PERRY’S MATERNAL CHILD
AND NURSING CARE QUESTIONS
AND THEIR CORRECT EXPECTED
ANSWERS
The nurse is preparing to check the blood pressure
(BP) of a school-age child. The maximum arm
circumference of the child is 20 cm. Which size cuff
does the nurse need to use to measure the BP?
Width of 9 cm and length of 18 cm
Rationale: To determine proper cuff size, the nurse should
make sure the bladder cuff with is approximately 40% of
measured arm circumference, and the length should cover
80% to 100% of measured arm circumference.
The nurse is assessing the neurologic function of an
infant. The elicited response is partial flexion of the
forearm. Which reflex is elicited by this response?
Biceps reflex
Which nerve is the nurse assessing when testing the
VII cranial nerve?
Facial nerve
Which clinical signs are associated with a deficiency
in Vitamin B6 and B12?
Fatigue, pallor, sore tongue, gingivitis, mood swings
, The nurse is assessing the apical pulse of a school-
age child older than 7 years of age. Where does the
nurse palpate to locate the apical pulse?
Left midclavicular line and 5th intercostal space
Which type of temperature recording should a nurse
use for an accurate temperature reading on a 3 month
old?
Rectal
The nurse is assessing the heart sounds of a child
and notices the child has a grade II murmur. Which is
a characteristic of a grade II murmur
The heart sound is easily heard and noticed in all positions
After assessing the apical pulse of a child, the nurse
documents the grade of the pulse as +2. Which does
this finding indicate?
The pulse is difficult to palpate and may be obliterated by
pressure.
Pulse grading scale of 0-4
A 10-year-old patient presented to the outpatient clinic
with cough, fever, and dyspnea. The nurse
understands the importance of evaluating heart
sounds on the patient. Place the sequence of
auscultating heart sounds in the correct order.
Aortic
Pulmonic
Erb's
Tricuspid
Mitral
What is the order of an abdominal assessment on an
infant?
AND NURSING CARE QUESTIONS
AND THEIR CORRECT EXPECTED
ANSWERS
The nurse is preparing to check the blood pressure
(BP) of a school-age child. The maximum arm
circumference of the child is 20 cm. Which size cuff
does the nurse need to use to measure the BP?
Width of 9 cm and length of 18 cm
Rationale: To determine proper cuff size, the nurse should
make sure the bladder cuff with is approximately 40% of
measured arm circumference, and the length should cover
80% to 100% of measured arm circumference.
The nurse is assessing the neurologic function of an
infant. The elicited response is partial flexion of the
forearm. Which reflex is elicited by this response?
Biceps reflex
Which nerve is the nurse assessing when testing the
VII cranial nerve?
Facial nerve
Which clinical signs are associated with a deficiency
in Vitamin B6 and B12?
Fatigue, pallor, sore tongue, gingivitis, mood swings
, The nurse is assessing the apical pulse of a school-
age child older than 7 years of age. Where does the
nurse palpate to locate the apical pulse?
Left midclavicular line and 5th intercostal space
Which type of temperature recording should a nurse
use for an accurate temperature reading on a 3 month
old?
Rectal
The nurse is assessing the heart sounds of a child
and notices the child has a grade II murmur. Which is
a characteristic of a grade II murmur
The heart sound is easily heard and noticed in all positions
After assessing the apical pulse of a child, the nurse
documents the grade of the pulse as +2. Which does
this finding indicate?
The pulse is difficult to palpate and may be obliterated by
pressure.
Pulse grading scale of 0-4
A 10-year-old patient presented to the outpatient clinic
with cough, fever, and dyspnea. The nurse
understands the importance of evaluating heart
sounds on the patient. Place the sequence of
auscultating heart sounds in the correct order.
Aortic
Pulmonic
Erb's
Tricuspid
Mitral
What is the order of an abdominal assessment on an
infant?
