NR 328 CMS Exam Practice Questions

NR 328 CMS Exam Practice Questions& Answers

Which interventions are included in the management of nosebleeds in children? Select all that apply.

• Apply warm compresses to the bridge of the nose if bleeding is

persistent.

• Apply continuous pressure to the nose with thumb and forefinger for at

least 10 minutes.

• Have the child sit down and tilt the head backward.
• Insert cotton or wadded tissue into each nostril if bleeding persists.
• Instruct the child to breathe through the mouth.

(- Answer: B, D, E

Rationale: During a nosebleed, the child should be instructed to breathe

through the mouth, cotton or wadded tissue can be inserted into the nostrils to stop bleeding, and continuous pressure using the thumb and forefinger should be applied for at least 10 minutes. The child should be instructed to sit up and lean forward, not tilt the head backward. Ice or cold cloths, not warm compresses, can be used on the bridge of the nose if bleeding persists.

The nurse is developing a teaching plan for the family of a toddler recently diagnosed with sickle cell disease. Of which does the nurse include as important for the family to be aware and to report in order to recognize signs of the major cause of death for children under age 5 with sickle cell disease?

• Presence of respiratory problems
• Signs and symptoms of stroke
• Localized swelling over joints
• Presence of fever

(- Answer: D

Rationale: The major cause of death for children with sickle cell disease

under the age of 5 is overwhelming infections; thus the family needs to 1 / 3

monitor the child closely for presence of fever. Signs and symptoms of stroke, presence of respiratory problems, and localized swelling over joints are also symptoms of issues related to sickle cell disease, but are not directly related to the leading cause of death for children under the age of 5.

Which symptom would the nurse recognize as an acquired immunodeficiency syndrome (AIDS)-defining condition in an American child with human immunodeficiency virus (HIV)?

• Parotitis
• Cytomegalovirus
• Oral candidiasis
• Hepatosplenomegaly

(- Answer: B

Rationale: Cytomegalovirus is a defining condition for AIDS in an HIV-

infected American child. Parotitis, oral candidiasis, and hepatosplenomegaly are common clinical manifestations of HIV infection in children but not AIDS-defining conditions.

The nurse is administering a blood transfusion to a child for treatment of hemophilia. Upon assessment, the nurse notes that the child is cyanotic, has difficulty breathing, and has rales upon inspiration throughout the lung fields. What is the nurse's best response to these findings?

• Stop the transfusion immediately.
• Administer epinephrine immediately.
• Insert a urinary catheter and monitor hourly outputs.
• Reassess the patient again in five minutes.

(- Answer: A

Rationale: Cyanosis, rales, and difficulty breathing are all potential signs of

circulatory overload. If signs of circulatory overload occur, the transfusion should be stopped immediately. Reassessing the patient in five minutes would not provide an immediate response to the situation. Epinephrine is administered for allergic reactions. Insertion of a urinary catheter may be done to treat an incompatibility reaction.

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The nurse is teaching the family of a child diagnosed with iron-deficiency anemia about the proper administration of iron supplements. Which points should the nurse include in the education session? Select all that apply.

• Stop the medication and call the primary care provider if tarry stools are

noted.

• Administer with milk products to alter the taste if taste is an issue.
• Administer in two divided doses between meals.
• Administer with citrus fruits or juices to increase absorption.
• Use a straw to administer the iron if it is in liquid form.

(- Answer: C, D, E

Rationale: The family should be instructed to administer the iron

supplement in two divided doses between meals, when free hydrochloric acid is at its greatest levels to aid in absorption. Using a straw for liquid iron is recommended to avoid staining the teeth. Citrus fruits or juices also help increase acidity and therefore absorption of the iron. Milk products bind the iron and interfere with absorption and should not be used with administration of iron. Tarry stools are an expected change with iron supplements, and therefore calling the primary care provider is not necessary

The family of a child hospitalized for care during a sickle cell crisis calls the nurse into the room because the child is struggling to breathe. Upon assessment, the nurse notes a respiratory rate of 30 and that the child is clutching the abdomen and crying. What does the nurse determine the child may be experiencing?

• Deficient fluid volume
• Acute chest syndrome
• Increasing splenomegaly
• Cerebrovascular accident

(- Answer: B

Rationale: In a child experiencing a sickle cell crisis, dyspnea, tachypnea,

and severe abdominal pain can indicate acute chest syndrome, which can be fatal if not addressed immediately. Deficient fluid volume is characterized by loss of skin turgor, dry mucous membranes, sunken eyes, dark urine, and rapid breathing or rapid thready pulse. Severe unrelieved

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