EVALUATIVE EXAMINATION – NORMAL PEDIA

1. The nurse is teaching a class of pregnant women about diet. Which nutrient decreases
the incidence of neural tube defects (NTDs)?

a. Vitamin A
b. Vitamin C
c. Vitamin D
d. Folic acid

2. Which assessment finding suggests that Rod has spina bifida occulta?

a. Bilateral hip dislocation

b. Bulging anterior fontanel
c. Noticeable dimpling above the separation of the buttocks.
d. No movement in the lower extremities

3. A mother brought a 10-month-old boy born with myelomeningocele and underwent

surgical repair of myelomeningocele. Which measure should the nurse use to prevent
musculoskeletal deformity in the infant?

a. Placing the feet in flexion.

b. Allowing the hips to be abducted.
c. Maintaining knees in the neutral position.
d. Placing the legs in adduction.

4. When assessing the infant admitted to the pediatric unit with upper lumbar
myelomeningocele, which characteristic should Nurse Lilibeth anticipate finding?

a. Minimal movement of the lower extremities.

b. Upper extremity paralysis.
c. Urinary bladder prolapsed.
d. Respiratory problems.

5. When positioning a neonate with unrepaired myelomeningocele, which of the following

positions is the most appropriate?

a. Supine with hips at 90 degrees.

b. Right side-lying position with the knees flexed.
c. Prone with hips in abduction.
d. Supine in semi-fowler’s position with chest and abdomen elevated.
6. Which of the following signs and symptoms would the nurse most likely find when
assessing an infant with Arnold-Chiari formation?

a. Flaccidity, lack of sensation in the lower extremities, and loss of bowel and bladder control
b. Diminished or absent gag and swallowing reflex, hydrocephalus, and respiratory distress
c. thick mass over the neck muscle, holds the head tilted to the site of the muscle involved
d. The foot cannot be properly aligned, the foot turns out

7. What would cause the closure of the Foramen ovale after the baby had been delivered?

a. Decreased blood flow

b. Shifting of pressures from the right side to the left side of the heart
c. Increased PO2
d. Increased in oxygen saturation

8. Which of the following are defects associated with the Tetralogy of Fallot?

a. Coarctation of the aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus
b. Ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy
c. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right
ventricle
d. Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two
noncommunicating circulations

9. A child diagnosed with Tetralogy of Fallot becomes upset, crying and thrashing around
when a blood specimen is obtained. The child’s color becomes blue and the respiratory rate
increases to 44 breaths per minute. Which of the following actions should Nurse Aubrey do
first?

a. Obtain an order for sedation for the child.

b. Assess for an irregular heart rate and rhythm.
c. Explain to the child that it will hurt for a short time.
d. Place the child in a knee-to-chest position.

10. When assessing the child with tetralogy of Fallot, which of the following positions
would the nurse expect to see as a compensatory mechanism?

a. Low Fowler’s
b. Prone
c. Supine
d. Squatting
11. When teaching a preschool child how to perform coughing and deep-breathing
exercises before corrective surgery for Tetralogy of Fallot, which of the following teaching
principles should Nurse Aubrey address first?

a. Organizing information to be taught in a logical manner.

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 to most complex.

12. The mother of a hospitalized child diagnosed with TOF tells the nurse that the child’s
3-year-old sibling has become quiet and shy and demonstrates more than the usual amount
of sexual curiosity since her other child has been hospitalized. Nurse Aubrey responds to
the mother based on the interpretation that these behaviors reflect:

a. Usual behavior for a 3-year-old.

b. Need for more attention.
c. Exposure to a sexual experience.
d. Indication of depression.

13. The nurse assesses a newborn with absent femoral pulses. This physical finding is
associated with which neonatal problem?

a. PDA
b. VSD
c. TOF
d. COA

14. While assessing a child with coarctation of the aorta, the nurse would expect to find
which of the following?

a. Absent of diminished femoral pulses

b. Squatting posture
c. Cyanotic (“tet”) episodes
d. Severe cyanosis at birth

15. When developing a teaching plan for the parents of a child with pulmonic stenosis, the
nurse would keep in mind that this disorder involves which of the following?

a. Return of blood to the heart without entry into the left atrium
b. Obstruction of blood flow from the right ventricle
c. Obstruction of blood from the left ventricle
d. A single vessel arising from both ventricles
16. Failure of the Foramen Ovale to close will cause what congenital heart disease?

a. Total anomalous Pulmonary Artery

b. Atrial Septal defect
c. Transposition of great arteries
d. Pulmonary Stenosis

17. After birth, the newborn’s circulation converts from a fetal to a neonatal circulation.
The nurse understands that the increase in the infant’s PO2 causes which shunt to close?

a. Foramen ovale
b. Ductus arteriosus
c. Ductus venosus
d. Ventricular septum

18. Which of the following represents an effective nursing intervention to reduce cardiac
demands and decrease cardiac workload?

a. Scheduling care to provide for uninterrupted rest periods

b. Developing and implementing a consistent plan of care
c. Feeding the infant over long periods of time
d. Allowing the infant to have her way to avoid conflict

19. Which of the following nursing interventions would be appropriate to promote

optimal nutrition in an infant with congestive heart failure?

a. Offering formula that is high in sodium and calories

b. Providing large feedings evenly spaced every 4 hours
c. Replacing regular nipples with easy-to-suck ones
d. Allowing the infant to feed for at least 1 hour

20. Which of the following would the nurse do first for a 3-year-old boy who arrives in the
emergency room with a temperature of 105 degrees, inspiratory stridor, and restlessness,
who is leaning forward and drooling?

a. Auscultate his lungs and place him in a mist tent

b. Have him lie down and rest after encouraging fluids
c. Examine his throat and perform a throat culture
d. Notify the physician immediately and prepare for intubation
21. Which of the following respiratory conditions is always considered a medical
emergency?

a. Laryngotracheobronchitis
b. Epiglottitis
c. Asthma
d. Acute nasopharyngitis

22. Epiglottitis, an inflammation of the epiglottis creates an emergency situation. This is:

a. An autoimmune disorder
b. Viral only in nature
c. Caused only by bacteria
d. Is bacterial and viral in nature

23. If the child has epiglottitis, the nurse should not attempt to do which of the following
before an artificial airway is established?

a. Give intravenous therapy to maintain hydration

b. Administer oxygen
c. Visualize the epiglottis using a tongue blade
d. Give moist air to reduce epiglottis inflammation

24. A child in the emergency room is diagnosed with an acute episode of Croup (Acute
laryngotracheobronchitis).

During the initial assessment, which of the following findings would the nurse expect to
find?

a. Diffuse expiratory wheezing

b. inspiratory stridor with a brassy cough
c. Decreased aeration in lung fields
d. Shallow respirations

25. Croup is most likely to be caused by:

a. H. Influenza
b. Staphylococcus aureus
c. parainfluenza virus
d. Streptococcus
26. A 2-year-old child is brought to the emergency department with suspected croup.
Which of the following assessment findings reflects increasing respiratory distress?

a. Intercostals retractions
b. Bradycardia
c. Decreased level of consciousness
d. Flushed skin

27. Which of the following would the nurse keep in mind as a rationale for using a mist
tent for a child with acute laryngotracheobronchitis?

a. Provide 100% oxygen

b. Liquefy secretions
c. Warm the respiratory tract
d. reverse isolation

28. 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. Fever
c. Irritability
d. Tachycardia

30. One of the primary nursing diagnoses for a child with chronic bronchitis is “ineffective
airway clearance related to retained secretions,” plans to decrease retained secretions
should include:

a. Administering oxygen as ordered

b. Placing the client in a high-Fowler’s position
c. Gargling periodically with warm normal saline
d. Increasing fluid intake to at least 2,000 ml/day

30. A child with cystic fibrosis is hospitalized for a respiratory infection. Which
documentation in the chart would indicate the need for counseling regarding nutrition and
gastrointestinal complications?

a. Frothy, foul-smelling stools

b. Consumed 80 percent of breakfast
c. Weight unchanged from yesterday.
d. Eats three snacks every day.
31. A 2-year-old child has just been diagnosed with cystic fibrosis. The child's father asks
the nurse "What is our major concern now, and what will we have to deal with in the
future?" Which of the following is the best response?

a. "There is a probability of life-long complications."

b. "Cystic fibrosis results in nutritional concerns that can be dealt with."
c. "Thin, tenacious secretions from the lungs are a constant struggle in cystic fibrosis."
d. "You will work with a team of experts and also have access to a support group that the family can
attend."

32.The parent of a child with cystic fibrosis informs the nurse that they will be unable to
perform postural drainage at home because their bed does not recline like the hospital bed.
The nurse’s response is based on an understanding that:

a. Postural drainage is essential to mobilize secretions in the airways so they can be coughed out.
b. Postural drainage is not necessary as long as the child takes his pulmozyme to decrease the
viscosity of the mucus.
c. Postural drainage dose not influence the pulmonary status of a child with cystic fibrosis.
d. The parents can be referred to the Cystic Fibrosis Foundation for a flexible bed.

33.The nurse would expect the cystic fibrosis client to receive supplemental pancreatic
enzymes along with a diet

a. High in carbohydrates and proteins

b. Low in carbohydrates and proteins
c. High in carbohydrates, low in proteins
d. Low in carbohydrates, high in proteins

34. Which test result is a key finding in the child with cystic fibrosis?

a. Chest X-ray revealing interstitial fibrosis

b. Neck X-ray showing areas of upper airways narrowing
c. Lateral X-ray revealing an enlarged epiglottis
d. Positive pilocarpine iontophoresis sweat test

35. Baby Ama, an infant of Chavez couple, who has a cleft lip and palate is admitted for
surgery. Nurse Maganda teaches the mother of measures on feeding her infant. Which of
the following measures would be most effective in helping baby Ama to retain oral
feedings?

a. Burp the infant at frequent intervals.

b. Feed the infant small amounts at one time.
c. Place the end of the nipple far to the back of the infant’s tongue.
d. Maintain the infant in lying position while feeding.
36. After the teaching, Mrs. Chavez asks Nurse Maganda, “When would be the best time
for the repair of my baby’s cleft palate?” Nurse Maganda responds by stating that the first
repair of a cleft palate is usually done at which of the following times?

a. Before the eruption of teeth.

b. When the child’s weight is approximately 22 kg.
c. Before the development of speech.
d. After the child learns to drink from a cup.

37. Nurse Maganda is developing a plan of care for baby Ama with a cleft palate before a
surgery is performed. Which of the following should be a priority in the plan of care?

a. Maintaining skin Integrity in the oral cavity.

b. Using techniques to minimize crying.
c. Altering the usual method of feeding.
d. Preventing the infant from putting fingers in the mouth.

38. Immediately upon return to the nursing unit after the operation of baby Ama’s cleft
palate, in which position should Nurse Maganda place the baby?

a. On the back with the head on the position of comfort

b. Lying on the abdomen with the head turned to the side
c. In low Fowler’s with the head turn on the side
d. In Trendelenburg’s with the head tilted forward.

39. A 2-month-old is brought to the clinic by his mother. His abdomen is distended and he
has been vomiting forcefully and with increasing frequency over the past 2 weeks. On
examination, the nurse notes signs of dehydration and a palpable mass” to the right of the
umbilicus. Peristaltic waves are visible, moving from left to right. The nurse should suspect
which of the following conditions?

a. Colic
b. Failure to thrive
c. Intussusception
d. Pyloric stenosis
40. The nurse is caring for an infant vomiting secondary to pyloric stenosis. The mother
questions why the vomitus of this child appears different from that of her other children
when they have the flu. The nurse would explain that the emesis of an infant with pyloric
stenosis does not contain bile because:

a. The GI system is still immature in newborns and infants

b. The emesis is from passive regurgitation
c. The obstruction is above the bile duct
d. The bile duct is obstructed

41. A 2-week-old neonate returned 6 hours ago from surgery to correct pyloric stenosis.
Which postoperative nursing interventions are most important?

a. Feeding small amounts frequently, assessing the amount of emesis, and encouraging parental
involvement in care
b. Giving the neonate nothing by mouth until the wound heals, and encouraging parental
Involvement
c. Monitoring Intake and output, and encouraging parental involvement in care
d. Monitoring hydration status, and encouraging parental involvement

42. Which of the following would be the priority nursing diagnosis for a 4-week-old infant
with a diagnosis of pyloric stenosis?

a. Constipation
b. Deficient Fluid Volume
c. Imbalance nutrition: less than body requirements
d. Impaired swallowing

43. For the child experiencing excessive vomiting secondary to pyloric stenosis the nurse
should assess the child for which of the following acid-base imbalances?

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

44. The nurse is assessing the child diagnosed with Intussusception. The nurse would
expect to find which of the following?

a. Stool is light yellow, frothy and foul smelling

b. Stool is currant jelly-like
c. Stool is narrow and ribbon-like
d. Green liquid stools
45. The parents of an infant with Hirschsprung’s disease ask the nurse how their baby got
the disease. The nurse would be correct in telling the parents that:

a. Their infant was born with this condition

b. It is the result of the meconium ileus their Infant has experienced as a newborn
c. Their infant spontaneously developed this condition
d. It often occurs following the introduction of solid foods due to a genetically inherited metabolic
defect

46. Nurse Lilibeth provided health teachings regarding Hirschsprung’s disease to the
infant’s parents. She determined that no further teaching is required in relation to the
diagnosis when the mother said:

a. “There is no rectal opening for stool to pass.”

c. “The nerves at the end of the large colon are missing.”
b. “There is a tube between the trachea and the esophagus.”
d. “The muscle below the stomach is too tight.”

47. The nurse is assessing newborn infants and children during their hospital stay. The
nurse will notice which of the following symptoms as a primary manifestation of
Hirschsprung’s disease?

a. Failure to pass meconium during the first 24-48 hours after birth
b. Fine rash over the trunk
c. High-grade fever
d. Skin turns yellow and then brown after 48 hours of life

48. A 2-year-old diagnosed with Hirschsprung’s disease is being interviewed by the nurse.
During data collection, the parents described the child’s stools as “strange”. Which of the
following stool types would most likely fit the parent’s description?

a. Light yellow, frothy and foul smelling

b. Currant jelly-like
c. Narrow and ribbon-like
d. Green liquid

49. During an assessment of a 4-month-old infant with Hirschsprung’s disease, Nurse

Lilibeth should most likely note:

a. Scaphoid-shaped abdomen.
b. Weight less than expected for height and age.
c. Cyanosis of the fingers and toes.
d. Hyperactive deep tendon reflexes.

50. A 2-year-old male is admitted through the emergency department with a suspected
diagnosis of Hirschsprung’s disease. The child’s mother asks about treatment of the
disease. The nurse’s response should be based on which of the following facts?

a. He’ll have a permanent colostomy; as he matures, he can learn the required care.
b. He’ll have a temporary colostomy; “pull through” surgery will be done in the future
c. He’ll require many reconstructive colostomy surgeries over a lifetime
d. Hell require chemotherapy and radiation to treat his disease

51. A 4-month old infant has been diagnosed with PKU. The child has eczema and
sensitivity to the sunlight. The mother asks the nurse why her child's skin is so sensitive.
An appropriate explanation by the nurse would be:

a. "Some children just have sensitive skin, don’t worry about it."
b. "Your child will outgrow his sensitivity when he is 5 years old. Just use sunscreen for now."
c. "Your child has a deficiency in melanin because of decreased tyrosine. You will always have to
take special care of his skin."
d. "The phenylketones in your baby's blood concentrate the sun's rays, making burning more likely.
Children with PKU can never be in the sun."

52. Mothers in the waiting room of the endocrine clinic are discussing their children's
illnesses. The mothers of children with phenylketonuria and congenital hypothyroidism
recognize there is a common goal in the early treatment of their children. That goal is the
avoidance of:

a. mental retardation
b. fever
c. obesity
d. protein foods

53. The nurse is teaching the parents of a child with celiac disease about the dietary
restrictions. The nurse would explain that the most appropriate diet for their child is:

a. Gluten-free
b. Salt-free
c. Fat-free
d. High-calorie, low-fat.
54. The nurse is giving nutritional counseling to the mother of a child with celiac disease.
Which statement by the mother would indicate understanding?

a. “My son can’t eat wheat, rye oats or barley

b. “My son needs a diet rich in gluten”
c. “My son must avoid potatoes, rice, flour and cornstarch”
d. “My son can safely eat frozen and packaged foods”

55. Nurse Lilibeth is teaching the mother of a child with celiac disease about dietary
management. Which of the following statements by the mother indicates successful
teaching?

a. “I will feed my child foods that contain wheat products.”

c. “I will plan to feed my child foods that contain rice.”
b. “I will be sure to give my child lots of milk.”
d. “I will be sure my child gets oatmeal every day.”

56. The mother asks Nurse Lilibeth, “How long must my child stay on this diet?” Which
response should Nurse Lilibeth give?

a. “Until the jejunal biopsy is normal”

b. “Until his stools appear normal”
c. “For the next 6 months.”
d. “For the rest of his life.”

57. The nurse is caring for a child with celiac disease. How should the nurse evaluate the
effectiveness of nutritional therapy?

a. Monitor vital signs every 4 hours

b. monitor the appearance, size, and number of stools
c. Measure BUN and serum creatinine levels
d. Measure intake and output

58. Which of the following statements by the mother would suggest that the child has
celiac disease?

a. “His urine is so dark.”

b. “His stool is large and smelly.”
c. “His belly is so small.”
d. “He is so short.”
59. During the assessment of the child with celiac disease, Nurse Lilibeth should most
likely note which of the following physical findings?

a. Enlarged liver.
b. Protuberant abdomen.
c. Tender inguinal lymph nodes.
d. Periorbital edema.

60. Parents whose first child has celiac disease ask the nurse if all of their children will
have the disease. To whom should the nurse refer them?

a. Registered dietitian
b. Genetic counselor
c. Certified nurse midwife
d. Social worker