CCRN Pediatric Practice Exam with 100% correct answers

To promote effective grieving in a 6-year-old sibling following the death of an infant, 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 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 - correct answer️️Answer: D) Explain to the sibling that thoughts and wishes did not cause the infant's death: At age 6, children may take words literally and because of their egocentrism, they believe that thoughts are all-powerful. They may truly believe they caused the death of their sibling. A simple, honest explanation of why the sibling died is indicated. This intervention is consistent with Caring Processes. A) Recommend that the sibling not attend the infant's memorial service: This intervention is not a solution to the problem and will not promote effective grieving for the sibling. It is not consistent with Caring Processes. B) Encourage the parents to minimize their expression of grief with the sibling: This intervention will lead to ineffective grieving for the sibling and is not consistent with Caring Processes C) Explain to the sibling that the infant went to heaven: This intervention will not address the sibling's problem A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at four weeks of age is admitted with increased somnolence, decreased appetite, and increased complaints of 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 having a CT scan followed by possible shunt revision C) Administering mannitol or hypertonic saline D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) - correct answer️️Answer: B) The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. A) The physician ordering lumbar puncture and blood and urine cultures: These interventions will not address the most likely primary problem, which is suspected VP shunt malfunction. Additionally, lumbar puncture is contraindicated in the presence of increased intracranial pressure, because downward herniation of the brainstem can occur. C) Administering mannitol or hypertonic saline: These medication are indicated for the medical management of increased intracranial pressure, of which this patient has symptoms. However, they will not address the most likely primary problem, which is suspected VP shunt malfunction. D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most likely primary problem, which is suspected increased intracranial pressure as a result of VP shunt malfunction An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? A) Small Bowel Injury B) Cardiac Contusion C) Splenic Laceration D) Pulmonary Embolism - correct answer️️Answer: C) Splenic laceration: Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis A) Small bowel injury: Signs of small bowel injury may include progressive abdominal distension, not referred left shoulder pain. B) Cardiac Contusion: Signs of cardiac contusion include chest pain, arrhythmias, and other indicators of myocardial dysfunction, such as elevated cardiac isoenzymes. Upper quadrant abdominal pain with radiation to the left shoulder is not consistent with a cardiac contusion D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on exertion, not left shoulder pain An 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) Airway Patency - correct answer️️Answer: D) Airway Patency: The first priority after admitting an infant with encephalitis is to assess the patient's ability to maintain airway patency. Such patients can develop rapid neurologic deterioration, and the nurse must be prepared to support the airway, oxygenation, and ventilation as needed. A) Pupillary Response: The infant with encephalitis should be monitored for changes in neurologic status, including pupillary response. However, assessing the patient;s ability to maintain airway patency is the first priority. B) Blood Glucose Level: The infant with encephalitis will need blood glucose levels monitored, especially if unable to maintain adequate oral intake. However, assessing the patient's ability to maintain airway patency is the first priority. C) Level of consciousness: The infant with encephalitis should be monitored for changes in neurologic status, including assessment of the level of consciousness. However, assessing the patient's ability to maintain airway patency is the first priority. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with: A) Tachypnea B) Cyanosis C) Confusion D) Hypotension - correct answer️️Answer: C) Confusion: The patient with asphyxia from smoke inhalation will experience cerebral hypoxemia and demonstrate symptoms of neurologic dysfunction, including confusion A) Tachypnea: While the patient with smoke inhalation may experience tachypnea as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia B) Cyanosis: While the patient with smoke inhalation may experience cyanosis as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia D) Hypotension: While the patient with smoke inhalation and a burn injury may demonstrate hypotension from fluid shifts, this symptoms is not specific to asphyxia 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 is the most useful resource for a nurse caring for this infant? A) Classes conducted by the primary nurse as the need arises B) An interpreter who is proficient in the parents' language C) Information about the cultural backgrounds represented in the community D) Ongoing classes addressing the cultural needs of the community - correct answer️️Answer: B) An interpreter who is proficient in the parents' language: This intervention is consistent with Response to Diversity. Providing an interpreter may facilitate communication by the parents. Trained interpreters can improve outcomes by helping to ensure effective communication between the healthcare team and the patient/family A) Classes conducted by the primary nurse as the need arises: This intervention is not consistent with Response to Diversity. It will not help in this situation. While addressing needs as they arise is important, the parents are not communicating these needs at present. C) Information about the cultural backgrounds represented in the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents' needs during this stressful time. D) Ongoing classes addressing the cultural needs of the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents; needs during this stressful time. A toddler with a history of unrepaired tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. The most appropriate nursing intervention would be to: A) Administer A pre-medication before attempting the IV B) Apply a face mask with oxygen C) Transfuse red blood cells D) Place the child in knee-chest position - correct answer️️Answer: D) Place the child in knee-chest position: This maneuver aids blood return to the heart, thus alleviating cyanotic spells A) Administer a pre-medication before attempting the IV: This may be appropriate if it helps the infant to experience minimal pain, and thus cry less during the IV start. B) Apply a face mask with oxygen: Administering oxygen is helpful to minimize the hypoxia, but the mask may cause even more distress. C) Transfuse red blood cells: If other measures do not alleviate the spells, volume in the form of packed red blood cells may be ordered to maintain the hematocrit greater than or equal to 45% A 1-month old infant presents with failure to thrive, frequent vomiting and irritability since birth. The mother reports having another infant with the same symptoms who died at 2 months of age. Which additional assessment finding would cause the nurse to suspect an inborn error of metabolism? A) Micrognathia B) Microglossia C) Petite Facial Features D) Musty Urine Odor - correct answer️️Answer: D) Musty urine odor: This is a common indicator of a metabolic disorder, especially with a family history of siblings dying early A) Micrognathia: This is not associated with an inborn error of metabolism B) Microglossia: This is not associated with an inborn error of metabolism C) Petite Facial Features: This is not associated with an inborn error of metabolism A school-aged child 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 a child life therapist per shift B) Encourage lots of visitors C) Adhere to a home schedule D) Initiate new activities to keep the patient occupied - correct answer️️Answer: C) Adhere to a home schedule: Autism spectrum disorders are a complex neurodevelopmental disorder of brain function accompanied by a broad range and severity of intellectual and behavioral deficits, which is best managed when adhering to a schedule and minimizing change, so adhering to a home schedule is optimal. The schedule allows the child and family to optimally cope. A) Assign a child life therapist per shift: The assignment of a child life therapist can be very beneficial to help facilitate patient and family understanding of the hospital environment and provide therapeutic coping interventions, but it is not realistic that a child life therapist would be assigned to an individual patient for every shift. B) Encourage lots of visitors: The management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. maintenance of a schedule and minimizing visitors will provide a healing environment appropriate for an autistic patient who has a possible head injury. D) Initiate new activities to keep the patient occupied: Management of a possible head injury includes a quiet restful environment, which is consistent with Caring Practices that will optimally provide patient and family coping and safety. The introduction of new activities may be stressful and potentially harmful with a head injury, so maintenance of a schedule and known activities will provide a healing environment appropriate for an autistic patient with a possible head injury. 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 translation and asking of questions D) Allowing time for the translator to decode the medical jargon used in the teaching. - correct answer️️Answer: B) Standing next to the translator and as close to the patient as possible: This response is consistent with high competency levels in Facilitation of Learning. It supports the patient through the process of obtaining the information required from a professional individual and the translator A) Having the translator ask questions that you don't feel comfortable asking: This response is not consistent with high competency levels in Facilitation of Learning. A translator should be used to obtain all pertinent patient information C) Providing all of the information, then allowing translation and asking of questions: This response is not consistent with high competency levels in Facilitation of Learning. Content may be accidentally omitted with the process described in this option. D) Allowing time for the translator to decode the medical jargon used in the teaching: This response is not consistent with high competency levels in Facilitation of Learning. Jargon should not have to be decoded by the translator. This can lead to errors by the translator, who might provide inaccurate information. Family members of a patient who has just died are crying and wailing loudly both inside and outside the patient's room. Staff are expressing frustration with the outbursts. The nurse's best response is to acknowledge the noise and A) Ask a security officer to remove the family from the unit B) Guide the family to a nearby room where they can express their emotions C) Tell the family they must quiet down, or they will have to leave the unit D) Tell the other staff they are being insensitive to the family's expression of grief - correct answer️️Answer: B) Guide the family to a nearby room where they can express their emotions: People from various cultures express grief and mourning in different ways. This expression may include loud, emotional responses. Providing the family a place close to the patient's room allows them privacy while minimizing disruption to other patients and staff in the area. A) Ask a security officer to remove the family from the unit: Removing the family is not a culturally sensitive way to allow the family to experience their grief and mourning C) Tell the family they must quiet down or they will have to leave the unit: Asking the family to be quiet or removing them from the unit are not culturally sensitive ways to allow the family toe experience their grief and mourning D) Tell the other staff they are being insensitive to the family's expression of grief: Telling other staff members that they are being insensitive does not promote cultural awareness and does not address the family's need to express their grief and mourning. Cardiac defects associated with increased pulmonary blood flow place the patient at greatest risk for: A) Heart Failure B) Air Emboli C) Hypoxemia D) Syncope - correct answer️️Answer: A) Heart Failure: Heart Failure is a common manifestation associated with increased pulmonary blood flow B) Air Emboli: Although air emboli are possible with a septal defect, it would be a rare occurrence. This may be seen later in life due to chronic increased pulmonary blood flow C) Hypoxemia: Hypoxemia is not usually associated with cardiac defects that result in increased pulmonary blood flow D) Syncope: Syncope is not associated with cardiac defects that result in increased pulmonary blood flow A nurse believes the number of hemolyzed blood samples that have been reported by the laboratory is excessive. The best action for the nurse would be to A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed B) Request a staff meeting to discuss the problem and ask for feedback C) Develop an educational in-service on the proper blood-sampling technique for the staff D) Create a poster and post-test demonstrating the proper method of drawing blood samples - correct answer️️Answer: A) Track the number of blood samples drawn, by what method and the number reported as hemolyzed: Evidence-based practice is the use of available data to support care and address care concerns. The nurse currently has only an impression and no data to support the concern B) Request a staff meeting to discuss the problem and ask for feedback: this intervention will not address the need for data to validate the concern C) Develop an educational in-service on the proper blood-sampling technique for the staff: This intervention will not address the need for data to validate the concern D) Create a poster and post-test demonstrating the proper method of drawing blood samples: This intervention will not address the need for data to validate the concern Which ventilatory parameters should be weaned first in a patient with bronchopulmonary dysplasia (BPD)? A) Tidal Volume (VT) and oxygen (FiO2) B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV) C) Oxygen (FiO2) and intermittent mandatory ventilation (IMV) D) Oxygent (FiO2) and peak inspiratory pressure (PIP) - correct answer️️Answer: D) Oxygen (FiO2) and peak inspiratory pressure (PIP): FiO2 should be weaned as soon as oxygenation improves. PIP is weaned as lung compliance improves A) Tidal Volume (VT) and oxygen (FiO2): Patients with BPD are usually ventilated using a pressure cycled ventilator mode, as breaths delivered at a set volume to non compliant lungs may generate a pressure higher than the desired peak pressure. B) Peak inspiratory pressure (PIP) and intermittent mandatory ventilation (IMV): PIP is weaned as the lung compliance improves but IMV is a mode of ventilation, not a weanable parameter C) Oxygent (FiO2) and intermittent mandatory ventilation (IMV): FiO2 is weaned as oxygenation improves but IMV is a mode of ventilation, not a weanable parameter Which of the following interventions would be the most valuable in aiding management of a child requiring PEEP of 14 cm water? A) Extracorporeal membrane oxygenation (ECMO) B) Placement of a thoracostomy tube C) Placement of a pulmonary artery catheter D) High-frequency oscillatory ventilation (HFOV) - correct answer️️Answer: D) High-frequency oscillatory ventilation (HFOV): HFOV improves oxygenation through alveolar recruitment without the complications associated with high PEEP, which is also used to improve oxygenation A) Extracorporeal Membrane Oxygenation (ECMO): This is used to provide support to patients with reversible cardiac or respiratory failure B) Placement of a thoracostomy tube: Placement of a thoracostomy tube is not indicated in this situation. This procedure would be performed in the case of air leak syndrome C) Placement of a pulmonary artery catheter: Pulmonary artery catheters are rarely used in pediatric patients. Clinical manifestations observed in a child diagnosed with failure to thrive may include A) Avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development C) Distress when held of left alone D) No interest in surroundings - correct answer️️Answer: A) Avoidance of eye contact and delayed motor development: The clinical manifestations of failure to thrive may include growth failure, apathy, avoidance of eye contact and delayed motor development B) Excessive crying and delayed language development: The child may have a history of excessive irritability and may cry during feedings. Delayed language development is not associated with failure to thrive. C) Distress when held of left alone: When held these children may protest briefly when being put down but are apathetic when left alone D) No interest in surroundings: These children may display intense interest in inanimate objects such as toys but are much less interested in social interactions A nursing unit needs to be able to place patients back on ventilator support, as ordered, while patients nap Due to staffing patters, the respiratory therapist is not always available on the unit to place patients on the ventilator. An appropriate response by the nurse would be to: A) Place the patient on the ventilator when needed, despite current policy B) Wait for the therapist to intervene. C) Ask the parent to be responsible for this task. D) Question the current policy that only respiratory therapists can manage the ventilator. - correct answer️️Answer: D) Question the current policy that only respiratory therapists can manage the ventilator: Clinical Inquiry is questioning the appropriateness of policies, guidelines, and current practices to improve patient care A) Place the patient on the ventilator when needed, despite current policy: This is not a Caring Practice as the RN may not have the knowledge to perform this task safely