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Quiz Session - Attempts With Random Questions

PNCB CPN Exam Questions

Page 9 of 20

161.

A 3-year-old with a history of asthma has a respiratory rate of 30/min, an O2 saturation of 95%, mild retractions, and wheezing audible with a stethoscope. Based on these assessment findings, which nursing intervention should be prioritized?

  • Administer a rescue inhaler as prescribed

  • Perform chest physiotherapy

  • Prepare for discharge with asthma education

  • Administer intranasal oxygen

Correct answer: Administer a rescue inhaler as prescribed

Administering a rescue inhaler directly addresses the immediate need to relieve wheezing and improve breathing in an asthma flare-up.

Chest physiotherapy is not the primary intervention for acute asthma symptoms and does not directly alleviate wheezing or improve oxygenation quickly. Preparing for discharge should follow stabilization of the child’s respiratory status and education, not precede it. Administering oxygen is not indicated at an O2 saturation of 95%, which is within acceptable limits for a child with asthma.

162.

A 10-year-old child with asthma presents with a mild cough and slight wheezing. Which follow-up action is most important to anticipate potential changes in the child's respiratory status?

  • Assessing the child’s peak expiratory flow rates

  • Asking about the child's recent activity level

  • Checking the child's temperature

  • Reviewing the child’s vaccination history

Correct answer: Assessing the child’s peak expiratory flow rates

Monitoring peak expiratory flow rates is crucial for assessing the severity of asthma symptoms and predicting potential exacerbations, allowing timely intervention and management adjustments.

While understanding activity levels may provide context for symptoms, it does not directly measure the current respiratory function or predict worsening conditions. Checking temperature is important but less relevant in anticipating respiratory status changes in asthma unless there is a specific reason to suspect an infection. Reviewing vaccination history is part of general health maintenance but does not provide immediate data on the current respiratory status or needs of a child with asthma.

163.

A 4-year-old child with acute gastroenteritis has been receiving oral rehydration therapy but shows signs of increased dehydration. What modification should the nurse make to the care plan?

  • Initiate IV fluid administration

  • Switch to water-only hydration

  • Increase the frequency of oral rehydration

  • Assess parental compliance with the treatment plan

Correct answer: Initiate IV fluid administration

If oral rehydration is not sufficient to manage dehydration in a child with acute gastroenteritis, initiating IV fluid administration is crucial to prevent further dehydration and promote recovery.

Switching to water-only hydration may exacerbate electrolyte imbalances and is not adequate in cases of severe dehydration. Increasing the frequency of oral rehydration may not be effective if the current method is failing, and dehydration that does not respond to oral hydration measures requires more immediate intervention. Assessing parental compliance may be important but does not address the immediate need to correct dehydration.

164.

A 12-year-old child with limited mobility due to recent surgery is in the hospital. Which assessment is crucial to promote patient safety?

  • Ensuring that the call bell is within reach

  • Regularly checking the child's pain levels

  • Providing the child’s favorite TV shows to keep them in bed

  • Adjusting the lighting in the child's room

Correct answer: Ensuring that the call bell is within reach

Ensuring the call bell is within reach allows the child with limited mobility to quickly alert staff if assistance is needed, which is crucial in preventing accidents or addressing immediate needs.

While regularly checking the child's pain levels is important for comfort, it does not directly contribute to the prevention of accidents or emergencies. Providing entertainment like TV shows may keep the child engaged, but it does not ensure safety or facilitate the child's ability to seek help in an emergency. Adjusting the lighting may contribute to comfort and prevent some accidents but does not offer direct safety measures such as enabling the child to alert staff when help is needed.

165.

The nurse needs to instruct a 15-year-old with a learning disability on managing a new medication. What is the best way to ensure the information is understood?

  • Repeat key points and check for understanding using the teach-back method

  • Provide broad, generic information to reduce the patient's stress about the new medication

  • Use diagrams and medical illustrations to explain how the medication works

  • Use video and tactile teaching aids to ensure comprehension

Correct answer: Repeat key points and check for understanding using the teach-back method

Repeating key points simplifies learning, and the teach-back method ensures the patient has understood the information correctly, which is crucial for managing medication properly.

Providing broad, generic information can leave important details unclear or misunderstood, especially for a patient with a learning disability who may need specific instructions. While diagrams and medical illustrations are helpful, they do not alone guarantee comprehension, particularly for individuals with learning disabilities who might benefit more from interactive and repetitive learning methods. Although using various teaching aids can be helpful, it is important to first assess which teaching aids are likely to be most effective for a specific patient. Repeating key points and checking understanding are more critical for ensuring that the patient fully grasps the information.

166.

A pediatric nurse has been working overtime for several weeks due to staffing shortages and is feeling exhausted. What should the nurse prioritize to prevent burnout?

  • Speak to the supervisor about modifying the schedule to reduce their workload

  • Recognize that it’s a temporary situation and push through the next two weeks

  • Use caffeine to help stay alert and maintain a high level of attention to patient care

  • Consider using FMLA leave to take a break and prevent burnout

Correct answer: Speak to the supervisor about modifying the schedule to reduce their workload

Speaking to the supervisor about modifying the schedule to reduce workload addresses the issue directly with the potential for a practical solution. This approach helps prevent burnout by ensuring the nurse’s concerns are heard and addressed appropriately.

Recognizing that it’s a temporary situation and pushing through could lead to burnout if not managed properly, potentially compromising patient care and the nurse’s health. Using caffeine to stay alert does not address the root problem of excessive workload and can contribute to further physical and mental health issues. Considering FMLA leave could be an option but should be a last resort after other strategies like schedule adjustments have been explored.

167.

A 3-year-old is experiencing tantrums when facing unfamiliar situations. What should the nurse suggest to the parents to help the child develop coping strategies?

  • Provide consistent responses and reassure the child during new experiences

  • Ignore the tantrums to discourage this behavior

  • Punish the child after each tantrum to improve the behaviors

  • Avoid new experiences to reduce the occurrence of tantrums

Correct answer: Provide consistent responses and reassure the child during new experiences

Consistent responses and reassurance during new experiences help the child understand that they are safe and supported, which is crucial for developing confidence and coping strategies in unfamiliar situations. This approach builds trust and security, helping to reduce tantrums and anxiety.

Ignoring the tantrums can make the child feel misunderstood and unsupported, potentially leading to increased frustration and behavioral issues. Punishing the child after each tantrum does not address the root cause of the behavior. Avoiding new experiences to prevent tantrums can limit the child’s development and ability to adapt to new situations.

168.

A nurse is counseling a group of adolescents on handling cyberbullying. What key advice should be included?

  • Save evidence of bullying and report it to a trusted adult.

  • Engage with cyberbullies to understand their motives.

  • Keep all interactions private to avoid affecting others.

  • Create and share only positive content to counteract the bullies.

Correct answer: Save evidence of bullying and report it to a trusted adult.

Saving evidence and reporting it helps in documenting the incidents for action against bullies and provides tangible proof to support the claims. This proactive approach also empowers the victim and can help prevent further incidents.

Engaging with cyberbullies could escalate the situation and increase the emotional distress of the victim. It does not contribute to a resolution and can expose the victim to further harm. Keeping interactions private can prevent the victim from seeking help and allow bullying to continue unchecked. It isolates the victim and may worsen the emotional impact of the bullying. While creating positive content could be constructive, it does not address the issue of being targeted by bullies and can sometimes lead to further provocation by the aggressors.

169.

A nurse encounters a teenage patient showing signs of substance abuse. What is the most appropriate initial action?

  • Refer the teenager to a community-based substance abuse program

  • Suggest strict home supervision by the parents

  • Advise reducing interaction with peers who may be a bad influence

  • Recommend more extracurricular activities to keep the teenager busy

Correct answer: Refer the teenager to a community-based substance abuse program

Referring the teenager to a community-based substance abuse program provides access to specialized treatment and support systems designed to address substance abuse issues. This approach offers professional guidance and a structured environment for recovery, which are crucial for effective intervention.

Suggesting strict home supervision might create a confrontational or overly restrictive atmosphere at home, which could lead to resistance rather than cooperation. The approach also does not offer professional support and may be less effective than using community-based programs run by professionals. Advising reducing interaction with peers might address one aspect of the problem but does not provide comprehensive support or treatment for the substance abuse itself. While extracurricular activities are beneficial for general well-being, they are not a substitute for professional treatment of substance abuse.

170.

In the pediatric ICU, a nurse observes that a 2-year-old patient with a recent head trauma after falling off a chair suddenly becomes unresponsive with pupils dilated. What should be the nurse's immediate action?

  • Alert the rapid response team

  • Prepare to administer dantrolene

  • Start cardiopulmonary resuscitation

  • Perform a Glasgow Coma Scale assessment

Correct answer: Alert the rapid response team

Alerting the rapid response team is critical when a child with head trauma becomes unresponsive with dilated pupils, indicating a possible life-threatening increase in intracranial pressure or other complications.

Preparing to administer dantrolene is inappropriate as it is used for conditions such as malignant hyperthermia and not for trauma-related complications. Starting cardiopulmonary resuscitation is not indicated unless the child is found pulseless and not breathing; the immediate concern here is neurological. Performing a Glasgow Coma Scale assessment is important, but it is secondary to immediate medical intervention for potentially life-threatening conditions.

171.

A nurse is working with a family who has limited access to transportation, which affects their child’s chronic care management. What is the most appropriate action for the nurse to take first?

  • Coordinate with social services to facilitate access to community resources

  • Advise the family to relocate closer to a healthcare facility

  • Suggest fewer appointments to reduce the burden of travel necessity

  • Recommend telehealth appointments instead of in-person appointments

Correct answer: Coordinate with social services to facilitate access to community resources

Coordinating with social services can help address the root issue of transportation barriers by connecting the family with community resources that might provide transportation assistance or other support.

Advising the family to relocate is not likely to be feasible and does not address immediate needs or the broader issue of access to healthcare. Suggesting fewer appointments might reduce the burden of travel but could negatively impact the child’s necessary medical care and follow-up. Recommending telehealth appointments exclusively might not be suitable for all aspects of chronic care management that require physical exams or procedures. It also assumes access to the technology required to use telehealth services.

172.

An 8-year-old is fearful of getting an MRI scan. How should the nurse best prepare the child for this procedure?

  • Show the child a video that explains the MRI process with a tour of the MRI room

  • Reassure the child that there is nothing to worry about and that the procedure is painless

  • Inform the child that the MRI machine makes loud noises and may seem scary

  • Ask the MRI team to provide patient teaching so they will not be anxious

Correct answer: Show the child a video that explains the MRI process with a tour of the MRI room

Showing a video that explains the MRI process and includes a tour of the MRI room can help demystify the procedure, making the actual experience less frightening for the child.

Simply reassuring the child without providing detailed information does not address the child’s specific fears about the unknown aspects of the MRI. Informing the child that the machine makes loud noises and may seem scary without providing context or reassurance can increase fear rather than alleviate it. Delegating the responsibility of patient teaching to the MRI team without preliminary preparation could result in the child feeling unprepared at the time of the procedure.

173.

To promote physical activity for school-aged children, what type of exercise does the American Academy of Pediatrics particularly endorse?

  • Moderate to vigorous physical activity

  • High-intensity interval training

  • Alternating periods of activity and inactivity to improve focus

  • Muscle-strengthening exercises

Correct answer: Moderate to vigorous physical activity

The American Academy of Pediatrics recommends moderate to vigorous physical activity for children to improve cardiovascular health, strengthen bones, and reduce the risk of chronic diseases such as obesity and diabetes.

High-intensity interval training may not be suitable for all children and can pose a risk of injury without proper supervision and gradual progression. This makes it not universally recommended for school-aged children. Alternating periods of activity and inactivity can be part of an effective exercise regimen, but focusing solely on this aspect does not provide the consistent and comprehensive activity level that children need for overall health. While muscle-strengthening exercises are important, they should be part of a balanced exercise routine that also includes cardiovascular and flexibility activities.

174.

Which action by a pediatric nurse best demonstrates anticipatory guidance in the context of palliative and end-of-life care for a child with a degenerative condition?

  • Discussing potential disease progression and symptom management early in the care process

  • Avoid distressing the family by waiting until symptoms worsen before discussing end-of-life care options

  • Ensure that the patient and their family understand there is no hope of a cure to avoid unrealized optimism

  • Focusing on cure-oriented treatments to maintain hope throughout the process

Correct answer: Discussing potential disease progression and symptom management early in the care process

Discussing potential disease progression and symptom management early in the care process is essential in anticipatory guidance, as it helps the family prepare for what to expect and enables them to make informed decisions about future care needs. This proactive approach can reduce anxiety and help in planning appropriate interventions at different stages.

Avoiding discussions about end-of-life care until symptoms worsen can leave the family unprepared for critical decisions and potentially limit their options for palliative care, reducing the child’s quality of life as the disease progresses. Informing the patient and family that there is no hope of a cure without focusing on the supportive care aspects can lead to despair and neglect the potential benefits of palliative care and symptom management. Focusing solely on cure-oriented treatments in the context of a degenerative condition is likely to be ineffective and may prevent the family from fully engaging with necessary palliative care options, adversely affecting the child's overall well-being.

175.

A 10-year-old child with advanced neuroblastoma has recently shown signs of significant pain despite current analgesic treatment. What is the most appropriate step for the pediatric nurse to take next in managing this child's care?

  • Consult with the palliative care team to assess and optimize pain management

  • Advocate for an increase in the current dosage of analgesics

  • Advise the family to integrate non-pharmacological pain relief methods into the patient’s pain management plan

  • Recommend discontinuing treatments that may be exacerbating pain

Correct answer: Consult with the palliative care team to assess and optimize pain management

Consulting with the palliative care team is the best intervention, as they specialize in managing pain and overall quality of life for patients with severe illnesses. This ensures an integrated approach to care that can better address complex pain issues. This team can evaluate and adjust the child's pain management plan, possibly incorporating additional or alternative therapies as needed.

Simply increasing the dosage of current analgesics may not be adequate or safe without a thorough reassessment of the child's pain and overall condition. This could lead to potential side effects or overdose if not managed within a multidisciplinary context. While non-pharmacological methods can be supportive, they may not be sufficient on their own for managing significant pain in a case of advanced neuroblastoma. This approach should complement, not replace, medical pain management strategies. Recommending discontinuation of treatments requires a comprehensive review by the healthcare team to weigh the benefits and drawbacks in the context of the child’s overall care plan.

176.

In a meeting about healthcare reform, a pediatric nurse advocates for improved access to pediatric specialty care in rural areas. What is the most impactful approach the nurse should suggest?

  • Encouraging the use of telemedicine for specialty consultations

  • Requesting funding for transportation for rural families to urban centers

  • Increasing the number of general practitioners in rural areas

  • Recommending the reduction of healthcare costs across the board

Correct answer: Encouraging the use of telemedicine for specialty consultations

Encouraging the use of telemedicine for specialty consultations in rural areas allows for greater access to specialized medical advice without the need for extensive travel. This approach can provide timely and effective care to children in remote locations.

Requesting funding for transportation for rural families to urban centers, while potentially helpful, would be less efficient and sustainable compared to developing local resources like telemedicine. Increasing the number of general practitioners in rural areas does not address the specific need for pediatric specialty care and would be difficult to impact with policy or legislation when compared to promoting telehealth utilization. Recommending the reduction of healthcare costs across the board does not directly address the issue of access to pediatric specialty care in rural areas. This approach could also meet with resistance if a government body is specifically setting price reductions.

177.

A 7-year-old child with asthma and his parents are at a follow-up appointment. The nurse notes the child demonstrates incorrect use of his inhaler. What should the nurse do first to assess the family's understanding of the asthma management plan?

  • Demonstrate proper inhaler technique and ask the child and parents to demonstrate back

  • Print an instruction handout for the parents

  • Suggest they watch online videos on asthma management at home

  • Schedule a follow-up appointment to review asthma management

Correct answer: Demonstrate proper inhaler technique and ask the child and parents to demonstrate back

Demonstrating proper inhaler technique and then asking the child and parents to demonstrate it back ensures they understand how to use the inhaler correctly. This interactive approach helps correct any misuse and confirms their ability to manage asthma effectively.

Simply providing a handout is less engaging and may not ensure that the family understands or remembers the correct technique. Suggesting they watch videos is passive and does not allow for real-time feedback and correction of technique. Scheduling a follow-up without addressing the immediate issue of incorrect inhaler use does not ensure that the family will use the inhaler correctly in the interim.

178.

A 10-year-old child has been prescribed a rescue inhaler. What should the nurse emphasize when teaching the child and parents about inhaler use?

  • How to follow the proper inhalation technique

  • The chemical composition of the inhaler medication

  • How to ensure that a dose of the inhaler is not missed

  • Using the inhaler before each dose of inhaled steroids

Correct answer: How to follow the proper inhalation technique

Correct inhalation technique is crucial for ensuring the medication's effectiveness, which directly impacts the management of the child’s respiratory condition. Proper technique ensures that the drug reaches the lungs effectively, which is essential for controlling symptoms and preventing exacerbations.

The chemical composition is less relevant to daily use and does not directly impact the child’s ability to use the inhaler correctly. A rescue inhaler is not used routinely, only in instances of respiratory distress. Scheduled or routine doses of a rescue inhaler are not indicated. Because rescue inhalers are not scheduled, they should not routinely be used prior to inhaled steroids unless specifically indicated in the situation.

179.

A pediatric nurse is participating in a state healthcare committee that is revising patient-to-nurse ratios in pediatric wards. What should be the nurse's primary focus during discussions?

  • Advocating for ratios that safely manage workload and improve patient outcomes

  • Suggesting subsidizing any increased staffing costs

  • Encouraging the use of unlicensed assistive personnel to reduce the nurse workload

  • Promoting shorter working hours to prevent nursing burnout

Correct answer: Advocating for ratios that safely manage workload and improve patient outcomes

Advocating for ratios that safely manage workload and improve patient outcomes ensures that the quality of care is maintained and that nurses can effectively manage their responsibilities without compromising patient safety.

Suggesting subsidizing increased staffing costs does not directly address the need for appropriate patient-to-nurse ratios and may be seen as a financial rather than clinical advocacy. Encouraging the use of unlicensed assistive personnel to reduce nurse workload might help but does not address the underlying issue of ensuring that patient care is delivered by adequately trained and qualified nursing staff. Promoting shorter working hours, while important for nurse well-being, does not directly relate to improving patient-to-nurse ratios and could be viewed as less directly beneficial to patient care.

180.

During a team meeting, a dispute arises over the nutritional management of a pediatric patient with diabetes. How should the nurse advocate for the patient’s best interest?

  • Present evidence-based practices and encourage a discussion on them

  • Advocate for the position presented that seems to make the best clinical sense

  • Ask to defer the decision until later to allow tensions to subside

  • Recommend differing to the attending physician to avoid negatively impacting team dynamics

Correct answer: Present evidence-based practices and encourage a discussion on them

Presenting evidence-based practices and encouraging discussion on them is an effective way to advocate for the patient’s best interest. This approach helps ensure that decisions are informed by the most current and relevant clinical data and not just by personal opinions or experiences.

Advocating for a position that seems to make the best clinical sense without discussing evidence-based practices may miss the opportunity to explore all options or engage in a more informed decision-making process. Asking to defer the decision until later to allow tensions to subside might delay the nutritional adjustments needed for the patient's immediate care. Recommending deferring to the attending physician to avoid a negative impact on team dynamics may undermine the interdisciplinary approach necessary for comprehensive patient care.

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