Chapter 10- The Critically Ill Pediatric Patient My Nursing Test Banks

 

1.

A child in the ICU exhibits tachycardia, tachypnea, hypertension, and low pulse pressure in the extremities. Which of these signs is the best indicator of inadequate perfusion of blood?

A)

Tachycardia

B)

Tachypnea

C)

Hypertension

D)

Low pulse pressure

2.

A 12-month-old child is admitted to the ICU after being found abandoned in a hot car. The child is responsive, but the nurse notices that the anterior fontanelle of the child is sunken. Which of the following conditions should the nurse suspect in this situation?

A)

Dehydration

B)

Increased intracranial pressure

C)

Fluid overload

D)

Hypertension

3.

An ICU nurse, in testing the reflexes of a 3-month-old baby girl, strokes the lateral aspect of the sole of the foot to test for possible nerve damage. In response, the child fans her toes and dorsiflexes her big toe. What is the name of this reflex, and is the childs response normal?

A)

Moro reflex; abnormal

B)

Rooting reflex; normal

C)

Grasp reflex; abnormal

D)

Babinski reflex; normal

4.

A nurse in the ICU observes paradoxical irritability, meningeal irritability, and nuchal rigidity in a 5-year-old girl. She suspects meningitis. What other finding or findings would support this belief? Select all that apply.

A)

Positive Babinski reflex

B)

Positive Moro reflex

C)

Positive Brudzinskis sign

D)

Positive Kernigs sign

5.

A newborn baby involved in an auto accident has been admitted to the ICU and is currently being assessed by a nurse in a drafty, cool room. The nurse notes mottling on the infants skin, a progression of coolness toward the trunk, peripheral cyanosis, normal blood pressure, low pulse pressure, and tachycardia. Given the circumstances, which of the following are reliable signs that the infant is in shock? Select all that apply.

A)

Mottled skin

B)

Progression of coolness toward the trunk

C)

Peripheral cyanosis

D)

Normal blood pressure

E)

Low pulse pressure

F)

Tachycardia

6.

A nurse working with an infant patient observes that the child, who has a nasogastric tube, is grunting on expiration, wheezing, and seesaw breathing. The nurse recognizes that the infant is most likely experiencing which condition?

A)

Respiratory distress due to obstructed nasal passages

B)

Respiratory arrest due to obstruction of the glottis

C)

Epileptic seizure due to overstimulation

D)

Shock due to loss of blood

7.

A 2-year-old is admitted to the ICU due to severe dehydration. The mother of the child is distraught and feels guilty that she took a long walk with her child in the sun earlier in the day. She said that she and the rest of the family had no issues with dehydration. What would be the best response for the nurse to give the mother?

A)

Children his age should have limited sun exposure and should be covered with sunscreen.

B)

The mother should regularly test the specific gravity of the childs urine to determine whether he is adequately hydrated.

C)

Children are at increased risk for dehydration due to a higher percentage of total-body water.

D)

The mother should look for taut skin and edema as signs of dehydration in her child.

8.

A 6-year-old girl who is in the ICU for an unrelated reason confides in the nurse that her father sometimes hits her. Which of the following findings would most likely indicate abuse in this situation?

A)

A bruise on her knee

B)

A bruise on the bottom of her foot

C)

A bruise on her abdomen

D)

A bruise on her face

9.

A 12-year-old boy is experiencing severe pain following emergency surgery in the ICU. He is visibly frustrated and restless. His parents would like to achieve a steady state of pain relief for their son and to give him a sense of some control over the pain. Which pain relief method would be most appropriate in this situation?

A)

Distraction by means of a video game

B)

Massage

C)

Opioids

D)

PCA

10.

The nurse observes that a child in the ICU who has been admitted following an auto accident is visibly stressed and crying. The child has a broken arm, which has been splinted, and is receiving analgesics. No other injuries have been found. When the nurse performs a pain assessment test with the child, the child refuses to cooperate. The patients mother is hysterical and is frantically pacing next to the bed. What is the most likely cause of the childs distress?

A)

Fear of further medical interventions

B)

The mothers communicated anxiety

C)

Pain from the broken arm

D)

Shock

11.

The nurse is caring for a critically ill child. The child has been experiencing tachypnea for several hours despite appropriate interventions. Suddenly, the child becomes bradypneic. What is the most appropriate nursing action?

A)

Continue the current plan of care, as this change indicates improvement.

B)

Initiate positive-pressure ventilation with a manual bag-mask device.

C)

Increase intravenous sedation and narcotic dosages to continue improvement.

D)

Ask the family to leave the room in anticipation of further action.

12.

A child is admitted to the ICU after being in a motor vehicle crash. The nurse assesses a sudden decrease in the pulse rate. The nurse knows that this change in pulse rate is most likely related to what pathology?

A)

Anxiety

B)

Hyperventilation

C)

Shock

D)

Hypoxemia

13.

A critically ill child who is experiencing internal bleeding from a motor vehicle accident demonstrates a sudden significant drop in blood pressure. What intervention should the nurse implement first?

A)

Administer 20 mL/kg intravenous crystalloid fluid.

B)

Assess for oversedation with benzodiazepines or narcotics.

C)

Increase frequency of vital sign assessment to every 15 minutes.

D)

Reassess mental status and level of consciousness.

14.

A 6-month-old infant, who was admitted for gastroenteritis, has depressed fontanelle at rest and while in a supine position. What additional assessments should the nurse perform or facilitate?

A)

Denver Developmental Test

B)

Deep tendon reflexes

C)

Number of wet diapers per day

D)

Measure the frontal occipital circumference

15.

An infant with a history of diarrhea and poor feeding for 2 days is admitted to a CCU. The infant has progression of coolness toward the trunk, prolonged capillary refill, and moderate tachycardia and is somewhat difficult to arouse. What additional assessment data should the nurse collect first?

A)

Cardiac monitor pattern

B)

Serial blood pressure

C)

Deep tendon reflexes

D)

Status of anterior fontanelle

16.

The nurse notices that a 5-month-old patient is having difficulty breathing, with nasal flaring, audible grunting, and sternal and intercostal retractions. The infants respiratory rate is rapid, and the infant is restless and obtunded. What intervention should the nurse implement first?

A)

Position the baby with head in a neutral midline position and apply the jaw-thrust maneuver.

B)

Facilitate administration of an inhaled bronchodilator.

C)

Administer intravenous sedation or pain medication.

D)

Ask the parent to use comforting measures for the infant.

17.

A young child has repeated upper respiratory infections. The mother is distressed and states that she is sure she is taking care of her child properly and does not understand why her child is constantly ill. Nursing assessment validates that the mother is providing a balanced diet, the child eats well, the mother is careful with hand hygiene, and the child has no genetic or chronic diseases. The child does attend day care while the mother works. On what rationale should the nurse base her reassurance to the mother?

A)

All small children are sick all the time, and they outgrow this behavior in a few years.

B)

The day care center is probably the cause of the constant illness, and the child should be moved.

C)

Small children have an immature immune system and are more susceptible to viral illness.

D)

The mother should be referred for counseling as she is exhibiting a pathological lack of coping.

18.

The nurse enters the room of a critically ill child who is newly unresponsive. What is the next nursing action?

A)

Open the airway.

B)

Place on side.

C)

Give abdominal thrusts.

D)

Start rescue breathing.

19.

A child experiences a respiratory arrest and is intubated. What is the best nursing assessment parameter to immediately verify proper placement of the endotracheal tube?

A)

Symmetrical rise and fall of the chest

B)

Chest x-ray shows right bronchial intubation.

C)

Tidal volume is within limits for age.

D)

Absence of sternal retractions and grunting

20.

The nurse is preparing to administer a medication to a child. The medication is ordered as 10 mg/kg. When the nurse looks up the childs weight on the vital sign record, no unit of measure is documented. What is the best nursing action?

A)

Assume that the weight was measured in kilograms, since that is unit policy.

B)

Call the staff member who weighed the child and verify the unit of measure.

C)

Use arithmetic analysis to determine the probable unit of measure used.

D)

Reweigh the child to ensure accuracy of weight determination for the day.

21.

Since most medications in pediatrics are calculated based on the childs weight, considerable nursing time is required to verify correct dosages. This time constraint can be a problem in emergent situations. What mechanism can be used to facilitate accuracy of dosing during emergencies?

A)

Precalculate doses of emergency drugs for each child admitted.

B)

Estimate childs weight and drug doses in emergencies to save time.

C)

Use the standard doses from the Pediatric Advanced Life Support recommendations.

D)

Add a pharmacist to the emergency response team for pediatrics.

22.

The nurse is caring for a 1-year-old child who has had major surgery and suspects that the child is in pain. What method should the nurse use to assess the child for pain?

A)

A one-dimensional system such as the Faces scale

B)

A multidimensional system such as COMFORT

C)

Ask the parents to decide if the child is in pain.

D)

Assess vital signs, restlessness, crying, and diaphoresis.

23.

A young child is experiencing pain secondary to surgical repair of a fractured femur. The child is on supplemental oxygen and is breathing spontaneously and crying. The nurse wishes to administer the most effective pain relief with the least risk of adverse effects. Which combination of relief measures is most likely to meet this goal?

A)

Antipsychotic medication and sedative

B)

Opioid and distraction strategies

C)

Sedative and opioid

D)

Muscle relaxant and massage

24.

A pediatric critical care unit wishes to ensure family-centered care. What nursing actions will best support family-centered care?

A)

Asking parents to leave during painful procedures for the child

B)

Assuming that the childs illness is secondary to parental ignorance

C)

Encouraging a family member to be constantly present at the childs side

D)

Restricting visits by family to ensure that the child can rest

Answer Key

1.

D

2.

A

3.

D

4.

C, D

5.

B, E

6.

A

7.

C

8.

C

9.

D

10.

B

11.

B

12.

D

13.

A

14.

C

15.

D

16.

A

17.

C

18.

A

19.

A

20.

D

21.

A

22.

B

23.

B

24.

C

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