“who they are,” and discussion often focuses on which
directions they want to take in school and life, as well as peer relationships. According to Erikson, this stage is known as: a. identity vs. role confusion. b. adolescent rebellion. c. career experimentation. d. relationship testing 13. The nurse is assessing a 9-month-old boy for a well-baby check up. Which of the following observations would be of most concern?
a. The baby cannot say “mama” when he wants his mother.
b. The mother has not given him finger foods. c. The child does not sit unsupported. d. The baby cries whenever the mother goes out. 14. Cheska, the mother of an 11-month-old girl, KC, is in the
clinic for her daughter’s immunizations. She expresses concern
to the nurse that Shannon cannot yet walk. The nurse correctly replies that, according to the Denver Developmental Screen, the median age for walking is: a. 12 months. b. 15 months. c. 10 months. d. 14 months. 15. Sally Kent., age 13, has had a lumbar puncture to examine the CSF to determine if bacterial infection exists. The best position to keep her in after the procedure is: a. prone for two hours to prevent aspiration, should she vomit. b. semi-
fowler’s so she can watch TV for five hours and be
entertained. c. supine for several hours, to prevent headache. d. on her right sides to encourage return of CSF
16. Buck’s traction with a 10 lb. weight is securing a
while she is waiting for surgery to repair a hip fracture. It is important to check circulation- sensation-movement: a. every shift. b. every day. c. every 4 hours. d. every 15 minutes. 17. Carol Smith is using bronchodilators for asthma. The side effects of these drugs that you need to monitor this patient for include: a. tachycardia, nausea, vomiting, heart palpitations, inability to sleep, restlessness, and seizures. b. tachycardia, headache, dyspnea, temp . 101 F, and wheezing. c. blurred vision, tachycardia, hypertension, headache, insomnia, and oliguria. d. restlessness, insomnia, blurred vision, hypertension, chest pain, and muscle weakness. 18. The adolescent patient has symptoms of meningitis: nuchal rigidity, fever, vomiting, and lethargy. The nurse knows to prepare for the following test: a. blood culture. b. throat and ear culture. c. CAT scan. d. lumbar puncture. 19. The nurse is drawing blood from the diabetic patient for a glycosolated hemoglobin test. She explains to the woman that the test is used to determine: a. the highest glucose level in the past week. b. her insulin level. c. glucose levels over the past several months. d. her usual fasting glucose level. 20. The twelve-year-old boy has fractured his arm because of a fall from his bike. After the injury has been casted, the nurse knows it is most important to perform all of the following assessments on the area distal to the injury except: a. capillary refill. b. radial and ulnar pulse. c. finger movement d. skin integrity 1.
. When administering chemotherapy, the nurse should observe for an anaphylactic reaction for 20 minutes and stop the medication if one is suspected. Chemotherapy is associated with both general and specific adverse effects, therefore close monitoring for them is important. 2.
. When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided. Proceeding from distal to proximal is inappropriate at any age. 3.
. Rheumatic fever results as a delayed reaction to
inadequately treated group A β
-hemolytic streptococcal infection.