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Question 1

Following placement of a central venous catheter, a mechanically ventilated child develops acute tachycardia, hypotension, and arterial desaturation. A nurse should evaluate the need for:

Options :

A : Administration of a sedative

B : Insertion of a chest tube

C : An increase in the ventilator rate

D : An IV fluid bolus

Answer: B

Question 2

Immediately following a heart transplant, a patient has two P waves followed by one QRS segment each cardiac cycle. What is the nurse's next step?

Options :

A : Request isoproterenol

B : Continue to monitor

C : Start temporary pacing

D : Obtain an echocardiogram

Answer: B

Question 3

A child has a fever, moderate hypertension, petechiae, decreased urinary output, and bloody diarrhea. A nurse should suspect:

Options :

A :

Hepatorenal syndrome

B : Hemolytic uremic syndrome

C : Nephrotic syndrome

D : Acute glomerulonephritis

Answer: B

Question 4

A patient is postoperative day 1 from a laparotomy for appendicitis. Which intervention best prevents surgical wound infection?

Options :

A : Apply a dressing with plastic tape over the wound, encourage handwashing, and offer a high-calorie diet

B : Shower twice daily, apply betadine to the skin around the wound, and maintain NPO status

C :

Encourage nutritional support as early as possible, bathe daily with pH-balanced cleanser, and encourage mobility

D : Cleanse the wound with antibacterial soap and water, maintain NPO status, and encourage mobility

Answer: C

Question 5

When evaluating the effectiveness of a new skin care protocol, a nurse should assess the:

Options :

A : Preventive measures implemented

B : Change in nursing care hours

C : Presence of lesions, ulcers, or erythema

D : Documentation of nursing interventions

Answer: C