PEDIATRIC NURSING

FINAL COACHING
Marc Jade C. Adlawan, RN, MSPH

1. You are caring for a 2 month-old infant to which a pH probe test indicated “reflux”. Which nursing action is MOST appropriate?
1. Raise the HOB 3. Instruct properly the mother how to do
2. Do not give the nest feeding CPR
4. Keep a normal feeding schedule

2. You are visiting a 3 month-old child whom you previously saw in your clinic. He is now on Bryant’s Traction for developmental
dysplasia of the hips. Which of the following toys would be appropriate for you to offer the infant to keep him occupied while
hospitalized?
1. Colorful plastic, non-toxic blocks
2. A toy rattle
3. A stuffed toy animal nursery rhymes played on tape
4. Nursery rhymes played on tape

3. One early morning as you were opening your nursing clinic, a 5 year-old boy was rushed to you in an emergency after ingesting a
bottle of baby aspirin. You are to observe the boy for which signs and symptoms?
1. Tinnitus and gastric distress 3. Nausea and vertigo
2. Dysrhythmia and hypoventilation 4. Epistaxis and paralysis

4. A 14 year-old girl whose parents have been consulting with you in your Family Care Nursing Clinic (FCNC) was admitted to the
hospital for treatment of 2nd and 3rd degree burns sustained from a house fire. You visited them in the hospital and noted an IV
infusion started over the girl’s left forearm. Instantly what comes to mind is that the primary purpose of this IV to:
1. Maintain IV fluid balance 3. Provide a route for pain medications
2. Prevent GI upset 4. Obtain blood specimens for analysis

5. A toddler name Peter, whose parents were also consulting in your FCNC had lead poisoning and was rushed to the hospital. There
was an order to encourage fluids and the same were relayed to the parents. When you visited the parents asked what kind of
fluids are best given and as a family nurse coordinating closely with the nurse-on-duty you reiterated that it is best to give:
1. Fruit juice 3. Water
2. Orange juice 4. Milk

6. A 34 year-old single mother dropped by your FCNC and tells you that she always have difficulty forming relationships. The mother
conveyed to you the message that she is worried that her 7 year-old daughter might have the same problems later. Of the
following statements which do you think is BEST to make?
1. “Children develop trust from 6 - 12 years of age”
2. “Children develop trust from birth to 18 months of age”
3. “Children develop trust from 18 months to 3 years of age”
4. “Children develop trust from 3 - 6 years of age”

7. Again at your FCNC a couple came to you with relating problems relative to the care of their newborn with fetal alcohol syndrome.
Which of the following should be reiterated as important considerations by the parents?
1. Provide feedings via gavage to decrease energy expenditure
2. Decrease touch to prevent overstimulation
3. Replace vitamins depleted as a result of poor maternal diet
4. Prevent iron deficiency anemia

SITUATION: A major continuing and non-negotiable task of every nurse in the care of infants and children at varying stages of their growth
and development is the application of her assessment skills. The following questions apply.

8. Nurse Sarah inquires about the activity level of a 3 year-old under her care. The mother states that the child loves to play at the
park and the nurse encourages the mother to continue physical activities. What important principle guides the nurse’s response?
1. Allowing the toddler to walk, run and hop enhances the child’s kinesthesia
2. Socialization with other toddlers helps develop communication skills
3. Maternal bonding is enhanced through play
4. Only an emotionally happy child can enjoy the park

9. In caring for a 3 year-old Nurse Sarah knows that she needs to obtain the height of the child as part of routine health screening.
To obtain an accurate measurement, the child must:
1. Remove his shoes and stand upright, with head level
2. Stand with his feet wide apart
3. Be measured in a recumbent position
4. Face the wall as he is measured

10. The mother of a 3 year-old child also under Nurse Sarah care tells her that the child has frequent nightmares. The statement by
the mother that indicates the need for more teaching is:
1. “I read her a story until she calms down.”
 2. “I take her to my bed so she will calm down.”
3. “I stay with her awhile to reassure her.”
4. “I usually talk quietly and rub her back to reassure her.”

11. Our school curricula now include educating the young regarding human sexuality. What is the most appropriate age group for the
nurse to incorporate these in her instructions?
1. 9 year-olds 3. 12 year-olds
2. 15 year-olds 4. 11 year-olds

SITUATION: Mary, a 12 month-old infant, was brought to the well-baby clinic. Her mother is concerned with her child’s growth and
development. She verbalized the desire to learn about this concept. The nurse then assisted the mother during check-up and did health
teaching on childcare.

13. The child’s birth weight was 8 lbs. Upon assessment the child now weighs 18 lbs. In documenting this result, the nurse knows that
this weight is:
1. Individualized and thus unpredictable 3. Below the expected weight
2. Above the expected weight 4. Appropriate for the child’s age

12. In formulating the nursing diagnosis regarding the mother’s concern, which of the following should the nurse consider?
1. Altered health maintenance 3. Anxiety
2. Knowledge deficit 4. Health-seeking behavior

13. In planning care for the infant, the nurse should advise the mother that the best way to help her child complete the development
task of the first year is to:
1. Respond to her consistently
2. Talk to her at a special time each day
3. Expose her to many caregivers to help her learn variability
4. Keep her stimulated with many toys

14. To relieve teething discomfort, which measure would the nurse suggest an infant’s mother to use?
1. Give her a cold teething ring to chew 3. Provide her with a fluid diet for 2 days
2. Offer her Aspergum to chew 4. Ask her pediatrician for a sedative for her

15. In evaluating the health teaching on breastfeeding, which of the following observations made by the mother would reveal correct
understanding on breastfed infants?
1. Breastfed infants usually have fewer stools than bottle-fed infants
2. Breastfed infants usually have soft stools than bottle-fed infants
3. Stools of breastfed infants are usually harder than those of bottle-fed infants
4. Stools of breastfed infants tend to have a strong odor

17. A 4-year-old child sustains a fall at home. After an x-ray examination, the child is determined to have a fractured arm and a plaster cast
is applied. The nurse provides instructions to the parents regarding care for the child’s cast. Which statement by the parents indicates a
need for further instruction?
1. “The cast may feel warm as the cast dries.”
2. “I can use lotion or powder around the cast
edges to relieve itching.”
3. “A small amount of white shoe polish can touch
up a soiled white cast.”
4. “If the cast becomes wet, a blow drier set on the
cool setting may be used to dry the cast.”

FOCUS: In various stages of child growth and development, the nurses’ concern for safety and quality remains a priority. The following
situations apply.

18. Which of the following actions of a 4-month old infant would be noted appropriate for his stage of development?
1. Tries to pick up a dropped object 3. Transfer on object from one hand to another
2. Holds a bottle well 4. Grasps objects with two hands

19. The nurse obtains the vital signs measurement in a 6 month-old infant. Which set of vital signs would the nurse be most concerned
about?
1. Pulse 148 bpm, Temperature 38°C, Blood pressure 92/62 mm Hg
2. Pulse 162 bpm, Temperature 38.5°C, Blood pressure 96/56 mm Hg
3. Pulse 114 bpm, Temperature 37.6°C, Blood pressure 88/60 mm Hg
4. Pulse 90 bpm, Temperature 36.9°C, Blood pressure 80/50 mm Hg

20. When doing a physical examination on an infant, an understanding of the child’s development is essential. The nurse does
examination from:
1. A. Neurologic status before the back 3. Heart before the abdomen
2. B. Chest before the nose 4. Extremities before the eyes
 21. The nurse is inserting a nasogastric tube on a toddler. Which of the following restraints would be most appropriate for the nurse
to use with this child during the procedure?
1. Jacket 3. Elbow
2. Mummy 4. Clove hitch

FOCUS: Infants’ and children’s growth and development patterns, whether sick or well are vital component of the nurses’ assessment
responsibility. The following questions apply.

22. Nurse Jodi is preparing to assess an infant under the age of 6 months. The infant is quiet and awake, sucking on a pacifier. Nurse
Jodi should start with:
1. A lung, heart and abdomen exam 3. An otoscopic exam
2. An exam for hip dysplasia 4. An oral exam

23 Nurse Jodi assesses a 12 month-old boy. When she palpates the fontanels which area should Nurse Jodi focus on to determine
normal physical anatomical development?
1. Posterior fontanel 3. Anterior fontanel
2. Suture lines 4. Lambdoidal suture

24. While assessing a 4-year-old child, Nurse Jodi noted the child to be round-chested, with the anterior diameter approximately equal
to the lateral diameter. The most appropriate interpretation of this finding is:
1. Abnormal and pectus excavates could be present
2. Abnormal and may indicate a chronic obstructive lung condition
3. Normal and no cause for concern
4. Abnormal and pectus carinatum might be present

25. Nurse Jodi assessed a 10-year-old child and noted that the child has an abnormal Romberg’s sign. What is the MOST appropriate
nursing action based on this abnormal assessment?
1. Speak when entering the room
2. Place the child in restraints
3. Explain the replacement of food on the child’s plate
4. Instruct the child to get help when getting out of bed

26. Nurse Jodi is assessing a newborn. Nurse Jodi knows that the best way to assess the newborn’s respiratory rate is to:
1. Place a hand on the newborn’s back and count for 30 seconds
2. Use the stethoscope and count the rate for 15 seconds
3. Place a hand on the newborn’s chest and count the rate for 30 seconds
4. Use the stethoscope or place a hand on the newborn’s abdomen and count the rate for one minute

FOCUS: In the growth and development of any child, you are fully aware that your responsibility for caring encompasses physical and
psychological/emotional dimensions of caring. The following apply:

27. A worried mother of a preschool-age says to the nurse, “My 4 year-old frequently touches his genital.” Which of the following
statements would be appropriate for the nurse to make?
1. “Masturbation is normal behavior, so providing another activity for the child would be appropriate.”
2. “Masturbation is embarrassing to the parents; scolding the child will stop the behavior.”
3. “When children are angry or upset, they often masturbate.”
4. “When this child masturbates, it can be unhealthy and dangerous.”

28. The mother asked, “What will I do if my child masturbates while watching his favorite program in television?” What would you
suggest?
1. Hold his hand gently but firmly to prevent him from masturbating
2. Schedule a team to observe and assess his behavior
3. Stay beside him while watching television and spank his hand when he starts to touch his genitals
4. Remind him that some activities are private

29. During a clinic visit, Charlie suddenly yells, “I’m talking to my friend Ervin!” The parent whispers that Ervin is an imaginary friend.
The nurse’s health teaching for this family should include:
1. Special instructions that Ervin is a very good conversationalist and your child may not be able to comprehend
2. Referral for counseling regarding Ervin
3. Investigation by child protective services
4. Increasing peer social interaction for Charlie

30. A hospitalized child, Earl, 4 years old, being away from his home and normal environment, goes through separation anxiety. Which
of the following behaviors might indicate that Earl is in the “denial” stage of separation? He:
1. Searches for the caregiver and waits for her to arrive
2. Quietly lies in the crib when no one is in the room
3. Cries loudly even when being helped by the nurse
4. Ignores caregivers when they visit

31. When caring for Princess, a 3 ½ year-old child, who is receiving oxygen in an oxygen tent, which of the following toys or activities
would be BEST to offer?
1. Board games the child can play with while alone
2. Age-appropriate book
3. A radio playing soothing music
4. A favorite blanket belonging to the child
 32. Tonton, a 9 year old, 4th grader bed wets. The mother asks your advice how this can be corrected. Your MOST appropriate
response is:
1. “It is normal for his age. Don’t scold him.”
2. “Limit his fluids before sleeping.”
3. “Wake him up 2-3 hours from the time he sleeps.”
4. “He might have problems at home and school.”
A. 1 & 2 C. 3 & 4
B. 2 & 3 D. 1 & 4

FOCUS: ENURESIS is a common and troublesome disorder that maybe intentional or involuntary passage of urine.

33. The following predominantly pertains to enuresis, except:

1. Urgency that is immediate 3. Common in boys than in girls
2. Familial tendency 4. Depth of sleep

34. Various therapeutic techniques are employed in the management of Enuresis, these include the following:
1. Desmopressin nasal spray
2. Elimination of fluids after the evening meal
3. Interruption of sleep to void
4. Electrical device designed to condition the child
A. 2 only C. 1, 2 & 3
B. 1 and 2 D. All 1 to 4

35. A therapeutic verbal approach that communicates strong disapproval is:

1. “You are supposed to get up and go in the toilet when you feel you have to go and did not. The next time you bed
wet, I’ll tell your friends and hang your sheets out the window for them to see.”
2. “You are supposed to get up and go in the toilet when you feel you have to go and did not. I expect you to from
now on without fail.”
3. “If you wet, you will change your bed linen and wash the sheets.”
4. “If you don’t make an effort to control your bedwetting, I’d be upset and disappointed.”

FOCUS: Child Safety

SITUATION: Teddy, 8 years old, was playing in the garden when all of a sudden he stopped playing and started scratching his legs. Teddy’s
mother washed his legs but Teddy complained of difficulty of breathing was nauseated and had moist skin. In the Emergency Department,
anaphylaxis was suspected. Insect bites were noted on Teddy’s legs.

36. The health team suspects that Teddy experienced a sting at some previous time. Which of the following could be the rationale for
the itchy skin?
1. Irritation caused by digestive substance released by the insect
2. Infiltration of inflammatory cells into the epidermis
3. Sensory nerve endings irritation
4. Occurs from hypersensitivity reaction due to the release of histamine

37. Which of the following drugs will the nurse expect the physician to prescribe INITIALLY?
1. Corticosteroids 3. Aminophylline
2. Epinephrine 4. Antihistamine

38. The mother asked the nurse what could have caused her son to experience difficulty of breathing. Which of the following is the
MOST appropriate response of the nurse?
1. “It was an early sympathetic response to the insect bite.”
2. “Chemical mediators due to hypersensitivity reactions caused bronchodilation.”
3. “Histamine released due to the allergic reaction caused narrowing of the airway”
4. “It was due to a threatening laryngeal edema.”

39. The mother claimed this is the first time it happened. Which of the following should be given PRIORITY by the nurse?
1. Instruct mother on emergency measures in case of recurrence
2. Recommend desensitization
3. Identification of allergens
4. Identification of environment hazards

40. Since Teddy is allergic to insect venom, which of the following is MOST appropriate to ensure that Teddy gets immediate treatment
during a recurrence?
1. Have Teddy carry an emergency kit all the time
2. Teach Teddy how to apply ice and protective clothing
3. Use of medical information such as a bracelet or necklace
4. Teach Teddy to get help when symptoms develop

41. A pediatric nurse has received report from the previous shift. Which of the following patients should the nurse attend to FIRST?
1. A 4 month-old baby girl with Ventricular Septal Defect (VSD) with heart murmurs
2. A 3 year-old baby girl with Tetralogy of Fallot (TOF) with blue lips when crying
3. A 12 month-old baby boy with Coarctation of Aorta (COA) who has weakness on the right extremity
4. A 10 month-old baby boy with Patent Ductus Arteriosus with positive babinski

42. A nurse is assigned in the pediatric unit. Which of the following patients should be assessed FIRST by the nurse?
1. A 6 month-old baby boy who vomited three times an hour ago
 2. A 1year-old baby boy who cries when his mother leaves
3. A 2 month-old baby girl with PR=122
4. A 9 month-old baby boy who mobilizes through his abdomen

43. In which of the following situations should the charge nurse in the pediatric unit INTERVENE in the staff nurse's action?
1. The nurse is going to do throat culture to a child who is drooling with saliva and sore throat
2. The nurse feeds the child with gastroesophageal reflux in an upright position
3. The nurse places the child with meningocele in prone position
4. The nurse gives popsicle to a child who had undergone tonsillectomy

44. After receiving endorsement, which of the following clients should the nurse see FIRST?
1. A 2 day-old infant, lying quietly, alert and with a heart rate of 135 bpm
2. A day-old infant with tense anterior fontanel
3. A 12 hour-old infant held by the mother with respiration of 45 bpm
4. A 3 hour-old infant, whose temperature is 36.7°C, with irregular abdominal breathing & respiratory rate of 50 bpm

45. Which of the following situations is most dangerous among children?

1. Medications are placed in the cupboard
2. Gun is found inside the locker but the child doesn't know where the keys are
3. An 11 year-old boy is skating along highway, going the same direction with the cars
4. A 4 year-old playing tricycle with pedal in the backyard wearing helmet, elbow pads and knee pads

SITUATION: Lilette, 4 year old girl with a recent history of nausea, vomiting and diarrhea was admitted to the Pediatric Unit with a diagnosis
of Acute Gastroenteritis. Your significant physical examination include: dry skin with turgor, sunken soft eyeballs, parched lips, abdominal
distention, and malaise. She has tachycardia and fever (38°C).

46. Based on your assessment findings, which of the following is your nursing diagnosis?
1. Ineffective peripheral tissue perfusion related to fluid volume deficit
2. Fluid volume deficit related to abnormal loss and decreased intake
3. Activity intolerance related to malaise
4. Impaired skin integrity related to frequent diarrhea

47. The following management goals for Lilette are most important for you to include in your plan EXCEPT:
1. Adequate rehydration and fluid maintenance
2. Nothing per orem at all times
3. Continue assessment of fluid and electrolyte imbalance
4. Reintroduction of adequate diet

FOCUS: CONGETINAL HEART DISEASE

48. Mother Elena is surprised to have informed that her baby upon assessment at birth, the umbilical cord has only one artery and one
vein. What explanation would you provide to Mother Elena who is a first time mother?
1. “The umbilical cord contains no nerve supply, you need not have to worry”
2. “About 15% of these infants are found to have accompanying congenital anomalies, particularly of the kidney and
heart”
3. “The walls of the umbilical cord arteries are lined with smooth muscles that constricts after birth to prevent
hemorrhage”
4. “It’s ok as it provides a circulatory pathway that connects the embryo to the chorionic villi of the placenta.

49. The nurse would gather more information regarding mother Elena’s worry about what could have THREATEN the health of her
baby. What would the nurse hope to find?
1. Has she been fond of drinking non alcoholic drinks
2. Has she suffered from any anxiety-producing circumstances
3. Has she engaged in sexual activity during the fetal development state of her child
4. Has she been into work-related lunches in coffee rooms or social functions

50. After a month, mother Elena’s baby is admitted for confirmation of the diagnosis of Ventricular Septal Defect. During the initial
admission assessment, the nurse would EXPECT to find:
1. Bradycardia at rest 3. An activity related cyanosis
2. Bounding peripheral pulses 4. A murmur at the left sternal border

SITUATION: A 3 month-old Baby Lolita is diagnosed with Tetralogy of Fallot was admitted to the unit for cardiac surgery.

51. Preoperative orders include “NPO and maintain in semi-Fowler’s position.” Nurse Jane should?
1. Defer hospital policy and document the infant’s most recent weight
2. Weigh the infant in an infant seat and then subtract the weight of the seat
3. Place the infant on the scale in the supine position and weigh quickly
4. Have an adult hold the infant, weigh them both, and then subtract the weight of the adult

52. Vincent is hospitalized for evaluation & management of Tetralogy of Fallot. Nurse Mimi should DISCUSS which topic with the
parents, EXCEPT?
1. The need to withhold childhood immunizations
2. The importance of hydration for Nathan
3. Proper positioning to decrease workload of the heart
4. The need to adhere to Propanolol as prescribed by the physician
 53. Daniel, a 3-year old child is brought to the emergency department because of a barking cough, a loud inspiratory stridor, and
sternal retractions. A diagnosis of acute spasmodic laryngitis (CROUP) is made. Daniel is placed on a MIST TENT. For children
beyond early infancy, the mist tent is a satisfactory means for administration of oxygen; nursing care is planned carefully so that
the child receives the BEST nursing care, which are:
1. Toys made of vinyl or Plastic
2. Ensure that Daniel’s clothes are of cotton type
3. Noting the temperature inside the tent periodically to be certain it is maintained at desired level
4. Tent must be tucked-in snugly under the bed without open edges
5. Providing stuffed toy items
6. Playing with his favorite mechanical or electrical toys
A. 1 & 2 C. 1, 2 & 4
B. 1, 2 & 3 D. All 1-4

SITUATION: A 3-week-old infant is admitted with a tentative diagnosis of hypertrophic pyloric stenosis (HPS).

54. Before doing the admission assessment of the abdomen, the nurse bicycles the infant’s legs. This enables the nurse to:
1. Palpate abdominal contour
2. Assess abdominal rebound and exercise the nurse’s limbs
3. Relax the abdominal muscles
4. Detect weak abdominal muscles

55. The nurse is caring for a child who has intussusception. Which of the following assessment is most important to REPORT to the
physician?
A. Greasy, bulky, foul-smelling stool C. Formed stool
B. Pellet-like stool D. Currant jelly stool

56. Nurse Marky is performing the Ortolani test on Baby Pitoy. The finding that would indicate a POSITIVE results would be:
A. Dorsiflexion and fanning C. An arched back and crying
B. Hypertonia and jitteriness D. An audible click on abduction

SITUATION: The mother of Charisse, 6-years-old brought her child to the pediatric clinic and complains that the child has malaise, weakness,
lethargy, anorexia, headaches and SMOKY URINE.

57. When taking the nursing history, the nurse asks the mother whether Charisse has had a:
A. Pain in the shoulders and knees C. Recent weight loss of at least 2 pounds
B. Strep throat within the past 2 weeks D. Rash on the palms and feet for several weeks

58. The nurse would ensure that which of the following is an important part of Charisse’s care?
1. Assessing BP and obtaining daily weight
2. Obtaining blood sample for electrolyte analysis every morning
3. Checking every urine specimen for protein and specific gravity
4. Ensuring that the child has accurate intake and output and eats high protein diet

59. In glomerulonephritis, the glomeruli are injured and the symptoms may include:
1. Hypoalbuminemia 3. Hematuria
2. Proteinuria 4. Hypotension

SITUATION: Rico, 4 years old is admitted to the hospital because of marked ascites and edema. The physician’s diagnosis is Nephrotic
Syndrome

60. The nurse recognizes that Nephrotic Syndrome is an autoimmune response responsible for which of the following?
1. Bacterial infection of the nephron 3. Extensive nephron destruction
2. Decreases glomerular filtration 4. Increased glomerular permeability

61. The symptoms may include:

1. Hyperalbuminemia 3. Hematuria
2. Proteinuria 4. Hypertension

62. The mother of Rico asked the nurse, “Why is Rico gaining too much weight?” Which of the following is the MOST appropriate
response of the nurse?
1. “Carlo has retained so much fluid in his body, thus his weight increased”
2. “Carlo has been losing protein because his kidneys could not control this”
3. “He is not voiding enough urine because his kidneys are defective”
4. “He should not be drinking too much water to avoid fluid to be retained”

63. Nursing care for this child in the acute phase should include:
1. Providing low protein diet 3. Providing time for active play
2. Encouraging fluids every hour periods
4. Encouraging frequent changes of
position
 64. The therapy of choice for Rico is Prednisone. Which of the following is the CORRECT information given by the nurse to the mother
of Rico regarding purpose of the therapy?
1. Reduce inflammation of the 3. Promote diuresis
nephron 4. Decrease blood volume
2. Reduce proteinuria

65. The nurse evaluates its effectiveness by:

1. Checking BP every 4 hours
2. Checking his urine for protein
3. Weighing him each morning before breakfast
4. Observing him for behavioral changes
66. While Rico is on Prednisone therapy, the nurse makes the mother understands that the MOST important intervention is to:
1. Maintain on a high protein diet 3. Avoid exposure to infection
2. Promote activity and exercise 4. Keep skin clean and dry

SITUATION: Juanchito, 5 years old, has idiopathic nephritic syndrome. He has generalized edema with a puffy face, distended abdomen and
edematous legs. Blood pressure is normal. Blood tests show hypoalbuminemia.

67. The nurse is aware that generalized edema is due to hypoalbuminemia which lead primarily to which of the following?
1. Increased secretion of antidiuretic 3. Decreased plasma osmotic pressure
hormone 4. Stimulation of the rennin-
2. Reduced intravascular volume angiotensin system

68. The nurse closely monitors the urine output of the patient. Which of the following characteristics of a urine sample will the nurse
expect?
1. Fruity odor 3. Urine is frothy
2. Increased amount 4. Blood in urine

69. The attending physician of Juanchito prescribed renal biopsy. When the nurse plans for the nursing care of Juanchito after the
biopsy, which of the following will be a PRIORITY intervention to prevent bleeding?

1. Observe for abdominal pain and tenderness

2. Monitor vital signs
3. Place on complete bed rest
4. Closely watch urine output

70. Corticosteroid therapy was prescribed. Which of the following is the MOST relevant nursing intervention to address complications
of the therapy?
1. Weigh daily to monitor fluid balance 3. Maintain on a salt restricted diet
2. Closely monitor for changes in body 4. Offer small frequent meals
temperature

71. When the nurse prepares her health instruction for the mother of Juanchito, which of the following side effects of the drug will
the nurse include in her plan?
1. Diuresis 4. Loss of appetite
2. Hirsutism 5. Rounding of the face
3. Abdominal distention
A. 3, 4 & 5 C. 1, 2 & 5
B. 2, 3 & 5 D. 1, 2 & 3

72. Nurse Bondoc is about to assess a five month old infant but the mother said the child has just fallen asleep. Which of the
following will the nurse do?
1. Assess the child later when the child awake
2. Tell the mother to wake the child gently so the child will not cry
3. Ask the mother to lay the child on the examining table
4. Proceed with the assessment of RR

73. At what age does a child speak one or two words in addition to mama and papa?
1. 0 to 2 months
2. 3 to 6 months
3. 6 – 9 months
4. 10 – 12 months

74. When the newly delivered baby opened her eyes, the mother noticed that they are crossed. Which of the following explanations
of the nurse is CORRECT?
1. “Bring him to the pediatrician for proper evaluation and treatment”
2. “It is normal because your baby cannot focus a light at his age”
3. “This is normal because there is lack of eye muscle coordination among neonates”
4. Maybe we should refer your baby to an eye doctor”

75. During the home visit on the fifth post-partum day, the weight of baby Bentong is 2,835 grams. Which of the following health
teachings of the nurse is CORRECT?
1. “Supplement your breast milk with formula so she can regain her weight”
2. “Continue breast feeding him on demand because his weight loss is normal”
3. “Give additional feedings because her weight loss is alarming”
4. “Drink milk and eat nutritious food so your baby will get more from you”
76. A mother of a newborn asked the nurse “When will the swelling of her head disappear?” You would respond:
 1. 12 to 18 months
2. 2 to 3 months
3. 3 to 6 weeks
4. 2 to 3 days

77. The nurse is monitoring a child with burns during treatment for burn shock. Which assessment provides the most accurate
guide to determine the adequacy of fluid resuscitation?

1. Skin turgor

2. Level of edema at burn site

3. Adequacy of capillary filling

4. Amount of fluid tolerated in 24 hours

78. The mother of a 3-year-old child arrives at a clinic and tells the nurse that the child has been scratching the skin continuously
and has developed a rash. The nurse assesses the child and suspects the presence of scabies. The nurse bases this suspicion on
which finding noted on assessment of the child’s skin?

1. Fine grayish red lines

2. Purple-colored lesions

3. Thick, honey-colored crusts

4. Clusters of fluid-filled vesicles

79. Permethrin is prescribed for a child with a diagnosis of scabies. The nurse should give which instruction to the parents regarding
the use of this treatment?

A. Apply the lotion to areas of the rash only.

B. Apply the lotion and leave it on for 6 hours.

C. Avoid putting clothes on the child over the

lotion.

D. Apply the lotion to cool, dry skin at least

30 minutes after bathing.

80 The school nurse has provided an instructional session about impetigo to parents of the children attending the school. Which
statement, if made by a parent, indicates a need for further instruction?

A.“It is extremely contagious.”

B.“It is most common in humid weather.”

C. “Lesions most often are located on the arms and chest.”

D.“It might show up in an area of broken skin, such as an insect bite.”

81. The nurse caring for a child who sustained a burn injury plans care based on which pediatric considerations associated with
this injury? Select all that apply.

1. Scarring is less severe in a child than in an adult.

2. A delay in growth may occur after a burn injury.

3. An immature immune system presents an increased risk of infection for infants and young children.

4. Fluid resuscitation is unnecessary unless the burned area is more than 25% of the total body surface area.

5. The lower proportion of body fluid to body mass in a child increases the risk of cardio- vascular problems.

6. Infants and young children are at increased risk for protein and calorie deficiency because they have smaller muscle mass and
less body fat than adults.

A. 123
B. 134
C. 236
D. 245
E. 126

82. The nurse is reviewing a health care provider’s prescriptions for a child with sickle cell anemia who was admitted to the hospital
for the treatment of vaso occlusive crisis. Which prescriptions documented in the child’s record should the nurse question? Select
all that apply.

1. Restrict fluid intake.

2. Position for comfort.

3. Avoid strain on painful joints.

4. Apply nasal oxygen at 2 L/minute.

5. Provide a high-calorie, high-protein diet.

6. Give meperidine, 25 mg intravenously,

every 4 hours for pain.

a. 1234
b. 16
 c. 134
d. 145
e. 1234567

83. The nurse is instructing the parents of a child with iron deficiency anemia regarding the administration of a liquid oral iron
supplement. Which instruction should the nurse tell the parents?

1. Administer the iron at mealtimes.

2. Administer the iron through a straw.

3. Mix the iron with cereal to administer.

4. Add the iron to formula for easy administration.

84. Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory
results, knowing that which result indicates this type of anemia?

1. Elevated hemoglobin level

2. Decreased reticulocyte count

3. Elevated red blood cell count

4. Red blood cells that are microcytic and

hypochromic

85. Which specific nursing interventions are implemented in the care of a child with leukemia who is at risk for infection? Select
all that apply.

1. Maintain the child in a semiprivate room.

2. Reduce exposure to environmental organisms.

3. Use strict aseptic technique for all procedures.

4. Ensure that anyone entering the child’s room

wears a mask.

5. Apply firm pressure to a needle-stick area for

at least 10 minutes.

f. 123
g. 234
h. 235
i. 124
86. The nurse is performing an assessment on a 10- year-old child suspected to have Hodgkin’s disease. Which assessment findings
are specifically characteristic of this disease? Select all that apply.

1. Abdominal pain

2. Fever and malaise

3. Anorexia and weight loss

4. Painful, enlarged inguinal lymph nodes

5. Painless, firm, and movable adenopathy in

the cervical area

j. 14
k. 15
l. 1234
m. 12345
n. 12346

87. Ways to lessen pain in getting blood glucose sample to children SATA

1.Hold the finger under warm water for a few seconds before puncture (enhances blood flow to the finger).

2.Use the ring finger or thumb to obtain a blood sample because blood flows more easily to these areas; puncture the finger just
to the side of the finger pad because there are more blood vessels in this area and fewer nerve endings.

3.Press the lancet device lightly against the skin to prevent a deep puncture.

4.Use glucose monitors that require very small blood samples for measurement.

o. 12
p. 234
q. 12345
r. 1234

88. Ways to manage hypoglycemia SATA

1. If possible, confirm hypoglycemia with a blood glucose reading.

2. Administer glucose immediately; rapid-releasing glucose is followed by a complex carbohydrate and protein, such as a
slice of bread or a peanut butter cracker.
3. Give an extra snack if the next meal is not planned for more than 30 minutes or if activity is planned.
 4. If the child becomes unconscious, squeeze cake frosting or glucose paste onto the gums and retest the blood glucose
level in 15 minutes (monitor the child closely); if the reading remains low, administer additional glucose.
5. If the child remains unconscious, the administration of glucagon may be necessary.
In the hospital, prepare to administer dextrose intravenously if the child is unable to consume an oral glucose product.

89. The nurse should implement which interventions for a child older than 2 years with type 1 diabetes mellitus who has a blood
glucose level of 60 mg/dL (3.4 mmol/L)? Select all that apply.

1. Administer regular insulin.

2. Encourage the child to ambulate.

3. Give the child a teaspoon of honey.

4. Provide electrolyte replacement therapy

intravenously.

5. Wait 30 minutes and confirm the blood glucose reading.

6. Prepare to administer glucagon subcutaneously if unconsciousness occurs.

90. A school-age child with type 1 diabetes mellitus has soccer practice and the school nurse provides instructions regarding how
to prevent hypoglycemia during practice. Which should the school nurse tell the child to do?

1. Eat twice the amount normally eaten at lunchtime.

2. Take half the amount of prescribed insulin on practice days.

3. Take the prescribed insulin at noontime rather than in the morning.

4. Eat a small box of raisins or drink a cup of orange juice before soccer practice.

91. The mother of a 6-year-old child who has type 1 diabetes mellitus calls a clinic nurse and tells the nurse that the child has been
sick. The mother reports that she checked the child’s urine and it was positive for ketones. The nurse should instruct the mother
to take which action?

1. Hold the next dose of insulin.

2. Come to the clinic immediately.

3. Encourage the child to drink liquids.

4. Administer an additional dose of regular

insulin.

92. Which interventions should the nurse include when creating a care plan for a child with hepatitis? Select all that apply.

1. Providing a low-fat, well-balanced diet.

2. Teaching the child effective hand-washing techniques.

3. Scheduling playtime in the playroom with other children.

4. Notifying the health care provider (HCP) if

jaundice is present.

5. Instructing the parents to avoid administering medications unless prescribed.

6.Arranging for indefinite home schooling because the child will not be able to return to school.

93. After a tonsillectomy, a child begins to vomit bright red blood. The nurse should take which initial action?

1. Turn the child to the side.

2. Administer the prescribed antiemetic.

3. Notify the health care provider (HCP).

4. Maintain NPO (nothing by mouth) status.

94. The mother of a 6-year-old child arrives at a clinic because the child has been experiencing itchy, red, and swollen eyes. The
nurse notes a discharge from the eyes and sends a culture to the laboratory for analysis. Chlamydial conjunctivitis is diagnosed.
On the basis of this diagnosis, the nurse determines that which requires further investigation?

1. Possible trauma

2. Possible sexual abuse

3. Presence of an allergy

4. Presence of a respiratory infection

95. The nurse prepares a teaching plan for the mother of a child diagnosed with bacterial conjunctivitis. Which, if stated by the
mother, indicates a need for further teaching?

1. “I need to wash my hands frequently.”

2. “I need to clean the eye as prescribed.”

3. “It is okay to share towels and washcloths.”

4. “I need to give the eye drops as prescribed.”

96. The nurse is reviewing the laboratory results for a child scheduled for a tonsillectomy. The nurse determines that which
laboratory value is most significant to review?
1. Creatinine level

2. Prothrombin time

3. Sedimentation rate

4. Blood urea nitrogen level

97. The nurse is preparing to care for a child after a tonsillectomy. The nurse documents on the plan of care to place the child in
which position?

1. Supine

2. Side-lying

3. High Fowler’s

4. Trendelenburg

98. After a tonsillectomy, the nurse reviews the health care provider’s (HCP’s) postoperative prescriptions. Which prescription
should the nurse question?

1. Monitor for bleeding.

2. Suction every 2 hours.

3. Give no milk or milk products.

4. Give clear, cool liquids when awake and alert.

99. The nurse is caring for a child after a tonsillectomy. The nurse monitors the child, knowing that which finding indicates the
child is bleeding?

1. Frequent swallowing

2. A decreased pulse rate

3. Complaints of discomfort

4. An elevation in blood pressure

100. Antibiotics are prescribed for a child with otitis media who underwent a myringotomy with insertion of tympanostomy tubes.
The nurse provides discharge instructions to the parents regarding the administration of the antibiotics. Which statement, if made
by the parents, indicates under- standing of the instructions provided?

1. “Administer the antibiotics until they are gone.”

2. “Administer the antibiotics if the child has

a fever.”

3. “Administer the antibiotics until the child

feels better.”

4. “Begin to taper the antibiotics after 3 days of a

full course.

101. RSV causes an acute viral infection and is a com- mon cause of bronchiolitis (other organisms that causes bronchiolitis include
adenoviruses, parainfluenza viruses, and human meta pneumo virus) The initial manifestations are SATA

1. Rhinorrhea

2. Eye or ear drainage

3. Pharyngitis

4. Coughing

5. Sneezing

6. Wheezing

7. Intermittent fever

102. Asthma is classified on the basis of disease severity; management includes medications, environ- mental control of allergens,
and child and family education. The allergic reaction in the airways caused by the precipitant can result in an immediate reaction
with obstruction occurring, and it can result in a late bronchial obstructive reaction several hours after the initial exposure to the
precipitant. What are the best diagnostic tests for Asthma

1. Pulmonary Function Tests: Spirometry testing assesses the presence and degree of disease and can determine the response to
treatment.

2. Peak Expiratory Flow Rate Measurement: Measures maxi- mum flow of air that can be forcefully exhaled in 1 second; child uses
a peak expiratory flow meter to determine a “personal best” value that can be used for comparison at other times, such as during
and after an asthma attack.

3. Broncho provocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to
suspected allergen in increasing amounts.

4. Skin Testing: Done to identify specific allergens.

5.Exercise Challenges: Exercise is used to identify the occurrence

of exercise-induced bronchospasm.

6. Radio allegro sorbent Test: Blood test used to identify a specific

allergen.

7. Chest Radiograph: May show hyper expansion of the airways

103. The clinic nurse is providing instructions to a parent of a child with cystic fibrosis regarding the immunization schedule for
the child. Which statement should the nurse make to the parent?

1. “The immunization schedule will need to be altered.”

2. “The child should not receive any hepatitis vaccines.”

3. “The child will receive all of the immunizations except for the polio series.”

4. “The child will receive the recommended basic series of immunizations along with a yearly influenza vaccination.”

104. The nurse is preparing for the admission of an infant with a diagnosis of bronchiolitis caused by respiratory syncytial virus
(RSV). Which interventions should the nurse include in the plan of care? Select all that apply.

1. Place the infant in a private room.

2. Ensure that the infant’s head is in a flexed

position.

3. Wear a mask at all times when in contact

with the infant

4. Place the infant in a tent that delivers warm humidified air.

5. Position the infant on the side, with the head lower than the chest.

6. Ensure that nurses caring for the infant with RSV do not care for other high-risk children.

105. The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On
the basis of this finding, which is the most appropriate nursing action?

1. Initiate strict enteric precautions.

2. Move the infant to a room with another child

with RSV.

3. Leave the infant in the present room because

RSV is not contagious.

4. Inform the staff that they must wear a mask,

gloves, and a gown when caring for the child.

106. A child with laryngotracheobronchitis (croup) is placed in a cool mist tent. The mother becomes concerned because the child
is frightened, consistently crying and trying to climb out of the tent. Which is the most appropriate nursing action?

1. Tell the mother that the child must stay in the tent.

2. Place a toy in the tent to make the child feel more comfortable.

3. Call the health care provider and obtain a prescription for a mild sedative.

4. Let the mother hold the child and direct the cool mist over the child’s face.

107. The clinic nurse reads the results of a tuberculin skin test (TST) on a 3-year-old child. The results indicate an area of induration
measuring 10 mm. The nurse should interpret these results as which finding?

1. Positive

2. Negative

3. Inconclusive

4. Definitive and requiring a repeat test

108. The nurse is monitoring an infant with congenital heart disease closely for signs of heart failure (HF). The nurse should assess
the infant for which early sign of HF?

1. Pallor

2. Cough

3. Tachycardia

4. Slow and shallow breathing

109. The nurse reviews the laboratory results for a child with a suspected diagnosis of rheumatic fever, knowing that which
laboratory study would assist in confirming the diagnosis?

1. Immunoglobulin

2. Red blood cell count

3. White blood cell count

4. Anti–streptolysin O titer
110. On assessment of a child admitted with a diagnosis of acute-stage Kawasaki disease, the nurse expects to note which clinical
manifestation of the acute stage of the disease?

1. Cracked lips

2. Normal appearance

3. Conjunctival hyperemia

4. Desquamation of the skin

111. The nurse provides home care instructions to the parents of a child with heart failure regarding the procedure for
administration of digoxin. Which statement made by the parent indicates the need for further instruction?

1. “I will not mix the medication with food.”

2. “I will take my child’s pulse before administering the medication.”

3. “If more than 1 dose is missed, I will call the

health care provider.”

4. “If my child vomits after medication administration, I will repeat the dose.”

112. The nurse is closely monitoring the intake and out- put of an infant with heart failure who is receiving diuretic therapy. The
nurse should use which most appropriate method to assess the urine output?

1. Weighing the diapers

2. Inserting a urinary catheter

3. Comparing intake with output

4. Measuring the amount of water added to

formula

113. The clinic nurse reviews the record of a child just seen by a health care provider and diagnosed with suspected aortic stenosis.
The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

1. Pallor

2. Hyperactivity

3. Exercise intolerance

4. Gastrointestinal disturbances

114. The nurse has provided home care instructions to the parents of a child who is being discharged after cardiac surgery. Which
statement made by the parents indicates a need for further instruction?

1. “A balance of rest and exercise is important.”

2. “I can apply lotion or powder to the incision if it

is itchy.”

3. “Activities in which my child could fall need to

be avoided for 2 to 4 weeks.”

4. “Large crowds of people need to be avoided for

at least 2 weeks after surgery.”

115. A child with rheumatic fever will be arriving to the nursing unit for admission. On admission assessment, the nurse should
ask the parents which question to elicit assessment information specific to the development of rheumatic fever?

1. “Has the child complained of back pain?”

2. “Has the child complained of headaches?”

3. “Has the child had any nausea or vomiting?”

4. “Did the child have a sore throat or fever within the last 2 months?”

116. A health care provider has prescribed oxygen as needed for an infant with heart failure. In which situation should the nurse
administer the oxygen to the infant?

1. During sleep

2. When changing the infant’s diapers

3. When the mother is holding the infant

4. When drawing blood for electrolyte level testing

117. The nurse is creating a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure?
Select all that apply.
1. Time the seizure.
2. Restrain the child.
3. Stay with the child.
4. Place the child in a prone position.
5. Move furniture away from the child.
6. Insert a padded tongue blade in the child’s
mouth.

118. The nurse prepares a list of home care instructions for the parents of a child who has a plaster cast applied to the left forearm.
Which instructions should be included on the list? Select all that apply.
1. Use the fingertips to lift the cast while it is drying.
2. Keep small toys and sharp objects away from the cast.
3. Use a padded ruler or another padded object to scratch the skin under the cast if it itches. 4. Place a heating pad on the lower
end of the cast and over the fingers if the fingers
feel cold.
5. Elevate the extremity on pillows for the first
24 to 48 hours after casting to prevent
swelling.
6. Contact the health care provider (HCP) if
the child complains of numbness or tingling in the extremity.

119. A child has a right femur fracture caused by a motor vehicle crash and is placed in skin traction temporarily until surgery can
be performed. During assessment, the nurse notes that the dorsalis pedis pulse is absent on the right foot. Which action should
the nurse take?
1. Administer an analgesic.
2. Release the skin traction.
3. Apply ice to the extremity.
4. Notify the health care provider (HCP).

120. A child is placed in skeletal traction for treatment of a fractured femur. The nurse creates a plan of care and should include
which intervention?
1. Ensure that all ropes are outside the pulleys.
2. Ensure that the weights are resting lightly on the floor.
3. Restrict diversional and play activities until the child is out of traction.
4. Check the health care provider’s (HCP’s) prescriptions for the amount of weight to be applied.

Do what is necessary, then act what is possible, then eventually you will do the impossible.