Neuro/Endocrine
Mother of a 3 day old s/p myelomeningocele repair and VP shunt placement would like to breastfeed. The nurse's most appropriate response is to tell the mother:
A. myelomeningocele repair is a contraindication for feeding
B. how to position the infant so she is not lying on her back
C. the infant can only bottle feed
D. the infant requires more calories than breastmilk can provide
B - position infant so she is not lying on her back
R: Normal growth and development can occur with proper positioning.
In which of the following congential heat defects would systemic-to-pulmonary-artery pallative shunting (e.g. Blalock-Taussig shunt) most likely be indicated?
A. Total anomalous pulmonary venous return
B. Tricuspid atresia
C. Isolated ventricular septal defect
D. Transposition of the Great Arteries
B. Tricuspid atresia
R: With a closed/absent tricupsid valve, the patient will need a source of pulmonary blood flow once the ductus closes.
In which of the following situations would the nurse expect Heliox therapy?
A. Croup
B. Bacterial pneumonia
C. Trycyclic antidepressant overdose
D. Acute chest syndrome
A. Croup
R: Heliox is indicated for airway narrowing or obstruction.
A newborn infant is noted to have copious oral and nasal secretions despite frequent bulb suctioning. Attempts to feed result in coughing episodes with respiratory distress and transient cyanosis. If these symptoms are the result of a common type of congenital transesophageal fistula, which of the following is likely when attempting to place a NG tube?
A. uncomplicated placement of the NG into the stomach.
B. Inability to pass the NG or coiling of the tube in the mediastinal region
C. Passage of the NG into the trachea.
D. Inability to pass the NG through one side of the nose.
B. Inability to pass the NG or coiling of the tube in the mediastinal region
R: Inability to pass a NGT is a symptom of a TEF. It is unlikely you would pass a tube through the fistula into the lungs.
All of the following lab findings are consistent with acute kidney injury EXCEPT:
A. metabolic alkalosis
B. elevated BUN
C. elevated serum phosphorus
D. elevated serum potassium
A. metabolic alkalosis
R: Metabolic acidosis is present in AKI.
A 10 yo previously healthy child has a generalized tonic-clonic seizure that ended spontaneously after 6 minutes. The child is combative and confused. Appropriate management includes:
A. Placing the child in physical restraints
B. Providing calm reassurance while monitoring the patient
C. Administering rectal diazepam
D. Administering IM Haldol
B. Providing calm reassurance while monitoring the patient
R: Confusion is normal for the post-ictal phase after a seizure.
A 10 yo is admitted with viral myocarditis. He acutely develops diaphoresis, pallor, and decreased responsiveness. Vital signs reveal HR 190, RR 50, BP 82/30. Carotid and femoral pulses are palpable. EKG on the monitor shows a wide and bizarre rhythm.
Which of the following is the most appropriate intervention?
A. IV beta-blocker admin
B. Immediate cardioversion
C. IV epinephrine admin
D. Vagal maneuvers
B. Immediate Cardioversion
R: Wide and bizarre fast rhythm with palpable pulse indicates possible VTach with a pulse.
A 4 month old is admitted with RSV. Assessment reveals an alert, fussy infant with course breath sounds, moderate retractions, and expiratory grunting. RR 68, O2 sat 95% on 2L NC. ABG reveals: pH 7.30, PCO2 50, PO2 130, HCO3 24. Appropriate management includes:
A. Trial off supplemental O2
B. Elective intubation
C. Nebulized budesonide admin
D. Nasal continuous positive airway pressure trial
D. Nasal continuous positive airway pressure trial
R: We need to correct respiratory acidosis. pH and PCO2 move in opposite directions. This patient is not in respiratory failure.
You are caring for a 3 week old born at 29 weeks gestation. The infant has been progressing well with a gradual advance in enteral feedings. Suddenly the infant has had several episodes of apnea and one episode of a small emesis prior to a scheduled feeding. What should be done next by the nurse?
A. Continue to advance feeds according to existing orders.
B. Continue to feed as scheduled, but hold off on ordered increase in formula volume
C. Hold off on giving scheduled feedings until the infant can be examined further
D. Change the infant's formula type with the next feeding to decrease likelihood of vomiting.
C. Hold off on giving scheduled feedings until the infant can be examined further
R: You should not advance feeds, change formula, or continue to feed after emesis that is a new event.
A teenager with progressive glomerulonephritis and resultant renal failure develops muscle cramps, agitation, shortness of breath, and tingling sensations in his extremities. Which of the following is the most likely cause:
A. Hypocalcemia
B. Hypokalemia
C. Panic attack
D. Hypoglycemia
A. Hypocalcemia
R: Hypocalcemia causes tetany, tingling, and altered mental status. Hypokalemia does not cause altered mental status. Hypoglycemia does not cause muscle cramps or tingling.
A 15 yo who has Guillain-Barre develops progressive shortness of breath. Which of the following intervention is the most appropriate?
A. Transcutaneous cardiac pacing
B. Nebulized bronchodilator administration
C. IM Epinephrine administration
D. Endotracheal intubation
D. Endotracheal intubation
R: Ascending parathesis is progressing and will lead to respiratory failure.
Which of the following signs indicates right-sided heart failure?
A. Decreased central venous pressure
B. Pulmonary edema
C. Enlarged left ventricle on chest x-ray
D. Hepatomegaly
D. Hepatomegaly
R: Right sided heart failure will cause a back up of blood to the liver.
A 9 yo is admitted for observation after smoke inhalation in a house fire. Assessment reveals an awake patient with a hoarse voice and inspiratory stridor who is anxious. RR 40, O2 sat 97% on room air. Which of the following is most appropriate?
A. Racemic epinephrine & corticosteroids
B. Portable Chest X-ray
C. Intubation
D. Anxiolytic medication
C. Intubation
R: With inhalation injury, early intubation is needed if upper airway patency is in danger as the injury will likely progress.
A 2 week old previously healthy infant presents with vomiting & lethargy. He refused a feeding and was fussy. Soon after he had several episodes of forceful bilious emesis. Temp 37C, HR 190, RR 60, BP 80/45, O2 sats 97% on RA. Infant has mildly distended abdomen with decreased bowel sounds & diffuse tenderness. Which of the following is most appropriate?
A. Prepare for abdominal ultrasound to evaluate for hypertrophic pyloric stenosis.
B. Place infant on supplemental O2 and gather supplies for intubation.
C. Prepare to place a NG tube and obtain IV access for fluid resuscitation
D. Begin oral rehydration therapy with an appropriate electrolyte solution
C. Prepare to place a NG tube and obtain IV access for fluid resuscitation
R: Tachycardia and emesis suggestion dehydration so fluid resuscitation is needed while awaiting evaluation. Intubation is not indicated.
You are caring for a 10 yo patient who sustained an accidental crush injury and has developed renal failure secondary to severe rhabdomyolysis. As his condition worsens, the team prepares to start continuous renal replacement therapy (CRRT). All of the following statements are true EXCEPT:
A. CRRT allows for less dramatic fluid shifts in the hemodynamically unstable patient
B. There is less need for anticoagulation therapy with CRRT than with other dialysis methods
C. Young small patients are at higher risk for hypothermia with CRRT than with other dialysis methods
D. CRRT allows for improved nutritional support in the critically ill patient since by-products of a protein-containing diet can be cleared continuously.
B. There is less need for anticoagulation therapy with CRRT than with other dialysis methods.
R: Anticoagulation is needed to prevent clotting in the CRRT circuit.
A 12 yo boy getting PT after a severe MVC during which he suffered an upper thoracic spinal cord injury. During PT his left patella is momentarily dislocated, but quickly returns to a normal position. Immediately afterward, he complains of a headache and blurry vision. His BP is 170-100 and HR 54. He is anxious with flushed skin and diaphoresis visible on his face, neck, and shoulders. The most likely explanation is:
A. Acute fat embolus secondary to his knee injury
B. Pheochromocytoma
C. Autonomic Dysreflexia secondary to the spinal cord injury
D. Anxiety
C. Autonomic Dysreflexia secondary to the spinal cord injury
R: Spinal cord injury, hypertension, flushed skin & diaphroesis (vasodilation)
Which of the following statements regarding the use of inotropic agents in the critically ill pediatric patient is the most accurate?
A. Inotropic agents should be initiated before fluid resuscitation in patients with hypovolemic shock.
B. Dobutamine infusion in contraindicated in patients with cardiogenic shock.
C. Milrinone administration requires less invasive monitoring than other inotropic agents.
D. Inotropic agents such as dopamine & norepinephrine, with vasoconstrictive effects may be indicated in patients with septic shock
D. Inotropic agents such as dopamine & norepinephrine, with vasoconstrictive effects may be indicated in patients with septic shock
R: This is true. The other answers are incorrect.
A 3 yo child is in the ICU after an accidental near-strangulation on a window blinds cord. On arrival, the patient is alert without any signs of respiratory distress. 45 minutes later, the patient is agitated, tachypneic, and hypoxic. She is emergently intubated and has frothy pink secretions. The nurses suspects the patient has developed:
A. Anaphylaxis
B. Elevated ICP secondary to hypoxia
C. Congestive heart failure
D. Post-obstructive pulmonary edema
D. Post-obstructive pulmonary edema
R: Non-cardiogenic pulmonary edema can occur after an episode of acute airway obstruction. Forceful attempts to inhale against an obstruction create highly negative intrathoracic pressure, which causes increased venous return, decreased cardiac output and fluid transudation into the alveolar space.
In caring for a patient with fulminant hepatic failure, the nurse anticipates all of the following clinical features EXCEPT:
A. coagulopathy requiring Vitamin K
B. hyperglycemia requiring Insulin
C. altered mental status
D. jaundice
B. hyperglycemia requiring Insulin
R: Hyperglycemia is not associated with Fulminant hepatitis.
The most accurate statement about acute renal failure is which of the following?
A. Nephrotoxic drugs do not contribute to acute tubular necrosis.
B. Prerenal failure occurs secondary to inadequate renal perfusion
C. Prerenal failure is irreversible even when recognized and treated early
D. Acute renal failure is always associated with poor urine output
B. Prerenal failure occurs secondary to inadequate renal perfusion.
R: A is false. Prerenal failure is reversible. You can still have adequate UOP in acute renal failure. UOP is determined not by the GFR alone, but also by the difference between the GFR and the rate of tubular reabsorption.
A 10 yo girl is sedated in the ICU after resection of a pituitary tumor 24 hours ago. She develops increasing UOP, tachycardia, and worsening peripheral perfusion. Lab results show Na 150, Urine Osms 160, Urine Spec Grav 1.002, & Serum Osm 325. The most likely explanation is:
A. Excessive sodium administration in the postoperative period
B. Diabetes insipidus
C. Diabetes mellitus
D. Chronic renal disease, complicating the postoperative course.
B. Diabetes insipidus
R: hypernatremia, elevated serum osmolality, increasing UOP
Which of the following statements about anti-arrhythmic medications is most accurate?
A. All anti-arrhythmic medications work by prolonging repolarization time
B. Adenosine is the treatment of choice in Wolff-Parkinson-White syndrome
C. Calcium-channel blockers are the treatment of choice for ventricular arrhythmias
D. A common complication of anti-arrhythmic medications is cardiac arrhythmias
D. A common complication of anti-arrhythmic medications is cardiac arrhythmias
R: Calcium channel blockers are used for reentry SVT, ablation is the treatment for WPW, and answer A is false (lidocaine increases stimulation threshold).
A patient with status asthmaticus is intubated for respiratory failure. Which of the following statements is true?
A. Airway obstruction and air trapping leads to greater risk of barotrauma with mechanical ventilation.
B. Asthmatic patients benefit from shortened exhalation times
C. Pulmonary air trapping leads to increased venous return to the heart and increased cardiac output
D. Asthmatic patients usually benefit from higher than normal respiratory rates.
A. Airway obstruction and air trapping leads to greater risk of barotrauma with mechanical ventilation.
R: Asthma patients need prolonged expiratory times, air trapping decreases venous return, slower rates are needed to allow for prolonged expiration.
You are caring for a 9 year old restrained passenger s/p MVC with sudden onset of abdominal pain. On assessment his abdomen is distended and tender. You suspect the patient could have:
A. Intussusception
B. Meconium ileus
C. Bowel perforation
D. Volvulus
C. Bowel perforation
R: Bowel perforation can result from abdominal trauma and presents with sudden onset of abdominal pain and tenderness.
A 4 yo is admitted with dehydration d/t gastrointestinal illness. 5 days ago she developed vomiting and diarrhea. After 1 day the diarrhea became bloody. She has not urinated in 24 hours and is irritable, pale, tachycardic, and mildly hypertensive. Labs are: WBC 18,000 Hgb 8, Plt 54,000, Na 135, K 6.0, Cl 97, HCO3 15, BUN 48, Cr 1.7. The patient's most likely condition is:
A. Irritable bowel syndrome
B. Intussusception
C. Hemolytic Uremic Syndrome
D. Ureteral obstruction d/t nephrolithiasis
C. Hemolytic Uremic Syndrome
R: Bloody diarrhea, mild to moderate hypertension, decreased UOP, elevated WBC (NML 4500-11000) and low platelet count (NML 150,000-450,000) indicate HUS.