Question: A nurse is preparing a plan of care for a child with a primary immunodeficiency. What will be the priority nursing intervention for this client?
Answer Choices:
Providing high-calorie meals and snacks to promote weight gain
Administering regularly scheduled analgesia to address joint pain
Implementing strict infection control measures to prevent infections
Referring to therapists to promote fine and gross motor development
Answer: Implementing strict infection control measures to prevent infections 26.
Question: After undergoing subtotal thyroidectomy, an adolescent develops hypothyroidism. The physician prescribes levothyroxine, 25 mcg P.O. daily. The nurse is teaching the parents how to administer levothyroxine. Which information should the nurse include in the teaching?
Answer Choices:
Levothyroxine should be given after dinner
Levothyroxine should be given with breakfast
Levothyroxine is best absorbed on empty stomach
Methimazole should be given instead of levothyroxine
Answer: Levothyroxine is best absorbed on empty stomach 27.
Question: The nurse is caring for a newborn whose birthing parent is HIV positive. The nurse expects to administer a 6-week course of which medication?
Answer Choices:
Lopinavir
Ritonavir
Nevirapine
Zidovudine
Answer: Zidovudine 28.
Question: A client with diabetes insipidus has had limited fluid intake over the past 12 hours. For which complications should the nurse monitor the client?
Answer Choices:
Glucosuria and weight gain
Hypertension and bradycardia
Peripheral edema and hyperglycemia
Severe dehydration and hypernatremia
Answer: Severe dehydration and hypernatremia 29.
Question: While reviewing the history of a 15-month-old child, which finding does the nurse recognize as a warning sign for primary immunodeficiency?
Answer Choices:
Consistent weight and height growth
Three episodes of otitis media in the last year
History of pneumonia infection in the past year
Antibiotic therapy for the past 3 months without improvement
Answer: Antibiotic therapy for the past 3 months without improvement 30.
Question: The health care provider ordered Tylenol (Acetaminophen) 500 mg PO every 4 hrs. for a child who weighs 50 pounds. The recommended safe dose for Tylenol is 10 mg-15 mg/kg every 6 hrs. Which of the following doses is a safe dose to give to the patient?
Answer Choices:
909.09 mg-1,363.64 mg/day
227.27 mg-340.90 mg/day
2000 mg/day
500 mg/dose
Answer: 227.27 mg-340.90 mg/day 31.
Question: The nurse is caring for a client after a thyroidectomy. What are the priority nursing interventions for this client? Select all that apply.
Answer Choices:
Assess Trousseau’s sign
Keep noise and movement to a minimum
Keep emergency tracheotomy equipment at the bedside
Insert an I.V. line for emergency administration of calcium
Observe for development of renal calculi by straining the urine
Answer: Assess Trousseau’s sign; Keep emergency tracheotomy equipment at the bedside; Insert an I.V. line for emergency administration of calcium 32.
Question: The nurse is providing home care instructions for a 13-year-old child recently diagnosed with systemic lupus erythematosus. Which response by the child indicates a need for further teaching?
Answer Choices:
“I need an eye examination every year.”
“I need to wear sunscreen in the summer to prevent rashes.”
“I need to eat a healthy diet, exercise, and get plenty of sleep.”
“I need to be careful when it is cold
I should always wear gloves.”
Answer: “I need to wear sunscreen in the summer to prevent rashes.” 33.
Question: A 2-month-old infant is brought to the emergency department by their parent. The parent reports that the infant was healthy at birth but has become lethargic and started vomiting. “And my infant has stopped feeding well,” the parent adds. An inborn error of metabolism is suspected and laboratory tests are obtained. Which action does the nurse anticipate performing?
Answer Choices:
Stopping the infant’s feedings
Administering prescribed diuretics
Preparing the infant for a lumbar puncture
Instituting transmission-based precautions
Answer: Stopping the infant’s feedings 34.
Question: A child with type I diabetes received 6 units of regular insulin (Humulin R) and 10 units of NPH insulin at 9:00am. What time does the nurse expect the child to most likely have a hypoglycemic reaction?
Answer Choices:
Around 9:15 am
Around 11:00am
Around 9:10am
The above insulins do not have a peak
Answer: Around 11:00am 35.
Question: When caring for a child with a diagnosis of diabetes insipidus, which nursing intervention should be the nurse’s priority?
Answer Choices:
Monitor urine for specific gravity greater than 1.030
Check weight every 3 days
Maintain adequate fluid intake
Watch for signs and symptoms of hyperglycemia
Monitor urine for specific gravity greater than 1.030
Answer: Maintain adequate fluid intake
Question: A client presents with diaphoresis, palpitations, jitters, and tachycardia approximately 4 hours after taking the prescribed usual morning insulin. What is the nurse’s priority action?
Answer Choices:
Check pulse oximetry, and administer oxygen therapy.
Give nitroglycerin, and perform an electrocardiogram (ECG).
Check blood glucose level, and administer carbohydrates.
Restrict salt, administer diuretics, and perform paracentesis.
Answer: Check blood glucose level, and administer carbohydrates.