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Silvestri201-300

Silvestri201-300

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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PN~Comp~Review~CD~201-300~
PN Comprehensive Review CD Questions 201-300
{COMP: No Equations/Formulas; No <AQ> questions}201. A concerned mother of a newborn with a cleft lip asks the nurse when the surgicalrepair will occur. The appropriate nursing response is which of the following?1. “Surgical repair cannot be performed.”2. “Surgical repair is usually performed around 10 weeks of age.”3. “Surgical repair is individualized and depends on the size of the infant.”4. “Surgical repair will be done immediately; otherwise, the infant will not be able toeat.”Answer: 2Rationale: Cleft lip repair is usually performed around 10 weeks of age. Early repair may improve bonding and makes feeding much easier. Cleft palate repair isindividualized and based on the degree of deformity and the size of the child. Closure of the cleft palate is completed between the ages of 6 months and 2 years. Early closure of cleft palate facilitates speech development. Although repair of a cleft lip makes feedingeasier and improves bonding, it is not necessary to perform the surgical procedureimmediately.Test-Taking Strategy: Use the process of elimination. Option 1 can be easily eliminatedfirst. Eliminate option 4 next because this response is inaccurate and can cause alarm inthe mother. From the remaining options, remember that cleft lip repair is usually performed around 10 weeks of age. This will direct you to option 2. Review thesesurgical procedures if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Psychosocial IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: Price, D., & Gwin, J. (2005).
Thompson’s pediatric nursing 
(9th ed.).Philadelphia: W.B. Saunders, p. 96.202. A newborn is diagnosed with a hiatal hernia. The mother of the newborn asks thenurse to explain the diagnosis. The nurse bases the response on which of the followingcharacteristics of this disorder?1. A portion of the stomach protrudes through the esophageal hiatus of the diaphragm2. Abdominal contents herniate through an opening of the diaphragm3. Gastric contents regurgitate back into the esophagus4. The esophagus terminates before it reaches the stomachAnswer: 1Rationale: In a hiatal hernia, a protrusion of a portion of the stomach through theesophageal hiatus of the diaphragm occurs. Option 2 describes a congenitaldiaphragmatic hernia. Option 3 describes gastroesophageal reflux. Option 4 describesesophageal atresia.Test-Taking Strategy: Use the process of elimination. Careful reading of each option andnoting the word “hiatal” in the question and “hiatus” in option 1 will direct you to thecorrect option. If you had difficulty with this question, review this disorder.Level of Cognitive Ability: Comprehension
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PN~Comp~Review~CD~201-300~
Client Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Maternity/PostpartumReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
Maternal-child nursing 
(2nd ed.). St. Louis: Elsevier, p. 1115.203. The mother of a child that had a myringotomy with insertion of tympanostomytubes calls the nurse and tells the nurse that the “tubes” fell out. The nurse makes whichresponse to the mother?1. “Replace the tubes immediately so that the created opening does not close.”2. “This is an emergency and requires immediate intervention. Bring the child to theemergency room.”3. “This is not an emergency. I will speak to the physician and call you right back.”4. “Soak the tubes in alcohol for 1 hour before replacing them in the child’s ears.”Answer: 3Rationale: The size and appearance of the tympanostomy tubes should be described tothe parents following surgery. They should be reassured that if the tubes fall out, it is notan emergency but that the physician should be notified. Options 1, 2, and 4 are incorrect.Test-Taking Strategy: Use the process of elimination. Option 2 should be eliminated first because this will cause concern in the parent. Next, eliminate options 1 and 4 becausethey are similar and relate to replacing the tubes. Review home care instructionsfollowing this procedure if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
Maternal-child nursing 
(2nd ed.). St. Louis: Elsevier, p. 1119.204. A child is scheduled for a tonsillectomy in the “day stay” surgical unit. On the dayfollowing surgery, the mother calls the surgical unit and expresses concern because thechild has very bad mouth odor. The nurse makes which response to the mother?1. “The child probably has an infection.”2. “You need to contact the physician immediately.”3. “Bad mouth odor is normal and may be relieved by drinking more liquids.”4. “Have the child gargle with mouthwash.”Answer: 3Rationale: Bad mouth odor is normal following a tonsillectomy and may be relieved bydrinking more liquids. Options 1, 2, and 4 are incorrect. Additionally, mouthwashgargles will irritate the throat.Test-Taking Strategy: Use the process of elimination. Eliminate option 4 first knowingthat mouthwash gargles will irritate the surgical site. Options 1 and 2 are similar and can be eliminated; these responses will cause additional concern in the mother. Review postoperative expectations following a tonsillectomy if you had difficulty with thisquestion.Level of Cognitive Ability: Application
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PN~Comp~Review~CD~201-300~
Client Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Child HealthReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
Maternal-child nursing 
(2nd ed.). St. Louis: Elsevier, p. 1203.205. A child suspected of sickle cell disease is seen in the clinic, and laboratory studiesare performed. The nurse reviews the results of the laboratory studies and expects to notewhich of the following that is a characteristic of this disease?1. Increased hematocrit count2. Increased platelet count3. Increased reticulocyte count4. Increased hemoglobin countAnswer: 3Rationale: A laboratory diagnosis is established on the basis of a complete blood cellcount, examination for sickled red blood cells (RBCs) on the peripheral smear, andhemoglobin electrophoresis. Laboratory studies will show decreased hemoglobin,hematocrit, and platelet counts; an increased reticulocyte count; and the presence of nucleated red blood cells. Elevated reticulocyte counts occur in children with sickle celldisease because the lifespan of their sickled RBCs is shortened.Test-Taking Strategy: Recalling the pathophysiology associated with sickle cell diseasewill assist in answering this question. Remember, elevated reticulocyte counts occur inchildren with sickle cell disease. Review the characteristics of this disease if you haddifficulty with this question.Level of Cognitive Ability: AnalysisClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Child HealthReference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005).
Maternal-child nursing 
(2nd ed.). St. Louis: Elsevier, p. 1307.206. Laboratory studies are performed on a child suspected of iron deficiency anemia.The nurse reviews the laboratory results knowing that which of the following wouldindicate this type of anemia?1. An elevated hemoglobin level with a low hematocrit level2. A decreased reticulocyte count3. An elevated red blood cell (RBC) count4. RBCs that are microcytic and hypochromicAnswer: 4Rationale: The results of a complete blood cell count in children with iron deficiencyanemia will show low hemoglobin levels and microcytic and hypochromic RBCs. Thereticulocyte count is usually normal or slightly elevated.Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 firstknowing that the RBC and hemoglobin counts would be decreased. From the remainingoptions, select option 4 because of the relationship between anemia and RBCs. Reviewthe characteristics of iron deficiency anemia if you had difficulty with this question.
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