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Urden: Thelan’s Critical Care Nursing, 5th Edition

Test Bank

Chapter 11: The Pediatric Patient in the Adult Critical Care Unit

MULTIPLE CHOICE

1. Calculate the daily fluid requirement for a 60-kg child.


a. 2600 ml/m2 per day
b. 1500 ml/m2 per day
c. 2400 ml/m2 per day
d. 3000 ml/m2 per day

ANS: B
Fluids at 1500 ml/m2 per day can be used for children who weigh more than 10 kg.

DIF: Cognitive Level: Application REF: 197


OBJ: Nursing Process Step: Assessment TOP: Pediatrics
MSC: NCLEX: Health Promotion and Maintenance

2. What is the circulating blood volume of a neonate?


a. 40 to 60 ml/kg
b. 75 to 80 ml/kg
c. 85 to 90 ml/kg
d. 65 to 70 ml/kg

ANS: C
The circulating blood volume in a neonate is 85 to 90 ml/kg.

DIF: Cognitive Level: Knowledge/Application REF: 189


OBJ: Nursing Process Step: N/A TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

3. Susie is a 1-month-old infant with stable supraventricular tachycardia at a rate of 250


beats/min. She weighs 6 kg. How much adenosine should be given?
a. 0.05 mg rapid IV push
b. 0.1 mg rapid IV push
c. 0.6 mg rapid IV push
d. 0.5 mg rapid IV push

ANS: C

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Test Bank 2

The dose of adenosine in a child with stable supraventricular tachycardia is 0.1 mg/kg
rapid IV push and may be increased by 0.05 mg/kg increments every 2 minutes to a
maximum of 0.25 mg/kg up to 12 mg or until termination of supraventricular tachycardia.

DIF: Cognitive Level: Knowledge REF: 191


OBJ: Nursing Process Step: Intervention TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

4. The normal cerebral perfusion pressure in an infant is


a. 50 mm Hg.
b. 40 to 60 mm Hg.
c. unknown.
d. 60 mm Hg.

ANS: C
The normal cerebral perfusion pressure values are unknown in children. Cerebral
perfusion pressure is believed to be in the range of 40 to 60 mm Hg, but this figure may
vary because perfusion is determined by blood flow and not blood pressure.

DIF: Cognitive Level: Knowledge/Comprehension REF: 193


OBJ: Nursing Process Step: N/A TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

5. The upper airway of the infant is different from that of an adult in that the infant’s
a. epiglottis is located lower than an adult’s.
b. tongue is larger and it fills the oral cavity.
c. larynx is tubular shaped with its narrowest portion at the epiglottis.
d. airway is more rigid than an adult's.

ANS: B
The upper airway of the infant is different from that of an adult in that the infant’s tongue
is larger and it fills the oral cavity.

DIF: Cognitive Level: Knowledge REF: 177


OBJ: Nursing Process Step: Assessment TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

6. To establish a patent airway in an infant or child younger than 2 years, the nurse
would
a. perform the head tilt/chin lift maneuver.
b. hyperextend the neck and pull the jaw forward.
c. place a towel under the upper shoulders with the jaw slightly extended into
“sniffing” position.

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Test Bank 3

d. place a folded towel under the head to extend the neck.

ANS: C
To establish a patent airway in an infant or child younger than 2 years, a towel should be
placed under the upper shoulders with the jaw slightly extended into “sniffing” position.

DIF: Cognitive Level: Application REF: 177


OBJ: Nursing Process Step: Intervention TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

7. Which of the following methods can be used to establish an endotracheal tube size for
a child younger than 2 years?
a. No formula exists; the endotracheal tube size is matched to the infant’s age.
b. Take the child’s age, add 16, and divide by 4.
c. Measure the length of the child’s little finger and divide by 2.
d. Only one size available; thus no method is needed.

ANS: A
For the child younger than 2 years, no formula exists for measuring endotracheal tube
size. Endotracheal tube size is matched to the child's age.

DIF: Cognitive Level: Application REF: 178


OBJ: Nursing Process Step: Intervention TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

8. The pathophysiologic consequences of respiratory syncytial virus include


a. inflammation of the respiratory epithelium, resulting in submucosal edema.
b. necrosis of the alveoli, resulting in collapse.
c. inflammation of the diaphragm, resulting in alveolar hypoventilation.
d. bronchoconstriction, resulting in severe air-flow obstruction.

ANS: A
The pathophysiologic consequences of respiratory syncytial virus include inflammation
of the respiratory epithelium, resulting in submucosal edema.

DIF: Cognitive Level: Knowledge REF: 180


OBJ: Nursing Process Step: Assessment TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

9. C is a 5-year-old boy who has been admitted with severe asthma. His initial PaCO2
was 30. One hour later his PaCO2 is 45, and 1 hour after that his PaCO2 is 56. Which
of the following interventions would be anticipated?
a. High-dose steroids

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Test Bank 4

b. Chest percussion and vibration


c. Fluid resuscitation with normal saline
d. Mechanical ventilation

ANS: D
Criteria for mechanical ventilation include a PaCO2 more than 55 mm Hg or increasing
greater than 5 to 10 mm Hg/hr.

DIF: Cognitive Level: Application REF: 184


OBJ: Nursing Process Step: Evaluation TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

10. The pathophysiologic characteristic of a left-to-right shunt resulting from a congenital


heart defect is
a. decreased pulmonary blood flow.
b. mixed blood flow.
c. increased pulmonary blood flow.
d. obstruction to blood flow from the ventricles.

ANS: C
The pathophysiologic characteristic of a left-to-right shunt is increased pulmonary blood
flow.

DIF: Cognitive Level: Knowledge REF: 189


OBJ: Nursing Process Step: Assessment TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

11. Cyanosis that increases with crying is thought to be


a. pulmonary in origin.
b. cardiac in origin.
c. neurologic in origin.
d. both pulmonary and cardiac in origin.

ANS: B
Cyanosis that increases with crying is thought to be cardiac in origin. Cyanosis that
decreases with crying is thought to be respiratory in origin.

DIF: Cognitive Level: Knowledge REF: 190


OBJ: Nursing Process Step: Assessment TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

12. The most common cardiac arrest–related dysrhythmia in the pediatric patient is
a. supraventricular tachycardia.

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Test Bank 5

b. ventricular tachycardia.
c. bradycardia.
d. first-degree heart block.

ANS: C
The most common dysrhythmia in the pediatric patient is bradycardia resulting from
hypoxia, acidosis, or hypothermia.

DIF: Cognitive Level: Comprehension REF: 191


OBJ: Nursing Process Step: Evaluation TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

13. The initial setting for defibrillation of a child is


a. 100 joules.
b. 360 joules.
c. 2 joules/kg.
d. 4 joules/kg.

ANS: C
The initial setting for defibrillation of a child is 2 joules/kg.

DIF: Cognitive Level: Application REF: 193


OBJ: Nursing Process Step: Intervention TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

K is a 4-year-old girl admitted to the critical care unit with fever, chills, headache,
vomiting, lethargy, photophobia, and nuchal rigidity.

14. Based on K’s clinical manifestations, what is the anticipated diagnosis?


a. Status epilepticus
b. Meningitis
c. Head trauma
d. Septic shock

ANS: B
Fever, chills, headache, vomiting, lethargy, photophobia, and nuchal rigidity are clinical
manifestations of meningitis

DIF: Cognitive Level: Application REF: 195


OBJ: Nursing Process Step: Evaluation TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

15. Nursing management for K would include

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Test Bank 6

a. measuring and documenting head circumference.


b. allowing her siblings to visit.
c. isolating her during initial antibiotic treatment and for 24 hours thereafter.
d. administering anticonvulsant medications every 6 hours.

ANS: C
The child with meningitis is isolated during initial antibiotic treatment and for 24 hours
thereafter.

DIF: Cognitive Level: Application REF: 195


OBJ: Nursing Process Step: Planning TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

16. K has been unable to eat, and tube feedings are to be initiated. The preferred method
for determining the insertion length of the nasogastric tube is to measure from the
a. nares to the ears to the xiphoid process.
b. ears to the umbilicus.
c. nares to the xiphoid to the ears.
d. nares to the ears to a point between the xiphoid process and the umbilicus.

ANS: D
The preferred method for determining the insertion length of the nasogastric tube is to
measure from nares to the ears to a point between the xiphoid process and the umbilicus.

DIF: Cognitive Level: Application REF: 199


OBJ: Nursing Process Step: Intervention TOP: Pediatrics
MSC: NCLEX: Physiologic Integrity

COMPLETION

1. __________ and __________ are the most common causes of cardiopulmonary


failure in the child.

ANS:
Apnea, bradycardia
Bradycardia, apnea
Rationale: Unlike adults, most cardiac arrests in the pediatric population are related to
respiratory failure.

DIF: Cognitive Level: Application REF: 178


OBJ: Nursing Process Step: Diagnosis
TOP: The Pediatric Patient in the Adult Critical Care Unit
MSC: NCLEX: Physiologic Integrity

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Test Bank 7

PROBLEM

1. By using the “rule of 6,” calculate the amount of dopamine needed to add to the
intravenous fluid for an 18-kg infant.

ANS:
108 mg
Rationale: Dopamine is dosed in micrograms per kilogram per minute. The “rule of 6”
formula is to multiply the patient’s weight in kilograms by 6 and add that amount to 100
ml of fluid.

DIF: Cognitive Level: Analysis REF: 192


OBJ: Nursing Process Step: Intervention
TOP: The Pediatric Patient in the Adult Critical Care Unit
MSC: NCLEX: Physiologic Integrity

2. Calculate the estimated daily fluid needs for an infant weighing 10 kg and receiving
mechanical ventilation.

ANS:
880 ml/day
Rationale: A health 10-kg infant requires approximately 100 ml/kg per day of fluid.
However, when receiving humidified mechanical ventilation, this amount should be
reduced by 12%.

DIF: Cognitive Level: Analysis REF: 197


OBJ: Nursing Process Step: Implementation
TOP: The Pediatric Patient in the Adult Critical Care Unit
MSC: NCLEX: Physiologic Integrity

OTHER

1. Which of the following anatomic and physiologic findings are normal in the infant?
Select all that apply.
a. The epiglottis is large and floppy.
b. The basal metabolic rate is lower than that of an adult.
c. The size of the head is smaller compared with the rest of the body.
d. The hormonal and metabolic response to pain is the same as that of an adult.
e. A positive Babinski response is a normal finding.

ANS:
a, d, e

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Test Bank 8

Rationale: Many anatomic and physiologic differences exist between the adult and the
infant.

DIF: Cognitive Level: Comprehension REF: 177-178, 193, 197, 199


OBJ: Nursing Process Step: Assessment
TOP: The Pediatric Patient in the Adult Critical Care Unit
MSC: NCLEX: Physiologic Integrity

2. Optimal treatment of the pediatric patient with asthma includes which of the
following? Select all that apply.
a. Placing the patient in the knee-chest position
b. Extending the neck to promote opening of the airway
c. Reducing exposure to allergens
d. Patient education
e. Alleviating anxiety

ANS:
c, d, e
Rationale: The goals of treatment for the pediatric patient with asthma are controlling the
environment, managing pharmacologic therapy, and providing patient education in
preventing exacerbations.

DIF: Cognitive Level: Application REF: 184-185


OBJ: Nursing Process Step: Intervention
TOP: The Pediatric Patient in the Adult Critical Care Unit
MSC: NCLEX: Physiologic Integrity

Copyright © 2006 Mosby, Inc.

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