NSG 6435 Final Exam 2
1. The nurse is seeing an adolescent boy and his parents in the clinic for the first
time. What should the nurse do first? Correct answer- introduce self
2. What action is most likely to encourage parents to talk about their feelings related
to their child's illness? Correct answer- Use open-ended questions.
3. What is the single most important factor to consider when communicating with
children? Correct answer- The child's developmental level
4. What is an important consideration for the nurse who is communicating with a
very young child? Correct answer- Use transition objects such as a doll.
5. When introducing hospital equipment to a preschooler who seems afraid, the
nurse's approach should be based on which principle? Correct answer- The child
may think the equipment is alive.
6. Which age group is most concerned with body integrity? Correct answer- School-
age child
7. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The
most appropriate nursing action is to: Correct answer- Explain in simple terms
how it works.
8. When the nurse interviews an adolescent, it is especially important to: Correct
answer- Allow an opportunity to express feelings.
9. The nurse is having difficulty communicating with a hospitalized 6-year-old child.
What technique might be most helpful? Correct answer- Ask the child to draw a
picture.
10. The nurse is taking a health history on an adolescent. What best describes how
the chief complaint should be determined? Correct answer- Ask adolescent,
"Why did you come here today?"
11. Where in the health history should the nurse describe all details related to the
chief complaint? Correct answer- Present illness
12. The nurse is interviewing the mother of an infant. She reports, "I had a difficult
delivery, and my baby was born prematurely." This information should be
recorded under which heading? Correct answer- Birth history
,13. When interviewing the mother of a 3-year-old child, the nurse asks about
developmental milestones such as the age of walking without assistance. This
should be considered because these milestones are: Correct answer- An
important part of the child's past growth and development
14. The nurse is taking a sexual history on an adolescent girl. The best way to
determine whether she is sexually active is to: Correct answer- Ask her, "Are you
having sex with anyone?"
15. When doing a nutritional assessment on an Hispanic family, the nurse learns that
their diet consists mainly of vegetables, legumes, and starches. The nurse
should recognize that this diet: Correct answer- May provide sufficient amino
acids.
16. Which parameter correlates best with measurements of the body's total protein
stores? Correct answer- Upper arm circumference
17. An appropriate approach to performing a physical assessment on a toddler is to:
Correct answer- Use minimal physical contact initially.
18. With the National Center for Health Statistics (NCHS) criteria, which body mass
index (BMI)-for-age percentile indicates a risk for being overweight? Correct
answer- 85th percentile
19. The nurse is using the NCHS growth chart for an African-American child. The
nurse should consider that: Correct answer- The NCHS charts are accurate for
U.S. African-American children.
20. Which tool measures body fat most accurately? Correct answer- Calipers
21. By what age do the head and chest circumferences generally become equal?
Correct answer- 1 to 2 years
22. The earliest age at which a satisfactory radial pulse can be taken in children is:
Correct answer- 2 years
23. Where is the best place to observe for the presence of petechiae in dark-skinned
individuals? Correct answer- Oral mucosa
24. When palpating the child's cervical lymph nodes, the nurse notes that they are
tender, enlarged, and warm. The best explanation for this is: Correct answer-
Infection or inflammation close to the site.
25. The nurse has just started assessing a young child who is febrile and appears
very ill. There is hyperextension of the child's head (opisthotonos) with pain on
, flexion. The most appropriate action is to: Correct answer- Refer for immediate
medical evaluation.
26. The nurse should expect the anterior fontanel to close at age: Correct answer- 12
to 18 months
27. During a funduscopic examination of a school-age child, the nurse notes a
brilliant, uniform red reflex in both eyes. The nurse should recognize that this is:
Correct answer- A normal finding.
28. Binocularity, the ability to fixate on one visual field with both eyes simultaneously,
is normally present by what age? Correct answer- 3 to 4 months
29. The most frequently used test for measuring visual acuity is the: Correct answer-
Snellen letter chart.
30. The nurse is testing an infant's visual acuity. By what age should the infant be
able to fix on and follow a target? Correct answer- 3 to 4 months
31. The appropriate placement of a tongue blade for assessment of the mouth and
throat is the: Correct answer- Side of the tongue.
32. What type of breath sound is normally heard over the entire surface of the lungs
except for the upper intrascapular area and the area beneath the manubrium?
Correct answer- Vesicular
33. What term is used to describe breath sounds that are produced as air passes
through narrowed passageways? Correct answer- Wheezes
34. The nurse must assess a child's capillary filling time. This can be accomplished
by: Correct answer- Palpating the skin to produce a slight blanching.
35. What heart sound is produced by vibrations within the heart chambers or in the
major arteries from the back-and-forth flow of blood? Correct answer- murmur
36. Examination of the abdomen is performed correctly by the nurse in this order:
Correct answer- inspection, auscultation, and palpation
37. The nurse has a 2-year-old boy sit in "tailor" position during palpation for the
testes. The rationale for this position is that: Correct answer- It prevents
cremasteric reflex.
38. During examination of a toddler's extremities, the nurse notes that the child is
bowlegged. The nurse should recognize that this finding is: Correct answer-
Normal because the lower back and leg muscles are not yet well developed.
1. The nurse is seeing an adolescent boy and his parents in the clinic for the first
time. What should the nurse do first? Correct answer- introduce self
2. What action is most likely to encourage parents to talk about their feelings related
to their child's illness? Correct answer- Use open-ended questions.
3. What is the single most important factor to consider when communicating with
children? Correct answer- The child's developmental level
4. What is an important consideration for the nurse who is communicating with a
very young child? Correct answer- Use transition objects such as a doll.
5. When introducing hospital equipment to a preschooler who seems afraid, the
nurse's approach should be based on which principle? Correct answer- The child
may think the equipment is alive.
6. Which age group is most concerned with body integrity? Correct answer- School-
age child
7. An 8-year-old girl asks the nurse how the blood pressure apparatus works. The
most appropriate nursing action is to: Correct answer- Explain in simple terms
how it works.
8. When the nurse interviews an adolescent, it is especially important to: Correct
answer- Allow an opportunity to express feelings.
9. The nurse is having difficulty communicating with a hospitalized 6-year-old child.
What technique might be most helpful? Correct answer- Ask the child to draw a
picture.
10. The nurse is taking a health history on an adolescent. What best describes how
the chief complaint should be determined? Correct answer- Ask adolescent,
"Why did you come here today?"
11. Where in the health history should the nurse describe all details related to the
chief complaint? Correct answer- Present illness
12. The nurse is interviewing the mother of an infant. She reports, "I had a difficult
delivery, and my baby was born prematurely." This information should be
recorded under which heading? Correct answer- Birth history
,13. When interviewing the mother of a 3-year-old child, the nurse asks about
developmental milestones such as the age of walking without assistance. This
should be considered because these milestones are: Correct answer- An
important part of the child's past growth and development
14. The nurse is taking a sexual history on an adolescent girl. The best way to
determine whether she is sexually active is to: Correct answer- Ask her, "Are you
having sex with anyone?"
15. When doing a nutritional assessment on an Hispanic family, the nurse learns that
their diet consists mainly of vegetables, legumes, and starches. The nurse
should recognize that this diet: Correct answer- May provide sufficient amino
acids.
16. Which parameter correlates best with measurements of the body's total protein
stores? Correct answer- Upper arm circumference
17. An appropriate approach to performing a physical assessment on a toddler is to:
Correct answer- Use minimal physical contact initially.
18. With the National Center for Health Statistics (NCHS) criteria, which body mass
index (BMI)-for-age percentile indicates a risk for being overweight? Correct
answer- 85th percentile
19. The nurse is using the NCHS growth chart for an African-American child. The
nurse should consider that: Correct answer- The NCHS charts are accurate for
U.S. African-American children.
20. Which tool measures body fat most accurately? Correct answer- Calipers
21. By what age do the head and chest circumferences generally become equal?
Correct answer- 1 to 2 years
22. The earliest age at which a satisfactory radial pulse can be taken in children is:
Correct answer- 2 years
23. Where is the best place to observe for the presence of petechiae in dark-skinned
individuals? Correct answer- Oral mucosa
24. When palpating the child's cervical lymph nodes, the nurse notes that they are
tender, enlarged, and warm. The best explanation for this is: Correct answer-
Infection or inflammation close to the site.
25. The nurse has just started assessing a young child who is febrile and appears
very ill. There is hyperextension of the child's head (opisthotonos) with pain on
, flexion. The most appropriate action is to: Correct answer- Refer for immediate
medical evaluation.
26. The nurse should expect the anterior fontanel to close at age: Correct answer- 12
to 18 months
27. During a funduscopic examination of a school-age child, the nurse notes a
brilliant, uniform red reflex in both eyes. The nurse should recognize that this is:
Correct answer- A normal finding.
28. Binocularity, the ability to fixate on one visual field with both eyes simultaneously,
is normally present by what age? Correct answer- 3 to 4 months
29. The most frequently used test for measuring visual acuity is the: Correct answer-
Snellen letter chart.
30. The nurse is testing an infant's visual acuity. By what age should the infant be
able to fix on and follow a target? Correct answer- 3 to 4 months
31. The appropriate placement of a tongue blade for assessment of the mouth and
throat is the: Correct answer- Side of the tongue.
32. What type of breath sound is normally heard over the entire surface of the lungs
except for the upper intrascapular area and the area beneath the manubrium?
Correct answer- Vesicular
33. What term is used to describe breath sounds that are produced as air passes
through narrowed passageways? Correct answer- Wheezes
34. The nurse must assess a child's capillary filling time. This can be accomplished
by: Correct answer- Palpating the skin to produce a slight blanching.
35. What heart sound is produced by vibrations within the heart chambers or in the
major arteries from the back-and-forth flow of blood? Correct answer- murmur
36. Examination of the abdomen is performed correctly by the nurse in this order:
Correct answer- inspection, auscultation, and palpation
37. The nurse has a 2-year-old boy sit in "tailor" position during palpation for the
testes. The rationale for this position is that: Correct answer- It prevents
cremasteric reflex.
38. During examination of a toddler's extremities, the nurse notes that the child is
bowlegged. The nurse should recognize that this finding is: Correct answer-
Normal because the lower back and leg muscles are not yet well developed.
