1. The nurse is caring for a 3-year-old child who is 2 hours postop from a cardiac catheterization via the right femoral artery. Which assessment finding
... [Show More] is an
indication of arterial obstruction? Right foot is cool to the touch and appears pale and blanched
2. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first? Place the infant in a kneechest position
3. A child admitted with diabetic ketoacidosis is demonstrating Kussmaul respirations. The nurse determines that the increased respiratory rate is a
compensatory mechanism for which acid base alteration? Metabolic Acidosis
4. Patient with diarrhea for 3 days – what does this cause? Metabolic Alkalosis?
5. Which drink choice on a hot day indicates to the nurse that a teenager with sickle cell anemia understands dietary considerations related to the disease?
Lemonade
6. The HR for a 3-year-old with CHF has steadily decreased over the last few hours, now is 76 bpm, the previous reading 4 hours ago was 110 bpm. Which
additional finding should be reported immediately to a heDaowltnhlcoaadreedpbryo: vCiHdReIrS?JABYP| 7 m 0 a /rr 4j o 0 n182 @ g mail .c o m
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7. 2-year-old is admitted to the hospital with possible encephalitis, and a lumbar puncture is scheduled. Which information should the nurse provide this
child concerning the procedure? Describe he side-lying, knees to chest position that must be assumed during the procedure
8. Patient has low platelets. Bleeding precaution
9. The nurse is assessing an infant with pyloric stenosis. Which pathophysiological mechanism is the most likely consequence of this infant's clinical
picture? Metabolic Alkalosis
10. A month old girl is brought to the clinic by her mother because she has had a cold for 2 to 3 days and woke up this morning with a hacking cough and
difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress? Flaring of the nares
11. During a well-baby visit the parents explain that the soft bulge appears in the groin of their 4 month old son when he cries or strains with stool. The
infant is scheduled for surgical repair of the inguinal hernia in 2 weeks. The parent should be instructed to take which measure if the hernia becomes
incarcerated prior to surgery? Gently manipulate the hernia for reduction
12. The nurse is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in
this child’s plan of care? Guard against bleeding injuries
13. How should then nurse instruct the parents of a 4-month-old with seborrheic dermatitis (cradle cap) to shampoo the child’s hair? use a soft brush and
gently scrub the area
14. The mother of a one-month-old calls the clinic to report that the back of her infant’s head is flat. How should the nurse respond? Position the infant on
the stomach occasionally when awake and active
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15. A 7-year-old child is admitted to the hospital with acute glomerulonephritis (AGN). When obtaining the nursing history which finding should the nurse
expect to obtain? A recent strep throat infection
16. In assessing a 10-year-old newly diagnosed with osteomyelitis, which information is most for the nurse to obtain? recent recurrence of infection
17. A mother brings her 8-month-old baby boy to the clinic because he has been vomiting and had diarrhea for the last 3 days. Which assessment is more
important for the nurse to make?
Measure the infant's pulse.
18. Following admission for a cardiac catheterization, the nurse is providing discharge teaching to the parents of a 2-year-old toddler with Tetralogy of
Fallot. What instruction should the nurse give the parents if their child becomes pale, cool, and lethargic? Contact their healthcare provider
immediately.
19. A mother brings her 2-year-old son to the clinic because he has been crying and pulling on his earlobe for the past 12 hours. The child's oral temperature
is 101.2 F. Which intervention should the nurse implement? Ask the mother if the child has had a runny nose
20. During a follow-up clinical visit a mother tells the nurse that her 5-month-old son who had surgical correction for Tetralogy of Fallot has rapid breathing,
often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held and his growth is in the expected range.
Which intervention should the nurse implement? Auscultate heart and lungs while infant is held.
21. An adolescent's mother calls the primary HCP's office to inquire about the results of her daughter's serum test results that were drawn last week. Since it
is the teenager's 18th birthday, how should the nurse respond to this mother's inquiry? Explain that the information cannot be released without the
18-year old’s permission
22. Albumin 25% IV is prescribed for a child with nephrotic syndrome. Which assessment finding indicates to the nurse that the medication is having the
desired effect? Reduction of edema
23. An infant with Tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first? Place the infant in a kneechest position [Show Less]