NCLEX Practice Questions — Set 25
How to use this set
Run it as a timed block rather than dipping in and out. 100 items at roughly a minute each is close to the pace the real exam asks for, and pacing is a skill that only improves under a clock. Answer every item before you open a single rationale — checking as you go turns a test into a reading exercise and hides the questions you were unsure about.
These sets are numbered rather than sorted by subject. The questions come from a general NCLEX bank that carries no topic field, and labelling them by eye would put a share of them under the wrong heading, so they are presented as mixed sets — which is how the exam itself arrives.
The 100 questions
A mother brings an 8-month-old infant into the health clinic. An examination reveals that the infant’s height and weight are below the fifth percentile, skin is dry and wrinkled, the abdomen protrudes, and muscle wasting is evident. The most appropriate nursing diagnosis for this child at this time would be
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Correct answer: A. failure to thrive related to unknown causes.
A diagnosis of failure to thrive is an appropriate nursing diagnosis for an 8-month-old infant who falls below the fifth percentile, and has dry and wrinkled skin, a protruding abdomen, and muscle wasting. Although a child with diarrhea may have the clinical manifestations of failure to thrive, diarrhea is not a presenting manifestation. Diarrhea is a diagnosis in itself, but may be a defining characteristic of imbalanced nutrition.
An infant, who has had a cleft palate repair, is positioned side-lying or on the back. The rationale for this positioning is that it
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Correct answer: C. promotes drainage.
After surgery for a cleft lip and palate repair, increased salivation is expected and aspiration is a potential complication. Positioning the child in a side-lying position maintains an open airway and facilitates drainage. The suture line is usually not observed unless bleeding is suspected. The rationale for the side-lying is to maintain a patent airway and promote drainage, which in turn will relieve anxiety. Prone position is not suggested as a means to facilitate feeding unless the medical condition prevents any other positioning.
The mother of an infant who has had a cleft lip repair tells the nurse that the physician said it was very important not to let the baby cry and wants to know why. Which of the following is the appropriate response by the nurse? "Crying
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Correct answer: D. stresses the sutures."
Crying stretches the facial muscles, especially those around the lips, which stresses the suture line and leads to potential separation of the incision site following a cleft lip and repair. Impairment of breathing and gagging are more of an issue with cleft palate. Scarring occurs as a result of suture line crusting and tissue trauma from rubbing.
Which of the following interventions is a priority for the nurse to implement in the postoperative care of a child with a cleft lip repair?
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Correct answer: D. Assess for edema of the tongue, lips, and mucous membranes
Trauma to the mucous membranes of the mouth that occurs with a cleft lip repair causes edema, leading to the respiratory distress and potential closing of the airway. Trauma to the suture line would occur in the prone position. Familycentered care is very important; because the parents can help calm the child, their visits are not limited. Elbow restraints, not blankets, are used to keep the child’s hands away from the suture line.
Which of the following is the first intervention to include in the initial postoperative care of an infant following a bilateral cleft lip and palate repair?
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Correct answer: B. Clean the suture line to prevent formation of crusts
Crusting of the suture line following a bilateral cleft lip and palate repair can lead to scarring and uneven closure of the incision. The child is not kept NPO and can take oral feedings when fully awake from anesthesia. Only the elbows are restrained to protect the suture line and only analgesics are used to control the pain.
Ongoing nursing measures for the infant with a tracheoesophageal fistula (TEF) include
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Correct answer: D. observing respiratory status.
Because the fistula links the trachea and esophagus, acidic substances from the gastrointestinal tract can irritate the pulmonary system. Aspiration can occur from any secretions in the oropharyngeal cavity. There is no evidence of infection. Close observation of respiratory status is critical. The child is NPO until after surgical repair, because of the risk for aspiration.
When planning the care of an infant suspected of having a tracheoesophageal fistula (TEF), it is critical for the nurse to
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Correct answer: A. hold all feedings.
In a tracheoesophageal fistula, the fistula forms an open connection between the trachea and esophagus. Because the client can aspirate anything entering the oral cavity, the goal of treatment is to prevent aspiration.
When evaluating the assessment data of a preterm infant who has bloody stools, apnea, and bradycardia, the nurse should suspect
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Correct answer: B. necrotizing enterocolitis (NEC).
In necrotizing enterocolitis (NEC), the bowel is perforated as a result of necrosis, causing blood loss. Apnea and bradycardia are secondary to the hemorrhaging. The clinical manifestations are not always specific. Apnea and a low hematocrit are consistent with bleeding in the ventricles of the brain. Central apnea without hemorrhaging is expected with meconium aspiration. Evidence is not present for esophageal atresia.
A mother who brings a 6-week-old infant into the clinic reports that the baby has been spitting up for about 3 weeks. The vomitus has become more frequent and projectile since yesterday. In reviewing the child’s record, the nurse notes that the child has gained only 1�pound since birth and suspects that the child may have pyloric stenosis. Which of the following assessment findings would confirm a diagnosis of pyloric stenosis?
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Correct answer: B. Immediate postfeeding vomiting
In pyloric stenosis, the circular muscle of the pylorus thickens, causing constriction and obstruction of the gastric outlet. Projectile vomiting immediately after feeding is a cardinal indicator of pyloric stenosis. Bilestained vomitus is not expected since bile is passed through the pyloric valve. Fever is an indication of an infection and is not usually seen with pyloric stenosis. With pyloric stenosis, a child will usually eat immediately after vomiting if a feeding is offered.
Which of the following is the nurse’s priority in the plan of care for a child admitted with pyloric stenosis?
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Correct answer: C. Evaluate fluid status
Fluid and electrolyte imbalance is a problem because of the loss of gastric secretions and poor nutrition secondary to projectile vomiting in pyloric stenosis. Respiratory status and perfusion may be affected by severe imbalance, making it a priority to evaluate fluid status. Thermoregulation is not an issue with pyloric stenosis. Altered perfusion is a result of altered fluid balance.
A priority nursing diagnosis in the care of a child with pyloromyotomy is
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Correct answer: A. fluid deficit related to loss of gastric secretions.
The priority nursing diagnosis following a pyloromyotomy is fluid status, because the loss of gastric secretions can lead to more serious dysfunction of the respiratory and cardiac systems. Tissue trauma is important but is not a priority at this time. The child is not placed NPO without maintaining nutritional status by parenteral fluids until the child is able to take nutrition by mouth. Mucous membrane irritation secondary to vomiting usually does not lead to ineffective breathing.
The parents of a child with Hirschsprung’s disease ask the nurse what the expected treatment is. Which of the following is the most appropriate response by the nurse?
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Correct answer: A. "The affected bowel segment will be surgically removed."
Hirschsprung’s disease, a congenital aganglionic megacolon, is a motility disorder of the bowel caused by the absence of parasympathetic ganglion cells in the large intestine. Feces accumulate proximal to the defect. The aganglionic segment must be removed to enable peristalsis to return, producing normal evacuation of fecal material. Antibiotic enemas are only given prior to surgery to reduce the intestinal flora. The colostomy is temporary, to allow the colon to rest before resection.
The nurse caring for a child with Hirschsprung’s disease documents the stools to have what characteristic appearance?
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Correct answer: C. Ribbonlike
Ribbonlike stool is characteristically seen with Hirschsprung’s disease. Tarry and tenacious stools would be related to high gastrointestinal bleeding. Currant jellylike stools are related to the presence of blood and mucus seen with intussusception. Frothy and foul-smelling stool would indicate cystic fibrosis.
When preparing a child with probable intussusception for a hydrostatic reduction procedure, the nurse should explain which of the following aspects of the procedure? The procedure will
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Correct answer: C. blow air into a cavity of the bowel.
Intussusception occurs when one segment of the bowel telescopes into the lumen of an adjacent segment of intestine. The purpose of the hydrostatic reduction procedure is to pull the invaginated bowel out from another section of bowel, allowing normal fecal material to pass. The procedure uses barium or air insufflation; air insufflation is considered to be safer than barium insufflation. The procedure will not empty the bowel completely nor relax it. The currant jelly stools will stop when the bowel is no longer irritated.
Which of the following should the nurse perform to minimize reflux in a 4-month-old infant who has gastroesophageal reflux without other complications?
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Correct answer: B. Thicken formula with rice cereal
Gastroesophageal reflux is the reflux of the gastric contents into the lower portion of the esophagus through the lower esophageal sphincter. Thickened formula decreases acid reflux and increases the emptying time of the stomach. Reflux precautions include positioning the child supine or on the right side with head elevated. Continuous NG feedings are not necessary because the child can tolerate bolus feedings. To reduce the reflux process, small, frequent feedings are more appropriate than three large meals.
While assisting another nurse with the postoperative care of neonate with an omphalocele repair, the nurse explains that it is a priority to monitor which of the following?
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Correct answer: C. Respiration
An omphalocele is a congenital malformation that results from a failure of the intestines to reenter the abdominal cavity at approximately 7 weeks of gestation. The defect, which permits the abdominal contents to herniate through the abdominal cavity, is located centrally and includes the umbilical cord. Surgical intervention is the treatment of choice. Once the abdominal contents have been replaced into the peritoneal cavity, the organs place pressure on the diaphragm, which can lead to respiratory compromise. Decreased cardiac output, altered hemodynamics, and congestive heart failure occur secondary to a respiratory compromise.
The triage nurse in the emergency department is evaluating the following four clients. Which client is the priority and a surgical emergency?
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Correct answer: C. A child with malrotation/volvulus
Malrotation is an incomplete rotation of the midgut during the period of fetal development when the gut returns from the umbilical pouch to the abdominal cavity. With this condition, the bowel fails to rotate normally as it returns to the abdominal cavity and obstructs blood flow to the mesentery organs. This leads to bowel death and necrosis, which is not compatible with life. Malrotation is considered a surgical emergency. Gastroschisis is a congenital malformation where a defect in the abdominal wall allows a segment of the�abdominal contents to herniate outside the abdominal cavity. Although surgery is the�recommended treatment, it is not a priority. Hypertrophic pyloric stenosis involves a hypertrophic pyloric sphincter generally with a width four times normal that results in a narrow opening and gastric outlet obstruction. A pyloromyotomy is the surgical repair but not an emergency. Celiac disease is a glutensensitive enteropathy in which there is a permanent intolerance to gluten. Treatment involves providing a gluten-free diet.
Which of the following serum bilirubin levels supports a diagnosis of pathologic jaundice?
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Correct answer: A. An increase of 5 mg/dl or greater in 24 hours
Pathologic jaundice is present when serum bilirubin exceeds 15 mg/dl at any time. Jaundice appears within the first 24 hours and is diagnosed when the serum bilirubin concentration in cord blood is greater than 4�mg/dl and there is an increase of 5 mg/dl or greater in 24 hours.
Which of the following nursing actions takes priority in the plan of care for an infant receiving phototherapy?
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Correct answer: B. Provide opportunities for parent-infant interaction
Phototherapy is the use of high-intensity fluorescent lights as a way of reducing serum bilirubin levels to prevent kernicterus. Although the infant needs to stay under phototherapy, the infant can be removed for brief periods that should not last longer than 30�minutes. Because phototherapy interrupts parent-infant attachment during the first few days of life, it is considered very stressful for the child and family. Encouraging all opportunities for parent-infant interaction is the priority.
Which of the following in a newborn’s assessment should be reported as a critical sign of an imperforate anus?
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Correct answer: C. The infant has not passed a meconium stool in the first 48 hours
An imperforate anus is an anorectal condition in which there is no obvious anal opening. A�meconium stool is expected to pass within 48�hours after the neonate’s birth. A rectal temperature would be indicative of a patent anus. Urine output is not indicative of an imperforate anus. A family history of congenital defects is not usually associated with an imperforate anus.
The registered nurse is making the day’s clinical assignments for a pediatric unit. Which of the following clinical assignments would be most appropriate to delegate to a licensed practical nurse?
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Correct answer: A. A child with celiac disease
A volvulus is a complication of malrotation. It occurs when an incompletely rotated bowel twists on itself. This leads to arterial obstruction, ischemia, and necrosis and is a surgical emergency. Short bowel syndrome is a condition that results from surgical resection of the intestine in cases of volvulus, Crohn’s disease, or necrotizing enterocolitis. There is an inadequate surface area of the small intestine. Treatment focuses on maintaining optimal nutrition. This usually involves administration of total parenteral nutrition by a central line and enteral feeding by a nasogastric or gastrostomy tube, which require the skills of a registered nurse. Esophageal atresia and tracheoesophageal fistula generally occur together when the esophagus is incomplete and terminates before it reaches the stomach. After preventing aspiration pneumonia, treatment generally requires surgery and neonatal intensive care, which require the skills of a registered nurse. Celiac disease is a glutensensitive enteropathy caused by a permanent intolerance to gluten. Control involves medical management and control through a gluten-free diet. The licensed practical nurse can assist a child and parents of a child with celiac disease to select foods free of gluten.
The nurse is caring for a preterm neonate who has necrotizing enterocolitis. Which of the following is a clinical manifestation that this infant’s condition is deteriorating?
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Correct answer: D. Hypotension
Necrotizing enterocolitis is a necrosis of the mucosa of the small and large intestine generally in preterm neonates. Classical features include abdominal tenderness and distention, bloody stools, decreased bowel sounds, increased gastric residuals, erythema of the abdominal wall, and bilious vomiting after feeding. Clinical manifestations of deterioration include bradycardia, apnea, lethargy, temperature instability, decreased urine output, and evidence of shock. A late deteriorating sign is hypotension.
The nurse is reviewing the diagnostic criteria in a child with necrotizing enterocolitis. Which of the following findings is indicative of severe disease and perforation of the bowel?
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Correct answer: C. Pneumoperitoneum
Necrotizing enterocolitis is a necrosis of the mucosa of the small and large intestine. Radiographic findings found in necrotizing enterocolitis include dilated bowel loops and pneumatosis intestinalis. Pneumoperitoneum or free air in the peritoneal cavity or portal circulation indicates severe disease and perforation of the bowel. Deep crypts on the intestinal mucosa are found in celiac disease.
The nurse is caring for a child with inflammatory bowel disease. Which of the following should the nurse include in the plan of care?
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Correct answer: D. Provide the child with increased calories
Inflammatory bowel disease (IBD) consists of ulcerative colitis and Crohn’s disease because of an inflammation or ulceration of the small and large intestine. A gluten-free diet is the diet of choice with celiac disease. Although some children with inflammatory bowel disease poorly tolerate lactose, there is no special diet for IBD. Omeprazole (Prilosec) is a proton pump inhibitor used in the treatment of peptic ulcers. The goal of nutritional therapy is to replace nutrients and increase calories in the diet to maintain normal metabolic functions. Melena or black tarry stools occur in peptic ulcer disease.
Which of the following should the nurse include in the nursing assessment of the endocrine system in a child?
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Correct answer: B. Family health history
The family health history is important, as many endocrine disorders run in families. The number of pets, calcium intake, and history of streptococcus infection are not specifically relevant to the endocrine system.
A nurse is caring for a client with short stature from a growth hormone (GH) deficiency. Which of the following measures would be essential to include in the child’s plan of care?
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Correct answer: D. Monitor linear growth
Growth hormone deficiency is an endocrine disorder in which there is a poor growth in stature as a result of a failure of the pituitary to produce sufficient growth hormone. Linear growth is monitored to evaluate the need for medication prior to treatment and the effectiveness of medication during treatment. Bruising and weight control are not part of growth hormone deficiency. Monitoring milk intake is part of a normal healthy diet in children and not just in growth hormone deficiency.
Which of the following children being cared for by the nurse is in need of treatment for precocious puberty?
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Correct answer: C. An 8-year-old boy with secondary sex characteristics
The development of secondary sex characteristics in boys before age 9 years is abnormal and in need of treatment for precocious puberty. A 10-year-old Caucasian girl with beginning breast development, an 8-year-old African-American girl with breast development, and a 10-year-old boy with beginning pubic hair are considered within the normal range. Precocious puberty is defined as breast development occurring in Caucasian girls before 7 years of age and before 6 years of age in African-American girls. Children with precocious puberty have accelerated growth rates, develop secondary sex characteristics earlier than normal, and exhibit advanced bone age, acne, body odor, and some behavioral changes. Psychosocial development is generally age appropriate.
Which of the following instructions is most appropriate for the nurse to give the parents of a child with diabetes insipidus?
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Correct answer: C. Technique for administering desmopressin acetate (DDAVP)
Desmopressin acetate (DDAVP) is the drug of choice for the child with diabetes insipidus. It is a synthetic antidiuretic hormone that acts to increase the absorption of water in the kidney. It is important that the parents learn how to administer the drug intranasally or orally. Diabetes insipidus is a disorder of water regulation in which there is a deficiency of the antidiuretic hormone. Urine dipstick and insulin administration would be used by parents of a child with diabetes mellitus. Home safety is important for all children.
The nurse is caring for a 10-year-old child who has been diagnosed with acquired hypothyroidism. The parents ask the nurse for information on the disorder. Which of the following should the nurse include in the information given to the parents?
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Correct answer: C. A thyroid replacement drug will be given
Acquired hypothyroidism is an endocrine disorder that generally has an autoimmune cause. It is associated with weight gain, hypothyroidism, and constipation. Thyroid replacement medication must be taken daily.
The nurse is assessing a child’s thyroid status. Which of the following assessment findings should the nurse document as a subjective finding?
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Correct answer: B. Fatigue
A subjective finding is something the client tells the nurse. An objective finding is one the nurse detects through evaluative procedures. Fatigue, something felt and described by the child, is a subjective finding. Weight loss, hypertension, and tachycardia are all objective findings.
The nurse is caring for a child with Cushing’s syndrome. Which of the following should the nurse include in the plan of care?
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Correct answer: C. Encourage a diet low in sodium
Hypertension is common in a child with Cushing’s syndrome due to sodium retention, so limiting the salt intake will help control blood pressure. Weight gain is common, and a high-carbohydrate intake would contribute to weight gain. Premature puberty is not part of Cushing’s syndrome because growth is slowed.
The nurse is working with the parents of a newborn with ambiguous genitalia due to congenital adrenal hyperplasia (CAH). Which of the following instructions should the nurse provide the parents?
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Correct answer: B. An assignment of sex may be delayed
Congenital adrenal hyperplasia is a group of inherited disorders characterized by a deficiency of an enzyme essential for the synthesis of cortisol and occasionally aldosterone. Ambiguous genitalia are difficult for parents to adjust to and accept. The process of gender selection is controversial, which is stressful for the family, and an assignment of sex may be delayed. There is no heat intolerance with congenital adrenal hyperplasia; heat intolerance occurs with hyperthyroidism.
When planning the education for the parents of a child with type 1 diabetes mellitus, which of the following should the nurse include?
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Correct answer: C. Rotate insulin injection sites
Rotation of injection sites is one of the most important things to teach a child with type 1 diabetes mellitus. Rotating the site allows for the best absorption and most accurate dosing of insulin. Blood sugar testing is often one of the earliest skills a child with type 1 diabetes mellitus acquires. A high-carbohydrate diet would contribute to an elevated blood sugar level. Activity is important in the treatment and management of diabetes.
The nurse is admitting a child with suspected type 1 diabetes mellitus. Which of the following questions should the nurse ask the parents?
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Correct answer: A. "Has the child experienced nocturia or bedwetting?"
Frequent urination (polyuria) is one of the classic clinical manifestations of diabetes mellitus, along with increased appetite (polyphagia) and increased thirst (polydipsia). Weight loss is also common in children.
Which of the following is a priority for the nurse to include in the discharge instructions for the family of a child with type 2 diabetes?
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Correct answer: C. Daily blood sugar and ketone testing
In type 2 diabetes mellitus, the pancreas still produces some insulin. However, the body is unable to use the insulin effectively and is unable to produce enough insulin to lower the glucose. Type 2 diabetes can usually be managed with an oral hypoglycemic agent, exercise, diet, and home glucose monitoring. Testing of blood sugar and ketone levels is the priority and basis for all care for children with diabetes. Recognition of complex blood sugar patterns, carbohydrate counting, and changes the family needs to make are important but not the priority.
Which of the following statements by a child with type 2 diabetes mellitus indicates a lack of understanding about the disease and a need for further instructions?
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Correct answer: A. "I will take my injections of insulin on time."
Because the pancreas still produces some insulin in type 2 diabetes mellitus, it is generally managed with oral hypoglycemic drugs and lifestyle changes such as a healthy diet, regular exercise, carbohydrate counting, and avoidance of high-calorie junk food.
The parents of a child with newly diagnosed type 2 diabetes mellitus want to know more about the condition. The nurse should include which of the following?
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Correct answer: D. Type 2 diabetes is increasing in frequency in children
Type 2 diabetes is increasing in frequency, even in youth. Type 2 diabetes mellitus generally can be controlled with oral hypoglycemic drugs, diet, exercise, and home glucose monitoring.
The nurse should implement which intervention when caring for a child with hypoparathyroidism?
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Correct answer: D. Instruct the parents about the signs of hypocalcemia
Hypoparathyroidism is a disorder of the parathyroid hormone. The primary function of the parathyroid hormone is to maintain the serum calcium. Thyroid replacement is used with hypothyroidism. Weight is not directly affected by the parathyroid glands and daily weighing is not necessary. A medical alert bracelet is also unnecessary. A medical alert bracelet should be worn for disorders such as Addison’s disease.
Leuprolide acetate (Lupron) is prescribed for a child with precocious puberty. Based on an understanding of this drug, the nurse caring for this child should
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Correct answer: A. administer the drug intramuscularly once every 4 weeks.
Leuprolide acetate (Lupron) depot injection is a GnRH analog administered once every 3 to 4 weeks by subcutaneous or intramuscular injection or intranasally two to three times a day for precocious puberty. Shakiness and a general malaise are not common adverse reactions, and assessing blood pressure or respiration prior to administration is not necessary. Fluids need not be increased with Lupron.
Which of the following tasks may the registered nurse delegate to unlicensed assistive personnel?
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Correct answer: D. Documentation of the urinary output after toileting of a child with diabetes mellitus
Although unlicensed assistive personnel may ambulate and bathe a child, assessing and monitoring for the presence of an abnormality are not tasks that can be delegated to them. Unlicensed assistive personnel can never inform or instruct new information. Unlicensed assistive personnel may document the urinary output after toileting a child.
The nurse receives a report on a newborn who is lethargic and exhibiting jittery movements during morning care. Which of the following is the priority nursing intervention?
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Correct answer: C. Administer intravenous calcium
Jittery movements in a lethargic newborn indicate the presence of hypoparathyroidism and of tetany. This poses an emergency situation, and intravenous calcium is the treatment of choice and the priority. Poor feeding behavior would be assessed in any newborn but is not the priority. Oral gluconate is reserved for the nonacute treatment of transient hypocalcemia. Assessing for the presence of bone deformities would be done on a growing child and is not a priority in a newborn.
The nurse is preparing discharge for a child with type 1 diabetes. Which of the following should the nurse include in the discharge instructions?
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Correct answer: D. Sugar-free products are not always carbohydrate-free
In type 1 diabetes mellitus, glucose accumulates in the blood, and the body cannot make efficient use of the glucose. Daily insulin doses are required. Sugar-free products are not necessarily carbohydrate-free. A physical examination should be performed annually. Activity is not restricted, but insulin should be adjusted according to exercise level. Increased insulin is necessary with increased activity. A blood glucose test should be performed before every insulin dose.
The nurse identifies which of the following adolescents with type 1 diabetes mellitus as being at greatest risk for complications? An adolescent
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Correct answer: B. who has an eating disorder.
An eating disorder poses a serious health hazard in the management of diabetes. Not only do bulimic behaviors such as binging and vomiting pose serious complications, but starvation that occurs with anorexia nervosa also raises the potential for serious complications. The omission of insulin can lead to serious complications too. A urinary infection with Candida albicans is often an early sign in adolescents that type 2 diabetes may be present. Sore throat and fever do not necessarily pose serious health risks but simply may indicate that an insulin adjustment may be necessary during the illness. Sexual activity and birth control do not directly alter an adolescent’s risk for complications.
Which of the following is a priority for the nurse to include in the assessment of a child admitted with dehydration who is to begin on intravenous potassium?
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Correct answer: A. Evaluate the output
The priority assessment in a child admitted with dehydration who is to begin on intravenous potassium is to evaluate the child’s output. The child must have functioning kidneys necessary for excretion. Intravenous potassium should never be given to a child with an impaired renal output. Obtaining a blood pressure and a weight and evaluating for edema may be appropriate interventions, but not the priority.
The nurse is admitting a child suspected of having acquired hypothyroidism. Which of the following assessments should the nurse evaluate as confirming the diagnosis?
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Correct answer: B. Goiter
Acquired hypothyroidism generally results from an autoimmune cause. The thyroid gland becomes inflamed, is infiltrated by the antibodies, and is progressively destroyed. Goiter is an indication found in acquired hypothyroidism. Exophthalmos and proptosis are present in hyperthyroidism. Hirsutism is a clinical manifestation in congenital adrenal hyperplasia.
During hospitalization, a child experiences a tonic-clonic seizure. To provide for the client’s safety, which of the following actions should the nurse take?
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Correct answer: C. Perform a jaw thrust and administer oxygen
To provide for the safety of the child during a tonic-clonic seizure, the nurse should perform a jaw thrust and administer oxygen. Holding the child down, restraining the child, or putting a padded tongue blade between the child’s teeth may cause injury to the child. Benzodiazepine is not used to treat a tonicclonic seizure but is used in status epilepticus.
Postoperatively, for placement of a shunt for hydrocephalus, the nurse should place a child in which of the following positions?
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Correct answer: D. Flat and lying on the unoperated side
A child who has had a shunt revision for hydrocephalus should be placed flat in bed, lying on the unoperated side. The headelevated position may cause the cerebrospinal fluid to drain too quickly from the ventricles. Lying on the operated side can cause injury to the shunt, and the prone position may cause interference with respiration.
The parents of a 2-year-old toddler who has cerebral palsy notice the child does not sit up alone. They ask the nurse whether the child will be able to learn to walk alone or with crutches. Which of the following is the appropriate response by the nurse?
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Correct answer: A. "Your child will most likely not be able to walk alone or with crutches."
If a child cannot sit up by the age of 2, there is every indication that the child has cerebral palsy affecting voluntary motor control. As a result, the child will not be able to walk with or without crutches.
The parents of a child with cerebral palsy ask the nurse what the most common cause of cerebral palsy is. The most appropriate response by the nurse is which of the following?
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Correct answer: C. "It is the result of a premature birth or very low birth weight."
Although the cord getting wrapped around the neck in the birth canal, a forceps delivery, and preeclampsia in the mother all place a child at risk for cerebral palsy, children born prematurely or those who have very low birth weights are the most at risk.
When caring for a child with meningitis, it is essential that the nurse evaluate for a positive Brudzinski’s sign, which would indicate
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Correct answer: A. meningeal irritation.
Brudzinski’s sign, when the legs flex at both hips and knees in response to flexing the head and neck, indicates meningeal irritation.
A nurse is providing discharge instructions to the parents of a child who suffered a head injury 6 hours ago. Which statement by the parents indicates additional teaching is needed?
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Correct answer: A. "We will provide for uninterrupted sleep when we get home."
Waking children to check neurological status following a head injury is important, no matter the time of day. Vomiting could indicate increased intracranial pressure requiring further evaluation. Narcotics should be avoided after a head injury. Amnesia following a head injury is not uncommon.
The nurse is assigned to administer bismuth subsalicylate (Pepto-Bismol) to a 10-year-old child who has Reye’s syndrome and is experiencing gastrointestinal clinical manifestations. Which of the following is the priority action for the nurse to take?
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Correct answer: C. Question the physician’s order
Bismuth subsalicylate (Pepto-Bismol) contains aspirin, and there is a suspected link between aspirin and the etiology of Reye’s syndrome. It�is a priority to question the order for Pepto-Bismol to be given to this child. One tablet is appropriate for a child 10�years of age. Chewing the tablet and informing the child and parents that the stool will be dark in appearance are all appropriate interventions in the plan of care for a child taking Pepto-Bismol, but not for a child with Reye’s syndrome.
The nurse assesses cranial nerve VII in a pediatric client by which of the following techniques?
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Correct answer: B. Gently swab the cornea with a sterile cottontipped applicator
Gently swabbing the cornea with a sterile cottontipped applicator assesses cranial nerve VII, which evaluates the corneal reflex. Holding the eyes open and turning the head from side to side evaluates cranial nerves II, IV, and VI and the oculocephalic reflex. Placing the child’s head in a midline position with the head elevated prior to injecting ice water into the ear canal evaluates cranial nerves III and VIII, or the oculovestibular reflex. Irritating the pharynx with a tongue depressor or cotton swab evaluates cranial nerves IX and X, or the gag reflex.
With an infant who has anencephaly, the most appropriate nursing intervention is to
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Correct answer: B. monitor the infant for respiratory failure and prepare the parents that death is imminent.
Anencephaly is the absence of the cranial vault, with the cerebral hemisphere missing or reduced in size. Although the brainstem may be intact, respiratory failure and death are imminent. The abnormal gait with foot weakness or deformity appears in toddlerhood with spina bifida. Leakage of cerebrospinal fluid occurs with meningomyelocele. Difficulties in bowel and bladder functions occur at the time of toilet training with spina bifida occulta.
When planning client assignments for the day, which of the following nursing tasks would be appropriate for the registered nurse to assign to unlicensed assistive personnel?
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Correct answer: A. Document the temperature of a child with bacterial meningitis
It is appropriate for a registered nurse to assign only those activities that are basic cares and do not involve assessing, explaining or teaching, or monitoring for change. Unlicensed assistive personnel are trained only to take a temperature.
The nurse is caring for a child who had a seizure 15 minutes after sustaining a head injury. After assuring a patent airway, which of the following is the priority intervention?
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Correct answer: C. Administer prescribed benzodiazepine
If a seizure occurs within 30 minutes of a head injury, benzodiazepine is administered intravenously to stop the seizure. If the seizure continues, phenytoin may be administered. Although the remaining interventions of assessing fluid and electrolyte status, monitoring for postconcussive syndrome, and observing for increased intracranial pressure are appropriate, the priority intervention is to stop the seizure.
The nurse receives report from an emergency room nurse that a child is being admitted with a C7 spinal cord injury. Based on this information, the nurse prepares to care for a child with which of the following deficits?
Show answer and rationale
Correct answer: A. Quadriplegia but with gross arm movements and diaphragmatic breathing
C1 to C2 spinal cord lesions result in quadriplegia with total loss of respiratory function and flaccid paralysis. Spinal cord lesions at C7 to C8 would result in quadriplegia with biceps intact and diaphragmatic breathing. Spinal cord lesions at T1 to T2 would result in paraplegia with loss of leg, bowel, bladder, and sexual function. Spinal cord lesions at C5 to C6 would result in paraplegia with loss of varying degrees of intercostals and abdominal muscle use, but gross arm movements would be present.
The nurse should monitor a child who has survived a submersion injury in a hot tub for pneumonia caused by which of the following organisms?
Show answer and rationale
Correct answer: C. Pseudomonas aeruginosa
Because Pseudomonas aeruginosa is an organism commonly found in hot tubs, a child who suffers a submersion injury in a hot tub is at risk for pneumonia caused by this organism.
The nurse assesses a child who cries, withdraws from painful stimuli, and opens the eyes to pain to have a Glasgow Coma Scale score of
Show answer and rationale
Correct answer: B. 9
Crying to painful stimuli is a 3, withdrawing from pain is a 4, and opening the eyes to painful stimuli is a 2 on the Glasgow Coma Scale. This gives a total score of 9. A score of 3 means there is neither a verbal nor a motor response to painful stimuli. A score of 12 indicates the child opens the eyes on command, withdraws at simple touch, and has an irritable cry to painful stimuli. A score of 6 is a minimal response to all of the categories, but still a response.
The nurse observes a child having a seizure that begins with tonic contractions of the fingers in the left hand and progresses into tonic-clonic movements that proceed up the muscles of the left side of the body. The nurse should report these seizures as
Show answer and rationale
Correct answer: D. Jacksonian.
Jacksonian seizures begin with tonic contractions of the fingers in the left hand and progress into tonic-clonic movements that proceed up the muscles of the left side of the body. Rolandic seizures include tonic-clonic movements of the face, with increased salivation and arrested speech; they commonly occur during sleep. Complex seizures have an aura, and consciousness may not be completely lost. Children are rarely violent, but may demonstrate confusion or purposeless behaviors. General seizures are secondary to diffuse electrical activity throughout the cortex and into the brain.
Which of the following statements indicates the family of a child with a seizure disorder has followed the nurse’s discharge instructions?
Show answer and rationale
Correct answer: C. "Our child has had a growth spurt, so we made an appointment to review the medication to prevent seizures."
As children gain weight, the dose of the seizure medication may need to be altered. Dosages of medications should not be missed at all. Children with seizure disorders should be allowed to participate in most activities and should not be overprotected by parents, and parents should divide their time equally among all their children. Reminders of what an affected child can and cannot do should not be necessary.
The parents of a child suspected of having a shunt malfunction ask the nurse what caused it. The appropriate response by the nurse is which of the following?
Show answer and rationale
Correct answer: A. Increased flow of cerebrospinal fluid
Decreased reabsorption is a common cause of hydrocephalus. Increased flow of and decreased production of cerebrospinal fluid (CSF) do not relate to hydrocephalus, intracranial pressure (ICP), or shunt malfunction.
The nurse assists the parents of a child with myoclonic seizures to make which of the following menu selections?
Show answer and rationale
Correct answer: B. Pecan pie with ice cream
A ketogenic diet, in which 90% of calories come from fat, and protein and carbohydrates are limited, is used in the treatment of myoclonic seizures. Roast beef is high in protein. Baked potato and creamed corn are high in carbohydrates. Pecans and ice cream are high in fat, so that menu selection is appropriate to a ketogenic diet. Why ketones affect seizures is not understood, but researchers theorize that ketones change lipid concentrations, reduce fluid and electrolyte imbalances, modify the seizure threshold, and stabilize the central nervous system.
The nurse is planning the care for a child who has an elevated blood pressure and slow pulse, is flushed, has profuse facial perspiration, and is experiencing urinary retention and constipation 4 days after sustaining a C3 injury. Which of the following is the priority nursing intervention?
Show answer and rationale
Correct answer: A. Insert a prescribed Foley catheter
Spinal shock occurs shortly after the injury and may persist for up to 10 days with a high cervical or thoracic injury. After the spinal shock has resolved and reflex activity has returned, high cervical or thoracic lesions may react with a potential life-threatening sympathetic nervous system response to stimuli such as a distended bladder, constipation, or fecal impaction. Spasms of the pelvic viscera and arterioles produce vasoconstriction below the lesion, resulting in hypertension, superficial vasodilatation, flushing, piloerection, and profuse perspiration above the injury. To compensate for the increased blood pressure, the heart rate is slowed via vagal stimulation. Without prompt reversal of the clinical manifestations, which is usually just removal of the stimulant, the client may stroke, have a seizure, or die.
Which of the following should the nurse include in the discharge instructions for a child who had a punch biopsy done on the back?
Show answer and rationale
Correct answer: D. Keep the site clean, dry, and covered for 24 hours
Following a punch biopsy, the area should be kept clean, dry, and covered for 24 hours to protect the wound and promote healing. No physical restrictions are necessary following a skin biopsy. Sutures should be removed in 10 to 14 days.
Which of the following should the nurse include when preparing a teaching plan for a child with atopic dermatitis regarding application of steroid ointments?
Show answer and rationale
Correct answer: C. Apply the ointment sparingly and rub into the skin
Atopic dermatitis is a chronic relapsing inflammation of the dermis and epidermis. It may be referred to as "eczema" but is only one disorder in a group of eczematous disorders. Topical corticosteroids are the most often prescribed. Steroid ointments should be applied in a thin layer and rubbed into the skin twice a day. Because the steroid cannot penetrate the emollient, it must be applied before the emollient.
The nurse should prepare an 18-year-old adolescent with acne who has not responded to antibiotic therapy for which of the following tests prior to starting treatment with isotretinoin (Accutane)?
Show answer and rationale
Correct answer: A. Pregnancy test
Isotretinoin (Accutane) is a retinoid used in the treatment of severe recalcitrant nodular acne that does not respond to standard therapies. It has severe teratogenic effects. Two negative pregnancy tests are required prior to starting Accutane therapy.
A mother calls the pediatric office and states that her 8-year-old child is complaining of intense itching around the nape of her neck. Which of the following is the priority intervention?
Show answer and rationale
Correct answer: B. Inspect the child for lice or nits
The main clinical manifestation of pediculosis capitis, or head lice, is intense pruritus. Nits are commonly found on the hairs of the occipital area of the scalp.
Which of the following should the nurse include when instructing the mother of a child with pediculosis capitis on the use of permethrin 1% (Nix)?
Show answer and rationale
Correct answer: D. After rinsing the hair, comb to remove the nits
Permethrin 1% (Nix) is both pediculocidal and ovicidal and generally considered the treatment of choice. Nix should be applied to clean, damp hair. It should be left on for 10 minutes followed by rinsing and combing with fine-toothed comb to remove nits.
Following application of permethrin 5% (Elimite) for scabies, the nurse should anticipate that the pruritus will
Show answer and rationale
Correct answer: C. subside within 14 to 21 days.
Permethrin 5% is considered the treatment of choice for scabies. The pruritus is a hypersensitivity response to the nit and its ova and feces. Following application of Elimite, the pruritus may continue for 14 to 21 days. Emollients may help to relieve the discomfort.
Following excision of a nevus on the arm, which of the following should the nurse include in this child’s discharge instructions?
Show answer and rationale
Correct answer: A. Take acetaminophen (Tylenol) for discomfort
Following excision of a nevus, the wound should be kept dry until sutures are removed to avoid infection. Physical activity should be avoided for 2 to 4 weeks to prevent wound dehiscence.
The nurse should inform a child with atopic dermatitis that which of the following may cause a flare?
Show answer and rationale
Correct answer: C. Sudden changes in temperature
Atopic dermatitis is a chronic inflammation of the dermis and epidermis resulting in pruritus, erythema, edema, papules, serous discharge, and crusting. Cotton clothing, daily baths, and moisturizing are all part of the plan of care for atopic dermatitis. Sudden temperature changes can cause dryness or sweating, which may contribute to a flare.
The parent of a child infested with scabies asks the nurse how the child got scabies. Based on the nurse’s knowledge of scabies, the most likely method of contracting scabies is
Show answer and rationale
Correct answer: C. being in close contact with an infested individual.
Scabies is an infestation of the scabies mite with Sarcoptes scabiei and is dependent on a�human host for survival. It is transmitted by�skin-to-skin contact with an infested individual. It is less likely to contract through fomites. Animals do not carry scabies. The mite�can survive for 24 to 36 hours away from the host.
The client with tinea capitis asks the nurse what the treatment for a kerion is. Based on the treatment of tinea capitis, the nurse replies
Show answer and rationale
Correct answer: B. "oral corticosteroids (Orapred, Prelone, Pediapred)."
Oral corticosteroids (Orapred, Prelone, Pediapred) are used to treat a kerion. It is not necessary to shave the hair or apply soaks. Topical treatment is ineffective.
Which of the following should the nurse include in the medication instructions for a child with tinea capitis for whom griseofulvin (Grifulvin V, Fulvicin P/G, Grisactin) has been prescribed?
Show answer and rationale
Correct answer: D. Take the drug with a fatty meal
Griseofulvin (Grifulvin V, Fulvicin P/G, Grisactin) is the standard treatment for tinea capitis. It is best absorbed when taken with fatty foods. Treatment generally lasts for a minimum of 8 weeks.
The mother of a 4-week-old infant with a small hemangioma asks the nurse if the hemangioma will get any bigger. Which of the following is the most appropriate response by the nurse?
Show answer and rationale
Correct answer: C. "Hemangiomas generally grow rapidly during the first year of life, followed by a gradual spontaneous involution."
Hemangiomas are benign proliferations of the blood vessels of the skin. Although rarely present at birth, most appear by 1 to 4 weeks of life. They grow rapidly during the first year of life and then have a spontaneous involution that may begin as early as 6 to 10�months. They become soft and gray. About 50% of hemangiomas are gone by age 5�years and 90% are gone by age 12�years.
Which of the following should the nurse include in the information given to the parents of an infant born with a port-wine stain?
Show answer and rationale
Correct answer: D. Port-wine stains generally become darker and thicker with age
A port-wine stain is a capillary malformation present at birth. It generally is not associated with any medical condition. Port-wine stains usually grow with the child, but do not become raised.
The nurse prepares to include which of the following in the plan of care of a child with molluscum contagiosum?
Show answer and rationale
Correct answer: B. Administer cantharidin directly to the lesion
Molluscum contagiosum is a viral infection of the skin caused by a DNA pox virus. The main feature is a flesh-colored, dome-shaped papule with central umbilication. Cantharidin is applied with a wooden applicator directly to the lesion. Although contagious, the child does not have to be kept out of school. Corticosteroids, such as Prelone, are used in the�treatment of tinea capitis.
A client with molluscum contagiosum has read on the Internet that no treatment is required and asks why the molluscum should be treated. The nurse’s most appropriate response is which of the following?
Show answer and rationale
Correct answer: A. "The lesions may resolve spontaneously, but they may continue to spread."
Molluscum contagiosum is a viral infection of the skin characterized by flesh-colored, domeshaped papules with central umbilication. Although molluscum will eventually resolve, lesions spread easily, may become infected, may be itchy or irritated, and are sometimes cosmetically objectionable. For these reasons, they are usually treated with cantharidin applied directly to the lesion.
The child with molluscum contagiosum is going to be treated with cantharidin. The parents of the child ask the nurse how the cantharidin is given. The nurse’s response would be which of the following?
Show answer and rationale
Correct answer: D. "A wooden applicator is used to apply the cantharidin directly to each lesion."
Molluscum contagiosum is a viral infection of the skin that causes flesh-colored, dome-shaped papules with central umbilication. Cantharidin is very potent and can cause significant burns if not used properly. It must be applied carefully to each lesion with a wooden applicator. This treatment is only done in the doctor’s office. A prescription is never given and the drug is never administered in the home by the client.
The nurse prepares a 10-year-old child who presents with a single wart on the hand for which of the following treatments?
Show answer and rationale
Correct answer: C. Liquid nitrogen
Verrucae, or cutaneous warts, are benign tumors of the epidermis caused by a human papillomavirus. For a 10-year-old child with a single wart, the most likely treatment would be liquid nitrogen. Cryotherapy with liquid nitrogen is reserved for children over the age of 8�years. Tagamet is given for multiple warts and is often used in younger children who cannot tolerate liquid nitrogen. Aldara and Retin-A are used to treat flat warts on the face. In addition, Aldara is used to treat genital warts.
The parents of a 3-month-old infant who has a�hemangioma on the nasal tip asks the nurse�what the treatment is. Based on an understanding of hemangiomas, which of the�following is the nurse’s response?
Show answer and rationale
Correct answer: B. "Nasal tip hemangiomas are treated with oral corticosteroids."
Hemangiomas are benign proliferations of the blood vessels in the skin. They are rarely present at birth. Most of them develop within 1 to 4 weeks after birth. To prevent excessive tissue growth on the nasal tip (Cyrano nose deformity) in a nasal tip hemangioma, oral corticosteroids (Prelone, Pediapred, Orapred) are given. Surgical intervention is recommended only after the hemangioma has involuted. It will continue to grow for up to 1 year of age. Some hemangiomas can be life threatening.
The nurse is admitting a 4-month-old infant with an irregularly shaped reddish-purple macular vascular lesion on the face. The mother states it was present at birth. The nurse documents this as which of the following?
Show answer and rationale
Correct answer: C. Port-wine stain
Port-wine stains are capillary malformations present at birth. They are generally irregularly shaped reddish-purple macular vascular lesions. Hemangiomas are not usually present at birth and grow rapidly during the first year of life. Congenital nevi are brown. Pyogenic granulomas are raised reddish-purple papules that bleed profusely with trauma.
The nurse should prepare a child with a pyogenic granuloma on the chin that has been bleeding for which of the following treatments?
Show answer and rationale
Correct answer: A. Shave excision and electrodessication
Pyogenic granulomas are benign growths of blood vessels that can bleed profusely with trauma. Treatment is to shave the lesion and cauterize the base to prevent recurrence. A pulsed dye laser is used to destroy wart tissue.
The registered nurse is delegating nursing tasks for the day. Which of the following tasks should the nurse delegate to a licensed practical nurse?
Show answer and rationale
Correct answer: D. Administer Prelone to a child with tinea capitis who has a kerion
Instructing, informing, and assessing are all nursing skills that are most appropriately performed by the registered nurse. A�licensed�practical nurse may administer a�prescribed drug.
The parents of a 4-year-old child whose femur is fractured at the growth plate ask the nurse what type of fracture this is. Based on an understanding of the growth plate, the nurse should respond, "The growth plates
Show answer and rationale
Correct answer: A. control the growth of long bones."
Growth plates are located in the metaphysis of long bones. They control bone growth until about 21�years of age. Fractures of the growth plate retard the growth of the affected long bone. Red blood cells are produced in the marrow of the bone, not the growth plate.
The nurse completes an orthopedic assessment of a 6-year-old child who has a new cast applied for a fractured radius. Which of the following clinical manifestations is a priority for the nurse to report immediately to the physician?
Show answer and rationale
Correct answer: D. The child states that hand feels "asleep"
The sensation of numbness or tingling indicates neurovascular impairment. If not reported immediately, the impairment can lead to permanent tissue or nerve damage. The skin around the cast often feels warm. Capillary refill of 3 seconds is acceptable. As long as edema is decreasing, this is not an adverse sign.
The nurse is told in a report that an infant has talipes equinovarus. In doing the physical assessment of this infant, the nurse would expect to find which of the following?
Show answer and rationale
Correct answer: B. One foot is rotated in and down and is fixed and difficult to move
Talipes equinovarus, referred to as clubfoot, is a congenital abnormality characterized by the affected foot being rotated in and down while in a fixed position. Clinical manifestations of developmental hip dysplasia include asymmetry of gluteal and thigh skin folds and one knee being lower when both legs are flexed. An upward rotation of the foot is known as talipes calcaneus.
While assessing a newborn infant for developmental hip dysplasia (DDH), the nurse evaluates which of the following signs as indicating the presence of DDH?
Show answer and rationale
Correct answer: C. One knee is lower when both legs are flexed
Developmental hip dysplasia (DDH) is characterized by one knee being lower when both knees are flexed, asymmetrical gluteal and thigh skin folds, limited abduction of hip on affected side, and a positive Ortolani sign when the hips are abducted.
The nurse evaluates the musculoskeletal systems of children to be different from adults in which of the following ways?
Show answer and rationale
Correct answer: B. The skull bones are not rigid or fused at birth
In the musculoskeletal systems of children, the tendons, ligaments, and periosteum are stronger that those of adults. The bones of children are more porous and less dense than the bones of adults. The skull bones of children are not rigid or fused at birth to allow for ease of delivery and growth of the brain.
While caring for a 4-year-old child with a fractured femur in skeletal traction, the nurse notes that the child is crying with pain and the foot of the affected leg is pale and pulseless. Which of the following nursing actions is a priority?
Show answer and rationale
Correct answer: C. Notify the physician of the changes noted
It is a priority to notify the physician when a child with a fractured femur in skeletal traction complains of pain in the affected foot and the foot is pale and pulseless. This may be an indication of neurovascular damage. Traction weights are not removed unless there is a doctor’s order to do so. The nurse should administer an analgesic and chart the observations after notifying the physician.
The nurse is caring for a child with a new full-leg cast. Which of the following is an appropriate nursing intervention for this client?
Show answer and rationale
Correct answer: A. Make sure that all cast edges are smooth and free of irritating projections
The child’s position can be changed carefully using the palms of hands to allow the cast to dry on all sides. The casted extremity should be elevated above the level of the heart to encourage venous return while the cast is drying. To prevent skin irritation and breakdown, the cast edges should always be smooth and free of projections.
When providing information about osteogenesis imperfecta (OI) to the parents of a newly diagnosed child, the nurse should include which of the following information about the disorder?
Show answer and rationale
Correct answer: B. It is an inherited disease of the connective tissue
Osteogenesis imperfecta (OI) is an inherited disease of the connective tissue that is very difficult to treat and control. Earlier onset usually means a more difficult course of the disease. Braces and splints may be of therapeutic value to treat fractures and prevent deformity.
While teaching 9- and 10-year-old children about safety measures to prevent injuries, the school nurse considers which of the following as the priority influence in the risk-taking behavior in this age group?
Show answer and rationale
Correct answer: A. Pressure from peers
Although 9- and 10-year-olds have concrete thinking patterns and lack well-developed identities, peer pressure is the most likely cause of risk-taking behavior in this age group. Inadequate rule enforcement is less likely to cause risk-taking behavior.
When caring for a 4-year-old child whose left leg is in traction, the nurse notices that the traction weights are resting on the floor at the foot of the bed. What is the best action that the nurse should take in this situation?
Show answer and rationale
Correct answer: D. Pull the child up in the bed
When the traction weights are resting on the floor, the child needs to be pulled up in bed so that the weights can hang freely and the proper traction can be applied to the leg. Elevating the foot of the bed or lowering the head of the bed would not allow the proper traction to be applied to the child’s leg. Cutting the ropes would not improve the traction if the child remains down at the foot of the bed.
A mother of an infant asks the nurse when the anterior fontanel usually closes. The most appropriate response by the nurse is
Show answer and rationale
Correct answer: C. 18�months.
An infant’s anterior fontanel normally closes at 18�months.
The nurse should assess a child admitted with a diagnosis of slipped capital femoral epiphysis for which of the following additional health problems?
Show answer and rationale
Correct answer: A. Obesity
The upper femoral epiphysis slips from its functional position in slipped capital femoral epiphysis. The incidence of slipped capital femoral epiphysis is greatest in AfricanAmerican obese males. An emaciated appearance, anemia, and developmental delays are not usually associated with this diagnosis.
Based on an understanding of the treatment for moderate scoliosis, which of the following is a priority?
Show answer and rationale
Correct answer: D. The use of a Boston or TLSO brace
When moderate scoliosis is found, the priority treatment is usually to fit the child with a brace to limit progression of the disease. The Boston brace is a prefabricated plastic shell that fits under the arm and is used for curves of the low thoracolumbar and lumbar spine. The TLSO brace is a molded custom jacket used for thoracolumbar curves. Stretching and exercising may be done in mild forms of the disease, and surgery may be performed for more severe forms of scoliosis.
A school nurse is conducting a screening program for scoliosis. At which grade level should the school nurse begin testing for scoliosis?
Show answer and rationale
Correct answer: A. 5th grade
In order to detect scoliosis in the early stage, the school nurse should begin testing for scoliosis in the 5th grade and continue testing until mid-adolescence. The 3rd grade is too early to begin testing.
The mother of an 8-year-old with osteogenesis imperfecta asks the nurse if there is a sport in which her child could safely participate. Which of the following sports should the nurse suggest?
Show answer and rationale
Correct answer: B. Swimming
Participating in sports is a problem for children with osteogenesis imperfecta, or brittle bone disease. Swimming is a sport that would not place stress on the child’s bones. Soccer, track, and baseball are all sports that would be too dangerous for a child with osteogenesis imperfecta.
What to do with your score
Score the set, then spend longer on the review than you did on the questions. For every item you missed, decide which of three things went wrong: you did not know the fact, you misread what the item was asking, or you knew the fact and still chose second-best. Those need three different fixes — content review, slower reading, and priority-framework practice — and lumping them together is why question banks stop working for people.
Read the rationale on the items you got right as well. Arriving at the correct option for the wrong reason is common, and it does not survive a harder version of the same question.
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