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WorksheetsN396 Exam 3 Practice
Total questions: 51
Worksheet time: 26mins
A nurse is assessing an infant with suspected cardiovascular compromise. Which physiological mechanism do infants primarily use to maintain cardiac output?
Increased stroke volume
Vasodilation
Increased heart rate
Enhanced contractility
The nurse is teaching a group of nursing students about differences in pediatric cardiac and respiratory physiology. Which of the following are accurate statements? Select all that apply.
Children have a larger heart size relative to their chest, which reduces pulmonary reserve.
Bradycardia in pediatric patients is often caused by hypoxia.
Stroke volume increases significantly in infants under stress.
Infants have higher oxygen demands due to their metabolic rate.
A lower heart rate in infants is an expected sign of adaptation.
Which of the following would the nurse recognize as a late sign of shock in a child?
Tachycardia
Cool extremities
Delayed capillary refill
Hypotension
The nurse is caring for a 3-month-old infant. Which assessment finding requires immediate intervention?
Heart rate of 168 bpm during crying
Respiratory rate of 52 while sleeping
Oxygen saturation of 89% with bradycardia
Capillary refill of 3 seconds after feeding
The nurse is preparing to measure an infant's vital signs. The nurse should use which of the following sites to assess a heart rate?
Carotid artery
Apex of the heart
Brachial artery
Radial artery
A nurse is performing a cardiovascular assessment on a pediatric patient. Which of the following techniques and considerations are appropriate during this assessment? Select all that apply.
Warm the stethoscope before placing it on the child's skin.
Use only the diaphragm of the stethoscope for heart sounds.
Assess the heart sounds when the child is quiet or asleep.
Use the bell to assess high-pitched heart sounds.
Have older children sit upright for the assessment.
A nurse is caring for a pediatric patient after a cardiac catheterization procedure. Which post-procedure nursing interventions are essential? Select all that apply.
Monitor vital signs and assess for signs of bleeding at the catheter insertion site.
Encourage increased oral fluid intake if not contraindicated.
Assess distal pulses in the affected extremity and compare bilaterally.
Keep the affected extremity straight for the prescribed period.
Monitor for signs of contrast material reaction, such as rash or difficulty breathing.
A nurse is assessing a child after cardiac catheterization via the femoral vein. Which of the following findings would require immediate intervention?
Mild discomfort at the catheter insertion site
Capillary refill of 2 seconds in the affected extremity
Pallor and coolness in the affected extremity
Slight bruising at the catheter insertion site
A nurse is caring for a child recovering from a cardiac catheterization via the femoral artery. Which positioning instruction is most appropriate immediately post-procedure?
High Fowler's position with knees flexed
Supine with affected leg straight for 2-3 hours
Supine with affected leg straight for 6-8 hours
Semi-Fowler's with the head of bed at 45 degrees
A nurse is providing discharge teaching to the parents of a child who just underwent cardiac catheterization. Which instructions are appropriate? Select all that apply.
Keep the site clean and dry.
Limit physical activity for at least 72 hours.
Avoid tub baths for at least 3 days.
Call the provider if your child has a fever or the site is red or swollen.
Change the bandage daily for 2 days.
A child who had a cardiac catheterization suddenly develops bleeding at the insertion site. What are the nurse's priority actions? Select all that apply.
Send labs for CBC as ordered
Apply pressure 1 inch above the insertion site
Monitor vital signs
Call the provider immediately
Place the child flat
A nurse is teaching a caregiver how to meet the nutritional needs of an infant with heart failure. Which strategies should be included? Select all that apply.
Use gavage feeding if the infant tires easily during oral feeding
Increase caloric density of formula or breast milk
Monitor weight gain and feeding tolerance
Space feedings far apart to allow for digestion
Allow rest periods during feeding
Which of the following nursing actions are appropriate when administering oral digoxin to a pediatric patient? Select all that apply.
Verify dose with a second nurse
Administer at regular intervals and rinse or brush teeth after
Withhold the dose if apical HR is below parameters
Use only a calibrated oral syringe for doses under 0.2 mL
Mix the dose with applesauce to mask taste
The nurse is obtaining a health Hx from a child who has suspected acute rheumatic fever. Which of the following questions should the nurse ask?
Has your child had a sore throat recently?
Was your child born with this cardiac defect?
Has your child had any injuries recently?
Have you given your child aspirin in the past 2 weeks?
A 9-year-old child is admitted with suspected Acute Rheumatic Fever (ARF). Which findings would support this diagnosis based on the Revised Jones Criteria? Select all that apply.
Firm, painless nodules on fingers
New-onset heart murmur
Migratory pain in knees and ankles
Fever of 39°C (102.2°F)
Evidence of recent group A strep infection
A nurse is caring for a child who has Kawasaki disease. Which of the following are common manifestations of this disease? (select all that apply)
Strawberry tongue
Joint pain
Recent sore throat
Rash on the trunk and groin
Bloodshot eyes
A child recovering from the sub-acute phase of Kawasaki Disease has cracking lips, peeling of fingertips, and joint pain. The nurse is planning discharge teaching. What information should be included? Select all that apply.
Peeling of hands and feet is painless and expected
Joint stiffness may persist; encourage passive range of motion
Notify provider if fever returns
Continue low-dose aspirin as prescribed
Delay routine immunizations for 11 months
A nurse is caring for an infant who has a congenital heart defect. Which of the following defects is associated with increased pulmonary blood flow?
Coarctation of the aorta
Patent ductus arteriosus
Tetralogy of Fallot
Transposition of the great arteries
A 2-month-old baby has S/Sx of 'turning blue' while crying. The father also reports that the baby has labored breathing. On physical examination, the mucous membranes appear to be mildly cyanotic. Based on these findings, which CHD is the likely diagnosis?
Atrial Septal Defect
Patent Ductus Arteriosus
Coarctation of Aorta
Tetralogy of Fallot
A newborn has a failed pulse oximeter screen with an oxygen saturation of 89% in the right hand and 94% in the lower extremity. What is the priority action by the nurse?
Recheck oximeter in 4 hours
Notify the healthcare provider immediately
Begin chest compressions
Initiate oxygen at 2 L/min by nasal cannula
The nurse is preparing to administer indomethacin to a preterm newborn. Which heart defect is this medication most appropriate for?
Transposition of the great arteries
Coarctation of the aorta
Tetralogy of Fallot
Patent ductus arteriosus (PDA)
Which of the following clinical findings would alert the nurse to coarctation of the aorta in a newborn? Select all that apply.
Strong brachial pulses and weak femoral pulses
Equal BP in all four limbs
Bounding pedal pulses
Increased capillary refill time in the lower extremities
Cardiomegaly on chest x-ray
A nurse is planning care for an infant with a large VSD and signs of CHF. Which nursing interventions are appropriate? (Select all that apply)
Provide frequent small, high-calorie feedings
Weigh daily at the same time
Restrict fluids to prevent overload
Cluster care to minimize oxygen demand
Elevate legs to improve venous return
Which statement by a student nurse indicates correct understanding of newborn pulse oximetry screening for critical CHD?
A difference of 2% between the right hand and foot is abnormal.
It's done before 12 hours of age to identify issues early.
A saturation of 94% in the foot is considered a passing result.
A greater than 3% difference between hand and foot may indicate critical CHD.
The nurse is assessing a child in a cast and notes the leg is tight, warm, shiny, and the child reports tingling. Which priority complication should the nurse suspect?
Osteopenia
Deep vein thrombosis
Compartment syndrome
Joint contracture
The nurse assesses a 10-year-old with a fracture and suspects a growth plate injury. Why is this injury concerning?
It requires less healing time
It's likely to cause joint stiffness
It may lead to long-term growth disturbances
It always requires
Why is a growth plate injury concerning?
It requires less healing time
It's likely to cause joint stiffness
It may lead to long-term growth disturbances
It always requires surgical intervention
The nurse is teaching a parent about spica cast care for their child. Which of the following instructions should the nurse include in the teaching? Select all that apply.
Report any numbness or tingling in the toes.
Apply lotion to areas of itching under the cast.
Use a fan or cool hair dryer setting for itching.
Expect the cast to dry within 24-72 hours if it is made of plaster.
Use the palm of your hands to handle the wet cast.
A nurse is assessing an infant for developmental dysplasia of the hip (DDH). Which findings would support this diagnosis? (Select all that apply.)
Unequal gluteal folds when prone
Positive Ortolani test
Lengthened limb on affected side
Restricted hip abduction
Positive Barlow test
A newborn diagnosed with DDH is placed in a Pavlik harness. What should the nurse include in the plan of care and family teaching? (Select all that apply.)
The harness should be removed during diaper changes.
Use of the harness is typically 22-24 hours/day.
Monitor skin under straps frequently.
Encourage age-appropriate activity while in the harness.
Apply lotion or powders under straps to prevent friction.
A nurse is caring for a child who has just undergone scoliosis surgery. Which of the following post-operative interventions should the nurse implement? (Select all that apply.)
Assess vital signs regularly
Encourage the child to sit up immediately
Maintain spinal alignment by log rolling
Assess neurovascular status of the lower extremities
Provide pain management with opioids only
Which of the following are appropriate nursing management interventions for a child with osteomyelitis? (Select all that apply.)
Monitor for medication side effects
Encourage frequent ambulation
Provide adequate rest
Use standard precautions for draining wounds
Assess nutrition and hydration status
Which of the following are clinical features of Cerebral Palsy in children? (Select all that apply.)
Abnormal muscle tone and posture
Seizures and epilepsy
Delayed communication or cognitive skills
Hypotension and bradycardia
Drooling and poor oral motor control
A nurse is developing a plan of care for a child with Cerebral Palsy. Which interventions are appropriate? (Select all that apply.)
Provide thickened feeds or tube feeding if swallowing is impaired.
Refer the child to PT, OT, and ST for developmental support.
Monitor skin under orthotic devices and assess for breakdown.
Avoid use of adaptive utensils to encourage independence.
Educate family to monitor for respiratory issues and constipation.
A newborn is diagnosed with a myelomeningocele. Which of the following interventions should the nurse anticipate including in the plan of care? (Select all that apply)
Place the infant in a prone position
Keep the sac moist with sterile dressing
Apply dry gauze to the lesion site
Avoid diapering the infant over the defect
Monitor for signs of hydrocephalus
A nurse is assessing a child with spina bifida occulta. Which of the following findings might the nurse observe?
Visible sac with cerebrospinal fluid on the back
Sacral dimple with a tuft of hair
Flaccid lower extremities
Herniation of brain tissue
Open vertebral column with exposed meninges
A nurse is educating the family of a child recovering from Guillain-Barré syndrome about the phases of the condition. Which statement by the parent indicates understanding?
The plateau phase is when symptoms get worse every day.
In the acute phase, symptoms stay stable and don't change.
The recovery phase may take several weeks or even months.
After the acute phase, the child will return to normal function immediately.
A nurse is assessing a 4-week-old infant suspected of having tetanus. Which clinical manifestations support this diagnosis? Select all that apply.
Painful rigidity of the neck
Stiff body with arched back
Seizures and ataxia
Difficulty swallowing
Masseter muscle spasms (trismus)
A school-aged child presents to the emergency department with symptoms of diplopia, weakness, and dizziness following consumption of home-canned green beans. The nurse suspects foodborne botulism. What is the initial priority action?
Notify public health department
Administer IV fluids
Prepare for mechanical ventilation
Give antiemetics for vomiting
Which of the following is the priority nursing action when caring for a child diagnosed with Duchenne Muscular Dystrophy (DMD)?
Administer corticosteroids to reduce inflammation
Promote self-care and encourage independence
Monitor and maintain circulatory and respiratory status
Implement high-calorie feeding to promote weight gain
A 6-year-old boy with Duchenne Muscular Dystrophy (DMD) demonstrates Gower sign when attempting to stand. Which of the following is the best description of this sign?
The child uses their arms to 'walk' up their legs to stand
The child shows excessive stiffness in their legs and difficulty bending their knees
The child experiences an abnormal heart rhythm while attempting to stand
The child falls backward due to weakness in the legs
A nurse is educating the parents of a child with hemophilia about preventing injury. Which of the following strategies should the nurse recommend to the parents? (Select all that apply)
Use padded furniture and play areas for the child
Encourage participation in contact sports like football
Use small bore needles for vaccinations
Encourage swimming instead of contact sports
Monitor the child for frequent epistaxis
A nurse is caring for a 6-year-old child with hemophilia who presents with a nosebleed. The nurse should perform which of the following actions? (Select all that apply)
Have the child lie down
Apply continuous pressure to the child's nose
Insert cotton or tissue into the child's nostrils
Place a cold compress on the back of the child's neck
Instruct the child to breathe through the mouth
A nurse is educating parents of a child newly diagnosed with sickle cell disease (SCD). Which statements should the nurse include? Select all that apply.
Avoid exposing your child to cold temperatures.
Encourage your child to rest during pain crises.
Ensure your child receives all routine vaccinations.
Limit fluid intake to reduce the risk of edema.
Administer aspirin for pain management during crises.
A nurse is caring for a patient with SCD during a vaso-occlusive crisis. Which intervention should the nurse prioritize?
Administer IV morphine sulfate
Apply cold compresses to painful joints
Restrict oral fluids to reduce nausea
Encourage ambulation to improve circulation
A patient with SCD reports severe pain but appears calm. The nurse should:
Question the patient's pain rating due to their demeanor
Administer prescribed opioids and document findings
Delay analgesia until objective signs of pain are observed
Request a psychology consult for possible malingering
A nurse is educating parents of a child with SCD about splenic sequestration. Which instruction is most important?
Massage the abdomen daily to assess spleen size.
Ensure your child receives the pneumococcal vaccine.
Limit fluid intake to reduce splenic congestion.
Avoid all physical activity to prevent injury.
A 5-year-old child with Wilms' tumor is admitted for surgery. Which preoperative nursing action is critical?
Palpate the abdomen to assess tumor size
Administer IV antibiotics to prevent infection
Avoid abdominal manipulation to prevent metastasis
Encourage high-protein foods to boost immunity
A parent notices a white reflex in their 2-year-old's eye during a photo. Which action is most appropriate from the nurse?
Reassure the parent this is a normal finding
Schedule an ophthalmology referral within 2 weeks
Administer topical antibiotic eye drops
Prepare the child for an immediate MRI
A child with leukemia has an ANC of 400/mm³. Which precautions should the nurse implement? Select all that apply.
Place the child in a semi-private room with another neutropenic patient
Restrict fresh flowers and potted plants from the room
Allow the child to eat fresh fruits if they are washed thoroughly
Use the child's dedicated stethoscope for assessments
Permit visits from siblings with mild cold symptoms
A nurse is supporting a family withdrawing life-sustaining care for their child. Which actions are essential? Select all that apply.
Ensure the child is unaware of the decision to prevent distress
Provide uninterrupted time for family to be with the child
Administer medications to manage agitation or pain
Delay spiritual care until after the child passes
Document the family's preferences for postmortem care
