Exam Review
- A nurse is caring for a 15-year-old adolescent who has cellulitis of the left lower call. Exhibits The nurse is assessing the adolescent 24 hr after the initial visit. How should the nurse interpret the findings? For each finding, click to specify whether the finding is an Indication of potential improvement or an indication of potential worsening condition. There must be at least 1 selection in every row. There does not need to be a selection in every column.
Indication of potential Improvement Indication of potential worsening condition WBC count ✓ Temperature ✓ Wound assessment ✓ Weight-bearing ability on the affected leg ✓ - A nurse is caring for an adolescent. Exhibits Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.✓Administer acetaminophen 650 mg PO every 6 hr PRN pain✓Place the adolescent on bedrest in semi-Fowler's position.✓Pelvic Inflammatory Disease✓Temperature greater than 38.3°C(100.9°F)✓Vaginal bleedingAction to Take Choices✓Administer acetaminophen 650 mg PO every 6 hr PRN pain✓Place the adolescent on bedrest in semi-Fowler's position.✕Instruct the adolescent about the use of sitz baths✕Administer an enema✕Maintain an NPO statusCondition Most Likely Experiencing Choices✓Pelvic Inflammatory Disease✕Unary tract Infection✕Ectopic pregnancy✕Acute AppendicitisParameter to Monitor Choices✓Temperature greater than 38.3°C(100.9°F)✕Rebound tenderness✓Vaginal bleeding✕Presence of a Cullen’s sign✕Irritation of the phrenic nerve
- A nurse is reinforcing the provider's explanation about treatment options to the parents of a 1-month-old who has coarctation of the aorta. Which of the following statements should the nurse include?A)"Surgical repair is the recommended treatment for infants younger than 6 months old."B)"The obstruction will be treated with a medication called indomethacin."C)"Most cases resolve spontaneously without treatment by 12 months of age."D)The cardiologist will monitor your infant closely until they are able to receive treatment with a heart transplant."
- A nurse in an emergency department is caring for a child who weighs 18 kg (39.7 lb) and ingested six 500 mg acetaminophen tablets 4 hr ago. Which of the following actions should the nurse take?A)Send the child home on increased fluid intake.B)Begin hemodialysis within the next 24 hr.C)Perform gastric lavage with activated charcoal.D)Prepare to give oral N-acetylcysteine.
Exam Review
- A nurse is caring for a 12-year-old client who has sickle cell disease. Exhibits Complete the following sentence by using the lists of options. The nurse should anticipate a provider prescription for ▾ IV hydromorphone due to the child's ▾ pain.Dropdown 1:Option 1: Oxygen at 2 L/min via nasal cannulaOption 2: IV hydromorphoneOption 3: Oral amoxicillinDropdown 2:Option 1: HypoxiaOption 2: painOption 3: signs of infection
- A nurse is caring for a toddler admitted to the hospital. Exhibits (Highlight — findings requiring follow-up are marked)
A nurse is caring for a toddler admitted to the hospital.
ExhibitsClick to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again.Body system
Findings
Respiratory
Respiratory rate 26/min
Cardiovascular
Heart rate 112/min
Capillary refill 4 seconds
Gastrointestinal
Hyperactive bowel sounds
Integumentary
Diaper area reddened
Extremities cool
Reports no tears
Neurologic
Lethargic
- A nurse is teaching an adolescent how to manage his cystic fibrosis. Which of the following statements by the adolescent indicates an understanding of the teaching?A)"I will increase my intake of vitamin D."B)"I will limit my calcium intake to prevent kidney stones."C)"I will be excused from physical education class."D)"I will take fewer enzymes when I eat high-fat foods."
- A nurse is assessing a school-age child who is receiving cefazolin. For which of the following adverse effects should the nurse monitor?A)NauseaB)HypertensionC)Increased appetiteD)Constipation
Exam Review
- A nurse is preparing to insert a peripheral intravenous (IV) catheter for a preschooler. Which of the following actions should the nurse take?A)Ask the child to hold their breath while the IV catheter is placed.B)Place the IV catheter on the dominant arm.C)Apply vapocoolant spray before the IV insertion.D)Explain the procedure to the child in detail.
- A nurse is providing teaching to a parent about sudden unexpected infant death (SUID). Which of the following statements should the nurse include?A)"Place your infant on a soft crib mattress after they are 4 months old."B)"Use bumper pads around the interior of your infant's crib."C)"Share a bedroom with your infant for the first 6 months."D)Cover your infant with a nonflammable blanket at bedtime."
- A nurse is planning a staff in-service about infection control measures to prevent the spread of influenza in school-age children. Which of the following instructions should the nurse include?A)"Administer the influenza vaccine every 6 months."B)"Administer antibacterial medication within 24 hr of the onset of symptoms."C)"Children should be considered infectious for 14 days after the onset of symptoms."D)"Wear a face mask when working within 3 feet of a child who is infected."
- A nurse is assessing a school-age child prior to administering digoxin. For which of the following findings should the nurse withhold the medication?A)Urine output 25 mL/hrB)Respiratory rate 18/minC)Oxygen saturation 88%D)Heart rate 64/min
Exam Review
- A nurse is teaching the guardian of a child who is suspected of having cystic fibrosis and is scheduled for a sweat chloride test. Which of the following statements should the nurse include?A)"Your child will need to receive sedation to minimize pain during the test."B)"It will take approximately 3 hours to complete the test."C)Two separate samples will be collected to ensure accuracy of the test results."D)"Your child should avoid eating and drinking 6 hours prior to the test."
- A nurse is admitting an 8-year-old child to the pediatric unit. Exhibits For each potential condition, click to specify if the child's assessment findings are consistent with Hodgkin Lymphoma, Bacterial Meningitis, or Acute Lymphoblastic Leukemia (ALL). Each finding may support more than 1 diseases.
Hodgkin Lymphoma Bacterial Meningitis Acute Lymphoblastic Leukemia (ALL) Neurologic ✓ Skin ✓ ✓ Pain ✓ ✓ Lymph nodes ✓ ✓ - A nurse is admitting an 8-year-old child to the pediatric unit.. Exhibits The nurse suspects the child has bacterial meningitis. Drag words from the choices below to fill in each blank in the following sentence. The child is at greatest risk for developing ▾ seizures and ▾ increased intracranial pressure.Dropdown 1:Option 1: seizuresOption 2: hypothermiaOption 3: increased intracranial pressureOption 4: disseminated intravascular coagulationOption 5: hydrocephalusDropdown 2:Option 1: seizuresOption 2: seizuresOption 3: increased intracranial pressureOption 4: disseminated intravascular coagulationOption 5: hydrocephalus
- A nurse is admitting an 8-year-old child to the pediatric unit. Exhibits A nurse is reviewing the child's electronic medical record (EMR). Which of the following findings should the nurse identify as requiring immediate follow-up? Select the 5 findings that require immediate follow-up.(SATA)A)HemoglobinB)Pain assessmentC)Neurologic assessmentD)GlucoseE)Abdominal assessmentF)Peripheral pulsesG)WBCH)Temperature
Exam Review
- A nurse is admitting an 8-year-old child to the pediatric unit. Exhibits Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The nurse should anticipate a provider's prescription for ▾ preparing for a lumbar puncturedue to the child's ▾ neurological findingsDropdown 1:Option 1: preparing for a lumbar punctureOption 2: administering potassium chiorideOption 3: Initiating airborne precautionsOption 4: administering acyclovirOption 5: increasing environmental stimuliDropdown 2:Option 1: pain levelOption 2: WBCOption 3: lymph node findingsOption 4: potassium levelOption 5: neurological findings
- A pediatrician has evaluated the child and has written new prescriptions. Exhibits The nurse is preparing to assist with a lumbar puncture. Which of the following actions should the nurse take? Select all that apply.(SATA)A)Apply pressure to the puncture site following the procedure.B)Limit the child's fluid intake following the procedure.C)Position the child in a prone position during the procedure.D)Ensure the guardian has signed the consent form prior to the procedure.E)Insert an indwelling urinary catheter during the procedure.F)Monitor for paresthesia and tingling in extremities following the procedure.G)Ensure the child voids prior to the procedure.
- A nurse is caring for the child the following day. Exhibits (Highlight — findings requiring follow-up are marked)
A nurse is caring for the child the following day.
ExhibitsClick to highlight the findings that indicate the child is progressing as expected. To deselect a finding, click on the finding again.Nurses' Notes
Day 2, 0730:
Drowsy and lethargic, but responsive to verbal stimuli. Nuchal rigidity present. Mucous membranes pink and moist. Cervical lymph slightly enlarged. Respirations are regular. No accessory muscle use noted. Breath sounds clear anterior posterior bilaterally. Heart rhythm regular without murmurs. Radial pulse 2+ bilateral. Capillary refill less than 2 seconds. Abdomen flat and non- distended. Bowel sounds active in all 4 quadrants. Extremities are warm and dry to touch. Good skin turgor.
Flow Sheet
Temperature 38.9° C (102° F)
Heart rate 104/min
Respiratory rate 24/min
Blood pressure 104/80 mm Hg
SpO2 98% on room air
- A nurse is providing teaching to a 14-year-old adolescent who has a new diagnosis of type 1 diabetes mellitus. Which of the following statements by the adolescent indicates an understanding of the teaching?A)"I will increase my food intake before I exercise."B)"As long as I take my insulin, I can eat whatever I want."C)"As I get older, my sugar levels will automatically decrease."D)"The blood pressure medicine I'm taking will help to keep my insulin level low."