Priority/Delegation
Which patient should the registered nurse see first?
a. a child who had diarrhea three times in a day and is refusing to drink water
b. a child who has non productive cough, his temperature is 37
c. a child who has red and swollen eyes
d. a child who is breastfed and has some rash on the face
ANSWER : A
Baby is dehydrated and can have imbalanced fluid and electrolyte. this is the most urgent situation in these four cases. b. child's temperature is still normal, do not need immediate attention. c, red and swollen eyes, could be due to allergies or bacterial infection. its not an emergency. d. a child who is breastfed can develop rash on the face potentially due to transfer of hormone in the milk, its often not worried about.
When asked by nurse about immunizations, a mother of 2 month old states that “I don’t want to give my baby immunizations because I read on google that there is a link between immunization vaccine and autism”. How should you as the nurse respond?
a) “If you don’t give your baby their immunizations, they will get sick.”
b) “Okay, that is fine. I will see you at your next appointment.”
c) “I hear you saying that you are scared of the risk with immunizations, tell me more about your concerns.”
d) “There is a multitude of studies that have researched this linkage and have concluded that there is no linkage with immunization vaccine and autism. So I will get the immunization shots ready.”
ANSWER: C
– Addressing mothers fears, educate her about the benefits of immunizations.
According to safe medication administration principles, which of the following statements is most correct?
a) It is acceptable to administer medication prepared by another nurse as long as you double-check that the dosage is correct
b) It is acceptable to administer medication prepared by another nurse when there are time constraints
c) The nurse can administer medication prepared by another nurse because it promotes teamwork
d) The nurse should only administer medication that was prepared by him/herself
ANSWER: D
upholds safe medication practice and reduces risk of errors
While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised?
a) Sucking ability
b) Respiratory status
c) Locomotion
d) GI function
ANSWER : A
Because of the defect, the child will be unable to from the mouth adequately around nipple, thereby requiring special devices to allow for feeding and sucking gratification. Respiratory status may be compromised if the child is fed improperly or during postoperative period, Locomotion would be a problem for the older infant because of the use of restraints. GI functioning is not compromised in the child with a cleft lip.
A toddler's parents ask the nurse how long their child needs to use a front facing car seat. The nurse would answer:
A) Your child must be at least 5 years old.
b) Your child should use the car seat with a harness until he weighs 48 pounds.
c) Your child should be at least 3 years.
d) The child is mature enough to sit without a front facing seat.
ANSWER: B
Must use a front facing car seat with a harness until the maximum time possible that the child weighs 22 kg/48 pounds
The nurse on a pediatric unit has received the a.m shift report and tells the UAP to keep the 2-year old child NPO for a procedure. At 0830, the nurse observes the mother feeding the child. Which action should the nurse implement first?
A) Determine what the UAP did not understand about the instruction
B) Tell the HCP the UAP did not follow the nurse’s instruction
C) Ask the mother why she was feeding her child who was NPO
D) Notify the dietary department to hold the child’s meal trays
Answer: A - Communication to the UAP must be clear, concise, correct, and complete. The nurse must determine why there was a lack of communication, which resulted in the child receiving food: therefore, this action should be implemented first
You had administered a 12-month old her first dosage of the varicella vaccine. Her mother asks you when her next dosage of the varicella (chickenpox) vaccine should be. You answer that it should be given:
A) When she turns 18-months old
B) Anytime when she is between 4-6 years old
C) When she turns 18 months and anytime after
D) Anytime at 18 months and after, but before entering school
ANSWER: D
Rationale: The first dosage of the varicella vaccine is at 12-15 months of age; the second dosage is at 18 months of age or anytime thereafter, but should be given no later than around school entry
A 6-year-old child weighs 30.8 lb. She is to be given a drug of 2mg/kg. The stocked medication is 4mg/ mL. What is volume in mL of the drug should be given?
a) 123.2 mL
b) 24 mL
c) 7 mL
d) 4 mL
ANSWER : C
SOLUTION:
Convert lbs à kg
· 30.8 lbs / 2.2 lbs/kg = 14 kg
Order dosage
· 14kg X 2mg/kg = 28 mg
DO/ DH = V
· 28mg / 4mg = 7 mL
When assessing an 18-month-old, the nurse notes a characteristic protruding abdomen. Which of the following would explain the rationale for this finding?
a) Increased food intake owing to age
b) Underdeveloped abdominal muscles
c) Bowlegged posture
d) Linear growth curve
ANSWER B:
Underdeveloped abdominal musculature gives the toddler a characteristically protruding abdomen. During toddlerhood, food intake decreases, not increases. Toddlers are characteristically bowlegged because the leg muscles must bear the weight of the relatively large trunk. Toddler growth patterns occur in a step like, not linear pattern
1. Which of the following statement is false?
a) Fine motor skills include picking up small objects and writing with a marker.
b) An 18-month old who is unable to form 2-3 word phrases requires close follow-up.
c) Starting to read to children at a young age has a positive impact on their cognitive development.
d) It is during the 18-month to 2 year period where infants start to develop their own gender identity.
ANSWER : B
At 18-months old, it is expected that they only have a few words within their vocabulary. It is by their 2nd year where they are able to string together 2-3 word phrases
You are a nurse on a very busy pediatric unit – there are several patients who require your attention. Which situation requires immediate attention from you?
A) A 9-month old with yellow nasal mucous and a fever of 101 F (38.3 C) who is crying loudly
B) A 13 year old who was injured while playing football the previous day and now cannot bear weight on her foot due to severe pain
C) A 9 year old who got hit in the head with a baseball bat, exhibiting a bruise on his left eye and clear nasal discharge
D) A 5 year old who started wetting the bed
ANSWER C
Bruising behind the ear following a head injury can be referred to as Battle Sign. A battle sign is indicative of a bassilar skull fracture. The clear fluid that is leaking out of the child’s nose may be cerebral spinal fluid (CSF) leaking, which indicates the severity of the head injury and the amount of damage that the brain may have sustained.
A parent comes in to the pediatric clinic with their 3-year-old child, who has a constant bark-like cough, is drooling, has a persistent runny nose, and appears to be unwell. The child is running around the waiting area, playing with multiple toys with close interaction with other children. What action should the nurse manager take?
a) Allow the child to continue playing as usual
b) Encourage interactions between the 3-year-old child and other young children
c) Tell the parent that running is not permitted in the waiting area and that they should stop their child from running around
d) Kindly ask the parent to have their child sit and wait with them, rather than playing with all the toys and children in the waiting room, in order to prevent the spread of infection
ANSWER :D
The child is exhibiting signs of a potential respiratory infection, and should therefore have minimal contact with other children in order to reduce the spread of infection to other patients of the clinic.
Doctor orders Zofran 2 mg for a child that weighs 13.6 kg. The safe dosage range of this drug is 0.15 mg/kg. Is this a safe dose?*
A) No, this is not a safe dose. A safe dose would be 1.02 mg/dose.
B) Yes, this is a safe dose
C) No, this is not a safe dose. A safe dose would be 0.5 mg/dose
ANSWER : B
The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child’s skin?
A) Fine grayish red lines
B) Purple-colored lesions
C) Thick, honey-colored crusts
D) Clusters of fluid-filled vesicles
ANSWER: A
Rationale: Scabies is a parasitic skin disorder caused by an infestation of Sarcoptes scabiei (itch mite). Scabies appears as burrows or fine, grayish red, threadlike lines. They may be difficult to see if they are obscured by excoriation and inflammation. Purple-colored lesions may indicate various disorders, including systemic conditions. Thick, honey-colored crusts are characteristic of impetigo or secondary infection in eczema. Clusters of fluid-filled vesicles are seen in herpesvirus infection
Parents of an eight month child come to the community clinic asking the pediatric nurse how many teeth their baby should have. Which information should the nurse provide:
a) At this age, babies may have up to four teeth.
b) Your baby is not expected to have teeth until one year of age.
c) At this age, babies should have 8-12 teeth
d) All babies are different
ANSWER: A
Central incisors (front teeth) usually erupt between 6 to 12 months of age. Lower incisors comes before upper incisors.
Which patient should the nurse manager assign to an RN for immediate attention?
a) A 2 month old with pneumonia, who presents with chest retractions when breathing and a respiratory rate of 65
b) A 13 year old who sustained an ankle fracture from a skateboarding accident
c) A 48 hour old newborn with jaundice and a bilirubin level of 13 mg/dL
d) A 16 year old with anorexia who drinks bottles of Ensure every meal and avoids regular food
ANSWER: A
a) Chest retractions and a higher than normal respiratory rate is indicative of respiratory distress, which requires immediate intervention/care from an RN with expertise.
During a scheduled appointment for a 2-month old baby to receive their Tetanus, Diphtheria, and Pertussis vaccination, the child’s mother states “Once my baby receives this vaccination today, she will be completely immune to all these diseases for the rest of her life”. What is the best response by the registered nurse?
a) Yes, that is correct. You have really done your research!
b) Actually, you child will need a TDaP booster vaccine in 10 years to ensure she continues to have immunity.
c) You will need to bring your child back to receive booster TDaP vaccines at 4-months old, 6-months old, 18-months old, 4-6 years old and at 11-12 years old to maintain immunity against these diseases.
d) Where did you read that from? Clearly you have been getting your information from non-reputable internet websites.
ANSWER: C
Babies require 3 TDaP injections (at 2 month, 4 months, and 6 months old) in order to build up high levels of protection against Tetanus, Diphtheria, and Pertussis. Children then need 3 additional TDaP booster shots (at 18 months, 4-6 years, and 11-12 years old) to maintain their protection. In terms of adults, they should be receiving TD boosters every 10 years.
Doctor orders an IV drip of Dopamine for a child that weighs 78 lbs. The safe dosage range for this medication is 5-20 mcg/kg/min. What is the safe dosage range for this child?
A. 177.3-709.1 mcg/min
B. 289.6-652.3 mcg/min
C. 152.4-189.5 mcg/min
D. 250-350 mcg/min
ANSWER: A
177.3-709.1 mcg/min
While performing a neurodevelopmental assessment on a 3-month-old infant, which of the following characteristics would be expected?
a) A strong Moro reflex
b) A strong parachute reflex
c) Rolling from front to back
d) Lifting of head and chest when prone
ANSWER: D
A 3-month-old infant should be able to lift the head and chest when prone. The Moro reflex typically diminishes or subsides by 3 months. The parachute reflex appears at 9 months. Rolling from front to back usually is accomplished at about 5 months.
Which of the following is not a characteristic of infants that are born small-for-gestational-age?
a) Decreased muscle mass and subcutaneous fat tissue
b) Weight that is less than the 10th percentile for gestational age
c) At risk for hypoglycemia and polycythemia
d) Lose behavioral characteristics, such as alertness, that normal-sized infants demonstrate, due to their small size
ANSWER: D
Infants born small for gestational age maintain behavioural characteristics such as alertness.
Which responsibilities can the RN delegate to a UAP / PSW? SATA
a) Breastfeeding education & techniques to new parents
b) Transporting a client to another unit in the hospital for an MRI
c) Restarting a client’s IV infusion pump that was alarming
d) Restocking isolation gowns and gloves outside of patient rooms
ANSWER: b & d
a) Health teaching regarding breastfeeding should be done by an RN, not a UAP
b) UAPs are able to transport clients
c) PSWs are not trained or authorized to use IV pumps
d) PSWs are allowed to restock supplies
You are a nurse working in a paediatric clinic which provides toys for the children in the waiting room. What principles should you apply that might relate to the supply and maintenance of the toys? SATA
A) Only provide toys that are made of washable material
B) Have shareable items that reduce risk for conflict
C) Building toy sets are recommended in order to stimulate the creativity and imagination of the children
D) Establish a schedule for regular inspection of the toys
E) Create a separate area for used toys to be placed after use
ANSWERS: A, D, E
A) Only provide toys that are made of washable material- Regular cleaning and disinfecting is recommended so nonporous, hard toys are best
B) Have shareable items that reduce risk for conflict-toys should not be shared so as to reduce the transmission of pathogens
C) Building toy sets are recommended in order to stimulate the creativity and imagination of the children- Building set toys often contain loose, detachable pieces that pose a risk for choking for the children. In addition, it is more difficult to clean up each individual piece and thus increases the risk for infection transmission
D) Establish a schedule for regular inspection of the toys- Toys should be inspected after use and at least weekly for any damage that could compromise safety such as loose parts that could be swallowed or cracks that could make cleaning difficult
E) Create a separate area for used toys to be placed after use- Toys are given a designated space to avoid clutter-related hazards and to facilitate infection control
A child weighs 52 lbs. The child has a fever and the doctor orders Tylenol. The safe dose range of this medication is 10-15 mg/kg every 6 hours. What is the maximum safe dose this child can have per day?
ANSWER : 1,418 mg/day
The nurse is monitoring a child with burns during treatment for burn shock. Which assessment provides the most accurate guide to determine the adequacy of fluid resuscitation?
A) Skin turgor
B) Level of edema at burn site
C) Adequacy of capillary filling
D) Amount of fluid tolerated in 24 hours
ANSWER: C
Parameters such as vital signs (especially heart rate), urinary output volume, adequacy of capillary filling, and state of sensorium determine adequacy of fluid resuscitation. Although options A, B , and D may provide some information related to fluid volume, in a burn injury, and from the options provided, adequacy of capillary filling is most accurate.
A maternity nurse is providing instruction to a new mother regarding the psychosocial development of the newborn infant. Using Erikson's psychosocial development theory, the nurse would instruct the mother to
A) Allow the newborn infant to signal a need
B) Anticipate all of the needs of the newborn infant
C) Avoid the newborn infant during the first 10 minutes of crying
D) Attend to the newborn infant immediately when crying
ANSWER: A
Allow the newborn infant to signal a need. Trust vs Mistrust stage-This will allow the infant opportunity to gain trust.