NCLEX Practice Exam 11 (10 Questions)

1. An adolescent brings a physician's note to school stating that he is not to participate in sports due to a diagnosis of Osgood-Schlatter disease. Which of the following statements about the disease is correct?

The condition was caused by the student’s competitive swimming schedule.

The student will most likely require surgical intervention.

The student experiences pain in the inferior aspect of the knee.

The student is trying to avoid participation in physical education.

Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle. causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps. including track and soccer. Swimming is not a likely cause. The condition is usually self-limited. responding to ice. rest. and analgesics. Continued participation will worsen the condition and the symptoms.

Explanation

Osgood-Schlatter disease occurs in adolescents in rapid growth phase when the infrapatellar ligament of the quadriceps muscle pulls on the tibial tubercle. causing pain and swelling in the inferior aspect of the knee. Osgood-Schlatter disease is commonly caused by activities that require repeated use of the quadriceps. including track and soccer. Swimming is not a likely cause. The condition is usually self-limited. responding to ice. rest. and analgesics. Continued participation will worsen the condition and the symptoms.

2. A two-year-old child has sustained an injury to the leg and refuses to walk. The nurse in the emergency department documents swelling of the lower affected leg. Which of the following does the nurse suspect is the cause of the child's symptoms?

Possible fracture of the tibia.

Bruising of the gastrocnemius muscle.

Possible fracture of the radius.

No anatomic injury. the child wants his mother to carry him.

The child’s refusal to walk. combined with swelling of the limb is suspicious for fracture. Toddlers will often continue to walk on a muscle that is bruised or strained. The radius is found in the lower arm and is not relevant to this question. Toddlers rarely feign injury to be carried. and swelling indicates a physical injury.

Explanation

The child’s refusal to walk. combined with swelling of the limb is suspicious for fracture. Toddlers will often continue to walk on a muscle that is bruised or strained. The radius is found in the lower arm and is not relevant to this question. Toddlers rarely feign injury to be carried. and swelling indicates a physical injury.

3. Thrombolytic therapy is frequently used in the treatment of suspected stroke. Which of the following is a significant complication associated with thrombolytic therapy?

Air embolus.

Cerebral hemorrhage.

Expansion of the clot.

Resolution of the clot.

Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible. often before the cause of stroke has been determined. Air embolus is not a concern. Thrombolytic therapy does not lead to expansion of the clot. but to resolution. which is the intended effect.

Explanation

Cerebral hemorrhage is a significant risk when treating a stroke victim with thrombolytic therapy intended to dissolve a suspected clot. Success of the treatment demands that it be instituted as soon as possible. often before the cause of stroke has been determined. Air embolus is not a concern. Thrombolytic therapy does not lead to expansion of the clot. but to resolution. which is the intended effect.

4. A child is admitted to the hospital several days after stepping on a sharp object that punctured her athletic shoe and entered the flesh of her foot. The physician is concerned about osteomyelitis and has ordered parenteral antibiotics. Which of the following actions is done immediately before the antibiotic is started?

The admission orders are written.

A blood culture is drawn.

A complete blood count with differential is drawn.

The parents arrive.

Antibiotics must be started after the blood culture is drawn. as they may interfere with the identification of the causative organism. The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Parental presence is important for the adjustment of the child but not for the administration of medication.

Explanation

Antibiotics must be started after the blood culture is drawn. as they may interfere with the identification of the causative organism. The blood count will reveal the presence of infection but does not help identify an organism or guide antibiotic treatment. Parental presence is important for the adjustment of the child but not for the administration of medication.

5. The clinic nurse asks a 13-year-old female to bend forward at the waist with arms hanging freely. Which of the following assessments is the nurse most likely conducting?

Spinal flexibility.

Leg length disparity.

Hypostatic blood pressure.

Scoliosis.

A check for scoliosis. a lateral deviation of the spine. is an important part of the routine adolescent exam. It is assessed by having the teen bend at the waist with arms dangling. while observing for lateral curvature and uneven rib level. Scoliosis is more common in female adolescents. Choices A. B. and C are not part of the routine adolescent exam.

Explanation

A check for scoliosis. a lateral deviation of the spine. is an important part of the routine adolescent exam. It is assessed by having the teen bend at the waist with arms dangling. while observing for lateral curvature and uneven rib level. Scoliosis is more common in female adolescents. Choices A. B. and C are not part of the routine adolescent exam.

6. An infant is brought to the clinic by his mother. who has noticed that he holds his head in an unusual position and always faces to one side. Which of the following is the most likely explanation?

Torticollis. with shortening of the sternocleidomastoid muscle.

Craniosynostosis. with premature closure of the cranial sutures.

Plagiocephaly. with flattening of one side of the head.

Hydrocephalus. with increased head size.

In torticollis. the sternocleidomastoid muscle is contracted. limiting the range of motion of the neck and causing the chin to point to the opposing side. In craniosynostosis one of the cranial sutures. often the sagittal. closes prematurely. causing the head to grow in an abnormal shape. Plagiocephaly refers to the flattening of one side of the head. caused by the infant being placed supine in the same position over time. Hydrocephalus is caused by a build-up of cerebrospinal fluid in the brain resulting in large head size.

Explanation

In torticollis. the sternocleidomastoid muscle is contracted. limiting the range of motion of the neck and causing the chin to point to the opposing side. In craniosynostosis one of the cranial sutures. often the sagittal. closes prematurely. causing the head to grow in an abnormal shape. Plagiocephaly refers to the flattening of one side of the head. caused by the infant being placed supine in the same position over time. Hydrocephalus is caused by a build-up of cerebrospinal fluid in the brain resulting in large head size.

7. A clinic nurse interviews a parent who is suspected of abusing her child. Which of the following characteristics is the nurse LEAST likely to find in an abusing parent?

Low self-esteem.

Unemployment.

Self-blame for the injury to the child.

Single status.

The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury sustained. These parents also have a high incidence of low self-esteem. unemployment. unstable financial situation. and single status.

Explanation

The profile of a parent at risk of abusive behavior includes a tendency to blame the child or others for the injury sustained. These parents also have a high incidence of low self-esteem. unemployment. unstable financial situation. and single status.

8. A nurse is assigned to the pediatric rheumatology clinic and is assessing a child who has just been diagnosed with juvenile idiopathic arthritis. Which of the following statements about the disease is most accurate?

The child has a poor chance of recovery without joint deformity.

Most children progress to adult rheumatoid arthritis.

Nonsteroidal anti-inflammatory drugs are the first choice in treatment.

Physical activity should be minimized.

Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children with the disorder recover without joint deformity and about a third will continue with symptoms into adulthood. Physical activity is an integral part of therapy.

Explanation

Nonsteroidal anti-inflammatory drugs are important first line treatment for juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis). NSAIDs require 3-4 weeks for the therapeutic anti-inflammatory effects to be realized. Half of children with the disorder recover without joint deformity and about a third will continue with symptoms into adulthood. Physical activity is an integral part of therapy.

9. A child has recently been diagnosed with Duchenne's muscular dystrophy. The parents are receiving genetic counseling prior to planning another pregnancy. Which of the following statements includes the most accurate information?

Duchenne’s is an X-linked recessive disorder. so both daughters and sons have a 50% chance of developing the disease.

Each child has a 1 in 4 (25%) chance of developing the disorder.

Sons only have a 1 in 4 (25%) chance of developing the disorder.

The recessive Duchenne gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus. there is a 50% chance of a son being affected. Daughters are not affected. but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father. who cannot be a carrier.

Explanation

The recessive Duchenne gene is located on one of the two X chromosomes of a female carrier. If her son receives the X bearing the gene he will be affected. Thus. there is a 50% chance of a son being affected. Daughters are not affected. but 50% are carriers because they inherit one copy of the defective gene from the mother. The other X chromosome comes from the father. who cannot be a carrier.

10. A toddler has recently been diagnosed with cerebral palsy. Which of the following information should the nurse provide to the parents? Note: More than one answer may be correct.

Regular developmental screening is important to avoid secondary developmental delays.

Developmental milestones may be slightly delayed but usually will require no additional intervention.

Parent support groups are helpful for sharing strategies and managing health care issues.

Delayed developmental milestones are characteristic of cerebral palsy. so regular screening and intervention is essential. Because of injury to upper motor neurons. children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.

Explanation

Delayed developmental milestones are characteristic of cerebral palsy. so regular screening and intervention is essential. Because of injury to upper motor neurons. children may have ocular and speech difficulties. Parent support groups help families to share and cope. Physical therapy and other interventions can minimize the extent of the delay in developmental milestones.