Final Exam Questions
The nurse is teaching parents how to avoid a power struggle with their 2-year-old girl. Which comment indicates that more teaching is needed? A. "We will make sure she shares her toys with cousins her age." B. "We will give her a choice whenever possible." C. "Both of us, as parents, will agree on and consistently enforce the limits we set." D. "Childproofing our home will make it less necessary to say 'No!'"
Answer: "We will make sure she shares her toys with cousins her age."
A nurse is preparing a presentation for a health fair at a local college. The nurse is creating a poster to emphasize the need for cervical cancer screening. The nurse would list which age to begin screening? A. 18 years B. 21 years C. 25 years D. 30 years
Answer: B. 21 years
Language development is rapid in the preschool years. At the age of 2 most children use about 50 to 100 words. By the time the child is 5 years of age, how many words do most children use? A. 1,000 words B. 1,500 words C. 2,000 words D. 3,000 words
Answer: C. 2,000 words
The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months? A. 10 lb 8 oz (4760 g) B. 13 lb (5900 g) C. 15 lb 4 oz (6920 g) D. 19 lb 8 oz (8825 g)
Answer: D. 19 lb 8 oz (8825 g)
A pregnant woman with diabetes is having a glycosylated hemoglobin (HgbA1C) level drawn. Which result would require the nurse to revise the client's plan of care? A. 5.5% B. 6.0% C. 7% D. 8.5%
Answer: 5.5%
A mother calls a clinic nurse to ask if her infant born prematurely should receive the seasonal influenza vaccine. The nurse's next question should be: A. "How old is your baby?" B. "How premature was your baby?" C. "Does your baby have any allergies?" D. "Did your baby have any respiratory problems?"
Answer: A. "How old is your baby?"
The nurse suspects poor literacy skills in a child's family member when which statement is made? A. "I forgot my glasses, so I'll read this when I get home and let you know if I have questions." B. "I need you to review once more the best way to be sure he swallowed all his medicine." C. "He gets a suppository every 3 days to prevent constipation." D. "We communicate with the special education teachers and school daily with a notebook."
Answer: A. "I forgot my glasses, so I'll read this when I get home and let you know if I have questions."
The nurse is taking a health history for a 12-year-old child whose BMI is greater than 30. Which general question should the nurse ask the child's parents? A. "Is there a family history of hypertension, heart disease, or diabetes?" B. "Is breakfast eaten regularly?" C. "What beverages are preferred?" D. "How important is exercise?"
Answer: A. "Is there a family history of hypertension, heart disease, or diabetes?"
The nurse is conducting a presentation about urinary incontinence for a local women's group. During the presentation, which statement by a member of the group would the nurse need to clarify? A. "It's normal for a woman to develop incontinence as she ages." B. "There are ways to prevent urinary incontinence." C. "Urinary incontinence is a treatable condition." D. "Incontinence can be cured in some cases."
Answer: A. "It's normal for a woman to develop incontinence as she ages."
A nurse is teaching the parents of a child diagnosed with rheumatic fever about prescribed drug therapy. Which statement would indicate to the nurse that additional teaching is needed? A. "We can stop the penicillin when her symptoms disappear." B. "If she needs dental surgery, we might need additional medication." C. "She needs to take the drug for the full 14 days." D. "To prevent another episode, she'll need preventive antibiotic therapy for at least 5 years."
Answer: A. "We can stop the penicillin when her symptoms disappear."
A child is diagnosed with hyperthyroidism. What finding would the nurse expect to assess? A. Heat intolerance B. Constipation C. Weight gain D. Facial edema
Answer: A. Heat intolerance
A 10-year-old child tells the school nurse that she is embarrassed that she is afraid of the dark. Which is the best response by the nurse? A. "I was afraid of the dark at your age. You will grow out of that fear soon." B. "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?" C. "Are you afraid that something is going to happen to you or that something or someone may be outside that you can't see?" D. "That is so horrible that you are afraid of the dark. Can you sleep at night at all?"
Answer: B. "It is normal for a 10-year-old to be afraid of the dark so there is no need to be embarrassed. Would you like to talk about it?"
A 16-year-old pregnant client presents to the office for the third time this week. While completing the client's admission, the nurse screens for intimate partner violence. The client responds, "I have already told you twice this week I am not being abused. Why do you keep asking me these questions?" Which response by the nurse is best? A. "Based on your age and being pregnant, you are at high risk." B. "It is protocol to screen all clients for intimate partner violence at every visit." C. "It is possible for you to be a victim since your last visit and I want to ensure your safety." D. "You have been here three times this week and I am concerned about you."
Answer: B. "It is protocol to screen all clients for intimate partner violence at every visit."
A mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. What is the best response by the nurse? A. "Make sure that you test the milk on your wrist before feeding." B. "You should warm the milk under warm water instead." C. "Breast milk can be given cold, so there is no need to heat it." D. "You should only give fresh breast milk to an infant."
Answer: B. "You should warm the milk under warm water instead."
A nurse realizes the importance of nutritional assessment during the health history. When doing so, the nurse must assess the quality as well as quantity of food eaten. The best way to assess food intake is to do a: A. 12-hour recall. B. 24-hour recall. C. 3-day recall. D. 1-week recall.
Answer: B. 24-hour recall.
A client has had a cesarean birth. Which amount of blood loss would the nurse document as a postpartum hemorrhage in this client? A. 500 ml B. 750 ml C. 1000 ml D. 250 ml
Answer: C. 1000 ml
A pregnant client with type 1 diabetes is in labor. The client's blood glucose levels are being monitored every hour and she has a prescription for an infusion of regular insulin as needed based on the client's blood glucose levels. Her levels are as follows: 1300: 105 mg/dL (5.83 mmol/L) 1400: 100 mg/dL (5.55 mmol/L) 1500: 120 mg/dL (6.66 mmol/L) 1600: 106 mg/dl (5.88 mmol/L) Based on the recorded blood glucose levels, at which time would the nurse likely administer the regular insulin infusion? A. 1300 B. 1400 C. 1500 D. 1600
Answer: C. 1500
General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? A. The client is more sensitive to preanesthetic medications. B. The client is less sensitive to inhalation anesthetics. C. Neonatal depression is possible. D. Fetal hypersensitivity to anesthetic is possible.
Answer: C. Neonatal depression is possible.
A nurse is caring for a baby admitted to the hospital with suspected abusive head trauma (shaken baby syndrome). Which assessment finding would confirm this suspicion? A. periorbital edema B. bruising on the face C. retinal hemorrhages D. drainage from the ear
Answer: C. retinal hemorrhages
The nurse is documenting the child's intake. The child ate 4 cups of ice during this shift. How many cups of fluid did the child ingest? A. 4 cups of fluid B. 1 cup of fluid C. ½ cup of fluid D. 2 cups of fluid
Answer: D. 2 cups of fluid
Which action should nurses advocate to help the nation achieve the 2020 National Health Goals? Select all that apply. A. teaching about folic acid supplementation prior to conception B. obtaining early prenatal care C. providing support after the diagnosis of a fetal disorder D. encouraging sonograms at every prenatal visit E. initiating oral iron supplementation at the time of conception
Answer: A, B, C
A woman comes to the clinic. She gave birth about 2 months ago to a healthy term male newborn. During the visit, the woman tells the nurse, "I've noticed that I'm a bit uncomfortable now when we have sexual intercourse. Is there anything that I can do?" The woman's menstrual period has not yet resumed. Which suggestion by the nurse would be most appropriate? A. "You might try using a water-soluble lubricant to ease the discomfort." B. "It takes a while to get your body back to its normal function after having a baby." C. "This is entirely normal, and many women go through it. It just takes time." D. "Try doing Kegel exercises to get your pelvic muscles back in shape."
Answer: A. "You might try using a water-soluble lubricant to ease the discomfort."
The nurse is educating a 17-year-old adolescent after a new diagnosis of diabetes. What does the nurse understand about teaching an adolescent? A. The adolescent will likely have the greatest influence on one's own decisions. B. The parents will need to be instructed separately from the adolescent. C. The siblings of the adolescent will need to be taught healthy cooking classes related to diabetes. D. The adolescent will respond best to teaching about how to avoid future complications.
Answer: A. The adolescent will likely have the greatest influence on one's own decisions.
A nurse educator is teaching a client about sexually transmitted infections. The client would learn that which medications are appropriate to treat chlamydia? Select all that apply. A. acyclovir B. doxycycline C. azithromycin D. ceftriaxone E. metronidazole
Answer: A, C, D
The nurse is teaching parents of a 12-year-old child how to administer otic medication. Which statement by the parent indicates a need for further education? A. "I will pull the outer ear down and back before administering the medication." B. "After removing the medication from the refrigerator, I need to roll it gently in my palms to warm it." C. "I will hold the dropper 0.5 in (1.25 cm) above the ear canal and be certain not to touch the ear with the dropper." D. "After administering the drops, I will ask my child to remain side-lying for several minutes."
Answer: A. "I will pull the outer ear down and back before administering the medication."
A 30-minute-old newborn starts crying in a high-pitched manner and cannot be consoled by the mother. Which action should the nurse prioritize if jitteriness is also noted and the infant is unable to breastfeed? A. Check blood glucose. B. Place child in a radiant warmer. C. Assess for pain source. D. Assess the baby's temperature.
Answer: A. Check blood glucose.
The nurse is assessing a 35-year-old woman at 22 weeks' gestation who has had recent laboratory work. The nurse notes fasting blood glucose 146 mg/dl (8.10 mmol/L), hemoglobin 13 g/dl (130 g/L), and hematocrit 37% (0.37). Based on these results, which instruction should the nurse prioritize? A. Check blood sugar levels daily. B. the signs and symptoms of urinary tract infection C. Include iron-enriched foods in the diet. D. Take daily iron supplements.
Answer: A. Check blood sugar levels daily.
A nurse is assessing a client who has come to the office to find out if she is pregnant after a home pregnancy test was positive. The nurse will record the client's last menstrual period in which component of her medical record? A. Chief concern/complaint B. Demographic data C. History of past illnesses/surgeries D. Review of systems
Answer: A. Chief concern/complaint
A client who is 12 hours postbirth is reporting perineal pain. After the assessment reveals no signs of an infection, which measure could the nurse offer the client? A. an ice pack applied to the perineum B. opioid pain medication C. a heating pad applied to the perineum D. a sitz bath
Answer: A. an ice pack applied to the perineum
When planning the care for a child with leukemia who is receiving methotrexate, the nurse would assess the child closely for which possible effect? A. mucositis B. cushingoid facial appearance C. weight gain D. paresthesias of the fingers
Answer: A. mucositis
The nurse is assessing the abdomen of a 3-year-old. Which finding should be reported immediately? A. visible peristaltic waves B. active bowel sounds C. rounded abdomen D. tympany over the abdomen
Answer: A. visible peristaltic waves
The young boy has fractured his left leg and has had a cast applied. The nurse educates the boy and his parents prior to discharge from the hospital. The parents should call the physician when which incidents occur? Select all that apply. A. The boy experiences mild pain when wiggling his toes. B. The boy has had a fever of greater than 102° F (38.9°C) for the last 36 hours. C. New drainage is seeping out from under the cast. D. The outside of the boy's cast got wet and had to be dried using a hair dryer. E. The boy's toes are light blue and very swollen.
Answer: B, C, E
When working in a local community health care center, a nurse is frequently asked about cervical cancer and ways to prevent it. Which information should the nurse provide? Select all that apply. A. Encourage the use of an intrauterine device (IUD) for contraception. B. Encourage cessation of smoking and drinking. C. Encourage prevention of sexually transmitted infections (STIs) to reduce risk factors. D. Avoid stress and high blood pressure. B. Encourage cessation of smoking and drinking. C. Encourage prevention of sexually transmitted infections (STIs) to reduce risk factors.
Answer: B, C, E
At 3 years of age, a child has a cardiac catheterization. After the procedure, which interventions would be most important? A. Assuring the child that the procedure is now over B. Allowing the child to adapt to the light in the room gradually C. Taking pedal pulses for the first 4 hours D. Allowing the child to talk about the procedure
Answer: C. Taking pedal pulses for the first 4 hours
A parent has a 3-year-old child and a 4-month-old infant who both have gastroenteritis. The 3-year-old child is well enough to be cared for at home, but the 4-month-old infant requires hospitalization. How does the nurse explain the difference between these outcomes to the family? A. The 3-year-old child is taking solid foods they can be fed at home, but the 4-month-old infant requires greater nutritional support. B. The 3-year-old child has a milder case of the illness, and the 4-month-old infant has a more severe case. C. The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration. D. The 4-month-old infant has not yet had all of their vaccinations and is more prone to severe illness.
Answer: C. The 4-month old infant has a greater proportion of extracellular fluid, which increases risk of dehydration.
A 13-month-old child is brought to the clinic for a well-child visit. The child's parent expresses concern that the child has not started to walk yet. What is the best action should the nurse take? A. Refer the child to a developmental specialist for evaluation. B. Explain that the child could start walking any day. C. Ask the parent if the child has been ill recently. D. Explain that children can take their first steps as late as 18 months of age.
Answer: D. Explain that children can take their first steps as late as 18 months of age.
The nurse is assessing a multipara client who presents to the hospital after approximately 2 hours of labor and notes the fetus is in a transverse lie. After notifying the RN and primary care provider, which action should the LPN prioritize? A. Include a set of piper forceps when the table is prepped. B. Apply pressure to the client's lower back with a fisted hand. C. Assist with nitrazine and fern tests. D. Prepare to assist with external version.
Answer: D. Prepare to assist with external version.
The nurse is caring for multiple clients on the pediatric unit. Which child will the nurse see first? A. a child diagnosed with chicken pox reporting nausea and malaise B. a child with herpes simplex who is reporting mouth pain and pruritis C. a child diagnosed with measles experiencing photophobia and coryza D. a child with erythema infectiosum experiencing fatigue and confusion
Answer: D. a child with erythema infectiosum experiencing fatigue and confusion
The nurse is admitting a G3 P2 client at 38 weeks' gestation who arrived reporting painless bleeding from the vagina leading to the diagnosis of placenta previa. When questioned by the client as to what caused this, which most likely factor should the nurse point out in her answer? A. morbidly obese B. maternal age more than 30 years C. living in coastal areas D. previous cesarean birth
Answer: D. previous cesarean birth
A woman is scheduled to undergo a modified radical mastectomy. Which information would the nurse include when describing this surgery to the client? A. the resulting concave appearance of the anterior chest B. sparing of the pectoral muscles and axillary lymph nodes C. wide excision of the tumor along with a 1-cm margin of normal tissue D. removal of breast tissue and axillary nodes
Answer: D. removal of breast tissue and axillary nodes
The nurse is providing preoperative care for a 7-year-old boy with a brain tumor, as well as his parents. Which intervention is a priority? A. Assessing the child's level of consciousness. B. Providing a tour of the intensive care unit. C. Educating the child and parents about shunts. D. Having the child talk to another child who has had this surgery.
ANswer: A. Assessing the child's level of consciousness.
A child has been diagnosed with atopic dermatitis. The nurse is teaching the parents about measures to control this condition. What does the nurse teach the parents? Select all that apply. A. "Keep your child's nails trimmed short." B. "Do not use hot water to cleanse the skin." C. "Pat dry the skin after a bath. Do not rub." D. "Apply prescribed moisturizer several times per day." e. "Use prescribed steroidal lotions every day."
Answer: A, B, C, D
The licensed practical nurse is evaluating the tracings on the fetal heart monitor. The nurse is concerned that there is a change in the tracings. What should the LPN do first? A. Assess and reposition the woman. B. Notify the registered nurse. C. Notify the health care provider. D. Wait 2 minutes to review another tracing.
Answer: A. Assess and reposition the woman
The nurse prepares to examine a 4-year-old boy. How would the nurse proceed? A. Examine the child's head and work down to the child's toes. B. Examine the child's chest and then go to the head and down. C. Examine the child's extremities first and then the chest. D. Examine different sections of the body at various times.
Answer: A. Examine the child's head and work down to the child's toes.
The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication? A. Let the child hold the medication cup. B. Administer the medication using a dropper. C. Ask the parent to hold the child's arms during administration. D. Have the child lying down with the head elevated on a pillow.
Answer: A. Let the child hold the medication cup.
A child with an intellectual disability is evaluated and found to have an intelligence quotient (IQ) of 65. The nurse interprets this as reflecting which category of intellectual disability? A. Mild B. Moderate C. Severe D. Profound
Answer: A. Mild
An infant is seen in the emergency department with several raised red welts over the abdomen and lower extremities. The parent states that the symptoms developed suddenly over the past few hours. The infant is fussy and has a low grade temperature. What assessment is most important for the nurse to perform?//3339 A. Observe the infant's respiratory effort. B. Examine the lips and oral mucosa for cyanosis. C. Question the parent about methods of punishment. D. Determine whether the child is breastfed or formula fed.
Answer: A. Observe the infant's respiratory effort.
Computer use at home and at school has increased adolescents' comfort in gaining access to and using the Internet. This has expanded their exposure to risks. What potential risks are there for an adolescent to be exposed to? A. Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation. B. Teens are at risk for identity theft from sharing personal information with others whom they do not know. C. Computer use can contribute to adolescent obesity due to decreased activity and increased consumption of snacks. D. Teens can become addicted to the online gaming and role-playing that is popular with their peers.
Answer: A. Teens can be exposed to inappropriate materials, harassment, threats, and potential for molestation.
A client is in the first stage of labor and asks the nurse what type of pain she should expect at this stage. What is the nurse's most appropriate response? A. pain from the dilation (dilatation) or stretching of the cervix B. hypoxia of the contracting uterine muscles C. distention of the vagina and perineum D. pressure on the lower back, buttocks, and thighs
Answer: A. pain from the dilation (dilatation) or stretching of the cervix
A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests: A. placing the syrup in an medicine syringe. B. mixing the syrup in a small amount of formula. C. using a measured medicine spoon. D. placing the syrup in a small amount of oat cereal.
Answer: A. placing the syrup in an medicine syringe.
A nurse is preparing to examine the ear of a 2-year-old child. The nurse would pull the pinna in which direction? A. up B. down and back C. up and back D. forward
Answer: B. down and back
A nurse is teaching a child with type 1 diabetes mellitus how to self-inject insulin. Which method should she recommend to the child for regular doses? A. Subcutaneously in the outer thigh B. Intravenously in the chest C. Intramuscularly in the abdomen D. Intradermally in the outer arm
ANswer: A. Subcutaneously in the outer thigh
An adolescent girl is going to be treated for a severe case of acne vulgaris. A pregnancy test should be done prior to the adolescent starting treatment with: A. isotretinoin. B. benzoyl peroxide. C. tretinoin. D. erythromycin.
ANswer: A. isotretinoin.
A nurse is assisting a postpartum client out of bed to the bathroom for the first time. Which interventions would be most appropriate? Select all that apply. A. Walk alongside the client to the bathroom. B. Check her blood pressure after she stands up. C. Elevate the head of the bed for several minutes before getting her up. D. Sit her in a chair after getting out of bed before going to the bathroom. E. Frequently ask the client how her head feels.
Answer: A, C, D
The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective? A. The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog B. The parent spanks the child while taking the child into another room away from the dog C. The parent allows the child to continue pulling at the dog and states, "If the dog bites her she will learn." D. The parent places the child in time-out and explains the reason for the time-out
Answer: A. The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog
A nurse working with older adult clients recognizes a common report contributing to multiple pelvic organ issues. This common report would most likely be: A. constipation. B. diarrhea. C. urinary incontinence. D. pelvic pain.
Answer: A. constipation
When developing a program for STI prevention, which action would need to be done first? A. educating on how to promote sexual health B. getting individuals to change their behaviors C. increasing the availability of resources D. interfering with the mode of transmission
Answer: A. educating on how to promote sexual health
A client presents for a routine checkup at a local health care center. One of the client's distant relatives died of ovarian cancer, and the client wants to know about measures that can reduce the risk of ovarian cancer. The nurse informs the client about which measure to reduce the risk of ovarian cancer? A. maintaining a healthy weight B. avoiding the use of oral contraceptive pills (OCPs) C. not breastfeeding D. using perineal talc or hygiene sprays
Answer: A. maintaining a healthy weight
A nurse is assessing a woman who gave birth vaginally approximately 24 hours ago. Which finding would the nurse report to the primary care provider immediately? A. oral temperature 100.8° F (38.2° C) B. pulse rate 75 beats per minute C. respiratory rate 16 breaths/minute D. uterine fundus 1 cm below umbilicus
Answer: A. oral temperature 100.8° F (38.2° C)
Which client outcome during the active phase labor is best? A. The client will state a pain level of 7 or less during contractions. B. The client will practice breathing techniques during contractions. C. The client will walk in the hall for 15 minutes every 2 hours. D. The client will tolerate 8 oz (240 ml) of clear liquids.
Answer: B. The client will practice breathing techniques during contractions.
The caregivers of an 8-year-old bring their child to the pediatrician and report that the child has not had breathing problems before, but since taking up lacrosse the child has been coughing and wheezing at the end of every practice and game. Their friend's child has often been hospitalized for asthma; they are concerned that their child has a similar illness. The nurse knows that because the problems seem to be directly related to exercise, it is likely that the child will be able to be treated with: A. decreased activity and increased fluids. B. corticosteroids and leukotriene inhibitors. C. removal of allergens in the home and school. D. a bronchodilator and mast cell stabilizers.
Answer: D. a bronchodilator and mast cell stabilizers.
When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss? A. evaporation B. convection C. radiation D. conduction
Answer: D. conduction
A nurse is caring for a pregnant client in labor in a health care facility. The nurse knows that which sign marks the termination of the first stage of labor in the client? A. diffuse abdominal cramping B. rupturing of fetal membranes C. start of regular contractions D. dilation (dilatation) of cervix diameter to 10 cm
Answer: D. dilation (dilatation) of cervix diameter to 10 cm
The parent of a child with periorbital cellulitis comes to the nurses' station and asks to speak with the nurse. The parent states, "The oral pain medication you gave my child 45 minutes ago is not working!" What is the nurse's best response? A. "Oral medications take about 45 minutes to start working. I will be back in 20 minutes to check the pain level again." B. "For the safety of your child, I cannot give additional pain medication at this time." C. "You need to be patient and wait for the medicine I gave your child to work." D. "Please return to your child's room and I will be there in a moment to assess your child."
ANswer: A. "Oral medications take about 45 minutes to start working. I will be back in 20 minutes to check the pain level again."
The nurse is caring for a 7-year-old client who suffered extensive burns from a house fire. Which finding in the client's history most concerns the nurse? A. The child appears withdrawn and frightened. B. The child's clothing was burned when exiting the home. C. The child was home alone when the fire started. D. The child was trapped in a burning bedroom
ANswer: D. The child was trapped in a burning bedroom
A client has undergone an abdominal hysterectomy to remove uterine fibroids (uterine myomas). Which interventions should a nurse perform as a part of the postoperative care for the client? Select all that apply. A. Administer analgesics promptly and use a patient-controlled analgesia (PCA) pump. B. Avoid pillows and changing positions frequently. C. Avoid intake of excess carbonated beverages in the diet. D. Ambulate frequently. E. Administer antiemetics to control nausea and vomiting.
Answer: A, D, E
The nurse is teaching the parents of a 6-year-old who has sustained a large laceration about providing care to the wound at home. The nurse determines that the parents need additional teaching when they state: A. "We need to keep the wound tightly bandaged for at least 3 days." B. "We should call the doctor if the wound becomes red and hot looking." C. "If we notice some yellowish drainage, we need to call the doctor." D. "If our son starts telling us that the pain is increasing, we need to have it checked out."
Answer: A. "We need to keep the wound tightly bandaged for at least 3 days."
The nurse is teaching injection techniques to a school-aged child newly diagnosed with type 1 diabetes. Which observation would be the best evaluation that learning was successful? A. The child developed a schedule for injection times and sites and has placed it on the refrigerator. B. The child needs occasional cueing during return demonstration of the injection technique. C. The child shows an eagerness to learn more about type 1 diabetes. D. The child explains the importance of performing the injections to keep feeling well.
Answer: B. The child needs occasional cueing during return demonstration of the injection technique.
A child in the clinic has a fever and reports a sore neck. Upon assessment the nurse finds a swollen parotid gland. The nurse suspects which infectious disease? A. measles B. mumps C. whooping cough D. scabies
Answer: B. mumps
The nurse knows that which statement is a description of peritoneal dialysis when compared to hemodialysis: A. The child can live a more normal lifestyle. B. There are strict diet and fluid restrictions. C. Therapy is only 3 to 4 days per week. D. The child must go into a facility to get peritoneal dialysis.
Answer: A. The child can live a more normal lifestyle
The majority of skin variations are transient and fade or disappear with time. The nurse assesses a permanent skin variation in a newborn and counsels the parents to monitor it because of its link to potential childhood cancer. The nurse implements this counseling based on which finding? A. nevus flammeus B. erythema toxicum C. congenital dermal melanocytosis (slate gray nevi) D. infantile (strawberry) hemangioma
Answer: A. nevus flammeus
A nurse is reading a journal article about female reproductive cancers. Which malignancy would the nurse expect to be described as a "silent killer"? A. ovarian cancer B. vaginal cancer C. endometrial cancer D. cervical cancer
Answer: A. ovarian cancer
The nurse is working with a child diagnosed with encopresis. After a complete medical workup has been done, no organic cause has been found for the disorder. What follow-up will the nurse expect? A. referred for counseling B. started on methylphenidate C. administered antidiarrheal medications D. put on a high-calorie, high-protein diet
Answer: A. referred for counseling
A pregnant client is diagnosed with syphilis. Which response would demonstrate respect for the client and therapeutic communication? A. "Why didn't you use protection when having intercourse with your partner?" B. "I am sure it is frightening to you to be diagnosed with a disease that can affect your baby." C. "I noticed that you seem fidgety. Is there something wrong besides your STI?" D. "You should have thought about what diseases you could be exposed to. At least you are HIV negative."
Answer: B. "I am sure it is frightening to you to be diagnosed with a disease that can affect your baby."
The nurse is preparing to send a child with cancer for a radiation treatment. Which medication should the nurse provide to premedicate the child for this procedure? A. Analgesic B. Antiemetic C. Antipyretic D. Antineoplastic
Answer: B. Antiemetic
The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize? A. Soak the penis daily in warm water. B. Cover the glans generously with petroleum jelly. C. Cleanse the glans daily with alcohol. D. Notify the primary care provider if it appears red and sore.
Answer: B. Cover the glans generously with petroleum jelly.
The parents of a 16-year-old male are worried about recent changes in his behavior, ignoring his schoolwork and sports, and spending almost all of his free time interacting with his girlfriend. Which suggestion should the nurse would best address this situation? A. He is not mature enough to make healthy choices about the ways he spends his time, so it would be helpful if they would make a schedule for him that includes about a half-hour per day to talk with his girlfriend. B. He developed his own identity by now; establishing close relationships with girls is important preparation for his adult relationships. They should honor his need to be with his girlfriend as long as he has completed his schoolwork for the day. C. He is not developmentally mature enough to have an intimate relationship with one girl; they should encourage him to spend time with groups of friends D. He has chosen a girl who is overly dependent
Answer: B. He has developed his own identity by now; being able to establish close relationships with girls is important preparation for all of his adult relationships. They should honor his need to be with, or talk to, his girlfriend as long as he has completed his schoolwork for the day.
The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team? A. Bradypnea B. Sudden shortness of breath C. Bradycardia D. Unrelieved pain
Answer: B. Sudden shortness of breath
A parent of a newborn asks the nurse if there is any way to prevent acute otitis media. What would the nurse state to the parent? A. Prophylactic acetic acid instillations may be helpful. B. The frequency of otitis media is reduced in breastfed infants. C. Prophylactic myringotomy tubes can be inserted at birth. D. Starting immunizations at birth rather than age 2 months might help.
Answer: B. The frequency of otitis media is reduced in breastfed infants
A young woman has been referred for a colposcopy by the health care provider. The nurse is educating the woman on the procedure. Which information about the colposcopy should the nurse provide? A. The procedure may be painful. B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done. C. Sexual intercourse should be avoided for 2 weeks. D. There may be some pain while urinating for up to 1 week after the test.
Answer: B. The results of the Papanicolaou test were abnormal; therefore, this procedure must be done.
A nurse is caring for a non-breastfeeding client in the postpartum period. The client reports engorgement. What suggestion should the nurse provide to alleviate breast discomfort? A. Apply warm compresses. B. Wear a well-fitting bra. C. Express milk frequently. D. Apply hydrogel dressing.
Answer: B. Wear a well-fitting bra.
A nurse is assessing a neonate during the first 24 hours after birth. Which finding would the nurse recognize as normal? A. heart rate of 90 to 100 beats/min B. body temperature of 97.9° to 99.7° F (36.5° to 37.5° C) C. positive Ortolani sign D. enlarged labia with pseudomenstruation
Answer: B. body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)
The nurse is assessing the breast of a woman who is 1 month postpartum. The woman reports a painful area on one breast with a red area. The nurse notes a local area on one breast to be red and warm to touch. What should the nurse consider as the potential diagnosis? A. breast yeast B. mastitis C. plugged milk duct D. engorgement
Answer: B. mastitis
A newborn has been diagnosed with a congenital heart disease. Which congenital heart disease is associated with cyanosis? A. coarctation of aorta B. tetralogy of Fallot C. pulmonary stenosis D. aortic stenosis
Answer: B. tetralogy of Fallot
A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice? A. "That's wonderful. Medication during labor is not good for the baby." B. "Your health care provider is a man and has never been in labor; he may be underestimating the pain you will have." C. "I respect your preference, whether it is to have medication or not." D. "Let me get you something for relaxation if you don't want anything for pain."
Answer: C. "I respect your preference, whether it is to have medication or not."
The nurse is educating the parents of a 7-year-old boy scheduled for surgery to help prepare the child for hospitalization. Which statement by the parents indicates a need for further teaching? A. "We should talk about going to the hospital and what it will be like coming home." B. "We should visit the hospital and go through the preadmission tour in advance." C. "It is best to wait and let him bring up the surgery or any questions he has." D. "It is a good idea to read stories about experiences with hospitals or surgery."
Answer: C. "It is best to wait and let him bring up the surgery or any questions he has."
The nurse is caring for a child who is receiving a skin test to determine the presence of allergies. A positive skin test for one particular allergen shows the mediation of which type of immune globulin? A. IgG B. IgM C. IgE D. IgA
Answer: C. IgE
A school-aged child learns how to do range-of-motion exercises but has been unable to perform them correctly from day to day. Which approach is best for the nurse to take to encourage compliance by the child? A. Extend the child's visitation hours on days the child performs the exercises correctly. B. Encourage the parents to reward the child for performing the exercises correctly. C. State "Good job" to the child when performing the range-of-motion exercises correctly. D. Impress upon the child the importance of the exercises to prevent disfiguring complications.
Answer: C. State "Good job" to the child when performing the range-of-motion exercises correctly.
A nurse is preparing to administer a prescribed dose of digoxin to an 6-month-old infant. After assessing the infant's apical pulse, the nurse decides to withhold the dose and notify the health care provider. The nurse bases this decision on which apical pulse rate? A. 118 beats/min B. 102 beats/min C. 94 beats/min D. 80 beats/min
Answer: D. 80 beats/min
A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment? A. Avoid extremes of temperature to the genital area. B. Use condoms during sex. C. Increase fluid intake. D. Avoid alcohol.
Answer: D. Avoid alcohol
