Exam 3 NCLEX Questions

A child with rheumatic fever is being admitted to the pediatric floor. On admission assessment, the nurse should ask the parents which question to elicit assessment information specific to the development of rheumatic fever? A. "Has your child complained of back pain?" B. "Has your child complained of headaches?" C. "Has your child had any nausea or vomiting?" D. "Did your child have a sore throat or fever within the last 2 months?"

D. "Did your child have a sore throat or fever within the last 2 months?"

A nurse is caring for a 5-year-old with a fracture of the tibia involving the growth plate. When providing information to the parents, the nurse should indicate that: A. The child will never be able to play contact sports. B. The fracture usually heals within 6 weeks without further complications. C. This is a serious injury that could cause long-term growth issues. D. Fractures involving the growth plate require pain medication.

C. This is a serious injury that could cause long-term growth issues.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for the splenectomy? A. To decrease potential for infection. B. To prevent sickling of the red blood cells C. To prevent splenic sequestration D. To prevent sickle cell crisis

C. To prevent splenic sequestration

The nurse is working with a child who has just had a fracture reduction and casting. The nurse knows that the child is at risk for compartment syndrome. What objective assessment items will the nurse monitor for while completing the nursing assessment? Select all that apply. A. Burning B. Fever C. Weak pulse D. Tingling E. Pale grey extremity

C. Weak pulse E. Pale grey extremity

The nurse should tell the parents of a child with Duchenne muscular dystrophy that some of the progressive complications include: A. dry skin, hirsutism, protruding tongue, and mental retardation. B. anorexia, gingival hyperplasia, and dry skin and hair. C. contractures, obesity, and pulmonary infections. D. trembling, frequent loss of consciousness, and slurred speech.

C. contractures, obesity, and pulmonary infections.

The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which statement by the parents indicates a need for further instructions? A. "A balance of rest and exercise is important." B. "I can apply lotion or powder to the incision if it is itchy." C. "Activities in which my child could fall need to be avoided for 2-4 weeks." D. "We should avoid going to places like the mall or grocery stores for at least 2 weeks after surgery."

B. "I can apply lotion or powder to the incision if it is itchy."

A child is receiving morphine sulfate to control her postoperative pain after scoliosis repair. Which of the following findings is a side effect of morphine? A. Bradycardia B. Respiratory distress C. Severe hypotension D. Pruritis

D. Pruritis

A nurse is reviewing the health care provider's orders for a child with sickle cell anemia being admitted to the pediatric floor for treatment of vaso-occlusive crisis. Which orders should the nurse question? Select all that apply. A. Restrict fluid intake B. Position for comfort C. Avoid strain on painful joints D. Apply nasal oxygen at 2L/minute E. Provide a high calorie, high protein diet F. Give Meperidine (Demerol) intravenously, every four hours for pain.

A. Restrict fluid intake F. Give Meperidine (Demerol) intravenously, every four hours for pain.

The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for administration of digoxin (Lanoxin). Which statement by the parent indicates a need for further instruction? A. "If my child vomits after the medication administration, I will repeat the dose." B. "I will not mix the medication with food." C. "I will take my child's pulse before administering the medication." D. "If more than one dose is missed, I will call the provider."

A. "If my child vomits after the medication administration, I will repeat the dose."

The nurse teaching the parent of a child diagnosed with systemic lupus erythematosus (SLE). The nurse evaluates the teaching as effective when the parent states: A. "The cause is unknown." B. "There is no genetic involvement." C. "Drugs are not a trigger for the illness." D. "Antibiotics improve disease outcome."

A. "The cause is unknown."

Why are chemotherapeutic agents such as methotrexate and cyclophosphamide sometimes used to treat JIA? A. Affect the immune system B. Effective against cancer-like JIA C. Are similar to NSAIDS D. Are absorbed into the synovial fluid

A. Affect the immune system

Which are the most serious complications for a child with Kawasaki disease? Select all that apply. A. Coronary thrombosis B. Hypocoagulability C. Decreased sedimentation time (ESR) D. Coronary stenosis E. Coronary artery aneurysm F. Hypoplastic left heart syndrome

A. Coronary thrombosis D. Coronary stenosis E. Coronary artery aneurysm

The nurse is conducting staff in-service training on von Willebrand's disease. Which should the nurse include as characteristics of von Willebrand's disease? Select all that apply. A. Easy bruising occurs B. Gum bleeding occurs C. It is a hereditary bleeding disorder. D. Treatment and care are similar to that for hemophilia. E. It is characterized by high white blood cell levels. F. The disorder causes platelets to adhere to damaged endothelium. G. Excessive menstruation in post-pubertal female

A. Easy bruising occurs B. Gum bleeding occurs C. It is a hereditary bleeding disorder. D. Treatment and care are similar to that for hemophilia. G. Excessive menstruation in post-pubertal female

A 5-year-old has recently been diagnosed with JIA. The nurse is reviewing his diagnostic findings from his blood work. Which of the following findings would the nurse expect to see? Select all that apply. A. Elevated sedimentation rate (ESR) B. Positive antinuclear antibody test (ANA) C. C-reactive protein (CRP) greater than 10mg/L D. Positive rheumatoid factor test E. Low vitamin D levels F. Low hemoglobin levels

A. Elevated sedimentation rate (ESR) B. Positive antinuclear antibody test (ANA) C. C-reactive protein (CRP) greater than 10mg/L D. Positive rheumatoid factor test

The nurse is caring for a child who is experiencing hives and respiratory difficulty following exposure to latex. Which drug should the nurse initially plan to administer to this child if indicated? A. Give epinephrine through an EpiPen B. Administer prednisone immediately C. Place the child on oxygen D. Give diphenhydramine (Benadryl)

A. Give epinephrine through an EpiPen

A 3-year-old child diagnosed with congestive heart failure is receiving maintenance doses of digoxin and furosemide (Lasix). She is rubbing her eyes when she is looking at the lights in the room and her heart rate is 65 beats per minute. The nurse expects which laboratory finding? A. Hypokalemia B. Hypomagnesemia C. Hypocalcemia D. Hypophosphatemia

A. Hypokalemia

The following are examples of acquired heart disease. Select all that apply. A. Infective endocarditis B. Coarctation of the aorta C. Rheumatic fever (RF) D. Cardiomyopathy E. Kawasaki disease (KD) F. Transposition of the great vessels

A. Infective endocarditis C. Rheumatic fever (RF) D. Cardiomyopathy E. Kawasaki disease (KD)

Symptoms that define anaphylaxis include (select all that apply): A. Lip and tongue edema B. Urticarial and pruritis C. Shortness of breath D. Nonadventitious breath sounds E. Hypertension F. Stridor G. Wheezing

A. Lip and tongue edema B. Urticarial and pruritis C. Shortness of breath F. Stridor G. Wheezing

Sepsis has a systemic effect on the body and is most likely to impair which organs? A. Lungs, liver, and kidneys B. Bowels, kidneys, and lungs C. Gallbladder and appendix D. Heart and spleen

A. Lungs, liver, and kidneys

Which will help the school-aged child with muscular dystrophy stay active longer? A. Normal activities, such as swimming B. Using a treadmill every day C. Several periods of rest every day D. Using a wheelchair upon getting tired

A. Normal activities, such as swimming

Which factors are associated with slipped capital femoral epiphysis (SCFE)? Select all that apply. A. Obesity B. Female gender C. African descent D. Age of 5-10 years E. Pubertal hormonal changes F. Endocrine disorders

A. Obesity C. African Decent E. Pubertal hormonal changes F. Endocrine disorders

Which of the following is the most common opportunistic infection in children infected with human immunodeficiency virus (HIV)? A. Pneumosystic pneumonia B. Cytomegalovirus C. Encephalitis D. Meningitis

A. Pneumosystic pneumonia

When planning a rehabilitative approach for a child with osteogenesis imperfecta (OI), the nurse should work to prevent which of the following? Select all that apply. A. Positional contractures and deformities B. Bone infection C. Muscle weakness D. Osteoporosis E. Misalignment of lower extremity joints

A. Positional contractures and deformities C. Muscle weakness D. Osteoporosis E. Misalignment of lower extremity joints

For the child with hypoplastic left heart syndrome, which medication may be given to keep the patent ductus arteriosus (PDA) open until surgery can be done? A. Prostaglandin E B. Indomethicin C. Ibuprofen D. Digoxin

A. Prostaglandin E

Clinical manifestations of sepsis in infants with septicemia include (select all that apply): A. Temperature instability B. Hypotonia C. Lethargy D. Weight loss E. Decreased urine output

A. Temperature instability B. Hypotonia C. Lethargy E. Decreased urine output

The nurse is caring for child being treated for ALL. Laboratory results indicate that the child has a white blood count of 5ooo/mm3 with 5% polys and 3% bands. Which of the following analyses is most appropriate? A. The absolute neutrophil count (ANC) is 400/mm3, and the child is neutropenic. B. The absolute neutrophil count is 800/mm3, and the child is neutropenic C. The absolute neutrophil count is 4000/mm3, and the child is not neutropenic D. The absolute neutrophil count is 5800/mm3, and the child is not neutropenic

A. The absolute neutrophil count (ANC) is 400/mm3, and the child is neutropenic.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. A. The extremity should be immobilized. B. The extremity should be elevated. C. Warm, moist compresses should be applied to decrease pain. D. Passive range of motion should be administered to the extremity. E. Factor VIII should be administered.

A. The extremity should be immobilized. B. The extremity should be elevated. E. Factor VIII should be administered.

The nurse is assisting the health care provider (HCP) examining an infant with developmental dysplasia of the hip perform an Ortolani maneuver. The nurse knows that this maneuver is performed for which purpose? A. To assess for hip instability B. To assess for movement of the hips C. To push the femoral head into the acetabulum D. To ensure full range of motion exists

A. To assess for hip instability

Indomethacin is being given to an infant with a patent ductus arteriosus in an attempt to promote closure of the PDA. The nurse caring for this infant becomes concerned about adverse side effects when noticing: A. decreased urine output, decreased platelets, and abdominal distention. B. increased blood pressure, tachycardia, and decreased oxygen requirements. C. increased urine output, increased white blood cell count, and increased reticulocyte count. D. Jaundice, pallor, and a petechial rash

A. decreased urine output, decreased platelets, and abdominal distention.

The parent of a child with osteomyelitis asks how the child acquired the illness. Which is the best response by the nurse? A. "Direct inoculation of the bone from stepping barefoot on a sharp stick." B. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone." C. "The blood supply to the bone was disrupted because of the child's diabetes." D. "An infection of the upper respiratory tract."

B. "An infection from a scratched mosquito bite carried the infection through the bloodstream to the bone."

Parents bring their 2-week-old infant to a clinic for treatment after a diagnosis of clubfoot was made at birth. Which statement by the parent indicated the need for further teaching regarding this disorder? A. "Treatment needs to be started as soon as possible." B. "I need to bring my child back to the clinic in 1 month for a new cast." C. "I need to come to the clinic every week with my infant for the casting." D. "I realize my infant will require follow-up care until he reaches skeletal maturity."

B. "I need to bring my child back to the clinic in 1 month for a new cast."

Which is the nurse's best explanation to the parent of a toddler who asks what a greenstick fracture is? A. "It is a fracture in the growth plate of the bone." B. "It is a fracture that does not go all the way through the bone." C. "Because children's bones are not fully developed, any fracture in a young child is called a greenstick fracture." D. "It is a fracture in which a complete break occurs in the bone and small pieces of bone are broken off."

B. "It is a fracture that does not go all the way through the bone."

Which test provides a definitive diagnosis of aplastic anemia? A. Complete blood count with differential B. Bone marrow aspiration C. Serum IgG levels D. Basic metabolic panel

B. Bone marrow aspiration

A child born with Trisomy 21 should be evaluated for which associated cardiac manifestation? A. Systemic hypertension B. Congenital heart defect C. Hyperlipidemia D. Cardiomyopathy

B. Congenital heart defect

Sepsis results from the effects of circulating bacterial toxins and is mediated by: A. IgM B. Cytokines C. Hemoglobin D. Proteins

B. Cytokines

A child with ẞ-thalassemia is receiving long-term blood transfusion therapy for the treatment of the disorder. Which medication should the nurse expect to administer for chelation therapy? A. Fragamin B. Deferoxamine (Desferal) C. Metroprolol (Toprol - XL) D. Meropenem (Merrem)

B. Deferoxamine (Desferal)

A 4-year-old has just had a plaster cast applied to a fractured left arm. The nurse provides instructions to the parents regarding care for the cast. Which statement by the parent indicates a need for further instruction" A. "The cast may feel warm as it dries." B. I can use lotion or powder around the cast edges to relieve itching." C. "A small amount of white shoe polish can touch up a soiled white cast." D. "If the cast becomes wet, a blow dryer set on the cool setting may be used to dry it."

B. I can use lotion or powder around the cast edges to relieve itching."

Which of the following describe(s) idiopathic thrombocytopenia purpura (ITP)? Select all that apply. A. ITP is a congenital hematological disorder. B. ITP causes excessive destruction of platelets. C. Children with ITP have normal bone marrow. D. Platelets are small in ITP. E. Purpura is involved in ITP.

B. ITP causes excessive destruction of platelets. C. Children with ITP have normal bone marrow. E. Purpura is involved in ITP.

Which of the following should the nurse expect to administer to a child with ITP and a platelet count of 5000/mm3? A. Platelets B. Intravenous immunoglobulin C. Packed red blood cells D. White blood cells

B. Intravenous immunoglobulin

The home health nurse visits a child with infectious mononucleosis and provides home care instructions to the parents about the care of the child. Which instructions should the nurse give to the parents? Select all that apply. A. Maintain the child on bed rest for 2 weeks. B. Notify the health care provider if the child develops abdominal pain or left shoulder pain. C. Maintain respiratory isolation for 1 week. D. Notify the health care provider if the child develops a fever. E. The child should refrain from contact sports until splenomegaly resolves.

B. Notify the health care provider if the child develops abdominal pain or left shoulder pain. E. The child should refrain from contact sports until splenomegaly resolves.

A toddler who has been hospitalized for vomiting due to gastroenteritis is sleeping and difficult to wake up. Assessment reveals vital signs of a regular heart rate of 230 beats per minute, respiratory rate of 30 per minute, BP of 84/52, and capillary refill time of 3 seconds. Which dysrhythmia does the nurse suspect in this child? A. Rapid atrial flutter B. Supraventricular tachycardia C. Sinus bradycardia D. Rapid atrial fibrillation

B. Supraventricular tachycardia

The nurse is closely monitoring the intake and output of an infant with heart failure who is receiving diuretic therapy. The nurse should use which most appropriate method to assess urine output? A. Inserting a foley catheter. B. Weighing the diapers. C. Comparing intake with output. D. Measuring the amount of water added to the formula.

B. Weighing the diapers.

Which statement by the mother of a child with rheumatic fever (RF) indicates that she has an understanding of prevention for her other children? A. "Whenever one of them gets a sore throat, I will give that child an antibiotic." B. "There is no treatment since it is viral and must run its course." C. "If their culture is positive for group A streptococcus, I will give them a full course of their antibiotic." D. "If their culture is positive for staphylococcus A, I will give them a full course of their antibiotic."

C. "If their culture is positive for group A streptococcus, I will give them a full course of their antibiotic."

A child with osteosarcoma is going to receive chemotherapy before surgery. Which statement by the parents indicates they understand the side effect of neutropenia? A. "My child will be more at risk for diarrhea." B. "My child's hair will fall out." C. "My child will be more at risk for infection." D. "My child will need to remain hydrated."

C. "My child will be more at risk for infection."

On assessment of a child admitted with a diagnosis of Kawasaki Disease, the nurse expects to note which clinical manifestation of the acute phase of the disease? A. Cracked lips B. Normal appearance C. Conjuntival hyperemia D. Desquamation of the skin

C. Conjuntival hyperemia

The clinic nurse reviews the record of a child just seen by the health care provider and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder? A. Pallor B. Hyperactivity C. Exercise intolerance D. Gastrointestinal disturbances

C. Exercise intolerance

The nurse is caring for a child with Kawasaki disease. A student nurse who is on the unit asks if there are medications to treat the disease. The nurse's best response to the student nurse is: A. Immunogloulin G and ACE inhibitors B. Immunoglobulin and heparin C. Immunoglobulin G and aspirin D. Immunoglobulin and ibuprofen

C. Immunoglobulin G and aspirin

The nurse is instructing the parent of a child with HIV about immunizations. Which of the following should the nurse tell the parent? A. Hepatitis B vaccine will not be given to this child. B. Members of the family should be cautioned not to receive the varicella vaccine. C. Inactivated pneumococcal and influenza vaccines are recommended. D. The child will need to have a Western blot done prior to all immunizations.

C. Inactivated pneumococcal and influenza vaccines are recommended.

When providing dietary guidance to a child with spina bifida with a known latex allergy, the nurse should encourage the child/caretaker to avoid which foods? A. Oranges, apples, and brussel sprouts B. Broccoli, corn, and strawberries C. Kiwi fruit, avocados, and bananas D. Carrots, onions, and blueberries

C. Kiwi fruit, avocados, and bananas

A child who has undergone spinal fusion for scoliosis complains of abdominal discomfort and has periods of vomiting. On further assessment, the nurse notes abdominal distention. The priority action by the nurse at this time would be to: A. administer an antiemetic B. Increase the intravenous fluids. C. Notify the health care provider (HCP). D. Place the child in Sim's position.

C. Notify the health care provider (HCP).

The nurse is monitoring an infant with a congenital heart disease closely for signs of heart failure. Which early sign should the nurse be most concerned about? A. Pallor B. Cough C. Tachycardia D. Slow and shallow breathing

C. Tachycardia

A child has been diagnosed with valvular disease following rheumatic fever (RF). During patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics for dental procedures, surgery, and childbirth. The parents Indicate they understand when they say: A. "She will need to take the antibiotics until she turns 18 years old." B. "She will need to take the antibiotics for 5 years after the last attack." C. "She will need to take the antibiotics for 10 years after the last attack." D. "She will need to take the antibiotics for the rest of her life."

D. "She will need to take the antibiotics for the rest of her life."

The nurse is planning care for a child recently admitted for Guillain-Barré Syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the parents ask about the paralysis, what is the best response by the nurse? A. "It must be difficult to accept the permanency of your child's paralysis." B. "Your child will first regain the use of their legs and then their arms." C. "In addition to the paralysis, your child will experience sensory loss." D. "The paralysis caused by this disease is temporary but the recovery can take up to 2 years."

D. "The paralysis caused by this disease is temporary but the recovery can take up to 2 years."

The nurse teaching the parents of a child newly diagnosed with juvenile idiopathic arthritis (JIA). The nurse would evaluate the teaching as successful when the parent is states that, "The disorder is caused by...: A. ...the breakdown of osteoclasts in the joint space causing bone loss." B. ...loss of cartilage in the joints." C. ...a build-up of calcium crystals in joint spaces." D. ...an immune-stimulated inflammatory response."

D. ...an immune-stimulated inflammatory response."

The nurse is caring for a school-aged child with Duchenne muscular dystrophy. Which would be the most appropriate nursing diagnosis? A. Anticipatory grieving B. Anxiety reduction C. Increased pain D. Activity intolerance

D. Activity intolerance

The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever. The nurse knows that which laboratory study would assist in confirming the diagnosis? A. Immunoglobulin B. Red blood cell count C. White blood cell count D. Anti-streptolysin O titer

D. Anti-streptolysin O titer

Laboratory tests are done for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which result indicates this type of anemia? A. Elevated hemoglobin level B. Decreased reticulocyte count C. Elevated red blood cell count D. Microcytic and hypochromic red blood cells

D. Microcytic and hypochromic red blood cells

A child with a right femur fracture is placed in skin traction until surgery can be performed. During assessment of the child, the nurse notes that the dorsalis pedis is absent on the right foot. Which action should the nurse take? A. Administer an analgesic B. Release the skin traction C. Apply ice to the extremity D. Notify the health care provider (HCP)

D. Notify the health care provider (HCP)

Which of the following laboratory tests will be ordered to determine the presence of the human immunodeficiency virus antigen in an infant whose parent is HIV+? A. CD4 cell count B. Western blot C. IgG levels D. P24 antigen assay

D. P24 antigen assay

1.The nurse analyzes the laboratory results of a child with hemophilia. The nurse recognizes that which result would most likely be abnormal in this child? A. Platelet count B. Hematocrit level C. Hemoglobin level D. Partial thromboplastin time

D. Partial thromboplastin time

While looking through the chart of an infant with a congenital heart defect (CHD) of decreased pulmonary blood flow, the nurse would expect which laboratory finding? A. Decreased platelet count B. Decreased ferritin level C. Respiratory alkalosis D. Polycythemia

D. Polycythemia

Which of the following confirms a diagnosis of Hodgkin disease in a 15-year-old? A. Creatinine in the urine B. Blast cells in the blood C. Lymphocytes in the bone marrow D. Reed-Sternberg cells in the lymph nodes

D. Reed-Sternberg cells in the lymph nodes

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID? A. Prolonged bleeding B. Failure to thrive C. Fatigue and malaise D. Susceptibility to infection

D. Susceptibility to infection

A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse administer the oxygen? A. During sleep B. When changing the infant's diapers C. When the mother is holding the infant D. When drawing blood for electrolyte level testing

D. When drawing blood for electrolyte level testing