Family Health Test 4
The nurse is preparing to give oral care to a school age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child?
Chlorhexidine gluconate (Peridex) Antifungal troches (lozenges) Lip balm (aquaphor)
The nurse is providing health teaching to a group of women of childbearing age. One woman, who states that she is a smoker, ask's about smoking's impact on the pregnancy. The nurse responds that which of the following fetal complications can develop if the mother smokes?
Fetal intrauterine growth restriction
Which of the following pregnant woman is at highest risk for developing a hypertensive illness of pregnancy?
G1 P0000, age 44 with history of diabetes mellitus
What is the body's response to gluten for the child with Celiac disease?
Gluten causes damage to the mucosal cells in the intense, leading to absorption problems
A pregnant mother is admitted to the hospital with a 4+ proteinuria and 3+ reflexes with 1- beat of clonus. The labor and delivery nurse should closely monitor the mother for which of the following?
Grand mal seizure
During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops severe respiratory distress and becomes cyanotic. What would be the nurse's first action?
Hold the child in the knee-chest position to increase venous blood return
A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of digoxin and furosemide. The child rubs the eyes when looking at room lights. The HR is 70 BPM. Which expected laboratory finding correlates with the nurse's observations?
Hypokalemia
Which statement by a parent of an infant with congestive heart failure (CHF) indicates the need for further discharge instructions?
I will mix the digoxin in some formula to make it taste better
Which of the following would be included in the treatment plan for the child with Kawasaki disease?
Immunoglobulin G and acetylsalicylic acid
A pregnant woman presents with severe preeclampsia. The nurse would expect the primary health care practitioner to order tests to assess the fetus for which of the following?
Intrauterine growth restriction
The nurse is caring for a newborn with esophageal atresia. Based on the diagnosis, what would the nurse expect to find in the mother's history?
Maternal polyhydramnios
A client is receiving Pergonal (menotropins) IM for ovarian stimulation. Which of the following is a common side effect of this therapy?
Mood swings
The nurse is caring for an 8 week old infant being evaluated for pyloric stenosis. Which statement by the parent would be typical for a child with this diagnosis?
The baby is always hungry after vomiting
The nurse is providing discharge instructions to the parents of a child who had an appendectomy for a ruptured appendix 5 days ago. The nurse knows that further education is required when the parent states:
We will wait 2 weeks before allowing our child to return to sports
Which statement by the parent of a child with rheumatic fever (RF) shows good understanding of the care? "I will:
"Give the acetylsalicylic acid (ASA) that is ordered for pain and inflammation"
The nurse is discharging a child who has just received chemotherapy for neuroblastoma. Which of the following statements made by the child's parent indicates a need for additional teaching?
"I will take a rectal temperature daily and report a temperature greater than 101 F (38.3 C) immediately to the physician"
A client who is undergoing ovarian stimulation for infertility calls the infertility nurse and states: "My abdomen feels very bloated, my clothes are very tight, and my urine is very dark." Which of the following is the appropriate statement for the nurse to make at this time?
"It is important for you to come into the office to be examined today"
Which of the following statements is appropriate for the nurse to say to a pregnant woman with a complete placenta previa?
"It is important that you inform me if you become constipated"
On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with diarrhea and fever. The parent asks why the pediatrician never said anything about the murmur. The nurse replies:
"The fever increased the intensity of the murmur"
The parents of a 3 month old ask why their baby will not need an operation to correct a ventricular septal defect (VSD). The nurse's best response is to:
"Your baby's defect is small and will likely close on it's own by 1 year of age"
The nurse has assessed four primigravid clients in the prenatal clinic. Which of the woman would the nurse refer to the nurse midwife for further assessment?
32 weeks gestation, complains of epigastric pain and facial edema
The nurse has assessed four primigravid women in the prenatal care clinic. Which of the women should be referred to the physician or midwife for further testing?
32 weeks gestation, complains of epigastric pain and facial edema
A nurse educator is providing a teaching session for the nursing staff. The greatest risk for developing betathalassemia (Cooley anemia) is a child who:
Is of Mediterranean descent
A child who has reddened eyes with no discharge; red, swollen, and peeling palms and soles of the feet; dry, cracked lips; and a "strawberry tongue" most likely has which condition?
Kawasaki disease
A nurse is caring for a 15 year old who has just been diagnosed with non-Hodgkin lymphoma. Which of the following should the nurse include in teaching the parents about this lymphoma?
The malignancy originates in the lymphoid system Mediastinal involvement is typical The disease is diffuse rather than nodular Treatment includes chemotherapy and radiation
Medical abortions are:
Can be either elective or therapeutic
The nurse is preparing a child for possible alopecia from chemotherapy. Which suggestion should be included in the teaching?
Explaining to the child that, when hair regrows, it may have a slightly different color or texture
Which of the following findings would the nurse expect to assess in a pregnant woman in her first trimester suspected of having gestational trophoblastic disease (hydatidiform mole)?
Grape-like clusters passed from the vagina Markedly elevated blood pressure
The nurse is giving discharge instructions to the parent of a 1 month old infant with tracheoesophageal fistula and a gastrostomy tube. The nurse knows the mother understands the discharge teaching when she states:
I will clean the area around the gastrostomy tube with soap and water everyday
A 10 year old is being evaluated for possible appendicitis and complains of nausea and sharp abdominal pain in the right lower quadrant. An abdominal ultrasound is scheduled, and blood count has been obtained. The child vomits, finds the pain relieved, and calls the nurse. Which should be the nurse's next action?
Immediately notify the healthcare provider of the child's status
Which discharge instruction for a child diagnosed with encopresis should the nurse question?
Offer a diet high in protein
A 4 month old is brought to the ED with severe dehydration. The heart rate is 198, and BP is 68/38. The infant's anterior fontanel is sunken. The nurse notes that the infant does not cry when IV line is inserted. The child's parents state that she has not "held anything down" in 18 hours. The nurse obtains a finger-stick blood sugar of 94. What would the nurse's most immediate action be?
Prepare to administer a bolus of normal saline
Which of the following medications is used to treat transposition of the great vessels?
Prostaglandin E
On ultrasound, it is noted that the pregnancy of a hospitalized woman who is carrying monochorionic twins is complicated by twin-to-twin transfusion. The pregnant mother should be carefully monitored for which of the following?
Rapid fundal growth
The nurse expects which of the following clinical manifestations in a child diagnosed with SCID (Severe Combine Immune Deficiency)?
Susceptibility to infection
A nurse is caring for a child with von Willebrand disease. Which of the following is a (are) clinical manifestation(s) of von Willebrand disease?
Bleeding of the mucous membranes The child bruises easily Excessive menstruation The child has frequent nosebleeds
A young child with leukemia screams whenever being turned or moved. The most probable cause of pain is:
Bone involvement
A 9 month old with diarrhea secondary to rotavirus, has not vomited and is mildly dehydrated. Which instruction should be included in the discharge teaching for the breastfeeding mother?
Continue breastfeeding
A woman enters the prenatal clinic accompanied by her partner. When the nurse asks her about her reason for seeking care, the woman looks down as her partner states, "She says she thinks she's pregnant. She constantly complains of feeling tired. And her vomiting is disgusting!" Which of the following is the priority action for the nurse to perform?
Continue the interview with the woman in private
A pregnant woman, G5 P0401, is in the post-anesthesia care unit (PACU) after a cervical cerclage procedure. During the immediate post procedure period, what should the nurse carefully monitor for?
Uterine contractions
Which immunization should be given with caution to children infected with HIV?
Varicella
Which defects are present with Tetralogy of Fallot (TOF)?
Ventricular septal defect (VSD) Right ventricular hypertrophy Pulmonic stenosis (PS) Overriding aorta
A woman at 32 weeks gestation was last seen in the prenatal care clinic at 28 weeks gestation. Which of the following changes should the nurse bring to the attention of the certified nurse midwife?
Weight change from 128 pounds to 138 pounds
A woman has been diagnosed with a ruptured ectopic pregnancy. Which of the following signs/symptoms is characteristic of this diagnosis?
Sharp unilateral pain
The nurse is administering an intravenous chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action?
Stop the infusion immediately
The parents of an 8 year old indicate the child has developed spastic movements of the extremities and trunk, facial grimace, and speech disturbances. The state is seems worse when the child is anxious and does not occur while sleeping. The nurse questions the parents about which recent illness?
Strep throat
A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurse's most appropriate response would be:
"Your current medications will reduce the effectiveness of the pill"
A patient, 32 weeks pregnant with severe headache, is admitted with preeclampsia. In addition to obtaining baseline vital signs and placing the client on bed rest, the healthcare provider ordered the following four items. Which of the orders should the nurse perform first?
Assess deep tendon reflexes
The nurse is planning care for a school-age child admitted to the hospital with hemophilia. Which interventions should the nurse plan to implement for this child?
Avoidance of IM injections Acetaminophen for mild pain control Soft toothbrush for dental hygiene
A woman is using basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is:
You probably didn't ovulate during this cycle
