NCLEX Secrets - Level of Cognitive Ability (Analysis 41-45)

NCLEX Secrets - Level of Cognitive Ability

41. A physician prescribes home health nurse visits for a child discharged with Reye's syndrome. During a home visit, a nurse instructs the parents about the residual effects of Reye's syndrome. Which statement, if made by the parents, indicates a need for further instruction?

a) we need to check for jaundiced skin and eyes everyday
b) we need to have the child nap during the day to provide rest
c) we need to decrease the stimuli at home to prevent increased intracranial pressure
d) we need to give frequent, small, nutritious meals to decrease the amount of vomiting

42. A nurse is reviewing the laboratory results for a child scheduled for tonsillectomy. The nurse determines that which laboratory value is most significant to review?

a) creatinine
b) prothrombin
c) sedimentation rate
d) blood urea nitrogen level

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NCLEX Review About The Aging Eye (16-20)

NCLEX Review About The Aging Eye

16. A nurse is providing instructions to a client and the family regarding home care after right eye cataract removal. Which statement by the client would indicate an understanding of the instructions?

a) I will not sleep on my left side
b) I will not sleep on my right side
c) I will not sleep with my head elevated
d) I will not wear my glasses until my physician says it is okay

17. A day care nurse is observing a 2-year old child and suspects that the child may have strabismus. Which observation made by the nurse might indicate this condition?

a) the child has difficulty
b) the child consistently tills the head to see
c) the child consistently turns the head to see
d) the child does not respond when spoken to

18. The mother of a 6-year old child arrives at a clinic because the child has been experiencing scratchy, red, and swollen eyes. The nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed. Based on this diagnosis, the nurse determines that which of the following requires further investigation?

a) possible trauma
b) possible sexual abuse
c) presence of an allergy
d) presence of a respiratory infection

19. A nurse prepares a teaching plan for a mother of a child diagnosed with bacterial conjunctivitis. Which of the following, if stated by the mother, indicates a need for further teaching?

a) I need to wash my hands frequently
b) I need to clean the eye as prescribed
c) it is okay to share towels and washcloths
d) I need to give the eye drops as prescribed

20. A nurse provides discharge instructions to the mother of a child after myringotomy with insertion of tympanostomy tubes. The nurse determines that the mother needs additional instructions if the mother states that:

a) swimming in deep water is prohibited
b) swimming in lake water needs to be avoided
c) she will place earplugs in the child's ears during baths and showers
d) she will be sure to give her child soft tissues to blow his nose




NCLEX Review About The Aging Eye:
ANSWERS AND RATIONALE

16) B
- after cataract surgery, the client should not sleep on the side of the body that was operated on. The client also should be placed in a semi-fowler's position to assist in minimizing edema and intraocular pressure. During the day, the client may wear glasses or a protective shield; at night, the protective shield alone is sufficient.

17) B
- Strabismus is a condition in which the eyes are not aligned because of lack of coordination of the extraocular muscles. The nurse may suspect strabismus in a child when the child complains of frequent headaches, squints, or tilts the head to see. Options A, C, and D are not indicative of this condition.

18) B
- Conjunctivitis is an inflammation of the conjunctiva. A diagnosis of chlamydial conjunctivitis in a child who is not sexually active should signal the health care provider to assess the child for possible sexual abuse. Allergy, infection, and trauma can cause conjunctivitis, but the causative organism is not likely to be chlamydia.

19) C
- Conjunctivitis is an inflammation of the conjunctiva. Bacterial conjunctivitis is highly contagious, and the nurse should teach infection control measures. These include good hand washing and not sharing towels and washcloths. Options A, B, and D are correct treatment measures.

20) D
- A myringotomy is the insertion of tympanoplasty tubes into the middle ear to equalize pressure and keep the ear aerated. Parents need to be instructed that the child should not blow his or her nose for 7 to 10 days. Bath and lake water are potential sources of bacterial contamination. Diving and swimming in deep water are prohibited. The child’s ears need to be kept dry. Options A, B, and C are appropriate instructions.



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NCLEX Reviewer Download about Pediatric Nursing (76-80)

NCLEX Reviewer Download about Pediatric Nursing

76. An emergency room nurse is performing an assessment on a child suspected of being sexually abused. Which assessment data obtained by the nurse most likely support this suspicion?

a) poor hygiene
b) fear of the parents
c) difficulty walking
d) bald spots on the scalp  

77. A nurse is performing an assessment of a 7-year old child who is suspected of having episodes of absence seizures. Which assessment question to the mother will assist in providing information that will identify the symptoms associated with this type of seizure?

a) does twitching occur in the face and neck?
b) does the muscle twitching occur on one side of the body?
c) does the muscle twitching occur on both sides of the body?
d) does the child have a blank expression during these episodes?

78. A nurse has provided discharge instructions to the parents of an infant who has had a ventriculoperitoneal shunt procedure performed for the treatment of hydrocephalus. Which statement, if made by the parents, indicates an accurate understanding of the presence of a shunt complication?

a) I should call my doctor if my infant refuses baby food
b) if my infant has a high-pitched cry, I should call the doctor
c) my infant will pass urine more often now that the shunt is in place
d) I should position my infant on the side with the shunt when sleeping

79. A nurse is performing an admission assessment on a newborn infant with a diagnosis of spina bifida (myelomeningocele). A priority nursing assessment for this newborn is:

a) pulse rate
b) palpation of the abdomen
c) specific gravity of the urine
d) head circumference measurement

80. A mother arrives in an emergency room with her 5-year old child and the mother states that the child fell off a bunk bed. A head injury is suspected, and a nurse is assessing the child continuously for signs of increased intracranial pressure (ICP). Which of the following is a late sign of increased ICP in this child?

a) nausea
b) bradycardia
c) bulging fontanel
d) dilated scalp veins





NCLEX Reviewer Download about Pediatric Nursing:
ANSWERS AND RATIONALE

76) C
- the most likely assessment findings in sexual abuse include difficulty walking or sitting; torn, stained, or bloody underclothing; pain, swelling, or itching of the genitals; and bruises, bleeding, or lacerations in the genitals, or anal area. Poor hygiene may indicate physical neglect. Bald spots on the scalp and fear of the parents most likely are associated with physical abuse.

77) D
- Absence seizures are brief episodes of altered awareness. No muscle activity occurs except eyelid fluttering or twitching. The child has a blank facial expression. These seizures last only 5 to 10 seconds, but they may occur one after another several times a day. Myoclonic seizures are brief random contractions of a muscle group that can occur on one or both sides of the body. Simple partial seizures consist of twitching of an extremity, face, or neck, or the sensation of twitching or numbness in an extremity or face or neck.

78) B
- If the shunt is broken or malfunctioning, the fluid from the ventricle part of the brain will not be diverted to the peritoneal cavity. The cerebrospinal fluid will build up in the cranial area. The result is increased intracranial pressure, which then causes a high-pitched cry in the infant. The infant should not have pressure placed on the shunt side. Skin breakdown and possible compressions to the apparatus could result. This type of shunt affects the gastrointestinal system, not the genitourinary system. Option A is only a concern if the infant becomes malnourished or dehydrated, which then could raise the body temperature. Otherwise, the infant’s refusing baby food has no direct relationship to the shunt functioning.

79) D
- Newborn infants with spina bifida (myelomeningocele type) are at risk for hydrocephalus; therefore, the head circumference should be measured to obtain a baseline. Options A, B, and C are incorrect because pulse rate will not be affected with this disorder, the specific gravity can indicate hydration status but it is not priority at this time, and abdominal masses do not occur with this disorder.

80) B
- Late signs of increased intracranial pressure (ICP) include a significant decrease in level of consciousness, bradycardia, and fixed and dilated pupils. A bulging fontanel and dilated scalp veins are early signs of increased ICP and would be noted in an infant, not a 5-year-old child. Nausea is an early sign of increased ICP. 


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Pediatric Nurse Education (71-75)

Pediatric Nurse Education Questions 71-75

71. A clinic nurse provides instructions to a parent of a toddler experiencing physiological anorexia. Which statement if made by the parent indicates a need for further instructions?

a) I will not force-feed my child
b) I will be feed my child if she will not eat
c) I will limit the juice intake to less than 12 ounces per day
d) At mealtime, I will offer less than my child may eat and let my child ask for more  

72. A child with autism is being admitted to the hospital for diagnostic tests. The nurse should assign this child to a:

a) private room
b) semiprivate room
c) four-bed ward room
d) contact isolation room

73. A nurse is assigned to care for an 8-year old child with basilar skull fracture. The nurse reviews the physician's orders and contacts the physician to question which order?

a) obtain daily weight
b) suction as needed
c) provide clear liquid diet
d) maintain a patent intravenous line

74. A lumbar puncture is performed on a child suspected of having bacterial meningitis and cerebrospinal fluid (CSF) is obtained for analysis. A nurse reviews the results of the CSF analysis and determines that which of the following results would verify the diagnosis?

a) clear CSF, elevated protein and deceased glucose level
b) clear CSF, decreased pressure and elevated protein level
c) cloudy CSF, elevated protein and decrease glucose level
d) cloudy CSF, decreased protein and decreased glucose level

75. A clinic nurse is observing a child diagnosed with autistic disorder. The nurse would expect to observe which characteristic of this disorder?

a) normal social play
b) lack of social interaction
c) normal responses to sensory stimuli
d) normal verbal but abnormal nonverbal communication




Pediatric Nurse Education:
ANSWERS AND RATIONALE

71) B
- a toddler has the skills required to feed himself or herself. The parent needs to be instructed not to feed children who can feed themselves and not to force-feed a child. To increase nutritious intake at mealtime, juice intake needs to be limited to less than 12 oz per day. At mealtime, the best option is to offer less than the toddler may eat and let the child ask for more food.

72) A
- autistic disorder is a complex childhood disorder that involves abnormalities in behavior, social interactions, and communication. Autistic children are unable to relate to persons or to respond to social and emotional cues. Characteristically, these children engage in repetitive behaviors, including head banging, twirling in circles, biting themselves, and flapping their hands or arms. Abnormal communication patterns include verbal and nonverbal communication. A child with autism needs deceased stimulation, with limited visual and auditory distractions. A private room would be the best environment, allowing for control of visual and auditory distractions. The semiprivate and four-bed ward rooms would be too stimulating for the child with autism. Autism is not a disorder that requires contact isolation.

73) B
- nasotracheal suctioning is contraindicated in a child with a basilar skull fracture. Because of the nature of the injury, there is a high risk of secondary infection and the probability of the catheter entering the brain through the fracture. Fluid balance is monitored closely by daily weight, intake and output measurement, and serum osmolality, determination to detect early signs of water retention, excessive dehydration, and states of hypertonicity or hypotonicity. The child is maintained on an NPO status or restricted to clear fluids until it is determined that vomiting will not occur. An intravenous line is maintained to administer fluids or medications if necessary.

74) C
- meningitis is an infectious process of the central nervous system caused by bacteria and viruses; it may be acquired as a primary disease or a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections. Meningitis is diagnosed by testing cerebrospinal fluid obtained by lumbar puncture. In the case of bacterial meningitis, findings usually include an elevated pressure, turbid or cloudy cerebrospinal fluid and elevated leukocyte, elevated protein, and decreased glucose levels

75) B

 - Autistic disorder is a complex childhood disorder that involves abnormalities in behavior, social interactions, and communication. Autistic children are unable to relate to persons or to respond to social and emotional cues. Characteristically, these children engage in repetitive behaviors, including head banging, twirling in circles, biting themselves, and flapping their hands or arms. Abnormal communication patterns include verbal and nonverbal communication.





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Pediatric Nurse Education (66-70)

Pediatric Nurse Education Questions 66-70

66. A nurse is evaluating the developmental level of a 2-year old child. Which of the following does the nurse expect to observe?

a) use fork to eat
b) uses a cup to drink
c) pours own milk into a cup
d) uses a knife for cutting food  

67. The parents of a 2-year old child arrive at a hospital to visit their child. The child is in the playroom when the parents arrive. When the parents enter the playroom, the child does not readily approach the parents. The nurse interprets this behavior as indicating that:

a) the child is withdrawn
b) this is a normal pattern
c) the child is self-centered
d) the child has adjusted to the hospital setting

68. A clinic nurse provides information to the mother of a toddler regarding toilet training. Which statement by the mother indicates a need for further information regarding the toilet training?

a) bladder control usually is achieved before bowel control
b) the child should not be forced to sit on the potty for long periods
c) the ability of the child to remove clothing is a sign of physical readiness
d) the child will not be ready to toilet train until the age of about 18 to 24 months

69. A clinic nurse assesses the communication patterns of a 5-month old infant. The nurse determines that the infant is demonstrating the highest level of developmental achievement expected if the infant:

a) coos when comforted
b) links syllables together
c) uses monosyllabic babbling
d) uses simple words such as "mama"

70. A 2-year old child is treated in the emergency room for a burn to the chest and abdomen. The child sustained the burn by grabbing a cup of hot coffee that was left on the kitchen counter. The nurse reviews safety principles with the parents before discharge. Which statement by the parents indicates an understanding of measures to provide safely in the home?

a) we will be sure not to leave hot liquids unattended
b) I guess my children need to understand what the word hot means
c) we will be sure that the children stay in their rooms when we work in the kitchen
d) We will install a safely gate as soon as we get home so the children cannot get into the kitchen




Pediatric Nurse Education:
ANSWERS AND RATIONALE
66) B
- by age 2-years, the child can use a cup and spoon correctly but with some spilling. By age 3 to 4, the child begins to use fork. By the end of the preschool period, the child should be able to pour milk into a cup and begin to use a knife for cutting.

67) B
- the phrases through which young children progress when separated from their parents include protest, despair, and denial or detachment. In the stage of protest, when the parents return, the child readily goes to them. In the stage of despair, the child may not approach them readily or may cling to a parent. In denial or detachment, when the parents return, the child becomes cheerful, interested in the environment and new persons (seemingly unaware of the lost parents), friendly with the staff, and interested in developing superficial relationships. Options A, C,A and D are incorrect interpretations of the child's behavior.

68) A
- bowel control usually is achieved before bladder control. The child should not be forced to sit for long periods. The ability to remove clothing is one of the physical signs of readiness. The physical ability to control the anal and urethral sphincters is achieved some time after the child is walking, probably between the age of 18 and 24 months.

69) C
- using monosyllabic babbling occurs between 3 and 6 months of age. Using simple words such as "mama" occurs between 9 and 12 months of age. Linking syllables together when communicating occurs between 6 and 9 months of age. Cooing begins at birth and continues until 2 months of age.

70) A
- toddler's, with their increased mobility and development of motor skills, can reach hot water or hot objects placed on counters and stoves and can reach open fires or stove burners above their eye level. The nurse should encourage parents to remain in the kitchen when preparing a meal, use the back burners of the stove, and turn pot handles inward and toward the middle of the stove. Hot liquids should never be supervised. The statements in option B, C, and D do not indicate an understanding of the principles of safety.


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Test Prep for Nursing Exam about Pediatric Nursing (61-65)

61. A nurse is planning care for a newborn of a diabetic mother. A priority nursing diagnosis for this infant:

a) hyperthermia related to excess fat and glycogen
b) risk for injury related to low blood glucose levels
c) risk for delayed development related to excessive size
d) risk for aspiration related to impaired suck and swallow  

62. A nursing instructor asks a nursing student to describe the procedure for administering erythromycin (0.5% Ilotycin) ointment on the eyes of a neonate. The instructor determines that the student needs to research this procedure further if the student state that:

a) I will flush the eyes after instilling the ointment
b) I will cleanse the neonate's eyes before instilling the ointment
c) administration of the eye ointment is within 1 hour after delivery
d) I will instill the eye ointment into each of the neonate's conjunctival sacs

63. Which statement would indicate the "law and order orientation" found in level two of Kohlberg's theory of moral development?

a) If I skip down the hall, will the teacher be mad at me?
b) We will spend time talking about the activities for the week
c) I don't like it when you yell while I am talking to my friend. Here are some activities to do until I am finished talking
d) If you do all of your class work today without bothering others in the class, you will get an extra seed for your good garden.

64. A home health nurse visits a 70-year old woman weekly. At each visit, the client reminisces about pas t life experiences in a positive way. Using Erickson's psychosocial development theory, the home health nurse interprets this behavior as:

a) a mental status alteration
b) a normal psychosocial response
c) requiring a psychiatric consultation
d) a sensory deficit requiring social activities

65. Which of the following car safety devices should be used for a child who is 8-years old and is 4 feet tall?

a) seat belt
b) booster seat
c) rear-facing convertible seat
d) front-facing convertible seat



ANSWERS AND RATIONALE

61) B
- the neonate born to a diabetic mother is at risk for hypoglycemia so risk for injury related to low blood glucose levels would be priority nursing diagnosis. The infant would also be at risk for hyperbilirubinemia, respiratory distress, hypocalcemia, and congenital anomalies. Hyperthermia, risk for delayed development, and risk for aspiration are not expected problems.

62) A
- eye prophylaxis protects the neonate against Neisseria gonorrhoeae and Chlamydia tranchomatis. The eyes are not flushed after instillation of the medication because the flush will wash away the administered medication. Option B, C and D are correct statements regarding the procedure for administering eye medication to the neonate.

63) A
- in the law and order orientation of Kohlberg's theory, the child has more concern with society as a whole and emphasis is on obeying laws to maintain social order. The child wants to be considered "good" by persons whose opinions matter to them. Option A is the only option that reflects these criteria. Option B, C, and D are unrelated to the law and order orientation.

64) B
- according to Erickson, late adulthood is the period of old age. The adult reminisces about past life experiences, viewing them in a positive way. The adult needs to feel good about accomplishments, see successes in life, and feel that he or she has made a contribution to society. Option A, C, and D are incorrect interpretations.

65) B
- children should remain in a booster seat until the are 8 to 12 years old and at least 4 feet, 9 inches tall. An infant should ride in a car in a semi reclined, rear-facing position in an infant-only seat or a convertible seat until they weigh at least 20 lb and are at least 1 year of age. The transition point for switching to the forward-facing position is defined by the manufacturer of the convertible car safety seat bu is generally at a body weight of 9 kg (20lb) and 1 year of age. Convertible car safety seats are used until the child weighs at least 40 lb. 


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Online Nursing Practice Test about Pharmacology (71-75)

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71. A nursing student needs to administer potassium chloride intravenously as prescribed to a client with hypokalemia. The nursing instructor determines that the student is unprepared for this procedure if the student states that which of the following is part of the plan for preparation and administration of the potassium?

a) obtaining a controlled IV infusion pump
b) monitoring urine output during administration
c) diluting in appropriate amount of normal saline
d) preparing the medication for bolus administration  

72. A client is brought to the emergency room stating that he has accidentally been taking two times his prescribed dose of warfarin (Coumadin) for the past week. After noting that the client has no evidence of obvious bleeding, the nurse plans to do which of the following next?

a) prepares to administer the antidote
b) draws a sample for type crossmatch and transfuse the client
c) draws a sample for an activated partial thromboplastin (aPTT)
d) draws a sample for prothrombin (PT) and international normalized ration (INR) level

73. Methylergonovine (Methergine) is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, the priority nursing assessment is to check the:

a) uterine tone
b) blood pressure
c) amount of lochia
d) deep tendon reflexes

74. A nurse is preparing to administer beractant (survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which of the following routes?

a) intradermal
b) intratracheal
c) subcutaneous
d) intramuscular

75. A nurse is caring for a client who is receiving oxytocin (Pitocin) to induce labor. The nurse discontinuous the oxytocin infusion if which of the following is noted on assessment of the client?

a) fatigue
b) drowsiness
c) uterine hyperstimulation
d) early decelerations of the fetal heart rate




ANSWERS AND RATIONALE

71) D
- potassium chloride administered intravenously must always be diluted in IV fluid and infused via a pump or controller. The usual concentration of IV potassium chloride is 20 to 40 mEq/L. Potassium chloride is never given by bolus (IV push). Giving potassium chloride by IV push can result in cardiac arrest. Dilution in normal saline is recommended, but dextrose solution is avoided because this type of solution increases intracellular potassium shifting. The IV bag containing the potassium chloride is always gently agitated before hanging. The IV site is monitored closely because potassium chloride is irritating to the veins and the risk of phlebitis exists.

72) D
- the next action is to draw a sample for PT and INR level to determine the client's anticoagulation status and risk for bleeding. These results will provide information as to how to best treat this client if an antidote (vitamin K) or blood transfusion is needed. The aPTT monitors the effects of heparin therapy.

73) B
- methylergonovine, an ergot alkaloid, is an agent that is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The physician should be notified if hypertension is present. Although options A, C, and D may be components of postpartum assessment, option B, blood pressure, is related specifically to the administration of this medication.

74) B
- respiratory distress is common in a premature neonates and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Option A, C, and D are not routes of administration for this medication.

75) C
- oxytocin stimulates uterine contractions and is a common pharmacological method to induce labor. An adverse reaction associated with administration of this medication is hyperstimulation of uterine contractions. Therefore, oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are reassuring sign and do not indicate fetal distress.


Related Topics:

• Online Nursing Practice Test about Pharmacology (76-80)
• Go back to Online Nursing Practice Test about Pharmacology (1-5) to start the test from the beginning.

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