- (Topic 4)
A child receiving chemotherapeutic drugs experiences a loss of appetite directly related to the therapy. Which of the following strategies should be most effective in encouraging the child to eat?

1. A. Provide a well-balanced diet at usual times, and restrict dessert if the child fails to eat well.
2. B. Schedule procedures immediately after eating so that the child will not be tired or in pain at mealtime.
3. C. Offer the child a diet with a wider variety of foods and with more seasoning than her usual diet.
4. D. Offer the child smaller meals more frequently than usual, and include as many of her favorite foods as possible.

Correct Answer: D
(A) Because the child??s appetite is capricious at best, regular servings may be overwhelming. Praise the child for what is eaten. (B) The child will soon learn that procedures follow meals and may play with food rather than eat it to avoid or delay the procedure. (C) Young children usually do not like highly seasoned foods and may need the security of usual foods. Such a change may actually increase anorexia. (D) Small servings appear more achievable to the child, and the inclusion of favorite foods can add a sense of security.

- (Topic 5)
As a nurse in the emergency room, you receive an outside call from an elderly woman who states she has just been raped. She states, ??I know I must come to the hospital, but what do I do next??? You advise her to call the police, then come to the hospital emergency room. What action by the nurse would indicate an understanding of the examination process once the victim enters the emergency room?

1. A. Inform the victim not to wash, change clothes, douche, brush teeth, or eat or drink anything.
2. B. Inform the victim to bring insurance information with her to the hospital so she can be properly cared for.
3. C. Phone a rape counselor to begin working with the victim as soon as she enters the hospital.
4. D. Do not leave the victim alone to collect her thoughts.

Correct Answer: A
(A) Providing the victim with these instructions will aid in the determination of physical evidence of rape. Victims frequently feel ??dirty?? after rape, and their first instinct is to take care of personal hygiene before facing anyone. (B) This action is of lesser importance at this time. (C) Although this is a nursing measure appropriate in this situation, contacting a counselor can be done once the victim enters the hospital. Frequently victims call but do not follow up with the visit. (D) Once the victim enters the emergency room, it is important not to leave her alone.

- (Topic 4)
A 27-year-old primigravida at 32 weeks?? gestation has been diagnosed with complete placenta previa. Conservative management including bed rest is the proper medical management. The goal for fetal survival is based on fetal lung maturity. The test used to determine fetal lung maturity is:

1. A. Dinitrophenylhydrazine
2. B. Metachromatic stain
3. C. Blood serum phenylalanine test
4. D. Lecithin-sphingomyelin ratio

Correct Answer: D
(A) Dinitrophenylhydrazine is a laboratory test used to detect phenylketonuria, maple syrup urine disease, and Lowe??s syndrome. (B) Metachromatic stain is a laboratory test that may be used to diagnose Tay-Sachs and other lipid diseases of the central nervous system. (C) The blood serum phenylalanine test is diagnostic of phenylketonuria and can be used for wide-scale screening. (D) A lecithin-sphingomyelin ratio of at least 2:1 is indicative of fetal lung maturity, and survival of the fetus is likely.

- (Topic 3)
Painless vaginal bleeding in the last trimester may be caused by:

1. A. Menstruation
2. B. Abruptio placentae
3. C. Placenta previa
4. D. Polyhydramnios

Correct Answer: C
(A) Menstruation should not occur during pregnancy. (B) Abruptio placentae is marked by painful vaginal bleeding following a premature placental detachment after 20th week of gestation. (C) A low-lying placenta separates from the uterine wall as the uterus contracts and cervix dilates. This separation causes painless bleeding in the 7th-8th month. (D) Polyhydramnios is excessive amniotic fluid.

- (Topic 4)
A male client is diagnosed with hypoparathyroidism. He has been on dialysis for several years. He is experiencing symptoms such as numbness of the lips, muscle weakness, carpopedal spasms, and wheezing. Given the client??s symptoms, nursing assessment would focus on:

1. A. Detection of tetany
2. B. Detection of hypocalcemia to prevent seizures
3. C. Evidence of depression
4. D. Detection of premature cataract formation

Correct Answer: A
(A) Assessment should focus on detection of tetany, which is the most common symptom of hypoparathyroidism. Left undetected and untreated, tetany resulting from hypocalcemia can progress to seizures. (B) Hypocalcemia is difficult to detect on nursing assessment alone. Abdominal cramping may be an indication of hypocalcemia, but laboratory data are required to confirm diagnosis. (C) Depression can be a symptom of hypoparathyroidism, but it is not definitive. (D) Premature cataract formation can occur, but it also is not specific to parathyroidism and poses no immediate danger to the client.