G&W

1. The nurse is caring for the mother of a newborn. The nurse recognizes that the mother needs
more teaching regarding cord care because she

A. keeps the cord exposed to the air.

B. washes her hands before sponge bathing her baby.
C. washes the cord and surrounding area well with water at each diaper change.
D. checks it daily for bleeding and drainage.

2. A client telephones the clinic to ask about a home pregnancy test she used this morning. The
nurse understands that the presence of which hormone strongly suggests a woman is pregnant?

A. Estrogen
B. HCG
C. Alpha-fetoprotein
D. Progesterone

3. The nurse is assessing a six-month-old child. Which developmental skills are normal and
should be expected?

A. Speaks in short sentences.

B. Sits alone.
C. Can feed self with a spoon.
D. Pulling up to a standing position.

4. While teaching a 10 year-old child about their impending heart surgery, the nurse should

A. Provide a verbal explanation just prior to the surgery

B. Provide the child with a booklet to read about the surgery
C. Introduce the child to another child who had heart surgery three days ago
D. Explain the surgery using a model of the heart

5. When caring for an elderly client it is important to keep in mind the changes in color vision
that may occur. What colors are apt to be most difficult for the elderly to distinguish?

A. Red and blue.

B. Blue and gold.
C. Red and green.
D. Blue and green.

6. While giving nursing care to a hospitalized adolescent, the nurse should be aware that the
MAJOR threat felt by the hospitalized adolescent is

A. Pain management
B. Restricted physical activity
 C. Altered body image
D. Separation from family

7. A woman who is 32 years old and 35 weeks pregnant has had rupture of membranes for eight
hours and is 4 cm dilated. Since she is a candidate for infection, the nurse should include which
of the following in the care plan?

A. Universal precautions.
B. Oxytocin administration.
C. Frequent temperature monitoring.
D. More frequent vaginal examinations.

8. The nurse prepares for a Denver Screening test with a 3 year-old child in the clinic. The
mother asks the nurse to explain the purpose of the test. The BEST response is to tell her that the
test

A. Measures potential intelligence

B. Assesses a child’s development
C. Evaluates psychological responses
D. Diagnoses specific problems

9. A 27-year-old woman has Type I diabetes mellitus. She and her husband want to have a child
so they consulted her diabetologist, who gave her information on pregnancy and diabetes. Of
primary importance for the diabetic woman who is considering pregnancy should be

A. a review of the dietary modifications that will be necessary.

B. early prenatal medical care.
C. adoption instead of conception.
D. understanding that this is a major health risk to the mother.

10. The nurse is planning care for an 18 month-old child. Which of the following should be
included the in the child’s care?

A. Hold and cuddle the child often

B. Encourage the child to feed himself finger food
C. Allow the child to walk independently on the nursing unit
D. Engage the child in games with other children

11. The nurse in an infertility clinic is discussing the treatment routine. The nurse advises the
couple that the major stressor for couples being treated for infertility is usually

A. having to tell their families.

B. the cost of the interventions.
C. the inconvenience of multiple tests.
D. the right scheduling of sexual intercourse.
12. The nurse is assessing a four month-old infant. The nurse would anticipate finding that the
infant would be able to

A. Hold a rattle
B. Bang two blocks
C. Drink from a cup
D. Wave “bye-bye”

13. The nurse is evaluating a new mother feeding her newborn. Which observation indicates the
mother understands proper feeding methods for her newborn?

A. Holding the bottle so the nipple is always filled with formula.

B. Allowing her seven – pound baby to sleep after taking 1 ½ ounces from the bottle.
C. Burping the baby every ten minutes during the feeding.
D. Warming the formula bottle in the microwave for 15 seconds and giving it directly to the
baby.

14. The nurse is caring for a pregnant client. The client asks how the doctor could tell she was
pregnant ‘just by looking inside.’ The nurse tells her the most likely explanation is that she had a
positive Chadwick’s sign, which is a

A. Bluish coloration of the cervix and vaginal walls

B. Pronounced softening of the cervix
C. Clot of very thick mucous that obstructs the cervical canal
D. Slight rotation of the uterus to the right

15. When caring for an elderly client it is important to keep in mind the changes in color vision
that may occur. What colors are apt to be most difficult for the elderly to distinguish?

A. Red and blue.

B. Blue and gold.
C. Red and green.
D. Blue and green.

16. The nurse’s FIRST step in nutritional counseling/teaching for a pregnant woman is to

A. Teach her how to meet the needs of self and her family
B. Explain the changes in diet necessary for pregnant women
C. Question her understanding and use of the food pyramid
D. Conduct a diet history to determine her normal eating routines

17. A woman who is six months pregnant is seen in antepartal clinic. She states she is having
trouble with constipation. To minimize this condition, the nurse should instruct her to

A. increase her fluid intake to three liters/day.

B. request a prescription for a laxative from her physician.
 C. stop taking iron supplements.
D. take two tablespoons of mineral oil daily.

18. The nurse is observing children playing in the hospital playroom. She would expect to see 4
year-old children playing

A. Competitive board games with older children

B. With their own toys along side with other children
C. Alone with hand held computer games
D. Cooperatively with other preschoolers

19. The nurse is caring for residents in a long term care setting for the elderly. Which of the
following activities will be MOST effective in meeting the growth and development needs for
persons in this age group?

A. Aerobic exercise classes

B. Transportation for shopping trips
C. Reminiscence groups
D. Regularly scheduled social activities

20. A pregnant woman is advised to alter her diet during pregnancy by increasing her protein and
Vitamin C to meet the needs of the growing fetus. Which diet BEST meets the client’s needs?

A. Scrambled egg, hash browned potatoes, half-glass of buttermilk, large nectarine

B. 3oz. chicken, ½ C. corn, lettuce salad, small banana
C. 1 C. macaroni, ¾ C. peas, glass whole milk, medium pear
D. Beef, ½ C. lima beans, glass of skim milk, ¾ C. strawberries

21. Which age group has the greatest potential to demonstrate regression when they are sick?

A. Adolescent
B. Young Adult
C. Toddler
D. Infant

22. Which is a major concern when providing drug therapy for older adults?

A. Alcohol is used by older adults to cope with the multiple problems of aging
B. Hepatic clearance is reduced in older adults
C. Older adults have difficulty in swallowing large tablets
D. Older adults may chew on tablets instead of swallowing them.

23. One of the participants attending a parenting class asks the teacher “what is the leading cause
of death during the first month of life?

A. Congenital Abnormalities
 B. Low birth weight
C. SIDS
D. Infection

24. Which stage of development is most unstable and challenging regarding development of
personal identity?

A. Adolescence
B. Toddler hood
C. Childhood
D. Infancy

25. Which age group would have a tendency towards eating disorders?

A. Adolescence
B. Toddler hood
C. Childhood
D. Infancy

26. When assessing an older adult. The nurse may expect an increase in:

A. Nail growth
B. Skin turgor
C. Urine residual
D. Nerve conduction

27. A maternity nurse is providing instruction to a new mother regarding the psychosocial
development of the newborn infant.  Using Erikson’s psychosocial development theory, the
nurse would instruct the mother to

A. Allow the newborn infant to signal a need

B. Anticipate all of the needs of the newborn infant
C. Avoid the newborn infant during the first 10 minutes of crying
D. Attend to the newborn infant immediately when crying

28. A mother of a 3-year-old tells a clinic nurse that the child is rebelling constantly and having
temper tantrums.  The nurse most appropriately tells the mother to:

A. Punish the child every time the child says “no”, to change the  behavior
B. Allow the behavior because this is normal at this age period
C. Set limits on the child’s behavior
D. Ignore the child when this behavior occurs

29. The parents of a 2-year-old arrive at a hospital to visit their child.  The child is in the
playroom when the parents arrive.  When the parents enter the playroom, the child does not
readily approach the parents.  The nurse interprets this behavior as indicating that:
 A. The child is withdrawn
B. The child is self-centered
C. The child has adjusted to the hospitalized setting
D. This is a normal pattern

30. The mother of a 3-year-old is concerned because her child still is insisting on a bottle at nap
time and at bedtime.  Which of the following is the most appropriate suggestion to the mother?

A. Do not allow the child to have the bottle

B. Allow the bottle during naps but not at bedtime
C. Allow the bottle if it contains juice
D. Allow the bottle if it contains water

31. A nurse is evaluating the developmental level of a 2-year-old.  Which of the following does
the nurse expect to observe in this child?

A. Uses a fork to eat

B. Uses a cup to drink
C. Uses a knife for cutting food
D. Pours own milk into a cup

32.   The nurse is providing an educational session to new employees, and the topic is abuse to
the older client.  The nurse tells the employees that which client is most characteristic of a victim
of abuse

A. A 90-year-old woman with advanced Parkinson’s disease

B. A 68-year-old man with newly diagnosed cataracts
C. A 70-year-old woman with early diagnosed Lyme’s disease
D. A 74-year-old man with moderate hypertension

33. The home care nurse is visiting an older female client whose husband died 6 months ago. 
Which behavior, by the client, indicates ineffective coping?

A. Visiting her husband’s grave once a month

B. Participating in a senior citizens program
C. Looking at old snapshots of her family
D. Neglecting her personal grooming

34. A clinic nurse assesses the communication patterns of a 5-month-old infant.  The nurse
determines that the infant is demonstrating the highest level of developmental achievement
expected if the infant:

A. Uses simple words such as “mama”

B. Uses monosyllabic babbling
C. Links syllables together
D. Coos when comforted
35. A nurse is preparing to care for a 5-year-old who has been placed in traction following a
fracture of the femur.  The nurse plans care, knowing that which of the following is the most
appropriate activity for this child?

A. Large picture books

B. A radio
C. Crayons and coloring book
D. A sports video

36.  A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is
performed.  Which of the following nursing interventions is most appropriate to facilitate normal
growth and development?

A. Allow the family to bring in the child’s favorite computer games

B. Encourage the parents to room-in with the child
C. Encourage the child to rest and read
D. Allow the child to participate in activities with other individuals in the same age group
when the condition permits

37. The mother of a toddler asks a nurse when it is safe to place the car safety seat in a face-
forward position.  The best nursing response is which of the following?

A. When the toddler weighs 20 lbs

B. The seat should not be placed in a face-forward position unless there are safety locks in
the car
C. The seat should never be place in a face-forward position because the risk of the child
unbuckling the harness
D. When the weight of the toddler is greater than 40 lbs

38. The nurse is caring for an agitated older client with Alzheimer’s disease.  Which nursing
intervention most likely would calm the client?

A. Playing a radio
B. Turning the lights out
C. Putting an arm around the client’s waist
D. Encouraging group participation

39. The nurse who volunteers at a senior citizens center is planning activities for the members
who attend the center.  Which activity would best promote health and maintenance for these
senior citizens?

A. Gardening every day for an hour

B. Cycling 3 times a week for 20 minutes
C. Sculpting once a week for 40 minutes
D. Walking 3 to 5 times a week for 30 minutes
40. A 16 year old child is hospitalized, according to Erik Erikson, what is an appropriate
intervention?

A. tell the friends to visit the child

B. encourage patient to help child learn lessons missed
C. call the priest to intervene
D. tell the child’s girlfriend to visit the child.
Answers and Rationales

1. Answer C. Exposure to air helps dry the cord. Good hand washing is the prime
mechanism for preventing infection. Washing the surrounding area is fine but wetting the
cord keeps it moist and predisposes it to infection. It is important to check for
complications of bleeding and drainage that might occur.
2. Answer B. Human chorionic gonadotropin (HCG) is the biologic marker on which
pregnancy tests are based. Reliability is about 98%, but the test does not positively
confirm pregnancy.
3. Answer B. The child develops language skills between the ages of one and three. A six-
month-old child is learning to sit alone. The child begins to use a spoon at 12-15 months
of age. The baby pulls himself to a standing position about ten months of age.
4. Answer D. According to Piaget, the school age child is in the concrete operations stage
of cognitive development. Using something concrete, like a model will help the child
understand the explanation of the heart surgery.
5. Answer D. The elderly are better able to distinguish between red and blue because of the
difference in wavelengths. The elderly are better able to distinguish between blue and
gold because of the difference in wavelengths. The elderly are better able to distinguish
between red and green because of the difference in wavelengths. Red and green color
blindness is an inherited disorder that is unrelated to age. The elderly have poor blue-
green discrimination. The effects of age are greatest on short wavelengths. These changes
are related to the yellowing of the lens with age.
6. Answer C. The hospitalized adolescent may see each of these as a threat, but the major
threat that they feel when hospitalized is the fear of altered body image, because of the
emphasis on physical appearance.
7. Answer C. Universal precautions are necessary for all clients but a specific assessment of
the client’s temperature will give an indication the client is becoming infected. Oxytocin
may be needed to induce labor if it is not progressing, but it is not done
initially.Temperature elevation will indicate beginning infection. This is the most
important measure to help assess the client for infections, since the lost mucous plug and
the ruptured membranes increase the potential for ascending bacteria from the
reproductive tract. This will infect the fetus, membranes, and uterine cavity. More
frequent vaginal examinations are not recommended, as frequent vaginal exams can
increase chances of infection.
8. Answer B. The Denver Developmental Test II is a screening test to assess children from
birth through 6 years in personal/social, fine motor adaptive, language and gross motor
development. A child experiences the fun of play during the test.
9. Answer B. A review of dietary modifications is important once the woman is pregnant.
However, it is not of primary importance when considering pregnancy. Pregnancy makes
 metabolic control of diabetes more difficult. It is essential that the client start prenatal
care early so that potential complications can be controlled or minimized by the efforts of
the client and health care team. The alternative of adoption is not necessary just because
the client is a diabetic. Many diabetic women have pregnancies with successful outcomes
if they receive good care. While there is some risk to the pregnant diabetic woman, it is
not considered a major health risk. The greater risk is to the fetus.
10. Answer B. According to Erikson, the toddler is in the stage of autonomy versus shame
and doubt. The nurse should encourage increasingly independent activities of daily
living.
11. Answer D. Having to tell families may also be a factor contributing to stress but is not
the major stressor. Cost may also be a contributing factor to stress but is not usually the
major factor. The inconvenience of multiple tests may also be a factor contributing to
stress but is not usually the major factor. Sexual activity “on demand” is the major cause
of stress for most infertile couples.
12. Answer A. The age at which a baby will develop the skill of grasping a toy with help is 4
to 6 months.
13. Answer A. Holding the bottle so the nipple is always filled with formula prevents the
baby from sucking air. Sucking air can cause gastric distention and intestinal gas pains. A
seven-pound baby should be getting 50 calories per pound: 350 calories per day.
Standardized formulas have 20 calories per ounce. This seven-pound baby needs 17.5
ounces per day. 17.5 ounces per day divided by 6-8 feedings equals 2-3 ounces per
feeding. A normal newborn without feeding problems could be burped halfway through
the feeding and again at the end. If burping needs to be at intervals, it should be done by
ounces or half ounces, not minutes. Microwaving is not recommended as a method of
warming due to the uneven heating of the formula. If used, the formula should be shaken
after warming and the temperature then checked with a drop on the wrist. The
recommended method of warming is to place the bottle in a pan of hot water to warm,
and then check the temperature on the wrist before feeding.
14. Answer A. Chadwick’s sign is a bluish-purple coloration of the cervix and vaginal walls,
occurring at 4 weeks of pregnancy, that is caused by vasocongestion.
15. Answer D. The elderly are better able to distinguish between red and blue because of the
difference in wavelengths. Red and green color blindness is an inherited disorder that is
unrelated to age. The elderly have poor blue-green discrimination. The effects of age are
greatest on short wavelengths. These changes are related to the yellowing of the lens with
age.
16. Answer D. Assessment is always the first step in planning teaching for any client.
17. Answer A. In pregnancy, constipation results from decreased gastric motility and
increased water reabsorption in the colon caused by increased levels of progesterone.
Increasing fluid intake to three liters a day will help prevent constipation. The client
should increase fluid intake, increase roughage in the diet, and increase exercise as
tolerated. Laxatives are not recommended because of the possible development of
laxative dependence or abdominal cramping. Iron supplements are necessary during
pregnancy, as ordered, and should not be discontinued. The client should increase fluid
intake, increase roughage in the diet, and increase exercise as tolerated. Laxatives are not
recommended because of the possible development of laxative dependence or abdominal
 cramping. Mineral oil is especially bad to use as a laxative because it decreases the
absorption of fat-soluble vitamins (A, D, E, K) if taken near mealtimes.
18. Answer D. Cooperative play is typical of the preschool period.
19. Answer C. According to Erikson”s theory, older adults need to find and accept the
meaningfulness of their lives, or they may become depressed, angry, and fear death.
Reminiscing contributes to successful adaptation by maintaining self-esteem, reaffirming
identity, and working through loss.
20. Answer D. Beef and beans are an excellent source of protein as is skim milk.
Strawberries are a good source of Vitamin C.
21. Answer C.
22. Answer B.
23. Answer C.
24. Answer A.
25. Answer A.
26. Answer C.
27. Answer A. According to Erikson, the caregiver should not try to anticipate the newborn
infant’s needs at all times but must allow the newborn infant to signal needs.  If a
newborn is not allowed to signal a need, the newborn will not learn how to control the
environment.  Erikson believed that a delayed or prolonged response to a newborn’s
signal would inhibit the development of trust and lead to mistrust of others.
28. Answer C.  According to Erikson, the child focuses on independence between ages 1 and
3 years.  Gaining independence often means that the child has to rebel against the
parents’ wishes.  Saying things like “no” or “mine” and having temper tantrums are
common during this period of development.  Being consistent and setting limits on the
child’s behavior are the necessary elements.
29. Answer D.  The phases through which young children progress when separated from
their parents include protest, despair, and denial or detachment.  In the stage of protest,
when the parents return, the child readily goes to them.  In the stage of despair, the child
may not approach them readily or may cling to a parent.  In denial or detachment, when
the parents return, the child becomes cheerful, interested in the environment and new
persons (seemingly unaware of the lost parents), friendly with the staff, and interested in
developing superficial relationships.
30. Answer D.  A toddler should never be allowed to fall asleep with a bottle containing
milk, juice, soda, or sweetened water because of the risk or nursing caries.  If a bottle is
allowed at nap time or bedtime, it should contain only water.
31. Answer B.  By age 2 years, the child can use a cup and can use a spoon correctly but
with some spilling.  By ages 3 to 4, the child begins to use a fork.  By the end of the
preschool period, the child should be able to pour milk into a cup and begin to use a knife
for cutting.
32. Answer A.   The typical abuse victim is a woman of advanced age with few social
contacts and at least one physical or mental impairment that limits the ability to perform
activities of daily living.  In addition, the client usually lives alone or with the abuser and
depends on the abuser for care.
33. Answer D.  Coping mechanisms are behaviors used to decrease stress and anxiety.  In
response to a death, ineffective coping is manifested by an extreme behavior that in some
instances may be harmful to the individual physically or psychologically.  Option D is
 indicative of a behavior that indentifies an ineffective coping behavior in the grieving
process.
34. Answer B.  Using monosyllabic babbling occurs between 3 and 6 months of age.  Using
simple words such as “mama” occurs between 9 and 12 months.  Linking syllables
together when communicating occurs between 6 and 9 months.  Cooing begins at birth
and continues until 2 months.
35. Answer C. In the preschooler, play is simple and imaginative and includes activities such
as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh.  Large
picture books are most appropriate for the infant.  A radio and a sports video are most
appropriate for the adolescent.
36. Answer D. Adolescents often are not sure whether they want their parents with them
when they are hospitalized.  Because of the importance of the peer group, separation from
friends is a source of anxiety.  Ideally, the members of the peer group will support their
ill friend.  Options a, b, and c isolate the child from the peer group.
37. Answer A.  The transition point for switching to the forward facing position is defined by
the manufacturer of the convertible car safety seat but is generally at a body weight of 9
kg or 20 lb and 1 year of age.  Convertible car safety seats are used until the child weighs
at least 40 lb.  Options b, c, and d are incorrect
38. Answer C. Nursing interventions for the client with Alzheimer’s disease who is angry,
frustrated, or hostile include decreasing environmental stimuli, approaching the client
calmy and with assurance, not demanding anything from the client, and distracting the
client.  For the nurse to reach out, touch, hold a hand, put an arm around the waist, or in
some way maintain physical contact is important.  Playing a radio may increase stimuli,
and turning the lights out may produce more agitation.  The client with Alzheimer’s
disease would not be a candidate for group work if the client is agitated.
39. Answer D.  Exercise and activity are essential for health promotion and maintenance in
the older adult and to achieve an optimal level of functioning.  About half of the physical
deterioration of the older client is caused by disuse rather that by the aging process or
disease.  One of the best exercises for an older adult is walking, progressing to 30
minutes session 3 to 5 times each week.  Swimming and dancing are also beneficial.
40. Answer A. The child is 16 years old, In the stage of IDENTITY VS. ROLE
CONFUSION. The most significant persons in this group are the PEERS. B refers to
children in the school age while C refers to the young adulthood stage of INTIMACY
VS. ISOLATION. The child is not dying and the situation did not even talk about the
child’s belief therefore, calling the priest is unnecessary.