Saunders Nclex exam questions for Exam 2

antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes. The nurse provides discharge instructions to the parent regarding the administration of the antibiotics Which statement is made by the parents indicates an understanding of the instructions provided? a. Administer the antibiotics until they are gone b. administer the antibiotics if the child has a fever c. administer the antibiotics until the child feels betters d. begin to taper the antibiotics after 3 days of a full course

A

The nurse is preparing for the admission of an infant with bronchiolitis as diagnosed from RVS. Which interventions should the nurse include if plan of care. Select all that apply A. Place infant in private room B. Ensure that the infants head is in a flexed position C. Wear a mask at all times with infant D. Place the infant in a tent that delivers warm humidified air E. Position infant on side with the head lower than the chest F. Ensure that the nurse caring for the infant does not care for any another high risk children

A, F Infants head should be placed at 30-40 degrees Humidified air is for dyspnea, hypoxia and is insensible for water loss in the trachea

A child has been diagnosed with acute otitis media of the right ear. Which interventions should the nurse include in the plan of care? Select all apply a. provide a soft diet b. postition on the left side c. administer an antihistamine twice daily d. irrigate the right ear with normal saline every 8 hours e. administer ibuprofen for fever every four hours as prescribed an as needed f. instruct the parents about the need to administer the prescribed anitbiotics for the ful course of therapy

A,E,F

A daycare nurse is observing a 2-year-old child and suspects that the child may have strabismus. Which of the following observations may be indicative of this condition? a. the child has difficulty hearing b. the child consistently tilts the head to see c. the child does not respond when spoken to d. The child consistently turns the head to hear

B

A nurse is providing at home care instructions to the parents of a child who is being discharged after cardiac surgery. What statement by the parents indicates the need for further teaching. 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 weeks after surgery D. Large crowds of people need to be avoided for at least 2 weeks after surgery

B

After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action a. maintain NPO status b. turn the child on the side c. administer the prescribed antiemetic d. notify the health care provider

B

a 10 year old child with asthma is treated for acute exacerbation in the emergecy department The nurse is caring for the hild should monitor for which sign knowing that is indicates a worsening of the condition a. warm and dry skin b. decreased wheezing c. pulse rate of 90 beats/min d. respirations of the 18 breaths/min

B

the emergency department nurse is caring for a child diagnosed with epiglottis In assessing the child, the nurse should monitor for which indicate that the child may be experiencing air obstruction a. the child exhibits nasal flaring and brady b. the child is leaning forward with the chin thrust out c. the child has a low-grade fever and complains of a sore throat d. the child is leaning backward supporting himself or herself with the hands and arms

B

the nurse is reviewing the lab results for a child scheduled for tonsillectomy The nurse determines that which lab value is most significant to review a. creatine levels b. prothrombin time c. sedimentation rate d. blood urea nitrogen level

B prothrombin is similar clotting time as bleeding is a big concern

The nurse is caring for a infant with bronchiolitis and diagnostic tests have confirmed respiratory syncytial virus On the basis of this finding which is the most appropriate nursing action A. Initiate strict enteric precautions B. Move the infant to a room with a another child with RsV C. Leave the infant in the current room because RSV is not contagious D. Inform the staff that they must wear gown,gloves and mask when taking care of infant

B Masks are not required with RVS and enteric precautions are unescassary

After tonsillectomy, the nurse reviews the health care providers' postoperative prescriptions Which prescription should the nurse question a. monitor for bleeding b. suction every 2 hours c. give no milk or milk products d. give clear cool liquids when awake and alert

B' only if there is airway obstruction

An assessment of a child with acute stage Kawasaki disease the nurse excepts to note which clinical manifestations A. Cracked lips B. Normal appearance C. Conjunctival hyperemia D. Desqumation of the skin

C Cracked lips and dequamation of the skin is subacute state and convalescent stage is when a child may have normal appearance

The nurse is monitoring an infant with congenital heart disease closet for signs of HF. The nurse should asses for which early sign of HF? A. Pallor B. Cough C. Trachycardia D. Slow and shallow breathing

C Other early signs are trachypnea, fatigue irritability, sudden weight gain and respiratory distress.

The mother of a hospitalized 2 year old with croup asks the nurse why the HCP has not prescribe antibiotics Which response should the nurse make? A.the child may be allergic to antibiotics B.the child is too young to receive antibiotics C.Antibiotics are not indicated unless a bacterial infection is present D. The child still has maternal antibodies from birth and does not need antibiotics

C Croup is viral

A child with croup is placed in a cool-mist tent. The mother becomes concerned because the child is frightened, consistently crying, and tries to climb out of the tent. The appropriate nursing action would be to: A. Tell the mother the child needs to stay in the tent B. Place a toy in the tent to make the child more comfortable C.call the hcp and obtain a prescription for a sedative D. Let the mother hold the child and direct the cool air to the child's face

D

A nurse reviews the laboratory results for child with suspected results to have rhematic fever knowing what lab study would confirm the diagnosis A. Immunoglobulin B. RBC count C. WBC count D.anti-streptolysin O tier

D

the clinic nurse is providing instructions regarding the immunizations schedule for the child Which statement should the nurse make to the parents a. the immunizations schedule will need to be altered b. the child should not receive any hep vaccines c. the child will receive all the immunizations except for the polio series d. the child will receive the recommended basic series of immunizations along with a yearly influenza vaccination

D