1. 1. The nurse is caring for a 3-year old child who is 2 hours postop from a
cardiac catheterization via the right femoral artery. Which assessment
finding is an indication of arterial obstruction?
a.Blood pressure trend is downward and pulse is rapid and
irregular. b.Right foot is cool to the touch and appears pale and
blanched.
c.Pulse distal to the femoral artery is weaker on the left foot than right
foot. d.The pressure dressing at right femoral area is moist and oozing
blood.: - b.Right foot is cool to the touch and appears pale and
blanched.
2. 2. Following a motor vehicle collision, a 3-year old girl has a spica
cast applied. Which toy is best for the nurse for this 3-year-old child?
A. Duckthatsqueaks.
B. Fashiondollandclothes.
C. Set of cloth and hand puppets.
D. Hand held video game.: C. Set of cloth and hand puppets.
3. 3. An infant with tetralogy of Fallot becomes acutely cyanotic and
,hyperp- neic. Which action should the nurse implement first?
A. Administer morphine sulphate.
B. Start IV fluids.
C. Place the infant in a knee-chest position.
D. Provide 100% oxygen by face mask.: C. Place the infant in a knee-
chest position.
4. 4. A child admitted with diabetic ketoacidosis is demonstrating
Kussmaul respirations. The nurse determines that the increased
respiratory rate is a compensatory mechanism for which acid base
alteration?
A. Metabolicalkalosis.
B. Respiratory acidosis.
C. Respiratoryalkalosis.
D. Metabolic acidosis.: D. Metabolic acidosis.
5. 5. 7 years old is admitted to the hospital with persistent vomiting, and a
nasogastric tube attached to low intermittent suction is applied. Which
finding is most important for the nurse to report to the healthcare provider?
A. Gastric output of 100 mL in the last 8 hours.
B. Shift intake of 640 mL IV fluids plus 30 mL PO ice chips.
,C. Serum potassium of 3.0 mg/dL.
D. Serum pH of 7.45.: C. Serum potassium of 3.0 mg/dL.
6. 6. The nurse is evaluating diet teaching for a client who has nontropical
sprue (celiac disease). Choosing which food indicates that the teaching
has been effective?
A. Creamed corn.
, B. Pancakes.
C. Rye crackers.
D. Cooked oatmeal.: A. Creamed corn.
7. 7. During a well-baby check, the nurse hides a block under the baby's
blan- ket, and the baby looks for the block. Which normal growth and
development milestone is the baby developing?
A. Separation anxiety.
B. Associativeplay.
C. Object prehension.
D. Object permanence.: D. Object permanence.
8. 8. The nurse is measuring the frontal occipital circumference (FOC)
of a 3-months old infant, and notes that the FOC has increased 5 inches
since
birth and the child's head appears large in relation to body size. Which
action is most important for the nurse to take next?
A. Measuretheinfant'shead-to-toelength.
B. Palpate the anterior fontanel for tension and bulging.
C. Observe the infant for sunken eyes.
D. Plot the measurement on the infant's growth chart.: B. Palpate the