NCLEX-PN
NCLEX Practice Questions Maternal Newborn Questions
Extract:
Question 1 of 5
A 6-year-old with tetralogy of Fallot has open heart surgery. The septal defect was closed, and the pulmonic valve was replaced. When the child returns to the unit, he has oxygen, IVs, and closed chest drainage. How should the nurse position the chest drainage system?
Correct Answer: C
Rationale: The chest drainage system must be below the bed to facilitate gravity-dependent drainage of fluid and air.
Question 2 of 5
A child with a cyanotic heart defect has an elevated hematocrit. What is the most likely cause of the elevated hematocrit?
Correct Answer: D
Rationale: Chronic oxygen deficiency in cyanotic heart defects stimulates erythropoiesis, elevating hematocrit.
Question 3 of 5
Ten days after cardiac surgery, an 18-month-old child is recovering well. The child is alert and fairly active and is playing well with the parents. The nurse notes that the parents are still very reluctant to allow the child to do anything without help. What is the best initial action for the nurse to take?
Correct Answer: C
Rationale: Reassessing the parents' needs and concerns helps identify barriers to promoting autonomy, fostering a supportive approach.
Question 4 of 5
The nurse is caring for a child who has epiglottitis. What position would the child be most likely to assume?
Correct Answer: B
Rationale: Sitting upright and leaning forward (tripod position) maximizes airway opening in epiglottitis.
Question 5 of 5
During aminophylline infusion, a child becomes restless and nauseated, and his blood pressure drops. What is the appropriate nursing response to these findings?
Correct Answer: B
Rationale: Restlessness, nausea, and hypotension suggest aminophylline toxicity, requiring immediate cessation and physician notification.