After explaining to the parents about their child’s unique psychological

needs related to a seizure disorder and possible stressors, which of the

following interests uttered by them would indicate further teaching?.
Single choice.
(1 Point)
A. Feeling different from peers
B. Poor self-image
C. Cognitive delays
C
D. Dependency
2.Which of the following statements about ADHD in children is false?.
Single choice.
(1 Point)
A. Black parents tend to be less sure of potential causes of and treatments for ADHD
than white parents, and they are less likely to connect ADHD to their child’s school
experiences.
B. Because of its frequent genetic etiology, ADHD in a child is likely foreshadowed by
ADHD in other family members.
C. The chances of successful treatment are adversely affected if the parent responsible
for implementing the treatment has untreated ADHD.
D. More than 40% of respondents in the recent National Stigma Study-Children (NSS-
C) believe that children will face rejection in school for receiving mental health
treatment and that negative ramifications will continue into adulthood. More than half
expected psychiatric medications to cause a zombie-like effect.
E. The Multimodal Treatment Study of Children with ADHD suggests that
pharmacological treatment of ADHD is as effective as behavioral therapy alone
3.All of the following are important in the immediate care of the
premature neonate. Which nursing activity should have the greatest
priority?. Single choice.
(1 Point)
a. Instillation of antibiotic in the eyes
b. Identification by bracelet and footprints
c. Placement in a warm environment
d. Neurological assessment to determine gestational a
C
4.While examining a 2-year-old child, the nurse in charge sees that the
anterior fontanel is open. The nurse should:. Single choice.
(1 Point)
A. Notify the doctor
B. Look for other signs of abuse
C. Recognize this as a normal finding
D. Ask about a family history of Tay-Sachs disease
5.Lactation Amenorrhea Method(LAM) can be an effective method of
natural birth control if. Single choice.
(1 Point)
A. The mother breastfeeds mainly at night time when ovulation could possibly occur
B. The mother breastfeeds exclusively and regularly during the first 6 months without
giving supplemental feedings
C. The mother uses mixed feeding faithfully
D. The mother breastfeeds regularly until 1 year with no supplemental feedings
6.Nurse Jeremy is evaluating a client’s fluid intake and output record.
Fluid intake and urine output should relate in which way?. Single choice.
(1 Point)
A. Fluid intake should be double the urine output.
B. Fluid intake should be approximately equal to the urine output.
C. Fluid intake should be half the urine output.
D. Fluid intake should be inversely proportional to the urine output.
7.Reye’s syndrome is a rare and severe illness affecting children and
teenagers. Its development has been linked with the use of aspirin and
which of the following?. Single choice.
(1 Point)
A. Meningitis
B. Encephalitis
C. Strep throat
D. Varicella
8.Methergine or Pitocin is prescribed for a woman to treat postpartum
hemorrhage. Before administration of these medications, the priority
nursing assessment is to check the:. Single choice.
(1 Point)
a. Amount of lochia
b. Blood pressure
c. Deep tendon reflexes
d. Uterine tone
9.When caring for a patient who has started anticoagulant therapy with
warfarin (Coumadin), the nurse knows not to expect therapeutic benefits
for:. Single choice.
(1 Point)
a. At least 12 hours
b. The first 24 hours
c. 2-3 days
d. 1 week
10.Which of the following is the correct practice of self-breast
examination in a menopausal woman?. Single choice.
(1 Point)
A. She should do it at the usual time that she experiences her menstrual period in the
past to ensure that her hormones are not at its peak
B. Any day of the month as long it is regularly observed on the same day every month
C. Anytime she feels like doing it ideally every day
D. Menopausal women do not need regular self-breast exam as long as they do it at
least once every 6 months
11.A child diagnosed with intellectual disability (ID) is under the
supervision of Nurse Tasha. The nurse is aware that the signs and
symptoms of mild ID include which of the following?. Single choice.
(1 Point)
A. Few communication skills
B. Lateness in walking
C. Mental age of a toddler
D. Noticeable developmental delays
12.Immunization of children with Haemophilus influenzae type B (Hib)
vaccine decreases the incidence of which of the following conditions?.
Single choice.
(1 Point)
A. Bronchiolitis
B. Laryngotracheobronchitis (LTB)
C. Epiglottitis
D. Pneumonia
13.Mrs. Byers tells the nurse that she is very worried because her 2-year
old child does not finish his meals. What should the nurse advise the
mother?. Single choice.
(1 Point)
A. Make the child seat with the family in the dining room until he finishes his meal
B. Provide quiet environment for the child before meals
C. Do not give snacks to the child before meals
D. Put the child on a chair and feed him
14.Nurse Joyce is assessing a child’s cultural background, she should
keep in mind that:. Single choice.
(1 Point)
A. Cultural background usually has little bearing on a family’s health practices
B. Physical characteristics mark the child as part of a particular culture
C. Heritage dictates a group’s shared values
D. Behavioral patterns are passed from one generation to the next
15.The nurse is assessing a client who is 6 hours postpartum after
delivering a full-term healthy infant. The client complains to the nurse of
feelings of faintness and dizziness. Which of the following nursing
actions would be most appropriate?. Single choice.
(1 Point)
a. Obtain hemoglobin and hematocrit levels
b. Instruct the mother to request help when getting out of bed
c. Elevate the mother’s legs
d. Inform the nursery room nurse to avoid bringing the newborn infant to the mother
until the feelings of lightheadedness and dizziness have subsided.
16.Which of the following should be included when developing a
teaching plan to prevent urinary tract infection? Select all that apply..
Multiple choice.
(1 Point)
A. Maintaining adequate fluid intake
B. Avoiding urination before and after intercourse
C. Emptying bladder with urination
D. Wearing underwear made of synthetic material such as nylon
E. Keeping urine alkaline by avoiding acidic beverages
F. Avoiding bubble baths and tight clothing
17.When developing a plan of care for a male adolescent, the nurse
considers the child’s psychosocial needs. During adolescence,
psychosocial development focuses on:. Single choice.
(1 Point)
A. Becoming industrious
B. Establishing an identity
C. Achieving intimacy
D. Developing initiative
18.Molly, with suspected rheumatic fever, is admitted to the pediatric
unit. When obtaining the child’s history, the nurse considers which
information to be most important?. Single choice.
(1 Point)
A. A fever that started 3 days ago
B. Lack of interest in food
C. A recent episode of pharyngitis
D. Vomiting for 2 days
19.What is most likely the underlying physiology of primary enuresis?.
Single choice.
(1 Point)
A. Psychogenic stress
B. Delayed bladder maturation
C. Urinary tract infection
D. Vesicoureteral reflux
20.Veronica’s parents were told that their daughter needs ribavirin
(Virazole). This drug is used to treat which of the following?. Single
choice.
(1 Point)
A. Cystic fibrosis
B. Otitis media
C. Respiratory syncytial virus (RSV)
D. Bronchitis
21.The nurse is evaluating a female child with acute post streptococcal
glomerulonephritis for signs of improvement. Which finding typically is
the earliest sign of improvement?. Single choice.
(1 Point)
A. Increased urine output
B. Increased appetite
C. Increased energy level
D. Decreased diarrhea
22.Patient S is a sexually active adolescent; which of the following
instructions would be included in the preventive teaching plan about
urinary tract infections?. Single choice.
(1 Point)
A. Drinking acidic juices
B. Avoiding urinating before intercourse
C. Wearing nylon underwear
D. Wiping back to front
23.A postpartum patient was in labor for 30 hours and had ruptured
membranes for 24 hours. For which of the following would the nurse be
alert?. Single choice.
(1 Point)
a. Endometritis
b. Endometriosis
c. Salpingitis
d. Pelvic thrombophlebitis
24.In assisted reproductive technology (ART), there is a need to
stimulate the ovaries to produce more than one mature ova. The drug
commonly used for this purpose is:. Single choice.
(1 Point)
A. Bromocriptine
B. Clomiphene
C. Provera
D. Estrogen
25.The nurse is about the give a Type 2 diabetic her insulin before
breakfast on her first day postpartum. Which of the following answers
best describes insulin requirements immediately postpartum?. Single
choice.
(1 Point)
a. Lower than during her pregnancy
b. Higher than during her pregnancy
c. Lower than before she became pregnant
d. Higher than before she became pregnant
26.What should be the initial bolus of crystalloid fluid replacement for a
pediatric patient in shock?. Single choice.
(1 Point)
A. 20 ml/kg
B. 10 ml/kg
C. 30 ml/kg
D. 15 ml/kg
27. Parents bring their infant to the clinic, seeking treatment for
vomiting and diarrhea that has lasted for 2 days. On assessment, the
nurse in charge detects dry mucous membranes and lethargy. What
other findings suggests a fluid volume deficit?. Single choice.
(1 Point)
A. A sunken fontanel
B. Decreased pulse rate
C. Increased blood pressure
D. Low urine specific gravity
28.A nurse is preparing to perform a fundal assessment on a postpartum
client. The initial nursing action in performing this assessment is which
of the following?. Single choice.
(1 Point)
a. Ask the client to turn on her side
b. Ask the client to lie flat on her back with the knees and legs flat and straight.
c. Ask the mother to urinate and empty her bladder
d. Massage the fundus gently before determining the level of the fundus.
29.Which of the following circumstances is most likely to cause uterine
atony and lead to postpartum hemorrhage?. Single choice.
(1 Point)
a. Hypertension
b. Cervical and vaginal tears
c. Urine retention
d. Endometritis
30.Which of the following is a TRUE statement about normal ovulation?.
Single choice.
(1 Point)
A. It occurs on the 14th day of every cycle
B. It may occur between 14-16 days before next menstruation
C. Every menstrual period is always preceded by ovulation
D. The most fertile period of a woman is 2 days after ovulation
31.A client comes to the outpatient clinic and tells the nurse that he has
had legs pains that began when he walks but cease when he stops
walking. Which of the following conditions would the nurse assess for?.
Single choice.
(1 Point)
a. An acute obstruction in the vessels of the legs
b. Peripheral vascular problems in both legs
c. Diabetes
d. Calcium deficiency
32.Martin Sanchez is a nine (9)-year-old child admitted to a psychiatric
treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust
and position of neutrality, which action would the nurse take?. Single
choice.
(1 Point)
A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed.
B. Interview Martin with his parents together, observing their interaction.
C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone.
D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.
33.A 24-year old man seeks medical attention for complaints of
claudication in the arch of the foot. A nurse also notes superficial
thrombophlebitis of the lower leg. The nurse would next assess the
client for:. Single choice.
(1 Point)
a. Familial tendency toward peripheral vascular disease
b. Smoking history
c. Recent exposures to allergens
d. History of insect bites
34.A nurse is assessing the cerebrovascular status of a client who
returned to the surgical nursing unit 4 hours ago after undergoing
aortoiliac bypass graft. The affected leg is warm, and the nurse notes
redness and edema. The pedal pulse is palpable and unchanged from
admission. The nurse interprets that the neurovascular status is:. Single
choice.
(1 Point)
a. Normal because of the increased blood flow through the leg
b. Slightly deteriorating and should be monitored for another hour
c. Moderately impaired, and the surgeon should be called.
d. Adequate from the arterial approach, but venous complications are arising.
35.The parents of Suzanne, a child with attention deficit hyperactivity
disorder, tell the nurse they have tried everything to calm their child and
nothing has worked. Which action by the nurse is most appropriate
initially?. Single choice.
(1 Point)
A. Actively listen to the parents’ concern before planning interventions.
B. Encourage the parents to discuss these issues with the mental health team.
C. Provide literature regarding the disorder and its management.
D. Tell the parents they are overacting to the problem.
36.Intravenous heparin therapy is ordered for a client. While
implementing this order, a nurse ensures that which of the following
medications is available on the nursing unit?. Single choice.
(1 Point)
a. Vitamin K
b. Aspirin
c. Potassium chloride
d. Protamine sulfate
37.Daya’s child is scheduled for surgery due to myelomeningocele; the
primary reason for surgical repair is which of the following?. Single
choice.
(1 Point)
A. To prevent hydrocephalus
B. To reduce the risk of infection
C. To correct the neurologic defect
D. To prevent seizure disorders
38.Which of the following infants is least probable to develop sudden
infant death syndrome (SIDS)?. Single choice.
(1 Point)
A. Baby Angela who was premature
B. A sibling of Baby Angie who died of SIDS
C. Baby Gabriel with prenatal drug exposure
D. Baby Gabby who sleeps on his back
39.A nurse is monitoring a new mother in the postpartum period for
signs of hemorrhage. Which of the following signs, if noted in the
mother, would be an early sign of excessive blood loss?. Single choice.
(1 Point)
a. A temperature of 100.4*F
b. An increase in the pulse from 88 to 102 BPM
c. An increase in the respiratory rate from 18 to 22 breaths per minute
d. A blood pressure changes from 130/88 to 124/80 mm Hg
40.The American Association on Mental Deficiency (AAMD), now
American Association on Intellectual and Developmental Disabilities
(AAIDD) definition of mental retardation emphasizes which of the
following?. Single choice.
(1 Point)
A. An IQ level that must be below 50
B. Cognitive impairment occurring after age 22 years
C. Deficits in adaptive behavior with intellectual impairment
D. No responsiveness to contact
41.Which of the following respiratory conditions is always considered a
medical emergency?. Single choice.
(1 Point)
A. Asthma
B. Cystic fibrosis (CF)
C. Epiglottiditis
D. Laryngotracheobronchitis (LTB)
42.The psychiatric nurse is alert to warning signs of suicide in the
adolescent population. From the following list, select those behaviors
that are indicative of adolescent suicidal thinking. Select all that apply..
Multiple choice.
(1 Point)
A. Giving away prized possessions
B. Associating with friends who are substance abusers
C. Sudden withdrawal from friends and family
D. Having difficulty concentrating on one thing at a time
E. Being easily distracted by environmental events
F. Verbal hints or threats about suicide
43.Alex who has separation anxiety disorder has not attended school for
three (3) weeks, and she cries and exhibits clinging behaviors when her
mother encourages attendance. The priority nursing action by the
home-care psychiatric nurse would be to:. Single choice.
(1 Point)
A. Assist the child in returning to school immediately with family support.
B. Arrange for a home-school teacher to visit for two (2) weeks
C. Encourage family discussion of various problem areas.
D. Use play therapy to help the child express her feelings.
44.Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the
following must Nurse Archie keep in mind when developing a care plan
for the child?. Single choice.
(1 Point)
A. Pulmonary secretions are abnormally thick.
B. Elevated levels of potassium are found in the sweat.
C. CF is an autosomal dominant hereditary disorder.
D. Obstruction of the endocrine glands occurs.
45.Perineal care is an important infection control measure. When
evaluating a postpartum woman’s perineal care technique, the nurse
would recognize the need for further instruction if the woman:. Single
choice.
(1 Point)
a. Uses soap and warm water to wash the vulva and perineum
b. Washes from symphysis pubis back to episiotomy
c. Changes her perineal pad every 2 – 3 hours
d. Uses the peri bottle to rinse upward into her vagina
46.Which of the following organisms is the most common cause of
urinary tract infection (UTI) in children?. Single choice.
(1 Point)
A. Klebsiella
B. Staphylococcus
C. Escherichia coli
D. Pseudomonas
47.Which of the following complications is most likely responsible for a
delayed postpartum hemorrhage?. Single choice.
(1 Point)
a. Cervical laceration
b. Clotting deficiency
c. Perineal laceration
d. Uterine subinvolution
48.Nurse Daya, a school nurse, is meeting with the school and health
treatment team about a child who has been receiving methylphenidate
(Ritalin) for two (2) months. The meeting is to evaluate the results of the
child’s medication use. Which behavior change noted by the teacher will
help determine the medication’s effectiveness.. Single choice.
(1 Point)
A. Decrease repetitive behaviors
B. Decreased signs of anxiety
C. Increased depressed mood
D. Increased ability to concentrate on tasks
49.Spina bifida is one of the possible neural tube defects that can occur
during early embryological development. Which of the following
definitions most accurately describes meningocele?. Single choice.
(1 Point)
A. Complete exposure of spinal cord and meninges
B. Herniation of spinal cord and meninges into a sac
C. Sac formation containing meninges and spinal fluid
D. B and C
E. Spinal cord tumor containing nerve roots
50.Which of the following is the best method for performing a physical
examination on a toddler. Single choice.
(1 Point)
A. From head to toe
B. Distally to proximally
C. From abdomen to toes, the to head
D. From least to most intrusive
51.A nurse has the order to begin administering warfarin sodium
(Coumadin) to a client. While implementing this order, the nurse ensures
that which of the following medications is available on the nursing unit
as the antidote for Coumadin?. Single choice.
(1 Point)
a. Vitamin K
b. Aspirin
c. Potassium chloride
d. Protamine sulfate
52.The nurse is aware that the most common assessment finding in a
child with ulcerative colitis is:. Single choice.
(1 Point)
A. Intense abdominal cramps
B. Profuse diarrhea
C. Abdominal Distention
D. Vomiting
53.Nurse Gloria is teaching the Mr. and Mrs. Diaz about the early signs
and symptoms of lead poisoning; which of the following if stated by the
couple would indicate the need for further understanding of the case?.
Single choice.
(1 Point)
A. Anemia
B. Seizures
C. Irritability
D. Anorexia
54.A nurse performs an assessment on a client who is 4 hours PP. The
nurse notes that the client has cool, clammy skin and is restless and
excessively thirsty. The nurse prepares immediately to:. Single choice.
(1 Point)
a. Assess for hypovolemia and notify the health care provider
b. Begin hourly pad counts and reassure the client
c. Begin fundal massage and start oxygen by mask
d. Elevate the head of the bed and assess vital signs
55.Nurse Kim is teaching a group of parents about otitis media. When
discussing why children are predisposed to this disorder, the nurse
should mention the significance of which anatomical feature?. Single
choice.
(1 Point)
A. Eustachian tubes
B. Nasopharynx
C. Tympanic membrane
D. External ear canal
56.Beta-adrenergic agonists such as albuterol are given to Reggie, a
child with asthma. Such drugs are administered primarily to do which of
the following?. Single choice.
(1 Point)
A. Dilate the bronchioles
B. Reduce secondary infections
C. Decrease postnasal drip
D. Reduce airway inflammation
57.Mica, a 43-year old construction worker, has a history of
hypertension. He smokes two packs of cigarettes a day, is nervous about
the possibility of being unemployed, and has difficulty coping with
stress. His current concern is calf pain during minimal exercise that
decreased with rest. The nurse assesses Mica’s symptoms as being
associated with peripheral arterial occlusive disease. The nursing
diagnosis is probably:. Single choice.
(1 Point)
a. Alteration in tissue perfusion related to compromised circulation
b. Dysfunctional use of extremities related to muscle spasms
c. Impaired mobility related to stress associated with pain
d. Impairment in muscle use associated with pain on exertion.
58.The community nurse visits the home of George, a child recently
diagnosed with autism. The parents express feelings of shame and guilt
about having somehow caused this problem. Which statement by the
nurse would best help alleviate parental guilt?. Single choice.
(1 Point)
A. “Autism is a rare disorder. Your other children shouldn’t be affected.”
B. “The specific cause of autism is unknown. However, it is known to be associated
with problems in the structure of and chemicals in the brain.”
C. “Sometimes a lack of prenatal care can be cause of autism.”
D. “Although autism is genetically inherited if you didn’t have testing you could not
have known this would happen.”
59.Nurse Lonnie is aware that the most common assessment finding in a
child with ulcerative colitis is:. Single choice.
(1 Point)
A. Intense abdominal cramps
B. Profuse diarrhea
C. Anal fissures
D. Abdominal distention
60.The school nurse assesses Brook, a child newly diagnosed with
attention deficit hyperactivity disorder (ADHD). Which of the following
symptoms are characteristic of the disorder? Select all that apply..
Multiple choice.
(1 Point)
A. Constant fidgeting and squirming
B. Excessive fatigue and somatic complaints
C. Difficulty paying attention to details
D. Easily distracted
E. Running away
F. Talking constantly, even when inappropriate
61.Archie who weighs 44 lb has been given an order for amoxicillin 500
mg b.i.d. The drug text notes that the daily dose of amoxicillin is 50
mg/kg/day in two divided doses. What dose in milligrams is safest for
this child?. Single choice.
(1 Point)
A. 1000 mg
B. 750 mg
C. 500 mg
D. 250 mg
62.7-year-old Damon has cystitis; which of the following would Nurse
Elena expect when assessing the child?. Single choice.
(1 Point)
A. Dysuria
B. Costovertebral tenderness
C. Flank pain
D. High fever
63.A neonate is admitted to a hospital’s central nursery. The neonate’s
vital signs are: temperature = 96.5 degrees F., heart rate = 120 bpm, and
respiration = 40/minute. The infant is pink with slight acrocyanosis. The
priority nursing diagnosis for the neonate is. Single choice.
(1 Point)
A. Ineffective thermoregulation related to fluctuating environmental temperatures.
B. Potential for infection related to lack of immunity.
C. Altered nutrition, less than body requirements related to diminished sucking reflex.
D. Altered elimination pattern related to lack of nourishment.
64.Before giving a postpartum client the rubella vaccine, which of the
following facts should the nurse include in client teaching?. Single
choice.
(1 Point)
a. The vaccine is safe in clients with egg allergies
b. Breastfeeding isn’t compatible with the vaccine
c. Transient arthralgia and rash are common adverse effects
d. The client should avoid getting pregnant for 3 months after the vaccine because the
vaccine has teratogenic effects
65.A nurse is assessing a client in the 4th stage if labor and notes that
the fundus is firm but that bleeding is excessive. The initial nursing
action would be which of the following?. Single choice.
(1 Point)
a. Massage the fundus
b. Place the mother in the Trendelenburg’s position
c. Notify the physician
d. Record the findings
66.A nurse is developing a plan of care for a postpartum woman with a
small vulvar hematoma. The nurse includes which specific intervention in
the plan during the first 12 hours following the delivery of this client?.
Single choice.
(1 Point)
a. Assess vital signs every 4 hours
b. Inform health care provider of assessment findings
c. Measure fundal height every 4 hours
d. Prepare an ice pack for application to the area.
67.Which of the following factors might result in a decreased supply of
breast milk in a postpartum mother?. Single choice.
(1 Point)
a. Supplemental feedings with formula
b. Maternal diet high in vitamin C
c. An alcoholic drink
d. Frequent feedings
68.A nurse is preparing to assess the uterine fundus of a client in the
immediate postpartum period. When the nurse locates the fundus, she
notes that the uterus feels soft and boggy. Which of the following
nursing interventions would be most appropriate initially?. Single choice.
(1 Point)
a. Massage the fundus until it is firm
b. Elevate the mother’s legs
c. Push on the uterus to assist in expressing clots
d. Encourage the mother to void
69.If a couple would like to enhance their fertility, the following means
can be done: 1. Monitor the basal body temperature of the woman
every day to determine peak period of fertility; 2. Have adequate rest
and nutrition; 3. Have sexual contact only during the dry period of the
woman; 4. Undergo a complete medical check-up to rule out any
debilitating disease. Single choice.
(1 Point)
A. 1 only
B. 1 & 4
C. 1,2,4
D. 1,2,3,4
70.Methergine or Pitocin are prescribed for a client with postpartum
hemorrhage. Before administering the medication(s), the nurse contacts
the health provider who prescribed the medication(s) in which of the
following conditions is documented in the client’s medical history?.
Single choice.
(1 Point)
a. Peripheral vascular disease
b. Hypothyroidism
c. Hypotension
d. Type 1 diabetes
71.Which of the following complications may be indicated by
continuous seepage of blood from the vagina of a postpartum client,
when palpation of the uterus reveals a firm uterus 1 cm below the
umbilicus?. Single choice.
(1 Point)
a. Retained placental fragments
b. Urinary tract infection
c. Cervical laceration
d. Uterine atony
72.In basal body temperature (BBT) technique, the sign that ovulation
has occurred is an elevation of body temperature by. Single choice.
(1 Point)
A. 1.0-1.4 degrees centigrade
B. 0.2-0.4 degrees centigrade
C. 2.0-4.0 degrees centigrade
D. 1.0-4.0 degrees centigrade
73.Infertility can be attributed to male causes such as the following
EXCEPT:. Single choice.
(1 Point)
A. Cryptorchidism
B. Orchitis
C. Sperm count of about 20 million per milliliter
D. Premature ejaculation
74.A nurse is preparing a list of self-care instructions for a postpartum
client who was diagnosed with mastitis. Select all instructions that would
be included on the list.. Multiple choice.
(1 Point)
a. Take the prescribed antibiotics until the soreness subsides.
b. Wear supportive bra
c. Avoid decompression of the breasts by breastfeeding or breast pump
d. Rest during the acute phase
e. Continue to breastfeed if the breasts are not too sore.
75.When performing a postpartum assessment on a client, the nurse
notes the presence of clots in the lochia. The nurse examines the clots
and notes that they are larger than 1 cm. Which of the following nursing
actions is most appropriate?. Single choice.
(1 Point)
a. Document the findings
b. Notify the physician
c. Reassess the client in 2 hours
d. Encourage increased intake of fluids.
76.A nurse is assessing a mother who delivered a healthy newborn infant
by C-section. The nurse is assessing for signs and symptoms of
superficial venous thrombosis. Which of the following signs or
symptoms would the nurse note if superficial venous thrombosis were
present?. Single choice.
(1 Point)
a. Paleness of the calf area
b. Enlarged, hardened veins
c. Coolness of the calf area
d. Palpable dorsalis pedis pulses
77.Which behavioral assessment in a child is most consistent with a
diagnosis of conduct disorder?. Single choice.
(1 Point)
A. Arguing with adults
B. Gross impairment in communication
C. Physical aggression toward others
D. Refusal to separate from caretaker
78.A nurse is providing instructions to a mother who has been
diagnosed with mastitis. Which of the following statements if made by
the mother indicates a need for further teaching?. Single choice.
(1 Point)
a. “I need to take antibiotics, and I should begin to feel better in 24-48 hours.
b. “I can use analgesics to assist in alleviating some of the discomfort.”
c. “I need to wear a supportive bra to relieve the discomfort.”
d. “I need to stop breastfeeding until this condition resolves.”
79.Nurse Karen is providing postoperative care for Dustin who has cleft
palate (CP); she should position the child in which of the following?.
Single choice.
(1 Point)
A. In an infant seat
B. In the supine position
C. In the prone position
D. On his side
80.A woman is considered to be menopause if she has experienced
cessation of her menses for a period of. Single choice.
(1 Point)
A. 6 months
B. 12 months
C. 18 months
D. 24 months
81.The twelve-year-old boy has fractured his arm because of a fall from
his bike. After the injury has been casted, the nurse knows it is most
important to perform all of the following assessments on the area distal
to the injury except:. Single choice.
(1 Point)
A. capillary refill.
B. radial and ulnar pulse.
C. finger movement
D. skin integrity
82.Nurse Bennie is a community nurse practicing primary prevention for
psychiatric disorders in children. On which of the following risk factors
would he focus?. Single choice.
(1 Point)
A. Being raised in a single-parent home
B. Family history of mental illness
C. Lack of peer friendship
D. Family culture
83.A postpartum client is being treated for DVT. The nurse understands
that the client’s response to treatment will be evaluated by regularly
assessing the client for:. Single choice.
(1 Point)
a. Dysuria, ecchymosis, and vertigo
b. Epistaxis, hematuria, and dysuria
c. Hematuria, ecchymosis, and epistaxis
d. Hematuria, ecchymosis, and vertigo
84. A child with a poor nutritional status and weight loss is at risk for a
negative nitrogen balance. To help diagnose this problem, the nurse in
charge anticipates that the doctor will order which laboratory test?.
Single choice.
(1 Point)
A. Total iron-binding capacity
B. Hemoglobin
C. Total protein
D. Serum transferrin
85.A nurse is caring for a postpartum client with a diagnosis of DVT who
is receiving a continuous intravenous infusion of heparin sodium. Which
of the following laboratory results will the nurse specifically review to
determine if an effective and appropriate dose of the heparin is being
delivered?. Single choice.
(1 Point)
a. Prothrombin time
b. International normalized ratio
c. Activated partial thromboplastin time
d. Platelet count
86.Baby Jonathan was born with cleft lip (CL); Nurse Barbara would be
alert that which of the following will most likely be compromised?.
Single choice.
(1 Point)
A. GI function
B. Locomotion
C. Sucking ability
D. Respiratory status
87.A postpartum nurse is preparing to care for a woman who has just
delivered a healthy newborn infant. In the immediate postpartum
period, the nurse plans to take the woman’s vital signs:. Single choice.
(1 Point)
a. Every 30 minutes during the first hour and then every hour for the next two hours.
b. Every 15 minutes during the first hour and then every 30 minutes for the next two
hours.
c. Every hour for the first 2 hours and then every 4 hours
d. Every 5 minutes for the first 30 minutes and then every hour for the next 4 hours.
88.Which measure would be least effective in preventing postpartum
hemorrhage?. Single choice.
(1 Point)
a. Administer Methergine 0.2 mg every 6 hours for 4 doses as ordered
b. Encourage the woman to void every 2 hours
c. Massage the fundus every hour for the first 24 hours following birth
d. Teach the woman the importance of rest and nutrition to enhance healing
89.Which of the following characteristics is typical of the pain associated
with DVT?. Single choice.
(1 Point)
a. Dull ache
b. No pain
c. Sudden onset
d. Tingling
90.Which of the following changes best described the insulin needs of a
client with type 1 diabetes who has just delivered an infant vaginally
without complications?. Single choice.

(1 Point)
a. Increase
b. Decrease
c. Remain the same as before pregnancy
d. Remain the same as during pregnancy
91.A client who has been receiving heparin therapy also is started on
warfarin sodium (Coumadin). The client asks the nurse why both
medications are being administered. In formulating a response, the
nurse incorporates the understanding that warfarin sodium:. Single
choice.
(1 Point)
a. Stimulates the breakdown of specific clotting factors by the liver, and it takes 2-3
days for this is exhibit an anticoagulant effect.
b. Inhibits synthesis of specific clotting factors in the liver, and it takes 3 to 4 days for
this medication to exert an anticoagulation effect.
c. Stimulates production of the body’s own thrombolytic substances, but it takes 2-4
days for it to begin.
d. Has the same mechanism action of heparin, and the crossover time is needed for
the serum level of warfarin sodium to be therapeutic.
92.Which of the following responses is most appropriate for a mother
with diabetes who wants to breastfeed her infant but is concerned about
the effects of breastfeeding on her health?. Single choice.
(1 Point)
a. Mothers with diabetes who breastfeed have a hard time controlling their insulin
needs
b. Mothers with diabetes shouldn’t breastfeed because of potential complications
c. Mothers with diabetes shouldn’t breastfeed; insulin requirements are doubled.
D. Mothers with diabetes may breastfeed; insulin requirements may decrease from
breastfeeding.
93.The nurse is preparing to discharge a multipara 24 hours after a
vaginal delivery. The client is breastfeeding her newborn. The nurse
instructs the client that if engorgement occurs the client should. Single
choice.
(1 Point)
A. wear a tight fitting bra or breast binder.
B. apply warm, moist heat to the breasts.
C. contact the nurse midwife for a lactation suppressant.
D. restrict fluid intake to 1000 ml. daily .
94.The nurse is assessing the lochia on a 1-day postpartum patient. The
nurse notes that the lochia is red and has a foul-smelling odor. The
nurse determines that this assessment finding is:. Single choice.
(1 Point)
a. Normal
b. Indicates the presence of infection
c. Indicates the need for increasing oral fluids
d. Indicates the need for increasing ambulation
95.Nurse Nancy is assessing a child with pyloric stenosis; she is likely to
note which of the following?. Single choice.
(1 Point)
A. “Currant jelly” stools
B. Regurgitation
C. Steatorrhea
D. Projectile vomiting
96.An adolescent with a depressive disorder is more likely than an adult
with the same disorder to exhibit:. Single choice.
(1 Point)
A. Negativism and acting out.
B. Sadness and crying.
C. Suicidal thoughts.
D. Weight gain.
97.The nurse hears the mother of a 5-pound neonate telling a friend on
the telephone, “As soon as I get home, I’ll give him some cereal to get
him to gain weight?” The nurse recognizes the need for further
instruction about infant feeding and tells her. Single choice.
(1 Point)
A. “If you give the baby cereal, be sure to use Rice to prevent allergy.”
B. “The baby is not able to swallow cereal, because he is too small.”
C. “The infant’s digestive tract cannot handle complex carbohydrates like cereal.”
D. “If you want him to gain weight, just double his daily intake of formula.”
98.Nikko was born with hypospadias; which of the following should be
avoided when a child has such condition?. Single choice.
(1 Point)
A. Surgery
B. Circumcision
C. Intravenous pyelography (IVP)
D. Catheterization
99.Soon after delivery a neonate is admitted to the central nursery. The
nursery nurse begins the initial assessment by. Single choice.
(1 Point)
A. auscultate bowel sounds.
B. determining chest circumference.
C. inspecting the posture, color, and respiratory effort.
D. checking for identifying birthmarks.
100.A significant cause of venous thrombosis is: select all that apply..
Multiple choice.
(1 Point)
a. Altered blood coagulation
b. Stasis of blood
c. Vessel wall injury
d. Excessive Activity