Certified Nurses Day 2024 Quiz

CCRN:

A 5-year-old with a history of congenital hydrocephalus and VP shunt placement at four weeks of age is admitted with increased somnolence, decreased appetite, and increased complaints of headache. This morning the child vomited twice. The nurse should anticipate: 

• The physician ordering lumbar puncture and blood and urine cultures 
  

• The patient having a CT scan followed by possible shunt revision 
  

• Administering mannitol or hypertonic saline 
  

• Administering phenytoin (Dilantin) or fosphenytoin (Cerebyx) 

Answer explanation

The patient having a CT scan followed by possible shunt revision: This patient is demonstrating signs of increased intracranial pressure. The most likely etiology is malfunction of the VP shunt as a result of blockage or disconnection, which is particularly likely over time as the child grows. The definitive diagnosis is made by a CT scan and a shunt series. Surgical intervention for a shunt revision would be indicated. 

CPHON:

Which of the following nursing actions would be appropriate when providing care to an infant receiving thiotepa? 

• Administer medication without a filter. 

• Change diapers every 2 hours.

• Infuse medication over 24 hours. 

• Apply lotion frequently to skin. 

Answer explanation

Thiotepa skin toxicity requires frequent bathing without soap or lotions, frequent diaper changes, and sheet changes.

1. CPN:

2. Anticipatory guidance most appropriate for a male child during early adolescence (11-14) includes: 

• 1. age-appropriate sports activities. 

• 2. abstinence, safe sex, and contraception. 

• 3. risk taking behaviors (drugs, drinking, smoking, speeding). 

• 4. bodily changes and secondary sex characteristics. 

Answer explanation

Anticipatory guidance most appropriate for a male child during early adolescence (11-14) includes bodily changes and development of secondary sexual characteristics. The child will undergo changes in thought patterns as well as begin to experience peer pressure to conform to the norms of a group, so the pediatric nurse should begin discussions about issues such as gangs, tobacco, drugs, alcohol, and abusive relationships.

CCRN:

An adolescent trauma patient is complaining of left upper quadrant abdominal pain radiating to the left shoulder. Blood pressure has dropped to 80/50. Which condition is most likely? 

• Small Bowel Injury 

• Cardiac Contusion 

• Splenic Laceration 

• Pulmonary Embolism 

Answer explanation

Kehr's sign, which is referred pain to the left shoulder during compression of the left upper abdominal quadrant, is an indication of splenic injury. Additional symptoms include tachycardia, hypotension, and leukocytosis 

CPHON:

2. A patient's father is discussing strategies used for nausea and vomiting with the nurse. Which of the following warrants further investigation by the nurse? 

• 1. Guided imagery with deep breathing exercises. 

• 2. Stretching exercises throughout the day. 

• 3. Ground ginger by mouth once daily. 

• 4. Ondansetron by mouth as needed. 

Answer explanation

While ginger can provide antiemetic relief, it can also interfere with platelet aggregation and increase stomach acidity so this option should be explored further with the patient's physician. 

2. CPN:

3. The pediatric nurse is serving as an advocate for an adolescent patient when: 

• 1. telling the parents how cooperative the patient is. 

• encouraging the parents to allow the patient to manage his diabetes. 

• 4. telling the patient that he must be independent in diabetic management. 

• encouraging the parents to manage the patient’s diabetes. 

Answer explanation

The pediatric nurse is serving as an advocate for an adolescent patient when encouraging the parents to allow the patient to manage his diabetes. Adolescents often want to assert their independence and don't want to rely on parents for disease management. While the pediatric nurse should avoid pressure the patient to manage his disease, the patient should be included in all aspects of the care plan and educated about diabetic management.

CCRN:

A toddler with a history of unrepaired tetralogy of Fallot begins to cry while intravenous access is attempted. Cyanosis, diaphoresis and tachypnea are noted. The most appropriate nursing intervention would be to:  

• Administer A pre-medication before attempting the IV 

• Apply a face mask with oxygen 

• Transfuse red blood cells

• Place the child in knee-chest position

Answer explanation

Place the child in knee-chest position: This maneuver aids blood return to the heart, thus alleviating cyanotic spells 

CPHON:

3. A 3-year-old presents to the hospital after the mother found a medium-sized mass on the patient's abdomen. The patient's other symptoms include a blood pressure of 139/88 mm Hg and hematuria found on urinalysis. The nurse suspects the patient might have which underlying genetic condition?

• 1. Down syndrome. 

• 2. Li-Fraumeni syndrome. 

• 3. Beckwith-Wiedemann syndrome. 

• 3. Neurofibromatosis type 1. 

Answer explanation

Renal tumors are associated with aniridia, hemihypertrophy or genital or renal malformations; Beckwith-Wiedemann syndrome, and other overgrowth syndromes.

CPN:

3. The nursing diagnosis that applies to all pediatric patients who are hospitalized for invasive procedures is: 

• 1. risk for impaired gas exchange. 

• 2. risk for impaired skin integrity. 

• 3. risk for fluid volume imbalance. 

• 4. risk for infection. 

Answer explanation

While all of these nursing diagnoses may apply to children hospitalized for invasive procedures, depending on the child's condition and type of procedures, the nursing diagnosis that applies to all children in that situation is risk for infection. Hospital-acquired infections are common and the risk increases with the length of hospital stay and the number and type of invasive procedures. Children must be monitored carefully for early signs of infection, especially fever and erythema.

CCRN:

Family members of a patient who has just died are crying and wailing loudly both inside and outside the patient's room. Staff are expressing frustration with the outbursts. The nurse's best response is to acknowledge the noise and: 

• Ask a security officer to remove the family from the unit 

• Guide the family to a nearby room where they can express their emotions 

• Tell the family they must quiet down, or they will have to leave the unit 

• Tell the other staff they are being insensitive to the family's expression of grief 

Answer explanation

Guide the family to a nearby room where they can express their emotions: People from various cultures express grief and mourning in different ways. This expression may include loud, emotional responses. Providing the family a place close to the patient's room allows them privacy while minimizing disruption to other patients and staff in the area.