CMA Study Flash Cards
NGN Question
A nurse is caring for a school-age child who has cystic fibrosis.History and PhysicalSchool-age child admitted, diagnosed with cystic fibrosis at 3 months of age, has experienced failure to thrive, and has chronic obstructive pulmonary disease. The child presents with wheezing, rhonchi, paroxysmal cough, and dyspnea. The parent reports large, frothy, foul-smelling stools. The child has deficient levels of vitamin A, D, E, and K.Barrel-shaped chestClubbing of the fingers bilaterallyRespiratory rate 40/min with wheezing and rhonchi noted bilaterally, dyspnea, and paroxysmal coughA nurse is reviewing the child’s medical record. Which of the following medications should the nurse expect the provider to prescribe or reconcile from the child’s home medication list?Select all that apply.
Water-soluble vitamins
Acetaminophen
Dornase alfa
Meperidine
Pancreatic lipase
Water-Soluble Vitamins
Dornase Alfa
Pancreatic Lipase
Nurses’ Notes 0730: Child presents to the emergency department (ED). Guardians report the child woke up coughing with a low-grade fever. Child appears alert and restless in guardian’s arms. Respirations easy, no cough noted. 0800: Child became agitated. Hoarse cry noted with audible inspiratory stridor. Barking, non-productive cough present.
For each of the following findings, click to specity if the finding is consistent with acute laryngotracheobronchitis or pneumonia. Each finding may support more than one disease process.
Assessment Findings: Acute laryngotracheobronchitis/ Pneumonia
Temperature
Stridor
Irritability
Cough findings at 0800
Irritability: This finding is consistent with both acute laryngotracheobronchitis and pneumonia, as both conditions can cause discomfort and distress in children.
Temperature: Fever can be present in both acute laryngotracheobronchitis and pneumonia as they are both infections of the respiratory tract. It is a non-specific symptom that can occur with various respiratory illnesses.
Cough findings at 0800: This finding is more consistent with acute laryngotracheobronchitis than pneumonia, as acute laryngotracheobronchitis is characterized by a barking, non-productive cough that worsens at night or with agitation, while pneumonia causes a productive cough that may be accompanied by chest pain or difficulty breathing.
Stridor: This finding is more consistent with acute laryngotracheobronchitis than pneumonia, as acute laryngotracheobronchitis causes inflammation and narrowing of the upper airway, leading to a high-pitched sound during inhalation, while pneumonia affects the lower airway and does not usually cause stridor.
A nurse is caring for a 7-year-old child who has a urinary tract infection (UTI).
Exhibit 1
Exhibit 2
Exhibit 3
The nurse is planning care for the client.
For each the following interventions, click to specify if the potential intervention is anticipated or contraindicated for the client.
Nurses’ Notes
0700:
7-year-old client who weighs 18.1 kg (39.9 lb) admitted with a UTI. Child reports pain and burning upon urination and feeling like they need to go to the bathroom all the time. Child’s guardian reports the client has been incontinent of urine the past 2 nights and that the urine has a very strong odor.
A nurse is caring for a 7-year-old child who has a urinary tract infection (UTI).
Exhibit 1
Exhibit 2
Exhibit 3
The nurse is planning care for the client.
For each the following interventions, click to specify if the potential intervention is anticipated or contraindicated for the client.
Nurses’ Notes
0700:
7-year-old client who weighs 18.1 kg (39.9 lb) admitted with a UTI. Child reports pain and burning upon urination and feeling like they need to go to the bathroom all the time. Child’s guardian reports the client has been incontinent of urine the past 2 nights and that the urine has a very strong odor.
A. Administer salicylic acid for pain and fever.
B. Administer sulfamethoxazole and trimethoprim.
C. Educate the child about proper perineal hygiene.
D. Advise child’s guardian about the use of sunscreen.
A. Administer salicylic acid for pain and fever: CONTRAINDICATED
B. Administer sulfamethoxazole and trimethoprim: ANTICIPATED
C. Educate the child about proper perineal hygiene: ANTICIPATED
D. Advise child’s guardian about the use of sunscreen: ANTICIPATED
E. Ensure the child receives a maximum of 1,200 mL/day of fluid: ANTICIPATED
0915
Received the child awake, alert, and crying.
Parent states that child was playing with remote control toy and when the parent the child crying, they noticed that a battery was missing from the toy. The parent states that the child was drooling more and witnessed them gagging periodically.
0930
Child is lying on parent’s chest with eyes open and requesting ‘sippy cup.’ Continues to have
expiratory wheezing in bilateral upper lobes. Preparing child for diagnostic testing
A nurse in the emergency departments is caring for a toddler
Exhibits
Complete the following sentence by using the list of options.
The nurse should first
Options A
A. Keep the child NPO
B. Teach the child’s parents the importance of inspecting the child’s play area
C. Obtain informed consent
Options B.
A. Encourage parents to inspect toys for easily removable parts
B. Prepare the child for flexible endoscopy
C. Monitor the child closely for return of gag reflex
Drop down 1: “keep the child NPO”
Drop down 2: Prepare the child for flexible endoscopy
A nurse in the emergency department is preparing to discharge a 3-year- old child.
Nurses’ Notes
The child’s guardian states the child has been unable to sleep recently and has been very irritable. Guardian expresses concern about the child’s atopic dermatitis worsening and the child
scratching excessively, which results in the areas bleeding. Guardian states the child has a history of allergic rhinitis.
Which of the following statements should the nurse plan to include in the discharge instructions for the child’s guardian? (Select all that apply.)
A. “You should apply a thick layer of pimecrolimus cream to your child’s lesions.”
B. “You can apply gloves to your child’s hands.”
C. “You should cut and file your child’s fingernails frequently.”
D. “Your child will experience occasional flare-ups of this condition.”
E. You should use a mild detergent for your child’s laundry.”
F. “You should apply emollients to your child’s skin after bathing.”
G. “Your child’s condition is contagious when lesions are present.”
B. “You can apply gloves to your child’s hands.”
C. “You should cut and file your child’s fingernails frequently.”
D. “Your child will experience occasional flare-ups of this condition.”
E. You should use a mild detergent for your child’s laundry.”
F. “You should apply emollients to your child’s skin after bathing.”
A nurse is teaching the parent of a school-age child about bicycle safety. Which of the following instructions should the nurse include in the teaching?
A. “Your child should ride the bicycle against the flow of traffic.”
B. “Your child should keep the bicycle at least 3 feet from the curb while riding in the street.”
C. “Your child should walk the bicycle through intersections.”
D. “Your child’s feet should be 3 to 6 inches off the ground when seated on the bicycle.”
C. “Your child should walk the bicycle through intersections.”
Rationale: walking the bicycle through intersections allows the child to safely navigate intersections as pedestrians, reducing the risk of accidents with vehicles
A nurse is caring for a client who is postoperative following placement of a halo vest to manage a cervical vertebral fracture. Which of the following actions should the nurse take?
A. Encourage flexion and extension of the neck.
B. Reposition the client using a turning sheet.
C. Assess the pin sites for infection once every other day.
D. Tighten the screws on the halo device one-quarter turn every 48 hr.
B. Reposition the client using a turning sheet.
Repositioning the client using a turning sheet helps to maintain proper alignment and prevent complications such as pressure ulcers
A nurse is evaluating the pain level of a toddler who is cognitively impaired to a nonpharmacologic intervention. Which of the following pain scales should the nurse use to evaluate the toddler’s pain level?
A. Visual analog
B. FACES
C. FLACC
D. CRIES
C. FLACC
Is a validated tool for assessing pain in young children, including those who are cognitively impaired
The nurse is teaching the parent of an infant who has a new diagnosis of heart failure about nutrition. Which of the following instructions should the nurse include in the teaching?
A. Allow the infant to self soothe by crying prior to feeding
B. Place the infant in a recumbent position during feeding
C. Implement a 3 hr feeding schedule
D. Allow the infant 45 min for each feeding
C. Implement a 3 hr feeding schedule
Infants with heart failure have a weakened heart that struggles to pump blood efficiently. Feeding can be tiring for them, and they might not be able to consume large volumes at once. A smaller, more frequent feeding schedule allows them to take in enough calories without overexertion. This approach helps manage their energy expenditure and reduces stress on the heart
A 15-year-old adolescent is admitted for a
vaso-occlusive crisis. The parent reports that the adolescent has a low-grade fever and has vomited for 3 days. The adolescent reports having right- sided and low back pain. They also report hands and right knee are painful and swollen. The client reports pain as 8 on a scale of 0 to 10.
A nurse is caring for an adolescent who is admitted with a vaso-occlusive crisis.
Exhibits
The nurse is planning care for the adolescent. Select the 5 interventions the nurse should include.
A. Monitor oxygen saturation continuously.
B. Restrict oral intake.
C. Give oral hydroxyurea.
D. Administer meperidine IV for pain.
E. Instruct the parent to ensure the pneumococcal vaccine is current.
F. Place the client on strict bed rest.
G. Administer folic acid as prescribed.
A. Monitor oxygen saturation continuously.
C. Give oral hydroxyurea.
D. Administer meperidine IV for pain.
G. Administer folic acid as prescribed.
A nurse is assessing a child who is 2 hr postoperative following a cardiac catheterization and finds the dressing is saturated with blood. Which of the following actions should the nurse take first?
A. Apply pressure just above the insertion site
B. Monitor the pulse distal to the insertion site.
C. Obtain vital signs.
D. Reinforce the dressing
A. Apply pressure just above the insertion site
Applying pressure just above the insertion site helps to control bleeding by compressing the vessel and promoting hemostasis.
A nurse is planning care for a child who is in the acute stage of nephrotic syndrome.
Which of the following interventions should the nurse include in the plan of care?
A. Weigh the child once per day
B. Position the child supine at bed time.
C. Limit calorie intake to 45 cal/kg/day.
D. Increase fluid intake to 2 L/day.
A. Weigh the child once per day
Daily weight monitoring is essential in managing nephrotic syndrome to assess for fluid retention and response to treatment.
A nurse is caring for a newly admitted child who has cystic fibrosis. For which of the following members of the interprofessional team should the nurse initiate a referral?
A. Dietitian
B. Occupational therapist
C. Speech-language pathologist
D. Physical therapist
A. Dietitian
Nutritional management is crucial in cystic fibrosis due to malabsorption issues.A dietitian can provide guidance on appropriate dietary intake and may recommend enzyme replacement therapy.
A nurse is reviewing the laboratory results of a child who was recently admitted for suspected rheumatic fever.
The nurse should identify that which of the following laboratory tests can contribute to confirming this diagnosis? (Select all that apply.)
A.Blood urea nitrogen (BUN)
B. Erythrocyte sedimentation rate (ESR)
C. Antistreptolysin O (ASO) titer
D. Partial thromboplastin time (PTT)
E. C-reactive protein (CRP).
B. Erythrocyte sedimentation rate (ESR)
C. Antistreptolysin O (ASO) titer
E. C-reactive protein (CRP).
B rationale: Elevated erythrocyte sedimentation rate (ESR) is a marker of inflammation and can be elevated in rheumatic fever
C rationale: Elevated Antistreptolysin O (ASO) titer indicates recent streptococcal infection, which is a predisposing factor for rheumatic fever.<
A nurse is planning care for a preschooler who has autism spectrum disorder.Which of the following interventions should the nurse include in the plan
A. Maintain extended eye contact.
B. Establish a reward system
C. Engage in cooperative play.
D. Hold the child during assessments.
B. Establish a reward system
Establishing a reward system can help reinforce positive behaviors and encourage desired outcomes in children with ASD.
A nurse is assessing a 4-month-old infant during a well-baby visit. For which of the following findings should the nurse notify the provider?
A. No head lag when pulled to a sitting position
B. Doll’s eye reflex intact
C. Presence of tears when crying
D. Positive Babinski reflex
B. Doll’s eye reflex intact
The Doll’s eye reflex (also known as oculocephalic reflex) should be absent by 4 months of age. Its persistence could indicate neurological abnormalities and warrants further evaluation by the provider.
A nurse is applying soft limb restraints to a child who is acting aggressively toward staff. Which of the following actions should the nurse take?
A. Tie the restraints to the side rails of the child’s bed.
B. Request that the provider renew the prescription for restraints every 48 hr
C. Secure the restraints with a quick-release
D. Assess the child every 4 hr while in restraints
C. Secure the restraints with a quick-release
Securing restraints with a quick-release knot allows for quick removal in case of emergency and is the correct method for applying restraints.
A nurse is reviewing the complete blood count results for a 4- year-old child who is receiving treatment for acute lymphoblastic leukemia. Which of the following findings should indicate to the nurse that the treatment is having a therapeutic effect?
A. Hemoglobin 6.8 g/dL (9.5 to 14 g/dL)
B. Platelet count 98,000/mm3 (150,000 to 400,000/ mm3)
C. RBC count 5/mm3
D. WBC count 150,000/mm3 (5,000 to 10,000/mm3)
C. RBC count 5/mm3
Normalization of the RBC count indicates bone marrow recovery, suggesting treatment effectiveness in acute lymphoblastic leukemia
A nurse is caring for a 5-year-old child who has acute poststreptococcal glomerulonephritis. Which of the following findings should indicate to the nurse that treatment has been effective?
A. Temperature 37.2° C (99° F)
B. No report of pain with voiding
C. Clear urine
D. Odorless urine
C. Clear urine
Clear urine indicates resolution of hematuria, a common symptom of acute poststreptococcal glomerulonephritis, suggesting treatment effectiveness.
A nurse is caring for a 1-week-old newborn who has hyperbilirubinemia and is being treated with phototherapy. Which of the following actions should the nurse take?
A. Check the newborn’s eyes every 8 hr.
B. Place mittens on the placing mittens on the newborn’s hands
C. Monitor the newborn’s temperature every 2 hr
D. Apply lotion to the newborns skin
C. Monitor the newborn’s temperature every 2 hr
Monitoring the newborn’s temperature every 2 hours is important during phototherapy to prevent complications such as hypothermia or hyperthermia
A nurse is assessing a preschool-age child who is in the immediate postoperative period following a tonsillectomy. Which of the following assessment findings is the priority?
A. The child’s throat pain increases.
B. The child refuses clear liquids.
C. The child cries often.
D. The child swallows frequently
D. The child swallows frequently
Frequent swallowing could indicate bleeding, a potential complication post- tonsillectomy, and requires immediate attention to
prevent further complications.
A nurse is providing teaching to the guardian of a 2- year-old child about typical toddler behavior. Which of the following behaviors should the nurse include?
A. Resistant to routines
B. Frequent negative responses
C. Less emotionally labile
D. Increased dependency
B. Frequent negative responses
Toddlers are in a stage of development where they assert their independence and autonomy by saying “no” or “mine” to almost everything. This is a normal and healthy behavior that reflects their growing sense of self and identity. The nurse should explain to the guardian that this behavior is not meant to be defiant or disrespectful, but rather a way of exploring their environment and expressing
their preferences.
