Question

Which of the following symptoms are most likely seen in a client diagnosed with bulimia nervosa? Select all that apply.

Answer 1

Correct Answers:

calluses and scars on hands
metabolic alkalosis
normal weight

Rationale :

calluses and scars on hands

🟣 Calluses/scars on the knuckles (Russell sign) occur from repeated contact with teeth during self-induced vomiting.

🟣 This finding is strongly linked to purging behaviors, which are common in bulimia nervosa.

🟣 It may also be accompanied by dental enamel erosion and sore throat due to gastric acid exposure.

🟣 The presence of this sign helps differentiate bulimia from some restrictive eating disorders.

🟣 It is an important physical cue that warrants assessment for electrolyte imbalance and complications.

metabolic alkalosis

🟣 Repeated vomiting causes loss of hydrogen ions (H⁺) and chloride, leading to metabolic alkalosis.

🟣 Acid loss also promotes hypokalemia, increasing risk for cardiac dysrhythmias.

🟣 Alkalosis may present with weakness, cramps, or palpitations depending on severity.

🟣 This is a classic lab pattern in purging-type bulimia.

🟣 Recognizing this helps prioritize monitoring of ABGs, potassium, and ECG.

normal weight

🟣 Many clients with bulimia maintain normal or near-normal weight because bingeing and purging may not cause major weight loss.

🟣 This can delay detection because the client may not “look” ill.

🟣 Behavioral signs (secretive eating, bathroom use after meals) and physiologic clues become key.

🟣 Normal weight does not reduce the risk of life-threatening electrolyte disturbances.

🟣 The nurse should still assess for purging complications despite normal BMI.

amenorrhea

🟣Amenorrhea is more strongly associated with anorexia nervosa due to severe caloric restriction and low body fat.

🟣It is not a hallmark symptom of bulimia, especially when weight is often normal.

lanugo

🟣Lanugo develops as the body attempts to conserve heat with very low body fat, typical of anorexia nervosa.

🟣It is not commonly seen in bulimia where weight is usually not extremely low.

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Answer 2

Correct Answers:

4 to 6 years

Rationale :

🔷 Varicella vaccination is a 2-dose series in childhood for strong long-term immunity.

🔷 The first dose is typically given at 12–15 months, matching the child’s dose at 14 months.

🔷 The recommended second dose is at 4–6 years, often before school entry.

🔷 This booster improves protection and reduces breakthrough infections.

🔷 Following the schedule supports both individual protection and community immunity.

11 to 12 years

🔷This age is not the routine timing for the second varicella dose when the first was given on time.

🔷Adolescents may receive catch-up doses if not previously immunized.

13 to 15 years

🔷This is not a routine timeframe for the second dose in children vaccinated on schedule.

🔷Catch-up schedules apply only when earlier doses were missed.

20 to 36 months

🔷The second dose can be given earlier in some catch-up plans, but routine scheduling targets 4–6 years.

🔷The standard pediatric schedule is the best answer for a normally immunized child.

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Answer 3

Correct Answers:

Projectile vomiting

Rationale :

💠 Projectile vomiting in hydrocephalus is a red flag for increased intracranial pressure (ICP).

💠 Rising ICP can rapidly compromise cerebral perfusion and lead to neurologic deterioration.

💠 Vomiting without a GI cause often indicates worsening ventricular enlargement or shunt issues (if present).

💠 This finding requires immediate provider notification for further evaluation and possible imaging.

💠 Early reporting prevents progression to seizures, decreased LOC, or herniation.

Pain of 3/10 using the FLACC scale

💠 Mild pain alone is not the most urgent hydrocephalus complication compared with signs of increasing ICP.

💠 Pain should still be managed and reassessed, but projectile vomiting is more critical.

Unable to palpate posterior fontanel

💠 The posterior fontanel typically closes by 2–3 months, so inability to palpate it at 9 months is expected.

💠 This does not indicate worsening hydrocephalus by itself.

Respiratory rate of 30 breaths/minute

💠 RR 30 can be within expected range for an infant depending on context and activity.

💠 It is not a classic urgent sign of worsening ICP like projectile vomiting.

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Answer 4

Correct Answers:

The patient has developed a rigid, firm abdomen with rebound tenderness.

Rationale :

🟠 A rigid abdomen with rebound tenderness suggests peritonitis, possible perforation, or toxic megacolon complication.

🟠 This is a surgical emergency because it indicates acute abdominal guarding and inflammation in the peritoneal cavity.

🟠 In ulcerative colitis, severe inflammation can lead to toxic megacolon, ischemia, and perforation.

🟠 Steroids can mask infection signs, so abdominal rigidity becomes even more concerning.

🟠 The provider must be notified immediately for rapid assessment and urgent intervention.

"Moon-face" appearance and mild ankle swelling

🟠These reflect steroid side effects (fluid retention, Cushingoid features) and are not immediately life-threatening.

🟠They require monitoring and education but not emergent notification.

Fasting blood glucose 145 mg/dL

🟠Steroids commonly cause hyperglycemia, and 145 mg/dL is elevated but usually not emergent alone.

🟠It needs monitoring and possible treatment adjustments, not the highest priority.

10 episodes of bloody diarrhea in 12 hours

🟠This indicates active disease and risk for dehydration, but it is less emergent than signs of peritonitis/perforation.

🟠It requires prompt management, yet rebound tenderness signals a more immediate danger.

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Answer 5

Correct Answers:

Administer 100% oxygen

Rationale :

🔵 Suctioning can cause hypoxemia by removing oxygen along with secretions.

🔵 Pre-oxygenating with 100% oxygen is the safest first step to prevent desaturation.

🔵 This is especially important in a client with increased ICP because hypoxia can worsen cerebral swelling.

🔵 Audible gurgling indicates secretions present, but oxygenation must be protected before suction.

🔵 After pre-oxygenation, suction can be performed efficiently and briefly to reduce risk.

Place the head in a neutral position

🔵 Positioning is helpful, but oxygenation is the immediate priority before suctioning.

🔵 Neutral positioning does not prevent suction-induced hypoxia.

Stop the sedative administration while suctioning

🔵 Stopping sedation can increase coughing/agitation and may raise ICP.

🔵 Sedation changes are provider-directed and not the first suction prep step.

Hyperextend the neck

🔵 Hyperextension is not indicated and can compromise alignment and venous return.

🔵 It does not address the primary suction risk: oxygen desaturation.

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Answer 6

Correct Answers:

Client expresses satisfaction with body appearance.

Rationale :

🟣 Disturbed body image focuses on the client’s perception and feelings about their body, not just nutrition status.

🟣 The most appropriate outcome measures a change in self-acceptance and body perception.

🟣 Expressing satisfaction reflects progress toward healthier thinking patterns and reduced distortion.

🟣 Weight and calorie goals relate more to imbalanced nutrition or ineffective health maintenance diagnoses.

🟣 This outcome directly matches the psychological goal of improving body image.

Weight reaches the established normal range for the client.

🟣This evaluates nutritional restoration rather than body-image perception.

🟣 A client may reach normal weight and still have severe distorted body image.

Calorie intake is within required parameters of the treatment plan.

🟣This measures adherence to nutritional therapy, not body image improvement.

🟣It fits better under a nutrition-focused diagnosis.

Weight, muscle, and fat are congruent with height, frame, age, and sex.

🟣This is an objective body composition measure, not the client’s perception of their body.

🟣Body image outcomes should assess thoughts/feelings, not only physical measures.

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Answer 7

Correct Answers:

Assess pitch and quality of the child's cry.
Assess lung sounds.
Obtain vital signs.
Palpate the anterior fontanel.

Rationale :

Assess pitch and quality of the child's cry

🟢 A high-pitched cry is a classic sign of increased ICP in infants.

🟢 VP shunt malfunction can cause rising ICP leading to irritability and abnormal cry.

🟢 Cry changes often precede more severe neurologic decline.

🟢 This assessment provides early detection of worsening neurologic status.

🟢 It supports rapid escalation if shunt failure is suspected.

Assess lung sounds

🟢 Vomiting and lethargy increase risk for aspiration, making lung assessment essential.

🟢 Hydrocephalus symptoms can also reduce protective reflexes, worsening airway safety.

🟢 Lung sounds help detect crackles, decreased air entry, or aspiration pneumonia early.

🟢 Respiratory compromise can worsen oxygenation and indirectly increase ICP.

🟢 Early detection guides prompt interventions like positioning and suction readiness.

Obtain vital signs

🟢 Vital signs reveal instability and clues of rising ICP or infection (fever, altered RR).

🟢 Shunt malfunction or infection can present with changes in temperature and heart rate.

🟢 Monitoring supports trending for deterioration and guides urgency of provider notification.

🟢 Early abnormal trends help prevent progression to decreased LOC or seizures.

🟢 Accurate vitals are essential for emergency decision-making.

Palpate the anterior fontanel

🟢 A bulging anterior fontanel suggests increased ICP.

🟢 In an infant with a VP shunt, a bulging fontanel strongly supports shunt failure or blockage.

🟢 Palpation provides rapid bedside information about intracranial pressure changes.

🟢 This finding warrants urgent escalation and possible imaging.

🟢 It also helps correlate symptoms like vomiting and irritability with neurologic cause.

Weigh the child.

🟢Weight can be useful for baseline data and fluid status, but it is not the most urgent intervention for suspected VP shunt malfunction.

🟢Neurologic and respiratory assessments take priority due to risk of rising ICP.

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Answer 8

Correct Answers:

Place the infant’s arms in soft elbow restraints.

Rationale :

🔶 After cleft repair, the priority is protecting the surgical site from the infant’s hands.

🔶 Soft elbow restraints prevent bending the arms enough to touch or rub the incision.

🔶 This reduces risk of wound dehiscence, bleeding, and infection.

🔶 Restraints are used with frequent skin checks and are removed periodically per policy for ROM.

🔶 This is a standard post-op intervention to maintain repair integrity.

Avoid touching the suture line.

🔶This is too vague and does not prevent the infant from accidentally rubbing the site.

🔶Physical prevention (elbow restraints) is more effective for infants.

Give the infant a pacifier to help soothe him.

🔶Pacifiers create suction and pressure that can damage a palate repair and stress healing tissue.

🔶Post-op care usually avoids objects that promote suction depending on procedure type.

Place the infant in the prone position.

🔶Prone positioning can increase risk of rubbing the face against bedding and may compromise airway safety.

🔶Recommended positions are usually supine or side-lying per facility protocol.

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Answer 9

Correct Answers:

States first and last name

Rationale :

🔷 At age 4, children typically can state their first and last name and speak in clear sentences.

🔷 They show expanding language skills, improved memory, and better social communication during well-child checks.

🔷 This milestone reflects normal preschool cognitive and language development.

🔷 Many 4-year-olds can also hop, draw simple shapes, and follow multi-step instructions, but name identification is a common benchmark.

🔷 The nurse should expect this skill during routine developmental screening.

Copies a triangle

🔷Copying a triangle is more typical around 5 years when fine motor and visual-spatial skills are more refined.

🔷Four-year-olds more commonly copy a circle or cross.

Ties shoelaces independently

🔷Shoelace tying usually develops closer to 6–7 years due to complex fine motor coordination.

🔷It is not expected at 4 years.

Balances on one foot for 10 seconds

🔷Balancing for 10 seconds is more consistent with 5 years.

🔷At 4 years, balance is improving but usually not that sustained.

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Answer 10

Correct Answers:

Broiled white fish with white bread and a side of peaches.

Rationale :

💠 IBS teaching commonly emphasizes avoiding foods that increase gas, bloating, or irritation, especially during symptom flares.

💠 Broiled white fish and white bread are generally low-fat and easier to digest, which can reduce GI stimulation.

💠 Peaches are often better tolerated than high-gas cruciferous vegetables or legumes.

💠 Many clients benefit from limiting high-fat foods, caffeine, and common gas-formers.

💠 This menu reflects a more bland, lower-residue option compared to the others listed.

A garden salad with cabbage, beans, and cauliflower.

💠Cabbage, beans, and cauliflower are high gas-producing foods that can worsen bloating and cramping.

💠These are common IBS triggers, especially in sensitive clients.

Lentil soup with a glass of whole milk

💠Lentils can increase gas and abdominal discomfort due to fermentable carbohydrates.

💠Whole milk can worsen symptoms if the client has lactose intolerance, which is common in IBS.

Grilled chicken with brown rice and steamed broccoli.

💠Brown rice and broccoli are higher in fiber and can trigger symptoms during flares, especially gas and urgency.

💠While healthy, this choice is less ideal if the goal is symptom reduction.

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☑️Exam 1 N 232 Spring 2026 Feb-Community College of Philadelphia

No.

1 :
Which of the following symptoms are most likely seen in a client diagnosed with bulimia nervosa? Select all that apply.

2 :
The child received varicella vaccine at 14 months. The second dose should be administered at what age?

3 :
Which assessment finding should the nurse report to the healthcare provider in a 9 month old infant with hydrocephalus?

4 :
A nurse is caring for a patient with ulcerative colitis who is receiving IV methylprednisolone. Which assessment finding requires the most immediate notification of the healthcare provider?

5 :
A client in a barbiturate coma for increased intracranial pressure has audible gurgling through the endotracheal tube. What should the nurse do FIRST before suctioning this client?

6 :
Disturbed body image is the nursing diagnosis for a client with an eating disorder. Which outcome is appropriate to monitor?

7 :
A 10 month-old with myelomeningocele and hydrocephalus is brought to the Emergency Department (ED). The client has a ventriculoperitoneal shunt. Symptoms include vomiting, poor feeding, lethargy, and irritability. Which intervention(s) by the nurse are appropriate? Select all that apply.

8 :
A 3 month-old infant just had a cleft lip and palate repair. How will the nurse prevent trauma to the operative site?

9 :
A nurse is assessing a 4-year-old child during a well-child visit. Which developmental milestone should the nurse expect at this age?

10 :
The nurse is providing discharge teaching to a client newly diagnosed with irritable bowel syndrome (IBS). Which menu selection by the client indicates an understanding of the dietary teaching?

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☑️Exam 1 N 232 Spring 2026 Feb-Community College of Philadelphia

No.

1 : Which of the following symptoms are most likely seen in a client diagnosed with bulimia nervosa? Select all that apply.

2 : The child received varicella vaccine at 14 months. The second dose should be administered at what age?

3 : Which assessment finding should the nurse report to the healthcare provider in a 9 month old infant with hydrocephalus?

4 : A nurse is caring for a patient with ulcerative colitis who is receiving IV methylprednisolone. Which assessment finding requires the most immediate notification of the healthcare provider?

5 : A client in a barbiturate coma for increased intracranial pressure has audible gurgling through the endotracheal tube. What should the nurse do FIRST before suctioning this client?

6 : Disturbed body image is the nursing diagnosis for a client with an eating disorder. Which outcome is appropriate to monitor?

7 : A 10 month-old with myelomeningocele and hydrocephalus is brought to the Emergency Department (ED). The client has a ventriculoperitoneal shunt. Symptoms include vomiting, poor feeding, lethargy, and irritability. Which intervention(s) by the nurse are appropriate? Select all that apply.

8 : A 3 month-old infant just had a cleft lip and palate repair. How will the nurse prevent trauma to the operative site?

9 : A nurse is assessing a 4-year-old child during a well-child visit. Which developmental milestone should the nurse expect at this age?

10 : The nurse is providing discharge teaching to a client newly diagnosed with irritable bowel syndrome (IBS). Which menu selection by the client indicates an understanding of the dietary teaching?

1 :
Which of the following symptoms are most likely seen in a client diagnosed with bulimia nervosa? Select all that apply.

2 :
The child received varicella vaccine at 14 months. The second dose should be administered at what age?

3 :
Which assessment finding should the nurse report to the healthcare provider in a 9 month old infant with hydrocephalus?

4 :
A nurse is caring for a patient with ulcerative colitis who is receiving IV methylprednisolone. Which assessment finding requires the most immediate notification of the healthcare provider?

5 :
A client in a barbiturate coma for increased intracranial pressure has audible gurgling through the endotracheal tube. What should the nurse do FIRST before suctioning this client?

6 :
Disturbed body image is the nursing diagnosis for a client with an eating disorder. Which outcome is appropriate to monitor?

7 :
A 10 month-old with myelomeningocele and hydrocephalus is brought to the Emergency Department (ED). The client has a ventriculoperitoneal shunt. Symptoms include vomiting, poor feeding, lethargy, and irritability. Which intervention(s) by the nurse are appropriate? Select all that apply.

8 :
A 3 month-old infant just had a cleft lip and palate repair. How will the nurse prevent trauma to the operative site?

9 :
A nurse is assessing a 4-year-old child during a well-child visit. Which developmental milestone should the nurse expect at this age?

10 :
The nurse is providing discharge teaching to a client newly diagnosed with irritable bowel syndrome (IBS). Which menu selection by the client indicates an understanding of the dietary teaching?