The nurse enters the room as a 3 year-old
Takes frequent rest periods while
is having a generalized seizure. Which
intervention should the nurse do first?
A. Clear the area of any hazards
B. Place the child on the side
C. Restrain the child
D. Give the prescribed anticonvulsant
A client has just returned to the
medical-surgical unit following a parents have the child drink orange juice?
segmental lung resection. After assessing
the client, the first nursing action would be
to
A. Administer pain medication
B. Suction excessive
tracheobronchial secretions
C. Assist client to turn, deep breath
and cough
D. Monitor oxygen saturation
A nurse from the surgical department is
reassigned to the pediatric unit. The
charge nurse should recognize that the
child at highest risk for cardiac arrest and
is the least likely to be assigned to this
nurse is which child?
A. Congenital cardiac defects
B. An acute febrile illness
C. Prolonged hypoxemia
D. Severe multiple trauma
Which of the following would be the best
strategy for the nurse to use when
teaching insulin injection techniques to a
newly diagnosed client with diabetes?
A. Give written pre and posttests
B. Ask questions during practice
C. Allow another diabetic to assist
D. Observe a return demonstration
The nurse is assessing a 2-year-old client
with a possible diagnosis of congenital
heart disease. Which of these is most
likely to be seen with this diagnosis?
A. Several otitis media episodes in
the last year
B. Weight and height in 10th
percentile since birth
C.
playing
D. Changing food preferences and
dislikes
The nurse is reassigned to work at the
Poison Control Center telephone hotline.
In which of these cases of childhood
poisoning would the nurse suggest that
A. An 18 month-old who ate an
undetermined amount of crystal
drain
B. A 14 month-old who chewed 2
leaves of a philodendron plant
C. A 20 month-old who is found sitting
on the bathroom floor beside an
empty bottle of diazepam (Valium)
D. A 30 month-old who has
swallowed a mouthful of charcoal
lighter fluid
A 23-year-old single client is in the 33rd
week of her first pregnancy. She tells the
nurse that she has everything ready for
the baby and has made plans for the first
weeks together at home. Which normal
emotional reaction does the nurse
recognize?
A. Acceptance of the pregnancy
B. Focus on fetal development
C. Anticipation of the birth
D. Ambivalence about pregnancy
Upon examining the mouth of a 3-year-old
child, the nurse discovers that the teeth
have chalky white-to-yellowish staining
with pitting of the enamel. Which of the
following conditions would most likely
explain these findings?
A. Ingestion of tetracycline
B. Excessive fluoride intake
C. Oral iron therapy
D. Poor dental hygiene
Which of the following should the nurse
teach the client to avoid when taking
chlorpromazine HCL (Thorazine)?
 A. Direct sunlight
B. Foods containing tyramine
C. Foods fermented with yeast
D. Canned citrus fruit drinks
The nurse is discussing dietary intake with
an adolescent who has acne. The most
appropriate statement for the nurse is
A. "Eat a balanced diet for your age."
B. "Increase your intake of protein
and Vitamin A."
C. "Decrease fatty foods from your
diet."
D. "Do not use caffeine in any form,
including chocolate."
The nurse is caring for a child who has
just returned from surgery following a
tonsillectomy and adenoidectomy. Which
action by the nurse is appropriate?
A. Offer ice cream every 2 hours
B. Place the child in a supine position
C. Allow the child to drink through a
straw
D. Observe swallowing patterns
The nurse is caring for a client with acute
pancreatitis. After pain management,
which intervention should be included in
the plan of care?
A. Cough and deep breathe every 2
hours
B. Place the client in contact isolation
C. Provide a diet high in protein
D. Institute seizure precautions
The nurse is caring for a client with
trigeminal neuralgia (tic douloureaux). To
assist the client with nutrition needs, the
nurse should
A. Offer small meals of high calorie
soft food
B. Assist the client to sit in a chair for
meals
C. Provide additional servings of fruits
and raw vegetables
D. Encourage the client to eat fish,
liver and chicken
A client treated for depression tells the
nurse at the mental health clinic that he
recently purchased a handgun because
he is thinking about suicide. The first
nursing action should be to
A. Notify the health care provider
immediately
B. Suggest in-patient psychiatric care
C. Respect the client's confidential
disclosure
D. Phone the family to warn them of
the risk
The initial response by the nurse to a
delusional client who refuses to eat
because of a belief that the food is
poisoned is
A. "You think that someone wants to
poison you?"
B. "Why do you think the food is
poisoned?"
C. "These feelings are a symptom of
your illness."
D. "You're safe here. I won't let
anyone poison you."
A client has just been admitted with portal
hypertension. Which nursing diagnosis
would be a priority in planning care?
A. Altered nutrition: less than body
requirements
B. Potential complication hemorrhage
C. Ineffective individual coping
D. Fluid volume excess
The nurse in a well-child clinic examines
many children on a daily basis.
Which of the following toddlers requires
further follow up?
A. A 13 month-old unable to walk
B. A 20 month-old only using 2 and 3
word sentences
C. A 24 month-old who cries during
examination
D. A 30 month-old only drinking from
a sippy cup
Which of the following conditions who is sitting contentedly on his mother's
assessed by the nurse would lap. Which of the following should the
contraindicate the use of benztropine A. Elicit reflexes
(Cogentin)? B. Measure height and weight
A. Neuromalignant syndrome C. Auscultate heart and lungs
B. Acute extrapyramidal syndrome D. Examine the ears
C. Glaucoma, prostatic hypertrophy
D. Parkinson's disease, atypical Which of these principles should the nurse
tremors apply when performing a nutritional
assessment on a 2 year-old client?
A 15 year-old client with a lengthy A. An accurate measurement of
confining illness is at risk for altered intake is not reliable
growth and development of which task? B. The food pyramid is not used in
A. Loss of control this age group
B. Insecurity C. A serving size at this age is about
C. Dependence 2 tablespoons
D. Lack of trust D. Total intake varies greatly each day

The nurse is caring for a client with The nurse is assessing a client with
cirrhosis of the liver with ascites. When delayed wound healing. Which of the
instructing nursing assistants in the care of following risk factors is most important in
the client, the nurse should emphasize this situation?
that A. Glucose level of 120
A. The client should remain on bed B. History of myocardial infarction
rest in a semi-Fowler's position C. Long term steroid usage
B. The client should alternate D. Diet high in carbohydrates
ambulation with bed rest with legs
elevated Which of the following nursing
C. The client may ambulate and sit in assessments indicate immediate
chair as tolerated discontinuance of an antipsychotic
D. The client may ambulate as medication?
tolerated and remain in A. Involuntary rhythmic stereotypic
semi-Fowlers position in bed movements and tongue protrusion
B. Cheek puffing, involuntary
In providing care to a 14 year-old movements of extremities and
adolescent with scoliosis, which of the trunk
following will be most difficult for this C. Agitation, constant state of motion
client? D. Hyperpyrexia, severe muscle
A. Compliance with treatment rigidity, malignant hypertension
regimens
B. Looking different from their peers A client with HIV infection has a secondary
C. Lacking independence in activities herpes simplex type 1 (HSV-1) infection.
D. Reliance on family for their social The nurse knows that the most likely
support cause of the HSV-1 infection in this client
is
The nurse is preparing to perform a A. Immunosuppression
physical examination on an 8 month-old B. Emotional stress
C. Unprotected sexual activities
 D. Contact with saliva
The nurse measures the head and chest
circumferences of a 20 month-old infant.
After comparing the measurements, the
nurse finds that they are approximately the
same. What action should the nurse take?
A. Notify the health care provider
B. Palpate the anterior fontanel
C. Feel the posterior fontanel
D. Record these normal findings
At a routine clinic visit, parents express
concern that their 4 year-old is wetting the
bed several times a month. What is the
nurse's best response?
A. "This is normal at this time of day."
B. "How long has this been
occurring?"
C. “Do you offer fluids at night?"
D. "Have you tried waking her to
urinate?"
A client was admitted to the psychiatric
unit after refusing to get out of bed. In the
hospital the client talks to unseen people
and voids on the floor. The nurse could
best handle the problem of voiding on the
floor by
A. Requiring the client to mop the
floor
B. Restricting the client's fluids
throughout the day
C. Withholding privileges each time
the voiding occurs
D. Toileting the client more frequently
with supervision
The nurse is caring for a client with a
sigmoid colostomy who requests
assistance in removing the flatus from a l
piece drainable ostomy pouch. Which is
the correct intervention?
A. Piercing the plastic of the ostomy
pouch with a pin to vent the flatus
B. Opening the bottom of the pouch,
allowing the flatus to be expelled
C. Pulling the adhesive seal around
the ostomy pouch to allow the
flatus to escape
D. Assisting the client to ambulate to
reduce the flatus in the pouch
The nurse is teaching parents of an infant
about introduction of solid food to their
baby. What is the first food they can add to
the diet?
A. Vegetables
B. Cereal
C. Fruit
D. Meats
When counseling parents of a child who
has recently been diagnosed with
hemophilia, what must the nurse know
about the offspring of a normal father
A. It is likely that all sons are affected
B. There is a 50% probability that
sons will have the disease
C. Every daughter is likely to be a
carrier
D. There is a 25% chance a daughter
will be a carrier
When teaching a client with chronic
obstructive pulmonary disease about
oxygen by cannula, the nurse should also
instruct the client's family to
A. Avoid smoking near the client
B. Turn off oxygen during meals
C. Adjust the liter flow to 10 as
needed
D. Remind the client to keep mouth
closed
The nurse is caring for a post-op
colostomy client. The client begins to cry
saying, "I'll never be attractive again with
this ugly red thing." What should be the
first action by the nurse?
A. Arrange a consultation with a sex
therapist
B. Suggest sexual positions that hide
the colostomy
 C. Invite the partner to participate in
colostomy care
D. Determine the client's
understanding of her colostomy
A schizophrenic client talks animatedly but
the staff are unable to understand what
the client is communicating. The client is
observed mumbling to herself and
speaking to the radio. A desirable
outcome for this client's care
A. Expresses feelings appropriately
through verbal interactions
B. Accurately interprets events and
behaviors of others
C. Demonstrates improved social
relationships
D. Engages in meaningful and
understandable verbal
communication
A 7 year-old child is hospitalized following
a major burn to the lower extremities. A
diet high in protein and carbohydrates is
recommended. The nurse informs the
child and family that the most important
reason for this diet
A. Promote healing and strengthen
the immune system
B. Provide a well-balanced nutritional
intake
C. Stimulate increased peristalsis
absorption
D. Spare protein catabolism to meet
metabolic needs
The parents of a 7 year-old tell the nurse
their child has started to "tattle" on
siblings. In interpreting this new behavior,
how should the nurse explain the child's
actions to the parents?
A. The ethical sense and feelings of
justice are developing
B. Attempts to control the family use
new coping styles
C. Insecurity and attention getting are
common motives
D. Complex thought processes help
to resolve conflicts
A school nurse is advising a class of
unwed pregnant high school students.
What is the most important action they can
perform to deliver a healthy child?
A. Maintain good nutrition
B. Stay in school
C. Keep in contact with the child's
father
D. Get adequate sleep
A client continually repeats phrases that
others have just said. The nurse
recognizes this behavior as
A. Autistic
B. Ecopraxic
C. Echolalic
D. Catatonic
A client is admitted for hemodialysis.
Which abnormal lab value would the nurse
anticipate not being improved by
hemodialysis?
A. Low hemoglobin
B. Hypernatremia
C. High serum creatinine
D. Hyperkalemia
The nurse is caring for a fl year-old child
who is being discharged following a
tonsillectomy. Which of the following
instructions is appropriate for the nurse to
teach the parents?
A. Report a persistent cough to the
health care provider
B. The child can return to school in 4
days
C. Administer chewable aspirin for
pain
D. The child may gargle with saline as
necessary for discomfort
The nurse is caring for a 14 month-old just
diagnosed with Cystic Fibrosis. The
parents state this is the first child in either
family with this disease, and ask about the
risk to future children. What is the best
response by the nurse?
A. 1 in 4 chance for each child to
carry that trait
B. 1 in 4 risk for each child to have
the disease
C. 1 in 2 chance of avoiding the trait
and disease
D. 1 in 2 chance that each child will
have the disease
The nurse is performing an assessment
on a client with pneumococcal pneumonia.
Which finding would the nurse anticipate?
A. Bronchial breath sounds in outer
lung fields
B. Decreased tactile fremitus
C. Hacking, nonproductive cough
D. Hyper resonance of areas of
consolidation
During seizure activity which observation
is the priority to enhance further direction
of treatment?
A. Observe the sequence or types of
movement
B. Note the time from beginning to
end
C. Identify the pattern of breathing
D. Determine if loss of bowel or
bladder control occurs
Which of the following statements
describes what the nurse must know in
order to provide anticipatory guidance to
parents of a toddler about readiness for
toilet training?
A. The child learns voluntary
sphincter control through repetition
B. Myelination of the spinal cord is
completed by this age
C. Neuronal impulses are interrupted
at the base of the ganglia
D. The toddler can understand cause
and effect
A client complaining of severe shortness
of breath is diagnosed with congestive
heart failure. The nurse observes a falling
pulse oximetry. The client's color changes
to gray and she expectorates large
amounts of pink frothy sputum. The first
action of the nurse would be which of the
following?
A. Call the health care provider
B. Check vital signs
C. Position in high Fowler's
D. Administer oxygen
The nurse is caring for a client with benign
prostatic hypertrophy. Which of the
following assessments would the nurse
anticipate finding?
A. Large volume of urinary output with
each voiding
B. Involuntary voiding with coughing
and sneezing
C. Frequent urination
D. Urine is dark and concentrated
An anxious parent of a 4 year-old consults
the nurse for guidance in how to answer
the child's question, "Where do babies
come from?" What is the nurse's best
response to the parent?
A. "When a child asks a question,
give a simple answer."
B. "Children ask many questions, but
are not looking for answers."
C. "This question indicates interest in
sex beyond this age."
D. "Full and detailed answers should
be given to all questions."
A 3 year-old child is treated in the
emergency department after ingestion of 1
ounce of a liquid narcotic. What action
should the nurse do first?
A. Provide the ordered humidified
oxygen via mask
B. Suction the mouth and the nose
C. Check the mouth and radial pulse
D. Start the ordered intravenous fluids
The charge nurse on the eating disorder
unit instructs a new staff member to weigh
each client in his or her hospital gown
only. What is the rationale for this nursing
intervention?
A. To reduce the risk of the client
feeling cold due to decreased fat
and subcutaneous tissue
B. To cover the bony prominence and
areas where there is skin
breakdown
C. So the client knows what type of
clothing to wear when weighed
D. To reduce the tendency of the
client to hide objects under his or
her
In teaching parents to associate
prevention with the lifestyle of their child
with sickle cell disease, the nurse should
emphasize that a priority for their child to
A. Avoid overheating during physical
activities
B. Maintain normal activity with some
restrictions
C. Be cautious of others with viruses
or temperatures
D. Maintain routine immunizations
The nurse understands that during the
"tension building" phase of a violent
relationship, when the batterer makes
unreasonable demands, the battered
victim may experience feelings of
A. Anger
B. Helplessness
C. Calm
D. Explosive
A parent has numerous questions
regarding normal growth and development
of a 10 month-old infant. Which of the
following parameters is of most concern to
the nurse?
A. 50% increase in birth weight
B. Head circumference greater than
chest
C. Crying when the parents leave
D. Able to stand up briefly in play pen
The nurse has been assigned to these
clients in the emergency room. Which
client would the nurse go check first?
A. Viral pneumonia with atelectasis
B. Spontaneous pneumothorax with a
respiratory rate of 38
C. Tension pneumothorax with slight
tracheal deviation to the right
D. Acute asthma with episodes of
bronchospasm
The nurse is assessing a 4 year-old for
possible developmental dysplasia of the
right hip. Which finding would the nurse
expect?
A. Pelvic tip downward
B. Right leg lengthening
C. Ortolani sign
D. Characteristic limp
A 2 year-old child has recently been
diagnosed with cystic fibrosis. The nurse
is teaching the parents about home care
for the child. Which of the following
information is appropriate for the nurse to
include?
A. Allow the child to continue normal
activities
B. Schedule frequent rest periods
C. Limit exposure to other children
D. Restrict activities to inside the
house
The nurses on a unit are planning for
stoma care for clients who have a stoma
for fecal diversion. Which stomal diversion
poses the highest risk for skin breakdown
A. Ileostomy
B. Transverse colostomy
C. Ileal conduit
D. Sigmoid colostomy
A client is unconscious following a
tonic-clonic seizure. What should the
nurse do first?
A. Check the pulse
B. Administer Valium
 C. Place the client in a side-lying
position
D. Place a tongue blade in the mouth
The nurse is teaching a client who has a
hip prostheses following total hip
replacement. Which of the following
should be included in the instructions for
A. Avoid climbing stairs for 3 months
B. Ambulate using crutches only
C. Sleep only on your back
D. Do not cross legs
A nurse who travels with an agency is
uncertain about what tasks can be
performed when working in a different
state. It would be best for the nurse to
check which resource?
A. The state nurse practice act in
which the assignment is made
B. With a nurse colleague who has
worked in that state 2 years ago
C. The Nursing Social Policy
Statement within the United States
D. The policies and procedures of the
assigned agency in that state
Parents of a 7 year-old child call the clinic
nurse because their daughter was sent
home from school because of a rash. The
child had been seen the day before by the
health care provider and diagnosed with
Fifth Disease (erythema infectiosum).
What is the most appropriate action by the
nurse?
A. Tell the parents to bring the child to
the clinic for further evaluation
B. Refer the school officials to printed
materials about this viral illness
C. Inform the teacher that the child is
receiving antibiotics for the rash
D. Explain that this rash is not
contagious and does not require
isolation
What principle of HIV disease should the
nurse keep in mind when planning care for
a newborn who was infected in utero?
A. The disease will incubate longer
and progress more slowly in this
infant
B. The infant is very susceptible to
infections
C. Growth and development patterns
will proceed at a normal rate
D. Careful monitoring of renal function
is indicated
While teaching a client about their
medications, the client asks how long it
will take before the effects of lithium take
place. What is the best response of the
nurse?
A. Immediately
B. Several days
C. 2 weeks
D. 1 month
The nurse is caring for a 12 year-old with
an acute illness. Which of the following
indicates the nurse understands common
sibling reactions to hospitalization?
A. Younger siblings adapt very well
B. Visitation is helpful for both
C. The siblings may enjoy privacy
D. Those cared for at home cope
better
Following a cocaine high, the user
commonly experiences an extremely
unpleasant feeling called
A. Craving
B. Crashing
C. Outward bound
D. Nodding out
One reason that domestic violence
remains extensively undetected is
A. Few battered victims seek medical
care
B. There is typically a series of minor,
vague complaints
C. Expenses due to police and court
costs are prohibitive
 D. Very little knowledge is currently
known about batterers and
battering relationships
When making a home visit to a client with
chronic pyelonephritis, which nursing
action has the highest priority?
A. Follow-up on lab values before the
visit
B. Observe client findings for the
effectiveness of antibiotics
C. Ask for a log of urinary output
D. Ask for the log of the oral intake
When a client is having a general tonic
clonic seizure, the nurse should
A. Hold the client's arms at their side
B. Place the client on their side
C. Insert a padded tongue blade in
client's mouth
D. Elevate the head of the bed
The nurse is teaching a client with
dysrhythmia about the electrical pathway
of an impulse as it travels through the
heart. Which of these demonstrates the
normal pathway?
A. AV node, SA node, Bundle of His,
Purkinje fibers
B. Purkinje fibers, SA node, AV node,
Bundle of His
C. Bundle of His, Purkinje fibers, SA
node , AV node
D. SA node, AV node, Bundle of His,
Purkinje fibers
Clients with mitral stenosis would likely
manifest findings associated with
congestion in the
A. Pulmonary circulation
B. Descending aorta
C. Superior vena cava
D. Bundle of His
In assessing the healing of a client's
wound during a home visit, which of the
following is the best indicator of good
healing?
A. White patches
B. Green drainage
C. Reddened tissue
D. Eschar development
The nursing intervention that best
describes treatment to deal with the
behaviors of clients with personality
disorders include
A. Pointing out inconsistencies in
speech patterns to correct thought
disorders
B. Accepting client and the client's
behavior unconditionally
C. Encouraging dependency in order
to develop ego controls
D. Consistent limit-setting enforced 24
hours per day
A client received her first dose of
fluphenazine (Prolix in) 2 hours ago. She
suddenly experiences torticollis and
involuntary spastic muscle movement. In
addition to administering the ordered
anticholinergic drug, what other measure
should the nurse implement?
A. Have respiratory support
equipment available
B. Immediately place her in the
seclusion room
C. Assess the client for anxiety and
agitation
D. Administer prn dose of IM
antipsychotic medication
The nurse asks a client with a history of
alcoholism about the client's drinking
behavior. The client states "I didn't hurt
anyone. I just like to have a good time,
and drinking helps me to relax." The client
is using which defense mechanism?
A. Denial
B. Projection
C. Intellectualization
D. Rationalization
The nurse is teaching a smoking cessation
class and notices there are 2 pregnant
women in the group. Which information is
a priority for these women?
A. Low tar cigarettes are less harmful
during pregnancy
B. There is a relationship between
smoking and low birth weight
C. The placenta serves as a barrier to
nicotine
D. Moderate smoking is effective in
weight control
The nurse is caring for a client with end
stage renal disease. What action should
the nurse take to assess for patency in a
fistula used for hemodialysis?
A. Observe for edema proximal to the
site
B. Irrigate with 5 mls of 0.9% Normal
Saline
C. Palpate for a thrill over the fistula
D. Check color and warmth in the
extremity
Which therapeutic communication skill is
most likely to encourage a depressed
client to vent feelings?
A. Direct confrontation
B. Reality orientation
C. Projective identification
D. Active listening
The nurse walks into a client's room and
finds the client lying still and silent on the
floor. The nurse should first
A. Assess the client's airway
B. Call for help
C. Establish that the client is
unresponsive
D. See if anyone saw the client fall
What is the best way for the nurse to
accomplish a health history on a 14
year-old client?
A. Have the mother present to verify
information
B. Allow an opportunity for the teen to
express feelings
C. Use the same type of language as
the adolescent
D. Focus the discussion of risk factors
in the peer group
A new nurse on the unit notes that the
nurse manager seems to be highly
respected by the nursing staff. The new
nurse is surprised when one of the nurses
states: "The manager makes all decisions
and rarely asks for our input." The best
description of the nurse manager's
management style is
A. Participative or democratic
B. Ultraliberal or communicative
C. Autocratic or authoritarian
D. Laissez faire or permissive
A 2 year-old child is being treated with
Amoxicillin suspension, 200 milligrams per
dose, for acute otitis media. The child
weighs 30 lb. (15 kg) and the daily dose
range is 20-40 mg/kg of body weight, in
three divided doses every 8 hours. Using
principles of safe drug administration,
what should the nurse do next?
A. Give the medication as ordered
B. Call the health care provider to
clarify the dose
C. Recognize that antibiotics are
over-prescribed
D. Hold the medication as the dosage
is too low
The nurse is performing a developmental
assessment on an 8 month-old. Which
finding should be reported to the health
care provider?
A. Lifts head from the prone position
B. Rolls from abdomen to back
C. Responds to parents' voices
D. Falls forward when sitting
The nurse is participating in a community
health fair. As part of the assessments, the
nurse should conduct a mental status
examination when
A. An individual displays restlessness
 B. There are obvious signs of
depression
C. Conducting any health assessment
D. The resident reports memory
lapses
The nurse caring for a 14 year-old boy
with severe Hemophilia A, who was
admitted after a fall while playing
basketball. In understanding his behavior
and in planning care for this client, what
must the nurse understand about
adolescents with hemophilia?
A. Must have structured activities
B. Often take part in active sports
C. Explain limitations to peer groups
D. Avoid risks after bleeding episodes
When assessing a client who has just
undergone a cardioversion, the nurse
finds the respirations are 12. Which action
should the nurse take first?
A. Try to vigorously stimulate normal
breathing
B. Ask the RN to assess the vital
signs
C. Measure the pulse oximetry
D. Continue to monitor respirations
In order to enhance a client's response to
medication for chest pain from acute
angina, the nurse should emphasize
A. Learning relaxation techniques
B. Limiting alcohol use
C. Eating smaller meals
D. Avoiding passive smoke
The primary nursing diagnosis for a client
with congestive heart failure with
pulmonary edema is
A. Pain
B. Impaired gas exchange
C. Cardiac output altered: decreased
D. Fluid volume excess
After talking with her partner, a client
voluntarily admitted herself to the
substance abuse unit. After the second
day on the unit the client states to the
nurse, "My husband told me to get
treatment or he would divorce me. I don't
believe I really need treatment but I don't
want my husband to leave me." Which
response by the nurse would assist the
client?
A. "In early recovery, it's quite
common to have mixed feelings,
but unmotivated people can't get
well."
B. "In early recovery, it's quite
common to have mixed feelings,
but I didn't know you had been
pressured to come."
C. "In early recovery it's quite
common to have mixed feelings,
perhaps it would be best to seek
treatment on an out client bases."
D. "In early recovery, it's quite
common to have mixed feelings.
Let's discuss the benefits of
sobriety for you."
Clients taking which of the following drugs
are at risk for depression?
A. Steroids
B. Diuretics
C. Folic acid
D. Aspirin
The nurse is assessing a client on
admission to a community mental health
center. The client discloses that she has
been thinking about ending her life. The
nurse's best response would be
A. "Do you want to discuss this with
your pastor?"
B. "We will help you deal with those
thoughts."
C. "Is your life so terrible that you
want to end it?"
D. "Have you thought about how you
would do it?"
The nurse is caring for a client 2 hours
after a right lower lobectomy. During the
evaluation of the water-seal chest
drainage system, it is noted that the fluid
level bubbles constantly in the water seal
chamber. On inspection of the chest
dressing and tubing, the nurse does not
find any air leaks in the system. The next
best action for the nurse is to
A. Check for subcutaneous
emphysema in the upper torso
B. Reposition the client to a position
of comfort
C. Call the health care provider as
soon as possible
D. Check for any increase in the
amount of thoracic drainage
The nurse is caring for a newborn who has
just been diagnosed with hypospadias.
After discussing the defect with the
parents, the nurse should
A. Circumcision can be performed at
any time
B. Initial repair is delayed until ages
6-8
C. Post-operative appearance will be
normal
D. Surgery will be performed in
stages
A client has been receiving lithium
(Lithane) for the past two weeks for the
treatment of bipolar illness. When planning
client teaching, what is most important to
emphasize to the client?
A. Maintain a low sodium diet
B. Take a diuretic with lithium
C. Come in for evaluation of serum
lithium levels every 1-3 months
D. Have blood lithium levels drawn
during the summer months
When an autistic client begins to eat with
her hands, the nurse can best handle the
problem by
A. Placing the spoon in the client's
hand and stating, "Use the spoon
to eat your food."
B. Commenting "I believe you know
better than to eat with your hand."
C. Jokingly stating, "Well I guess
fingers sometimes work better than
spoons."
D. Removing the food and stating
"You can't have anymore food until
you use
A client develops volume overload from an
IV that has infused too rapidly. What
assessment would the nurse expect to
find?
A. S3 heart sound
B. Thready pulse
C. Flattened neck veins
D. Hypoventilation
A neonate born 12 hours ago to a
methadone maintained woman is
exhibiting a hyperactive MORO reflex and
slight tremors. The newborn passed one
loose, watery stool. Which of these is a
nursing priority?
A. Hold the infant at frequent
intervals.
B. Assess for neonatal withdrawal
syndrome
C. Offer fluids to prevent dehydration
D. Administer paregoric to stop
diarrhea
While planning care for a preschool aged
child, the nurse understands
developmental needs. Which of the
following would be of the most concern to
the nurse?
A. Playing imaginatively
B. Expressing shame
C. Identifying with family
D. Exploring the playroom
A depressed client who has recently been
acting suicidal is now more social and
energetic than usual. Smilingly he tells the
nurse "I've made some decisions about
my life." What should be the nurse's initial
response?
A. "You've made some decisions."
 B. "Are you thinking about killing
yourself?" Baby lucia is 6 months old, what is the
C. "I'm so glad to hear that you've appropriate toy for lucia?
made some decisions." A. push and pull toys
D. "You need to discuss your B. wooden blocks
decisions with your therapist." C. Soft stuffed toys
D. Walkey talkey
The nurse is caring for 2 children who
have had surgical repair of congenital A toddler who has been treated for a
heart defects. For which defect is it a foreign body aspiration begins to fuss and
priority to assess for findings of heart cry when the parents attempt to leave the
conduction disturbance? hospital for an hour. The nurse interprets
A. Artrial septal defect this behavior as indicating separation
B. Patent ductus arteriosus anxiety involving which of the following?
C. Aortic stenosis A. Protest
D. Ventricular septal defect B. Despair
C. Regression
The nurse is caring for a post myocardial D. Detachment
infarction client in an intensive care unit. It
is noted that urinary output has dropped All the following takes place in this age
from 60 -70 ml per hour to 30 ml per hour. group, except?
This change is most likely due to A. alldecidous teeth are present
A. Dehydration B. the secondary sex structure
B. Diminished blood volume develops
C. Decreased cardiac output C. ossification and calcification of
D. Renal failure bone
D. the digestive tract becomes
SITUATION: JOSE, a 4 years old had no functionally mature
problem in his growth and development.
You advise the parents what they expect The most reliable pain indicator for child
from jose in the coming years. is:
A. crying and sobbing
The nurse has assessed four children of B. changes in behavior
varying ages; which one requires further C. decrease in heart rate
evaluation? D. verbal report of pain
A. 7 month-old who is afraid of
strangers The concept of death of child ages 2 years
B. 4 y/o who talks to an imaginary old
playmate A. sleeping
C. 9 y/o with enuresis B. punishment and reversible
D. 16 y/o male who had nocturnal C. end of life
emissions D. none of the above

Which age group does JOSE belong Nurse Hannah is assessing a healthy
A. pre-schooler neonate upon admission to the nursery.
B. Toddler Which characteristic would the admitting
C. School age nurse record as normal?
D. Infants
 A. Head circumference measuring 31
cm
B. Hypertonia
C. Irregular respiratory rate of 50 bpm
D. High-pitched or shrill cry
The initial nursing observation of newborn
is
A. Wt in kg
B. Ht
C. APGAR
D. Breast circumference
Boy Francisco, 36 weeks AOG has
cryptorchidism,which refers to
A. undescended testes
B. unretracted foreskin on penis
C. ventral location of urethral meatus
D. dorsal location of urethral meatus
Boy greg develops jaundice.When does
physiologic jaundice occurs
A. 24 hours
B. 12 hours
C. 36 hours
D. 3 to 5 days
When the crib of greg is jarred,she
develops sudden outward extension of her
arms then slowly relaxes. What reflex is
this
A. tonic neck
B. Babinski
C. Rooting
D. Mororeflex
Soon after birth the nurse stimulates
infants respiration by:
A. gentle slapping of the feet
B. bringing the feet upside down
C. immerging him in a cold water
D. digital dilation of anus
The mother brought her child to the clinic
with nose bleeding.The nurse showed the
mother the most appropriate position for
the child?
A. sitting position
B. with low back rest
C. with moderate back rest
D. lying semi flat
A physician has prescribed oxygen PRN
for an infant with congestive heart failure
(CHF). In which situation would the nurse
plan to administer the oxygen to the
infant?
A. During feeding
B. When the mother is holding the
infant
C. When changing the infant's diapers
D. When drawing blood for electrolyte
values
An infant with congestive heart failure
(CHF) is receiving diuretic therapy, and a
nurse is closely monitoring the intake and
output (I & 0). The nurse uses which most
appropriate method to assess the urine
output?
A. Inserting a Foley catheter
B. Weighing the diapers
C. Comparing intake with output
D. Measuring the amount of water
added to formula
A nurse is monitoring the daily weight of
an infant with congestive heart failure
(CHF). Which of the following alerts the
nurse to suspect fluid accumulation and
the need to call the physician?
A. Bradypnea
B. Diaphoresis
C. Decreased blood pressure (BP)
D. A weight gain of 1 pound in 1 day
Judy, 12 years old is at what stage of
psychosocial stage
A. trust vs mistrust
B. autonomy vs shame
C. initiative versus guilt
D. identity vs role confusion
For dental check up... the nurse
encourages parents that child should be
brought to a dentist at what age?
 A. 2 years old B. A sponge ball
B. 5 years old C. A stuffed animal
C. 7 years old D. A toy gun
D. 25 years old
An essential clinical feature of autistic
Tonton,12 months old child. When disorder
choosing toy, What criteria should be A. inattention
considered as priority B. attachment to inanimate object
A. educational purpose C. easily distracted
B. developmental function D. hyperactivity
C. safety
D. recreational use Head banging is common to a autistic
child, A relevant diagnosis would be
A 7 month old the child could already able A. Potential for activity intolerance
to B. potential for injury
A. social smile C. impaired physical mobility
B. mmmm----when crying D. potential impaired skin integrity
C. say mama/dad
D. say 2 words other than Typical changes in the environment, a
mama\dada autistic child would manifest one of the
following
The normal visual acuity of pedia A. clinging behavior
A. 20/20 B. temper tantrums
B. 20/100 C. destructive behavior
C. 20/200 D. masturbates
D. 20/10
According to freud super ego is develop
A mother brings her baby in the primary during:
care clinic reporting that her baby always A. infant
vomits after breast feeding. Which of the B. Toddler
following question asked by the nurse will C. pre-schooler
support the diagnosis of intussusception? D. Adolescence
A. Is the child having difficulty to pass
stool regularly? In the pubescent boys, the pubic hair star
B. Does he have a jelly-like stool? to grow at
C. Is there a presence of olive-shaped A. base of penis
mass in the child's epigastric area? B. base of scrotum
D. Does the stool resemble a C. base of glans penis
ribbon-like appearance? D. penile shaft

Treatment was delayed for a 4-year-old At what day does complete bath should be
child with congenital hip dysplasia. The done
child has now undergone surgery and is A. after delivery
on a spica cast. Which object should the B. 3 days postpartum
nurse immediately remove from the child's C. 7 days postpartum
bed because of its potential safety D. during the day umbilical cord had
hazards? slough off
A. Legos
The specific age where sense of humor C. post term
developed: D. none of the above
A. 4 years old
B. 5 years old small for gestational age newborn are
C. 10 years old those delivered at term who weights less
D. 15 years old than
A. 2,500grams
This is an appropriate topic to start when B. 1500 grams
teaching sexuality to adolescence C. 3,000 grams
A. dating issues D. 4,300 grams
B. menstruation and wet dreams
C. family planning If the child is resistant to brush his teeth,
D. sexually transmitted disease which of the following fruits should be
given?
The nurse gives the mother home A. pears
instruction regarding digoxin B. apple
administration. Correct instruction C. papaya
includes: D. guyabano
A. give full glass of water
B. drug should be given before meals Which of the following fruit is given to
C. sign of toxicity is tachycardia asthmatic client?
D. normal blood therapeutic level is A. apple
0.9-3meq/l B. pears
C. papaya
The characteristic stool of client with D. guyabano
intussusception
A. currant jelly The immunoglobulin present on breast
B. ribbon like stool milk
C. steatorrhea A. G
D. bloodflect B. A
C. E
The brain reaches its adult size at what D. D
age
A. 3 years old Baby boy Alvin has persistent vomiting,
B. 6 years old The mother tells you that aside from being
C. 4 years old persistent, she vomits forcibly.Pyloric
D. 5 years old stenosis is diagnose, which of the
following physical assessment would you
Foramen ovale shunts blood consider very important?
A. from left atrium to right atrium A. presence of vomiting
B. from right atrium to left atrium B. peristaltic wave
C. from left ventricle to right ventricle C. dehydration
D. from right ventricle to left ventricle D. crakles

A child delivered at 30 weeks gestation,is Baby boy roy a post cheiloplasty and
considered as: uranoplasty is transferred to the ward...
A. full term which of the following is appropriate
B. pre term restrain for the client.
 A. mummy restrain
B. elbow retrain
C. hand restrain
D. jacket restrain
A nurse admits a child to the hospital with
a diagnosis of pyloric stenosis. On
admission assessment, which data would
the nurse expect to obtain when asking
the mother about the child's symptoms?
A. Vomiting large amounts of bile
B. Watery diarrhea
C. Increased urine output
D. Projectile vomiting
A clinic nurse reviews the record of a
3-week-old infant and notes that the
physician has documented a diagnosis of
suspected Hirschsprung's disease. The
nurse reviews the assessment findings
documented in the record, knowing that
which symptom most likely led the mother
to seek health care for the infant?
A. Diarrhea
B. Projectile vomiting
C. Regurgitation of feedings
D. Foul-smelling ribbon-like stools
Baby Louise, born with a
myelomeningocele with accompanying
hydrocephalus. She should be placed in
which of the following positions?
A. Trendelenburg's
B. On her back
C. With her legs abducted
D. On her abdomen
A 4 y/o with TOF is seen in a squatting
position near his bed. The nurse should
A. Administer oxygen
B. Take no action if he looks
comfortable but continue to
observe him
C. Pick him up and place him in
Trendelenburg's Position in bed
D. Have him stand up and walk
around the room
A nurse provides home care instructions
to the parents of a child with celiac
disease. The nurse teaches the parents to
include which of the following food items in
the child's diet?
A. Rice
B. Rye toast
C. Oatmeal
D. Wheat bread
A nurse is gathering supplies in
preparation to administer a tepid bath to a
child with a fever. The nurse understands
that which of the following items would not
be needed for the bath?
A. Washcloths and towels
B. A bottle of alcohol
C. Toys
D. Lightweight pajamas
The nurse is aware that children born with
a missing chromosome are most likely to
have:
A. Cretinism
B. Phenylketonuria
C. Down syndrome
D. Turner's syndrome
A nurse admits a child to the hospital with
a diagnosis of pyloric stenosis. On
admission assessment, which data would
the nurse expect to obtain when asking
the mother about the child's symptoms?
A. Vomiting large amounts of bile
B. Watery diarrhea
C. Increased urine output
D. Projectile vomiting
A 3-year-old child is hospitalized because
of persistent vomiting. A nurse monitors
the child closely for:
A. Diarrhea
B. Metabolic acidosis
C. Metabolic alkalosis
D. Hyperactive bowel sounds
A nurse provides home care instructions
to the parents of a child with celiac
disease. The nurse teaches the parents to
include which of the following food items in
the child's diet?
A. Rice
B. Rye toast
C. Oatmeal
D. Wheat bread
A sweat test is performed on a child with a
suspected diagnosis of cystic fibrosis.
(CF). The nurse reviews the test results
and determines that which of the following
is a positive result for CF?
A. Chloride level of 20 mEq/L
B. Chloride level of 30 mEq/L
C. Chloride level of 40 mEq/L
D. Chloride level of 70 mEq/L
Christopher, 2 months-old, is suspected of
having coarctation of the aorta. The
cardinal sign of this defect is
A. clubbing of the digits and
circumoral cyanosis
B. pedal edema and portal congestion
C. systolic ejection murmur
D. upper extremity hypertension
An infants intestines are sterile at birth,
therefore lacking the bacteria necessary
for the synthesis of
A. Prothrombin
B. Bile salts
C. Intrinsic factor
D. Bilirubin
On April 16 at 3:45pm, a 34 week 1550gm
female infant is delivered to Dina. The
infant demonstrates nasal flaring,
intercostals retractions, expiratory grunt,
and slight cyanosis. An umbilical catheter
is inserted with IV infusion of 5% Dextrose
and water 30cc to run over a ten hour
period. Blood gasses and electrolyte
studies are ordered immediately. The
premature baby is placed in a heated
isolette because:
A. The premature infant has a small
body surface for her weight
B. Heat increases flow of oxygen to
extremities
C. Temperature control mechanism is
immature
D. Heat within the isolette facilitates
drainage of mucus
The premature infant has a difficulty in
concentrating urine and may have large
amounts of fluid lost. The nurse caring for
Dina's baby would:
A. Force fluid every half hour
B. Observe color and amounts of
urine and check its specific gravity
C. Administer only high protein fluids
D. Warm fluids before administering
them
A newborn develops cephalhematoma.
The nurse should plan to explain to the
mother that:
A. The swelling may cross the suture
line
B. The soft sac will bulge when the
infant cries
C. It will resolve spontaneously in 3-6
weeks
D. This condition is unusual with
vaginal delivery
A lumbar puncture is performed on a child
suspected of having bacterial meningitis.
Cerebrospinal fluid is obtained for
analysis. A nurse reviews the results of
the CS analysis and determines that which
of the following results would verify the
diagnosis?
A. cloudy CS, decreased protein, and
decreased glucose
B. cloudy CSF, elevated protein, and
decreased glucose
C. clear CSF, elevated protein, and
decreased glucose
D. clear CS, decreased pressure and
elevated protein
A home care nurse provides instructions
to the mother of an infant with cleft palate
regarding feeding. Which statement if
made by the mother indicates a need for
further instructions?
A. “I will use a nipple with a small hole
to prevent chocking”
B. b. "I will stimulate sucking by
rubbing the nipple on the lower lip”
C. "I will allow the infant time to
swallow."
D. "I will allow the infant to rest
frequently to provide time for
swallowing what has been placed
in the mouth."
A nurse is caring for a newborn infant with
a suspected diagnosis of an imperforate
anus. The nurse monitors the infant,
knowing that which of the following is not
a clinical manifestation associated with
this disorder?
A. The presence of stool in the urine
B. Failure to pass a rectal
thermometer
C. Failure to pass meconium in the
first 24 hours after birth
D. The passage of currant jelly-like
stools
A nurse is gathering supplies in
preparation to administer a tepid bath to a
child with a fever. The nurse understands
that which of the following items would not
be needed for the bath?
A. Washcloths and towels
B. A bottle of alcohol
C. Toys
D. Lightweight pajamas
A clinic nurse is assessing a child for
dehydration. The nurse determines that
the child is moderately dehydrated if which
symptom is noted on assessment?
A. Flat fontanels
B. Moist mucous membranes
C. Pale skin color
D. Oliguria
A nurse interviews the parents of a child
recently diagnosed with
glomerulonephritis, The nurse
understands that which information
collected during the assessment is most
often associated with the diagnosis of
glomerulonephritis?
A. Streptococcal throat infection 2
weeks prior to diagnosis
B. Child fell off a bike onto the
handlebars
C. Nausea and vomiting for the last
24 hours
D. Urticaria and itching for 1 week
prior to diagnosis
A nurse is assigned to care for child
suspected of having glomerulonephritis.
The nurse reviews the child's record and
notes that which finding is associated with
the diagnosis of glomerulonephritis?
A. Low blood urea nitrogen (BUN)
B. Hypotension
C. Low urinary specific gravity
D. Red-brown urine
A nurse is developing a plan of care for a
7-year-old child diagnosed with acute
glomerulonephritis. The nurse includes
which priority intervention in the plan of
care?
A. Encourage limited activity and
provide safety measures
B. Catheterize the child to strictly
monitor intake and output
C. Force oral fluids to prevent
hypovolemic shock
D. Encourage classmates to visit and
to keep the child informed of
school events
A mother brings her 2-week-old infant to a
clinic for treatment following a diagnosis of
clubfoot made at the time of birth. Which
of the following statements, if made by the
mother, indicates a need for further
education regarding this disorder?
 A. "I need to bring my infant back to
the clinic in 1 month for a new
cast."
B. "Treatment needs to be started as
soon as possible."
C. "I need to come to the clinic every
week with my infant for the
casting."
D. "I realize my infant will require
follow-up care until full grown."
When performing a physical assessment
of a newborn with Down syndrome, the
nurse should carefully evaluate the
infant's:
A. Heart sounds
B. Anterior fontanel
C. Pupillary reaction
D. Lower extremities
A 12-year-old is diagnosed as having
idiopathic scoliosis. Because proper
exercise and avoidance of fatigue are
essential components of care, the nurse is
aware that the most therapeutic sport for
this child would be:
A. Golf
B. Bowling
C. Swimming
D. Badminton
A 3-month-old infant has been diagnosed
as having congenital hypothyroidism. If
care is not instituted until after early
infancy, the child will probably have:
A. Myxedema
B. Thyrotoxicosis
C. Some mental retardation
D. Abnormal deep tendon reflexes
A 6-year-old has received partial-thickness
burns of the face and chest in a house
fire. For the first 24 hours after
hospitalization, the nurse should primarily
observe this child for:
A. Wound sepsis
B. Separation anxiety
C. Pulmonary distress
D. Fluid and electrolyte imbalance
An infant is diagnosed a having pyloric
stenosis. When palpating this infant's
abdomen, the nurse would expect to find:
A. An impacted and distended colon
B. Marked tenderness around the
umbilicus
C. An olive-sized mass in the right
upper quadrant
D. Rhythmic peristaltic waves in the
lower abdomen
A test that is done on all neonates to
detect PKU is:
A. Phenistix test
B. Guthrie blood test
C. Ferric chloride urine test
D. Clinitest serum phospho pyruvic
acid
The cardiac defects associated with
tetralogy of Fallot include:
A. Right ventricular hypertrophy, atrial
and ventricular defects, and mitral
valve stenosis
B. Origin of the aorta from the right
ventricle and of the pulmonary
artery from the left ventricle
C. Right ventricular hypertrophy,
ventricular septal defect, stenosis
of pulmonary artery, and overriding
aorta
D. Abnormal connection between the
pulmonary artery and the aorta,
right ventricular hypertrophy, and
atrial septal defects
When observing a newborn with Down
syndrome, the nurse should be aware that
a common defect associated with this
condition is:
A. Deafness
B. Hydrocephaly
C. Muscular hypertonicity
D. Congenital heart defect
The nurse analyzes the laboratory values
of a child with leukemia who is receiving
chemotherapy. The nurse notes that the
platelet count is 20,000/mm3. On the
basis of this laboratory result, which
intervention will the nurse document in the
plan of care?
A. Initiative protective isolation
precautions
B. Monitor the temperature every 4
hours
C. Monitor closely for signs of
infection
D. Use Toothettes for mouth care
Which of the following definitions best
describes the form of clubfoot called
talipes equino varus?
A. inversion of the foot
B. eversion of the foot
C. plantar flexion
D. dorsiflexion
A cleft lip predisposes an infant to
infections primarily because of:
A. poor nutrition from disturbed
feeding
B. poor circulation of the defective
area
C. waste products that accumulate
along the defect
D. mouth breathing, which dries the
oropharyngeal mucous
membranes
The nurse should carefully observe the
infant with a tentative diagnosis of pyloric
stenosis for:
A. quality of cry
B. quality of stool
C. signs of dehydration
D. coughing and gagging after
feeding
Children with nasal infection usually may
have problems developing otitis media
because?
A. Eustachian tubes are shorter,
narrower
B. The tympanic membranes are
more prone to adhere
microorganisms
C. The eustachian tubes in children
are shorter and horizontal
D. The eustachian tubes in children
are longer and sloped compared to
adults
Tonya a 6 year-old child is rushed to the
ER due to cyanosis after playing with her
older sister. She is known to have
Tetralogy of Fallot since birth. Three of the
following are congenital defects
associated with Tetralogy of Fallot. Which
ONE is NOT included?
A. Deviation of the aorta
B. Stenosis of the mitral valve
C. Stenosis of the pulmonary artery
D. Intraventricularseptal defect
A mother arrives at an ER with her
5-year-old child. The mother states that
the child fell off a bunk bed. A head injury
is suspected, and a nurse is assessing the
child continuously for signs of increased
intracranial pressure (ICP). Which of the
following would indicate a late sign of
increased ICP in this child?
A. Nausea
B. Dilated scalp veins
C. Bulging fontanel
D. Widened pulse pressure
Most newborns void in the first 24 hrs after
birth. Which of the following may cause a
reddish stain sometimes called as "red
brick dust" on the diaper?
A. Uric acid crystals in the urine
B. Mucus and urate in the urine
C. Bilirubin in the urine
D. Excess iron in the urine
The nurse is performing a newborn
assessment, which of the following is
considered normal?
 A. presence of 2 veins and 1 artery in
umbilical cord
B. presence of tuft of hair at the
lumbar area of baby's back
C. presence of "witch milk" in the
breast
D. presence of ortolani's click
A nurse assigned in a newborn nursery
receives a telephone call from the delivery
room and is told that a newborn with spina
bifida (meningomyelocele type) will be
transported to the nursery. Which of the
following priority items would the nurse
prepares at the newborn's bedside?
A. A specific gravity urinometer.
B. A bottle of sterile normal saline.
C. A rectal thermometer.
D. A blood pressure cuff.
A nurse is reviewing the laboratory results
for a child scheduled for tonsillectomy. The
nurse determines that which of the
following laboratory values is the most
significant to review?
A. Creatinine
B. BUN
C. Sedimentation rate
D. Prothrombin time
While assessing a child with coarctation of
the aorta, the nurse would expect to find
which of the following?
A. Absent or diminished femoral
pulses
B. Cyanotic ("tet") episodes
C. Squatting posture
D. Severe cyanosis at birth
The nurse is assessing an 11-month old
infant. Which of the following is a normal
assessment?
A. tonic-neck reflex
B. babinski reflex
C. moro reflex
D. rooting reflex
The nurse knows which of the following is
a normal assessment for an 9-month old
infant?
A. infant able to roll over
B. infant crawls
C. infant able to stand alone
D. infant able to walks with support
A neonate after delivery is having routine
newborn care. When administering
oxygenation to the infant, the nurse knows
to take caution with the level of oxygen
delivery and not exceed it because of the
possibility of the child to develop:
A. ChoanalAtresia
B. RetrolentalFibroplasia
C. Hypospadias
D. Phenylketonuria
This kind of immunity is acquired resulting
form previous effect of a disease or
repeated exposure to doses of an
organism?
A. Anaphylactic
B. Active
C. Passive
D. artificial
The nurse is caring for a child with
tetralogy of Fallot who experiences an
episode of acute cyanosis. Which of the
following is the primary clinical
manifestation the nurse will assess?
A. Loss of consciousness
B. Anxiousness and irritability
C. Decreased respiratory rate
D. Decreased pulse rate and blood
pressure
When preparing discharge teaching for a
family of a child recovering from rheumatic
fever, the nurse's priority instruction is
A. Parents should inform the school
nurse of the child's illness
B. Parents should monitor the child
for poor appetite and growth
C. The child should resume school
activities as soon as tolerated
 D. The child needs to take
prophylactic antibiotics to prevent
endocarditis
Wendy, a pediatric nurse gives lecture on
appropriate games/toys for children
among mothers and caregivers in the
pediatric ward. For 2-year old Raphael,
what kind of toy will she prescribe most
likely?
A. Colorful and attractive
B. Safe to play by himself
C. Competitive
D. Can share with his siblings
Which of the following interventions is a
priority for the nurse to implement in the
postoperative care of a child with a cleft lip
repair?
A. Encourage the parents to limit their
visits to allow the child to rest
B. Restrain the child's arms with
blankets to prevent the rubbing the
suture line
C. Place the child prone to facilitate
drainage
D. Assess for edema of the tongue,
lips and mucus membranes
Which of the following activities will
enhance the growth and development of a
6-year-old child?
A. Allow her to explore her
surroundings
B. Allow ample time when toileting
C. Have her take care of his sister
D. Let her choose the clothes she
wants to wear
Which of the following is the first
intervention to include in the initial
postoperative care of an infant following a
bilateral cleft lip and palate repair?
A. Maintain nothing by mouth until the
incision is sealed
B. Restrain all extremities to prevent
rubbing of the face and lip
C. Clean the suture line to prevent
formation of crusts
D. Administer sedation to prevent
picking at the incision site
The nurse seeks to provide appropriate
diversional activities for a school-age child
with chorea associated with rheumatic
fever. The best activity for the nurse to
select would be:
A. Cutting out paper dolls
B. Watching educational television
C. String beads to make necklace
D. Assembling a puzzle
Situation 1: Raphael, a 6 year's old prep
pupil is seen at the school clinic for growth
and development monitoring
Which of the following is characterized by
the rate of growth during this period?
A. most rapid period of growth
B. a decline in growth rate
C. growth spurt
D. slow uniform growth rate
In assessing Raphael's growth and
development, the nurse is guided by
principles of growth and development.
Which is not included?
A. All individuals follow
cephalo-caudal and proximo-distal
B. Different parts of the body grows at
different rate
C. All individual follow standard
growth rate
D. Rate and pattern of growth can be
modified
What type of play will be ideal for Raphael
at this period?
A. Make believe
B. Hide and seek
C. Peek-a-boo
D. Building blocks
Which of the following information indicate
that Raphael is normal for his age?
 A. Determine own sense self
B. Develop sense of whether he can
trust the world
C. Has the ability to try new things
D. Learn basic skills within his culture
Based on Kohlberg's theory, what is the
stage of moral development of Raphael?
A. Punishment-obedience
B. "good boy-Nice girl"
C. naïve instrumental orientation
D. social contact
Situation 2: Baby boy Lacson delivered at
36 weeks gestation weighs 3,400 gm and
height of 59 cm (6-10)
Baby boy Lacson's height is
A. Long
B. Short
C. Average
D. Too short
Growth and development in a child
progresses in the following ways EXCEPT
A. From cognitive to psychosexual
B. From trunk to the tip of the
extremities
C. From head to toe
D. From general to specific
As described by Erikson, the major
psychosexual conflict of the above
situation is
A. Autonomy vs. Shame and doubt
B. Industry vs. Inferiority
C. Trust vs. mistrust
D. Initiation vs. guilt
Which of the following is true about
Mongolian Spots?
A. Disappears in about a year
B. Are linked to pathologic conditions
C. Are managed by tropical steroids
D. Are indicative of parental abuse
Signs of cold stress that the nurse must be
alert when caring for a Newborn is:
A. Hypothermia
B. Decreased activity level
C. Shaking
D. Increased RR
Situation 3: Nursing care after delivery
has an important aspect in every stages of
delivery
After the baby is delivered, the cord was
cut between two clamps using a sterile
scissors and blade, then the baby is
placed at the:
A. Mother's breast
B. Mother's side
C. Give it to the grandmother
D. Baby's own mat or bed
The baby's mother is RH(-). Which of the
following laboratory tests will probably be
ordered for the newborn?
A. Direct Coomb's
B. Indirect Coomb's
C. Blood culture
D. Platelet count
Hypothermia is common in newborn
because of their inability to control heat.
The following would be an appropriate
nursing intervention to prevent heat loss
except:
A. Place the crib beside the wall
B. Doing Kangaroo care
C. By using mechanical pressure
D. Drying and wrapping the baby
The following conditions are caused by
cold stress except
A. Hypoglycemia
B. Increase ICP
C. Metabolic acidosis
D. Cerebral palsy
During the feto-placental circulation, the
shunt between two atria is called
A. Ductus venosous
B. Foramen Magnum
C. Ductus arteriosus
D. Foramen Ovale

What would cause the closure of the
Foramen ovale after the baby had been
delivered?
A. Decreased blood flow
B. Shifting of pressures from right
side to the left side of the heart
C. Increased PO2
D. Increased in oxygen saturation
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
Situation 4: Children are vulnerable to
some minor health problems or injuries
hence the nurse should be able to teach
mothers to give appropriate home care.
A mother brought her child to the clinic
with nose bleeding. The nurse showed the
mother the most appropriate position for
the child which is:
A. Sitting up
B. With low back rest
C. With moderate back rest
D. Lying semi flat
A common problem in children is the
inflammation of the middle ear. This is
related to the malfunctioning of the:
A. Tympanic membrane
B. Eustachian tube
C. Adenoid
D. Nasopharynx
For acute otitis media, the treatment is
prompt antibiotic therapy. Delayed
treatment may result in complications of:
A. Tonsillitis
B. Eardrum Problems
C. Brain damage
D. Diabetes mellitus
When assessing gross motor development
in a 3 year old, which of the following
activities would the nurse expect to find?
A. Riding a tricycle
B. Hopping on one foot
C. Catching a ball
D. Skipping on alternate foot.
When assessing the weight of a 5-month
old, which of the following indicates
healthy growth?
A. Doubling of birth weight
B. Tripling of birth weight
C. Quadrupling of birth weight
D. Stabilizing of birth weight
An appropriate toy for a 4 year old child is:
A. Push-pull toys
B. Card games
C. Doctor and nurse kits
D. Books and Crafts
Which of the following statements would
the nurse expects a 5-year old boy to say
whose pet gerbil just died
A. "The boogieman got him"
B. "He's just a bit dead"
C. “I’ll be good from now on so I won’t
die like my gerbil”
D. "Did you hear the joke"
When assessing the fluid and electrolyte
balance in an infant, which of the following
would be important to remember?
A. Infant can concentrate urine at an
adult level
B. The metabolic rate of an infant is
slower than in adults
C. Infants have more intracellular
water that adult do
D. Infant have greater body surface
area than adults
When assessing a child with aspirin
overdose, which of the following will be
expected?
A. Metabolic alkalosis
B. Respiratory alkalosis
 C. Metabolic acidosis
D. Respiratory acidosis
Which of the following is not a possible
systemic clinical manifestation of severe
burns?
A. Growth retardation
B. Hypermetabolism
C. Sepsis
D. Blisters and edema
When assessing a family for potential child
abuse risks, the nurse would observe for
which of the following?
A. Periodic exposure to stress
B. Low socio-economic status
C. High level of self esteem
D. Problematic pregnancies
Which of the following is a possible
indicator of Munchausen syndrome by
proxy type of child abuse?
A. Bruises found at odd locations,
with different stages of healing
B. STD's and genital discharges
C. Unexplained symptoms of
diarrhea, vomiting and apnea with
no organic basis
D. Constant hunger and poor hygiene
Which of the following is an inappropriate
interventions when caring for a child with
HIV?
A. Teaching family about disease
transmission
B. Offering large amount of fresh
fruits and vegetables
C. Encouraging child to perform at
optimal level
D. Teach proper hand washing
technique
Situation 5: Agata, 2 years old is rushed
to the ER due to cyanosis precipitated by
crying. Her mother observed that after
playing she gets tired. She was diagnosed
with Tetralogy of Fallot.
The goal of nursing care fro Agata is to:
A. Prevent infection
B. Promote normal growth and
development
C. Decrease hypoxic spells
D. Hydrate adequately
The immediate nursing intervention for
cyanosis of Agata is:
A. Call up the pediatrician
B. Place her in knee chest position
C. Administer oxygen inhalation
D. Transfer her to the PICU
Agata was scheduled for a palliative
surgery, which creates anastomosis of the
subclavian artery to the pulmonary artery.
This procedure is:
A. Waterston-Cooley
B. Raskkind Procedure
C. Coronary artery bypass
D. Blalock-Taussig
Which of the following is not an indicator
that Agata experiences separation anxiety
brought about her hospitalization?
A. Friendly with the nurse
B. Prolonged loud crying, consoled
only by mother
C. Occasional temper tantrums and
always says NO
D. Repeatedly verbalizes desire to go
home
When Agata was brought to the OR, her
parents where crying. What would be the
most appropriate nursing diagnosis?
A. Infective family coping r/t
situational crisis
B. Anxiety r/t powerlessness
C. Fear r/t uncertain prognosis
D. Anticipatory grieving r/t gravity of
child's physical status
Which of the following respiratory
condition is always considered a medical
emergency?
A. Laryngotracheobronchitis (LTB)
 B. Epiglottitis The main element of immunization
C. Asthma program is one of the following?
D. Cystic Fibrosis A. Information, education and
communication
Which of the following statements by the B. Assessment and evaluation of the
family of a child with asthma indicates a program
need for additional teaching? C. Research studies
A. "We need to identify what things D. Target setting
triggers his attacks"
B. "He is to use bronchodilator inhaler What does herd immunity means?
before steroid inhaler" A. Interruption of transmission
C. "We'll make sure he avoids B. All to be vaccinated
exercise to prevent asthma C. Selected group for vaccination
attacks" D. Shorter incubation
D. "he should increase his fluid intake
regularly to thin secretions" Measles vaccine can be given
simultaneously. What is the combined
Which of the following would require vaccine to be given to children starting at
careful monitoring in the child with ADHD 15 months?
who is receiving Methylphenidate A. MCG
(Ritalin)? B. MMR
A. Dental health C. BCG
B. Mouth dryness D. BBR
C. Height and weight
D. Excessive appetite Situation 7: Braguda brought her 5-month
old daughter in the nearest RHU because
Situation 6: Laura is assigned as the her baby sleeps most of the time, with
Team Leader during the immunization day decreased appetite, has colds and fever
at the RHU for more than a week. The physician
diagnosed pneumonia.
What program for the DOH is launched at
1976 in cooperation with WHO and Based on this data given by Braguda, you
UNICEF to reduce morbidity and mortality can classify Braguda's daughter to have:
among infants caused by immunizable A. Pneumonia: cough and colds
disease? B. Severe pneumonia
A. Patak day C. Very severe pneumonia
B. Immunization day on Wednesday D. Pneumonia moderate
C. Expanded program on
immunization For a 3-month old child to be classified to
D. Bakuna ng kabtaan have Pneumonia (not severe), you would
expect to find RR of:
One important principle of the A. 60 bpm
immunization program is based B. 40 bpm
A. Statistical occurrence C. 70 bpm
B. Epidemiologic situation D. 50 pbm
C. Cold chain management
D. Surveillance study You asked Braguda if her baby received
all vaccines under EPI. What legal basis is
used in implementing the UN's goal on A. Varicella
Universal Child Immunization? B. Rotavirus
A. PD no. 996 C. MMR
B. PD no. 6 D. IPV
C. PD no. 46
D. RA 9173 When assessing a newborn for
developmental dysplasia of the hip, the
Braguda asks you about Vitamin A nurse would expect to assess which of the
supplementation. You responded that following?
giving Vitamin A starts when the infant A. Symmetrical gluteal folds
reaches 6 months and the first dose is" B. Trendelenburg sign
A. 200,000 "IU" C. Ortolani's sign
B. 100,000 "IU" D. Characteristic limp
C. 500,000 "IU"
D. 10,000 "IU" While assessing a male neonate whose
mother desires him to be circumcised, the
As part of CARI program, assessment of nurse observes that the neonate's urinary
the child is your main responsibility. You meatus appears to be located on the
could ask the following question to the ventral surface of the penis. The physician
mother except: is notified because the nurse would
A. "How old is the child?" suspect which of the following?
B. "IS the child coughing? For how A. Phimosis
long?" B. Hydrocele
C. "Did the child have chest C. Epispadias
indrawing?" D. Hypospadias
D. "Did the child have fever? For how
long?" When teaching a group of parents about
seat belt use, when would the nurse state
A newborn's failure to pass meconium that the child be safely restrained in a
within 24 hours after birth may indicate regular automobile seatbelt?
which of the following? A. 30 lb and 30 in
A. Aganglionic Mega colon B. 35 lb and 3 y/o
B. Celiac disease C. 40 lb and 40 in
C. Intussusception D. 60 lb and 6 y/o
D. Abdominal wall defect
When assessing a newborn with cleft lip,
The nurse understands that a good snack the nurse would be alert which of the
for a 2 year old with a diagnosis of acute following will most likely be compromised?
asthma would be: A. Sucking ability
A. Grapes B. Respiratory status
B. Apple slices C. Locomotion
C. A glass of milk D. GI function
D. A glass of cola
For a child with recurring nephritic
Which of the following immunizations syndrome, which of the following areas of
would the nurse expect to administer to a potential disturbances should be a prime
child who is HIV (fi) and severely consideration when planning ongoing
immunocompromised? nursing care?
 A. Muscle coordination Jeffrey Baynes is 5 months old. Which one
B. Sexual maturation of the following tasks would the nurse
C. Intellectual development consider abnormal for this age
D. Body image A. Rolls from abdomen lo back
B. Cannot reach for objects
An inborn error of metabolism that causes C. Smiles
premature destruction of RBC? D. Purposely turns from side to side
A. G6PD
B. Hemocystinuria Sean Abbott is 11 months old. Which one
C. Phenylketonuria of the following would the nurse consider
D. Celiac Disease abnormal for this age?
A. Has been creeping for 2 months
Which of the following would be a B. Cannot sit without support
diagnostic test for Phenylketonuria which C. Pulls himself to stand
uses fresh urine mixed with ferric D. Picks up small objects using thumb
chloride? and finger
A. Guthrie Test
B. Phenestix test Beth Garvey is 17 months old. Which one
C. Beutler's test of the following would the nurse consider
D. Coomb's test abnormal for this age?
A. Has a vocabulary of approximately
Dietary restriction in a child who has 6 words
Hemocystenuria will include which of the B. Uses a spoon
following amino acid? C. Needs support to work
A. Lysine D. Shows signs of readiness for toilet
B. Methionine training
C. Isolensine tryptophase
D. Valine SITUATION: Baby Boy Adler is born
prematurely and remains hospitalized for
A milk formula that you can suggest for a care, which includes oxygen therapy. His
child with Galactosemia: mother has been discharged, and the
A. Lofenalac parent of Baby Boy Adler visit him
B. Lactum frequently.
C. Neutramigen
D. Sustagen Baby Boy Adler is monitored closely. The
nurse should understand that if oxygen is
Pattie Evans is 3 months old. Which one administered in excess of ordered
of the following would the nurse consider amounts and the concentration of oxygen
abnormal for this age? becomes too high, there is risk of damage
A. Engages in diffuse and random to the infants:
physical activity A. Eyes
B. Holds rattle B. Heart
C. Attempts to roll over C. Liver
D. Unable to raise her head off of a D. Kidneys
flat surface
When feeding Baby Boy Adler the nurse
must remember that premature infants:
A. Require feeding every hour
 B. Usually take 3 to 4 oz each feeding
C. Have weak or absent sucking and
swallowing reflexes
D. Are given only glucose for the first
4 weeks of life
When caring for Baby Boy Adler the nurse
must remember that premature infants;
A. Have not received antibody
protection from their mothers and
are subject to infection
B. Are able to manufacturer their
antibodies
C. Rarely can breathe on their own
and require respiratory assistance
with a ventilator
D. Almost always develop cerebral
palsy
Baby Boy Adler's parents ask why his
respirations are closely monitored by his
caregivers. The nurse can explain that
Baby Boy Adler is monitored carefully
because he is likely to lack a sufficient
amount of pulmonary surfactant, which
predisposes him to:
A. Cystic fibrosis
B. Tracheobronchitis
C. Hyaline membrane disease
D. sudden infant death syndrome
SITUATION: Ms. Philips, whose blood
type is Rh negative, is in 38th week of
pregnancy when she delivers a boy. Ms
Philips tells the nurse that this is her
second pregnancy and she had not seen
a physician until she came to the hospital
emergency room in active labor. Baby Boy
Philips is Rh positive. The physician states
that the infant has congenital hemolytic
disease caused by Rh incompatibility.
To answer Ms. Phillips questions and
concerns, the nurse should know that
Baby Boy Philips congenital hemolytic
disease is called:
A. Thalassemia
B. Sickle cell disease
C. Megaloblastic anemia
D. erythroblastosis fetalis
Which one of the following might the nurse
observe if Baby Boy Philips has congenital
hemolytic disease
A. Slowed respiratory rate
B. Absence of reflexes
C. Limited movement in his lower
extremities
D. Jaundice within 24 to 36 hours
after birth
A direct comb's test is ordered to confirm
the diagnosis of hemolytic disease. The
nurse should be prepared to assist with
the collection of a blood specimen taken
from Baby Boy Philips.
A. Fingertip
B. Jugular vein
C. Femoral vein
D. Umbilical cord
After Baby Boy Philips receives an
exchange transfusion, the nurse observes
him for signs of neurologic damage, All the
following signs suggest neurologic
damage except having:
A. Poor muscle tone
B. Poor sucking ability
C. Decreased urine production
D. Decreased responsiveness to
stimuli
SITUATION: Andy Jones is 1 day old and
was born with spina bifida with a
myelomeningocele high in the spinal
column. Andy is scheduled to have
immediate surgical repair of the spina
bifida and myelomeningocele.
Which of the following nursing measure is
most important for the nurse to include in
Andy's preoperative
A. Prevent skin breakdown by placing
a sheepskin under his head. *
B. Position him so that there is no
pressure on the myelominingocele
 C. Keep his myelominingocele clean
by washing it with antiseptic soap
D. Support his bottle of formula on a
rolled towel for ease in feeding
him.
The physician explains the importance of
immediate surgery for Andy. To answer
the parents questions and reinforce the
surgeons recommendations the nurse
should know that surgery for this disorder
is performed as soon as possible to:
A. Prevent paralysis of the upper
extremities
B. Restore bowel function
C. Prevent infection
D. Restore respiratory function
Unless the physician orders otherwise,
what position should the nurse use for
Andy during the postoperative period and
until the operative site heals?
A. The supine position (back lying
position)
B. The prone position (face lying
position)
C. Either the left or right side- lying
position
D. The position in which the infant
appears most comfortable.
SITUATION: Andy's caretakers discuss
the infant's prognosis in a conference in
which his home care is considered.
To assist in developing a plan for Andy's
home care the nurse should know that:
A. It is unlikely that Andy will be able
to walk without crutches or braces
B. Andy has approximately a 50%
chance of eventually walking alone
if he has good health care
C. Andy has approximately a 95%
chance of eventually walking alone
if he has good health care
D. Andy will someday be able to walk
without having to use crutches or
braces
When planning discharge teaching for
Andy's parents the nurse should be aware
of the many needs Andy will require now
and in the future. Which one of the
following neurologic disturbances usually
is seen in those with spina bifida with a
myelomeningocele?
A. Respiratory difficulties
B. Paralysis of the muscle of the head
and neck
C. Paralysis of the arms
D. Urinary and bowel control
problems
SITUATION: Baby Girl Lyons is born with
hydrocephalus. Her parents named her
Jenny. She is now 1 week old and is
scheduled for surgery.
To understand and plan for Jenny's care,
the nurse should know that the most
prominent symptom of hydrocephalus is:
A. An increase in head size
B. Paralysis of the lower extremities
C. An absence of the sucking reflex
D. A marked depression of the
anterior fontanel
To reinforce the physician's explanations
of Jenny's congenital malformation and
allow the family to talk about Jennys
problem, the nurse should know that
hydrocephalus is probable due to
A. An absence absence of dura mater
B. A blockage that prevents proper
circulation of cerebrospinal fluid
C. An increased amount of
cerebrospinal fluid proteins
D. A blockage in the cerebral arteries
During the preoperative period the nurse
should plan to:
A. Weigh Jenny every week
B. Change Jenny's position every 2
hours
C. Feed Jenny a low- fat formula to
decrease the formation of
cerebrospinal fluid
 D. Observe Jenny for signs of
decreased intracranial pressure
The position of choice for Jenny after
feeding her is the:
A. Sitting Position
B. Back lying position
C. Face lying position
D. Side lying position
The nurse places a sheepskin under
Jenny's head and shoulders, the primarily
purpose is to:
A. Keep the infant's head higher than
her trunk
B. Prevent strain on the infants neck
and shoulders
C. Relieve areas of pressure on the
infants head and ears
D. Allow the infant to remain
undisturbed for longer periods
SITUATION: A shunting device is placed
through an incision on the right side off
Jenny's head.
The postoperative position of choice is on
Jenny's:
A. Right side to increase absorption
of cerebrospinal fluid
B. Abdomen to prevent obstruction in
the shunt catheter
C. Left side to avoid pressure on the
operative site
D. Back to promote ventricular
drainage
Postoperatively, the nurse should
observed Jenny closely for signs of
increased intracranial pressure, one sign
is.
A. Depression of the fontanels
B. A decrease in the pulse and
respiratory rate
C. Changes in the number ol bowel
movements
D. A sudden gain in weight
SITUATION: Billy Keeler, 3 weeks old is
admitted to a children's hospital. He is
being readied for surgical repair of a
unilateral cleft lip.
When developing a care plan the nurse
should expect that, until repaired, Billy's
anomaly most likely will make him unable
to:
A. Suck
B. Salivate
C. Breathe
D. Swallow
Which of the following utensils is best for
the nurse to use preoperatively and
postoperatively when feeding Billy his
formula?
A. A gavages' tube
B. A plastic spoon
C. An Asepto syringe with a rubber tip
D. A firm rubber nipple
Postoperatively, the nurse should plan to
A. Position Billy on his abdomen
B. Hold Billy as little as possible Y
C. Feed Bily with a regular bottle X
D. Apply arm restraints as ordered by
the physician
SITUATION: Three-week old Joseph
Morgan, who has pyloric stenosis is
admitted to a hospital for surgery to
correct the defect.
To develop a care plan for Joseph, the
nurse should understand that pyloric
stenosis prevents food from moving
normally in the gastrointestinal tract from
his:
A. Jejunum into his stomach
B. Esophagus into his stomach
C. Duodenum into his jejunum
D. Stomach into his duodenum
Intravenous therapy to correct fluid and
electrolyte imbalances is to be started on
Joseph. To obtain the necessary materials
for assisting with starting an intravenous
infusion, the nurse should know that the
vein most frequently used for an infant is a
vein located in the:
A. Neck
B. AScalo
C. Upper extremity
D. Lower extremity
SITUATION: Joseph has a surgical repair
of his pyloric stenosis
What is the position of choice for Joseph
once he is allowed oral glucose water?
A. back lying position
B. A semi sitting position
C. A normal left side lying position
D. An exaggerated right side lying
position
SITUATION: Six month old Cindy Connors
has concern for dislocation of the hip (DH)
and is scheduled for the application of a
bilateral hip spica cast for correction of the
disorder.
The nurse is assigned to collect materials
necessary for application of the cast. To
help eliminate skin irritation from the
edges of Cindy's cast, the physician
usually:
A. Trims the cast edges with sand
papers
B. Covers the cast edges with plastic
C. Petals the cast edges with strips of
adhesive
D. Protects the cast edges with a
disposable diaper
Following application of the cast the nurse
should observe Cindy for signs of
complications. Which one of the following
might indicate that a neurovascular
problem is occurring?
A. She cries 4 hours after her last
feeding
B. She wiggles her toes*
C. Her toes are pale and cold
D. Her pulse rate is 110
SITUATION: Nicky Harris is born after 36
weeks of gestation by breech
presentation. He has the talipes
equinovarus form of bilateral clubfoot. The
physician has recommended immediate
treatment for this congenital disorder.
To answer questions raised by Ms. Harris,
the nurse should know that early treatment
of clubfoot is necessary because:
A. Later treatment is more expensive
B. Early treatment may prevent the
need for surgery
C. If not treated, the bones and
muscle continue to develop
abnormally.
D. Its easier on the infant
At a nursing conference, the nurse
assistant asks the nurse why Nicky's legs
and feet are to be elevated. on pillows
after the cast has been applied. The most
correct answer is based on the fact that
this position:
A. Fastens drying the cast
B. Keeps his hips and lower back off
the bedding
C. Helps avoid postoperative shock
D. Prevents his feet from swelling
Of the following techniques, the best one
for the nurse to use when moving Nicky's
wet casts is to handle them with:
A. The fingers
B. Gloved hands
C. Slings made of gauze
D. The palms of the hands
Nicky is & weeks bld. And his cast is to be
changed. Which of the following types of
amusement can the nurse use to
determine if Nicky appears to be following
a normal growth and development
pattern?
A. Encourage the infant to crawl
about in his crib
 B. Play peek a boo with his favorite
blanket
C. Permit him to reach for cuddly toys
D. Place a brightly colored mobile
over his crib
During discharge teaching, Nicky's mother
says to the nurse, "I can barely feel the
soft spot in the back part of Nicky's head.
My daughter's soft spot did not close until
about 3 months of age. Is there anything
wrong?" The most correct response is
based on the fact that the amount of
closure of the posterior fontanel for 8 week
old Nicky is judged to be:
A. Normal because the posterior
fontanel usually closes at
approximately 2 month of age
B. Abnormal because the posterior
fontanel usually closes in male
children later than in female
children
C. Abnormal because the posterior
fontanel usually does not close
until about 6 to 8 month of age
D. Normal because the posterior
fontanel usually closes early in
children with any type of congenital
skeletal defects
SITUATION: Ms. Hale brings 6 month old
Ricky to the clinic because he has
elevated temperature. She states that
Ricky has been irritable and crying
frequently. Ricky is examined by physician
and found to have otitis media
The physician asks the nurse to weigh
Ricky, Ricky's weight probably will be used
to help:
A. Determine the nutritional needs of
infant
B. Determine dosages for drugs to be
prescribed for the infant
C. Calculate whether the infant needs
to rèceive parenteral fluids
D. Calculate whether the infant is
suffering from an electrolyte
imbalance
The nurse observes Ricky. Which one of
the following would most likely indicate he
has pain in his ear?
A. Lying on his affected ear
B. Pulling on his affected ear
C. Rolling his head from side to side
D. Tipping his head toward the
affected ear
SITUATION: The physician prescribes an
antibiotic to be given to Ricky for 10 days
Which of the following should the nurse
emphasize when explaining the
prescribed antibiotic treatment to Ms.
Hale?
A. Stop the drug if Ricky feels better
B. Limit Ricky's fluid intake during the
time he is given the drug
C. Do not allow Ricky lie on his
affected ear
D. Stopping the drug too soon may
result in a return of the infection
SITUATION: Jeff Baker, age 3 months,
has chickenpox and his taken by his
mother to the emergency room. Following
examination by a physician, Jeff is
admitted to the hospital because he also
has a congenital heart defect with possible
congestive heart failure. He is placed on
strict isolation
The nurse is assigned to prepare Jeff's
room. Which one of the following is
instituted for strict isolation?
A. Used gowns may be discarded
with the general linen
B. Clothing and articles in the room,
must be decontaminated before
reuse
C. Gloves are not required for
caretakers
 D. The door to the room may be left
open
The nurse wears a mask when caring for
Jeff. Which of the following actions is
Incorrect?
A. The nurse's fingers and hands
should not touch the mask
B. A supply of unused, disposable
mask is kept outside the clients
room
C. The mark should be change every
hour
D. The used mask is discarded
outside the room
The nurse prepares to leave Jeff's room
after giving morning care. Which one of
the following is incorrect?
A. The gown is removed before the
gloves are removed K
B. Clean hands are used to unfasten
the gown for removal
C. When removing the gown,
touching the front of the gown is
avoided
D. Clean paper towels are used to
open the door of the room
To prepare Jeff for intravenous therapy,
the nurse should withhold fluids and food
immediately prior to starting the therapy
because:
A. Fluids and calories will be supplied
by intravenous fluid
B. Vomiting and aspiration may occur
C. Oral food and fluids may interfere
with the absorption of intravenous
fluid
When an infant requires intravenous
therapy, the nurse should:
A. Request that the parents not see
the infant until intravenous therapy
is complete
B. Encourage the family to continue
providing tactile and verbal
stimulation to the infant
C. Warn the parents not to touch the
infant until intravenous therapy is
completed
D. Ask the parents to disturb the
infant as little as possible
The nurse is assigned to closely monitor
Jeff while he is receiving intravenous
therapy, Which one of the following should
the nurse report to the nurse in charge?
A. Jeff sleeps for short intervals
during the day.
B. An increase in the frequency and
amount of urine voided
C. Jeff occasionally cries when he is
disturbed by noise
D. An increase in the rate of flow of
the intravenous infusion
the intravenous solution infuses too
rapidly, the nurse should closely observe
Jeff for sign of:
A. Heart failure
B. Renal failure
C. Excessive voiding
D. Diarrhea
SITUATION: Ms. Scott brings a 2 year old
Timmy to the clinic because the skin on
his face and neck is inflamed and covered
with tiny vesicle-type lesions. Timmy is
diagnosed as having atopic dermatitis
(acute infantile eczema) Ms. Scott shows
concern and asks many questions about
Timmy's problem.
The nurse explains to Ms. Scott that when
the vesicles on Timmy's skin break. They
typically release fluid containing.
A. Pus
B. Bloody
C. Lymph
D. Serum
Ms. Scott asks what caused Timmy's skin
condition and why the physician asked
many questions about Timmy's home
environment. The nurse explains that it is
believed that the problem cause of atopic
dermatitis is thought to be:
A. Poor nutrition
B. premature birth
C. An allergic reaction
D. A hormone imbalance
The nurse should be prepared to give Ms.
Scott suggestions concerning care
measures that will help relieve Timmy's:
A. Nausea
B. Vomiting
C. Severe itching
D. Prolonged drowsiness
SITUATION: A 9-month-old child was
diagnosed to have tetralogy of fallot after
series of examinations, intensive physical
assessments and history taking. The child
is admitted to the hospital for the
scheduled heart surgery for its repair.
The nurse reviews the child's record and
notes that the child has clubbed fingers.
The nurse understands that the clubbing
is most likely caused by:
A. Peripheral hypoxia
B. Delayed physical growth
C. Chronic hypertension n
D. Destruction of bone marrow
Which of the following should the nurse
expect to include in the plan of care of a
child diagnosed with tetralogy of fallot who
has undergone corrective surgery?
A. 2 to 3 g of sodium in the diet each
day
B. Visits limited to a selected few
C. Physical activity restrictions
D. Assignment to an isolation room
SITUATION: Congenital heart defect is
the most common form of cardiac disease
in children. When performing an infant's
admission examination, the nurse notes all
the following abnormal findings.
Which one is the most common sign of
heart disease that the nurse should
assess?
A. Diastolic murmur
B. Circumoral cyanosis
C. Hypertension
D. Tachycardia
Upon assessment, an infant with the
coarctation of the aorta would be expected
to have:
A. Edema
B. Absence of palpable femoral
pulses
C. Strong pedal pulses
D. Shortness of breath
Tetralogy of Fallot is a defect that results
in decreased pulmonary blood flow
because:
A. Deoxygenated blood is shunted
from the right ventricle to the left
ventricle through and the
overriding aorta
B. Deoxygenated blood is shunted
from the right atrium to the left
atrium and increased pressure
from aortic stenosis
C. Deoxygenated blood is forced into
the ;eft atrium through a patent
ductus arteriosus
D. Deoxygenated blood continuously
circulates from the right ventricle to
the lungs and back to the right
ventricles.
A child with Tetralogy of Fallot who has not
had surgical repair may assume a
posturing position as a compensatory
mechanism. The position automatically
assumed by the child would be:
A. prone
B. Kneeling
C. Supine
D. Squatting
A neonate born 18 hours ago with
myelomeningocele over the lumbosacral
region is scheduled for corrective surgery.
Preoperatively, what is the most important
nursing goal?
A. Preventing infection
B. Providing adequate nutrition
C. Ensuring adequate hydration
D. Preventing contracture deformity
Wally is a 4-year-old child scheduled for a
cardiac catheterization. Preoperative
teaching should be:
A. Directed at his parents, because
he is too young to understand.
B. Detailed in regard to the actual
procedures so he will know what to
expect.
C. Done several days before the
procedure so that he will be
prepared.
D. Adapted to his level of
development so that he can
understand.
Which of the following is a complication
that may occur after a cardiac
catheterization?
A. Cardiac arrhythmia
B. Congestive heart failure
C. Hypostatic pneumonia
D. Rapidly increasing blood pressure
Which of the following explanations
regarding cardiac catheterization is
appropriate for a preschool child?
A. Postural drainage will be
performed every 4 to 6 hours after
the test.
B. It is necessary to be completely
"asleep" during the test.
C. The test is very short, usually
taking less than 1 hour.
D. When the procedure is done, you
will have to keep your leg straight
for at least 4 hours.
Nurse Donna is discussing the categories
of congenital heart defects. Which defect
results in increased pulmonary blood flow?
A. Pulmonic Stenosis
B. Tricuspid atresia
C. Atrial septal defect
D. Transposition of great arteries
A child is diagnosed with tetralogy of
Fallot. The nurse caring for the child
understands that the following structural
defects constitute tetralogy of Fallot?
A. Pulmonary stenosis, ventricular
septal defect, overriding aorta,
right ventricular hypertrophy
B. Aortic stenosis, ventricular septal
defect, overriding aorta, right
ventricular hypertrophy
C. Aortic stenosis, atrial septal defect,
overriding aorta, left ventricular
hypertrophy
D. Pulmonary stenosis, ventricular
septal defect, aortic hypertrophy,
left ventricular hypertrophy
Clubbing of fingers seen in a child with
tetralogy of Fallot is most likely caused by:
A. Polycythemia
B. Decreased circulating WBC
C. Decreased blood viscosity
D. Destruction of bone marrow
An infant known to have a tetralogy of
Fallot is seen in the emergency
department because of a 2 day history of
diarrhea and poor oral intake. The priority
intervention for this child is directed toward
the prevention of which complication?
Hemolysis
Metabolic alkalosis
A. Endocarditis
B. Cerebrovascular accident (CVA)
During IV insertion, an infant with tetralogy
of fallot suddenly becomes highly agitated
and exhibiting text spells. Nurse Isabel
advises the mother to:
A. Place the infant in side-lying
position
B. immediately breastfeed the child
 C. Hold the infant in knee-chest
position
D. Administer bronchodilator
The parents of a young child with
congestive heart failure tell the nurse that
they are "nervous" about giving digoxin.
The nurse's response should be based on
which of the following?
A. It is a very safe, frequently used
drug.
B. It is difficult to either overmedicate
or undermedicate with digoxin.
C. Parents lack the expertise
necessary to administer digoxin.
D. Parents must learn specific,
important guidelines for
administration of digoxin.
Which of the following should the nurse
consider when preparing a school-age
child and the family for heart surgery
A. Unfamiliar equipment should not
be shown.
B. Let child hear the sounds of an
ECG monitor.
C. Avoid mentioning postoperative
discomfort and interventions.
D. Explain that an endotracheal tube
will not be needed if the surgery
goes well.
What is the most frequent cause of
cardiac arrest in children?
A. Respiratory failure
B. Congenital defect
C. Metabolic anomalies
D. Drowning
When telling a 4-year-old child about an
upcoming procedure, the nurse's most
important consideration is to:
A. use simple terms.
B. offer a toy to keep the child happy.
C. speak loudly and clearly.
D. include every detail
Miko, a 4-year-old child, has Kawasaki
disease. During the first stage of this
disease, what is the primary
manifestation?
A. Desquamation of the palms and
the soles
B. High fever
C. Platelet count rises
D. Strawberry tongue
Which of the following is a common,
serious complication of rheumatic fever?
A. Seizures
B. Cardiac arrhythmias
C. Pulmonary hypertension
D. Cardiac valve damage
Which of the following is a major clinical
manifestation of rheumatic fever?
A. Low grade fever
B. Polyarthritis
C. Arthralgia
D. Splinter hemorrhages of distal third
of nails
The therapeutic management of the child
with rheumatic fever includes:
A. Administration of penicillin.
B. Strict bed rest for 4 to 6 weeks.
C. Avoid salicylates (aspirin).
D. Administration of corticosteroids if
chorea develops.
Which of the following actions by the
school nurse is important in the prevention
of rheumatic fever?
A. Encourage routine cholesterol
screenings.
B. Conduct routine blood pressure
screenings.
C. Refer children with sore throats for
throat cultures.
D. Recommend salicylates instead of
acetaminophen for minor
discomforts.
A child is admitted with a diagnosis of
"rule out rheumatic fever." Which
assessment finding supports this
diagnosis?
A. Elevated antistreptolysin-O (ASO)
B. Decreased hemoglobin
C. Elevated hematocrit
D. Decreased salicylate level
During the acute phase of rheumatic fever,
which of the following findings would be
present?
A. Swelling of the hands and
petechiae
B. Nodules over bony prominences,
dependent edema and elevated
blood pressure
C. Bleeding gums, dyspnea and
failure to gain weight
D. Fever, migratory joint pain and a
red rash on the abdomen
A school-age child with rheumatic fever
develops heart failure and is placed on
Digoxin, Lasix and potassium. The chief
purpose of giving potassium is to:
A. Enhance the cardiogenic effect of
Digoxin
B. Prevent hypokalemia
C. Potentiate the diuretic action of
Lasix
D. Pharmacologically induce
hyperkalemia
A school-age child experiences the
following signs and symptoms of
rheumatic fever. The nurse should plan
any intervention based on the knowledge
that the only one that may result in
permanent damage is:
A. Sydenham's chorea
B. Migratory polyarthritis
C. Carditis
D. Erythema marginatum
A school-age child is being discharged
with a diagnosis of rheumatic fever. Which
of the following should be included in the
teaching plan for the family?
A. the child should stay on penicillin
and return for a follow-up
appointment.
B. At home, be sure to keep the child
on bed rest.
C. All children with rheumatic fever
need monthly blood tests.
D. The child should stay out of school
until the source of the infection is
determined.
A 9-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
When caring for the child with Kawasaki
disease, the nurse should know which of
the following?
A. Child's fever is usually responsive
to antibiotics within 48 hours.
B. Principal area of involvement is the
joints.
C. Aspirin is contraindicated.
D. Therapeutic management includes
administration of gamma globulin
and aspirin.
A 6-month-old infant is receiving digoxin
(Lanoxin). The nurse should notify the
practitioner and withhold the medication if
the apical pulse is less than which of the
following?
A. 60
B. 70
C. 90 - 110
D. 110 - 120
An 8-month-old infant has a hypercyanotic
spell while blood is being drawn. The
nurse's first action should be which of the
following?
A. Assess for neurological defects.
B. Begin cardiopulmonary
resuscitation.
 C. Place the child in the knee-chest
position
D. Prepare family for imminent death.
SITUATION: The nurse must understand
various cardiac diseases and problems;
treatment of cardiac disease; and care
measures for an infant, child, or
adolescent with cardiac conditions.
A parent brings a 2-month-old who has
tetralogy of Fallot for a health
maintenance visit. The parent's chief
concern is most apt to be that the infant:
A. Is overweight.
B. Coughs bloody sputum.
C. Has difficulty sucking.
D. Appears pale.
Tetralogy of Fallot is the most frequently
occurring type of congenital heart disease
in children. The four anomalies associated
with this defect are:
A. Atrial septal defect, pulmonary
stenosis, left ventricular
hypertrophy, overriding aorta.
B. Ventricular septal defect, aortic
stenosis, mitral stenosis,
right-sided aorta.
C. Tricuspid stenosis, right ventricular
hypertrophy, pulmonary stenosis,
atrial septal defect.
D. Ventricular septal defect,
pulmonary stenosis, right
ventricular hypertrophy, overriding
aorta.
The nurse assessing an infant will be most
concerned about which of the following
findings?
A. Peripheral cyanosis of the hands
B. Cyanosis of the lips and/or tongue
C. Perioral cyanosis
D. Cyanosis of the feet
Which of the following actions would the
nurse take when she finds an innocent
murmur while listening to a child's heart?
A. Refer the child and mother to a
cardiologist.
B. Advise the caregiver(s) to restrict
the child's activity.
C. Teach the family that this murmur
needs no intervention.
D. Get an order for oxygen and
administer it as soon as possible.
Nurse Isabel is assessing an infant with
chronic heart failure. Which of the
following symptoms would the nurse most
likely find in this infant?
A. Jugular vein distention
B. Greatly elevated blood pressure
C. Peripheral edema
D. Diaphoresis during feeding
Which of the following symptoms would
the nurse most likely find in assessing a
child with right ventricular failure?
A. Rales and rhonchi, falling oxygen
saturation, labored breathing
B. Falling blood pressure, falling
pulse rate, increased respirations
C. Diaphoresis, nausea and vomiting,
and tingling in extremities
D. Hepatomegaly, jugular venous
distention, and peripheral edema
When you are making plans for the
discharge of a child following rheumatic
fever, you anticipate that you will be giving
her parents instructions to
A. Administer oral penicillin to the
child daily.
B. Watch for signs of poor platelet
function, such as petechiae.
C. Ensure that the child remains
inside until surgery is scheduled.
D. Test the child's urine daily for
protein.
When planning the care for a child with
Kawasaki disease, which of the following
would be most important?
A. Making sure he performs postural
drainage daily.
 B. Encouraging him to cough and
deep-breathe.
C. Observing him for symptoms of
bowel obstruction.
D. Teaching him to live with a chronic
illness.
SITUATION: Nurse Aubrey has been
working in a specialized hospital for
pediatric clients, where she handled
young clients on different ages and
developmental stages with cardiovascular
affectations. She definitely knows that
each age group requires a different
approach in rendering nursing care.
Nurse Aubrey is caring for a 4-year-old
child diagnosed with ventricular septal
defect who will be undergoing a cardiac
catheterization. Which of the following
nursing diagnoses would be the priority for
Nurse Aubrey?
A. Pain related to the structural
defect.
B. Deficient knowledge (parental)
related to cardiac catheterization.
C. Risk for infection related to
decreased oxygenation.
D. Decreased cardiac output related
to the structural defect.
When developing a plan of care for a
4-year-old child, Nurse Aubrey includes
actions that foster the development of
which of the following psychosocial tasks
according to Erikson?
A. Autonomy versus shame and
doubt.
B. Initiative versus guilt.
C. Identity versus role confusion.
D. Industry versus inferiority.
When developing the discharge teaching
plan for the parents of the child who has
undergone a cardiac catheterization,
which of the following should nurse
Aubrey expect to include?
A. Restriction of child's activities for
the next 3 months.
B. Use a sponge bath until the
stitches are removed.
C. Use of prophylactic antibiotics
before receiving any dental work.
D. Maintenance of a pressure
dressing until a return visit with the
physician.
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. Explain to the child that it will hurt
for a short time.
C. Assess for an irregular heart rate
and rhythm.
D. Place the child in a knee-to-chest
position.
When teaching a preschool child how to
perform coughing and deep-breathing
exercises before corrective surgery of
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.
After the surgery to correct tetralogy of
Fallot, the child's parents express concern
to the nurse that their 4year-old child
wants to be held more frequently than
usual. Nurse Aubrey interprets the child's
behavioral response to stress as:
A. Repression.
 B. Depression.
C. Regression.
D. Discomfort.
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 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. Exposure to a sexual experience.
C. Need for more attention.
D. Indication of depression.
Which of the following cardiac anomalies
produces a left-right shunt?
A. Tetralogy of Fallot
B. Atrial septal defect
C. Pulmonary stenosis
D. Congestive heart failure
A child with a cyanotic heart defect has
developed a physiological compensation
in meeting his oxygen needs.
If not kept well hydrated, the child will be
at risk for developing:
A. Elevated blood pressure
B. Infection
C. Polycythemia
D. Thrombocytopenia
It is the most common congenital cardiac
defect that accounts for 30% of all the
cases of congenital heart disease.
A. Atrial septal defect
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Coarctation of the aorta
It is an accessory fetal structure that
connects the pulmonary artery to the
aorta:
A. Tricuspid valve
B. Sinoatrial node
C. Ductus arteriosus
D. Mitral valve
A newborn with a patent ductus arteriosus
is being given medication to improve his
condition. The nurse would prepare the
following medication:
A. Digoxin
B. Lasix
C. Prostaglandin
D. Indomethacin
This is the leading cause of congestive
heart failure in the first few months of life.
A. Truncus arteriosus
B. Coarctation of the aorta
C. Tricuspid atresia
D. Aortic stenosis
A child with coarctation of the aorta would
be expected to have:
A. Low blood pressure
B. Dizziness
C. Cyanosis
D. Weak pedal pulses
An infant is diagnosed with congestive
heart failure. Pediatric Lanoxin (digoxin) is
prescribed. The teaching plan for
medication administration should include
the signs of digoxin toxicity, which are:
A. Apical pulse rate of 90, vomiting
B. Fatigue, diaphoresis
C. Tachycardia, tachypnea
D. Wheezing, pallor
A parent asks the nurse why altering the
amount of time the child feeds is important
in the care of the child with congestive
heart failure. Which response by the nurse
is the most appropriate?
A. Resting is essential in the care of
the newborn with congestive heart
failure.
B. Calories are not a major concern in
congestive heart failure.
 C. Extending feeding time allows the
infant to consume the calories
required to gain weight.
D. Limiting fluids is necessary in
congestive heart failure.
SITUATION: Pepito, a 10-year-old child
has been admitted with a diagnosis of
rheumatic fever and is on bed rest. He
complains of a sore throat. His joints are
painful and swollen. He has a red rash on
his trunk and is experiencing aimless
movements of his extremities. You are
assigned to take care for him to render
efficient care, assist in pharmacologic
treatment and provide health teaching with
regards to the child's condition.
Pepito has a history of long-term aspirin
use. Which of the following statements by
him indicates that you should assess him
further?
A. "I hear ringing in my ears."
B. "My stomach hurts after I take
those."
C. "Is it right to put lotion on my itchy
skin."
D. "These pills make me cough."
Which of the following initial physical
findings would indicate the development of
carditis due to rheumatic
A. Heart murmur
B. Low blood pressure
C. Irregular pulse
D. Anterior chest wall pain
Which of the following should you expect
to include in the plan of care for Pepito
who is diagnosed with rheumatic fever and
carditis?
A. Ensuring continuous parental
presence at the child's bedside
B. Providing the child with periods of
rest
C. Encouraging participation in
age-appropriate activities
D. Advising the child to eat as much
as possible
Which of the following outcomes indicates
that the activity restriction necessary for
Pepito during the acute phase has been
effective?
A. Joints demonstrate absence of
permanent injury
B. The resting heart rate is between
75 to 100 bpm
C. The child exhibits decrease In
chorea movements
D. The subcutaneous nodules over
the joints are no longer palpable
Which of the following should the nurse
perform to help alleviate Pepito's joint pain
associated with rheumatic fever
A. Maintaining the joints in an
extended position
B. Applying gentle traction to the
child's affected joints
C. Supporting proper alignment with
rolled pillow
D. Using a bed cradle to avoid the
weight of bed linens on joints
A child is brought to the clinic with fever,
macular rash on the trunk and swollen and
tender joints. Rheumatic fever is
suspected. The nurse should ask the
mother if the child recently had which
illness?
A. Strep throat
B. Influenza
C. Chickenpox
D. Mononucleosis
A school-age child with rheumatic fever
develops heart failure and is placed on
Digoxin, Lasix and potassium. The chief
purpose of giving potassium is to:
A. Enhance the cardiogenic effect of
Digoxin
B. Prevent hypokalemia
C. Potentiate the diuretic action of
Lasix
 D. Pharmacologically induced
hyperkalemia
A school-age child experiences the
following signs and symptoms of
rheumatic fever. The nurse should plan
any intervention based on the knowledge
that the only one that may result in
permanent damage is:
A. Sydenham's chorea
B. Migratory polyarthritis
C. Carditis
D. Erythema marginatum
A child with suspected rheumatic fever is
admitted to the pediatric unit. When
obtaining the child's history, the nurse
considers which information to be most
important?
A. Fever that started 3 days ago
B. A recent episode of pharyngitis
C. Lack of interest in food
D. Vomiting for 2 days
Which of the following criteria is required
to establish a diagnosis of acute
rheumatic fever?
A. Laboratory tests
B. Positive blood cultures for
Staphylococcus organisms
C. Fever and four diagnostic criteria
D. Use of ones criteria and presence
of a streptococcal infection
Which of the following diagnostic criteria is
considered major for Jones criteria for
acute rheumatic fever?
A. Carditis
B. Prolonged PR interval
C. Low-grade fever
D. Previous heart disease
A nurse is caring for a child with acute
rheumatic fever. Which of the following
symptoms can be recognized as
Sydenham's chorea, a major
manifestation of acute rheumatic fever?
A. Cardiomegaly
B. Pericardial friction rubs
C. Regurgitant murmur
D. Involuntary muscle movements
A school-age child is being discharged
with a diagnosis of rheumatic fever. Which
of the following should be included in the
teaching plan for the family?
A. The child should stay on penicillin
and return for a follow-up
appointment.
B. At home, be sure to keep the child
on bed rest.
C. All children with rheumatic fever
need monthly blood tests.
D. The child should stay out of school
until the source of the infection is
determined.
A nurse prepares to administer digoxin
(Lanoxin) to a 4-year-old child with a
diagnosis of congestive heart failure. The
nurse notes that the apical rate is 80 beats
per minute. Based on this finding, which
nursing action is most appropriate?
A. Administer the digoxin.
B. Notify the physician.
C. Recheck the apical rate in 15
minutes.
D. Hold the medication.
A nurse is caring for a child with Kawasaki
disease. The principal and life threatening
finding is:
A. Fever
B. Vasculitis
C. Vomiting
D. Pallor
Which of the following test results may
contribute to the diagnosis of Kawasaki
disease?
A. Hematuria
B. Normal or decreased platelet count
C. Elevated leukocyte count
D. Decreased erythrocyte
sedimentation rate
Which of the following criteria is required
to establish a diagnosis of acute
rheumatic fever?
A. Laboratory tests
B. Positive blood cultures for
Staphylococcus organisms
C. Fever and four diagnostic criteria
D. Use of Jones criteria and presence
of a streptococcal infection
Long term therapy for a child with
rheumatic fever would include:
A. Antibiotics
B. Diuretics
C. Vitamins
D. Steroids
When taking a history from the parent of
an eight-year-old child who has rheumatic
fever, a nurse would expect the child's
parent to report a recent episode of
A. Urinary tract infection
B. Acute gastroenteritis
C. Contact dermatitis
D. Acute pharyngitis
Nurse Isabelle reviews the laboratory data
on a 6 year old child admitted with
rheumatic fever. Which of the following
data is consistent with the child’s disease
process?
A. Decreased white blood cell count
B. Elevated antibody level
C. Elevated hematocrit
D. Low ESR
A child diagnosed with rheumatic fever is
prescribed aspirin. The purpose of this
medication is to:
A. Decrease fever
B. Prevent headache
C. Promote relaxation
D. Reduce inflammation
The most frequent cause of cardiac arrest
in children is:
A. Respiratory failure
B. Rheumatic heart disease
C. Hypertension
D. Congenital heart disease
A. In resuscitating an infant (one
rescuer), the ratio of compressions
to ventilations is: 15:2
B. 15:1
C. 5:2
D. 5:1
Which of the following areas is the most
frequent area and the most frequent site
of internal bleeding associated with
hemophilia?
A. Brain tissue
B. Gl tract
C. Joint cavities
D. Spinal cord
The preferred site for bone marrow
aspiration in a child is the:
A. Iliac crest
B. Sternum
C. Xiphoid process
D. Scapula
What intervention is crucial for any child
with hemophilia?
A. Intravenous heparin administration
to stop blood coagulation
B. Oral prednisone to reduce the
immune response
C. Control bleeding with Factor VIII
administration
D. Enhance iron absorption
Which of the following statements best
describes sickle cell anemia?
A. Decreased oxygen tension causes
RBC 's to sickle
B. Increased oxygen tension causes
RBC 's to sickle
C. Sickle shaped cells are caused by
an enzyme deficiency
D. Sickle shaped cells are caused by
a chromosomal defect
During an assessment of a child with
sickle cell anemia the nurse would
observe for:
A. Icteric sclera
B. Hair loss
C. Muscle wasting
D. Bronze toned skin
When assessing a child's basic knowledge
about the prevention of sickling, the nurse
knows the child understands how to
prevent sickle cell crisis when the child
states:
A. I will take extra iron, folic acid, and
fluid so I can overcome this
disease.
B. I'm going to live in Baguio because
the air and water are pure.
C. I know my whole life will include
maintaining my lungs and drinking
large quantities of water.
D. I'm going to take up swimming and
running to build up my respiratory
and cardiovascular reserves.
Upon assessment, an infant with the
coarctation of the aorta would be expected
to have:
A. Edema
B. Strong pedal pulses
C. Absence of palpable femoral
pulses
D. Shortness of breath
When teaching parents about sickle cell
disease, the nurse should tell them that
their child's anemia is caused
A. Reduced oxygen capacity of cells
due to lack of iron
B. An imbalance between red cell
destruction and production
C. Depression of red and white cells
and platelets
D. Inability of sickle shaped cells to
regenerate
The nurse explains to a parent that the
anemia in sickle cell disease is caused by:
A. Increased blood viscosity
B. Increased white cell production
C. Increased red cell destruction
D. Decreased red blood cell
precursors
A 4-year-old child is having a sickle cell
crisis. The initial nursing intervention
should be to:
A. place ice packs on the client's
painful joints.
B. provide oral and I.V. fluids.
C. administer antibiotics.
D. administer folic acid supplements.
The nurse explains to the parents of a
2-year-old child admitted to the hospital
due to sickle cell crisis, that the child is
experiencing local tissue damage during
admission due to:
A. Autoimmune reaction complicated
by hypoxia
B. Obstruction to circulation
C. Lack of oxygen in the red blood
cells
D. Elevated serum bilirubin
concentration
To promote safety in the environment of a
client with Von Willebrand's disease,
which actions would the nurse take?
A. Administer ibuprofen if the client
has a - temperature of 101.5°F or
experiences pain.
B. Advise the client to wear gloves
while doing household chores.
C. Provide oral care and recommend
daily flossing.
D. Administer vitamins C and K on a
daily basis.
A 12-year old hemophiliac client has been
admitted to the medical center for an
acute episode of hemarthrosis. Which of
these expected outcomes should receive
priority in the client's care?
A. Family will receive genetic
counseling
 B. Maximum function of the joint will
be restored
C. Child and family will seek support
from the association of
hemophiliacs
D. Child will participate in appropriate
activities for present condition
To promote optimal functioning of a
12-year old child with hemarthrosis, the
nurse's best action would be to:
A. Elevate and immobilize the
affected joint
B. Institute passive range of motion to
the affected joint during acute
phase
C. Apply pressure to the area as
needed
D. Apply warm compresses to the
affected joint
A couple has an infant who has a
diagnosis of Hemophilia A. The mother is
worried because her baby is starting to
walk and may have injury or wounds.
Which of the following instructions should
the nurse provide to the parents as their
infant becomes more mobile?
A. Administer one-half of a children's
aspirin for a temperature higher
than 38.3 degree Celsius.
B. Sewing thick padding into the
elbows and knees of the child's
clothing.
C. Check the color of the child's urine
every day.
D. Expect the eruption of the primary
teeth to produce moderate to
severe bleeding.
The parents of a child with hemophilia A
ask the nurse about their probability of
having another child with hemophilia A.
Which information is the basis for the
nurse's response? (Select all that apply.)
1. Autosomal dominance occurs with
this disorder.
2. Sons of female carriers have a
50% chance of inheriting
hemophilia.
3. Men with hemophilia have sons
who also manifest the disease.
4. The disease occurs in daughters of
men with hemophilia.
5. Hemophilia is an X-linked
recessive disorder.
A. 2, 5
B. 1, 2, 5
C. 1, 3, 4
D. All except 3
A nurse should recognize that hemophilia
is transmitted generically by which of the
following inheritance patterns?
A. Autosomal recessive
B. Autosomal dominant
C. X- linked recessive
D. X- linked dominant
A 10-year-old has hemophilia and his
parents are very upset because he will not
be able to play contact sports. The nurse
will recommend which of the following
activities for the child to meet physical and
emotional needs?
A. Basketball
B. Swimming
C. Chess
D. Snakes and ladders
A boy, aged 2, is diagnosed with
hemophilia, an X-linked recessive
disorder. His parents and newborn sister
are healthy. The nurse explains how the
gene for hemophilia is transmitted. Which
statement by the father indicates an
understanding of X-linked recessive
disorders?
A. "Our newborn daughter may be a
carrier of the trait."
B. "If we have more sons, all of them
will have hemophilia."
C. "All of our offspring will carry the
trait for hemophilia."
 D. "Our daughter will develop
hemophilia when she gets older."
A toddler is admitted to the hospital with
classic hemophilia. Which admission
procedure by the nurse would not be the
one to perform and probably the most
frightening for this child?
A. Blood pressure
B. Weight
C. Urine specimen
D. Rectal temperature
SITUATION: Infancy is designated as a
period from 1 month to 1 year of age. In
these important months, an infant
undergoes such rapid development,
however not all infants follow the same as
with another's development, especially
those who has disorders and diseases.
Nurses should apply her knowledge in
dealing appropriately with both sick and
well client.
Which of the following is an appropriate
language development for a 7-month-old
child?
A. Saying "goo-goo" and "gah-gah"
B. Saying "oh-oh", "ah-ah" and
"oo-oo"
C. Saying "da-da" as his first word
D. Saying "ma-ma" or "da-da" plus
two vocabulary words
The nurse should refer the parents of an
8-month-old child to a health care provider
if the child is unable to do which of the
following?
A. Stand momentarily without holding
onto furniture.
B. Stoop to recover an object.
C. Stand alone well for long period of
time.
D. Sit without support for long periods
of time.
The nurse is discharging from the hospital
a 7-month-old who weighs 15 lb. The
parents have put the child in the back seat
of the car with the car seat facing the front
seat. Upon seeing the parents' action,
what should the nurse prioritize to do?
A. Ask the parents to wait while the
nurse obtains the correct car seat.
B. Complete the discharge with the
child sitting facing the front seat.
C. Give the parents a manual on
proper car seat placement.
D. Show the parents' proper
placement of the car seat facing
the back seat.
A mother tells you that her 6-month-old
child is grasping things such as a spoon in
the palms and asks when the child will be
able to grasp the spoon between thumb
and fingers.
A. "This is normal for this age. The
pincer grasp isn't mastered until 9
months."
B. "Encourage your child to play with
an older child who uses pincer
grasp and your child will pick up
the skill from the other child."
C. "Begin teaching your baby to use
pincer grasp. It will take time."
D. "I will ask your physician about
doing developmental testing to
evaluate your baby's level of
development."
The mother of 6-month-old states that she
has started her infant on 2% milk. Which
of the following should be the nurse's best
response?
A. "Your baby will probably be fine
with this milk."
B. "You need to keep the infant on
formula."
C. "The baby should be switched to
whole milk."
D. "You need to switch to formula
right now."
The nurse notes that an infant stares at an
object placed in her hand and take it to
her mouth, coos and gurgles when talked
to, and sustains part of her own weight
when held in a standing position. The
nurse correctly interprets these findings as
characteristics of an infant at which of the
following ages?
A. 2 months
B. 4 months
C. 8 months
D. 9 months
A mother states that she thinks her
9-month-old "is developing slowly." When
assessing the infant's development, the
nurse is also concerned because the
infant should be demonstrating which of
the following characteristics?
A. Vocalizing single syllables.
B. Building a tower of two cubes.
C. Standing alone.
D. Drinking from a cup with little
spilling.
SITUATION: During the toddler period,
children accomplish a wide array of
developmental tasks and change from
largely immobile and preverbal infants
who are dependent on caregivers to a
child with a growing sense of autonomy.
The parents should support the child's
growing independence with patience and
sensitivity and to learn methods for
handling the child’s frustrations.
A 2-year-old tells his mother that he is
afraid to go to sleep because "the
monsters will get him." The nurse should
tell his mother to:
A. Allow him to sleep with his parents
in their bed whenever he is afraid.
B. Increase his activity before he
goes to bed, so he eventually falls
asleep from being tired.
C. Read a story to him before bedtime
and allow him to have a cuddly
animal or a blanket.
D. Allow him to stay up an hour later
with the family until he falls asleep.
The nurse gives instructions to Bea, a
mother, about the development of depth
perception of a toddler. Which the
following should the nurse instruct her to
watch for?
A. An unusual sense of dizziness will
be experience at times
B. An increased fear of heights and of
falling out of bed at night
C. A difficulty in learning how to swim
D. d. An increased fall risk when the
toddler is learning to walk, run and
climb stairs
The mother of a 2-year-old is concerned
because the child's right eye seems to
turn in toward his nose when he is tired.
The nurse should:
A. Assure the mother that this is a
normal event when the child is
tired.
B. Advise the mother to continue to
watch his eyes closely and if the
problem persists to call the clinic.
C. Test the child with the cover 3
uncover test and refer the mother
and child to an ophthalmologist if
the test is abnormal.
D. Explain to the mother that the child
will probably outgrow the
weakness and she need not be
concerned.
When observing a parent on instilling
prescribed ear drops for a toddler, the
nurse decides that teaching about
positioning of the pinna for instillation of
the drops is effective when the parents
pulls the toddler's pinna in which of the
following directions?
A. Up and forward
B. Up and backward
C. Down and forward
D. Down and backward
The mother asks the nurse for advice
about disciplining her 18-month-old child.
Which of the following should the nurse
suggest that the mother uses first?
A. Structured interactions
B. Spanking
C. Reasoning
D. Time out
When assessing pain in a toddler, which
of the following methods should be the
most appropriate?
A. Ask the child about the pain.
B. Use a numeric pain scale.
C. Observe the child for restlessness.
D. Assess for changes in vital signs.
When planning a 15-month-old toddler's
daily diet with the parents, which of the
following amounts of milk should the nurse
include?
A. ½ to 1 cup
B. 2 to 3 cups
C. 3 to 4 cups
D. 4 to 5 cups
SITUATION: The preschool period
traditionally includes ages 3, 4 and 5
years. Most children of this age want to do
things on for themselves. These behaviors
are typical and help a child develop more
initiative and control of
life.
When developing the teaching plan about
illness for the mother of a preschooler,
which of the following should the nurse
include about how a preschooler
perceives illness?
A. A necessary part of life.
B. A punishment for wrongdoing.
C. A test of self-worth.
D. The will of God.
The mother of a 4-year-old expresses
concern that her child may be hyperactive.
She describes the child as always in
motion, constantly dropping and spilling
things. Which of the following action would
be most appropriate at this time?
A. Determine whether there have
been any changes at home.
B. Explain that this is not unusual
behavior.
C. Explore the possibility that the child
is being abused.
D. Suggest that the child be seen by a
pediatric neurologist.
When providing health teaching for a
4-year-old, the nurse knows that the child
is capable of:
A. Understanding another's point of
view
B. Exhibiting intuitive thought
C. Making simple classifications
D. Seeing relationships in reverse
SITUATION: Nurse Sarah is a pediatric
specialist; she is the most sought pediatric
nurse in the unit for she is very patient and
loving to her clients. When she is asked by
her co-nurse about her secret, she
answered, "by simply knowing the
developmental stages of the child and
responding to that accordingly, it's easy for
me to handle pediatric issues".
The mother asks the nurse about her
9-year-old child's apparent need for
between-meal snacks, especially after
school. When developing a sound
nutritional plan for the child with the
mother, which of the following should the
nurse need to keep in mind?
A. The child does not need to eat
between-meal snacks.
B. The child should eat the snacks
the mother thinks are appropriate.
C. The child should help with
preparing his or her own snacks.
D. The child will instructively select
nutritional snacks.
When assessing a school-age child, which
of the following best describes a typical
annual growth?
A. The child grows an average of 2
inches (5.1 cm) per year
 B. The child gains an average of 3 lb
(1.4 kg) per year
C. Few differences are noted between
age mates
D. Increased fat pads give school-age
children a chubby appearance
A nurse is assessing the growth and
development of a 10-year-old. What is the
expected behavior of this child?
A. Enjoys physical demonstrations of
affection.
B. Is uncooperative in play and
school.
C. Is selfish and insensitive to the
welfare of others.
D. Has a strong sense of justice and
fair play.
A 10-year-old child proudly tells the nurse
that brushing and flossing her teeth is her
responsibility. The nurse interprets this
statement as an indication of which of:
A. She is too young to be given this
responsibility.
B. She is most likely capable of this
responsibility.
C. She should have assumed this
responsibility much sooner.
D. She is probably just exaggerating
the responsibility.
The mother tells the nurse that her
8-year-old child is continually telling jokes
and riddles to the point of driving the other
family members crazy. The nurse should
explain this behavior as a sign of:
A. Inadequate parental attention.
B. Inappropriate peer influence.
C. Mastery of language ambiguities.
D. Excessive television watching.
SITUATION: Adolescence is a time that
serves as a transition between childhood
to adulthood. The drastic change in
physical appearance and change in
expectations of others (especially parents)
that occur during the period may lead to
both emotional and physical health
problems. The following questions are
ways in handling common concerns of
adolescence and the appropriate
approach to some behavioral changes in
this client.
The school nurse is invited to attend a
meeting with several parents who express
frustration with the amount of time their
adolescents spend in front of the mirror
and the length of time it takes them to get
dressed. The nurse explains that this
behavior indicates:
A. An abnormal narcissism.
B. A way of testing the parents'
limit-setting.
C. A method of procrastination.
D. A result of developing self-concept.
Several high school seniors are referred to
the school nurse because of suspected
alcohol misuse. When the nurse assesses
the situation, what would be the most
important assessment to determine?
A. What they know about the legal
implications of drinking.
B. The reasons they choose to use
alcohol.
C. The type of alcohol they usually
drink.
D. When and with whom they use
alcohol.
A nurse is assessing the growth and
development of a 14-year-old boy. He
reports that his 13-year-old sister is 2
inches taller than he is. The nurse should
advise the boy that the growth spurt of
adolescent boys, compared with the
growth spurt of adolescent girls:
A. Occurs at the same time.
B. Occurs 2 years earlier.
C. Occurs 2 years later.
D. Occurs 1 year earlier.
Based on the understanding of Erikson's
stages of psychosocial development,
which of the following is a priority to
communicate to the parents of an infant to
assist them in meeting the basic needs of
infancy?
A. Provide the infant with
entertainment and stimulation for
psychological growth
B. Talk with the infant during the times
when the infant is awake
C. Hold the infant in a way the infant
prefers
D. Attend to the infant's needs for
comfort, security, predictability,
food and warmth
Mrs. Angie brought her 1-month-old infant
to the pediatrician for a general
developmental check. She asked whether
her infant is developing normally. Which of
the following developmental milestones
should the nurse expect to see in a
1-month-old infant to perform?
A. Smiling and laughing out loud
B. Turning the head from side to side
C. Rolling from back to side
D. Holding a rattle briefly
Mrs. Angie comes to the clinic after a year.
She is now concerned that her 1-year-old
infant is not yet walking. The nurse's
response when ask will be based on the
knowledge that the age when most
children should be able to walk is:
A. 12 months
B. 15 months
C. 18 months
D. 24 months
Mrs. Angie voices her concern with
regards to the infant's nutrition most
especially in introducing new foods. Which
of the following should the nurse include
when preparing to teach her on the
introduction of new foods during the first
year of life?
A. Place up to three foods on the
spoon at one time with an old
favorite on the front of the spoon
B. Introduce fruits first; introduce one
new fruit per day until all fruits are
introduced
C. Alternate between offering one
spoonful of fruits and one spoonful
of vegetables
D. Introduce one new food at a time
at seven day intervals
At a well-clinic visit, Mrs. Angie's 1 year
old boy's height is assessed to be below
what is expected. His current height is 28
inches, and his birth length was 20 inches.
What should his current height be?
A. 27 inches
B. 30 inches
C. 32 inches
D. 35 inches
The pediatric nurse observed that the
infant is talkative, babbling and gurgling
when spoken to. She also noted the infant
laughed out loud. The nurse correctly
interpreted these findings as
characteristics of an infant at which of the
following ages?
A. 2 months
B. 4 months
C. 8 months
D. 9 months
The nurse in the well baby clinic is
assessing a 5-month-old infant when the
client suddenly cries. Which of the
following toys should you expect the nurse
give to a 5-month- old infant?
A. A big balloon
B. A teddy bear with button eyes
C. A push-pull wooden truck
D. A rattle
A friend is shopping for a toy to give her
nephew. The friend knows nothing about
children and asks what would be the most
appropriate toy to give an 18-month-old
child. Based on growth and development
skills, the nurse recommends a:
A. Tricycle
 B. Large ball
C. Pull toy
D. Stuffed animal
A developmental assessment of a
9-month-old would be expected to reveal:
A. A two to three-word vocabulary
B. The ability to sit steadily without
support
C. An ability to feed self with a spoon
D. Closure of both anterior and
posterior fontanels
A mother tells you that her 6-month-old
child is grasping things such as a spoon in
the palms and asks when the child will be
able to grasp the spoon between thumb
and fingers. Your best reply is:
A. "Encourage your child to play with
an older child who uses pincer
grasp and your child will pick up
the skill from the other child."
B. "This is normal for this age. The
pincer grasp isn't mastered until 9
months."
C. "Begin teaching your baby to use
pincer grasp. It will take time."
D. "I will ask your physician about
doing developmental testing to
evaluate your baby's level of
development."
After assessing and recording her finding
about the gross motor skills of the 4
infants who visited the clinic at the same
day, the nurse knows that who among the
following infants needs further evaluation?
A. A 6-month-old infant who can sit
alone and use his hands for
support
B. A 8-month-old who begins to creep
by moving the hands and knees
with the abdomen off the floor.
C. A 1-month-old child who can turn
his head to the side while in a
prone position
D. A 7-month-old infant who begins to
roll back to the abdomen
The nurse counsels a mother of a
9-month-old infant to make sure the floors
are free of small objects when her child is
crawling on the floor. The major rationale
for this instruction would be based on
which of the following
A. Sharp objects can injure the fragile
skin of a 9-month-old
B. A 9-month-old infant can easily
pick up small objects
C. It is essential for giving space for
crawling
D. The infant could hide small objects,
making them difficult to locate
In assessing an infant's cognitive
development, which of the following
actions will show an infant has developed
object permanence?
A. He cries when he is either hungry
or lonely
B. He looks for a ball that falls off his
high chair tray
C. He prefers a large yellow ball to a
small red one
D. He smiles when the mobile on his
crib jingles
SITUATION: During the toddler period, a
child accomplishes a wide array of
developmental tasks and change from
largely immobile and preverbal infant who
is dependent on caregiver to a child with a
growing sense of autonomy. The parents
should support the child's growing
independence with patience and
sensitivity and learn methods for handling
the child's frustrations.
Toilet training is the developmental
milestone during toddlerhood. A mother
asks Nurse Jianne how she will know if
her 2 year old is ready for potty training
and how she will start training him. Which
of the following, if done by the mother,
indicates the need for further teaching?
 A. Provide training pants that can be
pull down readily and slacks are
free of complicated buttons or
gripes.
B. Purchase either a potty chair that
sits on the floor or an infant seat
that is placed on the regular diet.
C. Waking up her child during night
and carry him to the bathroom to
void.
D. If child does not successfully use
the potty on a day-to-day basis,
have him return to diapers for a
short period. Continue with
readiness activities and attempt
toilet training again.
Furthermore, the mother also expresses
concern that her 2-year-old child has
become a "picky" eater and is eating less.
The nurse's best response will be:
A. "She has become manipulative."
B. "She is probably experiencing the
stress of the terrible 2s."
C. "I can refer you to have her
evaluated for an eating disorder."
D. "This is not an unusual behavior."
Prior to discharge, Bernice's mother tells
the nurse that she is concerned about the
safety of her 15-month old daughter who
seems to be "getting into everything" and
needs to be watched constantly. The
nurse will base her response that the most
important consideration in accident
prevention with toddler is:
A. Teaching them the meaning of "no"
B. Not allowing them to play with
dangerous item
C. Buying only age-appropriate toys
D. Ensuring a safe environment by
childproofing
Bernice, a 15-month-old girl, is brought to
the clinic for her well-being examination.
During an interview with the mother, the
nurse becomes aware that teaching
regarding toddler development is needed
when the mother states:
A. "She's always trying to get out of
her car seat."
B. "I just can't seem to get her to sit
on the potty chair."
C. "Lately, she's been crying when I
leave her with the sitter."
D. "At home she gets into everything.
Toys are scattered everywhere."
When planning Bernice's daily diet with
the parents, which of the following
amounts of milk will the nurse recommend
to prepare at this time?
A. ½ to 1 cup
B. 2 to 3 cups
C. 3 to 4 cups
D. 4 to 5 cups
The mother asks the nurse for advice
about disciplining her 24-month-old child.
The mother chooses to discipline her child
by timeout. The nurse will emphasize
which of the following as a good rule for
time out?
A. The child should sit still for as
many minute as his age.
B. The child should sit still for as
many minutes he misbehaved.
C. Timeout activities can include quiet
play or reading books
D. Children are not ready for timeout
until school-age
During a home visit following a discharge
from the hospital after treatment for severe
gastroenteritis, the mother tells the nurse
that her toddler answers "No!" and is
difficult to manage. After discussing this
further with the mother, the nurse explains
that the child's behavior is most probably
the result of:
A. Beginning leadership skills.
B. Expression of individuality.
C. Inherited personality traits.
D. Usual lack of interest in everything.
The mother also tells the nurse that when
her toddler cannot have things the way
she wants, she throws her legs and arms
around and screams, and cries. The
mother further says, "I don't know what to
do!" After teaching the mother about ways
to manage this behavior, which of the
following statements indicates that the
nurse's teaching is successful?
A. "Next time she screams and throw
her legs, I'll ignore the behavior."
B. "I'll allow her to have what she
wants once in a while."
C. "I'll explain why she cannot have
what she wants."
D. "When she behaves like this, I'll tell
her that she is being bad girl."
SITUATION: The preschool period
traditionally includes ages 3, 4 and 5
years. Most children of these ages want to
do things on for themselves. These
behaviors are typical and help a child
develop more initiative and control of life.
Also, caring for this preschool group, who
is ill or sick requires nurses to be
knowledgeable in order to apply nursing
interventions appropriately.
Several 3-year-old girls in the day care
centers are having a tea party with their
dolls. Nurse Celia, the center's nurse
should assess this behavior to be:
A. Evidence of abstract thought
B. Inappropriate exclusion of boys
C. Appropriate make-believe play
D. Maladaptive use of magical
thinking
A 4-year-old child's concept of death is
based on a sense of causality. The nurse
should plan care for a terminally ill child of
this age based on which of the following
stages of cognitive thought?
A. Formal operations
B. Sensorimotor operations
C. Preoperational thought
D. Concrete operational thought
During a clinic visit, a 4-year-old girl
suddenly screams, "Don't sit on Happy!"
The parent whispers that Happy is an
imaginary friend. As the pediatric nurse,
your health teaching plan for this family
should include:
A. Special instructions for discipline
B. Referral for counseling regarding
"Happy"
C. Investigation by child protective
services
D. Increasing social interactions
between their daughter and her
peers
Janice, a 4 year old child is admitted with
a tentative diagnosis of shigella. Her
mother tells the nurse that she has 3 loose
stools in the past 2 hours. Which of the
following would most likely alert the nurse
to the possibility that Janice is
experiencing moderate dehydration?
A. Deep, rapid respirations.
B. Absence of tear formation.
C. Diaphoresis.
D. Decreased urine specific gravity.
A recently hospitalized 4 3 year 3 old
client, Janice, screams and shouts that
she wants a "bottle". Her parents are
puzzled, and state that she has drank
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 child's need for parental
attention
C. Various forms of punishment are
necessary when such behavior
occur
D. Regression to and earlier behavior
often helps that child cope with
stress and anxiety
The mother of Janice says to the nurse
that she cannot stay with her child
because she has to take care of her other
children at home. Which of the responses
by the nurse would be most appropriate?
A. "You really shouldn't leave right
now because your child is very
sick."
B. "I understand, but feel free to visit
or call anytime to see how your
child is doing."
C. "It isn't necessary to stay with your
child because we will take very
good care of him."
D. "Can you find someone to stay
with your children? Your child
needs you here."
When providing health teaching to
Michael, a 5-year-old boy, the nurse
knows that the child is capable of:
A. Exhibiting intuitional thought
B. Aware of the property of
conservation
C. Making mental substitutions
D. Understanding another's point of
view
A 5-year-old is brought to the pediatric
clinic for a routine visit. When assessing
the child's relationship with other children,
the nurse would expect to observe:
A. Team play
B. Parallel play
C. Associative play
D. Solitary play
Which of the following is a characteristic of
a preschooler?
A. Sexual identity is known
B. Toilet training
C. Satisfaction is in the mouth
D. Focus is not on the self
A parent asks the nurse how to react to
their 4-year-old child when they see him
masturbate while watching television. The
nurse would suggest:
A. Refuse to allow him to watch
television
B. Remind him that some activities
are private
C. Call unnecessary attention to the
act and tell the child it is a bad
thing to do
D. Schedule their child for a health
check-up for a sex related disease
Which of the following describes the
sexual identification of a pre-schooler as
stated by Sigmund Freud?
A. Attachment to the same-sex parent
B. Attachment to the teacher
C. Attachment to the opposite-sex
parent
D. Attachment to the peers
A mother of a 5-year-old child asks when
the deciduous teeth usually begin to fall
out. Which of the following is the nurse's
appropriate response?
A. When the child is 2-3 years old
B. When the child is 6-7 years old
C. When the child is 4-5 years old
D. When the child is 8-9 years old
The nurse discusses dental care with the
parents of a 3-year-old. The nurse
explains that by the age of 3, their child
should have:
A. 5 temporary teeth
B. 10 temporary teeth
C. 15 temporary teeth
D. 20 temporary teeth
After teaching a group of parents about
temper tantrums, the nurse knows that
teaching has been effective when one of
the parents states:
A. "I will ignore the temper tantrums"
B. "I'll talk to my daughter during the
tantrum"
C. "I should pick up the child during
the tantrum"
D. "I should put my child in time out"
SITUATION: The term "school-age"
commonly refers to children between the
ages of 6 to 12.
The 3 year old child is at the 98th
percentile for weight and at the 40th
percentile for height. The school nurse will
interpret that this child is:
A. Underweight or small in stature
B. Experiencing a prepubescent
growth spurt
C. Overweight or large in stature
D. Normal for size
The nurse is preparing an 3 year old child
for a procedure. What is the most
appropriate nursing intervention?
A. Provide visual aids such as dolls,
puppets, and diagrams in the
explanation
B. Provide a written pamphlet for the
child to review prior to the
procedure
C. Discourage any display of
emotional outbursts
D. Request that parents wait outside
while the nurse provides
instructions to the child
When the child is beginning to identify
behaviors that please others as "good"
behaviors. It is a characteristic of which
Kohlberg's levels of normal development?
A. Pre-conventional morality
B. Conventional morality
C. Pre-autonomous morality
D. Autonomous morality
When the nurse asks the child and mother
about the child's best friend, the nurse is
assessing the schoolage's
A. Language development
B. Motor development
C. Neurologic development
D. Social development
The nurse is asking who the child's best
friend is because during this age (school
age) the child develops Peer relationships.
This is to assess therefore the social
development of the child. During this time,
the following are seen as social
development of the child:
A. Child makes first real friends
during this period
B. Is able to understand concepts of
cooperation and compromise
(assist in acquiring attitudes and
values); learns fair play vs
competition
C. Help child develop self-concept
D. Provide feeling of belonging
The mother also voices her concern about
her daughter's compulsion for collecting
things. Her daughter is 8 years old and
loves to collect different stamps. The
nurse explains that this behavior is related
to the cognitive ability to perform:
A. Concrete operations
B. Formal operations
C. Coordination of secondary
schemas
D. Tertiary circular reactions
SITUATION: Adolescence is a time that
serves as a transition between childhood
to adulthood. The drastic change in
physical appearance and change in
expectations of other (especially parents)
that occur during the period may lead to
both emotional and physical health
problems.The following questions are
ways in handling common concerns of the
adolescence and the appropriate
approach to some behavioral changes in
this client.
In discussing sexual maturation during a
health class, the nurse would include
information that secondary sex
characteristics begin to appear at:
A. 10 years in girls, 12 years in boys
B. 68
C. 12 years in girls, 16 years in boys
D. 12 years in girls, 12 years in boys

The school nurse develops a plan with an
adolescent to provide relief of
dysmenorrhea to aid in her development
of:
A. Positive peer relations
B. Positive self 3 identity
C. A sense of autonomy
D. A sense of independence
A teenager refuses to wear clothes his
mother brought for him. He states he
wants to look like the other kids at school
and wear clothes like they wear. The
nurse explains this behavior is an example
of teenage rebellion related to:
A. Autonomy vs. shame and doubt
B. Identity vs. Role confusion
C. Trust vs. Mistrust
D. Initiative vs. Inferiority
Maydeline, a 15-year-old girl, is grounded
for two weeks by her parents for smoking
in school. The adolescent tells the school
nurse that it is not fair that she gets
punished when her friends get away with
doing the same thing. The nurse's most
appropriate response would be which of
the following statements?
A. "The others will pay someday for
lying to school authorities."
B. "I intend to report your friends to
the principal so they can also be
punished."
C. "When errors in judgment are
made, people must be prepared to
take the consequences of their
actions."
D. "It is difficult enough to get
teenagers to obey the rules. If the
parents don't act, it reinforces the
behavior."
Which of the following characteristics
would the nurse expect to see in an
adolescent who has developed the
capacity for formal thought?
A. Ability to analyze relationships for
their effects
B. Use of random cognitive behavior
to approach problems
C. Ability to say that something is
wrong but not why
D. Focusing on immediate physical
reality of here and now
SITUATION: From newborns to teens,
parents often have questions and wonder
if their children are developing normally
Which of the following statements best
describes the infant's physical
development?
A. Anterior fontanel closes by age 6
to 10 months.
B. Binocularity is well established by
age 8 months.
C. Birth weight doubles by age 5
months and triples by age 1 year.
D. Maternal iron stores persist during
the first 12 months of life.
The nurse is assessing a 6-month-old
healthy infant who weighed 7 pounds at
birth. The nurse should expect the infant
to now weigh approximately how many
pounds?
A. 10
B. 15
C. 20
D. 25
The nurse is doing a routine assessment
on a 14-month-old infant and notes that
the anterior fontanel is closed. This should
be interpreted as which of the following?
A. Normal finding
B. Questionable finding4infant should
be rechecked in 1 month
C. Abnormal finding indicates need
for immediate referral to
practitioner
D. Abnormal finding indicates need
for developmental assessment
The parent’s of a 9 month old infant tell
the nurse that they have noticed foods
such as peas and corn are not completely
digested and can be seen in their infant’s
stools. On which of the following should
the nurse base her explanation of this?
A. Child should not be given fibrous
foods until the digestive tract
matures at age 4 years.
B. Child should not be given any solid
foods until this digestive problem is
resolved.
C. This is abnormal and requires
further investigation.
D. This is normal because of the
immaturity of digestive processes
at this age.
In terms of fine motor development, what
should the infant of 7 months be able to
do?
A. Transfer objects from one hand to
the other
B. Hold crayon and make a mark on
paper
C. Use thumb and index finger in
crude pincer grasp
D. Release cubes into a cup
Nurse Hannah is assessing the infant's
gross motor development. What would
she expect to find in a 5 month-old infant?
A. Roll from abdomen to back
B. Sit erect without support
C. Roll from back to abdomen
D. Move from prone to sitting position
According to Piaget, the 6-month-old
infant would be in what developmental
stage?
A. Use of reflexes
B. Secondary circular reactions
C. Primary Circular reactions
D. Coordination of secondary
schemata
What information could be given to the
parents of a 12-month-old child regarding
appropriate play activities for this age
A. Give large push-pull toys for kinetic
stimulation.
B. Place a cradle gym across the crib
to facilitate fine motor skills.
C. Provide child with finger paints to
enhance fine motor skills.
D. Provide stick horse to develop
gross motor coordination.
At what age should the nurse expect an
infant to begin smiling in response to
pleasurable stimuli?
A. 1 month
B. 2 months
C. 3 months
D. 4 months
The psychosocial developmental tasks of
toddlerhood include which of the
following?
A. Development of a conscience
B. Ability to get along with age mates
C. Recognition of sex differences
D. Ability to withstand delayed
gratification
The mother asks the nurse for advice
about disciplining her 18-month-old child.
Which of the following should the nurse
suggest that the mother uses first?
A. Structured interactions
B. Spanking
C. Reasoning
D. Time out
A parent of an 18-month-old boy tells
Nurse Isabel that he says "no" to
everything and has rapid mood swings. If
he is scolded, he shows anger and then
immediately wants to be held. Nurse
Isabel's best interpretation of this behavior
is which of the following?
A. This is normal behavior for his age.
B. He is not effectively coping with
stress.
 C. This is unusual behavior for his
age.
D. He is showing he needs more
attention.
Which of the following is descriptive of a
toddler's cognitive development at age 20
months?
A. Searches for an object only if he or
she sees it being hidden
B. Realizes that "out of sight" is not
out of reach
C. Puts objects into a container but
cannot take them out
D. Understands the passage of time,
such as "just a minute" and "in an
hour"
Hannah, 16 months old, falls down a few
stairs. She gets up and "scolds" the stairs
as if they caused her to fall. This is an
example of which of the following?
A. Animism
B. Ritualism
C. Irreversibility
D. Delayed cognitive development
Which of the following statements is
correct about toilet training?
A. Bladder training is usually
accomplished before bowel
training.
B. Wanting to please the parent helps
motivate the child to use the toilet.
C. Watching older siblings use the
toilet confuses the child.
D. Children must be forced to sit on
the toilet when first learning.
A toddler's parent asks the nurse for
suggestions on dealing with temper
tantrums. Which of the following is the
most appropriate recommendation?
A. Punish the child.
B. Remain close by the child but
without eye contact.
C. Leave the child alone until the
tantrum is over.
D. Explain to the child that this is
wrong.
Which of the following would the nurse
expect of a healthy 3-year-old child?
A. Jump rope
B. Skip on alternate feet
C. Ride a two-wheel bicycle
D. Balance on one foot for a few
seconds
When developing the teaching plan about
illness for the mother of a preschooler,
which of the following should the nurse
include about how a preschooler
perceives illness?
A. A necessary part of life.
B. A test of self-worth.
C. A punishment for wrongdoing.
D. The will of God.
In assessing the cognitive development of
a 5-year-old child, Nurse Daniel would
expect the child to do which of the
following?
A. Use magical thinking
B. Understand conservation of matter
C. Think abstractly
D. Be unable to comprehend another
person's perspective
Imaginary playmates are beneficial to the
preschool child because they do which of
the following?
A. Take the place of social
interactions
B. Become friends in times of
loneliness
C. Take the place of pets and other
toys
D. Accomplish what the child has
already successfully accomplished.
Which of the following statements
accurately describes physical
development during the school-age
years?
A. Child's weight almost triples.
 B. Child grow an average of 2 inches
per year.
C. Few physical differences are
apparent among children at the
end of middle childhood.
D. Fat gradually increases, which
contributes to a child's heavier
appearance.
Which of the following statements
characterizes moral development in the
older school-age child?
A. They are able to judge an act by
the intentions that prompted it
rather than just by the
consequences.
B. Rules and judgments become
more absolute and authoritarian.
C. They view rule violations in an
isolated context.
D. They know the rules but cannot
understand the reasons behind
them.
Which of the following is descriptive of the
play of school-age children?
A. Individuality in play is better
tolerated than at earlier ages.
B. Knowing the rules of a game gives
an important sense of belonging.
C. They like to invent games, making
up the rules as they go.
D. Team play helps children learn the
universal importance of
competition and winning.
When teaching injury prevention during
the school-age years, which of the
following should the nurse include?
A. Teach the need to fear strangers.
B. Avoid letting children cook in
microwave ovens.
C. Teach basic rules of water safety.
D. Caution child against engaging in
competitive sports.
In girls, the initial indication of puberty is
which of the following?
A. Menarche
B. Growth spurt
C. Growth of pubic hair
D. Breast development
According to Erikson, the psychosocial
task of adolescence is developing which
of the following?
A. Intimacy
B. Identity
C. Initiative
D. Independence
According to Piaget, the adolescent is in
the fourth stage of cognitive development
or period of what?
A. Formal operations
B. Concrete operations
C. Conventional thought
D. Post-conventional thought
The school nurse is invited to attend a
meeting with several parents who express
frustration with the amount of time their
adolescents spend in front of the mirror
and the length of time it takes them to get
dressed. The nurse explains that this
behavior indicates:
A. An abnormal narcissism.
B. A way of testing the parents'
limit-setting.
C. A method of procrastination.
D. A result of developing self-concept.
The nurse is assisting the family of a child
with a history of encopresis. Which one of
the following should be included in the
nurse's discussion with this family?
A. Instruct the parents to sit the child
on the toilet at twice-daily routine
intervals.
B. Instruct the parents that the child
will probably need to have daily
enemas.
C. Suggest the use of stimulant
cathartics weekly.
D. Reassure the family that most
problems are resolved
 successfully, with some relapses
during periods of stress.

The feeling of guilt that the child "caused"

the disability or illness is especially critical
in which of the following children?
A. Toddler
B. Preschooler
C. School-age child
D. Adolescent