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1. Which of the following would the nurse identify as the initial priority for a child with acute
lymphocytic leukemia?
A. Instituting infection control precautions.
B. Encouraging adequate intake of iron-rich foods.
C. Assisting with coping with chronic illness.
D. Administering medications via IM injections.
Correct Answer: A. Instituting infection control precautions
Acute lymphocytic leukemia (ALL) causes leukopenia, resulting in immunosuppression and
increasing the risk of infection, a leading cause of death in children with ALL. Therefore, the
initial priority nursing intervention would be to institute infection control precautions to decrease
the risk of infection.
Option B: Iron-rich foods help with anemia, but dietary iron is not an initial
intervention. For the treatment of iron deficiency anemia in adults, 100 to 200 mg
of elemental iron per day has been recommended. The best way to take the
supplement so that it can be absorbed in the greatest amount of iron is to take it in
two or more doses during the day.
Option C: The prognosis of ALL usually is good. However, later on, the nurse
may need to assist the child and family with coping since death and dying may
still be an issue in need of discussion.
Option D: Injections should be discouraged, owing to increased risk of bleeding
due to thrombocytopenia.
,2. The client tells the nurse that her last menstrual period started on January 14 and ended on
January 20. Using Nagele’s rule, the nurse determines her EDD to be which of the following?
A. September 27
B. October 21
C. November 7
D. December 27
Correct Answer: B. October 21
To calculate the EDD by Nagele’s rule, add 7 days to the first day of the last menstrual period
and count back 3 months, changing the year appropriately.
Option A: To obtain a date of September 27, 7 days have been added to the last
day of the LMP (rather than the first day of the LMP), plus 4 months (instead of 3
months) were counted back.
Option C: To obtain the date of November 7, 7 days have been subtracted
(instead of added) from the first day of LMP plus November indicates counting
back 2 months (instead of 3 months) from January.
Option D: To obtain the date of December 27, 7 days were added to the last day
of the LMP (rather than the first day of the LMP) and December indicates
counting back only 1 month (instead of 3 months) from January.
3. Which of the following would the nurse do first for a 3-year-old boy who arrives in the
emergency room with a temperature of 105 degrees, inspiratory stridor, and restlessness, who is
leaning forward and drooling?
A. Auscultate his lungs and place him in a mist tent.
B. Have him lie down and rest after encouraging fluids.
C. Examine his throat and perform a throat culture.
D. Notify the physician immediately and prepare for intubation.
Correct Answer: D. Notify the physician immediately and prepare for intubation.
, The child is exhibiting classic signs of epiglottitis, always a pediatric emergency. The physician
must be notified immediately and the nurse must be prepared for an emergency intubation or
tracheostomy.
Option A: Further assessment with auscultating lungs and placing the child in a
mist tent wastes valuable time. The situation is a possible life-threatening
emergency. In children, stridor may become louder in the supine position. Causes
of stridor are pertussis, croup, epiglottis, aspirations. The recommended
auscultation position for the stethoscope is the chest wall position.
Option B: Having the child lie down would cause additional distress and may
result in respiratory arrest. Inspiratory stridor is often a medical emergency.
Assessment of vital signs and degree of respiratory distress is the first step. In
some cases, securing the airway may be necessary before or in parallel with the
physical examination.
Option C: Throat examination may result in laryngospasm that could be fatal.
Physical examination of a patient with suspected acute epiglottitis is
contraindicated. The patient may prefer certain positions that alleviate the stridor.
4. The nurse is counseling a couple who has sought information about conceiving. The couple
asks the nurse to explain when ovulation usually occurs. Which statement by the nurse is
correct?
o A. Two weeks before menstruation.
o B. Immediately after menstruation.
o C. Immediately before menstruation.
o D. Three weeks before menstruation.
Correct Answer: A. Two weeks before menstruation
Ovulation occurs 14 days before the first day of the menstrual period (A). Although ovulation
can occur in the middle of the cycle or 2 weeks after menstruation, this is only true for a woman
who has a perfect 28-day cycle. For many women, the length of the menstrual cycle varies.
Option B: After the follicle releases its egg, it changes into the corpus luteum.