NURSING PEDIATRICS TEST

1. Failure of the Foramen Ovale to close will cause what Congenital Heart Disease?
A. Total anomalous Pulmonary Artery
B. Atrial Septal defect
C. Transposition of great arteries
D. Pulmonary Stenosis

2. Coarctation of Aorta is a congenital narrowing of part of the aorta. A toddler has been diagnosed as
having coarctation of the aorta. Considering the child’s diagnosis, the nurse should EXPECT which
of these findings?
A. Bounding femoral pulse
B. Blood pressure higher in upper extremities
C. Machinery-like murmur
D. Weak, thready radial pulse

3. The comment made by a parent of a 1-month-old that would alert the nurse about the presence of
a congenital heart defect is:
A. "He is always hungry."
B. "He tires out during feedings."
C. "He is fussy for several hours every day."
D. "He sleeps all the time."

4. The nurse explained how to position an infant with tetralogy of Fallot if the infant suddenly
becomes cyanotic. The nurse can determine the father understood the instructions when he states
"If the baby turns blue, I will:
A. hold him against my shoulder with his knees bent up toward his chest."
B. lay him down on a firm surface with his head lower than the rest of his body."
C. immediately put the baby upright in an infant seat."
D. put the baby in supine position with his head elevated."

5. A child diagnosed with tetralogy of Fallot becomes upset, cries, and thrashes around when a blood
specimen is obtained. The child becomes cyanotic, and the respiratory rate increases to 44
breaths/min. Which action should the nurse do first?
A. Obtain a prescription 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 a knee-to-chest position.

6. A newborn is diagnosed with a congenital heart defect (CHD). The test results reveal that the
lumen of the duct between the aorta and pulmonary artery remains open. This defect is known as
A. Coartation of the Aorta
B. Patent Ductus Arteriosus
C. Transposition of great arteries
D. Tetralogy of Fallot

7. While looking through the chart of an infant with a congenital heart defect (CHD) of decreased
pulmonary blood flow, the nurse would expect which laboratory finding?
A. Decreased platelet count
B. Polycythemia
C. Decreased ferritin level
D. Shift to the left

8. Nurse Jacob is assessing a 12 year old who has hemophilia A. Which of the following assessment
findings would the nurse anticipate?
A. An excess of RBC
B. An excess of WBC
C. A deficiency of clotting factor VIII
 D. A deficiency of clotting factor IX

9. The physician has ordered several laboratory tests to help diagnose an infant's bleeding disorder.
Which of the following tests, if abnormal, would the nurse interpret as most likely to indicate
hemophilia?
A. Bleeding time
B. Tourniquet test
C. Clot retraction test
D. Partial thromboplastin time (PTT)

10. The mother tells the nurse she will be afraid to allow her child with hemophilia to participate in
sports because of the danger of injury and bleeding. After explaining that physical fitness is
important for children with hemophilia, which activity should the nurse suggest as ideal?
A. snow skiing
B. swimming
C. basketball
D. gymnastics

11. In children diagnosed with sickle cell disease (SCD), tissue damage results from which of the
following?
A. Air hunger and respiratory alkalosis due to deoxygenated red blood cells.
B. Hypersensitivity of the central nervous system (CNS) due to elevated serum bilirubin levels
C. A general inflammatory response due to an autoimmune reaction from hypoxia
D. Local tissue damage with ischemia and necrosis due to obstructed circulation

12. Nurse Christine is planning a client education program for sickle cell disease (SCD) in children;
which of the following interventions would be included in the care plan?
A. Health teaching to help reduce sickling crises
B. Avoidance of the use of opioids
C. Administration of an anticoagulant to prevent sickling
D. Observation of the imposed fluid restriction

13. A pediatric nursing instructor asks a nursing student to describe the cause of the clinical
manifestations that occur in sickle cell disease. The student responds correctly by telling the
instructor that
A. Sickled cells increase the blood flow through the body and cause a great deal of pain.
B. sickled cells mix with the unsickled cells and cause the immune system to become depressed.
C. bone marrow depression occurs because of the development of sickled cells.
D. sickled cells are unable to flow easily through the microvasculature and their clumping
obstructs blood flow.

14. A nurse in a clinic is assessing the weight of an infant. Which infant's weight indicates to the nurse that the
infant's weight is normal for the infant's age?
A. The baby's weight has tripled in the first 6 months of life
B. The baby's weight has doubled in the first year of life
C. The baby's weight has doubled in the first 6 months of life and tripled in the first year.
D. The baby's weight has doubled in the first 6 months and doubled again in the next 6 months

15. The nurse prepares for a MMDST test with a 3 year-old child in the clinic. The mother asks the nurse to explain
the purpose of the test. The BEST response is to tell her that the test
A. Measures potential intelligence
B. Assesses a child’s development
C. Evaluates psychological responses
D. Diagnoses specific problem
16. When the child with rheumatic fever begins involuntary, purposeless movements of her limbs, the
nurse recognizes that this is an indication of:
A. seizure activity
B. hypoxia
C. Sydenham's chorea
D. decreasing level of consciousness

17. The clinic nurse reviews the record of an infant and notes that the health care provider has
documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment
findings documented in the record, knowing that which symptom most likely led the mother to
seek health care for the infant?
A. Diarrhea
B. Projectile vomiting
C. Regurgitation of feedings
D. Foul-smelling ribbon-like stools

18. During physical assessment of a 4-month-old infant with Hirschsprung’s disease, the nurse would
most likely note which finding?
A. scaphoid-shaped abdomen
B. weight less than expected for height and age
C. cyanosis of the fingers and toes
D. hyperactive deep tendon reflexes

19. Which statement about how sickle cell anemia is passed to offspring is CORRECT?
A. This disease is an x-linked recessive disease.
B. Sickle cell anemia is an autosomal dominant disease.
C. This condition is an autosomal recessive disease.
D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant disease.

20. A child is hospitalized because of persistent vomiting. The nurse should monitor the child closely
for which problem?
A. Diarrhea
B. Metabolic acidosis
C. Metabolic alkalosis
D. Hyperactive bowel sounds

21. When obtaining the nursing history from the mother of an infant with suspected intussusception,
which question would be most helpful?
A. “What do the stools look like?”
B. “When was the last time your child urinated?”
C. “Is your child eating normally?”
D. “Has your child had any episodes of vomiting?”

22. The mother asks the primary nurse, "How does someone get hemophilia A?" Which statement would be the
primary nurse's best response?
A. "It is an inherited X-linked recessive disorder."
B. "There is a deficiency of the clotting factor VIII."
C. "The person is born with hemophilia A."
D. "The mother carries the gene and gives it to the son."
23. The nurse is preparing to care for a child with a diagnosis of intussusception. The nurse reviews
the child's record and expects to note which symptom of this disorder documented?
A. Watery diarrhea
B. Ribbon-like stools
C. Profuse projectile vomiting
D. Bright red blood and mucus in the stools

24. A nurse is caring for a 11-month-old infant. Based on the developmental age of the child, which motor skill
should the nurse expect to see during an assessment?
A. Walk without support
B. Able to lift the head and chest
C. Grabs objects using a palmar grasp
D. Cruising

25. A mother brings her 5-week-old infant to the health care clinic and tells the nurse that the child
has been vomiting after meals. The mother reports that the vomiting is becoming more frequent
and forceful. The nurse suspects pyloric stenosis and asks the mother which assessment question
to elicit data specific to this condition?
A. "Are the stools ribbon-like and is the infant eating poorly?"
B. "Does the infant suddenly become pale, begin to cry, and draw the legs up to the chest?"
C. "Does the vomit contain sour undigested food without bile, and is the infant constipated?"
D. "Does the infant cry loudly and continuously during the evening hours but nurses or takes
formula well?"

26. An infant was admitted for correction of hypertrophic pyloric stenosis. HPS is a condition that the
circular muscle of the pylorus hypertrophy causing narrowing of pyloric canal between the
stomach and duodenum. In assessing the infant, which one of the following clinical manifestations
is NOT consistent with the diagnosis of pyloric stenosis?
A. Severe projectile vomiting after each feeding
B. Fluid deficit, demonstrated by sunken fontanels, dry mucous membrane and scanty urine
C. Sausage-shaped mass in the upper left quadrant
D. Visible peristaltic waves passing left to right during and after feeding

27. When an infant with pyloric stenosis is admitted to the hospital, which aspect of the plan of care
should the nurse implement first?
A. Weigh the infant.
B. Begin an intravenous infusion.
C. Switch the infant to an oral electrolyte solution.
D. Orient the mother to the hospital unit.

28. After the nurse teaches the parent of an infant with pyloric stenosis about the condition, which
cause, if stated by the parent, indicates effective teaching?
A. “an enlarged muscle below the stomach”
B. “a telescoping of the large bowel into the smaller bowel”
C. “a result of giving the baby more formula than is necessary”
D. “a genetically smaller stomach than normal”

29. The nurse is monitoring a newborn with a suspected diagnosis of imperforate anus. Which
assessment finding is unassociated with this diagnosis?
A. The presence of stool in the urine
B. Failure to pass a rectal thermometer
C. The passage of currant jelly–like stool
D. Failure to pass meconium in the first 24 hours after birth

30. A 3-year-old child is admitted with a tentative diagnosis of Wilms' tumor. What nursing action is
essential because of the diagnosis?
 A. Avoid palpating the abdomen
B. Encourage the child to eat adequately
C. Give emotional support to the parents
D. Keep the child on strict bed rest

31. A 2-year-old child has just been diagnosed with a Wilms' tumor. Surgery is recommended. The
parents tell the nurse that they feel they are being pushed into surgery and wonder if they should
wait and get more opinions. What information
is essential for the nurse to include when responding to the parents?
A. Surgery is one of several options for treating a Wilms' tumor.
B. Surgery is an essential part of the treatment for Wilms' tumor and must be done immediately.
C. Surgery can be safely delayed for up to a year after diagnosis.
D. Wilms' tumor has been successfully treated by chemotherapy and radiation therapy.
.
32. The nurse is assessing a child who has epiglottitis and is having respiratory difficulty. Which of
the following is the nurse most likely to assess in the child?
A. Flaring of the nares; cyanosis; lethargy
B. Diminished breath sounds bilaterally; easily agitated
C. Scattered rales throughout lung fields; anxious and frightened
D. Mouth open with a protruding tongue; inspiratory stridor

33. Which factor would most likely be a cause of epiglottitis?

A. Acquiring the child's first puppy the day before the onset of symptoms
B. Exposure to the parainfluenza virus
C. Exposure to Haemophilus influenzae, type B
D. Frequent upper respiratory infections as an infant

34. Which nursing action could be life-threatening for a child with epiglottitis?
A. Examining the child's throat with a tongue blade
B. Placing the child in a semi-sitting position
C. Maintaining high humidity
D. Obtaining a nasopharyngeal culture

35. Which of the following would the nurse expect to assess in a child with celiac disease having a
celiac crisis secondary to an upper respiratory infection?
A. Respiratory distress
B. Lethargy
C. Watery diarrhea
D. Weight gain

36. After the nurse provides dietary restrictions to the parents of a child with celiac disease, which
statement by the parents indicates effective teaching?
A. “Well follow these instructions until our child’s symptoms disappear.”
B. “Our child must maintain these dietary restrictions until adulthood.”
C. “Our child must maintain these dietary restrictions lifelong.”
D. “We’ll follow these instructions until our child has completely grown and developed.”

37. In the pediatric surgical ward, you have been assigned to a one-month-old child with cleft lip and
palate. You have to teach the mother a proper way of providing nutrition to the child. The following
are correct steps except:
A. Use rubber nipples with a small opening in order to prevent aspiration
B. Place the child in a semi-upright position when feeding
C. Feeding session should be done slowly
D. Teach the mother to stimulate the sucking reflex by rubbing the nipple against the lower lip of
the baby

38. At 18 months of age a child born with a cleft lip and palate is readmitted for palate surgery. Why
does the nurse teach the parents not to brush their child's teeth immediately after the surgery?
 A. The suture line might be injured.
B. A toothbrush might be frightening.
C. The child will probably have no teeth.
D. A toothbrush has not been used before.

39. A mother asks why her 2-year-old toddler's cleft palate was not repaired at the same time that
the cleft lip was repaired. What is the best response by the nurse?
A. "Waiting leaves time for other birth defects to be detected and corrected."
B. "The cleft lip was so disfiguring that surgery was done as quickly as possible."
C. "Your surgeon prefers to separate the operations to minimize the potential for complications."
D. "The palate usually is repaired before a child starts to speak. Some surgeons prefer to wait up
to 2 years."

40. A 3-month-old infant is doing well after the repair of a cleft lip. The nurse wants to provide the
client with appropriate stimulation. What is the best toy for the nurse to provide?
A. Colorful rattle
B. String of large beads
C. Mobile with a music box
D. Teddy bear with button eyes

41. When the nurse is developing the plan of care for an infant with a cleft lip before corrective
surgery is performed, what should be a priority?
A. maintaining skin integrity in the oral cavity
B. using techniques to minimize crying
C. altering the usual method of feeding
D. preventing the infant from putting fingers in the mouth

42. After teaching the parent of an infant who has had a surgical repair for a cleft lip about the use of
elbow restraints at home, the nurse determines that the teaching has been successful when the
parent makes which statement?
A. “We will only remove the restrains one at a time to check the skin under them for redness.”
B. “We will keep the restraints on during the day while he is awake, but take them off when we put
him to bed at night.”
C. “After we get home, we will not have to use the restraints because our child does not suck on
his hands or fingers.”
D. “We will be sure to keep the restraints on all the time until we come to see the care provider for
a follow-up visit.”

43. The nurse should understand that the genetic defect of cystic fibrosis causes which change to the
mucus secretions?
A. They become thin and watery.
B. They become bloody.
C. They become thick and sticky.
D. They become yellow with pus.

44. The nurse is assessing a client with suspected cystic fibrosis (CF). Which clinical manifestation
should the nurse recognize as a hallmark sign of the disease that would support this suspicion?
A. An increased amount of chloride in the sweat
B. A decreased amount of chloride in the nasal secretions
C. A decreased amount of chloride in the sweat
D. An increased amount of chloride in the nasal secretions

45. One of the most important pulmonary treatments in cystic fibrosis is:
A. Chest physiotherapy
B. Inhaled beta agonists
C. Oral enzymes
D. Inhaled corticosteroids
46. The Father of Marimar, a patient with cystic fibrosis (CF), asks the clinic nurse about the disease.
The nurse tells the father that Cystic fibrosis is which of the following?
A. A disease that causes the formation of multiple cysts in the lungs
B. A chronic multisystem disorder affecting the exocrine glands
C. Transmitted as an autosomal dominant trait
D. A disease that causes dilation of the passageways of many organs

47. The nurse is providing a health teaching to the mother of an 8-year-old child with cystic fibrosis.
Which of the following statement if made by the mother would indicate to the nurse the need for
further teaching about the medication regimen of the child?
A. “My child might need an extra capsule if the meal is high in fat”
B. “I’ll give the enzyme capsule before every snack”
C. “I’ll give the enzyme capsule before every meal”
D. “My child hates to take pills, so I’ll mix the capsule into a cup of hot chocolate

48. A child with cystic fibrosis does not like taking a pancreatic enzyme supplement with meals and
snacks. The parent does not like to force the child to take the supplement. What is the most
important reason for the child to take the pancreatic enzyme supplement with meals and snacks?
A. The child will become dehydrated if the supplement is not taken with meals and snacks.
B. The child needs these pancreatic enzymes to help the digestive system absorb fats,
carbohydrates, and proteins.
C. The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear.
D. The child will experience severe diarrhea if the supplement is not taken as prescribed.

49. When developing the plan of care for a child with cystic fibrosis (CF) who is scheduled to receive
postural drainage, the nurse should anticipate performing postural drainage at which times?
A. after meals
B. before meals
C. after rest periods
D. before inhalation treatments

50. Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates
understanding the underlying problem of the disease?
A. an abnormality in the body’s mucus-secreting glands
B. formation of fibrous cysts in various body organs
C. failure of the pancreatic ducts to develop properly
D. reaction to the formation of antibodies against streptococcus

51. To assess the development of a 2-month-old, the nurse asks the parent if the infant is
able to demonstrate which skill?
A. Crawling C. Hold a rattle briefly
B. Roll from back to side D. Lift head from prone position

52. The parent of a 9-month-old expressed concern that the baby “is developing slowly.” The
nurse is concerned about a developmental delay when finding the baby is unable to
accomplish which skill?
A. Crawling C. cruising
B. standing alone D. Walking

53. Which infant most needs a developmental referral for a gross motor delay?
A. the 2-month-old who does not roll over
B. the 4-month-old who does not sit without support
C. the 6-month-old who does not crawl
D. the 10-month-old who does not stand holding on
 54. When assessing a 2-year-old child at the clinic for a routine checkup, which skill should
the nurse expect the child to be able to perform?
A. riding a tricycle C. kicking a ball forward
B. pointing at object D. throwing a ball

55. A term neonate weighs 7.5 lb (3 kg) at birth. The parents ask the nurse how much the
child should weigh when he is 1 year old. What is the best response by the nurse?
A. 16 lb (7.3 kg) C. 28 lb (12.7 kg)
B. 22 lb (10 kg) D. 32 lb (14.5 kg)

56. A child is hospitalized because of persistent vomiting. The nurse should monitor the child
closely for which problem?
A. Diarrhea C. Metabolic alkalosis
B. Metabolic acidosis D. Hyperactive bowel sounds

57. Which of the following is a congenital anomaly that results in mechanical obstruction
form inadequate motility of part of the intestine which resulted to megacolon?
A. Intussusception C. Crohn disease
B. Short-bowel syndrome D. Hirschsprung disease

58. The nurse would expect to see what clinical manifestations in the child diagnosed with
Hirschsprung disease?
A. History of bloody diarrhea, fever and vomiting
B. Irritability, severe abdominal cramps, fecal soiling
C. Decreased hemoglobin, increased serum lipids, and positive stool for O&P
D. History of constipation, abdominal distention and passage of ribbonlike, foul-smelling
stools

59. Justin age 1 month is brought to the clinic by his mother. The nurse suspects pyloric
stenosis. Which of the following symptoms would support this theory?
A. Diarrhea C. Fever and dehydration
B. Projectile vomiting D. Abdominal distention

60. An invagination of one portion of the intestine into another is called:

A. intussusception C. tracheoesophageal fistula
B. pyloric stenosis D. Hirschsprung disease

61. Jungkook, age 5 months, is suspected of having intussusception. What clinical

manifestations would he most likely have?
A. crampy abdominal pain, inconsolable crying, a drawing up of the knees to the chest, and
passage of red, currant jelly-like stools
B. fever; diarrhea; vomiting; lowered WBC count; and tender, distended abdomen
C. Weight gain, constipation, refusal to eat, and rebound tenderness
D. Abdominal distention, periodic pain, hypotension, and lethargy

62. The nurse is assessing a five-month-old infant. The nurse would anticipate finding that
the infant
would be able to
A. Hold a rattle
B. Bang two blocks
C. Move the small toy from one hand to another
D. Wave “bye-bye”

63. Which of the following is a sign of abnormal gross motor development:

A. Running at age 2 years
B. Climbing and descending stairs at age 2 years
C. Changing from lying to sitting position at age 9–12 months
D. Crawling at age 18 months

64. The nurse is caring for a newborn immediately after delivery. Which action by the
nurse shows an understanding of the newborn’s thermoregulatory ability?
A. Suctions the newborn’s nostrils with a bulb syringe
B. Inspects the condition of the newborn’s umbilical cord
C. Places the newborn under a radiant warmer
D. Obtains an Apgar score during the first one and five minutes

65. The nurse is assessing the newborn’s heart rate while the newborn is asleep. Which
result does the nurse consider a normal finding?
A. 100 beats per minute C. 80 beats per minute
B. 140 beats per minute D. 120 beats per minute

66. A parent brings a newborn into the healthcare clinic for a well-baby check-up. During
the assessment of fontanelles, which findings by the nurse show a normal finding?
A. A bulging anterior fontanel; a sunken posterior fontanel
B. An anterior fontanel larger than the posterior fontanel
C. A diamond-shaped posterior; a triangular-shaped anterior
D. A posterior fontanel that is closed at 18 months

67. Immediately after delivery of the neonate, Nurse Alexa keeps the neonate under
radiant warmer away from the cooling ducts in the room to prevent heat loss. The nurse
should inform the mother that keeping the neonate away from the cooling ducts prevents
heat loss by:
A. Radiation C. Conduction
B. Evaporation D. Convection

68. In an APGAR assessment, the newborn’s heart rate was 101 bpm with slow respiratory
breathing, grimaces, cyanotic, and floppy. A nurse would give the newborn an APGAR score
of:
A. 4 C. 6
B. 5 D. 7

69. A nurse in a newborn nursery receives a phone call to prepare for the admission of a
43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of
this infant, the nurse’s highest priority should be to:
A. Connect the resuscitation bag to the oxygen outlet
B. Turn on the apnea and cardiorespiratory monitors
C. Set up the intravenous line with 5% dextrose in water
D. Set the radiant warmer control temperature at 36.5C

70. A nursery nurse wraps a neonate in a blanket and keeps the nursery temperature
warm. Which type of heat loss is she trying to prevent in the neonate?
A. Conduction C. Evaporation
B. Convection D. Radiation
71. Which neonate would be most at risk for a problem with thermoregulation?
A. A term neonate born to a diabetic mother.
B. A neonate born at 36 weeks’ gestation.
C. A neonate born at 39 weeks’ gestation.
D. A term neonate with signs of jaundice at 36 hours of age.

72. Which would be the highest priority in regulating the temperature of a neonate?
A. Supply extra heat sources to the neonate.
B. Keep the ambient room temperature less than 100° F (37.8° C).
C. Minimize the energy needed for the neonate to produce heat.
D. Block radiant, convective, conductive, and evaporative losses.

73. A clinic nurse instructs the mother of a child with sickle cell disease about the
precipitating factors related to pain crisis. Which of the following, if identified by the mother
as a precipitating factor, indicates the need for further instructions?
A. infection C. fluid overload
B. trauma D. Stress

74. A nurse is caring for an eight-month-old who has recently been diagnosed with hemophilia
B. The nurse instructs the parents that their child is missing which of the following clotting
factors?
A. IX C. X
B. XI D. VIII

75. A nurse teaches a coworker that the treatment for hemophilia will likely include periodic
administration of:
A. platelets
B. whole blood
C. factor concentrates
D. fresh frozen plasma