Overview/Health Promotion
Developmental Milestones
Pain
Emergencies
Drug Calc
100

Which term best describes a group of people who share a set of values, beliefs, practices, social relationships, law, politics, economics, and norms of behavior?

A. Race

B. Social Group

C. Culture

D. Ethnicity

C. Culture

Ethnicity is a classification aimed at grouping individuals who consider themselves, or are considered by others, to share common characteristics that differentiate them from the other collectivities in a society, and from which they develop their distinctive cultural behavior. Race is a term that groups together people by their outward physical appearance. Culture is a pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people. A culture is composed of individuals who share a set of values, beliefs, and practices that serve as a frame of reference for individual perception and judgments. Superiority is the state or quality of being superior; it does not apply to ethnicity.

100

Which is the single most important factor to consider when communicating with children?

A. Presence of the child’s parent

B. Child’s physical condition

C. Child’s developmental level

D. Child’s nonverbal behaviors

C. Child’s developmental level

The nurse must be aware of the child’s developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child’s developmental level and physical condition. Although the child’s physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children but may be detrimental when speaking with adolescents.

100
True or False


Pain is whatever the experiencing person says it is. 

True.

100

A 7-month old infant arrives to the ED via ambulance. Upon examination, the nurse suspects possible drowning. What is the most important questions the nurse should ask the parents?

A. Why did you do this?

B. Who did this?

C. How long was the baby submerged?

D. What was the temperature of the water?

C. How long was the baby submerged?

While knowing the temperature of the water is important, the most important piece of information is to know how long the victim was submerged. Asking why the parents did this is inappropriate and who did it is not important in the aspect of care for the infant.

100

A child weighs 66 pounds.  How many kilograms would that be?

30 kg

200

When assessing a family, the nurse determines that the parents exert little or no control over their children. This style of parenting is called which?

A. Permissive

B. Dictatorial

C. Democratic

D. Authoritarian

A. Permissive

Permissive parents avoid imposing their own standards of conduct and allow their children to regulate their own activity as much as possible. The parents exert little or no control over their children’s actions. Dictatorial or authoritarian parents attempt to control their children’s behavior and attitudes through unquestioned mandates. They establish rules and regulations or standards of conduct that they expect to be followed rigidly and unquestioningly. Democratic parents combine permissive and dictatorial styles. They direct their children’s behavior and attitudes by emphasizing the reasons for rules and negatively reinforcing deviations. They respect their children’s individual natures.

200

Because children younger than 5 years are egocentric, the nurse should do which when communicating with them?

A. Focus communication on the child.

B. Use easy analogies when possible.

C. Explain experiences of others to the child.

D. Assure the child that communication is private.

A. Focus communication on the child.

Because children of this age are able to see things only in terms of themselves, the best approach is to focus communication directly on them. Children should be provided with information about what they can do and how they will feel. With children who are egocentric, analogies, experiences, and assurances that communication is private will not be effective because the child is not capable of understanding.

200

Which is the most consistent and commonly used data for assessment of pain in infants?

A. Self-report

B. Behavioral

C. Psychologic

D. Parental Report

B. Behavioral

Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.

200

A toddler in the ED was brought in due to “not breathing appropriately” and “looking a little blue in the face”. The nurse suspects which of the following?

A. SIDS

B. SIADH

C. ALTE

D. ATP

C. ALTE

Key characteristics of an ALTE are not breathing appropriately and cyanotic spells. SIDS is appropriate to a dead infant. SIADH is appropriate when referring to the kidneys. ATP is a form of energy.

200

The nurse receives an order for 525 micrograms (mcg) of fentanyl.  The nurse knows that this is how many milligrams?

0.525mg

300

Which type of family should the nurse recognize when the paternal grandmother, the parents, and two minor children live together?

A. Blended

B. Nuclear

C. Extended

D. Binuclear

C. Extended

An extended family contains at least one parent, one or more children, and one or more members (related or unrelated) other than a parent or sibling. A blended family contains at least one stepparent, stepsibling, or half-sibling. A nuclear family consists of two parents and their children. No other relatives or nonrelatives are present in the household. In binuclear families, parents continue the parenting role while terminating the spousal unit. For example, when joint custody is assigned by the court, each parent has equal rights and responsibilities for the minor child or children.

300

The nurse is planning care for a hospitalized preschool-aged child. Which should the nurse plan to ensure atraumatic care?

A. Limit explanation of procedures because the child is preschool aged. 

B. Ask that all family members leave the room when performing procedures. 

C. Allow the child to choose type of juice to drink with the administration of oral medications.

D. Explain that EMLA cream cannot be used for the lab draw because there's not enough time for it to be effective. 

C. Allow the child to choose type of juice to drink with the administration of oral medications.

The overriding goal in providing atraumatic care is first, do no harm. Allowing the child a choice of juice to drink when taking oral medications provides the child with a sense of control. The preschool child should be prepared before procedures, so limiting explanations of procedures would increase anxiety. The family should be allowed to stay with the child during procedures, minimizing stress. Lidocaine/prilocaine (EMLA) cream is a topical local anesthetic. The nurse should plan to use the prescribed cream in time for morning laboratory draws to minimize pain.

300

The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse’s response should be based on which characteristic about preterm infants’ pain?

A. They may react to painful stimuli but are unable to remember the pain experience.

B. They perceive and react to pain in much the same manner as children and adults.

C. They do not have the cortical and subcortical centers that are needed for pain perception.

D. They lack neurochemical systems associated with pain transmission and modulation.

B. They perceive and react to pain in much the same manner as children and adults.

Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.

300

A mother presents to the ED with her 4 month old infant. Upon examination, the nurse suspects shaken baby syndrome. When explaining to the mother what this is, what key characteristics should the nurse include? (Select all that apply). 

A. Retinal Hemorrhage

B. Broken leg

C. Heart murmur

D. Subdural Hematoma

E. Subcostal retractions

A. Retinal Hemorrhage

D. Subdural Hematoma

Shaken baby syndrome is identified by retinal hemorrhage and subdural hematoma. 

300

The doctor orders 100 mg Dilantin oral suspension three times a day for your patient. The label says Dilantin 125 mg/5 mL. How many milliliters should you give?

4 mL

400

The nurse is planning care for a patient with a different ethnic background. Which should be an appropriate goal?

A. Adapt, as necessary, ethnic practices to health needs.

B. Attempt, in a nonjudgmental way, to change ethnic beliefs.

C. Encourage continuation of ethnic practices in the hospital setting.

D. Strive to keep ethnic background from influencing health needs.

A. Adapt, as necessary, ethnic practices to health needs.

Whenever possible, nurses should facilitate the integration of ethnic practices into health care provision. The ethnic background is part of the individual; it should be difficult to eliminate the influence of ethnic background. The ethnic practices need to be evaluated within the context of the health care setting to determine whether they are conflicting.

400

The nurse is aware that which age group is at risk for childhood injury because of the cognitive characteristic of magical and egocentric thinking?

A. Preschool

B. Middle-school age

C. Adolescent

D. Young-school age

A. Preschool

Preschool children have the cognitive characteristic of magical and egocentric thinking, meaning they are unable to comprehend danger to self or others. Young and middle school-aged children have transitional cognitive processes, and they may attempt dangerous acts without detailed planning but recognize danger to themselves or others. Adolescents have formal operational cognitive processes and are preoccupied with abstract thinking.

400

A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include?

A. The child will continue to sleep and be pain free.

B. Parents cannot administer additional medication with the button.

C. The pump can deliver baseline and bolus dosages.

D. There is a high risk of overdose, so monitoring is done every 15 minutes.Bottom of Form

C. The pump can deliver baseline and bolus dosages.

The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hours for patient response is sufficient.

400

Which is the leading cause of death in infants younger than 1 year in the United States?

A. Congenital anomalies

B. Sudden infant death syndrome

C. Disorders related to short gestation and low birth weight

D. Maternal complications specific to the perinatal period

A. Congenital anomalies

Congenital anomalies account for 20.1% of deaths in infants younger than 1 year compared with sudden infant death syndrome, which accounts for 8.2%; disorders related to short gestation and unspecified low birth weight, which account for 16.5%; and maternal complications such as infections specific to the perinatal period, which account for 6.1% of deaths in infants younger than 1 year of age.

400

The order is for Amoxicillin 120 mg PO once a day (Qday) for a 33 pound child. The recommended dosage of Amoxicillin for children is 8 mg/kg/day PO as a single dose. Is this dosage safe?

Recommended does is 120mg/day; order is safe

500

Which is a consequence of the physical punishment of children, such as spanking?

A. The psychologic impact is usually minimal.

B. The child’s development of reasoning increases.

C. Children rarely become accustomed to spanking.

D. Misbehavior is likely to occur when parents are not present.

D. Misbehavior is likely to occur when parents are not present.

Through the use of physical punishment, children learn what they should not do. When parents are not around, it is more likely that children will misbehave because they have not learned to behave well for their own sake but rather out of fear of punishment. Spanking can cause severe physical and psychologic injury and interfere with effective parent–child interaction. The use of corporal punishment may interfere with the child’s development of moral reasoning. Children do become accustomed to spanking, requiring more severe corporal punishment each time.

500

A 6 year old child is attending a kindergarten roundup. Which of the following would be an appropriate play activity to offer the child?

A. Offer the child a coloring book

B. Offer the child a video game

C. Offer the child a teething toy

D. Offer the child a board game

A. Offer the child a coloring book

The only age appropriate option for preschoolers is a coloring book. A video game is appropriate for an adolescent. A teething toy is appropriate for an infant. A board game is appropriate for a school aged child.

500

Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period?

A. Codeine sulfate (Codeine)

B. Morphine (Roxanol)

C. Methadone (Dolophine)

D. Meperidine (Demerol)

B. Morphine (Roxanol)

The most commonly prescribed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.

500

A father brings his daughter into the ED with suspected lead toxicity. When the father asks the nurse what could have caused this, the nurse tells the father that since she is anemic, she is at an increased risk for lead toxicity. The nurse further states that which of the following are characteristics of lead toxicity? (Select all that apply). 

A. Distracted

B. Cyanosis

C. Impulsiveness

D. Poor performance in activities

E. Dysrhythmia

F. Leg cramps

A. Distracted

C. Impulsiveness

D. Poor performance in activities

Distracted, Impulsiveness, and Poor performance in activities are all characteristics of lead toxicity. 

500

Codeine 20 mg PO Q4h as needed for pain in a child who weighs 40 kg. The recommended dosage is 0.5 mg/kg/dose. Is this ordered dosage safe?

Recommended dose is 20 mg; order is safe

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