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A nurse is caring for a child diagnosed with asthma. Which of the following best describes the underlying pathophysiology of an acute asthma exacerbation?
A. Collapse of alveoli leading to impaired oxygen exchange
B. Inflammation and narrowing of the airways with increased mucus production
C. Accumulation of fluid in the alveolar spaces
D. Infection of the bronchioles causing mucosal sloughing
Correct Answer: B
Which dietary recommendation should the nurse include in the plan of care for a school-aged child with cystic fibrosis?
A. Low-calorie, low-fat diet
B. High-protein, high-calorie diet with vitamin supplementation
C. High-fiber, high-sodium diet with calcium restriction
D. Fluid restriction and carbohydrate loading
Correct Answer: B. High-protein, high-calorie diet with vitamin supplementation
A nurse is caring for a 5-year-old child who just returned from a cardiac catheterization via the right femoral artery. Which of the following actions should the nurse take first?
A. Encourage fluid intake to flush the contrast dye
B. Check the child’s pedal pulses bilaterally
C. Elevate the head of the bed to semi-Fowler’s
D. Administer pain medication as prescribed
Correct Answer: B. Check the child’s pedal pulses bilaterally
Which diagnostic test is most definitive in confirming the diagnosis of patent ductus arteriosus (PDA)?
A. Chest X-ray
B. Echocardiogram
C. Electrocardiogram (ECG)
D. Pulse oximetry
Answer: B. Echocardiogram
Which of the following is the most important initial nursing intervention for a newborn diagnosed with transposition of the great vessels (TGV)?
A. Administer high-flow oxygen therapy continuously
B. Prepare the infant for prostaglandin E1 infusion to maintain ductus arteriosus patency
C. Begin antibiotics to prevent endocarditis
D. Encourage frequent feedings to improve oxygenation
Answer:
B. Prepare the infant for prostaglandin E1 infusion to maintain ductus arteriosus patency
A school-aged child with exercise-induced bronchospasm is beginning a new physical education class. What instruction should the nurse provide?
A. Avoid all strenuous activity to prevent symptoms
B. Take a dose of long-acting corticosteroid 1 hour before exercise
C. Use a short-acting bronchodilator 15 minutes before activity
D. Eat a high-protein snack immediately before exercising
Correct Answer: C
A nurse is assessing a child with known cystic fibrosis who is being admitted for a pulmonary exacerbation. Which of the following findings should the nurse expect?
Select all that apply.
A. Barrel-shaped chest
B. Bulky, foul-smelling stools
C. Decreased breath sounds
D. Clubbing of the fingers
E. Hyperactive bowel sounds
F. Weight gain despite poor appetite
Correct Answers: A, B, C, D
Which of the following best describes an interventional cardiac catheterization procedure?
A. It is used to obtain tissue samples from the myocardium
B. It provides visual images of coronary artery anatomy
C. It is used to treat defects such as stenotic valves via balloon dilation
D. It is used to evaluate the electrical conduction system of the heart
Correct Answer: C. It is used to treat defects such as stenotic valves via balloon dilation
Which medication is commonly used to promote closure of a patent ductus arteriosus in premature infants?
A. Prostaglandin E1
B. Indomethacin
C. Digoxin
D. Furosemide
Answer: B. Indomethacin
A child with heart failure is prescribed a diuretic. Which electrolyte imbalance is the nurse most concerned about monitoring?
A. Hyperkalemia
B. Hypokalemia
C. Hypercalcemia
D. Hypomagnesemia
Answer: B. Hypokalemia
During assessment, a nurse notes a "silent chest" in a child with severe asthma. What is the most appropriate interpretation of this finding?
A. The child is improving
B. The airway obstruction is severe
C. The child has a foreign body obstruction
D. Lung sounds are normal in asthma
Correct Answer: B
The nurse is caring for a 6-year-old child who is 2 hours post-tonsillectomy. Which of the following findings requires immediate intervention?
A. The child is frequently swallowing
B. The child is drowsy but arousable
C. The child refuses to drink fluids
D. The child has a low-grade fever
Correct Answer: A. The child is frequently swallowing
A child with heart failure is receiving digoxin. Which finding indicates the nurse should hold the medication and notify the healthcare provider?
A. Serum digoxin level of 1.2 ng/mL
B. Heart rate of 58 beats per minute
C. Mild nausea after medication administration
D. Apical pulse of 95 beats per minute
Answer: B. Heart rate of 58 beats per minute
A nurse is assessing a school-age child with suspected coarctation of the aorta. Which finding would most likely support this diagnosis?
A. Equal blood pressure in all four extremities
B. Bounding pulses in the lower extremities
C. Weak or absent pulses in the lower extremities
D. Loud diastolic murmur heard at the apex
Answer: C. Weak or absent pulses in the lower extremities
An infant with heart failure is showing signs of fluid overload. Which of the following is the most important nursing intervention?
A. Restrict all fluids completely
B. Monitor daily weight and intake/output closely
C. Encourage the infant to drink more fluids
D. Increase sodium in the diet to maintain blood pressure
Answer: B. Monitor daily weight and intake/output closely
A 6-month-old infant is suspected of having cystic fibrosis. Which diagnostic test result is most indicative of this disease?
A. Positive stool culture for Pseudomonas aeruginosa
B. Elevated serum lipase and amylase
C. Sweat chloride concentration of 65 mEq/L
D. Blood glucose level of 120 mg/dL
Correct Answer: C. Sweat chloride concentration of 65 mEq/L
A nurse is teaching the parents of a child scheduled for a tonsillectomy. Which of the following instructions should the nurse include in the discharge teaching?
Select all that apply.
A. Offer ice chips and clear, cool fluids.
B. Encourage frequent coughing to clear the throat.
C. Avoid red-colored liquids postoperatively.
D. Monitor for signs of bleeding such as frequent swallowing.
E. Give aspirin for pain relief.
F. Avoid straws and suctioning near the throat.
Correct Answers: A, C, D, F
Which statement by the parent indicates understanding of digoxin administration for their child?
A. "I will give the medicine with food to avoid an upset stomach."
B. "I will count my child’s heart rate for one full minute before giving digoxin."
C. "If my child vomits after taking digoxin, I will give another dose."
D. "I do not need to keep track of the number of doses I give daily."
Answer: B. "I will count my child’s heart rate for one full minute before giving digoxin."
A nurse notes rib notching on a chest X-ray of a child with suspected coarctation of the aorta. What is the best explanation for this finding?
A. Rib fractures due to trauma
B. Enlargement of collateral arteries eroding the ribs
C. Osteoporosis from chronic illness
D. Normal anatomical variation
Answer: B. Enlargement of collateral arteries eroding the ribs
The nurse educates the parents of a child with heart failure about feeding techniques. Which statement indicates a need for further teaching?
A. "I will feed my baby small amounts frequently."
B. "I will allow my baby to rest between feeding."
C. "I will make sure to keep the baby lying flat during feedings."
D. "I will burp my baby often to prevent discomfort."
Answer: C. "I will make sure to keep the baby lying flat during feedings."
Which nursing intervention is most important to maintain airway patency in a child with cystic fibrosis?
A. Encouraging the child to drink milk with each meal
B. Performing chest physiotherapy several times daily
C. Administering antiemetics before meals
D. Limiting physical activity to conserve energy
Correct Answer: B. Performing chest physiotherapy several times daily
During auscultation, the nurse notes coarse crackles in both lower lobes of a client admitted with fever, chills, and productive cough. Which condition does this most likely suggest?
A. Asthma
B. Cystic fibrosis
C. Pneumonia
D. Pleural effusion
Correct Answer: C. Pneumonia
An infant diagnosed with patent ductus arteriosus (PDA) is being assessed by the nurse. Which clinical finding would the nurse expect to observe?
A. Decreased peripheral pulses and narrow pulse pressure
B. Harsh, continuous machine-like murmur heard best under the left clavicle
C. Cyanosis and cool extremities
D. Bradycardia and hypotension
Answer: B. Harsh, continuous machine-like murmur heard best under the left clavicle
When comparing blood pressure measurements in a child with coarctation of the aorta, the nurse expects to find:
A. Blood pressure higher in the lower extremities than upper extremities
B. Blood pressure equal in all four extremities
C. Blood pressure higher in the upper extremities than in the lower extremities
D. Blood pressure consistently low in all extremities
Answer: C. Blood pressure higher in the upper extremities than in the lower extremities
A 4-year-old child is admitted with a diagnosis of bacterial pneumonia. Which assessment finding would most concern the nurse?
A. Respiratory rate of 36 breaths/min
B. Oxygen saturation of 91% on room air
C. Nasal flaring and intercostal retractions
D. Rhonchi heard in bilateral lung fields
Correct Answer: C. Nasal flaring and intercostal retractions