COLEGIO DE DAGUPAN

Arellano St. Dagupan City

COLLEGE OF NURSING

MIDTERM EXAMINATIONS

PEDIATRIC NURSING

I. MULTIPLE CHOICE:

GENERAL DIRECTION:
Read and understand each question carefully. Select the best answer. Shade the answer of your
choice on the answer sheet provided for. Please use your black or blue pen only.

Situation 1: An infant named Russell was diagnosed to have Down syndrome. This syndrome
has a trisomy in the 21st chromosome causing certain abnormalities in the child.
1. The doctor explained to Russell’s parents that the type of Down syndrome that he has is
Mosaicism. Which of the following statements would best explain this type?
a. This kind of Down syndrome is frequently associated to women with advanced
age.
b. There is mixture of normal cells and cells that are trisomic for 21.
c. Chromosome is transmitted by the mother who is a carrier but age is not a factor.
d. This type is inherited when the father is carrier of the genes that are trisomic for
21 and a mother who is normal.

2. The nurse who is taking care of baby Russell noticed that there is speckling of the iris of
the child. This speckling is commonly known as
a. Mongolian spots
b. Kayser-Fleischer Ring
c. Brushfield’s Spots
d. Roth’s Spot

3. Russell is further assessed for other signs of Down syndrome. The nurse would indicate
that positive signs of Down syndrome are

a. Delayed or incomplete sexual development (men with Down syndrome usually

are infertile)
b. Inner epicanthic folds and oblique palpebral fissures
c. Hypotonic musculature (protruding abdomen, umbilical hernia)
d. All of the above

4. The nurse is about to take the history of the parents of Russell. Which of the following
findings would show that the mother of Russell would indicate a high risk factor to have
a child with Down syndrome?

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 a. The mother is suffering from adult-onset diabetes mellitus.
b. The mother during pregnancy took in liberal amounts of ferrous sulfate.
c. The mother is age 45 during her pregnancy.
d. The mother did not properly medicate herself with insulin during pregnancy

5. After teaching the parents about their child’s condition, which of the following
statements would need further teaching?

a. “Our son will need supervision when he will grow up because he may be
cognitively challenged.”
b. “Russell must avoid crowded places as to prevent him from having an infection.”
c. “We have our hopes up for Russell. When he grows up he will probably also have
a children of his own.”
d. “We need to bring Russell to a special school to attend to his needs.”
Situation 2: A child named Christian is seen to have both unilateral cleft lip and palate. He was
born to have deformity. He is now 9 months of age and the parents brought their child to the
hospital to have a repair.
6. The child will have to undergo Cheiloplasty as the surgeon has advised the parents. The
following is NOT true regarding this kind of operation.

a. Age for repair is usually after the child has grown but before speech is well
developed.
b. Helps parents with the visible aspects of the defect
c. Aids infant’s ability to suck
d. Performed soon after birth – further modification may be necessary

7. After the operation the nurse should expect which of the following equipments at the
bedside of the child?

a. Tracheostomy set
b. Defibrillator
c. Ambu bag
d. Endotracheal tube and suction

8. It is imperative to teach the parents to turn their child from side to side to prevent which
of the following complications of prolonged immobility on the bed?

a. Orthostatic hypotension
b. Hypostatic pneumonia
c. Aspiration pneumonia
d. Anemia

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 9. The child is sent home after everything has already been stabilized but the doctor again
advised the parents to return with their child for the next operation which is palatoplasty?
When would be the best time to do this?

a. 1 ½ years old
b. 5 years old
c. 7 years old
d. 3 years old

10. After the child has had palatoplasty, which of the following position should the child be
placed unto to prevent aspiration pneumonia and drainage of secretions?

a. High-Fowlers
b. Supine
c. Tredenlenburg
d. Prone
Situation 3: Grace, a newborn who is diagnosed to have a tracheoesophageal anomaly. The child
was immediately brought to the operating room for surgical correction of the anomaly.
11. During the diagnosis, the findings show that there is an absent connection of the
esophagus to the stomach. It also showed that there is a connection between the
esophagus and the trachea. What type of anomaly is this?

a. Absence of esophagus
b. Tracheoesophageal atresia
c. Aplasia of trachea
d. Esophageal atresia combined with tracheoesophageal fistula

12. Before the surgery the nurse have observed excessive accumulation of mucus in the
nasopharynx causing the child to have cyanosis. The best intervention for this is to

a. Place the child in an upright position

b. Provide bronchial clapping for the child
c. Suction the secretions
d. Place the child on NPO

13. When assessing the newborn for other problems, which of the following neonatal
conditions are associated with this problem?

a. Large for gestational age

b. Small for gestational age
c. Low birth weight
d. Hyperbilirubinemia

14. In order to provide the child with nourishment, the surgeon created an opening in the
stomach where food will pass through. This is known as

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 a. Colostomy
b. Ileostomy
c. Sigmoidostomy
d. Gastrostomy

15. You have observed that Grace is still crying after providing her with the nutrition that she
needs. The best thing to do for the child is to

a. Provide a pacifier
b. Administer oxygen per doctor’s order
c. Increase her nutritional intake
d. Play with the child
Situation 4: Mark was observed to have spina bifida upon birth. This condition is a
malformation of the spine that is caused by certain factors. Immediate interventions should be
done in order for the child to develop properly.
16. The doctor upon observing Mark’s spina bifida has seen protrusion of both meninges and
spinal cord. This kind of spina bifida is known as
a. Spina bifida occulta
b. Meningocele
c. Meningomyelocele
d. Anencephaly
17. The father of Mark asks the nurse what is the common cause of this kind of condition.
The nurse is utterly correct when she says

a. “Spina bifida is primarily caused by intake of a teratogen known as thalomid.”

b. “This condition is caused by a deficiency in folate during the pregnancy of your
wife.”
c. “Spina bifida is passed on genetically and your wife is a probable carrier of this
ailment.”
d. “The condition of your child can be caused in the deficiency of thiamine and
riboflavin during pregnancy.”

18. This is the defect of the occipitocervical region with swelling and displacement of the
medulla and spinal cord

a. Hydrocephalus
b. Arnold-Chiari malformation
c. Psoas sign
d. Kernig’s sign

19. When taking care of the sac of the child with spina bifida it is essential for the nurse to

a. Avoid pressure on the sac

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 b. The area must be kept clean, especially from urine and feces
c. Sterile gauze with antibiotic solution may be placed over the sac
d. All of the above

20. The child is also suffering from a neurogenic bladder. The best way to help the child
eliminate urine is for the nurse to do which of the following techniques?

a. Let water flow through the fingers of the child.

b. Allow the child to hear flowing water.
c. Slight pressure against the abdomen for complete emptying of the bladder
d. None of the above
Situation 5: A newborn named Julie is seen to have hydrocephalus. Her head circumference was
larger than what is normal. She also has protruding eyeballs. There are prominent scalp veins.

21. Julie’s intracranial pressure is expected to above the normal range. What would be the
normal intracranial pressure?

a. 10 to 15 mm Hg
b. 20 to 30 mm Hg
c. 5 to 20 mm Hg
d. 10 to 21 mm Hg

22. Which of the following signs and symptoms would indicate that Julie is suffering from
increased intracranial pressure?

a. Projectile vomiting not associated with feeding, irritability, anorexia, high shrill
cry, seizures
b. Dizziness, there is low-pitched cry, increased feeding, fever and weight loss
c. Child appears calm, lethargy, leakage of cerebrospinal fluid from the ears and
nose
d. There are rashes on the scalp, bloodshot eyes, epistaxis, and gum bleeding

23. The doctor of Julie advised the parents to undergo treatment to relieve the hydrocephalus
of the child. What would be the best intervention for the child’s condition?

a. Ventriculo-peritoneal shunting
b. Ventriculostomy
c. Burr-hole drainage
d. Craniotomy

24. If hydrocephalus is left untreated the child may grow up to be

a. Cognitively challenged
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 b. Autistic
c. Attention-deficit hyperactive disorder
d. Conduct disorder

25. When monitoring for the child’s intracranial pressure it is important that the nurse must
avoid giving the child which of the following medications?
a. Diuretics
b. Sedative
c. Analgesics
d. Both B and C
Situation 6: A child named Brendon 5 months old was rushed to the hospital because of
seizures. Vital signs were observed: Temperature: 38.6 degrees Celsius, RR: 56 cycles/minute,
PR: 102 beats/min, BP: 90/80 mm Hg. He was diagnosed to have meningitis.
26. In the culture exams, the doctor have found out that the child has mycobacterium
infection of the meninges. This type of meningitis is considered as

a. Bacterial
b. Tuberculosis
c. Viral
d. Fungal

27. The doctor has ordered to infuse Mannitol, which is an osmotic diuretic, to the patient
every 4 hours for relief of meningeal edema. Before administering this drug it is
important for the nurse to

a. Check for the blood pressure of the patient

b. Assess the patient’s intake and output
c. Check for the pulse rate of the patient
d. All of the above

28. What would be the best position of the child who is suffering from meningitis?

a. Supine
b. Side lying
c. Prone
d. High Fowler’s

29. Which of the following signs would confirm that the child is suffering from meningitis?

a. Opisthotonus
b. Brudzinski’s sign
c. Seizures
d. Increased intracranial pressure

30. Which of the following medications would be best to treat Julie’s meningitis?

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 a. Pancyclovir, acyclovir and zidovudine
b. Penicillin, gentamycin, and garamycin
c. Cefuroxime, cefoxitin and ampicillin
d. Rifampin, pyrazinamide and isoniazid
Situation 7: Jennifer 7 month old infant was brought to the emergency department because of
seizures. The infant had spiking fever of 39.3 degrees Celsius. She was diagnosed to have a
urinary tract infection. She has suffered from a febrile seizure.
31. The following are true regarding febrile seizures EXCEPT

a. Usually occur in children between 6 months and 5 years of age

b. They usually progress until adulthood
c. Associated with disease outside the CNS
d. Affects 3% to 5% of children in this age group

32. What type of seizure is shown if Jennifer exhibits flexion of the upper limbs and
extension of the lower limbs followed by extension of the upper limbs and flexion of the
lower limbs in rapid succession?

a. Absence seizures
b. Tonic-clonic seizures
c. Petit mal seizures
d. Partial seizures

33. When the child is having another seizure the nurse must do the following interventions
EXCEPT

a. Place the child in a side-lying position

b. Raise the side rails
c. Lower the bed
d. Apply a padded tongue blade

34. Which of the following drugs would help best control seizures in the patient?

a. Valproic acid
b. Carbamazepine
c. Diazepam
d. All of the above

35. The best way to manage the febrile seizures of the patient is to

a. Treat the underlying cause

b. Give round the clock doses of antipyretics
c. Loosen the clothing of the patient
d. Apply a cool sponge bath

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Situation 8: A child named Annie was born to have congenital hip dysplasia. She was brought to
the hospital for correction of the anomaly. The nurse has observed several signs that indicate the
condition.
36. Annie has undergone an x-ray. On the film the doctor has observed that the femoral head
is not in contact with the acetabulum and it is displaced superiorly and posteriorly. The
type of congenital hip dysplasia that Annie has is
a. Subluxation
b. Acetabular dysplasia
c. Dislocation
d. Fracture

37. When assessing for the hip of Annie you have observed for an audible click when
abducting and externally rotating the hip on the affected side. This is known as

a. Galeazzi’s sign
b. Ortolani’s sign
c. Psoas sign
d. Kernig’s sign

38. What kind of gait will the child have if Annie will begin to walk with this kind of
condition?

a. Waddling gait
b. Shuffling gait
c. Wide-based gait
d. None of the above

39. What is the most common complication if a cast is applied to the hips of the child?

a. Infection
b. Hypostatic pneumonia
c. Compartment syndrome
d. Skin excoriation

40. When feeding the child who is placed with a cast and bedridden it is vital to provide the
child with

a. A high calorie diet

b. A low calorie diet
c. A medium calorie diet
d. A fat and carbohydrate diet

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 41. A child was born and was observed for the first 24 hours of life. After the observation the
child did not yet pass out stools. The nurse also assessed that the child has no imperforate
anus. The nurse must suspect for

a. Meconium ileus
b. Diaphragmatic hernia
c. Aganglionic megacolon
d. Celiac disease
42. A child was born to have an imperforate anus. In the diagnosis, the child’s puborectalis
muscle, internal and external sphincter present and well developed with normal function.
What type of anomaly is shown in this condition

a. High
b. Low
c. Medium
d. Intermediate

43. Which among the anomalies may be persistent opening to the genitourinary tract

a. Intermediate
b. High
c. Medium
d. Low

44. Which of the following statement best describe pyloric stenosis?

a. Failure of the membrane separating the rectum from the anus to absorb during
eighth week of fetal life
b. Absence of parasympathetic ganglion cells in a portion of the bowel, which
causes enlargement of the bowel proximal to the defect
c. Telescoping of one portion of the intestine into another; occurs more frequently at
the ileocecal valve
d. Congenital hypertrophy of muscular tissue of the pyloric sphincter, usually
asymptomatic until 2 to 4 weeks after birth
45. What site is commonly affected to a child who is suffering from aganglionic megacolon?

a. Ascending colon
b. Descending colon
c. Transverse colon
d. Rectosigmoid colon

46. Which of the following signs is indicative of Hirschprung’s disease?

a. Passage of ribbonlike or pellet-like stools

b. Constipation
c. Intestinal obstruction
d. Abdominal distention

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 47. If an olive-mass is palpated on the abdomen of the child, the child is positive for pyloric
stenosis. Where is this usually palpated?

a. Right lower quadrant

b. Left upper quadrant
c. Right upper quadrant
d. Left lower quadrant

48. What is the description of the vomitus of the patient who is suffering from pyloric
stenosis?

a. Projectile, non-bile stained

b. Non projectile, red stained
c. Projectile, brown stained
d. Non projectile, yellow stained

49. The child’s parents with pyloric stenosis are advised by the surgeon for the child to have
the Fredet-Ramstedt procedure. How is this procedure done?

a. Longitudinal splitting of the hypertrophied muscle

b. Removal of the olive shaped mass
c. Excision of the pyloric sphincter
d. Creating an opening in the pyloric sphincter

50. After feeding the infant who has undergone an abdominal surgery because of pyloric
stenosis. The child must be placed on which of the following position afterwards?

a. Supine
b. Left side lying
c. Prone
d. Right side lying

51. This kind of condition is the telescoping of one portion of the intestine into another;
occurs more frequently at the ileocecal valve

a. Aganglionic megacolon
b. Hirschprung’s disease
c. Intussusception
d. Pyloric stenosis

52. When positioning the infant who has diaphragmatic hernia it is best to place the infant on

a. The affected side

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 b. The stomach
c. The unaffected side
d. The back

53. What would be the characteristic of the abdomen of the infant with diaphragmatic hernia?

a. Small abdomen
b. Large abdomen
c. Protruding abdomen
d. Reddish abdomen

54. Which of the following signs would indicate that the child has intussusception?

a. Passage of currant-jelly stools

b. Palpation of sausage-shaped mass on the abdomen
c. Tender, distended abdomen
d. Both A and B

55. Which of the following types of enema would help relieve the intussusception of the
child?

a. Barium enema
b. Fleet enema
c. Carminative enema
d. Cleansing enema

56. Which of the following are true regarding epispadias in a child

a. Occurs only in males

b. Urethra opens on dorsal surface of the penis
c. Often associated with exstrophy of the bladder
d. All of the above

57. What is the correct description of talipes equinovarus, which is the most common type of
clubfoot?

a. Planter flexion and deviated medially

b. Dorsiflexion and deviated laterally
c. Dorsiflexion and deviated medially
d. Plantar flexion and deviated laterally
58. How many weeks is the cast placed on the feet of the client with clubfoot?

a. 2 to 4 weeks

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 b. 4 to 6 weeks
c. 1 to 2 weeks
d. 3 to 5 weeks

59. Treatment of talipes equinovarus must be performed

a. Early in infancy
b. Late in infancy
c. Early in toddlerhood
d. Late in toddlerhood

60. This type of congenital hip dysplasia shows that the femoral head is partially displaced.
This is also the most common type of hip dysplasia.

a. Acetabular dysplasia
b. Dislocation
c. Subluxation
d. None of the above

61. Which of the following would best describe Galeazzi’s sign?

a. Apparent shortening of the femur

b. There is clicking sound upon abduction and applying pressure on the extremity
c. There is asymmetric gluteal folds
d. Restricted abduction of hip on the affected side

62. This is a splint that maintains abduction of the legs – for short term mild subluxation.

a. Pavlik harness
b. Bryant’s traction
c. Frejka pillow
d. Spica cast

63. If the patient is to be confined on the bed for a long time because of application of a hip
spica cast, the best way to promote proper lung expansion of the child is to

a. Initiate deep breathing exercises

b. Let the child blow bubbles
c. Do postural drainage
d. Chest physiotherapy

64. When teaching the parents about the care of the hip spica cast applied to a child with
congenital hip dislocation. The nurse should emphasize on which of the following?

a. Do not let the child put small toys or food inside the cast

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 b. Protect cast edges with adhesive tape or waterproof material, especially around
perineum
c. Use diapers and plastic lining to minimize soiling of cast by feces or urine
d. All of the above

65. When providing meals to a child with a hip spica cast the nurse must bear in mind that
a. To provide the child with small, frequent meals
b. To provide a high calorie diet
c. To provide the child with large amounts of food
d. All of the above

66. Which of the following amino acids cannot be converted by the child who has
phenylketonuria?

a. Tyrosine
b. Alanine
c. Phenylalanine
d. Cytosine

67. The following are true regarding the signs and symptoms of phenylketonuria EXCEPT

a. Absence of tyrosine reduces the production of melanin and results in blond hair
and blue eyes
b. There is yellowish discoloration of the skin and the sclera of both eyes
c. Strong musty odor in urine from phenylactic acid
d. All of the above

68. This is a test for the presence of phenylketonuria and it should be done after protein
ingestion.

a. Rumple leads test

b. Beutler test
c. Newborn screening
d. Guthrie blood test

69. The IQ levels of children who are suffering from untreated phenylketonuria are
frequently below?

a. 50
b. 20
c. 70
d. 35

70. Test to detect for the presence of galactosemia in children?

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 a. Beutler test
b. Guthrie blood test
c. Newborn screeining
d. Rumple leads test

71. What type of milk will be given to children who are suffering from galactosemia?

a. Cow’s milk
b. Breast milk
c. Soy based milk
d. Formula milk

72. Which among are the clinical findings of a child with galactosemia?

a. Jaundice
b. Nausea and vomiting
c. Hepatosplenomegaly
d. All of the above

73. Which hormone is absent in a child who is suffering from congenital hypothyroidism?

a. Thyroxine
b. Calcitonin
c. Epinephrine
d. Vasopressin

74. The signs and symptoms of congenital hypothyroidism usually appear at around how
many months in formula fed babies?

a. 2 to 4 months
b. 3 to 6 months
c. 8 to 9 months
d. 1 to 2 months

75. This is the condition where the skin is yellowish because of failure to convert beta-
carotene into vitamin A?

a. Jaundice
b. Kernicterus
c. Carotenemia
d. Cyanosis

76. Blood is needed to test the infant for the presence of congenital hypothyroidism and
phenylketonuria. The usual site of obtaining blood is to prick the
a. Index finger

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 b. Thumb
c. Sole
d. Heel

77. What is the common cause of cleft lip and palate?

a. Unknown
b. Hereditary
c. Teratogenics
d. Cigarette smoking

78. What is the most common complication that a child with cleft palate will have aside from
aspiration pneumonia?

a. Acute bronchitis
b. Asthma
c. Otitis media
d. Sinusitis

79. This is the most dangerous type of tracheoesophageal anomaly

a. Absence of esophagus
b. Aplasia of trachea
c. Tracheoesophageal fistula
d. Proximal esophageal atresia combined with distal tracheoesophageal fistula

80. How much amount of fluid will be delivered through the enema for a child who is 11
years of age?
a. 120 to 240 ml
b. 240 to 360 ml
c. 360 to 480 ml
d. 480 to 720 ml

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