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Practice Test 2

The nurse is educating a parent about a meter dose inhaler. Which of the following should the nurse include in the teaching? (Select all that apply).

Hold inhaler with mouthpiece at the bottom

Hold inhaler with thumb near mouthpiece, and index and middle finger at the top

Hold breath for 20 seconds

Wait 1 minute in between each puff

Take inhaler out and exhale slowly through the mouth

When educating about the open mouth method in MDI, which of the following should the nurse include?

Hold inhaler 5-6 cm away from the mouth

Place MDI between lips and form a seal around the mouthpiece

Hold inhaler 3-4 cm away from the mouth

Rinse mouth before using MDI

A toddler presents to the ED with a high fever, drooling, and difficuty breathing. The parent tells the nurse "my child sounds like he has a frog stuck in his throat." The nurse identifies that this are signs and symptoms of:

Bronchiolitis

Emphysema

Epiglottitis

Asthma

Which of the following is a diagnostic procedure for bacterial epiglottitis?

MRI of the head and neck

PET Scan of anterior and lateral chest

Lateral neck radiograph

Throat culture

The nurse is caring for a school-age child with bacterial epiglottitis. What interventions should the nurse include in the plan of care? (Select all that apply)

Use a tongue blade during oral examination

Prepare for intubation

Provide nasopharyngeal suctioning

Administer corticosteroids and antibiotic therapy as prescribed

Implement droplet precautions for first 24 hr after IV antibiotics initiated

Use an 18 Gauge IV needle for IV access

A new licensed nurse is caring for an adolescent with bacterial pneumonia. Which of the following signs and symptoms should the nurse expect? (Select all that apply)

High fever

Tachypnea

Bradycardia

Pale skin color

Hyperreflexia

Rhonchi

A new licensed nurse is caring for an adolescent with bacterial pneumonia. Which of the following signs and symptoms should the nurse expect? (Select all that apply)

Nasal flaring

Post nasal drip

Chest pain

Epistaxis

Abdominal pain

A new licensed nurse is caring for an adolescent with bacterial pneumonia. Which of the following signs and symptoms should the nurse expect? (Select all that apply)

Vomiting and diarrhea

Cough (productive or unproductive with white sputum)

Excessive hunger

Fine crackles

Low blood sugar

What is a complication of bacterial pneumonia?

Acute epiglottitis

Pleural effusion

Peripheral edema

Tracheobronchitis

What is a complication of bacterial pneumonia?

COPD

Allergic rhinitis

Pneumothorax

Streptococcal pharyngitis

A Charge RN is presenting about the differences in care for viral vs. Bacterial pneumonia. Match the interventions to the correct type of pneumonia.

Viral Pneumonia

Encourage rest, Give IV antibiotics, administer oxygen

Bacterial Pneumonia

Administer oxygen with cool mist

The physician orders a lab test to confirm a diagnosis of bacterial pneumonia. The nurse expects the physician to order which of the following? (Select all that apply)

Radiographic examination

MRI with contrast

Blood culture

Nasopharyngeal specimens

Nasal Smear

The physician orders a lab test to confirm a diagnosis of bacterial pneumonia. The nurse expects the physician to order which of the following? (Select all that apply)

Gram stain and culture of sputum in older children

Fluorescent antibody testing

Bronchoprovocation testing

Antistreptolysin

Which of the following preventative measures are recommended for a 12 month old infant with increased risk of bronchiolitis?

Give nasal corticosteroids as prescribed

Provide a salmeterol inhaler to decreased the risk of bronchiolitis

Give palizumab injection

Obtain a CMP to determine risk for RSV

A nurse is providng care for a 12 month old infant with bronchiolitis. Which of the following interventions are appropriate? (Select all that apply)

Supplemental oxygen (Keep O2SAT 90% or above)

Give brochodilators as prescribed

Provide nasal suctioning before each feeding

Provide CPT one hour before feedings

Administer antibiotics if a bacterial infection is present

Match the following heart defects with the correct expected finding

Obstruction to blood flow

Tetralogy of Fallow, Tricuspid atresia

Decreased pulmonary blood flow

Aortic Stenosis, pulmonary stenosis, coarctation of the aorta

Increased pulmonary blood flow

ASD, VSD, PDA

A 11 year old child presents to the ED with ICP. The nurse expects the physician to order which medication?

Hydrochlorothiazide

Spironolactone

Mannitol

Furosemide

What are the expected findings of ICP in an infant? (select all that apply)

Closed fontanels

Setting-sun sign

Increased sleeping

Increased appetite

Separation of cranial sutures

Distended scalp veins

Facial erythema

What are the expected findings of ICP in a child? (select all that apply)

Forceful vomiting

Cannot follow simple comands

Seizures

Improved school performance

Which of the following are signs of Cushing's Triad (increase in ICP). (Select all that apply)

Bradycardia

Tachycardia

Hypertension

Hypotension

Tachypnea

Respiratory depression

Expected physical assessment findings of meningitis according to age group.

2 yrs to adolescence

Seizures with a high-pitch cry, fever, poor feeding, vomiting

3 months to 2 years

Seizures (initial finding), nuchal rigidity, Positive Brudzinski, positive Kernig's

Newborns

Poor muscle tone, weak cry, poor suck, refuses feeding, vomiting and diarrhea

The nurse is preparing a school age child for a lumbar puncture. What is the appropriate action prior to this procedure?

Turn bright lights to provide the physician a better view and prevent medical malpractice

Tell the client a full bladder is needed for the procedure for better visualization of internal structures

Place the client in the side-lying position with the head flexed and knees drawn up to the chest

Keep the room warm to prevent vasoconstriction

The nurse is preparing a school age child for a lumbar puncture. What is the appropriate action prior to this procedure?

Verify with the physician that the spinal needle is inserted into the subarachnoid space between L6 and L7

Aminister fentanyl and midazolam to sedate the client

Clean the site with Isopropyl alcohol (IPA) prior to the procedure

Administer lidocaine and prolocaine 2 hours before the procedure

What are appropriate nursing interventions when caring for a client with meningitis? (Select all that apply)

Implement droplet precautions

Provide oral fluids if client has a decreased level of conciousness

Minimize exposure to bright light

Keep the room cool

Isolate the client with clients who have a respiratory infection

Position the client without a pillow, and slightly elevate the HOB

Provide a high carb and high protein diet immediately after the client shows signs of improvement

Position client in side lying position to reduce neck discomfort

What are appropriate nursing interventions when caring for a client with meningitis? (Select all that apply)

Monitor head circumference and fontanles (bulging)

Initiate vagal nerve stimulation to prevent impending seizure activity due to ICP

Restrict fluids until no evidence of increased ICP and blood sodium levels are WDL

Keep bed in its lowest position and implement seizure precautions

A nurse is caring for a child with bacterial meningitis. Which of the following medications does the nurse expect the physician to prescribe?

Acetylsalicylic acid

Atenolol

Carbimazole

Dexamethasone

A nurse is caring for a child with meningitis. Which of the following medications does the nurse expect the physician to prescribe?

Doxorubicin

Irinotecan

Acetaminophen with codeine

Cyclophosphamide

Match the term with its definition

Brudzinski's sign

Resistance to extension of the child's leg from a flexed position

Kernig's sign

Flexion of extremities occurring with deliberate flexion of the child's neck

Which of the following shows severe dysfunction at the level of the midbrain?

Match the term to its definition

Extension posturing

Severe dysfunction at the level of the midbrain

Severe dysfunction of the cerebral cortex

Flexion posturing

Which of the following is the definitive test to diagnose Cystic Fibrosis?

Pulmonary function test

Duodenal analysis

Sweat chloride test

Chest radiography

DNA testing

The nurse is educating the parents of a child who has CF prior to a sweat chloride test, which of the following statements indicates understanding of the teaching? (Select all that apply)

My child must drink plenty of fluids to ensure accurate test results

My child will walk in a treadmill for 30 minutes to provide a sample

The healthcare professional will collect sweat from two different sites of the body

My child will need to provide a urine sample to detect the presence of fat and enzymes

A nurse is admitting a child who has CF. Which of the following medications should the nurse expect the physician to prescribe? (Select all that apply)

Tobramycin

Loperamide

Fat-soluble vitamins

Albuterol

Dornase alfa

A nurse is performing an admission assessment for a child who has CF. Which of the following findings should the nurse expect? (Select all that apply)

Wheezing

Thin, watery mucus

Clubbing of fingers and toes

Barrel-shaped chest

Rapid growth spurts

What are some of the risk factors for Reye Syndrome? (Select all that apply)

Using ibuprofen to treat mild to moderate pain

Using aspiring products for treating fevers caused by viral infections

Frequent use of St. John's wort

Viral infection (influenza, varicella)

Match the term with its definition

Tetralogy of Fallow

IPBF (Hole in atrial septum) Murmur with split secnd heart sound

Pulmonary Stenosis

Narrowing of pulmonary valve / artery = obstruction of blood. Signs: Cyanosis, cardiomegaly

VSD

DPBF. Pulmonary stenosis, ventricular septal defect, overriding aorta, righ ventricular hyperthrophy. Signs: Systolic murmur, acute cyanosis and hypoxia

PDA

DPBF. Closure of tricuspid valve. Signs: Dyspnea, tachycardia, cyanosis, hypoxemia, clubbing of fingers

ASD

IPBF (circulation conduit between pulmonary artery and aorta fails to close. Signs: Bounding pulses, Rales, Wide pulse pressure

Aortic stenosis

Narrowing of aortic valve. Signs: Faint pulses, hypotension, tachucardia, poor fedding tolerance, chest pain, intolerance to exercise

Coartaction of the aorta

Narrowing of lume of aorta. Signs (HTN in the arms, bouding pulses of upper extremities, decreased BP in lower extremities, cool skin of lower extremities, weak femoral pulses, nosebleeds.

Tricuspid atresia

IPBF (hole in ventricular septum). Murmur auscultated at left sternal boder

The nurse is taking care of a 13-year-old with Rheumatic fever. Which of the following findings is expected in this client? (Select all that apply)

H/o upper respiratory infection

Carditis (chest pain, pericaedial friction rub, muffled heart sounds)

Periorbital edema

Large joints with painful swelling

Erythema marginatum

Involuntary muscle movements

Poor concentration

Stupor

Peritonitis

The nurse is performing a circulatory assessment on a child with Rheumatic fever. Which should the nurse assess first?

Dorsalis pedis pulse

Capillary refill

Assesing extremities for peripheral edema

Heart tones (PMI)

Jones criteria for the diagnosis of Rhematic fever (match term and definition)

Major criteria

Carditis, polyarthritis, erythema marginatum, chorea, subcutaneous modues

Minor criteria

Fever, arthralgia

Which if the following are diagnostic procedures for Rheumatic fever? (select all that apply)

ECG

EEG

Allen test

Chest radiography

CMP

Lab work (ESR, CRP, GABHS)

A nurse is caring for an adolescent with Rheumatic fever. The Charge RN intervenes when the floor nurse makes which of the following statements?

Your child will receive prophylactic treatment of antibiotics

The registered dietitian will talk to your child about healthy food choices

Your child may need a valve repair or replacement surgery

Your child needs to exercise vigorously to promote a healthy weight

What are the signs and symptoms of hemorrage after a tonsillectomy? (Select all that apply)

Chest pain

Tachycardia

Decreased appetite

Frequent swallowing & clearing of throat

Jaundice

Brigh red emesis

Dyspnea

Pallor

Which of the following is a late manifestation of shock due to hemorraghe following a tonsillectomy?

Hypertension

Central cyanosis

Hypotension

Stupor

Which of the following fluids are discouraged immediately after a tonsillectomy? (Select all that apply)

Orange juice

Water

Milk

Raspberry Juice

A nurse is educating an adolescent client about ways to protect the surgical site after a tonsillectomy. The nurse intervenes when the client makes which of the following statements?

I should avoid spicy and higly seasoned foods

I should avoid couging, clearing my throat, and nose

I should avoid drinking form a straw

I should exercise to increase vasodilation and promote healing of the surgical site

Which of the following is correct in GI management of CF?

Provide a well-balanced diet low in protein and calories

Avoid using salt in foods to prevent fluid retention

Administer pancreatic enzymes within 30 minutes of eating a meal or snack

Avoid the use of laxatives or stool softeners for constipation as they can cause further damage to their already compromised GI system

Match the term with its definition

Extension posturing

Arms, wrists, elbows, and fingers flexed and bent inward onto the chest and the legs extended and rotated internally

Flexion posturing

Demonstrates a backward arching of the legs and arms, flexed wrists and fingers, extended back, clenched jaw, and possibly an arched back

Expected physical assessment findings of meningitis according to age group.

3 months to 2 years

Fever, chills, headache, vomiting, restlessness, drowsiness, petechiae or purpuric-type rash, stupor

Newborn

Brudzinkis and Kernig signs are not reliable

2 years to adolescence

Possible fever or hypothermia

Match the disorder with its expected findings

Reye syndrome

Photophobia, vomiting, irritability, headache

Head injury

Amnesia, dizziness, diplopia, vomiting, headache

Meningitis

Delirium, combativeness, seizures, lethargy

Match the types of skull fractures with its definition

Open

Fracture worsens due to pressure fromm brain herniation

Basilar

Broken bone fragments are pushed inward

Linear

Most common, single fracture, does not cross suture line

Growing

Disruption of skin surface, involvement of respiratory mucosa, paranasal surfaces or inner ear.

Comminuted

More than one linear fracture

Depressed

Involve those at the anterior or posterior base of the skull

Which of the following are complications of an open fracture? (Select all that apply)

Epileptic encephalopathy

Osteomyelitis

Frontotemporal dementia

Huntington's disease

Meningitis

Which of the following is a correct statement about the closed mouth method for MDI?

Take the cover off the mouthpiece after each puff

Wait 5 minutes between each puff

Place inhaler between the lips and form a seal around the MDI

Clean the MDI and spacer once weekly

The nurse is taking care of a pediatric client requiring Chest Physiotherapy. Which of the following is not correct when educating a client about CPT?

Offer the child and emesis basin and facial tissues

Schedule treatments before meals or at least 1 hour after meals

Loosening of respiratory secretions is the goal of CPT

Administer a bronchodilator after postural drainage if prescribed

A nurse caring for a child with Reye syndrome anticipates which of the following diagnotic tests to be ordered by the physician? (Select all that apply)

Livery biopsy

ETOH

CSF analysis

ALT & AST

HLA Typing

Ammonia

Trace elements

Electrolytes

The nurse anticipates which drug class medication to be ordered for Reye Syndrome?

Loop diuretics

Potassium-sparing diuretics

Osmotic diuretics

Thiazide diuretics

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