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FINAL COACHING EXAMINATION

INFANT CARE AND FEEDING
Prepared by: Prof.Archie Alviz
Philippine Midwifery Licensure Examination
NAME:

PART B
1. At birth, a newborn’s assessment reveals tolerated protein feedings for at least 48
the following: heart rate of 140 bpm, loud hours?
crying, some flexion of extremities, crying A. Hypothyroidism
when bulb syringe is introduced into the B. Cystic fibrosis
nares, and a pink body with blue extremities. C. Phenylketonuria
The RM would document the newborn’s D. Sickle cell disease
Apgar score as: 7. Which therapy would the RM use to
A. 5 points reduce the incidence of respiratory distress
B. 6 points syndrome (RDS) in a preterm infant?
C. 7 points A. Administering corticosteroids to the
D. 8 points mother prenatally.
2. The RM is explaining phototherapy to the B. Giving corticosteroids to the preterm
parents of a newborn. The RM would include infant after birth.
which of the following as the purpose? C. Limiting painful procedures that would
A. Increase surfactant levels stimulate crying.
B. Stabilize the newborn’s temperature D. Maintaining adequate oxygen
C. Destroy Rh-negative antibodies saturation levels.
D. Oxidize bilirubin on the skin 8. For which complication is the premature
3. The RM administers a single dose of infant who develops respiratory distress
vitamin K intramuscularly to a newborn after syndrome at high risk?
birth to promote: A. Anemia
A. Conjugation of bilirubin B. Bronchopulmonary dysplasia
B. Blood clotting C. Hyperbilirubinemia
C. Foreman ovale closure D. Patent ductus arteriosis
D. Digestion of complex proteins 9. When feeding a premature infant, what
4. The American Academy of Pediatrics should the RM remember?
recommends that all newborns be placed on A. Gavage feedings should be done until
their backs to sleep to reduce the risk of: 32 weeks gestation.
A. Respiratory distress syndrome B. Premature infant formula is the ideal
B. Bottle mouth syndrome food.
C. Sudden Infant Death Syndrome C.Respiratory difficulty can occur with an
D. GI regurgitation syndrome overdistended stomach.
5. Which of the following immunizations is D.Use of a pacifier will depress the
received by newborns before hospital infant’s sucking ability.
discharge? 10. The RM is assisting in a newborn
A. Pneumococcus assessment of gestational age using the
B. Varicella newborn Maturity Rating and Classification
C. HepatitIs A (Ballard) scoring system. Of the following
D. Hepatitis B characteristics, which would be noted in a
6. Which condition would be missed if newborn with the oldest gestational age? The
newborns are screened before they have 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,
11. 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
12. The RM is caring for the newborn of a
mother who abused cocaine during her
pregnancy which of the following
characteristics would the RM 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
13. Drying the infant immediately after birth
helps prevent heat loss from what
mechanism?
A. Conduction
B. Convection
C. Evaporation
D. Radiation
14. 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
15. The RM 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 RM 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.”
16. In caring for a 4-months-old infant, which
of the following actions by the infant would
the RM 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
17. In taking vital signs on a 6-month-old
infant, the RM obtains the following vital
signs measurements. Which set of vital signs
would the RM 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
18. 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
19. The RM is inserting a nasogastric tube on
a toddler. Which of the following restraints
would be the most appropriate for the RM to
use with this child during the procedure?
A. mummy restraints
B. clove hitch restraints
C. elbow restraints
D. jacket restraints
20. The RM 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 RM expect to find in this visit? The child
A. weighs 54 pounds
B. measures 40 inches in height
 C. has two permanent teeth
D. sleeps 2 hours for a morning nap
21. The RM 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.”
22. A caregiver for a preschool-age child says
to the RM, “My 4-year-old touches her
genitals sometimes when she is resting.”
Which of the following statements would be
appropriate for the RM 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.”
23. 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 RM
B. searches for the caregiver to arrive
C. ignores caregivers when they visit
D. quietly lies in the crib when no one is
in the room
24. 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
C. request to go visit the RMs at the
hospital
D. wakes up very early in the morning
25. 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
B. age-appropriate book
C. a favorite blanket belonging to the
child
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.
26. A mother asks the pediatric RM 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.
27. 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 RM 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.
28. A school RM 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."
29. The mother discusses with the RM that
her toddler asks every night for a bedtime
story. The mother asks why the child does
this. The RM would explain that this behavior
demonstrates:
A. Ritualism.
B. Object permanence.
C. Dependency.
D. Conservation.
30. Whenever the parents of a 10-month-old
leave their hospitalized child for short
periods, he begins to cry and scream. The
RM 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.
31. The RM 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.
32. 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 RM 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.
33. A mother of a 4-year-old tells the RM that
her son is a "picky eater." The RM 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.
34. 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 RM?
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.”
D. “My son likes to eat mashed potatoes.”
35. An inexperienced mother is playing with
her 8 month-old in the playroom. The RM has
taught the mother about toys that are
developmentally appropriate for the child.
The RM will know the teaching has been
successful when the mother selects:
A. Blocks
B. Tricycle
C. Puzzles
D. Rattles
Situation: RM 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 RM patient relationship.
36. The RM is discussing STDs with a 17-year-
old student. To correctly plan the teaching
lesson, the RM 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.
37. The pediatric RM 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 RM explains that the
most frequent accidents in school-age
children involve:
A. Motor vehicles, diving, and drugs and
alcohol.
B. Swing sets, drowning, and poisonings.
C. Bicycles, skateboards, and in-line
skates.
D. Aspiration of food, plastic bags, and
stairways.
38. 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.
39. The RM is preparing to administer
eardrops to an infant. To instill the drops
into the canal, the RM should pull the pinna
of the ear:
A. Down and forward.
B. Back and down
C. Up and forward.
D. Up and back.
40. 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.
41. The mother wants to lay the baby
down for his nap. The infant refuses to lie
down. The RM 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.
42. The mother has been taught to perform
chest physiotherapy on her child. Which
observation by the RM 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.
43. A client is admitted with a diagnosis of "
Rheumatic Fever." Based on Jones Criteria,
the RM 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.
44. 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 RM'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."
45. A child is being seen in the ambulatory
clinic for a sore throat diagnosed as caused
by group A beta hemolytic streptococcus. The
RM 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 RM
admitted a child with a symptoms of
Kawasaki disease.
46. 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
47. When reviewing a urinalysis report of a
client with acute Glomerulonephritis, the RM
would expect to note:
A. Decreased creatinine clearance.
B. Decreased specific gravity.
C. Proteinuria.
D. Decreased erythrocyte sedimentation rate
48. While a child is receiving Prednisone
(Deltasone) for treatment of Nephrotic
syndrome, it is important for the RM to
assess the child for:
A. Infection.
 B. Urinary retention.
C. Easy bruising.
D. Hypoglycemia.
49. Considering a child's developmental level
in diabetic care is essential. The RM 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.
50. Which of the following symptoms is not
typical in an adolescent with
IdiopathicStructural Scoliosis?
A. Back pain
B. Skirts that hang unevenly
C. Unequal shoulder heights
D. Uneven waist angles
51. 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.
Rationale: C. A sense of trust is difficult
to learn if things are constantly changing.
Consistently responding to an infant’s
needs helps to build a sense of trust.
52. Whenever the parents of a 10-month-
old leave their hospitalized child for short
periods, he begins to cry and scream. The
RM 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.
53. 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.
54. A school RM 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."
55. 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 RM formulates a
Nursing Care Plan to children with different
health disorders.
56. 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.
57. 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.
58. 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 RMs 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.
59. 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.
60. 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.
61. A common symptom that would alert
the RM that a preterm infant is developing
respiratory distress syndrome is:
A. inspiratory stridor.
B. expiratory grunting.
C. expiratory wheezing.
D. inspiratory “crowing.”
62. Elvis 8 months old was diagnosed with
Acute Laryngotracheobronchitis ( LTB ) and is
managed inside a mist tent. As the RM
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.
63. A child is scheduled for a Myringotomy
with placement of Tympanostomy tube. What
is the goal of this procedure that the RM 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: Fely RM aims to help the family
cope with Cardiac Disorders. 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.
65. A young child was diagnosed to have
Coarctation of the Aorta. When taking the
child’s vital signs, the RM 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