MATERNAL FINAL EXAM REVIEW –
• The nurse is caring for a 5-year-old child with a central venous access device
(CAD) for chemotherapy administration. Which action by the nurse is most
appropriate? o Allow the child to play freely without restrictions.
o Change the occlusive dressing every two weeks.
o Allow the child to hold the medication filled syringes.
o Flush the line with heparin or saline as per protocol.
• The nurse is caring for a child with growth hormone deficiency who is receiving
recombinant human growth hormone (rhGH) therapy. The child's parent
expresses concern about the child's recent reports of hip pain and limping.
Based on this information, which action would the nurse take?
o Reassure the parent that hip pain is a common side effect of rhGH therapy o
Observe the child's ambulation for signs of slipped capital femoral
epiphysis o Suggest the parent apply a warm compress to the child's hip
o Advise the parent to increase the child's physical activity to strengthen the hip muscles
• The nurse is planning care for a 6-year-old child admitted with dehydration secondary
to influenza. The child has a congenital hearing impairment and uses a hearing aid.
The child is also learning to read lips. Which nursing intervention ensures effective
communication with the child? Select all that apply.
o Provide written communication for all interactions.
o Communicate only through the child's parents.
o Incorporate visual aids when communicating.
o Use a sign language interpreter for all communications
o Ensure the child's hearing aid is functioning.
• The nurse cares for a G4P4 postpartum client who delivered a macrocosmic term
infant 2 hours ago via cesarean section. The client's pregnancy was complicated by
gestational diabetes controlled with diet. What initial assessment does the nurse
prioritize? o Blood glucose levels.
o Fundal height and tone.
o Comfort and pain level.
o Skin integrity and incision.
• A child with a neurological disorder is undergoing a lumbar puncture. Which action
would the nurse take to minimize the risk of a post-procedure headache?
o Encourage the child to ambulate after the procedure
o Encourage the child to lie flat for at least 30 minutes
o Apply a cold compress to the puncture site
o Allow the child to drink a caffeinated drink after the procedure
• A nurse working in a homeless shelter provides care to a child who was a victim of
emotional neglect. Which assessment findings would the nurse anticipate in this
child? o Multiple fractures at various stages of healing.
o Antisocial or withdrawing from social interaction.
, o Bruises and burns on the buttocks.
o Pain on urination and itching of the genital area.
• A nurse is providing discharge teaching to a postpartum client. What does the
nurse educate the client to report to their provider immediately?
o Feeling tired and needing frequent naps
o Mild cramping and light bleeding.
o Moderate breast tenderness and fullness.
o Increased lochia flow with larger clots.
• A nurse is educating parents on preventing child maltreatment. Which
recommendation should the nurse prioritize?
o Enroll the child in multiple extracurricular activities.
o Avoid discussing stressful topics in front of the child.
o Use physical discipline sparingly and only when necessary.
o Establish a strong support network of family and friends.
• A child with Cushing syndrome presents with a moon-faced appearance, low serum
protein levels due to muscle wasting, and consistent blood pressures averaging
between 160-180/90-95 mmHg. The healthcare provider has written several orders.
As the nurse is planning care for this child, which intervention would be prioritized
to address the underlying cause of these symptoms?
o Schedule the child for surgical removal of the adrenal tumor
o Encourage the child to engage in muscle-strengthening exercises
o Provide a low-sodium diet to manage hypertension
o Administer an antihypertensive medication
• A nurse is evaluating a postpartum client's understanding of self-care after
discharge. Which statement by the client indicates a need for further teaching?
o "I will monitor the color and amount of my lochia."
o "I can use tampons to manage my lochia flow."
o "I will call my healthcare provider if I develop a fever."
o "I will wash my hands before and after perineal hygiene."
• During a well-child visit, a nurse is discussing anticipatory guidance with the
caregivers of a 9-month-old infant. Which advice should the nurse prioritize to
prevent unintentional injuries as the infant begins to crawl?
o Encourage the purchase of soft toys only
o Schedule regular developmental screenings
o Install stairway gates and cabinet locks
o Ensure the infant's diet includes sufficient iron
• A nurse is planning care for a child with a chronic illness and their family. Which
outcome is most realistic and supportive of the family's adjustment to the illness? o
The family will relocate to be closer to a specialized treatment center.
o The parents will avoid discussing the illness to protect the child's emotional
well-being. o The family will plan for the child to be cured of the illness within six
, months.
o The family will develop a daily routine that incorporates the child's care needs.
• A 7-year-old child undergoing chemotherapy for leukemia is experiencing severe
nausea and vomiting. The parents are concerned about the child's nutritional
intake. Which nursing intervention is most appropriate to address this issue?
o Suggest small, frequent, high-calorie meals throughout the day.
o Advise the parents to give the child their favorite foods regardless of nutritional
value. o Encourage the child to eat large meals three times a day.
o Administer intramuscular antiemetics when the child starts vomiting.
• A 10-year-old child is brought to the emergency department with a head injury after
falling from a bicycle. The child is conscious but has a headache and nausea. The
nurse notes that the child's left pupil is more dilated than the right and reacts
sluggishly to light. Which action would the nurse prioritize in this situation?
o Providing reassurance to the child and parents.
o Administering pain medication for the headache.
o Giving intravenous dexamethasone to decrease inflammation.
o Preparing the child for a CT scan of the head.
• A client with a history of severe dysmenorrhea is considering a non-hormonal
intrauterine device (IUD) for contraception. Which statement by the nurse is most
appropriate? o This type of IUD may be spontaneously expelled at a higher rate due to
the heaving bleeding associated with dysmenorrhea."
o This type of IUD may cause uterine cramping for a few weeks but will help to
improve the symptoms associated with dysmenorrhea over time."
o This type of IUD will not have a positive or negative impact on symptoms
associated with dysmenorrhea."
o This type of IUD may not be the best choice because it may worsen the
symptoms associated with dysmenorrhea."
• During a home visit, a nurse observes that a 4-month-old infant is frequently placed
in a semi-reclined position in a swing for naps. Which instruction by the nurse is
most appropriate?
o Allow the infant to sleep in the parent's bed for better supervision.
o Place the infant on their back in a crib for naps and nighttime
sleep. o Use a car seat for naps as it provides a safer semi-reclined
position.
o Continue using the swing as it helps the infant sleep longer.
• A 10-month-old infant is brought to the clinic for a well-baby visit. The parent states
that the infant is not yet creeping or crawling. Which action by the nurse is most
appropriate? o Refer the infant to a neurologist for further evaluation.
o Assess the infant's overall development and motor skills.
o Advise the parent to use a baby walker to encourage movement.
o Suggest the parent enroll the infant in a physical therapy program.
• A nurse is assessing a 3-year-old child who presents with multiple bruises in various
• The nurse is caring for a 5-year-old child with a central venous access device
(CAD) for chemotherapy administration. Which action by the nurse is most
appropriate? o Allow the child to play freely without restrictions.
o Change the occlusive dressing every two weeks.
o Allow the child to hold the medication filled syringes.
o Flush the line with heparin or saline as per protocol.
• The nurse is caring for a child with growth hormone deficiency who is receiving
recombinant human growth hormone (rhGH) therapy. The child's parent
expresses concern about the child's recent reports of hip pain and limping.
Based on this information, which action would the nurse take?
o Reassure the parent that hip pain is a common side effect of rhGH therapy o
Observe the child's ambulation for signs of slipped capital femoral
epiphysis o Suggest the parent apply a warm compress to the child's hip
o Advise the parent to increase the child's physical activity to strengthen the hip muscles
• The nurse is planning care for a 6-year-old child admitted with dehydration secondary
to influenza. The child has a congenital hearing impairment and uses a hearing aid.
The child is also learning to read lips. Which nursing intervention ensures effective
communication with the child? Select all that apply.
o Provide written communication for all interactions.
o Communicate only through the child's parents.
o Incorporate visual aids when communicating.
o Use a sign language interpreter for all communications
o Ensure the child's hearing aid is functioning.
• The nurse cares for a G4P4 postpartum client who delivered a macrocosmic term
infant 2 hours ago via cesarean section. The client's pregnancy was complicated by
gestational diabetes controlled with diet. What initial assessment does the nurse
prioritize? o Blood glucose levels.
o Fundal height and tone.
o Comfort and pain level.
o Skin integrity and incision.
• A child with a neurological disorder is undergoing a lumbar puncture. Which action
would the nurse take to minimize the risk of a post-procedure headache?
o Encourage the child to ambulate after the procedure
o Encourage the child to lie flat for at least 30 minutes
o Apply a cold compress to the puncture site
o Allow the child to drink a caffeinated drink after the procedure
• A nurse working in a homeless shelter provides care to a child who was a victim of
emotional neglect. Which assessment findings would the nurse anticipate in this
child? o Multiple fractures at various stages of healing.
o Antisocial or withdrawing from social interaction.
, o Bruises and burns on the buttocks.
o Pain on urination and itching of the genital area.
• A nurse is providing discharge teaching to a postpartum client. What does the
nurse educate the client to report to their provider immediately?
o Feeling tired and needing frequent naps
o Mild cramping and light bleeding.
o Moderate breast tenderness and fullness.
o Increased lochia flow with larger clots.
• A nurse is educating parents on preventing child maltreatment. Which
recommendation should the nurse prioritize?
o Enroll the child in multiple extracurricular activities.
o Avoid discussing stressful topics in front of the child.
o Use physical discipline sparingly and only when necessary.
o Establish a strong support network of family and friends.
• A child with Cushing syndrome presents with a moon-faced appearance, low serum
protein levels due to muscle wasting, and consistent blood pressures averaging
between 160-180/90-95 mmHg. The healthcare provider has written several orders.
As the nurse is planning care for this child, which intervention would be prioritized
to address the underlying cause of these symptoms?
o Schedule the child for surgical removal of the adrenal tumor
o Encourage the child to engage in muscle-strengthening exercises
o Provide a low-sodium diet to manage hypertension
o Administer an antihypertensive medication
• A nurse is evaluating a postpartum client's understanding of self-care after
discharge. Which statement by the client indicates a need for further teaching?
o "I will monitor the color and amount of my lochia."
o "I can use tampons to manage my lochia flow."
o "I will call my healthcare provider if I develop a fever."
o "I will wash my hands before and after perineal hygiene."
• During a well-child visit, a nurse is discussing anticipatory guidance with the
caregivers of a 9-month-old infant. Which advice should the nurse prioritize to
prevent unintentional injuries as the infant begins to crawl?
o Encourage the purchase of soft toys only
o Schedule regular developmental screenings
o Install stairway gates and cabinet locks
o Ensure the infant's diet includes sufficient iron
• A nurse is planning care for a child with a chronic illness and their family. Which
outcome is most realistic and supportive of the family's adjustment to the illness? o
The family will relocate to be closer to a specialized treatment center.
o The parents will avoid discussing the illness to protect the child's emotional
well-being. o The family will plan for the child to be cured of the illness within six
, months.
o The family will develop a daily routine that incorporates the child's care needs.
• A 7-year-old child undergoing chemotherapy for leukemia is experiencing severe
nausea and vomiting. The parents are concerned about the child's nutritional
intake. Which nursing intervention is most appropriate to address this issue?
o Suggest small, frequent, high-calorie meals throughout the day.
o Advise the parents to give the child their favorite foods regardless of nutritional
value. o Encourage the child to eat large meals three times a day.
o Administer intramuscular antiemetics when the child starts vomiting.
• A 10-year-old child is brought to the emergency department with a head injury after
falling from a bicycle. The child is conscious but has a headache and nausea. The
nurse notes that the child's left pupil is more dilated than the right and reacts
sluggishly to light. Which action would the nurse prioritize in this situation?
o Providing reassurance to the child and parents.
o Administering pain medication for the headache.
o Giving intravenous dexamethasone to decrease inflammation.
o Preparing the child for a CT scan of the head.
• A client with a history of severe dysmenorrhea is considering a non-hormonal
intrauterine device (IUD) for contraception. Which statement by the nurse is most
appropriate? o This type of IUD may be spontaneously expelled at a higher rate due to
the heaving bleeding associated with dysmenorrhea."
o This type of IUD may cause uterine cramping for a few weeks but will help to
improve the symptoms associated with dysmenorrhea over time."
o This type of IUD will not have a positive or negative impact on symptoms
associated with dysmenorrhea."
o This type of IUD may not be the best choice because it may worsen the
symptoms associated with dysmenorrhea."
• During a home visit, a nurse observes that a 4-month-old infant is frequently placed
in a semi-reclined position in a swing for naps. Which instruction by the nurse is
most appropriate?
o Allow the infant to sleep in the parent's bed for better supervision.
o Place the infant on their back in a crib for naps and nighttime
sleep. o Use a car seat for naps as it provides a safer semi-reclined
position.
o Continue using the swing as it helps the infant sleep longer.
• A 10-month-old infant is brought to the clinic for a well-baby visit. The parent states
that the infant is not yet creeping or crawling. Which action by the nurse is most
appropriate? o Refer the infant to a neurologist for further evaluation.
o Assess the infant's overall development and motor skills.
o Advise the parent to use a baby walker to encourage movement.
o Suggest the parent enroll the infant in a physical therapy program.
• A nurse is assessing a 3-year-old child who presents with multiple bruises in various
