National Council of State Boards of Nursing Practice Questions 76-90 and Answers
A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the
first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of
this child, which one would be a priority at this time?
A. Use aseptic technique during dressing changes
B. Check results of liver enzyme tests
C. Maintain central line catheter integrity
D. Monitor serum glucose levels - ansD
Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose load of the TPN
solution. Thus, a priority nursing responsibility is blood glucose testing.
A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours after admission, during
a planning conference, which of the actions suggested to the registered nurse (RN) by the practical nurse (PN)
would be appropriate to add to the plan of care?
A. Provide an over-the-crib protective top
B. Measure head circumference
C. Initiate droplet precautions
D. Provide passive range of motion - ansB
In meningitis, assessment of neurological signs should be done frequently. Head circumference is measured
because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis. The
client would have already been placed on droplet precautions and had a crib top applied to the bed when he
was admitted to the unit.
A 12 year-old pediatric cancer client is distraught about the alopecia that occurred after the last chemotherapy
treatment. Which nursing interventions are appropriate for this side effect of chemotherapy? (Select all that
apply.)
A. Practice and teach thorough hand washing
,B. Administer prescribed antiemetic medication before nausea is too severe
C. Encourage visits from friends before discharge from the hospital
D. Allow the child to choose a cap, scarf, wig or other head cover to use - ansC,D
Alopecia is the loss of hair, which is a frequent side effect of certain types of chemotherapy. Although it is not
life-threatening, the body image change is difficult for many individuals, particularly children and adolescents.
Encouraging visits from friends before discharge helps the young client and friends adjust. Wearing preferred
forms of head cover-ups increases comfort and decreases embarrassment. The other options are proper
interventions for chemotherapy, but do not help the client with hair loss.
A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for treatment of Kawasaki
disease and treatment involving immunoglobulins. The nurse should recognize which scheduled immunizations
will be delayed?
A. Inactivated polio vaccine (IPV)
B. Haemophilus Influenzae Type b (Hib)
C. Mumps, measles, rubella (MMR)
D. Diptheria, tetanus, pertussis (DTaP) - ansC
Medical management of Kawasaki involves administration of immunoglobulins. Measles, mumps, rubella
(MMR) is a live virus vaccine. Following administration of immunoglobulins, live vaccines should be held due to
possible interference with the body's ability to form antibodies.
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 should be
an initial action by the nurse?
A. Arrange to change client care assignments
B. Explain that the child needs extra attention
C. Discuss the appropriate use of "time-out"
D. Explain that this behavior is expected - ansD
During normal development, fear of strangers becomes prominent and begins around age 6 to 8 months-old.
Such behaviors include clinging to parent, crying and turning away from the stranger. These fears and
,behaviors extend into the toddler period. In the toddler period, separation anxiety is at its peak. As the child
ages the behavior has a tendency to wane.
A 2-year-old child has just been diagnosed with cystic fibrosis. The child's parent asks the nurse what the most
important concerns are at this time. Which is the appropriate response from the nurse?
A. "Thick, sticky secretions from the lungs are a constant challenge."
B. "Cystic fibrosis results in nutritional concerns that can be dealt with."
C. "You will work with a team of experts and have access to a support group."
D. "There is a high probability of life-long complications." - ansA
The primary factor, and the one responsible for many of the clinical manifestations of cystic fibrosis, is
mechanical obstruction caused by the increased viscosity of mucous gland secretions.Because of the increased
viscosity of bronchial mucus, there is greater resistance to ciliary action (probably secondary to infection and
ciliary destruction), a slower flow rate of mucus and incomplete expectoration, which also contributes to the
mucus obstruction. This retained mucus serves as an excellent medium for bacterial growth. Reduced oxygen-
carbon dioxide exchange causes variable degrees of hypoxia, hypercapnia and acidosis.In severe cases,
progressive lung involvement, compression of pulmonary blood vessels and progressive lung dysfunction
frequently lead to pulmonary hypertension, cor pulmonale, respiratory failure and death. Pulmonary
complications are present in almost all children with cystic fibrosis, but the onset and extent of involvement are
variable.
A 3 year-old child has findings that may suggest a neuroblastoma. While listening to the concerns of the
parents, which finding is consistent with this diagnosis and requires follow-up by the health care provider?
A. "He seems to be getting weaker and weaker and is sometimes unsteady on his feet."
B. "We keep having to buy him larger size pants because he's growing so big around the waist."
C. "He doesn't seem to be going to the bathroom as much and his urine is dark yellow in color."
D. "Our child has been quieter than normal lately and has lost weight." - ansB
One of the most common signs of neuroblastoma is increased abdominal girth due to the mass or tumor in the
abdomen. The mass can cause pain and/or a feeling of fullness and the pressure may affect the child's bladder
or bowel. Although the child with a neuroblastoma may not want to eat (which can lead to weight loss), this
finding could have many causes. A more significant finding would be if the parents reported that child keeps
outgrowing clothing or that clothing is tight around the abdomen.
, A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg; resting pulse is 78
BPM; respirations are 28 BPM; and the serum potassium level is 4.8 mEq/L (4.8 mmol/L). The client is irritable
and has vomited twice since the morning dose of digoxin. Which finding is most indicative of digoxin toxicity?
A. Irritability
B. Vomiting
C. Bradycardia
D. Dyspnea - ansC
The most common sign of digoxin toxicity in children is bradycardia which is a heart rate below 100 BPM in an
infant. Normal resting heart rate for infants 1-11 months-old is 100-160 BPM.
A 52 year-old postmenopausal woman asks the nurse how frequently she should have a mammogram. How
should the nurse respond?
A. "Unless you had previous problems, every two years is best."
B. "Your health care provider will advise you about your risks and the frequency."
C. "Yearly mammograms are advised for any women over 35."
D. "Once a woman reaches 50, she should have a mammogram yearly." - ansD
The American Cancer Society recommends a screening mammogram by age 40, every one to two years for
women 40 to 49, and every year from age 50 onward. If there are family or personal health risks, other more
frequent and additional assessments may be recommended.
A 57 year-old male client has a hemoglobin of 10 g/dL (6.21 mmol/L) and a hematocrit of 32% (0.32). What
would be the most appropriate follow-up by a home care nurse?
A. Ask the client if the client has noticed any bleeding or dark stools
B. Call 911 and send the client to the emergency department
C. Refer the client to schedule an appointment with a hematologist
A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central venous line. This is the
first day of TPN therapy. Although all of the following nursing actions must be included in the plan of care of
this child, which one would be a priority at this time?
A. Use aseptic technique during dressing changes
B. Check results of liver enzyme tests
C. Maintain central line catheter integrity
D. Monitor serum glucose levels - ansD
Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose load of the TPN
solution. Thus, a priority nursing responsibility is blood glucose testing.
A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours after admission, during
a planning conference, which of the actions suggested to the registered nurse (RN) by the practical nurse (PN)
would be appropriate to add to the plan of care?
A. Provide an over-the-crib protective top
B. Measure head circumference
C. Initiate droplet precautions
D. Provide passive range of motion - ansB
In meningitis, assessment of neurological signs should be done frequently. Head circumference is measured
because subdural effusions and obstructive hydrocephalus can develop as a complication of meningitis. The
client would have already been placed on droplet precautions and had a crib top applied to the bed when he
was admitted to the unit.
A 12 year-old pediatric cancer client is distraught about the alopecia that occurred after the last chemotherapy
treatment. Which nursing interventions are appropriate for this side effect of chemotherapy? (Select all that
apply.)
A. Practice and teach thorough hand washing
,B. Administer prescribed antiemetic medication before nausea is too severe
C. Encourage visits from friends before discharge from the hospital
D. Allow the child to choose a cap, scarf, wig or other head cover to use - ansC,D
Alopecia is the loss of hair, which is a frequent side effect of certain types of chemotherapy. Although it is not
life-threatening, the body image change is difficult for many individuals, particularly children and adolescents.
Encouraging visits from friends before discharge helps the young client and friends adjust. Wearing preferred
forms of head cover-ups increases comfort and decreases embarrassment. The other options are proper
interventions for chemotherapy, but do not help the client with hair loss.
A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for treatment of Kawasaki
disease and treatment involving immunoglobulins. The nurse should recognize which scheduled immunizations
will be delayed?
A. Inactivated polio vaccine (IPV)
B. Haemophilus Influenzae Type b (Hib)
C. Mumps, measles, rubella (MMR)
D. Diptheria, tetanus, pertussis (DTaP) - ansC
Medical management of Kawasaki involves administration of immunoglobulins. Measles, mumps, rubella
(MMR) is a live virus vaccine. Following administration of immunoglobulins, live vaccines should be held due to
possible interference with the body's ability to form antibodies.
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 should be
an initial action by the nurse?
A. Arrange to change client care assignments
B. Explain that the child needs extra attention
C. Discuss the appropriate use of "time-out"
D. Explain that this behavior is expected - ansD
During normal development, fear of strangers becomes prominent and begins around age 6 to 8 months-old.
Such behaviors include clinging to parent, crying and turning away from the stranger. These fears and
,behaviors extend into the toddler period. In the toddler period, separation anxiety is at its peak. As the child
ages the behavior has a tendency to wane.
A 2-year-old child has just been diagnosed with cystic fibrosis. The child's parent asks the nurse what the most
important concerns are at this time. Which is the appropriate response from the nurse?
A. "Thick, sticky secretions from the lungs are a constant challenge."
B. "Cystic fibrosis results in nutritional concerns that can be dealt with."
C. "You will work with a team of experts and have access to a support group."
D. "There is a high probability of life-long complications." - ansA
The primary factor, and the one responsible for many of the clinical manifestations of cystic fibrosis, is
mechanical obstruction caused by the increased viscosity of mucous gland secretions.Because of the increased
viscosity of bronchial mucus, there is greater resistance to ciliary action (probably secondary to infection and
ciliary destruction), a slower flow rate of mucus and incomplete expectoration, which also contributes to the
mucus obstruction. This retained mucus serves as an excellent medium for bacterial growth. Reduced oxygen-
carbon dioxide exchange causes variable degrees of hypoxia, hypercapnia and acidosis.In severe cases,
progressive lung involvement, compression of pulmonary blood vessels and progressive lung dysfunction
frequently lead to pulmonary hypertension, cor pulmonale, respiratory failure and death. Pulmonary
complications are present in almost all children with cystic fibrosis, but the onset and extent of involvement are
variable.
A 3 year-old child has findings that may suggest a neuroblastoma. While listening to the concerns of the
parents, which finding is consistent with this diagnosis and requires follow-up by the health care provider?
A. "He seems to be getting weaker and weaker and is sometimes unsteady on his feet."
B. "We keep having to buy him larger size pants because he's growing so big around the waist."
C. "He doesn't seem to be going to the bathroom as much and his urine is dark yellow in color."
D. "Our child has been quieter than normal lately and has lost weight." - ansB
One of the most common signs of neuroblastoma is increased abdominal girth due to the mass or tumor in the
abdomen. The mass can cause pain and/or a feeling of fullness and the pressure may affect the child's bladder
or bowel. Although the child with a neuroblastoma may not want to eat (which can lead to weight loss), this
finding could have many causes. A more significant finding would be if the parents reported that child keeps
outgrowing clothing or that clothing is tight around the abdomen.
, A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg; resting pulse is 78
BPM; respirations are 28 BPM; and the serum potassium level is 4.8 mEq/L (4.8 mmol/L). The client is irritable
and has vomited twice since the morning dose of digoxin. Which finding is most indicative of digoxin toxicity?
A. Irritability
B. Vomiting
C. Bradycardia
D. Dyspnea - ansC
The most common sign of digoxin toxicity in children is bradycardia which is a heart rate below 100 BPM in an
infant. Normal resting heart rate for infants 1-11 months-old is 100-160 BPM.
A 52 year-old postmenopausal woman asks the nurse how frequently she should have a mammogram. How
should the nurse respond?
A. "Unless you had previous problems, every two years is best."
B. "Your health care provider will advise you about your risks and the frequency."
C. "Yearly mammograms are advised for any women over 35."
D. "Once a woman reaches 50, she should have a mammogram yearly." - ansD
The American Cancer Society recommends a screening mammogram by age 40, every one to two years for
women 40 to 49, and every year from age 50 onward. If there are family or personal health risks, other more
frequent and additional assessments may be recommended.
A 57 year-old male client has a hemoglobin of 10 g/dL (6.21 mmol/L) and a hematocrit of 32% (0.32). What
would be the most appropriate follow-up by a home care nurse?
A. Ask the client if the client has noticed any bleeding or dark stools
B. Call 911 and send the client to the emergency department
C. Refer the client to schedule an appointment with a hematologist
