“Pediatric Nursing Practice Test” plus 3 more nursing article(s): NursingCrib.com Updates

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• Pediatric Nursing Practice Test
• Passing the Nursing Board Exam in Retrospect (1/2)
• Jatene Procedure
• Acute Poststreptococcal Glomerolunephritis

Pediatric Nursing Practice Test Posted: 21 Nov 2010 10:55 PM PST December 2010 Nursing Board Exam Review Questions on Pediatric Nursing. Mark the letter of your choice then click on the next button. Your score will be posted as soon as the you are done with the quiz. We will be posting more of this soon. If you want a simulated Nursing Board Exam, get a copy of our Nursing Board Exam Reviewer v1.0 and v2 now. 1. The fetal accessory ductus venosus closes due to which of the following? a. Increase pressure of the right side of the heart b. Clamping of the cord c. Increase pressure of left side of the heart d. Increase prostaglandin levels 2. The fetal accessory that is located in between the two atria is called: a. Foramen ovale b. Ductus venosus c. Ductus arteriosus d. Pulmonary arteries 3. Presence of what hormone causes the ductus arteriosus to open? a. Estrogen b. Progesterone c. Human Chorionic Gonadrotopin d. Prostaglandin 4. Inborn errors of metabolism are discussed in a nursing lecture. Absence of liver enzyme phenylalanine hydroxylase directly causes the absence of which of the following? a. Thyroxine b. Melanin c. Epinephrine d. Tyrosine 5. An infant with phenylketonuria (PKU) has a mousy odor of urine. Which of the following causes this indifferent odor? a. Phenylpyruvic acid b. Lactic Acid c. Galactic acid d. Insulin 6. A child diagnosed with PKU should be managed by giving which soy-based milk formula? a. Nutraminogen b. Similac c. Lofenalac d. Sustagen 7. A mother comes in a clinic asking about the normal development of her child. The nurse, told her that DDST (Denver Developmental Screening Test) is done for children to assess their developmental processes. When is DDST first done? a. 3 months b. 10 months c. 3-4 years d. 5 years 8. The child was admitted in the ER with the presenting symptoms of sitting in a leaning position, with the tongue protruding, drooling and muffled cough. The nurse should prepare what equipment at the bedside? a. Tongue depressor b. Intubation set c. Sterile gauze d. Clamp 9. As the nurse is assessing a 3-year old child, the toddler appears good. However the child's mother told the nurse that her child usually appears ill at nighttime. The cough is barking and inspiratory stridor is noted. The nurse interprets this as: a. Laryngotracheobronchitis b. Epiglotitis c. Pneumonia d. Bronchitis 10. A preschool child has been admitted for rheumatic fever. In the diagnosis of the disease which of the following meets the Jone's criteria? a. Increase ESR, arthralgia, fever b. Leukocytosis, carditis, fever c. Arthralgia, fever, leukocytosis d. Leukocytosis, increase ESR, history of Rheumatic fever 11. To manage the chorea in rheumatic fever which of the following is administered? a. Ampicillin b. Erythromycin c. Diazepam d. Mannitol 12. A 3 year old child is admitted in the hospital. The mother asks what developmental milestone is expected for this child to accomplish. The nurse correctly responds by pinpointing which of the following? a. Bowel control achieved b. Riding a tricycle c. Sitting without support d. Tying shoelaces 13. The statements are true about communicating hydrocephalus apart from: a. It is also known as non-obstructive hydrocephalus. b. It is due to the functional impairment of arachnoid granulations. c. It is caused by a CSF-flow obstruction ultimately preventing the CSF from flowing into the subarachnoid spaces. d. It can be caused by diffuse ventricular dilatation from scarring and fibrosis of subarachnoid space following infectious, inflammatory and hemorrhagic events preventing the flow of CSF. 14. A child is diagnosed with Kawasaki Disease. Which of the following manifestations is seen during the subacute phase of the disease? a. Fever b. Conjunctivitis c. Strawberry tongue d. Desquamation of palms and soles 15. The platelet receptor inhibitor specific for Kawasaki Disease is prescribed by the physician. Which of the following drugs will you expect in the doctor's order? a. Ibuprofen b. Abciximab c. Succimer d. Dimercaprol 16. Health teaching is important in successful management of a certain disease. In Kawasaki disease, what is the main reason why steroids are not administered to clients with Kawasaki disease? a. It can cause aneurysms. b. It can cause increase body temperature. c. It decreases WBC count and increases ESR. d. It causes more rashes in children. 17. Angelo, 1 year old has been tested for lead levels in the blood. Result shows that his blood lead level is 28 microgram pre deciliter. Which of the following management would be appropriate for Angelo? a. Rescreen the child to confirm level every year for 6 years b. Administer oral Succimer c. Hospitalization and administer Edetate Calcium Disodium (EDTA) intramuscularly d. Assess kidney function 18. The following observations are noted in a child under the acute phase of Kawasaki disease except: a. Fever b. Increase platelet count c. Conjunctivitis d. Increase WBC count 19. A 2 year old child is diagnosed with Plumbism. Edetate Calcium Disodium (EDTA) is ordered to be administered intramuscularly. In the preparation of the medication, what should the nurse do? a. Hold the syringe by the plunger. b. Prepare calcium to be administered after EDTA is given c. Add 0.5 ml of procaine in the medication d. Add 10 ml of procaine 20. Clamping of the cord causes the closure of what fetal accessory structure? a. Ductus arteriosus b. Foramen ovale c. Pulmonary blood vessels d. Ductus Venosus 21. Understanding a clubfoot disorder means knowing the normal anatomy and physiology of a skeletal foot. The weight of the body is carried by the largest tarsal bones of the foot which are: A. Cuneiform B. Talus C. Navicular D. Calcaneus E. Cuboid a. A and D b. B and D c. A and E d. C and E 22. A diagnosis of hydrocephalus is confirmed. The mother of a 2 year old patient is asking about the types of hydrocephalus. Which of the following correctly defines non-communicating hydrocephalus? a. It is also known as non-obstructive hydrocephalus. b. It is characterized by enlarged cerebral ventricles, with only intermittently elevated cerebrospinal fluid pressure. c. It is due to the functional impairment of arachnoid granulations. d. It is caused by a CSF-flow obstruction ultimately preventing the CSF from flowing into the subarachnoid spaces. 23. The surgical management for atrial septal defect (ASD) and ventricular septal defect (VSD) is which of the following? a. Dacron or Silastic patch placement b. Ductal ligation c. Fontan procedure d. Brock Procedure 24. Which of the following accurately describes the treatment of a Pseudo talipes? a. Pseudo-talipes does not need a surgical procedure, however ilizarov frames can be used at nighttime b. Pseudo-talipes only requires tendon replacement c. No procedures are done with pseudo-talipes, however passive foot exercises would be fine d. A cast above the knee is required for alignment; if the procedure poses no effect surgical procedures can be done 25. Phalanges form the toes and are composed of 14 bones. The big toe is made up of how many phalanges? a. 2 b. 3 c. 1 d. 5 Related posts: Nursing Board Review: Fundamentals of Nursing Practice Test Part 2 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 1 Nursing Board Review: Maternal and Child Health Nursing Practice Test Part 2

Passing the Nursing Board Exam in Retrospect (1/2) Posted: 21 Nov 2010 09:56 PM PST Looking back from all the trials and hardships, it would be great to share some of my personal encounter in facing the board exam for nurses. As for my opinion, the Philippine Nursing License Examination is the epitome of my nursing education. Ever since I stepped into my 3rd year in nursing these words would repeatedly play on my mind: "What is my four years in the college of nursing when I won't be on the roster of new professional nurses?" Other factors also entered my mind, like having been included in one of the Top Nursing Schools in the Philippines, the payment that my parents had made for my board examination and review as well as the challenge to take and pass the PNLE once strike only. In retrospect, I graduated last March 2009 and was privileged to belong in Henderson's Batch of West Visayas State University. It is our school's tradition to immediately take the board exam following our graduation and that was last June 2009. We were trained starting from our freshmen years to collect all notes, presentations and examinations for later use in preparation for the said examination. I would like to emphasize that the things that I will tackle were based on my experience and does not generalize or claim it as the best way to pass the board exam. The board examination review was officially started two weeks after our graduation and two months before the board examination. Preparing for the Board Exam for Nurses does not start a year, 6 months, 3 months or 2 weeks before the scheduled date of examination. It all starts with the first year in the college after all. Here are the salient points in the journey of passing the Board Examination: Freshmen Year: "Collect them all!" Have you heard this favorite line flashed in television programs or advertisements? I really believe you had, because in Nursing, it is also applicable. Collecting lessons, notes, presentation and procedures to read are a must. It is like making a record or bank of all notes you'll have. Who knows what questions will the Board of Nurses put in the examination? Sophomore Year: "Walk your talk" This period of time I was exposed to various nursing procedures as well as the requirements of completing the scrubs. At this time, we were taught the "the right way" of giving nursing care. In other words, everything almost has been taught in an ideal set-up and much of it would call for good discipline and memory of the nursing procedures. Having your mind set on what's ideal and more of the theory is essential since  the Board of Nurses usually would ask about what is ideal in giving the appropriate nursing care. Junior Year: "Warming-up" Practice examinations, drills and current events that had something to do with the profession matters a lot. Most of the hours were spent for "hands-on" learning in the hospital and joggling between the test drills and duty was a bit challenging in the first place. What I did was somehow like having a case study so that I could blend my related learning experience to the theoretical aspects of it. For example: When I handled a patient with typhoid ileitis, I would read about it the night after my duty and explore many aspects of it. I would then discover new terms and subtopics that are essential enough for the review. Senior Year: "Tic Toc" Time flies so fast that I could merely see the "head" of the board examination. It was undeniable that it was only months before the board examination. I posted important notes and acronyms on manila papers and posted it on the walls of my room. In this way it was very helpful for me to scan from time to time and exercise my mind in recalling those things. The next thing I did was I also placed a countdown calendar on my desk, signifying the days before the board exam. I even used the time when riding the jeepney or being trapped in the traffic to scan my review notes so that I would keep my mind at pace with the materials I had. Double tasking was essential at this moment. Even the day of our graduation was like a fleeting moment for us, for our batch it was not the end but the beginning of the deeper challenge in our nursing life – the intensive review for the board examination. As I took my diploma and faced the crowed I remembered the feeling of wishing the time to be slow and allow me to prepare more, but the reality was a bit harsh and all I have to do was to face it and have faith in the Almighty that He will let this pass with a triumphant praise for Him. Photo credits: www.orchestroscopy.blogspot.com Related posts: Preboard July 2010 Nursing Board Exam Nursing Board Review: Pharmacology, Nursing Research and Nutrition Nursing Board Review: Psychiatric Nursing Practice Test Part 2

Jatene Procedure Posted: 21 Nov 2010 05:11 PM PST Definition jatene procedure or arterial switch Jatene Procedure is an open heart surgery procedure used to correct transposition of the great arteries. It is also called an Arterial Switch that was developed by a Canadian cardiac surgeon William Mustard. The name of the procedure was from a Brazilian cardiac surgeon, Adib Jatene, who was the one to use it successfully. Transposition of the Great Arteries In the cardiovascular disorder, transposition of the great arteries, the two arteries – pulmonary artery and aorta – switched places. Normally, the pulmonary artery branches from the right ventricle and the aorta from the left ventricle. In this disorder, the arteries switched. The pulmonary artery is located in the left ventricle and the aorta from the right ventricle. Unoxygenated blood entering the right atrium drains to the right ventricle and is distributed to the different parts of the body by the aorta without oxygenation from the lungs. Thus, a corrective Jatene procedure is necessary for a normal heart circulation and function. Jatene Procedure or Arterial Switch sequential steps in jatene procedure Jatene procedure or arterial switch is used to correct transposition of the great arteries by switching the transposed pulmonary artery and aorta. Ideally, this procedure is performed on an eight to fourteen (8-14) days old infant. The procedure takes about 6-8 hours to complete, including the anesthesia and post operative recovery. During the surgery, the aorta and pulmonary artery are both transected. Before swapping or switching the two arteries, the coronary arteries are separated from the aorta and attached to the neo-aorta. Laboratory Tests needed Blood typing Angiography MRI CT Scan Before the Procedure / Pre-operative General anesthesia Aprotinin (prevent excessive bleeding) Solumedrol (reduce swelling and inflammation) Regitine (prevent hypertension) Prophylactic antibiotics (to prevent infection) During the Procedure / Intra-operative Median sternotomy is used to view the heart and vessels. Heparin administration to prevent blood from clotting. For a continuous systemic and heart circulation during the operation, a cardiopulmonary bypass machine is also used. Since the machine needs its own circulation to be filled with blood, a blood transfusion is necessary to be done. Aorta and pulmonary artery are both transected. post-op Jatene neonate The coronary arteries are separated from the aorta and attached to the neo-aorta. Aorta and pulmonary artery are switched. After the procedure / Post-operative Chest tubes placement. Temporary pacemaker and ventilation. Muscle relaxants (induce temporary paralysis) Opioid analgesics (alleviate pain) Inotrope (assist the heart in contracting adequately) Nasogatric Tube Feeding (gradually introduce breast milk or formula milk) images from twobeautifulblessings.blogspot.com, radiology.rsna.org, en.wikipedia.org Related posts: Fontan Procedure Difference Between Adult and Fetal Circulation Fetal Circulation

Acute Poststreptococcal Glomerolunephritis Posted: 21 Nov 2010 05:00 PM PST Definition Glumerolunephritis is the inflammation of the glumeruli of the kidney. Acute glumerolunephritis (AGN) is a disease described as the abrupt appearance of edema, hematuria, proteinuria and hypertension. The inflammation of the glomerulus is manifested by the spread of cellular elements as a result of an immune response. Acute Poststreptococcal Glomerolunephritis (APSGN) occurs as an immune complex disease after an infection with nephritogenic streptococci (most commonly subtypes of Group A beta-hemolytic streptococci). As a result of the antigen-antibody reaction, aggregates of molecules are formed and circulate throughout the body. The glomeruli, the filtering portion of the kidney, trap some of this circulating molecules resulting to the inflammation of glomeruli. Incidence Occurs more commonly in males. Most common in children between 5-10 years (peak prevalence at about 5-6 years). Occurs more often during winter and spring. Pathophysiology Etiology Acute poststreptococcal glomerulonephritis is an immune reaction of the body to nephritogenic streptococci infection. It usually follows an infection caused by the group A beta hemolytic streptococci such as: Strep throat Pharyngitis Tonsillitis Otitis media Impetigo Recent respiratory infection Scarlet fever Disease Process In Acute poststreptococcal glomerulonephritis (APSGN), the streptococcal product acts as the antigen that stimulates the circulating antibodies which results to deposit of molecules in the glomeruli leading to injury of the kidney. The IgG, major immunoglobulin found in the human blood, can be detected in the bloodstream and the glomerular capillary walls. This results to antigen-antibody reaction which is characterized by the formation and circulation of the complexes (molecules) in the body. A complement, cascade of proteins activated by antigen-antibody reactions which plugs or obstructs the glomerul, is formed. Complement fixation reaction of the glomeruli results to tissue damage. As endothelial cells on the linings of the glomerulus are increased as a response to the inflammatory process, it can result to the infiltration of the leukocytes in the glomeruli. Intravascular coagulation may occur in small renal tubules. The thickening of the glomerular filtration membrane results to the scarring and loss of the filtering surfaces. Thus, unusual large particles (such as protein) can be excreted in the urine due to the increased glomerular permeability related to ischemic damage. Decreased glomerular filtration rate (GFR) would result to the accumulation of sodium and water in the bloodstream. Clinical manifestations History of recent group A streptococcal infection (2-3 weeks) Sudden onset of hematuria Proteinuria Urine: tea-colored, reddish-brown or smoky Hypertension Abdominal pain Low-grade fever Edema (mild) Anorexia Vomiting Headache Decreased urine output Cardiac involvement: orthopnea, cardiac enlargement, pulmonary edema, galloping heart rhythm Diagnostic evaluation Anti-streptolysin O (ASO) titer elevated BUN and serum creatinine elevated Anti-Dnase B titer elevated 1+ to 4+ protein in urine Increased specific gravity of the urine Management The course of acute glomerulonephritis is 1-2 weeks. Antibiotics are ineffective in treating the disease because APSGN is caused by an antigen-antibody inflammatory response to a previous infection. Unless residual streptococcal infection is suspected, penicillin may be given. If heart failure occurs, place the child in a semi-fowler's position, digitalis therapy and oxygen administration. Calcium channel blocker – for diastolic BP of more than 90 mmHg. Normal diet for age Weighing the child every day and monitoring intake and output. Children can attend school and engage in normal activities after 1 week but competitive activity is limited. Related posts: Glomerulonephritis Acute Rheumatic Fever Acute Renal Failure

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