‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات العامة للتمريض و امتحانات‬

‫دول الخليج‬
Pediatric Nursing Exam Answers
0782470430 – 0786207997 ‫عبدالرحمن ديباجة‬

‫ مصدر هذه االسئلة من مواقع تمريض عالمية و أي تشابه بينها و بين اسئلة أي‬:1 ‫مالحظة هامة‬
‫امتحان اخر داخل االردن او خارجها هو بسبب اخذها من نفس المصدر‬
‫ االسئلة هي فقط لتدريبك‬, ‫ ال تعتمد على االسئلة فقط في التحضير الي امتحان‬:2 ‫مالحظة هامة‬
. ‫على النمط و طريقة تعاملك مع االمتحان و تقسيم وقت االمتحان بين االسئلة‬

Part 1

1 The answer is A. According the AAP (American Academy of Pediatrics) a child should use a rear-facing car seat
starting at birth and up until the time the child outgrows the device based on the manufacture’s limits. This
typically is until about 4 years of age. In 2018, the AAP removed the age criteria of 2 years of age and
recommends a child uses a rear-facing restraint longer.

2 The answer is FALSE. When selecting a car safety restraint for a child the parent should avoid going by an age
parameter but rather by: does the child fit in that specific device (example: meets the manufactures height and
weight limits for that restraint), child’s height and weight, and the child’s development.

3 The answer is B. Option B is FALSE. All the other options are true. Option B is false because new guidelines set
by the AAP (in 2018) states that children should continue to use a rear-facing restraint until they outgrow it. This
typically is until about 4 years of age. In 2018, the AAP removed the age criteria of 2 years of age and
recommends a child uses a rear-facing restraint longer.

4 The answer is C. All the other options are findings that demonstrate the rear-facing device correctly fits the
child. Option B does not indicate the child is ready for a forward-facing device yet. If the legs start to come into
contact with the back seat, the parent can add a leg extension panel to allow for more room (many manufactures
have this option on car seats today). Option C demonstrates the restraint does NOT

5 The answers are A and C. These findings demonstrate the child doesn’t fit the restraint and is not secured
properly. The top of the child’s ear should be BELOW the top of the restraint, and the buckled chest clip should
be found AT armpit level (NOT 1 inch below it).

6 The answer is D. All the other options are INCORRECT. Option D is the only correct statement and should be
stressed to the parent during booster seat education (The lap belt should always go under BOTH sides of the arm
rest). Both the shoulder strap and lap belt should be used with a booster seat, the safest place for a child 12 and
under is in the BACK seat (not the front), and children are typically ready to use a booster seat by the age of 6
years (this varies based on their size and development…age should not be the main determining factor for
selecting a car safety restraint).

7 The answer is B. The lap belt should be positioned on the lower part of the hips (NOT abdomen) and rest on the
upper legs (thighs).

8 The answers are A and C. Options a and c demonstrate the seat belt fits the child. However, options B and D
demonstrate the seat belt does NOT fit the child. The legs should dangle and bend down over the edge of the
seat, and the shoulder strap should sit on the middle of the shoulder and chest.

9 The answer is FALSE. The car seat should NOT move no more than 1 inch from side to side or front to back.

Part 2

The answers are A and D. Tanner Stages is a 5-point scale that can be used to help determine how far along a
person is in the puberty period. This scale goes from 1 to 5 (with 5 being mature). It grades girls based on breast
development and pubic hair growth, and it grades boys based on genital (penis and scrotum) development and
pubic hair growth.

The answer is D: breast development

The answer is B. The statement should say: Due to the activation of the sebaceous glands (NOT apocrine
glands…these are sweat glands) acne can develop in the teenager.

The answers are A, B, and C. Due to all the changes that occur during puberty and major peer influence in the
teen’s life, body image can be affected which can affect the teen’s self-esteem and self-concept. This can lead to
depression, eating disorders, and more. The teenager will compare their body changes to their peers. In addition
social media and regular media (magazines, tv etc.) does not help with this because it gives a false perception of
what is real vs. filtered/fake. This isn’t just a girl thing but boys also struggle too.

The answer is true.

The answer is B. This statement is the most alarming because the patient is communicating they have a plan on
how to end their life. This requires immediate intervention and should be taken seriously. Other signs of risk of
suicide: leaving messages on social media or hints that they want to die, expressing they hate life, telling people
goodbye, outburst of anger or depression, giving away things they own, have a plan (written it or shared it),
recent traumatic event (death, bullied, rejection)

The answer is B: Normal. Underweight: BMI less that 5th percentile for age, height, and gender, Normal: BMI is
5th percentile or greater but not higher than 85th percentile, Overweight: BMI is 85th percentile or greater but
less than 95th percentile, Obese: BMI is 95th percentile or greater

The answer is B. Light exposure (especially blue light from phones and other electronic items) can affect the sleep
and be avoided 1-2 around before bedtime. The teen should get 8-10 hours of sleep per night.

The answer is A: Identity vs. Role Confusion; fidelity

The answer is B: loss of control. When the adolescent experience a loss of control they may start to act out and
refused procedures/medications…by doing this it gives them a sense of control. Therefore, the medical team
should allow the teen to have control with certain situations so this doesn’t occur.
The answers are A an D. Option A allows the patient to have control and option D allows the teen to socialize
which is very important to them.

The answer is D: formal operational

Infant Developmental Milestones Questions

1 The answer is B. This is a normal finding in a 10-month-old infant. The anterior fontanelle closes around 18
months.

2 The answer is C. The birth weight should DOUBLE at 6 months and triple at 1 year. Therefore, if the infant
weighed 8 lbs. at birth, he or she should weigh 16 lbs. at 6 months.

3 The answer is B. At 6 months the infant should grow about 1/2 to 1 inch every month. Therefore, if the infant
was 21 inches at birth, he or she should be around 24-27 inches at 6 months.

4 The answer is A. The lower central incisors are the first teeth that erupt in an infant’s mouth and this tends to
occur by 10 months of age.

5 The answer is C. An infant at this age should be smiling. All the other options are too advanced for this infant at
this age.

6 The answer is B. An infant should not be swaddled once they can roll over, which is about 4 months.

7 The answer is C. The infant at 8-9 months should be able to sit without support. The other options are
milestones for a 10-12 month old.

8 The answer is D. At this age, stranger anxiety begins to develop. Therefore (if possible), the same nursing staff
should be used for providing care. Option A would increase anxiety in the infant and options C and B are for older
children.

9 The answer is B. The infant is able to grasp small objects with the index finger and thumb.

10 The answer is C: 9-month-old. Infants at this age understand object permanence. This is when an object can
be hidden and the infant understands it still exists. This happens around 8-9 months.

11 The answers are: C, D, E, F. The other options are milestones for older children.

12 The answer is B. A 5-month-old should be able to roll over from its back to tummy. The other options are
milestones for older infants.

13 The answer is A. The best sleeping position for the baby is on their BACK….NOT side or tummy.

14 The answers are A and C. Option B should be avoided because it’s a choking hazard, and option D is wrong
because infants under 12 months should not have honey.

15 This answer is D: Rear-facing and back seat

16 The answers are B and D. An infant this age should have their needs responded to promptly. Appropriate
interventions would be swaddling and rocking the infant. The other nursing interventions listed are more
appropriate for an older infant. This infant is very young.
17 The answer is B: Trust vs. Mistrust

18The answer is B. Infants that are exclusively (ONLY) breast fed should receive Vitamin D supplementation (400
IU) daily

Newborn Infant Reflexes Nursing Quiz Questions

1The answer is D. When the infant’s head is turned to a particular side, the leg and arm on that
side will extend, while the leg and arm on the opposite side will flex.

2The answer is D. Stroking the inside of the infant’s hand with an object and assessing if the
hand closes around the object helps assess the palmar grasp reflex.

3The answer is B. This is known as the plantar grasp reflex.

4The answer is B. When the Moro Reflex is stimulated in an infant, the infant will EXTEND the
arms with the palms of the hand turned UPWARD and then move the arms BACK TO the body.

5The answer is C: 4 months. The sucking reflex in an infant will disappear and become a
voluntary function at about 4 months of age.

6The answer is C. The Babinski reflex should disappear around 1 year of age. However, in an
infant this age the big toe should dorsiflex (bend back) and the other toes spread outward.

7The answer is D. This is known as the step reflex.

8 The answer is A: The nurse places the infant in the prone position and applies pressure with
the hand to the sole of the foot. In response, the infant should attempt to push against the hand
and move the arms and legs in a crawling like motion.

Atrial septal defects

1 The answer is FALSE. Atrial septal defects are characterized by a hole in the interatrial
septum that allows blood to mix in the right and left atria, which are the UPPER (not lower)
chambers of the heart.

2 The answers are B, C, and D. All of these are complications of a large atrial septal defect.

3 The answer is A. An ostium primum is an atrial septal defect located at the bottom of the
septum near the tricuspid and mitral valves (atrioventricular valves).

4 The answer is D. A left-to-right shunt is occurring because the pressure in the left side of the
heart is higher than the right, which allows blood to easily flow into the right side through the
hole in the interatrial septum. This will cause pulmonary hypertension and heart failure
overtime.

5 The answer is D. In patients with ASDs, the nurse may notice a midsystolic (also called
systolic ejection murmur) at the 2nd ICS at the left sternal border. This is due to increased
blood flow through the pulmonic valve. The murmur is quiet at the beginning of systole,
increases mid-systole and then decreases at the end of systole…it ends before S2 . S2 is wide,
fixed splitting due to the slowness of the pulmonic valve closing.

6 The answer is B. The formen ovale allows this to occur.

7 The answers are A, B, C, and D. Patients who are hospitalized with an ASD will be having
complications that arise from the left to right shunt of blood flow in the heart, which can lead to
heart failure and pulmonary hypertension. In heart failure, there is decreased cardiac output,
which will lead to activity intolerance and excess fluid volume. Furthermore, pulmonary
hypertension is presenting and this will cause the lungs to become congested with fluid. Many
patients with a large ASD will have frequent lung infections from the congestion in the lungs.
So, the patient is at risk for infection.

8 The answer is FALSE: ASDs can lead to an INCREASE in lung blood flow (not decrease).

Ventricular Septal Defect (VSD) Questions

1 The answer is C. In this condition, the blood in the heart is shunting from the LEFT ventricle to
the RIGHT ventricle, which is INCREASING pulmonary blood flow.”

2 The answer is D. This describes a membranous VSD. Please review the notes or video for
the other types of VSDs (there are four of them).

3 The answer is TRUE.

4 The answer is FALSE. Signs and symptoms of a ventricular septal defect are NOT commonly
found in a baby after birth, but rather a little later on. VSD signs and symptoms most likely start
to present around 1-3 months after birth. WHY? In utero, the baby has the same pressure on
the right and left side of the heart. However, after birth the lungs start to work and this pressure
changes gradually over the next 2-3 weeks. The pressure in the right side will decrease
compared to the left side. Therefore, when a large VSD is present the pressure changes will
cause blood to begin shunting from the LEFT ventricle to the RIGHT ventricle (hence increasing
lung blood flow which leads to pulmonary hypertension and eventually heart failure). Therefore,
at about 1-3 months of life the infant will be presenting with heart failure, growth problems, and
respiratory issues.

5 The answers are: B, D, and E The nurse should listen for signs and symptoms that could
represent heart failure or pulmonary hypertension. Options B, D, and E can be found in infants
or children with a VSD.
6 The answer is A. The size of the VSD depends on the how loud the murmur will be, but it will
be heard at the LOWER LEFT sternal border and is considered a holosystolic or pansystolic
murmur. This means it will start at S1 and extend into S2.

7 The answer is A and D. Before giving Digoxin, the apical pulse should be checked for 1
complete minute. The infant’s heart rate is too low in this scenario. Guidelines say to hold
Digoxin in infants if the apical pulse rate is less than 90-110 beats per minute, children less than
70 bpm, or adults less than 60 bpm. The nurse would HOLD the dose and NOTIFY the
physician for further orders. The physician needs to be informed of this and may want to
investigate if the patient is experiencing toxicity of this medication.

8 The answer is D. If the VSD is not treated, (later on in life) a reversal of blood shunting
(shunting from right to left) will occur due to the extensive pulmonary hypertension in a
condition called Eisenmenger’s Syndrome. With this shunting, unoxygenated blood will start to
enter circulation and cyanosis and clubbing can start to be seen. It is irreversible and a lung or
heart transplant is the current option.

Patent Ductus Arteriosus Questions

1 The answer is B. Patent ductus arteriosus (PDA) occurs when the vessel that normally
connects the aorta and pulmonary artery in utero has failed to close at birth, which leads to a
left-to-right shunting of blood. This shunting of blood will increase blood flow to the lungs and
can cause pulmonary hypertension and eventually heart failure (left-sided), especially if the
PDA is large.

2 The answers are A and B. These are correct statements about the ductus arteriosus. Option
A is correct because every newborn should have this structure, but it will close shortly after
birth. Option C is wrong because the purpose of this structure is to help carry blood that is
entering the RIGHT side (not left) of the heart to the rest of the body, hence bypassing the
lungs. Option D is wrong because this structure connects the aorta to the pulmonary ARTERY
(not vein).

3 The answer is C. The pulse pressure will be widened. Pulse pressure is the difference
between the systolic and diastolic pressure and indicates the force the heart needs to contract.
With PDA, the diastolic pressure will be low, which will widen the difference between the
systolic and diastolic pressure. WHY? When blood is leaving through the extra vessel (patent
ductus arteriosus) back into the pulmonary artery, this will decrease diastolic pressure (which is
the pressure of the blood in the arteries when the heart if filling or in between heart beats). This
will lead to a wide pulse pressure, hence a decrease is diastolic pressure and will then in turn
lead to bounding pulses.

4 The answer is C. The hallmark murmur with PDA is a continuous (heard both during diastole
and systole) that is harsh and machinery-like. It can be noted at the left upper sternal border.

5 The answer is B. A medication (NSAIDs) can be used to close the ductus arteriosus.
Indomethacin is a prostaglandin inhibitor. It is used in premature babies or sometimes in very
young infant’s days old. It won’t work for older infants, children, or adults.
6 The answer is C. Options A, B, and D (although are abnormal findings) is expected to be
found in a large PDA. However, option C is a sign and symptoms that the patient is entering
into left-sided heart failure (a life-threatening complication of this condition in a neonate), which
would require immediate intervention. PDA can lead to heart failure when the left-to-right shunt
is severe enough.

7 The answers are A, B, C, and E. These are complications that can occur with PDA. Clubbing
of the nails can be seen in tetralogy of fallot.

tetralogy of Fallot Questions

1 The answer is A. This statement is INCORRECT. It should say: “Unoxygenated blood enters
through the superior and inferior vena cava to the RIGHT (not left) atrium.

2 The answers are: B, D, E, and F. Let the condition’s name help you: “TETRAOLOGY”…this
means there will be FOUR problems with this heart defect. Remember from the lecture the
mnemonic RAPS: Right ventricular hypertrophy, Aorta displacement, Pulmonary stenosis,
Septal defect (ventricular)

3 The answers are A, B, and D. Option C is wrong because this condition can be treated with
both palliative surgery (used to help alleviate symptoms until the child is old enough for
complete repair) and complete repair. All the other options are correct.

4 The answer is C. The patient is experiencing a “tet spell”. This is where during any type of
activity like feeding, crying, playing etc. the child’s heart (due to Tetralogy of Fallot) is unable to
maintain proper oxygen levels in the blood (these activities place extra work on the heart and it
can’t keep up). Therefore, there are low amounts of oxygen in the blood, and the skin will
become cyanotic (bluish tint) and the respiratory rate will increase (this is the body’s way of
trying to increase the oxygen levels in the body but it doesn’t work because it’s not a gas
exchange problem in the lungs but a heart problem). The nurse would want to place the infant
in the knee-to-chest position. WHY? This increases systemic vascular resistance (which will
help decrease the right to left shunt that is occurring in the heart…hence helps replenish the
body with oxygenated blood). In addition, the nurse would want to place the patient on oxygen.

5 The answer is B. The patient will have a harsh systolic murmur due to pulmonary stenosis,
which would lead you to find the murmur at the LEFT of the sternal border (the sound location
of the pulmonary valve).

6 The answers are C and D. A patient with TOF will have activity intolerance because
remember this is a cyanotic heart defect where there is not enough oxygen in the blood (due to
the structural defect of the heart) and any activity (feeding, crying, play etc.) can increase the
demands for oxygen. Therefore, the patient will experience activity intolerance. In addition, the
patient can experience failure to thrive because the constant hypoxemia (low oxygen in the
blood) experienced can lead the child to have poor growth, weight loss, clubbing of the nails
etc. Remember organs need plenty of oxygen to work and grow but in TOF this isn’t happening
very well. Options A, B, and E are not appropriate nursing diagnoses.
7 The answer is A. Squatting is common in patient with TOF. Why? Squatting helps to increase
systemic vascular resistance, which will decrease the right to left shunt that is occurring in the
ventricles and this helps increase oxygen levels.

8 The answer is D. Alprostadil, prostaglandin E, will keep the ductus arteriosus open after birth.
This will help with keeping the oxygen levels up because it allows more blood to flow to the
lungs that is oxygenated via the ductus arteriosus. Remember this usually closes shortly after
birth, but in a patient with severe Tetralogy of Fallot this opening needs to stay opened until
surgery can be performed.