lethargy and hypotension
94. To verify a diagnosis of DIC, a significant laboratory findings is an elevation in A. Fibrin split products B. Prothrombin C. Fibrinogen D. Platelets
Fibrin split products
34. A 15-year-old with acute myelogenous leukemia has undergone multiple rounds of chemotherapy. One night, the patient tells the nurse, "I'm tired of all the chemo and I want to stop." The nurse should A. Explain the adolescent patients cannot legally make healthcare decisions B. Encourage the patient to, "express these feelings to your parents." C. Arrange for the patient to discuss the treatment plan with the physicians D. Ask the patient, "Do you realize you could die if you stop chemotherapy?"
Encourage the patient to, "express these feelings to your parents."
97. Initially unconscious, post motor vehicle crash, a child is admitted awake and responsive. The child develops a severe localized headache and shows signs of rapid deterioration. The most likely cause would be A. Acute subdural hematoma B. Epidural hematoma C. Subacute subdural hematoma D. Cerebral contusion
Epidural hematoma
50. To promote effective grieving in a 6-year-old sibling following the death of a neonate, the nurse should A. Recommend that the sibling not attend the infant's memorial service B. Encourage the parents to minimize their expression of grief when with the sibling C. Explain to the sibling that the infant went to heaven D. Explain to the sibling that thoughts and wishes did not cause the infant's death
Explain to the sibling that thoughts and wishes did not cause the infant's death
99. The nurse is caring for a patient experiencing a fourth episode of heart failure. The patient states, "I cannot take it anymore. I wish I could end all of this." A priority when caring for this patient's response to stress is to A. Place the patient in a hospital gown or pajamas B. Explore suicidal intent with the patient C. Manage the patient in a restrictive environment for the first 48 hours D. Allow the patient to have only short periods alone in a safe environment
Explore suicidal intent with the patient
129. A 10-year-old non-English-speaking patient has arrived to the unit postoperatively. The nurse recognizes pain control will be a priority nursing intervention. The best tool for pain assessment would be A. Numeric pain scale B. Richmond agitation scale C. Visual analog scales D. FACES pain scale
FACES pain scale
3. Which ventilator parameters would be weaned first in a patient with bronchopulmonary dysplasia (BPD)? A. VT and FiO2 B. peak inspiratory pressure and IMV C. FiO2 and IMV D. FiO2 and peak inspiratory pressure
FiO2 and peak inspiratory pressure
100. A 12-year-old is admitted after being struck by a speeding car. During the initial evaluation, the nurse notes increasing respiratory distress and displacement of a segment of the chest wall inward during inspiration. The nurse should suspect A. Open pneumothorax B. Flail chest C. Traumatic asphyxia D. Cardiac tamponade
Flail chest
63. A 5-year-old has been admitted after a motor vehicle crash. The child is tachypneic, pale and hypotensive; nailbeds are dusky. Paradoxical chest movement is observed. These signs and symptoms are most indicative of a A. Compound rib fracture B. Fractured sternum C. Flail chest D. Ruptured diaphragm
Flail chest
60. Which of the following are expected findings in a child admitted in the early stage of septic shock A. Flushed skin, bounding pulses and wide pulse pressure B. Flushed skin, weak pulses and narrow pulse pressure C. Pale and mottled skin, bounding pulses and wide pulse pressure D. Pale and mottled skin, weak pulses and narrow pulse pressure
Flushed skin, bounding pulses and wide pulse pressure
119. Medical management of Phenobarbital (Luminal) overdose includes A. Forced dieresis B. Fluid restriction C. Nitroprusside (Nitropress) infusion D. Naloxone (Narcan) administration
Forced dieresis
43. A hospital's current policy states that medication drips should be changed within 24 hours after surgery. Nurses note that many postoperative cardiac patients develop blood pressure instability after inotrope syringes are changed. The best approach to solving this problem is to A. Notify the physician of a patient's blood pressure instability B. Disregard the policy and wait for the syringes to empty C. Form a committee to examine the problem and look for solutions D. Give a bolus of inotrope immediately prior to changing a drip
Form a committee to examine the problem and look for solutions
128. A 6-month-old cries with diaper changes and does not interact with the mother or staff. The infant appears thin for height and has bruises on the lower arms. X-ray reveals a tibial fracture. The nurse suspects maltreatment. The most important portion of the workup and documentation would be the A. CT scan B. History given by the mother C. Growth chart from previous visits D. Complete blood count
History given by the mother
61. In the patient with distributive shock and low systemic vascular resistance (SVR), the nurse would expect which early physical findings? A. Decreased urine output, hypotension, decreased level of consciousness and prolonged capillary refill B. Hypotension, hyperthermia, respiratory distress, and hypoxemia C. Hyperthermia, warm, pink flushed extremities, capillary refill time less than 2 seconds and hypotension D. Brisk capillary refill, increased urine output, hypoxemia and hyperthermia
Hyperthermia, warm, pink flushed extremities, capillary refill time less than 2 seconds and hypotension
103. While performing an exchange transfusion for a sickle cell patient, which of the following electrolyte abnormalities should the nurse anticipate? A. Hypocalcemia B. Hypercalcemia C. Hypoglycemia D. Hyperglycemia
Hypocalcemia
108. A 4-year-old with sickle cell disease is admitted with confusion, aphasia and complaints of "head hurting." An order for IVF and one unit of PRBCs is to be administered prior to MRI with contrast. The nurse explains to the mother that this is done because can A. Cause cerebral hemorrhage B. Increase sickling of hemoglobin C. Cause severe allergic reaction D. Decrease circulation to the brain
Increase sickling of hemoglobin
84. A child being treated for diabetic ketoacidosis (DKA) becomes lethargic, is difficult to arouse and has vomited twice in the past hour. These occurrences could be interpreted as indications of A. Exhaustion due to lack of sleep B. The development of hypoglycemia C. Decreased intestinal motility D. Increased ICP
Increased ICP
80. In patients with dilated cardiomyopathy, which of the following intracardiac pressure changes would be seen? Left Atrial Pressure Right Atrial Pressure A. Increased Increased B. Decreased Decreased C. Decreased Increased D. Increased Decreased
Increased Increased
98. A child is diagnosed with Guillain-Barre syndrome. It would be imperative for the nurse to inform the physician after observing which of the following? A. Increasing hoarseness B. Tingling in the hands C. Weak muscle tone in feet D. Weak muscle tone in legs
Increasing hoarseness
11. A 2-month-old with a history of unrepaired Tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. Nursing interventions are aimed at A. Increasing pulmonary flow and relaxing the infundibulum. B. Decreasing systemic flow and increasing pulmonary vascular resistance. C. Decreasing pulmonary flow and increasing systemic vascular resistance (SVR). D. Increasing systemic flow and relaxing the left ventricular outflow tract.
Increasing pulmonary flow and relaxing the infundibulum.
54. Medications used in the medical management of a closure of a PDA include A. Prostaglandin (PGE1) B. Digoxin (Lanoxin) C. Indomethacin (Indocin) D. Lasix (Furosemide)
Indomethacin (Indocin)
44. An acutely ill infant is born to a Vietnamese family. The father asks few questions about the infant's condition and the mother asks none. Both parents appear to be proficient in English. Which of the following would be the most useful resource for a nurse caring for this patient? A. Classes conducted by the primary nurse as the need arises B. An interpreter proficient in the parents' language C. Information about Vietnamese culture D. Ongoing classes addressing the cultural needs of the local community
Information about Vietnamese culture
57. A 2-month-old is admitted to the PICU status post surgical repair of a malrotation. Twenty-four hours later the patient has absent bowel sounds and increased drainage from the nasogastric tube. The most likely cause is A. Intestinal ileus B. Recurrent malrotation C. Postoperative infection D. Small bowel obstruction
Intestinal ileus
5. A 3-year-old is admitted to the ICU with a 10-hour history of an acute-onset asthma attack. Initial assessment reveals the following HR 160 pH 7.25 RR 48 pCO2 35 BP 112/76 pO2 40 T 32*C HCO3 22 A. Administration of NaHCO3 B. Fluid resuscitation C. Racemic epinephrine D. Intubation
Intubation
90. A 4-month-old born at 26-weeks is admitted with respiratory distress. The patient was discharged from the NICU with minimal O2 and an apnea monitor. Three weeks after admission the patient fails extubation for the third time, and it is determined that a tracheostomy and home ventilator will be needed. The nurse should A. Involve the discharge coordinator in obtaining home care and needed equipment B. Reassure the family that the tracheostomy can probably be removed in a year or so C. Begin tracheostomy teaching care with the mother and explain that the child will probably need a gastrostomy tube also D. Wait until after the tracheostomy is completely healed to start the process of home ventilator teaching
Involve the discharge coordinator in obtaining home care and needed equipment
55. A patient with receptive aphasia and dementia is to be enrolled in a clinical trial. How should the nurse proceed to ensure informed consent is ethically obtained? A. Involve the patient's legal guardian in the consent process B. Ensure that the investigator is aware of the patient's condition C. Inform the institutional review board (IRB) of the potential risk to the patient D. Obtain a copy of the consent form to place in the patient's chart
Involve the patient's legal guardian in the consent process
79. A 2-month-old born with spina bifida is admitted with dehydration and sepsis. Before the infant was discharged from the hospital a month ago the parents had been instructed on the proper technique and importance of performing catheterization every six hours. While interviewing the parents, the nurse learns this was not done consistently for the past two weeks. Interventions at this point should include A. Involving social services B. Notifying law enforcement C. Demonstrating catheterization technique D. Eliminating parental visitation
Involving social services
73. Which of the following conditions occurs at the renal tubular cell to initiate acute tubular necrosis? A. Azotemia B. Hyperphosphatemia C. Ischemia D. Hyperkalemia
Ischemia
116. The best medication to improve gastric motility is A. Ranitidine (Zantac) B. Famotidine (Pepcid) C. Sucralfate (Carafate) D. Metoclopramide (Reglan)
Metoclopramide (Reglan)
111. A 1-month-old is admitted with failure to thrive. The mother states that the baby has been taking Similac with iron, 4 ounces about every four hours. Bright red blood is noted in the stool. The nurse should suspect A. Parental neglect B. Vitamin K deficiency C. Milk protein allergy D. Gastritis
Milk protein allergy
6. A 2-year-old is experiencing manifestations of digoxin (Lanoxin) toxicity. BP is 94/60, capillary refill time is 2 seconds and the electrocardiogram reveals AV block with a heart rate of 60. The critical care nurse would anticipate which of the following interventions? A. Performance of cardioversion B. Administration of Atropine C. Performance of vasovagal maneuvers D. Monitoring of HR and rhythm and perfusion status
Monitoring of HR and rhythm and perfusion status
85. When planning care for an infant who presents in status epilepticus, it is important for the nurse to understand that A. Most seizures are a symptom of a problem, not a disease entity B. A focal seizure cannot progress to a generalized tonic-clonic seizure. C. Child abuse should be considered a causative factor of seizures only if no obvious signs of trauma are noted D. Prolonged seizures do not result in brain damage
Most seizures are a symptom of a problem, not a disease entity
A 4-year-old presents with a chief complaint of blood in her urine. A review of the medical records shows multiple admissions for the same symptom. No etiology has been found. The patient is symptomatic only when the mother is present. The most appropriate diagnosis for this patient would be A. Munchausen syndrome by proxy. B. non-accidental trauma. C. physical abuse D. sexual abuse.
Munchausen syndrome by proxy
For an acetaminophen level of 140 mcg/mL, the treatment choice is A. activated charcoal. B. N-acetylcysteine (Acetadote). C. deferoxamine (Desferal). D. pralidoxime chloride (Protopam).
N-acetylcysteine (Acetadote).
7. The nurse is providing patient education for a family whose child has cerebral palsy and will be receiving a Baclofen (Lioresal) pump to control spasticity. Which of the following is most important for the nurse to include in the discussion? A. The drug acts to inhibit the neurotransmitter gamma-amniobutyric acid (GABA). B. Parents can be taught to regulate the dosage based on symptoms. C. The child will have a normal gait after insertion of the pump. D. Parents must bring the child back to the clinic to have the medicine added to the pump.
Parents must bring the child back to the clinic to have the medicine added to the pump.
118. Which of the following clinical manifestations is an indication of the need for an artificial airway in a 2-year-old with laryngotracheo-bronchitis? A. Respiratory alkalosis B. Increased production of mucus C. Metabolic acidosis D. Persistent agitation/lethargy
Persistent agitation/lethargy
82. An infant with respiratory distress syndrome (RDS) requiring mechanical ventilation (PIP=34 cm water, PEEP=10 cm water) suddenly desaturates and becomes bradycardic. The most likely explanation is which of the following? A. Pneumomediastinum B. Hemothorax C. Pleural effusions D. Pneumothorax
Pneumothorax
59. The best explanation for a patient's esophageal/gastrointestinal hemorrhage is A. Gastric ulcerations B. Systemic hypertension C. Portal hypertension D. Increased ammonia levels
Portal hypertension
126. A 5-year-old with a history of frequent urinary tract infections is admitted with influenza type A sepsis. On admission blood pressure was 70/30 and capillary refill was greater than 4 seconds with weak central pulses. On day two the patient develops oliguria. BUN is 54 and creatinine is 2.1. Which type of renal failure is this patient experiencing? A. Intrarenal B. Pre-renal C. Post-renal D. Chronic renal
Pre-renal
109. Which one of the following is the first action to take in the case of a patient with a suspected tension pneumothorax? A. Administer a NaCl fluid bolus B. Assist with intubation C. Call for a chest radiograph D. Prepare for a needle thoracostomy
Prepare for a needle thoracostomy
70. Which one of the following cerebrospinal fluid results is indicative of bacterial neningitis? A. WBCs 200/mm3 B. RBCs 3/mm3 C. Protein 120 mg/dL D. Glucose 90 mg/dL
Protein 120 mg/dL
67. A major trauma patient is transported from a rural hospital. The patient died before arrival of the family to the ICU. The nurse would best prepare for the arrival of the family by planning to A. Give them information about the local bereavement support group B. Escort them to the waiting room to await the physician's arrival C. Provide them with information about the care the patient received prior to death D. Accompany them to the morgue to see the patient
Provide them with information about the care the patient received prior to death
123. A 22-month-old is admitted with meningococcemia. Which of the following is associated with this diagnosis? A. Purpura fulminans B. Gram-positive bacteria C. Hypertension D. CBC count 20,000 mm3
Purpura fulminans
64. The purpose of administering mannitol (Osmitrol) to a patient with a head injury is to A. Deplete water from the intravascular space B. Raise the patient's serum osmolality C. Decrease the patient's serum osmolality D. Increase the patient's cerebral blood flow
Raise the patient's serum osmolality
120. An adolescent with a history of admissions for chronic status asthmaticus is being prepared for discharge. The nurse determines that the patient has not been compliant with medications because doing so "makes him feel too different" from his peers. The nurse should A. Arrange for the patient's school nurse to monitor compliance B. Provide the patient with articles on the relationship of hospitalization and medication compliance C. Refer the patient to a support group for adolescents with asthma D. Advise the parents to withhold privileges if the patient remains non-compliant
Refer the patient to a support group for adolescents with asthma
40. A 10-year old patient is intubated due to a sudden deterioration in respiratory status. ABGs post intubation are as follows: pH 7.31 pCO2 50 pO2 80 HCO3 22 O2 Sat 95% The blood gases reflect A. Respiratory acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Metabolic acidosis
Respiratory acidosis
8. An unconscious 5-month-old is admitted. The parent reports the baby fell off the table during a diaper change by an older sibling. What findings would indicate further inquiry of the history? A. A reddened or bruised are on the skull B. Poorly reactive pupils C. Retinal hemorrhage D. A linear skull fracture
Retinal hemorrhage
130. A nurse notices that there seems to be an increase in medication errors when medication infusions are started. The nurse's best course of action would be to A. Ask the nurse manager to remind all staff to be careful when hanging and checking medication infusions B. Keep a list of all nurses who have made errors and give it to the nurse manager C. Review the medication error rate, then offer to help revise the unit policy for checking medication drips D. Be more careful when hanging and checking medication infusions
Review the medication error rate, then offer to help revise the unit policy for checking medication drips
3. A child admitted with a gunshot wound to the head, accidentally inflicted by an older sibling. The parents are overcome with grief and appear to be ignoring the following statements made by the older sibling: "It was an accident; I didn't mean to do it; I'm sorry!" Which of the following actions by the nurse would be most appropriate? A. Discuss the importance of gun safety with the older sibling while the parents are at the bedside. B. Seek additional support for the parents for ways they can assist the older sibling C. Tell the parents that they need to provide support for the older sibling D. Tell the older sibling, "Accidents happen; I know you didn't mean to do it."
Seek additional support for the parents for ways they can assist the older sibling
53. Prior to the administration of digoxin (Lanoxin), the nurse assesses the heart rate and rhythm, as well as the A. Serum calcium level and QRS duration B. Serum potassium level and PR interval C. Serum calcium level and QT interval D. Serum potassium level and ST segment
Serum potassium level and PR interval
110. A 3-year-old is admitted after being found in the family swimming pool. The family does not know how long he was in the pool before they found him. He is intubated on mechanical ventilation with no spontaneous respirations and does not respond to painful stimuli. The most likely reason for this is A. Temporary depletion of ATP B. Reversible failure of the sodium potassium C. Concurrent head injury when he fell into the pool D. Sever cerebral injury with neuronal death due to hypoxemia
Sever cerebral injury with neuronal death due to hypoxemia
76. Which complication is most common in infants with congenital diaphragmatic hernia? A. Alveolar-arterial ratio mismatch B. Inhibition of surfactant delivery C. Left-to-right shunting through patent ductus arteriosus D. Sever pulmonary hypertension
Sever pulmonary hypertension
124. A 7-year-old is admitted following a bike versus motor vehicle crash. The patient complains of LUQ abdominal pain. The child has positive Kehr's sign and ecchymosis in the left upper quadrant. Amylase is 60 units/L, AST is 22 units/L, and PT is 12 seconds. Injury to which of the following organs is suspected? A. Spleen B. Liver C. Pancreas D. Kidney
Spleen
48. A 15-year-old trauma patient admitted for evaluation is complaining of left upper quadrant abdominal pain radiating to the left shoulder. BP has dropped to 80/50. Which condition is indicated? A. Small bowel injury B. Cardiac contusion C. Splenic laceration D. Pulmonary embolism
Splenic laceration
105. An infant is admitted after unsuccessful reduction of an intussception. Further assessment reveals abdominal distention, fever and hypoactive bowel sounds. The nurse should immediately notify the surgeon if the patient has A. Abdominal erythema B. Hypertension C. Tachycardia D. White stools
Tachycardia
113. A 9.6 kg toddler is admitted after vomiting 250 mL of frank blood in the emergency department. The history is significant for end-stage liver failure. The assessment would be expected to reveal A. Tachycardia with bounding pulse B. Tachycardia with weak peripheral pulses C. Normal heart rate with weak pulses D. Normal heart rate with bounding pulses
Tachycardia with weak peripheral pulses
31. A 26-week-gestation infant with multiple congenital abnormalities dies shortly after admission to the NICU. The parents saw the infant briefly in the delivery room, but decline to come to the NICU. The nurse should first A. Take the infant to the parents. B. Refer the parents to a genetic counselor. C. Prepare a memory box for the parents. D. Take an instant photo of the infant to the parents.
Take an instant photo of the infant to the parents.
46. A child with myelomeningocele is started on a bowel management plan. The nurse would recognize that more education is needed when the mother states, "My child A. Tends to more prone to diarrhea B. Will be unable to control his stools C. Will require more activity to increase stools D. Needs to have a stool every day
Tends to more prone to diarrhea
122. To determine whether a child is hypocalcemic, it is important to obtain not only a total Ca++ serum level, but also an ionized Ca++ serum level, because ionized Ca++ is A. Approximately 80% of the total plasma calcium B. The biologically active form of calcium C. Not filtered into the glomerular filtrate D. Deposited in bone
The biologically active form of calcium
56. A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at 4 weeks of age is admitted. Over the last two days the child has been sleeping more, appetite has decreased and complains of a headache. This morning the child vomited twice. The nurse should anticipate A. The physician ordering lumbar puncture and blood and urine cultures B. The patient getting a CT scan followed by possible shunt revision C. Administering mannitol or hypertonic saline D. Administering a loading dose of phenytoin (Dilantin)
The patient getting a CT scan followed by possible shunt revision
83. The ECG of a child requiring VVI pacing demonstrates pacer spikes and ventricular depolarization. The patient's intrinsic rate is greater than the demand rate set on the pulse generator. This discrepancy is due to A. Understanding B. Loss of capture C. Excessive capture D. Oversensing
Understanding
89. A child weighing 15 kg is admitted with chronic renal failure. Which of the following assessment findings should be reported immediately? A. Urine output of 2-5 mL/hr B. Elevated BUN, elevated creatinine C. Hyperalbuminemia D. Headache, nausea and vomiting
Urine output of 2-5 mL/hr
112. A child has the following physical findings: decrease in tissue perfusion, lethargy, acidosis and oliguria. The patient's hemodynamic status remains unstable after three fluid boluses. The next intervention should be A. Use of inotropic agents to increase myocardial contractility B. Administration of diuretics for vascular congestion C. Use of vasodilators to decrease afterload D. Administration of NaHCO3
Use of inotropic agents to increase myocardial contractility
2. An adolescent with the developmental age of a 4-year-old requires placement of a chest tube. The best way to prepare the patient for this procedure is to A. Use short simple sentences and limit descriptions to concrete explanations. B. Show the patient a chest tube and explain how it will feel. C. Explain in detail why a chest tube is needed and how it works. D. Tell the parents what will be done so they can explain it to their child.
Use short simple sentences and limit descriptions to concrete explanations.
107. A child is admitted with a tricyclic antidepressant overdose. The most common arrhythmias seen are A. Atrial B. Sinus C. Heart blocks D. Ventricular
Ventricular
35. A 9-year-old presents with recurrent episodes of intermittent palpitations associated with weakness. Physical examination is unremarkable. An ECG reveals a heart rate of 125 beats per minute, a shortened PR interval and a slurred upstroke prior to each widened QRS complex. This slurred upstroke (Delta wave) can be explained by A. Atrial pre-excitation B. Atrial depolarization C. Ventricular repolarization D. Ventricular pre-excitation
Ventricular pre-excitation
1. A 1-month-old infant presents with poor feeding, vomiting and diarrhea since birth. The infant is lethargic and in mild respiratory distress. The mother reports having another infant with the same symptoms who died at 2 months of age. Which finding would cause the nurse to suspect an inborn error of metabolism? A. micrognathia B. microglossia C. petite facial features D. abnormal urine odor
abnormal urine odor
The initial therapy for children at risk for pulmonary embolus related to venous thromboembolism from a central venous line (CVL) is A. placement of an inferior vena cava filter. B. administration of anticoagulants. C. immediate removal of the CVL. D. thrombectomy by a surgeon.
administration of anticoagulants
21. Respiratory therapists, physical therapists, occupational therapists and nurses are all responsible for discharge teaching, with each discipline currently documenting on its own flow sheet. The best way to coordinate teaching would be to have A. daily care conferences to review and discuss patient teaching and the flow sheets. B. each discipline distribute copies of its flow sheets to each team member. C. nurses review the flow sheets of all disciplines during shift change. D. all disciplines document patient teaching on the same flow sheet.
all disciplines document patient teaching on the same flow sheet
2. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for A. heart failure. B. systemic air emboli. C. hypoxemia. D. syncope.
heart failure
9. PEEP is intended to do which of the following? A. increase functional residual capacity B. decrease functional residual capacity C. increase venous return to the heart D. increase cardiac output
increase functional residual capacity
6. A 15-year-old patient underwent a classic Fontan repair of tricuspid atresia 12 hours ago. The patient is cool, diaphoretic, restless, mottled peripherally, with no pedal pulses and faint femoral pulses. Vital signs are: HR 140 MAP 60 mm Hg CVP 20 mm Hg Cardiac Index 2.1 L/min/m2 SVR 2000 dynes/sec/cm-5 The nurse should suspect A. a pulmonary embolus. B. cardiac tamponade. C. cardiogenic shock. D. hypovolemic shock.
cardiogenic shock.
The primary objective in the treatment of an infant with persistent pulmonary hypertension is to A. maintain the pH level at less than 7.40. B. dilate the pulmonary vascular bed. C. dilate the systemic vascular bed. D. constrict the pulmonary vascular bed.
dilate the pulmonary vascular bed
An 8-month-old with bronchopulmonary dysplasia (BPD) is admitted with heart failure. Nursing interventions should be done to A. decrease preload. B. increase afterload. C. decrease heart rate. D. increase contractility.
decrease preload
65. Following bronchoscopy for removal of a foreign body, the patient becomes dyspneic, with retractions and stridor. This is most likely due to A. Hypoxia B. edema C. anxiety D. atelectasis
edema
A 4-year-old has been admitted twice in the past six months for status asthmaticus. The parents smell of smoke when they come to the hospital, but state they don't smoke in the house. The most appropriate discharge planning intervention would be to A. discuss with the parents how to avoid asthma triggers at home. B. give the parents literature about smoking cessation treatment and support groups. C. call Child Protective Services to report a medically unsafe home environment. D. remind parents they shouldn't smoke around the child.
give the parents literature about smoking cessation treatment and support groups.
5. Which of the following procedures would be most valuable in aiding management of a child requiring PEEP of 14 cm of water? A. ECMO therapy B. placement of a thoracostomy tube C. placement of a pulmonary artery catheter D. high-frequency ventilation
high-frequency ventilation
The chest x-ray of a patient with status asthmaticus will reveal A. hyperinflation. B. foreign-body aspiration. C. perihilar infiltrations. D. an elevated diaphragm
hyperinflation
A 10-day-old infant is admitted with a suspected congenital heart defect, a history of poor feeding, and sudden onset of respiratory distress and cyanosis. Initial assessment shows: HR 180 pH 7.28 RR 72 pCO2 30 BP 48/Doppler pO2 48 CRT greater than 5 sec. HCO3 16 The patient is intubated and placed on mechanical ventilation at a rate of 20; PIP/PEEP=24/4 cm water; FiO2=100%. Subsequent ABG results show: pH 7.27 pCO2 28 pO2 50 HCO3 15 The most probable etiology of the patient's cardiopulmonary status is A. Tetralogy of Fallot. B. hypoplastic left heart syndrome. C. persistent pulmonary hypertension. D. diaphragmatic hernia.
hypoplastic left heart syndrome
In an infant with bronchopulmonary dysplasia (BPD), factors that impair the release of oxygen by negatively affecting oxyhemoglobin dissociation include A. hyperthermia. B. metabolic acidosis C. respiratory acidosis D. hypothermia
hypothermia
52. Common laboratory findings associated with acute renal failure include an increase in the blood urea nitrogen (BUN) level, as well as which of the following changes in the concentrations of potassium and creatinine? Potassium Creatinine A. increased increased B. decreased increased C. increased decreased D. decreased decreased
increased increased
A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing neurological assessment is A. level of consciousness. B. papillary response. C. motor response. D. assessment of the cranial nerves.
level of consciousness
Which of the following rhythms is expected one day post cardiac catheterization for repair of an arterial septal defect (ASD)? A. premature atrial contraction B. junctional ectopic tachycardia C. sinus bradycardia D. sinus tachycardia
premature atrial contraction
8. A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration that this venture is financially worthwhile is to A. present a report summarizing research relating developmental care to decreased length of stay. B. request that the neonatologist present the plan. C. present case studies demonstrating favorable outcomes to developmental care. D. invite members of administration to attend the classes.
present a report summarizing research relating developmental care to decreased length of stay.
When inhaled nitric oxide (iNO) is administered to infants with congenital heart disease complicated by pulmonary artery hypertension, the desired result is A. smooth muscle relaxation. B. pulmonary vasoconstriction. C. pulmonary vasodilation. D. systemic vasodilation.
pulmonary vasodilation
19. A patient with hypovolemic shock is receiving fluid resuscitation. Dopamine (Intropin) is started at 3 mcg/kg/min for A. hypotension. B. decreased cardiac contractility. C. decreased heart rate. D. renal perfusion.
renal perfusion
During surgery on a 2-month-old with Tetralogy of Fallot, a trans-thoracic PA catheter was placed. Upon removal of this line, the PA pressure is 29 mm Hg systolic. As the line is 'pulled back' into the right ventricle, the pressure measures 72 mm Hg systolic. RA Sat=72, PA Sat=72. This change in measurement may indicate a/an A. right bundle branch block. B. residual VSD. C. incompetent pulmonic valve. D. residual right ventricular outflow obstruction
residual right ventricular outflow obstruction
A patient who does not speak or understand English is admitted. Guidelines for using a translator may include A. having the translator ask questions that you don't feel comfortable asking. B. standing next to the translator and as close to the patient as possible. C. providing all of the information, then allowing for translation and asking of questions. D. allowing time for the translator to decode the medical jargon used in the teaching.
standing next to the translator and as close to the patient as possible
An infant post cardiac surgery is displaying signs of hypovolemia. The nurse suspects there is an increased insensible fluid loss due to A. decreased activity. B. hypothermia. C. the radiant warmer. D. sedation.
the radiant warmer
4. Amrinone lactate (Inocor) produces which of the following effects? A. vasodilation B. phospholipid inhibition C. decreased myocardial contractility D. antagonism to other catecholamines
vasodilation
20. A patient admitted following an acute asthma attack has been given multiple albuterol (Proventil) inhalation treatments. The following measurements are obtained: BP 130/78 HR 160 RR 48 FiO2 60% (by non-rebreather mask) O2 Sat 88% Physical findings could include which of the following? A. wheezing and agitation B. coughing and grunting C. pleural rub and wheezing D. stridor and bronchospasm
wheezing and agitation