1. A nurse is caring for a client who ispostoperative placement of a halo vest to manage a cervicalvertebral fracture. Which of the following actions should the nursetake?
a. Encourage flexion and extension of the neck
b. Assess the pin sites for injection once every otherday
c. Reposition the client using a turning sheet
d. Tighten the screw on the halo device once-quarterturn every 48 hr.
2. A nurse is teaching about growth and developmentto a parent of 12-year-old child. The nurse should instruct theparent to expect the child to exhibit which of the followingcharacteristics during early adolescence?
a. Mood swings
b. Increased self-esteem
c. Emotional separation from parents
d. Decreasing growth rate
3. A nurse is caring for a group of client. Which ofthe following findings should the nurse report to theprovider?
a. A 3-month-old infant who has a respiratory rate of30/min
b. A school-age child who has a rectal body temperatureof 37.3oC (99.1oF)
c. An 18-month-old toddler who has a heart rate of68/min
d. An adolescent who has a BP of 132/82 mm Hg
4. A nurse is caring for a child who receivedpartial thickness burns to over 55% of his body 10 days ago and hassplints over his joint to prevent contractures. Which of thefollowing actions should the nurse take? (SATA)
a. Remove splints during sleep
b. Change dressings using aseptic technique
c. Administer analgesics IM
d. Monitor intake and output
e. Provide a high-calorie diet
5. A nurse in the emergency department is caring fora school-age child who has developed respiratory stridor, wheezing,and urticaria after receiving an IV which of the following actionshould the nurse take first?
a. Administer methylprednisolone.
b. Administer oxygen
c. Administer a nebulizer bronchodilator
d. Administer epinephrine.
6. A nurse is caring for an adolescent who has majordepressive disorder. Which of the following action should the nursetake first?
a. Encourage the client to attend a group therapysession.
b. Administer an antidepressant to the client
c. Assist the client in completing the ADLs.
d. Ask the client if he is considering harminghimself.
7. A nurse is reviewing the medical record of24-month -old child who has acute lymphocytic leukemia. Which ofthe following action should the nurse take?
a. Obtain a rectal temperature every 4 hr.
b. Initiate bleeding precaution
c. Place the child in knee-chest position
d. Apply viscous lidocaine to the oral mucosa
8. A nurse is communicating with a child who hashearing loss. Which of the following actions should the nursetake?
a. Change position frequently to maintain the child’sattention
b. Exaggerate the pronunciation of words.
c. Maintain a neutral facial expression when speakingto the child.
d. Use light touch when initiating conversation.
9. A nurse is caring for a school-age child who haspertussis. Which of the following actions should the nursetake?
a. Report the diagnosis to the public healthdepartment
b. Administer the pertussis vaccine
c. Restrict oral fluids to 500 ml per day
d. Place the child in a protected environment for 48hrs.
10. A nurse at an inpatient facility is planningcare for a child who has autism spectrum disorder. Which of thefollowing intervention should the nurse include in the plan ofcare?
a. Keep staff visit with the child brief
b. Keep the television on in the child’s room forbackground noise
c. Place the child in a semiprivate room
d. Vary daily routine when providing care for thechild
11. A nurse is assessing a child who has multipleclosed fractures of the lower extremities closed fractures of thelower extremities due to motor-vehicle crash. The nurse shouldmonitor the child for which of the following complications duringthe first 24 hr. after the injury occurred?
a. Osteomyelitis
b. Volkmann ischemic contracture
c. Compartment syndrome
d. Renal calculi
