Health Promotion and Maintenance

1
Health Promotion and Maintenance

• Maternity Newborn Growth and Development
  Elderly Pediatrics

2

1. Use Nageles rule to estimate the EDC for a
   patient whose LMP began on October 1. 2000.
2. October 11, 2001
3. August 1, 2001
4. July 1, 2001
5. July 8, 2001

3

1. Use Nageles rule to estimate the EDC for a
   patient whose LMP began on October 1. 2000.
2. October 11, 2001
3. August 1, 2001
4. July 1, 2001
5. July 8, 2001

• Add 7 days to the first day of LMP
• Subtract 3 months
• Add One year

4

1. The client has been pregnant 4 times. Her first
   died in utero at 16 weeks gestation. She
   delivered one infant at 24 weeks. Twins were
   born at 36 weeks gestation. The youngest
   delivered at 41 weeks. This clients GTPAL would
   be _____.

(G)4,(T)1,(P)2,(A)1,(L)4
Gravidity pregnancies Term term
births Preterm Births occurring before 40
weeks. Note that there are some discrepancies in
the literature re twin births. The GBCN OB
faculty define a twin pregnancy as one
pregnancy. Abortions/Miscarriages . Living
live births
5

• The pregnant clients hemoglobin and hematocrit
  levels are 11g/dL and 30g/dL. What is the most
  appropriate intervention for this client?
• Administration of 1 unit of packed cells
• Administration of 1000ml of D5NS with 40 KCL
• Administration of Epoetin sq QD.
• No intervention is indicated.

6

• The pregnant clients hemoglobin and hematocrit
  levels are 11g/dL and 30g/dL. What is the most
  appropriate intervention for this client?
• Administration of 1 unit of packed cells
• Administration of 1000ml of D5NS with 40 KCL
• Administration of Epoetin sq QD. Stimulates RBC
  production.
• No intervention is indicated.

7

• Which of the following clients requires further
  teaching regarding nutrition during
  pregnancy/lactation?
• Client 1 is at the beginning of her third
  trimester. She has gained 40 lbs at this point
  of her pregnancy.
• Client 2 is at the beginning of the 2nd
  trimester. She has increased calories by adding
  additional servings of fruits and vegetables.
• Client 3 is in the middle of her 3rd trimester.
  She has been feeling bloated and full over
  the past few days. She has decided to limit her
  fluid intake to 8 glasses of water per day to
  correct this problem.
• Client 4 has eliminated all foods with folic
  acid from her diet. She has read that folic acid
  might cause cancer in laboratory rats.

8

• Which of the following clients requires further
  teaching regarding nutrition during
  pregnancy/lactation?
• Client 1 is at the beginning of her third
  trimester. She has gained 30 lbs at this point
  of her pregnancy. 25-35 lb OK
• Client 2 is at the beginning of the 2nd
  trimester. She has increased calories by adding
  additional servings of fruits and vegetables.
  Increase by 300 cal. / day
• Client 3 is in the middle of her 3rd trimester.
  She has been feeling bloated and full over
  the past few days. She has decided to limit her
  fluid intake to 8 glasses of water per day to
  correct this problem. 8 glasses minimal OK
• Client 4 has eliminated all foods with folic
  acid from her diet. She has read that folic acid
  might cause cancer in laboratory rats. Should
  consume a diet rich in folic acid.

9

• The nurse is caring for a client in labor. The
  FHR has averaged around 150 beats/minute for the
  past hour. The nurse notices now that as the
  clients contraction begins, the FHR begins to
  decline. The decline returns to the 150 baseline
  by the end of each contraction. Which nursing
  intervention is indicated for this deceleration
  pattern?
• Continue to monitor the client.
• Turn the client on her left side.
• Place the client in the Lithotomy position.
• Decrease the rate of the Pitocin drip, notify the
  MD.

10

• The nurse is caring for a client in labor. The
  FHR has averaged around 150 beats/minute for the
  past hour. The nurse notices now that as the
  clients contraction begins, the FHR begins to
  decline. The decline returns to the 150 baseline
  by the end of each contraction. Which nursing
  intervention is indicated for this deceleration
  pattern?
• Continue to monitor the client.
• Turn the client on her left side.
• Place the client in the Lithotomy position.
• Decrease the rate of the Pitocin drip, notify the
  MD.

Early decelerations
11

• The FHR has been 105 for 15 minutes. Select the
  appropriate actions for the nurse
• Increase the rate of the Pitocin drip.
• Turn the client to her side.
• Notify the MD.
• Administer facemask oxygen at 8 L/minute.
• Elevate the foot of the bed.

12

• The FHR has been 105 for 15 minutes. Select the
  appropriate actions for the nurse
• Increase the rate of the Pitocin drip.
• Turn the client to her side.
• Notify the MD.
• Administer facemask oxygen at 8 L/minute.
• Elevate the foot of the bed.

13

• Which change in the FHR described below would
  necessitate a nursing intervention?
• The FHR goes from 145 to 155 when a vaginal exam
  is performed on the mother.
• The FHR goes from 145 to 143 as the mothers
  contraction begins.
• The FHR goes from 145 to 142 after the mothers
  contraction begins.
• The FHR goes from 145 to 160 as the fetus moves
  about in the uterus.

14

• Which change in the FHR described below would
  necessitate a nursing intervention?
• The FHR goes from 145 to 155 when a vaginal exam
  is performed on the mother. Normal acceleration
• The FHR goes from 145 to 143 as the mothers
  contraction begins. Early deceleration
• The FHR goes from 145 to 142 after the mothers
  contraction begins. Late deceleration
• The FHR goes from 145 to 160 as the fetus moves
  about in the uterus. Normal acceleration

15

• The nurse is caring for a client in labor. Her
  BP is 70/52. What nursing action is indicated
  first?
• Turn her on her left side.
• Administer facemask oxygen.
• Notify MD.
• Monitor FHR.

16

• The nurse is caring for a client in labor. Her
  BP is 70/52. What nursing action is indicated
  first?
• Turn her on her left side.
• Administer facemask oxygen.
• Notify MD.
• Monitor FHR.

17

• The nurse has just received report from the night
  shift. Which of the following postpartum clients
  should the nurse see first?
• The client in room 1 who is complaining of pain
  secondary to breast engorgement.
• The client in room 2 who is 24 hours post
  caesarian section and needs assistance to
  ambulate.
• The client in room 3 who has not voided since
  delivery at 2 AM.
• The client in room 4 who delivered 24 hours ago
  and continues to have rubra described as bright
  red.

18

• The nurse has just received report from the night
  shift. Which of the following postpartum clients
  should the nurse see first?
• The client in room 1 who is complaining of pain
  secondary to breast engorgement. psychosocial
• The client in room 2 who is 24 hours post
  caesarian section and needs assistance to
  ambulate. Not an acute need
• The client in room 3 who has not voided since
  delivery at 2 AM.
• The client in room 4 who delivered 24 hours ago
  and continues to have rubra described as bright
  red. See 2nd no info to indicate acute need.

19
Newborn, Concepts r/t GD
20

• All of the following interventions are indicated
  during the initial care of a newborn. Sequence
  the interventions as appropriate immediately
  following the birth
• Position newborn on his side.
• Dry newborn and stimulate crying by rubbing.
• Wrap newborn in warm blankets.
• Suction mouth and nares with bulb syringe.

21

• All of the following interventions are indicated
  during the initial care of a newborn. Sequence
  the interventions as appropriate immediately
  following the birth
• Position newborn on his side4
• Dry newborn and stimulate crying by rubbing.2
• Wrap newborn in warm blankets.3
• Suction mouth and nares with bulb syringe1

22

• The newborns initial Apgar score is 8. What
  nursing interventions are indicated?
• Rub the infants back.
• Tickle the infant s feet.
• Administer nasal cannula oxygen at 2L/min.
• Place the infant on his side.

23

• The newborns initial Apgar score is 8. What
  nursing interventions are indicated?
• Rub the infants back.
• Tickle the infant s feet.
• Administer nasal cannula oxygen at 2L/min.
• Place the infant on his side.

24

• Which of the following sets of vital signs would
  be considered to be within normal limits for a
  newborn?
• HR90, R32, Axillary Temp. 99 degrees F.
• HR 110, R45, Axillary Temp. 99 degrees F.
• HR152, R20, Axillary Temp. 98.6 degrees F.
• HR98, R16, Axillary Temp. 100 degrees F.

25

• Which of the following sets of vital signs would
  be considered to be within normal limits for a
  newborn?
• HR90, R32, Axillary Temp. 99 degrees F.
• HR 110, R45, Axillary Temp. 99 degrees F.
• HR152, R20, Axillary Temp. 98.6 degrees F.
• HR98, R16, Axillary Temp. 100 degrees F.

26
Normal newborn vital signs

• HR100-170,
• Resp. 30-80,
• Axillary temp 96.8-99 degrees F.
• BP 73/55.

27

• Vitamin K is prescribed for a neonate. The
  nurse prepares the medication and selects which
  muscle site to administer the medication?
• Deltoid
• Triceps
• Vastus lateralis
• Biceps

28

• Vitamin K is prescribed for a neonate. The
  nurse prepares the medication and selects which
  muscle site to administer the medication?
• Deltoid
• Triceps
• Vastus lateralis
• Biceps

29

• Magnesium sulfate is being used in a client
  diagnosed with preeclampsia. Assessment of the
  client reveals respirations of 8, sluggish
  reflexes, and a HR of 42. Which intervention
  described below would be appropriate?
• Increase the dosage of Magnesium sulfate.
• Administer calcium gluconate.
• Turn the client on her right side.
• Elevate the foot of the bed.

30

• Magnesium sulfate is being used in a client
  diagnosed with preeclampsia. Assessment of the
  client reveals respirations of 8, sluggish
  reflexes, and a HR of 42. Which intervention
  described below would be appropriate?
• Increase the dosage of Magnesium sulfate.
• Administer calcium gluconate.
• Turn the client on her right side.
• Elevate the foot of the bed.

31

• Which of the following represents a developmental
  task of a 13 year old girl?
• Jane reminisces about the major events of her
  life.
• Mary is looking for some one to share her life
  with.
• Jennifer enjoys working on service projects with
  the other members of her girl scout troop.
• Lilly is trying hard to improve her grades in
  Math.

32

• Which of the following represents a developmental
  task of a 13 year old girl?
• Jane reminisces about the major events of her
  life. ..Later (65 yrs )
• Mary is looking for some one to share her life
  with Early adulthood(20-35yrs)
• Jennifer enjoys working on service projects with
  the other members of her girl scout troop.
  ..Adolescence (12-20yrs)
• Lilly is trying hard to improve her grades in
  Math. ..School Age (6-12yrs)

33

• The mother of an 8-year-old child tells the
  clinic nurse that she is concerned about the
  child because the child seems to be more
  attentive to friends than anything else. The
  most appropriate nursing response would be which
  of the following?
• You need to be concerned.
• You need to monitor the childs behavior
  closely.
• At this age the child is developing his own
  personality.
• You need to provide more praise to the child to
  stop this behavior.

34

• The mother of an 8-year-old child tells the
  clinic nurse that she is concerned about the
  child because the child seems to be more
  attentive to friends than anything else. The
  most appropriate nursing response would be which
  of the following?
• You need to be concerned.
• You need to monitor the childs behavior
  closely.
• At this age the child is developing his own
  personality.
• You need to provide more praise to the child to
  stop this behavior.

35

• Which patient described below would experience
  the greatest distress when separated from his
  parent(s)?
• Joshua who is 18 months old and the youngest of
  three children.
• Jonathon who is 4 years old and is the oldest of
  2 children.
• Michael who is 10 years old and is the second of
  three children in his family.
• Michael who is 13 years old and is an only child.

36

• Which patient described below would experience
  the greatest distress when separated from his
  parent(s)?
• Joshua who is 18 months old and the youngest of
  three children.
• Jonathon who is 4 years old and is the oldest of
  2 children.
• Michael who is 10 years old and is the second of
  three children in his family.
• Michael who is 13 years old and is an only
  childmight not experience at all

37

• Select the statement below that is true
  regarding the use of Vitamin K (Aquamephyton)
  with a neonate.
• This medication should be administered at the 1
  week check up.
• Vitamin K is light activated and must be placed
  in direct sunlight 1 hour prior to
  administration.
• Vitamin K is administered in the deltoid.
• Vitamin K can precipitate hyperbilirubinemia in
  the newborn.

38

• Select the statement below that is true
  regarding the use of Vitamin K (Aquamephyton)
  with a neonate.
• This medication should be administered at the 1
  week check up. early neonal period
• Vitamin K is light activated and must be placed
  in direct sunlight 1 hour prior to
  administration. ..light sensitive
• Vitamin K is administered in the deltoid. vastis
  lateralis
• Vitamin K can precipitate hyperbilirubinemia in
  the newborn.

39

• A mother calls for assistance in picking a
  formula for her 6 month old. Which of the
  following is her BEST choice?
• Soy-based formula
• Whole milk fortified with iron
• 2 milk
• Iron-fortified formula

40

• A mother calls for assistance in picking a
  formula for her 6 month old. Which of the
  following is her BEST choice?
• Soy-based formula
• Whole milk fortified with iron
• 2 milk
• Iron-fortified formula

41

• The parents of a 10 month old who weighs 38
  pounds are seeking advice regarding a car seat.
  Which of the following is a true statement?
• This child should travel in a semi-reclined
  rear-facing car seat.
• This child should travel in a front-facing car
  seat, strapped into the back seat.
• This child should travel in a toddler booster
  seat.
• This child weighs enough to travel without a car
  seat of any type he just needs to be buckled in
  with the vehicles seat belts.

42

• The parents of a 10 month old who weighs 38
  pounds are seeking advice regarding a car seat.
  Which of the following is a true statement?
• This child should travel in a semi-reclined
  rear-facing car seat. Note that the child must be
  at least one year old to ride in a front-facing
  car seat.
• This child should travel in a front-facing car
  seat, strapped into the back seat.
• This child should travel in a toddler booster
  seat.
• This child weighs enough to travel without a car
  seat of any type he just needs to be buckled in
  with the vehicles seat belts.

43

• The RN is supervising a nursing student who is
  caring for a 4 year old girl. Which scenario
  described below indicates that the student needs
  to review growth and development concepts r/t the
  care of the child?
• The child is allowed to wear her Barbie panties.
• The nursing student sits and listens as the child
  talks to her.
• The nursing student allows the child to play with
  other 4 year olds in the playroom.
• The nursing student encourages the childs
  parents to leave the hospital for the night so
  that the child can become more independent.

44

• The RN is supervising a nursing student who is
  caring for a 4 year old girl. Which scenario
  described below indicates that the student needs
  to review growth and development concepts r/t the
  care of the child?
• The child is allowed to wear her Barbie panties.
• The nursing student sits and listens as the child
  talks to her.
• The nursing student allows the child to play with
  other 4 year olds in the playroom.
• The nursing student encourages the childs
  parents to leave the hospital for the night so
  that the child can become more independent.

45

• Select the nursing interventions below that would
  be appropriate when caring for an 8 year old
  child. Select all that apply
• Encourage the childs parents to stay with the
  child.
• Allow the child to assist with the completion of
  the dietary menu for the next day.
• Facilitate contact with friends from school.
• Allow the child to perform ADLs according to his
  abilities.
• Do not explain procedures, tell the child shortly
  before the procedure is to be performed to
  decrease anxiety.
• Minimize the use of pain control therapies to
  prevent masking of symptoms.

46

• Select the nursing interventions below that would
  be appropriate when caring for an 8 year old
  child. Select all that apply
• Encourage the childs parents to stay with the
  child.
• Allow the child to assist with the completion of
  the dietary menu for the next day.
• Facilitate contact with friends from school.
• Allow the child to perform ADLs according to his
  abilities.
• Do not explain procedures, tell the child shortly
  before the procedure is to be performed to
  decrease anxiety.
• Minimize the use of pain control therapies to
  prevent masking of symptoms.

47

• Which of the following is not a true statement
  about nutrition for an infant?
• An 8 month old can be offered rice cereal.
• Yellow fruits should be the first fruit
  introduced.
• Popcorn can be introduced as a snack food at 6
  months.
• Peanuts should be avoided.

48

• Which of the following is not a true statement
  about nutrition for an infant?
• An 8 month old can be offered rice cereal.solid
  fds introduced at 6 months
• Yellow fruits should be the first fruit
  introduced.yes, rice cereal, then yellow
  fruits/veges, then green
• Popcorn can be introduced as a snack food at 6
  months.choking hazard
• Peanuts should be avoided.choking hazard

49
Elderly
50

• Which of the following assessment findings occur
  as part of the physiological process of aging.
  Select all that apply.
• Skin turgor is elastic.
• The client is unable to remember events that
  occurred yesterday.
• The client is unable to remember events that
  occurred 10 years ago.
• Range of motion is decreased for the upper and
  lower extremities.
• Peripheral pulses are weak.
• Increased need for calories.

51

• Which of the following assessment findings occur
  as part of the physiological process of aging.
  Select all that apply.
• Skin turgor is elastic.
• The client is unable to remember events that
  occurred yesterday.
• The client is unable to remember events that
  occurred 10 years agolong term memory intact
• Range of motion is decreased for the upper and
  lower extremities.
• Peripheral pulses are weak.
• Increased need for caloriesCaloric needs
  decrease

52

• Mrs. M. brings her 85 year old father to the
  emergency room because he suddenly became
  confused and disoriented last night. Each
  alternative below provides a piece of his medical
  history. Which is most likely related to his
  change in mental status?
• history of heart disease
• History of rheumatoid arthritis
• takes Digoxin every day.
• M.D. started him on a new NSAID for arthritis two
  days ago.

53

• Mrs. M. brings her 85 year old father to the
  emergency room because he suddenly became
  confused and disoriented last night. Each
  alternative below provides a piece of his medical
  history. Which is most likely related to his
  change in mental status?
• history of heart disease
• History of rheumatoid arthritis
• takes Digoxin every day.
• M.D. started him on a new NSAID for arthritis two
  days ago.

54
Pediatrics
55

• The parents of a 2 year old are about to purchase
  a vaporizer for their childs room. What
  information described below is most important for
  the nurse to convey to the parents?
• Vaporizers poise a risk of infection if not
  cleaned properly.
• Steam vaporizers are ideal because they optimize
  the distribution of vapor.
• Cool vaporizers should be used instead of steam
  to prevent burn injuries.
• Cool vaporizers are ideal because they optimize
  the distribution of vapor.

56

• The parents of a 2 year old are about to purchase
  a vaporizer for their childs room. What
  information described below is most important for
  the nurse to convey to the parents?
• Vaporizers poise a risk of infection if not
  cleaned properly.
• Steam vaporizers are ideal because they optimize
  the distribution of vapor.
• Cool vaporizers should be used instead of steam
  to prevent burn injuries.
• Cool vaporizers are ideal because they optimize
  the distribution of vapor.

57

• The nurse is caring for a 5 year old admitted
  with a head injury. Which of the following is
  the earliest sign of an increase in intracranial
  pressure?
• Headache
• Diplopia
• Nausea
• Change in the level of consciousness

58

• The nurse is caring for a 5 year old admitted
  with a head injury. Which of the following is
  the earliest sign of an increase in intracranial
  pressure?
• Headache
• Diplopia
• Nausea
• Change in the level of consciousness

59

• Which of the following is the BEST position for a
  child who has a head injury?
• Left side
• Semi-fowlers
• Fowlers
• supine

60

• Which of the following is the BEST position for a
  child who has a head injury?
• Left side
• Semi-fowlers
• Fowlers
• supine

61

• The nurse is caring for a patient who is postop
  placement of a ventriculoperitoneal shunt on the
  left side of his head. How should this child be
  positioned postop?
• Supine, Head of bed elevated 40 degrees.
• Prone, Head of the bed flat.
• Laterally on the left side, head of bed flat.
• Laterally on the right side, head of bed flat.

62

• The nurse is caring for a patient who is postop
  placement of a ventriculoperitoneal shunt on the
  left side of his head. How should this child be
  positioned postop?
• Supine, Head of bed elevated 40 degrees.
• Prone, Head of the bed flat.
• Laterally on the left side, head of bed flat.
• Laterally on the right side, head of bed flat.
  Note that if the HOB is elevated that the shunt
  would drain too quickly initially.

63

• An eight year old diagnosed with conjunctivitis
  is preparing for discharge. Which statement, if
  made by his mother, would indicate the need for
  more teaching?
• His father and I will be careful to not share
  towels with him.
• He can return to school today as long as he
  receives his first dose of medication before
  returning to school.
• Warm compresses will lesson his discomfort.
• He cannot wear contacts until the infection
  clears.

64

• An eight year old diagnosed with conjunctivitis
  is preparing for discharge. Which statement, if
  made by his mother, would indicate the need for
  more teaching?
• His father and I will be careful to not share
  towels with him.
• He can return to school today as long as he
  receives his first dose of medication before
  returning to school.
• Warm compresses will lesson his discomfort.
• He cannot wear contacts until the infection
  clears.

65

• Which of the following is the best method for
  administering ear drops to a 2 year old?
• Position the child side-lying with the affected
  ear up, administer the drops directly into the
  ear.
• Position the child prone, pull the pinna up and
  back.
• Sit the child in the mothers lap, pull the pinna
  toward the back of the head.
• Pull the pinna down and back.

66

• Which of the following is the best method for
  administering ear drops to a 2 year old?
• Position the child side-lying with the affected
  ear up, administer the drops directly into the
  ear.
• Position the child prone, pull the pinna up and
  back.
• Sit the child in the mothers lap, pull the pinna
  toward the back of the head.
• Pull the pinna down and back.

67

• A 4 year old child and his mother have received
  discharge instructions post surgical placement of
  tympanoplasty tubes. Which statement below, if
  made by the mother, indicates that further
  teaching is necessary?
• He must wear earplugs when I wash his hair.
• He can go swimming this summer if he wears
  earplugs.
• I have to be careful to not get water in his ears
  for the next 6 months.
• He cannot swim on the bottom of the pool even
  with his earplugs in.

68

• A 4 year old child and his mother have received
  discharge instructions post surgical placement of
  tympanoplasty tubes. Which statement below, if
  made by the mother, indicates that further
  teaching is necessary?
• He must wear earplugs when I wash his hair.
• He can go swimming this summer if he wears
  earplugs.
• I have to be careful to not get water in his ears
  for the next 6 months.
• He cannot swim on the bottom of the pool even
  with his earplugs in.

69

• What is the drug of choice for a child who has
  had a tonsillectomy and is experiencing a sore
  throat postop?
• Advil
• Aspirin
• Codeine
• Tylenol

70

• What is the drug of choice for a child who has
  had a tonsillectomy and is experiencing a sore
  throat postop?
• Advil
• Aspirin
• Codeine
• Tylenol

71

• The RN is caring for a child who is 4 hours
  postop tonsillectomy. Which of the following
  actions indicate that this nurse needs further
  review regarding the postop care of this type
  patient?
• Select All that apply
• The child is positioned prone.
• The child is allowed to drink cool milk.
• The child is not allowed to use straws.
• The child is allowed to drink room temperature
  cherry Kool-Aid.
• The childs vital signs are assess every 4 hours
  as ordered by the MD.

72

• The RN is caring for a child who is 4 hours
  postop tonsillectomy. Which of the following
  actions indicate that this nurse needs further
  review regarding the postop care of this type
  patient?
• Select All that apply
• The child is positioned proneor sidelying
• The child is allowed to drink cool milk.
• The child is not allowed to use strawsno straws,
  forks, sharp objects
• The child is allowed to drink room temperature
  cherry Kool-AidRed liquid
• The childs vital signs are assess every 4 hours
  as ordered by the MDmonitoring for s/s of
  infection

73

• Which of the following calls should the RN return
  first?
• The parent describes the childs cough as
  sounding like a seal.
• The child is 72 postop tonsillectomy and
  continues to refuse fluids because her throat
  hurts.
• The child has had an upper respiratory infection
  for 2 days and now has a temp of 101 degrees F.
  and is complaining of an earache.
• The child has clear drainage from the left eye,
  the eye is red, and the child complains that it
  itches.

74

• Which of the following calls should the RN return
  first?
• The parent describes the childs cough as
  sounding like a seal.
• The child is 72 postop tonsillectomy and
  continues to refuse fluids because her throat
  hurts.
• The child has had an upper respiratory infection
  for 2 days and now has a temp of 101 degrees F.
  and is complaining of an earache.
• The child has clear drainage from the left eye,
  the eye is red, and the child complains that it
  itches.

75

• Which of the following is a true statement
  regarding Tuberculosis?
• If the Mantoux test is negative 1 week after
  exposure then the individual was not infected.
• A definitive diagnosis of Tuberculosis is made
  with a positive Chest X-ray.
• A child infected with Tuberculosis will most
  likely be required to take isoniazid, rifampin,
  and pyrazinamide daily for 2 months.
• Children infected with Tuberculosis are placed on
  airborne precautions until the medication regime
  has been completed.

76

• Which of the following is a true statement
  regarding Tuberculosis?
• If the Mantoux test is negative 1 week after
  exposure then the individual was not infected 2
  -10 weeks
• A definitive diagnosis of Tuberculosis is made
  with a positive Chest X-ray. Positive sputum
  culture
• A child infected with Tuberculosis will most
  likely be required to take isoniazid, rifampin,
  and pyrazinamide daily for 2 months.
• Children infected with Tuberculosis are placed on
  airborne precautions until the medication regime
  has been completed. meds initiated, sputum
  cultures demo improvement, cough improves

77

• The nurse continues to monitor a 5 year old who
  is admitted because of an acute exacerbation of
  her asthma. Which assessment finding below would
  necessitate an immediate intervention?
• Wheezing is not heard on auscultation.
• Lips are dark red.
• Episodes of coughing occur with minimal exertion.
• Percussion of the lower chest reveals
  hyperresonance.

78

• The nurse continues to monitor a 5 year old who
  is admitted because of an acute exacerbation of
  her asthma. Which assessment finding below would
  necessitate an immediate intervention?
• Wheezing is not heard on auscultation.
• Lips are dark red.
• Episodes of coughing occur with minimal exertion.
• Percussion of the lower chest reveals
  hyperresonance.

79

• The MD has prescribed chest physiotherapy ad lib
  for a child who is experiencing an acute
  asthmatic episode. When should this therapy be
  begun?
• Immediately
• During an acute episode of coughing
• After an acute episode of coughing
• After the symptoms of the acute episode have
  diminished and the child is improving.

80

• The MD has prescribed chest physiotherapy ad lib
  for a child who is experiencing an acute
  asthmatic episode. When should this therapy be
  begun?
• Immediately
• During an acute episode of coughing
• After an acute episode of coughing
• After the symptoms of the acute episode have
  diminished and the child is improving.

81

• A child with cystic fibrosis has been admitted to
  the pediatric unit. Which assessment finding(s)
  below would be consistent with this diagnosis?
• Clubbing of the toes.
• Multiple bruises over the arms and legs.
• Steatorrhea.
• Negative Sweat Chloride test.
• Signs/symptoms of emphysema.
• Brisk refill of the nail beds of the fingers.

82

• A child with cystic fibrosis has been admitted to
  the pediatric unit. Which assessment finding(s)
  below would be consistent with this diagnosis?
• Clubbing of the toes. chronic hypoxia
• Multiple bruises over the arms and legs.
  Deficiency of fat-soluble vitamins (ADEK)
• Steatorrhea. .deficiency of fat-soluble vitamins
  frothy, foul-smelling
• Negative Sweat Chloride test.
• Signs/symptoms of emphysema. thick secretions
  obstruct airway trap air
• Brisk refill of the nail beds of the fingers.

83

• The RN is caring for an infant who is
  experiencing the following signs/symptoms HR
  200, R 92, scalp sweating, suprasternal
  retractions. Which intervention listed below is
  indicated in the care of this infant?
• Assess carotid pulse every 30 minutes.
• Weigh diapers.
• Position the infant supine with head of bed in
  high-fowlers.
• Awaken the infant every hour for neuro checks.

84

• The RN is caring for an infant who is
  experiencing the following signs/symptoms HR
  200, R 90, scalp sweating, suprasternal
  retractions. Which intervention listed below is
  indicated in the care of this infant?
• Assess carotid pulse every 30 minutes. apical
  pulse, count for full minute
• Weigh diapers. I and O
• Position the infant supine with head of bed in
  high-fowlers. semi-fowlers
• Awaken the infant every hour for neuro checks.
  Needs periods of uninterrupted sleep
• Infant has signs of CHF

85

• A student nurse is preparing to administer
  Digoxin to an infant. Which of the following
  would indicate that this student needs further
  teaching regarding this drug?
• The student questions the MDs prescribed dosage
  of 5 mg.
• The medication is administered 60 minutes ac.
• Oral care is performed immediately post
  medication administration.
• The student nurse notes that she is 5 hours late
  administering this medication. She administers
  the medication and changes the time for the next
  dosage.

86

• A student nurse is preparing to administer
  Digoxin to an infant. Which of the following
  would indicate that this student needs further
  teaching regarding this drug?
• The student questions the MDs prescribed dosage
  of 5 mg . 0.05mg normal infant dose
• The medication is administered 60 minutes ac.
• Oral care is performed immediately post
  medication administration.
• The student nurse notes that she is 5 hours late
  administering this medication. She administers
  the medication and changes the time for the next
  dosage. skip missed dose if over 4 hours late

87
Cardiac Defects

• Increased Pulmonary Blood Flow (ASD, VSD,
  Atrioventircular canal defect, Patent ductus)s/s
  CHF
• Obstructive Defects (Coarctation of the aorta,
  Aortic Stenosis, Pulmonary Stenosis) s/s CHF
• Decreased Pulmonary Blood Flow (ASD, VSD,
  Tetralogy of Fallot, Tricuspid atresia, ).s/s
  hypoxemia, cyanosis
• Mixed Defects (Transposition, etc.)

88

• The RN is supervising the feeding of an infant
  with a cleft palate. Which behavior, if observed
  below, would necessitate an intervention by the
  nurse?
• The opening of the nipple is enlarged.
• The child is positioned in high Fowlers position
  for the feeding.
• The child is fed small amounts and then burped
  every 5-10 minutes.
• The child is positioned prone after the feeding.

89

• The RN is supervising the feeding of an infant
  with a cleft palate. Which behavior, if observed
  below, would necessitate an intervention by the
  nurse?
• The opening of the nipple is enlarged.
• The child is positioned in high Fowlers position
  for the feeding.
• The child is fed small amounts and then burped
  every 5-10 minutes.
• The child is positioned prone after the feeding.

90

• The RN is assessing the lunch tray that has been
  prepared for a child with Celiac Disease. Which
  of the following trays would be suitable for this
  child?
• Cheeseburger on whole wheat bun, fruit salad,
  glass of milk.
• Fish fillet, french fries, sliced cantaloupe,
  chocolate milkshake.
• Spaghetti with meat sauce, watermelon, ice cream,
  glass of orange juice.
• Chicken leg, corn on the cob, apple, glass of
  milk.

91

• The RN is assessing the lunch tray that has been
  prepared for a child with Celiac Disease. Which
  of the following trays would be suitable for this
  child?
• Cheeseburger on whole wheat bun, fruit salad,
  glass of milk. bun with cheeseburger
• Fish fillet, french fries, sliced cantaloupe,
  chocolate milkshake. ...french fries, milkshake
  not sure
• Spaghetti with meat sauce, watermelon, ice cream,
  glass of orange juice. .. spaghetti, ice cream.
• Chicken leg, corn on the cob, apple, glass of
  milk.

92

• Which of the following is a true statement about
  Phenylketonuria?
• All newborns should be screened before they have
  begun formula or breast milk feedings.
• If initial screening is positive, dietary
  restrictions are implemented immediately.
• If the initial screening was before the child was
  48 hours old, the child should be rescreened in 2
  weeks.
• Individuals with Phenylketonuria cannot eat
  fruits.

93

• Which of the following is a true statement about
  Phenylketonuria?
• All newborns should be screened before they have
  begun formula or breast milk feedings.not true.
  The newborn should be on full feed for 24 hrs
  before the initial screening.
• If initial screening is positive, dietary
  restrictions are implemented immediately. Note
  that an initial positive screening would mandate
  further evaluation.
• If the initial screening was before the child was
  48 hours old, the child should be rescreened in 2
  weeks.
• Individuals with Phenylketonuria cannot eat
  fruits. fruits no protein
• PKU now is part of a Metabolic Panel or the
  Newborn Screen.

94

• The 13 year old girl in room 411 has been
  admitted in sickle cell crisis. Which of the
  following does the RN anticipate as part of her
  prescribed plan of care?
• Minimize the use of prn pain medication as these
  drugs can be addictive.
• Limit fluid intake to 200 ml/shift.
• Position the child so that she is in a
  comfortable position with extremities extended.
• Assist the child to select dietary items that are
  low-calorie, low protein..

95

• The 13 year old girl in room 411 has been
  admitted in sickle cell crisis. Which of the
  following does the RN anticipate as part of her
  prescribed plan of care?
• Minimize the use of prn pain medication as these
  drugs can be addictive.
• Limit fluid intake to 200 ml/shift.
• Position the child so that she is in a
  comfortable position with extremities extended.
• Assist the child to select dietary items that are
  low-calorie, low protein..

96

• Which of the following is a true statement
  regarding the administration of iron supplements?
• Iron supplements should be taken with fruit
  juices.
• Iron supplements should be taken with milk.
• Liquid iron supplements should be administered
  via a nasogastric tube.
• Iron supplements should be administered with
  meals.

97

• Which of the following is a true statement
  regarding the administration of iron supplements?
• Iron supplements should be taken with fruit
  juices. Vit. C
• Iron supplements should be taken with milk.
  Calcium interferes with absorption
• Liquid iron supplements should be administered
  via a nasogastric tube. not needed
• Iron supplements should be administered with
  meals. between meals

98

• Medication B 5 mg/kg/day is prescribed PO BID
  for Little Lisa. Lisa weighs 44 pounds.
  Calculate Lisas AM dose if the medication is
  supplied in a 10mg/ml solution.
• First calculation mg/day.
• 5 mg/1kg x mg to a child who weighs 44 pounds.
• 5 mg/1kg x mg /20 kg cross multiply 100
  mg/day

99

• Medication B 5 mg/kg/day is prescribed PO BID
  for Little Lisa. Lisa weighs 44 pounds.
  Calculate Lisas AM dose if the medication is
  supplied in a 10 ml/ml solution.
• Next calculate mg/dose. 100 mg divided by
  doses in 24 hours 50 mg/dose.

100

• Medication B 5 mg/kg/day is prescribed PO BID for
  Little Lisa. Lisa weighs 44 pounds. Calculate
  Lisas AM dose if the medication is supplied in a
  10 mg/ml solution.
• First calculation mg/day.
• 5 mg/1kg x mg to a child who weighs 44 pounds.
• 5 mg/1kg x mg /20 kg cross multiply 100
  mg/day
• Next calculate mg/dose. 100 mg divided by
  doses in 24 hours 50 mg/dose.
• Finally calculate ml to administer 50 mg/x ml
  10 mg/ml solution. 5 ml.

101

• Larry weighs 22 lbs and is to receive Drug W QID.
  The proper dosage is 20 mg/kg/day. Calculate
  his per dose dosage if the medication is supplied
  as an 10 mg/ml solution.

102

• Larry weighs 22 lbs and is to receive Drug W QID.
  The proper dosage is 20 mg/kg/day. Calculate
  his per dose dosage if the medication is supplied
  as an 10 mg/ml solution.
• Mg/day (22 lbs/x kg 2.2 lbs\1 kg. 10 kg)
• 20mg/1 kg x mg\10 kg. 200 mg/day.
• Mg/dose
• 200 divided by 4 50 mg/dose.

103

• Larry weighs 22 lbs and is to receive Drug W QID.
  The proper dosage is 20 mg/kg/day. Calculate
  his per dose dosage if the medication is supplied
  as an 10 mg/ml solution.
• 50 mg/x ml 10 mg/1ml
• 5 ml

104

• Which of the following would be the most
  appropriate meal for a child with HIV or AIDS?
• Baked chicken, green beans, apple
• Roast Beef, fruit salad, water
• Cheeseburger, cheese fries, milkshake.
• Salad with low calorie dressing, cantaloupe,
  water.

105

• Which of the following would be the most
  appropriate meal for a child with HIV or AIDS?
• Baked chicken, green beans, apple
• Roast Beef, fruit salad, water
• Cheeseburger, cheese fries, milkshake.
• Salad with low calorie dressing, cantaloupe,
  water.

High calorie, high protein
106

• The parents of a child with HIV have just
  completed an educational seminar on caring for a
  child with HIV. Which statement, if made by the
  parents, indicates that they understand this
  material?
• Well keep her home from school when shes
  sick.
• Her eating utensils will have to be soaked in
  bleach for 15 minutes after use.
• She should receive the vaccine for varicella
  (chickenpox).
• We can never kiss our child.

107

• The parents of a child with HIV have just
  completed an educational seminar on caring for a
  child with HIV. Which statement, if made by the
  parents, indicates that they understand this
  material?
• Well keep her home from school when shes
  sick.
• Her eating utensils will have to be soaked in
  bleach for 15 minutes after use. ..dishwasher
  OK
• She should receive the vaccine for varicella
  (chickenpox). no, do not give live vaccines
  without clarification of childs
  immunosuppressent status. Live vaccines
  varicella and MMR. Polio OK (not a live
  vaccine). keep others UTD
• We can never kiss our child. ..not on mouth

108

• A child who is immediately postop removal of a
  supratentorial brain tumor should be place in
  which of the following positions?
• Lateral on the unoperative side, HOB flat.
• Lateral on the operative side, HOB flat.
• Lateral on the unoperataive side, HOB 20 degrees
  elevated.
• Lateral on the operative side, HOB 20 degrees
  elevated.

109

• A child who is immediately postop removal of a
  supratentorial brain tumor should be place in
  which of the following positions?
• Lateral on the unoperative side, HOB flat.
• Lateral on the operative side, HOB flat.
• Lateral on the unoperataive side, HOB 20 degrees
  elevated.
• Lateral on the operative side, HOB 20 degrees
  elevated.

110

• The child in bed 2 is postop removal of a
  brainstem tumor. Which of the following
  represents the BEST position for this patient?
• Supine, HOB elevated 45 degrees
• Lateral, HOB elevated 20 degrees
• Sims position, HOB elevated 90 degrees
• Lateral, HOB flat.

111

• The child in bed 2 is postop removal of a
  brainstem tumor. Which of the following
  represents the BEST position for this patient?
• Supine, HOB elevated 45 degrees
• Lateral, HOB elevated 20 degrees
• Sims position, HOB elevated 90 degrees
• Lateral, HOB flat.