Question 1

A nursing student asks a pediatric intensive care nurse why being bed-bound for several weeks would affect a young child's growth and development.Which response by the nurse is the most appropriate?

Accepted Answer

A)  "A child on bedrest has depression, slowing development." 
B)  "Bedrest causes muscle weakness that limits activity." 
C)  "Growth and development are highly connected to activity." 
D)  "Isolation from peers has a negative effect on growth."

Question 2

A child has just had an invasive hemodynamic monitor inserted.After connecting the monitoring device to the monitor,what action should the nurse take next?

Accepted Answer

A)  Assess the child's postprocedural pain status. 
B)  Document hemodynamic assessments. 
C)  Have the parents return to the room to comfort the child. 
D)  Perform hand hygiene and dispose of equipment.

Question 3

A critically ill child on a ventilator is mildly anemic.Which action by the nurse is the most appropriate?

Accepted Answer

A)  Decrease the administration rate of the IV fluids. 
B)  Draw minimal amounts of blood for laboratory tests. 
C)  Have parents sign consent for blood transfusions. 
D)  Monitor the child's hemoglobin levels daily.

Question 4

A 7-year-old child is in the pediatric intensive care unit on a ventilator.Sedation is maintained with a midazolam (Versed)drip.Which items should the nurse ensure are readily available at the child's bedside?

Accepted Answer

A)  Back-up ventilator 
B)  Bag-valve mask device 
C)  Flumazinil (Romazicon) 
D)  Narcan (Naloxone) 
E)  Working suction setup

Question 5

A child is mechanically ventilated.Which assessment finding indicates that a priority goal is being met?

Accepted Answer

A)  Enteral feeding tube present 
B)  PaCO2: 40 mm Hg 
C)  Intact skin integrity 
D)  Ventilator on control mode

Question 6

A child in the intensive care unit had a pulmonary artery catheter inserted 2 hours ago.The child is increasingly restless.The child's vital sign trends show a slow increase in pulse rate.Which action by the nurse is the most appropriate based on the assessment findings?

Accepted Answer

A)  Check to ensure the connections are secure. 
B)  Document the findings in the patient's chart. 
C)  Increase the frequency of hemodynamic readings. 
D)  Notify the health-care provider immediately.

Question 7

The nursing manager is collaborating with health-care providers to determine appropriate candidates for ventilator weaning in the pediatric intensive care unit.Which child is the best candidate?

Accepted Answer

A)  Oxygen requirement: 60% 
B)  Peak inspiratory pressure: 32 cm H2O 
C)  Spontaneous tidal volume: 2 mL/kg 
D)  Ventilator rate: 6 breaths/minute

Question 8

A nurse is preparing to transfer a child from the intensive care unit to progressive care.The parents seem very anxious and do not want the child to transfer.Which responses by the nurse are most appropriate?

Accepted Answer

A)  "I am interested in what is most stressful about moving your child." 
B)  "Parents are always involved with their child's care in any unit." 
C)  "The nurses will monitor your child closely as often as needed." 
D)  "We can keep her here if you really insist on it." 
E)  "You should be happy because your child is getting better."

Question 9

A mechanically ventilated 2-year-old child has copious oral secretions.What action by the nurse takes priority?

Accepted Answer

A)  Assess placement of the endotracheal tube. 
B)  Clean and dry the skin around the mouth. 
C)  Raise the head of the child's bed to 60°. 
D)  Suction the oral cavity every 2 hours.

Question 10

A 62-lb (28.1-kg)child has symptomatic bradycardia.Which medication does the nurse anticipate administering?

Accepted Answer

A)  Atropine, 0.28 mg IV push 
B)  Atropine, 28 mg IV push 
C)  Norepinephrine, 0.28 mg IV push 
D)  Norepinephrine, 28 mg IV push

Question 11

A child who weighs 28 lb needs fluid resuscitation.The nurse plans to administer ____________________.

Accepted Answer

The answer of A child who weighs 28 lb needs...

Question 12

A nurse is assessing a critically ill child's respiratory status.The child is grunting and has nasal flaring,but the pulse oximeter reads the child's oxygen saturation at 96%.Which nursing action is the priority in this situation?

Accepted Answer

A)  Conduct a thorough assessment and call the provider. 
B)  Document the findings in the child's medical chart. 
C)  Notify the rapid response team immediately. 
D)  Turn up the oxygen and reassess the child in 30 minutes.

Question 13

A patient in the pediatric intensive care unit has hemodynamic monitoring.Her cardiac output is 3 L/minute.Which assessment finding is consistent with this reading?

Accepted Answer

A)  Capillary refill: 2 seconds 
B)  Temperature: 103°F (39.4°
C)  
C)  Urine output: 3 mL/kg/hour 
D)  Weak, thready pulse

Question 14

A child on a ventilator suddenly desaturates.Which nursing action is the priority?

Accepted Answer

A)  Assess for displacement of the tube. 
B)  Assess for obstruction of the tube. 
C)  Ensure the ventilator is functioning properly. 
D)  Listen to lung sounds for pneumothorax.

Question 15

The nurse has just repositioned a child who is intubated and mechanically ventilated.Which action by the nurse takes priority?

Accepted Answer

A)  Assess placement of the endotracheal tube. 
B)  Document the condition of the child's skin. 
C)  Ensure that the child cannot pull on tubing. 
D)  Turn the ventilator alarms back on.

Question 16

A child is being weaned from the ventilator.He is awake and alert but getting increasingly tired.Which action by the nurse is the most appropriate?

Accepted Answer

A)  Cluster nursing care so the child is able to get uninterrupted periods of rest. 
B)  Collaborate with other health team members to slow or stop the weaning process. 
C)  Draw a blood sample for blood gas analysis, and compare the results to the last blood gas values. 
D)  Have all of the child's visitors leave to allow the child to take a short nap.

Question 17

A nurse is supervising a student who is suctioning a 5-year-old patient in the pediatric intensive care unit.Which action by the student results in the nurse intervening?

Accepted Answer

A)  Auscultates lung sounds beforehand 
B)  Cleanses catheter after suctioning 
C)  Hyperoxygenates prior to suctioning 
D)  Sets suction pressure to 150 mm Hg

Question 18

A child weighs 32 lb.The health-care provider orders a loading dose of midazolam (Versed)prior to intubation.The safe dose range for this drug is ____________________.

Accepted Answer

The answer of A child weighs 32 lb.The health-care provider...

Question 19

A nursing student asks how excessive noise and sensory overload could cause feelings of panic in hospitalized children.Which response by the registered nurse is the most appropriate?

Accepted Answer

A)  "Children are frightened by all the activity in the intensive care unit." 
B)  "Excessive noise irritates the inner ear, which leads to behavior changes." 
C)  "It's just the body's natural way of dealing with unfamiliar stimuli." 
D)  "Stimulation of the adrenal glands leads to secretion of stress hormones."

Question 20

A child in the emergency department has just undergone emergent intubation.When listening to lungs,the nurse notes absent sounds on the left side.What action by the nurse is the most appropriate?

Accepted Answer

A)  Ask a more experienced provider to assess the child. 
B)  Facilitate completion of a portable chest x-ray. 
C)  Hyperoxygenate the patient and suction the airway. 
D)  Reposition the endotracheal tube and reassess.

Exam 35: Caring for the Critically Ill Child