1
Comprehensive Pediatric Nursing Care for
Down Syndrome: High-Yield Practice
Questions & Rationales (2025 Edition)"
, 2
Comprehensive Pediatric Nursing Care for Down
Syndrome: High-Yield Practice Questions & Rationales
(2025 Edition)"
1. The nurse is caring for a 65-year-old male client with a history of ischemic heart disease
who has been admitted to the ICU following a myocardial infarction. The client is currently
receiving lidocaine I.V. to manage his ventricular ectopy, which has been persistent. Which
of the following factors would be most important for the nurse to consider in relation to the
administration of this medication?
A. Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter
B. Increase in systemic blood pressure
C. Presence of premature ventricular contractions (PVCs) on a cardiac monitor
D. Increase in intracranial pressure (ICP)
E. A drop in serum potassium levels as indicated in the latest lab results
The answer is: E. A drop in serum potassium levels as indicated in the latest lab results
Explanation:
Lidocaine is an antiarrhythmic used to treat ventricular arrhythmias, especially after myocardial
infarction. Its effectiveness and safety are highly dependent on the client’s electrolyte balance,
particularly potassium. Hypokalemia (low potassium) can increase myocardial irritability,
leading to more ectopy and potentially reducing lidocaine’s effectiveness. Moreover, low
potassium enhances the risk of proarrhythmia or toxicity when lidocaine is administered. Nurses
must carefully monitor potassium levels and correct any imbalances promptly. The other
choices—SaO2, blood pressure, PVC presence, or ICP—may be important in overall care but are
not as directly critical to lidocaine's safe and effective use as serum potassium.
2. A 72-year-old male patient with a history of atrial fibrillation and controlled
hypertension has been initiated on warfarin therapy. Upon assessment of the patient’s
history, it was revealed that he has a history of peptic ulcer. This patient also has a recent
history of a peptic ulcer. Given the client’s medical history and current medication
regimen, which of the following instructions should the nurse prioritize when providing
discharge teaching?
A. Report incidents of diarrhea
B. Avoid foods high in vitamin K
C. Use a straight razor when shaving
D. Take aspirin for pain relief
E. Monitor for signs of bleeding, such as bruising or black tarry stools
, 3
F. Check blood pressure regularly at home
G. Inform all healthcare providers about the anticoagulant therapy
The answer is: E. Monitor for signs of bleeding, such as bruising or black tarry stools
Explanation:
Warfarin is an oral anticoagulant used to prevent thromboembolic events in patients with atrial
fibrillation. A history of peptic ulcer significantly increases this patient’s risk for gastrointestinal
(GI) bleeding. Because warfarin affects clotting factors, even minor GI lesions may lead to
life-threatening hemorrhage. Therefore, the nurse must prioritize teaching about recognizing
signs of bleeding, particularly melena (black tarry stools) and unexplained bruising. Although
informing providers (option G) and avoiding high vitamin K foods (option B) are important,
early detection of bleeding complications is the most urgent and potentially life-saving
instruction. Aspirin (option D) is contraindicated due to its antiplatelet effects.
3. In a busy surgical unit, a nurse is preparing to insert an I.V. catheter for a 33-year-old
patient who is scheduled for elective surgery and has a notably hairy forearm where the
I.V. is to be placed. The patient is allergic to a variety of adhesives and has sensitive skin
that is prone to irritation. Given these considerations, how should the nurse manage excess
hair at the intended catheter insertion site?
A. Leaving the hair intact
B. Shaving the area
C. Clipping the hair in the area
D. Removing the hair with a depilatory
E. Applying a small amount of water-soluble gel to tame the hair without cutting
F. Use a sterile surgical scalpel to trim the hair as close to the skin as possible without causing
abrasions
The answer is: C. Clipping the hair in the area
Explanation:
When preparing a site for IV insertion, especially in patients with sensitive skin or allergies to
adhesives, clipping is the safest method to manage excess hair. Shaving (option B) can cause
microabrasions, increasing the risk of infection and skin irritation—particularly problematic in
sensitive or allergic individuals. Depilatories (option D) are also risky due to potential allergic
reactions. Leaving the hair (option A) or applying gel (option E) might interfere with catheter
adhesion or secure placement. Using a scalpel (option F) is not standard nursing practice for hair
removal and could cause skin damage. Clipping removes hair close to the skin without trauma.
4. A nurse is tasked with the education of an elderly female patient who has been recently
diagnosed with osteoporosis. The patient leads a sedentary lifestyle, has a diet low in
Comprehensive Pediatric Nursing Care for
Down Syndrome: High-Yield Practice
Questions & Rationales (2025 Edition)"
, 2
Comprehensive Pediatric Nursing Care for Down
Syndrome: High-Yield Practice Questions & Rationales
(2025 Edition)"
1. The nurse is caring for a 65-year-old male client with a history of ischemic heart disease
who has been admitted to the ICU following a myocardial infarction. The client is currently
receiving lidocaine I.V. to manage his ventricular ectopy, which has been persistent. Which
of the following factors would be most important for the nurse to consider in relation to the
administration of this medication?
A. Decrease in arterial oxygen saturation (SaO2) when measured with a pulse oximeter
B. Increase in systemic blood pressure
C. Presence of premature ventricular contractions (PVCs) on a cardiac monitor
D. Increase in intracranial pressure (ICP)
E. A drop in serum potassium levels as indicated in the latest lab results
The answer is: E. A drop in serum potassium levels as indicated in the latest lab results
Explanation:
Lidocaine is an antiarrhythmic used to treat ventricular arrhythmias, especially after myocardial
infarction. Its effectiveness and safety are highly dependent on the client’s electrolyte balance,
particularly potassium. Hypokalemia (low potassium) can increase myocardial irritability,
leading to more ectopy and potentially reducing lidocaine’s effectiveness. Moreover, low
potassium enhances the risk of proarrhythmia or toxicity when lidocaine is administered. Nurses
must carefully monitor potassium levels and correct any imbalances promptly. The other
choices—SaO2, blood pressure, PVC presence, or ICP—may be important in overall care but are
not as directly critical to lidocaine's safe and effective use as serum potassium.
2. A 72-year-old male patient with a history of atrial fibrillation and controlled
hypertension has been initiated on warfarin therapy. Upon assessment of the patient’s
history, it was revealed that he has a history of peptic ulcer. This patient also has a recent
history of a peptic ulcer. Given the client’s medical history and current medication
regimen, which of the following instructions should the nurse prioritize when providing
discharge teaching?
A. Report incidents of diarrhea
B. Avoid foods high in vitamin K
C. Use a straight razor when shaving
D. Take aspirin for pain relief
E. Monitor for signs of bleeding, such as bruising or black tarry stools
, 3
F. Check blood pressure regularly at home
G. Inform all healthcare providers about the anticoagulant therapy
The answer is: E. Monitor for signs of bleeding, such as bruising or black tarry stools
Explanation:
Warfarin is an oral anticoagulant used to prevent thromboembolic events in patients with atrial
fibrillation. A history of peptic ulcer significantly increases this patient’s risk for gastrointestinal
(GI) bleeding. Because warfarin affects clotting factors, even minor GI lesions may lead to
life-threatening hemorrhage. Therefore, the nurse must prioritize teaching about recognizing
signs of bleeding, particularly melena (black tarry stools) and unexplained bruising. Although
informing providers (option G) and avoiding high vitamin K foods (option B) are important,
early detection of bleeding complications is the most urgent and potentially life-saving
instruction. Aspirin (option D) is contraindicated due to its antiplatelet effects.
3. In a busy surgical unit, a nurse is preparing to insert an I.V. catheter for a 33-year-old
patient who is scheduled for elective surgery and has a notably hairy forearm where the
I.V. is to be placed. The patient is allergic to a variety of adhesives and has sensitive skin
that is prone to irritation. Given these considerations, how should the nurse manage excess
hair at the intended catheter insertion site?
A. Leaving the hair intact
B. Shaving the area
C. Clipping the hair in the area
D. Removing the hair with a depilatory
E. Applying a small amount of water-soluble gel to tame the hair without cutting
F. Use a sterile surgical scalpel to trim the hair as close to the skin as possible without causing
abrasions
The answer is: C. Clipping the hair in the area
Explanation:
When preparing a site for IV insertion, especially in patients with sensitive skin or allergies to
adhesives, clipping is the safest method to manage excess hair. Shaving (option B) can cause
microabrasions, increasing the risk of infection and skin irritation—particularly problematic in
sensitive or allergic individuals. Depilatories (option D) are also risky due to potential allergic
reactions. Leaving the hair (option A) or applying gel (option E) might interfere with catheter
adhesion or secure placement. Using a scalpel (option F) is not standard nursing practice for hair
removal and could cause skin damage. Clipping removes hair close to the skin without trauma.
4. A nurse is tasked with the education of an elderly female patient who has been recently
diagnosed with osteoporosis. The patient leads a sedentary lifestyle, has a diet low in
