NCSBN Practice Questions 76-90 Latest Update

NCSBN Practice Questions 76-90 Latest Update

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A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of this child, which one would be a priority at this time?

• Use aseptic technique during dressing changes
• Check results of liver enzyme tests
• Maintain central line catheter integrity

D. Monitor serum glucose levels - CORRECT ANSWER: D

Hyperglycemia may occur during the first day or two as the child adapts to the high- glucose load of the TPN solution. Thus, a priority nursing responsibility is blood glucose testing.

A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours after admission, during a planning conference, which of the actions suggested to the registered nurse (RN) by the practical nurse (PN) would be appropriate to add to the plan of care?

• Provide an over-the-crib protective top
• Measure head circumference
• Initiate droplet precautions

D. Provide passive range of motion - CORRECT ANSWER: B

In meningitis, assessment of neurological signs should be done frequently. Head circumference is measured because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis. The client would have already been placed 1 / 4

on droplet precautions and had a crib top applied to the bed when he was admitted to the unit.

A 12 year-old pediatric cancer client is distraught about the alopecia that occurred after the last chemotherapy treatment. Which nursing interventions are appropriate for this side effect of chemotherapy? (Select all that apply.)

• Practice and teach thorough hand washing
• Administer prescribed antiemetic medication before nausea is too severe
• Encourage visits from friends before discharge from the hospital
• Allow the child to choose a cap, scarf, wig or other head cover to use - CORRECT

ANSWER: C,D

Alopecia is the loss of hair, which is a frequent side effect of certain types of chemotherapy. Although it is not life-threatening, the body image change is difficult for many individuals, particularly children and adolescents. Encouraging visits from friends before discharge helps the young client and friends adjust. Wearing preferred forms of head cover-ups increases comfort and decreases embarrassment. The other options are proper interventions for chemotherapy, but do not help the client with hair loss.

A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for treatment of Kawasaki disease and treatment involving immunoglobulins. The nurse should recognize which scheduled immunizations will be delayed?

• Inactivated polio vaccine (IPV)
• Haemophilus Influenzae Type b (Hib)
• Mumps, measles, rubella (MMR)

D. Diptheria, tetanus, pertussis (DTaP) - CORRECT ANSWER: C

Medical management of Kawasaki involves administration of immunoglobulins.Measles, mumps, rubella (MMR) is a live virus vaccine. Following administration of immunoglobulins, live vaccines should be held due to possible interference with the body's ability to form antibodies.

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A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What should be an initial action by the nurse?

• Arrange to change client care assignments
• Explain that the child needs extra attention
• Discuss the appropriate use of "time-out"

D. Explain that this behavior is expected - CORRECT ANSWER: D

During normal development, fear of strangers becomes prominent and begins around age 6 to 8 months-old. Such behaviors include clinging to parent, crying and turning away from the stranger. These fears and behaviors extend into the toddler period. In the toddler period, separation anxiety is at its peak. As the child ages the behavior has a tendency to wane.

A 2-year-old child has just been diagnosed with cystic fibrosis. The child's parent asks the nurse what the most important concerns are at this time. Which is the appropriate response from the nurse?

• "Thick, sticky secretions from the lungs are a constant challenge."
• "Cystic fibrosis results in nutritional concerns that can be dealt with."
• "You will work with a team of experts and have access to a support group."
• "There is a high probability of life-long complications." - CORRECT ANSWER: A

The primary factor, and the one responsible for many of the clinical manifestations of cystic fibrosis, is mechanical obstruction caused by the increased viscosity of mucous gland secretions.Because of the increased viscosity of bronchial mucus, there is greater resistance to ciliary action (probably secondary to infection and ciliary destruction), a slower flow rate of mucus and incomplete expectoration, which also contributes to the mucus obstruction. This retained mucus serves as an excellent medium for bacterial growth. Reduced oxygen-carbon dioxide exchange causes variable degrees of hypoxia, hypercapnia and acidosis.In severe cases, progressive lung involvement, compression of pulmonary blood vessels and progressive lung dysfunction frequently lead to pulmonary hypertension, cor pulmonale, respiratory failure and death. Pulmonary 3 / 4

complications are present in almost all children with cystic fibrosis, but the onset and extent of involvement are variable.

A 3 year-old child has findings that may suggest a neuroblastoma. While listening to the concerns of the parents, which finding is consistent with this diagnosis and requires follow-up by the health care provider?

• "He seems to be getting weaker and weaker and is sometimes unsteady on his feet."
• "We keep having to buy him larger size pants because he's growing so big around

the waist."

• "He doesn't seem to be going to the bathroom as much and his urine is dark yellow

in color."

• "Our child has been quieter than normal lately and has lost weight." - CORRECT

ANSWER: B

One of the most common signs of neuroblastoma is increased abdominal girth due to the mass or tumor in the abdomen. The mass can cause pain and/or a feeling of fullness and the pressure may affect the child's bladder or bowel. Although the child with a neuroblastoma may not want to eat (which can lead to weight loss), this finding could have many causes. A more significant finding would be if the parents reported that child keeps outgrowing clothing or that clothing is tight around the abdomen.

A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg; resting pulse is 78 BPM; respirations are 28 BPM; and the serum potassium level is 4.8 mEq/L (4.8 mmol/L). The client is irritable and has vomited twice since the morning dose of digoxin. Which finding is most indicative of digoxin toxicity?

• Irritability
• Vomiting
• Bradycardia

D. Dyspnea - CORRECT ANSWER: C

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