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Schedule of Licensure Exams 2009
Schedule of Licensure Exams 2009
1
Physiological Adaptation Nutrition
1.
For a client receiving total parenteral nutrition (TPN), the nurse reviews the following lab values:Glucose = 72 mg/dL Chloride =98 mEq/L Sodium = 138 mEq/L Potassium = 3.0 mEq/LBased on this assessment, which nursing action is appropriate?a.
Discontinue TPN administration.b.
Notify physician and obtain order for potassium supplement.c.
Administer IV glucose immediately.d.
Check client vital signs immediately.
The normal plasma potassium level is 3.5-5.5mEq/L. This clients potassium is low and needs replacement. Options#1, #3, and #4 do not address the problems.
2.
Which nursing action is most appropriate for a 2-month-old infant with reflux?a.
Hold the next feeding.b.
Teach the mother CPR.c.
Maintain normal feeding schedule.d.
Elevate the head of the bed.
An infant with reflux should be maintained in an upright position. The head of the bed should be raised at a 30-degree angle. Option #1 may not be necessary, if positioning is effective. Option #2 is an action for the motherversus the infant. Option #3 is incorrect because the clients feedings should be changed to small volume, frequentfeedings.
3.
A client is taking metoclopramide hydrochloride (Reglan) orally for nausea secondary to chemotherapy. Inreference to the timing of the medication, when would the nurse instruct the client to take the medication?a.
With each mealb.
Thirty minutes before mealsc.
One hour after each meald.
At the same time each day
Since metaclopramide facilitates gastric emptying, it must be taken before meals. Options #1 and #3 do notpromote optimum effects of the medication. Option #4 is incorrect because the time of administration should bechanged to give with the clients meals.
4.
Before breakfast, a 9-year-old child with juvenile diabetes (Type I) passed out on the living room floor aftertaking his morning insulin dose. The nurses best response is based on which concept?a.
A child with a viral infection can have hypoglycemia,b.
Children with diabetes may act out to get attention.c.
Insulin shouldnt be taken until 30-60 minutes after breakfast.d.
The morning dose caused hypoglycemia before the child ate.
When children become distracted and fail to eat after a dose of insulin, hypoglycemia can easily occur. Option #1 isincorrect because viral infections result in hyperglycemia and there is no indication the child has an infection.Option #2 may be correct, but it would be a mistake to assume so in this situation. Option #3 is incorrect becauseinsulin should be taken before meals.
5.
A 3-month-old infant is scheduled for a barium swallow in the morning. Prior to the procedure, the mostappropriate nursing action would be to:a.
offer the infant only clear liquids.b.
make the infant NPO for 3 hours.c.
feed the infant regular formula.d.
maintain NPO for 6 hours.
An infant should be NPO 3 hours prior to the procedure. Options #1 and #3 are inappropriate. Option #4 isincorrect because it is not necessary for an infant to be NPO for 6 hours.
6.
Which nursing action is most appropriate for a client receiving a tube feeding around the clock?a.
Rinse the bag and change the formula every 4 hours.b.
Rinse the bag and change the formula every shift.c.
Change the bag and formula every shift.d.
Rinse the bag and change the formula every 2 hours.
Research indicates there is an increased growth of organisms after four hours. Options . #2 and #3 areinappropriate due to increased organism growth. Option #4 is not a necessary action to maintain asepsis.
7.
A nurse is obtaining a health history from a mother of a child with failure to thrive. Which assessment would
2
provide the most pertinent data?a.
Weight and heightb.
Urine outputc.
Type of feedingsd.
Mother-child interactions
This provides the most pertinent data in assessing actual growth. Option #2 is inappropriate for this situation.Options #3 and #4 are important assessments but are not a priority to Option #1.
8.
What instructions would a nurse give a diabetic client who has been vomiting for 24 hours and is concernedabout blood glucose levels?a.
Take only half of the regular insulin dose.b.
Attempt to maintain a regular diabetic diet.c.
Limit intake of sweets and sugar.d.
Drink liquids as often as possible.
Diabetic ketoacidosis is frequently associated with dehydration. Fluids should be encouraged. Option #1 isincorrect because a diabetic should alter the dose according to serial glucose checks. Option #2 is incorrect becausethe client is not tolerating PO foods. Option #3 is incorrect because sweets can be used as calories in this situation.
9.
What type of foods would be best for an 8-year-old receiving chemotherapy?a.
A diet high in nutrientsb.
Hot and spicy foodsc.
Small and frequent mealsd.
Foods on a regular schedule to promote a routine
Offering small and frequent meals will help prevent nausea and enable the client to eat adequate amounts. Option#1 is important but is not a priority to Option #3. Option #2 may promote vomiting. Option #4 does not provideadjustments for the clients illness.
10.
Which of the following would be the best plan for prevention of constipation during the first trimester of pregnancy?a.
Take mineral oil every morning.b.
Increase bulk and fiber in the diet.c.
Take a mild laxative as needed.d.
Decrease fluid intake.
This will assist in preventing constipation. Options #1 and #3 are incorrect for the pregnant woman. Option #4 willlead to more constipation.
11.
Which foods indicate the most appropriate breakfast choices for a young adult female client, 5'7" tall, weighing257 pounds, who is seeking weight loss assistance?a.
Applesauce, Cream of Wheat, toast
b.
Scrambled eggs and toast,
one
slice
of bacon
c.
1 glass of grapefruit juiced.
Bagel with 2 ounces of cream cheese and a banana
A breakfast with some substance wont leave her feeling hungry most of the morning. Options #2 and #4 have highfat content which is inappropriate for weight loss. Option #3 doesnt provide a balance of nutrients and may leavethe client feeling very hungry before lunch.
12.
While managing a clients nutritional status during the weaning from total parenteral nutrition (TPN), whichnursing intervention should be most appropriate?a.
Evaluate weight daily.b.
Monitor I&O.c.
Encourage client to eat a variety of foods.d.
Maintain a calorie count.
This is the best method of determining the clients nutritional status. Option #1 and #2 only indicate the clientshydration. Option #3 does not guarantee that this food will be eaten.
13.
Which dietary requirements must be considered for an 8-year-old client with cystic fibrosis?a.
High protein, high fat, and high caloriesb.
High protein, low fat, and high caloriesc.
Low protein, low fat, and low carbohydratesd.
High protein, high fat, and low carbohydrates
The impaired intestinal absorption of cystic fibrosis necessitates a diet higher in protein and calories. Fat isdecreased because it may interfere with absorption of other nutrients. Options #1 and #4 contain high fat. Option
3
#3 is not adequate for this child.
14.
A diabetic client, controlled with oral antihyperglycemic agents, questions the need for postoperativesubcutaneous insulin injections. What is the most accurate explanation the nurse would give the client for theinjections?a.
Tissue injury after surgery decreases blood sugar.b.
Anesthesia acts to increase glycogen stores.c.
Being NPO inhibits normal blood sugar control.d.
Surgery often leads to insulin dependency.
The inability to control diabetes mellitus by diet and oral agents, coupled with surgically-induced metabolicchanges, being NPO both prior to and after surgery, necessitates temporary control by insulin. Options #1, #2, and#4 are not true statements.
15.
One hour after receiving 7 units of regular insulin, the client presents with diaphoresis, pallor, and tachycardia.The priority nursing action would be:a.
notify the physician.b.
call the lab for a blood glucose level.c.
offer the client milk and crackers.d.
administer glucagon.
The onset of action for regular insulin is 30-60 minutes. The assessment indicates a problem with hypoglycemia.Foods such as milk and crackers should be given if the blood sugar level is around 40 to 60 mg/dL. If orange juiceor simple sugar is given, it should be followed with a meal or protein intake. Option #1 is incorrect because actionshould be taken prior to notifying the physician. Option #2 delays the response to the problem. Option #4 isinappropriate for this client.
16.
After a month of taking iron supplements, a client complains of constipation. Based on client tastes, the nurseadapts a diet plan to include:a.
oatmeal, green beans, celery.b.
strawberries, rice, mushrooms.c.
grits, orange juice, cheddar cheese.d.
pasta, buttermilk, banana.
This option contains foods highest in fiber to assist in counteracting constipation (green vegetables and grains).Options #2, #3, and #4 do not have as high a fiber content.
17.
Which foods would the nurse discourage the client from eating prior to a parathyroidectomy?a.
Milk products.b.
Green vegetables.c.
Seafood.d.
Poultry products.
A low calcium diet is recommended preoperatively. Options #2, #3, and #4 would not be discouraged.
18.
A school-aged child is being treated for Hepatitis A which was diagnosed two weeks ago. He plans to return toschool this week with a physicians permit. The school nurse should plan for his return by:a.
isolating him from the other children.b.
talking with the physician about the reason for his return so soon.c.
no specific health requirements are necessary.d.
not allowing his participation in any sports.
Type A Hepatitis is not infectious within a week or so after the onset of jaundice, and the child can return to school.Options #1 and #2 are not necessary. Option #4 depends on the childs energy level.
19.
The nurse is preparing a teaching plan for feeding an infant postoperative repair of a cleft lip. In order to preventcomplications, the nurse would teach the mother to:a.
feed the infant with a newborn nipple while holding him in the recumbent position.b.
clean the suture site with a cotton dipped swab soaked in Betadine.c.
place the infant in prone position after feeding.d.
feed the infant with a rubber-tipped syringe and bubble frequently.
The rubber tip can be placed in from the side of the mouth to avoid the operative area and to prevent sucking onthe tubing. Infants with cleft lip swallow excessive amounts of air so they require frequent bubbling. Option #1 isunsafe due to aspiration. Option #2 is incorrect. Option #3 is incorrect because the site is cleansed with saline orhydrogen peroxide.
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Physiological Adaptation Nutrition Rationales
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