CCRN Pediatric Practice Exam Questions from AACN 2023

CCRN Pediatric Practice Exam Questions from AACN 2023To promote effective grieving in a 6-year-old sibling following the death of an infant, the nurse should: A) Recommend that the sibling not attend the infant's memorial service B) Encourage the parents to minimize their expression of grief with the sibling C) Explain to the sibling that the infant went to heaven D) Explain to the sibling that thoughts and wishes did not cause the infant's death Answer: D) Explain to the sibling that thoughts and wishes did not cause the infant's death: At age 6, children may take words literally and because of their egocentrism, they believe that thoughts are all-powerful. They may truly believe they caused the death of their sibling. A simple, honest explanation of why the sibling died is indicated. This intervention is consistent with Caring Processes. A) Recommend that the sibling not attend the infant's memorial service: This intervention is not a solution to the problem and will not promote effective grieving for the sibling. It is not consistent with Caring Processes. B) Encourage the parents to minimize their expression of grief with the sibling: This intervention will lead to ineffective grieving for the sibling and is not consistent with Caring Processes C) Explain to the sibling that the infant went to heaven: This intervention will not address the sibling's problem A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at four weeks of age is admitted with increased somnolence, decreased appetite, and increased complaints of headache. This morning the child vomited twice. The nurse should anticipate: A) The physician ordering lumbar puncture and blood and urine cultures B) the patient having a CT scan followed by possible shunt revision C) Administering mannitol or hypertonic saline D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) Answer: B) The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. A) The physician ordering lumbar puncture and blood and urine cultures: These interventions will not address the most likely primary problem, which is suspected VP shunt malfunction. Additionally, lumbar puncture is contraindicated in the presence of increased intracranial pressure, because downward herniation of the brainstem can occur. C) Administering mannitol or hypertonic saline: These medication are indicated for the medical management of increased intracranial pressure, of which this patient has symptoms. However, they will not address the most likely primary problem, which is suspected VP shunt malfunction. D) Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx): These medications are indicated for seizure management and would not address the patient's most likely primary problem, which is suspected increased intracranial pressure as a result of VP shunt malfunction 00:10 01:23 An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? A) Small Bowel Injury B) Cardiac Contusion C) Splenic Laceration D) Pulmonary Embolism Answer: C) Splenic laceration: Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis A) Small bowel injury: Signs of small bowel injury may include progressive abdominal distension, not referred left shoulder pain. B) Cardiac Contusion: Signs of cardiac contusion include chest pain, arrhythmias, and other indicators of myocardial dysfunction, such as elevated cardiac isoenzymes. Upper quadrant abdominal pain with radiation to the left shoulder is not consistent with a cardiac contusion D) Pulmonary Embolism: Symptoms of pulmonary embolism include chest pain and dyspnea on exertion, not left shoulder pain An infant has been admitted with encephalitis. The nurse should first assess the patient's: A) Pupillary response B) Blood glucose level C) Level of consciousness D) Airway Patency Answer: D) Airway Patency: The first priority after admitting an infant with encephalitis is to assess the patient's ability to maintain airway patency. Such patients can develop rapid neurologic deterioration, and the nurse must be prepared to support the airway, oxygenation, and ventilation as needed. A) Pupillary Response: The infant with encephalitis should be monitored for changes in neurologic status, including pupillary response. However, assessing the patient;s ability to maintain airway patency is the first priority. B) Blood Glucose Level: The infant with encephalitis will need blood glucose levels monitored, especially if unable to maintain adequate oral intake. However, assessing the patient's ability to maintain airway patency is the first priority. C) Level of consciousness: The infant with encephalitis should be monitored for changes in neurologic status, including assessment of the level of consciousness. However, assessing the patient's ability to maintain airway patency is the first priority. The pediatric patient with suspected asphyxia from smoke inhalation will typically present with: A) Tachypnea B) Cyanosis C) Confusion D) Hypotension Answer: C) Confusion: The patient with asphyxia from smoke inhalation will experience cerebral hypoxemia and demonstrate symptoms of neurologic dysfunction, including confusion A) Tachypnea: While the patient with smoke inhalation may experience tachypnea as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia B) Cyanosis: While the patient with smoke inhalation may experience cyanosis as a result of damage to the lung parenchyma, this symptoms is not specific to asphyxia D) Hypotension: While the patient with smoke inhalation and a burn injury may demonstrate hypotension from fluid shifts, this symptoms is not specific to asphyxia An acutely ill infant is born to a Vietnamese family. The father asks few questions about the infant's condition, and the mother asks none. Both parents appear to be proficient in English. Which of the following is the most useful resource for a nurse caring for this infant? A) Classes conducted by the primary nurse as the need arises B) An interpreter who is proficient in the parents' language C) Information about the cultural backgrounds represented in the community D) Ongoing classes addressing the cultural needs of the community Answer: B) An interpreter who is proficient in the parents' language: This intervention is consistent with Response to Diversity. Providing an interpreter may facilitate communication by the parents. Trained interpreters can improve outcomes by helping to ensure effective communication between the healthcare team and the patient/family A) Classes conducted by the primary nurse as the need arises: This intervention is not consistent with Response to Diversity. It will not help in this situation. While addressing needs as they arise is important, the parents are not communicating these needs at present. C) Information about the cultural backgrounds represented in the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents' needs during this stressful time. D) Ongoing classes addressing the cultural needs of the community: This intervention will not help in this situation. Cultural backgrounds in the community will not address the parents; needs during this stressful time. A toddler with a history of unrepaired tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. The most appropriate nursing intervention would be to: A) Administer A pre-medication before attempting the IV B) Apply a face mask with oxygen C) Transfuse red blood cells D) Place the child in knee-chest position Answer: D) Place the child in knee-chest position: This maneuver aids blood return to the heart, thus alleviating cyanotic spells A) Administer a pre-medication before attempting the IV: This may be appropriate if it helps the infant to experience minimal pain, and thus cry less during the IV start. B) Apply a face mask with oxygen: Administering oxygen is helpful to minimize the hypoxia, but the mask may cause even more distress. C) Transfuse red blood cells: If other measures do not alleviate the spells, volume in the form of packed red blood cells may be ordered to maintain the hematocrit greater than or equal to 45%