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Title of test: DAVID'S Q&A FOR THE NCLEX-RN EXAMINATION TEST # 4 Description: NCLEX-RN EXAMINATION REVIEW Author: omatal Other tests from this author Creation Date: 01/04/2025 Category: Others Number of questions: 87

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1182. Which gland illustrated should a nurse palpate if Graves’ disease is suspected? 1. Gland A 2. Gland B 3. Gland C 4. Gland D. 1183. Which instruction should a nurse include when teaching parents who have a child diagnosed with hypoparathyroidism? 1. Monitor for muscle spasms, tingling around the mouth, and muscle cramps. 2. Monitor for side effects of excess medication therapy, including dry, scaly, coarse skin. 3. Decrease intake of foods high in calcium and phosphorus. 4. Increase environmental stimuli and encourage participation in high-energy activities. 1184. Which nursing diagnosis has the highest priority for a child diagnosed with Addison’s disease? 1. Potential excess fluid volume 2. Disturbed body image 3. Altered development 4. Altered sleep and rest. 1185. An adolescent is admitted with a diagnosis of sus pected Addison’s disease. Which assessment mani festations should the nurse expect to find if Addi son’s disease is the correct diagnosis? 1. Long history of fatigue, weight loss, and muscle tetany 2. Sudden onset of skin hypopigmentation, polydipsia, and hyperactivity 3. Gradual onset of salt craving, decreased pubic and axillary hair, and irritability 4. Sudden onset of increasing weight gain, hirsurtism, and skin hyperpigmentation. 1186. A nurse teaches the parents of a child diagnosed with Addison’s disease signs of Addisonian crisis. Which sign identified by the parents indicates that further teaching is needed? 1. Severe hypertension 2. Abdominal pain 3. Seizures 4. Coma . 1187. A nurse instructs the parents of a child diagnosed with Addison’s disease. Which instructions should be included by the nurse? SELECT ALL THAT APPLY 1. Have the child wear a medical alert bracelet. 2. Encourage the child to ingest adequate fluids, particularly on hot summer days. 3. Include emergency cortisone treatment for Addisonian crisis on the school medical care plan. 4. If the child vomits the dose of cortisone within 1 hour, the dose is not repeated but the health care provider notified. 5. Administer epinephrine subcutaneously immediately if Addisonian crisis should occur. 1188. Glucocorticoids are prescribed for a child diagnosed with congenital adrenal hyperplasia. Which mani festation should indicate to a nurse that therapy is successful? 1. Feminization in girls 2. Absence of symptoms of Cushing’s syndrome 3. Precocious penile enlargement in boys 4. Increased growth rate in both boys and girls. 1189.Which nursing diagnosis has the highest priority for an infant diagnosed with congenital adrenal hypoplasia? 1. Disproportionate growth 2. Excess fluid volume 3. Impaired parent-infant attachment 4. Knowledge deficit of lifelong medication requirements. 1190. Which outcomes should a nurse plan for a child di agnosed with adrenal insufficiency? SELECT ALL THAT APPLY. 1. Child demonstrates a positive body image. 2. Child demonstrates no complications related to inactivity. 3. Child responds to oxygen regimes to avoid hospitalization. 4. Child and family verbalizes causes of the disease and treatment regimen. 5. Child responds to activity restrictions to conserve energy. 1191. A 10-year-old child is admitted for testing to diag nose Cushing’s syndrome. For which initial test should a nurse prepare the child and parents? 1. Glucose tolerance test (GTT) 2. Urine or saliva cortisol level 3. Dexamethasone suppression test 4. Serum 17-hydroxyprogesterone level . 1192.Based on a child’s growth chart from birth to age 12 months (illustrated below),which diagnostic test should a nurse expect a health-care provider to prescribe? 1.Radiographic views of the sella turcica 2.Bone age 3.Insulin-like growth factors (IGFs) 4.17-alpha-hydroxyl progesterone. 1193.A 12-year-old child is being treated for growth hormone deficiency. The child is angry and refus ing to go to school because all the other children are taller. In addition, this child is belligerent to ward the mother,who gives the daily injection of growth hormone. Which initial intervention should be attempted by the nurse? 1.Teach the child self-administration of growth hormone. 2.Refer the family for counseling with particular emphasis on anger management. 3.Assist the parents to contact the school district so that home schooling can begin and last until the child has reached normal height. 4.Talk to the mother about requesting an Individual Educational Planning (IEP) team to assist in planning school interventions. 1194. Which assessment findings should the nurse expect for a child diagnosed with diabetes insipidus? SELECT ALL THAT APPLY. 1. Polydipsia 2. Polyphagia 3. Polyuria 4. Glycosuria 5. Ketonuria. 1195. A nurse is assessing a 4-year-old child diagnosed with precocious puberty. Which physical assess ment manifestation should the nurse expect to find? 1. Short stature 2. Hypothalmic tumor 3. Advanced bone age 4. Pubic and axillary hair . 1196. An older adolescent is diagnosed with acromegaly. Which medication should the nurse expect to be prescribed for this individual? 1. Somatropin (Genotropin®) 2. Desmopressin (Desmotabs®) 3. Somatostatin (Sandostatin®) 4. Clozapine (Clozaril®) . 1197. A 6-year-old child is diagnosed with pheochromo cytoma. Which manifestations should lead a nurse to conclude that this child is in crisis? 1. Systolic blood pressure of 120 mm Hg 2. Rhabdomyolysis 3. Urine output of 30 mL/hr 4. Hyperexcitability. 1198. A nurse is reviewing the laboratory report results for an infant who has diarrheal stools. Which analy sis of the laboratory report results is correct? 1. The color is more characteristic of normal stools than diarrheal stools. 2. The pH is abnormal and the stool is alkaline 3. The odor is uncharacteristic for diarrheal stools. 4. The stools are discolored from the presence of visible blood. 1199. A child is to have a breath hydrogen test to evaluate for malabsorption syndrome. Which instruction is most important for a nurse to include when teaching the parents about the preparation needed for the test? 1. “Be sure to administer the prescribed antibiotics an hour before the test.” 2. “The dinner the night before the test should consist of meat, rice, and water; avoid other starchy foods.” 3. “Give the child an enema to cleanse the child’s bowel the morning of the test.” 4. “Encourage fluids just before the test to moisten the child’s mouth for blowing into the mouthpiece.”. 1200.A nurse is caring for a 2-month-old infant who has been admitted to a pediatric unit for hypovolemia secondary to gastroenteritis. The baby is irritable and will not calm when the parents hold the infant. The nurse’s assessment findings include pulse, 180; respiratory rate, 48; blood pressure, 80/50 mm Hg; mucous membranes, dry; and decreased tears. The nurse interprets the information and determines that the child is moderately dehydrated. Which assess ment finding further supports this conclusion? 1. Capillary refill greater than 2 seconds 2. Intense thirst 3. Normal to sunken anterior fontanel 4. Absence of tears. 1201. An infant is hospitalized with a diagnosis of infectious gastroenteritis and dehydration. A nurse determines that a nursing assistant caring for the infant understands the necessary precautions when the nursing assistant states:SELECT ALL THAT APPLY. 1.“I should put on a mask,gown,and gloves when I enter the room.” 2.“I should put on gloves when I am holding the baby.” 3.“I should wear gown and gloves to change the baby’s diapers.” 4.“I should keep the door to the baby’s room closed most of the time.” 5.“I should perform hand hygiene each time I change the baby’s diaper.” 6.“I should keep the baby in the room unless instructed otherwise.”. 1202. A nurse is developing a teaching plan for the parents of a 5-month-old infant diagnosed with gastroenteritis caused by a rotavirus. Which instruc tions should the nurse include to reduce the risk for transmission? SELECT ALL THAT APPLY. 1.Vacuum carpets and upholstery daily to rid the house of the infectious organism. 2.Wash the child’s clothing soiled with stool separately from other family clothing. 3.Tell family members to wash hands frequently, especially after changing the infant’s diaper. 4.Once the child is well, take the child to the clinic to complete the rotavirus immunization series. 5.Use alcohol-based wipes to cleanse the infant after a stool to disinfect the skin. 6.Store toothbrushes,pacifiers,and other personal items away from the diaper-changing area. 1203.A nurse is recording intake for a child hospitalized with diarrhea who has now begun to eat. The nurse should document ____ mL for the 3 ounces of pop sicle that the child consumed. 1204.A nurse is caring for a 12-month-old child who has been admitted to a pediatric unit for dehydration secondary to vomiting and diarrhea. The toddler weighs 22 pounds. The toddler is to receive D51/2NS with 20 mEq KCL at 4 mL/kg/hr. The nurse should set the pump to deliver _____ mL per hour. 1204.A nurse is caring for a 12-month-old child who has been admitted to a pediatric unit for dehydration secondary to vomiting and diarrhea. The toddler weighs 22 pounds. The toddler is to receive D51/2NS with 20 mEq KCL at 4 mL/kg/hr. The nurse should set the pump to deliver _____ mL per hour. 1205.A clinic nurse is providing instructions to the par ents of an 18-month-old child experiencing acute diarrhea. The child weighs 12 kilograms. When teaching the parents,which points should the nurse emphasize? SELECT ALL THAT APPLY. 1.“Have your child drink plenty of fluids, including apple juice and other fruit juices.” 2.“Put your child on a diet of bananas,rice, applesauce, tea,and toast (BRATT) until the diarrhea resolves.” 3.“Encourage your child to eat small amounts of foods included in the child’s normal diet,except cow’s milk or milk products.” 4.“Avoid using commercial baby wipes that contain alcohol to cleanse your child’s skin.” 5.“Wash your hands often,especially after changing your toddler,and keep soiled articles away from clean areas.” 6.“Give 1/2glass (120 mL) of an oral replacement fluid,such as Pedialyte®for each diarrheal stool.”. 1206. An experienced nurse is observing a new nurse pro viding care to an 11-month-old child who is 12 hours postoperative from a cleft palate repair. Which nurs ing action requires the experienced nurse to intervene? 1. Using a suction catheter to remove oral secretions 2. Feeding soft, blended foods 3. Removing an arm restraint to check the skin 4. Administering an analgesic . 1207. A 2-week-old infant born with cleft lip and palate is being discharged from a hospital. The in fant’s parents have each demonstrated the proper technique of feeding the infant with a special soft sided bottle equipped with a cleft palate nipple. Which complication should a nurse inform the parents to monitor for with this type of feeding? 1. Overstimulation 2. Overfeeding 3. Aspiration 4. Hiccups. 1208.A nurse is completing discharge teaching with the parents of a 12-month-old child who has undergone a cleft palate repair. Which topics should be dis cussed in the discharge teaching? SELECT ALL THAT APPLY. 1. Checking the temperature of foods 2. Administering prescribed pain medication routinely 3. Demonstrating how to use a regular baby bottle for feeding 4. Applying elbow restraints when the baby is not being monitored 5. Demonstrating how to suction the baby’s mouth using a bulb syringe 6. Addressing financial concerns for long-term care. 1209.In an infant who has been tentatively diagnosed with esophageal atresia, what should be the priority nursing outcome? 1. Infant will maintain adequate fluid volume. 2. Infant will demonstrate effective breathing pattern. 3. Nutritional status will be maintained. 4. Parents will exhibit emotional health. 1210. A novice nurse is assessing a newly born infant with respiratory distress and copious oral secretions. The nurse’s initial thought is tracheoesophageal atresia (TEA). Which nursing action should confirm this? 1. Respiratory distress decreases with oral suctioning. 2. Nasogastric tube (NG) easily advances to obtain stomach contents. 3. Catheter tip noted to be in the stomach on x-ray. 4. Soft NG advances, but unable to obtain stomach contents. 1211. A 39-week-old infant is postoperative day 1 after emergency surgery for tracheoesophageal atresia. Which nursing action would be unsafe for the infant? 1. Providing a pacifier during gastrostomy feedings 2. Performing both oral and tracheal suctioning 3. After a gastrostomy feeding, elevating the gastrostomy tube, covering it with sterile gauze, and leaving it unclamped 4. Turning the infant frequently . 1212. A nurse completes teaching the parents of a 3-month-old infant diagnosed with pyloric steno sis who underwent surgical correction. Which statement by the parents indicates teaching has been effective? 1. “We should use a special infant feeder, such as a Breck® feeder, so our baby does not get so much air.” 2. “Increasing the amount of formula at each feeding will help to expand our baby’s stomach.” 3. “After feedings, our baby should be handled as little as possible.” 4. “Once put back to bed after the feeding, our baby should be positioned on the right side.”. 1213. An experienced nurse and a new nurse who is ori enting to a pediatric unit are caring for an infant newly diagnosed with a pyloric stenosis. Using an illustration, the experienced nurse asks the new nurse to identify the area affected by a pyloric stenosis. Place an X on the area that the new nurse should identify as the affected area. . 1214. An infant with prolonged vomiting secondary to pyloric stenosis has arterial blood gases (ABG) drawn. Which ABG results should a nurse expect when reviewing the laboratory report if the infant has an acid-base imbalance? 1. Increased pH and increased bicarbonate 2. Decreased pH and decreased bicarbonate 3. Increased pH and decreased bicarbonate 4. Decreased pH and increased bicarbonate. 1215. Which interventions should a nurse include in the management of an infant newly diagnosed with pyloric stenosis? SELECT ALL THAT APPLY 1. Assess the amount, character, and frequency of vomitus 2. Keep the infant NPO 3. Administer parenteral solutions intravenously 4. Maintain patency of the nasogastric tube (NG) 5. Monitor for signs of hypokalemia 6. Maintain patency of the rectal tube. 1216. A nurse is admitting a 5-week-old infant through an outpatient surgical unit for a laparoscopic correction of pyloric stenosis. Which manifestations should the nurse expect when asking the parents about the in fant’s symptoms? SELECT ALL THAT APPLY. 1. Projective vomiting 2. Bile-colored emesis 3. Sweet smelling vomitus 4. Weight loss 5. Absence of tears when crying 6. Hungry immediately after vomiting. 1217. Based on assessment findings, a nurse thinks an in fant may have developed necrotizing entercolitis (NEC) and plans interventions. In what order should a nurse plan to intervene for the infant? Place the items in order of priority. ______ Notify the health-care provider (HCP) ______ Immediately stop feedings. ______ Start prescribed antibiotics. ______ Prepare the infant for an abdominal x-ray. ______ Start prescribed intravenous fluids. 1218. A nurse is admitting an infant with a tentative diag nosis of intussusception. Which question to the mother would be most helpful in obtaining addi tional information to confirm the diagnosis? 1. “Does your baby vomit after each feeding?” 2. “What does the infant do when experiencing pain?” 3. “Is your infant passing ribbonlike stools?” 4. “Have you felt a mass in your infant’s abdomen?”. 1219. A nurse is planning caring for an infant newly hospitalized with a diagnosis of intussusception. Which nursing diagnosis should the nurse establish as the immediate priority? 1. Pain related to abnormal abdominal peristalsis 2. Risk for deficient fluid volume related to bowel obstruction 3. Altered nutrition, less than body requirements related to vomiting 4. Risk for altered skin integrity related to bloody stools. 1220.A nurse is preparing a 4-month-old infant diag nosed with intussusception for surgery when the in fant passes a normal brown stool. What is the nurse’s most important action? 1. Notifying the health-care provider (HCP) 2. Palpating the infant’s abdomen 3. Documenting the character of the stool 4. Checking the stool for the presence of blood. 1221. A nurse is taking the history from a parent of an in fant diagnosed with Hirschsprung’s disease. Which statement is the parent most likely to make? 1. “My baby has ribbonlike stools that have a foul smell.” 2. “My baby has projective vomiting and swollen arms and legs.” 3. “My baby has gained weight faster than my other children.” 4. “My baby cries for 4 hours every evening with leg and fist clenching.”. 1222.Which assessment findings might a nurse observe when assessing a neonate diagnosed with an anorec tal malformation? SELECT ALL THAT APPLY. 1. Ribbonlike stools 2. Stenosed anal opening 3. Vomiting 4. Abdominal distention 5. Meconium in the urine 6. Poorly developed anal dimple. 1223.A nurse is planning care for children diagnosed with inflammatory bowel diseases. After collecting and analyzing the information about the clients, which statement should best reflect the nurse’s con clusion about the information? 1. All clients diagnosed with Crohn’s disease are adolescent females. 2. None of the clients with a diagnosis of ulcerative colitis have a family history of the condition. 3. Most of the clients with either a diagnosis of Crohn’s disease or ulcerative colitis are adolescent males. 4. Those clients diagnosed with Crohn’s disease have more severe and bloody diarrhea than those diagnosed with ulcerative colitis. 1224.A parent is describing the stool number, consis tency, appearance, and size for a child diagnosed with celiac disease to a nurse. Which changes in the child’s stools should prompt the nurse to con clude that the child’s ability to absorb nutrients is improving? 1. Disappearance of currant jelly–like stools 2. Reduction of ribbonlike stools 3. Absence of large, bulky, greasy stools 4. Absence of liquid green stools. 1225.A nurse is using a food list to address foods to be eliminated from a child’s diet when counseling a parent of a child diagnosed with celiac disease. Which foods should appear on the elimination food list? 1. Cereal containing oat, wheat, or rye and certain frozen foods 2. Breads made with potato or corn and white whole or skim milk 3. Soups, sauces, and peanut butter 4. Cereals and breads containing rice, and cottage cheese. 1226.A child is diagnosed with early hypovolemic shock following surgical intervention for a ruptured ap pendix. Which nursing assessment findings support this diagnosis? 1. Tachycardia, capillary refill greater than 2 seconds, cold extremities, and weak distal pulses 2. Bradycardia, hypotension, mottled color, and weak distal pulses 3. Irritability and anxiousness, capillary refill greater than 2 seconds, and absent distal pulses 4. Lethargy, cold extremities, decreased urine output, and absent distal pulses. 1227. A nurse is caring for a 10-year-old child who has been diagnosed with peritonitis secondary to a rup tured appendix. Which prescription by the health care provider (HCP) should the nurse question? 1. Irrigation of incision site bid with 0.9% NaCl solution 2. Empty and measure JP drain q8 hrs. or as needed 3. Continue IV fluids as previously requested and keep NPO 4. NG to high intermittent suction (HIS); empty and measure q8 hr. 1228.A nurse is caring for a 5-year-old child who has been diagnosed with peritonitis secondary to a rup tured appendix. The child begins complaining of abdominal pain and nausea, even though a nasogas tric tube (NG) is in place. When pulling back the covers, the nurse notes that the child’s abdomen is distended. Which action should be taken by the nurse first? 1. Call the primary health-care provider (HCP). 2. Check the NG to determine if fluid is moving within the tubing to the drainage container. 3. Finish the abdominal assessment and check the child’s vital signs. 4. Obtain and administer an antiemetic. 1229.Before administering an enteral feeding to a 2-month-old infant, a nurse aspirates 5 mL of gastric contents. Which action should the nurse take next? 1. Return the aspirate and withhold the feeding. 2. Discard the aspirate and give the full feeding. 3. Return the aspirate before beginning the feeding. 4. Discard the aspirate and add an equal amount of normal saline to the feeding. 1230.An infant, who is unable to suck effectively, re quires gavage feedings. Which statements best de scribes the proper protocol a nurse should follow when feeding an infant via gavage feedings? SELECT ALL THAT APPLY. 1. The gavage tube can be inserted in either the mouth or the nose. 2. The feedings should mimic the bottle feedings in amount. 3. Continuous feedings rather than intermittent feedings are preferred. 4. Aspirate stomach contents before the feeding and discard the aspirates. 5. Provide mouth care at least twice daily or more often to reduce bacterial growth. 6. Warm the gavage formula to room temperature before starting the feeding. . 1231. A nurse is caring for a 1-year-old child who had surgery for a gastrostomy tube insertion. Which statement describes the nurse’s best action in the care of the child? 1. Place thick dressings under the gastrostomy tube area to keep it clean and dry. 2. Apply the prescribed antibiotic ointment to the insertion site. 3. Apply tension on the gastrostomy device to ensure the balloon is against the stomach wall. 4. Begin tube feedings as soon as the child returns from surgery. 1232.A public health nurse is caring for a 10-year-old child who is diagnosed with hepatitis A. The nurse is instructing the parents to avoid giving their child oral medications. Which is the nurse’s rationale for giving this instruction? 1. The child does not need pain medications because there is no pain associated with hepatitis A. 2. The medication of choice is antibiotics, and the child will be on those only while hospitalized. 3. Normal medication doses may become dangerous due to the liver’s inability to detoxify and excrete them. 4. The foods provided will contain all of the natural substances the child will need for recovery. . 1233.A nurse is using an illustration to teach the parents of a child the location in which bone marrow will be aspirated for a bone marrow biopsy. Which anatomical site should the nurse identify to the parents as the site for a child’s bone marrow aspi ration? Place an X on the anatomical site. 1234.Which nursing diagnosis should be the priority for a child hospitalized in sickle cell crisis? 1. Risk for deficient fluid volume related to inadequate fluid intake 2. Chronic pain related to chronic physical disability and clustering of sickled cells 3. Risk for infection related to ineffectively functioning spleen 4. Ineffective tissue perfusion related to pulmonary infiltrates of abnormal blood cells. 1235.The parents of an 8-year-old African American child diagnosed with sickle cell anemia are being taught pain control measures for their child. Which measure is most important to teach the parents to prevent the onset of vaso-occlusive pain? 1. Apply ice packs to all joints as soon as the child awakens. 2. Encourage drinking large amounts of fluids daily. 3. Administer acetaminophen (Tylenol®) 650 mg orally daily. 4. Increase outdoor exercise and exposure to the fresh air and sunshine. 1236.After 7 days of iron therapy, a child diagnosed with iron-deficiency anemia has serum laboratory tests completed. Which finding indicates that the medica tion is beginning to correct the anemia? 1. Increased reticulocyte count 2. Increased granulocytes 3. Increased indirect bilirubin 4. Increased erythropoietin levels. 1237. A child having recovered following ingestion of rat poison, develops aplastic anemia. Which assessment finding should a nurse conclude is specifically re lated to the aplastic anemia? SELECT ALL THAT APPLY 1. Petechiae 2. Epistaxis 3. Easily fatigued 4. Pale skin color 5. Watery, itching eyes 6. Ulcerations around the mouth. 1238.A child diagnosed with aplastic anemia has had hu man leukocyte antigen (HLA) typing, evaluation of organ function, and laboratory studies completed as an outpatient. Which action should a nurse plan to implement first when the child is admitted to a transplant center for a hematopoietic stem cell transplant? 1. Checking the patency of the central line catheter 2. Placing the child in protective isolation 3. Ensuring that all food entering the child’s room has been irradiated 4. Preparing the child to receive high doses of chemotherapy. 1239. A child diagnosed with hemophilia is brought to a clinic due to pain and restricted movement of the left knee after tripping going upstairs. A nurse assesses that the knee is hot, swollen, and tender to touch. The nurse should initially conclude that the child is likely experiencing: 1. a Baker’s cyst. 2. hemarthrosis. 3. a patella fracture. 4. disseminated intravascular coagulation (DIC). 1240.Which actions should a school nurse include in the emergency treatment of a child diagnosed with von Willebrand’s disease who is experiencing epistaxis? SELECT ALL THAT APPLY. 1. Have the child lie down. 2. Elevate the child’s feet. 3. Apply pressure to the child’s nose with the thumb and forefinger. 4. Keep pressure applied for at least 10 minutes. 5. Apply ice or a cold cloth to the bridge of the child’s nose 6. Ask the child if he or she is carrying medication to treat the nosebleed. 1241. Which finding should a nurse expect when review ing the laboratory results of an infant newly diag nosed with hemophilia A? 1. Prolonged prothrombin time (PT) 2. Decreased hemoglobin level 3. Decreased hematocrit level 4. Prolonged activated partial thromboplastin time (aPTT). 1242. A new nurse is telling an experienced nurse about treatments that a physician discussed with the parents of a child who has thalassemia major. Which statement by the new nurse should the experienced nurse question? 1. “Plasmapheresis will help remove the toxins that are destroying the red blood cells.” 2. “Blood transfusions will need to be administered about every 2 to 4 weeks.” 3. “A splenectomy may become necessary to reduce the child’s abdominal discomfort.” 4. “Bone marrow stem cell transplant can possibly cure this child’s thalassemia major.”. 1243.A child has iron overload from receiving multiple blood transfusions for treating thalassemia major. A nurse should anticipate the physician will likely: 1. order intravenous (IV) fluids to dilute the excess iron and increase urinary excretion. 2. change the type of blood product being transfused. 3. reduce the frequency of blood transfusions. 4. begin chelation therapy. 1244. During a routine physical examination, a par ent states to a nurse, “When I am taking pictures of my baby using the camera flash, I see a red col oration to my baby’s left eye but the right eye has a white reflection. Is this normal?” Which response by the nurse is correct? 1. “Yes, the white reflection is normal; sometimes the light from the camera flash only catches one eye directly.” 2. “Interesting. Your baby’s eyes may be changing color. Many babies are born with what appears to be blue eyes but later they change to brown.” 3. “It is good that you brought this to our attention because it is not the usual response. After further examining your baby’s eyes, we can discuss what the white reflection may suggest.” 4. “You seem concerned that your baby’s eyes have different responses to the flash of the camera. Tell me more about your concern.”. 1245. A nurse is assessing a 6-year-old child newly diagnosed with acute lymphocytic leukemia (ALL). Which assessment findings should the nurse expect based on the child’s diagnosis? SELECT ALL THAT APPLY. 1. Alopecia 2. Petechiae 3. Anorexia 4. Insomnia 5. Bleeding gums 6. Pallor. 1246. A nurse is caring for a 5-year-old child diagnosed with acute lymphocytic leukemia (ALL). The nurse reviews the child’s laboratory report after noting a large amount of blood on the bed linens and in tis sues. Place an X on the specific laboratory value on the report illustrated that should be of greatest con cern to the nurse. 1247. A child diagnosed with leukemia is to receive a unit of platelets. The child’s weight is 33 lbs. The ordered rate for the platelets is 10 mL/kg/hr. A nurse should plan to transfuse the platelets at a rate of _______ mL/hr. 1248.A hospitalized child diagnosed with leukemia is be ing discharged after an initial treatment with chemotherapy. A nurse is teaching the parents about the allopurinol (Zyloprim®), which the child will continue to take at home. The nurse explains that the purpose of this medication is to: 1. help promote the child’s sleep. 2. treat the joint pain and swelling caused by the child’s gout. 3. prevent the child from developing gouty arthritis. 4. protect the child’s kidneys by reducing the formation of uric acid. 1249. A child with Hodgkin’s disease is treated with irradiation to the cervical area. The child’s parent is concerned because the child lacks energy and is ex periencing malaise. Based on this information, the nurse should further assess the child for: SELECT ALL THAT APPLY. 1. hypothyroidism. 2. anemia. 3. impaired nutrition. 4. difficulty swallowing. 5. difficulty voiding. 1250.A child is neutropenic due to chemotherapy treat ments. Which instructions should a nurse include when preparing the parents to take the child home? SELECT ALL THAT APPLY. 1.Prohibit visitors who have been recently vaccinated. 2.Keep the child’s immediate surroundings free of plants and flowers. 3.Provide items such as goldfish, television, sanitized toys,or books for your child’s playtime. 4.Arrange for the child to sleep alone,preferably in his or her own room. 5.Be sure the child bathes or showers daily. 6.Take your child’s temperature,respiratory rate, and pulse four times daily. 1251. A 10-year-old pediatric client receiving treat ment with aggressive combination chemotherapy has stomatitis. Which nursing actions should be taken to perform oral care for this child? SELECT ALL THAT APPLY. 1.Performing oral care with a soft sponge toothette 2.Mixing water with the alcohol-based mouthwash to be used to lessen irritation 3.Swabbing the child’s mouth with viscous lidocaine before performing oral care 4.Massaging the area on the back of the child’s hands between the thumb and index finger with an ice cube for 5 to 7 minutes 5.Providing oral care every 2 to 4 hours,especially after the child eats 6.Cleansing the child’s gums using a piece of gauze soaked in saline or plain water. 1252.Four parents call a clinic to have their children seen for unusual lumps or swelling. A nurse is trying to work the children into a physician’s overbooked schedule. Which child should the nurse schedule to be seen first? 1. A child with Down’s syndrome 2. A child who lives close to power lines 3. A child who has had chronic ear infections 4. A child whose sibling was treated for an osteosarcoma. 1253. Following diagnostic testing for an enlarged cervical lymph node, a health-care provider informs a 20-year-old female client of a diagnosis of Hodgkin’s disease and explains the disease process and recommended treatment. Which statement, overhead by a nurse when the client telephoned her parents, indicates that the client understands the diagnosis and treatment? 1. “I am so relieved; I was worried that I had cancer and there wasn’t anything that could be done to treat it.” 2. “I have a good chance of being cured with radiation therapy, chemotherapy, or a combination of both.” 3. “I will need to have a laparotomy to stage the disease before I can start irradiation and chemotherapy.” 4. “I am so upset; I wanted to go to college, marry, and raise a family. Now, I won’t be able to do any of this.”. 1254. A nurse is completing a health history and an assessment for a male adolescent client tentatively diagnosed with Hodgkin’s lymphoma. Which findings should the nurse conclude support this diagnosis? SELECT ALL THAT APPLY. 1. Firm, nontender lymph node enlargement in the axillary area 2. Drenching night sweats 3. Unexplained fever with temperatures above 100.4°F (38°C) for 3 consecutive days 4. Unexplained weight loss of 10% or more in the previous 6 months 5. A diet consisting mostly of seafood and saturated fats 6. A brother who was also diagnosed with Hodgkin’s disease when an adolescent. 1255.A nurse suspects that a 10-year-old client diag nosed with non-Hodgkin’s lymphoma (NHL) has superior vena cava syndrome when assessing that the client has: 1. thrombocytopenia and leukocytosis. 2. hyperuricemia, hypocalcemia, and hyperphosphatemia. 3. tingling and paresthesias of the lower extremities and pain on light touch. 4. cyanosis of the upper chest, neck, face, upper extremity edema, and distended neck veins. 1256.An experienced nurse and a new nurse are provid ing preoperative care for a 5-year-old child diag nosed with Wilms’ tumor. The experienced nurse should intervene when observing the new nurse: 1. inform the child that water is not allowed because the procedure will be performed soon. 2. palpate the child’s abdomen during assessment. 3. provide the child with a doll for play that has removable kidneys. 4. state to the child, “You’ll get some medicine that you breathe or get through your arm to make you sleep.”. 1257. While an experienced nurse is orienting a new nurse to a pediatric oncology unit, the new nurse asks why there seems to be so many adolescents with osteosarcoma and not other age groups. The experienced nurse explains that osteosarcoma has a peak incidence during adolescence because of the: 1. increase in hormonal production. 2. epiphyseal growth plates have closed. 3. rapid growth spurt experienced during adolescence. 4. increase in sports-related injuries that occurs during this time. 1258.A 5-year-old child, hospitalized following surgical intervention for osteosarcoma, is uninterested in eating. Which nursing action would best support the child’s nutrition? 1. Providing only foods that the child likes best 2. Asking the child’s parents to visit at mealtime 3. Turning on the television so the child is distracted while eating 4. Offering juice, popsicles, or ice cream every 2 hours. 1259.A nurse is planning care for a child following re moval of brain tumor. The child is confused, dis oriented, and restless. Which nursing diagnosis should receive the highest priority? 1. Sensory perceptual alterations related to neurological surgery 2. Self-care deficit related to confusion and restlessness 3. Impaired verbal communication related to confusion 4. Risk for injury related to disorientation and restlessness. 1260.A 6-year-old child is being seen in a clinic after dis charge from a hospital for removal of a brain tumor. Which finding, reported by a parent, best suggests the child has likely developed a complication? 1. Reports occasional headaches 2. Voiding large amount of dilute urine 3. Able to walk with use of crutches 4. Ventricular–peritoneal shunt tubing palpable under the skin. 1261. Leukemic cells have invaded a 16-year-old male’s testes and irradiation of the testes is planned. The client asks a nurse if this means he will be ster ile. The nurse’s best response to the client is based on knowing that: SELECT ALL THAT APPLY. 1. the irradiation to the testes will lead to sterilization. 2. the irradiation of the testes will decrease sperm production but not cause sterilization. 3. this is a question that only the oncologist and radiologist would be able to answer. 4. a lead shield will be used to protect the pelvic area and preserve reproductive organs. 5. if the male is past puberty and is forming sperm, sperm banking may be an option before treatment. 1262.Prior to administering L-asparaginase to a 12-year-old child with acute lymphocytic leukemia, a nurse re views the child’s laboratory report. Which lab value should prompt the nurse to notify a physician before administering the chemotherapeutic agent? 1. Hemoglobin (Hgb) 11.8 mg/dL 2. Blood glucose 252 mg/dL 3. Total bilirubin 1.2 mg/dL 4. Absolute neutrophil count (ANC) 1,078. 1263.Prednisone is ordered three times a day for a child receiving chemotherapy. Which is the best schedule for a nurse to suggest to a parent? 1. 6 a.m., 2 p.m., and 10 p.m. 2. 8 a.m., 1 p.m., and 6 p.m. 3. 10 a.m., 6 p.m., and 2 a.m. 4. 11 a.m., 4 p.m., and 9 p.m. . 1264. A 5-year-old girl with alopecia secondary to chemotherapy refuses to wear a wig. The child’s mother consults a nurse because she thinks her daughter should wear a wig. She states feeling un comfortable when people stare at her daughter. Which response is most appropriate? 1. “Have you tried having your child wear a colorful hat instead?” 2. “Does your child feel uncomfortable when others are looking at her?” 3. “You seem concerned about people looking at your daughter. Tell me more about what you are feeling.” 4. “Your daughter only needs to wear a head covering when she is exposed to sunlight, wind, or the cold.”. 1265.A child is receiving radiation to the left thorax to treat metastases. A nurse adds a nursing diagnosis of Risk for impaired skin integrity to the child’s plan of care. Which interventions should the nurse in clude for this nursing diagnosis? SELECT ALL THAT APPLY. 1. Avoid using soap on the irradiated area 2. Apply lotion to the target skin area after bathing 3. Use water to carefully wash the area, leaving markings on the skin 4. Wear a lead apron when in direct contact with the child 5. Apply a Tegaderm®-type dressing after irradiation to the target area. 1266.A nurse is preparing a child for abdominal irradia tion. Which medications should the nurse plan to administer to prevent nausea and vomiting? 1. Ondansetron (Zofran®) and dexamethasone (Decadron®) 2. Promethazine (Phenergan®) and cyclophosphamide (Cytoxan®) 3. Metoclopramide (Reglan®) and methotrexate (Amethopterin®) 4. Marijuana and L-asparaginase (Elspar®). 1267. A 15-year-old adolescent is scheduled to have total body irradiation in preparation for a bone marrow transplant. A nurse has completed teaching about care following irradiation. Which statements by the adolescent indicate correct understanding of the in formation? SELECT ALL THAT APPLY. 1. “I should report if I have any bleeding, such as after brushing my teeth, because my platelets will be low.” 2. “I will work hard to improve my health by eating plenty of raw fruits and vegetables.” 3. “To relieve the dry mouth, I can suck on lozenges or popsicles or drink cold liquids.” 4. “I will need to take an antiemetic around the clock to help prevent nausea and vomiting.” 5. “Once the irradiation is completed, I will no longer need to be in protective isolation.” 6. “My friends know that I can’t have live plants or flowers so they wanted to know if silk flowers are okay.”.

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