Pediatric Physical ExamP a g e | 1
Pediatric Physical Pediatric Physical
Examination & Health Assessment 1st Edition
by Sawyer Test Banknation & Health
Assessment 1st Edition by Sawyer Test
Bankination & Health Assessment 1st Edition
by Sawyer Test Bank
Which of the following is a daily practice that should be a part of the bundle to reduce the incidence of
central line-associated bloodstream infections?
A) Review of antibiotics
B) Replacement of the infusion tubing
C) Replacement of the catheter
D) Review of catheter necessity –
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, Pediatric Physical ExamP a g e | 2
Correct AnswerAnswer: D) Review of catheter necessity: The Institute for Healthcare Improvement's
Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter
insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin
antisepsis for children older than 2 months of age, along with a daily review of the line necessity. The
consideration of catheter removal should be documented daily in the medical record. Unnecessary
catheters should be removed promptly.
A) Review of antibiotics: while it is important to review the patient's medication list daily, the Institute
for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter
and dressing the catheter insertion site, the use of maximal barrier precautions during catheter
insertion, chlorhexidine skin antisepsis for children older than 2 months of age, along with a daily
review of the line necessity.
B) Replacement of the infusion tubing: Daily replacement of infusion tubing is not a listed practice in
the Institute for healthcare Improvement's Central Line Bundle
C) Replacement of the catheter: Central venous catheters should not be replaced daily.
A patient with end-stage pituitary adenoma is in the ICU being treated for aspiration pneumonia and
diabetes insipidus. Despite knowing a plan for transpyloric tube feedings and nothing by mouth the
mother is giving water and soft drinks to the patient. What is the nurse's best response to this
situation?
A) Ask the resident physician to change the diet order to include oral fluids.
B) Notify the social worker that the mother is interfering with the medical plan.
C) Ask the mother to explain why she is giving fluids to her son
D) Ask security to restrict the mother's ability to visit the ICU –
Correct AnswerAnswer: C) Ask the mother to explain why she is giving fluids to her son: The nurse
needs to understand the reasons for the mother's behavior before the nurse can advocate for the
child's needs and the mother's goals for her son's care.
A) Ask the resident physician to change the diet order to include oral fluids: A change in diet order may
put the patient at risk for further aspiration and does not address the mother's concerns or care goals
for her child.
B) Notify the social worker that the mother is interfering with the medical plan: While the social worker
may be able to help the mother identify personal resources, the nurse should first determine the
mother's reasons for not following the medical plan and then help her articulate her goals for her son's
care.
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, Pediatric Physical ExamP a g e | 3
D) Ask security to restrict the mother's ability to visit the ICU: Removing the mother from the unit
does not address the mother's concerns or goals for her son's care and may create an adversarial
relationship between the mother and the hospital staff.
A 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated
that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In
order to determine the discharge needs of the patient, the nurse should arrange for:
A) Home nursing care for the first few days following discharge
B) A social worker to meet with the family and assess adequacy of the home environment
C) An outreach educator to determine the learning needs of the family
D) A multidisciplinary care conference before discharge
- Correct AnswerAnswer: B) A social worker to meet with the family and assess adequacy of the home
environment: The first predischarge priority for a technology-dependent child is to assess the
adequacy of the home environemtn. Further discharge planning is then based on the needs of the
patient and family.
A) Home nursing care for the first few days following discharge: While home nursing care may be
needed after discharge, the first predischarge priority in this scenario is to evaluate the home
environment. From there, a determination can be made about nursing care that will be needed at
home. The home may not be adequate for a safe transition for the infant.
C) An outreach educator to determine the learning needs of the family: Education may be necessary
before discharging a technology-dependent child, but that cannot be determined without further
information about the patient's home environment and family needs.
D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking.
Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to
prepare to meet the complex needs of the child at home.
A child with a myelomeningocele is started on a bowel management plan. the nurse would recognize
that more education is needed when the mother states, "My child:
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, Pediatric Physical ExamP a g e | 4
A) tends to be more prone to diarrhea."
B) will be unable to control his bowel movements."
C) will require more activity to increase bowel movements."
D) needs to have a bowel movement every day." –
Correct AnswerAnswer: A) tends to be more prone to diarrhea.": With Facilitation of Learning the
nurse recognizes this mother does not yet understand that patients with a myelomeningocele are
prone to constipation and impaction, rather than diarrhea. Additional education is needed to help the
mother understand the bowel management plan.
B) will be unable to control his bowel movements.": This statement is correct and would demonstrate
that the mother understands the necessity of the bowel management plan.
C) will require more activity to increase bowel movements.": This statement is correct and would
demonstrate that the mother understands the necessity of the bowel management plan.
D) needs to have a bowel movement every day.": This statement is correct and would demonstrate
that the mother understands the necessity of the bowel management plan.
A newborn is admitted with transposition of the great arteries. The SpO2 equals 46%. No murmur is
heard. Until a balloon septostomy can be performed, which of the following medications should the
nurse anticipate being administered as a temporary measure?
A) Alprostadil (PGE1)
B) Tolazoline (Priscoline)
C) Indomethacin (Indocin)
D) Digoxin (Lanoxin) –
Correct AnswerAnswer: A) Alprostadil (PGE1): The initial management of the patient with transposition
of the great arteries involves maintaining adequate arterial oxygen saturation via intercirculatory
mixing of blood Until a balloon septostomy can be performed, alprostadil (PGE1) infusion is used to
maintain patency of the ductus arteriosus. Additionally, it lowers pulmonary and systemic vascular
resistance.
B) Tolazoline (Priscoline): Tolazoline (Priscoline) is a vasodilator and is indicated for the treatment of
persistent pulmonary hypertension of the newbon.
P a g e 4 | 291
Pediatric Physical Pediatric Physical
Examination & Health Assessment 1st Edition
by Sawyer Test Banknation & Health
Assessment 1st Edition by Sawyer Test
Bankination & Health Assessment 1st Edition
by Sawyer Test Bank
Which of the following is a daily practice that should be a part of the bundle to reduce the incidence of
central line-associated bloodstream infections?
A) Review of antibiotics
B) Replacement of the infusion tubing
C) Replacement of the catheter
D) Review of catheter necessity –
P a g e 1 | 291
, Pediatric Physical ExamP a g e | 2
Correct AnswerAnswer: D) Review of catheter necessity: The Institute for Healthcare Improvement's
Central Line Bundle includes hand hygiene before inserting the catheter and dressing the catheter
insertion site, the use of maximal barrier precautions during catheter insertion, chlorhexidine skin
antisepsis for children older than 2 months of age, along with a daily review of the line necessity. The
consideration of catheter removal should be documented daily in the medical record. Unnecessary
catheters should be removed promptly.
A) Review of antibiotics: while it is important to review the patient's medication list daily, the Institute
for Healthcare Improvement's Central Line Bundle includes hand hygiene before inserting the catheter
and dressing the catheter insertion site, the use of maximal barrier precautions during catheter
insertion, chlorhexidine skin antisepsis for children older than 2 months of age, along with a daily
review of the line necessity.
B) Replacement of the infusion tubing: Daily replacement of infusion tubing is not a listed practice in
the Institute for healthcare Improvement's Central Line Bundle
C) Replacement of the catheter: Central venous catheters should not be replaced daily.
A patient with end-stage pituitary adenoma is in the ICU being treated for aspiration pneumonia and
diabetes insipidus. Despite knowing a plan for transpyloric tube feedings and nothing by mouth the
mother is giving water and soft drinks to the patient. What is the nurse's best response to this
situation?
A) Ask the resident physician to change the diet order to include oral fluids.
B) Notify the social worker that the mother is interfering with the medical plan.
C) Ask the mother to explain why she is giving fluids to her son
D) Ask security to restrict the mother's ability to visit the ICU –
Correct AnswerAnswer: C) Ask the mother to explain why she is giving fluids to her son: The nurse
needs to understand the reasons for the mother's behavior before the nurse can advocate for the
child's needs and the mother's goals for her son's care.
A) Ask the resident physician to change the diet order to include oral fluids: A change in diet order may
put the patient at risk for further aspiration and does not address the mother's concerns or care goals
for her child.
B) Notify the social worker that the mother is interfering with the medical plan: While the social worker
may be able to help the mother identify personal resources, the nurse should first determine the
mother's reasons for not following the medical plan and then help her articulate her goals for her son's
care.
P a g e 2 | 291
, Pediatric Physical ExamP a g e | 3
D) Ask security to restrict the mother's ability to visit the ICU: Removing the mother from the unit
does not address the mother's concerns or goals for her son's care and may create an adversarial
relationship between the mother and the hospital staff.
A 1-year-old who is ventilator dependent has been hospitalized since birth. The physician has indicated
that the patient will be discharged home with a tracheostomy and a gastrostomy in one week. In
order to determine the discharge needs of the patient, the nurse should arrange for:
A) Home nursing care for the first few days following discharge
B) A social worker to meet with the family and assess adequacy of the home environment
C) An outreach educator to determine the learning needs of the family
D) A multidisciplinary care conference before discharge
- Correct AnswerAnswer: B) A social worker to meet with the family and assess adequacy of the home
environment: The first predischarge priority for a technology-dependent child is to assess the
adequacy of the home environemtn. Further discharge planning is then based on the needs of the
patient and family.
A) Home nursing care for the first few days following discharge: While home nursing care may be
needed after discharge, the first predischarge priority in this scenario is to evaluate the home
environment. From there, a determination can be made about nursing care that will be needed at
home. The home may not be adequate for a safe transition for the infant.
C) An outreach educator to determine the learning needs of the family: Education may be necessary
before discharging a technology-dependent child, but that cannot be determined without further
information about the patient's home environment and family needs.
D) A multidisciplinary care conference before discharge: This is not consistent with Systems Thinking.
Waiting until discharge for a multidisciplinary conference will not allow the family adequate time to
prepare to meet the complex needs of the child at home.
A child with a myelomeningocele is started on a bowel management plan. the nurse would recognize
that more education is needed when the mother states, "My child:
P a g e 3 | 291
, Pediatric Physical ExamP a g e | 4
A) tends to be more prone to diarrhea."
B) will be unable to control his bowel movements."
C) will require more activity to increase bowel movements."
D) needs to have a bowel movement every day." –
Correct AnswerAnswer: A) tends to be more prone to diarrhea.": With Facilitation of Learning the
nurse recognizes this mother does not yet understand that patients with a myelomeningocele are
prone to constipation and impaction, rather than diarrhea. Additional education is needed to help the
mother understand the bowel management plan.
B) will be unable to control his bowel movements.": This statement is correct and would demonstrate
that the mother understands the necessity of the bowel management plan.
C) will require more activity to increase bowel movements.": This statement is correct and would
demonstrate that the mother understands the necessity of the bowel management plan.
D) needs to have a bowel movement every day.": This statement is correct and would demonstrate
that the mother understands the necessity of the bowel management plan.
A newborn is admitted with transposition of the great arteries. The SpO2 equals 46%. No murmur is
heard. Until a balloon septostomy can be performed, which of the following medications should the
nurse anticipate being administered as a temporary measure?
A) Alprostadil (PGE1)
B) Tolazoline (Priscoline)
C) Indomethacin (Indocin)
D) Digoxin (Lanoxin) –
Correct AnswerAnswer: A) Alprostadil (PGE1): The initial management of the patient with transposition
of the great arteries involves maintaining adequate arterial oxygen saturation via intercirculatory
mixing of blood Until a balloon septostomy can be performed, alprostadil (PGE1) infusion is used to
maintain patency of the ductus arteriosus. Additionally, it lowers pulmonary and systemic vascular
resistance.
B) Tolazoline (Priscoline): Tolazoline (Priscoline) is a vasodilator and is indicated for the treatment of
persistent pulmonary hypertension of the newbon.
P a g e 4 | 291
