SUCCEED REVIEW CENTER

NOVEMBER 2014 SIMULATED NLE

DAY 1, AM SESSION
PREPARED BY: DR. ERIC TACLAWAN
Situation: Angela, a 48 hours old neonate is for discharge from the nursery. The nurse goes through her chart and noticed that a
newborn screening test has not yet been performed.
1. In the case of Angela, the next step that the nurse should do is:
a. Notify the physician of the failure to perform NBS
b. Perform a heel prick to obtain a blood sample for NBS
c. Discharge Angela and advise the parents to return the child after a week for NBS
d. Report to the supervisor the failure of the other nurses to follow hospital protocol
2. When obtaining a blood sample from Angela, the nurse should keep in mind which of the following ethical principles?
a. Beneficence
b. Advocacy
c. Non-maleficence
d. Justice
3. Newborn screening is important because it helps detect harmful or potentially fatal disorders that are not apparent at birth.
These disorders include the following. Select all that do not apply.
1. Phenylketonuria
6. Galactosemia
2. Cystic Fibrosis
7. Cerebral palsy
3. Thalassemia
8. Maple Syrup Urine Disease
4. Congenital Adrenal Hyperplasia
9. Sickle Cell Disease
5. Congenital hypothyroidism
10. Idiopathic Thrombocytopenic Purpura
a. 1, 8 and 9
b. 3, 7 and 10
c. 2, 5 and 6
d. 4, 7 and 9
4. Angelas mother asked the nurse to explain the possible effects of these disorders when not detected at birth. The nurse
mentions that which of the above disorders can result in retarded growth and brain development if not detected early?
a. Congenital hypothyroidism
c. Galactosemia
b. Thalassemia
d. Cerebral Palsy
5. Republic Act No. 9288 is the act promulgating a comprehensive policy and a national system for ensuring newborn screening.
Important provisions of this act are all of the following, except:
a. Health practitioners should inform the parents or legal guardians of the newborn of the availability, nature and benefits of
newborn screening
b. NBS shall be performed after 24 hours of life but not later than 3 days from complete delivery of the newborn
c. A newborn that must be placed in intensive care in order to ensure survival must be tested by 10 days of age
d. A parent or guardian may refuse testing on the grounds of religious beliefs
Situation: Baby A is a newborn delivered via normal spontaneous delivery. APGAR score during the first minute of life is 9. He is
now under your care for monitoring and immediate newborn interventions.
6. Knowing that the first minute APGAR score of Baby A is reflective of good adjustment, you should:
a. Take the APGAR score again after 15 minutes
b. Take the second APGAR scoring at 5 minutes after birth
c. Proceed with other interventions; the first minute APGAR is sufficient to determine the babys adjustment to extrauterine
life
d. Take the APGAR reading after 5 minutes and every 15 minutes thereafter to ensure stability of the newborns extrauterine
adjustment
7. An APGAR score of 9 at one minute after birth is most often due to:
a. Acrocyanosis
b. Weak cry
c. Flaccid extremities
d. Heart rate below 100
8. When assessing baby A for his APGAR score, you should keep in mind the five assessment categories and the scores given
for every observation. The following are true regarding the scoring in APGAR. Select all that apply.
1. A baby who is blue all over is given a score of 1 in the Color category
2. Heart rate of 10 is given a score of 0
3. When the baby, grimaces when suctioned, a score of 2 is given in the Reflex irritability category
4. If the baby is observed to be well flexed, a score of 2 is given in the Reflex irritability category
5. If the baby has a good cry, the baby is given a score of 2 in the respiration category
a. 5 only
b. 2 and 4
c. 3 only
d. 1 and 4
9. While taking Baby As APGAR score, you keep in mind that the most important assessment is the babys:
a. Heart Rate
b. Respiratory Rate
c. Muscle Tone
d. Reflex Irritability
10. You evaluate Baby As respiratory status using the Silverman and Anderson Scoring System. You conclude that Baby A does
not have respiratory distress if he has a score of:
a. 0
b. 5
c. 8
d. 10
Situation: A nurse receives a telephone call from the admitting office and is told that a child with rheumatic fever will be arriving
in the nursing unit for admission.
11. On admission, the nurse prepares to ask the mother which question to elicit assessment information specific to the
development of rheumatic fever?
a. Has the child complained of back pain?
c. Has the child had any nausea or vomiting?
b. Has the child complained of headaches? d. Did the child have a sore throat or fever within the last 2 months?
12. Acetylsalicylic acid (aspirin) is prescribed for the child. The nurse would question the order if there were documented
evidence that the child had which of the following?
a. Joint pain
b. Arthralgia
c. Facial edema
d. A viral infection
13. The nurse is reviewing the chart of the child. Which of the following laboratory results assisted the physician in confirming
the diagnosis of Rheumatic fever?
a. Immunoglobulin
b. Red blood cell count c. White blood cell count d. Antistreptolysin O titer
14. The nurse went over other laboratory and diagnostic study findings of the child. The following are consistent with the
diagnosis of Rheumatic Fever. Select all that do not apply:
1. Elevated erythrocyte sedimentation rate
2. Elevated C-reactive protein
3. CBC reveals transient anemia and elevated white blood cell count
4. Chest radiography study discloses cardiac enlargement
5. Electrocardiogram reveals a shortened PR interval

a. 1 only
b. 2 and 3
c. 4 only
d. 5 only
15. During admission, the nurse must promote adequate nutrition. The diet suitable for the childs condition is:
a. Rich in protein and adequate calories
c. Bland, protein-rich diet
b. Low salt and high in carbohydrates
d. Soft, high-carbohydrate diet
Situation: Gian, a 2-year-old child, is admitted to the pediatric unit with a diagnosis of nephrotic syndrome. You are the nurse
assigned in his care.
16. You are conducting an admission assessment on Gian. You know that the manifestations associated with nephritic syndrome
are the following. Select all that apply.
1. Hypertension
5. Massive proteinuria
2. Generalized edema
6. Weigh loss
3. Increased urinary output
7. Dark and frothy urine
4. Frank, bright red blood in the urine
8. Abdominal swelling
a. 1, 3, 4 and 6
b. 2, 5, 7 and 8 c. 1, 2, 3 and 4
d. 1, 3, 5 and 7
17. Gians mother feels guilty every time she sees her child. She asked you if Gian will ever look thin again. You appropriately
respond by telling the mother:
a. Do you feel guilty because you didnt notice the weight gain?
b. When children are little, its expected theyll look a little chubby
c. In most cases, medication and diet will control the fluid retention
d. Wearing loose-fitting clothing should help conceal the extra weight
18. Gian has severe edema. A priority nursing diagnosis for him would be risk for:
a. Constipation
c. Ineffective thermoregulation
b. Impaired skin integrity
d. Imbalanced nutrition: more than body requirements
19. You are to collaborate Gians care with dietary department. Which of the following should be observed with regards to Gians
nutritional intake? Select all that apply.
1. High protein
4. No salt
7. Liberal fluid intake
2. High calorie
5. Limit salt
3. Low protein
6. Fluid restriction
a. 2, 3, 4 and 7
b. 1, 2, 4 and 6
c. 1, 3, 5 and 6 d. 2, 3, 5 and 6
20. You are conducting a health teaching session with Gians parents. You should include all of the following in your health
teachings, except:
a. Explain measures to prevent infection
b. Explain that immunization with initial live vaccines, but not boosters, may cause relapse. Live vaccines should be held
until the child enters school
c. Explain that hospitalization is usually warranted every episode
d. Demonstrate hoe to test for urine albumin
Situation: Ramil, 1-month old, is seen in a clinic and is diagnosed with developmental dysplasia of the hip (DDH).
21. The nurse is assisting the physician during the examination of Ramil. The physician performs Ortolani maneuver. The nurse
is aware that this maneuver is performed to:
a. Assess for asymmetry on the affected side
b. Determine the presence of range of motion
c. Push the unstable femur head out of the acetabulum
d. Attempt reduction of the dislocated femoral head back into the acetabulum
22. The physician also performs Barlow maneuver. In this maneuver, the physician:
a. Attempts reduction of the dislocated femoral head back into the acetabulum
b. Assesses for asymmetry on the affected side
c. Pushes the unstable femur head out of the acetabulum
d. Determines the presence of range of motion
23. The nurse assesses the infant, knowing that which of the following findings would be noted in this condition?
a. Limited range of motion in the affected hip
b. An apparent lengthened femur on the affected side
c. Asymmetrical adduction of the affected hip when the infant is placed supine with the knees and hips flexed
d. Symmetry of the gluteal skinfolds when the infant is placed prone and the legs are extended against the examining table
24. Ramils mother asked the nurse the possible causes of DDH. The nurse responds by stating that the cause of DDH is
unknown, but it may result from one of the following, except:
a. Effect of maternal estrogen on the fetus, causing relaxation of the ligaments
b. Hip and leg positioning in utero, such as breech presentation
c. Genetic factors, including a positive family history
d. Fall injury during the neonatal period
25. The nurse provides instructions to the parents of Ramil regarding care of the Pavlik harness. Which of the following should
the nurse include in the instructions?
a. The harness should be worn 12 hours a day
b. The infant should not be moved when out of the harness
c. The harness needs to be removed for diaper changes and for feeding
d. The harness should be removed only to check the skin and for bathing
Situation: Sickle cell anemia is the most common form of sickle cell disease. Joey, 3 years old, is admitted to the pediatric unit
for treatment of vaso-occlusive crisis. The following questions are related to his care.
26. Clinical manifestations of sickle cell anemia are varied. The nurse understands the cause of clinical manifestations that occur
in sickle cell anemia when she states that:
a. Bone marrow depression occurs because of the development of sickled cells
b. Sickled cells increase blood flow through the body and cause a great deal of pain
c. Sickled cells mix with the unsickled cells and cause the immune system to become depressed
d. Sickled cells are unable to flow easily through the microvasculature and their clumping obstructs blood flow
27. Which orders documented in Joeys record should the nurse question? Select all that apply.
1. Restrict fluid intake
2. Position for comfort

3. Avoid strain on painful joints

4. Apply nasal oxygen at 2 L/min.
5. Provide a high-calorie, high-protein diet
6. Give meperidine (Demerol), 25 mg IV, every 4 hours for pain
a. 3 and 4
b. 1 and 6
c. 2 and 5
d. 4, 5 and 6
28. During admission, the nurse should provide the following appropriate therapeutic measures for Joey, except:
a. Apply heat to affected areas and avoid cold compresses
b. Institute bed rest and schedule nursing measures at the same time to minimize energy expenditure
c. Provide pharmacologic and non pharmacologic pain relief mechanisms
d. Position the child for maximum comfort
29. Joeys mother informed the nurse that Joey is still bottle feeding up to the present. She asked for advice on what to do
knowing that Joey should have already been weaned from bottle at his age. The nurse appropriately responds by stating:
a. Now is the best time to wean Joey from bottle
b. Postpone weaning until the child is feeling better
c. Weaning should not be your priority. If bottle feeding will provide more fluid intake for Joey, allow him to bottle feed as
long as he wants
d. This is not something to be concerned of. I know children who bottle feed up to 5 years of age
30. Prior to discharge, the nurse instructed Joeys mother 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. Stress
b. Trauma
c. Infection
d. Fluid overload
Situation: A 4 year old child is admitted to the hospital for abdominal pain. The mother reports that the child has been pale and
excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted.
Diagnostic studies are being performed on the child because acute lymphocytic leukemia is suspected.
31. The nurse understands that which diagnostic study will confirm the diagnosis?
a. A platelet count
c. Bone marrow biopsy
b. A lumbar puncture
d. White blood cell count
32. The diagnosis of acute lymphocytic leukemia was confirmed and the child is started on combination chemotherapy.
Laboratory results indicate that the child is neutropenic, and protective isolation procedures are initiated. The grandmother of the
child visits and brings a fresh bouquet of flowers picked from her garden and asks the nurse for a vase for the flowers. The
nurse responds to the mother by telling her:
a. I have a vase in the utility room, and I will get it for you
b. I will get the vase and wash it well before you put the flowers in it
c. The flowers from your garden are beautiful but should not be placed in the childs room at this time
d. When you bring the flowers into the room, place them on the bedside stand as far away from the child as possible
33. The child is complaining of nausea and the nurse suspects that the nausea is related to the chemotherapy regimen. The
nurse, concerned about the childs nutritional status, most appropriately would offer which of the following during this episode of
nausea?
a. Cool, clear liquids
c. Low-calorie foods
b. Low-protein foods
d. The childs favorite foods
34. Knowing that a child with leukemia is at risk for infection, the nurse should implement the following interventions. Select all
that apply.
1. Maintain the child in a private room
2. Reduce exposure to environmental organisms
3. Use strict aseptic technique for all procedures
4. Ensure that anyone entering the childs room wears a mask
5. Apply firm pressure to a needlestick area for at least 10 minutes
6. Avoid rectal suppositories and enemas
a. 1, 2, 3, 4, 5, 6
b. 2, 4, 5, 6
c. 1, 2, 3, 4
d. 2, 4, 5, 6
35. Prior to discharge, the nurse instructs the parents of the child regarding measures related to monitoring for infection. Which
statement, if made by the parent, indicates a need for further instructions?
1. I will take a rectal temperature daily
c. I will inspect the mouth daily for lesions
2. I will inspect the skin daily for redness
d. I will perform proper hand washing techniques
Situation: Nurses should be cautious when giving medications to pediatric patients. The following questions will test your ability
in safe drug administration.
36. Diphenhydramine hydrochloride (Benadryl), 25 mg orally every 6 hours, is prescribed for a child with an allergic reaction.
The child weighs 25 kg. The safe pediatric dosage is 5 mg/kg/day. The nurse determines that:
a. The dose prescribed is safe
c. The dose prescribed is too high
b. The dose prescribed is too low
d. There is not enough information to determine the safe dose
37. Penicillin G procaine 1,000,000 units IM, is prescribed for a child with an infection. The medication label reads 1,200,000
units per 2 ml.A nurse has determined that the dose prescribed is safe. The nurse administers how many milliliters per dose to
the child?
a. 0.8 mL
b. 1.2 mL
c. 1.44 mL
d. 1.66 mL
38. Morphine sulfate, 2.5 mg, IV piggyback, in 10 mL of normal saline, is prescribed for a child postoperatively. The medication
label reads 1/15 gr per mL. The nurse has determined that the dosage is safe. The nurse adds how many milliliters of
morphine sulfate to the 10 mL of normal saline solution?
a. 0.62 mL
b. 0.82 mL
c. 1.35 mL
d. 1.62 mL
39. Oral penicillin V potassium, 250 mg every 8 hours, is prescribed for a child with respiratory infection. The childs weight is 45
lb. The safe pediatric dosage is 25 to 50 mg/kg/day. The nurse determines that:
a. The dose prescribed is too low
b. The dose prescribed is too high
c. The dose prescribed is within the safe dosage range
d. There is not enough information to determine the safe dose
40. A physician has prescribed Phenobarbital sodium, 25 mg orally twice daily, for a child with febrile seizures. The medication
label reads Phenobarbital sodium, 20 mg per 5 ml. A nurse has determined that the dosage prescribed is safe for the child. The
nurse prepares to administer how many milliliters per dose to the child?

a. 0.2 mL

b. 4.5 mL

c. 6.25 mL

d. 7 mL

Situation: You are a community health nurse conducting follow-up visits to home delivered infants. Agatha, a 3-day-old baby, is
scheduled for a follow up visit today.
41. You are assessing Agatha for the presence of jaundice. Which anatomical area will provide the best data regarding the
presence of jaundice?
a. Nail beds
c. Membranes in the ear canal
b. Skin in the sacral area
d. Skin in the abdominal area
42. After assessing Agathas respiration, you concluded that everything was normal. Normal findings regarding an infants
respiration are as follows. Select all that apply.
1. Respiratory rate of 45 breaths per minute
2. The chest and abdomen rise at the same time during respirations
3. Periodic apnea of 5 seconds accompanied by cyanosis
4. Respiration is regular and shallow
5. RR decreases with sensory and tactile stimulation
a. 1 and 2
b. 1 and 3
c. 4 and 5
d. 2 and 4
43. You assessed Agathas vital signs. An assessment that caught your attention was a temperature of 37.8 degrees Celsius.
Based on your knowledge on an infants vital signs, you know that this:
a. Usually occurs secondary to fluid loss and poor intake of milk because of inability to suck well
b. Is an early sign of infection
c. Is caused by too hot external environment
d. Is commonly due to overdressing of babies: too many covers or clothes on the baby
44. Agathas mother expresses concern because one of Agathas eyes appears to be crossed. The appropriate and supportive
response you can make is which of the following?
a. The baby will probably need surgery
b. This condition is probably permanent
c. It should be observed because the other eye may do the same thing
d. This is normal in the young infant but should not be present after about age 4 months
45. During your home visit, you observed the presence of insects in the household. Agathas mother asked you if in case an
insect has somehow flown into the babys ear, what should be done?
a. Report to the clinic immediately
c. Use a tweezer to try to remove the insect
b. Use a flashlight to coax the insect out of the ear
d. Irrigate the ear
Situation: Melody, 4 years old, is in the pediatric ambulatory care unit and is scheduled for myringotomy. She is with her parents
and is in the waiting area.
46. The nurse overheard Melodys parents talking with other parents in the waiting area. Melodys mother was telling stories
about what Melody is able to do at her age. The nurse would expect that at this age, Melody would be able to:
a. Use 4-word sentences
c. Ask the definitions of new words
b. Name several different colors
d. Have a vocabulary of 1500 words
47. The nurse approached Melody and her family in the waiting room. When the nurse was about to sit down, Melody suddenly
yells, Dont sit on Erica! Melodys mother whispers that Erica is an imaginary friend. The nurses health teaching for this family
should include:
a. Special instructions for discipline
c. nvestigation by Child Protective Services
b. Referral for counseling regarding Erica
d. Increasing peer social interaction for their daughter
48. When talking with Melody, the nurse observes that the child is shy and stutters. The nurse is aware that stuttering in a 4year-old child is considered:
a. The result of an emotional problem
c. A common characteristic of a preschooler
b. An indication of speech impediment
d. A symptomatic delay in neural development
49. After several minutes in the waiting area, Melody is called to go to the operating room. The nurse should:
a. Remove the childs toys
c. Have the parents accompany the child
b. Allow the child to walk from the waiting area
d. Ask the parents to leave before giving sedation
50. Prior to sending Melody home, the nurse encouraged the childs parents to allow activities that would foster independence.
The nurse expects Melody to be able to:
a. Part and comb hair
c. Cut meat using a fork and a knife
b. Put on a shirt and button it
d. Slip into shoes and tie shoelaces
Situation: Gilbert, 4 years old, is rushed to the emergency department by his parents. Gilbert was continuously crying and does
not want anyone to touch his abdomen. His parents told the nurse that Gilbert was complaining of abdominal pain and now, the
pain seems unbearable.
51. The nurse assesses the childs abdominal pain by:
a. Asking the child to point where it hurts
b. Auscultating the childs abdomen for bowel sounds
c. Observing the position and behavior while the child is moving
d. Questioning the parents about their childs eating and bowel habits
52. Gilbert was admitted to the pediatric unit with diagnosis of appendicitis and is scheduled for an emergency appendectomy.
Based on an understanding of typical preschool behavior during hospitalization, the nurse is aware that Gilbert will probably:
a. Refuse to cooperate with nurses during the parents absence
b. Demonstrate despair if parents do not visit at least once a week
c. Cry when the parents leave and return but not during their absence
d. Be unable to relate to and play with peers in the playroom if there are parents present
53. The nurse plans care for Gilbert based on his developmental level. The nurse understands that children in this age-group are
vulnerable to:
a. Separation anxietyb. Altered family roles
c. Intrusive procedures d. Enforced dependency
54. During hospitalization, Gilbert can best have his developmental needs met if the nurse:
a. Helps him learn to read
b. Plays simple games with him
c. Encourages visits from family members
d. Provides materials for simulating home activities

55. Gilbert always pulls out his intravenous line. His arm is then immobilized during intravenous therapy. The most appropriate
play activity that the nurse should provide for him at this time is:
a. Watching television
c. Looking at comic books
b. Cutting out paper toys
d. Playing with jigsaw puzzles
Situation: Child Abuse is one of the situations a nurse should be ready to encounter.
56. When the adolescent mother of an infant admitted to the hospital with multiple traumas sees her infant in the intensive care
unit for the first time, she cries out, I didnt mean to hurt her. The nurse should:
a. Encourage the mothers family to visit and comfort her
b. Offer support by saying, This must be difficult for you
c. Notify the Child Abuse Hotline of this probable instance of abuse
d. Respond by saying, You caused your babys injury and you feel guilty
57. When assessing the family dynamics of a suspected abusing family, the nurse would be surprised to observe that the:
a. Parents provide little emotional support to the child
b. Child cringes and appears unduly afraid when approached
c. Parents offer consistent, detailed stories about the injuries
d. Child has many unexplained old injuries, scars, and bruises
58. A toddler who has been physically abused is admitted to the pediatric unit. When approaching this child, the nurse should
expect the child to:
a. Smile readily when anyone enters the room
b. Be wary of physical contact initiated by anyone
c. Begin to cry when anyone approaches the bedside
d. Pay little attention to anyone standing at the bedside
59. A female client who has been abusing her son is receiving treatment to control her behavior. The clients statement that
indicates the development of insight into her behavior as a parent is:
a. I promise I wont get so angry when my son causes trouble again
b. Once my son gets straightened out, we would not have these problems
c. I think the root of the problem is when my husband comes home after drinking
d. I feel angry at my son again, Im going to find a pillow in the bedroom to punch
60. A toddler is brought to the emergency room by her parents. The parents claimed that the child feel off a chair and broke her
leg. The child is unconscious and is in a deteriorating condition. Upon assessment, you noticed multiple bruises at different
stages of healing. The childs mother approached you and told you that these injuries were caused by her husband. What should
be your initial action?
a. Ensure the childs safety by preventing the father from seeing the child
b. Document the mothers statement accurately and objectively
c. Assist the physician in giving emergency care
d. Call security to ensure that the father does not leave the hospital premises
Situation: A competent nurse should be aware of drug-related responses. The following questions apply:
61. A 14-year-old with osteomyelitis is admitted to the pediatric unit with IV antibiotics to be administered four times a day. The
nurse knows that in order to maintain constant blood level, the antibiotics should be administered at:
a. 8 AM, 12 PM, 4 PM, 8 PM
c. 6 AM, 12 PM, 6 PM, 12 AM
b. 8 AM, 4 PM, 12 AM, 4 AM
d. 10 AM, 2 PM, 10 PM, 2 AM
62. An infant with a seizure disorder is receiving Phenobarbital. The infant becomes lethargic and sleeps for long periods. The
nurse may reduce the mothers anxiety by telling her:
a. The doctor may order a drug to prevent this problem
b. This means your babys dose of medication needs to be adjusted
c. This is a temporary response to the drug that usually stops after several weeks
d. Many infants experience the same problem but your baby needs the medication
63. The nurse is reviewing discharge instructions with the parent of an infant with cystic fibrosis. The statement that indicates
that the parent knows how to administer the pancreatic enzyme replacement is:
a. I will give the medication with feedings
b. I will give the pills in applesauce every morning
c. I must dissolve the enteric-coated pills in the formula
d. I must give the medication every 6 hours including during the night
64. Screening for hearing loss should be planned for a child who is receiving:
a. Amoxicillin
b. Gentamicin
c. Clindamycin d. Ciprofloxacin
65. A 7-year-old boy with the diagnosis of attention-deficit/hyperactivity disorder (ADHD) is receiving methylphenidate (Ritalin).
His mother is concerned that he will be doped up. The nurse explain that:
a. The medication usually causes an increase in appetite
b. Your child must continue to take the medication until adulthood
c. This is a short-acting medication that must be administered four times a day
d. Stimulants have a calming effect when given to children who have ADHD
Situation: Miley, 5 years old, is brought to the emergency department with chief complaints of acute crampy abdominal pain,
vomiting, constipation and anorexia. A history of pica was determined. Laboratory findings include anemia and serum lead level
on 80 mcg. Hence, Miley was admitted with diagnosis of lead poisoning and was immediately scheduled for chelation therapy.
66. Miley is to receive succimer (Chemet). The nurse recognizes that chelating agents cause:
a. Lead to be excreted in the urine
c. Free lead to be excreted from the feces
b. Lead to be removed form the bone
d. Free lead to combine with hemoglobin
67. Priority nursing care for Miley who is on chelation therapy for lead poisoning should include:
a. Scrupulous skin acre
c. Careful monitoring of intake and output
b. Providing a high-protein diet
d. Drawing blood daily for liver function tests
68. Because the chelating agent may cause hypocalcemia, the child should be encouraged to choose a menu consisting of:
a. Beef broth, glazed ham, potato salad, and green beans
b. Chicken noodle soup, liver and onions, creamed carrots, and fruit
c. Vegetable soup, roast beef and gravy, mashed potatoes, peas, and fruit
d. Cream of mushroom soup, fried shrimp, and broccoli covered with cheese sauce

69. The nurse knows that in order to evaluate the success of chelation therapy, which of the following should be monitored?
a. Fecal excretion of lead
c. Increased urinary excretion of lead
b. Elevated blood-lead levels
d. Decreased deposition of lead in the bones
70. The nurse plans to conduct a health teaching session with parents regarding prevention of lead poisoning. The following
should be included in the teaching plan. Select all that do not apply.
1. Ensure that your child does not have access to peeling paint or chewable surfaces that are coated with lead-based paint
2. Wash and dry your childs hands frequently
3. Avoid planting grass or placing ground cover on soil
4. Use inadequately fired ceramic ware or pottery for food or drink
5. Store food and drink in lead crystal
a. 3, 4 and 5
b. 3 and 4
c. 2 and 5
d. 1, 4 and 5
Situation: Ethan, 8 months old, is admitted for surgery for hypospadias.
71. Ethans mother asks the nurse how this defect could have happened. The nurse responds that this defect occurred during
fetal development in the:
a. First trimester
b. Third trimester
c. Second trimester
d. Implantation phase
72. After knowing that hypospadias developed during the fetal period, the mother cries and says So this is my fault. It is me who
placed by son in such endeavor. The nurse responds therapeutically by stating:
a. Was it something I said that made you disappointed?
b. Why do you feel guilty? Was there something you did while you were pregnant?
c. This may be difficult for you. We could talk more if you like
d. I know exactly how you feel. Would you like to talk about it?
73. The plan of care for Ethan should include:
a. Interpreting for the parents the genetic basis of the defect
b. Preparing the infant for the insertion of a cystostomy tube
c. Keeping the infants penis wrapped with petrolatum gauze
d. Explaining to the parents why a circumcision should not be done
74. Ethans mother asks the nurse why surgical repair needs to be performed. The nurse is correct when she states the following
reasons for repair of hypospadias, except:
a. To improve the childs ability to stand when urinating
b. To improve the appearance of the penis
c. To decrease the incidence of urinary tract infections
d. To preserve sexual adequacy
75. During the postoperative period, it is important for the nurse to:
a. Minimize pain with adequate analgesia
c. Maintain the surgically implanted tension device
b. Ensure that the childs privacy is maintained
d. Gradually increase the time that the catheter is clamped
Situation: Hazel, 6 months old, is admitted to the pediatric cardiac unit with diagnosis of Pulmonic Stenosis.
76. The parent of Hazel asked the nurse, The doctor said my baby has pulmonic stenosis. What does that mean? The nurse
should respond:
a. What else did your doctor say?
c. Are you concerned about your baby?
b. Your baby has a heart problem
d. Ill page your doctor so that you can discuss this again
77. Hazels mother stated: Im so afraid. Every time my baby turns blue, I feel like she is going to have a heart failure. The
nurse teaches Hazels mother how to detect impending heart failure. An early sign is:
a. Distended neck veins
c. Tachycardia and dyspnea
b. Increased urinary output
d. Gasping and grunting respirations
78. Hazel is being fed by the nurse in the semi-Fowlers position. After the nurse feeds and burps Hazel and changes her
position, Hazel has a bowel movement and almost immediately becomes cyanotic, diaphoretic, and limp. Theses signs were
most likely caused by:
a. Burping
b. Feeding
c. Position change
d. Bowel movement
79. Hazed was scheduled for cardiac catheterization to determine the degree of the stenosis. Hazel has just returned to the unit
after cardiac catheterization. The nurse manager immediately intervenes when the infants nurse:
a. Performs range-of-motion exercises
c. Monitors the apical pulse for rate and rhythm
b. Administers fluids and foods as tolerated
d. Assesses the pulses distal to the catheterization site
80. The nurse is planning to give discharge instructions to Hazels parents. Keeping in mind that Hazel underwent cardiac
catheterization, the nurse should include:
a. Giving a sponge bath for the first 3 days at home
b. Using ice compresses every 20 minutes at the entry site
c. Limiting fluid intake for the next 3 days to prevent nausea
d. Returning to the clinic in 5 days for removal of the pressure dressing
Situation: A group of nurse researchers is conducting a study entitled: The effect of Guava decoction on the healing rate of
lesions in children diagnosed with Eczema. The following questions are relevant to their research.
81. The research problem of the above title is best stated as:
a. Is guava decoction effective in managing children with eczema?
b. What is the effect of guava decoction on the healing rate of lesions in children diagnosed with eczema?
c. Do lesions of children with eczema heal faster when they are treated with guava decoction?
d. How much guava decoction is needed to achieve the desired effect of having a faster healing rate?
82. In the given study, the variable to be measured is:
a. Healing rate
b. Number of lesions
c. Eczema
d. Guava decoction
83. On the other hand, the variable to be manipulated is:
a. Healing rate
b. Number of lesions
c. Eczema
d. Guava decoction
84. The group of children who will receive guava decoction for the treatment of eczema is referred to as:
a. Control group
b. Experimental group
c. Research group
d. Endogenous group
85. In this research wherein the subjects are children, the researchers should know that informed consent:
a. Is not vital especially because the treatment involved is simply topical and does not pose any risk on the childrens wellbeing
b. Should be obtained from the childrens parents or legal guardian

c. Should be discussed and decided in court

d. Should be obtained form the state where the research will be conducted
Situation: Nurses assigned in the pediatric ward should be clinically competent in assessing and determining normal and
abnormal pediatric assessment findings.
86. The nurse is aware that the play of a 5-month-old infant would probably consist of:
a. Picking up a toy and putting it into the mouth
b. Waving the fists and dropping toys placed in the hands
c. Exploratory searching when an object is hidden from view
d. Simultaneously kicking the legs while batting the hands in the air
87. While caring for 6-month-old infants, it is likely that the nurse will observe the infants to:
a. Abduct and extend their arms and legs, their fingers assume a typical C position, and they then bring their arms into an
embrace position and pull up their legs against their abdomen when the nurse jar their bassinet
b. Fan their toes when the side of the sole of the foot is stroked in an inverted J curve from the heel upward
c. Extrude any substance that is placed on the anterior portion of the tongue
d. Extend the arm and the leg on the side to which the head turns, and the opposite arm and leg contract
88. A 1-month-old infant is admitted for confirmation of the diagnosis of ventricular septal defect. During the initial admission
assessment, the nurse would expect to find:
a. Bradycardia at rest
c. An activity related cyanosis
b. Bounding peripheral pulses
d. A murmur at the left sterna border
89. To best ascertain the magnitude of fluid loss of an infant with gastroenteritis and diarrhea, the nurse should:
a. Evaluate the infants skin turgor
b. Note the elevation of the infants hematocrit value
c. Assess the moistness of the infants mucous membranes
d. Compare the infants preillness weight with the current weight
90. The nurse is caring for a child with diabetes and suspects that the child is experiencing an episode of hyperglycemia. Which
assessments led the nurse to this conclusion? Select all that apply.
1. Irritability
4. Increased thirst
2. Headache
5. Redness of the face
3. Diaphoresis
6. Deep, rapid breathing
a. 1, 3 and 4
b. 4, 5 and 6
c. 2, 3 and 4
d. 1, 2 and 5
Situation: Romeo, 11 years old, is hospitalized with juvenile idiopathic arthritis.
91. The primary objective of care for Romeo is preventing and correcting:
a. Infection
c. Contracture deformities
b. Hemarthrosis
d. Delayed intellectual development
92. Romeo complains of pain in the knees. The intervention that would most likely relieve some of the discomfort is:
a. Immobilizing the affected joints
c. Massaging the swollen areas gently
b. Supporting the knees with pillows
d. Applying moist heat to the affected areas
93. Several nursing diagnoses were identified by the nurse caring for Romeo. Of the following, which should the nurse prioritize
in the care of Romeo?
a. Risk for peripheral neurovascular dysfunction
c. Acute pain
b. Risk for injury
d. Impaired skin integrity

94. The nurse is helping Romeo perform range-of-motion exercises. The nurse knows that the exercise have been effective
when the:
a. Knees become more mobile
c. Childs pedal pulses become stronger
b. Child states that there is less pain
d. Subcutaneous nodules at the joints recede
95. Romeo is now for discharge. Prior to discharge, the nurse teaches him activities that will prevent the loss of joint function.
The nurse should caution Romeo to avoid:
a. Riding a bicycle
b. Walking to school
c. Isometric exercises
d. Sitting for long periods
96.
97. Situation: Irene, an 8-week-old infant diagnosed with pyloric stenosis is admitted to the surgical pediatric ward and is
scheduled for pyloromyotomy.
98. The nurse admitting Irene does her admission assessment. Before doing the admission assessment of the abdomen, the
nurse bicycles the infants legs. This enables the nurse to:
a. Palpate abdominal contour
c. Relax the abdominal muscles
b. Assess abdominal rebound
d. Detect weak abdominal muscles
99. The mother of Irene states that she has never heard of pyloric stenosis and asks many questions. When responding, the
nurse should emphasize that:
a. It is unlikely that surgery is necessary, your child might be a unique case
b. This is a disorder with an excellent prognosis
c. This disorder results from an inborn error of metabolism
d. It is unlikely that special feedings will be necessary for several months
100. Irene is sent to the operating room for surgery. The nurse caring for her anticipates the postoperative orders that will be
given. Oral feedings usually are initiated a few hours after surgery. The nurse expects that initially the infant will receive:
a. Clear fluids
c. Full-strength formula
b. Half-strength formula
d. Thickened formula with cereal
101. Immediately after surgery, Irene is to receive nothing per mouth. An important nursing intervention at this point would be:
a. Provide good oral care
c. Increase flow of intravenous fluid
b. Offer a pacifier
d. Assess for dehydration
102. 100. Irene underwent surgery and is now being fed by her mother. To decrease the chance of vomiting after feedings, the
nurse teaches the mother that after a feeding, Irene should be:
a. Rocked for 20 minutes
c. Positioned flat on the right side
b. Placed in an infant seat
d. Kept awake with sensory stimulation