Pediatric Nursing Final Coaching Exam – Prof.

Archie Alviz
1. What is the process involved when the child cannot learns to control his knees until his
buttocks are strong enough

a. Proximodistal
b. Cephalocaudal
c. Simple to complex
d. Interdependent

Growth and Development

● Cephalocaudal
● Proximodistal
● Gross to fine gross - large muscles fine - maliliit na muscles

2.To meet the major developmental need of a 4 month old infant in the immediate
postoperative period the nurse should:

a. Give the infant a pacifier

b. Put a mobile over the infant’s crib
c. Provide the infant with a soft cuddly toy
d. Warm the infant’s formula before feeding

Infant: 0 - 12 mos
Erikson: Trust vs mistrust
- build trust by providing basic needs
● feeding, warmth, care
Freud: Oral stage (mouth)
- feeding, pacifiers, teethers
- ↑ risk for aspiration, suffocation
Piaget: Sensorimotor
- learning through senses
- mobile toys Kohlberg: —Play: Solitary play
Fear: Stranger anxiety
 Toddler: 1 - 3 years old Erikson:
Autonomy vs shame and doubt
- gusto niya, siya nasusunod
- offer choices,
- allow them to participate, especially with medical procedures
- play therapy / therapeutic use of play
Freud: Anal stage (anus)
- Toilet training
- Criteria for readiness
● can sit and squat
● ability to remain dry for 2 hours
● verbalized the need to defecate and urinate
● willingness to please parents
● soiled diapers → they want to be changed immediately
- important factor: attitude of parents towards toilet training
Piaget: Pre-operational (egocentric)
- egocentric: self-centered, inability to see the point of view of others
Kohlberg: Pre-conventional (Punishment and obedience)
- Use time-out: face the wall → decreasing stimuli
- Rules when conducting face the wall
● Audible alarm
● 1 minute/year of age
Play: Parallel play → side by side play
- sabay lang sila mag pe-play pero not related
Fear: Separation anxiety
● Protest
● Despair
● Denial
Pre-schooler: 3 - 6 years old -
↑ imagination
Erikson: Initiative vs guilt
- allow them to participate
Freud: Phallic Stage - complexes
- masturbation is common
● Oedipal : baby boy → mother (mama’s boy)
● Electra: baby girl → father (daddy’s girl)
Piaget: Pre-operational (can understand symbols)
Kohlberg: Pre-conventional (egocentric)
Play: Associative / Cooperative play
- related na ang play
Fear: Body mutilation and castration
 - ghost, monster, dark

Schooler / School Age: 6 - 12 years old Erikson:

Industry vs Inferiority
● Industry - pabida
● Inferiority - mga nahihiya
Freud: Latent stage
- Same sex orientation
- Girls with girls then boys with boys Piaget: Concrete operational Theory of:
- conservation
- reversibility
● ice tinanggal sa ref magiging tubig, clay na pinag tanggal tanggal na maliliit pero
mababalik na lalaki, rubix cube
Kohlberg: Conventional
- they want to be good to the eyes of others because they believe in → Authority
Play: Competitive (indoor)
- board games, ball games, traditional games Fear: Death

Adolescent: 12 - 18 years old Erikson:

Identity vs Role confusion
- focus: body image
Freud: Genital
Piaget: Formal Operational (hypothetical thinking)
Kohlberg: Post-conventional
- believe in moral / laws/ responsible
Play: Competitive (outdoor)
Fear: Peer Rejection
3. When the child is about 9 months of age, he will be expected to be able to play peek-a-
boo.
Which critical event of the sensorimotor phase of cognitive development does this demonstrate?

a. Egocentrism

b. Use of symbols
c. Object permanence
d. Separation of self from environment
Object permanence - ability of the child na marecognize yung object kahit nakatago like
peek-a-boo
4.The mother of a 5 year old child tells the nurse that the child scolds the floor or the table if
the child hurts herself on the object. This behavior is identified as:

a. Object permanence
b. Egocentric speech
c. Animism
d. Global organization

5. A nursing instructor asks the students to describe the formal operation stage. The most
appropriate response would be

a. The child has the ability to think abstractly

b. The child develops logical thought pattern
c. The child has difficulty separating fantasy from reality
d. The child begins to understand the environment

6.The mother of a 4 year old child calls the clinic nurse and expresses concern because the child
has been masturbating. The most appropriate response by the nurse is which of the following?

a. The child is very young to begin this behavior and should be brought to the clinic
b. This is not normal behavior, and the child should be seen by the physician
c. This is a normal behavior at this age
d. Children usually begin this behavior at 8y.o.

7. A nursing instructor ask the nursing students to present a clinical conference to peer
regarding Freud’s psychosexual stages of development, specifically anal stage. The student
plans the conference, knowing that which of the following most appropriately relates to this
stage of development.

a. This stage is associated with toilet training

b. This stage is associated with pleasurable and conflicting feelings about the genital organ
c. This characterized by a tapering off of conscious biological and sexual urges
d. The stage is characterized by gratification of self.
8. A clinic nurse is preparing to discuss the concept of moral development with a mother. The
nurse understands that according to Kohlberg’s theory of moral development, in the pre-
conventional level. It is thought to be motivated by which of the following: a. The parent’s
behavior
b. Peer pressure
c. Social pressure
d. Punishment and reward

9. If the school-age child has an unsuccessful resolution of the psychosocial crisis according to
Erikson, which of the following may result?

a. Trust-fear conflict and general difficulties relating to people

b. Independence-fear conflict and severe feelings of self-doubt
c. Sense of inferiority and difficulty learning and working
d. Aggression-fear conflict and feelings of inadequacy or guilt

10. The mother of an 8 year old child tells the clinic nurse that she is concerned about the child
because the child seems to be more attentive to friends than anything else. The most
appropriate nursing response would be which of the following

a. You need to be concerned

b. You need to monitor the child’s behavior closely
c. At this age, the child is developing his own personality
d. You need to provide more praise to the child to stop this behavior

11. Which intervention is most appropriate in order to facilitate the development of trust in an
infant?

a. Place pictures of the child's family at the bedside.

b. Play tapes of the mother's voice.
c. Encourage the parents to room in and participate in care. – Rooming in →
breastfeeding → providing basic need
d. Offer the infant a pacifier.

12. Which action would show an infant has developed object permanence?

a. He looks for a Cheerio that falls off his highchair tray.

b. He cries when he is either hungry or lonely.
c. He prefers a large yellow ball to a small red one.
d. He smiles when the mobile on his crib jingles.

13. Piaget identifies that the 2- to 7-year-old child is in a preoperational stage. The nurse
observes a toddler take a toy from another. The nurse recognizes the child unable to put him-
or herself in the place of another is displaying:
a. Concentration.
b. Negativism.
c. Egocentrism.
d. Selfishness.

14. When teaching parents about the child’s readiness for toilet training, which of the
following signs should the nurse instruct them to watch for in the toddler?

a. Demonstrates dryness for 4 hours – should be 2 hours

b. Demonstrates inability to sit and walk
c. Has a new sibling for stimulation
d. Verbalizes desire to go to the bathroom

15. Ms. N. tells you that she found her 5-yr old daughter and her male cousin of the same
age inspecting each other’s private areas. What interpretation of this behavior would give to Ms.
N?

a. The child should be punished so this behavior won’t happen again.

b. Your daugther need counseling.
c. Sexual curiousity is quite normal during this stage.
d. Children are quite curious. Give them lots of opportunities to explore each other.

16. Which of the following would the nurse identify as the underlying rationale for a 4 year

old who tells the nurse that her doll is in the hospital because it was bad. a. egocentrism

b. past experience
c. magical thinking
d. decentering

17. The nurse observes parents playing with their 10 month old daughter. Which behavior
indicates that the infant is developing object permanence?
a. She looks for the toy that her parents hid under the blanket
b. She returns the play blocks to the same spot on the table
c. She recognizes that a ball of clay is the same object even when it’s flattened out.
d. She bangs two cubes in her hands and throws them to the floor

18. Piaget describes the main characteristic of the 2 to 7-year-old child’s intellectual
development as egocentric. This means
a. Stubbornness
b. Inability to see another’s point of view
c. Sharing toys
d. Preferring to play and assume responsibilities by oneself

19. By the end of the preschool period, a 6-year-old usually has mastered the developmental
task of:

a. Identity
b. Industry
c. Initiative
d. Autonomy

20. A 14-year-old child must have the capacity for self-awareness to

a. Develop identity
b. Eliminate fear of the dark
c. Maintain self-control
d. Focus on more than one dimension of an object

21. Negativism demonstrated by toddlers is frequently an expression of

a. A quest for autonomy

b. Hyperactivity
c. Separation anxiety
d. Sibling rivalry

22. The nurse explained to the mother that according to Erikson’s framework of psychosocial

development, play as a vehicle of development can help the school-age develop a sense of a.

Initiative

b. Industry
c. Identity
d. Intimacy

23. The nurse is aware that the play of a 5 month-old infant Is in the oral stage. The nurse
knows that this behavior most likely to consist of:
a. picking up a rattle or toy and putting it into the mouth
b. Exploratory searching when a cuddly toy is hidden from view
c. simultaneously kicking the legs and batting the hands in the air
d. waving and clenching fits and dropping toys placed in the hands

24. the nurse is aware that the theorist behind psychosocial theory is which of the following?
a. Freud - psychosexual
b. Erikson
c. Piaget
d. Kohlberg

25. The adolescent’s inability to develop a sense of who he is and what he can become results
in a sense of which of the following?

a. Shame
b. Guilt
c. Inferiority
d. Role confusion

26. In terms of preventive teaching for the parents of a 1 year old, the nurse should speak to
them about:

a. Aspiration
b. Toilet training
c. Adequate nutrition
d. Sexual development

27. The nurse is aware that an appropriate toy for a 3 month old infant during hospitalization
would be:

a. Rattles → played by a child up to 6 months

b. Tricycle
c. Ten piece puzzle
d. Wagon

28. A term neonate weighs 7 ½ pounds at birth. When he’s 1 year old, approximately how
much should he weigh?

a. 36 lb
b. 22 lb
c. 28 lb
d. 32 lb
● 6 months – double
● 1 year - triple
29. During physical assessment of a newborn, which of the following comparative
measurements would necessitate additional investigation?

a. Head circumference 34 cm; chest circumference 31 cm

b. Head circumference 31 cm; chest circumference 33 cm
c. Head circumference 34.5 cm; chest circumference 32 cm
d. Head circumference 32 cm; chest circumference 30 cm

30. A 6 month old infant is admitted with a diagnosis of failure to thrive. The birth weight was 7
pounds. Based on growth and development chart, the nurse should expect an infant at 6
months to weigh approximately:

a. 10 pounds
b. 14 pounds → 7 x 2 (double kasi)
c. 18 pounds
d. 21 pounds

31. Popcorn and nuts should not be given to a toddler primarily because they

a. Will spoil the child’s appetite

b. Are easily aspirates

c. Have very little food value
d. Can cause tooth decay
32. Besides adolescents, children in which of the following age groups experience the most rapid
growth?

a. Infancy
b. Toddler stage
c. Preschool age
d. School age
33. A mother tells the nurse that each morning she offers her 24 month old son juice and he
always shakes his head and says, “No.” She asks the nurse what to do, because she knows the
child needs fluids. The nurse suggests that the mother:

a. Distract him with some food

b. Be firm and hand him the glass
c. Let him see that he is making her angry
d. Offer him a choice of two things to drink

34. A 2 year old boy, is admitted to the hospital for further evaluation, is standing in his crib
crying. The child refuses to be comforted and calls for his mother. As the nurse approaches the
crib to provide morning care the child screams louder. The nurse, recognizing that the behavior
is typical of the stage of protest, decides to:

a. Pick him up and carry him around the room

b. Fill the basin with water and proceed to bathe him
c. Sit by his crib and bathe him later when his anxiety decreases
d. Skip the bath because the child is upset and does not really need a bath

35. A mother asks when to take her 2 year old to the dentist. For dental prophylaxis, the nurse
encourages her to take the child:

a. Before starting school

b. Between 2 to 3 years old
c. When the child begins to lose deciduous teeth
d. The next time another family member goes to the dentist

36. When ordering a regular diet for a young toddler the nurse should choose foods such as:

a. Spaghetti and bread

b. Corn dog and French fries

c. Hamburger with bun and grapes → nakaka aspirate
d. Hot dog with bun and potato chips → nakakaspirate

37. The nurse plans to talk to a mother about toilet training a toddler, knowing that the most
important factor in the process of toilet training is the:

a. Child’s desire to be dry

b. Ability of the child to sit still
c. Child’s willingness to work at it
d. Approach and attitude of the parent

38. A mother tells the nurse that her 22 – month old child says “no” to everything. When
scolded, the toddler becomes angry and starts crying loudly but then immediately wants to be
held. What is the best interpretation of this behavior?

a. The toddler isn’t effectively coping with the stress

b. The toddler’s need for attention isn’t being met
c. This is a normal behavior for a 2 – year old child
d. This behavior suggests a need for counseling

39. When asked about spanking as a disciplinary technique, the nurse’s best response would be:

a. “It really depends on the child’s age.”

b. “It is strongly suggestive of negative role modeling.”
c. “This may be the only option when no other technique works.”
d. “Research studies have shown it to be an effective disciplinary technique.”

40. Preschool children role play. This is an important part of socialization because it: a.

Encourages expression

b. Help children think about careers

c. Teaches children about stereotypes
d. Provides guidelines for adult behaviour

41. The nurse is aware that Freud’s phallic stage of psychosexual development, which compares

with Erikson’s psychosocial phase of initiative vs. guilt, is best seen at: a. Adolescent

b. 6 to 12 years
c. Birth to 1 year
d. 3 to 5 ½ years

42. During the oedipal stage of growth and development, the child:

a. Loves and hates both parents

b. Loves the parent of the same sex and the parent of the opposite sex
c. Loves the parent of the opposite sex and hates the parent of the same sex
d. Loves the parent of the same sex and hates the parent of the opposite sex

43. When teaching a parents’ class, the nurse explains that medication and household cleaning
products should be kept out of the reach of the pre - school because:

a. They have high level of curiosity

b. Their sense of taste is developing at this time
c. Their appetite is greater to support rapid growth
d. They rebel against parental authority during this phase

44. A 5-year-old boy believes that there are “bogeymen and monsters” in his bedroom at night.

What advice can the nurse give to Eric’s parent to help Eric cope with his fears? a. Let Eric sleep

with his parent

b. Tell Eric that bogeymen and monster do not exist

c. Keep a night-light on in Eric’s room
d. Tell Eric that no one else sees any monsters, so he must not see them either

45. A 6 year old is brought to the pediatric clinic for a routine visit. When assessing the child’s

relationship with other children, the nurse would expect to observe: a. Solitary play

b. Parallel play
c. Initiative play
d. Cooperative play

46. The mother of a 5 year old asks, “When do the deciduous teeth usually begin to fall out?”
Which of the following is the nurse’s most appropriate response?

a. Age 5 years

b. Age 6 years
c. Age 7 years
d. Age 8 years

47. Which of the following statements about causes of accidents during the school-age years is
inaccurate?
a. School-age children are more active and become more adventurous and daring
b. School-age children are more susceptible to hazards in the home environment
c. School-age children are the age group commonly aspirated
d. School-age children are less subject to parental control over their behavior

48. Practices common to school-age children include all the following except:

a. Talking in code

b. Starting collections
c. Telling jokes
d. Participating mostly in activities with both boys and girls

49. An adolescent client has just had surgery and has a dressing on the abdomen. Which of the
following questions would the nurse expect the client to ask initially?

a. “Did the surgery go okay?”

b. “Will I have a large scar?”
c. “What complication can I expect?”
d. “When can I return to school?”

50. On average, the adolescent growth spurt begins

a. Earlier for boys than for girls

b. Earlier for girls than for boys
c. At approximately the same time for both sexes
d. Between the seventh and eighth years

PEDIATRIC DISORDERS
51. A child with leukemia complains of fatigue. The nurse assesses the skin color as pallor.
Considering the child’s diagnosis, which of the following data explain these findings?
a. Cerebrospinal fluid with elevated white cells
b. Hemoglobin of 8 g/dl
c. Platelete count of 150,000/mm3
d. Sodium level of 130
52. A 7-year-old child complains of shakiness, hunger, and headache. Based on these findings,

the school nurse should suspect the student has which of these conditions? a. Diabetic

ketoacidosis

b. Hyperglycemia
c. Hypoglycemia
d. Polyphagia

53. A mother of newly diagnosed diabetic is receiving nutritional counseling. Which of these
statements by the mother indicates the need for further teaching? (-)

a. “Calories and nutrient proportions have to be consistent on a daily basis.”

b. “Chocolate milk with meals is accepted.” → chocolate mataas ang glucose →
hyperglycemia
c. “Meals and snacks must be eaten at the same time each day.”
d. “Cola may be exchanged for fruit juice.”

54. The mother of a newly diagnosed diabetic asks why insulin needs to be injected. The nurse
responds that the child cannot take oral insulin because it

a. Is not tolerated well in oral form by children

b. Is not available in pill form
c. Is destroyed by digestive enzymes
d. Will cause gastric ulcers
Insulin
- refrigerated
- given @ room temperature
- do not shake, gently rotate
- rotate injection sites – prevent lipodystrophy
- Never:
● massage
● aspirate
 ● use alcohol (drink)
if you do these 3, insulin will not be absorbed
Onset Peak Duration

Regular 30 - 1 2- 4 3.5 7

Intermediate 1- 2 4- 8 7 - 14

Long 2- 4 8 - 16 14 - 28
Remember 1, 4, 7 → then doblehen mo, then kada box, divide mo lang by 2

55. A 9-year-old girl has been brought to the emergency department following an automobile
accident and is diagnosed with femoral fracture. Which of these goals should receive priority in
the child’s care?

a. Adequate nutrition will be maintained

b. Infection will be prevented
c. Disturbance in body image will be reduced
d. Pain will be reduced

FRACTURE
● Rest
● Immobilize
● Compress
● Elevate Cast
- turn every 1-2 hours to facilitate dryness
Compartment syndrome
6 Ps – symptoms of lack of circulation – EMERGENCY
● Pain
● Pallor
● Pulselessness
● Paresthesia
● Paralysis
● Poikilothermia – cool extremities
- may makita lang isa or dalawa jan – report to physician

- Retalling – used for round edges

 - Bivaling - process of breaking the cast → to relieve the pressure
- Windowing - create small square in the cast, to see the skin turgor and compare to the
other arm if healthy pa → for comparison
56. Which of these assessments of a child with a cast for correction of a clubfoot needs to be
reported?

a. Cast has not dried in 2 hours

b. Color change and cool skin proximal
c. Moves toes and capillary refill is <3 seconds
d. Rough edges on the cast

57. A child diagnosed with rheumatic fever is prescribed aspirin. The purpose of this medication
is to

a. Decrease fever
b. Prevent headache
c. Promote relaxation
d. Reduce inflammation
Rheumatic Heart Fever
- caused by an infection: GABHS (group A beta hemolytic streptococcus)
- caused sore throat and AGN

Jones criteria
2 Major symptoms + History of GABHS
1 Major + 2 minor + History of GABHS

Major symptoms Minor symptoms

● Carditis ● Low grade fever

● Polyarthritis – inflammation of the ● Arthralgia - painful joints without
joints swelling
● Chorea - st. vitus dance – worm-like ● ASO titer elevation
movements ● Elevation of inflammatory markers
● Subcutaneous nodules ○ C- reactive protein
● Erythema marginatum - rashes in the ○ ESR
trunk area
 DOC: Penicillin → Broad Spectrum [Positive and negative]
○ 5-10 days: Average of 7 days
○ If with allergy with penicillin → Clindamycin & Erythromycin

ASA – Aspirin
- Salicylates: for Pain & Swelling
4A'S ASA
■ Antiplatelet = WOF Bleeding
■ Antipyretic
■ Analgesic → this is the function of aspirin for RF
■ Anti Inflammatory → this is the function of aspirin for RF

● Corticosteroid
○ To relieve carditis – Major symptom of RF
○ Anti-inflammatory
58. Following surgical correction for Tetralogy of Fallot, which of these goals should receive
priority in a child’s care?

a. Adequate sleep and rest periods provided

b. Adequate nutrition
c. Pain management
d. Prevention of vascular complications

59. An infant is experiencing uncontrolled vomiting. Based on this finding, the nurse would
expect which acid-base imbalance?

a. Metabolic alkalosis
b. Metabolic acidosis
c. Respiratory alkalosis
d. Respiratory acidosis

60. When performing a postoperative assessment on an infant with surgical correction of a

myelomeningocele, the nurse observes bulging anterior fontanel and increased head size. Based
on these findings the nurse knows the infant is at imminent risk for developing. a. Encephalitis
b. Hydrocephalus
c. Meningitis
d. Fluid overload
61. A child has diagnosed with a urinary tract infection. Which statement about appropriate
dietary choices should be given to the parents?

a. The child should drink adequate amounts of water and juices

b. Carbonated and caffeinated beverages are recommended
c. Citrus juices are highly effective in eliminating urinary tract infection
d. No special recommendations should be made

62. When performing a physical assessment on an infant with hyospadias with chordee, the
nurse should expect which of the following findings?

a. Bladder exposed with visible urethral opening

b. Bulge in the scrotal sac
c. Urethra opens on the dorsal aspect of the penis
d. Urethra opens on the ventral side of the penis

63. Before assessing an infant for undescended testes, the nurse should plan to

a. Allow the child to defecate

b. Assess vital signs

c. Palpate the inguinal canals
d. Warm her hands and the room

64. Following a tonsillectomy, a child grows increasingly restless. The nurse assesses the child to
find a pulse rate of 120 and frequent swallowing. Based o n this findings, the nurse should
suspect the client has which of these conditions?

a. Airway obstruction
b. Hemorrhage
c. Infection
d. Usual signs following this surgery

65. Which of the following statements is accurate regarding the mode of transmission for
autosomal recessive disorders such as cystic fibrosis (CF)?

a. Both parents must have the disease to have a child with CF

b. There is a 75% chance with each pregnancy that the child will have CF
c. Both parents must be carriers of the trait in order for the child to have the disease
d. There is a 50% chance with each pregnancy that the child will not have CF

66. A preschooler is admitted to the hospital with moderate burns sustained in a house fire. He
has sustained partial-thickness burns over 20% of his body surface area, including his hands
and feet. Because of the client’s condition, which of these nursing diagnoses should receive
priority on admission to the hospital unit?

a. Altered parenting
b. Fluid volume deficit
c. Knowledge deficit
d. Self-esteem disturbance

67. A preschool who has been burned exhibits a decreased interest in eating. Which of the
following measures should the nurse take to increase the child’s intake?

a. Ask the mother to feed the child

b. Eliminate the snacks
c. Offer smaller and more frequent feedings
d. Withhold dessert until the meal is eaten

68. An intravenous infusion is started on a child with severe burns. The nurse should assess for
signs of fluid overload, which include

a. Depressed anterior fontanel

b. Increased abdominal circumference
c. Moist rales in lung fields
d. Tea-colored urine

69. Which statement best describes the problem of regulation of body temperature in a 3-pound
premature infant?

a. The surface area of the premature infant is relatively smaller than that of a healthy term
infant.
b. There is a lack of subcutaneous fat, which furnishes insulation.
c. There are frequent episodes of diaphoresis causing loss of body heat.
d. There is limited ability to produce body proteins.
70. The nurse would identify which situation as an indication for the administration of RhoGAM?
a. A woman who has been Rh-sensitized in the past two pregnancies.
b. An infant with increased hemolysis of red blood cells because of ABO incompatability
c. An infant with an increase in serum bilirubin levels as a result of the presence of Rh factor
antibopdies.
d. A primigravida who is Rh negative is pregnant with an infant who is Rh positive.

71. While in the recovery room, the best immediate postoperative position for an infant who has
had a cleft lip repair is:

a. Prone with the head turned to one side. → cleft palate

b. Left Sims’ position
c. Supine with the head turned to the side.
d. Trendelberg’s position to facilitate drainage

- both cause by heredity, maternal smoking

- both difficulty feeding, risk for aspiration, infection (Upper respiratory tract infection)

Cleft Lip Cleft Palate

- common males - common in females

- L - lalake - P - pempem
- tuwid magsalita - (+) speech problem

Management Management
● large nipples (synthetic) ● Cup, medicine droppers → delivers
Surgery precise fluid flow
● Cheiloplasty - surgical repair of cleft lip Surgery
Rule of 10 ● Palatoplasty
- 10 weeks Rule
- 10 lbs - not too early → if too early it will just
- 10,000 x WBC reopen
- 10,000 g/dL hgb - not too late → may lead to speech
problem
● should be 18 - 25 months
- dito natutoto mag salita ng bata

72. An infant born at 28 weeks’ gestation weighs 4 lb 3 oz. What does the initial nursing care of
this infant include?
a. Place the infant in protective isolation because of the underdeveloped immune system
b. Feed him a low phenylalanine formula to increase digestion and utilization of calories.
c. Provide gavage feedings every 2 hours because of an inadequate sucking and swallow reflex.
d. Place the infant in a regulatory heater to maintain regulation of body
temperature.

73. The clinical nurse observes that a 3-day-old baby girl is jaundiced. A bilirubin level is
determined, and it is 11.4 mg/dl. What cause the bilirubin level?

a. Physiological jaundice
b. Hemolytic disease
c. Erythroblastosis fetalis.
d. Sepsis.

first 24 hours→ pathologic more

than 24 hours → physiologic

74. The nurse assigned to the nursery understands the importance of keeping the newborn
swaddled in a warm blanket to prevent heat loss because:

a. Chilling leads to increased heat production and greater oxygen needs.

b. The newborn’s metabolic rate is decreased
c. Evaporation will affect the newborn’s ability to feed
d. The newborn will sleep more comfortably.

75. The newborn’s mother is concerned about the shape of the baby’s head after delivery. She
states that it looks like a “cone head.” The most appropriate response by the nurse is:

a. “You don’t need to worry about it. It is perfectly normal after birth.”
b. “It is molding caused by the pressure during birth and will disappear in a few
days.”
c. “I will report it to the physician, and he will order a diagnostic scan.”
d. “It is a collection of blood related to the trauma of delivery and will absorb in a few weeks.”

76. The nurse is responsible for documenting the first meconium stool the newborn passes. If
the newborn does not have stool in the first 24 to 48 hours of life, the nurse should first:

a. Insert a rectal thermometer to facilitate the process

b. Inspect the anal area for an opening
c. Monitor the vital signs for a rise in temperature
d. Increase oral feeding to stimulate passage of stool
 2 Cases kung bakit hindi nakaka pass ng meconium ang bata:
- Imperforated anus
- Hirschprung’s Disease Hirschprung’s Disease
- megacolon
- anganglionic – absence of ganglion
● ganglions - nerves / cells responsible for peristalsis -
ribbon-like stool
● pellet-like stool
- Since there's no more peristalsis, the stool becomes the shape of the colon

77. A 10-pound newborn of a diabetic mother is admitted to the intensive care unit because of
the hypoglycemia. His mother is concerned that he will diabetes. The most appropriate response
by the nurse is that the baby will:

a. Not have any long-term consequences because of his mother’s diabetes.

b. Not be at risk for diabetes until he reaches puberty.
c. Have to follow a diabetic diet to avoid complications
d. Need to be monitored closely during his childhood years.

78. The nurse is providing discharge teaching a 20-year-old who has had her first male child.
Which statement by the mother demonstrates that she understands the discharge teaching
regarding his circumcision?

a. “I will observe the whitish-yellow drainage on his penis but I will not remove it.”
b. “I will bring him back to the clinic in 3 days to have the drainage removed.”
c. “I will use antibiotic ointment on his penis with every diaper change.”
d. “I will rub the area briskly with a washcloth to remove the discharge.”

whitish yellow drainage – Granulation → sign of healing

79. A 12-year-old hemophiliac client has been admitted to the medical center for an acute
episode of hemarthrosis. Which of these expected outcomes should receive priority in the
client’s care?

a. Family will receive genetic counseling

b. Maximum function of the joint will be restored
c. Child and family will seek support from National Hemophilia Foundation
d. Child will participate in appropriate activities for present condition

80. Sally, age 12 months, weighs 21 pounds. The nurse reviews the child’s record and finds out
that her birth weight was 7 pounds. In planning care, the nurse knows that the child:

A. Has not gained the expected weight related to the birth weight.
B. Must not be eating enough.
C. Should be referred to Protective Services immediately for being severely underweight.
D. Falls within normal weight gain related to the birth weight.

81. A preschool-age client needs a central line dressing change. The most appropriate technique
to use to explain this procedure is to:

A. show a picture of the procedure in a book

B. explain the procedure with few words
C. let the child perform a dressing change on a doll
D. explain the procedure to the child’s mother as the child listens

82. A parent has understood the teaching for introducing solid foods to her child if she states:

A. “I can start to feed rice cereal at 2 months of age.”

B. “I will begin with cereal, then introduce meats next.”
C. “I will introduce one new food at a time.”
D. “I will begin to wean my baby from the bottle after I start rice cereal, at 6 months of age.”

83. The nurse is preparing to assess an infant under the age of 6 months. The infant is quiet
and awake, sucking on a pacifier. The nurse should start with:

A. An otoscopic exam.
B. A lung, heart, and abdomen exam.
C. An oral exam.
D. An exam for hip dysplasia.
84. The nurse palpates the anterior fontanel of a 12-month-old infant. Identify the area
where the nurse is palpating.

A. Anterior fontanel
B. Posterior fontanel
C. Suture lines
D. Lambdoid Suture
85. The nursing assessment of a 4-year-old child reveals a rounded chest, with the anterior
diameter approximately equal to the lateral diameter. The most appropriate interpretation of
this finding is:

A. Abnormal, and could indicate a chronic obstructive lung condition.

B. Abnormal, and pectus carinatum might be present.
C. Normal, and no cause for concern.
D. Abnormal, and pectus excavatum could be present.

86. The nurse reviews the assessment of a 10-year-old child and notes that the child has an
abnormal Romberg’s sign. What is the most appropriate nursing action based on this abnormal
assessment finding?

A. Instruct the child to get help when getting out of bed. → instruct to wear with
grip
B. Speak when entering the room.
C. Explain the placement of food on the child’s plate.
D. Place the child in restraints.

87. A nurse is assessing a newborn. What is the most accurate way for the nurse to assess
the newborn’s respiratory rate? → they are abdominal breathers

A. Place a hand on the newborn’s chest and count the rate for 30 seconds.
B. Use the stethoscope and count the rate for 15 seconds.
C. Use the stethoscope or place a hand on the newborn’s abdomen, and count the
rate for one minute.
D. Place a hand on the newborn’s back and count for 30 seconds.

88. During a routine developmental screening, the nurse is concerned about the development of
a 5-year-old. Which of the following would be recommended?
A. Refer the child to a social worker.
B. Tell the parent to take the child to a physical therapist.
C. Refer the child to a trained specialist to administer developmental testing.
D. Tell the mother that the child should be retested in a year.

89. Which of the following assessment questions and instructions used by the nurse would give
information regarding relationship issues of the child?
A. “Describe your infant’s temperament to me.”
B. “What does your toddler like to do at school?”
C. “Tell me about your child’s after school activities.”
D. “How does your infant comfort himself?”

90. The nurse is assessing a newborn, and notes all of the findings. Which of the following
nursing assessments would cause the nurse to be concerned?

A. Baby enjoys sucking on a pacifier and sleeps 16 hours a day.

B. Baby is nursing every 2–2½ hours and has 2 stools daily.
C. Birth weight is 6 pounds, 10 ounces. Present weight is 5 pounds, 4 ounces. →
dapat bumibigat
D. Baby is sleeping in between feedings and is not babbling.

91. A new mother asks the nurse whether breastfeeding is better than formula for her newborn.
Which response by the nurse is most appropriate?

A. “It often is easier to breastfeed, because you do not have to prepare bottles.”
B. “Breastfeeding is best for your baby; of course you should choose this.”
C. “There are no advantages to breastfeeding. You should do what is best for you.”
D. “There are many benefits to breastfeeding; let me tell you more about it.”

92. The father of a 9-month-old infant tells the nurse that his wife picks up the baby
immediately whenever she begins to cry. The most appropriate response by the nurse is:

A. “It is important for the child to learn to comfort herself. Does the baby try to calm
herself by sucking her thumb?”
B. “It is OK to pick her up often; eventually, she will stop crying.”
C. “Most infants do not know how to calm themselves. It is important to be responsive when
they cry.”
D. “At 9 months, she is too young to learn to calm herself. Wait until she is 2 years old before
letting her cry longer.”

93. The nurse inquires about the activity level of a 3-year-old. The mother states that the child
loves to play at the park, and that they go there as much as possible. The nurse encourages the
mother to continue to take the child to the park for play. What important principle is guiding the
nurse’s response?

A. Socialization with other toddlers helps develop communication skills.

B. Allowing the toddler to walk, run, and hop enhances the child’s kinaesthesia.
C. Maternal bonding is enhanced through play.
D. Only an emotionally happy child can enjoy the park.

94. The father of a 2½ - year-old asks the nurse how to prevent early-childhood dental cavities.
The best response by the nurse would be:

A. “Your child has only baby teeth; they will eventually fall out, and so there is no need to
worry.”
B. “Make sure your child’s diet is nutritious, and limit snacks high in sugar.”
C. “Take the child to the dentist to see if he has any cavities.”
D. “Let the child watch you brush your teeth so that he can learn how to do it himself.”

95. The nurse needs to obtain the height of a 3-year-old as part of routine health screening.
To obtain an accurate measurement, the child will:

A. Be measured in a recumbent position.

B. Remove his shoes and stand upright, with head level.
C. Stand with his feet wide apart.
D. Face the wall as he is measured

96. Mother of a 3-year-old tells the nurse that her child has frequent nightmares. The statement
by the mother that indicates the need for more teaching is:

A. “I usually talk quietly and rub her back to reassure her.”

B. “I read her a story until she calms down.”
C. “I take her to my bed so she will calm down.” → don’t take to bed magiging
dependent
D. “I stay with her awhile to reassure her.”
97. Most schools include curricula regarding human sexuality. What is the most appropriate age
group for the nurse to include in her instruction?
A. 12-year-olds
B. 9-year-olds
C. 11-year-olds
D. 15-year-olds

98. A 7-year-old sibling of a child with special needs is acting out in school. This behavior has
been attributed to jealousy over the attention the special needs child receives. The school nurse
should suggest to the parents that the sibling should:
A. Have a special time or activity with each parent alone.
B. Be dealt with using behavior modifications.
C. Be asked to participate in the care of the special needs child to understand why the child
needs more attention.
D. Be evaluated by a psychologist to rule out any mental illness.

99. A 2-year-old with epilepsy is showing signs of developmental delay. The nurse has been
working with the family to support development. The response from the parents that indicates
the need for further teaching is:

A. “He has a schedule by which we abide at all times.”

B. “We make sure he is always in a playpen or enclosed area when he plays.”
C. “He has temper tantrums all the time. We stay near, but don’t give in to what he gets
mad about.”
D. “He gets his Depakote every day at the same time. He hasn’t shown signs of a seizure
since he was 6 months old.”

100. The mother of a trainable adolescent with Down syndrome states to the school nurse, “I
don’t know what’s going to happen to my child when I die. How will he take care of himself?”
What is the nurse’s best response?

A. “There will always be somebody to take care of him. Don’t worry, everything will be okay.”
B. “Is there a relative who can take care of him if something happens? You need to develop a
plan for the future.”
C. “I am sure there is something we can do. Let me look into alternative care and see what kind
of insurance you have.”
D. “We do have a program that will assist with vocational learning. I need to get
your consent first; then, we can look at alternatives.”
101. At birth, a newborn’s assessment reveals the following: heart rate of 140 bpm, loud crying,
some flexion of extremities, crying when bulb syringe is introduced into the nares, and a
pink body with blue extremities. The nurse would document the newborn’s Apgar score as:

A. 5 points
B. 6 points
C. 7 points
D. 8 points

102.The nurse is explaining phototherapy to the parents of a newborn. The nurse would include
which of the following as the purpose?

A. Increase surfactant levels

B. Stabilize the newborn’s temperature
C. Destroy Rh-negative antibodies
D. Oxidize bilirubin on the skin

103.The nurse administers a single dose of vitamin K intramuscularly to a newborn after birth to
promote:

A. Conjugation of bilirubin
B. Blood clotting
C. Foreman ovale closure
D. Digestion of complex proteins

104.The American Academy of Pediatrics recommends that all newborns be placed on their
backs to sleep to reduce the risk of:

A. Respiratory distress syndrome

B. Bottle mouth syndrome
C. Sudden Infant Death Syndrome
D. GI regurgitation syndrome

105.Which of the following immunizations is received by newborns before hospital discharge?

A. Pneumococcus
B. Varicella
C. Hepatitis A
D. Hepatitis B

106.Which condition would be missed if newborns are screened before they have tolerated
protein feedings for at least 48 hours?

A. Hypothyroidism
B. Cystic fibrosis
C. Phenylketonuria
D. Sickle cell disease

PKU
- blonde hair
- blue eye
- musky odor urine
- mental retardation

107.Which therapy would the nurse use to reduce the incidence of respiratory distress syndrome
(RDS) in a preterm infant?

A. Administering corticosteroids to the mother prenatally.

B. Giving corticosteroids to the preterm infant after birth.
C. Limiting painful procedures that would stimulate crying.
D. Maintaining adequate oxygen saturation levels.
108.For which complication is the premature infant who develops respiratory distress syndrome
at high risk?

A. Anemia
B. Bronchopulmonary dysplasia
C. Hyperbilirubinemia
D. Patent ductus arteriosis
109.When feeding a premature infant, what should the nurse remember?

A. Gavage feedings should be done until 32 weeks gestation.

B. Premature infant formula is the ideal food.
C. Respiratory difficulty can occur with an overdistended stomach.
D. Use of a pacifier will depress the infant’s sucking ability.

110.The nurse is assisting in a newborn assessment of gestational age using the newborn
Maturity Rating and Classification (Ballard) scoring system. Of the following characteristics,
which would be noted in a newborn with the oldest gestational age? The newborn has

A. abundant lanugo, flat areola, and pinna flat

B.anterior transverse plantar crease, ear recoil, and few scrotal rugae
C.transparent skin, no lanugo, and prominent clitoris
D.bald areas, plantar creases cover sole, and 3 to 4 – mm breast bud

111. In planning care for an infant who had a spica cast applied to treat a congenital hip
dysplasia, which of the following nursing interventions would be included in this newborn’s plan
of care?

A.inspect skin for redness and irritation

B.change bedding and clothing every 4 hours
C.weigh every morning and evening using same scale
D.monitor temperature and pulse every 2 hours

112. The nurse is caring for the newborn of a mother who abused cocaine during her pregnancy
which of the following characteristics would the nurse likely to see in this newborn? The
newborn

A. weighs above average when born

B. sleeps for long periods of time
C. cries when touched
D. has facial deformities

113.Drying the infant immediately after birth helps prevent heat loss from what mechanism?

A. Conduction
B. Convection
C. Evaporation
D. Radiation

114. Which chemical stimulus contributes to the initiation of breathing immediately after birth?

A. Chest wall compression with recoil

B. Decreased peripheral oxygen levels
C. Rubbing the infant’s back with a blanket
D. Temperature change in extrauterine environment

115. The nurse observes a new mother applying a dressing or belly band over the umbilical cord
site when getting the baby ready to go home. Although she states she understands reasons why
a belly band is not necessary, the mother insists on using it. What is the best response by the
nurse to this situation?

A. “I will explain again why you don’t need to use the belly band.”
B. “If you use a belly band, the baby will get a cord infection.”
C. “Let us discuss the signs of infection of the cord.”
D. “When you are at home, you do what you think is best.”

116. In caring for a 4-months-old infant, which of the following actions by the infant would the
nurse note as appropriate for a 4-month-old infant? The infant

A. grasps objects with two hands

B. holds a bottle well
C. tries to pick up a dropped object
D. transfers an object from one hand to the other

117. In taking vital signs on a 6-month-old infant, the nurse obtains the following vital signs
measurements. Which set of vital signs would the nurse be most concerned about?

A. Pulse 90 bpm, temperature 36.9°C, blood pressure 80/50 mm Hg

B. Pulse 114 bpm, temperature 37.6°C, blood pressure 88/60 mm Hg
C. Pulse 148 bpm, temperature 38.0°C, blood pressure 92/62 mm Hg
D. Pulse 162 bpm, temperature 38.5°C, blood pressure 96/56 mm Hg

118. When doing a physical exam on an infant, an understanding of this child’s developmental
needs are recognized when the exam is done by examining the
A. heart before the abdomen
B. chest before the nose
C. extremities before the eyes
D. neurologic status before the back

119. The nurse is inserting a nasogastric tube on a toddler. Which of the following restraints
would be the most appropriate for the nurse to use with this child during the procedure?

A. mummy restraints
B. clove hitch restraints
C. elbow restraints
D. jacket restraints

120. The nurse is assisting with a well-child visit for a 5 ½ year-old child’s records show that at
the age of 3 years, this child weighs 32 pounds, was 35.5 inches tall, had 20 teeth, and slept 11
hours a day. If this child is following a normal pattern of growth and development, which of the
following would the nurse expect to find in this visit? The child

A.weighs 54 pounds
B.measures 40 inches in height
C.has two permanent teeth → 6 years old (2 permanent teeth)
D.sleeps 2 hours for a morning nap

121.The nurse is talking with a group of caregivers of preschool-age children. Which of the
following statements made by a caregiver would require further data collection?

A.“My child calls her sister bad names when she doesn’t get her way.”
B.“She told me her imaginary friend broke my favorite picture frame.”
C.“My son always wants to eat cookies for lunch and for snacks.”
D.“Even when his friends are over to play, he wants to play by himself.”
122.A caregiver for a preschool-age child says to the nurse, “My 4-year-old touches her genitals
sometimes when she is resting.” Which of the following statements would be appropriate for the
nurse to respond?

A. “Masturbation is embarrassing to the parents; scolding the child will stop the behavior.”
B. “When children are angry or upset, they often masturbate.”
C. “When this child masturbates, it can be unhealthy and dangerous.”
D. “Masturbation is normal behavior, so providing another activity for the child
would be appropriate.”

123. The hospitalized child away from her or his home and normal environment goes through
stages of separation. Which of the following behaviors might indicate the child is in the “denial”
stage of separation? The child

A. cries loudly even when being help by the nurse

B. searches for the caregiver to arrive
C. ignores caregivers when they visit → denial stage
D. quietly lies in the crib when no one is in the room

124. After the discharge of a preschool-age child from the hospital, which of the following
behaviors by the child might indicate he or she is afraid of another separation? The child

A. plays with siblings for long periods of time

B. carries a favorite blanket around the house → security blanket / object
C. request to go visit the nurses at the hospital
D. wakes up very early in the morning

125. When caring for a 3½-year-old child who is receiving oxygen in an oxygen tent, which of
the following toys or activities would be best to offer this child?

A. a radio playing soothing music – bawl battery operated

B. age-appropriate book
C. a favorite blanket belonging to the child – bawal blanket
D. board games the child can play alone

Situation: Care of the children is a specialized field that requires a comprehensive and unique
approach of responding to their behaviours and problems.
126. A mother asks the pediatric nurse about what she should begin to feed her 6-month-old
infant. The correct response is:

A. Egg whites are the least allergenic food to be introduced into the baby's diet.
B. Rice cereal is the first solid introduced that is least allergenic of the cereals.
C. Formula is the only source of nutrition given for the first year.
D. Fruits and vegetables are good sources of iron.

1. Cereal
 2. Vegetables
3. Fruits
4. Meats
5. Table foods

127. A 1-year-old male child is scheduled for a routine exam at the pediatric clinic. The child's
birth weight was 8 lbs. 2 oz. The child now weighs 18 pounds, 4 oz. The nurse knows that this
weight is:

A. Below the expected weight.

B. Appropriate for the child's age.
C. Above the expected weight.
D. Individualized and thus unpredictable.

128. A school nurse prepares a lecture on puberty for 5th- and 6th-grade girls. She asks the
group, "What is the first sign of puberty?" A student correctly replies:

A. "The appearance of breast buds."

B. "An increase in energy and appetite."
C. "The occurrence of the first menarche."
D. "Appearance of body odor."

129.The mother discusses with the nurse that her toddler asks every night for a bedtime story.
The mother asks why the child does this. The nurse would explain that this behavior
demonstrates:

A. Ritualism.
B. Object permanence.
C. Dependency.
D. Conservation.
130. Whenever the parents of a 10-month-old leave their hospitalized child for short periods, he
begins to cry and scream. The nurse explains that this behavior demonstrates that the child:

A. Needs to remain with his parents at all times.

B. Is experiencing separation anxiety.
C. Is experiencing discomfort.
D. Is extremely spoiled.
Situation: Principles of Growth and Development is essential in understanding the behaviors and
problems of children. A teenager refuses to wear the clothes his mother bought for him. He
states he wants to look like the other kids at school and wear clothes like they wear.

131.The nurse explains this behavior is an example of teenage rebellion related to internal
conflicts of:

A. Autonomy vs. shame and doubt.

B. Trust vs. mistrust.
C. Identity vs. role confusion.
D. Initiative vs. inferiority.

132. The mother of a 5-year-old expresses concern about her child who believes that "Grandma
is still alive" 3 months after the grandmother's death. The nurse explains that:

A. Magical thinking often accounts for a preschooler who believes that dead people
will come back.
B.There is a need for psychological counseling for this child and family.
C.This is a form of regression exhibited by the preschooler.
D.The child is in denial regarding Grandma's death.

133. A mother of a 4-year-old tells the nurse that her son is a "picky eater." The nurse should
inform the mother that she should:

A.Increase the amount of carbohydrates in the daily menu plan.

B.Administer vitamins twice a day to her child.
C.Be more concerned with the quantity of food than the quality of food.
D.Recognize this is common for preschoolers as their caloric requirements have
decreased slightly. → offer choices
134. A mother of a 15 month-old brings her son to the clinic. While doing a nursing assessment,
the mother makes the following comments. Which comment merits further investigation by the
nurse?

A.“My son cries sometimes when I leave him at his grandparent’s house.”
B. “My son always takes his blanket with him.”
C. “My son is not crawling yet.” → Crawling → 9 months
D. “My son likes to eat mashed potatoes.”
135. An inexperienced mother is playing with her 8 month-old in the playroom. The nurse has
taught the mother about toys that are developmentally appropriate for the child. The nurse will
know the teaching has been successful when the mother selects:

A. Blocks
B.Tricycle
C. Puzzles
D. Rattles → 6 months old

Situation: Nurse Melia is conducting an interview with different age group in the Pediatric ward.
She observes the proper communication techniques depending on the age of the child and
disease conditions to facilitate a Nurse patient relationship.

136. The nurse is discussing STDs with a 17-year-old student. To correctly plan the teaching
lesson, the nurse utilizes Piaget's theory to determine the adolescent's cognitive abilities. The
educational plan should be based on the:

A. Sensorimotor reactions.
B. Limited cause and effect understanding.
C. Concrete thinking.
D. Mature abstract thinking.

137.The pediatric nurse practitioner is working with a group developing school playgrounds. The
playground designers must identify the major causes of potential injury for the school-aged
child. The nurse explains that the most frequent accidents in school-age children involve:

A.Motor vehicles, diving, and drugs and alcohol. – adolescent

B.Swing sets, drowning, and poisonings. → common in toddlers / preschoolers
C.Bicycles, skateboards, and in-line skates.
D.Aspiration of food, plastic bags, and stairways. → common in infants
138.During a day-surgery hospitalization experience for tonsillectomy, a 3-year-old child will
most likely be fearful of:

A.Intrusive procedures.
B.Perceived abandonment.
C.Premature death.
D.Unfamiliar caregivers.
139.The nurse is preparing to administer eardrops to an infant. To instill the drops into the
canal, the nurse should pull the pinna of the ear:

A.Down and forward.

B.Back and down.
C.Up and forward.
D.Up and back.

Back up – adult (pag may kaaway hihingi ng back up)

140.Which of the following is recommended to stop an episode of epistaxis in an otherwise

healthy child?

A.Position the child supine with head hyperextended.

B.Apply ice on the upper lip.
C.Position supine in Trendelenberg position.
D.Position upright with head tilted forward.

Situation: An 18-month-old child is seen in the Emergency Department with respiratory distress
and is admitted with a diagnosis of pneumonia. Following the initial workup, the baby is still
short of breath but is rubbing his eyes as if he is sleepy.

141. The mother wants to lay the baby down for his nap. The infant refuses to lie down. The
nurse would suggest:

A.Rocking the baby until he is asleep and then lay him down.
B.The mother hold him in her arms while he sleeps.
C.The mother allow the baby to sleep in an upright position.
D.A sleeping pill to help the baby rest.
142.The mother has been taught to perform chest physiotherapy on her child. Which
observation by the nurse indicates the need for additional teaching?

A.The child has on only a T-shirt.

B.The mother delayed the treatment until the child had finished breakfast.
C.The mother is making a popping sound when doing percussion.
D.The child is positioned in various head-down positions.

Percussion
- percussion
 - vibration postural drainage
- done on an empty stomach

143.A client is admitted with a diagnosis of " Rheumatic Fever." Based on Jones Criteria, the
nurse assesses for:

A.Polyarthritis and dental caries.

B.Fever, headache, and low red blood cell count.
C.Chorea, muscle weakness, and decreased erythrocyte sedimentation rate.
D.Erythema, polyarthritis, and elevated antistreptolysin-O (ASO) titer.

144.A 2-year-old child is being discharged home and will have palliative surgery for Tetralogy of
Fallot at a later date. The mother wants to know about how much physical activity she can allow
for the child. The nurse's best answer is:

A."Allow the child to regulate her activity."

B."Keep her on complete bedrest."
C."Limit her activities to a few hours."
D."Keep the child from crying."

145.A child is being seen in the ambulatory clinic for a sore throat diagnosed as caused by
group A beta hemolytic streptococcus. The nurse provides care with the understanding that the
risk of developing rheumatic fever is greatest:

A.Two weeks later.

B.Prior to the administration of an antibiotic.
C.Once the child has begun antibiotic therapy.
D.With the onset of the strep infection.
Situation: In the pediatric ward, a nurse admitted a child with a symptoms of Kawasaki disease.

146.Which assessment data will be most indicative of a potential complication of Kawasaki's

disease?

A. Dermatitis of extremities
B. Strawberry tongue, erythema of mouth
C. Change in blood pressure, pulse, skin color
D. Fever over 5 days, bilateral conjunctivitis
147. When reviewing a urinalysis report of a client with acute Glomerulonephritis, the nurse
would expect to note:

A. Decreased creatinine clearance.

B. Decreased specific gravity.
C. Proteinuria.
D. Decreased erythrocyte sedimentation rate (ESR).

148.While a child is receiving Prednisone (Deltasone) for treatment of Nephrotic syndrome, it is

important for the nurse to assess the child for:

A. Infection.
B. Urinary retention.
C. Easy bruising.
D. Hypoglycemia.

149. Considering a child's developmental level in diabetic care is essential. The nurse should
include which information in teaching the parents of a recently diagnosed toddler with diabetes?

A. Allow the toddler to assist with the daily insulin injections.

B. Prepare meat, vegetables, and potatoes for each dinner. The toddler cannot be allowed any
choices in food selection.
C. Test the toddler's blood glucose every time he goes outside to play.
D. Allow the toddler to assist with cleaning off his fingers before blood glucose
monitoring.

150.Which of the following symptoms is not typical in an adolescent with Idiopathic Structural
Scoliosis?
A. Back pain
B. Skirts that hang unevenly
C. Unequal shoulder heights
D. Uneven waist angles

151.The best way for an infant’s father to help his child complete the developmental task of the
first year is to:

A. expose her to many caregivers to help her learn variability.

B. talk to her at a special time each day.
C. respond to her consistently.
D. keep her stimulated with many toys.

152.Whenever the parents of a 10-month-old leave their hospitalized child for short periods, he
begins to cry and scream. The nurse explains that this behavior demonstrates that the child:

A. Needs to remain with his parents at all times.

B. Is experiencing separation anxiety.
C. Is experiencing discomfort.
D. Is extremely spoiled.

153. Dennis, a preschooler sees you pour his liquid medicine from a tall, thin glass into a short,
wide one, he will probably reason that:

A. the amount of medicine is less (the glass is not as full).

B. the amount of medicine did not change, only the appearance.
C. pouring medicine hurts it in some way because it changes.
D. the glass changed shape to accommodate the medicine.

154. A school nurse prepares a lecture on Puberty changes for first year high school girls. She
asks the group, "What is the first sign of Puberty?" A student correctly replies :

A."The appearance of breast buds."

B."An increase in energy and appetite."
C."The occurrence of the first menarche."
D."Appearance of body odor."

155.When encouraging the hospitalized physically challenged or chronically ill adolescent to

develop and maintain a sense of identity, you would :
A.provide the opportunity for individual decision making.
B.provide physical comfort to the individual.
C.ask the parents what the adolescent is capable of doing.
D.provide care until the adolescent insists on being independent.

Situation: A Pediatric Nurse formulates a Nursing Care Plan to children with different health
disorders.

156. A school-age child needs 5 units of regular insulin to be administered. She is in the
playroom when you are ready to give the injection. Your best action would be to :
A.inject it in the playroom; insulin injections do not hurt.
B.tell her to come outside the playroom for the injection.
C.ask the other children if they would mind if you gave the injection in the playroom.
D.ask the girl if she would mind if you gave the injection in the playroom.

Play room → safe haven for them

157.Which toy would you expect to provide the best therapeutic play for a child who has to
receive daily medicine injections?

A. An anatomically correct puppet.

B. A doll with a cast in place.
C. A syringe to practice injections.
D. A stuffed bear with Band-Aids.

158. A 3-year-old is admitted to the hospital for eye surgery. You provide her with a doll and
syringe for therapeutic play. She sticks the doll in the eye with the syringe and says, “You won’t
watch TV again when I tell you not to!” What is your best response to this?

A.Ask her if she ever accidentally stuck herself in the eye.

B.Explain that nurses never give injections into eyes.
C.Pretend that you are the doll and say, “Ouch!”
D.Ask her if she thinks having surgery is punishing her.

159.An infant’s mother does not visit her in the hospital for 3 days. The infant cries insistently
for her during this time, then becomes extremely quiet and withdrawn. This reaction best
indicates :
A. the infant’s temperament is resistant.
B. the infant is denying she is hospitalized.
C. beginning fatigue from illness.
D. development of a sense of despair.

160. Visiting is limited to 10 minutes every hour in the intensive care unit where a child is
receiving care. In order not to disrupt the child-parent time you would:

A. perform procedures during visiting hours to assure the parents that their child is receiving
continual care.
B. leave the immediate care area while the parents are visiting.
C. avoid performing procedures during family visits.
D. tell the parents to perform all care while they are visiting.

161.A common symptom that would alert the nurse that a preterm infant is developing
respiratory distress syndrome is:

A.inspiratory stridor.
B.expiratory grunting.
C.expiratory wheezing. – asthma
D.inspiratory “crowing.”

162. Elvis 8 months old was diagnosed with Acute Laryngotracheobronchitis ( LTB ) and is
managed inside a mist tent. As the nurse conducts assessment, which of the following
observations would lead her to suspect that airway occlusion is occurring?

A. He states he is tired and wants to sleep.

B. His respiratory rate is gradually increasing.
C. His cough is becoming harsher.
D.His nasal discharge is increasing.

163. A child is scheduled for a Myringotomy with placement of Tympanostomy tube. What is the
goal of this procedure that the nurse will discuss with the parents?

A.To decrease infection in the ear

B.To irrigate the eustachian tube
C.To correct a malformation in the inner ear
D.To equalize pressure in the tympanic membrane
Situation: An ICU Pediatric Nurse, Fely aims to help the family cope with Cardiac Disorders.
Nurse Fely plans to demonstrate therapeutic interventions to assist them in their treatment.

64. You would teach the mother of a boy with Tetralogy of Fallot (TOF) that if he suddenly
becomes cyanotic and dyspneic to:

A.place him in a semi-Fowler’s position in an infant seat.

B.lie him supine with the head turned to one side.
C.lie him prone, being sure he can breathe easily.
D.place him in a knee-chest position.

165.A young child was diagnosed to have Coarctation of the Aorta. When taking the child’s vital
signs, the nurse can expect to observe:
A.Bounding femoral pulse
B.Weak, thready radial pulse
C.Increase blood pressure in upper extremities
D.Increase blood pressure in lower extremities

166.An 8 year old female child was admitted in the hospital with medical diagnosis of Acute
Rheumatic fever. When obtaining a health history from the child’s mother, the nurse should ask
the questions to determine if the child was recently ill with:

A.Mumps
B.Measles
C.a viral flu
D.a sore throat

Situation:There are varied Pediatric disorders that require comprehensive assessment and
nursing interventions. The following scenarios refer to health problems of children.

167. A 5-week-old infant is brought to the pediatrician’s office with symptoms of irritability,
weight loss, and projectile vomiting. On physical examination, the infant appears dehydrated.
From these symptoms, you know that the infant probably has:

A.Hirschsprung’s disease → ribbon-like stool

B.Tracheoesophageal Fistula
C.Pyloric stenosis → without bile
D.Intussusception → curant jelly-like stools
168.A Pediatric Nurse admitted a post cleft palate repair child and immediately the nurse should
position the child:

A.Left side lying.

B.Prone.
C.Dorsal recumbent.
D.Semi Fowler's.

169. Another neonate is suspected of having a Tracheoesophageal fistula. Priority nursing care
until the diagnosis is confirmed includes:

A.monitoring the neonate carefully during and after feedings

B.elevating the neonate’s head after feedings
C.feeding only glucose
D.feeding nothing by mouth

170.Upon interviewing the parents of the child with Acute Glomerulonephritis, the nurse
understands that which information collected is most often associated with this condition?

A.Nausea and vomiting for the last 24 hours

B.Streptococcal throat infection 2 weeks prior to diagnosis
C.History of urinary tract infection for 5 days
D.Pruritus for 1 week prior to diagnosis

171.A newly admitted 5-year old child in the Pediatric ward is diagnosed with Wilm’s Tumor.
Upon initial interview, the nurse would be most concerned about which statement by the child’s
mother?

A. My child has lost 3 pounds in the last month.

B. Urinary output seemed to be less over the past 2 days.
C. All the pants have become tight around the waist.
D. The child prefers some salty foods more than others.

172. Pedro, a 4-year-old child is being evaluated for Hydrocephalus. An early indication of
Hydrocephalus in this child would be:

A.Bulging fontanels.
B.Rapid enlargement of the head.
C. Shrill, high-pitched cry.
D. Early morning headache.

173.To meet the sensory need of a child with Viral Meningitis, nursing strategies should include:

A. Minimizing bright lights and noise

B. Promoting active range of motion
C. Increasing environmental stimuli
D. Avoiding physical contact with family members

Viral meningitis → risk for seiszure

174.The nurse provides care for a child with congenital Hip Dysplacia. Which of the following
should the nurse consider as part of intervention for the client?
A.Place client in supine position and prevent abduction of the legs
B.Encourage the use of Milwaukee brace
C.Observe proper placement of Pavlik harness
D.Never place a pillow between the thighs when the child is in supine position
Congenital Hip Dysplasia
SADDER
- Shortened
- Adducted
- Externally rotated
Management
Spica-cast - pavlik harness
175. If a child with Hemophilia is admitted because of Hemarthrosis in the right elbow, which of
the following nursing actions should be prioritized?

A.Applying warm compress to relieve pain

B.Elevating and immobilizing the affected part for 48 hours
C.Continuous compression for 5 minutes
D.Administering cryoprecipitate or fresh frozen plasma as ordered

176.Vitamin K is administered to all neonates immediately after birth because:

A.their fetal blood cells are prone to coagulation problems

B.their immature livers predispose them to low vitamin K levels
C.they lack intestinal organisms to synthesize vitamin K
D.they all experience avitaminosis

177.While evaluating a neonate in the surgery, you check his hips for signs of dislocation. Which
of the following signs indicates that the hips are in the normal position?

A. Both legs abduct easily

B.Skin folds are asymmetrical
C.A click is heard when hip integrity is assessed
D.The femur head is felt to slip forward in the acetabulum

178.A new mother asks you why her neonate is voiding so often. Your best reply is that the:

A.kidneys of the neonate can’t concentrate urine well

B.intestines of a neonate aren’t yet absorbing fluid
C.fluid retained during fetal life is being excreted
D.neonate’s fluid intake is too great for his age

179.Which characteristic best describes a breast-fed neonate’s stools, as compared with a

formula-fed neonate’s stools?

A. Soft and seedy → consistent di ganun kalambot di ganun katigas

B.Dry
C.Light yellow in color
D.Less frequent

180. You’re assessing a neonate. Normal assessment findings include:

A.absent Babinski’s reflex and pale skin

B. heart rate of 130 to 140 beats/minute and acrocyanosis
C.absence of head control and a relaxed posture while awake
D.respiratory rate of 60 breaths/minute and expiratory grunting → RDS

181.Which statement is accurate regarding neonatal respirations?

A. The neonate should grunt on expiration

B. The neonate has minimal amounts of surfactant at term
C.The neonate’s respirations are commonly irregular
D.The neonate’s respiratory rate is less than 28 breaths/minute
182.The care plan for a neonate with fetal alcohol syndrome should include:

A.increased sensory stimulation to promote cerebral function

B.maintenance of a quiet, dimly lit environment
C.assessment of the mother’s readiness to care for the infant and, if necessary, restrictions on
contact with the infant
D.fluid restrictions

183. You’re caring for a 28 preterm infant. You carefully monitor the infant’s oxygen levels to
prevent which complication of oxygen therapy?

A.Pulmonary hypertension
B.Respiratory distress syndrome
C.Retinopathy of prematurity → pag masyadong mataas ang oxygen → mag
rurupture ang veins? nerves? → cause retinopathy
D.Patent ductus arteriosus

184. You observe that the neonate of a mother with diabetes is jittery 6 hours after delivery.
Which nursing action should you carry out first?

A.Offer the neonate formula

B.Feed the neonate glucose water
C.Take the neonate out to nurse
D.Check the neonate’s blood glucose level

185. On the postpartum unit, a new mother expresses concern about her family’s history of
cystic fibrosis. You instruct the client to observe her neonate for which of the following signs
and symptoms?

A. Joint pain and anemia

B. Progressive weakening of the muscles
C. Steatorrhea, poor weight gain, and salty perspiration
D. Difficulty swallowing, chronic ear infections, and speech defects

Cystic fibrosis → meron kadin pancreatitis

186.A 25-year-old woman gave birth to a neonate with a cleft lip. Which of the following
information should you give the mother?

A. Cleft lip primarily affects appearance

B.Chronic ear infections can result from cleft lip
C.Speech defects are common in children with cleft lip → does not cause speech problem
D.Orthodontia may be needed to correct the angle of the teeth

187. A neonate is suspected of having a tracheoesophageal fistula. Priority nursing care until the
diagnosis is confirmed includes:

A. monitoring the neonate carefully during and after feedings

B.elevating the neonate’s head after feedings
C.feeding only glucose
D.feeding nothing by mouth

188.The nurse expects an infant to say words such as “dada” and “mama” with meaning at
what age?

A.4 months
B.6 months
C.8 months
D.10 months

189.You’re assessing a 7 month old brought to the clinic for a well-baby checkup. You expect
which of the following behaviors to develop first in a healthy 7 month old?

A.Walking
B.Placing objects in a container
C.Sitting up
D.Throwing a ball

190. A mother brings her 6 month old to the clinic for a well-baby checkup. What assessment
finding indicates that a 6 month old’s growth developmentally appropriate?

A.Weight has doubled since birth.

B.Height has increased by 1” (2.5 cm) since birth.
C.Head circumference has increased 1” per month since birth.
D.The posterior fontanel is open.
191.During a well-baby checkup, the nurse assesses the social development of an infant. At
what age does the nurse expect to see the social smile?

A. 2 months
B. 4 months
C. 6 months
D. 8 months

192. A 2-month-old who had a cleft lip repair is in the immediate postoperative period. Which
nursing intervention is most important?

A. Withhold oral fluids for 24 hours

B. Tape the lip protection device to the cheeks
C.Vigorously aspirate the mouth and nasopharynx
D.Position the infant on his abdomen with elbow restraints

193. An infant is admitted to the nursery from the delivery room. On initiation of the first
feeding of sterile water, the infant coughs fluid through the nose and mouth, struggles for air,
and turn dusky. You suspect a tracheoesophageal fistula. Which finding helps confirm your
suspicion?

A.Maternal history of prolonged labor

B.Maternal history of polyhydramnios
C.Absent bowel sounds on admission to the nursery
D.Poor suckling response at initial assessment

194. A 10-month-old with developmental dysplasia of the hip has returned to the pediatric floor
postoperatively following an open reduction. A hip-spica cast is in place. To help the plaster cast
dry evenly, the nurse can:

A. cover the cast

B. use a heated blow-dryer
C. assess for dryness with her fingers
D. turn the infant at least every 2 hours

195. A 4-year-old is brought to the ambulatory care clinic for well-child care. His height (37” [94
cm]) and weight (29 lb [13.2 kg]) are below the fifth percentile for his age and sex. What
should you do first to evaluate his growth?
A. Compare his growth trends with those of his parents and siblings.
B. Elicit more history to assess the presence of metabolic disease.
C. Gather additional data by assessing baseline vital signs.
D. Initiate radiographic assessment to evaluate his stature.

196. Which screening test is the most widely used to assess a young child’s development?

A.Denver II test → DDST

B.Cognition test
C.Standard growth charts
D.Intelligence quotient test

197. During a well-child checkup, you’re preparing to give a measles, mumps, and rubella
vaccine injection to a 5-year-old boy. Which nursing action is most appropriate?
A. Demonstrate on a toy how the injection will be given.
B. Use a small needle to give the injection.
C. Ask the child’s parents to leave the room while the injection is given.
D. Explain the procedure in simple sentences just before giving the injection.

198.You’re assessing a 4 year old with a speech articulation disorder. The child should have
which test before the speech evaluation itself?

A. Tympanometry
B. Audiogram
C. Vision screening
D. IQ test

199.You’re assessing a 3 year old who has had surgery for ventriculoperitoneal shunt
placement to treat hydrocephalus. Which of the following symptoms indicates that the client has
increased intracranial pressure (ICP)?

A. Bulging fontanel
B. Vomiting
C. Nuchal rigidity
D. Sunset eyes
200. A 4 year old is in the emergency department for a 2-day-old puncture wound that occurred
when he stepped on a nail. Which assessment finding suggests tetanus?

A. Stiffness of the neck and jaw

B. Decreased level of consciousness
C. Abdominal cramping and vomiting
D. Purulent drainage from the puncture site