Nursing 203 Exam 2

The nurse is explaining the effects of heat application for pain relief. Which effect would the nurse be likely to include?

Increased pressure on nociceptive fibers

A 9-year-old child has undergone a cardiac catheterization and is being prepared for discharge. The nurse is instructing the parents and child about postprocedure care. Which statement by the parents indicates that the teaching was successful?

"He should avoid taking a bath for about 3 days but he can shower."

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition?

"This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

The nurse is providing instructions to a mother on how to use thought stopping to help her child deal with anxiety and fear associated with frequent painful injections. Which statement indicates the mother understands the technique?

"We'll repeat 'quick stick, feel better, go home soon' several times."

The nurse is teaching an 8-year-old child and his family how to manage cancer pain using nonpharmacologic methods. Which parent statement signifies successful child teaching?

'I will begin using the technique before he experiences pain.'

The nurse is teaching the parent of a child with cystic fibrosis about nutrition requirements for the child. What should be included in this teaching? SATAAAAA

-"Give your child high-calorie foods and snacks." -"Feed your child foods that are high in protein." -"Give panreatic enzymes with meals."

A 14-year-old boy is diagnosed with Hodgkin disease. When palpating for enlarged lymph nodes, the nurse would expect to find which nodes as most commonly enlarged? Select all that apply.

-Cervical -Supraclavicular

The nurse is managing children who have chronic diseases in a neighborhood clinic. What are some examples of chronic conditions? Select all that apply.

-Diabetes mellitus -Rheumatoid arthritis -Acute asthma

The nurse is assessing a child with aplastic anemia. What would the nurse expect to assess? Select all that apply.

-Ecchymoses -Tachycardia -Guaiac-positive stool -Epistaxis

The parents bring their 4-year-old son to the emergency department. The child is receiving chemotherapy for acute lymphoblastic leukemia. The parents report that the child has become lethargic and has had significant episodes of vomiting and diarrhea. Why findings would lead the nurse to suspect the child may be experiencing tumor lysis syndrome? Select all answers that apply.

-Hyperkalemia -Hypocalcemia -Hyperuricemia

A child is diagnosed with Kawasaki disease and is in the acute phase of the disorder. What would the nurse expect the physician to prescribe? Select all that apply.

-IV Immunoglobulin -Acetaminophen -Aspirin

An infant with a high respiratory rate is NPO and is receiving IV fluids. What assessment(s) will the nurse make to assure this infant is hydrated? Select all that apply.

-Measure skin turgor -Palpate anterior fontanel -Determine urine output

The nurse is reviewing the medical record of a child with infective endocarditis. What would the nurse expect to find? Select all that apply.

-Microscopic hematuria with urinalysis -Electrocardiogram with prolonged PR interval -Petechiae on palpebral conjunctiva

The nurse is developing a plan of care for a child with thalassemia. What information would the nurse expect to include? Select all that apply.

-Packed RBC transfusions -Deferoxamine therapy

The nurse is caring for a child who is experiencing pain related to chemotherapy treatment. What is a behavioral factor that might affect the child's pain experience?

-Participation in normal routine activities

The nurse is researching behavioral-cognitive pain relief strategies to use on a 5-year-old child with unrelieved pain. Which methods might the nurse choose? Select all that apply.

-Relaxation -Distraction -Thought stopping

The nurse educator prepares to speak to a group of nursing students about direct and indirect insults to the lungs that may lead to the development of acute respiratory distress syndrome (ARDS). Which conditions will the nurse include in the teaching session? Select all that apply.

-Sepsis -Viral Pneumonia -Drug Overdose -Near Drowning in Saltwater

The nurse caring for infants in the neonatal intensive care unit (NICU) relies on the use of behavioral and physiologic indicators for determining pain. Which examples are behavioral indicators? Select all that apply.

-The infant grimaces -The infant flails his arm and legs -The infant is crying uncontrollably

The nurse is teaching the parents of a child diagnosed with iron-deficiency anemia about ways to increase their child's intake of iron. The parents demonstrate understanding of the teaching when they identify which foods as good choices for the child? Select all that apply.

-Tuna -Salmon -Tofu -Dried fruits

The nurse is teaching the student nurse the physiology involved in pain transmission. Which statements accurately describes a physiologic event in the nervous system related to pain transmission? Select all that apply.

-When nociceptors are activated by noxious stimuli, the stimuli are converted to electrical impulses that are relayed to the spinal cord and brain. -Myelinated A-delta fibers are large fibers that conduct the impulse at very rapid rates; unmyelinated small C fibers transmit the impulse slowly. -Once in the dorsal horn of the spinal cord, the nerve fibers divide and then cross to the opposite side and rise upward to the thalamus. -Peripheral sensitization allows the nerve fibers to react to a stimulus that is of lower intensity than would be needed to cause pain.

The nurse is preparing a room for a child being transferred out of the intensive care unit. The child has a tracheostomy. What item(s) are essential for the nurse to have available at the bedside in case of emergency? Select all that apply.

-new tracheostomy tube of the same size -A new tracheostomy tube of a smaller size -A bag valve mask

The nurse is developing a plan of care for an infant with heart failure who is receiving digoxin. The nurse would hold the dose of digoxin and notify the physician if the infant's apical pulse rate was:

80 beats per minute

For which child would nonopioid analgesics be recommended?

A child with juvenile arthritis

The nurse is administering digoxin as ordered and the child vomits the dose. What should the nurse do next?

Administer next dose as ordered in 12 hours

The nurse is administering pain medication for a child with continuous pain from internal injuries. Which method would be ordered to dispense the medication?

Administer the medication around the clock at timed intervals.

After teaching a class about the hemodynamic characteristics of congenital heart disease, the instructor determines that the teaching has been successful when the class identifies which defect as an example of a disorder involving increased pulmonary blood flow?

Atrial septal defect

The nurse is reviewing the laboratory test results of a child diagnosed with disseminated intravascular coagulation (DIC). What would the nurse interpret as indicative of this disorder?

C. Positive fibrin split products

Prior to administering morphine to a 10-year-old child, the nurse reviews the adverse effects of the drug. Which system is primarily affected by the drug, causing most of the adverse effects?

Central Nervous System

A group of nursing students are reviewing information about the variations in respiratory anatomy and physiology in children in comparison to adults. The students demonstrate understanding of the information when they identify which of the following?

Children develop hypoxemia more rapidly than adults do

A child with a pneumothorax has a chest tube attached to a water seal system. When assessing the child, the nurse notices that the chest tube has become disconnected from the

Clamp the chest tube

The student nurse is learning about the effects of heat and cold when used in a pain management plan. What accurately describes one of these effects?

Cold alters capillary permeability

The nurse tells a joke to a 12-year-old to distract him from a painful procedure. What pain management technique is the nurse using?

Distraction

A patient undergoing inhaled ipratropium (Atrovent) therapy visits the clinic for a follow-up. Which complaint does the nurse anticipate from the patient?

Dry Mouth

Which clinical manifestation does the nurse correctly attribute to hypoxia in a client with acute respiratory distress syndrome (ARDS)?

Dyspnea

Which test result would the nurse least likely expect to find in a child diagnosed with Wilms tumor?

Elevated homovanillic acid with 24 hour urine collection

The nurse is assessing a child with suspected thalassemia. What would the nurse expect to assess?

Frontal bossing

Auscultation of a child's heart reveals a loud murmur with a precordial thrill. The nurse documents this as which grade?

Grade IV

The nurse is caring for an infant with suspected patent ductus arteriosus. Which assessment finding would the nurse identify as helping to confirm this suspicion?

Harsh, continuous, machine like murmur under the left clavicle

Tonsillectomy may be indicated in all scenarios except:

History of one case of pharyngitis last year

The nurse is conducting a physical examination of a child with a ventricular septal defect. Which finding would the nurse expect to assess?

Holosystolic harsh murmur along the left sternal border

The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?

Impaired skin integrity, related to desquamation from cellular destruction

A newborn is diagnosed with patent ductus arteriosus. The nurse anticipates that the physician will most likely order which medication?

Indomethacin

The nurse is caring for a child who has been admitted for a sickle cell crisis. What would the nurse do first to provide adequate pain management?

Initiate pain assessment with a standaridized pain scale

The nurse is discussing discharge instructions with the parents of a 6-year-old who had a tonsillectomy. What is the most important thing to stress?

Inspect the throat for bleeding

The nurse is counseling the parents of a 9-year-old boy who is receiving morphine for postoperative pain. Which statement from the nurse accurately reflects the pain experience in children?

It is very rare that children become addicted to narcotics

A nurse is reviewing the medical record of a child and finds that the child has a grade III murmur. After auscultating the child's heart sounds, how would the nurse document this murmur?

Loud without a thrill

The nurse is reviewing the development of the newborn infant. Regarding the sinuses, which statement is true in relation to a newborn infant?

Maxillary and ethmoid sinuses are the only sinuses present at birth

The nurse is caring for a 7-year-old girl who is undergoing a stem cell transplant. What information would the nurse include in the child's postoperative plan of care?

Monitoring for severe diarrhea and maculopapular rash

Which tool would be the least appropriate scale for the nurse to use when assessing a 4-year-old child's pain?

Numeric pain intensity scale

The nurse is conducting a pain assessment of a 10-year-old boy who has been taking acetaminophen for chronic knee pain. The assessment indicates that the recommended dose is no longer providing adequate relief. What is the appropriate nursing action?

Obtain an order for a different medication

A nurse is teaching the parents of a child diagnosed with cystic fibrosis about medication therapy. Which would the nurse instruct the parents to administer orally?

Pancreatic enzymes

A child is prescribed monthly injections of vitamin B12. When developing the teaching plan for the family, the nurse would focus on which type of anemia?

Pernicious Anemia

n stage IV neuroblastoma, there is metastasis to the bone, bone marrow, other organs, or distant lymph nodes. Additionally, the tumor was located in the abdomen, which is associated with a poor prognosis. Therefore, the most important diagnosis would be grieving. Although infection, skin integrity, and imbalanced nutrition may be relevant, they would not be the most important.What would be most appropriate to include in the plan of care for a child who has undergone surgery for removal of an astrocytoma?

Positioning the child on his unaffected side

A hospitalized child suddenly begins reporting "my chest hurts," is tachypneic, and has tachycardia. The nurse auscultates the lung sounds and finds absent breath sounds on one side. After notifying the health care provide what action would the nurse take first?

Prepare for chest tube insertion

10. The nurse is examining a 5-year-old boy. Which of the following signs or symptoms is a reliable first indication of respiratory illness in children?

Rapid, shallow breathing

The nurse is assessing the pain of a postoperative newborn. The nurse measures the infant's facial expression, body movement, sleep, verbal or vocal ability, consolability, and response to movements and touch. Which behavioral assessment tool is being used by the nurse?

Riley Infant Pain Scale

When providing care to a child with aplastic anemia, which nursing diagnosis would be the priority?

Risk for Injury

The nurse is caring for a 16-year-old boy with acute myelogenous leukemia who is having chemotherapy and who has incomplete records for varicella zoster immunization. Which is the priority nursing diagnosis?

Risk for infection related to neutropenia and immunosuppression.

The nurse is assessing a child with suspected infective endocarditis. Which assessment finding would the nurse interpret as a sign of extracardiac emboli?

Roth Spots

The nurse uses the FLACC behavioral scale to assess a 6-year-old's level of postoperative pain and obtains a score of 9. The nurse interprets this to indicate that the child is experiencing:

Severe Pain

When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?

Strawberry Tongue

A nurse is caring for a newborn with congenital heart disease (CHD). Which finding would the nurse interpret as indicating distress?

Subcostal retraction at the time of feeding

The nurse is preparing to administer a topical anesthetic for a 10-year-old girl with a chin laceration. The nurse would expect to apply what as ordered in preparation for sutures?

TAC (tetracaine, epinephrine, cocaine)

The nurse is using the acronym QUESTT to assess the pain of a child. Which is an accurate descriptor of this process?

Take the cause of pain into account when intervening

The nurse is caring for an infant girl with a suspected cardiovascular disorder. Which statement by the mother would warrant further investigation?

The baby seems more comfortable over my shoulder

The nurse is caring for a child who reports chronic pain. What is the priority nursing assessment?

The pain's history, onset, intensity, duration, and location

The nurse is assessing a 3-year-old boy whose parents brought him to the clinic when they noticed that the right side of his abdomen was swollen. What finding would suggest this child has a neuroblastoma?

The parents report that their son is vomiting and not eating well

When the nurse is assessing a child's pain, which is most important?

Using the same tool to assess the child's pain each time