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

development of Alzheimer’s disease? 6. Disulfiram serves as a treatment for alcoholism, it
A. Acetylcholine B. Dopamine functions to:
C. Epinephrine D. Serotonin A. lessen alcohol withdrawal symptoms
B. decrease serum alcohol levels
2. The nurse is administering a psychotropic drug to an C. restrict from alcohol drinking
elderly client who has history of benign prostatic D. treat alcohol intoxication
hypertrophy. It is most important for the nurse to
teach this client to: 7. One morning the nurse sees the client in a
A. Add fiber to his diet. depressed mood. The nurse asks her “What are you
B. Report incomplete bladder emptying. thinking about?” This communication technique is:
C. Exercise on a regular basis. A. Focusing
D. Take the prescribed dose at bedtime. B. validating.
C. reflecting.
3. The nurse is teaching a client taking a MAOI about D. giving broad opening.
foods with tyramine that he or she should avoid.
Which of the following statement indicates that the 8. Which of the following theorists believed that a
client needs further teaching? corrective interpersonal relationship with the
A. “I’m so glad I can have pizza as long as I don’t therapist was the primary mode of treatment?
order pepperoni.” A. Sigmund Freud
B. “I will be able to eat cottage cheese without B. Hildegard Peplau
worrying.” C. William Glasser
C. “I will have to avoid drinking nonalcoholic beer.” D. Harry Stack Sullivan
D. “I can eat green beans on this diet.”
9. Correcting how one thinks about the world and one-
4. A client who has been depressed and suicidal self is the focus of:
started taking a tricyclic antidepressant 2 weeks ago A. behaviorism.
and is now ready to leave the hospital to go home. B. cognitive therapy.
Which of the following is a concern for the nurse as C. Psychoanalysis
discharge plans are finalized? D. reality therapy.
A. The client may need a prescription for
diphenhydramine (Benadryl) to use for side 10. Nurse John is a aware that most crisis situations
effects. should resolve in about:
B. The nurse will evaluate the risk for suicide by A. 1 to 2 weeks
overdose of the tricyclic antidepressant.
C. The nurse will need to include teaching B. 4 to 6 weeks
regarding the signs of neuroleptic malignant
syndrome. C. 4 to 6 months
D. The client will need regular laboratory work to
monitor therapeutic drug levels. D. 6 to 12 months

11. Which factors are most essential for the nurse to

5. The nurse is caring for a client with schizophrenia
assess when providing crisis intervention foe a
who is taking haloperidol (Haldol). The client
client?
complains of restlessness, cannot sit still, and has
A. The client’s communication and coping skills.
muscle stiffness. Of the following PRN medications,
B. The client’s anxiety level and ability to express
which would the nurse administer?
feelings.
A. Haloperidol (Haldol) 5 mg PO
C. The client’s perception of the triggering event
and availability of situational supports.
B. Propranolol (Inderal) 20 mg PO D. The client’s use of reality testing and level of
C. Benztropine (Cogentin) 2 mg PO depression.
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?
37. While on duty in the ER, Nurse Pharlynis
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:
38. Nurse Rinoa is the nurse attending to a client
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.”
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.”
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.