PEDIATRIC NURSING

Carefully choose the best answer for each question.

1. When completing an assessment of a healthy adolescent client, which of the following would be most appropriate
a. Obtain a detailed account of the adolescent’s prenatal and early developmental history
b. Discuss sexual preference and behaviors with the parents present for legal reasons
c. Discuss the client’s smoking with parents present in the room
d. Assess the adolescent in private; gather additional information from the parents
Ans: D. When assessing an adolescent, it is appropriate to first obtain information from the adolescent in private then interview the parents
for additional information. Doing so helps to promote independence and responsibility for self-care.
2. During the assessment of a small infant admitted with a diagnosis of meningitis, the infant becomes less responsive to stimuli and
exhibits bradycardia, slight hypertension, irregular respirations and a temperature of 39.5 C. the infants fontanel also seems tense.
What will the nurse do first?
a. Ask the nurse to verify the findings
b. Notify the physician of the findings
c. Raise the head of the head
d. Administer antipyretics
Ans: C. signs such as decrease I the level of consciousness; bradycardia, hypertension, irregular respirations, and tense fontanel strongly
suggest increased intracranial pressure. The first action should be to attempt to lower the pressure by raising the head of the bed to
improve venous return and ease pressure.
3. After undergoing a barium enema, which of the following indicates that the infant has adequately evacuated the barium?
a. Absence of fecal mass in the lower abdomen
b. Stools that progress from clay colored to brown
c. Bowel sounds of 30 per minute
d. Stool guaiac that is negative
Ans: B. The presence of barium produces white or clay colored stools. A change from this color to brown means that barium has been
evacuated.
4. Which of the following would be best to help prepare a preschool aged child for an injection?
a. Having an older child explain that shots do not hurt
b. Helping the child ti imagine she is in a different place
c. Giving the child a play syringe and a bandage to give a doll injections
d. Giving the child a pounding board to encourage expressions of anger
ANS: C. allowing the preschool aged child to give play injections can help to prepare the child to receive an injection. Preschoolers have a
limited vocabulary. They express their feelings through play. They also use play to help cope with stress. Having an older child explain that
shots do not hurt is inappropriate because preschool children know that injections hurt. Misrepresenting would instill mistrust in a trust.
Imagery is appropriate with much older children. Using a pound board after the procedure ca help the child express her feelings.
5. Which of the following would the nurse include when developing the plan of care for a neonate prior to surgical repair of a
myelomeningocele?
a. Applying thin layers of tincture of benzoin around the defect
b. Positioning the neonate on the side
c. Covering the defect with moist, sterile saline dressings
d. Leaving the defect exposed to air
ANS: C. The sac is kept moist by covering it with non adherent, sterile saline dressings. The dressings will need to ne moistened often to
prevent them from drying out. The sac also inspected carefully for leaks, abrasions and signs of infection.
6. A 4 year old child asks the nurse if t will hurt to have the tonsils and adenoids taken out. Which is the best response of the nurse?
a. It wont hurt because you are going to put you to sleep
b. It won’t hurt because you are such a big boy
c. It will hurt because of he incisions made in the throat
d. It will hurt, but we have medicine to help you feel better
ANS: D. Preschool aged children are fearful of physical injury. Truthful but simple explanations will minimize distorted fears and reduce
anxiety.
7. When preparing to give a neonate the first feeding by nipple, for which of the following reasons would the nurse anticipate using a
5 ml feeding of sterile water first?
a. Ascertain the patency of the neonate’s esophagus
b. Determine if the neonate can retain the feeding
c. Ensure that the neonate has the energy to take oral feedings
d. Ensure that the mother will be able to feed the neonate
ANS: A. small amounts of sterile water given to a neonate first to ascertain if the esophagus is patent and to prevent the aspirations of
formula if it is not.. An increased respiratory rate may mean increased need for oxygen.
8. An 18 year old senior tells the nurse. “everyone does it, so it’s all right,” to justify rule breaking behavior. The nurse realizes this is
an example of which level or stage of moral reasoning development as described by Kohlberg?
a. Preconventional
b. Conventional
c. Postconventional
d. Autonomous
ANS. B. Stage three behaviors of Kohlberg’s conventional level of moral reasoning focus on the approval of others. Moral dilemmas are
solved by the group standard, with an emphasis on conformity. Adolescents despite of their age function at this level of moral development
9. Which of the following methods would the nurse use to feed an infant after surgical repair of cleft lip?
a. Gastric lavage
b. Intravenous fluids
c. Rubber- tipped medicine dropper
 d. Bottle with lamb’s nipple
ANS: C. Feeding methods should produce the least tension possible on the sutures to promote effective healing of the cleft lip repair.
Therefore, a rubber tipped medicine dropper has been found to be a satisfactory method for feeding an infant who has had surgical repair
of a cleft lip.
10. Parents ask for advice about handling their 2 year old’s negativism. Which of the following would be the best recommendation.
a. Ignore this behavior because it is a stage the child is going through
b. Set realistic limits for the child, then be sure to stick to them
c. Encourage the grandmother to visit frequently to relieve them
d. Punish the child for misbehaving or violating set, strict limits.
ANS: B. A characteristic of a 2 year old is negativism, a response to their developing autonomy. Setting realistic limits is important so that
the toddler learns what behavior is and not acceptable
11. Which of the following suggestions would be most appropriate in helping parents to prepare their children for starting school?
a. Have an older sibling tell the chi9ild about school
b. Orient the child to the school’s physical environment
c. Offer to stay with the child for the first few days of school
d. Discuss school with the child if he or she asks about it
ANS: B. To help prepare the child to enter school, it is generally recommended that the child be taken to school to become oriented to the
physical surroundings. This helps to lessen the child’s concerns about what school looks like and where he or she is going, thereby helping
to alleviate some fears of the unknown. Staying with the child for a few days is not advised because it may foster dependence. The child
may ask a question out of fear therefore a good preparation cannot be accomplished through discussions.
12. Which of the following would be best to offer first to a 4 year old child who has had tonsillectomy?
a. Yellow popsicle
b. Chocolate milk
c. Cherry fruit drink
d. Vanilla pudding

13. Upon the child’s return from the post anesthesia recovery unit (PACU) after a tonsillectomy, the nurse would place the child in
which of the following positions?
a. Trendelendburg
b. Supine
c. Prone
d. Lithotomy
ANS: C. Placing the child in a prone or a side lying position facilitates drainage of secretios and helps prevent aspiration
14. Before corrective surgery, the newborn with tracheoesophageal fistula (TEF) is placed on his back in a crib with his head and
shoulders elevated. The nurse positions the infant to accomplish which of the following?
a. Reduce cardiac workload that has been increased by the anomaly
b. Alleviate the pressure of the distended abdominal contents on the diaphragm
c. Enhance pooling of secretions in the bottom of the upper esophageal pouch
d. Allow air to escape from the fistula into the trachea to educe gastric distention
Ans C : When an infant with TEF is placed on the back with the head and shoulders elevated, gravity encourages the flow of secretions with
pooling in the bottom of the upper pouch. More effective removal of secretions can be accomplished by positioning a catheter in his pool of
secretions.
15. A parent group is discussing different types of punishment. The parents ask the nurse to discuss corporal punishment. The nurse
tells the group that corporal punishment:
a. Does not physically harm the child
b. Can result in children becoming accustomed to spanking
c. Reinforces the idea that violence is not acceptable
d. Can be beneficial in teaching children what they do
ANS: B. Corporal punishment is an aversion technique that teaches children what not to do. Children can often become accustomed to
physical punishment, so the punishment must become more severe to get the same results
16. An 8 year old child with severe cerebral palsy is underweight and undersized for his age. He is being fed a diet of pureed foods and
liquids through a syringe. An appropriate nursing diagnosis for this child would be Imbalanced nutrition: Less than Body
Requirements related to:
a. Increased metabolism
b. Inability to metabolize fats
c. Impaired oral motor control
d. Increased intracranial pressure
ANS: C. A child with severe cerebral palsy has a lack of oral motor that interferes with tongue conrol, chewing, and swallowing. This is the
reason that this child is being fed pureed foods and liquids.
17. When developing a [plan of care for the mother of a child diagnosed with spastic cerebral palsy, which of the following
descriptions would the nurse include?
a. Increased muscle tone and stretch reflexes
b. Slow, wormlike writhing movements
c. Wide- based gait and poor muscle coordination
d. Tremors and lack of active movement
ANS: A. Spastic cerebral palsy, the most common clinical type, represents an upper motor neuron disorder that results in increased muscle
tone and stretch reflexes, persistent reflexes, and a lack and delay of postural control. Slow and writhing movements are characteristics of
dyskinethic or athetoid type. Ataxic type is the least common type. Children have a wide based gait and perform rapid repetitive
movements of the body.
18. When discussing the appropriate iron rich food selections with the mother of an 11 month old infant with iron deficiency anemia,
which of the following choices verbalized by the mother indicates successful teaching?
 a. Eggs, fortified cereals, meats and green vegetables
b. Fruits, cereals, milk, and yellow vegetables
c. Eggs, fruits, milk and mixed vegetables
d. Juices, fruits, fortified cereals and milk
ANS: A. Fortified cereals and green leafy vegetables are generally good sources of iron.

19. A male neonate with a 3 cm by 5 cm sac in the lumbar region of his back is diagnosed with myelomenigocele. Which of the
following would the nurse expect to find when inspecting this sac?
a. Serosanguineous fluid and fatty tissue
b. Bits of hair covered by skin
c. Spinal fluid and meninges
d. Spinal fluid, nerve tissue, and spinal bony defect
ANS: D. A myelomenigocele has three components (bony defect, spinal fluid, and nerve tissue such as meninges, spinal cord, or nerve roots)
and protrudes over the vertebrae, usually in the lower back.
20. The parents of a child with rheumatic fever express concern that their other children will develop the disease. Which of the
following would be the nurses’s best response?
a. This disease is usually not contagious
b. Your other children are easily as likely to develop this disease
c. Medicine is available to prevent this, so check with your doctor
d. Your other children are all girls. So there is no need to worry.
ANS: A. Rheumatic Fever is not usually a contagious disease as this is due to an auto immune response of the body due to recurrent
bouts of streptococcocal infection leading to the inflammation of the connective tissues.
21. After having surgery to reduce he invagination of intussusceptions, the infant has a nasogastric tube in place, is receiving
intravenous fluids, and is allowed nothing by mouth. In addition to the body weight, which of the following parameters would the
nurse use to calculate the amount of intravenous fluid and electrolyte solution to be infused over the next 24 hours?
a. Stool output
b. Urine output
c. Gastric output
d. Degree of temperature elevation
ANS: C. The volume of parenteral fluids needed is based on fluid requirements determined according to body weight and in thi situation,
gastric output. If the fluids are not replaced properly, serious fluid and electrolyte imbalances could develop

22. After teaching the parents of an infant who has had pyloromyotomy about proper postoperative feeding techniques, the nurse
determines that they have understood the teaching when they position the infant in the brib after feeding with the head elevated
and lying on whih of the following?
a. Left Side
b. Abdomen
c. Right Side
d. Back
Ans: C. positioning the infant on the right side with the head of the bed elevated facilitates passage of food through the pyloric sphincter
into the intestine.
23. A mother brings her 2 year old child to the clinic because of her concerns about the child’s nutritional status. “For the last week, he
has refused to eat anything except crackers and peanut butter. Which of the following measures would be most appropriate for
the nurse to suggest.
a. Giving the child a small reward if he eats extra food given to him
b. Consulting a physician because this behavior could lead to nutritional deficiency
c. Not worrying about this behavior food fads last only a short time and common in toddlers
d. Insisting the child eat small portions of the family’s meal to maintain adequate nutrition
ANS: C. During the toddler years, food preferences and appetite are changeable. They usually have food jags which is normal. Attempts
to alter this are met with resistance and obstinacy. Accepting this and offering some small portions of food is appropriate. Giving food
as reward is not good because eating may become a power struggle between child and parent.

24. On admission for heart surgery to repair tetralogy of Fallot. The nurse observes that a 6 year old child is cyanotic. The nurse judges
that the parents understand this disorder when they explain that one of the underlying causes of their child’s cyanosis is related to
which of the following?
a. Construction of the aorta
b. Stenosis of the mitral valve
c. Stenosis of the pulmonary artery
d. Aorta receiving blood directly from the vena cava
ANS: C. The four congenital defects associated with Tetralogy of Fallot are stenosis of the pulmonary artery, ventricular septal defect,
deviation of the aorta and hypertrophy of the right ventricle

25. A 10 year old child with history of bronchial asthma triggered by exposure to cold, smoke and nuts and is brought to the hospital’s
emergency room by his mother. Appearing restless and anxious. The child’s respiratory rate is 36 breaths per minute and a pulse
rate of 160 bpm. Which of the following findings would be of greatest concern to the nurse?
a. Increased respiratory effort
b. Moist, loose cough
c. Absence of wheezing
d. Prolonged expiratory phase
 ANS C : Knowing that this child is having an asthma attack, the nurse would expect to hear wheezing and note some shortness of
breath with prolonged expiratory phase. The absence of breathing may be indicating that the child is not moving well through the lungs
and is at risk for hypoxia and possible respiratory failure.

26. On initial assessment of a 7 year old with rheumatic fever, which of the following would require contacting the physician
immediately?
a. Heart rate of 150 bpm
b. Swollen and painful joints
c. Twitching in the extremities
d. Red rash on the trunk
ANS: A. A heart of 150 bpm is very high for a 7 year old. This may indicate carditis. Swollen, painful joints is a sign of polyarthritis,
chorea (twitching of the extremities) and erythema marginatum (rashes) are all classic signs of rheumatic fever.

27. Which of the following statements indicates that the parents understand the need for their child to receive long term antibiotic
therapy after an episode of rheumatic fever.
a. It will prevent further streptococcal infections
b. It will protect against further joint damage
c. The inflammation will subside more quickly
d. The inflammation will be reduced with future attacks
ANS A: Long term treatment for rheumatic fever involves monthly penicillin injections to prevent subsequent streptococcal infections that
can cause further heart damage.
28. The adolescent client who is very body conscious asks the nurse that he would like to lose weight and asks the nurses’s opinion on
how to accomplish his goal. Which of the following suggestions would be most appropriate?
a. Exercising more often
b. Severely limiting caoric intake
c. Participating in an adolescent weight reduction program
d. Cutting fown on sweets and other snacks
ANS: C. Weight loss treatment modalities that include peer involvement have been proven to be the most successful approach for
adolescents. This is because peer support is critical to adolescents.
29. Which of the following activities would the nurse include in the teaching plan for a mother to help channel her 4 year old child’s
energy?
a. Participation in parallel play
b. Play involving a game such as Simon says
c. Bicycle riding
d. Stringing of large beads
ANS: B. A game such as Simon says, which requires the preschooler to imitate, use a variety of motor skills and can help channel activity to
meet developmental needs.
30. Which of the following behaviors absent in an 18th month old child would cause the nurse to be concerned?
a. Copying a circle
b. Playing with pull toys
c. Playing tag with other children
d. Building a tower of 8 blocks
ANS:B. Playing with pull toys is a typical task of a normally developed 18 month old. Child inability of the toddler to do so would be concern.
Copying a circle is a behavior type for 3 year old. Playing tag requires rules so is best played by

31. Which of the following nursing diagnoses would the nurse identify as the priority for a 4 month infant with heart failure and
congenital heart disease?
a. Activity Intolerance
b. Risk for Infection
c. Impaired Mobility
d. Ineffective Health Maintenance
ANS: A. An infant with congenital heart disease and congestive heart failure usually tires easily, leading to a priority nursing diagnosis of
Activity Intolerance. Nursing care needs to focus on allowing the infant to have frequent rest periods.
32. The mother, concerned about her infant’s surgery for inguinal hernia repair, asks the nurse if her infant would have been
scheduled for surgery even if the hernia had been asymptomatic. Which of the following statements offers the best explanation
why the surgical repair would be done at this time?
a. An infant is better to tolerate the physical stress of surgery than an older adult child is.
b. The experience of surgery is less frightening for the younger child
c. Less and danger and fewer complications result when surgery is an elective procedure
d. Doing surgery near the genital organs is preferred before a child becomes conscious of sexual identity

ANS: C. Inguinal hernia repair is ordinarily done promptly after diagnosis in healthy infants and children. Delaying surgery may
result for an obstruction (incarcerated hernia).This may lead to gangrene and can be fatal.

33. Mark 9 years old conceives death as:

a. A person
b. Temporary
c. A form of sleep
d. Cessation of corporal life
 D. At the age 9 children already have the adult concept of what death is. They know that death is final and universal. Seeing death as a
person (eg The Grim), and as temporary is common in preschool children

34. Your patient, Tyrone is 15 years old and is admitted in the hospital for Hemophilia.
Which factor would be least important when assigning Tyrone to a room unit?

a. Ensuring Tyrone’s privacy

b. Placing Tyrone with another Hemophiliac, regardless of age
c. Ensuring the opportunity for peer interaction while resting in bed
d. Ensuring that the room is close to the teen ager’s lounge

ANS:B. Since the patient is an adolescent interaction with the same age group is important and should be considered.

35. The nurse is instructing a mother about the nutritional needs of her full-term breastfeeding infant at age 2 months. Which of the
following responses show that the mother understands the infant’s dietary needs?

a. “We won’t start any new foods now.”

b. “We’ll start any new foods now.”
c. “We’ll introduce cereal into the diet now.”
d. “We should add new fruits to the diet one at a time.”

ANS: A. The infant is only 2 months old. They can be fed with breastmilk. Solid food can be introduced earliest at 4 months. However the
best time to give solid feeding is at 6 months.

SITUATION: Raphael, a 6 year old pupil is seen at the clinic for growth and development monitoring.
36. Which of the following characterize the rate of growth during this period?
a. Most rapid period of growth
b. A decline in growth rate
c. Growth spurt
d. Slow and uniform growth rate

ANS. D. School aged children as described as having slow and uniform growth rate often labeled as “growth gap”. The most rapid period is
seen during the infancy period and the growth spurt during the period of adolescence.

37. You typically gag children to inspect the back of their throat. When is it important not to elicit a gag reflex?
a. When children are under 5 years of age
b. When a child has symptoms of epiglottitis
c. When a boy has a possible inguinal hernia
d. When a girl has a geographic tongue
ANS: C. Children diagnosed or suspected as having epiglotitidis are not supposed to be gagged because this increases the risk of
laryngospasms and lead to complete airway obstruction.

38. Elisa, a 14-month-old, is admitted to the hospital with laryngotracheobronchitis (croup). On assessment, the nurse would expect
to find:
A. Cyanosis and dyspnea
B. Productive coughing and a high fever
C. Pale laryngeal tissue and dyspnea
D. Barking cough and inspiratory stridor
ANS. D. The hallmark manifestations of children having croup (LTB) are hoarseness, barking cough, mild wheezing and stridor. The
manifestations are also more commonly seen at night time.
39. A four-year-old is experiencing an acute asthma attack. Why should the nurse avoid chest percussion with this child?
a. Chest percussion may lead to increased bronchospasm and more respiratory distress.
b. Chest percussion may cause mucous plugging of the alveoli.
c. Chest percussion is useful in removing airway secretions and should be used.
d. Chest percussion will produce increased coughing and thereby enhance respiratory distress.

ANS: B. Chest percussions during an asthmatic attack are not advisable because it will cause further mucous plugging. During an asthma
attack a child will have not productive coughing and will not be able to expectorate the mucous. Thus mobilizing the secretions through
chest trappings may just contribute to the plugging of the airways.

SITUATION: Three-year old Dugyot gas been admitted to the Pediatric Unit. His blood pressure 100/700 mmHg; pulse rate, 110 beats per
minute; temperature, 38°C and weight, 18 kg. Impression: Nephrotic Syndrome.

40. During his previous afew days ago. check-up, his blood pressure was 95/60 mmHg; PR was 110 beats per minute and weighed 15
kg. Which assessment finding would support the impression of nephrotic syndrome?
a. Blood pressure c. Temperature
b. Weight d. Pulse rate

ANS. B. Excessive protein loss in the urine produces one of the most characteristic manifestation of nephrotic syndrome which is edema. A
sudden increase in weight may reflect this manifestation.
 41. The nurse is caring for an infant whose cleft lip was repaired. Important aspects of this infant’s postoperative care include which of
the following?
a. Arm restraints, postural drainage, mouth irrigations
b. Cleansing suture line, supine and side-lying positions, arm restraints
c. Mouth irrigations, prone position, cleaning suture line
d. Supine and side-lying positions, postural drainage and restraints.

ANS. B. As part of the post op care after cleft lip repair. Suture lines should be cleansed with sterile water especially after feeding. The
preferred position is supine and/or side lying position to promote drainage and prevent pressure over the suture lines. Restraints can also
applied to prevent the infant from touching the surgical site.

42. Which of the following statements from the nursing history would support the medical diagnosis of febrile seizure?
a. The child has bad a low-grade fever for several weeks
b. The family history is negative for convulsions
c. The seizure resulted in respiratory arrest
d. The seizure occurred when the child had a cough, rhinorrhea, and complaints of ear pain

ANS: D. Febrile seizure is a benign neurologic condition that is mostly related to a high grade fever. This may be precipitated during an
infectious process that triggered the fever or after an immunization. A positive family history can help in the diagnosis of a febrile
seizure.

43. The nurse identifies the teaching plan of the parents of a child with cystic fibrosis. The mother demonstrates correct
understanding about a child’s medication when she says:
a. “I’ll dilute the enzyme in a glass of milk and give it to him after his meal.”
b. “I’ll dilute the enzyme in hot soup and give it to him in between meals.”
c. “I’ll mix the enzyme in a small amount of food and give to him before each meal.”
d. “I don’t have to give him the enzyme if he has a good bowel movement.”

ANS: C. Pancreatic enzymes are often necessary to be administered to a patient with cystic fibrosis because the plugging of the pancreatic
ducts cause a decrease or absence of the enzymes. It should be given before each meal and can be mixed in a small amount of food but not
diluted since the medication is often in an enteric coated form of capsule.
44. Which information should not be included in discharge teaching for a child with cystic fibrosis?
a. The child’s diet should be low in fat content
b. Restrict the child’s fluids to reduce excessive sweating
c. Encourage physical activities
d. High-salt foods such as pretzels should be regular part of the child’s diet

ANS: B. Restricting the diet of the child should not be included in the plan of care. CF usually causes the exocrine glands to produce
excess mucus. Water is important because it serves as a natural mucolytic and helps liquefy the secretions. Low fat diet may be
necessary because of the low levels of enymes to break it down. Added salt in the diet may be required in order to compensate for the
increase NaCl excretion in the sweat.

45. Which of the following statements by the parents of a child with school phobia would indicate the need for further teaching?
a. “We’ll keep him at home until the phobia subsides”
b. “We’ll work with his teachers and counselors at school”
c. “We’ll try to encourage him to talk about his problems”
d.”We’ll discuss possible solutions with him and a counselor”

ANS. A. When a child experiences school phobia. Actions should be taken in order to determine the cause of the problem.
However, it will be for the best of the interest of the child to be sent back to school the soonest possible time for the child to
understand that being out of school is not good as well.

46. For which of the following reasons would the nurse expect to institute intravenous fluid therapy and nothing by mouth (NPO)
status for an infant with bronchiolitis?
a. Tachypnea
b. Irritability
c. Fever
d. Tachycardia
ANS: A. When a child is having tachypnea chances of aspiration with feeding or giving fluids becomes high.

Situation- Graciela 1 ½ year old is admitted the hospital the emergency room with a fracture of the left femur due to a fell down a flight of
stairs.

47. The nurse notes that the fall might also cause a possible head injury. She will be observed for signs of increased intracranial
pressure which include:
a. Narrowing of the pulse pressure
b. Vomiting
c. Periorbital edema
 d. A positive Kernig’s sign

ANS: A. A widened pulse pressure accompanying hypertension, bradypnea, bradycardia, high pitch cry, bulging fontanelles are the common
signs of increased ICP. Vomiting in increased ICP is characteristically projectile in nature.

48. When teaching a child how to perform coughing and deep-breathing exercises before corrective surgery for Tetralogy of Fallot,
which of the following teaching and learning principles would the nurse address first?

a. Organizing information to be taught in a logical sequence

b. Arranging to use actual equipment for demonstrations
c. Building the teaching on the child’s current level of knowledge
d. Presenting the information in order from simplest
ANS C : Before any teaching is made. It is important to assess primarily the current level of knowledge of the child. This will be the
basis of the teaching approach for the patient.

49. In choosing toys for an infant, what criteria should be considered a priority?

a. Educational Purposes
b. Development Function
c. Safety
d. Recreation use

ANS:. C. The most significant consideration when choosing toys for children is the safety.

50. A recently hospitalized 2 – years – old client scream and shouts he wants a “ bottle”. His parents are puzzled and state he has
drunk from a cup for the past year. The nurse explains that:
a. Irritability is exhibited in all age groups.
b. Temper tantrums often represent the childs need for parental attention
c. Various forms of punishment are necessary when such behavior occur
d. Regression to an earlier behavior often helps the child cope with stress and anxiety

ANS: D.One of the most common defense mechanisms the young children used to cope with stress is regression

51. A 2 mos. Old infant is suspected of having coarctation of the aorta. The sign of this defect is.
a. Dubbing of the digits and circumoral cyanosis
b. Pedal edema and portal congestion
c. Systolic ejection murmur
d. Upper extremity hypertension

ANS. D. Because blood usually not able to flow to the descending aorta because of the narrowing of a portion of this vessel., blood is
shunted to the ascending aorta. This causes hypertension of the upper extremities, signs of increased ICP, weak and thready pulse in the
lower extremitites.

52. Left to right shunting is seen in:

a. ASD
b. VSD
c. TOF
d. Both A and B
ANS: D. Left to right shunting is seen with acyanotic defects

53. Nurse explains that a child with athetoid cerebral palsy most will demonstrate.
a. exaggerated hyperactive reflexes
b. normal intelligence level
c. slow, wormlike writing movements
d. unsteady gait and clumsy, uncoordinated upper extremity function
ANS: C. Athetoid CP is associated with slow movements, flaccidity. Spastic CP is associated with hyperactive reflexes, abnormal posturing,
rigid muscles. Disintegration of the movements of the upper extremities is seen in ataxic cerebral palsy.

54. In choosing an appropriate toy for a 9 year old asthmatic child the nurse would choose:
a. A board game
b. Sponge Bob the movie
c. A coloring book
d. A set of building blocks
ANS: A. A board game is developmentaly appropriate to a nine year old. It is stimulating without causing excessive physical
exertion.
55. The mother discusses with the nurse that her toddlers 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
 ANS: A. Ritualism is commonly observed in toddlers. Knowing what will happen next decreases their anxiety. Object permanence is
demonstrated by infants when they try to look for objects that falls, it is knowing that an objects exists even if it is out of sight.

56. During a post of period for child who has had a ventriculoperitoneal shunt repair the nurse know that the child should be
positioned:
a. On the unoperated side, HOB elevated 90 degrees.
b. High flowlers position.
c. On the operated side, flat.
d. On the unoperated side, flat for the first 24 hours
ANS: D. immediately after the shunt placement, the child is placed in a flat position on the unoperated side in order to avoid compression
of he shunt valve and the prevent the excessive draining of CSF. This can lead to the tearing of the brain tissues.

57. When caring for a child and family with a different cultural background, the nurse will conceive which of the following as an
appropriate goal?
a. Strive to keep the background from interfering with health needs
b. Discourage continuation of cultural practices in the hospital
c. Gently attempt to change the family’s belief
d. Adapting the family’s cultural beliefs to the health needs as necessary
ANS: D. Following the theory of transcultural nursing. It is best to adapt or taylor fit the cultural belief’s with the plan of care without
compromising the health of the patient. This also reflects acceptance of the patient and respect for his rights.
58. Which is the most likely associated with a stroke from a congenital heart disease?
a. Polycythemia
b. Cardiomyopathy
c. Endocarditis
d. Low blood pressure
ANS: A. Congenital heart disease may cause hypoxia thereby triggering the body to produce more red blood cells as a compensation.
Polycythemia increases the risk of thrombus formation that can lead to a stroke.
60. A Moro reflex is the single best assessment of neurologic ability in a newborn. What is the best way to test this reflex?
a. Observe the infant while she is on her abdomen to see whether she can turn her head.
b. Lift the infant’s head while she is supine and allow it to fall back 1 inch.
c. Shake the infant’s crib until the infant responds by flailing her arms.
d. Make a sharp noise, such as clapping your hands, to wake the infant.
ANS: B. Clinically speaking the best way to assess for the Moro reflex is by suddenly shifting the sense of balance of the child. Infants may
not respond to the shaking of the crib or a loud sound especially when they get used to it. Infants have the capacity to undergo habituation
or shutting out external stimuli.

61. Bryan’s mother is concerned about him developing baby-bottle syndrome. What would be her best action to prevent this?
a. Use plastic rather than glass bottles
b. Boil formula to reduce the curd
c. Don’t put Bryan to bed with a bottle
d. Check the expiration date on formula
ANS: C. Putting the child to bed with a bottle. Increases contact time milk and the teeth. When bacteria acts on lactose it may cause the
enamel breakdown of the teeth.
62. You teach Robin imaging to help reduce pain from blood drawing. Why does a technique such as imagery work well for children?
a. Children’s pain is not as acute as in adults.
b. Intravenous pain relief is not effective in children.
c. Children’s imaginations are at their peak.
d. Children’s muscles are less tense than adults’ muscles.
ANS: C. Children have very active imaginations making imagery a very effective technique .
63. Barry’s mother tells you she often makes milkshakes with raw eggs. What infectious organism is easily spread this way?
a. Pneumococcus
b. Salmonella
c. Streptococcus A
d. H. pylori
ANS: B. Eating raw, improperly cooked eggs can cause salmonelliosis.
64. What is typically the first symptom of acute glomerulonephritis?
a. Low blood pressure from excessive aldosterone.
b. “Old blood” in urine from kidney bleeding.
c. Dependent edema from protein accumulation
d. Pain on urination from urethra inflammation.
ANS; B. Old blood in the urine or hematuria is a common manifestation for children with AGN
65. What information would you want parents to know about their child with cerebral palsy?
a. Symptoms of cerebral palsy usually fade by puberty.
b. All children with cerebral palsy are cognitively challenged.
c. Cerebral palsy may be associated with a vaccine.
d. Symptoms may seem to grow worse as fine motor skill is needed.
ANS: D. The main problem of children with CP is muscular control. The symptoms become more obvious as the child requires more
control as in doing fine motor skills. CP does not fade nor is curable. Not all children with CP has mental retardation.
66. Another concern in the care of toddlers is toilet-training. Which of the following is the most important factor for a successful
toilet-training?
 a. Age of the child
b. Developmental readiness of the child
c. Toilet-training at scheduled time
d. Mother’s flexibility for growth and development
ANS: B. The most important thing to consider during toilet training is the developmental readiness of the child this may include being able
to sit, stand, walk, talk, keep dry for a few hours. Children usually show signs of readiness at about the age of 1 ½ years old.
67. His mother expresses concern about her sons, Rico 1 year old, slow development.. Upon assessment, the nurse observes that
Rico’s motor development is normal for his age. Which of the following is inappropriate for his stage?
a. Sits down from standing position without help
b. Walks alone
c. Walks with support
d. Stands for a moment without support

ANS: B. Children at age 1 can stand up, walk with support but not walk alone very well. This can be expected at about 15 to 20 months of
age.
68. Rico currently weighs 9 kg. His mother asks if this is normal for him because his previous birth weight was 3 kg. Which of the following
is an appropriate response?
a. “Yes, because at 1 year old, he usually weighs three times his birth weight.”
b. “His weight is below normal. You should give him food supplements.”
c. “He should have doubles his birth weight by now.”
d. “You need not worry. His weight is advance for his age.”
ANS: A. infants normally double their birth weight at 6 months and triple this when they reach 1 year old.
69. An infant with respiratory synctial virus (RSV) is on (Virazole) therapy. The nurse would be correct to explain that:
a. The prescribed medication would be given intravenously
b. The child will receive the medication once a week for 4 weeks
c. Individuals who are pregnant should not visit during treatments
d. The child will be put in protective isolation during treatments

ANS: C. Virazole is normally given via aerosols not IV. It is important to consider that pregnant visitors or nurses are not allowed inside the
room during the administration because the drug is highly teratogenic.

70. immediately after the first oral feeding after correcting pyloric stenosis, a 4 month old infant becomes fussy and restless. Which of the
following actions is considered appropriate?

a. Encourage parents to hold the child

b. Hang a mobile toy over the crib
c. Give he infant more food to eat
d. give the infant pacifier to suck on

ANS: D. Giving a pacifier will meet the nonnutritive requirement sucking needs and allows for oral gratification. Sucking may help n calming
down the infant. Holding the infant may be better for an older infant.
71. Which of the following is a cardiovascular disease of the infant?
a. Rheumatic heart disease
b. Coronary artery disease
c. Acute glomerulonephritis
d. Congenital heart disease
ANS: A. For most the part infants suffering from cardiovascular disease are having Congenital heart disease. CAD is more common in adults.
RHD and AGN are acquired illnesses that can be seen much more later in life.
SITUATION: Baby Nicole is born with myelomeningocele.
72. The nurse explains to Baby Nicole’s parents that even if surgery is successful, Nicole will need the continued health supervision of a:
a. Cardioloist
b. Dental hygienist
c. Urologist
d. Speech therapist
ANS: C. Most children with myelomeningocele has bowel and bladder problems so a urologist may be needed to provide care for the
patient.

73. Daily weights need be taken of children having all of the following disorders EXCEPT

a. cardiac failure
b. edema
c. vomiting
d. anemia

ANS: D. Children having any condition causing retention or loss of body fluids should have their weight monitored daily. These weight
give a clue to a child’s hydration status. Children who have anemia need not be monitored by daily weights

74. Passage of meconium after birth indicates patency of the gastrointestinal tracts. A nurse should become concerned if a newborn infant
still has not passed meconium
a. 6 hours after birth
 b. 12 hours after birth
c. 18 hours after birth
d. 24 hours after birth

The answer is D. Vanghan, ed 10. p 374) Meconium is the first product of the fetal gastrointestinal tract; it is odorless, dark green in
color, and composed of a mixture of amniotic fluid and intestinal secretions. By 24 hours after birth, more than 90 percent of infants
have passed meconium, and most of the remaining 10 percent of infants pass meconium within 36 hours after birth.

75. In helping a family cope with the birth of an abnormal child, a nurse should first
a. discuss the abnormality and its probable cause
b. discuss the effects the abnormality will have on the growth and development of the child
c. encourage the family to verbalize their feelings and reactions
d. present the child’s positive features and minimize the negative ones

The answer is C.) Expectant parents envision a perfect, healthy baby. When a child is born abnormal, the family can go into a state of
crisis. Family members need time to mourn the loss of the child they expected and to replace their feelings of guilt and grief with
understanding and acceptance

76. Which of the following findings in a baby most suggest the presence of Wilms’ tumor (nephroblastoma)?
a. alopecia
b. bleeding gums
c. tight diapers
d. muscle spasticity

The answer is C. Wilms’ tumor (nephoblastoma) is an encapsulated kidney tumor predominantly affecting children. It can be
discovered in a child by palpation of the abdomen by a physician during routine examination or by a family member when bathing or
diapering the child. Because the large mass (about the size of an orange) changes the abdominal girth, diapers that once fit may
appear tight.

77. Ms.S. asks how much her 3-day-old baby weighs. When the nurse tells her 5 lb 11 oz (2580g), she starts to cry because the baby is losing
weight. The baby weighed 6 lb 6 oz (2863) at birth. What is the expected weight loss pattern in newborn?

a. none
b. 5%
c. 5%- 10%
d. 10%-15%

The correct answer is C. within 3-4 days of birth, a weight loss of 5%-10% is normal.

78. A child is to receive radiation therapy following surgery for Wilm’s tumor. Which of the following measures would be important to
include in the care plan prior to radiation therapy.

a. Give compazine every six hours for nausea.

b. Place a sign over the bed that reads “no needle punctures.”
c. Practice lying in the required position
d. Encourage play appropriate to age.

ANS. C. The child stay in a fixed position during each therapy session, which may last 10-20 minutes.
Having the child practice the required position prior to beginning radiation therapy can be helpful.

79. A nine-year-old girl with rheumatic fever is asking to play. Which diversional activity is the nurse likely to offer?

a. Walking to the gift store.

b. Coloring books and crayons.
c. A 300 piece puzzle.
d. A dancing contest.

ANS. C. This will be quiet, yet stimulating.

Walking may be too strenuous
This is for the younger patient.
This is too strenuous

80. An infant with cardiac disease has been admitted to the nursery from the delivery room. Which finding helps the nurse to differentiate
between a cyanotic and an acyanotic defect?
a. Infants with cyanotic heart disease feed poorly.
b. The pulse oximeter does not read above 93%.
c. Infant with cyanotic heart disease usually go directly to the operating room.
d. Cyanotic heart disease causes high fevers.
81. . A male newborn was just admitted to the pediatric floor with a myelomeningocele. When developing the preoperative plan of care,
the nurse lists “high risk for infection of and trauma to the nonepithelialized lesion” as the diagnosis of most concern. The most effective
strategy to prevent infection and trauma to the lesion would be to:
a. leave the lesion uncovered and open to the air and place the baby supine.
b. cover the lesion with sterile, saline-soaked gauze and place the baby supine.
c. apply lotion to the lesion and place the baby on his side.
d. cover the lesion with moist sterile gauze and place the baby prone.

ANS. D. The lesion must be kept moist with sterile,

saline-soaked gauze. The prone position should be
maintained preoperatively to prevent tension on the
lesion and minimize trauma.

82. The most common manifestation in RF’s major criteria is

a. Sydenham’s Choreas
b. Migratory polyarthritis
c. Erythema marginatum
d. St. Vitus Dance
ANS: B. The most common major criteria is Polyarthirits. Almost 70% of patients have this manifestation
83. The nurse administers which of the following vaccines to help prevent the development of epiglottitis?
a. Diphtheria/tetanus/acellular pertussis (DTaP) combination vaccine
b. Varicella vaccine (Varivax)
c. Haemophilus influenzae vaccine (HIB)
d. Pneumococcal polysaccharide vaccine (Prevnar)
ANS: C. The most common etiologic factor leading to epiglottitidis is H. infulenzea
84. As a schooler what psychological task should be developed by him at his age?
a. Intimacy vs. isolation
b. Initiative vs. guilt
c. Industry vs. inferiority
d. Identity vs. role diffusion
ANS: C. According to Erikson the developmental task at this age is Industry. Sense of achievement is paramount.
85. The mother of one of the children was told to have her daughter confined. One of the effects of hospitalization for children is
separation. At what stage are children most likely to experience separation anxiety?
a. Pre-school age
b. Adolescence
c. Toddler
d. Newborn
ANS: C. Separation anxiety is strongly seen in toddlers

86. The primary nursing intervention that can be used to help a 1 month old infant tolerate hospitalization?
a. Using consistent caregivers
b. Providing sensorimotor stimulation
c. Following home schedule as closely as possible
d. Keeping the infant warm and dry

ANS: A. For an infant using consistent care and care giver is important for the child to be able to develop a sense of trust

87. After teaching a group of parents of preschoolers attending a well-child clinic about oral hygiene and teeth brushing, the nurse
determines that the teaching has been successful when the parents state that the children can begin to brush their teeth with minimum
help at which of the following ages?
A. 3 years
B. 5 years
C. 7 years
D. 9 years
ANS A: According to the MMDST, children at the age of 3 can already brush their teeth with minimal supervision and at age 7 can to it
alone.
88. Which of the following must be monitored preoperatively before a child has a tonsillectomy and adenoidectomy?
A. Clotting times
B. Serum electrolyte levels
C. Urinalysis
D. White blood cell differential

ANS: A. The bleeding and clotting status of a patient before tonsillectomy should be monitored because bleeding is a common complication
89. While discussing a plan of care for the neonate, the mother asks if her baby will be at risk for any other defects. The nurse’s answer
would be based on the fact the myelomeningocele is frequently associated with:
A. an abnormal increase in cerebrospinal fluid (CSF) within the cranial cavity
B. an abnormally small head
C. congenital absence of the cranial vault
D. premature fusion of the cranial sutures
ANS: A. Children with neural tube defects especially the cystic type may have an increased risk to develop hydrocephalus.
90. After cleft palate repair feeding is done through:
A. A soup spoon
B. A dessert fork
C. A plastic syringe
D. An infant spoon

91. An infant’s blood pressure is reported to be very high. What is the most appropriate nursing action to take?
a. Take it again in 20 minutes.
b. Call the house officer.
c. Measure the cuff width to the infant’s arm.
d. Prepare to give an antihypertensive.

ANS C . The cuff should be approximately two-thirds the length of the humerus then the blood pressure should be rechecked afterwards.
92. A child with tetralogy of Fallot has been admitted. What equipment is most important to have at the bedside?
a. Morphine
b. A blood pressure cuff.
c. A thermometer
d. An oxygen setup

ANS D. This is used emergently in a Tet spell. A is a necessary drug, but should not be at the bedside, B and C are necessary equipment,
but need not be at the bedside

93. An 18-month-old presents with nasal flaring, intercostals and substernal retractions, and a respiratory rate of 50. What is the most
appropriate nursing diagnosis?
a. Knowledge deficit.
b. Ineffective breathing pattern.
c. Ineffective
d. High risk for altered body temperature

ANS B. The findings on assessment suggest respiratory distress. Ineffective breathing pattern is an appropriate diagnosis
94. An 8 year-old presents to an urgent care center with respiratory distress and cyanosis. Parents report an initial episode of choking.
What is the best initial action for the nurse to take?
a. Call 911 and have parents wait for an ambulance to transport the child to a pediatric hospital.
b. Administer oxygen by face mask and call the child’s pediatrician.
c. Perform thrusts as described in the Heimlich maneuver.
d. Start CPR after the child loses consciousness.

ANS C. The reported episode of choking and the child’s condition suggest foreign body aspiration. The Heimlich maneuver should be
attempted as an initial action to remove the object.
95. A baby girl is born prematurely to a mother with polyhydramnios. The baby is diagnosed with esophageal atresia with
tracheosophageal fistula. What assessment finding would the nurse be likely to note?
a. Jaundice, high bilirubin
b. Seed yellow stools.
c. Projectile emesis.
d. Forthy saliva, drooling.
ANS: D. Infants with esophageal atresia (EA) with tracheoesophageal fistula (TEF) have difficulty handling their secretions
96. A six-month old boy is treated at home with saline enemas due to his Hirschsprung’s disease. His mother asks if she can use tap water
to reduce costs. The nurse responds,
a. “Yes, tap water is as effective as saline, just be sure to boil it first.”
b. “No, saline enemas must be used to maintain his electrolyte balance.
c. “Yes, you can use tap water after letting it run for one minute to clear any lead from the pipes.
d. “No, tap water enemas are not allowed, but soap suds enemas are just as effective.”
ANS B. Repeated water enemas cause electrolyte dilution. Tap H20 is effective for enemas but not in maintaining electrolyte, integrity in
a Hirschsprung’ patient
97. The nurse is planning care for a two-year –old who has AGN and is in remission. What type of diet would the nurse plan to feed this
child?

a. High protein, low calorie.

b. High calorie, low protein.
c. Low sodium low fat.
d. Regular diet, no added salt.

ANS: D. The child who is in remission is allowed a regular diet; salt is restricted in the form of no added salt at the table and excluding
foods with very high salt content. This prevents an increase in the blood pressure as well as more edema
98. In counseling parents about controlling fever in their child, a nurse should advise them to do all of the following EXCEPT
a. Give fluids every two hours
b. Keep the environmental temperature at 32°C (80°F) or more
c. Dress the child in light clothing
d. Take the child’s temperature every two hours when the fever is above 37°C (100°F)
Answer is B. It is an old wives’ tale that bundling a child in heavy clothing will reduce a fever. The danger of this practice with small
children is that heavy clothing increases a child’s temperature and thus can increase the risk of a febrile convulsion
99. If 200 ml of 5% dextrose in 0.25% normal saline (D51/4 NaCL) is to be given over a period of 8 hours, the flow should be adjusted to how
many microdrops per minute?
a. 2
b. 4
c. 8
d. 25

The answer: D. One milliliter of solution contains 60 microdrops. Thus, a child receiving 200 ml of solution in 8 hours receives. 25 ml per
hour, which equals 25 microdrops per minute (25) ml/hour x 60 microdrops/ml)/60 min/hour.
100. A hospitalized child who has increased intracranial pressure must be monitored closely for
a. decreased bowel sounds
b. diarrhea
c. fecal incontinence
d. constipation
The answer is D. Headache is a common symptom of increased intracranial pressure. Factors that transiently increase pressure usually
also increase the severity of headaches and thus should be prevented whenever possible. The Valsava maneuver, which is a common
cause of transient pressure increases, is elicited by a variety of activities, including crying, coughing, straining at stool, vomiting