PEDIATRIC NURSING

1. One minute after birth, the newborn is assessed to be limp like a rag doll, has cyanotic hands and feet, does not
cry but grimaces only in response to stimulation, with slow irregular breathing and heart rate of 110. The
Apgar score of this newborn is:
a. 7 c.5
b. 6 d. 4
Answer: C - One point each is given for his color, reflex irritability, and respiratory effort; 2 points for heart rate, and
no point for muscle tone..

2. The newborn is assessed for tonic neck reflex. What do you expect to observe when the baby is placed on his
back with his head is turned to the right?
a. extremities at both sides flex c. right extremities extend, left extremities flex
b. extremities at both sides extend d. right extremities flex and left extremities
extend
Answer: C- The tonic neck reflex (fencing position) is a spontaneous postural reflex of the newborn that may or may
not be present during the first days of life. Once apparent, it persists until the fourth month. Remember that in the
fencing position, you look at your opponent (therefore you turn your head towards that side) and you also extend your
weapon towards the same side.

3. A newborn with a birth weight of 3 kg may be expected to have which maximum weight loss in the first 3-4
days after birth?
a. None, newborns are expected to gain weight c. 300 grams
b. None, newborns are expected to maintain weightd. 150 grams
Answer: C- Within 3-4 days of birth, a weight loss of 5%-10% is expected due to passage of stool and urine The
baby also loses weight because of intake is less than output. There is only little feeding but output is great because of
loss of maternal hormones which promoted fluid retention during the fetal period.

4. An assessment of a newborn includes the differentiation between cephalhematoma and caput succedaneum.
When making this assessment, the nurse understands that with caput succedaneum the:
a. swelling crosses the suture line
b. swelling increases within 24 hours
c. scalp over the swelling becomes ecchymotic
d. area surrounding the swelling will be tender
Answer: A- This is the sign that differentiates between these two conditions; with caput succedaneum the swelling
crosses the suture line and it does not with cephalhematoma. This difference is caused by the fact that caput is edema
of the SCALP whereas cephalhematoma is bleeding under the periosteum (covering of a BONE)

5. Growth and development in a child progresses in the following ways EXCEPT

a. From psychosexual to moral c. From head to toe
b. From trunk to the tip of the extremities d. From general to specific
Answer: A- Growth and development occurs in cephalo-caudal (head to toe), proximo-distal (trunk to tips of the
extremities and general to specific, but it doesn’t occur from psychosexual to moral because they can develop at
the same time.

6. A developmental assessment of a 9-month old would be expected to reveal:

a. a two-word vocabulary aside from ‘mama’ and ‘dada’
b. grasping of objects using thumb and index finger
c. the ability to sit steadily without support
d. closure of both anterior and posterior fontanels
Answer: C- This usually occurs by age 8 months. (a) 12 months. (b) This is pincer grasp achieved at 10 months. (d)
The posterior fontanel closes at 2 months while the anterior fontanel closes at 12-18 months.

7. The nurse explains the infant’s risk of choking when sucking on a propped bottle of formula or fruit juice. The
nurse should also explain that this practice predisposes the infant to
a. Colic c. prolonged attachment to the bottle.
b. dental caries d. prolonged use of nighttime feedings.
Answer: B- Many mothers prop a bottle of formula or fruit juice at bedtime for their Infants who are old enough to
handle a bottle safely. The infant then awakens periodically to take more formula or juice, constantly bathing the teeth
with high-carbohydrate liquid. The practice has been noted to predispose infants to dental caries. Propping a bottle
does not necessarily lead to colic or an abnormally prolonged use of a bottle or nighttime feedings.

8. The nurse knows that one of the most effective strategies that parents can use to teach 4-year-olds about safety is
to
a. Show them potential dangers to avoid.
b. Tell them they are bad when they do something dangerous.
c. Provide good examples of safe behavior.
 d. Show them pictures of children who have been involved in accidents.
Answer: C- Young children tend to imitate what they see, and parents teach by example, whether intentionally or not.
Parents should know where their child plays and should discuss safety with him or her. Even a child who knows safety
measures may forget them while playing with friends. A child should not be labeled “bad” or “good”, based on
behavior; it is the behavior that is undesirable, not the child. As a child matures, parental interventions aimed at
preventing accidents progress from protection to education.

9. An appropriate way to decrease a preterm neonate’s stress is to:

a. Limit parental visitation
b. Maintain a neutral thermal environment
c. Cover the neonate’s eyes
d. Feed the baby only when he is hungry
Answer: B- Extrauterine temperature is considered as a stress to neonate. In a too cold environment, the newborn
attempts to maintain temperature by increasing muscular activity, thereby using up oxygen and glucose; If the
environment is too hot, the newborn’s body could overheat.

10. When observing a baby for pathologic jaundice, the nurse should be alert for:
a. the appearance of jaundice during the first 24 hours
b. jaundice developing between 24-72 hours
c. neurologic signs during the first 24 hours
d. muscular irritability at birth
Answer: A- Jaundice during the first 24 hours is pathologic, the onset of physiologic jaundice is 24-72 hours after
birth. It occurs because of the breakdown of RBCs after the neonate shifts from fetal to postnatal circulation. In the
postnatal circulation, blood no longer shunts from one side to the other, causing oxygenated blood to flow in the
systemic circulation ( not the mixture of oxygenated and deoxygenated blood that circulated in the fetus). Therefore
the newborn no longer needs the extra RBCs that he used to have as a fetus. These extra RBCs break down but this
should occur only after birth, so it takes a while before jaundice occurs. .

11. After tonsillectomy and adenoidectomy (T & A), which of the following findings would alert the nurse to suspect
early hemorrhage in a 5-year-old child?
a. Drooling of bright red secretions c. Vomiting of 25 ml of dark brown emesis
b. Pulse rate of 95 bpm d. Blood pressure of 95/56 mmHg
Answer: A- After T & A, drooling bright red blood is considered an early sign of hemorrhage. Often, because of
discomfort in the throat, children tend to avoid swallowing; instead, they drool. Frequent swallowing would also be an
indication of hemorrhage because the child attempts to clear the airway of blood by swallowing. Secretions may be
slightly blood-tinged because of a small amount of oozing after surgery. However, bright red secretions indicate
bleeding. A pulse rate of 95 bpm is within the normal range for a 5-year-old child, as is a blood pressure of 95/96 mm
Hg. A small amount of blood that is partially digested, and therefore dark brown, is often present in postoperative
emesis.

12. A full-term neonate is diagnosed with hydrocephalus. Nursing assessment is most likely to reveal:
a. wide or bulging fontanels. c. upward-slanting eyes.
b. a decreased occipitofrontal circumference. d. heightened alertness.
Answer: A- Hydrocephalus typically causes an enlarged head with wide or bulging fontanels, an excessive diameter
(increased occipitofrontal diameter), a shiny scalp with prominent veins, separation of the suture lines, and downward-
slanting eyes. Other findings in hydrocephalus include bradycardia, apneic episodes, vomiting, irritability, excessive
crying, and reduced alertness.

13. Which of the ff. newborns is aptly described as a ‘fragile giant’?:

a. LGA. c. newborn of a drug-dependent mother.
c. postterm. d. newborn of a diabetic mother.
Answer: D.- Newborns of diabetic mothers tend to be big. The macrosomia results from overstimulation of pituitary
growth hormone and extra fat deposits by high levels of insulin during pregnancy. Despite the large size, these babies
are usually preterm. In addition, even without the prematurity, these babies have a higher risk for RDS.

14. Which of the following infants is least likely to develop sudden infant death syndrome (SIDS)?
a. An infant who was premature c. sibling of an infant who died of SIDS
b. An infant with prenatal drug exposure d, An infant who sleeps on his back
Answer: D- Infants who sleep on their back are least likely to develop SIDS. However, SIDS has been associated with
infants who sleep on their abdomens. Preterm babies, sibling of an infant who has died of SIDS and those prenatally
exposed to drugs are all considered to be a high risk for the development of SIDS.

15. While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be
compromised?
a. Sucking ability c. Locomotion
b. Respiratory status d. GI function
Answer: A- Because of the defect, the child will unable to form the mouth adequately around nipple, thereby requiring
special devices to allow for feeding and sucking gratification. Respiratory status may be compromised if the child is
fed improperly or during postoperative period. Locomotion would be a problem for the older infant because of the use
of restraints. GI functioning is not compromised in the child with a cleft lip.

16. On the second postoperative day after repair of a cleft palate, which of the following would the nurse expect as
most appropriate to use with a toddler?
a. cup c. rubber-tipped syringe
b. straw d. large- holed nipple.
Answer: A- A cup is the preferred drinking or eating utensil after repair of a cleft palate. At the age when repair is
done, the child ordinarily able to drinks from a cup. Use of cup avoids having to place a utensil in the mouth, which
would increase the potential for injury to the suture lines.

17. While assessing a child with pyloric stenosis, the nurse is likely to note which of the following.
a. regurgitation c . Projectile vomiting
b. Steatorrhea d. “Currant jelly stool” stools
Answer: C- Projectile vomiting is a key symptom of pyloric stenosis. Regurgitation is seen more commonly with GER.
Steatorrhea occurs in malabsorption disorders such as celiac disease. “Currant jelly” stools are characteristic of
intussusception.

18. Discharge teaching for a child with celiac disease would include instructions about which of the following?
a. Rice c.Bread b. Milk
d. Chicken
Answer: C- Children with celiac disease cannot tolerate or digest gluten. Therefore, because of its gluten content,
wheat and wheat-containing products must be avoided. It is important that bread for this child should not be made from
wheat flour. Rice, milk and chicken do not contain gluten and need not be avoided.

19. When developing the plan of care for a school-aged child with glomerulonephritis who has a fluid restriction of
100 mL/ day, which of the following fluids would the nurse consider as most appropriate for the client’s condition
and effective for preventing excessive thirst?
a. Diet cola c. Lemonade.
b. Ice chips. d. Tap water.
Answer: B- The most appropriate and effective choice would be ice chips, because they help moisten the mouth and
lips while keeping fluid intake low. However, ice chips must still be counted as intake with the fluid restriction. Sweet
beverages, such as diet cola or lemonade, commonly increase thirst. Tap water effectively relieves thirst but does not
help keep fluid intake low.

20. It is the fifth birthday of a child with PKU. Which food should not be present?
a. spaghetti with cheese and tomato sauce
b. diet soft drinks
c. Nestle low-fat ice cream
d. All of these
Answer : D – Cheese and ice cream (even the low-fat kind) contain milk, Diet soft drinks use aspartame as sweetener.
Milk (except Lofenalac) and aspartame are not allowed in a low phenylalanine diet. When a person with PKU ingests
phenylalanine, it cannot be converted to tyrosine because of the absence of the hepatic enzyme, phenylalanine
hydroxylase. The buildup of serum levels of phenylalanine causes CNS damage and mental retardation. The child has
to have a low phenylalanine diet (restricted protein) throughout his life.