Health Promotion and

Maintenance
Maternity; Newborn; Growth and
Development; Elderly Pediatrics
1. Use Nagele’s rule to estimate the
EDC for a patient whose LMP began
on October 1. 2007.
1. October 11, 2008
2. August 1, 2008
3. July 1, 2008
4. July 8, 2008
1. Use Nagele’s rule to estimate the
EDC for a patient whose LMP began
on October 1. 2007
1. October 11, 2008
2. August 1, 2008
3. July 1, 2008
4. July 8, 2008
•Add 7 days to the first day of
LMP
•Subtract 3 months
•Add One year
2. The client has been pregnant 4 times.
Her first died in utero at 16 weeks
gestation. She delivered one infant at
24 weeks. Twins were born at 36 weeks
gestation. The youngest delivered at 41
weeks. This client’s GTPAL would be
_____.
(G)4,(T)1,(P)3,(A)1,(L)4
Gravidity = # pregnancies
Term = # term births
Preterm Births = occurring before 40 weeks
Abortions/Miscarriages .
Living = # live births
3. The pregnant client’s hemoglobin
and hematocrit levels are 11g/dL
and 30g/dL. What is the most
appropriate intervention for this
client?
1. Administration of 1 unit of packed cells
2. Administration of 1000ml of D5NS with
40 KCL
3. Administration of Epoetin sq QD.
4. No intervention is indicated.
3. The pregnant client’s hemoglobin and
hematocrit levels are 11g/dL and 30g/dL.
What is the most appropriate
intervention for this client?
1. Administration of 1 unit of packed cells
2. Administration of 1000ml of D5NS with 40
KCL
3. Administration of Epoetin sq QD.
Stimulates RBC production.
4. No intervention is indicated.
If drops below Hgb 10 g/dl and/or Hct
30% indicates anemia and need for
intervention.
4. Which of the following clients requires
further teaching regarding nutrition during
pregnancy/lactation?
1. Client #1 is at the beginning of her third
trimester. She has gained 40 lbs at this point
of her pregnancy.
2. Client #2 is at the beginning of the 2nd
trimester. She has increased calories by
adding additional servings of fruits and
vegetables.
3. Client #3 is in the middle of her 3rd trimester.
She has been feeling “bloated” and “full” over
the past few days. She has decided to limit
her fluid intake to 8 glasses of water per day
to correct this problem.
4. Client #4 has eliminated all foods with folic
acid from her diet. She has read that folic acid
might cause cancer in laboratory rats.
4. Which of the following clients requires
further teaching regarding nutrition during
pregnancy/lactation?
1. Client #1 is at the beginning of her third
trimester. She has gained 30 lbs at this point of
her pregnancy. 25-35 lb OK
2. Client #2 is at the beginning of the 2nd trimester.
She has increased calories by adding additional
servings of fruits and vegetables. Increase by
300 cal. / day
3. Client #3 is in the middle of her 3rd trimester.
She has been feeling “bloated” and “full” over
the past few days. She has decided to limit her
fluid intake to 8 glasses of water per day to
correct this problem. 8 glasses minimal OK
4. Client #4 has eliminated all foods with folic
acid from her diet. She has read that folic
acid might cause cancer in laboratory rats.
Should consume a diet rich in folic acid.
5. The nurse is caring for a client in labor.
The FHR has averaged around 150
beats/minute for the past hour. The
nurse notices now that as the client’s
contraction begins, the FHR begins to
decline. The decline returns to the 150
baseline by the end of each contraction.
Which nursing intervention is indicated
for this deceleration pattern?
1. Continue to monitor the client.
2. Turn the client on her left side.
3. Place the client in the Lithotomy position.
4. Decrease the rate of the Pitocin drip, notify
the MD.
5. The nurse is caring for a client in labor. The
FHR has averaged around 150 beats/minute for
the past hour. The nurse notices now that as
the client’s contraction begins, the FHR begins
to decline. The decline returns to the 150
baseline by the end of each contraction. Which
nursing intervention is indicated for this
deceleration pattern?
1. Continue to monitor the client.
2. Turn the client on her left side.
3. Place the client in the Lithotomy position.
4. Decrease the rate of the Pitocin drip, notify the MD.

Early decelerations
Early decelerations:
– decr in FHR below baseline
– Occur during contractions as fetal head
in pressed against the woman's pelvis or
soft tissues
– Return to baseline by the end of the
contraction
– Tracing shows uniform shape and mirror
image of uterine contractions
– Not asso with fetal compromise and
require no intervention
Late decelerations:
– Nonreassureing patterns
– Reflect impaired placental exchange or
uteroplacental insufficiency
– look similar to early decelerations
– Begin well after the contraction begins
and return to baseline after the
contraction ends
– Tx: improve placental bld flow and fetal
oxygenation
Variable decelerations:
– Caused by conditions that restrict Bld flow
through the umbilical cord
– Do not have uniform appearance
– Shape, duration, degree of fall below baseline
HR are variable
– Fall and rise abruptly with the onset and relief
of cord compression
– Can appear to be unrelated to contractions
– Significant when FHR repeatedly decr to less
than 70 and persists at that level for at least
60 seconds.
 Problems with L&D
 Dystocia
– Difficult, prolonged labor
– Excessive abdominal pain, abnormal
contraction pattern, fetal distress, lack of
progress in labor
– Assessment: FHR, uterine contractions,
maternal temp and HR
– adm prophylactic antibiotics as prescribed,
IVF as prescribed
– monitor I&O
– Monitor color of amniotic fluid
 Problems with L&D
 Prolapsed cord
– Compromises fetal circulation
– Assessment: mother feeling that something is coming
through vagina, visible/palpable umbilical cord
– FHR irregular and slow
– Fetal monitor shows variable decelerations or bradycardia
after rupture of membrane
– Fetal hypoxia: violent fetal activity then no/minimal
movement
– TX:
 Relieve cord pressure: extreme Trendelenburg or
modified Sims’s, knee-chest
 Elevate fetal presenting part (sterile gloved hand apply
finger pressure
 Monitor FHR

 Oxygen to mother

 Prepare for emergency C section

 Problems with L&D
 Precipitous L&D  Preterm Labor
– Labor lasting less – Occurs after 20th wk
than 3 hrs but before the 37th
– Delivery tray wk of gestation
available – Contractions occur
– Stay with mother more frequ than
– Do not try to keep q10 min and last 30
fetus from being seconds or longer,
delivered persist
– Asst with delivery if – May be assoc with
MD unavailable infection (UTI)
 Problems with L&D
 Premature Rupture of Membranes
– Spontaneous rupture of the amniotic membrane
before the onset of labor
– Gestational age determines the plan
– Risk of infection
– TX:
 tests to assess gestational age,

 monitor maternal and fetus status,

 adm antibiotics as prescribed

 Problems with L&D
 Rupture of uterus
– Complete or incomplete separation of the
uterus as a result of tear in the wall of the
uterus from the stress of labor
– Complete: direct communication betw uterine
and peritoneal cavities
– Incomplete: rupture into the peritoneum
covering the uterus but not the peritoneal
cavity
– Assessment: abd pain, chest pain,
contractions may stop or fail to progress, rigid
abdomen, absent FHR, maternal shock, fetus
palpated outside uterus
– TX: monitor and TX s/s shock (Oxygen, IVF,
Bld products)
– Prepare for c-section
– Emotional support
 Problems with L&D
 Placenta Previa
– Improperly implanted placenta in the lower uterine segment
– Assessment:
 Sudden onset of painless, bright reg vatinal bleedings in
the last half of pregnancy
 Uterus soft, relaxed, nontender,
 Fundal height amy be more than epected for gestational
age
– Tx:
 Monitor maternal v/s, FHR, fetal activity
 Ultrasound to confirm dx
 No vaginal exam
 Bedrest in a side-lying postion
 Montor bleeding, tx s/s shock
 Adm IVF, bld products, tocolytic medicaitons
 Perhaps c section
Abruptio Placentae
 Premature separation of the placenta from the
uterine wall after the 20th wk of gestation and
before the fetus is delivered
 Assessment:
– Dark red vaginal bleeding…or absence of Bld if bleed is
higher in the uterus
– Uterine pain/tenderness
– Uterine rigidity
– Severe abd pain
– Signs of fetal distress
– s/s maternal shock (excessive bleeding)
 Tx:
– Monitor maternal v/s and FHR
– Assess vaginal Bld, abd pain, incr in fundal ht
– Bedrest, oxygen, IVF, blood products
– Trendelenburg’s position if indicated to decr pressure of
fetus on placenta or lateral position with HOB flat if shock
occurs
– Monitor for s/s of disseminated intravascular coagulation
Amniotic Fluid Embolism
 Escape of amniotic fluid into the maternal
circulation
 Debris-containing amniotic fluid deposits in the
pulmonary arterioles and is usu fatal to mother
 Assessment:
– abrupt onset of resp distress and chest pain
– Cyanosis, seizures, heart failure, PE
 TX
– Emergency measures to maintain life
– Oxygen
– Prepare for intubation and mechanical ventilation
– Position mother lateral
– IVF, Bld products, medications to correct coagulation
failure
– Monitor fetal status
– Prepare for emergency delivery once the woman is
stable
 Problems with L&D
Supine hypotensive syndrome
 Venous return to the heart impaired
by the wt of the fetus
 Assessment:
– faintness, light-headedness, dizziness
– Hypotension
– fetal distress
 TX:
– Left lateral recumbent
– Monitor v/s and FHR
 Problems with L&D
 Fetal Distress
– Assessment:
 FHR less than 120 or greater than 160
 Meconium-stained amniotic fluid

 Fetal hyperactivity

 Progressive decr in baseline variability

 Severe variable decelerations

 Late decelerations

– TX:
 Positionmother lateral position
 Oxygen (8-10 L via face mask)

 d/c oxytocin

 Monitor…
6. The FHR has been 105 for 15
minutes. Select the appropriate
actions for the nurse:
1. Increase the rate of the Pitocin drip.
2. Turn the client to her side.
3. Notify the MD.
4. Administer facemask oxygen at 8
L/minute.
5. Elevate the foot of the bed.
6. The FHR has been 105 for 15
minutes. Select the appropriate
actions for the nurse:
1. Increase the rate of the Pitocin drip.
2. Turn the client to her side.
3. Notify the MD.
4. Administer facemask oxygen
at 8 L/minute.
5. Elevate the foot of the bed.
7. Which change in the FHR described
below would necessitate a nursing
intervention?
1. The FHR goes from 145 to 155 when a
vaginal exam is performed on the
mother.
2. The FHR goes from 145 to 143 as the
mother’s contraction begins.
3. The FHR goes from 145 to 142 after
the mother’s contraction begins.
4. The FHR goes from 145 to 160 as the
fetus moves about in the uterus.
7. Which change in the FHR described below
would necessitate a nursing intervention?
1. The FHR goes from 145 to 155 when a
vaginal exam is performed on the mother.
Normal acceleration
2. The FHR goes from 145 to 143 as the
mother’s contraction begins. Early
deceleration
3. The FHR goes from 145 to 142
after the mother’s contraction
begins. Late deceleration
4. The FHR goes from 145 to 160 as the fetus
moves about in the uterus. Normal
acceleration
8. The nurse is caring for a client in
labor. Her BP is 70/52. What
nursing action is indicated first?
1. Turn her on her left side.
2. Administer facemask oxygen.
3. Notify MD.
4. Monitor FHR.
8. The nurse is caring for a client in
labor. Her BP is 70/52. What
nursing action is indicated first?
1. Turn her on her left side.
2. Administer facemask oxygen.
3. Notify MD.
4. Monitor FHR.
9. The nurse has just received report from
the night shift. Which of the following
postpartum clients should the nurse see
first?
1. The client in room #1 who is complaining of
pain secondary to breast engorgement.
2. The client in room #2 who is 24 hours post
caesarian section and needs assistance to
ambulate.
3. The client in room #3 who has not voided
since delivery at 2 AM.
4. The client in room #4 who delivered 24 hours
ago and continues to have rubra described as
bright red.
9. The nurse has just received report from
the night shift. Which of the following
postpartum clients should the nurse see
first?
1. The client in room #1 who is complaining of
pain secondary to breast engorgement.
psychosocial
2. The client in room #2 who is 24 hours post
caesarian section and needs assistance to
ambulate. Not an acute need
3. The client in room #3 who has not
voided since delivery at 2 AM.
4. The client in room #4 who delivered 24 hours
ago and continues to have rubra described as
bright red. See 2nd – no info to
indicate acute need.
Newborn, Concepts
r/t G&D
10.All of the following interventions are
indicated during the initial care of a
newborn. Sequence the
interventions as appropriate
immediately following the birth:
1. Position newborn on his side.
2. Dry newborn and stimulate crying by
rubbing.
3. Wrap newborn in warm blankets.
4. Suction mouth and nares with bulb
syringe.
10.All of the following interventions are
indicated during the initial care of a
newborn. Sequence the
interventions as appropriate
immediately following the birth:
1. Position newborn on his side…4
2. Dry newborn and stimulate crying by
rubbing….2
3. Wrap newborn in warm blankets….3
4. Suction mouth and nares with bulb
syringe…1
11.The newborn’s initial Apgar score
is 8. What nursing interventions
are indicated?
1. Rub the infant’s back.
2. Tickle the infant’ s feet.
3. Administer nasal cannula oxygen at
2L/min.
4. Place the infant on his side.
11.The newborn’s initial Apgar score
is 8. What nursing interventions
are indicated?
1. Rub the infant’s back.
2. Tickle the infant’ s feet.
3. Administer nasal cannula oxygen at
2L/min.
4.Place the infant on his
side. Apgar of 8-10 OK
and no intervention is
indicated.
12.Which of the following sets of
vital signs would be considered to
be within normal limits for a
newborn?
1. HR90, R32, Axillary Temp. 99
degrees F.
2. HR 110, R45, Axillary Temp. 99
degrees F.
3. HR152, R20, Axillary Temp. 98.6
degrees F.
4. HR98, R16, Axillary Temp. 100
degrees F.
12.Which of the following sets of vital
signs would be considered to be
within normal limits for a
newborn?
1. HR90, R32, Axillary Temp. 99
degrees F.
2.HR 110, R45, Axillary
Temp. 99 degrees F.
3. HR152, R20, Axillary Temp. 98.6
degrees F.
4. HR98, R16, Axillary Temp. 100
degrees F.
Normal newborn vital signs
• HR100-170,
• Resp. 30-80,
• Axillary temp 96.8-99 degrees F
• BP 73/55.
13. Vitamin K is prescribed for a
neonate. The nurse prepares the
medication and selects which
muscle site to administer the
medication?
1. Deltoid
2. Triceps
3. Vastus lateralis
4. Biceps
13. Vitamin K is prescribed for a
neonate. The nurse prepares the
medication and selects which
muscle site to administer the
medication?
1. Deltoid
2. Triceps
3.Vastus lateralis
4. Biceps
14.Magnesium sulfate is being used in a
client diagnosed with preeclampsia.
Assessment of the client reveals
respirations of 8, sluggish reflexes, and a
HR of 42. Which intervention described
below would be appropriate?
1. Increase the dosage of Magnesium sulfate.
2. Administer calcium gluconate.
3. Turn the client on her right side.
4. Elevate the foot of the bed.
14. Magnesium sulfate is being used in a client
diagnosed with preeclampsia. Assessment of the
client reveals respirations of 8, sluggish reflexes,
and a HR of 42. Which intervention described
below would be appropriate?
1. Increase the dosage of Magnesium sulfate.
2. Administer calcium gluconate. s/s of
magnesium toxicity…Ca gluconate raises
Ca levels and therefore decr Magnesium
level
3. Turn the client on her right side.
4. Elevate the foot of the bed.
15.Which of the following represents
a developmental task of a 13
year old girl?
1. Jane reminisces about the major
events of her life.
2. Mary is looking for some one to
share her life with.
3. Jennifer enjoys working on service
projects with the other members of
her girl scout troop.
4. Lilly is trying hard to improve her
grades in Math.
15.Which of the following represents a
developmental task of a 13 year old girl?
1. Jane reminisces about the major events of her
life. ..Later (65 yrs +)
2. Mary is looking for some one to share her life
with …Early adulthood(20-35yrs)
3. Jennifer enjoys working on service
projects with the other members of her
girl scout troop. ..Adolescence (12-
20yrs)
4. Lilly is trying hard to improve her grades in
Math. ..School Age (6-12yrs)
16.The mother of an 8-year-old child
tells the clinic nurse that she is
concerned about the child because
the child seems to be more attentive
to friends than anything else. The
most appropriate nursing response
would be which of the following?
1. “You need to be concerned.”
2. “You need to monitor the child’s behavior
closely.”
3. “At this age the child is developing his
own personality.”
4. “You need to provide more praise to the
child to stop this behavior.”
16.The mother of an 8-year-old child
tells the clinic nurse that she is
concerned about the child because
the child seems to be more attentive
to friends than anything else. The
most appropriate nursing response
would be which of the following?
1. “You need to be concerned.”
2. “You need to monitor the child’s behavior
closely.”
3. “At this age the child is
developing his own personality.”
4. “You need to provide more praise to the
child to stop this behavior.”
17.Which patient described below
would experience the greatest
distress when separated from his
parent(s)?
1. Joshua who is 18 months old and
the youngest of three children.
2. Jonathon who is 4 years old and is
the oldest of 2 children.
3. Michael who is 10 years old and is
the second of three children in his
family.
4. Michael who is 13 years old and is
an only child.
17.Which patient described below would
experience the greatest distress when
separated from his parent(s)?
1. Joshua who is 18 months old
and the youngest of three
children.
2. Jonathon who is 4 years old and is the
oldest of 2 children.
3. Michael who is 10 years old and is the
second of three children in his family.
4. Michael who is 13 years old and is an only
child…might not experience at
all…
18. Select the statement below that is
true regarding the use of Vitamin K
(Aquamephyton) with a neonate.
1. This medication should be administered at
the 1 week check up.
2. Vitamin K is light activated and must be
placed in direct sunlight 1 hour prior to
administration.
3. Vitamin K is administered in the deltoid.
4. Vitamin K can precipitate
hyperbilirubinemia in the newborn.
18. Select the statement below that is
true regarding the use of Vitamin K
(Aquamephyton) with a neonate.
1. This medication should be administered at
the 1 week check up. …early neonatal
period…
2. Vitamin K is light activated and must be
placed in direct sunlight 1 hour prior to
administration. ..light sensitive…
3. Vitamin K is administered in the deltoid.
…vastis lateralis…
4. Vitamin K can precipitate
hyperbilirubinemia in the
newborn.
19. A mother calls for assistance in
picking a formula for her 6 month
old. Which of the following is her
BEST choice?
1. Soy-based formula
2. Whole milk fortified with iron
3. 2% milk
4. Iron-fortified formula
19. A mother calls for assistance in
picking a formula for her 6 month
old. Which of the following is her
BEST choice?
1. Soy-based formula
2. Whole milk fortified with iron
3. 2% milk
4.Iron-fortified formula
20. The parents of a 10 month old who
weighs 38 pounds are seeking advice
regarding a car seat. Which of the
following is a true statement?
1. This child should travel in a semi-reclined
rear-facing car seat.
2. This child should travel in a front-facing
car seat, strapped into the back seat.
3. This child should travel in a toddler
booster seat.
4. This child weighs enough to travel without
a car seat of any type – he just needs to
be buckled in with the vehicles’ seat belts.
20. The parents of a 10 month old who weighs 38
pounds are seeking advice regarding a car seat.
Which of the following is a true statement?
1. This child should travel in a semi-reclined
rear-facing car seat. Travel in a semi
reclined, rear-facing position until they
weigh at least 20 lbs and have reached at
least 1 year of age.
2. This child should travel in a front-facing car seat,
strapped into the back seat.
3. This child should travel in a toddler booster seat.
4. This child weighs enough to travel without a car seat of
any type – he just needs to be buckled in with the
vehicles’ seat belts.
21.The RN is supervising a nursing
student who is caring for a 4 year old
girl. Which scenario described below
indicates that the student needs to
review growth and development
concepts r/t the care of the child?
1. The child is allowed to wear her Barbie
panties.
2. The nursing student sits and listens as
the child talks to her.
3. The nursing student allows the child to
play with other 4 year olds in the
playroom.
4. The nursing student encourages the
child’s parents to leave the hospital for
the night so that the child can become
more independent.
21. The RN is supervising a nursing student who
is caring for a 4 year old girl. Which scenario
described below indicates that the student
needs to review growth and development
concepts r/t the care of the child?
1. The child is allowed to wear her Barbie panties.
2. The nursing student sits and listens as the child
talks to her.
3. The nursing student allows the child to play with
other 4 year olds in the playroom.
4. The nursing student encourages
the child’s parents to leave the
hospital for the night so that the
child can become more
independent.
22.Select the nursing interventions below
that would be appropriate when caring
for an 8 year old child. Select all that
apply:
1. Encourage the child’s parents to stay with
the child.
2. Allow the child to assist with the
completion of the dietary menu for the
next day.
3. Facilitate contact with friends from school.
4. Allow the child to perform ADL’s according
to his abilities.
5. Do not explain procedures, tell the child
shortly before the procedure is to be
performed to decrease anxiety.
6. Minimize the use of pain control therapies
to prevent masking of symptoms.
22. Select the nursing interventions below that
would be appropriate when caring for an 8
year old child. Select all that apply:
1. Encourage the child’s parents to
stay with the child.
2. Allow the child to assist with the
completion of the dietary menu for
the next day.
3. Facilitate contact with friends from
school.
4. Allow the child to perform ADL’s
according to his abilities.
5. Do not explain procedures, tell the child shortly
before the procedure is to be performed to
decrease anxiety.
6. Minimize the use of pain control therapies to
prevent masking of symptoms.
23.Which of the following is not a
true statement about nutrition for
an infant?
1. An 8 month old can be offered rice
cereal.
2. Yellow fruits should be the first fruit
introduced.
3. Popcorn can be introduced as a
snack food at 6 months.
4. Peanuts should be avoided.
23.Which of the following is not a true
statement about nutrition for an
infant?
1. An 8 month old can be offered rice
cereal….solid fds introduced at 6
months…
2. Yellow fruits should be the first fruit
introduced….yes, rice cereal, then
yellow fruits/veges, then green…
3. Popcorn can be introduced as a
snack food at 6
months….choking hazard…
4. Peanuts should be avoided….choking
hazard…
Elderly
24. Which of the following assessment findings
occur as part of the physiological process
of aging. Select all that apply.
1. Skin turgor is elastic.
2. The client is unable to remember events that
occurred yesterday.
3. The client is unable to remember events that
occurred 10 years ago.
4. Range of motion is decreased for the upper
and lower extremities.
5. Peripheral pulses are weak.
6. Increased need for calories.
24. Which of the following assessment findings occur
as part of the physiological process of aging.
Select all that apply.
1. Skin turgor is elastic.
2. The client is unable to remember events
that occurred yesterday.
3. The client is unable to remember events that occurred
10 years ago…long term memory intact…
4. Range of motion is decreased for the upper
and lower extremities.
5. Peripheral pulses are weak.
6. Increased need for calories…Caloric needs
decrease…
25. Mrs. M. brings her 85 year old father to the
emergency room because he suddenly
became confused and disoriented last
night. Each alternative below provides a
piece of his medical history. Which is most
likely related to his change in mental
status?
1. history of heart disease
2. History of rheumatoid arthritis
3. takes Digoxin every day.
4. M.D. started him on a new NSAID for arthritis
two days ago.
25. Mrs. M. brings her 85 year old father to the
emergency room because he suddenly
became confused and disoriented last
night. Each alternative below provides a
piece of his medical history. Which is most
likely related to his change in mental
status?
1. history of heart disease
2. History of rheumatoid arthritis
3. takes Digoxin every day.
4. M.D. started him on a new NSAID
for arthritis two days ago.
Pediatrics
26. The parents of a 2 year old are about to
purchase a vaporizer for their child’s
room. What information described below
is most important for the nurse to convey
to the parents?
1. Vaporizers poise a risk of infection if not
cleaned properly.
2. Steam vaporizers are ideal because they
optimize the distribution of vapor.
3. Cool vaporizers should be used instead of
steam to prevent burn injuries.
4. Cool vaporizers are ideal because they
optimize the distribution of vapor.
26. The parents of a 2 year old are about to purchase a
vaporizer for their child’s room. What information
described below is most important for the nurse to
convey to the parents?
1. Vaporizers poise a risk of infection if not cleaned properly.
2. Steam vaporizers are ideal because they optimize the
distribution of vapor.
3. Cool vaporizers should be used instead
of steam to prevent burn injuries.
4. Cool vaporizers are ideal because they optimize the
distribution of vapor.
27. The nurse is caring for a 5 year old
admitted with a head injury. Which of
the following is the earliest sign of an
increase in intracranial pressure?
1. Headache
2. Diplopia
3. Nausea
4. Change in the level of consciousness
27. The nurse is caring for a 5 year old
admitted with a head injury. Which of
the following is the earliest sign of an
increase in intracranial pressure?
1. Headache
2. Diplopia
3. Nausea
4. Change in the level of
consciousness
28. Which of the following is the BEST
position for a child who has a head
injury?
1. Left side
2. Semi-fowlers
3. Fowlers
4. supine
28. Which of the following is the BEST
position for a child who has a head
injury?
1. Left side
2. Semi-fowlers
3. Fowlers
4. supine
29. The nurse is caring for a patient who is
postop placement of a ventriculoperitoneal
shunt on the left side of his head. How
should this child be positioned postop?
1. Supine, Head of bed elevated 40 degrees.
2. Prone, Head of the bed flat.
3. Laterally on the left side, head of bed flat.
4. Laterally on the right side, head of bed flat.
29. The nurse is caring for a patient who is postop
placement of a ventriculoperitoneal shunt on the
left side of his head. How should this child be
positioned postop?
1. Supine, Head of bed elevated 40 degrees.
2. Prone, Head of the bed flat.
3. Laterally on the left side, head of bed flat.
4. Laterally on the right side, head of bed
flat. Unoperative side to prevent
pressure on the shunt, flat to prevent
rapid reduction of intracranial fluid.
30. An eight year old diagnosed with
conjunctivitis is preparing for discharge.
Which statement, if made by his mother,
would indicate the need for more
teaching?
1. “His father and I will be careful to not share
towels with him”.
2. “He can return to school today as long as he
receives his first dose of medication before
returning to school.”
3. “Warm compresses will lesson his discomfort.”
4. “He cannot wear contacts until the infection
clears”.
30. An eight year old diagnosed with conjunctivitis is
preparing for discharge. Which statement, if
made by his mother, would indicate the need for
more teaching?
1. “His father and I will be careful to not share towels with
him”.
2. “He can return to school today as long
as he receives his first dose of
medication before returning to
school.” Should be kept home form
school or day care until antibiotic eye
drops have been adm for 24 hrs.
3. “Warm compresses will lesson his discomfort.”
4. “He cannot wear contacts until the infection clears”.
31. Which of the following is the best method
for administering ear drops to a 2 year old?
1. Position the child side-lying with the affected
ear up, administer the drops directly into the
ear.
2. Position the child prone, pull the pinna up and
back.
3. Sit the child in the mother’s lap, pull the pinna
toward the back of the head.
4. Pull the pinna down and back.
31. Which of the following is the best method
for administering ear drops to a 2 year old?
1. Position the child side-lying with the affected
ear up, administer the drops directly into the
ear. Must reposition pinna
2. Position the child prone, pull the pinna up and
back. Up and back if older than 3 years
3. Sit the child in the mother’s lap, pull the pinna
toward the back of the head. Close…must
include “down”
4. Pull the pinna down and back.
32. A 4 year old child and his mother have
received discharge instructions post
surgical placement of tympanoplasty
tubes. Which statement below, if made by
the mother, indicates that further teaching
is necessary?
1. He must wear earplugs when I wash his hair.
2. He can go swimming this summer if he wears
earplugs.
3. I have to be careful to not get water in his ears
for the next 6 months.
4. He cannot swim on the bottom of the pool
even with his earplugs in.
32. A 4 year old child and his mother have received
discharge instructions post surgical placement of
tympanoplasty tubes. Which statement below, if
made by the mother, indicates that further
teaching is necessary?
1. He must wear earplugs when I wash his hair. true
2. He can go swimming this summer if he wears earplugs.
true
3. I have to be careful to not get water in
his ears for the next 6 months. Careful
of water in ears until tubes are no
longer in place
4. He cannot swim on the bottom of the pool even with his
earplugs in. true
33. What is the drug of choice for a child
who has had a tonsillectomy and is
experiencing a sore throat postop?
1. Advil
2. Aspirin
3. Codeine
4. Tylenol
33. What is the drug of choice for a child who
has had a tonsillectomy and is
experiencing a sore throat postop?
1. Advil
2. Aspirin
3. Codeine
4. Tylenol drug of choice …avoid
red liqu which simulates the
appearance of blood if the child
vomits.
34. The RN is caring for a child who is 4 hours
postop tonsillectomy. Which of the following
actions indicate that this nurse needs further
review regarding the postop care of this type
patient?

Select All that apply:

1. The child is positioned prone.
2. The child is allowed to drink cool milk.
3. The child is not allowed to use straws.
4. The child is allowed to drink room temperature cherry
Kool-Aid.
5. The child’s vital signs are assess every 4 hours as
ordered by the MD.
34. The RN is caring for a child who is 4 hours postop
tonsillectomy. Which of the following actions indicate
that this nurse needs further review regarding the postop
care of this type patient?
Select All that apply:
1. The child is positioned prone true…or sidelying is OK
2. The child is allowed to drink cool milk. No,
milk products coat the throat.
3. The child is not allowed to use straws true …no straws, forks,
sharp objects…
4. The child is allowed to drink room
temperature cherry Kool-Aid no …Red
liquid…
5. The child’s vital signs are assess every 4 hours as ordered by
the MD true …monitoring for s/s of infection
35. Which of the following calls should the
RN return first?
1. The parent describes the child’s cough as
“sounding like a seal”.
2. The child is 72 postop tonsillectomy and
continues to refuse fluids because her
“throat hurts”.
3. The child has had an upper respiratory
infection for 2 days and now has a temp
of 101 degrees F. and is complaining of
an earache.
4. The child has clear drainage from the left
eye, the eye is red, and the child
complains that it “itches”.
35. Which of the following calls should the RN return
first?
1. The parent describes the child’s
cough as “sounding like a seal”.
Indicative of Inspiratory stridor…
ABC’s
2. The child is 72 postop tonsillectomy and continues to
refuse fluids because her “throat hurts”. Maslow’s
Hierarchy…potential for fluid volume deficit
3. The child has had an upper respiratory infection for 2
days and now has a temp of 101 degrees F. and is
complaining of an earache. Upper resp could be
significant…but deal with most acute actual problem
first.
4. The child has clear drainage from the left eye, the eye
is red, and the child complains that it “itches”.
36. Which of the following is a true statement
regarding Tuberculosis?
1. If the Mantoux test is negative 1 week after
exposure then the individual was not infected.
2. A definitive diagnosis of Tuberculosis is made
with a positive Chest X-ray.
3. A child infected with Tuberculosis will most
likely be required to take isoniazid, rifampin,
and pyrazinamide daily for 2 months.
4. Children infected with Tuberculosis are placed
on airborne precautions until the medication
regime has been completed.
36. Which of the following is a true statement regarding
Tuberculosis?
1. If the Mantoux test is negative 1 week after exposure then the
individual was not infected …2 -10 weeks…
2. A definitive diagnosis of Tuberculosis is made with a positive Chest
X-ray. …Positive sputum culture…
3. A child infected with Tuberculosis will most likely be
required to take isoniazid, rifampin, and
pyrazinamide daily for 2 months. Then isoniazid and
rifampin twice weekly for 4 months
4. Children infected with Tuberculosis are placed on airborne
precautions until the medication regime has been completed. …
meds initiated, sputum cultures demo improvement, cough
improves…
37. The nurse continues to monitor a 5
year old who is admitted because of
an acute exacerbation of her asthma.
Which assessment finding below
would necessitate an immediate
intervention?
1. Wheezing is not heard on auscultation.
2. Lips are dark red.
3. Episodes of coughing occur with minimal
exertion.
4. Percussion of the lower chest reveals
hyperresonance.
37. The nurse continues to monitor a 5 year old
who is admitted because of an acute
exacerbation of her asthma. Which
assessment finding below would
necessitate an immediate intervention?
1. Wheezing is not heard on
auscultation. Suggest that the
condition has worsened
2. Lips are dark red.
3. Episodes of coughing occur with minimal
exertion.
4. Percussion of the lower chest reveals
hyperresonance.
38. The MD has prescribed chest
physiotherapy ad lib for a child who is
experiencing an acute asthmatic episode.
When should this therapy be begun?
1. Immediately
2. During an acute episode of coughing
3. After an acute episode of coughing
4. After the symptoms of the acute episode have
diminished and the child is improving.
38. The MD has prescribed chest
physiotherapy ad lib for a child who is
experiencing an acute asthmatic episode.
When should this therapy be begun?
1. Immediately could exacerbate the attack
2. During an acute episode of coughing
3. After an acute episode of coughing
4. After the symptoms of the acute
episode have diminished and the
child is improving.
39. A child with cystic fibrosis has been
admitted to the pediatric unit. Which
assessment finding(s) below would be
consistent with this diagnosis?
1. Clubbing of the toes.
2. Multiple bruises over the arms and legs.
3. Steatorrhea.
4. Negative Sweat Chloride test.
5. Signs/symptoms of emphysema.
6. Brisk refill of the nail beds of the fingers.
39. A child with cystic fibrosis has been admitted to the
pediatric unit. Which assessment finding(s) below would
be consistent with this diagnosis?
1. Clubbing of the toes. …chronic hypoxia
2. Multiple bruises over the arms and legs. …
Deficiency of fat-soluble vitamins (ADEK)…
3. Steatorrhea. ….deficiency of fat-soluble
vitamins – frothy, foul-smelling…
4. Negative Sweat Chloride test. Positive sweat chloride test
5. Signs/symptoms of emphysema. …thick
secretions obstruct airway – trap air…
6. Brisk refill of the nail beds of the fingers. Sluggish refil
40. The RN is caring for an infant who is
experiencing the following signs/symptoms:
HR 200, R 92, scalp sweating,
suprasternal retractions. Which
intervention listed below is indicated in the
care of this infant?
1. Assess carotid pulse every 30 minutes.
2. Weigh diapers.
3. Position the infant supine with head of bed in
high-fowlers.
4. Awaken the infant every hour for neuro checks.
40. The RN is caring for an infant who is
experiencing the following signs/symptoms: HR
200, R 90, scalp sweating, suprasternal
retractions. Which intervention listed below is
indicated in the care of this infant?
1. Assess carotid pulse every 30 minutes. …apical
pulse, count for full minute…
2. Weigh diapers. …I and O
3. Position the infant supine with head of bed in high-
fowlers. …semi-fowlers…
4. Awaken the infant every hour for neuro checks. …
Needs periods of uninterrupted sleep…

Infant has signs of CHF

41. A student nurse is preparing to administer
Digoxin to an infant. Which of the following
would indicate that this student needs
further teaching regarding this drug?
1. The student questions the MD’s prescribed
dosage of 5 mg.
2. The medication is administered 60 minutes ac.
3. Oral care is performed immediately post
medication administration.
4. The student nurse notes that she is 5 hours
late administering this medication. She
administers the medication and changes the
time for the next dosage.
41. A student nurse is preparing to administer
Digoxin to an infant. Which of the following
would indicate that this student needs further
teaching regarding this drug?
1. The student questions the MD’s prescribed dosage of
5 mg . …0.05mg normal infant dose…
2. The medication is administered 60 minutes ac.
3. Oral care is performed immediately post medication
administration.
4. The student nurse notes that she is 5
hours late administering this medication.
She administers the medication and
changes the time for the next dosage. …
skip missed dose if over 4 hours
late…
 Cardiac Defects
• Increased Pulmonary Blood Flow (ASD, VSD,
Atrioventircular canal defect, Patent ductus)…s/s
CHF
• Obstructive Defects (Coarctation of the aorta,
Aortic Stenosis, Pulmonary Stenosis) …s/s CHF
• Decreased Pulmonary Blood Flow (ASD, VSD,
Tetralogy of Fallot, Tricuspid atresia, )….s/s
hypoxemia, cyanosis
• Mixed Defects (Transposition, etc.)
42. The RN is supervising the feeding of an
infant with a cleft palate. Which behavior, if
observed below, would necessitate an
intervention by the nurse?
1. The opening of the nipple is enlarged.
2. The child is positioned in high Fowler’s position
for the feeding.
3. The child is fed small amounts and then
burped every 5-10 minutes.
4. The child is positioned prone after the feeding.
42. The RN is supervising the feeding of an infant
with a cleft palate. Which behavior, if observed
below, would necessitate an intervention by the
nurse?
1. The opening of the nipple is enlarged. ESSR method of
feeding (enlarge the nipple, stimulate suck reflex,
swallow, rest to allow child to finish swallowing)
2. The child is positioned in high Fowler’s position for the
feeding. Hold upright and direct feeding to side and
back of mouth to prevent aspiration.
3. The child is fed small amounts and then burped every
5-10 minutes. ESSR method…must allow time for
swallowing
4. The child is positioned prone after the
feeding. Position child upright
43. The RN is assessing the lunch tray that
has been prepared for a child with Celiac
Disease. Which of the following trays would
be suitable for this child?
1. Cheeseburger on whole wheat bun, fruit
salad, glass of milk.
2. Fish fillet, french fries, sliced cantaloupe,
chocolate milkshake.
3. Spaghetti with meat sauce, watermelon, ice
cream, glass of orange juice.
4. Chicken leg, corn on the cob, apple, glass of
milk.
43. The RN is assessing the lunch tray that has been
prepared for a child with Celiac Disease. Which
of the following trays would be suitable for this
child?
1. Cheeseburger on whole wheat bun, fruit salad, glass
of milk. …bun with cheeseburger…
2. Fish fillet, french fries, sliced cantaloupe, chocolate
milkshake. ...french fries, milkshake not
sure…
3. Spaghetti with meat sauce, watermelon, ice cream,
glass of orange juice. .. …spaghetti, ice
cream….
4. Chicken leg, corn on the cob, apple,
glass of milk.
44. Which of the following is a true statement
about Phenylketonuria?

1. All newborns should be screened before they

have begun formula or breast milk feedings.
2. If initial screening is positive, dietary
restrictions are implemented immediately.
3. If the initial screening was before the child was
48 hours old, the child should be rescreened in
2 weeks.
4. Individuals with Phenylketonuria cannot eat
fruits.
44. Which of the following is a true statement about
Phenylketonuria?
1. All newborns should be screened before they have begun
formula or breast milk feedings. Must have begun formula
or breast milk feeding before specimen collection
2. If initial screening is positive, dietary restrictions are
implemented immediately. Always repeat test and
perform further diagnostic evaluation
3. If the initial screening was before the
child was 48 hours old, the child should
be rescreened in 2 weeks. true
4. Individuals with Phenylketonuria cannot eat fruits. …
fruits OK - no protein…
45. The 13 year old girl in room 411 has been
admitted in sickle cell crisis. Which of the
following does the RN anticipate as part of
her prescribed plan of care?
1. Minimize the use of prn pain medication as
these drugs can be addictive.
2. Limit fluid intake to 200 ml/shift.
3. Position the child so that she is in a
comfortable position with extremities
extended.
4. Assist the child to select dietary items that are
low-calorie, low protein..
45. The 13 year old girl in room 411 has been
admitted in sickle cell crisis. Which of the
following does the RN anticipate as part of her
prescribed plan of care?
1. Minimize the use of prn pain medication as these
drugs can be addictive. Not true: Pain is subjective
experience…pain control important for these pts –
avoid use of Demerol
2. Limit fluid intake to 200 ml/shift. Not true: Promote
fluid intake
3. Position the child so that she is in a
comfortable position with extremities
extended.
4. Assist the child to select dietary items that are low-
calorie, low protein. Not true: Promote high calorie,
high protein
46. Which of the following is a true statement
regarding the administration of iron
supplements?

1. Iron supplements should be taken with fruit

juices.
2. Iron supplements should be taken with milk.
3. Liquid iron supplements should be administered
via a nasogastric tube.
4. Iron supplements should be administered with
meals.
46. Which of the following is a true statement
regarding the administration of iron supplements?

1. Iron supplements should be taken with

fruit juices. …Vit. C promotes
absorption
2. Iron supplements should be taken with milk. …
Calcium interferes with absorption…
3. Liquid iron supplements should be administered via a
nasogastric tube. …NGT not needed…
4. Iron supplements should be administered with meals.
…between meals for maximum absorption
47. Medication B 5 mg/kg/day is prescribed
PO BID for Little Lisa. Lisa weighs 44
pounds. Calculate Lisa’s AM dose if the
medication is supplied in a 10mg/ml
solution.

First calculation mg/day.

5 mg/1kg = x mg to a child who weighs 44 pounds.
5 mg/1kg = x mg /20 kg; cross multiply: 100= mg/day
47. Medication B 5 mg/kg/day is
prescribed PO BID for Little Lisa. Lisa
weighs 44 pounds. Calculate Lisa’s
AM dose if the medication is supplied
in a 10 ml/ml solution.

Next calculate mg/dose. 100 mg divided

by # doses in 24 hours = 50 mg/dose.
47. Medication B 5 mg/kg/day is prescribed PO BID for
Little Lisa. Lisa weighs 44 pounds. Calculate
Lisa’s AM dose if the medication is supplied in a 10
mg/ml solution.
First calculation mg/day.
5 mg/1kg = x mg to a child who weighs 44 pounds.
44lbs/xkg = 2.2lbs = 1 kg; x = 20 kg
5 mg/1kg = x mg /20 kg; cross multiply: 100= mg/day

Next calculate mg/dose. 100 mg divided by # doses in

24 hours (BID=2 doses) = 50 mg/dose.

Finally calculate ml to administer:

50 mg/x ml = 10 mg/ml solution.
5 ml.
48. Larry weighs 22 lbs and is to receive
Drug W QID. The proper dosage is 20
mg/kg/day. Calculate his per dose
dosage if the medication is supplied as
an 10 mg/ml solution.
48. Larry weighs 22 lbs and is to receive Drug
W QID. The proper dosage is 20
mg/kg/day. Calculate his per dose dosage if
the medication is supplied as an 10 mg/ml
solution.

Mg/day: (22 lbs/x kg = 2.2 lbs\1 kg…. 10 kg)

20mg/1 kg = x mg\10 kg. 200 mg/day.

Mg/dose:
200 divided by 4 = 50 mg/dose.
48. Larry weighs 22 lbs and is to receive
Drug W QID. The proper dosage is 20
mg/kg/day. Calculate his per dose
dosage if the medication is supplied as
an 10 mg/ml solution.

50 mg/x ml = 10 mg/1ml
5 ml
49. Which of the following would be the most
appropriate meal for a child with HIV or
AIDS?
1. Baked chicken, green beans, apple
2. Roast Beef, fruit salad, water
3. Cheeseburger, cheese fries, milkshake.
4. Salad with low calorie dressing, cantaloupe,
water.
49. Which of the following would be the most
appropriate meal for a child with HIV or
AIDS?
1. Baked chicken, green beans, apple
2. Roast Beef, fruit salad, water
3. Cheeseburger, cheese fries,
milkshake.
4. Salad with low calorie dressing, cantaloupe,
water.

High calorie, high protein

50. The parents of a child with HIV have just
completed an educational seminar on caring for
a child with HIV. Which statement, if made by
the parents, indicates that they understand this
material?
1. “We’ll keep her home from school when she’s sick”.
2. “Her eating utensils will have to be soaked in bleach
for 15 minutes after use.”
3. “ She should receive the vaccine for varicella
(chickenpox)”.
4. “We can never kiss our child.”
50. The parents of a child with HIV have just
completed an educational seminar on caring for a
child with HIV. Which statement, if made by the
parents, indicates that they understand this
material?
1. “We’ll keep her home from school
when she’s sick”.
2. “Her eating utensils will have to be soaked in bleach for
15 minutes after use.” ..dishwasher OK…
3. “ She should receive the vaccine for varicella
(chickenpox)”. …no, but keep others UTD…
4. “We can never kiss our child.” ..not on mouth…
51. A child who is immediately postop removal
of a supratentorial brain tumor should be
place in which of the following positions?
1. Lateral on the unoperative side, HOB flat.
2. Lateral on the operative side, HOB flat.
3. Lateral on the unoperataive side, HOB 20
degrees elevated.
4. Lateral on the operative side, HOB 20 degrees
elevated.
51. A child who is immediately postop removal
of a supratentorial brain tumor should be
place in which of the following positions?
1. Lateral on the unoperative side, HOB flat. Not
flat…HOB at least 15 degrees to allow for ICP
2. Lateral on the operative side, HOB flat. Not
flat…HOB at least 15 degrees to allow for ICP
3. Lateral on the unoperataive side,
HOB 20 degrees elevated.
4. Lateral on the operative side, HOB 20 degrees
elevated. These pts have large dressing on
operative side – do not position on operative
side.
52. The child in bed 2 is postop removal of a
brainstem tumor. Which of the following
represents the BEST position for this
patient?
1. Supine, HOB elevated 45 degrees
2. Lateral, HOB elevated 20 degrees
3. Sims position, HOB elevated 90 degrees
4. Lateral, HOB flat.
52. The child in bed 2 is postop removal of a
brainstem tumor. Which of the following
represents the BEST position for this
patient?
1. Supine, HOB elevated 45 degrees
2. Lateral, HOB elevated 20 degrees
3. Sims position, HOB elevated 90 degrees
4. Lateral, HOB flat. Infratentorial
tumor…postop position with HOB
flat to promote cerebral perfusion.