NCLEX Pharmacology Questions (81-85)

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81. Sodium hypochlorite (Dakin's solution) is prescribed for a client with a leg wound that is draining purulent material and the home health nurse teaches a family member how to perform wound treatments. Which statement, if made by the family member, indicates a need for further teaching?

a) a fresh solution needs to be prepared frequently
b) the solution should not come in contact with normal skin tissue
c) I should rinse the solution off immediately following the irrigation
d) I will soak a sterile dressing with solution and pack it into the wound

82. Dextranomer (Debrisan) is prescribed for a client with a pressure ulcer. The nursing instructor asks the nursing student preparing to perform the treatment about the medication and procedure. Which statement, if made by the student, indicates a need for further research?

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NCLEX Integumentary Questions 16-20

Begin answering NCLEX Integumentary Questions . . .



16. The nurse has provided instructions to a client regarding the use of tretinoin (Retin-A). Which statement, if made by the client, indicates the need for further instructions?

a) I will apply a very thin layer to the skin
b) optimal results will be seen after 6 weeks
c) I will wash my hands thoroughly after applying the medication
d) I will cleanse the skin thoroughly before applying the medication

17. Isotretinoin (Accutane) is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which laboratory test will be prescribed?

a) platelet count
b) triglyceride level
c) complete blood count
d) white blood cell count

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Online Nursing Practice Test about Skin (Integumentary Disorder 11-15)

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11. The clinic nurse inspects the skin of a client suspected of having scabies. Which assessment finding would the nurse note if this disorder was present?

a) patchy hair loss and round red macules with scales
b) the presence of white patches scattered about the trunk
c) multiple straight or wavy, thread-like lines beneath the skin
d) the appearance of vesicles or pustules with a thick honey-colored crust

12. The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being performed for a third degree circumferential arm burn. The nurse understands that the anticipated therapeutic outcome of the escharotomy is:

a) return of distal pulses
b) brisk bleeding from the site
c) decreasing edema formation
d) formation of granulation tissue

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NCLEX Secrets - Level of Cognitive Ability (Analysis 46-50)

NCLEX Secrets - Level of Cognitive Ability

46. The nurse is caring for a client who sustained superficial partial-thickness burns on the anterior lower legs and anterior thorax. Which of the following does the nurse expect to note during the emergent phase of the burn injury?

a) decreased heart rate
b) increased urinary output
c) increased blood pressure
d) elevated hematocrit levels

47. The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate which of the following signs in the client?

a) coma
b) flushing
c) dizziness
d) tachycardia

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NCLEX Preparation Course - Level of Cognitive Ability - Analysis (Answers 1-25)

NCLEX Preparation Course Questions - Level of Cognitive Ability (1-25) --> 



1) B

- Phenylketonuria is characterized by blood phenylalanine levels higher than 8 mg/dL. A normal level is lower than 2 mg/dL. A result of 1 mg/dL is a negative test result.

2) D

- Indicators that fluid volume deficit is resolving would be capillary refill less than 3 seconds, specific gravity of 1.002 to 1.025, urine output of at least 1 mL/kg/hour, and adequate tear production. Therefore, a capillary refill time shorter than 3 seconds is the only indicator that the child is improving. Urine output of less than 1 mL/kg/hr, a specific gravity of 1.030 and no tears would indicate that the deficit is not resolving.

3) B 

- Nephrotic syndrome is defined as massive proteinuria, hypoalbuminemia, hyperlipemia, and edema. Other manifestations include weight gain, periorbital and facial edema that is most prominent in the morning, leg, ankle, labial or scrotal edema, decreased urine output and urine that is dark and frothy, abdominal swelling, and blood pressure that is normal or slightly decreased.

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Online Nursing Practice Test about Skin (Integumentary Diseases 6-10)

6. The client arrives at the emergency room and has experienced frostbite to the right hand. Which of the following would the nurse note on assessment of the client's hand?

a) a pink, edematous hand
b) a fiery red skin with edema in the nail beds
c) black fingertips surrounded by an erythematous rash
d) a white color to the skin, which is insensitive to touch

7. The nurse prepares to treat a client with frostbite of the toes. Which of the following does the nurse anticipate to be prescribed for this condition?

a) rapid and continuous rewarming of the toes after flushing returns
b) rapid and continuous rewarming of the toes in cold water for 45 minutes
c) rapid and continuous rewarming of the toes in hot water for 15 to 20 minutes
d) rapid and continuous rewarming of the toes in a warm water bath until flushing of the skin occurs

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Online Nursing Practice Test about Skin (Integumentary Diseases 1-5)

1. Which of the following individuals is least likely to be at risk of developing psoriasis?

a) a 32-year old African American
b) a woman experiencing menopause
c) a client with a family history of the disorder
d) an individual who has experienced a significant amount of emotional stress


2. Which of the following clients would least likely be at risk of developing skin breakdown?

a) a client incontinent of urine and feces
b) a client with chronic nutritional deficiencies
c) a client with decreased sensory perception
d) a client who is unable to move about and is confined to bed

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NCLEX Pharmacology Questions (76-80)

NCLEX Pharmacology Questions

76. The home care nurse provides medication instructions to an older hypertensive client who is taking lisinopril (Prinivil), 20 mg orally daily. Which statement, if made by the client, indicates that further teaching is necessary?

a) I can skip a dose once a week
b) I need to change my position slowly
c) I take the pill after breakfast each day
d) If I get bad headache, I should call my doctor immediately

77. The nurse is providing medication instructions to an older client who is taking digoxin (Lanoxin) daily. Th nurse notes that which age-related body changes could place the client at risk for digoxin toxicity?

a) decreased muscle strength and loss of bone density
b) decreased cough efficiency and decreased vital capacity
c) decrease salivation and decreased gastrointestinal motility
d) decreased lean body mass and decreased glomerular filtration rate

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Online Nursing Practice Test/Exam about Cancer (36-40)

36. The nurse on the oncology unit enters the room of the client with lung cancer. Which action is most appropriate for the nurse to do first?

a) check the client's IV infusion pump and IV fluid rate
b) take the client's blood pressure and pulse
c) assess the client's mental status
d) elevate the client's head of the bed

37. The nurse on the oncology unit is planning care for the client with colon cancer who is refusing a diagnostic test. Which action is most appropriate for the nurse to take first?

a) call the radiology department to let them know the client will not be going to take the test
b) speak with the client to determine the reason for refusing the test
c) inform the health care provider that the client is refusing the test
d) ask the client's spouse why the client is refusing the test

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NCLEX Preparation Course - Level of Cognitive Ability - Analysis (Questions 1-25)

NCLEX Preparation Course - Level of Cognitive Ability Answers (1-25) -->

1. A mother brings her 3-week old infant to a clinic for a phenylketonuria re-screening blood test. The test indicates a serum phenylalanine level of 1mg/dL. The nurse interprets this result as:

a) positive
b) negative
c) inconclusive
d) requiring re-screening at age 6 weeks 

2. A child has fluid volume deficit. The nurse performs an assessment and determines that the child is improving and the deficit is resolving if:

a) the child has no tears
b) urine specific gravity is 1.030
c) urine output is less than 1 ml/kg/hr
d) capillary refill is shorter than 3 seconds

3. A nurse is performing an admission assessment on a 2-year old child who has been diagnosed with nephrotic syndrome. The nurse knows that the most common characteristic associated with nephrotic syndrome is:

a) hypertension
b) generalized edema
c) increased urinary output
d) frank, bright red blood in the urine

4. A nurse is planning care for a child with hemolytic-uremic syndrome. The child has been anuric and will be receiving peritoneal dialysis treatment. The nurse plans to:

a) restrict fluids as prescribed
b) encourage foods high in potassium
c) administer analgesics as prescribed
d) care for the arteriovenous (AV) shunt

5. A nurse has provided a discharge instructions to the mother of a 2-year old child who had an orchiopexy to correct cryptorchidism. Which statement by the mother of the child indicates that further teaching is necessary?

a) I'll check his temperature
b) I'll give him medication so he'll be comfortable
c) I'll check his voiding to be sure there's no problem
d) I'll let him decide when to return to his play activities

6. A nurse collects a urine specimen preoperatively from a child with epispadias who is scheduled for surgical repair. When the nurse is analyzing the results of the urinalysis, which of the following would the nurse most likely expect to note?

a) hematuria
b) proteinuria
c) bacteriuria
d) glucosuria

7. A priority nursing diagnosis for a child with severe edema caused from nephrotic syndrome would be risk for:

a) constipation
b) impaired skin integrity
c) ineffective thermoregulation
d) imbalanced nutrition: more than body requirements

8. A 1-year old child with hypospadias is scheduled for surgery to correct this condition. The nurse prepares a nursing care plan for this child and understands that this surgery is taking place at a time when:

a) fears of separation
b) sibling rivalry will cause regression to occur
c) concern over size and function of the penis is present
d) embarrassment about voiding irregularities is common

9. A nurse is caring for an infant with a diagnosis of bladder exstrophy. To protect the exposed bladder tissue, the nurse plans to:

a) cover the bladder with petroleum jelly gauze
b) cover the bladder with non-adhering plastic wrap
c) apply sterile distilled water dressings over the bladder mucosa
d) keep the bladder tissue dry by covering it with dry sterile gauze

10. A nurse interviews the parents of a child recently diagnosed with glomerulonephritis. The nurse understands that which information collected during the assessment most often is associated with the diagnosis of glomerulonephritis?

a) child fell off a bike onto the handlebars
b) nausea and vomiting for the last 24 hours
c) urticaria and itching for 1 week before diagnosis
d) streptococcal throat infection 2 weeks before diagnosis

11. A nurse is assigned to care for a child suspected having glumerulonephritis. The nurse review's the child's record and notes that which finding is associated with the diagnosis of glumeronephritis?

a) hypotension
b) red-brown urine
c) low blood urea nitrogen level
d) low urinary specific gravity

12. A nurse is performing an assessment on a child admitted to the hospital with a probable diagnosis of nephrotic syndrome. What assessment findings would the nurse expect to observe? Select all that apply

a) pallor
b) edema
c) anorexia
d) proteinuria
e) weight loss
f) decreased serum lipid

13. A nurse is monitoring a child with burns during the treatment for burn shock. The nurse understands that which of the following assessments provides the most accurate guide to determining the adequacy of fluid resuscitation?

a) skin turgor
b) neurological assessment
c) level of edema at burn site
d) quality of peripheral pulses

14. A school nurse is conducting pediculosis capitis (head lice) assessments. A child with a "positive" head check would have:

a) maculopapular lesions behind the ears
b) lesions in the scalp that extend to the hairline or neck
c) white flaky particles throughout the entire scalp region
d) white sacs attached to the hair shafts in the occipital area

15. The nurse is developing a plan of care for a 12-year old girl with an exacerbation of eczema. Which nursing diagnosis applies to the care for this child?

a) risk for infection related to viral lesions
b) risk for infection related to scratching of pruritic lesions
c) imbalanced nutrition, less than body requirements related to throat edema and mouth ulcers
d) disturbed body image related to the presence of thick white crusty plaques over the elbow and knees

16. A mother of a 3-year old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on which finding noted on assessment of the child's skin?

a) fine-grayish-red lines
b) purple-colored lesions
c) thick, honey-colored crusts
d) clusters of fluid-filled vesicles

17. A clinic nurse is reviewing the physician's orders for a child who has been diagnosed with scabies. Lindane has been prescribed for the child. The nurse questions the order if which of the following is noted in the child's record?

a) the child is 18 months old
b) the child is being bottle-fed
c) a sibling is using lindane for the treatment of scabies
d) the child has a history of frequent respiratory infections

18. A clinic nurse instructs the mother of a child with sickle cell anemia about the precipitating factors related to pain crisis. Which of the following, if identified by the mother as a precipitating factor, indicates the need for further instructions?

a) stress
b) trauma
c) infection
d) fluid overload

19. A 10-year old child with hemophilia A has slipped on the ice and bumped his knee. The nurse should prepare to administer an:

a) injection of factor X
b) intravenous infusion of factor VIII
c) intravenous infusion of croprecipitate
d) intravenous infusion of desmopressin (DDAVP)

20. Laboratory studies are performed for a child suspected of having iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following results would indicate this type of anemia?

a) an elevated hemoglobin level
b) a decreased reticulocyte count
c) an elevated red blood cell count
d) red blood cells are microcytic and hypochromic

21. A nurse analyzes the laboratory results of a child wiht hemophilia. The nurse understands that which of the following would most likely be abnormal in this child?

a) platelet count
b) hematocrit level
c) hemoglobin level
d) partial thromboplastin time

22. A child with B-thalassemia is receiving long-term blood transfusion therapy for the treatment of this disorder. Chelation therapy is prescribed to prevent organ damage from the presence of too much iron in the body as a result of the transfusions. Which of the following medications would the nurse anticipate to be prescribed in chelation therapy?

a) meropenem (merrem)
b) metoiprolol (Toprol-XL)
c) deferoxamine (Desferal)
d) dalteparin sodium (Fragmin)

23. A nurse is receiving a physician's orders for a child with sickle cell anemia who was admitted to the hospital for the treatment of vasoocclusive crisis. Which orders documented in the child's record should the nurse question? Select all that apply

a) restrict fluid intake
b) position for comfort
c) avoid strain on painful joints
d) apply nasal oxygen at 12L/min
e) provide a high-calorie, high-protein diet
f) give meperidine (Demerol), 25 mg IV, every 4 hours for pain

24. Which of the following are characteristics of von Willebrand disease? Select all that apply

a) gum bleeding occurs
b) easy bruising occurs
c) it is a hereditary bleeding disorder
d) it is characterized by extremely high creatinine levels
e) the disorder causes platelets to adhere to damaged endothelium
f) treatment and care are similar to those implemented for hemophilia

25. The nurse analyzes the laboratory values of a child with leukemia who is receiving chemotherapy. The nurse notes that the platelet count is 20,000/μL. Based on this laboratory result, which intervention will the nurse document in the plan of care?

a) monitor closely for signs of infection
b) monitor the temperature every 4 hours
c) initiate protective isolation precautions
d) use a soft small toothbrush for mouth care


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Online Nursing Practice Test about Musculoskeletal Diseases (41-45)

41. A nurse is working with a nursing assistant on an orthopedic unit. The nurse observes the nursing assistant caring for a client after a left total hip replacement. The nurse will intervene if which of the following is observed?

a) the nursing assistant stoops by bending at the hips and knees to pick up an object that the client dropped on the floor
b) the nursing assistant keeps the client's bed in the low position when administering the bath
c) the client is positioned with leg abducted slightly
d) the head of the bed is elevated 30 degrees 

42. A nurse has conducted preoperative teaching for a client scheduled for surgery in 1 week. The client has a history of arthritis and has been taking acetylsalicylic acid (aspirin). The nurse determines that the client needs additional teaching if the client states:

a) aspirin can cause bleeding after surgery
b) aspirin can cause my ability to clot blood to abnormal
c) I need to discontinue the aspirin 48 hours before the scheduled surgery
d) I need to continue to take aspirin until the day of surgery

43. A 4-year old sustains a fall at home and is brought to the emergency room by the mother. After an x-ray examination, the child is determined to have a fractured arm and plaster cast is applied. The nurse provides instructions to the mother regarding care for the child's cast. Which statement by the mother indicates a need for further instructions?

a) the cast may feel warm as the cast dries
b) I can use lotion or powder around the cast edges to relieve itching
c) a small amount of white shoe polish can touch up a soiled white cast
d) if the cast becomes wet, a blow drier set on the cool setting may be used to dry the cast

44. A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by the parents indicates a need for further instruction?

a) I will encourage my child to perform prescribed exercises
b) I will have my child wear soft fabric clothing under the brace
c) I should apply lotion under the brace to prevent skin breakdown
d) I should avoid the use of powder because it will cake under the brace

45. A 1-month old infant is seen in a clinic and is diagnosed with developmental dysplasia of the hip (DDH). The nurse assesses the infant, knowing that which of the following findings would be noted in this condition?

a) limited range of motion in the affected hip 
b) an apparent lengthened femur on the affected side
c) asymmetrical adduction of hte affected hip when the infant is placed supine with the knees and hips flexed
d) symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table



ANSWERS AND RATIONALE

41) B
- during administration of bath, the nursing assistant should raise the bed to waist level to prevent bending and stooping. This prevents muscle strain and back injury.

42) D
- anticoagulants alter normal clotting factors and increase the risk of bleeding after surgery. Aspirin has properties that can alter the clotting mechanism and should be discontinued at least 48 hours before surgery. Options A, B, and C are accurate client statements.

43) B
- The mother needs to be instructed not to use lotion or powders on the skin around the cast edges or inside the cast. Lotions or powders can become sticky or caked and cause skin irritation. Options A, C, and D are appropriate instructions.

44) C
- The use of lotions or powders under a brace should be avoided because they can become sticky and cake under the brace, causing irritation. Options A, B, and D are appropriate interventions in the care of a child with a brace.

45) A
- In DDH, the head of the femur is seated improperly in the acetabulum or hip socket of the pelvis. Asymmetrical abduction of the affected hip, when the child is placed supine with the knees and hips flexed, would be an assessment finding in DDH in infants beyond the newborn period. Other findings include an apparent short femur on the affected side, asymmetry of the gluteal skinfolds, and limited range of motion in the affected extremity.




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Related Topics:

• Online Nursing Practice Test about Musculo-Skeletal Diseases (46-50)
• Go back to Online Nursing Practice Test about Musculo-Skeletal Diseases (1-8) to start the test from the beginning.

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NCLEX Endocrine Questions (26-30)

26. The following are characteristics of type I DM. Select all that apply

a) the client is thin
b) it requires lifelong insulin
c) the client may take sulfonylureas
d) the client is at risk to develop diabetic ketoacidosis
e) onset of the disease is after 30 years of age
f) there is insulin secretion, but the body's demands are increased  

27. The following are signs and symptoms that indicate hyperglycemia in a client with diabetes mellitus. Select all that apply

a) elevated blood sugar level
b) cold, clammy skin
c) increased urination
d) tremors
e) deep, rapid respiration
f) excessive thirst
g) metabolic acidosis

28. The client has been diagnosed to have IDDM. Which order should you question?

a) propranolol
b) insulin injection
c) acetaminophen
d) diltiazem

29. The nurse is assessing a pregnant client with type I diabetes mellitus about her understanding regarding changing insulin needs during pregnancy. The nurse determines that teaching is needed if the client makes which statement?

a) I will need to increase my insulin dosage during the first 3 months of pregnancy
b) my insulin dose will likely need to be increased during the second and third trimester
c) episodes of hypoglycemia are more likely to occur during the first 3 months of pregnancy
d) my insulin needs should return to normal within 7 to 10 days after birth if I am bottle-feeding

30. An adolescent client with type I diabetes mellitus is admitted to the emergency department for treatment of diabetic ketoacidosis. Which assessment findings should the nurse expect to note?

a) sweating and tremors
b) hunger and hypertension
c) cold, clammy skin and irritability
d) fruity breath and decreasing level of consciousness





NCLEX Endocrine Questions:
ANSWERS AND RATIONALE

26) A, B, D
- these are the characteristic of type I DM.

27) A, C, E, F, G
- these are signs and symptoms of hyperglycemia.

28) A
- propranolol, a beta-adrenergic blocker causes hypoglycemia. It is contraindicated among diabetic clients.

29) A
- insulin needs decrease in the first trimester because of increase insulin production by the pancreas and increased peripheral sensitivity to insulin. The statements in option B, C, and D are accurate and signify that the client understands control of her diabetes during pregnancy.

30) D
Hyperglycemia occurs with diabetic ketoacidosis. Signs of hyperglycemia include fruity breath and a decreasing level of consciousness. Hunger can be a sign of hypoglycemia or hyperglycemia, but hypertension is not a sign of diabetic ketoacidosis. Instead, hypotension occurs because of a decrease in blood volume related to the dehydrated state that occurs during diabetic ketoacidosis. Cold, clammy skin, irritability, sweating, and tremors are all signs of hypoglycemia.




Go to the next page ---> NCLEX Endocrine Questions (31-35)  

Or go back to NCLEX Endocrine Questions (1-7) to start the test from the beginning.

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NCLEX Review on Delegation and Prioritization Questions (26-30)

NCLEX Review on Delegation and Prioritization Questions

26. A nurse recently started working in a hospital that employs unlicensed assistant personnel (UAP). Which of the following are essential to effective delegation?

a) give the UAP written instructions for assignments
b) make frequent walking rounds to assess clients
c) delegate tasks based on the experience of the UAP
d) take frequent mini-reports from the UAP
e) have the UAP repeat instructions
f) explain unexpected outcomes of delegated tasks to the UAP  

27. A nurse is teaching a class regarding lead poisoning in children to student nurses. The nursing students learn to target which priority group of children for screening?

a) those with sickle cell anemia
b) those who live in homes built in the 1960's
c) those who live in low-income families
d) adolescents living in the inner city

28. A nurse is attending an In-service training class on delegation. The nurse learns that proper delegation can involve which of the following? Select all that apply

a) giving authority
b) delegating nursing process
c) delegating tasks
d) delegating accountability
e) delegating responsibility
f) giving orders

29. When developing the plan of care for a client with suicidal ideation, which of the following would the nurse anticipate as the priority?

a)Self-esteem
b)Sleep
c)Hygiene
d)Safety

30. A client in early labor is receiving oxytocin. When observing late decelerations in the fetal heart rate, the nurse should first:

a) Administer oxygen
b) Place her on her left side
c) Check the blood pressure
d) Discontinue the oxytocin infusion




NCLEX Review on Delegation and Prioritization Questions:
ANSWERS AND RATIONALE

26) A, B, C, D, E, F
- all of these aspects are essential fro effective delegation.

27) C
- lead poisoning is common in old houses (built in 1950's), and in places with unsanitary conditions including soil, dust, vehicles using leaded gas. These factors are common among low-income families.

28) A, C, and E
- proper delegation involves giving authority, delegating tasks, and delegating responsibility. Nursing process, accountability and giving orders are to be done by the RN, and not to be delegated.

29) D
- for the client with suicidal ideation, client safety is the priority. The nurse protects the client from self-harm or self-destruction. Although self-esteem, sleep and hygiene are common areas that require intervention for a client with suicidal ideation, ensuring the client’s safety is the most immediate and serious concern.

30) D
- the infusion should be stopped because it is placing the fetus in danger.




Go to the next page ---> NCLEX Review on Delegation and Prioritization Questions (31-35)  

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Pediatric NCLEX Practice Questions (86-90)

Pediatric NCLEX Practice Questions

86. A nurse is caring for a child with a suspected diagnosis of rheumatic fever. The nurse reviews the laboratory results, knowing that which laboratory study would assist in confirming the diagnosis?

a) immunoglobulin
b) red blood cell count
c) white blood cell count
d) antistreptolysin O titer

87. A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki disease. on assessment of the child, the nurse expects to note which clinical manifestation of the acute stage of the disease?

a) cracked lips
b) a normal appearance
c) conjunctival hyperemia
d) desquamation of the skin

88. A nurse reviews the record of a newborn infant and notes that a diagnosis of esophageal atresia with tracheoesophageal fistula is suspected. The nurse expects to note which most likely sign of this condition documented in the record?

a) increased crying
b) coughing at nighttime
c) chocking with feedings
d) severe projectile vomiting

89. A nurse admits a child to the hospital with a diagnosis of pyloric stenosis. On admission assessment, which data would the nurse expect to obtain when asking the mother about the child's symptoms?

a) watery diarrhea
b) projectile vomiting
c) increased urine output
d) vomiting large amounts of bile

90. A nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews the child's record and expects to note which symptom of this disorder documented?

a) watery diarrhea
b) ribbon-like stools
c) profuse projectile vomiting
d) bright red blood and mucus in the stools




Pediatric NCLEX Practice Questions:
ANSWERS AND RATIONALE

86) D
- A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive antistreptolysin O titer, Streptozyme assay, or an anti-DNase B assay. Options A, B, and C will not help to confirm the diagnosis of rheumatic fever.

87) C
- In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands, rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal, but signs of inflammation may be present.

88) C
- Any child who exhibits the “3 Cs”—coughing and choking with feedings and unexplained cyanosis—should be suspected of tracheoesophageal fistula. Options A, B, and D are not specifically associated with tracheoesophageal fistula.

89) B
- Clinical manifestations of pyloric stenosis include projectile vomiting, irritability, hunger and crying, constipation, and signs of dehydration, including a decrease in urine output.

90) D
- Intussusception is a telescoping of one portion of the bowel into another. The condition results in an obstruction to the passage of intestinal contents. The child with intussusception typically has severe abdominal pain that is crampy and intermittent, causing the child to draw in the knees to the chest. Vomiting may be present but is not projectile. Bright red blood and mucus are passed through the rectum and commonly are described as currant jelly–like stools. Watery diarrhea and ribbon-like stools are not manifestations of this disorder.


Go to the next page:  Pediatric NCLEX Practice Questions (91-95)   

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Online Nursing Practice Test about Cardiovascular Diseases 51-55

51. A clinic nurse has provided home care instructions o the client with a history of cardiac disease who has just been told that she is pregnant. Which statement, if made by the client, indicates a need for further instructions?

a) it is best that I rest lying on my side to promote blood return to the heart
b) I need to avoid excessive weight gain to prevent increased demands on my heart
c) I need to try to avoid stressful situations because stress increases the workload of the heart
d) During the pregnancy, I need to avoid contact with other individuals as much as possible to prevent infection

52. A nurse is providing instructions to a maternity client with a history of cardiac disease regarding appropriate dietary measures. Which statement, if made by the client, indicates an understanding of the information provided by the nurse?

a) I should drink adequate fluids and increase my intake of high-fiber foods
b) I should maintain a low-calorie diet to prevent any weight gain
c) I should lower my blood volume by limiting fluids
d) I should increase my sodium intake during pregnancy

53. A clinic nurse reviews the record of a child just seen by a physician and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

a) pallor
b) hyperactivity
c) exercise intolerance
d) gastrointestinal disturbances

54. A nurse has provided home care instructions to the mother of a child who is being discharged following cardiac surgery. Which statement made by the mother indicates a need for further instructions?

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 to 4 weeks
d) large crowds of people need to avoided for at least 2 weeks following surgery

55. A nurse provides home care instructions to the parents of a child with congestive heart failure (CHF) regarding the procedure for the administration of digoxin (Lanoxin). Which statement, if made by the parent, indicates the need for further instructions?

a) I will not mix the medication with food
b) If more than one dose is missed, I will call the physician
c) I will take the child's pulse before administering the medication
d) if the child vomits after medication administration, I will repeat the dose





ANSWERS AND RATIONALE

51) D
- to avoid infections, visitors with active infections should not be allowed to visit the client; otherwise, restrictions are not required. Stress causes increased heart workload, and the client should be instructed to avoid stress. Too much weight gain can place further demands on the heart. Resting should be done by lying on the side to promote blood return.

52) A
- constipation can cause the client to use Valsalva's maneuver. This maneuver can cause blood to rush to the heart and overload the cardiac system. Therefore, high-fiber foods are important. A low-calorie diet is not recommended during pregnancy and could be harmful to the fetus. Diets low in fluid can cause a decrease in blood volume, which could deprive the fetus of nutrients, so adequate fluid intake and high-fiber foods are important. Sodium should be restricted somewhat, as prescribed by the physician, because excess sodium will cause an overload to the circulating blood volume and contribute to cardiac complications.

53) C
- The child with aortic stenosis shows signs of exercise intolerance, chest pain, and dizziness when standing for long periods of time. Pallor may be noted but is not specific to this type of disorder alone. Options B and D are not related to this disorder.

54) B
- The mother should be instructed that lotions and powders should not be applied to the incision site. Lotions and powders can irritate the surrounding skin, which could lead to skin breakdown and subsequent infection of the incision site. Options A, C and D are accurate instructions regarding home care after cardiac surgery.

55) D
- The parents need to be instructed that if the child vomits after the digoxin is administered, they are not to repeat the dose. Options A, B and C are accurate instructions regarding the administration of this medication. In addition, the parents should be instructed that if a dose is missed and is not identified until 4 hours later, the dose should not be administered. 


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NCLEX Reviewer Download about Pediatric Nursing (81-85)

NCLEX Reviewer Download about Pediatric Nursing

81. A nurse is caring for an infant with bronchiolitis is assessing for signs of dehydration. The nurse checks which of the following, knowing that it is the most reliable method of determining fluid loss?

a) weight
b) fontanels
c) intake and output
d) mucous membrane

82. An emergency room nurse is caring for a child diagnosed with epiglotitis. Assessing the child, the nurse monitors for which indication that the child may be experiencing airway obstruction?

a) the child exhibits nasal flaring and bradycardia
b) the child is leaning forward, with the chin thrust out
c) the child has low-grade fever and complains of sore throat
d) the child is leaning backward, supporting himself or herself with the hands and arms

83. A sweat test is performed on a child with a suspected diagnosis of cystic fibrosis. The nurse reviews the test results and determines that which of the following is a positive result for cystic fibrosis?

a) chloride level of 20 mEq/L
b) chloride level of 30 mEq/L
c) chloride level of 40 mEq/L
d) chloride level of 70 mEq/L

84. A student nurse is caring for a 2-year old child diagnosed with croup and the nursing instructor asks the student about the clinical manifestations associated with the illness. Which statement by the student indicates a need for further research?

a) the cough is harsh and brassy
b) inspiratory stridor and a low-grad fever may be present
c) symptoms usually worsen at night and are better during the day
d) symptoms usually worsen during the day and are relieved during sleep

85. A nurse receives a telephone call from the admitting office and is told that a child with rheumatic fever will be arriving in the nursing unit for admission. On admission, the nurse prepares to ask the mother which question to elicit assessment information specific to the development of rheumatic fever?

a) has the child complained of back pain?
b) has the child complained of headache
c) has the child had any nausea or vomiting?
d) did the child have a sore throat or fever within the last two months?





NCLEX Reviewer Download about Pediatric Nursing:
ANSWERS AND RATIONALE
81) A
- Weight is the most reliable method of measurement of body fluid loss or gain. A weight change of 1 kg represents 1 L of fluid loss or gain. Although options B, C, and D identify components of the assessment for dehydration, these are not the most reliable determinants, because they require more subjective interpretation than weight, which is more objectively determined.

82) B
- Clinical manifestations suggestive of airway obstruction include tripod positioning (leaning forward while supported by arms, chin thrust out, mouth open), nasal flaring, tachycardia, a high fever, and a sore throat. Option D is an incorrect position. Options A and C are incorrect because epiglottitis causes a high fever and tachycardia.

83) D
- In a sweat test, sweating is stimulated on the child’s forearm with pilocarpine, the sample is collected on absorbent material, and the amounts of sodium and chloride are measured. A sample of at least 50 mg of sweat is required for accurate results. A chloride level higher than 60 mEq/L is considered to be a positive test result. A chloride level of 40 mEq/L suggests cystic fibrosis and requires a repeat test. A chloride level of less than 40 mEq/L indicates no cystic fibrosis.

84) D
- Croup often begins at night and may be preceded by several days of upper respiratory infection symptoms. Croup is characterized by a sudden onset of a harsh, brassy cough, sore throat, and inspiratory stridor. Symptoms usually worsen at night and are better in the day. Croup usually is accompanied by a low-grade fever, but occasionally the temperature may be as high as 104° F.

85) D
- Rheumatic fever characteristically presents 2 to 6 weeks after an untreated or partially treated group A beta-hemolytic streptococcal infection of the upper respiratory tract. Initially, the nurse determines whether the child had a sore throat or an unexplained fever within the past 2 months. Options A, B, and C are unrelated to rheumatic fever.



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