COLLEGE OF ALLIED HEALTH SCIENCES

Nursing Department
Rizal Street, Iloilo City

COMPETENCY APPRAISAL 1
Psychiatric and Pediatric Nursing
UNIT TEST 2

NAME: __________________________________________DATE: _____________ SCORE:____________

INSTRUCTION: Select the best response for each situation by shading the letter of your choice
on the answer sheet provided. Strictly, ERASURES or ALTERATIONS of any forms will
automatically invalidate your answer. HAVE FUN!

1. Which neurotransmitter has been implicated in the 6. Disulfiram serves as a treatment for alcoholism, it
development of Alzheimer’s disease? functions to:
A. Acetylcholine B. Dopamine A. lessen alcohol withdrawal symptoms
C. Epinephrine D. Serotonin B. decrease serum alcohol levels
C. restrict from alcohol drinking
2. The nurse is administering a psychotropic drug to an D. treat alcohol intoxication
elderly client who has history of benign prostatic
hypertrophy. It is most important for the nurse to 7. One morning the nurse sees the client in a
teach this client to: depressed mood. The nurse asks her “What are you
A. Add fiber to his diet. thinking about?” This communication technique is:
B. Report incomplete bladder emptying. A. Focusing
C. Exercise on a regular basis. B. validating.
D. Take the prescribed dose at bedtime. C. reflecting.
D. giving broad opening.
3. The nurse is teaching a client taking a MAOI about
foods with tyramine that he or she should avoid. 8. Which of the following theorists believed that a
Which of the following statement indicates that the corrective interpersonal relationship with the
client needs further teaching? therapist was the primary mode of treatment?
A. “I’m so glad I can have pizza as long as I don’t A. Sigmund Freud
order pepperoni.” B. Hildegard Peplau
B. “I will be able to eat cottage cheese without C. William Glasser
worrying.” D. Harry Stack Sullivan
C. “I will have to avoid drinking nonalcoholic beer.”
D. “I can eat green beans on this diet.” 9. Correcting how one thinks about the world and one-
self is the focus of:
4. A client who has been depressed and suicidal A. behaviorism.
started taking a tricyclic antidepressant 2 weeks ago B. cognitive therapy.
and is now ready to leave the hospital to go home. C. Psychoanalysis
Which of the following is a concern for the nurse as D. reality therapy.
discharge plans are finalized?
A. The client may need a prescription for 10. Nurse John is a aware that most crisis situations
diphenhydramine (Benadryl) to use for side should resolve in about:
effects. A. 1 to 2 weeks
B. The nurse will evaluate the risk for suicide by B. 4 to 6 weeks
overdose of the tricyclic antidepressant. C. 4 to 6 months
C. The nurse will need to include teaching D. 6 to 12 months
regarding the signs of neuroleptic malignant
syndrome. 11. Which factors are most essential for the nurse to
D. The client will need regular laboratory work to assess when providing crisis intervention foe a
monitor therapeutic drug levels. client?
A. The client’s communication and coping skills.
5. The nurse is caring for a client with schizophrenia B. The client’s anxiety level and ability to express
who is taking haloperidol (Haldol). The client feelings.
complains of restlessness, cannot sit still, and has C. The client’s perception of the triggering event
muscle stiffness. Of the following PRN medications, and availability of situational supports.
which would the nurse administer? D. The client’s use of reality testing and level of
A. Haloperidol (Haldol) 5 mg PO depression.
B. Propranolol (Inderal) 20 mg PO
C. Benztropine (Cogentin) 2 mg PO
D. Trazodone 50 mg PO
12. The nurse considers a client’s response to crisis
intervention successful if the client:
A. changes coping skills and behavioral patterns.
B. develops insight into reasons why the crisis
occurred.
C. learns to relate better to others.
D. returns to his previous level of functioning.
13. Nurse Monette recognizes that the focus of
environmental (MILIEU) therapy is to:
A. manipulate the environment to bring about
positive changes in behavior.
B. allow the client’s freedom to determine whether
or not they will be involved in activities.
C. role play life events to meet individual needs.
D. use natural remedies rather than drugs to
control behavior.
14. Nurse Sarah ensures a therapeutic environment for
all clients. Which of the following best describes a
therapeutic milieu?
A. A therapy that rewards adaptive behavior
B. A living, learning or working environment.
C. A cognitive approach to change behavior
D. A permissive and congenial environment
15. Joy who has just experienced her second
spontaneous abortion expresses anger towards her
physician, the hospital and the “rotten nursing care”.
When assessing the situation, the nurse recognizes
that the client may be using the coping mechanism
of:
A. Projection
B. Displacement
C. Denial
D. Reaction formation
16. When nurse Hazel considers a client’s placement on
the continuum of anxiety, a key in determining the
degree of anxiety being experienced is the client’s:
A. Perceptual field
B. Memory state
C. Delusional system
D. Creativity level
17. Psychotherapeutic treatment modalities were
created and developed based on their existing
theories. Modern therapies such as cognitive and
reality therapies were based on existential theories
which aim to:
A. Enhance patient’s self-awareness
B. Overcome fears and anxiety
C. Develop patient’s insight
D. Explore solutions to patient’s identified problems
18. Peplau has identified several sub roles of the
psychiatric nurse. When the nurse utilizes
interpersonal techniques to help the patient adapt or
cope with life experiences, he/she function as a:
A. counselor.
B. therapist.
C. surrogate.
D. teacher.
19. Older adults have reached Erikson's developmental
stage of ego integrity, when they:
A. acknowledge that one cannot get everything one
wants in life.
B. assess their lives and identify actions that had
value and purpose.
C. express a wish that life could be relived
differently.
D. feel that they are being punished for things they
did not do.
20. The superego is that part of the psyche that:
A. uses defensive function for protection.
B. determines the circumstances before making
decisions.
C. is impulsive and without morals.
D. the censoring portion of the mind.
21. The ego's role is to
A. alleviate hysteria
B. suppress the conscience
C. mediate between the id and superego
D. counteract the superego
E. counteract the id
22. Liza says, “Give me 10 minutes to recall the name of
our college professor who failed many students in
our anatomy class.” She is operating on her:
A. subconscious.
B. conscious.
C. unconscious.
D. ego.
23. A person who failed a class but tells people he got
an A is experiencing denial. Why is this an
unproductive way of dealing with disappointment?
A. Denial is unproductive because it is a refusal to
accept reality.
B. Denial is unproductive because it places blame
for the problem on someone else.
C. Denial is unproductive because it creates a
solution to a problem that does not exist.
D. Denial is unproductive because the problem is
not discussed at all.
24. A runner who trains twice as hard after suffering a
big loss in a race is experiencing _____.
A. sublimation.
B. displacement.
C. denial.
D. repression
25. Mr. Garcia, an attorney who throws books and
furniture around the office after losing a case is
referred to the psychiatric nurse in the law firm’s
employee assistance program. Nurse Beatriz knows
that the client’s behavior most likely represents the
use of which defense mechanism?
A. Regression
B. Projection
C. Reaction-formation
D. Intellectualization
26. A client is displaying reaction formation when:
A. he substitutes an activity for one that is truly
desired.
B. he redirects sexual drives into socially
acceptable channels.
C. he transforms mental conflict into a physical
symptom.
D. he’s consciously exhibiting behavior that is at
the exact opposite of an unconscious feeling.
27. The client is concerned about his coming discharge,
manifested by being unusually sad. Which is the
most therapeutic approach by the nurse?
A. “You are much better than when you were admitted
so there’s no reason to worry.”
B. “What would you like to do now that you’re about to
go home?”
C. “You seem to have concerns about going home.”
D. “Aren’t you glad that you’re going home soon?”
28. There are various conditions the nurse must meet to
establish a therapeutic relationship with the client.
Congruence between what is felt and what is being
expressed is a display of the nurse’s:
A. trust.
B. respect.
C. genuineness.
D. empathy.
29. Therapeutic communication is the key to enhancing
the nurse-client relationship. The nurse’s statement:
“I understand that this must be a tough time for you”
reflects:
A. concern
B. transference
C. respect
D. empathy
30. The therapeutic relationship has different phases
that overlap and interlock. Planning for termination of
the relationship occurs during what phase?
A. preorientation
B. orientation
C. working
D. termination
31. The nurse asks a client to roll up his sleeves so she
can take his blood pressure. The client replies “If you
want I can go naked for you.” The most therapeutic
response by the nurse is:
A. “You’re attractive but I’m not interested.”
B. “You wouldn’t be the first that I will see naked.”
C. “I will report you to the guard if you don’t control
yourself.”
D. “I only need access to your arm. Putting up your
sleeve is fine.”
32. Nurse Myrna develops a counter-transference
reaction. This is evidenced by:
A. Revealing personal information to the client.
B. Focusing on the feelings of the client.
C. Confronting the client about discrepancies in
verbal or non-verbal Behavior.
D. The client feels angry towards the nurse who
resembles his mother.
33. Anthony is very hostile toward one of the staff for no
apparent reason. He is manifesting:
A. Splitting
B. Transference
C. Countertransference
D. Resistance
34. A client with obsessive-compulsive disorder is
hospitalized on an inpatient unit. Which nursing
response is most therapeutic?
A. Accepting the client’s obsessive-compulsive
behaviors
B. Challenging the client’s obsessive-compulsive
behaviors
C. Preventing the client’s obsessive-compulsive
behaviors
D. Rejecting the client’s obsessive-compulsive
behaviors
35. Maladaptive behaviors are common responses to
patients to overcome severe anxiety and stress in
the medical-surgical setting. The nurse should know
how best to handle such situations. Mr. Ata Pees, a
COPD patient, keeps calling the nurse every 10
minutes to have his VS checked and insists that she
stay with him until his relatives arrive. The most
therapeutic response of the nurse would be:
A. “I have other patients to attend to. I can only
check on you every 30 minutes.”
B. “I’m sorry to have kept you waiting. There was
an emergency I have to attend to.”
C. “You’re perfectly fine, Mr. Bo Ang. Why do you
have to call on me often?”
D. “If you call on me again after 10 minutes, I just
have to ignore you.”
36. The nurse has power over the client by virtue of his
or her professional role. That power can be abused if
excessive familiarity or an intimate relationship
occurs. After 3 months of interaction with her patient,
Nurse Clara observes that he is making passes at
her. One time, the patient held her hand and
confessed his feelings for her. What would be Nurse
Clara’s most appropriate response?
A. “I am sorry but I don’t like you.”
B. “If you’ll get better, I’ll think about it.”
C. “It would be best if we’ll just remain friends.”
D. “Our nurse-patient relationship is strictly
professional.”
37. While on duty in the ER, Nurse Pharlynis assessing
a female patient to obtain subjective information
concerning the client’s sexual and reproductive
status. The client tells her: “I don’t want to talk about
that. It’s private and personal” Which of the following
will be the most therapeutic response nurse Pharlyn
can make?
A. “I hate being asked these questions too.”
B. “I am a professional nurse, and as such I’ll have
you know that all data will be kept confidential.”
C. “I know that some of these questions are difficult
for you, but as a professional nurse, I must
legally respect your confidentiality.”
D. “This is difficult for you to speak about, but I am
trying to perform a complete assessment and I
need this information.”
38. Nurse Rinoa is the nurse attending to a client with a
clinical diagnosis of major depression who had a
history of attempted suicide. The patient tells the
nurse: “I should have died a long time ago. I have
always been a failure. Nothing ever goes right for
me.” The most therapeutic response nurse Rinoa
may make to her client is:
A. “I do not see you as a loser.”
B. “You have everything to live for.”
C. “Feeling like this is all part of your illness.”
D. “You’ve been feeling like a failure for a
while?”
39. Client: “I had and accident.”
Nurse: “Tell me about your accident.”
This is an example of which therapeutic
communication technique?
A. Making observations
B. Offering self
C. General leads
D. Reflection
40. “Earlier today you said you were concerned that your
son was still upset with you. When I stopped by your
room an hour ago, you and your son seemed
relaxed and smiling as you spoke to each other.
How did things go between the two of you?”
A. Consensual validation
B. Accepting
C. Encouraging comparison
D. General leads
41. “Why do you always complain about the night
nurse? She is a nice woman and a fine nurse and
has five kids to support. You’re wrong when you say
she is noisy and uncaring.”
This example reflects which non-therapeutic
technique?
A. Requesting an explanation
B. Defending
C. Disagreeing
D. Advising
42. “How does Jerry make you upset?” is a non-
therapeutic communication technique because it
A. gives a literal response.
B. interprets what the client is saying.
C. indicates an external source of the emotion.
D. is just another stereotyped comment.
43. Client: “I was so upset about my sister ignoring my
pain when I broke my leg.”
Nurse: “When are you going to your next diabetes
education program?”
This is a non-therapeutic response because the
nurse has:
A. used testing to evaluate the client’s insight.
B. exhibited an egocentric focus.
C. changed the topic.
D. advised the client what to do.
44. When the client says, “I met Joe at the dance last
week,” what is the best way for the nurse to ask the
client to describe her relationship with Joe?
A. “Joe who?”
B. “Tell me about you and Joe.”
C. “Tell me about Joe.”
D. “Joe, you mean that blond guy with the dark blue
eyes?”
45. Which of the following is a concrete message?
A. “Help me put this pile of books on Marsha’s
desk.”
B. “When is she coming home?”
C. “Get this out of here.”
D. “They said it is too early to get in.”
46. Which of the following are examples of a therapeutic
communication response? Select all that apply:
i. “Don’t worry – everybody has a bad day
occasionally.”
ii. “Tell me more about your discharge plans.”
iii. “That sounds like a great idea.”
iv. “What might you do the next time you’re
feeling angry?”
v. “I don’t think your mother will appreciate that
behavior.”
A. i, ii, iii
B. ii, iii, iv
C. iii, iv, v
D. i, ii, iii, iv, v
47. The nurse observes a client pacing in the hall. Which
statement by the nurse may help the client recognize
his anxiety?
A. “I guess you’re worried about something, aren’t
you?”
B. “Can I get you some medication to help calm
you?”
C. “Have you been pacing for a long time?”
D. “I notice that you’re pacing. How are you
feeling?”
Situation: An old woman was brought for evaluation due
to the hospital for evaluation due to increasing
forgetfulness and limitations in daily function.
48. She tearfully tells the nurse “I can’t take it when she
accuses me of stealing her things.” Which response
by the nurse will be most therapeutic?
A. ”Don’t take it personally. Your mother does not
mean it.”
B. “Have you tried discussing this with your
mother?”
C. “This must be difficult for you and your mother.”
D. “Next time ask your mother where her things
were last seen.”
49. Nina reveals that the boyfriend has been pressuring
her to engage in premarital sex. The most
therapeutic response by the nurse is:
A. “I can refer you to a spiritual counselor if you
like.”
B. “I can refer you to your parents if you like.”
C. “It sounds like this problem is related to your
paralysis.”
D. “How do you feel about being pressured into sex
by your boyfriend?”
Situation: An old woman was brought for evaluation due
to the hospital for evaluation due to increasing
forgetfulness and limitations in daily function.
50. She says to the nurse who offers her breakfast, “Oh
no, I will wait for my husband. We will eat together”
The therapeutic response by the nurse is:
A. “Your husband is dead. Let me serve you your
breakfast.”
B. “I’ve told you several times that he is dead. It’s
time to eat.”
C. “You’re going to have to wait a long time,
because his dead already.”
D. “What made you say that your husband is alive?
51. The mother asks the nurse for advice about
discipline for her 3-year-old. Which of the following
should the nurse suggest that the mother use?
a. Structured interactions.
b. Spanking.
c. Reasoning.
d. Time-out.
52. After teaching the parents of a toddler about
commonly aspirated foods, which of the following
foods, if identified by the parents as easily aspirated,
would indicate the need for additional teaching?
a. Popcorn.
b. Raw vegetables.
c. Round candy.
d. Crackers.
53. Which of the following is appropriate language
development for an 8-month-old? The child should
be:
a. Saying “dada” and “mama” specifically
(“dada” to father and “mama” to mother).
b. Saying three other words besides “mama”
and “dada.”
c. Saying “dada” and “mama” nonspecifically.
d. Saying “ball” when parents point to a ball.
54. Which of the following, if described by the parents of
a child with cystic fibrosis (CF), indicates that the
parents understand the underlying problem of the
disease?
a. An abnormality in the body's mucus-
secreting glands.
b. Formation of fibrous cysts in various body
organs.
c. Failure of the pancreatic ducts to develop
properly.
d. Reaction to the formation of antibodies
against streptococcus.
55. When developing the plan of care for a child with
cystic fibrosis (CF) who is scheduled to receive
postural drainage, the nurse should anticipate
performing postural drainage at which of the
following times?
a. After meals.
b. Before meals.
c. After rest periods.
d. Before inhalation treatments.
56. The parent of an infant with a cleft lip and palate
asks the nurse when the infant's cleft palate will be
repaired. The nurse responds by stating that the first
repair of a cleft palate is usually done at which of the
following times?
a. Before the eruption of teeth.
b. When the child weighs approximately 10 kg
(22 lb).
c. Before the development of speech.
d. After the child learns to drink from a cup.
57. After teaching the parents of an infant diagnosed
with Hirschsprung's disease, the nurse determines
that the parents understand the diagnosis when the
father states which of the following?
a. “There is no rectal opening for stool to
pass.”
b. “There is a tube between the trachea and
esophagus.”
c. “The nerves at the end of the large colon are
missing.”
d. “The muscle below the stomach is too tight.”
58. A child diagnosed with tetralogy of Fallot becomes
upset, crying and thrashing around when a blood
specimen is obtained. The child's color becomes
blue and the respiratory rate increases to 44
breaths/min. Which of the following actions should
the nurse do first?
a. Obtain a prescription for sedation for the
child.
b. Assess for an irregular heart rate and
rhythm.
c. Explain to the child that it will only hurt for a
short time.
d. Place the child in a knee-to-chest position.
59. The parents of a 3-week-old healthy newborn ask
the nurse why their daughter is intermittently cross-
eyed. The nurse's best response is:
a. “An eye patch may be necessary for 6
weeks to correct her vision.”
b. “Your daughter will likely need an
ophthalmology consult.”
c. “It is normal to have eye-crossing in the
newborn period.”
d. “Surgery may be necessary to correct your
daughter’s vision.”
60. An 11-year-old is admitted for treatment of an
asthma attack. Which of the following indicates
immediate intervention is needed?
a. Thin, copious mucous secretions.
b. Productive cough.
c. Intercostal retractions.
d. Respiratory rate of 20 breaths/minute.
61. A mother states that she thinks her 9-month-old “is
developing slowly.” When assessing the infant's
development, the nurse is also concerned because
the infant should be demonstrating which of the
following characteristics?
a. Vocalizing single syllables.
b. Standing alone.
c. Building a tower of two cubes.
d. Drinking from a cup with little spilling.
62. A 2-year-old always puts his teddy bear at the head
of his bed before he goes to sleep. The parents ask
the nurse if this behavior is normal. The nurse
should explain to the parents that toddlers use
ritualistic patterns to:
a. Establish a sense of identity.
b. Establish control over adults in their
environment.
c. Establish sequenced patterns of learning
behavior.
d. Establish a sense of security.”
63. The mother of a 4-year-old expresses concern that
her child may be hyperactive. She describes the
child as always in motion, constantly dropping and
spilling things. Which of the following actions would
be appropriate at this time?
a. Determine whether there have been any
changes at home.
b. Explain that this is not unusual behavior.
c. Explore the possibility that the child is being
abused.
d. Suggest that the child be seen by a pediatric
neurologist.
64. An adolescent tells the school nurse that she would
like to use tampons during her period. The nurse
should first:
a. Assess her usual menstrual flow pattern.
b. Determine whether she is sexually active.
c. Provide information about preventing toxic
shock syndrome.
d. Refer her to a specialist in adolescent
gynecology.
65. A nurse is assessing the growth and development of
a 14-year-old boy. He reports that his 13-year-old
sister is 2 inches taller than he is. The nurse should
advise the boy that the growth spurt in adolescent
boys, compared with the growth spurt of adolescent
girls:
a. Occurs at the same time.
b. Occurs 2 years earlier.
c. Occurs 2 years later.
d. Occurs 1 year earlier.
66. A parent asks the nurse about head lice (pediculosis
capitis) infestation during a visit to the clinic. Which
of the following symptoms should the nurse tell the
parent is most common in a child infected with head
lice?
a. Itching of the scalp.
b. Scaling of the scalp.
c. Serous weeping on the scalp surface.
d. Pinpoint hemorrhagic spots on the scalp
surface.
67. A mother asks the nurse, “How did my children get
pinworms?” The nurse explains that pinworms are
most commonly spread by which of the following
when contaminated?
a. Food.
b. Hands.
c. Animals.
d. Toilet seats.
68. After teaching a group of parents about temper
tantrums, the nurse knows the teaching has been
effective when one of the parents states which of the
following?
a. “I will ignore the temper tantrum.”
b. “I should pick up the child during the
tantrum.”
c. “I'll talk to my daughter during the tantrum.”
d. “I should put my child in time-out.”
69. The nurse discusses the eating habits of school-age
children with their parents, explaining that these
habits are most influenced by:
a. Food preferences of their peers.
b. Smell and appearance of foods offered.
c. Examples provided by parents at mealtimes.
d. Parental encouragement to eat nutritious
foods.
70. A mother has heard that several children have been
diagnosed with mononucleosis. She asks the nurse
what precautions should be taken to prevent this
from occurring in her child. The nurse should instruct
the mother to:
a. Take no particular precautionary measures.
b. Sterilize the child's eating utensils before
they are reused.
c. Wash the child's linens separately in hot,
soapy water.
d. Wear masks when providing direct personal
care.
71. A father asks the nurse how he would know if his
child had developed mononucleosis. The nurse
explains that in addition to fatigue, which of the
following would be most common?
a. Liver tenderness.
b. Enlarged lymph glands.
c. Persistent nonproductive cough.
d. A blush-like generalized skin rash.
72. A child with cystic fibrosis is receiving gentamicin.
Which of the following nursing actions is most
important?
a. Monitoring intake and output.
b. Obtaining daily weights.
c. Monitoring the client for indications of
constipation.
d. Obtaining stool samples for hemoccult
testing.
73. At a follow-up appointment after being hospitalized,
an adolescent with a history of cystic fibrosis (CF)
describes his stools to the nurse. Which of the
following descriptions should the nurse interpret as
indicative of continued problems with
malabsorption?
a. Soft with little odor.
b. Large and foul-smelling.
c. Loose with bits of food.
d. Hard with streaks of blood.
74. Which one of the following children is at most risk for
sudden infant death syndrome (SIDS)?
a. Infant who is 3 months old.
b. 2-year-old who has apnea lasting up to 5
seconds.
c. First-born child whose parents are in their
early forties.
d. 6-month-old who has had two bouts of
pneumonia.
75. When developing the ongoing plan of care for the
parents whose infant died of sudden infant death
syndrome (SIDS), the nurse should plan to
accomplish which of the following on the second
home visit?
a. Allow the parents to express their feelings.
b. Have the parents gain an understanding of
the disease.
c. Assess the impact of the infant's death on
their other children.
d. Deal with issues such as having other
children.
76. A 3-year-old is brought into the emergency
department in her mother's arms. The child's mouth
is open and she is drooling and lethargic. Her
mother states that she became ill suddenly within
the past 2 hours. What should the nurse do first?
a. Draw blood cultures for complete blood
count.
b. Start an intravenous line.
c. Inspect the child's throat with a tongue
blade.
d. Maintain the child in an undisturbed, upright
position.
77. The father of a 16-month-old child calls the clinic
because the child has a low-grade fever, cold
symptoms, and a hoarse cough. Which of the
following should the nurse suggest that the father
do?
a. Offer extra fluids frequently.
b. Bring the child to the clinic immediately.
c. Count the child's respiratory rate.
d. Use a hot air vaporizer.
78. A father brings his 3-month-old infant to the clinic,
reporting that the infant has a cold, is having trouble
breathing, and “just doesn't seem to be acting right.”
Which of the following actions should the nurse do
first?
a. 1.Check the infant's heart rate.
b. 2.Weigh the infant.
c. 3.Assess the infant's oxygen saturation.
d. 4.Obtain more information from the father.
79. In preparation for discharge, the nurse teaches the
mother of an infant diagnosed with bronchiolitis
about the condition and its treatment. Which of the
following statements by the mother indicates
successful teaching?
a. 1.“I need to be sure to take my child's
temperature every day.”
b. 2.“I hope I don't get a cold from my child.”
c. 3.“Next time my child gets a cold I need to
listen to the chest.”
d. 4.“I need to wash my hands more often.”
80. A 13-year-old has been admitted with a diagnosis of
rheumatic fever and is on bed rest. He has a sore
throat. His joints are painful and swollen. He has a
red rash on his trunk and is experiencing aimless
movements of his extremities. Use the chart below
to determine what the nurse should do first.
a. Report the heart rate to the primary health
care provider.
b. Apply lotion to the rash.
c. Splint the joints to relieve the pain.
d. Request a prescription for medication to
treat the elevated temperature.
81. A nurse is planning care for a 12-year-old with
rheumatic fever. The nurse should teach the parents
to:
a. Observe the child closely.
b. Allow the child to participate in activities that
will not tire him.
c. Provide for adequate periods of rest
between activities.
d. Encourage someone in the family to be with
the child 24 hours a day.
82. A 14-year-old girl with sickle cell disease has her
fourth hospitalization for sickle cell crisis. Her family
is planning a ski vacation in the mountains. What
should the nurse tell the parents?
a. Encourage them to go on the trip.
b. Go on the trip, but find a sitter for the 14-
year-old.
c. Suggest the trip be postponed until next
year.
d. Explain that the high altitude may cause a
crisis.
83. The nurse explains to the parents of a 1-year-old
child admitted to the hospital in sickle cell crisis that
the local tissue damage the child has on admission
is caused by which of the following?
a. Autoimmune reaction complicated by
hypoxia.
b. Lack of oxygen in the red blood cells.
c. Obstruction to circulation.
d. Elevated serum bilirubin concentration.
84. A mother asks the nurse if her child's iron deficiency
anemia is related to the child's frequent infections.
The nurse responds based on the understanding of
which of the following?
a. Little is known about iron deficiency anemia
and its relationship to infection in children.
b. Children with iron deficiency anemia are
more susceptible to infection than are other
children.
c. Children with iron deficiency anemia are less
susceptible to infection than are other
children.
d. Children with iron deficiency anemia are
equally as susceptible to infection as are
other children.
85. Which of the following foods should the nurse
encourage the mother to offer to her child with iron
deficiency anemia?
a. Rice cereal, whole milk, and yellow
vegetables.
b. Potato, peas, and chicken.
c. Macaroni, cheese, and ham.
d. Pudding, green vegetables, and rice.
86. A diagnosis of hemophilia A is confirmed in an
infant. Which of the following instructions should the
nurse provide the parents as the infant becomes
more mobile and starts to crawl?
a. Administer one-half of a children's aspirin for
a temperature higher than 101°F (38.3°C).
b. Sew thick padding into the elbows and
knees of the child's clothing.
c. Check the color of the child's urine every
day.
d. Expect the eruption of the primary teeth to
produce moderate to severe bleeding.
87. A child with hemophilia presents with a burning
sensation in the knee and reluctance to move the
body part. The nurse collaborates with the care team
to provide factor replacement and:
a. Administer an aspirin-containing compound.
b. Institute rest, ice, compression, and
elevation (RICE).
c. Begin physical therapy with active range of
motion.
d. Initiate skin traction.
88. When positioning a neonate with an unrepaired
myelomeningocele, which of the following positions
is most appropriate?
a. Supine with the hips at 90-degree flexion.
b. Right side-lying position with the knees
flexed.
c. Prone with hips in abduction.
d. Supine in semi-Fowler's position with chest
and abdomen elevated.
89. The nurse reports to the primary health care provider
signs of increased intracranial pressure in an infant
with a myelomeningocele who has which of the
following?
a. Minimal lower-extremity movement.
b. A high-pitched cry.
c. Overflow voiding only.
d. A fontanel that bulges with crying.
90. Before placement of a ventriculoperitoneal shunt for
hydrocephalus, an infant is irritable, lethargic, and
difficult to feed. To maintain the infant's nutritional
status, which of the following actions would be most
appropriate?
a. Feeding the infant just before doing any
procedures.
b. Giving the infant small, frequent feedings.
c. Feeding the infant in a horizontal position.
d. Scheduling the feedings for every 6 hours.
91. A 4-year-old child with hydrocephalus is scheduled
to have a ventroperitoneal shunt in the right side of
the head. When developing the child's postoperative
plan of care, the nurse should place the preschooler
in which of the following positions immediately after
surgery?
a. On the right side, with the foot of the bed
elevated.
b. On the left side, with the head of the bed
elevated.
c. Prone, with the head of the bed elevated.
d. Supine, with the head of the bed flat.
92. The mother of a 17-year-old girl with Down
syndrome tells the nurse that her daughter recently
stated that she has a boyfriend. The mother is
concerned that her daughter might become
pregnant. Which of the following is the most
appropriate suggestion made by the nurse?
a. “I understand your concern; you may want to
start your daughter on a birth control pill.”
b. “Women with Down syndrome are infertile
so you don't need to worry about her getting
pregnant.”
c. “I understand your concern; you may want to
enroll your daughter in an abstinence
program.”
d. “I know it may be difficult, but you may want
to suggest that your daughter break off the
relationship.”
93. The nurse discusses with the parents how best to
raise the IQ of their child with Down syndrome.
Which of the following would be most appropriate?
a. Serving hearty, nutritious meals.
b. Giving vasodilator medications as
prescribed.
c. Letting the child play with more able
children.
d. Providing stimulating, nonthreatening life
experiences.
94. A 3-month-old infant with meningococcal meningitis
has just been admitted to the pediatric unit. Which
nursing intervention has the highest priority?
a. Instituting droplet precautions.
b. Administering acetaminophen (Tylenol).
c. Obtaining history information from the
parents.
d. Orienting the parents to the pediatric unit.
95. Which sign should lead the nurse to suspect that a
child with meningitis has developed disseminated
intravascular coagulation?
a. Hemorrhagic skin rash.
b. Edema.
c. Cyanosis.
d. Dyspnea on exertion.
96. When assessing an infant with suspected inguinal
hernia, which of the following findings would be most
significant?
a. The inguinal swelling is reddened, and the
abdomen is distended.
b. The infant is irritable, and a thickened
spermatic cord is palpable.
c. The inguinal swelling can be reduced, and
the infant has a stool in the diaper.
d. The infant's diaper is wet with urine, and the
abdomen is nontender.
97. “The primary care provider is able to reduce an
infant's hernia and schedules the infant for a
herniorrhaphy in 2 days. The mother asks the nurse
why the surgery is not performed now. Which of the
following responses indicates that the nurse
understands the rationale for delaying the surgery?
a. “Delaying the surgery ensures that your
infant will receive the proper preoperative
preparation.”
b. “We need to make sure that your infant
receives nothing by mouth for at least 24
hours before the surgery.”
c. “Waiting these 2 days helps to allow any
edema and inflammation in the area to
subside.”
d. “Your infant needs to wear a truss for at
least 24 hours before any surgery can be
attempted.”
98. Which of the following would be most appropriate for
the nurse to teach the mother of a 6-month-old infant
hospitalized with severe diarrhea to help her comfort
her infant who is fussy?
a. Offering a pacifier.
b. Placing a mobile above the crib.
c. Sitting at crib side talking to the infant.
d. Turning the television on to cartoons.
99. A child is started on a soft diet after having been on
clear liquids following an episode of severe
gastroenteritis. When helping the mother choose
foods for her child, which of the following foods
would be most appropriate?
a. Muffins and eggs.
b. Bananas and rice cereal.
c. Bran cereal and a bagel.
d. Pancakes and sausage.
100. A toddler is brought to the emergency room after
ingesting an undetermined amount of drain cleaner.
The nurse should expect to assist with which of the
following first?
a. Administering an emetic.
b. Performing a tracheostomy.
c. Performing gastric lavage.
d. Inserting an indwelling urinary (Foley)
catheter.