(Verified by Expert)
1. The nurse is has just admitted a client with severe depression. From which focus
should the nurse identify a priority nursing diagnosis?
A) Nutrition
B) Elimination
C) Activity
D) Safety
ANS: D: Safety
2. While explaining an illness to a 10 year-old, what should the nurse keep in mind
about the cognitive development at this age?
A) They are able to make simple association of ideas
B) They are able to think logically in organizing facts
C) Interpretation of events originate from their own perspective
D) Conclusions are based on previous experiences
ANS: B: Think logically in orga- nizing facts
,3. The nurse enters the room as a 3 year-old is having a generalized seizure. Which
intervention should the nurse do first?
A) Clear the area of any hazards
B) Place the child on the side
C) Restrain the child
D) Give the prescribed anticonvulsant
ANS: B: Place the child on the side
4. The nurse is reviewing a depressed client's history from an earlier admis- sion.
Documentation of anhedonia is noted. The nurse understands that this finding
refers to
A) Reports of difficulty falling and staying asleep
B) Expression of persistent suicidal thoughts
C) Lack of enjoyment in usual pleasures
D) Reduced senses of taste and smell
ANS: C: Lack of enjoyment in usual pleasures
5. A client has just returned to the medical-surgical unit following a segmental lung
resection. After assessing the client, the first nursing action would be to
A) Administer pain medication
B) Suction excessive tracheobronchial secretions
C) Assist client to turn, deep breathe and cough
D) Monitor oxygen saturation
, ANS: B) Suction excessive tracheobronchial secretions
6. While assessing a client in an outpatient facility with a panic disorder, the nurse
completes a thorough health history and physical exam. Which finding is most
significantfor this client?
A) Compulsive behavior
B) Sense of impending doom
C) Fear of flying
D) Predictable episodes
ANS: B) Sense of impending doom
, 7. A 16 month-old child has just been admitted to the hospital. As the nurse
assigned to this child enters the hospital room for the first time, the toddler runs
to the mother, clings
to her and begins to cry. What would be the initial action by the nurse?
A) Arrange to change client care assignments
B) Explain that this behavior is expected
C) Discuss the appropriate use of "time-out"
D) Explain that the child needs extra attention
ANS: B) Explain that this behavior is expected
8. A 15 year-old client with a lengthy confining illness is at risk for altered
growth and
development of which task?
A) Loss of control
B) Insecurity
C) Dependence
D) Lack of trust
ANS: C) Dependence
9. Which playroom activities should the nurse organize for a small group of 7 year-
old hospitalized children?
A) Sports and games with rules
B) Finger paints and water play