WITH ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS GRADED A+
A 4-year-old child with a history of the flu has a heart rate of
80 beats/minute, respirations of 16 breaths/minute, and
capillary refill of more than 3 seconds. The proper sequence
for nursing interventions would be:
A. Position the airway, administer 100% oxygen, obtain
venous access, and administer 20 ml/kg of an isotonic
solution.
B. Administer 100% oxygen, obtain venous access,
administer 0.
1 mg/kg of epinephrine 1:10,000, and prepare for
endotracheal intubation.
C. Position the airway, provide bag-mask ventilation, provide
synchronized cardioversion, and provide supplemental
warmth.
D. Administer 100% oxygen, prepare for a venous cutdown,
administer 20 ml/kg of an isotonic solution, and obtain a
chest x-ray.
A. Position the airway, administer 100% oxygen, obtain venous
access, and administer 20 ml/kg of an isotonic solution.
A 3-year-old is transported by prehospital personnel after
being struck by a car. The parents are en route. The child is
screaming and uncooperative. Which is the best approach
while conducting the secondary survey?
,A. Hold the child to comfort him.
B. Wait for the parent's arrival.
C. Observe for behavioral pain cues.
D. Use a doll to demonstrate the examination.
C. Observe for behavioral pain cues.
Which ocular finding is associated with child maltreatment?
A. Glaucoma.
B. Conjunctivitis.
C. Iritis.
D. Retinal hemorrhage.
Retinal hemorrhage.
A pregnant 18-year-old woman arrives at the emergency
department about ready to deliver a full-term infant. She
states that she noticed a large amount of dark green fluid the
last time she went to the bathroom. During the delivery, the
nurse should prepare to:
A. Dry and arm the infant as soon as is it delivered.
B. Stimulate and ventilate the infant immediately after
delivery.
C. Suction the mouth and nose of the infant while on the
perineum.
D. Administer blow-by oxygen and rub the back immediately
after delivery.
Suction the mouth and nose of the infant while on the perineum
A 4-year-old presents with vomiting, lethargy, frequent
urination, weight loss, and dry mucous membranes. Vital
signs reveal deep respirations at 44 breaths per minute, BP
of 70/44 mm Hg, and HR of 144 beats per minute. Which of
,the following laboratory values would be most expected in
this child?
Low pH level
A teenager presents to the ED for evaluation of pain with
deep inspiration. The pain was a sudden onset after running
track at school. While obtaining the history, the patient states
that they have Marfan Syndrome. What would be a priority
triage question based on this information?
"Have you ever had a pneumothorax?"
A 6-week-old is brought to the emergency department by the
caregivers for poor feeding, listlessness, and fever.
Assessment reveals a crying infant, HR 160 beats/minute, RR
52 breaths/minute, rectal temperature of 96.0 F (35.5 C), and a
bulging anterior fontanel. Capillary refill is 4 seconds. Based
on these findings what is the most likely diagnostic test the
nurse should anticipate?
Lumbar puncture
A 6-month-old arrives with swelling to the left thigh.
Caregivers deny any traumatic event. Assessment findings
include a patient who is active and alert, in the 10th
percentile for length, and has blue-grey sclera. Radiographs
reveal a midshaft fracture of the left femur. Which of the
following is the most likely cause?
Osteogenesis imperfecta
Which of the following is considered a "red flag" when
triaging a pediatric patient?
A 3-week-old with a temperature of 38.2°C (100.7°F)
, A 4-year-old patient is being assessed for a foreign body in
the nose. The child is awake and alert and watching a video
on the caregivers phone. Vitals include HR of 110
beats/minute, RR of 26 breaths per minute, BP of 138/90 mm
Hg, and T of 37.3oC (99.3oF) orally. Which of the following
interventions should the nurse perform next?
The normal systolic blood pressure for a 4 year old is between 89-
112 mm Hg. The other vitals are within normal limits for that age.
When the clinical picture of the patient does not match the vitals,
check to make sure you are using the correctly sized equipment
first. A blood pressure cuff that is too small will give a reading that
is higher than it actually is.
Parents with an infant requiring multiple laboratory tests,
radiographic studies, and invasive procedures appear to be
distressed and withdrawn. Which of the following
interventions would best ensure a sense of comfort and
control for these parents?
Providing frequent updates and re-educating them on the care
that is being provided
Caregivers state an 18-month-old child had a harsh, barky
cough, low-grade fever, and irritability throughout the night.
On assessment this morning, the child appears alert, is
interactive, their present cough is quiet, and their
temperature is 98.8°F (37.1°C) axillary. Which of the following
diagnoses is the highest probablity for this child?
Croup
A 2-year-old is seen with a 3-day history of irritability,
vomiting, and the presence of foul-smelling urine. The child