PNCB CPN Exam Questions

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21.

A 15-year-old is struggling with the recent divorce of their parents. What intervention should the nurse suggest to promote emotional resilience?

  • Encourage the teen to write a journal to express and process emotions

  • Recommend the teen focus on the positive aspects of having two households

  • Suggest the teen should choose sides to build strong family bonds by unifying their focus

  • Advise the teen to spend time alone to reflect on the changes

Correct answer: Encourage the teen to write a journal to express and process emotions

Journaling allows the teen to express and process complex emotions related to their parents' divorce, facilitating emotional healing and self-reflection. This method provides a personal space for the teen to explore feelings and cope with changes, promoting emotional resilience and understanding.

Focusing only on the positive aspects of having two households can overlook the real and often painful adjustments a teen has to make. This can invalidate their feelings and hinder emotional processing. Suggesting the teen choose sides can create further emotional conflict and stress, exacerbating feelings of division and negatively impacting the teen's relationships with both parents. Spending time alone to reflect on changes can lead to isolation and may prevent the teen from receiving necessary support and guidance during a critical time.

22.

A pediatric nurse is advising a family on how to support their teenager who is dealing with social anxiety. Which recommendation is the most effective for promoting resilience?

  • Recommend gradual exposure to social situations coupled with discussions afterward

  • Encourage the teenager to avoid social events that cause anxiety

  • Suggest the teenager confront peers who contribute to their anxiety

  • Advise the family to push the teenager into more social interactions to overcome their fears

Correct answer: Recommend gradual exposure to social situations coupled with discussions afterward

Gradual exposure to social situations helps the teenager manage social anxiety in controlled increments, building confidence and coping skills over time. Coupling this exposure with discussions provides a space to reflect on experiences and develop strategies for future interactions, which enhances resilience and understanding.

Encouraging the teenager to avoid social events can reinforce anxiety and prevent them from developing necessary social skills, which is counterproductive for overcoming social anxiety. Suggesting confrontation with peers can escalate stress and discomfort and is not likely to enhance social ability or comfort. Pushing the teenager into more social interactions without addressing their anxiety or building coping skills can be overwhelming and counterproductive.

23.

During a routine visit, an 8-year-old child mentions always feeling sad and no longer wanting to play with friends. The child's grades have also recently declined. What should be the primary focus of the nurse’s assessment?

  • Social isolation

  • Physical activity level

  • Nutritional deficiencies

  • School bullying

Correct answer: Social isolation

Focusing on social isolation is crucial given the child's withdrawal from friends and declining interest in activities. These symptoms can indicate emotional distress or developing depression, requiring immediate social and psychological intervention.

Physical activity level is important for overall health but would not directly address the root cause of sadness and social withdrawal. Nutritional deficiencies can affect mood but are less likely the primary cause of sudden social withdrawal and sadness. School bullying is important to consider, but the described symptoms broadly suggest a focus on the child's social interactions and potential emotional health issues first.

24.

A 2-month-old infant is brought to the clinic for a vaccination. Which vaccine is most appropriate to administer at this age?

  • DTaP

  • MMR

  • COVID-19

  • Influenza

Correct answer: DTaP

At 2 months old, the DTaP vaccine, which protects against diphtheria, tetanus, and pertussis, is part of the recommended immunization schedule to begin building the infant's protection against these serious diseases.

The MMR vaccine, which protects against measles, mumps, and rubella, is typically first administered to children around the age of one year. COVID-19 vaccines are generally not recommended for infants as young as 2 months; specific age recommendations depend on ongoing research and vaccine approvals. The influenza vaccine is generally recommended annually for children 6 months of age and older, not at 2 months.

25.

A 9-year-old recently diagnosed with leukemia is quiet and spends a lot of time drawing in his hospital room. His parents seem worried but try to maintain a cheerful demeanor around him. Which approach should the nurse take to assess the coping mechanisms of the family?

  • Encourage the family to express their feelings and fears about the diagnosis

  • Suggest the parents keep their worries to themselves to avoid stressing the child

  • Recommend that the child be more active and interact with other patients

  • Advise the parents to consider psychiatric counseling for the child

Correct answer: Encourage the family to express their feelings and fears about the diagnosis

Encouraging open expression of feelings and fears allows the family to confront and manage their emotions, which is crucial for effective coping. This approach also helps the nurse gauge the emotional climate of the family and provide appropriate guidance or referrals.

Suggesting that parents hide their worries does not support healthy coping mechanisms and can lead to increased stress within the family. Recommending that the child be more active and social does not directly address the family's coping mechanisms and ignores the individual needs and preferences of the child during treatment. While psychiatric counseling might eventually be helpful, it is not the initial step in assessing coping mechanisms; first, understanding the family's emotional state is necessary.

26.

During a routine visit, the nurse notes that a child with chronic asthma seems anxious about participating in any physical activity, and his mother expresses constant concern over his condition. What should the nurse assess next?

  • How the family manages stress related to asthma episodes

  • The mother’s understanding of asthma management

  • The child’s understanding of his asthma triggers and management

  • Whether the child has friends or engages in social activities

Correct answer: How the family manages stress related to asthma episodes

Assessing how the family manages stress related to asthma provides insights into their coping mechanisms and readiness to handle asthma episodes, which are crucial for effective asthma management. This information helps tailor educational and supportive interventions to improve their handling of such situations.

Understanding asthma management is important, but it does not directly address how stress from asthma affects their daily life and is not likely to address the impact asthma may have on the child’s participation in physical activity. While knowing the child’s understanding of asthma is important, it does not provide information on the emotional aspect of managing the condition. Assessing social activities is less directly related to understanding how anxiety about physical activities is managed by the child and his mother.

27.

In a discussion about preventing common childhood illnesses, what should the nurse emphasize about immunizations?

  • They may be started as early as the first few months of life.

  • They are generally recommended to start at 6 months old.

  • They are mostly unnecessary if the child does not travel internationally.

  • They cannot be started once the child reaches adolescence.

Correct answer: They may be started as early as the first few months of life.

Highlighting that vaccinations can start early in life educates parents on the importance of timely vaccinations to protect infants from preventable diseases. This approach reinforces the benefits of starting immunizations according to the recommended schedules.

Vaccinations start well before 6 months for several diseases, such as hepatitis B, which can be given at birth, and pertussis, part of the DTaP vaccine, started at 2 months. Suggesting that vaccinations are unnecessary unless the child travels internationally ignores the domestic prevalence of vaccine-preventable diseases. Stating that vaccines cannot be started once the child reaches adolescence is misleading because it implies a limitation on the effectiveness or appropriateness of starting vaccinations in adolescence. Many vaccines are recommended for this age group, like the HPV and meningococcal vaccines.

28.

A community nurse is planning a session on healthy relationships for young teens. What should be included to help participants understand emotional safety?

  • Recognizing emotional abuse and seeking help

  • Financial planning for future independence

  • Benefits of a healthy diet

  • Exercise routines for stress management

Correct answer: Recognizing emotional abuse and seeking help

Recognizing emotional abuse and knowing how to seek help are vital for understanding emotional safety. This knowledge empowers teens to identify harmful patterns and access resources, which is essential for maintaining healthy relationships.

Financial planning is crucial for independence but does not address emotional safety within relationships. The benefits of a healthy diet are important for overall well-being but do not specifically help teens understand or navigate the complexities of emotional safety in relationships. Exercise routines can manage stress but do not equip teens with the tools to recognize or address emotional abuse.

29.

A pediatric nurse is evaluating a 12-year-old who has started self-harming by cutting. The child expresses feelings of hopelessness and guilt. What is the most critical aspect for the nurse to assess next?

  • Suicide risk

  • Family history of mental health disorders

  • Peer relationships

  • Academic stress

Correct answer: Suicide risk

Self-harming behaviors combined with expressions of hopelessness and guilt are critical indicators of suicide risk. This combination necessitates immediate assessment to ensure the child’s safety and to determine the need for urgent psychological intervention.

While a family history of mental health disorders is relevant for a comprehensive assessment, the immediate risk of suicide posed by self-harm and expressions of hopelessness must be addressed first. Assessing peer relationships is part of understanding the child's social context but secondary to the urgent need to address safety concerns related to self-harm and suicidal ideation. Academic stress may contribute to the child's distress, but assessing for it does not take precedence over assessing for immediate risks to the child's safety.

30.

During an initial visit, a pediatric nurse identifies that a language barrier is affecting a family’s understanding of their child’s treatment plan. What should the nurse do next?

  • Arrange for a professional interpreter for future visits, even if this requires extensive planning

  • Use plain English, avoiding medical jargon, to explain the treatment plan more clearly

  • Explain the plan as usual to avoid biased treatment of the family from another culture

  • Provide written instructions in their preferred language

Correct answer: Arrange for a professional interpreter for future visits, even if this requires extensive planning

Arranging for a professional interpreter ensures effective communication, respects the family’s linguistic needs, and improves understanding of medical information. Accessibility to a translator is important, even if it does increase the work burden on the medical team.

Using plain English without medical jargon may still leave significant gaps in understanding if the family does not speak English fluently, potentially leading to miscommunications. Explaining the plan without modifications for the language barrier can exacerbate misunderstandings and fail to accommodate the family’s unique needs, compromising care quality. Providing written instructions in their preferred language is helpful but may not fully address the need for real-time, interactive communication during medical visits.

31.

To develop a plan of care for a 10-year-old girl with chronic abdominal pain, which complementary approach might the nurse include to support pain management?

  • Acupuncture

  • Scheduled unsupervised play

  • Kegel exercises

  • High-fiber diet

Correct answer: Acupuncture

Acupuncture is a well-regarded complementary approach for managing chronic pain, including abdominal pain. It can provide relief by stimulating nerves and affecting pain perception pathways.

Scheduled unsupervised play does not directly address pain management and is more about general well-being. Kegel exercises are targeted at strengthening pelvic floor muscles, not managing abdominal pain. A high-fiber diet may help with some types of abdominal pain associated with constipation but is not a direct method for pain management.

32.

How should a nurse prepare a 3-year-old for a blood test?

  • Use a doll to demonstrate the procedure

  • Focus on explaining to the parents about what will occur

  • Start the procedure without any prior explanation to avoid distress

  • Have the parents agree to hold the child while the nurse inserts the needle

Correct answer: Use a doll to demonstrate the procedure

Demonstrating the blood test procedure on a doll allows the child to visualize what will happen in a non-threatening way, thereby reducing anxiety and fear. This method is age-appropriate and helps the child understand the procedure in a simple and relatable manner.

While explaining the procedure to the parents is important, it does not directly prepare the 3-year-old child for the blood test, as young children benefit from visual and direct explanations tailored to their level of understanding. Starting the procedure without any prior explanation can increase distress and fear in a young child, as they are not mentally prepared for what to expect, leading to a possibly traumatic experience. Having parents hold the child down can be a distressing experience and may lead to negative associations with medical care. It is more appropriate to prepare and guide the child gently through the procedure, having medical personnel help maintain the child’s position if necessary and encouraging the parents to focus on providing comfort.

33.

What guidance should a pediatric nurse provide to parents regarding fluid intake for a 7-year-old during hot summer activities?

  • Ensure regular hydration with water or electrolyte solutions if active for long periods.

  • Limit water intake to avoid frequent urination.

  • Offer energy drinks to replace lost electrolytes.

  • Encourage drinking distilled water frequently to maintain hydration if outdoors for long periods.

Correct answer: Ensure regular hydration with water or electrolyte solutions if active for long periods.

Regular hydration with water or electrolyte solutions is essential during active periods to replace fluids lost through sweat and maintain hydration balance.

Limiting water intake to avoid urination can lead to dehydration, especially in hot weather when fluid loss increases. Energy drinks often contain high levels of sugar and caffeine, which are not advisable for young children. Distilled water lacks minerals and continuous consumption is not recommended for maintaining hydration compared to regular or mineral water. Using exclusively distilled water can lead to dangerous electrolyte balances when replacing significant fluid volumes lost to perspiration.

34.

In preparing the plan of care for a 6-year-old with moderate eczema, the nurse notes the child has dry, scaly skin and frequent itching. What is the best nursing action to include in the plan of care?

  • Apply topical steroids as prescribed

  • Recommend non-drying, fragrance-free soap

  • Increase oral fluid intake

  • Cover affected areas with bandages

Correct answer: Apply topical steroids as prescribed

Topical steroids are a primary treatment for reducing inflammation and managing symptoms in moderate eczema, directly addressing the child’s skin condition.

Non-drying, fragrance-free soap is supportive care but does not treat the underlying inflammation or prevent flare-ups as effectively as medicated creams. Increasing fluid intake supports overall health but is not a direct treatment for eczema symptoms like itching and dryness. Covering the skin with bandages does not treat eczema and may irritate or worsen this skin condition.

35.

During a home visit, a pediatric nurse observes that a child’s primary caregiver seems particularly stressed following a recent job loss. The child has missed several recent medical appointments. What should the nurse do next to assess the situation?

  • Inquire about the family’s current economic situation’s impact on their healthcare access

  • Recommend that the caregiver find employment as soon as possible and provide referrals to local employment agencies

  • Avoid discussing potential underlying reasons for the missed appointments, as it is outside the nurse’s scope and may cause embarrassment

  • Caution the caregiver about the importance of healthcare appointments

Correct answer: Inquire about the family’s current economic situation’s impact on their healthcare access

Understanding the economic situation helps identify barriers to accessing healthcare and allows for tailored interventions, such as connecting them with resources to ensure continued access to necessary medical care.

Recommending an immediate job search might increase stress and does not address the immediate healthcare needs of the child. Avoiding the discussion about underlying reasons for missed appointments can prevent the nurse from providing necessary support and identifying barriers to care. While there may be times it is appropriate to emphasize the importance of healthcare appointments, understanding and addressing the barriers to keeping those appointments is more important in this scenario.

36.

A 3-year-old child in the emergency department appears to be in pain but is non-verbal due to developmental delays. What is the best approach for the nurse to assess the child's pain?

  • Use the FLACC scale to observe pain behaviors

  • Ask the child to point to where it hurts

  • Request the child to draw the intensity of their pain

  • Ask the child’s parents if they believe the child appears to be in pain

Correct answer: Use the FLACC scale to observe pain behaviors

The FLACC scale, which stands for Face, Legs, Activity, Cry, and Consolability, is well-suited for assessing pain in non-verbal children by observing specific behaviors that indicate pain, making it appropriate for a 3-year-old with developmental delays.

Asking a non-verbal child to point to where it hurts may not yield accurate information if the child lacks the communication skills to understand or respond to the question effectively. Requesting a non-verbal child to draw the intensity of their pain assumes a level of motor and cognitive skills that might not be present, particularly in a child with developmental delays. While parental input is valuable, relying solely on parents to gauge pain can be subjective and may not fully capture the child's actual pain experience, making direct observation through a structured scale more reliable.

37.

During the initial assessment of a 7-year-old Orthodox Jewish boy who requires an elective surgery, the family requests that no procedures be performed during the Sabbath. What is the most appropriate action for the nurse to take?

  • Plan the surgery and pre-operative procedures around the Sabbath

  • Inform the family that scheduling may conflict with their request

  • Schedule a consultation to discuss potential exemptions with hospital administration

  • Advise the family on the medical risks of delaying surgery

Correct answer: Plan the surgery and pre-operative procedures around the Sabbath

Planning the surgery and related procedures around the Sabbath respects the family's religious practices without compromising medical care, thus adhering to cultural sensitivity in healthcare.

Informing the family of potential scheduling conflicts might appear dismissive of their religious needs and could lead to dissatisfaction or non-compliance. Discussing potential exemptions with hospital administration does not guarantee that the family's needs will be met and could delay necessary care. Advising on the medical risks of delaying surgery ignores the family's specific religious concerns and could strain the relationship between the healthcare provider and the patient's family.

38.

A pediatric nurse is caring for an 8-year-old with severe anxiety related to hospitalization. Which non-pharmacologic approach might be most beneficial for this child?

  • Guided imagery sessions

  • Distraction using television

  • Participation in competitive games

  • PRN benzodiazepines

Correct answer: Guided imagery sessions

Guided imagery is a non-pharmacologic approach that can help alleviate anxiety by allowing the child to visualize a calming and safe environment, which is beneficial in managing severe anxiety related to hospitalization.

Distraction using television can provide temporary relief but does not equip the child with tools to manage anxiety effectively. Participation in competitive games might increase anxiety in some children, depending on the nature of the anxiety and the child's personality. Administering PRN benzodiazepines is a pharmacologic approach, not non-pharmacologic, and should be reserved exclusively for cases where non-pharmacologic methods are ineffective.

39.

A 6-month-old infant is brought to the clinic for a routine check-up. Which indicator is most crucial for the nurse to assess current nutritional status?

  • Weight for age

  • Number of wet diapers

  • Parent-reported eating behaviors

  • Physical appearance

Correct answer: Weight for age

Assessing weight for age is crucial for determining a 6-month-old infant's nutritional status as it provides a direct measurement of growth and well-being, reflecting both past and current nutritional intake.

While the number of wet diapers can indicate hydration status, it does not provide comprehensive information on overall nutritional health. The number of wet diapers is also a less empirical approach to assessing the infant. Parent-reported eating behaviors are useful but can be subjective and variable. They do not provide as objective or immediate an assessment of nutritional status as weight for age. Physical appearance gives some insight into nutritional status, but it is less specific and quantifiable compared to using standardized growth charts and weight measurements to assess nutritional health.

40.

A new treatment plan is being devised for a child with a rare neurological disorder. What is the nurse's best approach to participate in this planning?

  • Provide input on the nursing and care aspects during the planning stages

  • Wait for the treatment plan to be finalized and then implement it

  • Communicate the parents' opinions to the care team and advocate that they be implemented

  • Challenge the decisions made by specialists if they affect nursing workflows

Correct answer: Provide input on the nursing and care aspects during the planning stages

Providing input on the nursing and care aspects during the planning stages ensures that the nurse’s knowledge and experience are integrated into the care plan from the beginning, promoting a more comprehensive and feasible treatment plan.

Waiting for the treatment plan to be finalized before providing input misses the opportunity for the nurse to influence the plan. Communicating the parents' opinions is important, but the nurse should advocate for these to be considered in the context of clinical evidence and feasibility rather than just pushing for their implementation. Challenging the decisions made by specialists if they affect nursing workflows can be necessary but should be done constructively and as part of the planning process to ensure the best care outcomes.