4. A group of people maternal health. Target 10.

Teaching parents the importance of

COMPREHENSIVE EXAM - MATERNAl related by blood, areas include:(1 Point) safeguarding their home by childproofing it
marriage, or adoption against poisoning is under:(1 Point)
1. Situation: The care of childbearing and living together” A. Reduction of maternal mortality
childrearing families is a major focus of nursing satisfies the definition ratio by three-quarters A. Health promotion
practice, because to have healthy adults you must of a family.(1 Point) B. Achievement of universal B. Health counselling
have healthy children. access to reproductive health C. Health restoration
A. True D. Health rehabilitation
The basic tenet of Maternal and Child Health B. False C. Reversal of the E. Health maintenance
Nursing is to understand and address the needs C. Partially true incidence of pregnancy-
of the:(1 Point) 11. Situation: Whether people are planning on
D. Partially false related losses childrearing or not, it is important to be
E. Indeterminate D. Two of the choices are correct familiar with reproductive anatomy and
A. Mother
E. All of the choices are correct physiology and one’s own reproductive and
B. Child 5. When a divorced or widowed person
C. Father sexual health.
with children marries someone who also 8. Maternal and Child Health Nursing
D. Two of the choices are correct has children, the family becomes:(1 can be visualized within a framework A nurse is providing information to a client on
E. All of the choices are correct Point) in which nurses, using the nursing the female reproductive system. While
process, nursing theories and evidence- discussing the uterus and its different layers, the
based practice, care for families during nurse understands that the myometrium has
2. To ensure family-centered Maternal and Child childbearing and childrearing years unique muscle fibers that make it ideally suited
Health care, all of the following principles A. Cohabitated through the following phases of health for the birth process. The nurse would describe
should be upheld, except:(1 Point) B. Extended care except:(1 Point) this layer to the client as:(1 Point)
C. Blended
A. The family is the basic unit of society D. Fostered A. Health promotion A. The inner layer of muscle that is in the
B. Parents should rear their children until E. Any of the above B. Health counseling uterus
adolescence C. Health restoration B. The middle layer of thick muscle in the
C. Families should represent diversity D. Health rehabilitation uterus
D. Children must grow both individually 6.The range of practice in Maternal and E. Health maintenance C. The outer layer of muscle that covers
and as part of the family Child Health Nursing includes the most of the uterus
3. Which of the following family types are following except:(1 Point) 9. Encouraging a woman with D. The functional layer that lies above the
used for the purposes of assessing families in gestational trophoblastic disease falls basal layer of the uterus
MCHN?(1 Point) A. Pre-conceptual health care 12. A nurse is conducting a prenatal class on
under which phase of health care?(1
B. Care of women during pregnancy Point) the female reproductive system. When a
A. Orientation and procreation and puerperium client in the class asks why the fertilized
C. Care of children during the A. Health promotion ovum stays in the fallopian tube for 3 days,
B. Nuclear and extended perinatal period the nurse responds that the reason for this is
B. Health counselling
D. Care of children from that it:(1 Point)
C. Cohabitation and communal C. Health restoration
birth to adulthood
D. Health rehabilitation
E. Health maintenance A. Promotes the fertilized ovum’s
D. Dyad and single-parent 7. Millennium chances of survival
Development Goal 5 is
focused on improving
 B. Promotes the fertilized ovum’s exposure 16. A pregnant adolescent client asks the A. Proliferative 23. All of the following physiologic changes can
to estrogen and progesterone nurse about the menstrual cycle. The B. Menstrual be seen in a woman who is in plateau except:(1
C. Promotes the fertilized ovum’s normal nurse describes the cycle and tells the C. Ischemic Point)
implantation in the top portion of the uterus adolescent that its normal duration is D.
D. Promotes the fertilized ovum’s about how many days?(1 Point) A. Clitoris is drawn backwards and
exposure to luteinizing hormone and A. 14 retracts under the clitoral prepuce
follicle-stimulating hormone
20. Which phase is a part of the normal
B. 28 uterine cycle?(1 Point) B. There is unremarkable nipple elevation
C. 30 C. The upper part of the vagina becomes
13. A nurse is teaching a group of 12-year old D. 45 A. Ovulation extremely congested
boys about the male reproductive system. The B. Luteal D. All of the above
nurse tells them that testosterone is produced by 17. A nursing instructor is reviewing the C. Proliferative E. None of the above
the:(1 Point) menstrual cycle with a nursing student D. Follicular
who will be conducting a prenatal 24. A remarkable increase in heart rate from 100
A. Cowper’s glands to 175 beats per minute and a respiratory rate
teaching session. The instructor asks the
B. Prostate gland student to describe the follicle- 21. Situation: Sexuality has always been from normal to approximately 40 respirations per
C. Interstitial cells stimulating hormone and the luteinizing a part of human life, but it is only in the minute is seen in what phase?(1 Point)
D. Vas deferens hormone. The student accurately past few decades that it has been studies
responds by stating that:(1 Point) scientifically in the field of sex research. A. Excitement
B. Plateau
14. Spermatogenesis takes place in the male’s:(1 A. FSH and LH are secreted Gender identity is best defined C. Orgasm
Point by the adrenal glands as:(1 Point) D. Resolution
B. FSH and LH are released
A. Seminiferous tubules from the anterior pituitary gland A. The inner sense a person has of
B. Bulbourethral glands C. FSH and LH are secreted by the being male or female 25. Which of the following statements about
C. Prostate glands corpus luteum of the ovary B. A person’s chromosomal sex: human sexual response is accurate?(1 Point)
D. Leydig’s cells D. FSH and LH stimulate the male (XY) or female (XX)
15. Which statement best describes when formation of milk during pregnancy C. The male or female behaviour a A. There is no physiologic difference between
fertilization occurs?(1 Point) 18. In a regular 32-day menstrual cycle, person exhibits an orgasm achieved through intercourse and one
the client will probably ovulate:(1 Point) D. Two of the choices are correct achieved by direct stimulation
A. When the spermatozoon passes into the E. All of the choices are correct
ovum and the nuclei fuse into a single cell A. 10 days after the start of 22. As early as two years of age, B. Resolution period usually takes 30
B. When the sperm and ova undergo the last menses children can:(1 Point) minutes for both men and women
developmental changes resulting in a reduction B. On day 22 C. Orgasm is usually experienced as
in the number of chromosomes C. On day 18 A. Distinguish between males and intense pleasure affecting the whole
C. When the ovum is discharged from the D. On day 11 female body, not just the pelvic area
ovary near the fimbriated end of the fallopian B. Say what sex they are D. Two of the choices are correct
tube 19. Ovulation occurs at the end of which C. Can absorb cultural expectations E. All of the choices are correct
D. When the embryo attaches to the uterine phase?(1 Point) of that sex role
uterine wall D. Two of the choices are correct 26. Situation: Your neighbor called you to
E. All of the choices are correct examine his G4P3 (3003) wife in labor. Upon
IE, your assessment is as follows: 6 cm cervical
dilatation, 50% effacement, - 3 station, cephalic, AOG>42 weeks but with no signsof while pulling the cord gently. What more likely to experience severe pain after
ruptured BOW What could be an immediate neither maternal nor fetal distress?(1 maneuver is this?(1 Point) giving birth?(1 Point)
complication of ruptured BOW?(1 Point) Point)
A. Crede’s A. A G1P1 (1001) patient who is bottle
A. Chorioamnionitis A. Induction of labor B. Brandt-Andrew’s feeding
B. Endometritis B. Augmentation of labor C. Ritgen’s B. A G3P2 (1102) patient who is bottle
C. Fetal hypoxia C. Emergency CS D. Duncan’s feeding
D. Cord prolapse D. NSD with assisted forceps C. A G2P2 (2002) patient who is
breastfeeding
33. Situation: As a practicing DR nurse D. A G1P1 (1001) patient who is
27. After few minutes, the mother tells you that 30. Situation: Mrs. Noceda delivered her in a lying-in maternity clinic, you are breastfeeding
she feels something coming out of her vagina. baby inside a taxicab while being almost cognizant of the differences
Upon inspection, you saw that a part of the transported to a hospital. between what is normal and what is not
umbilical cord is descending out of her vulva. with regard to pregnancy, labor, 36. One hour after delivery, which of the
What is your immediate nursing management?(1 What maneuver should have been done puerperium and neonatal conditions. following findings would you expect in a patient
Point) to prevent lacerations during the who doesn’t have complications?(1 Point)
expulsion of the fetal head if a birth Which of the following situations is
A. Ask the patient to lie on her left side attendant was present at the time of most likely to predispose a patient to A. Boggy uterus, moderate amount of
birth?(1 Point) postpartum hemorrhage?(1 Point) lochia rubra with small clots
B. Insert gloved finger to push the fetal B. Boggy uterus, moderate amount of
head up A. Crede’s A. Birth of a 3,000g infant lochia serosa
C. Cover the protruding cord with gauze B. Ritgen’s B. Prolonged first stage of labor C. Firm uterus, moderate amount of
soaked in salt solution and push the fetal head C. Brandt-Andrew’s C. Polyhydramnios lochia rubra with larger clots
up D. Calkin’s D. PIH D. Firm uterus, scanty amount of lochia
D. Ask her to assume knee chest position serosa
while being transported to the nearest hospital
31. You transferred the patient to the ER 34. To provide effective care, you must
bed and waited for the signs of placental recognize that in a postpartum woman, 37. Mary is brought to an emergency room
28. Which of the following is the nurse’s initial separation. Which of these is the first to subinvolution can be caused by which complaining of a headache and epigastric pain.
action when umbilical cord prolapse occurs?(1 be evident?(1 Point) disease?(1 Point) She is 18 years old and in the 36th week of her
Point) first pregnancy. Her blood pressure is
A. Lengthening of the cord A. PIH 160/120mm Hg; she has pitting edema of the
A. Begin monitoring maternal vital signs B. Sudden gush of blood B. Preterm vaginal delivery legs, hands, and face; and a clean-voided urine
and FHR C. Firm, globular mass C. Uterine infection specimen is 3+ for albumin.
B. Place the client in a knee-chest
D. Positive suprapubic dipping test D. Mastitis
position in bed Based on the initial data, the most likely
C. Notify the physician and prepare the diagnosis of Mary’s condition is(1 Point)
client for delivery
32. After observing the signs that 35. You are aware that periodic
D. Apply a sterile warm saline dressing to the A. Mild preeclampsia
placenta has already detached itself from relaxation and contraction of the uterine
exposed cord B. Severe preeclampsia
the maternal deciduas, you would now muscles causes pains and cramping after
29. What would be an appropriate immediate apply pressure on the suprapubic area birth. Which of the following patients is C. Eclampsia
management to a gravid woman in labor with an D. Chronic renal disease
 E. Chronic hypertensive vascular disease D. Inability to open the eyes upon 45. The nurse knows that hypertensive A. Placenta previa must be the underlying
waking in the AM disorders in pregnancy are associated problem because of the presence of pain
42. Which of the following would alert with vasospasm and decreased tissue B. Placental abruption must be the
38. Mary is admitted to the hospital. Which of you that the above patient may be about perfusion. Which symptoms are problem because of the presence of
the following diagnostic tests should be ordered to experience a seizure?(1 Point) considered danger signs signaling the bright-red vaginal bleeding
to better assess her condition?(1 Point) increase in severity of preeclampsia?(1 C. Infection is most likely because of the
A. Decreased contraction intensity Point) combination of pain and bleeding
A. 24-hour urine for protein B. Epigastric pain D. These may be signs of normal labor
B. Urinary estriol levels C. Increase in body temperature A. Headache, ankle edema and polyuria
C. Neurologic evaluation D. Hyporeflexia B. Headache, edema of the hands 49. A woman whose pregnancy is at term is
D. All of the above 43. The OB-gyne on duty orders an anti- and face, dysuria hospitalized on bedrest with placenta previa. She
convulsant drug, magnesium sulfate to C. Edema of the hands and face, complains of backache and abdominal cramping.
prevent the occurrence of convulsive visual disturbances, irritability The nurse should:(1 Point)
39. In the care plan adopted for Mary, all of the episodes. Which of these signs would D. Irritability, edema of the ankles,
following should be included except(1 Point) you report immediately?(1 Point) visual disturbances A. Check for vaginal bleeding at these
46. Situation: Mrs. Azucena, 45 y/o, early signs of labor
A. Bed rest A. Urine output=250 ml/shift G9P5 (5035) AOG 38 wks was brought B. Remind her of breathing and relaxing
B. Vital signs every four hours B. Patellar reflex +2 to OB-ER with a chief complaint of exercises in labor
C. Intake and output profuse vaginal bleeding. Having a C. Assist her with the bedpan so that she can
C. RR=11cpm
clinical eye on obstetric cases, what have a bowel movement
D. 500-milligram sodium diet D. BP=160/90 mmHg
would be your initial impression of Mrs. D. Perform a vaginal exam to check for
E. Activity restriction
Azucena’s condition?(1 Point)A. cervical changes
44. A 15- year – old adolescent at 26
40. Mary’s doctor orders that she be given Abruption placenta 50. A pregnant client is diagnosed with partial
weeks of gestation with a diagnosis of
placenta previa. In explaining the diagnosis, the
magnesium sulfate, because the drug induces(1 possible preeclampsia is referred to the
B. Placenta previa nurse tells the client that the usual treatment for
Point) nurse for nutrition counseling. The nurse
C. Preeclampsia partial placenta previa is which of the
suggests an added serving of protein
A. Central nervous system depression D. PROM following?(1 Point)
over the recommended minimum for 15-
B. Vasoconstriction year-olds who are pregnant because:(1 47. What is the most contraindicated
procedure to any patient presenting with A. Activity limited to bed rest
C. Hyporeflexia Point)
profuse bleeding per vagina?(1 Point) B. Platelet infusion
D. Decreased urinary output
A. The adolescent may C. Immediate cesarean delivery
E. All of the above
not have completed her A. Abdominal palpation D. Labor induction with oxytocin
own growth B. Blood extraction
41. Which of the signs and symptoms is not B. Hypertension problems in C. Internal examination
pregnancy are associated with loss D. Oral route of drug administration 51. Situation: A nurse is assigned at the pediatric
characteristic of the patient’s initial diagnosis?(1
of protein in the urine 48. The nurse in the emergency ward, as the nurse in charge, she should be able
Point)
C. Hypertension problems in department is evaluating a woman at 37 to answer queries about her clients’ growth and
pregnancy are caused by a low- weeks of gestation who has been development. As part of the assessment process,
A. BP>140/90 mmHg
protein diet admitted with complaints of abdominal the pediatric nurse often utilizes a standardized
B. Urinalysis: albumin ++ tool for a developmental screening. Which
C. Headache: severe, continuous D. The added protein will ensure pain and some bright-red vaginal
that the fetus can grow even with bleeding. The nurse knows that:(1 Point) nursing action is appropriate related to the use of
reduced placental circulation a developmental screening tool?(1 Point)
 A. Growth A. Role Fantasy The nurse assesses during her shift, at what age
B. Development B. Accommodation do infants demonstrate a social smile?(1 Point)
A. Administer the part of the tool that will C. Maturation C. Egocentrism
assess the child's problem area first. D. Patterns D. Assimilation A. 1 month
B. Have the parent administer the 55. A mother asks the nurse on duty B. 2 months
screening tool. C. 3 months
what are the factors influencing growth 58. The nurse knows that during this
C. Select the tool the nurse is most and development. She is corrects when period, children formulate the sense of D. 4 months
comfortable using. she states:(1 Point) right or wrong according to Kohlberg.(1
D. Practice administering the screening tool. 62. The nurse should recognize that an infant
Point)
A. “From the moment of conception, typically exhibit stranger anxiety at?(1 Point)
52. When assessing a child’s cultural the basic makeup of an individual is A. Infancy
background, the nurse in charge should keep in cast.” B. Toddler A. 7 months9
mind that:(1 Point B. “On the average, boys are born C. School age B. 8 months
lighter and shorter than girls.” D. Adolescent C. 9 months
A. Cultural background usually has little C. “A child who inherits a
bearing on a family’s health practices D. 10 months
genetically transmitted disease 59. The mother states that adolescents 63. The nurse include in the care an infant is
B. Physical characteristics mark the child as may grow still rapidly.” can be responsible for self care because able to pick up small objects using a pincer
part of a particular culture D. “Children with high intelligence they view this as a standard of behavior. grasp?(1 Point)
C. Heritage dictates a group’s shared generally grow faster physically and This is a nursing implication of what
values tend to advance faster in skills. stage of Kohlberg’s Moral
D. Behavioral patterns are passed from one A. 7 months
56. Situation: Nurse May should know development?(1 Point) B. 8 months
generation to the next the foundations of growth and C. 9 months
development and its theories. As the A. Preconventional
D. 10 months
nurse assigned to pediatric ward, she is B. Conventional
53. Which of the following is incorrect about now confident to relay this to her clients’
64. How many words would a typical 12-
C. Postconventional month-old infant use?(1 Point)
growth and development?(1 Point) SO. This theorist mentioned that his D. A and B
theory was based on his observations of E. A and C
A. All children pass through predictable A. 1
mentally disturbed adults and described 60. Concrete operations include
stages of growth and development as they child development as being a series of B. 2
mature. systematic reasoning at what age C. 3
psychosexual stages?(1 Point) according to Piaget?(1 Point)
B. Growth and development are assessed by D. 4
both observation and specific testing. A. Sigmund Freud 65. By what age would you expect an infant to
C. Developmental milestones are the major A. 18-24 months
B. Eric Erickson sits unsteadily and still needs support?(1 Point)
markers of normal development B. 2-7 years old
C. Jean Piaget C. 12 years old
D. None of the above A. 7 months
D. Lawrence Kohlberg
54. This term is used to indicate an increase in D. 7-12 years old B. 8 months
skill or the ability to function, it can be measured 57. According to Piaget’s theory, this is 61. Situation: Janessa, nurse in the C. 9 months
by observing a child’s ability to perform specific pediatric ward is in charge of mother and D. 10 months
perceiving that one’s thoughts and needs
tasks.(1 Point) infants. The following are the changes to
are better or more important than those
note and be knowledgeable about.
of others during preschool?(1 Point)
66. Situation: An infant usually is difficult to
take care because of the things that can
compromise the child’s safety. As Nurse Jocelyn 69. A 2 month old infant undergoes 72. You are caring for a 3-year-old who A. “My 2 year old should be able to draw
takes care of infants in the ward, she is able to repair of a cleft lip. After surgery, which is toilet trained but becomes incontinent circles, diamonds, triangles.”
give proper intervention when she knows and equipment should the nurse teach the when separated from his parents during a B. “My 2 year old should be willing to
does the following. parents to use to feed their infant?(1 hospitalization. Which defense share toys with our 5-year-old.”
Point) mechanism is the child using?:(1 Point) C. “My 2 year old should be able to speak in
A mother asks Nurse Jocelyn, when would an two-word sentence.”
infant be ready to play peek-a- boo, you are A. cross-cut nipple A. Rationalization D. “My 2 year old is able to determine
correct when you answer:(1 Point) B. plastic spoon B. Regression right from wrong.”
C. paper cup C. Fantasy
A. 7 months D. rubber dropper D. Repression 76. Situation: Nurse Joyce is new in the pediatric
B. 8 months ward, as the NOD, she noticed that most of her
C. 9 months 70. A 7 month old child has had 73. The nurse is assessing the patients during the shift have problems on
D. 10 months recurrent middle-ear infections since she development of a 2-year-old at a day- genitourinary. As the NOD, she should be
was 4 months old. Which of the care center. The nurse expects the knowledgeable that the cases are the following:
67. Jocelyn knows that infants swallows following is most important to assess?(1 toddler to be able to:(1 Point) A father brings his 4-week-old son to the clinic
substances that they see around, when this Point) for a check-up, stating that he is afraid that his
happen this reflex prevent the swallowing of A. Combine two words son’s testicle is missing. Which of the following
inedible substances?(1 Point) A. how well the clients eats B. Put on clothing explanations would be most appropriate?(1 Point)
B. the client's weight gain since her C. Wash and dry his hands
A. Landau reflex last visit A. “Although the testes should have been
D. Throwing ball overhand
B. Extrusion Reflex C. whether the client received all descended by now, it is not a cause for worry”
C. Swallowing Reflex her prescribed antibiotics at the B. “The testes often do not descend until age
74. A mother tells you that her toddler
D. Sucking Reflex time of the last infection 6 months, but let’s check to see whether the
has several temper tantrums every day.
68. D. the client's testes is present
The nurse explains that(1 Point)
temperature C. “The testes are present in the scrotal sac at
68. A breastfeeding client asks the nurse, “How birth, but surgery can remedy the situation
will I know that my baby is getting enough?” A. Temper tantrums aren’t preventable
D. “Although the testes normally
The nurse correctly responds:(1 Point) 71. Situation: A mother of a toddler asks B. Temper tantrums are a descend by 1 year of age, I can
Nurse Kristine what can be the best way common response to anger understand your concern.”
A. “As long as your baby is on the breast to train and develop the child holistically. and frustration
for 10 minutes, he is getting enough.” C. Giving the child what he 77. Nurse Joyce is assessing an infant with
B. “As long as the baby doesn’t lose any Nurse Kristine should expect a 3-year- wants commonly stops the undescended testis , the nurse would also be alert
weight during the first two weeks, he is old child to be able to perform which behavior for which of the following?(1 Point)
getting enough.” action?(1 Point) D. Scolding the child commonly stops
C. “Don’t worry; the baby will let you know. the behavior A. Abnormal lower extremity reflexes
As long as the baby is not crying, he is A. Ride a tricycle
B. A history of frequent emesis
probably not hungry.” B. Tie the shoelaces 75. You’re discussing growth and C. A bulging in the inguinal area
D. “By the fourth day of life, if the baby is C. Roller-skates development with the parents of a 2 year D. Poor weight gain
wetting at least 6 diapers a day, he is D. Jump rope old . Which statement by the mother
probably getting enough.” indicates understanding of normal
growth and development?(1 Point)
78. Nurse Joyce endorsed to the OR a 1 year old 81. Situation: Nurse Eileen was rotated D. Supine C. After the danger of hyperbilirubinemia
child who is scheduled for surgery to correct to the pediatric ward, an unfamiliar case 84. After nephrectomy for a Wilm’s has passed
hypospadias and chordee. The nurse explains to of a child suddenly caught her attention. tumor, the nurse continues to assess the D. After the effects of delivery have
the parents that this is the preferred time for As the NOD, she should be able to take child postoperatively for which of the subsided
surgical repair based on which of the care a child with Wilm’s tumor. When following as an early sign of a 87. A nurse is educating a family of a 1 year old
following?(1 Point) assessing a child admitted to the complication?(1 Point) with phenylketonuria (PKU). Which of the
pediatric unit with a diagnosis of Wilm’s following would be the most appropriate point to
A. At this age, the child will experience tumor, which of the following findings A. Increased abdominal distention present?(1 Point)
less pain would nurse Eileen expect?(1 Point) B. Elevated Blood pressure
B. The child is too young to have develop C. Increased Respiratory Rate A. The child should eat red meat once a day
castration anxiety A. Hypotension D. Increased urine output B. The child should limit the intake of
C. The child will not remember the B. Proteinemia 85. When developing the discharge plan carbohydrates
surgical experience C. Pallor for a child who had nephrectomy for a C. The child should consume dairy
D. The repair is easier to perform before the D. Petechiae Wilm’s tumor, the nurse identifies products three times daily
child is toilet trained outcomes to prevent damage to the D. The child should avoid products
82. The nurse determines that the child’s remaining kidney and accomplish containing aspartame
79. When developing the teaching plan for the mother of a child with Wilm’s tumor which of the following?(1 Point)
parents of a 12 month old infant with understands what stage II tumor means 88. Discharge teaching for a child with celiac
hypospadias and chordee repair, which of the when she states which of the A. Minimize pain disease would include instructions about
following would the nurse expect to include as following?(1 Point) avoiding which of the following?(1 Point)
B. Prevent dependent edema
most important?(1 Point)
C. Prevent UTI
A. “The tumor has extended beyond A. Rice
A. Assisting the child to become familiar D. Minimize sodium intake
the kidney but was completely B. Milk
with his dressings so he will leave them removed” 86. Situation: Metabolic disorders in
pediatric clients are rare but pose danger C. Wheat
alone B. “Although the tumor was in the
to an infant. The following are some D. Chicken
B. Encouraging the child to ambulate as soon kidney but was completely removed”
as possible by using a favorite push toy C. “The tumor has extended outside disorders that nurses should be capable
C. Forcing fluids to at least 2500 ml/day by of giving a competent nursing care. 89. The mother of the client asked nurse Eileen
the kidney to the lungs and the liver” what are the signs and symptoms of Celiac
offering his favorite juices D. “The tumor was solely located
A client is preparing to take her one disease. The following are the signs and
D. Preventing the child from disrupting in the kidney but it was totally
day old infant from the hospital. The symptoms except:(1 Point)
the catheters by using soft restraints. removed”
nurse discussed the test for
phenylketonuria (PKU) with the A. irritability
80. A recent history of which of the following 83. A child diagnosed with Wilm’s
mother. The nurse’s teaching should B. Diarrhea
would the Nurse Joyce alert nurse to suspect a tumor undergoes successful surgery for
urinary tract infection in a 2- year-old child who be based on an understanding that the C. Vomiting
removal of the diseased kidney. On
is exhibiting fever and fussiness?(1 Point) test is most reliable:(1 Point) D. None of the above
return to the room, the nurse would place
the child in which of the following 90. The nurse in-charge is correct when she
A. Abdominal pain A. After a source of protein has explains that galactosemia is:(1 Point)
positions?(1 Point)
B. Swollen lymph nodes been ingested A. A galactosemia test is only in blood test
C. Skin rash B. After the meconium has been B. Galactosemia is inherited in an
A. Modified trendelenburg
excreted autosomal recessive manner
D. Back pain B. Sims’
C. Semi-fowler’s
 C. Galactosemia is same as lactose 94. For which of the following D. Test CSF leakage for protein the most common defect in CNS?(1 Point)
intolerance symptoms will the nurse assess a 97. Nurse Jocelyn evaluates the
D. The treatment for galactosemia is never neonate diagnosed with bacterial discharge teaching as successful when A. Anencepahaly
eliminate lactose and galactose from the meningitis?(1 Point) the parents of a school-aged child with B. Encephalocele
diet ventriculoperitoneal shunt insertion C. Spina Bifida
A. Temperature instability, irritability, identify which of the following as D. None of the above
and poor feeding signaling a blocked shunt?(1 Point)
91. Situation: Danielle rushed her baby to the B. Positive babinski’s disease 100. When positioning unrepaired of a
ER after seizure attack. Nurse May the ER nurse reflex, motting and pallor A. Decreased urine output with myelomeningocele, which of the following
provided intervention for such illnesses. C. Headache, nuchal rigidity stable intake would the nurse prevent muskulosketal
and developmental delays B. Tense fontanel and increased deformity in the infant?(1 Point)
Which of the following would be the lowest D. Positive Moro’s reflex, head circumference
priority of Nurse May when caring for a child hypothermia and sunken fontanel C. Elevated temperature and A. Placing the feet in flexion
with a seizure disorder?(1 Point) reddened incisional site B. Allowing the hips to be abducted
D. Irritability and increasing
A. teaching the family about 95. Nurse May is evaluating a 1 year old difficulty with eating
C. Maintaining knees in the neutral
anticonvulsant therapy position
for possible cerebral palsy. Which of the
B. Assessing for signs and symptoms of following could be an indicator of D. Placing the legs in adduction
increased ICP cerebral palsy?(1 Point) 98. Before placement of
C. Ensuring safety and protection from ventriculoperitoneal shunt for
injury A. Lack of use of one dominant hand hydrocephalus, an infant is irritable,
D. observing and recording all seizure B. Vocabulary limited to three lethargic and difficult to feed. To
words: mama, dada and ball maintain the infant’s nutritional status,
92. Nurse May knows that the most useful tool C. Crawling with all extremities which of the following actions would be
in diagnosing seizure disorder is:(1 Point) D. Frequent arching of the back most appropriate?(1 Point

A. EEG 96. Situation: Patient with A. Feeding the infant just before
B. Lumbar puncture hydrocephalus and other neurologic doing any procedure
C. Brain scan disorders were admitted, Nurse Jocelyn B. Giving the infant small,
D. Skull radiographs takes care of these patients. The frequent feedings
93. Which of the following pathologic processes following are the interventions for such C. Feeding the infant in a
often associate with aseptic meningitis?(1 Point diseases. Which of the following would horizontal position
nurse Jocelyn do when providing post- D. Scheduling the feedings for
A. Ischemic infarction of cerebral tissue operative nursing care to a child after every 6 hours.
B. Childhood disease of viral causation insertion of ventriculoperitoneal
C. brain abscess caused by variety of shunt?(1 Point)
pyogenic organisms 99. Neural tube defect are group related
D. Cerebral ventricular irritation from a A. Administer narcotics for pain defects of the CNS involving cranium
traumatic brain injury control and spinal cord. This is the type of
B. Check urine for glucose and protein neural tube defect which has a defective
C. Monitoring for increased closure of the vertebral column and is
temperature