End of slide questions

Kamal is a formula-fed, 1 month old infant who weighed 3700 g at birth. She is gaining weight well and appears healthy. Kamals mother looks exhausted and states that she is concered and frustrated and feels like she is not a good mother. Kamals mother has heard of a condition called sudden infant death syndrome (SIDS) and asks the nurse how can she protect her baby.

The nurses should recommend which of the following:

A. Place kamal to sleep on her back

b. Place kamal to sleep on her stomach

c. recommend the use of a home monitor to assess for apneic episodes

d. place kamal to sleep on her side

A. Place kamal to sleep on her back

Matt is a healthy 2 ½-year-old boy whose mother asks the nurse for advice about toilet training

Matt's mother is expecting her second child in 4 months and has no previous experience with toilet training Matt is brought to the clinic 4 ½ months later because he has an ear infection.

The nurse asks about toilet training. His mother says, "He has done really well except since the baby came he has wanted to wear diapers instead of underpants.

I have been letting him wear diapers. He takes them on and off to use the toilet.

I hope that is O.K."

Which is the most appropriate action for the nurse to take?

A. Assess why the mother decided to let Matt wear diapers.

B.Recommend that the mother put Matt back into underpants immediately.

C.Reassure the mother that regression such as this is common in toddlers after the birth of a sibling.

D.Explain to the mother that negativism such as this is common in toddlers who are toilet trained before they are ready.

C.Reassure the mother that regression such as this is common in toddlers after the birth of a sibling.

Amanda is a healthy 4-year-old child who presents for her yearly well-child visit.

Amanda's mother is concerned that Amanda has trouble going to sleep.

Which would be an appropriate initial reply from the nurse?

A.Some children have trouble going to sleep.

B.Bring the child into your bed to make it easier for her.

C.Allow the child to stay awake beyond her usual bedtime.

D. Try eliminating naps so that she is more tired at bedtime.

A.Some children have trouble going to sleep.

Patrick is an active 7-year-old who lives with his parents and two younger siblings in a house in the suburbs of a small city. He enjoys being outside and riding his bike.

What is the most effective means to support accident prevention?

A.Purchase new equipment.

B.Supervise all activities.

C.Educate the child and family.

D.Hang posters in the school.

C.Educate the child and family.

A father brings in 15-year-old John for his sports physical.

This is the first time the nurse has met the family. According to his chart, John has not had a health assessment in 4 years. There have been a lot of changes in the household.

The father reports that he is now the primary care provider since he lost his job more than 1 year ago.

The mother lives with the family but works long hours and is unavailable for childcare issues.

While performing the health history, the nurse observe that John becomes anxious during the sexual history, avoiding eye contact with the nurse or his father, and answers questions with hesitation.

What is the best action for the nurse to take?

A. Provide John with the opportunity to complete the health history without the father present.

B.Encourage John to complete the questions honestly and openly.

C.Assure John that although confidentiality is important, it is good to share this information with his father.

D.Continue asking probing questions because the nurse does not want to attract attention to John's behaviour

A. Provide John with the opportunity to complete the health history without the father present.

A nurse is caring for an adolescent who has spina bifida and is paralyzed from the waist down. Which of the following statements by the client should indicate to the nurse a need for further teaching?

A. "I only need to catheterize myself twice every day. "

b. "I carry a water bottle with me because I drink a lot of water."

c. "I use a suppository every night to have a bowel movement."

• D. "I do wheelchair exercises while watching TV."

A. "I only need to catheterize myself twice every day. "

A nurse is orienting a newly licensed nurse in the care of an infant who has myelomeningocele. Which of the following actions by the new nurse indicates the teaching has been effective?

1. Performs range of motion on the infant's hips

2. Maintains a dry dressing over the sac

3. Takes an axillary temperature

4. Places the infant in a side-lying position

Takes an axillary temperature

A nurse is planning care for an infant who has spina bifida and is to undergo surgical closure of the myelomeningocele sac? Which of the following interventions should the nurse include in the plan of care?

1. Maintain the infant in the supine position.

2. Initiate contact precautions.

3. Provide a latex-free environment.

• D. Limit visitors to immediate family members.

Provide a latex-free environment.

Juan was just born to Sonia gonzales. He has a cleft lip and cleft palate (CL/P).

• Which of the two defects is usually repaired first?

• Protection of suture line for CL repair is provided by what?

• When is CP repaired?

• What are associated problems with CL/P?

• Lip is repaired before palate​

• Suture line prevention: don’t put prone, elbow restraints​

• Palette repaired: before speaking​

• Problems: speech, feeding, teeth, hearing (infections, hearing loss)​

A 12 month old is hospitialized and confined to a room. Which toys would meet the developmental needs of the child?

a. large building blocks

b. modeling clay

c. hanging crib toys

d. crayons and a colouring book

a. large building blocks

Appropriate nursing interventions for a newborn’s myelomeningocele sac prior to surgery including sterile technique and:

A. Applying dry dressing

B. Applying petrolatum to cover the sac

C. applying moist saline dressing

D. Leaving the sac open to air

C. applying moist saline dressing

A nurse is caring for an infant who had a cleft lip and palate repair. Which type of restraints should the nurse apply?

A. wrist

B. jacket

C. elbow

D. Mummy

C. elbow

A nurse is caring for a toddler, 24 hours post op cleft palate repair. Which action should the nurse take?

A. implement a soft diet

B. Administer opioids for pain

C. Offer fluids through a straw

D. Apply bilateral wrist restraints

B. Administer opioids for pain

What term is used to describe a fracture that does not produce a break in the skin?

A. Simple

B. Compound

C. Complicated

D. Comminuted

A. simple

A child is upset because, when the cast was removed from her leg, the skin surface was caked with desquamated skin and sebaceous secretions. What should the nurse to remove the material?

A. Soak in a bathtub

B. Vigorously scrub the leg

C. Apply powder to absorb the material

D. Carefully pick the material off the legs

A. Soak in a bathtub

Why does a nurse use the palms of their hands when handling a wet cast?

A. To assess the dryness of the cast

B. To facilitate easy turning

C. To keep patients limb balanced

D. To avoid indenting the cast

D. To avoid indenting the cast

When does idiopathic scoliosis become most noticeable?

A. During the newborn period

B. When the child starts to walk

C. During the preadolescent growth spurt

D. In adolescence

C. During the preadolescent growth spurt

True or false: Most idiopathic scoliosis that occurs in children appears before the age of 10

False

True or false: In most cases of scoliosis, health care providers cannot find the cause.

True

True or false: spinal curves less than 10 degrees require medical treatment

False

True or false: people with scoliosis should avoid exercise

False

True or false: fusion is one way to surgically treat scoliosis

True

True or false: chiropractic manipulation is an effective alternative to bracing

False

Does not stop progression, may alleviate s&s

A nurse is planning care for an adolescent who is post op following scollosis repair with harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?

A. Keep the head of the bed at a 30 degree angle

B. Reposition the patient by log rolling q4h

C. Place the client in a protective isolation

D. Initiate the use of a PCA pump

D. Initiate the use of a PCA pump

A nurse is planning care for an adolescent, who has scoliosis and requires surgical intervention. Which of the following behaviors by the adolescent should the nurse anticipate because it is the most common reaction?

A. Identity crisis

B. Body image change

C. Feelings of displacement

D. Loss of privacy

B. Body image change

A nurse is completing a pre op teaching plan for a client who is scheduled to have a total hop arthroplasty. Which of the following should the nurse include in the teaching plan? (SATA)

A. Use an abductor pillow when turning
B. Sit in a low reclining chair

C. Instruct the patient to roll onto the operative hip

D. Perform isometric exercises of foot/ankle

A. Use an abductor pillow when turning

D. Perform isometric exercises of foot/ankle

A nurse is assessing a client who had an external fixation device applied 2 hours ago for a fracture of the left tibia and fibula. Which of the following findings is a manifestation of compartment syndrome? (select all that apply)

1. Intense pain when the client's left foot is passively moved

2. Capillary refill of 2 sec on the client's left toes

3. Hard, swollen muscle in the client's left leg

4. Burning and tingling of the client's left foot

5. Client reported minimal pain relief following a second dose of opioid medication

A. Intense pain when the client's left foot is passively moved

C. Hard, swollen muscle in the client's left leg

D. Burning and tingling of the client's left foot

E. Client reported minimal pain relief following a second dose of opioid medication

A 74-year-old client is admitted to the ER after tripping and falling in their back yard. The client reports pain in the right hip radiating to the groin area. Their right leg is shorter than the left, adducted, and is externally rotated. They report their pain as an 8 on a 0 to 10 scale. They deny pain elsewhere

They take calcium 500 mg + vitamin D 500 mg tablet BID and Metamucil each morning Which sign or symptom does the client exhibit that would indicate a definite hip fracture?

A. Pain in hip radiating to groin

B. Injured leg shorter and externally rotated

C) Pain high on pain scale

d) No symptoms elsewhere

B. Injured leg shorter and externally rotated

A 52-year old client presents to the outpatient clinic reporting heartburn. They say they think the discomfort is caused by the stress they have been under at work. They describe the discomfort as "burning" and "gnawing" and states it hurts between the umbilicus and sternum.

Eating or taking antacids relieves the pain for 2-3 hours, then it begins again. They are often awakened at night by the pain. His vital signs are:

• Temperature: 36.9

• BP: 105/60

• Pulse: 88 bpm

• Resps: 18

• Pulse oximetry: 96% on room air

They report taking no routine medications, but they do take ibuprofen daily for headaches and other pain. When the nurse asks about changes in stools, the client says that their stools have been black and sticky.

Which aspect of the client's symptoms do you think are of greatest concern?

1. Recurrence of the pain 2-3 hours after antacids.

2. Black, sticky stools.

3. Being awakened by pain.

4. Location of the pain.

1. Black, sticky stools.

What other instructions should the nurse give the client? (select all that apply)

1. Consume 8 ounces of milk whenever the heartburn begins.

2. Decrease caffeine intake.

3. Avoid smoking tobacco.

4. Avoid taking ibuprofen, aspirin, and related medications.

5. Avoid drinking alcohol.

1. Decrease caffeine intake.

2. Avoid smoking tobacco.

3. Avoid taking ibuprofen, aspirin, and related medications.

4. Avoid drinking alcohol.

Two days later, the client reports to the ER department.

They report their epigastric pain has worsened and they are feeling fatigued and weak. Their stools are now maroon in color.

Their blood pressure is 88/52 mm Hg, pulse is 121 bpm and respiratory rate is 20/min.

• What is the most likely explanation for the client's symptoms?

Active bleeding in GI tract

Given the clients symptoms, what intervention is the highest priority ?

A. Insert a large IV bolus

B. Prepare the client for an endoscopy

C. Position the patient in semi Fowler’s position

D. Obtain a list of the clients current medications

A. Insert a large IV bolus

A nurse is providing teaching to the parents of a child who has iron deficiency anemia and is taking iron supplements. Which of the following statements by the parents indicates an understanding of the teaching?

1. "The medication should be administered in one large dose every day"

2. "Restricting fiber from our child's diet will help absorption of the iron."

3. "The medication will be more effective if it is administered with meals."

4. "Our child's blood count will need to be monitored routinely for several weeks."

"Our child's blood count will need to be monitored routinely for several weeks."

A nurse in a pediatric clinic is caring for a child who has iron deficiency anemia and a new prescription for ferrous sulfate tablets. Which of the following instructions should the nurse provide the parents regarding administration of this medication?

• A. Give with a 240 mL (8 oz) glass of milk.

1. Administer at mealtimes.

2. Give with orange juice.

3. Administer at bedtime.

Give with orange juice.

A patient is admitted with celiac disease. The patients friends brought them dinner. Which food item below should the patient avoid consuming?

1. Pork barbeque sandwich

2. Steak and steamed broccoli

3. Braised chicken with carrots

4. Vegetables and rice

Pork barbecue sandwich

A nurse is teaching a parent of a child who has a urinary tract infection.

Which of the following should the nurse include in the teaching? (Select all that apply.)

1. Wear nylon underpants.

2. Avoid bubble baths.

3. Empty bladder completely with each void.

4. Watch for manifestations of infection.

5. Wipe perineal area back to front

1. Avoid bubble baths.

2. Empty bladder completely with each void.

3. Watch for manifestations of infection.

• A nurse is planning care of a child who has a urinary tract infection. Which of the following interventions should the nurse include?

1. Administer an antidiuretic.

2. Restrict fluids.

3. Evaluate the child's self-esteem.

4. Encourage frequent voiding.

Encourage frequent voiding

A nurse is assessing a toddler who has acute nephrotic syndrome. Which of the following findings should the nurse report to the provider?

1. ?Yellow nasal discharge.

2. ?Facial edema

3. ?Poor appetite

4. ?Irritability

Yellow nasal discharge

A nurse is assessing a child who has nephrotic syndrome. Which of the following findings should the nurse expect? (Select all that apply.)

1. Urine dipstick +2 protein

2. Edema in the ankles

3. Hyperlipidemia

4. Polyuria

5. Anorexia

Urine dipstick +2 protein

Edema in the ankles

Hyperlipidemia

Anorexia

•Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea caused by a bacterial infection. An early clinical sign of dehydration is usually:

A. Hypotension

B.Decreased urine output

C.Capillary refill time over 3 seconds

D. Tachycardia

D. Tachycardia

•Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea caused by bacteria. Mild dehydration is often treated at home by administering

A. Diluted fruit juices

B.Oral rehydration flulds

C.Water

D Warm milk

B.Oral rehydration flulds

• Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea caused by bacteria, Some of the most serious potential outcomes of hypertonic dehydration are related to

A. Neurological disturbances

B.Hypovolemic shock

C. Impaired kidney function

D. Parenteral therapy complications

A. Neurological disturbances

•Four-month-old Shannon is being treated at home for mild dehydration secondary to diarrhea by bacteria, Shannon's dehydration Increases and she is hospitalized with parenteral fluid therapy Which replacement is not added until kidney function is re-established?

A. Magnesium

B.Sodlum chloride

C.Potassium

D.Sodium bicarbonate

C. Potassium

•Brian is 4 years old, and his brother, Adam, is 5 months old. Both children are brought to the binie by their mother because of diarrhea and fever. Brian has also vomited twice The nurse assesses the children and determines that they are mildly dehydrated Which of the following is the most appropriate method of rehydrating Brian?

A. Administer intravenous fluids.

B.Give an oral rehydration solution,

C Give soft drinks that have been diluted and decarbonated

D. Give small amounts of gelatin or clear liquids such as juice and water.

B.Give an oral rehydration solution,

•Brian is 4 years old, and his brother, Adam, is 5 months old, Both children are brought to the clinid by their mother because of diarrhea and fever. Brian has also vomited twice.

The nurse assesses the children and determines that they are mildly dehydrated

The mother asks what to do about breastfeeding Adam. The nurse should recommend:

A. Stop breastfeeding for 24 hours

B.Stop breastfeeding until diarrhea stops.

C. Bottle feed glucose/water, alternating it with breastfeeding.

D. Continue breastfeeding and give an oral rehydration solution to replace diarrheal losses

D. Continue breastfeeding and give an oral rehydration solution to replace diarrheal losses

•Brian is 4 years old, and his brother, Adam, is 5 months old. Both children are brought to the clinie by their mother because of diarrhea and fever. Brian has also vomited twice. The nurse assesses the children and determines that they are mildly dehydrated,

The mother asks about giving the children antidiarrheal medication.

The nurse's response should be based on knowledge that these medications are:

A.Not recommended.

B. Recommended for children over age 6 months.

C. Recommended for children over age 1 year.

D. Recommended for children over age 4 years.

A.Not recommended.

•Brian is 4 years old, and his brother, Adam, Is 5 months old. Both children are brought to the alinie by their mother because of diarhea and fever. Brian has also vomited twice. The nurse assesses the children and determines that they are mildly dehydrated

The mother asks about giving Brian food after he is rehydrated Which of the following is the most appropriate recommendation?

A.Offer a regular diet.

B.Offer a regular diet except high-protein foods.

C.Give clear liquids for the next 24 hours.

D. Start the BRAT diet (bananas, rice, apples, and toast or tea):

A.Offer a regular diet.

An 11-month-old infant is brought to the clinic. The mother states that he has watery diarrhea, and the nurse notice that his eyes are sunken and that his skin turgor is only fair. The mother tells the nurse she wants to give an antidiarrheal medicine that she has at home and asks how much to give.

What is the best response of the nurse?

Do not give the medicine at all.

A nurse is planning post-procedure care for a client who received hemodialysis. Which of the following interventions should the nurse include in the plan of care? (select all that apply).

1. Check BUN and serum creatinine,

2. Administer medications the nurse withheld prior to dialysis.

3. Observe for signs of hypovolemia,

4. Assess the access site for bleeding.

5. Evaluate blood pressure on the arm with AV access.

1. Check BUN and serum creatinine,

2. Administer medications the nurse withheld prior to dialysis.

3. Observe for signs of hypovolemia,

4. Assess the access site for bleeding.

A 63-year-old client is admitted with a diagnosis of right renal cell carcinoma. Past medical history Includes: chronic renal failure, DM2, HTN, dyslipidemia. The client Is POD 2, following a right nephrectomy. 

1. What are the priorities of care for this client?

1. What are the nursing interventions required for this client?

2. What client/family teaching would you include in your plan of care?

• Vitals: BP 92/60, HR 78, Temp 36.4, Respirations 18, 02 sat 90%, on room air.

• Blood work values;

Hemoglobin:	77 (reference) 140-180 g/L)
• Creatinine:	191 (reference: 53-106 umol/L.)
• GFR:	15 (reference: >90 ml/min)
• Potassium:	6.0 (reference: 3.5-5.1 mmol/L)
• Phosphate:	4.8 (reference: 1.0-1.5 mmol/L)
• Calcium:	2.0 (reference: 2,1-2.5 mmol/L)

1. What are the priorities of care for this client?

   maintain function of other kidney, decrease potassium and increase GFR.

2. What are the nursing interventions required for this client?

Intake and output, S+S of fluid overload.

1. What client/family teaching would you include in your plan of care?

   fluid restriction, diet, decrease sodium, potassium, and phosphorus.

An 18-year-old client presents to a clinic with report of trembling, palpitations, sweating, nausea, headache, dizziness. She was diagnosed with diabetes mellitus at the age of 7. She reports being dehydrated from a night out with friends, but her glucose has been low all morning and despite having a snack, it has not gone above 2.1 mmol/L.

1. What assessments will be priority?

Assess blood glucose

The client's glucose is 2.9 mmol/L. What Intervention will be priority?

Carbs 15g, from tabs or juice, want fast acting carbs.

You recheck the glucose in 15 minutes, and it is now 4.9 mmol/L. What is your next step?

Snack: peanut butter crackers, cereal and milk

What should you include in your discharge teaching?

Food to eat when glucose is low.

Patient was out drinking, she should take snacks when she goes out.

Your 64-year old family member is newly diagnosed with Type 2 diabetes mellitus. She tells you she is overwhelmed with all the information she has been given since being diagnosed. She asks why her doctor has started her on statin medication. She never had any issues with cholesterol and is confused. How do you respond?

• to protect

• Increased association with kidneys, heart

• Vessels damaged

• Cholesterol stickyyyy

A 48-year-old calls your helpline with report of nausea, vomiting and diarrhea x 24 hours. He tells you he has Type 2 diabetes mellitus and is unsure what to do about his medications. What advice would you provide?

• don’t take

• Monitor blood glucose frequently, insulin sliding scale

Which factor may have precipitated ketoacidosis in a client with type 1 diabetes who has been adhering to a prescribed insulin regimen?

1. Increased exercise

2. Decreased food intake

3. Working the night shift

4. Upper respiratory infection

4. Upper respiratory infection

How is a definite diagnosis of breast cancer confirmed?

1. Self-exam

2. Mammogram

3. Ultrasound

4. Biopsy

4. Biopsy

True or false: the purpose of a biopsy is to remove a tumourous growth

False

Which diagnostic test is used to screen for prostate cancer?

1. Prostate Specific Antigen (PSA) Level

2. Digital Rectal Exam

3. Ultrasound

4. Urinalysis

2. Digital Rectal Exam

Bloating and increased abdominal girth are symptoms often associated with which cancer?

1. Ovarian

2. Prostate

3. Colon

4. Lung

1. Ovarian

Which diagnostic test requires the patient to be NPO & drink prep fluids?

a) Mammogram

B) Biopsy

c) Colonoscopy

d) Bronchoscopy

Colonoscopy

Which information would you provide to a patient following a bronchoscopy?

a) Drink plenty of fluids

b) Coughing up small amount of blood is normal

c) Drink only clear fluids for the first 24-hours

d) NPO until gag reflex returns

D) NPO until gag reflex returns

Metastatic cancer is classified as what stage?

a) I

B) II

C) III

d) IV

D) IV

• A 54-year-old client, has come to the ER with a fever 39°C) that has persisted for two hours. They report finishing a round of chemotherapy for cancer treatment 10 days ago. For the last two days, they have felt extreme fatigue.

• On exam, you find the following:

• 5'7" tall, 120 lbs

• Pale, diaphoretic

• BP 92/40 mm hg

• Pulse 124 beats/min

• Temperature 41°C

• Respirations 26/min

• Oxygen saturation 93% on room air

  what is the primary concern?

  what are the risk factors?

  Investigations?

  Precautions?

what is the primary concern?

• Anemia

what are the risk factors?

• Chemotherapy

Investigations?

• CBC, LBC, urinalysis, sample from ports and drains, Chest X-ray

Precautions?

• Reverse isolation, PPE, dedicated supplies, watch diet, limit visitors.

Todd is a 3 year old who has acute lymphoid leukemia (ALL). He is being seen in the oncology clinic for chemotherapy. Todd asks the nurse “What is wrong with my blood?”. The nurses response should be based on knowledge that leukemia results in increased:

a) Platelets

b) Red blood cells

c) Mature white blood cells

d) Immature white blood cells

d) Immature white blood cells

Todd is a 3 year old who has acute lymphoid leukemia (ALL). He is being seen in the oncology clinic for chemotherapy. Todd has some oral ulcers (stomatitis). His parents ask about oral hygeine. The nurse should suggest which of the following:

a) avoid brushing teeth until ulcers heal

b) use frequent mouthwashes with normal saline

c) use frequent mouthwashes with hydrogen peroxide

d) cleanse teeth with lemon glycerin swabs

b) use frequent mouthwashes with normal saline

Todd is a 3 year old who has acute lymphoid leukemia (ALL). He is being seen in the oncology clinic for chemotherapy. Todd has recently had several upper respiratory tract infections. Which of the following should the nurse recommend to decrease his risk of infection?

a) dress him warmly

b) use good hand hygiene

c) isolate him from others

d) keep him inside as much as possible

b) use good hand hygiene

Todd is a 3 year old who has acute lymphoid leukemia (ALL). He is being seen in the oncology clinic for chemotherapy. The chemotherapeutic agents that Todd is receiving usually cause nausea and vomiting. Which of the following is an appropriate nursing intervention related to this?

a) discourage oral intake of fluids

b) administer antiemetic before chemotherapy begins

c) administer antiemetic as soon as symptoms begin

d) explain to Todd and his parents that nausea and vomiting cannot be avoided.

b) administer antiemetic before chemotherapy begins

A child is diagnosed with a Wilm’s tumor. Where is it located and how is it treated?

Inside the kidney (neuro ontop)

Will take it out of kidney, it could burst and cancer could go everywhere. (Cancer: do surgery first, normally chemo & radiation first)

Why is IT (intrathecal) chemo used?

Directly to C&P. Bypass BBB and target cells in brain.

Can’t do in veins/IV chemo

What is the top 2 clinical manifestations of a brain tumor?

• Nausea + vomiting

• Headache