Published - Thu, 23 Feb 2023

NCLEX-RN Exam Questions - Part 157

1. A 4-year-old boy is brought to the emergency room with bruises on his head, face, arms, and legs. His mother states that he fell down some steps. The nurse suspects that he may have been physically abused. In accordance with the law, the nurse must:

A) Tell the physician her concerns
B) Report her suspicions to the authorities
C) Talk to the child - s father
D) Confront the child - s mother

2. The mother of a preschooler reports to the nurse that he frequently tells lies. The admission assessment of the child indicates possible child abuse. The nurse knows that his:

A) Behavior is not normal, and a child psychiatrist should be consulted.
B) Mother is lying to protect herself.
C) Lying is normal behavior for a preschool child who is learning to separate fantasy from reality.
D) Behavior indicates a developmental delay, because preschoolers should be able to tell right from wrong.

3. A family by court order undergoes treatment by a family therapist for child abuse. The nurse, who is the childs case manager knows that treatment has been effective when:

A) The child is removed from the home and placed in foster care
B) The child - s parents identify the ways in which he is different from the rest of the family
C) The child - s father is arrested for child abuse
D) The child - s parents can identify appropriate behaviors for children in his age group

4. Nursing assessment of early evidence of septic shock in children at risk includes:

A) Fever, tachycardia, and tachypnea
B) Respiratory distress, cold skin, and pale extremities
C) Elevated blood pressure, hyperventilation, and thready pulses
D) Normal pulses, hypotension, and oliguria

5. A 3-year-old child is in the burn unit following a home accident. The first sign of sepsis in burned children is:

A) Disorientation
B) Low-grade fever
C) Diarrhea
D) Hypertension

1. Right Answer: B
Explanation: (A) Although the nurse probably would talk to the physician about these concerns, the nurse is not required by law to do so. (B) All healthcare workers are required by the Federal Child Abuse Prevention and Treatment Act of 1974 to report suspected and actual cases of child abuse and/or neglect. (C) Talking to the childs father may or may not help the child, and the nurse is not required by law to do so. (D) Confrontation may not be indicated; the nurse is not required by law to confront the childs mother with these suspicions.

2. Right Answer: C
Explanation: (A) Because preschoolers often tell 'stories' as they learn to differentiate fantasy from reality, the child s behavior is normal. (B) The nurse has no reason to believe the child s mother is lying, because children of his age often tell lies. (C) The child s lying is actually 'storytelling' as he learns to separate fantasy from reality, a normal developmental task for his age group. (D) The childs behavior is consistent with his age and does not indicate a developmental delay.

3. Right Answer: D
Explanation: (A) Removing an abused child from the home and placement in a foster home are not the desired outcome of treatment. (B) Children who are perceived as'different' from the rest of the family are more likely to be abused. (C) Although legal action may be taken against abusive parents, it is not an indicator of an effective treatment program. (D) Identification of age-appropriate behaviors is essential to the role of parents, because misunderstanding childrens normal developmental needs often contributes to abuse or neglect.

4. Right Answer: A
Explanation: (A) Fever, tachycardia, and tachypnea are the classic early signs of septic shock in children. (B) Respiratory distress, cold skin, and pale extremities are later signs of septic shock. (C) Elevated blood pressure, hyperventilation, and thready pulses are later signs of septic shock. (D) Normal pulses, hypotension, and oliguria are not early signs of septic shock.

5. Right Answer: A
Explanation: (A) Disorientation is the first sign of sepsis in burn children. (B) Low-grade fever is not indicative of sepsis. (C) Diarrhea is not indicative of sepsis. (D)Hypertension is not indicative of sepsis.

80% DISCOUNT: NCLEX-RN PRACTICE EXAMS