Blog about quiz / question and answer NCLEX (National Council Licensure Examination) For Nursing Student, Example Question NCLEX RN and NCLEX PN. Exam for Nurse
1. A hospitalized child with leukemia has received chemotherapy by the intravenous (IV) route and discharge to home is being planned. Laboratory values indicate that the child is neutropenic. During the course of the chemotherapy, the IV infiltrated and the child has a small open area at the site of infiltration that is being treated daily by cleansing and the application of a topical antibiotic. The nurse instructs the mother regarding the signs of infection at this affected site. Which statement by the mother indicates that the mother understands the instructions?
A. “Pus at the site means that an infection is present.”
B. “If I see redness at the site, I don’t need to worry as long as there is no pus.”
C. “I will clean the site and apply the topical ointment every day.”
D. “If the temperature is elevated, I don’t need to be concerned, because this is normal with affected white blood cells.”
Answer: C. “I will clean the site and apply the topical ointment every day.”
Rationale: Some neutropenic children will not produce purulent drainage. Because pus is made of white blood cells, drainage cannot be used as a sign of infection. Redness may be the only sign. An elevated temperature is a sign of infection. Option 3 is the only correct statement.
Test-Taking Strategy: Use the process of elimination. Recalling the physiology associated with leukemia will assist in eliminating options 1, 2, and D. Additionally, note that option 3 clearly rephrases the treatment to the affected site, as stated in the question. Review the signs of infection in a child with leukemia if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Evaluation
Content Area: Child Health
Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, pp. 1340, 1344.
2. A 9-year-old child with leukemia is in remission and has returned to school. The school secretary calls the mother of the child and tells the mother that a classmate has just been diagnosed with varicella (chickenpox). The mother immediately calls the nurse at the physician’s office because the leukemic child has never had chickenpox. The nurse makes which response to the mother?
A. “Monitor the child for an elevated temperature and call the physician if a fever occurs.”
B. “Keep the child out of school for a 2-week period.”
C. “There is no need to be concerned.”
D. “Bring the child to the office for a vaccine.”
Answer: D. “Bring the child to the office for a vaccine.”
Rationale: Immunocompromised children are unable to adequately fight varicella. Varicella can be deadly to the immunocompromised child. If an immunocompromised child who has not had chickenpox is exposed to someone with varicella, the child should receive varicella-zoster immune globulin (VZIG) within 96 hours of exposure.
Test-Taking Strategy: Use the process of elimination and note the key words never had chickenpox in the question. Recall that a child with leukemia is immunocompromised and is unable to fight infection. This should assist you in eliminating options 1, 2, and C. Review protective procedures for the immunocompromised child if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Implementation
Content Area: Child Health
Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1340.
3. A nurse reviews the laboratory values on a child with leukemia receiving chemotherapy. The nurse notes that the platelet count is 20,000/mmC. Based on this laboratory result, which of the following will the nurse include in the plan of care?
A. Protective isolation precautions
B. Monitoring the temperature every 4 hours
C. Monitoring closely for signs of infection
D. Using a soft toothbrush for oral care
Answer: D. Using a soft toothbrush for oral care
Rationale: If a child is severely thrombocytopenic, with a platelet count less than 20,000/mm3, precautions need to be taken because of the increased risk of bleeding. The precautions include limiting activity that could result in head injury, using soft toothbrushes, checking urine and stools for blood, and administering stool softeners to prevent straining with constipation. Additionally, suppositories and rectal temperature taking are avoided. Options 1, 2, and 3 relate to the prevention of infection rather than bleeding.
Test-Taking Strategy: Use the process of elimination. Noting that the platelet count is low and that a low platelet count places the child at risk for bleeding will assist in directing you to option D. Additionally, note that options 1, 2, and 3 are similar because they all relate to the prevention of and monitoring for infection. Review the procedures related to bleeding precautions if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Safe, Effective Care Environment
Integrated Process: Nursing Process/Planning
Content Area: Child Health
Reference: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1345.
4. A 12-year-old child is seen in the clinic, and a diagnosis of Hodgkin’s disease is suspected. Several diagnostic studies are performed to determine the presence of this disease. When evaluating the diagnostic results, the nurse would expect to note which of the following if this child has Hodgkin’s disease?
A. The presence of blast cells in the bone marrow
B. The presence of Reed-Sternberg cells
C. The presence of Epstein-Barr virus
D. Elevated creatinine level
Answer: B. The presence of Reed-Sternberg cells
Rationale: Hodgkin’s disease is a neoplasm of lymphatic tissue. The presence of giant, multinucleated cells (Reed-Sternberg cells) is the hallmark of this disease. The presence of blast cells in the bone marrow is indicative of leukemia. Infectious mononucleosis and the Epstein-Barr virus have been associated with Hodgkin’s disease, but would not determine the presence of Hodgkin’s disease. An elevated creatinine level is indicative of a renal system disorder.
Test-Taking Strategy: Use the process of elimination. Recalling that the Reed-Sternberg cell is characteristic of Hodgkin’s disease will direct you to option B. Review the clinical manifestations associated with Hodgkin’s disease if you had difficulty with this question.
Level of Cognitive Ability: Analysis
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Evaluation
Content Area: Child Health
Reference: Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 325.
5. A 6-year-old child has just been diagnosed with localized Hodgkin’s disease and chemotherapy is planned to begin immediately. The mother of the child asks the nurse about radiation therapy because it was not prescribed as a part of treatment. The appropriate response to the mother is:
A. “I’m not sure. I’ll discuss it with the physician.”
B. “The child is too young to have radiation therapy.”
C. “It’s very costly, and chemotherapy works just as well.”
D. “The physician would prefer that you discuss treatment options with the oncologist.”
Answer: B. “The child is too young to have radiation therapy.”
Rationale: Radiotherapy is usually delayed until a child is 8 years of age whenever possible to prevent retardation of bone growth and soft tissue development. Options 1 and 4 are nontherapeutic and place the mother’s inquiry on hold. Option 3 is a blunt and uncaring response.
Test-Taking Strategy: Use the process of elimination and note the age of the child. Additionally, use therapeutic communication techniques and knowledge regarding the effects of radiation to answer this question. Options 1 and 4 are nontherapeutic and place the mother’s inquiry on hold. From the remaining options, use the child’s age as a guide in directing you to option B. Review the treatment plan for a child with Hodgkin’s disease if you had difficulty with this question.
Level of Cognitive Ability: Application
Client Needs: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Child Health
References: McKinney, E., James, S., Murray, S., & Ashwill, J. (2005). Maternal-child nursing (2nd ed.). St. Louis: Elsevier, p. 1351.
Price, D., & Gwin, J. (2005). Thompson’s pediatric nursing (9th ed.). Philadelphia: W.B. Saunders, p. 325.
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