Pediatric Nursing Practice Test

Part 1
1. While performing physical assessment of a 12
month-old, the nurse notes that the infants anterior
fontanel is still slightly open. Which of the following is the
nurses most appropriate action?
a. Notify the physician immediately because there is a
problem.
b. Perform an intensie neurologic e!amination.
c. Perform an intensie deelopmental e!amination.
d. "o nothing because this is a normal finding for the age.
2. When teaching a mother about introducing solid
foods to her child, which of the following indicates the
earliest age at which this should be done?
a. 1 month
b. 2 months
c. # months
d. $ months
#. %he infant of a substance-abusing mother is at ris&
for deeloping a sense of which of the following?
a. 'istrust
b. (hame
c. )uilt
d. *nferiority
4. Which of the following toys should the
nurse recommend for a +-month-old?
a. , big red balloon
b. , teddy bear with button eyes
c. , push-pull wooden truc&
d. , colorful busy bo!
+. %he mother of a 2-month-old is concerned that she
may be spoiling her baby by pic&ing her up when she
cries. Which of the following would be the nurses best
response?
a. - .et her cry for a while before pic&ing her up, so you
dont spoil her/
b. -0abies need to be held and cuddled1 you wont spoil
her this way/
c. -2rying at this age means the baby is hungry1 gie
her a bottle/
d. -*f you leae her alone she will learn how to cry
herself to sleep/
6. When assessing an 13-month-old, the nurse notes a
characteristic protruding abdomen. Which of the following
would e!plain the rationale for this finding?
a. *ncreased food inta&e owing to age
b. 4nderdeeloped abdominal muscles
c. 0owlegged posture
d. .inear growth cure
5. *f parents &eep a toddler dependent in areas where
he is capable of using s&ills, the toddle will deelop a
sense of which of the following?
a. 'istrust
b. (hame
c. )uilt
d. *nferiority
3. Which of the following is an appropriate toy for an
13-month-old?
a. 'ultiple-piece pu66le
b. 'iniature cars
c. 7inger paints
d. 2omic boo&
9. When teaching parents about the childs readiness
for toilet training, which of the following signs should the
nurse instruct them to watch for in the toddler?
a. "emonstrates dryness for $ hours
b. "emonstrates ability to sit and wal&
c. 8as a new sibling for stimulation
d. 9erbali6es desire to go to the bathroom
10. When teaching parents about typical toddler eating
patterns, which of the following should be included?
a. 7ood -:ags/
b. Preference to eat alone
c. 2onsistent table manners
d. *ncrease in appetite
11. Which of the following suggestions should the
nurse offer the parents of a $-year-old boy who resists
going to bed at night?
a. -,llow him to fall asleep in your room, then moe him
to his own bed./
b. -%ell him that you will loc& him in his room if he gets
out of bed one more time./
c. -;ncourage actie play at bedtime to tire him out so
he will fall asleep faster./
d. -<ead him a story and allow him to play =uietly in his
bed until he falls asleep./
1
12. When proiding therapeutic play, which of the
following toys would best promote imaginatie play in a $-
year-old?
a. .arge bloc&s
b. "ress-up clothes
c. Wooden pu66le
d. 0ig wheels
13. Which of the following actiities, when oiced by the
parents following a teaching session about the
characteristics of school-age cognitie deelopment
would indicate the need for additional teaching?
a. 2ollecting baseball cards and marbles
b. >rdering dolls according to si6e
c. 2onsidering simple problem-soling options
d. "eeloping plans for the future
1$. , hospitali6ed schoolager states? -*m not afraid of
this place, *m not afraid of anything./ %his statement is
most li&ely an e!ample of which of the following?
a. <egression
b. <epression
c. <eaction formation
d. <ationali6ation
15. ,fter teaching a group of parents about accident
preention for schoolagers, which of the following
statements by the group would indicate the need for
more teaching?
a. -(choolagers are more actie and adenturous than
are younger children./
b. -(choolagers are more susceptible to home ha6ards
than are younger children./
c. -(choolagers are unable to understand potential
dangers around them./
d. -(choolargers are less sub:ect to parental control
than are younger children./
1@. Which of the following s&ills is the most significant
one learned during the schoolage period?
a. 2ollecting
b. >rdering
c. <eading
d. (orting
17. , child age 5 was unable to receie the measles,
mumps, and rubella A''<B accine at the recommended
scheduled time. When would the nurse e!pect to
administer ''< accine?
a. *n a month from now
b. *n a year from now
c. ,t age 1C
d. ,t age 1#
13. %he adolescents inability to deelop a sense of who
he is and what he can become results in a sense of which
of the following?
a. (hame
b. )uilt
c. *nferiority
d. <ole diffusion
1D. Which of the following would be most appropriate for
a nurse to use when describing menarche to a 1#-year-
old?
a. , females first menstruation or menstrual -periods/
b. %he first year of menstruation or -period/
c. %he entire menstrual cycle or from one -period/ to
another
d. %he onset of uterine maturation or pea& growth
20. , 1$-year-old boy has acne and according to his
parents, dominates the bathroom by using the mirror all
the time. Which of the following remar&s by the
nurse would be least helpful in tal&ing to the boy and his
parents?
a. -%his is probably the only concern he has about his
body. (o dont worry about it or the time he spends on it./
b. -%eenagers are an!ious about how their peers
perceie them. (o they spend a lot of time grooming./
c. -, teen may deelop a poor self-image when
e!periencing acne. "o you feel this way sometimes?/
d. -Eou appear to be &eeping your face well washed.
Would you feel comfortable discussing your cleansing
method?/
21. Which of the following should the nurse suspect
when noting that a #-year-old is engaging in e!plicit
se!ual behaior during doll play?
a. %he child is e!hibiting normal pre-school curiosity
b. %he child is acting out personal e!periences
c. %he child does not &now how to play with dolls
d. %he child is probably deelopmentally delayed.
2
22. Which of the following statements by the parents of a
child with school phobia would indicate the need for
further teaching?
a. -Well &eep him at home until phobia subsides./
b. -Well wor& with his teachers and counselors at
school./
c. -Well try to encourage him to tal& about his
problem./
d. -Well discuss possible solutions with him and his
counselor./
23. When deeloping a teaching plan for a group of high
school students about teenage pregnancy, the nurse
would &eep in mind which of the following?
a. %he incidence of teenage pregnancies is increasing.
b. 'ost teenage pregnancies are planned.
c. "enial of the pregnancy is common early on.
d. %he ris& for complications during pregnancy is rare.
24. When assessing a child with a cleft palate, the
nurse is aware that the child is at ris& for more fre=uent
episodes of otitis media due to which of the following?
a. .owered resistance from malnutrition
b. *neffectie functioning of the ;ustachian tubes
c. Plugging of the ;ustachian tubes with food particles
d. ,ssociated congenital defects of the middle ear.
2+. While performing a neurodeelopmental assessment
on a #-month-old infant, which of the following
characteristics would be e!pected?
a. , strong 'oro refle!
b. , strong parachute refle!
c. <olling from front to bac&
d. .ifting of head and chest when prone
26. 0y the end of which of the following would the
nurse most commonly e!pect a childs birth weight to
triple?
a. $ months
b. 5 months
c. D months
d. 12 months
25. Which of the following best describes parallel play
between two toddlers?
a. (haring crayons to color separate pictures
b. Playing a board game with a nurse
c. (itting near each other while playing with separate
dolls
d. (haring their dolls with two different nurses
28. Which of the following would the nurse identify as the
initial priority for a child with acute lymphocytic leu&emia?
a. *nstituting infection control precautions
b. ;ncouraging ade=uate inta&e of iron-rich foods
c. ,ssisting with coping with chronic illness
d. ,dministering medications ia *' in:ections
2D. Which of the following information, when oiced by
the mother, would indicate to the nurse that she
understands home care instructions following the
administration of a diphtheria, tetanus, and pertussis
in:ection?
a. 'easures to reduce feer
b. Need for dietary restrictions
c. <easons for subse=uent rash
d. 'easures to control subse=uent diarrhea
#C. Which of the following actions by a community health
nurse is most appropriate when noting multiple bruises
and burns on the posterior trun& of an 13-month-old child
during a home isit?
a. <eport the childs condition to Protectie (erices
immediately.
b. (chedule a follow-up isit to chec& for more bruises.
c. Notify the childs physician immediately.
d. "o nothing because this is a normal finding in a
toddler.
#1. Which of the following is being used when the
mother of a hospitali6ed child calls the student nurse and
states, -Eou idiot, you hae no idea how to care for my
sic& child/?
a. "isplacement
b. Pro:ection
c. <epression
d. Psychosis
#2. Which of the following should the nurse e!pect to
note as a fre=uent complication for a child with congenital
heart disease?
a. (usceptibility to respiratory infection
b. 0leeding tendencies
c. 7re=uent omiting and diarrhea
d. (ei6ure disorder
3
##. Which of the following would the nurse do first for a
#-year-old boy who arries in the emergency room with a
temperature of 1C+ degrees 7, inspiratory stridor, and
restlessness, who is learning forward and drooling?
a. ,uscultate his lungs and place him in a mist tent.
b. 8ae him lie down and rest after encouraging fluids.
c. ;!amine his throat and perform a throat culture
d. Notify the physician immediately and prepare for
intubation.
#$. Which of the following would the nurse need to &eep
in mind as a predisposing factor when formulating a
teaching plan for child with a urinary tract infection?
a. , shorter urethra in females
b. 7re=uent emptying of the bladder
c. *ncreased fluid inta&e
d. *ngestion of acidic :uices
#+. Which of the following should the nurse do first for a
1+-year-old boy with a full leg cast who is screaming in
unrelenting pain and e!hibiting right foot pallor signifying
compartment syndrome?
a. 'edicate him with acetaminophen.
b. Notify the physician immediately
c. <elease the traction
d. 'onitor him eery + minutes
#@. ,t which of the following ages would the nurse
e!pect to administer the aricella 6oster accine to child?
a. ,t birth
b. 2 months
c. @ months
d. 12 months
#5. When discussing normal infant growth and
deelopment with parents, which of the following toys
would the nurse suggest as most appropriate for an 3-
month-old?
a. Push-pull toys
b. <attle
c. .arge bloc&s
d. 'obile
#3. Which of the following aspects of psychosocial
deelopment is necessary for the nurse to &eep in mind
when proiding care for the preschool child?
a. %he child can use comple! reasoning to thin& out
situations.
b. 7ear of body mutilation is a common preschool fear
c. %he child engages in competitie types of play
d. *mmediate gratification is necessary to deelop
initiatie.
#D. Which of the following is characteristic of a
preschooler with mid mental retardation?
a. (low to feed self
b. .ac& of speech
c. 'ar&ed motor delays
d. )ait disability
$C. Which of the following assessment findings would
lead the nurse to suspect "own syndrome in an infant?
a. (mall tongue
b. %ranserse palmar crease
c. .arge nose
d. <estricted :oint moement
$1. While assessing a newborn with cleft lip, the nurse
would be alert that which of the following will most li&ely
be compromised?
a. (uc&ing ability
b. <espiratory status
c. .ocomotion
d. )* function
$2. When proiding postoperatie care for the child with
a cleft palate, the nurse should position the child in which
of the following positions?
a. (upine
b. Prone
c. *n an infant seat
d. >n the side
$#. While assessing a child with pyloric stenosis, the
nurse is li&ely to note which of the following?
a. <egurgitation
b. (teatorrhea
c. Pro:ectile omiting
d. -2urrant :elly/ stools
$$. Which of the following nursing diagnoses would be
inappropriate for the infant with gastroesophageal reflu!
A);<B?
a. 7luid olume deficit
b. <is& for aspiration
c. ,ltered nutrition? less than body re=uirements
d. ,ltered oral mucous membranes
4
$+. Which of the following parameters would the nurse
monitor to ealuate the effectieness of thic&ened
feedings for an infant with gastroesophageal reflu!
A);<B?
a. 9omiting
b. (tools
c. 4terine
d. Weight
$@. "ischarge teaching for a child with celiac disease
would include instructions about aoiding which of the
following?
a. <ice
b. 'il&
c. Wheat
d. 2hic&en
47. Which of the following would the nurse e!pect to
assess in a child with celiac disease haing a celiac crisis
secondary to an upper respiratory infection?
a. <espiratory distress
b. .ethargy
c. Watery diarrhea
d. Weight gain
$3. Which of the following should the nurse do first after
noting that a child with 8irschsprung disease has a feer
and watery e!plosie diarrhea?
a. Notify the physician immediately
b. ,dminister antidiarrheal medications
c. 'onitor child eer #C minutes
d. Nothing, this is characteristic of 8irschsprung
disease
$D. , newborns failure to pass meconium within the first
2$ hours after birth may indicate which of the following?
a. 8irschsprung disease
b. 2eliac disease
c. *ntussusception
d. ,bdominal wall defect
+C. When assessing a child for possible intussusception,
which of the following would be least li&ely to proide
aluable information?
a. (tool inspection
b. Pain pattern
c. 7amily history
d. ,bdominal palpation
Answers and Rationale
1. D. %he anterior fontanel typically closes anywhere between
12 to 13 months of age. %hus, assessing the anterior
fontanel as still being slightly open is a normal finding
re=uiring no further action. 0ecause it is normal finding
for this age, notifying he physician or performing
additional e!aminations are inappropriate.
2. D. (olid foods are not recommended before age $ to @
months because of the suc&ing refle! and
the immaturity of the gastrointestinal tract and immune
system. %herefore, the earliest age at which to introduce
foods is $ months. ,ny time earlier would be
inappropriate.
#. A. ,ccording to ;ri&son, infants need to hae their
needs met consistently and effectiely to deelop a sense
of trust. ,n infant whose needs are consistently unmet or
who e!periences significant delays in haing them met,
such as in the case of the infant of a substance-abusing
mother, will deelop a sense of uncertainty, leading to
mistrust of caregiers and the enironment. %oddlers
deelop a sense of shame when their autonomy needs
are not met consistently. Preschoolers deelop a sense
of guilt when their sense of initiatie is thwarted.
(choolagers deelop a sense of inferiority when they do
not deelop a sense of industry.
$. D. , busy bo! facilitates the fine motor deelopment that
occurs between $ and @ months. 0alloons are
contraindicated because small children may aspirate
balloons. 0ecause the button eyes of a teddy bear may
detach and be aspirated, this toy is unsafe for children
younger than # years. , +-month-old is too young to use
a push-pull toy.
+. B. *nfants need to hae their security needs met by being
held and cuddled. ,t 2 months of age, they are unable to
ma&e the connection between crying and attention. %his
association does not occur until late infancy or early
toddlerhood. .etting the infant cry for a time before
pic&ing up the infant or leaing the infant alone to cry
herself to sleep interferes with meeting the infants need
for security at this ery young age. *nfants cry for many
5
reasons. ,ssuming that the child s hungry may cause
oerfeeding problems such as obesity.
@. B. 4nderdeeloped abdominal musculature gies the
toddler a characteristically protruding abdomen. "uring
toddlerhood, food inta&e decreases, not increases.
%oddlers are characteristically bowlegged because the
leg muscles must bear the weight of the relatiely large
trun&. %oddler growth patterns occur in a stepli&e, not
linear pattern.
5. B. ,ccording to ;ri&son, toddlers e!perience a sense of
shame when they are not allowed to deelop appropriate
independence and autonomy. *nfants deelop mistrust
when their needs are not consistently
gratified. Preschoolers deelop guilt when their initiatie
needs are not met while schoolagers deelop a sense of
inferiority when their industry needs are not met.
3. C. Eoung toddlers are still sensorimotor learners and they
en:oy the e!perience of feeling different te!tures. %hus,
finger paints would be an appropriate toy choice. 'ultiple-
piece toys, such as pu66le, are too difficult to manipulate
and may be ha6ardous if the pieces are small enough to
be aspirated. 'iniature cars also hae a high potential for
aspiration. 2omic boo&s are on too high a leel for
toddlers. ,lthough they may en:oy loo&ing at some of the
pictures, toddlers are more li&ely to rip a comic boo&
apart.
D. D. %he child must be able to sate the need to go to the
bathroom to initiate toilet training. 4sually, a child needs
to be dry for only 2 hours, not $ hours. %he child also
must be able to sit, wal&, and s=uat. , new sibling would
most li&ely hinder toilet training.
1C. A. %oddlers become pic&y eaters, e!periencing food :ags
and eating large amounts one day and ery little the ne!t.
, toddlers food gags e!press a preference for the
ritualism of eating one type of food for seeral days at a
time. %oddlers typically en:oy sociali6ation and limiting
others at meal time. %oddlers prefer to feed themseles
and thus are too young to hae table manners. ,
toddlers appetite and need for calories, protein, and fluid
decrease due to the dramatic slowing of growth rate.
11. D. Preschoolers commonly hae fears of the dar&, being
left alone especially at bedtime, and ghosts, which may
affect the childs going to bed at night. Fuiet play and
time with parents is a positie bedtime routine that
proides security and also readies the child for sleep. %he
child should sleep in his own bed. %elling the child about
loc&ing him in his room will iewed by the child as a
threat. ,dditionally, a loc&ed door is frightening and
potentially ha6ardous. 9igorous actiity at bedtime stirs
up the child and ma&es more difficult to fall asleep.
12. B. "ress-up clothes enhance imaginatie play and
imagination, allowing preschoolers to engage in rich
fantasy play. 0uilding bloc&s and wooden pu66les are
appropriate for encouraging finemotor deelopment. 0ig
wheels and tricycles encourage gross motor
deelopment.
1#. D. %he school-aged child is in the stage of concrete
operations, mar&ed by inductie reasoning, logical
operations, and reersible concrete thought. %he ability to
consider the future re=uires formal thought operations,
which are not deeloped until adolescence. 2ollecting
baseball cards and marbles, ordering dolls by si6e, and
simple problem-soling options are e!amples of the
concrete operational thin&ing of the schoolager.
1$. C. <eaction formation is the schoolagers typical defensie
response when hospitali6ed. *n reaction formation,
e!pression of unacceptable thoughts or behaiors is
preented Aor oerriddenB by the e!aggerated e!pression
of opposite thoughts or types of behaiors. <egression is
seen in toddlers and preshcoolers when they retreat or
return to an earlier leel of deelopment. <epression
refers to the inoluntary bloc&ing of unpleasant feelings
and e!periences from ones awareness. <ationali6ation is
the attempt to ma&e e!cuses to :ustify unacceptable
feelings or behaiors.
1+. C. %he schoolagers cognitie leel is sufficiently
deeloped to enable good understanding of and
adherence to rules. %hus, schoolagers should be able to
understand the potential dangers around them. With
growth comes greater freedom and children become
more adenturous and daring. %he school-aged child is
also still prone to accidents and home ha6ards, especially
because of increased motor abilities and independence.
Plus the home ha6ards differ from other age groups.
6
%hese ha6ards, which are potentially lethal but tempting,
may include firearms, alcohol, and medications. (chool-
age children begin to internali6e their own controls and
need less outside direction. Plus the child is away from
home more often. (ome parental or caregier assistance
is still needed to answer =uestions and proide guidance
for decisions and responsibilities.
1@. C. %he most significant s&ill learned during the school-age
period is reading. "uring this time the child deelops
formal adult articulation patterns and learns that words
can be arranged in structure. 2ollectie, ordering, and
sorting, although important, are not most significant s&ills
learned.
15. C. 0ased on the recommendations of the ,merican
,cademy of 7amily Physicians and the ,merican
,cademy of Pediatrics, the ''< accine should be gien
at the age of 1C if the child did not receie it between the
ages of $ to @ years as recommended. *mmuni6ation for
diphtheria and tetanus is re=uired at age 1#.
13. D. ,ccording to ;ri&son, role diffusion deelops when the
adolescent does not deelop a sense of identity and a
sense or where he fits in. %oddlers deelop a sense of
shame when they do not achiee
autonomy. Preschoolers deelop a sense of guilt when
they do not deelop a sense of initiatie. (chool-age
children deelop a sense of inferiority when they do not
deelop a sense of industry.
1D. A. 'enarche refers to the onset of the first menstruation
or menstrual period and refers only to the first cycle.
4terine growth and broadening of the pelic girdle occurs
before menarche.
2C. A. (tating that this is probably the only concern the
adolescent has and telling the parents not to worry about
it or the time her spends on it shuts off further
inestigation and is li&ely to ma&e the adolescent and his
parents feel defensie. %he statement about peer
acceptance and time spent in front of the mirror for the
deelopment of self image proides information about the
adolescents needs to the parents and may help to gain
trust with the adolescent. ,s&ing the adolescent how he
feels about the acne will encourage the adolescent to
share his feelings. "iscussing the cleansing method
shows interest and concern for the adolescent and also
can help to identify any patient-teaching needs for the
adolescent regarding cleansing.
21. B. Preschoolers should be deelopmentally incapable of
demonstrating e!plicit se!ual behaior. *f a child does so,
the child has been e!posed to such behaior, and se!ual
abuse should be suspected. ;!plicit se!ual behaior
during doll play is not a characteristic of preschool
deelopment nor symptomatic of deelopmental delay.
Whether or nor the child &nows how to play with dolls is
irreleant.
22. A. %he parents need more teaching if they state that they
will &eep the child home until the phobia subsides. "oing
so reinforces the childs feelings of worthlessness and
dependency. %he child should attend school een during
resolution of the problem. ,llowing the child to erbali6e
helps the child to entilate feelings and may help to
uncoer causes and solutions. 2ollaboration with the
teachers and counselors at school may lead to
uncoering the cause of the phobia and to the
deelopment of solutions. %he child should participate
and play an actie role in deeloping possible solutions.
2#. C. %he adolescent who becomes pregnant typically denies
the pregnancy early on. ;arly recognition by a parent or
health care proider may be crucial to timely initiation of
prenatal care. %he incidence of adolescent pregnancy
has declined since 1DD1, yet morbidity remains high.
'ost teenage pregnancies are unplanned and occur out
of wedloc&. %he pregnant adolescent is at high ris& for
physical complications including premature labor and low-
birth-weight infants, high neonatal mortality, iron
deficiency anemia, prolonged labor, and fetopelic
disproportion as well as numerous psychological crises.
2$. B. 0ecause of the structural defect, children with cleft
palate may hae ineffectie functioning of their
;ustachian tubes creating fre=uent bouts of otitis media.
'ost children with cleft palate remain well-nourished and
maintain ade=uate nutrition through the use of proper
feeding techni=ues. 7ood particles do not pass through
the cleft and into the ;ustachian tubes. %here is no
association between cleft palate and congenial ear
deformities.
7
2+. D. , #-month-old infant should be able to lift the head and
chest when prone. %he 'oro refle! typically diminishes or
subsides by # months. %he parachute refle! appears at D
months. <olling from front to bac& usually is
accomplished at about + months.
2@. D. , childs birth weight usually triples by 12 months and
doubles by $ months. No specific birth weight parameters
are established for 5 or D months.
25. C. %oddlers engaging in parallel play will play near each
other, but not with each other. %hus, when two toddlers
sit near each other but play with separate dolls, they are
e!hibiting parallel play. (haring crayons, playing a board
game with a nurse, or sharing dolls with two different
nurses are all e!amples of cooperatie play.
23. A. ,cute lymphocytic leu&emia A,..B causes leu&openia,
resulting in immunosuppression and increasing the ris& of
infection, a leading cause of death in children with ,...
%herefore, the initial priority nursing interention would be
to institute infection control precautions to decrease the
ris& of infection. *ron-rich foods help with anemia, but
dietary iron is not an initial interention. %he prognosis of
,.. usually is good. 8oweer, later on, the nurse may
need to assist the child and family with coping since
death and dying may still be an issue in need of
discussion. *n:ections should be discouraged, owing to
increased ris& from bleeding due to thrombocytopenia.
2D. A. %he pertusis component may result in feer and the
tetanus component may result in in:ection soreness.
%herefore, the mothers erbali6ation of information about
measures to reduce feer indicates understanding. No
dietary restrictions are necessary after this in:ection is
gien. , subse=uent rash is more li&ely to be seen + to
1C days after receiing the ''< accine, not the
diphtheria, pertussis, and tetanus accine. "iarrhea is not
associated with this accine.
#C. A. 'ultiple bruises and burns on a toddler are signs child
abuse. %herefore, the nurse is responsible for reporting
the case to Protectie (erices immediately to protect the
child from further harm. (cheduling a follow-up isit is
inappropriate because additional harm may come to the
child if the nurse waits for further assessment data.
,lthough the nurse should notify the physician, the goal is
to initiate measures to protect the childs safety. Notifying
the physician immediately does not initiate the remoal of
the child from harm nor does it absole the nurse from
responsibility. 'ultiple bruises and burns are not normal
toddler in:uries.
#1. B. %he mother is using pro:ection, the defense mechanism
used when a person attributes his or her own undesirable
traits to another. "isplacement is the transfer of emotion
onto an unrelated ob:ect, such as when the mother would
&ic& a chair or bang the door shut. <epression is the
submerging of painful ideas into the unconscious.
Psychosis is a state of being out of touch with reality.
#2. A. 2hildren with congenital heart disease are more prone
to respiratory infections. 0leeding tendencies, fre=uent
omiting, and diarrhea and sei6ure disorders are not
associated with congenital heart disease.
##. D. %he child is e!hibiting classic signs of epiglottitis,
always a pediatric emergency. %he physician must be
notified immediately and the nurse must be prepared for
an emergency intubation or tracheostomy. 7urther
assessment with auscultating lungs and placing the child
in a mist tent wastes aluable time. %he situation is a
possible life-threatening emergency. 8aing the child lie
down would cause additional distress and may result in
respiratory arrest. %hroat e!amination may result in
laryngospasm that could be fatal.
#$. A. *n females, the urethra is shorter than in males. %his
decreases the distance for organisms to trael, thereby
increasing the chance of the child deeloping a urinary
tract infection. 7re=uent emptying of the bladder would
help to decrease urinary tract infections by aoiding
sphincter stress. *ncreased fluid inta&e enables the
bladder to be cleared more fre=uently, thus helping to
preent urinary tract infections. %he inta&e of acidic :uices
helps to &eep the urine p8 acidic and thus decrease the
chance of flora deelopment.
#+. B. 2ompartment syndrome is an emergent situation and
the physician needs to be notified immediately so that
interentions can be initiated to reliee the increasing
pressure and restore circulation. ,cetaminophen
A%ylenolB will be ineffectie since the pain is related to the
increasing pressure and tissue ischemia. %he cast, not
8
traction, is being used in this situation for immobili6ation,
so releasing the traction would be inappropriate. *n this
situation, specific action not continued monitoring is
indicated.
#@. D. %he aricella 6oster accine A9G9B is a lie accine
gien after age 12 months. %he first dose of hepatitis 0
accine is gien at birth to 2 months, then at 1 to $
months, and then again at @ to 13 months. "taP is
routinely gien at 2, $, @, and 1+ to 13 months and a
booster at $ to @ years.
#5. C. 0ecause the 3-month-old is refining his gross motor
s&ills, being able to sit unsupported and also improing
his fine motor s&ills, probably capable of ma&ing hand-to-
hand transfers, large bloc&s would be the most
appropriate toy selection. Push-pull toys would be more
appropriate for the 1C to 12-month-old as he or she
begins to cruise the enironment. <attles and mobiles are
more appropriate for infants in the 1 to # month age
range. 'obiles pose a danger to older infants because of
possible strangulation.
#3. B. "uring the preschool period, the child has mastered a
sense of autonomy and goes on to master a sense of
initiatie. "uring this period, the child commonly
e!periences more fears than at any other time. >ne
common fear is fear of the body mutilation, especially
associated with painful e!periences. %he preschool child
uses simple, not comple!, reasoning, engages in
associatie, not competitie, play Ainteractie and
cooperatie play with sharingB, and is able to tolerate
longer periods of delayed gratification.
#D. A. 'ild mental retardation refers to deelopment disability
inoling an *F +C to 5C. %ypically, the child is not noted
as being retarded, but e!hibits slowness in performing
tas&s, such as self-feeding, wal&ing, and ta&ing. .ittle or
no speech, mar&ed motor delays, and gait disabilities
would be seen in more seere forms mental retardation.
$C. B. "own syndrome is characteri6ed by the following a
transerse palmar crease Asimian creaseB, separated
sagittal suture, obli=ue palpebral fissures, small nose,
depressed nasal bridge, high-arched palate, e!cess and
la! s&in, wide spacing and plantar crease between the
second and big toes, hypere!tensible and la! :oints, large
protruding tongue, and muscle wea&ness.
$1. A. 0ecause of the defect, the child will be unable to from
the mouth ade=uately around nipple, thereby re=uiring
special deices to allow for feeding and suc&ing
gratification. <espiratory status may be compromised if
the child is fed improperly or during postoperatie period,
.ocomotion would be a problem for the older infant
because of the use of restraints. )* functioning is not
compromised in the child with a cleft lip.
$2. B. Postoperatiely children with cleft palate should be
placed on their abdomens to facilitate drainage. *f the
child is placed in the supine position, he or she may
aspirate. 4sing an infant seat does not facilitate drainage.
(ide-lying does not facilitate drainage only prone can.
$#. C. Pro:ectile omiting is a &ey symptom of pyloric stenosis.
<egurgitation is seen more commonly with );<.
(teatorrhea occurs in malabsorption disorders such as
celiac disease. -2urrant :elly/ stools are characteristic of
intussusception.
$$. D. );< is the bac&flow of gastric contents into the
esophagus resulting from rela!ation or incompetence of
the lower esophageal AcardiacB sphincter. No alteration in
the oral mucous membranes occurs with this disorder.
7luid olume deficit, ris& for aspiration, and altered
nutrition are appropriate nursing diagnoses.
$+. A. %hic&ened feedings are used with );< to stop the
omiting. %herefore, the nurse would monitor the childs
omiting to ealuate the effectieness of using the
thic&ened feedings. No relationship e!ists between
feedings and characteristics of stools and uterine. *f
feedings are ineffectie, this should be noted before there
is any change in the childs weight.
$@. C. 2hildren with celiac disease cannot tolerate or digest
gluten. %herefore, because of its gluten content, wheat
and wheat-containing products must be aoided. <ice,
mil&, and chic&en do not contain gluten and need not be
aoided.
$5. C. ;pisodes of celiac crises are precipitated by infections,
ingestion of gluten, prolonged fasting, or e!posure to
anticholinergic drugs. 2eliac crisis is typically
characteri6ed by seere watery diarrhea. <espiratory
9
distress is unli&ely in a routine upper respiratory infection.
*rritability, rather than lethargy, is more li&ely. 0ecause of
the fluid loss associated with the seere watery diarrhea,
the childs weight is more li&ely to be decreased.
$3. A. 7or the child with 8irschsprung disease, feer and
e!plosie diarrhea indicate enterocolitis, a life-threatening
situation. %herefore, the physician should be notified
immediately. )enerally, because of the intestinal
obstruction and inade=uate propulsie intestinal
moement, antidiarrheals are not used to treat
8irschsprung disease. %he child is acutely ill and re=uires
interention, with monitoring more fre=uently than eery
#C minutes. 8irschsprung disease typically presents with
chronic constipation.
$D. A. 7ailure to pass meconium within the first 2$ hours after
birth may be an indication of 8irschsprung disease, a
congenital anomaly resulting in mechanical obstruction
due to inade=uate motility in an intestinal segment.
7ailure to pass meconium is not associated with celiac
disease, intussusception, or abdominal wall defect.
+C. C. 0ecause intussusception is not belieed to hae a
familial tendency, obtaining a family history would proide
the least amount of information. (tool inspection, pain
pattern, and abdominal palpation would reeal possible
indicators of intussusception. 2urrent, :elly-li&e stools
containing blood and mucus are an indication of
intussusception. ,cute, episodic abdominal pain is
characteristics of intussusception. , sausage-shaped
mass may be palpated in the right upper =uadrant.
Pediatric Nursing Practice Test
Part 2
10
A. A term neonate is to be released from hospital at 2
das of age. The nurse performs a phsical
e!amination before discharge.
1. Nurse 9alerie e!amines the neonates
hands and palms. Which of the following findings re=uires further
assessment?
aB 'any crease across the palm.
bB ,bsence of creases on the palm.
cB , single crease on the palm.
dB %wo large creases across the palm.
2. %he mother as&s when the -soft spots/
close? %he nurse e!plains that the neonates anterior fontanel
will normally close by ageH
aB 2 to # months.
bB @ to 3 months.
cB 12 to 13 months.
dB 2C to 2$ months.
3. When performing the physical
assessment, the nurse e!plains to the mother that in a term
neonate, sole creases areH
aB ,bsent near the heels.
bB ;ident under the heels only,
cB (pread oer the entire foot.
dB ;ident only towards the transerse arch.
4. When assessing the neonates eyes, the
nurse notes the following? absence of tears, corneas of une=ual
si6e, constriction of the pupils in response to bright light, and the
presence of red circles on the pupils on ophthalmic e!amination.
Which of these findings needs further assessment?
aB %he absence of tears.
bB 2orneas of une=ual si6e.
cB 2onstriction of the pupils.
dB %he presence of red circles on the pupils.
5. ,fter teaching the mother about the
neonates positie 0abins&i refle!, the nurse determines that the
mother understands the instructions when she says that a
positie 0abins&i refle! indicatesH.
aB *mmature muscle coordination.
bB *mmature central nerous system.
cB Possible lower spinal cord defect.
dB Possible in:ury to neres that innerate the feet.
B. Nurse "ris is responsible for assessing a male
neonate appro!imatel 2# hours old. The neonate was
deli$ered $aginall.
@. %he nurse should plan to assess the neonates physical
conditionH.
aB 'idway between feedings.
bB *mmediately after a feeding.
cB ,fter the neonate has been NP> for three hours.
dB *mmediately before a feeding.
5. %he nurse notes a swelling on the neonates scalp that crosses
the suture line. %he nurse documents this condition asH
aB 2ephallic hematoma.
bB 2aput succedaneum.
cB 8emorrhage edema.
dB Perinatal caput.
3. %he nurse measures the circumference of the neonates heads
and chest, and then e!plains to the mother that when the two
measurements are compared, the head is normally aboutH
aB %he same si6e as the chest.
bB 2 centimeter larger than the chest.
cB 2 centimeter smaller than the chest.
dB $ centimeter larger than chest.
D. ,fter e!plaining the neonates cranial molding, the
nurse determines that the mother needs further instructions from
which statement?
aB -%he molding is caused by an oerriding of the cranial bones./
bB -%he degree of molding is related to the amount of pressure on
the head./
cB -%he molding will disappear in a few days./
dB -%he fontanels maybe damaged if the molding does not
resoled =uic&ly./
1C. When instructing the mother about the neonates need for
sensory and isual stimulation, the nurse should plan to e!plain
that the most highly deelop sense in the neonate isH
aB %as&
bB (mell
cB %ouch
dB 8earing
C. Nurse %oan wor&s in a children's clinic and helps
with the care for well and ill children of $arious
ages.
11
11. , mother brings her $ month old infant to the clinic. %he
mother as&s the nurse when she should wean the infant from
breastfeeding and begin using a cup. Nurse Ioan should e!plain
that the infant will show readiness to be weaned byH
aB %a&ing solid foods well.
bB (leeping through the night.
cB (hortening the nursing time.
dB ;ating on a regular schedule.
12. 'other ,rlene says the infants physician recommends certain
foods but the infant refuses to eat them after breastfeeding. %he
nurse should suggest that the mother alter the feeding plan byH
aB >ffering desert followed by egetable and meat.
bB >ffering breast mil& as long as the infant refuses to eat solid
food.
cB 'i!ing minced food with cows mil& and feeding it to the infant
through a large hole nipple.
dB )iing the infant a few minutes of breast and then offering solid
food.
1#. Which of the following abilities would a nurse e!pect a $ month
old infant to perform?
aB (itting up without support.
bB <esponding to pleasure with smiles.
cB )rasping a rattle when it is offered.
dB %urning from either side to the bac&.
1$. %he nurse plans to administer the "ener
"eelopmental (creening %est A""(%B to a fie month old
infant. %he nurse should e!plain to the mother that the test
measures the infantsH
aB *ntelligence =uotient.
bB ;motional deelopment.
cB (ocial and physical actiities.
dB Pre-disposition to genetic and allergic illnesses.
1+. When discussing a seen month old infants mother regarding the
motor s&ill deelopment, the nurse should e!plain that by age
seen months, an infant most li&ely will be able toH
aB Wal& with support.
bB ;at with a spoon.
cB (tand while holding unto a furniture
dB (it alone using the hands for support.
1@. , mother brings her one month old infant to the clinic for chec&-
up. Which of the following deelopmental achieements
would the nurse assess for?
aB (miling and laughing out loud.
bB <olling from bac& to side.
cB 8olding a rattle briefly.
dB %urning the head from side to side.
15. , two month old infant is brought to the clinic for the first
immuni6ation against "P%.%he nurse should administer the
accine ia what route?
aB >ral.
bB *ntramascular
cB (ubcutaneous
dB *ntradermal
13. %he nurse teaches the clients mother about the normal reaction
that the infant might e!perience 12 to 2$ hours after the "P%
immuni6ation, which of the following reactions would the
nurse discuss?
aB .ethargy.
bB 'ild feer.
cB "iarrhea
dB Nasal 2ongestion
1D. ,n infant is obsered to be competent in the following
deelopmental s&ills? stares at an ob:ect, place her hands to the
mouth and ta&es it off, coos and gargles when tal& to and
sustains part of her own weight when held to in a standing
position. %he nurse correctly assessed infants age asH
aB %wo months.
bB 7our months
cB (i! months
dB ;ight months.
2C. %he mother says, -the soft spot near the front of her babys head
is still big, when will it close?/ Nurse .ilibeths correct response
would be atH
aB 2 to $ months.
bB + to 3 months.
cB D to 12 months.
dB 1# to 13 months. Prop
21. , mother states that she thin&s her D-month old is Jdeeloping
slowly. When ealuating the infants deelopment, the
nurse would not e!pect a normal D-month old to be able toH
aB 2reep and crawl.
bB 0egin to use imitatie erbal e!pressions.
12
cB Put an arm through a sleee while being dressed.
dB 8old a bottle with good hand K mouth coordination.
22. %he mother of the D-month old says, -it is difficult to add new
foods to his diet, he spits eerything out/, she says. %he
nurse should teach the mother toH
aB 'i! new foods with formula
bB 'i! new foods with more familiar foods.
cB >ffer new foods one at a time.
dB >ffer new foods after formula has been offered.
2#. Which of the following tas&s is typical for an 13-month old baby?
aB 2opying a circle
bB Pulling toys
cB Playing toy with other children
dB 0uilding a tower of eight bloc&s
2$. 'other <i6a brings her normally deeloped #-year old to the clinic
for a chec&-up. %he nurse would e!pect that the child would be
at least s&illed inH
aB <iding a bicycle
bB %ying shoelaces
cB (tringing large beads
dB 4sing blunt scissors
2+. %he mother tells the nurse that she is haing problem toilet-
training her 2-year old child. %he nurse would tell the mother that
the number one reason that toilet training in toddlers fails
because theH
aB <ewards are too limited
bB %raining e=uipment is inappropriate
cB Parents ignore -accidents/ that occur during training
dB %he child is not deelop mentally ready to be trained
2@. , child is not deelopmentally ready to be trained. , 2-1L2 year
old child is brought to the clinic by his father who e!plains that
the child is afraid of the dar& and says -no/ when as&ed to do
something. %he nurse would e!plain that the negatiism
demonstrated by toddler is fre=uently an e!pression ofH
aB Fuest for autonomy
bB 8yperactiity
cB (eparation an!iety
dB (ibling rialry
25. %he nurse would e!plain to the father which concept of Piagets
cognitie deelopment as the basis for the childs fear of
dar&ness?
aB <eersibility
bB ,nimism
cB 2onseration of matter
dB >b:ect permanence
23. 'other as&s the nurse for adice about discipline. %he nurse
would suggest that the mother would first useH
aB (tructured interaction
bB (pan&ing
cB <easoning
dB (colding
2D. When a nurse assesses for pain in toddlers, which of the
following techni=ues would be least effectie?
aB ,s& them about the pain
bB >bsere them for restlessness
cB Watch their face for grimness
dB .isten for pain cues in their cries.
#C. %he mother reports that her child creates a =uite scene eery
night at bedtime and as&s what she can do to ma&e bedtime a
little more pleasant. %he nurse should suggest that the mother
toH
aB ,llow the child to stay up later one or two nights a wee&.
bB ;stablish a set bedtime and follow a routine
cB .et the child play toy :ust before bedtime
dB )ie the child a coo&ie if bedtime is pleasant.
#1. %he mother as&s about dental care for her child. (he says that
she helps brush the childs teeth daily. Which of the following
responses by the nurse would be most appropriate?
aB -(ince you help brush her teeth, theres no need to see a dentist
now/
bB -Eou should hae begun dental appointments last year but it is
not too late/
cB -Eour child does not need to see the dentist until she starts
school/
dB -, dental chec&-up is a good idea, een if no noticeable
problems are present/
#2. %he mother says that she will be glad to let her child brush her
teeth without help, but at what age should this begin? Nurse
<oselyn should respond atH
aB # years
bB + years
cB @ years
dB 5 years
13
##. %he mother tells the nurse that her other child, a $-year old boy,
has deeloped some -strange eating habits/, including not
finishing her meals and eating the same foods for seeral days
in a row. (he would li&e to deelop a plan to connect this
situation. *n deeloping such a plan, the nurse and mother
should considerH
aB "eciding on a good reward for finishing a meal
bB ,llowing him to ma&e some decisions about the foods he eats
cB <e=uiring him to eat the foods sered at meal times.
dB Not allowing him to play with friends until he eats all the food
she sered.
#$. Nurse 0ryan &nows that one of the most effectie strategies to
teach a 7our year old about safety is toH
aB (how him potential dangers to aoid
bB %ell him he is bad when they do something dangerous
cB Proide good e!amples of safety behaior
dB (how him pictures of children who hae inole with accidents
#+. , D year old girl is brought to the pediatricians office for an
annual physical chec&up. (he has no history of significant health
problems. When the nurse as&s the girl about her best friend, the
nurse is assessingH
aB .anguage deelopment
bB 'otor deelopment
cB Neurological deelopment
dB (ocial deelopment
#@. %he child probably tells the nurse that brushing and flossing her
teeth is her responsibility. When responding to this information,
the nurse should reali6e that the childH
aB *s too young to be gien this responsibility
bB *s most li&ely =uite capable of this responsibility
cB (hould hae assumed this responsibility much sooner
dB *s probably :ust e!aggerating the responsibility
#5. %he mother tells the nurse that the child is continually telling :o&es
and riddles to the point of driing the other family members
cra6y. %he nurse should e!plain that this behaior is a sign ofH
aB *nade=uately parental attention
bB 'astery of language ambiguities
cB *nappropriate peer influence
dB ;!cessie teleision watching
#3. %he mother relates that the child is beginning to identify
behaiors that pleases others as -good behaior/. %he childs
behaior is characteristics of which Mohlbergs leel of moral
deelopment?
aB Pre-conentional morality
bB 2onentional morality
cB Post conentional morality
dB ,utonomous morality
#D. %he mother as&s the nurse about the childs apparent need for
between-meals snac&s, especially after school. %he nurse and
mother deelop a nutritional plan for the child, &eeping in mind
that the child..
aB "oes not need to eat between meals
bB (hould eat snac&s his mother prepares
cB (hould help prepare own snac&s
dB Will instinctiely select nutritional snac&s
$C. %he mother is concerned about the childs compulsion for
collecting things. %he nurse e!plains that this behaior is related
to the cognitie ability to perform.
aB 2oncrete operations
bB 7ormal operations
cB 2oordination of
dB %ertiary circular reactions
$1. %he nurse e!plained to the mother that according to ;ric&sons
framewor& of psychosocial deelopment, play is a ehicle of
deelopment can help the school age child deelop a sense ofH
aB *nitiatie
bB *ndustry
cB *dentity
dB *ntimacy
$2. %he school nurse is planning a series of safety and accident
preention classes for a group of third grades. What preentie
measures should the nurse stress during the first class, &nowing
the leading cause of incidental in:ury and death in this age?
aB 7lame-retardant clothing
bB .ife preseres
cB Protectie eyewear
dB ,uto seat belts
14
$#. %he mother of a 1C-year old boy e!presses concern that he is
oerweight. When deeloping a plan of care with the mother,
Nurse Matrina should encourage her toH
aB .imit childs between-,meal snac&s
bB Prohibit the child from playing outside if he eat snac&s
cB *nclude the child in meal planning and preparation
dB .imit the childs calories inta&e to 1,2CC&2alLday
$$. When assessing an 13-month old, the nurse notes a
characteristics protruding abdomen. Which of the following would
e!plain the rationale for this findings?
aB *ncreased food inta&e owing to age
bB 4nderdeeloped abdominal muscles
cB 0owlegged posture
dB .inear growth cure
$+. *f parents &eep a toddler dependent in areas where he is capable
of using s&ills, the toddler will deelop a sense of which of the
following?
aB 'istrust
bB (hame
cB )uilt
dB *nferiority
$@. Which of the following fears would the nurse typically associate
with toddlerhood?
aB 'utilation
bB %he dar&
cB )hosts
dB )oing to sleep
$5. , mother of a 2 year old has :ust left the hospital to chec& on her
other children. Which of the following would best help the 2 year
old who is now crying inconsolably?
aB %a&ing a nap
bB Peer play group
cB .arge cuddly dog
dB 7aorite blan&et
$3. Which of the following is an appropriate toy for an 13 month old?
aB 'ultiple-piece pu66le
bB 'iniature 2ars
cB 7inger paints
dB 2omic 0oo&
$D. When teaching parents about typical toddler eating patterns,
which of the following should be included?
aB 7ood -:ags/
bB Preference to eat alone
cB 2onsistent table manners
dB *ncrease in appetite
+C. Which of the following toys should the nurse recommend for a +-
month old?
aB , big red balloon
bB , teddy bear with button eyes
cB , push-pull wooden truc&
dB , colorful busy bo!

1. 2
2. 2
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15
Answer "e(
16