Download MCQ for Nursing Students 5

MCQ for Nursing Students 5
1. A mother complains to the clinic nurse that her 2 ½-year-old son is not yet toilet trained. She is
particularly concerned that, although he reliably uses the potty seat for bowel movements, he
isn’t able to hold his urine for long periods. Which of the following statements by the nurse is
correct?
A. The child should have been trained by age 2 and may have a psychological problem that is
responsible for his “accidents.”
B. Bladder control is usually achieved before bowel control, and the child should be required to sit on
the potty seat until he passes urine.
C. Bowel control is usually achieved before bladder control, and the average age for completion of
toilet training varies widely from 24 to 36 months.
D. The child should be told “no” each time he wets so that he learns the behavior is unacceptable.
The answer is C. Bowel control is usually achieved before bladder control, and the
average age for completion of toilet training varies widely from 24 to 36 months.
Toddlers typically learn bowel control before bladder control, with boys often taking
longer to complete toilet training than girls. Many children are not trained until 36
months and this should not cause concern. Later training is rarely caused by
psychological factors and is much more commonly related to individual developmental
maturity. Reprimanding the child will not speed the process and may be confusing.
2. The mother of a 14-month-old child reports to the nurse that her child will not fall asleep at
night without a bottle of milk in the crib and often wakes during the night asking for another.
Which of the following instructions by the nurse is correct?
A. Allow the child to have the bottle at bedtime, but withhold the one later in the
night.
B. Put juice in the bottle instead of milk.
C. Give only a bottle of water at bedtime.
D. Do not allow bottles in the crib.
The answer is C.
Give only a bottle of water at bedtime.
Babies and toddlers should not fall asleep with bottles containing liquid other than plain
water due to the risk of dental decay. Sugars in milk or juice remain in the mouth during
sleep and cause caries, even in teeth that have not yet erupted. When water is
substituted for milk or juice, babies will often lose interest in the bottle at night.
3. Which of the following actions is NOT appropriate in the care of a 2-month-old infant?
A. Place the infant on her back for naps and bedtime.
B. Allow the infant to cry for 5 minutes before responding if she wakes during the
night as she may fall back asleep.
C. Talk to the infant frequently and make eye contact to encourage language
development.
D. Wait until at least 4 months to add infant cereals and strained fruits to the diet.
The answer is B. Allow the infant to cry for 5 minutes before responding if she wakes
during the night as she may fall back asleep.
Infants under 6 months may not be able to sleep for long periods because their stomachs are
too small to hold adequate nourishment to take them through the night. After 6 months, it
may be helpful to let babies put themselves back to sleep after waking during the night, but
not prior to 6 months. Infants should always be placed on their backs to sleep. Research has
shown a dramatic decrease in sudden infant death syndrome (SIDS) with back sleeping.
Eye contact and verbal engagement with infants are important to language development.
The best diet for infants under 4 months of age is breast milk or infant formula.
4. An older patient asks a nurse to recommend strategies to prevent constipation. Which of the
following suggestions would be helpful? Note: More than one answer may be correct.
A. Get moderate exercise for at least 30 minutes each day.
B. Drink 6-8 glasses of water each day.
C. Eat a diet high in fiber.
D. Take a mild laxative if you don’t have a bowel movement every day.
The answer is A, B, and C
A daily bowel movement is not necessary if the patient is comfortable and the bowels move
regularly. Moderate exercise, such as walking, encourages bowel health, as does
generous water intake. A diet high in fiber is also helpful. Laxatives should be used as a
last resort and should not be taken regularly. Over time, laxatives can desensitize the
bowel and worsen constipation.
5. A child is admitted to the hospital with suspected rheumatic fever. Which of the following
observations is NOT confirming of the diagnosis?
A. A reddened rash visible over the trunk and extremities.
B. A history of sore throat that was self-limited in the past month.
C. A negative antistreptolysin O titer.
D. An unexplained fever.
The answer is C.
A negative antistreptolysin O titer.
Rheumatic fever is caused by an untreated group A B hemolytic Streptococcus infection in
the previous 2-6 weeks, confirmed by a positive antistreptolysin O titer. Rheumatic fever
is characterized by a red rash over the trunk and extremities as well as fever and other
symptoms.
6. A patient with a history of congestive heart failure arrives at the clinic complaining of dyspnea.
Which of the following actions is the first the nurse should perform?
A. Ask the patient to lie down on the exam table.
B. Draw blood for chemistry panel and arterial blood gas (ABG).
C. Send the patient for a chest x-ray.
D. Check blood pressure.
The answer is D.
Check blood pressure.
A patient with congestive heart failure and dyspnea may have pulmonary edema, which
can cause severe hypertension. Therefore, taking the patient’s blood pressure should be
the first action. Lying flat on the exam table would likely worsen the dyspnea, and the
patient may not tolerate it. Blood draws for chemistry and ABG will be required, but not
prior to the blood pressure assessment.
7. A clinic patient has recently been prescribed nitroglycerin for treatment of angina. He calls the
nurse complaining of frequent headaches. Which of the following responses to the patient is
correct?
A. “Stop taking the nitroglycerin and see if the headaches improve.”
B. “Go to the emergency department to be checked because nitroglycerin can cause
bleeding in the brain.”
C. “Headaches are a frequent side effect of nitroglycerine because it causes
vasodilation.”
D. “The headaches are unlikely to be related to the nitroglycerin, so you should see
your doctor for further investigation.”
The answer is C. “Headaches are a frequent side effect of nitroglycerine because it
causes vasodilation.”
Nitroglycerin is a potent vasodilator and often produces unwanted effects such as
headache, dizziness, and hypotension. Patients should be counseled, and the dose
titrated, to minimize these effects. In spite of the side effects, nitroglycerine is effective
at reducing myocardial oxygen consumption and increasing blood flow. The patient
should not stop the medication. Nitroglycerine does not cause bleeding in the brain.
8. A patient received surgery and chemotherapy for colon cancer, completing therapy 3 months
previously, and she is now in remission. At a follow-up appointment, she complains of fatigue
following activity and difficulty with concentration at her weekly bridge games. Which of the
following explanations could account for her symptoms?
A. The symptoms may be the result of anemia caused by chemotherapy.
B. The patient may be immunosuppressed.
C. The patient may be depressed.
D. The patient may be dehydrated.
The answer is A.
The symptoms may be the result of anemia caused by chemotherapy.
Three months after surgery and chemotherapy the patient is likely to be feeling the aftereffects, which often includes anemia because of bone-marrow suppression. There is no
evidence that the patient is immunosuppressed, and fatigue is not a typical symptom of
immunosuppression. The information given does not indicate that depression or
dehydration is a cause of her symptoms.
9. A clinic patient has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict
vegetarian diet. Which of the follow nutritional advice is appropriate?
A. The diet is providing adequate sources of iron and requires no changes.
B. The patient should add meat to her diet; a vegetarian diet is not advised.
C. The patient should use iron cookware to prepare foods, such as dark green, leafy
vegetables and legumes, which are high in iron.
D. A cup of coffee or tea should be added to every meal.
The answer is C. The patient should use iron cookware to prepare foods, such as dark
green, leafy vegetables and legumes, which are high in iron.
Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly anemic.
When food is prepared in iron cookware its iron content is increased. In addition, dark
green leafy vegetables, such as spinach and kale, and legumes are high in iron.
Mild anemia does not require that animal sources of iron be added to the diet. Many
non-animal sources are available. Coffee and tea increase gastrointestinal activity and
inhibit absorption of iron.
10. A hospitalized patient is receiving packed red blood cells (PRBCs) for treatment of
severe anemia. Which of the following is the most accurate statement?
A. Transfusion reaction is most likely immediately after the infusion is completed.
B. PRBCs are best infused slowly through a 20g. IV catheter.
C. PRBCs should be flushed with a 5% dextrose solution.
D. A nurse should remain in the room during the first 15 minutes of infusion.
The answer is D.
infusion.
A nurse should remain in the room during the first 15 minutes of
Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse
should be present during this period. PRBCs should be infused through a 19g or larger
IV catheter to avoid slow flow, which can cause clotting. PRBCs must be flushed with
0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.
11. Emergency department triage is an important nursing function. A nurse working the evening
shift is presented with four patients at the same time. Which of the following patients should be
assigned the highest priority?
A. A patient with low-grade fever, headache, and myalgias for the past 72 hours.
B. A patient who is unable to bear weight on the left foot, with swelling and bruising
following a running accident.
C. A patient with abdominal and chest pain following a large, spicy meal.
D. A child with a one-inch bleeding laceration on the chin but otherwise well after
falling while jumping on his bed.
The answer is C.
A patient with abdominal and chest pain following a large, spicy meal.
Emergency triage involves quick patient assessment to prioritize the need for further evaluation and
care. Patients with trauma, chest pain, respiratory distress, or acute neurological changes are
always classified number one priority. Though the patient with chest pain presented in the
question recently ate a spicy meal and may be suffering from heartburn, he also may be having
an acute myocardial infarction and require urgent attention. The patient with fever, headache
and muscle aches (classic flu symptoms) should be classified as non-urgent. The patient with the
foot injury may have sustained a sprain or fracture, and the limb should be x-rayed as soon as is
practical, but the damage is unlikely to worsen if there is a delay. The child’s chin laceration may
need to be sutured but is also non-urgent.
12. A patient is admitted to the hospital with a calcium level of 6.0 mg/dL. Which of the following
symptoms would you NOT expect to see in this patient?
A. Numbness in hands and feet.
B. Muscle cramping.
C. Hypoactive bowel sounds.
D. Positive Chvostek’s sign.
The answer is C.
Hypoactive bowel sounds.
Normal serum calcium is 8.5 – 10 mg/dL. The patient is hypocalcemic. Increased gastric
motility, resulting in hyperactive (not hypoactive) bowel sounds, abdominal cramping
and diarrhea is an indication of hypocalcemia. Numbness in hands and feet and muscle
cramps are also signs of hypocalcemia. Positive Chvostek’s sign refers to the sustained
twitching of facial muscles following tapping in the area of the cheekbone and is a
hallmark of hypocalcemia.
13. A nurse cares for a patient who has a nasogastric tube attached to low suction because of a
suspected bowel obstruction. Which of the following arterial blood gas results might be expected
in this patient?
A. pH 7.52, PCO2 54 mmHg.
B. pH 7.42, PCO2 40 mmHg.
C. pH 7.25, PCO2 25 mmHg.
D. pH 7.38, PCO2 36 mmHg.
The answer is A.
pH 7.52, PCO2 54 mmHg.
A patient on nasogastric suction is at risk of metabolic alkalosis as a result of loss of
hydrochloric acid in gastric fluid. Of the answers given, only answer A (pH 7.52, PCO2
54 mm Hg) represents alkalosis. Answer B is a normal blood gas. Answer C represents
respiratory acidosis. Answer D is borderline normal with slightly low PCO2.
14. A patient is admitted to the hospital for routine elective surgery. Included in the list of current
medications is Coumadin (warfarin) at a high dose. Concerned about the possible effects of the
drug, particularly in a patient scheduled for surgery, the nurse anticipates which of the following
actions?
A. Draw a blood sample for prothrombin (PT) and international normalized ratio
(INR) level.
B. Administer vitamin K.
C. Draw a blood sample for type and crossmatch and request blood from the blood
bank.
D. Cancel the surgery after the patient reports stopping the Coumadin one week
previously.
The answer is A.
(INR) level.
Draw a blood sample for prothrombin (PT) and international normalized ratio
The effect of Coumadin is to inhibit clotting. The next step is to check the PT and INR to determine
the patient’s anticoagulation status and risk of bleeding. Vitamin K is an antidote
to Coumadin and may be used in a patient who is at imminent risk of dangerous bleeding.
Preparation for transfusion, as described in option C, is only indicated in the case of significant
blood loss. If lab results indicate an anticoagulation level that would place the patient at risk of
excessive bleeding, the surgeon may choose to delay surgery and discontinue the medication.
15. The follow lab results are received for a patient. Which of the following results are abnormal?
Note: More than one answer may be correct.
A. Hemoglobin 10.4 g/dL.
B. Total cholesterol 340 mg/dL.
C. Total serum protein 7.0 g/dL.
D. Glycosylated hemoglobin A1C 5.4%.
The answer is A and B
Normal hemoglobin in adults is 12 – 16 g/dL. Total cholesterol levels of 200 mg/dL or
below are considered normal. Total serum protein of 7.0-g/dL and glycosylated
hemoglobin A1c of 5.4% are both normal levels.
16. A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just
been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the
disease is most accurate?
A. The child has a poor chance of recovery without joint deformity.
B. Most children progress to adult rheumatoid arthritis.
C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
D. Physical activity should be minimized.
The answer is C. Nonsteroidal anti-inflammatory drugs are the first choice in treatment.
Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile
idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require
3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children
with the disorder recover without joint deformity, and about a third will continue with
symptoms into adulthood. Physical activity is an integral part of therapy.
17. A child is admitted to the hospital several days after stepping on a sharp object that punctured
her athletic shoe and entered the flesh of her foot. The physician is concerned about osteomyelitis
and has ordered parenteral antibiotics. Which of the following actions is done immediately
before the antibiotic is started?
A. The admission orders are written.
B. A blood culture is drawn.
C. A complete blood count with differential is drawn.
D. The parents arrive.
The answer is B.
A blood culture is drawn.
Antibiotics must be started after the blood culture is drawn, as they may interfere with the
identification of the causative organism. The blood count will reveal the presence of
infection but does not help identify an organism or guide antibiotic treatment. Parental
presence is important for the adjustment of the child but not for the administration of
medication.
18. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the
emergency department documents swelling of the lower affected leg. Which of the following
does the nurse suspect is the cause of the child’s symptoms?
A. Possible fracture of the tibia.
B. Bruising of the gastrocnemius muscle.
C. Possible fracture of the radius.
D. No anatomic injury, the child wants his mother to carry him.
The answer is A.
Possible fracture of the tibia.
The child’s refusal to walk, combined with swelling of the limb is suspicious for fracture.
Toddlers will often continue to walk on a muscle that is bruised or strained. The radius
is found in the lower arm and is not relevant to this question. Toddlers rarely feign
injury to be carried, and swelling indicates a physical injury.
19. A toddler has recently been diagnosed with cerebral palsy. Which of the following
information should the nurse provide to the parents? Note: More than one answer may be correct.
A. Regular developmental screening is important to avoid secondary developmental delays.
B. Cerebral palsy is caused by injury to the upper motor neurons and results in motor dysfunction, as
well as possible ocular and speech difficulties.
C. Developmental milestones may be slightly delayed but usually will require no additional
intervention.
D. Parent support groups are helpful for sharing strategies and managing health care issues.
The answer is A, B and D.
Delayed developmental milestones are characteristic of cerebral palsy, so regular screening
and intervention is essential. Because of injury to upper motor neurons, children may
have ocular and speech difficulties. Parent support groups help families to share and
cope. Physical therapy and other interventions can minimize the extent of the delay in
developmental milestones.
20. A child has recently been diagnosed with Duchenne’s muscular dystrophy. The parents are
receiving genetic counseling prior to planning another pregnancy. Which of the following
statements includes the most accurate information?
A. Duchenne’s is an X-linked recessive disorder, so daughters have a 50% chance of
being carriers and sons a 50% chance of developing the disease.
B. Duchenne’s is an X-linked recessive disorder, so both daughters and sons have a
50% chance of developing the disease.
C. Each child has a 1 in 4 (25%) chance of developing the disorder.
D. Sons only have a 1 in 4 (25%) chance of developing the disorder.
The answer is A. Duchenne’s is an X-linked recessive disorder, so daughters have a 50%
chance of being carriers and sons a 50% chance of developing the disease.
The recessive Duchenne gene is located on one of the two X chromosomes of a female
carrier. If her son receives the X bearing the gene he will be affected. Thus, there is a 50%
chance of a son being affected. Daughters are not affected, but 50% are carriers because
they inherit one copy of the defective gene from the mother. The other X chromosome
comes from the father, who cannot be a carrier.
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