NCSBN Practice Questions 76-90
A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central
venous line. This is the first day of TPN therapy. Although all of the following nursing actions
must be included in the plan of care of this child, which one would be a priority at this time?
A. Use aseptic technique during dressing changes
B. Check results of liver enzyme tests
C. Maintain central line catheter integrity
D. Monitor serum glucose levels - ANS-D
Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose
load of the TPN solution. Thus, a priority nursing responsibility is blood glucose testing.
\A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours
after admission, during a planning conference, which of the actions suggested to the
registered nurse (RN) by the practical nurse (PN) would be appropriate to add to the plan of
care?
A. Provide an over-the-crib protective top
B. Measure head circumference
C. Initiate droplet precautions
D. Provide passive range of motion - ANS-B
In meningitis, assessment of neurological signs should be done frequently. Head
circumference is measured because subdural effusions and obstructive hydrocephalus can
develop as a complication of meningitis. The client would have already been placed on
droplet precautions and had a crib top applied to the bed when he was admitted to the unit.
\A 12 year-old pediatric cancer client is distraught about the alopecia that occurred after the
last chemotherapy treatment. Which nursing interventions are appropriate for this side effect
of chemotherapy? (Select all that apply.)
A. Practice and teach thorough hand washing
B. Administer prescribed antiemetic medication before nausea is too severe
C. Encourage visits from friends before discharge from the hospital
D. Allow the child to choose a cap, scarf, wig or other head cover to use - ANS-C,D
Alopecia is the loss of hair, which is a frequent side effect of certain types of chemotherapy.
Although it is not life-threatening, the body image change is difficult for many individuals,
particularly children and adolescents. Encouraging visits from friends before discharge helps
the young client and friends adjust. Wearing preferred forms of head cover-ups increases
comfort and decreases embarrassment. The other options are proper interventions for
chemotherapy, but do not help the client with hair loss.
\A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for
treatment of Kawasaki disease and treatment involving immunoglobulins. The nurse should
recognize which scheduled immunizations will be delayed?
A. Inactivated polio vaccine (IPV)
B. Haemophilus Influenzae Type b (Hib)
,C. Mumps, measles, rubella (MMR)
D. Diptheria, tetanus, pertussis (DTaP) - ANS-C
Medical management of Kawasaki involves administration of immunoglobulins. Measles,
mumps, rubella (MMR) is a live virus vaccine. Following administration of immunoglobulins,
live vaccines should be held due to possible interference with the body's ability to form
antibodies.
\A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this
child enters the hospital room for the first time, the toddler runs to the mother, clings to her
and begins to cry. What should be an initial action by the nurse?
A. Arrange to change client care assignments
B. Explain that the child needs extra attention
C. Discuss the appropriate use of "time-out"
D. Explain that this behavior is expected - ANS-D
During normal development, fear of strangers becomes prominent and begins around age 6
to 8 months-old. Such behaviors include clinging to parent, crying and turning away from the
stranger. These fears and behaviors extend into the toddler period. In the toddler period,
separation anxiety is at its peak. As the child ages the behavior has a tendency to wane.
\A 2-year-old child has just been diagnosed with cystic fibrosis. The child's parent asks the
nurse what the most important concerns are at this time. Which is the appropriate response
from the nurse?
A. "Thick, sticky secretions from the lungs are a constant challenge."
B. "Cystic fibrosis results in nutritional concerns that can be dealt with."
C. "You will work with a team of experts and have access to a support group."
D. "There is a high probability of life-long complications." - ANS-A
The primary factor, and the one responsible for many of the clinical manifestations of cystic
fibrosis, is mechanical obstruction caused by the increased viscosity of mucous gland
secretions.Because of the increased viscosity of bronchial mucus, there is greater resistance
to ciliary action (probably secondary to infection and ciliary destruction), a slower flow rate of
mucus and incomplete expectoration, which also contributes to the mucus obstruction. This
retained mucus serves as an excellent medium for bacterial growth. Reduced
oxygen-carbon dioxide exchange causes variable degrees of hypoxia, hypercapnia and
acidosis.In severe cases, progressive lung involvement, compression of pulmonary blood
vessels and progressive lung dysfunction frequently lead to pulmonary hypertension, cor
pulmonale, respiratory failure and death. Pulmonary complications are present in almost all
children with cystic fibrosis, but the onset and extent of involvement are variable.
\A 3 year-old child has findings that may suggest a neuroblastoma. While listening to the
concerns of the parents, which finding is consistent with this diagnosis and requires
follow-up by the health care provider?
A. "He seems to be getting weaker and weaker and is sometimes unsteady on his feet."
B. "We keep having to buy him larger size pants because he's growing so big around the
waist."
C. "He doesn't seem to be going to the bathroom as much and his urine is dark yellow in
color."
D. "Our child has been quieter than normal lately and has lost weight." - ANS-B
,One of the most common signs of neuroblastoma is increased abdominal girth due to the
mass or tumor in the abdomen. The mass can cause pain and/or a feeling of fullness and
the pressure may affect the child's bladder or bowel. Although the child with a
neuroblastoma may not want to eat (which can lead to weight loss), this finding could have
many causes. A more significant finding would be if the parents reported that child keeps
outgrowing clothing or that clothing is tight around the abdomen.
\A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg;
resting pulse is 78 BPM; respirations are 28 BPM; and the serum potassium level is 4.8
mEq/L (4.8 mmol/L). The client is irritable and has vomited twice since the morning dose of
digoxin. Which finding is most indicative of digoxin toxicity?
A. Irritability
B. Vomiting
C. Bradycardia
D. Dyspnea - ANS-C
The most common sign of digoxin toxicity in children is bradycardia which is a heart rate
below 100 BPM in an infant. Normal resting heart rate for infants 1-11 months-old is 100-160
BPM.
\A 52 year-old postmenopausal woman asks the nurse how frequently she should have a
mammogram. How should the nurse respond?
A. "Unless you had previous problems, every two years is best."
B. "Your health care provider will advise you about your risks and the frequency."
C. "Yearly mammograms are advised for any women over 35."
D. "Once a woman reaches 50, she should have a mammogram yearly." - ANS-D
The American Cancer Society recommends a screening mammogram by age 40, every one
to two years for women 40 to 49, and every year from age 50 onward. If there are family or
personal health risks, other more frequent and additional assessments may be
recommended.
\A 57 year-old male client has a hemoglobin of 10 g/dL (6.21 mmol/L) and a hematocrit of
32% (0.32). What would be the most appropriate follow-up by a home care nurse?
A. Ask the client if the client has noticed any bleeding or dark stools
B. Call 911 and send the client to the emergency department
C. Refer the client to schedule an appointment with a hematologist
D. Schedule a repeat hemoglobin and hematocrit in one month - ANS-A
Normal hemoglobin for males is 14 - 18 g/dL (8.69 - 11.17 mmol/L). Normal hematocrit for
males is 42 - 52% (0.42-0.52). The lab values for this client are below normal and indicate
mild anemia. The nurse should ask if the client has noticed any bleeding or change in stools
that could indicate bleeding from the GI tract.
\A child is admitted to the hospital with findings consistent with rheumatic fever. During the
admission process, which statement made by a parent would the nurse associate with this
disease?
A. "Last week both feet had a fungal skin infection."
B. "Our child had a sore throat a month ago, which I treated with an herbal remedy."
C. "Our child is being tested for allergies and has reacted to some allergens."
D. "Both ears were infected when our child was 3 months-old." - ANS-B
, Evidence supports a strong relationship between group A streptococcal infections and
subsequent rheumatic fever (usually within two to six weeks). Therefore, the history of sore
throat may have been an undiagnosed strep A infection. Appropriate antibiotic treatment of
strep throat is the most effective way to reduce the risk of developing rheumatic fever.
\A child is injured on the school playground and appears to have a fractured leg. Which of
the following is the first action a school nurse should take?
A. Call for emergency transport to the hospital
B. Assess the child and the extent of the injury
C. Immobilize the limb and joints above and below the injury
D. Apply cold compresses to the injured area - ANS-B
Application of the nursing process dictates that assessment is the first step in the provision
of care. The 6 Ps of vascular impairment (pain, pulse, pallor, paresthesia, paralysis and
poikilothermia (coolness) can be used as a guide for assessment of the injured leg. The
other options would be done in this sequence - immobilize, call 911 and then apply ice as
indicated.
\A client admitted with heart failure is experiencing severe shortness of breath and states, "I
feel like something is terribly wrong!" The client is restless and begins to cough up large
amounts of pink frothy sputum. The client's skin is a dusky grayish color and the oxygen
saturation levels have decreased from 92% to 76% in the last hour. What is the first action
the nurse should take?
A. Check vital signs
B. Administer the PRN ordered oxygen
C. Call the health care provider
D. Place the bed in high Fowler's position - ANS-B
When dealing with a medical emergency, the rule is to assess airway first, then breathing,
and then circulation. Starting oxygen is the priority. The other actions should also be
implemented as quickly as possible, including activation of the rapid response team. The
client is experiencing an acute episode of fulminant pulmonary edema, likely as a result of a
new and severe cardiac event and possible cardiogenic shock. Emergency assessment and
intervention is indicated to prevent cardiac arrest and possible death.
\A client asks the nurse about including her 2 year-old and 12 year-old sons in the care of
their newborn sister. Which response is an appropriate initial statement by the nurse?
A. "Focus on your sons' needs during the first days at home."
B. "Suggest that your partner spend more time with the boys."
C. "Tell each child what he can do to help with the baby."
D. "Ask the children what they would like to do for the newborn." - ANS-A
In an expanded family, it is important for parents to reassure older children that they are
loved and as important as the newborn.
\A client being treated for hypertension returns to the community clinic for a follow-up. The
client says, "I know these pills are important, but I just can't take these water pills anymore. I
drive a truck for a living, and I can't be stopping every 20 minutes to go to the bathroom."
Which nursing diagnosis should the nurse select for this client?
A. Defensive coping related to chronic illness
B. Knowledge deficit related to misunderstanding of disease state
A 1 year-old child is receiving temporary total parental nutrition (TPN) through a central
venous line. This is the first day of TPN therapy. Although all of the following nursing actions
must be included in the plan of care of this child, which one would be a priority at this time?
A. Use aseptic technique during dressing changes
B. Check results of liver enzyme tests
C. Maintain central line catheter integrity
D. Monitor serum glucose levels - ANS-D
Hyperglycemia may occur during the first day or two as the child adapts to the high-glucose
load of the TPN solution. Thus, a priority nursing responsibility is blood glucose testing.
\A 10-month old infant is admitted with a diagnosis of bacterial meningitis. Several hours
after admission, during a planning conference, which of the actions suggested to the
registered nurse (RN) by the practical nurse (PN) would be appropriate to add to the plan of
care?
A. Provide an over-the-crib protective top
B. Measure head circumference
C. Initiate droplet precautions
D. Provide passive range of motion - ANS-B
In meningitis, assessment of neurological signs should be done frequently. Head
circumference is measured because subdural effusions and obstructive hydrocephalus can
develop as a complication of meningitis. The client would have already been placed on
droplet precautions and had a crib top applied to the bed when he was admitted to the unit.
\A 12 year-old pediatric cancer client is distraught about the alopecia that occurred after the
last chemotherapy treatment. Which nursing interventions are appropriate for this side effect
of chemotherapy? (Select all that apply.)
A. Practice and teach thorough hand washing
B. Administer prescribed antiemetic medication before nausea is too severe
C. Encourage visits from friends before discharge from the hospital
D. Allow the child to choose a cap, scarf, wig or other head cover to use - ANS-C,D
Alopecia is the loss of hair, which is a frequent side effect of certain types of chemotherapy.
Although it is not life-threatening, the body image change is difficult for many individuals,
particularly children and adolescents. Encouraging visits from friends before discharge helps
the young client and friends adjust. Wearing preferred forms of head cover-ups increases
comfort and decreases embarrassment. The other options are proper interventions for
chemotherapy, but do not help the client with hair loss.
\A 15 month-old child comes to the clinic for a follow-up visit after hospitalization for
treatment of Kawasaki disease and treatment involving immunoglobulins. The nurse should
recognize which scheduled immunizations will be delayed?
A. Inactivated polio vaccine (IPV)
B. Haemophilus Influenzae Type b (Hib)
,C. Mumps, measles, rubella (MMR)
D. Diptheria, tetanus, pertussis (DTaP) - ANS-C
Medical management of Kawasaki involves administration of immunoglobulins. Measles,
mumps, rubella (MMR) is a live virus vaccine. Following administration of immunoglobulins,
live vaccines should be held due to possible interference with the body's ability to form
antibodies.
\A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this
child enters the hospital room for the first time, the toddler runs to the mother, clings to her
and begins to cry. What should be an initial action by the nurse?
A. Arrange to change client care assignments
B. Explain that the child needs extra attention
C. Discuss the appropriate use of "time-out"
D. Explain that this behavior is expected - ANS-D
During normal development, fear of strangers becomes prominent and begins around age 6
to 8 months-old. Such behaviors include clinging to parent, crying and turning away from the
stranger. These fears and behaviors extend into the toddler period. In the toddler period,
separation anxiety is at its peak. As the child ages the behavior has a tendency to wane.
\A 2-year-old child has just been diagnosed with cystic fibrosis. The child's parent asks the
nurse what the most important concerns are at this time. Which is the appropriate response
from the nurse?
A. "Thick, sticky secretions from the lungs are a constant challenge."
B. "Cystic fibrosis results in nutritional concerns that can be dealt with."
C. "You will work with a team of experts and have access to a support group."
D. "There is a high probability of life-long complications." - ANS-A
The primary factor, and the one responsible for many of the clinical manifestations of cystic
fibrosis, is mechanical obstruction caused by the increased viscosity of mucous gland
secretions.Because of the increased viscosity of bronchial mucus, there is greater resistance
to ciliary action (probably secondary to infection and ciliary destruction), a slower flow rate of
mucus and incomplete expectoration, which also contributes to the mucus obstruction. This
retained mucus serves as an excellent medium for bacterial growth. Reduced
oxygen-carbon dioxide exchange causes variable degrees of hypoxia, hypercapnia and
acidosis.In severe cases, progressive lung involvement, compression of pulmonary blood
vessels and progressive lung dysfunction frequently lead to pulmonary hypertension, cor
pulmonale, respiratory failure and death. Pulmonary complications are present in almost all
children with cystic fibrosis, but the onset and extent of involvement are variable.
\A 3 year-old child has findings that may suggest a neuroblastoma. While listening to the
concerns of the parents, which finding is consistent with this diagnosis and requires
follow-up by the health care provider?
A. "He seems to be getting weaker and weaker and is sometimes unsteady on his feet."
B. "We keep having to buy him larger size pants because he's growing so big around the
waist."
C. "He doesn't seem to be going to the bathroom as much and his urine is dark yellow in
color."
D. "Our child has been quieter than normal lately and has lost weight." - ANS-B
,One of the most common signs of neuroblastoma is increased abdominal girth due to the
mass or tumor in the abdomen. The mass can cause pain and/or a feeling of fullness and
the pressure may affect the child's bladder or bowel. Although the child with a
neuroblastoma may not want to eat (which can lead to weight loss), this finding could have
many causes. A more significant finding would be if the parents reported that child keeps
outgrowing clothing or that clothing is tight around the abdomen.
\A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg;
resting pulse is 78 BPM; respirations are 28 BPM; and the serum potassium level is 4.8
mEq/L (4.8 mmol/L). The client is irritable and has vomited twice since the morning dose of
digoxin. Which finding is most indicative of digoxin toxicity?
A. Irritability
B. Vomiting
C. Bradycardia
D. Dyspnea - ANS-C
The most common sign of digoxin toxicity in children is bradycardia which is a heart rate
below 100 BPM in an infant. Normal resting heart rate for infants 1-11 months-old is 100-160
BPM.
\A 52 year-old postmenopausal woman asks the nurse how frequently she should have a
mammogram. How should the nurse respond?
A. "Unless you had previous problems, every two years is best."
B. "Your health care provider will advise you about your risks and the frequency."
C. "Yearly mammograms are advised for any women over 35."
D. "Once a woman reaches 50, she should have a mammogram yearly." - ANS-D
The American Cancer Society recommends a screening mammogram by age 40, every one
to two years for women 40 to 49, and every year from age 50 onward. If there are family or
personal health risks, other more frequent and additional assessments may be
recommended.
\A 57 year-old male client has a hemoglobin of 10 g/dL (6.21 mmol/L) and a hematocrit of
32% (0.32). What would be the most appropriate follow-up by a home care nurse?
A. Ask the client if the client has noticed any bleeding or dark stools
B. Call 911 and send the client to the emergency department
C. Refer the client to schedule an appointment with a hematologist
D. Schedule a repeat hemoglobin and hematocrit in one month - ANS-A
Normal hemoglobin for males is 14 - 18 g/dL (8.69 - 11.17 mmol/L). Normal hematocrit for
males is 42 - 52% (0.42-0.52). The lab values for this client are below normal and indicate
mild anemia. The nurse should ask if the client has noticed any bleeding or change in stools
that could indicate bleeding from the GI tract.
\A child is admitted to the hospital with findings consistent with rheumatic fever. During the
admission process, which statement made by a parent would the nurse associate with this
disease?
A. "Last week both feet had a fungal skin infection."
B. "Our child had a sore throat a month ago, which I treated with an herbal remedy."
C. "Our child is being tested for allergies and has reacted to some allergens."
D. "Both ears were infected when our child was 3 months-old." - ANS-B
, Evidence supports a strong relationship between group A streptococcal infections and
subsequent rheumatic fever (usually within two to six weeks). Therefore, the history of sore
throat may have been an undiagnosed strep A infection. Appropriate antibiotic treatment of
strep throat is the most effective way to reduce the risk of developing rheumatic fever.
\A child is injured on the school playground and appears to have a fractured leg. Which of
the following is the first action a school nurse should take?
A. Call for emergency transport to the hospital
B. Assess the child and the extent of the injury
C. Immobilize the limb and joints above and below the injury
D. Apply cold compresses to the injured area - ANS-B
Application of the nursing process dictates that assessment is the first step in the provision
of care. The 6 Ps of vascular impairment (pain, pulse, pallor, paresthesia, paralysis and
poikilothermia (coolness) can be used as a guide for assessment of the injured leg. The
other options would be done in this sequence - immobilize, call 911 and then apply ice as
indicated.
\A client admitted with heart failure is experiencing severe shortness of breath and states, "I
feel like something is terribly wrong!" The client is restless and begins to cough up large
amounts of pink frothy sputum. The client's skin is a dusky grayish color and the oxygen
saturation levels have decreased from 92% to 76% in the last hour. What is the first action
the nurse should take?
A. Check vital signs
B. Administer the PRN ordered oxygen
C. Call the health care provider
D. Place the bed in high Fowler's position - ANS-B
When dealing with a medical emergency, the rule is to assess airway first, then breathing,
and then circulation. Starting oxygen is the priority. The other actions should also be
implemented as quickly as possible, including activation of the rapid response team. The
client is experiencing an acute episode of fulminant pulmonary edema, likely as a result of a
new and severe cardiac event and possible cardiogenic shock. Emergency assessment and
intervention is indicated to prevent cardiac arrest and possible death.
\A client asks the nurse about including her 2 year-old and 12 year-old sons in the care of
their newborn sister. Which response is an appropriate initial statement by the nurse?
A. "Focus on your sons' needs during the first days at home."
B. "Suggest that your partner spend more time with the boys."
C. "Tell each child what he can do to help with the baby."
D. "Ask the children what they would like to do for the newborn." - ANS-A
In an expanded family, it is important for parents to reassure older children that they are
loved and as important as the newborn.
\A client being treated for hypertension returns to the community clinic for a follow-up. The
client says, "I know these pills are important, but I just can't take these water pills anymore. I
drive a truck for a living, and I can't be stopping every 20 minutes to go to the bathroom."
Which nursing diagnosis should the nurse select for this client?
A. Defensive coping related to chronic illness
B. Knowledge deficit related to misunderstanding of disease state
