Question 1

A nurse provides instructions to a parent of a toddler experiencing physiological anorexia. Which statement, if made by the parent, indicates a need for further instructions?
A)I will not force-feed my child
B)I will feed my child if she will not eat
C)I will limit the juice intake to less than twelve ounces per day
D)At mealtime, I will offer less than my child may eat and let my child ask for more

Accepted Answer

A statement, if made by the parent, that indicates a need for further instructions is "I will feed my child if she will not eat." A toddler has the skills required to feed him or herself. The parent need to be instructed not to feed children who can feed themselves and not to force-feed a child. To increase nutritious intake at mealtime, juice intake needs to be limited to less than twelve ounces per day. At mealtime, the best option is to offer less than the toddler may eat and let the child ask for more food.

Question 2

A nurse has provided discharge instructions to the parents of an infant who has had a ventriculoperitoneal shunt procedure performed for the treatment of hydrocephalus. Which statement, if made by the parents, indicates an accurate understanding of the presence of a shunt complication?
A)I should position my infant on the side with the shunt when sleeping
B)I should call my physician if my infant refuses baby food
C)My infant will pass urine more often now that the shunt is in place
D)If my infant has a high-pitched cry, I should call the physician

Accepted Answer

The statement that indicates an accurate understanding of the presence of a shunt complication is "if my infant has a high-pitched cry, I should call the physician." If the shunt is broken or malfunctioning, the fluid from the ventricle part of the brain will not be diverted to the peritoneal cavity. The cerebrospinal fluid will build up in the cranial area. The result is increased intracranial pressure, which then causes a high-pitched cry in the infant. The infant should not have pressure placed on the shunt side. Skin breakdown and possible compressions to the apparatus could result. This type of shunt affects the gastrointestinal system, not the genitourinary system.

Question 3

A nurse receives a telephone call from the admitting office and is told that a child with rheumatic fever will be arriving in the nursing unit for admission. On admission, the nurse prepares to ask the mother which question to elicit assessment information specific to the development of rheumatic fever?
A)Has the child complained of back pain?
B)Has the child complained of a headache?
C)Has the child had any nausea or vomiting?
D)Did the child have a sore throat or fever within the last two months?

Accepted Answer

On admission, the nurse should ask the mother a question to elicit assessment information specific to the development of rheumatic fever. The appropriate question would be: "did the child have a sore throat or fever within the last two months?" Rheumatic fever characteristically presents two to six weeks after an untreated or partially treated beta-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child has had a sore throat or an unexplained fever within the past two months.

Question 4

Which of the following responses by an eighteen-year-old father whose neonate has acute streptococcal pharyngitis indicates that he understands the nurse's instructions?
A)"I'll rest my child in bed for the first two days while administrating the medications."
B)"I will have my child take these antibiotic pills until all the medicine is finished."
C)"I won't get my child close to anyone until they are finished taking all of my medication."
D)"I will not give any over-the-counter pills to my child while he is taking the antibiotics."

Accepted Answer

The response that indicates the father understands the nurse's instructions is: "I will have my child take these antibiotic pills until all the medicine is finished." Therapeutic management of the disease involves a ten-day course of penicillin. This should be continued for ten days to eliminate organisms that might initiate rheumatic fever and to reduce spread of certain strains of strep to family members or contacts.

Question 5

The mother of a newborn with extrophy of the bladder tells the nurse that the doctor said her baby may develop an unusual gait when learning to walk. The nurse explains that these children may develop a waddling gait because of:
A)Separation of the pubic bones
B)Tibial torsion
C)Genu varum
D)Subluxation of femur

Accepted Answer

The nurse explains that these children may develop a waddling gait because of separation of the pubic bones. The lack of completion of fetal bladder development may interfere with development of the pelvis.

Question 6

The parents of a preterm infant are preparing to take their baby home. To evaluate the parents' competency in infant care, it would be most effective for the nurse to:
A)Observe the parents while they are giving care to their infant
B)Demonstrate care before having the parents give a return demonstration
C)Determine the rationale behind the parents' actions
D)Ask the parents what they plan to do at home

Accepted Answer

To evaluate the parents' competency in infant care, it would be most effective for the nurse to observe the parents while they are giving care to their infant. Observing the care that the parents actually give the infant provides direct validation of their skill and comfort levels.

Question 7

A newly hired nurse asks her nurse supervisor what to do when an apnea monitor sounds an alarm ten seconds after cessation of respirations. The nurse supervisor should respond that she should first:
A)Use tactile stimuli on chest or extremities
B)Assess skin color and respirations
C)Check the device for signs of malfunction
D)Resuscitate with face mask and Ambu bag

Accepted Answer

The nurse supervisor should respond that she should first use tactile stimuli on chest or extremities. The nurse should apply tactile stimulation first after validating that respirations are absent; this action may be sufficient to reestablish respirations in the high-risk neonate with frequent episodes of apnea.

Question 8

A patient has a baby boy via a cesarean birth. The pulse monitors the newborn's respirations because these infants are more apt to have atelectasis. The nurse explains that this is because:
A)Oxygen deprivation of the infant occurs following a cesarean birth
B)There is no chance during the birth for gravity to drain the fluid from the lungs
C)The rib cage is not compressed then released during birth
D)The sudden change in temperature at birth causes the infant to aspirate

Accepted Answer

The nurse explains that this is because the rib cage is not compressed then released during birth. The release following compression of the chest during vaginal birth is the mechanism for expansion of the newborn's lungs because this does not occur during a cesarean birth. Lung expansion may be incomplete and atelectasis may result.

Question 9

The nurse discusses nutrition with a pregnant woman who is iron deficient and follows a vegetarian diet. The selection of which foods indicates that the woman has learned sources of
Iron?
A)Leafy green vegetables and oranges
B)Cereal and dried fruits
C)Whole grains and yellow vegetables
D)Fish and dairy products

Accepted Answer

The selection of cereal and dried fruits indicates that the woman has learned sources of iron. Both of these foods would be good sources of iron.

Question 10

A nurse teaches a student nurse about caring for a newborn who is given oxygen via a hood. The student nurse asks the nurse about the plan of care for the patient. Considering that the patient is receiving oxygen therapy, the nurse should respond that the plan of care should include:
A)Monitoring oxygen levels in the hood every four hours
B)Informing the parents that oxygen levels will be kept low and therefore, blindness is not a risk
C)Ensuring that the oxygen is continuously warmed and humidified
D)Assessing that the patient's skin remains bright pink

Accepted Answer

Considering that the patient is receiving oxygen therapy, the nurse should respond that the plan of care should include ensuring that the oxygen is continuously warmed and humidified. This technique will prevent hypothermia and possible drying of the mucous membranes.

Question 11

A nurse who usually works in the NICU is floated to the emergency department. Which of these patients should the charge nurse assign to this nurse?
A)An adolescent patient who reports having taken a large crack hit ten minutes prior to walking into the emergency room
B)A pediatric patient who has been on pain medication for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10
C)A young adult who stated that he hears songs from heaven, his arms are jerking, and he needs money
D)An adolescent patient who stated that she took many diet pills and her heart feels like it is racing out of her chest

Accepted Answer

The patient who should be assigned by the charge nurse to the NICU nurse is a pediatric patient who has been on pain medication for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 10. Nurses who are floated to a different department should be assigned to patients with minimal anticipated immediate complications of their problems. The patient exhibits opiod toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future.

Question 12

An ER nurse seeks the help of her friend who is a NICU nurse in prioritizing patients as she just started her job yesterday. While on the phone, she stated that in the past ten minutes, the following patients have arrived. Which should she attend to first?
A)A teenager who got singed eyebrows while camping
B)A two-month-old infant with a history of rolling off the bed who has bulging fontanels
C)An elderly patient with chief complaints of frequent liquid brown colored stools
D)A middle aged patient with intermittent pain behind the right scapula

Accepted Answer

The nurse should first attend to a teenager who got singed eyebrows while camping. This patient is in the greatest danger of potential of respiratory distress. A patient with singed facial hair has been exposed to heat or fire in close rage that could have caused damage to the interior of the lung.

Question 13

Nurse Lara receives a phone call from her friend, who is also a nurse, at the emergency department because four patients arrived all at the same time. Which of the following patients need to be evaluated immediately?
A)An infant who presents with a loud, barking cough without swallowing problems
B)An infant who presents with a fever of 102°F for the last two hours
C)An infant who has had green, watery-type stools for the last twenty-four hours
D)An infant who has a low blood pressure, a pulse rate of 60 bpm, and petechia on face and trunk

Accepted Answer

A patient that needs to be evaluated immediately is an infant who has a low blood pressure, a pulse rate of 60 bpm, and petechia on face and trunk. Low blood pressure is a circulatory concern in this patient. Moreover, the patient is bradycardic and in a state of impending circulatory collapse.

Question 14

You were floated as a triage nurse at the emergency department. Four infant patients arrive at the same time. Which patient would you evaluate first?
A)A patient who has had watery stools for the last twelve hours prior to consult
B)A patient with temperature of 102°F and is involved in active play
C)A patient with drooling, difficulty breathing, and difficulty swallowing
D)A patient with temperature of 99°F, but evidently not lethargic

Accepted Answer

The patient that you would evaluate first is a patient with drooling, difficulty breathing, and difficulty swallowing. This patient with the above mentioned signs and symptoms would need immediate attention, as these are evidence of epiglotitis. Other options require nursing care, but they are not considered to be emergent.

Question 15

Your colleague at the emergency department asks for help to triage the following patients. Which patient should be attended immediately?
A)An infant with respiratory rate of 30 beats per minute
B)An infant with blood pressure of 74/85 mmHg
C)An infant with cardiac rate of 57 beats per minute
D)An infant with rectal temperature of 99.4°F

Accepted Answer

The patient that should be attended immediately is an infant with cardiac rate of 57 beats per minute. The normal cardiac rate for infants is 80-150 beats per minute. Bradycardia is a sign of severe hypoxia and respiratory failure. This patient could be in cardiac arrest primarily due to hypoxemia secondary to inadequate circulation.

Question 16

A nurse is assigned in caring for newborn patients admitted at the neonatal intensive care unit. The nurse should immediately refer a patient who has:
A)Cardiac rate that drops to 110 beats per minute
B)Immature kidneys with evidence of rust-colored stain in the diaper
C)Body temperature of 97.8°F
D)Respiratory rate of 25 beats per minute with sternal retractions

Accepted Answer

The nurse should immediately refer a patient who has a respiratory rate of 25 beats per minute with sternal retractions. A respiratory rate of 25 beats per minute and abnormal breathing pattern is indicative of respiratory distress. Among newborns, the expected breathing pattern is abdominal with synchronous chest movement.

Question 17

You previously worked as a triage nurse at the emergency department and are currently working in the neonatal intensive care unit. The staff nurse at the ER called you and requested to triage the following patients. Which patient should be assessed last?
A)An adolescent patient who has been on pain medication for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 12
B)A teenager who got a singed beard while in a barbeque party
C)A patient who is complaining of chest pain and requesting for pain medication
D)A patient with difficulty breathing and is drooling

Accepted Answer

The patient that should be assessed last is an adolescent patient who has been on pain medication for terminal cancer with an initial assessment finding of pinpoint pupils and a relaxed respiratory rate of 12. The patient exhibits opiod toxicity with the pinpoint pupils and has the least risk of complications; moreover, the patient's respiratory rate is still within the normal range.

Question 18

After receiving endorsement, which of the following patients should the nurse see first?
A)A seven-day-old infant who is crying, with anterior fontanel bulging
B)A two-hour-old infant, whose temperature is 36.7 °C, with irregular abdominal breathing; respiratory rate of 50 breaths pm
C)An eight-hour-old infant held by the mother, with respiration of 45 breaths pm
D)A one-day old infant, lying quietly, who is alert, with a heart rate of 135 bpm

Accepted Answer

After receiving endorsement, the patient that the nurse should see first is a seven-day-old infant who is crying, with anterior fontanel bulging. The patient with bulging fontanel is experiencing increased intracranial pressure. Options B, C, and D indicate normal conditions.

Question 19

A nurse is assigned to care for four neonates. Which of the following patients should the nurse attend to first after the endorsement?
A)A newborn at thirty-three weeks' gestation, with abdominal breathing
B)A newborn by cesarean birth whose mother has type 1 diabetes
C)A newborn by normal delivery with cardiac rate that drops to 116 beats per minute
D)A newborn at twenty-eight weeks' gestation with reddish skin and crackles on auscultation

Accepted Answer

The patient that the nurse should attend to first after the endorsement is a newborn by cesarean birth whose mother has type 1 diabetes. An infant whose mother has type 1 diabetes may have immature lung tissue that predisposes the patient to respiratory distress. Options A, C, and D are all expected among newborns. Red skin is due to the absence of subcutaneous fat tissue. Crackles occur in healthy newborns.

Question 20

The following infant patients were endorsed to you. Your colleague said that one of these patients needs to be attended immediately. You determined that your colleague is referring to:
A)A patient who is two hours post repair of diaphragmatic hernia with breath sounds heard bilaterally
B)A patient with asthma, with audible wheezing that is heard without stethoscope
C)A patient admitted for two days due to burns with edema distal to the burns and increasing activity level
D)A patient who became cyanotic during the previous shift, but currently no signs of distress

Accepted Answer

You determined that your colleague is referring to a patient with asthma with audible wheezing that is heard without stethoscope. Audible wheezing that is heard without a stethoscope is an indication that the airways are significantly compromised. Options A and C have normal and expected assessments with their condition. Option D is very specific that the infant is not experiencing distress.

Quiz 2: Neonatal

A nurse provides instructions to a parent of a toddler experiencing physiological anorexia. Which statement, if made by the parent, indicates a need for further instructions?

A nurse has provided discharge instructions to the parents of an infant who has had a ventriculoperitoneal shunt procedure performed for the treatment of hydrocephalus. Which statement, if made by the parents, indicates an accurate understanding of the presence of a shunt complication?

Which of the following responses by an eighteen-year-old father whose neonate has acute streptococcal pharyngitis indicates that he understands the nurse's instructions?

The mother of a newborn with extrophy of the bladder tells the nurse that the doctor said her baby may develop an unusual gait when learning to walk. The nurse explains that these children may develop a waddling gait because of:

The parents of a preterm infant are preparing to take their baby home. To evaluate the parents' competency in infant care, it would be most effective for the nurse to:

A newly hired nurse asks her nurse supervisor what to do when an apnea monitor sounds an alarm ten seconds after cessation of respirations. The nurse supervisor should respond that she should first:

A patient has a baby boy via a cesarean birth. The pulse monitors the newborn's respirations because these infants are more apt to have atelectasis. The nurse explains that this is because:

The nurse discusses nutrition with a pregnant woman who is iron deficient and follows a vegetarian diet. The selection of which foods indicates that the woman has learned sources of Iron?

A nurse teaches a student nurse about caring for a newborn who is given oxygen via a hood. The student nurse asks the nurse about the plan of care for the patient. Considering that the patient is receiving oxygen therapy, the nurse should respond that the plan of care should include:

A nurse who usually works in the NICU is floated to the emergency department. Which of these patients should the charge nurse assign to this nurse?

An ER nurse seeks the help of her friend who is a NICU nurse in prioritizing patients as she just started her job yesterday. While on the phone, she stated that in the past ten minutes, the following patients have arrived. Which should she attend to first?

Nurse Lara receives a phone call from her friend, who is also a nurse, at the emergency department because four patients arrived all at the same time. Which of the following patients need to be evaluated immediately?

You were floated as a triage nurse at the emergency department. Four infant patients arrive at the same time. Which patient would you evaluate first?

Your colleague at the emergency department asks for help to triage the following patients. Which patient should be attended immediately?

A nurse is assigned in caring for newborn patients admitted at the neonatal intensive care unit. The nurse should immediately refer a patient who has:

You previously worked as a triage nurse at the emergency department and are currently working in the neonatal intensive care unit. The staff nurse at the ER called you and requested to triage the following patients. Which patient should be assessed last?

After receiving endorsement, which of the following patients should the nurse see first?

A nurse is assigned to care for four neonates. Which of the following patients should the nurse attend to first after the endorsement?

The following infant patients were endorsed to you. Your colleague said that one of these patients needs to be attended immediately. You determined that your colleague is referring to: