COMPETENCY APPRAISAL 1

NURSING CARE MANAGEMENT 102

1. A home care nurse visits a pregnant who has a diagnosis of mild preeclampsia and who is being monitored for
gestational hypertension. Which assessment finding indicates a worsening of the preeclampsia and the need to notify
the physician?
a. Urinary output has increased c. BP reading is at the prenatal base line
b. Dependent edema has revolved d. Clients complains of a headache and blurred vision
2. A client with a 38 week twin gestation is admitted to a birthing center in early labor. One of the fetuses is a breech
presentation. Of the following interventions, which of the lowest priority in planning the nursing care of this client?
a. Measure fundal height c. Prepare client or a possible CS delivery
b. Attach electronic fetal monitoring d. Visually examine the perineum and vaginal opening
3. A nurse implements a teaching plan for a pregnant client who is newly diagnosed with gestational DM. Which
statement, if made by the client,. Indicates a need for further teaching:
a. “I should stay on the diabetic diet.”
b. “I should perform glucose monitoring at home.”
c. “I should avoid exercise because of the negative effect o insulin production.”
d. “I should be aware of any infections and report signs of infection immediately to my doctor.”
4. A nurse is reviewing the doctor’s orders for a client admitted for PROM. Gestational age of the fetus is determined to
be 37 weeks. Which doctor’s order should the nurse question?
a. Perform a vaginal examination every shift c. Monitor FHR continuously
b. Monitor maternal VS every 4 hours d. Administer Ampicilin 1 gram as an IV piggyback every 6 hours
5. A nurse is providing emergency measures to a client in labor who has been diagnosed with a prolapsed cord. The
mother becomes anxious and frightened and says to the nurse “Why are all of this people in here? Is my baby going to
be alright?” which of the following nursing diagnosis would be most appropriate for this client at this time?
a. Fear b. Fatigue c. Powerlessness d. Ineffective coping
6. A nurse has developed a plan of care for a client experiencing dystocia and includes several nursing interventions in
the plan of care. The nurse prioritizes the plan of care and selects which intervention as the highest priority?
a. Providing comfort measure c. Changing the client’s position frequently
b. Monitoring the fetal heart rate d. Keeping the significant other informed of the progress
7. Fetal distress is occurring with a laboring client. As the nurse prepares the client for a CS birth, what other
intervention should be done?
a. Slow the IV flow rate c. Continue the Oxytocin drip if infusing
b. Place the client in a high Fowler’s position d. Administer oxygen at 8 to 10 L/min via face
8. A nurse in postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with a
placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks
associated with placenta previa?
a. Infection b. Hemorrhage c. Chronic hypertension d. Disseminated intravascular coagulation
9. A nurse in a labor romm is performing a vaginal assessment on a pregnant client in labor. The nurse notes the
presence of the umbilical cord protruding from the vagina. Which of the following is the initial nursing action?
a. Gently push the cord into the vagina
b. Place the client in Trendelenburg’s position
c. Find the closest telephone and page the physician stat
d. Call the delivery room to notify the staff that the client will be transported immediately
10. A maternity nurse is caring for a client with abruption placentae and is monitoring the client for disseminated
intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular
coagulation?
a. Prolonged clotting times c. Swelling of the calf of one leg
b. Decreased platelet count d. Petechiae, oozing from injection sites, and hematuria
11. A nurse is assessing a pregnant client in the second trimester of pregnancy who is experiencing vaginal bleeding and
has suspected diagnosis of placenta previa. The nurse reviews the doctor’s orders and would question which order?
a. Prepare the client for an ultrasound
b. Obtain equipment for a manual pelvic examination]
c. Prepare to draw a hemoglobin and hematocrit blood sample
12. An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results
of the ultrasound indicate that abruptio placentae is present. Based on these findings, the nurse would prepare the
client for:
a. Delivery of the fetus
b. Strict monitoring of intake and output
c. Complete bed rest for the remainder of the pregnancy
d. The need for weekly monitoring of coagulation studies until the time of delivery
13.A nurse in a labor room is assessing with the vaginal delivery of a newborn infant. The nurse would monitor the client
closely for the risk of uterine rupture if which of the following occurred?
a. Forceps delivery b. Schultz presentation c. Hypotonic contractions d. Weak bearing-down efforts
14. A clinic nurse is performing a prenatal assessment on a pregnant client. The nurse would implement teaching related
to the risk of abruption placentae if which of the following information was obtained on assessment?
a. The client is 28 years of age c. The client has a history of hypertension
b. This is the second pregnancy d. The client performs moderate exercise on a regular daily schedule
15. A nurse is performing an assessment of a client who is scheduled for a cesarean delivery. Which assessment finding
would indicate a need to contact the physician?
a. Fetal heart rate of 180 beats per minute c. Maternal pulse rate of 85 beats per minute
3
b. White blood cell (WBC) count of 12 000/ mm d. Hemoglobin of 11.0 g/dL
16. A nurse is a delivery room is assisting with the delivery of a newborn infant. After the delivery of the newborn, the
nurse assists in delivering the placenta. Which observation would indicate that the placenta has separated from the
uterine wall and is ready for delivery?
a. The umbilical cord shortens in length and changes in color c. Maternal complaints of severe uterine cramping
b. A soft and boggy uterus d. Changes in the shape of the uterus
17. A nurse is performing an initial assessment on a client who has been told that a pregnancy test is positive. Which
assessment finding would indicate that the client is at risk preterm labor?
a. The client is a 35-year-old primigravida
b. The client is a 20-year-old primigravida of average weight and height
c. The client’s hemoglobin level is 13.5 g/dL
d. The client has history of cardiac disease
18. A nurse assists a pregnant client with cardiac disease to identify resources to help her care for her 18 month-old
child during the last trimester of pregnancy. The nurse encourages the pregnant client to use these resources primarily
to:
a. Reduce excessive maternal stress and fatigue
b. Help the mother prepare for labor and delivery
c. Avoid exposure to potential pathogens and resulting infections
d. Prepare the 18 moth-old child for maternal separation during hospitalization
19. A nurse is developing a plan of care from a client recovering from a CS delivery. To prevent thrombophebitis the
nurse plans to encourage the woman to:
a. elevate her legs b remain on bed rest c. ambulate frequently d. apply warm moist packs to the legs
20. A pregnant client is receiving MgSO4 for the management of preeclampsia. A nurse determines that the client is
experiencing toxicity from the medication if which of the following is noted on assessment?
a. Preteinuria of + 3 c. Serum magnesium of 6 mEq/L
b. Presence of DTR d. Respirations of 10 breaths per minute
21. RhoGAM is prescribed for a woman following delivery of a newborn infant and the nurse provides information to the
woman about the purpose of the medication. The nurse determines that the woman understands the purpose of the
medication if the woman states that it will protect her next baby from which of the following?
a. Having Rh positive blood c. Developing physiological jaundice
b. Developing a rubella infection d. Being affected by Rh incompatibility
22. A woman with preeclampsia is receiving MgSO 4. The nurse assigned to care for the client determines that the
medication is effective if:
a. Scotomas are present b. Seizures do not occur c. Ankle clonus is noted d. BP decreases
23. A nurse assists in the caginal delivery of a newborn infant, After the delivery, the nurse observes the umbilical cord
lengthen and a spurt of blood from the vagina. The nurse document these observations as signs of:
a. Hematoma b. Placenta previa c. Uterine atony d. Placental separation
24. A client arrives at a birthing center in active labor. Her membranes are till intact. A nurse-midwife prepares to
perform an amniotomy. A nurse who is assisting the nurse-midwife explains to the client hat after this procedure, she
will most likely have:
a. Less pressure on her cervix c. Decreased number of contractions
b. Increased efficiency of contractions d. The need for increased maternal blood pressure monitoring
25.A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is
noted on the external monitor tracing during a contraction?
a. Early decelerations b. Variable decelerations c. Late decelerations d. Short term variability
26. The child’s has been established to have cleft palate. A surgical repair is necessary to correct the defect; although the
surgical repair is postponed until the child reaches the age of:
a. 24 to 30 months b. 36 months c. 2 to 10 months d. 6 to 18 months
27. A diagnosis of bacterial meningitis is confirmed, and the child assumes an Opisthotonus position. In which position
should the nurse place this child?
a. Prone b. Supine c. Side-lying d. Trendelengburg
28. In teaching a teenager how to prevent further episodes of sickle cell crisis, the nurse should stress the need to avoid:
a. Moderate emotional stress b. Cool weather c. Swimming public pools d. Extra fluid consumption
st
29. The 1 night in the hospital, a 3-year-old hemophiliac suffers an episode of epistaxis. In which position should the
nurse place the child?
a. Prone, with head turned to side d. Sitting up with head titled backward
b. Semi-fowler’s with two pillows c. Sitting up and learning forward slightly
30. Nursing care for a toddler while she is in the croupette includes which of the following?
a. Give her a bald plastic doll c. Restraining her arms and legs
b. Removing her blanket and pajamas d. Restricting visitors to her immediate family
31. A child has asthma since age 6. In reviewing this child’s history, which one factor should the nurse realize may be
related to the development of the asthma?
a. Strep throat/tonsillitis at age 2 b. Eczema at age 3 c. Paternal death at age 5 d. Pneumonia at age 7
32. Following surgery close myelomeningocele sac, the nurse should place the infant on her:
a. Abdomen, with head 10 degrees lower than hips b. Abdomen, with hips 10 degrees lower than head
b. Abdomen, with head of bed developed to 30 degrees c. Abdomen, flat in bed
33. Which one behavior should the nurse expect a 5-month –old with CHF to be capable of demonstrating?
a. Rolling over from stomach to back c. Pincer grasp
b. Sitting with support d. Bearing some weights on legs
34. As a toddler recovers from meningitis, the nurse should watch carefully for which long-term complication?
a. Encephalitis b. Hydrocephalus c. Learning abilities d. Mental retardation
35. When parents ask how their baby might have been gotten pyloric stenosis, the nurse should tell them that:
a. Their baby was born with this condition
b. Their baby acquired it due to a formula allergy
c. Their baby was normal at birth and it developed spontaneously
d. There is no way to determine this preoperatively
36. Immediately, following birth, an infant’s condition is assessed. His respirations do not establish readily, he is slightly
cyanotic, and there is some muscle flaccidity. The most appropriate nursing action would be to:
a. Initiative CPR immediately
b. Clear airway and administer oxygen
c. Reassure the parents
d. Check the mother’s chart for her last medications (drug, time and amount)
37. When auscultating the heart, which of the following characteristics or statements best describes the 1 st heart
sound?
a. Heard late in diastole c. Closure of the mitral and tricuspid valve
b. Heard early in diastole d. Closure of the aortic and pulmonic valves
38. Which of the following factors indicating a cardiac defect might be found when assessing a 1-month-old infant?
a. Weight gain b. Hyperactivity c. Poor nutritional intake d. Pink mucus membrane
39. A child is given 0.5 mg/kg/day of prednisone divided into two doses. The child weighs 10kg. How much is given in
each dose?
a. 2.5 mg b. 5mg c. 10mg d. 1.5mg
40. Which of the following bone-related complications can occur in sickle cell anemia?
a. Arthritis b. Osteoporosis c. Osteogenic sarcoma d. Spontaneous fractures
41. Which of the following positions is recommended in placing an infant to sleep?
a. Prone position b. Supine position c. Side-lying position d. With head of bed elevated to 30 degrees
42. What should the nurse see in the vomitus that is characteristic of infants with pyloric stenosis?
a. Stomach contents only c. Stomach contents streaked with blood
b. Stomach contents plus bile d. Stomach contents with flecks of feces
43. A toddler is admitted to the hospital with severe eczema lesions on his face, scalp, neck and arms. The best nursing
intervention to prevent him from scratching the affected areas would be to apply:
a. clove-hitch restraints to his hands c. mittens to his hands
b. elbow restraints to his arms d. a porsey jacket to his torso
44. Which of the following would the nurse do when providing postoperative nursing care to a child after insertion of a
ventriculoperitoneal shunt?
a. Administer narcotics for pain control c. Monitoring for increased temperature
b. Check the urine for glucose and protein d. Test cerebrospinal fluid leakage for protein
45. The nurse evaluates the discharge teaching as successful when the parents of a school-aged child with a
ventriculoperitoneal shunt insertion identify which of the following as signaling a blocked shunt?
a.Decreased urine output with stable intake c. Elevated temperature and reddened incisional site
b. Tense fontanel and increased head circumference d. Irritability and increasing difficulty with eating
46. When obtaining a nursing history from parents who are suspected of abusing their child, which of the following
characteristics about the p parents would the nurse typically find?
a. Attentiveness to the child’s needs c. Ability to relate child’s developmental achievements
b. Self-blame for the injury to the child d. Evidence of little concern about the extent of the injury
47. The mother of a child with celiac disease asks, “How long must he stay on this diet?” Which of the following would
be the nurse’s best response?
a. “Until the jejuna biopsy is normal.” C. “For the next 6 months.”
b. “When his stools are appear normal.” D. “For the rest of his life.”
48. The nurse is caring for a 14-month-old just diagnosed with cystic fibrosis. The parents state this is the first child in
either family with this disease, and ask about the risk for future children. What is the best response by the nurse?
a. 1 in 4 chance for each child to carry that trait c. 1 in 2 chance of avoiding the trait and disease
b. 1 in 4 risk for each child to have the disease d. 1 in 2 chance that each child will have the disease
49. A child is seen in the pediatrician’s office for complaints of bone and joint pain. Which of the following other
assessment findings may suggest leukemia?
a. Abdominal pain b. Increased activity level c. Increased appetite d. Petechiae
50. Which of the following assessment findings in a client with leukemia would indicate that the cancer has invaded the
brain?
a. Headache and vomiting c. Hypervigilant and anxious behavior
b. Restlessness and tachycardia d. Increased heart rate and decreased BP
51. During an examination of a 2 year-old child with a tentative diagnosis of Wilm’s tumor, the nurse would be most
concerned about which statement by the mother?
a. My child has lost 3 pounds in the last month c. All the pants have become tight around the waist
b. Urinary output seemed to be less over the past 2 days d. The child prefers some salty foods more than others
52. The school nurse notes that a first-grade child is scratching her head almost constantly. It would be MOST important
for the nurse to take which of the following actions?
a. Discuss basic hygiene with the parents c. Inform the parents that they must contact an exterminator
b. Instruct the child not to sleep with her dog d. Observe the scalp for small white specks
53. A client who has had a premature rupture of membranes (PROM) is highly at risk for:
a. C-section delivery b. Hypertension c. Infection d. Abruptio placenta
54. A client 12 weeks’ pregnant come to the emergency department with abdominal cramping and moderate vaginal
bleeding. Speculum examination reveals 2 to 3 cm cervical dilation. The nurse would document these findings as which
of the following?
a. Threatened abruption b. Imminent abortion c. Complete abortion d. Missed abortion
55. Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy?
a. Risk for infection b. Pain c, Knowledge Deficit d. Anticipatory Grieving
56. A nurse implements a teaching plan for a pregnant client who is newly with gestational DM. Which statement, if
made by the client, indicates a need for further teaching:
a. “I should stay on the diabetic diet.”
b. “I should perform glucose monitoring at home.”
c. “I should avoid exercise because of the negative effect of insulin production
d. “I should be aware of any infections and report signs of infection immediately to my doctor.”
57. A nurse is reviewing the doctor’s orders for a client admitted for PROM. Gestational age of the fetus is determined
to be 37 weeks. Which doctor’s order should the nurse question?
a. Perform a vaginal examination every shift c. Monitor FHR continuously
b. Monitor maternal VS every 4 hours d. Administer Ampicilin 1 gram as an IV piggyback every 6 hours
58. A nurse is providing emergency, measures to a client in labor who has been diagnosed with a prolapsed cord. The
mother becomes anxious and frightened and says to the nurse “Why are all of this people in here? Is my baby going to
be alright?” which of the following nursing diagnosis would be most appropriate for this client at this time?
a. Fear b. Fatigue c. Powerlessness d. Ineffective coping
59. A nurse has developed a plan of care for a client experiencing dystocia and includes several nursing interventions in
the plan of care. The nurse prioritizes the plan of care and selects which intervention as the highest priority?
a. Providing comfort measures c. Changing the client’s position frequently
b. Monitoring the fetal heart rate d. Keeping the significant other informed of the progress of the labor
60. Fetal distress is occurring with a laboring client. As the nurse prepares the client for a CS birth, what other
intervention should be done?
a. Slow the IV flow rate c. Continue the Oxytocin drip if infusing
b. Place the client in a high Fowler’s position d. Administer oxygen at 8 to 10 L/min via face mask
61. A nurse in postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with a
placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks
associated with placenta previa?
a. Infection b. Hemorrhage c. Chronic hypertension d. Disseminated intravascular coagulation
62. A nurse in a labor room is performing a vaginal assessment on a pregnant client in labor. The nurse notes the
presence of the umbilical cord protruding from the vagina. Which of the following is the initial nursing action?
a. Gently push the cord into the vagina
b. Place the client ion Trendelenburg’s position
c. Find the closest telephone and page the physician stat
d. Call the delivery room to notify the staff that the client will be transported immediately
63. Which of the following represents an effective nursing intervention to reduce cardiac demands and decrease cardiac
workload?
a. Scheduling care to provide for uninterrupted rest periods
b. Developing and implementing a consistent plan of care
c. Feeding the infant over long periods of time
d. Allowing the infant o have her way to avoid conflict
64. A clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which of
the following assessment findings would indicate to the nurse that the client is at high risk contracting HIV?
a. A past history of IV drug use c. No history of any sexually transmitted disease
b. A history of one sexual partner for the past 10 years d. A significant other who is heterosexual
65. A pregnant client reports to a health care clinic, complaining of loss of appetite, weight loss and fatigue. Following
assessment of the client, TB is suspected. A sputum culture is obtained and identifies m. tuberculosis. The nurse
provides instruction to the client regarding therapeutic management of the TB and the nurse tells the client that:
a. Therapeutic abortion is required
b. She will have to stay at home until treatment is completed
c. Medication will not be started until delivery of the fetus
d. Isoniazid plus rifampin will be required for a total of 9 months
66. A woman is found out to be Rh negative. Under what circumstance would she be eligible for Rh (D) immune globulin
(RhiG)?
a. If she were having a multiple pregnancy c. If her fetus’s heart beat became tachycardic
b. If her fetus were found to be Rh negative d. If her fetus’s blood type was Rh positive
67. A home care nurse visits a pregnant client who has a diagnosis of mild preeclampsia and who is being monitored for
gestational hypertension. Which assessment finding indicated a worsening of the preeclampsia and the need to notify
the physician?
a. Urinary output has increased c. BP reading is at the prenatal base line
b. Dependent edema has resolved d. The clients complains of a headache and blurred vision
68.A client with a 38 week twin gestation is admitted to a birthing center in early labor. One of the fetuses is a breech
presentation. Of the following interventions, which is the lowest priority in planning the nursing care of this client?
a. Measure fundal height c. Prepare client or a possible CS delivery
b. Attach electronic fetal monitoring d. Visually examine the premium and vaginal opening
69. Which of the following would be the nurse’s most appropriate response to a client who asks why she must have a
cesarean delivery of she has a complete placenta previa?
a. “You will have to ask your physician when he returns.”
b. “You need a cesarean to prevent hemorrhage.”
c. “The placenta is covering most of your cervix.”
d. “The placenta is covering the opening of the uterus and blocking your baby.”
70. A client at 24 weeks gestation has gained 6 pounds in 4 weeks. Which of the following would be the priority when
assessing the client?
a. Glucosuria b. Depression c. Hand/face edema d. Dietary intake
71. A woman who has cervical cerclage for incompetent cervix is being instructed by the nurse. The nurse should include
which of the following?
a. Avoid sexual intercourse during the third trimester
b. Come to the hospital two days prior to the due date
c. Come to the hospital at the first signs of labor
d. Come to the hospital when having contractions that are five minutes apart
72. A multigravida at 38 weeks’ gestation is admitted with painless, bright red bleeding and mild contractions every 7 to
10 minutes. Which of the following assessments should be avoided?
a. Maternal vital sign b. Fetal heart rate c. Contraction monitoring d. Cervical dilation
73.A maternity nurse is caring for a client with abruption placentae and is monitoring the client for disseminated
intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular
coagulation?
a. Prolonged clotting times c. Swelling of the calf of one leg
b. Decreased platelet count d. Petechiae, oozing from injection sites, and hematuria
74. A nurse is assessing a pregnant client in the second trimester of pregnancy who is experiencing vaginal bleeding and
has a suspected diagnosis of placenta previa. The nurse reviews the doctor’s orders and would question which order?
a. Prepare the client for an ultrasound
b. Obtain equipment for a manual pelvic examination
c. Prepare to draw a hemoglobin and hematocrit blood sample
d. Obtain equipment for external electronic fetal heart rate monitoring
75. An ultrasound is performed on a client at term gestation who is experiencing moderate vaginal bleeding. The results
of the ultrasound indicate abruption placenta. Based on these findings, the nurse would prepare the client for:
a. Delivery of the fetus
b. Strict monitoring of intake and output
c. Complete bed rest for the remainder of the pregnancy
d. The need for weekly monitoring of coagulation studies until the time of delivery
76. A nurse in a labor room is assessing with the vaginal delivery of a newborn infant. The nurse would monitor the
client closely for the risk of uterine rupture if which of the following occurred?
a. Forceps delivery b. Schultz presentation c. Hypotonic contractions d. Weakly bearing-down efforts
77. A clinic nurse is performing a prenatal assessment on a pregnant client. The nurse would implement teaching related
to the risk of abruption placentae if which of the following information was obtained on assessment?
a. The client is 28 years of age c. The client has a history of hypertension
b. This is the second pregnancy d. The client performs moderate exercise on a regular daily schedule
78. When obtaining history, which of the following is the most likely the cause of acute glumerulonephritis in a child?
a. Impaired absorption of bicarbonate ions c. Gross inability to concentrate urine
b. An antecedent streptococcal infection d. Vesicouteral reflux
79. A nurse assigned to care for a child suspected of having glumerulonephritis. The nurse reviews the child’s record and
notes that which finding is associated with diagnosis of glumerulonephritis?
a. Low blood urea nitrogen (BUN) c. Low urinary specific gravity
b. Hypotension d. Reddish brown urine
80. Which of the following manifestation would the nurse expect to note in a child with nephrotic syndrome?
a. Hematuria and bacteriuria c. Gross hematuria and fever
b. Massive proteinuria and edema d. Hypertension and weight loss
81. A clinic nurse provides instructions to the parents of a infant with hip dysplasia regarding care of the Pavlik harness.
Which of the following should the nurse include in the instructions?
a. The harness should be worn 12 hours a day
b. The harness should be removed for diaper changes and for feeding
c. The harness should be removed only to check the skin and for bathing
c. The harness should not be removed when out of the harness
82. Which of the following statements by a 14 year old girl who wears a brace for structural scoliosis indicates effective
use of the brace?
a. “I wonder if I can take the brace off when I go to the JS Prom.”
b. “I’ll look forward to taking this thing off before I take a bath everyday.”
c. “I’m sure that I only have to wear this awful thing at night.”
d. “I’m really glad that I can take this thing off whenever I get tired.”
83. A 12 year-old child is seen in clinic, and a diagnosis of Hodgkin’s disease is suspected. Several diagnostic studies are
performed to determine the presence of this disease. When evaluating the diagnostic results, a nurse would expect to
note which of the following, if this child had Hodgkin’s disease?
a. The presence of blast cells the bone marrow
b. The presence of Reed Sternberg cells in the lymph nodes
c. The presence of Epstein Barr virus in the blood
d. Elevated “VMA” urinary levels
SITUATION: A 4-year-old child is admitted with a tentative diagnosis of acute lymphoid leukemia (ALL). To help
established the child’s diagnosis critical observations together with conservative and conventional therapies will be
needed to build up efficient and productive nursing interventions that aim to promote optimum body functioning of the
client.
84. To confirm a tentative diagnosis of leukemia, a bone marrow aspiration is to be performed to the child. In addition to
providing an age-appropriate explanation of the procedure, the nurse should:
a. Tell the child that there will be pressure, nut no pain
b. Administer the prescribed anesthetic before the procedure
c. Place the child in the semi-fowlers position supported with pillows
d. Have the child help by holding some of the nonsterile equipment
85. The child is to continue taking prednisone at home after discharge. The nurse discovers that the child’s sibling at
home has a chicken pox. The nurse plans the discharge teaching based on which of the following knowledge?
a. The child must be immunized before going home
b. Chicken pox can be fatal to individuals with leukemia
c. Clients receiving prednisone are immune to chicken pox
d. If direct contact between the two siblings is prevented, the child can go home
86. A child with acute lymphocytic leukemia presents with multiple ecchymotic areas on her arms and legs. This is most
likely due to:
a. Traumatic injury b. Polycythemia C. Neutropenia d. Thrombocytopenia
87. In order to identify the type of white blood cell involved or document the type of leukemia, a bone marrow
aspiration is done. In children, bone marrow is aspirated in which of the following sites?
a. Ribs b. Iliac rest c. Sternum d. Scapula
88. When caring for a child with leukemia, the nurse should use the following precaution:
a. Limit activity b. Limit invasive procedures c. Limit sodium intake d. Limit hair brushing
89. A child is admitted with partial thickness burn on the anterior surfaces of both arms and the chest. The nursing care
plan is based on the knowledge that:
a. Some grafting of the burned area will be required
b. The burns are extremely painful and disfiguring
c. Pressure dressings and prolonged hydrotherapy will be required
d. Spontaneous epithelial regeneration should occur within two to six weeks
90. A child who has a full-thickness burn is scheduled for skin grafts. The nurse explains to the child’s parents that for
permanent grafts, the child must have which of the following?
a. Steroids b. Autografts c. Allografts d. Immunosuppressives
91. When telling a 4-year-old child about an upcoming procedure, the nurse’s most important consideration is to:
a. Use simple terms c. Offer a toy to keep the child happy
b. Speak loudly and clearly d. Include every detail
92. Hypospadias is a congenital in which:
a. Genitalia are those of a female but chromosome studies show male genotype
b. One or both testes are underscended
c. The urinary bladder protrudes from the bladder wall
d. The urethral meatus is on the underside of the penis
93. Following surgery to correct hypospadias, a toddler returns to the unit with a Foley catheter in place. The nurse
would expect the drainage:
a. Have a clear yellow appearance c. To have small clots of blood or mucus
b. To have a brownish tinge d. To have gross hematuria in moderate amounts
SITUATION: Mrs. Rivera has noticed that over the past few weeks her 3-year-old son. Jenrick seems to be gaining
weight. His clothes fit tighter and his shoes are nearly impossible to get on in the morning, Mrs. Rivera remarks about
Jenrick’s puffy eyes and suggests a visit to the pediatrician. Following an examination and laboratory test, the
pediatrician’s diagnosis of Jenrick is nephritic syndrome.
94. For the majority (80%) of children with nephritic syndrome, the cause is:
a. Unknown b. Autoimmune response c. Acute glomeruloneohritis d. Post-infections process
95. Jenrick is placed on steroid therapy. The aim of this therapy is to prevent:
a. Diuresis b. Hematuria c. Proteinuria and edema d. Potassium loss
96. The diet prescribed for Jenrick during this acute phase will most likely be:
a. High protein, high potassium, low sodium c. High protein, low potassium, low sodium
b. Low protein, high potassium, low sodium d. Low protein, low potassium, high sodium
SITUATION: A 2-year-old child has been admitted to the pediatric unit with a diagnosis of thalassemia (Cooley’s anemia).
Thalassemias are group of hereditary disorders associated with defective hemoglobin-chain synthesis.
97. The parents of the child with thalassemia are told that there is no cure for this disorder but it can be treated with
frequent transfusion. The father tells the nurse that he is glad that there is a treatment that can fix his child’s problem.
The nurse should respond:
a. “Blood transfusions correct the anemia but also present a risk of hepatitis.”
b. “Blood transfusions temporarily correct the anemia; this treatment may cause other problems.”
c. “Blood transfusions are supportive treatment, and as your child grow older, fewer transfusions will be needed.”
d. “Yes, a blood transfusions replaces the defective red blood cells. It’s like giving insulin to a person with diabetes.”
98. The physician orders deferoxamine (Desferal) for a child with thalassemia. Which of the following should alert the
nurse to notify the physician?
a. Decreased hearing b. Vomiting c. Red urine d. Hypertension
99. The long term complication seen in thalassemia major is related to:
a. Hemochromatosis b. Splenomegaly c. Anemia d. Growth retardation
100.Before discharging the child from the hospital, the nurse should plan to instruct the parents regarding the need to:
a. Restrict activity b. Encourage fluids c. Prevent infection d. Provide small, frequent meals