Question 1
Which of the following would be most appropriate for the nurse to do after assessing a multiparous client at 24 hours postpartum who demonstrates positive Homan’s sign with
discomfort?
A. Place a cold pack on the client’s perineal area
B. Place the client in a semi-Fowler’s position
C. Notify the client’s physician immediately.
D. Ask the client to ambulate around the room
Which of the following would be most appropriate for the nurse to do after assessing a multiparous client at 24 hours postpartum who demonstrates positive Homan’s sign with
discomfort?
A. Place a cold pack on the client’s perineal area
B. Place the client in a semi-Fowler’s position
C. Notify the client’s physician immediately.
D. Ask the client to ambulate around the room
Answer
C. Notify the client’s physician immediately.
Question 2
When developing the plan of care for a primiparous client during the first 12 hours after vaginal delivery, which of the following concerns of the client would be the nurse’s primary focus of care?
A. The neonate.
B. The family.
C. The client’s own comfort.
D. The client’s significant other.
When developing the plan of care for a primiparous client during the first 12 hours after vaginal delivery, which of the following concerns of the client would be the nurse’s primary focus of care?
A. The neonate.
B. The family.
C. The client’s own comfort.
D. The client’s significant other.
Answer
C. The client’s own comfort.
Question 3
The nurse assesses a swollen ecchymosed area to the right of an episiotomy on a primiparous client 6 hours after a vaginal delivery. Which of the following should the nurse do next?
A. Apply an icepack to the perineal area.
B. Assess the client’s temperature.
C. Have the client take a warm sitz bath.
D. Contact the physician for orders of an antibiotic.
The nurse assesses a swollen ecchymosed area to the right of an episiotomy on a primiparous client 6 hours after a vaginal delivery. Which of the following should the nurse do next?
A. Apply an icepack to the perineal area.
B. Assess the client’s temperature.
C. Have the client take a warm sitz bath.
D. Contact the physician for orders of an antibiotic.
Answer
A. Apply an icepack to the perineal area.
Question 4
At which of the following locations would the nurse expect to palpate the fundus of a primiparous client 2 hours after delivery of a neonate?
A. Halfway between the umbilicus and the symphysis pubis.
B. At the level of the umbilicus.
C. Just below the level of the umbilicus.
D. Above the level of the umbilicus.
At which of the following locations would the nurse expect to palpate the fundus of a primiparous client 2 hours after delivery of a neonate?
A. Halfway between the umbilicus and the symphysis pubis.
B. At the level of the umbilicus.
C. Just below the level of the umbilicus.
D. Above the level of the umbilicus.
Answer
A. Hydatidiform mole
Question 5
Situation: The nurse on the Pediatric floor of Venus Hospital attends to patients of different conditions. The nurse asks a 9-year old child and mother about the child’s best friend to assess which of the following about the child?
A. Language development
B. Motor development
C. Neurologic development
D. Social development
Situation: The nurse on the Pediatric floor of Venus Hospital attends to patients of different conditions. The nurse asks a 9-year old child and mother about the child’s best friend to assess which of the following about the child?
A. Language development
B. Motor development
C. Neurologic development
D. Social development
Answer
D. Social development
Question 6
At a follow-up appointment after being hospitalized, an adolescent with a history of Cystic Fibrosis describes his stools to the nurse. Which of the following descriptions his stools to the nurse. Which of the following descriptions would the nurse interpret as indicative of continued problems with malabsorption?
A. Soft with little odor
B. Large and foul smelling
C. Loose with bits of food
D. Hard with streaks of blood
At a follow-up appointment after being hospitalized, an adolescent with a history of Cystic Fibrosis describes his stools to the nurse. Which of the following descriptions his stools to the nurse. Which of the following descriptions would the nurse interpret as indicative of continued problems with malabsorption?
A. Soft with little odor
B. Large and foul smelling
C. Loose with bits of food
D. Hard with streaks of blood
Answer
B. Large and foul smelling
Question 7
Which of the following initial physical findings would indicate the development of carditis in a child with rheumatic fever?
A. Heart murmur
B. Low blood pressure
C. Irregular pulse
D. Anterior chest wall pain
Which of the following initial physical findings would indicate the development of carditis in a child with rheumatic fever?
A. Heart murmur
B. Low blood pressure
C. Irregular pulse
D. Anterior chest wall pain
Answer
A. Heart murmur
Question 8
Which of the following food would the nurse encourage the mother to offer to her child with iron-deficiency anemia?
A. Rice, cereal, whole milk, and yellow vegetables
B. Potato, peas, and chicken
C. Macaroni, cheese and ham
D. Pudding, green vegetables, and rice
Which of the following food would the nurse encourage the mother to offer to her child with iron-deficiency anemia?
A. Rice, cereal, whole milk, and yellow vegetables
B. Potato, peas, and chicken
C. Macaroni, cheese and ham
D. Pudding, green vegetables, and rice
Answer
B. Potato, peas, and chicken
Question 9
Which of the following nursing diagnoses would the nurse identify as the priority when dealing with a child newly diagnosed with leukemia and the child’s family?
A. Risk for injury related to malignant process
B. Pain related to treatment modalities
C. Imbalanced nutrition: less than body requirements related to loss of appetite
D. Anticipatory grieving related to diagnosis and potential loss of child.
Which of the following nursing diagnoses would the nurse identify as the priority when dealing with a child newly diagnosed with leukemia and the child’s family?
A. Risk for injury related to malignant process
B. Pain related to treatment modalities
C. Imbalanced nutrition: less than body requirements related to loss of appetite
D. Anticipatory grieving related to diagnosis and potential loss of child.
Answer
D. Anticipatory grieving related to diagnosis and potential loss of child.
Question 10
When developing the plan of care for an infant with cleft lip before corrective surgery is performed, which of the following would be a priority?
A. Maintaining skin integrity in the oral cavity.
B. Using techniques to minimize crying.
C. Altering the usual method of feeding.
D. Preventing the infant from putting fingers in the mouth.
When developing the plan of care for an infant with cleft lip before corrective surgery is performed, which of the following would be a priority?
A. Maintaining skin integrity in the oral cavity.
B. Using techniques to minimize crying.
C. Altering the usual method of feeding.
D. Preventing the infant from putting fingers in the mouth.
Answer
C. Altering the usual method of feeding.
