1.

A child with leukemia is being

discharged after beginning
chemotherapy. Which of the following
instructions will the nurse include when
teaching the parents of this child?

a) provide a diet low in protein and high

carbohydrates
b) b) avoid fresh vegetables that are not cooked or
peeled
c) c) notify the doctor if the child's temperature
exceeds 101 F (39C)
d) d) increase the use of humidifiers throughout
the house
Answer B
fresh fruits and vegetables harbor
microorganisms, which can cause infections
in immune-compromised child. Fruits and
vegetables should either be peeled or
cooked. The physician should be notified
of a temperature above 100F, a diet low in
protein is not indicated, and humidifiers
harbor fungi in the water containers.
2. A client with hemophilia has a very
swollen knee after falling from bicycle
riding. Which of the following is the first
nursing action?
a) initiate an IV site to begin administration of
cryoprecipitate
b) type and cross-match for possible
transfusion
c) monitor the client's vital signs for the first
5 minutes
d) apply ice pack and compression dressings to
the knee
Answer D
rest, ice, compression, and elevation (RICE)
are the immediate treatments to reduce the
swelling and bleeding into the joint. These
are the priority actions for bleeding into the
joint of a client with hemophilia.
3. A client and her husband are positive
for the sickle cell trait. The client asks the
nurse about chances of her children having
sickle cell disease. Which of the following is
appropriate response by the nurse?

a) one of her children will have sickle cell disease

b) only the male children will be affected
c) each pregnancy carries a 25% chance of the
child being affected
d) if she had four children, one of them would
have the disease
Answer C
In autosomal recessive traits, both parents
are carriers. There is a 25% chance with each
pregnancy that a child will have the disease.
4. An 8 year old child has been diagnosed
to have iron deficiency anemia. Which of
the following activities is most appropriate
for the child to decrease oxygen demands
on the body?

a) Dancing
b) playing video games
c) reading a book
d) riding a bicycle
Answer C
reading a book is restful activity and can keep
the child from becoming bored. Choices a, b, and
d require too much energy for a child with
anemia and can increase oxygen demands on the
body.
5. A 16 month old child diagnosed with
Kawasaki Disease (KD) is very irritable,
refuses to eat, and exhibits peeling skin
on the hands and feet. Which of the
following would the nurse interpret as
the priority?

a) applying lotions to the hands and feet

b) offering foods the toddler likes
c) placing the toddler in a quiet environment
d) encouraging the parents to get some rest
Answer C
One of the characteristics of children with KD
is irritability. They are often inconsolable.
Placing the child in a quiet environment may
help quiet the child and reduce the workload of
the heart. The child's irritability takes priority
over peeling of the skin.
6.Which of the following should the nurse
do first after noting that a child with
Hirschsprung disease has a fever and
watery explosive diarrhea?

a. Notify the physician immediately

b. Administer antidiarrheal medications
c. Monitor child ever 30 minutes
d. Nothing, this is characteristic of
Hirschsprung disease
Answer A.
For the child with Hirschsprung disease, fever and
explosive diarrhea indicate enterocolitis, a life-
threatening situation. Therefore, the physician
should be notified immediately. Generally, because
of the intestinal obstruction and inadequate
propulsive intestinal movement, antidiarrheals are
not used to treat Hirschsprung disease. The child is
acutely ill and requires intervention, with monitoring
more frequently than every 30 minutes.
Hirschsprung disease typically presents with
chronic constipation.
7. A newborn’s failure to pass meconium
within the first 24 hours after birth
may indicate which of the following?

a. Hirschsprung disease

b. Celiac disease

c. Intussusception

d. Abdominal wall defect

Answer A
Failure to pass meconium within the first 24 hours
after birth may be an indication of Hirschsprung
disease, a congenital anomaly resulting in mechanical
obstruction due to inadequate motility in an
intestinal segment. Failure to pass meconium is not
associated with celiac disease, intussusception, or
abdominal wall defect.
8. When assessing a child for possible
intussusception, which of the following
would be least likely to provide valuable
information?

a. Stool inspection

b. Pain pattern

c. Family history

d. Abdominal palpation
Answer C.
Because intussusception is not believed to have a
familial tendency, obtaining a family history would
provide the least amount of information. Stool
inspection, pain pattern, and abdominal palpation
would reveal possible indicators of intussusception.
Current, jelly-like stools containing blood and
mucus are an indication of intussusception. Acute,
episodic abdominal pain is characteristics of
intussusception. A sausage-shaped mass may be
palpated in the right upper quadrant.
9. After teaching the parents of a
preschooler who has undergone T and A
(Tonsillectomy and Adenoidectomy) about
appropriate foods to give the child after
discharge, which of the following, if stated
by the parents as appropriate foods,
indicates successful teaching?
a) meatloaf and uncooked carrots
b) pork and noodle casserole
c) cream of chicken soup and orange
sherbet
d) hot dog and potato chips
Answer C
for the first few days after a T and A
(Tonsillectomy and Adenoidectomy), liquids and
soft foods are best tolerated by the child while the
throat is sore. Avoid hard and scratchy foods until
throat is healed.
10. 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
respiratory rate increases to 44 bpm.
Which of the following actions would the
nurse do first?
a) obtain an order for sedation for the
child
b) assess for an irregular heart rate and
rhythm
c) explain to the child that it will only
hurt for a short time
d) place the child in knee-to-chest
position
Answer D
the child is experiencing a "tet spell" or hypoxic episode.
Therefore the nurse should place the child in a knee-to-
chest position. Flexing the legs reduces venous flow of
blood from lower extremities and reduces the volume of
blood being shunted through the interventricular septal
defect and the overriding aorta in the child with
tetralogy of fallot. As a result, the blood then entering
the systemic circulation has higher oxygen content, and
dyspnea is reduced. Flexing the legs also increases
vascular resistance and pressure in the left ventricle. An
infant often assumes a knee-to-chest position to relieve
dyspnea. If this position is ineffective, then the child
may need sedative. Once the child is in this position, the
nurse may assess for an irregular heart rate and rhythm.
Explaining to the child that it will only hurt for a short
time does nothing to alleviate hypoxia.
11. Which of the following would the nurse
perform to help alleviate a child'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 pillows
d) using a bed cradle to avoid the weight of bed
lines on the joints
Answer D
for a child with arthritis associated with rheumatic
fever, the joints are usually so tender that even the
weight of bed linens can cause pain. Use of the bed
cradle is recommended to help remove the weight of
the linens on painful joints. Joints need to be
maintained in good alignment, not positioned in
extension, to ensure that they remain functional.
Applying gentle traction to the joints is not
recommended because traction is usually used to
relieve muscle spasms, not typically associated with
rheumatic fever. Supporting the body in good
alignment and changing the client's position are
recommended, but these measures are not likely to
relieve pain.
12. Which of the following health teachings
regarding sickle cell crisis should be
included by the nurse?

a) it results from altered metabolism and

dehydration
b) tissue hypoxia and vascular occlusion cause
the primary problems
c) increased bilirubin levels will cause
hypertension
d) there are decreased clotting factors with an
increase in white blood cells
Answer B
tissue hypoxia occurs as a result of the
decreased oxygen-carrying capacity of the red
blood cells. The sickled cells begin to clump
together, which leads to vascular occlusion.
13. Which of the following should the
nurse expect to note as a frequent
complication for a child with congenital
heart disease?

a. Susceptibility to respiratory
infection

b. Bleeding tendencies

c. Frequent vomiting and diarrhea

d. Seizure disorder
Answer A
Children with congenital heart disease are
more prone to respiratory infections.
Bleeding tendencies, frequent vomiting, and
diarrhea and seizure disorders are not
associated with congenital heart disease.
14. While assessing a newborn with cleft lip,
the nurse would be alert that which of the
following will most likely be compromised?

a. Sucking ability

b. Respiratory status

c. Locomotion

d. GI function
Answer A.
Because of the defect, the child will be unable to
from the mouth adequately around nipple, thereby
requiring special devices to allow for feeding and
sucking gratification. Respiratory status may be
compromised if the child is fed improperly or during
postoperative period, Locomotion would be a
problem for the older infant because of the use of
restraints. GI functioning is not compromised in the
child with a cleft lip.
15. When providing postoperative care for the
child with a cleft palate, the nurse should
position the child in which of the following
positions?

a. Supine

b. Prone

c. In an infant seat

d. On the side
Answer B.
Postoperatively children with cleft palate should
be placed on their abdomens to facilitate drainage.
If the child is placed in the supine position, he or
she may aspirate. Using an infant seat does not
facilitate drainage. Side-lying does not facilitate
drainage as well as the prone position
16. Which of the following nursing
diagnoses would be inappropriate for
the infant with gastroesophageal reflux
(GER)?

a. Fluid volume deficit

b. Risk for aspiration

c. Altered nutrition: less than body

requirements

d. Altered oral mucous membranes

Answer D
GER is the backflow of gastric contents into the
esophagus resulting from relaxation or
incompetence of the lower esophageal (cardiac)
sphincter. No alteration in the oral mucous
membranes occurs with this disorder. Fluid
volume deficit, risk for aspiration, and altered
nutrition are appropriate nursing diagnoses
17. Which of the following parameters would
the nurse monitor to evaluate the
effectiveness of thickened feedings for an
infant with gastroesophageal reflux
(GER)?
a. Vomiting

b. Stools

c. Uterine

d. Weight
Answer A
Thickened feedings are used with GER to stop
the vomiting. Therefore, the nurse would
monitor the child’s vomiting to evaluate the
effectiveness of using the thickened feedings.
No relationship exists between feedings and
characteristics of stools and uterine. If
feedings are ineffective, this should be noted
before there is any change in the child’s weight.
18. An adolescent with a history of surgical
repair for undescended testes comes to the
clinic for a sport physical. Anticipatory
guidance for the parents and adolescent
would focus on which of the following as
most important?

a) the adolescent sterility

b) the adolescent future plans
c) technique for monthly testicular self-
examinations
d) need for a lot of psychosocial support
Answer C
Because the incidence of testicular cancer is
increased in adulthood among children who have
undescended testes. It is extremely important to
teach the adolescent how to perform the testicular
self-examination monthly.
19. When developing the teaching plan for
the parents of a 12 month old infant with
hypospadias and chordee repair, which of
the following would the nurse expect to
include as most important?
a) assisting the child to become familiar with his
dressing so he will leave them alone
b) encouraging the child to ambulate as soon as
possible by using a favorite push toy
c) forcing fluids to at least 250 ml/day by offering
his favorite juices
d) preventing the child from disrupting the
catheter by using soft restraints
Answer D
The most important consideration for a
successful outcome of this surgery is maintenance
of the catheters or stents. A 12 month old likes to
explore his environment. Applying soft restraints
will prevent the child from disrupting the
catheter.
20. A school-aged client admitted to the
hospital because of decreased urine output
and periorbital edema is diagnosed with
glomerulonephritis. Which of the following
interventions would receive the highest
priority?

a) assessing vital signs every four hours

b) monitoring intake and output every 12
hours
c) obtaining daily weight measurements
d) obtaining serum electrolyte levels daily
Answer C
The child will glomerulonephritis experiences a
problem with renal function that ultimately
affects fluid balance. Because weight is the
best indicator of fluid balance, obtaining daily
weights would be the highest priority.
21. When assessing a 12 year old child with
Wilm's tumor, the nurse should keep in mind
that it most important to avoid which of the
following?

a) measuring the child's chest

circumference
b) palpating the child's abdomen
c) placing the child in an uprignt position
d) measuring the child's occipitofrontal
circumference
Answer B
The abdomen of the child with Wilm's tumor
should not be palpated because of the danger
of disseminating tumor cells. The child with
Wilm's tumor should always be handled gently
and carefully
22. When positioning the neonate with an
unrepaired myelomeningocele, which of the
following positions would be most
appropriate?

a) supine the hip at 90 degree flexion

b) right side-lying position with knees
flexed
c) prone with hips in abduction
d) semi-fowler's position with chest and
abdomen elevated
Answer C
Before surgery, the infant is kept in the prone
position to decrease tension on the sac. This allows
for optimal positioning of the hips, knees, and feet
because orthopedic problems are common. The
supine position is unacceptable because it causes
pressure on the defect
23. A 4 year old with hydrocephalus is
scheduled to have a ventroperitoneal shunt in
the right side of the head. When developing
the child's postoperative plan of care, the
nurse would expect to place the preschooler in
which of the following positions immediately
after surgery?
a) on the right side, with the foot of the bed
elevated
b) on the left side, with the head of the bed
elevated
c) prone with the head of the bed elevated
d) supine, with the head of the bed flat
Answer D
For at least the first 24 hours after insertion
of a ventriculoperitoneal shunt, the child is
positioned supine with the head of the bed flat
to prevent too rapid decrease in CSF pressure. A
rapid reduction in the size of the ventricles can
cause subdural hematoma. Positioning on the
operative site is to be avoided because it places
pressure on the shunt valve, possibly blocking
desired drainage of CSF. With continued
increased ICP, the child would be positioned with
the head of bed elevated to allow gravity to aid
drainage.
24. After talking with the parents of a child
with Down Syndrome, which of the following
would the nurse identify as an appropriate
goal of care of the child?

a) encouraging self-care skills in the child

b) teaching the child something new each day
c) encouraging more lenient behavior limits
for the child
d) achieving age-appropriate social skills
Answer A
The goal in working with mentally challenged children
is to train them to be as independent as possible,
focusing on the developmental skills. The child may not
be capable of learning something new every day but
needs to repeat what has been taught previously. Rather
than encouraging more lenient behavior limits, the
parents need to be strict and consistent when setting
limits for the child. Most children with Down syndrome
are unable to achieve age-appropriate social skills due to
their mental retardation. Rather, they taught socially
appropriate behaviors.
25. When teaching an adolescent with a
seizure disorder who is receiving Valproic
acid (Depakene), which of the following
would the nurse instruct the client to report
the health care provider?

a) three episodes of diarrhea

b) loss of appetite
c) jaundice
d) sore throat
Answer C
A toxic effect of valproic acid (Depakene) is liver
toxicity, which may manifest with jaundice and
abdominal pain. If jaundice occurs, the client needs
to notify the health care provider as soon as
possible.
26. A hospitalized preschooler with meningitis
who is to be discharged becomes angry when
the discharge is delayed. Which of the
following play activities would be most
appropriate at this time?

a) reading the child a story

b) painting with water colors
c) pounding on a pegboard
d) stacking a tower of blocks
Answer C
The child is angry and needs a positive outlet for
expression of feelings. An emotionally tense child
with pent-up hostilities needs a physical activity
that will release energy and frustration. Pounding on
a pegboard offers the opportunity.
Listening to a story does not allow child to express
emotions. It also places the child in a passive role
and does not allow the child to deal with feelings in
a healthy and positive way. Activities such as
paintings and stacking a tower of blocks require
concentration and fine movements, which could add
to frustration.
27. The parents of a child tell the nurse they feel
guilty because their child almost drowned. Which of
the following remarks by the nurse would be most
appropriate?

a) I can understand why you feel guilty, but

these things happen
b) tell me a bit more about your feelings of
guilt
c) you should not have taken your eyes off
your child
d) you really shouldn't fell guilty; you're lucky
because your child will be alright
Answer B
Guilt is a common parental response. The
parents need to be allowed to express their
feelings openly in a nonthreatening,
nonjudgmental atmosphere.
28. The nurse teaches the parents of an
infant with developmental dysplasia of the
hip how to handle their child in a Pavlik
harness. Which of the following
interventions would be most appropriate?

a) fitting the diaper under the straps

b) leaving the harness off while the infant sleeps
c) checking for the skin redness under straps
every other day
d) putting powder on the skin under the straps
every day
Answer A
The Pavlik harness is worn over a diaper. Knee socks are also
worn to prevent the straps and foot and leg pieces from
rubbing directly on the skin. For maximum results, the infant
needs to wear the harness continuously. The skin should be
inspected several times a day, not every other day, for signs of
redness or irritation. Lotions and powders are to be avoided
because they can cake and irritate the skin. (Hip dysplasia is a
condition in which the head of the femur is improperly rested
in the acetabulum, or hip socket of the pelvis. The
characteristic manifestations are as follows: asymmetry of the
gluteal and thigh folds; limited hip abduction in the affected
hip; apparent shortening of the femur on the affected side
(Galeazzi sign and Allis sign); weight bearing causes titling of
the pelvis downward on the unaffected side (Trendelenberg
sign); Ortolani click (in infant under 4 weeks of age).
29. When assessing the development of a 15
month old child with cerebral palsy, which of the
following milestones would the nurse expect a
toddler of this age to have achieved?

a) walking up steps
b) using a spoon
c) copying a circle
d) putting a block in cup
Answer D
Delay in achieving developmental milestones is a
characteristic of children with cerebral palsy. A 15
month old child can put a block in a cup. Walking up
steps typically is accomplished at 18 to 24 months.
A child usually is able to use a spoon at 18 months.
The ability to copy a circle is achieved at
approximately 3 to 4 years of age.
30. The nurse teaches the mother of a young
child with Duchenne's muscular dystrophy
about the disease and its management. Which
of the following statements by the mother
indicates successful teaching?
a) my son will probably be unable to walk
independently by the time he is 9 to 11 years old
b) muscle relaxants are effective for some children;
I hope they can help my son
c) when my son is a little bit older, he can have
surgery to improve his ability to walk
d) I need to help my son be as active as possible to
prevent progression of the disease
Answer A
Muscular dystrophy is an X-linked recessive disorder.
The gene is transmitted through female carriers to
affected sons 50% of the time. Daughters have a 50%
chance of being carriers. It is a progressive disease.
Children who are affected by this disease usually are
unable to walk independently by age 9-11 years. There is
no effective treatment for the disease. A
characteristic manifestation is Gower's sign -- the child
walks the hands up the legs in an attempt to rise from
sitting to standing position.
31. Which of the following foods would
the nurse encourage the mother to offer
to her child with iron-deficiency anemia?

a) rice cereal, whole milk, and yellow vegetables

b) potato, peas, and chicken
c) macaroni, cheese and ham
d) pudding, green vegetables and rice
Answer B
potato, peas, chicken, green vegetables, and
rice cereal contain significant amounts of iron
and therefore would be recommended. Milk and
yellow vegetables are not good iron sources.
Rice, by itself also is not a good source of iron.
32. Because of the risks associated with
administration of factor VIII
concentrate, the nurse would report which
of the following?

a) yellowing of the skin

b) constipation
c) abdominal distention
d) puffiness around the eye
Answer A
Because factor VIII concentrate is derived
from large pools of human plasma, the risk of
hepatitis is always present.
33. When teaching the mother of an infant
who has undergone surgical repair of a cleft
lip how to care for the suture line, the
nurse demonstrates how to remove formula
and drainage. Which of the following
solutions would the nurse use?

a) mouthwash
b) providone - iodine (betadine) solution
c) a mild antiseptic solution
d) half-strength hydrogen peroxide
Answer D
half-strength hydrogen peroxide is recommended
for cleansing the suture line after cleft lip repair.
The bubbling action of the hydrogen peroxide is
effective for removing debris. Normal saline also may
be used. Mouthwashes frequently contain alcohol
which can be irritating. Povidone-iodine solution is not
used because iodine contained in the solution can be
absorbed through the skin, leading to toxicity. A mild
antiseptic solution has some antibacterial properties
but is ineffective in removing suture-line debris.
34. Which of the following nursing diagnosis
would the nurse identify as a priority for
the infant with tracheoesophageal fistula
(TEF)?
a) impaired parenting related to newborn's
illness
b) risk of injury related to increased potential
for aspiration
c) ineffective nutrition: less than body
requirements, related to poor sucking ability
d) ineffective breathing pattern related to a
weak diaphragm
Answer B
because the blind pouch associated with
TEF fills quickly with fluids, the child is at
risk for aspiration. Children with TEF usually
develop aspiration pneumonia.
35. When the infant returns to the unit
after imperforate anus repair, the nurse
places the infant in which of the following
position?

a) on the abdomen, with legs pulled up under

the body
b) on the back, with legs extended straight
out
c) lying on the side with hips elevated
d) lying on the back in a position of comfort
Answer C
after surgical repair for an imperforate anus, the
infant should be positioned either supine with the
legs suspended at 90-degree angle or on either side
with the hips elevated to prevent pressure on the
perineum. A neonate who is placed on the abdomen
pulls the legs up under the body, which puts tension
on the perineum, as does positioning the neonate
with the legs extended straight out
36. A child presents to the emergency
room with the history of ingesting a large
amount of acetaminophen. For which of
the following would the nurse assess?

a) hypertension
b) frequent urination
c) Right upper quadrant pain
d) headache
Answer C
after ingesting a large amount of acetaminohen,
the child would complain of right upper quadrant
pain due to hepatic damage from glutathione
combining with the metabolite of acetaminophen
being broken down.
37. Which of the following statements by
the mother of an 18 month old would
indicate to the nurse that the child needs
laboratory testing for lead levels?

a) my child does not always wash after playing

outside
b) my child drinks 2 cups of milk everyday
c) my child has more temper tantrums than
other kids
d) my child is smaller than other kids of the
same age
Answer A
eating with dirty hands, especially after playing
outside, can lead to lead poisoning because lead is
often present in soil surrounding homes. When
blood levels of lead reaches 15-19 mg/dL.., an
investigation of the child's environment will be
initiated. Oral chelation therapy is started when
blood lead levels reached 45 mg/dL. When they
reach 70 mg/dL, the child usually is hospitalized
for intravenous chelation therapy.
 38. Which of the following statements is
LEAST accurate concerning urinary tract
infections (UTI) in children?

A)A negative urinalysis rules out UTI in children < 2

years of age.
B) B) Children with multiple UTIs should be evaluated
for abuse.
C) Infants younger than 3 months of age with a UTI
should be admitted for intravenous antibiotics.
D) Neonatal boys are more prone to UTIs than girls.
E) Well appearing children > 3 months old with
pyelonephritis may be treated as outpatients.
Answer A

A negative urinalysis rules out UTI in children < 2 years of age.

In children younger than 2-years-old, a negative urinalysis
does not rule out a urinary tract infection. Up to 50% of
children with UTIs can have a false negative urinalysis. Nitrite
and leukocyte esterase presence in urine dipstick have the
highest combined sensitivity for UTI. In addition, if both are
positive, the false positive rate is less than 4%. Most consider
young girls to be at the highest risk for UTI. This is in fact
true except for the neonatal period, when neonatal boys
actually have a higher risk than girls. Children with UTIs are
managed differently based on the age of the child. The very
young are treated conservatively, and those under 3 months of
age are generally admitted to the hospital for IV antibiotics.
Pyelonephritis used to be commonly managed as an inpatient,
but in well appearing children, this infection can be treated as
an outpatient with oral antibiotics.
39. A 6-year-old boy is returned to his
room following a tonsillectomy. He remains
sleepy from the anesthesia but is easily
awakened. The nurse should place the child
in which of the following positions?

a. Sims’.
b. Side-lying.
c. Supine.
d. Prone.
Answer B.

Side-lying — CORRECT: most effective to facilitate

drainage of secretions from the mouth and pharynx;
reduces possibility of airway obstruction.
Supine — increased risk for aspiration, would not
facilitate drainage of oral secretions
Prone — risk for airway obstruction and aspiration,
unable to observe the child for signs of bleeding
such as increased swallowing
Sims’ — on side with top knee flexed and thigh
drawn up to chest and lower knee less sharply
flexed: used for vaginal or rectal examination
40. Which of the following statements
indicate that the adolescent is having an
early sign of anorexia nervosa?

a) I have my menses every month

b) I go out to eat with my friends
c) I run three times a day for a total of 5 hours per
day
d) I try to maintain my weight around 115 lbs. for my
height of 5 feet
Answer C
excessive exercise, consumption of very small
amounts of food and food rituals, amenorrhea,
and excessive weight loss or weight is below
normal, lanugo, dry skin, bradycardia, are all
signs of anorexia nervosa.
41. Which of the following signs and
symptoms would observe in a child diagnosed
of laryngotracheobronchitis?

a) predominant stridor on inspiration

b) predominant expiratory wheeze
c) high fever
d) slow respiratory rate
Answer A
Because croup cause upper airway obstruction,
inspiratory stridor is predominant symptom
42. A child discharged with slow
cerebrospinal fluid (CSF) leak 3 days after
a head injury was sustained. What will the
nurse include in the discharge plans?

a) avoid use of nonsteroidal anti-inflammatory

drugs
b) turn from side to side only
c) maintain complete bed rest
d) gradually increase diet to clear liquids
Answer C
most CSF leaks resolve spontaneously. The child
should be maintained on bed rest until CSF leak
stops. NSAID's may be used. The child may assume
position of comfort. There are no dietary
restrictions.
43. 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
Answer B
During feto-placental circulation, the pressure in
the heart is much higher in the right side, but
once breathing/crying is established, the
pressure will shift from the R to the L side, and
will facilitate the closure of Foramen Ovale.
(Note: that is why you should position the NB in
R side lying position to increase pressure in the L
side of the heart.)
44. When assessing a newborn for
developmental dysplasia of the hip, the
nurse would expect to assess which of the
following?

a. Symmetrical gluteal folds

b. Trendelemburg sign
c. Ortolani’s sign
d. Characteristic limp
Answer C
Ortolani’s sign is the abnormal clicking sound when
the hips are abducted. The sound is produced when
the femoral head enters the acetabulum. Letter A is
wrong because its should be “asymmetrical gluteal
fold”. Letter B and C are not applicable for newborns
because they are seen in older children.
45. A newborn’s failure to pass meconium
within 24 hours after birth may indicate
which of the following?

a. Aganglionic Mega colon

b. Celiac disease
c. Intussusception
d. Abdominal wall defect
Answer A
Failure to pass meconium of Newborn during the
first 24 hours of life may indicate Hirschsprung
disease or Congenital Aganglionic Megacolon, an
anomaly resulting in mechanical obstruction due to
inadequate motility in an intestinal segment. B, C,
and D are not associated in the failure to pass
meconium of the newborn.
46. A 13-year-old girl appears at your office at 5:05 PM
for a 3:30 PM appointment scheduled for the day before.
Her mother tells you that the girl has been limping for a
couple of weeks and has much knee pain. She has been
afebrile, does not recall being hit in the knee or leg, and
has not had any illnesses recently. She has difficulty "moving
her leg inward." Given the late hour and that the workup will
be done in the emergency department, you impress the
pediatric emergency department staff by telling them that
the most likely diagnosis is one of the following:

A. She twisted the leg trying to be on time for the

appointment yesterday
B. Septic arthritis of the hip
C. Septic arthritis of the knee
D. Aseptic necrosis of the hip
E. Slipped capital femoral epiphysis
Answer E
Slipped capital femoral epiphysis typically presents
in girls aged 11 to 13 years and boys aged 13 to 15
years who are obese. It is most common in blacks.
Although a slipped capital femoral epiphysis can
produce pain localized to the groin area, it often
presents as knee pain, especially on the board
examination. Internal rotation is difficult. If you
were to suggest an x-ray, anteroposterior and frog
lateral x-rays of the pelvis would be the way to go.
47. You are in your office late one cold winter evening,
seeing a pair of siblings who have a cold and cough.
The mother and paternal grandmother are there. The
grandmother notes that the best way to prevent the
spread of colds is by wearing a wool hat at all times.
What should you say?
A. Agree and pull out a cartoon with the
trademarked hats promoting your practice
B. Wearing a face mask and eye shields is the best
method
C. Limiting exposure to other children to once
weekly would help
D.Washing hands and all toys frequently would be
fine
E. Isolating all children with colds is the best
method
Answer D
Hand washing and cleaning toys that are shared by
children are the most effective means of preventing
the spread of colds and upper respiratory tract
infections during winter. If wearing a hat during cold
weather prevented the spread of colds, then children
in warm climates, would never get sick.
48. A 12-year-old boy who is at the 90th percentile for
weight complains of slight pain in the right thigh and knee
for about a month. His complains are made worse by
physical activity and he has a mild limp. He has no history
of recent infections or trauma. Physical examination
reveals a slight decrease in internal rotation of the right
hip. There is mild right-sided metaphyseal osteopenia on
radiograph.
Of the following, which would be the MOST likely
diagnosis in this boy?
A) Transient synovitis
B) Septic arthritis
C) Osteomyelitis
D) Slipped capital femoral epiphysis
E) Legg-Calve-Perthes disease
ANSWER D

Slipped Capital Femoral Epiphysis occurs as the result of

acute or repetitive microtrauma to a probable abnormal
femoral growth plate. It is unilateral in 40%-80% of
cases and occurs during or just prior to the adolescent
growth spurt (age 10 to 13 years). It is more commonly
seen in boys and in very obese and/or very tall
adolescents. Onset prior to age 10 years may indicate an
underlying endocrine problem such as hypothyroidism.
The clinical presentation is a limp with pain related to
the hip joint. There may be some shortening of the
involved limb, and internal rotation is limited. Biplanar
radiographs or computed tomographic scans will
establish the diagnosis. Mild demineralization of the
metaphysis on the involved side is often associated.
49. A male infant weighing 3 kg is born via
spontaneous vaginal delivery at 37 weeks’
gestation. His Apgar score is 6/9 at 1 and 5
minutes. The patient is in no apparent distress.
Physical examination reveals no anus. What is
the most appropriate initial step in this
patient’s management?
(A)Colostomy
(B) Continued observation for 24 hours
(C) Intubation and mechanical ventilation
(D) Magnetic resonance imaging (MRI) of
the abdomen and pelvis
(E) Posterior sagittal anorectoplasty
Answer B
Continued observation for 24 hours. The patient should be observed
for delayed passage of meconium, as this can be normal up to 48 hours
of life. If delayed beyond this period, meconium ileus, meconium plug,
imperforate anus, or Hirschsprung’s disease should be considered.
Evaluation of imperforate anus should include inspection for drainage
of meconium through a fistula to the perineum or the urinary tract
because this significantly alters treatment.1 Specifically, fistulae
occur with low termination of the colon/rectum, which can be managed
definitively with anorectoplasty. Absence of a fistula significantly
increases the likelihood of a “high defect” imperforate anus, which can
be managed with colostomy and subsequent contrast imaging of the
distal colon/rectum, followed by definitive repair at a few months of
age. Some surgeons obtain a cross-table lateral abdominal radiograph
(not MRI) to determine where the terminal colon/rectum
lies in relation to the perineum, but this approach is unnecessary and is
not widely practiced. Ultrasonography and radiography are required to
rule out VACTERL association, but there is no need for MRI.
Intubation and mechanical ventilation are not indicated in this case.
50. A previously healthy 5-year-old girl presents to the ED with her
parents with a temperature of 100.8°F (38.2°C) and a 2-day history of
decreased appetite and persistent vague abdominal pain
withtenderness in the mid-abdomen and right lower quadrant. Her
parents report that she has had no appetite and felt nauseous but has
not vomited. Laboratory results are unremarkable except for a white
blood cell count of 16,000 cells/mL (normal, 4500– 11,000 cells/mL).
Ultrasound of the abdomen and pelvis is inconclusive, and the patient
is admitted to the hospital for observation. Eighteen hours into her
hospital stay, she passes copious amounts of bloody stool. She remains
hemodynamically stable with normal vital signs and no change in her
abdominal pain. What is this patient’s most likely diagnosis?
(A)Appendicitis

(B) Colonic arteriovenous malformation

(C) Colonic diverticulitis

(D) Gastric stress ulcer

(E) Meckel’s diverticulitis

Answer (E)
Meckel’s diverticulitis. Hemorrhage is the most
common complication of Meckel’s diverticulitis in
children; therefore, this condition should be considered
in any child with abdominal pain of unclear
etiology associated with GI hemorrhage. Intestinal
obstruction is another possible diagnosis but is more
common in adults. The diagnosis of Meckel’s diverticulitis
can be confirmed by 99mTc-pertechnetate
scan, which detects heterotopic gastric mucosa or
pancreatic tissue within the diverticulum. Meckel’s
diverticula are usually completely asymptomatic, but
resection is necessary when complications develop.
Colonic arteriovenous malformations can cause GI
hemorrhage in children but are much less common
than Meckel’s diverticula. Appendicitis is common in
children but very rarely causes hemorrhage. Colonic
diverticulitis and gastric stress ulcers are exceedingly
rare in children and are unlikely in this case.
51. A nurse has just started her rounds
delivering medication. A new patient on her
rounds is a 4 year-old boy who is non-
verbal. This child does not have on any
identification. What should the nurse do?
A: Contact the provider
B: Ask the child to write their name on
paper.
C: Ask a co-worker about the
identification of the child.
D: Ask the father who is in the room
the child’s name.
Answer D

In this case you are able to determine the name of

the child by the father’s statement. You should not
withhold the medication from the child following
identification.
52. A nurse is caring for an infant that has
recently been diagnosed with a congenital
heart defect. Which of the following
clinical signs would most likely be present?

A: Slow pulse rate

B: Weight gain
C: Decreased systolic pressure
D: Irregular WBC lab values
Answer B

Weight gain is associated with CHF and

congenital heart deficits.
53. A mother has recently been informed
that her child has Down’s syndrome. You will
be assigned to care for the child at shift
change. Which of the following
characteristics is not associated with Down’s
syndrome?
A: Simian crease

B: Brachycephaly

C: Oily skin

D: Hypotonicity
Answer C

The skin would be dry and not oily.

54. Who among the following pediatric client
should be assessed first by the nurse?

a) the child with 2 episodes of soft stools during the

shift
b) the child who had cough for the past three days, with
clear nasal discharge and is irritable
c) the child with 2 episodes of inconsolable crying while
the knees are drawn over the abdomen and plays
between the episodes
d) the child with skin rashes on his face and trunk
Answer C
- this indicates appendicitis. The pattern of abdominal
pain in appendicitis is as follows: pain occurs for 2 to 3
hours, pain is relieved in 2 to 3 hours, the n pain recurs
and persists. During the time that pain subsides, it is
when rupture of appendicitis may occur unnoticed.
55. The nurse is caring for several infants who
are 2-day old. Who among these infants should
be given highest priority by the nurse?

a) a bottlefed infant who takes 1-ounce of milk every 3 to 5

hours
b) a breastfed infant who lost 0.5 ounce of his weight
c) a bottlefed infant who takes 2 to 3 ounces of milk every 2
to 4 hours
d) a breastfed infant who feeds every 2 to 4 hours
Answer A
- the client experiences poor feeding (1 ounce = 30 ml)
which indicates specific problems. The infant normally
looses weight during the first week of life and he/she
usually gains weight on the second week.
56. Which of the following can indicate left-
sided heart failure in an infant?

A: fever

B: low appetite

C: increased respiratory rate

D: crying
. Answer C.
Shortness of breath and perspiration during
feeding can also indicate left-sided heart failure.
57. Which of the following is NOT part
of the triad of cystic fibrosis?

A: pancreatic enzyme deficiency

B: fever

C: high concentration of sweat

electrolytes

D: COPD
Answer B.
The triad of cystic fibrosis is COPD, pancreatic
enzyme deficiency, and a high concentration of
sweat electrolytes.
58. When assessing a child with a cleft
palate, the nurse is aware that the child is at
risk for more frequent episodes of otitis
media due to which of the following?

a. Lowered resistance from malnutrition

b. Ineffective functioning of the Eustachian

tubes

c. Plugging of the Eustachian tubes with food

particles

d. Associated congenital defects of the middle

ear.
Answer B
Because of the structural defect, children with cleft
palate may have ineffective functioning of their
Eustachian tubes creating frequent bouts of otitis
media. Most children with cleft palate remain well-
nourished and maintain adequate nutrition through
the use of proper feeding techniques. Food particles
do not pass through the cleft and into the
Eustachian tubes. There is no association between
cleft palate and congenial ear deformities.
59. Which of the following should the nurse
expect to note as a frequent complication
for a child with congenital heart disease?

a. Susceptibility to respiratory
infection

b. Bleeding tendencies

c. Frequent vomiting and diarrhea

d. Seizure disorder
Answer A.
Children with congenital heart disease are more prone
to respiratory infections. Bleeding tendencies,
frequent vomiting, and diarrhea and seizure disorders
are not associated with congenital heart disease.
60. Which of the following should the
nurse do first after noting that a child
with Hirschsprung disease has a fever
and watery explosive diarrhea?

a. Notify the physician immediately

b. Administer antidiarrheal medications

c. Monitor child ever 30 minutes

d. Nothing, this is characteristic of

Hirschsprung disease
Answer A.
For the child with Hirschsprung disease, fever and
explosive diarrhea indicate enterocolitis, a life-
threatening situation. Therefore, the physician
should be notified immediately. Generally, because
of the intestinal obstruction and inadequate
propulsive intestinal movement, antidiarrheals are
not used to treat Hirschsprung disease. The child
is acutely ill and requires intervention, with
monitoring more frequently than every 30
minutes. Hirschsprung disease typically presents
with chronic constipation.
61. While assessing a child with pyloric
stenosis, the nurse is likely to note which
of the following?
a. Regurgitation

b. Steatorrhea

c. Projectile vomiting

d. “Currant jelly” stools

Answer C.
Projectile vomiting is a key symptom of pyloric
stenosis. Regurgitation is seen more commonly with
GER. Steatorrhea occurs in malabsorption
disorders such as celiac disease. “Currant jelly”
stools are characteristic of intussusception.
62. Which of the following suggestions
should the nurse offer the parents of a
4-year-old boy who resists going to bed
at night?

a. “Allow him to fall asleep in your room, then

move him to his own bed.”

b. “Tell him that you will lock him in his room if he

gets out of bed one more time.”

c. “Encourage active play at bedtime to tire him

out so he will fall asleep faster.”

d. “Read him a story and allow him to play quietly

in his bed until he falls asleep.”
Answer D.
Preschoolers commonly have fears of the dark, being
left alone especially at bedtime, and ghosts, which
may affect the child’s going to bed at night. Quiet
play and time with parents is a positive bedtime
routine that provides security and also readies the
child for sleep. The child should sleep in his own bed.
Telling the child about locking him in his room will
viewed by the child as a threat. Additionally, a
locked door is frightening and potentially hazardous.
Vigorous activity at bedtime stirs up the child and
makes more difficult to fall asleep.
63. The nurse is caring for a 4-year old
with cerebral palsy. Which nursing
intervention will help ready the child for
rehabilitative services?
a. Patching one of the eyes to strengthen the
muscles
b. Providing suckers and pinwheels to strengthen
tongue movement
c. Providing musical tapes to [provide auditory
training
d. Encouraging play with a video game to improve
muscle coordination
Answer B
The nurse can help ready the child with cerebral
palsy for speech therapy by providing activities
that help the child develop tongue control.
64. The mother of a 3 year old with
esophageal reflux asks the nurse what she
can do to lessen the baby’s reflux. The nurse
should tell the mother to:

a. Feed the baby only when he is hungry

b. Burp the baby after feeding is completed
c. Place the baby in supine with head elevated
d. Burp the baby frequently throughout the
feeding
Answer D
Burping the baby throughout the feeding will
help prevent gastric distention that contributes
to esophageal reflux
65. The mother of a child with hemophilia
asks the nurse which over the counter
medication is suitable for her child’s
discomfort.

a. Advil (Ibuprofen)
b. Tylenol (Acetaminophen)
c. Aspirin (acetylsalicytic acid)
d. Naproxen (Naprosyn)
Answer B
The nurse should recommend acetaminophen for
the child’s joint discomfort because it will have no
effect on the bleeding time.
66. The nurse is assessing an infant with
hirschspung’s disease. The nurse can expect
the infant to:

a. Weight less than expected for height and age

b. Have infrequent bowel movements
c. Exhibit clubbing of fingers and toes
d. Have hyperactive deep tendon reflexes
Answer B
The infant with hirschsprung’s disease will have
infrequent bowel movements.
66. The nurse is to administer Digoxin
Elixir to a 6-month old with a congenital
heart defect. The nurse auscultates an
apical pulse rate of 100. the nurse should:

a. Record the heart rate and call the physician

b. Record the heart rate and administer the
medication
c. Administer the medication and recheck the
heart rate in 30 minutes
d. Hold the medication and recheck the heart
rate in 30 minutes.
Answer B
The infant’s apical heart rate is within the
accepted range for administering the
medication.
67. An 18-month old is scheduled for a
cleft palate repair. The usual type of
restraints for the child with cleft palate
repair are:

a. Elbow restraints
b. Full arm restraints
c. Wrist restraints
d. Mummy restraints
Answer A
The least restrictive restraint for infant with a
cleft lip and cleft palate repair is elbow restraint.
68. An infant with tetralogy of fallot is
discharged with a prescription of lanoxin
elixir. The nurse should instruct the mother
to:
a. Administer the medication using a nipple
b. Administer the medication using a
calibrated dropper in the bottle
c. Administer the medication using a plastic
baby spoon
d. Administer the medication in the baby
bottle with 1oz of water
Answer B
The medication should be administered using a
calibrated dropper that comes with the
medication. Other choices are not necessary
because a part or all of the medication could be
lost during administration.
69. The nurse is caring for an infant
following a cleft lip repair. While comforting
the infant, the nurse should avoid:

a. Holding the infant

b.Offering a pacifier
c. Providing a mobile
d. Offering sterile water
Answer B
The nurse should avoid giving the infant a
pacifier or bottle because sucking is not
permitted.
70. A 5-year old with congestive heart
failure has been receiving Digoxin (Lanoxin).
Which finding indicated that the medication
is having a desired effect.

a. Increased urinary output

b. Stabilized weight
c. Improved appetite
d. Increased pedal edema
Answer A
Lanoxin slows and strenghtens the contractions of
the heart. An increase in urinary output shows that
the medication is having a desired effect.
71. A 9-year old is admitted with suspected
rheumatic fever. Which finding is suggested
of polymigratory arthritis?

a. Irregular movements of the extremities and

facial grimacing
b. Painless swelling over the extensor surfaces
of the joints
c. Faint areas of red demarcation ovet the back
and abdomen
d. Swelling, inflammation and effusion of the
joints
Answer D
The child with poly migratory arthritis will exhibit a
painful and swollen joints.
72. A child with croup is placed in a cool,
high-humidity tent connected to room air.
The primary purpose of the tent is to:

a. Prevent insensible water loss

b. Provide a moist environment with oxygen
at 30%
c. Prevent dehydration and reduce fever
d. Liquefy secretions and relieve laryngeal
spasm
Answer D
The primary reason for placing the child with croup
under a mist tent is to liquefy secretions and
relieve laryngeal spasm.
73. The nurse is caring for an 8-year old
following a routine tonsillectomy. Which
finding should be reported immediately?

a. Reluctance to swallow
b. Drooling of blood-tinged saliva
c. An axillary temperature of 99F
d. Respiratory stridor
Answer D
Respiratory stridor is a symptom of partail airway
obstruction.choice A,B and C are expected with a
tonsillectomy.
74. A 2-year old is hospitalized with
suspected intussusception. Which finding is
associated with intussusception?

a. “currant jelly” stools

b. Projectile vomiting
c. “ribbonlike” stools
d. Palpable mass over the flank
Answer A
A child with intussusception has stools that
contain blood and mucus, which are described as
“currant jelly” stools.
75. A 4-year old is admitted with acute
leukemia. It will be most important to
monitor the child for:

a. Abdominal pain and anorexia

b. Fatigue and bruising
c. Bleeding and pallor
d. Petichiae and mucosal ulcers
Answer C
A child with leukemia has low platelet cout
which contributes to spontaneous bleeding.
76. A 6-month old client with ventral
septal defect is receiving digitalis for
regulation of his heart rate. Which finding
should be reported to the doctor?

a. Blood pressure of 126/80

b. Blood glucose of 110mg/dl
c. Heart rate of 60 bpm
d. Respiratory rate of 30 cpm
Answer C
A heart rate of 60 in the baby should be reported
immediately. The dise should be held if the heart
rate is blow 100bpm. The blood glucose, blood
pressure and respirations are within the normal
limits.
77. A priority nursing diagnosis for a child
being admitted from a surgery following a
tonsillectomy is:

a. Altered nutrition
b. Impaired communication
c. Risk for aspiration
d. Altered urinary elimination
Answer C
The first priority should be on airway, breathing
and circulation.
78. An infant is admitted to the unit
with tetralogy of fallot. The nurse would
anticipate an order for which
medication.
a. Digoxin
b. Epinephrine
c. Aminophyline
d. Atropine
Answer A
The infant with tetralogy of fallot has four heart
defects. He will be treated with Digoxin to slow
and strengthen the heart. Epinephrine,
aminophyline and atropine will speed the heart
rate and will not used in this client.
79. In a child with suspected coarctation
of the aorta, the nurse would expect to
find

A)Strong pedal pulses

B) Diminishing cartoid pulses
C) Normal femoral pulses
D) Bounding pulses in the arms
Answer D:
Bounding pulses in the arms
Coarctation of the aorta, a narrowing or
constriction of the descending aorta, causes
increased flow to the upper extremities
(increased pressure and pulses)
80. A client is admitted with the
diagnosis of meningitis. Which finding
would the nurse expect in assessing this
client?
A)Hyperextension of the neck with passive
shoulder flexion
B) Flexion of the hip and knees with passive
flexion of the neck
C) Flexion of the legs with rebound tenderness
D) Hyperflexion of the neck with rebound flexion
of the legs
Answer is B:
Flexion of the hip and knees with passive flexion
of the neck. A positive Brudzinski’s sign—flexion
of hip and knees with passive flexion of the neck;
a positive Kernig’s sign—inability to extend the
knee to more than 135 degrees, without pain
behind the knee, while the hip is flexed usually
establishes the diagnosis of meningitis
81. A 2 year-old child has just been
diagnosed with cystic fibrosis. The child's
father asks the nurse "What is our major
concern now, and what will we have to deal
with in the future?" Which of the following
is the best response?
A)"There is a probability of life-long complications."
B) "Cystic fibrosis results in nutritional concerns that
can be dealt with."
C) "Thin, tenacious secretions from the lungs are a
constant struggle in cystic fibrosis."
D) "You will work with a team of experts and also have
access to a support group that the family can attend."
Answer C:
"Thin, tenacious secretions from the lungs are a
constant struggle in cystic fibrosis." All of the
options will be concerns with cystic fibrosis,
however the respiratory threats are the major
concern in these clients. Other information of
interest is that cystic fibrosis is an autosomal
recessive disease. There is a 25% chance that
each of these parent''s pregnancies will result in
a child with systic fibrosis.
82. During an examination of a 2 year-old
child with a tentative diagnosis of Wilm's
tumor, the nurse would be most concerned
about which statement by the mother?

A) My child has lost 3 pounds in the last

month.
B) Urinary output seemed to be less over the
past 2 days.
C) All the pants have become tight around
the waist.
D) The child prefers some salty foods more
than others.
Answer C:
Clothing has become tight around the waist
Parents often recognize the increasing
abdominal girth first. This is an early sign of
Wilm''s tumor, a malignant tumor of the kidney.
83. A mother wants to switch her 9 month-old
infant from an iron-fortified formula to whole
milk because of the expense. Upon further
assessment, the nurse finds that the baby eats
table foods well, but drinks less milk than
before. What is the best advice by the nurse?

A)Change the baby to whole milk

B) Add chocolate syrup to the bottle
C) Continue with the present formula
D) Offer fruit juice frequently
Answer C
Continue with the present formula
The recommended age for switching from
formula to whole milk is 12 months. Switching
to cow''s milk before the age of 1 can
predispose an infant to allergies and lactose
intolerance.
84. Which nursing action is a priority as
the plan of care is developed for a 7
year-old child hospitalized for acute
glomerulonephritis?

A)Assess for generalized edema

B) Monitor for increased urinary output
C) Encourage rest during hyperactive
periods
D) Note patterns of increased blood
pressure
Answer D
Note patterns of increased blood pressure
Hypertension is a key assessment in the
course of the disease.
85. The nurse is preparing a 5 year-old for
a scheduled tonsillectomy and
adenoidectomy. The parents are anxious
and concerned about the child's reaction to
impending surgery. Which nursing
intervention would be best to prepare the
child?
A) Introduce the child to all staff the day before
surgery
B) Explain the surgery 1 week prior to the
procedure
C) Arrange a tour of the operating and recovery
rooms
D) Encourage the child to bring a favorite toy to
the hospital
Answer B
Explain the surgery 1 week prior to the
procedure
A 5 year-old can understand the surgery, and
should be prepared well before the procedure.
Most of these procedures are "same day"
surgeries and do not require an overnight stay.
86. The nurse is assessing a child for
clinical manifestations of iron deficiency
anemia. Which factor would the nurse
recognize as cause for the findings?

A)Decreased cardiac output

B) Tissue hypoxia
C) Cerebral edema
D) Reduced oxygen saturation
Answer B
Tissue hypoxia
When the hemoglobin falls sufficiently to
produce clinical manifestations, the findings
are directly attributable to tissue hypoxia, a
decrease in the oxygen carrying capacity of the
blood.
87. Which of the actions suggested to the
RN by the PN during a planning conference
for a 10 month-old infant admitted 2 hours
ago with bacterial meningitis would be
acceptable to add to the plan of care?

A)Measure head circumference

B) Place in airborne isolation
C) Provide passive range of motion
D) Provide an over-the-crib protective top
Answer A
Measure head circumference
In meningitis, assessment of neurological signs
should be done frequently. Head circumference is
measured because subdural effusions and
obstructive hydrocephalus can develop as a
complication of meningitis. The client will have
already been on airborne precautions and crib top
applied to bed on admission to the unit.
88. An eighteen month-old has been brought
to the emergency room with irritability,
lethargy over 2 days, dry skin and increased
pulse. Based upon the evaluation of these
initial findings, the nurse would assess the
child for additional findings of:

A)Septicemia
B) Dehydration
C) Hypokalemia
D) Hypercalcemia
Answer B
Dehydration
Clinical findings dehydration include
lethargy, irritability, dry skin, and
increased pulse.
89. A nurse aide is taking care of a 2 year-
old child with Wilm's tumor. The nurse aide
asks the nurse why there is a sign above the
bed that says DO NOT PALPATE THE
ABDOMEN? The best response by the nurse
would be which of these statements?
A) "Touching the abdomen could cause cancer
cells to spread."
B) "Examining the area would cause difficulty to
the child."
C) "Pushing on the stomach might lead to the
spread of infection."
D) "Placing any pressure on the abdomen may
cause an abnormal experience."
Answer A
"Touching the abdomen could cause cancer cells
to spread."
Manipulation of the abdomen can lead to
dissemination of cancer cells to nearby and
distant areas. Bathing and turning the child
should be done carefully. The other options are
similar but not the most specific.
90. A 13 year old girl is admitted to the ER
with lower right abdominal discomfort. The
admitting nursing should take which the
following measures first?

A: Administer Loritab to the patient for pain

relief.
B: Place the patient in right sidelying position for
pressure relief.
C: Start a Central Line.
D: Provide pain reduction techniques without
administering medication.
Answer D
Do not administer pain medication or start a
central line without MD orders.
91. A 6-year-old boy is returned to his
room following a tonsillectomy. He remains
sleepy from the anesthesia but is easily
awakened. The nurse should place the child
in which of the following positions?

a. Sims’.
b. Side-lying.
c. Supine.
d. Prone.
Answer B.

Side-lying — CORRECT: most effective to

facilitate drainage of secretions from the
mouth and pharynx; reduces possibility of
airway obstruction.
Supine — increased risk for aspiration, would
not facilitate drainage of oral secretions
Prone — risk for airway obstruction and
aspiration, unable to observe the child for signs
of bleeding such as increased swallowing
Sims’ — on side with top knee flexed and thigh
drawn up to chest and lower knee less sharply
flexed: used for vaginal or rectal examination
92. Which of the following nursing
diagnoses would be inappropriate for
the infant with gastroesophageal reflux
(GER)?

a. Fluid volume deficit

b. Risk for aspiration

c. Altered nutrition: less than body

requirements

d. Altered oral mucous membranes

Answer D

GER is the backflow of gastric contents into the

esophagus resulting from relaxation or
incompetence of the lower esophageal (cardiac)
sphincter. No alteration in the oral mucous
membranes occurs with this disorder. Fluid
volume deficit, risk for aspiration, and altered
nutrition are appropriate nursing diagnoses
93. Which of the following foods would
the nurse encourage the mother to offer
to her child with iron-deficiency anemia?

a) rice cereal, whole milk, and yellow vegetables

b) potato, peas, and chicken
c) macaroni, cheese and ham
d) pudding, green vegetables and rice
Answer B
potato, peas, chicken, green vegetables, and
rice cereal contain significant amounts of iron
and therefore would be recommended. Milk and
yellow vegetables are not good iron sources.
Rice, by itself also is not a good source of iron.
94. Which of the following would the nurse
perform to help alleviate a child'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 pillows
d) using a bed cradle to avoid the weight of bed
lines on the joints
Answer D
for a child with arthritis associated with rheumatic
fever, the joints are usually so tender that even the
weight of bed linens can cause pain. Use of the bed
cradle is recommended to help remove the weight of
the linens on painful joints. Joints need to be
maintained in good alignment, not positioned in
extension, to ensure that they remain functional.
Applying gentle traction to the joints is not
recommended because traction is usually used to
relieve muscle spasms, not typically associated with
rheumatic fever. Supporting the body in good
alignment and changing the client's position are
recommended, but these measures are not likely to
relieve pain.
95. A newborn’s failure to pass meconium
within the first 24 hours after birth
may indicate which of the following?

a. Hirschsprung disease

b. Celiac disease

c. Intussusception

d. Abdominal wall defect

Answer A
Failure to pass meconium within the first 24 hours
after birth may be an indication of Hirschsprung
disease, a congenital anomaly resulting in mechanical
obstruction due to inadequate motility in an
intestinal segment. Failure to pass meconium is not
associated with celiac disease, intussusception, or
abdominal wall defect.
96. Which of the following health teachings
regarding sickle cell crisis should be
included by the nurse?

a) it results from altered metabolism and

dehydration
b) tissue hypoxia and vascular occlusion cause
the primary problems
c) increased bilirubin levels will cause
hypertension
d) there are decreased clotting factors with an
increase in white blood cells
Answer B
tissue hypoxia occurs as a result of the
decreased oxygen-carrying capacity of the red
blood cells. The sickled cells begin to clump
together, which leads to vascular occlusion.
97. When teaching the mother of an infant
who has undergone surgical repair of a cleft
lip how to care for the suture line, the
nurse demonstrates how to remove formula
and drainage. Which of the following
solutions would the nurse use?

a) mouthwash
b) providone - iodine (betadine) solution
c) a mild antiseptic solution
d) half-strength hydrogen peroxide
Answer D
half-strength hydrogen peroxide is recommended
for cleansing the suture line after cleft lip repair.
The bubbling action of the hydrogen peroxide is
effective for removing debris. Normal saline also may
be used. Mouthwashes frequently contain alcohol
which can be irritating. Povidone-iodine solution is not
used because iodine contained in the solution can be
absorbed through the skin, leading to toxicity. A mild
antiseptic solution has some antibacterial properties
but is ineffective in removing suture-line debris.
98. A nurse is caring for an infant that has
recently been diagnosed with a congenital
heart defect. Which of the following
clinical signs would most likely be present?

A: Slow pulse rate

B: Weight gain
C: Decreased systolic pressure
D: Irregular WBC lab values
Answer B

Weight gain is associated with CHF and

congenital heart deficits.
99. In a child with suspected coarctation
of the aorta, the nurse would expect to
find

A)Strong pedal pulses

B) Diminishing cartoid pulses
C) Normal femoral pulses
D) Bounding pulses in the arms
Answer D:
Bounding pulses in the arms
Coarctation of the aorta, a narrowing or
constriction of the descending aorta, causes
increased flow to the upper extremities
(increased pressure and pulses)
100. Which of the following signs and
symptoms would observe in a child diagnosed
of laryngotracheobronchitis?

a) predominant stridor on inspiration

b) predominant expiratory wheeze
c) high fever
d) slow respiratory rate
Answer A
Because croup cause upper airway obstruction,
inspiratory stridor is predominant symptom