418 practice questions

Which fetal station is closest to delivery?

+3

A client is 48 hours post-delivery. While assessing fundal height, the nurse would expect the fundal height to be?

2 cm below the umbilicus The fundal height will decrease by 1 cm per day below the umbilicus.

Which instruction from the nurse is most appropriate when conducting teaching to new parents regarding infant care and feeding?

Delay supplemental foods until the infant is 4 to 6 months old.

The nurse is caring for a 17 year old expectant client who is currently at 28 weeks gestation who has been placed on bed rest to avoid premature labor. The client inquires on the true risk to the fetus if delivered early. What effects is the nurse most likely to discuss with the client? (Select all that apply)

Developmental Delays Cerebral palsy Vision and hearing disorders Respiratory disorders

The nurse is caring for an 18-month-old child and know the most developmentally appropriate pain scale is which of the following:

FLACC

The nurse is caring for a 1-year-old at a well child appointment that is new to the clinic and being seen for the first time. The parents indicate that the child doesn't use many words. The nurse is interacting with the infant and notices a lack of responsiveness to the interaction. As the provider enters the room, she accidentally slams the door and the infant does not turn in the direction of the noise. What is the nurse most likely going to document and refer to the provider?

Hearing impairment

The nurse is caring for a middle school child who is on month nine of chemotherapy. The nurse understand some of the psychological adaptation related to this may include:

Impact to normal childhood development Chronic stress for child and family Impact to autonomy and social interaction Impact on learning and routine development

The nurse is preparing education for nursing students in regard to risks associated with teen pregnancy. What areas is the nurse most likely to discuss related to Psychosocial disparities?

Income is low and poverty is high Most teen mothers are unmarried Many teen mothers are unable to complete high school

During a routine check-up laboratory tests reveal that a 1-year-old child is positive for lead poisoning. Which of the following statements about lead poisoning are true? Select all that apply

Lead poisoning can harm a child's growth, behavior, and ability to learn. Lead crosses the placenta. A newborn typically has a blood-lead concentration level similar to the mother's. Children age 3 and under are at the greatest risk for severe complications from lead poisoning.

A 4-year-old child with moderate isonatremic dehydration is admitted for IV rehydration. If the child remains lethargic after a crystalloid bolus, what is the most likely reason?

Low blood sugar

The nurse is working with the family of a 7-year-old newly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The nurse most anticipates which of the following medications will be prescribed?

Methylphenidate

The nurse is educating the mother of a newborn with a cyanotic heart defect about ways to decrease cardiac demands and minimize cardiac workload while providing adequate nutrition and growth potential. Which of the following should the nurse discuss with the mother? Select all that apply.

The "work" of breast-feeding is less than the work of bottle-feeding. Babies with heart disease tend to gain weight at a much slower rate. Nurse your baby 8-12 times a day to be sure the baby is getting enough milk

The nurse is preparing to administer a weight-appropriate dose of parenteral ondansetron to a 2-year-old patient admitted for acute gastroenteritis. Which of the following topics are relevant for medication teaching with the family?

The amount of medication administered is determined by your child's weight

The nurse in a postpartum unit evaluates new parents for risk factors that can indicate problems with bonding/attachment. Which situations does the nurse recognize as a cause for bonding/attachment problems? Select all that apply.

The mother experienced eclampsia in the third trimester of pregnancy. The neonate is being treated for meconium aspiration syndrome. The mother experienced dystocia in the second phase of labor. The father of the neonate is in the military and not yet home on leave.

A client with preeclampsia is assessed with the following: blood pressure 158/100; urinary output 50 mL/hour; lungs clear to auscultation; urine protein 1+ on dipstick; and edema of the hands, ankles, and feet. Which new assessment finding indicates the client's condition is getting worse?

Urinary output 20mL/hour

The nurse is preparing to administer an IM vaccine injection to a 1-year-old. The nurse knows which of the following is the best site for injection for this patient?

Vastus lateralis

A female client with infertility is suspected as having a problem with patent fallopian tubes and ovum motility. The nurse expects that this client will be evaluated for all of the following health problems except which?

Cervical stenosis

The nurse is caring for a 14-year-old with celiac disease. The nurse knows that the patient understands the diet instructions by ordering which of the following meals?

Cheese, banana slices, rice cakes, and whole milk.

The postpartum client is diagnosed with thrombophlebitis in the right leg. Which assessment finding requires immediate intervention by the nurse?

Chest pressure

IV potassium is ordered for electrolyte replacement in your 4-year-old patient. Which lab value is most important for the RN to review prior to administration?

Creatinine

The nurse is providing information to parents of infants regarding home safety. Which information will the nurse most likely present that is specific to this age group? Select all that apply.

Crib Safety Diaper rash prevention Signs and symptoms of illness to report

A 6-week-old is admitted to the hospital with influenza. The child is crying, and the father tells the nurse that his son is hungry. The nurse explains that the baby is not to have anything by mouth. The parent does not understand why the child cannot eat. Which is the nurse's best response to the parent?

"The shorter and narrower airway of infants increases their chances of aspiration so your child should not have anything to eat now."

An infant weighing 8 lb., 4 oz. at birth weighs 7 lb., 15 oz. three days later. What should the nurse explain to the parents about this change in the newborn's weight?

"This weight loss is within normal limits."

An alert, afebrile, previously healthy 6-month-old infant is brought to the Emergency Department by his parents for a rapid, non-variable heart rate of 220 and fussiness. The triage RN most suspects which of the following:

Supraventricular Tachycardia

A client who is at 32 weeks' gestation is determined to be at high risk for ABO incompatibility. Which intervention should the nurse anticipate implementing?

Note the potential for ABO incompatibility and plan to carefully assess the neonate for the development of hyperbilirubinemia.

In preparation for teaching a women's community center class about physiologic changes during menopause, the nurse is preparing a handout for students. Which information should the nurse include in this teaching?

Ovarian secretion of estrogen decreases between the ages of 45 and 55, after which point ovulatory activity ceases.

The nurse is assessing a newly-admitted 5-year-old child with a diagnosis of acute pericarditis. Which assessment finding would the nurse most expect?

Pericardial friction rub

Which developmental theoretical framework includes the sensorimotor, preoperational, concrete operational and formal operational stages?

Piaget's Theory of Cognitive Development

To create a neutral thermal environment for a newborn immediately after delivery, the nurse should consider:

Providing care and assessments while the infant is skin-to-skin on the mother's chest

When planning care for an infant newly diagnosed with a tracheoesophageal fistula, which potential problem is the highest priority?

Risk for aspiration