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Peds CCRN 112 Review Questions
The mother of a recently admitted, technology-dependent child tells the nurse that she has missed several clinic appointments. How can the nurse best help in this situation?
A. Inform the social worker about the medical neglect B. Assess the mother's access to tangible resources C. Notify the clinic physician that the child is admitted D. Reassure the mother that she is doing her best - ✔ ✔ B. Assess the mother's access to tangible resources
-The nurse's first response should be to further assess the mother's situation and determine why she has missed appointments. -Assessing tangible resources, like transportation, may better elicit the mother's needs and the nurse can then best respond from a systems thinking perspective. The nurse caring for a child who was injured in a motor vehicle crash notes positive Cullen's sign in the right abdomen around the umbilicus. This is indicative of:
A. Impending disseminated intravascular coagulopathy B. Necrotic bowel process C. Sepsis D. Intra-abdominal bleeding - ✔ ✔ D. Intra-abdominal bleeding
In cases of severe intra-abdominal bleeding, Cullen's sign (bluish discoloration around the periumbilical area) may be seen. The nurse should be concerned that the child has severe injuries and may need surgical exploration or repair. The nurse is caring for a child with liver failure and who is experiencing profound abdominal distention. What is the primary concern?
A. Renal insufficiency B. Biliary atresia C. Intestinal perforation
D. Cardiogenic/obstructive shock - ✔ ✔ D. Cardiogenic/obstructive shock
-Cardiogenic/obstructive shock occurs when cardiac output is obstructed and there is an inability to provide adequate tissue perfusion despite normal intravascular volume and myocardial function. -Causes include trauma to the great vessels, tamponade, pulmonary embolism, valvular stenosis, and coarctation of the aorta A toddler who was found unresponsive in a swimming pool is in respiratory distress. On chest x-ray you see bilateral infiltrates and the PaO2/FiO2 ratio is 190. These findings suggest:
A. Aspiration pneumonia B. Viral pneumonia C. Acute respiratory distress syndrome D. Pneumothorax - ✔ ✔ C. Acute respiratory distress syndrome
- This child has signs of acute respiratory distress syndrome (ARDS), which include bilateral infiltrates on chest x-ray, PaO2/FiO2 ratio <200, and pulmonary edema, among other things.
- Both aspiration and viral pneumonia may lead to ARDS, but that's not the correct answer for this question.
- The symptoms described are not consistent with a pneumothorax. A traumatically injured 8-year-old is being cared for in the ICU. The nurse notes the child has an ICP of 18 mmHg, arterial blood pressure of 112/72 mmHg, with MAP of 86 mmHg and central venous pressure of 7 mmHg. The nurse calculates the cerebral perfusion pressure and anticipates which intervention?
A. MRI evaluation B. Ongoing monitoring C. Emergent surgery D. Fluid bolus - ✔ ✔ B. Ongoing monitoring
-This child has age-appropriate values for blood pressure, MAP, and CVP. The calculated CPP is 68 mmHg (MAP minus ICP).
Which additional assessment finding is concerning for abusive head trauma?
A. Forehead bruising B. Poorly reactive pupils C. Retinal hemorrhage D. Linear skull fracture - ✔ ✔ C. Retinal hemorrhage
-You would not anticipate seeing retinal hemorrhage with the history provided. -You could see a bruise on the head where the baby fell, poorly reactive pupils, or a linear skull fracture. -A history that does not match the patient's injuries is concerning for inflicted trauma. A 9-month-old arrives with a burn injury. Which of these is most concerning for inflicted injury?
A. The burn injury is consistent with the history B. The parent sought out medical care immediately C. The burns have a splash pattern across the thighs
D. The parent reports the child pulled a hot pot off the stove - ✔ ✔ D. The parent reports the child pulled a hot pot off the stove
-A child this age would not have the developmental skills to pull a pot off a stove, so that statement is concerning. -Other red flags that a burn may be inflicted include linear demarcations without splash marks, and a pattern that resembles a hot object. -It is also concerning when the parent or caregiver delay seeking medical care A baby with BPD will have:
A. Left-sided heart failure B. Increased fluid requirements C. Decreased pulmonary vascular resistance D. Increased caloric needs - ✔ ✔ D. Increased caloric needs
-Infants with BPD have increased caloric needs because of the chronic increased work of breathing distress. -They require
A. Restrictive cardiomyopathy B. Hypertrophic cardiomyopathy C. Dilated cardiomyopathy D. Kawasaki disease - ✔ ✔ B. Hypertrophic cardiomyopathy
-Hypertrophic cardiomyopathy involves thickening of the heart muscles, which can obstruct blood flow out of the left ventricle. -Intense exercise can worsen the outflow obstruction, which makes this type of cardiomyopathy the most common cause of sudden cardiac death in people younger than age 35 and in athletes. A child experiencing Diabetes Insipidus (DI) has a urine output > mL/kg/hr and a serum sodium of 158 mEq/L. The nurse should expect the patient will need:
A. Hypotonic intravenous fluids and urine output replacement B. Vasopressin administration and urine output replacement C. Hypertonic saline administration and 75% maintenance intravenous fluid
D. Vasopressin and hypertonic saline administration - ✔ ✔ B. Vasopressin and urine output replacement
-Immediate treatment for a patient with symptomatic DI is ADH replacement and urine output replacement to keep the patient from progressing to profound hypovolemic shock. -Hypotonic fluids and hypertonic saline administration are contraindicated in this situation. -Fluid restriction to 75% of maintenance needs is a treatment for SIADH. A child has just died. What's the nurse's best response to the parents?
A." You can always have other children" B. "She's in a better place now" C. "I'm so sorry for your loss" D. "It's God's will when children die". - ✔ ✔ C. "I'm so sorry for your loss"
-The loss of a child is unimaginable for parents.
-Diabetes mellitus and DKA are disorders of glucose control. A child in DKA has a glucose of 350 mg/dL. One hour later the glucose is 250 mg/dL. The nurse would anticipate the administration of:
A. Potassium chloride B. Sodium bicarbonate C. Dextrose solution D. Subcutaneous insulin - ✔ ✔ C. Dextrose solution
-As the glucose decreases to 250 mg/dL, it will become necessary to administer glucose in addition to the insulin infusion that this patient is likely already receiving. -The child in DKA will not receive SQ insulin, as she will not be able to utilize that as effectively as IV insulin. -You have no information to suggest that this patient requires electrolyte supplementation. -Sodium bicarbonate is not appropriate A child is admitted after falling off a golf cart. The child was initially awake and
alert, but now is unresponsive. The nurse should suspect which condition?
A. Hydrocephalus B. Epidural hematoma C. Subdural hematoma D. Diffuse axonal injury - ✔ ✔ B. Epidural hematoma
Epidural hematomas result from hemorrhage into the extradural space, usually from a tear in the middle meningeal artery. With the classic presentation, the child is initially awake and alert, but as the bleeding continues, the hematoma gets larger and the child can become unresponsive. A child is admitted in a hypertensive crisis and vasodilators are ordered. The nurse understands that the intention is to improve cardiac function through:
A. Increasing SVR B. Inotropic and chronotropic actions C. Decreasing afterload
have Spinal Cord Injury Without Radiograph Abnormality (SCIWORA). -The patient should have spinal cord protective measures in place (eg, log rolling, cervical collar) at this point. A child recently underwent a diagnostic cardiac catheterization. The nurse notes the patient's distal foot is cool, with poor perfusion and an absent pulse, and should suspect what?
A. Post-procedure bleeding B. This is a normal finding C. Hematoma D. Heart failure - ✔ ✔ C. Hematoma
-Post-procedure monitoring after cardiac catheterization includes observing for bleeding and perfusion. -A hematoma can form, which may require intervention if distal perfusion is significantly compromised, and this is not a normal finding. -The assessment findings described in this question do not indicate there is bleeding or heart failure.
A child with a closed head injury has developed SIADH. Which of the following laboratory results would this patient exhibit?
A. Serum Na+ 122 mEg/L; serum Osm 262 mOsm/L B. Serum Na+ 134 mEq/L; serum Osm 280 mOsm/L C. Serum Na+ 144 mEq/L; serum Osm 282 mOsm/L D. Serum Na+ 158 mEq/L; serum Osm 295 mOsm/L - ✔ ✔ A. Serum Na+ 122 mEq/L; serum Osm 262 mOsm/L
-You know that patients with SIADH have hyponatremia and hypo-osmolality, you know that answer "A" is the best response. A critically ill patient is hypotensive with pale, mottled, and cool extremities. The nurse should be concerned for:
A. Skin failure B. Bacterial colonization C. Over hydration
-An appropriate response to diversity is to honor this family's request. -Of the options listed, documenting and including the information in the handoff report is the best way to communicate the request. -It would be important for the nurse to talk with the family about emergency scenarios where it might not be possible to honor this while still meeting the urgent needs of the child. -A plan for this scenario could then be articulated with the family's agreement. A large pediatric/adult hospital is implementing a new continuous renal replacement therapy. Crucial considerations in the process include identifying equipment, financial resources and:
A. Key stakeholders B. Staff educators C. Appropriate patients D. Attending physicians - ✔ ✔ A. Key stakeholders
-From a systems thinking perspective, key stakeholder identification is vital in the early stages of a major planned change.
-Stakeholders from both pediatric and adult areas may include nurses, physicians, educators, and others who will be impacted by the change. Decision- making and planning should include everyone's input. A nasogastric tube should not be inserted in the child with which injury?
A. Linear skull fracture B. Basilar skull fracture C. Depressed skull fracture D. Diffuse axonal injury - ✔ ✔ B. Basilar skull fracture
-Nasogastric tubes should not be inserted in patients with suspected basilar skull fractures because the tube could go up through the fracture into the brain. -These patients need an orogastric tube placed through the mouth A neonate is receiving an infusion of prostaglandin to keep the patent ductus arteriosus from closing. Which is a potential complication of this medication?
