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Questions and answers 2024
CCRN Pediatric Practice Exam
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 - n/n✔Answer: 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) - n/n✔Answer: 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 - n/n✔Answer: 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 - n/n✔Answer: 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.
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 - n/n✔Answer: 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 - n/n✔Answer: 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. - n/n✔Answer: 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 - n/n✔Answer: 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.
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) - n/n✔Answer: 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 - n/n✔Answer: 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.
- n/n✔Answer: 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 B) Wait for the therapist to intervene: This may not be satisfactory if the patient hypoventilates during sleep. C) Ask the parent to be responsible for this task: This response is not a safe or Caring Practice A patient with bronchopulmonary dysplasia (BPD) is admitted with heart failure. the nurse can expect to perform interventions to: A) Decrease Preload B) Increase Afterload C) Decrease Heart Rate D) Increase Contractility - n/n✔Answer: A) Decrease Preload: Decreasing the preload for a patient with BPD will improve right-sided heart failure related to chronic lung disease B) Increase Afterload: Increasing afterload would impede ventricular ejection, making heart failure worse. C) Decrease heart rate: Decreasing the heart rate would decrease cardiac output (CO = HR x SV) which would worsen the patient's heart failure. D) Increase contractility: Although increasing contractility may help improve left-sided heart failure, patients with BPD usually have right-sided heart failure. Factors that impair the release of oxygen to tissues by negatively affecting oxyhemoglobin dissociation include: A) Hyperthermia B) Metabolic acidosis C) Respiratory Acidosis D) Hypothermia - n/n✔Answer: D) Hypothermia: Hypothermia shifts the oxyhemoglobin dissociation curve to the left, resulting in oxygen that is more tightly bound to hemoglobin A) Hyperthermia: Hyperthermia shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen B) Metabolic Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve tot eh right, resulting in hemoglobin that has less affinity for oxygen C) Respiratory Acidosis: Acidosis shifts the oxyhemoglobin dissociation curve to the right, resulting in hemoglobin that has less affinity for oxygen A 15 yo 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 mmHg
A) Arrange for the patient's school nurse to monitor compliance: This will not help with the issue causing noncompliance and may worsen the problem. B) Provide the patient with articles on the relationship of hospitalization and medication compliance: Parents and older children often need education about eh maintenance aspect of asthma management to be reinforced. D) Advise the parents to withhold privileges if the patient remains non-compliant: For most children, withholding privileges is not a motivator to promote compliance. Amrinone lactate (Inocor) is given for which desired effect? A) Vasodilation B) Phospholipid inhibition C) Decreased myocardial contractility D) Catecholamine antagonism - n/n✔Answer: A) Vasodilation: Amrinone is a phosphodiesterase inhibitor that increases intercellular cAMP and delays uptake of intercellular calcium, resulting in improved cardiac contractility and vasodilation. B) Phospholipid Inhibition: This is not an effect of amrinone administration C) Decreased myocardial contractility: This is not an effect of amrinone administration. D) Catecholamine antagonism: This is not an effect of amrinone administration A family meeting is planned to discuss the family's ethical concerns regarding continuing life support measures for a child with end-stage cancer. The nurse's role should be to: A) Provide the legal standpoint regarding end-of-life decisions for children. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy C) Coordinate the meeting to ensure that everyone has the opportunity to speak D) Assist the parents in articulating their questions and concerns. - n/n✔Answer: D) Assist the parents in articulating their questions and concerns: The parents' thoughts and understanding are critical for making decisions about their child's care. Nurses act as advocates by assisting the parents in articulating their questions and concerns and empowering the family to speak for their child and themselves. A) Provide the legal standpoint regarding end-of-life decisions for children: This does not address the parents' concenrs. B) Articulate the reason for the child's poor prognosis and anticipated life expectancy: This does not specifically address the parents' concerns regarding continued life support measures and is not consistent with Caring Practices. C) Coordinate the meeting to ensure that everyone has the opportunity to speak: This intervention is not consistent with Caring Practices or Advocacy and Moral Agency, as the nurse's opinions and decisions may be in conflict with those of the parents. A hypertensive crisis as evidenced by acidosis, hypothermia, and alveolar hypoxia may be demostrated in which of the following children? A) Those with reactive pulmonary vascular bed B) Those with systemic vascular disease. C) Those with increases in ventricular afterload.
D)Those with sustained increases in afterload - n/n✔Answer: A) Those with reactive pulmonary vascular bed: Children with pulmonary vascular disease are at risk for developing a pulmonary hypertensive crisis. B) Those with systemic vascular disease: Systemic vascular disease does not affect pulmonary pressure C) Those with increases in ventricular afterload: The pediatric ventricle adapts to increases in ventricular afterload, provided the increases are not severe or acute. D) Those with sustained increases in afterload: Acute increases in afterload are poorly tolerated. 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 durg acts to inhibit the neurotransmitter gamma-aminobutyric 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 medicine added to the pump. - n/n✔Answer: D) Parents must bring the child back to the clinic to have medicine added to the pump: The intrathecal dose of baclofen delivered via implanted pump is adjusted in the outpatient clinic using a telemetry wand every three to six months. A) The drug acts to inhibit the neurotransmitter gamma-aminobutyric acid (GABA): Baclofen has the opposite effect described in this answer, as it is a GABA agonist. B) Parents can be taught to regulate the dosage based on symptoms: The intrathecal dose of baclofen is adjusted in the outpatient clinic using a telemetry wand. C) The child will have a normal gait after insertion of the pump: The child's gait may be improved due to relief of severe spasticity, but there is no guarantee of a normal gait with this therapy. Positive end-expiratory pressure (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 - n/n✔Answer: A) Increase functional residual capacity: PEEP increases functional residual capacity (FRC) by keeping the alveoli open after expiration, increasing alveolar volume B) Decrease functional residual capacity: This is the opposite of what occurs when PEEP is used. C) Increase venous return to the heart: PEEP can impede systemic venous return D) Increase cardiac output: At high levels, PEEP may decrease cardiac output. A nurse is interested in including other disciplines in the educational process of developmental care in the NICU. The best way to convince administration this venture is financially worthwhile is to: A) Present a report summarizing research relating developmental care to decrease length of stay. B) Request that the neonatoogist present the plan.
pose a higher risk for infection, it is important to strictly monitor output following resuscitation. B) "I found the catheter disconnected from the collection device during my hourly assessment.": This is a potential risk for introducing infection bacteria. However, if the nurse replaced the device and reported the incident to the provider, the risk is low. D) "It is so much easier to monitor hourly output with a catheter in place.": This is not an appropriate use of a urinary catheter. A child 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 nurse suspects that the diagnosis will be: A) Muchausen syndrome by proxy. B) Nonaccidental Trauma C) Physical Abuse D) Sexual Abuse - n/n✔Answer: A) Munchausen syndrome by proxy: Also known as medical child abuse or factitious disorder by proxy. Munchausen syndrome by proxy is the diagnosis given when a caregiver deliberately exaggerates or fabricates a medical history and symptoms, or induces symptoms resulting in caregiver gratification. The child's condition does not match the history, and diagnostic evidence does not support the diagnosis suggested by the history. B) Nonaccidental Trauma: Nonaccidental trauma resulting in hematuria would leave visible signs of abuse, such as bruising. C) Physical Abuse: Physical abuse resulting in hematuria would leave visible signs of abuse, such as bruising. D) Sexual Abuse: Sexual abuse of a child often involves exposure of genitalia, touching/fondling and/or oral genital contact. Hematuria alone would not support this diagnosis. 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 sheet 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. - n/n✔Answer: D) All disciplines document patient teaching on the same flow sheet: This plan is consistent with Collaboration. It gives opportunities for all disciplines to see the contributes of other team members. A) Daily care conferences to review and discuss patient teaching and the flow sheets: This plan is consistent with Collaboration but would be difficult to accomplish. Thus, it is not the best option. B) Each discipline distribute copies of its flow sheet to each team member: This plan is not consistent with Collaboration, and not an effective use of time for each team member.
C) Nurses review the flow sheets of all disciplines during shift change: This plan is not consistent with Collaboration. All team members should be involved in the teaching process. Which of the following rhythms is expected one day post-cardiac catheterization for repair of an atrial septal defect (ASD)? A) Premature atrial contraction B) Junctional ectopic tachycardia C) Sinus bradycardia D) Sinus tachycardia - n/n✔Answer: A) Premature atrial contraction: this is cause by an irritation to the atria during the cardiac catheterization. B) Junctional ectopic tachycardia: this is caused by an irritation to the AV node. C) Sinus bradycardia: Sinus bradycardia is not an expected complication of cardiac catheterization for repair of an atrial septal defect. D) Sinus tachycardia: Sinus tachycardia may be seen with stress, pain, hypoxemia, and low cardiac output, which are not expected or managed during the post-procedure phase. Which of the following would lead to hypovolemia due to increased insensible fluid loss in an infant post-cardiac surgery? A) Decreased activity B) Hypothermia C) Radiant warmer use D) Sedation - n/n✔Answer: C) Radiant warmer use: The radiant warmer increases the effects of evaporation, which increases insensible fluid loss. A) Decreased activity: Decreased activity would decrease insensible fluid loss. B) Hypothermia: Hypothermia would decreased insensible fluid loss. D) Sedation: Sedation would decrease insensible fluid loss. A child is admitted after sustaining a head injury. The most important aspect of the nurse's continuing assessment for early neurological deterioration is: A) Level of consciousness B) Pupillary response C) Motor response D) Cranial nerve assessment - n/n✔Answer: A) Level of consciousness: Level of consciousness is the earliest indicator of improvement or deterioration in neurological status. B) Pupillary response: Alterations in pupil size and reactivity are a late sign of neurological deterioration and may be affected by medications, trauma, and poisons. C) Motor response: Changes in motor response are a late sign of neurological deterioration and are assessed as part of the Glasgow Coma Score. D) Cranial nerve assessment: While it is important to note changes, cranial nerve assessment is not the most important aspect of a nurse's ongoing neurological assessment.
B) To teach the patient to avoid sugar and foods high in carbohydrates: A patient with diabetes most likely knows the effects of diet on blood glucose, but reinforcing the concepts may be indicated. D) For the patient and family to join a diabetes support group: This may be helpful if the family is willing, but it is not the most important intervention A 10-day-old infant is admitted with a suspected congenital heart defect, due to a history of poor feeding and sudden onsent of respiratory distress and cyanosis. Initial assessment shows: HR: 180 pH: 7. 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. Settings are as follows: rate of 20, PIP/PEEP: 24/4 cmH20, Fio2: 100%. Subsequent ABG results show: pH: 7. pCO2: 28 pO2: 50 HCO3: 15 The most probably etiology off the patient's cardiopulmonary status is which of the following? A) Tetrology of Fallot B) Hypoplasia C) Coarctation of aorta D) Transposition of the great arteries - n/n✔Answer: B) Hypoplasia: Ten days after birth, the ductus arteriosus has closed, increasing pulmonary blood flow, and aortic flow and ysstemic perfusion decreasing. This causes severe deterioration, including severe cyanosis, hypoxemia, acidosis, and low cardiac output. The hypoxemia does not improve with oxygen administration or mechanical ventilation. A) Tetralogy of Fallot: an infant with tetralogy of fallot will have hypercapnia during a hypoxemic spell ("tet" spell). This patient has lower than normal pCO2. C) Coarctation of the Aorta: Patients with coarctation of the aorta present with poor feeding, tachypnea, pallow, listlessness, acidosis, and weak or absent lower extremity pulses, but not sudden onset of respiratory distress. D) Transposition of the great arteries: In patients with transposition of the great arteries, cyanosis will not improve with oxygen administration. But oxygen administration helps decrease pulmonary vascular resistance, leading to increased pulmonary blood flow,
which improves mixing of systemic and venous blood and improves arterial oxygen saturation. 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 speak with you." - n/n✔Answer: B) "Would teaching you CPR help ease your anxieties?": This statement is consistent with Caring Practices and Facilitation of Learning. It identifies and clarifies the parents' concerns, which is a first step when providing information. It also shows support for the parents' concerns. A) "Now that your son has been diagnosed and treated, you need not worry.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. C) "Do you know how to access the EMS system?": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. D) "I will have your son's cardiologist speak with you.": This statement is not consistent with Caring Practices or Facilitation of Learning. It does not provide adequate information or address the parents' concerns. Referring the parents to another provider will delay getting answers. This issues is something the nurse should be able to address. Which of the following methods is the best to update a family that speaks primarily Spanish? A) Use hand gestures to point to key things, such as the patient and the surgeon. B) Have the patient's 12-year-old sibling provide interpretation for the family C) Utilize a medical interpreter either in person or on the telephone. D) Give the family the operative consent written in Spanish. - n/n✔Answer: C) Utilize a medical interpreter either in person or on the telephone: An interpreter whose role is to provide medical interpretation from English to the patient's or family's primary language is the best option, especially when care decisions are being made. A) Use hand gestures to point to key things, such as the patient and the surgeon: Hand gestures are not an appropriate method for medical interpretation when a patient's or family's primary language is not English. B) Have the patient's 12-year-old sibling provide interpretation for the family: It is not appropriate to have a child or other family member provide medical interpretation when a patient's or family's primary language is not English. D) Give the family the operative consent written in Spanish: Providing documents in the patient's or family's primary language is useful, but this option alone does not allow for verbal medical interpretation.
desmopressin (DDAVP), urine output falls, correcting the fluid and sodium balance. Increasing the patient's sodium intake would contribute to inadvertent hypernatremia. D) Decrease glucose intake: Glucose levels and intake are an important consideration in diabetes mellitus, not diabetes insipidus. Which of the following is a daily practice that should be a part of the bundle to reduce the incidence of central line-associated bloodstream infections? A) Review of antibiotics B) Replacement of the infusion tubing C) Replacement of the catheter D) Review of catheter necessity - n/n✔Answer: D) Review of catheter necessity: The Institute for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin antisepsis for children older than 2 months of age, along with a daily review of the line necessity. The consideration of catheter removal should be documented daily in the medical record. Unnecessary catheters should be removed promptly. A) Review of antibiotics: while it is important to review the patient's medication list daily, the Institute for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin antisepsis for children older than 2 months of age, along with a daily review of the line necessity. B) Replacement of the infusion tubing: Daily replacement of infusion tubing is not a listed practice in the Institute for healthcare Improvement's Central Line Bundle C) Replacement of the catheter: Central venous catheters should not be replaced daily. A patient with end-stage pituitary adenoma is in the ICU being treated for aspiration pneumonia and diabetes insipidus. Despite knowing a plan for transpyloric tube feedings and nothing by mouth the mother is giving water and soft drinks to the patient. What is the nurse's best response to this situation? A) Ask the resident physician to change the diet order to include oral fluids. B) Notify the social worker that the mother is interfering with the medical plan. C) Ask the mother to explain why she is giving fluids to her son D) Ask security to restrict the mother's ability to visit the ICU - n/n✔Answer: C) Ask the mother to explain why she is giving fluids to her son: The nurse needs to understand the reasons for the mother's behavior before the nurse can advocate for the child's needs and the mother's goals for her son's care. A) Ask the resident physician to change the diet order to include oral fluids: A change in diet order may put the patient at risk for further aspiration and does not address the mother's concerns or care goals for her child. B) Notify the social worker that the mother is interfering with the medical plan: While the social worker may be able to help the mother identify personal resources, the nurse should first determine the mother's reasons for not following the medical plan and then help her articulate her goals for her son's care.
D) Ask security to restrict the mother's ability to visit the ICU: Removing the mother from the unit does not address the mother's concerns or goals for her son's care and may create an adversarial relationship between the mother and the hospital staff. A 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In order to determine the discharge needs of the patient, the nurse 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 adequacy of the home environment C) An outreach educator to determine the learning needs of the family D) A multidisciplinary care conference before discharge - n/n✔Answer: B) A social worker to meet with the family and assess adequacy of the home environment: The first predischarge priority for a technology-dependent child is to assess the adequacy of the home environemtn. Further discharge planning is then based on the needs of the patient and family. A) Home nursing care for the first few days following discharge: While home nursing care may be needed after discharge, the first predischarge priority in this scenario is to evaluate the home environment. From there, a determination can be made about nursing care that will be needed at home. The home may not be adequate for a safe transition for the infant. C) An outreach educator to determine the learning needs of the family: Education may be necessary before discharging a technology-dependent child, but that cannot be determined without further information about the patient's home environment and family needs. D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking. Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to prepare to meet the complex needs of the child at home. A child with a 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 be more prone to diarrhea." B) will be unable to control his bowel movements." C) will require more activity to increase bowel movements." D) needs to have a bowel movement every day." - n/n✔Answer: A) tends to be more prone to diarrhea.": With Facilitation of Learning the nurse recognizes this mother does not yet understand that patients with a myelomeningocele are prone to constipation and impaction, rather than diarrhea. Additional education is needed to help the mother understand the bowel management plan. B) will be unable to control his bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan. C) will require more activity to increase bowel movements.": This statement is correct and would demonstrate that the mother understands the necessity of the bowel management plan.
