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NCLEX-RN Exam Questions - Part 108
1. A 7-year-old girl has been diagnosed with juvenile arthritis and has been placed on daily aspirin. Which statement made by the parent indicates a need for further teaching?
A) 'My daughter takes her aspirin with her meals.'
B) 'Her gums have been bleeding frequently. Maybe she is brushing too hard.'
C) 'I give her aspirin on a regular schedule every day.'
D) 'One sign of aspirin toxicity can be ringing in the ears.'
2. A young child has been placed in a spica cast. The chief concern of the nurse during the first few hours is:
A) Prevention of neurovascular complications
B) Prevention of loss of muscle tone
C) Immobilization of the affected limb
D) Using heated fans to dry the cast
3. The pediatrician has diagnosed tinea capitis in an 8- year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?
A) Administer oral griseofulvin on an empty stomach for best results.
B) Discontinue drug therapy if food tastes funny.
C) May discontinue medication when the child experiences symptomatic relief.
D) Observe for headaches, dizziness, and anorexia.
4. A 12-year-old girl has been diagnosed with insulindependent diabetes mellitus. Which of these principles would best guide her nutritional management?
A) Concentrated sweets are taken during increased activity.
B) Food restriction is imposed to reduce weight.
C) Caloric distribution should be calculated to fit activity patterns.
D) Fat requirements are increased owing to the possibility of ketoacidosis.
5. A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures should be included in the postoperative care?
A) Encourage the child to cough up blood if present.
B) Give warm clear liquids when fully alert.
C) Have child gargle and do toothbrushing to remove old blood.
D) Observe for evidence of bleeding.
A) 'My daughter takes her aspirin with her meals.'
B) 'Her gums have been bleeding frequently. Maybe she is brushing too hard.'
C) 'I give her aspirin on a regular schedule every day.'
D) 'One sign of aspirin toxicity can be ringing in the ears.'
2. A young child has been placed in a spica cast. The chief concern of the nurse during the first few hours is:
A) Prevention of neurovascular complications
B) Prevention of loss of muscle tone
C) Immobilization of the affected limb
D) Using heated fans to dry the cast
3. The pediatrician has diagnosed tinea capitis in an 8- year-old girl and has placed her on oral griseofulvin. The nurse should emphasize which of these instructions to the mother and/or child?
A) Administer oral griseofulvin on an empty stomach for best results.
B) Discontinue drug therapy if food tastes funny.
C) May discontinue medication when the child experiences symptomatic relief.
D) Observe for headaches, dizziness, and anorexia.
4. A 12-year-old girl has been diagnosed with insulindependent diabetes mellitus. Which of these principles would best guide her nutritional management?
A) Concentrated sweets are taken during increased activity.
B) Food restriction is imposed to reduce weight.
C) Caloric distribution should be calculated to fit activity patterns.
D) Fat requirements are increased owing to the possibility of ketoacidosis.
5. A 5-year-old has just had a tonsillectomy and adenoidectomy. Which of these nursing measures should be included in the postoperative care?
A) Encourage the child to cough up blood if present.
B) Give warm clear liquids when fully alert.
C) Have child gargle and do toothbrushing to remove old blood.
D) Observe for evidence of bleeding.
1. Right Answer: B
Explanation: (A) Aspirin should not be given on an empty stomach because it is irritating to the mucosa. (B) Bleeding from decreased clotting capacity may be caused by aspirin toxicity. (C) A regular schedule of aspirin administration is important to maintain a satisfactory drug level in the body. (D) Aspirin toxicity may affect cranial nerve VIII, leading to tinnitus (ringing in the ears).
2. Right Answer: A
Explanation: (A) Because the extremity may continue to swell and the cast could constrict circulation, the nurse should elevate the limb and observe for capillary refill, warmth, mobility of toes and circulation. (B) Although muscle tone may diminish over time in the affected limb, this is not the immediate concern. (C) The limb has been immobilized already by the cast, and therefore immobilization is not a concern. (D) Heated fans and dryers are discouraged because the outside cast will dry quickly, yet the area beneath the cast remains wet and could cause burns.
3. Right Answer: D
Explanation: (A) Giving the drug with or after meals may allay gastrointestinal discomfort. Giving the drug with a fatty meal (ice cream or milk) increases absorption rate. (B)Griseofulvin may alter taste sensations and thereby decrease the appetite. Monitoring of food intake is important, and inadequate nutrient intake should be reported to the physician. (C) The child may experience symptomatic relief after 4896 hours of therapy. It is important to stress continuing the drug therapy to prevent relapse (usually about 6 weeks). (D) The incidence of side effects is low; however, headaches are common. Nausea, vomiting, diarrhea, and anorexia may occur. Dizziness, although uncommon, should be reported to the physician.
4. Right Answer: C
Explanation: (A) Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. (B) Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. (C) Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. (D) Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
5. Right Answer: D
Explanation: (A) The nurse should discourage the child from coughing, clearing the throat, or putting objects in his mouth. These may induce bleeding. (B) Cool, clear liquids may be given when child is fully alert. Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to distinguish fresh or old blood from ingested liquid should the child vomit. (C) Gargles and vigorous toothbrushing could initiate bleeding. (D) Postoperative hemorrhage, though unusual, may occur. The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright red blood, continuous swallowing, and changes in vital signs.
Explanation: (A) Aspirin should not be given on an empty stomach because it is irritating to the mucosa. (B) Bleeding from decreased clotting capacity may be caused by aspirin toxicity. (C) A regular schedule of aspirin administration is important to maintain a satisfactory drug level in the body. (D) Aspirin toxicity may affect cranial nerve VIII, leading to tinnitus (ringing in the ears).
2. Right Answer: A
Explanation: (A) Because the extremity may continue to swell and the cast could constrict circulation, the nurse should elevate the limb and observe for capillary refill, warmth, mobility of toes and circulation. (B) Although muscle tone may diminish over time in the affected limb, this is not the immediate concern. (C) The limb has been immobilized already by the cast, and therefore immobilization is not a concern. (D) Heated fans and dryers are discouraged because the outside cast will dry quickly, yet the area beneath the cast remains wet and could cause burns.
3. Right Answer: D
Explanation: (A) Giving the drug with or after meals may allay gastrointestinal discomfort. Giving the drug with a fatty meal (ice cream or milk) increases absorption rate. (B)Griseofulvin may alter taste sensations and thereby decrease the appetite. Monitoring of food intake is important, and inadequate nutrient intake should be reported to the physician. (C) The child may experience symptomatic relief after 4896 hours of therapy. It is important to stress continuing the drug therapy to prevent relapse (usually about 6 weeks). (D) The incidence of side effects is low; however, headaches are common. Nausea, vomiting, diarrhea, and anorexia may occur. Dizziness, although uncommon, should be reported to the physician.
4. Right Answer: C
Explanation: (A) Concentrated sweets are eliminated from diet planning. Complex carbohydrates may be taken at the time of increased activity. (B) Food restriction is not used for diabetic control of growing children. Caloric restriction may be imposed for weight control if necessary. (C) Total caloric intake and proportions of basic nutrients should be consistent from day to day. Distribution of these calories should fit the activity pattern. Extra food is needed for increased activity. A balance of food, exercise, and insulin should be maintained. (D) Because of the increased risk of atherosclerosis, the fat percentage of the total caloric intake is reduced.
5. Right Answer: D
Explanation: (A) The nurse should discourage the child from coughing, clearing the throat, or putting objects in his mouth. These may induce bleeding. (B) Cool, clear liquids may be given when child is fully alert. Warm liquids may dislodge a blood clot. The nurse should avoid red- or brown-colored liquids to distinguish fresh or old blood from ingested liquid should the child vomit. (C) Gargles and vigorous toothbrushing could initiate bleeding. (D) Postoperative hemorrhage, though unusual, may occur. The nurse should observe for bleeding by looking directly into the throat and for vomiting of bright red blood, continuous swallowing, and changes in vital signs.
80% DISCOUNT: NCLEX-RN PRACTICE EXAMS
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