NUR 416 Final Exam Questions with Correct Answers Latest Update 2025-2026 Graded A+
Risks of vaccines - Answers [minor SE: local tender, red, swelling at the injection site, low grade fever,
behavioral changes within hours-day of administration]
Vaccines are: - Answers Safe, effective, serious disease can occur in unvaccinated individuals
for routine immunizations are among the safest and most reliable drugs available (most studied in kids)
Factors that contribute to hesitancy - Answers Lack of information on vaccines
Lack of information on diseases that vaccines prevent and their severity
Information from unreliable sources
Perceived risk of adverse effects
Mistrust of sources of information
Sucrose MOA - Answers provides stimulation to the cellular membrane receptors in the brain in which
endogenous opioid system is located
Non-narcotic (acetaminophen) - Answers (< 6 mo)
MOA: inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever. No anti-
inflammatory properties
Adverse Effects: hepatotoxicity (increased doses)
NSAID (ibuprofen, naproxen) - Answers MOA: inhibits prostaglandin synthesis
Adverse Effects: HA, GI bleeding, hepatitis, constipation, dyspepsia, N/V, exfoliative dermatitis, SJ
syndrome, toxic epidermal necrolysis, anaphylaxisis
Codeine - Answers Not used in kids anymore*
Analgesic: prodrug must be metabolized in the liver into morphine [enzyme is found in variable amounts
in individuals, no way for us to know how fast/slow a child can metabolize, may inc chance of OD*]
Conversion from codeine to morphine is regulated by an enzyme (CYP2D6)
Response: no effect to high sensitivity
Those that are rapid metabolizers: respiratory depression or apnea (even after normal therapeutic
doses)
Lidocaine 4% Topical - Answers MOA: inhibits the tranport of Na+ ions across the neuronal membrane,
thereby preventing initiation and conduction of normal nerve impulse
,Adverse Effect: seizures, confusion, drowsiness, cardiac arrest, anaphylaxis
Epinephrine - Answers Hormone
Affects beta 1 (cardiac) adrenergic receptors and beta 2 (pulmonary) adrenergic receptor sites.
Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells
Produces bronchodilation & vasoconstriction
Adverse Effect: nervousness, restlessness, tremor, paradoxical bronchospasm, angina, arrhythmias, HTN,
tachycardia
Fever Management - Answers Increased fluids
Rest
Remove excessive clothing, exposure skin to air
Reduce room temperature
Cool compresses (cool washcloth on forehead, under armpits)
Don't promote shivering/its counterproductive
Medication
Shivering is compensatory mechanism to raise the body temperature to the elevated set point. This
greatly increases metabolic demand above those already caused by the fever.
Fever management - Answers Acetaminophen 10-15 mg/kg/dose
Ibuprofen 10mg/kg/dose (not given to infants <6 months)
Alternating: not strong support
Aspirin avoided due to risk of Reye's Syndrome
When to treat a fever - Answers primary reason is to relieve discomfort (also consider metabolic
demand placed on body in certain populations; CP disease/immunocompromised)
Respiratory Acidosis - Answers Caused by decreased or inadequate pulmonary ventilation
(HYPOventilation)
3 possibilities for respiratory acidosis - Answers Depression of the respiratory center (head injury,
infections of CNS, narcotic toxicity)
Factors affecting the pulmonary structures (CF, atelectasis, asthma, pneumonia)
,Factors that interfere with chest expansion (trauma, muscular dystrophy, scoliosis, chest burns)
Respiratory alkalosis - Answers Caused by increase the rate and depth of ventilation (HYPERventilation)
causes of respiratory alkalosis - Answers CNS stimulation (pain, anxiety)
Factors that stimulate hyperventilation (high altitudes, fever, CHF, anemia)
Pulmonary disorders (asthma, pneumonia)
Metabolic Acidosis - Answers Decreased plasma pH
Gain of acid or loss of bicarbonate
causes of metabolic acidosis - Answers Acid gain (ingestion of salicylates, DKA, starvation, tissue hypoxia,
azotemia acidosis from advanced kidney failure
Loss of bicarbonate (diarrhea, fistula, drainage)
Metabolic alkalosis - Answers reduction in acid or an increase in bicarbonate
metabolic alkalosis causes - Answers Reduction in acid (vomiting such as with pyloric stenosis, gastric
tube suctioning
Increase in bicarbonate (ingestion - know what they consume and if it is acidic or alkalotic)
Mild Dehydration - Answers (<5%)
appearance - thirsty/alert
cap refil - <2 sec
tears - present
mucous membrane - moist
fontanelle - normal
breathing - normal
pulses - normal
skin - instant recoil
HR - normal
urine output - normal
Moderate Dehydration - Answers (5-10%)
, appearance - irritable, lethargic or drowsy
cap refil - 2 to 4 sec
tears - decreased
mucous membrane - dry
fontanelle - normal/sunken
breathing - tachypnea
pulses - weak, thready
skin - recoil slowly
HR - tachycardia
urine output - reduced (oliguria)
Severe Dehydration - Answers (<10%)
appearance - limp, cold, cyanosis
cap refil - >4 sec
tears - absent
mucous membrane - very dry
fontanelle - sunken
breathing - deep & rapid
pulses - feeble or impalpable
skin - >2 sec recoil
HR - tachycardia
urine output - anuria
Mild to moderate oral rehydrate - Answers Oral rehydration solution over 4-6 hours + provision for
maintenance fluid requirements and continuing losses
Mild - 50 ml/kg (on top of what maintenance requirement is)
Moderate - 100 ml/kg
If having diarrhea, need an addition 10ml/kg for each stool
Risks of vaccines - Answers [minor SE: local tender, red, swelling at the injection site, low grade fever,
behavioral changes within hours-day of administration]
Vaccines are: - Answers Safe, effective, serious disease can occur in unvaccinated individuals
for routine immunizations are among the safest and most reliable drugs available (most studied in kids)
Factors that contribute to hesitancy - Answers Lack of information on vaccines
Lack of information on diseases that vaccines prevent and their severity
Information from unreliable sources
Perceived risk of adverse effects
Mistrust of sources of information
Sucrose MOA - Answers provides stimulation to the cellular membrane receptors in the brain in which
endogenous opioid system is located
Non-narcotic (acetaminophen) - Answers (< 6 mo)
MOA: inhibits the synthesis of prostaglandins that may serve as mediators of pain and fever. No anti-
inflammatory properties
Adverse Effects: hepatotoxicity (increased doses)
NSAID (ibuprofen, naproxen) - Answers MOA: inhibits prostaglandin synthesis
Adverse Effects: HA, GI bleeding, hepatitis, constipation, dyspepsia, N/V, exfoliative dermatitis, SJ
syndrome, toxic epidermal necrolysis, anaphylaxisis
Codeine - Answers Not used in kids anymore*
Analgesic: prodrug must be metabolized in the liver into morphine [enzyme is found in variable amounts
in individuals, no way for us to know how fast/slow a child can metabolize, may inc chance of OD*]
Conversion from codeine to morphine is regulated by an enzyme (CYP2D6)
Response: no effect to high sensitivity
Those that are rapid metabolizers: respiratory depression or apnea (even after normal therapeutic
doses)
Lidocaine 4% Topical - Answers MOA: inhibits the tranport of Na+ ions across the neuronal membrane,
thereby preventing initiation and conduction of normal nerve impulse
,Adverse Effect: seizures, confusion, drowsiness, cardiac arrest, anaphylaxis
Epinephrine - Answers Hormone
Affects beta 1 (cardiac) adrenergic receptors and beta 2 (pulmonary) adrenergic receptor sites.
Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells
Produces bronchodilation & vasoconstriction
Adverse Effect: nervousness, restlessness, tremor, paradoxical bronchospasm, angina, arrhythmias, HTN,
tachycardia
Fever Management - Answers Increased fluids
Rest
Remove excessive clothing, exposure skin to air
Reduce room temperature
Cool compresses (cool washcloth on forehead, under armpits)
Don't promote shivering/its counterproductive
Medication
Shivering is compensatory mechanism to raise the body temperature to the elevated set point. This
greatly increases metabolic demand above those already caused by the fever.
Fever management - Answers Acetaminophen 10-15 mg/kg/dose
Ibuprofen 10mg/kg/dose (not given to infants <6 months)
Alternating: not strong support
Aspirin avoided due to risk of Reye's Syndrome
When to treat a fever - Answers primary reason is to relieve discomfort (also consider metabolic
demand placed on body in certain populations; CP disease/immunocompromised)
Respiratory Acidosis - Answers Caused by decreased or inadequate pulmonary ventilation
(HYPOventilation)
3 possibilities for respiratory acidosis - Answers Depression of the respiratory center (head injury,
infections of CNS, narcotic toxicity)
Factors affecting the pulmonary structures (CF, atelectasis, asthma, pneumonia)
,Factors that interfere with chest expansion (trauma, muscular dystrophy, scoliosis, chest burns)
Respiratory alkalosis - Answers Caused by increase the rate and depth of ventilation (HYPERventilation)
causes of respiratory alkalosis - Answers CNS stimulation (pain, anxiety)
Factors that stimulate hyperventilation (high altitudes, fever, CHF, anemia)
Pulmonary disorders (asthma, pneumonia)
Metabolic Acidosis - Answers Decreased plasma pH
Gain of acid or loss of bicarbonate
causes of metabolic acidosis - Answers Acid gain (ingestion of salicylates, DKA, starvation, tissue hypoxia,
azotemia acidosis from advanced kidney failure
Loss of bicarbonate (diarrhea, fistula, drainage)
Metabolic alkalosis - Answers reduction in acid or an increase in bicarbonate
metabolic alkalosis causes - Answers Reduction in acid (vomiting such as with pyloric stenosis, gastric
tube suctioning
Increase in bicarbonate (ingestion - know what they consume and if it is acidic or alkalotic)
Mild Dehydration - Answers (<5%)
appearance - thirsty/alert
cap refil - <2 sec
tears - present
mucous membrane - moist
fontanelle - normal
breathing - normal
pulses - normal
skin - instant recoil
HR - normal
urine output - normal
Moderate Dehydration - Answers (5-10%)
, appearance - irritable, lethargic or drowsy
cap refil - 2 to 4 sec
tears - decreased
mucous membrane - dry
fontanelle - normal/sunken
breathing - tachypnea
pulses - weak, thready
skin - recoil slowly
HR - tachycardia
urine output - reduced (oliguria)
Severe Dehydration - Answers (<10%)
appearance - limp, cold, cyanosis
cap refil - >4 sec
tears - absent
mucous membrane - very dry
fontanelle - sunken
breathing - deep & rapid
pulses - feeble or impalpable
skin - >2 sec recoil
HR - tachycardia
urine output - anuria
Mild to moderate oral rehydrate - Answers Oral rehydration solution over 4-6 hours + provision for
maintenance fluid requirements and continuing losses
Mild - 50 ml/kg (on top of what maintenance requirement is)
Moderate - 100 ml/kg
If having diarrhea, need an addition 10ml/kg for each stool
