RN exams pediatrics practice questions set 6

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Postoperatively in a client with a nasal fracture, a nurse would assess for airway obstruction. Nasal fractures can cause swelling, bleeding, and obstruction of the nasal passages, which could potentially compromise the client's ability to breathe. Monitoring for signs of airway compromise, such as difficulty breathing, stridor, or other respiratory distress, is crucial in the postoperative period to ensure prompt intervention if necessary. Assessing for airway patency is a priority to prevent any serious complications related to impaired breathing. While allergic reaction, extreme sense of smell, or stridor may occur in some cases, airway obstruction is the most critical concern that requires immediate attention to maintain the client's respiratory function.

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Disseminated intravascular coagulation (DIC) is a serious condition that involves widespread activation of coagulation leading to microthrombi formation in blood vessels throughout the body. This process can lead to consumption of clotting factors and platelets, causing both bleeding and thrombosis. In the context of DIC, there is a risk for altered tissue perfusion due to the combination of bleeding and microthrombi formation, which can impair blood flow to vital organs and tissues. This condition can ultimately result in organ dysfunction and failure, making it a significant concern in the care of a client with DIC. Therefore, the correct nursing diagnosis for a client with DIC is alteration in tissue perfusion related to bleeding and diminished blood flow.

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Xanthochromia refers to a yellowish discoloration of CSF due to the presence of blood breakdown products, such as bilirubin. A bloody tap occurs during the procedure when blood is introduced artifactually, resulting in red blood cells but not xanthochromia, as the blood is fresh and not yet degraded; thus, it is the exception and correct answer. Subarachnoid hemorrhage causxanthochromia due to hemolysis of RBCs over time. Carotenemia and hyperbilirubinemia can discolor CSF yellow due to elevated carotenoids or bilirubin levels, respectively. Markedly elevated CSF protein may also contribute to xanthochromia by altering CSF appearance. Since a bloody tap donot allow time for blood breakdown, it donot cause true xanthochromia, making A distinct from the others.

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When performing perineal care on an uncircumcised male patient, it is important to replace the foreskin over the head of the penis after washing. The foreskin should not be left retracted or pulled back forcibly as it can cause irritation and discomfort to the patient. Leaving the foreskin retracted can also lead to potential complications such as paraphimosis, where the foreskin becomes trapped behind the head of the penis. Proper hygiene involves gently retracting the foreskin to clean underneath it and then returning it to its natural position to protect the sensitive glans penis. Using gentle, warm water with mild soap is typically sufficient for cleaning, and alcohol should be avoided as it can cause irritation and dryness to the sensitive genital area.

Correct answer:

Elevated polymorphonuclear (PMN) cells in CSF indicate an acute inflammatory response, typically seen in bacterial infections or early viral processes. The early phase of aseptic (viral) meningitis often shows a PMN predominance before shifting to lymphocytes, making it the correct answer. Tuberculous meningitis typically presents with lymphocytic predominance, not PMNs, as it is a chronic infection. Fungal meningitis also shows lymphocytrather than PMNs due to its slower progression. Demyelinating diseasand brain or spinal cord tumors may cause mild CSF changes, but not a significant PMN increase, as they are not primarily infectious. The acute nature of PMN elevation aligns with the early viral meningitis phase, distinguishing B as the most fitting choice.

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S2 . The dura mater is the tough, outermost layer of the meningthat surrounds the brain and spinal cord. In the spinal column, it forms a sac called the dural sac, which extends from the foramen magnum (at the base of the skull) down to approximately the second sacral vertebra (S2) in adults, where it tapers off. Choice A, L2, is incorrect because the dura mater extends beyond the second lumbar vertebra, typically ending lower at S2. Choice B, S1, is closer but still incorrect as the dura mater consistently reachS2. Choice D, S3, is wrong because the dura mater donot extend this far inferiorly; it ends at S2, after which the filum terminale continues. Therefore, S2 accurately reflects the anatomical termination of the dura mater, making C the correct answer.

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Time of the day . While circadian rhythms influence eating patterns, immediate food intake is less driven by clock time than physiological cues. Choice A (blood sugar) directly regulathunger via hypothalamic glucoreceptors low levels trigger eating. Choice B (body temperature) affects intake; cold increasappetite for energy, per thermoregulation studies. Choice C (stomach fullness) suppresshunger through stretch receptor signals to the brainstem. (sight of food) potently stimulatappetite via reward pathways (e.g., dopamine in the nucleus accumbens). Time of day is secondary; it sets habits but lacks the direct, acute impact of glucose, fullness, or visual cues, as seen in free-feeding experiments. Thus, D plays the least role, making it the correct answer.

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RhIG (RhoGAM) is administered to Rh-negative women who deliver an Rh-positive newborn to prevent Rh isoimmunization. Rh isoimmunization can occur when an Rh-negative mother is exposed to Rh-positive fetal blood during childbirth, leading to the production of antibodies against Rh antigen. RhIG works by binding to and destroying any fetal Rh-positive red blood cells that have entered the mother's circulation, preventing her immune system from mounting an immune response and producing antibodies. This helps to protect subsequent pregnancies from complications related to Rh isoimmunization. Therefore, RhIG administration is crucial in preventing sensitization and ensuring the health of future pregnancies in Rh-negative women who deliver an Rh-positive newborn.

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The clinical manifestations described in the scenario are classic signs of neonatal abstinence syndrome (NAS), which occurs in newborns who were exposed to drugs, particularly narcotics, in utero. The newborn's symptoms of poor feeding, sucking on his hands, tachycardia, fever, projectile vomiting, loose stools, sneezing, and generalized sweating are consistent with NAS. These symptoms occur as the newborn experiences withdrawal from the drugs to which they were exposed during pregnancy. In this case, the lack of prenatal care suggests that the mother may have used narcotics during pregnancy, leading to NAS in the newborn. It is essential for healthcare providers to recognize these signs and provide appropriate care and support for infants experiencing NAS.

Correct answer:

The correct answer is B: Intrauterine growth restriction. Smoking during pregnancy can restrict the flow of oxygen and nutrients to the developing fetus, leading to intrauterine growth restriction (IUGR). This condition can result in a lower birth weight and potential health issues for the newborn. Although smoking during pregnancy can have other negative effects on the fetus, such as an increased risk of congenital heart defects, the primary concern related to smoking is the impact on fetal growth and development. Hearing loss and type 1 diabetes mellitus are not directly linked to smoking during pregnancy. Therefore, the most appropriate advice for the nurse to provide in this scenario is related to the increased risk of intrauterine growth restriction.