PEDIATRIC NURSING

SYNERGY REVIEW AND TRAINING CENTER

Situation 1. You are working as a Pediatric Nurse in your own Child
Health Nursing Clinic. The following cases pertain to Assessment
and Care of the Newborn at Risk conditions.
1. A mother of a 2-year-old daughter asks, At what age can I be
able to take the blood pressure of my daughter as a routine
procedure since hypertension is common in the family? The
most appropriate response would be:
a) 2 years old
c. 3 years old
b) 4 years old
d. 6 years old
2. You typically gag children to inspect the back of their throat.
When is it important not to elicit a gag reflex?
a. When a child has symptoms of epiglottitis
b. When a girl has a geographic tongue
c. When a boy has a possible inguinal hernia
d. When children are under 5 years of age
3. An infant was given a drug at birth to reverse the effects of a
narcotic given to his mother in labor. What drug is commonly
used for this:
a. Morphine Sulfate
b. Naloxone (Narcan)
c. Sodium Chloride
d. Penicillin G
4. Why are small-for-gestational-age newborns at risks for difficulty
maintaining body temperature?
a. They are more active than usual so throw off covers
b. They do not have as many fat stores as other infants
c. Their skin is more susceptible to conduction of cold
d. They are preterm so are born relatively small in size
5. An infant develops hyperbilirubinemia. What is a method used to
treat hyperbilirubinemia in a newborn?
a. Keeping infants in a warm and dark environment
b. Administration of cardiovascular stimulant
c. Early feeding to speed passage of meconium
d. Gentle exercise to stop muscle breakdown
Situation 2. Knowledge of the Growth and Developmental milestones
of children allows the parents and health care providers alike to
identify delays in the growth and development of the child.
6. While performing a neurodevelopmental assessment on a 3month-old infant, which of the following characteristics would be
expected?
a) A strong Moro reflex
b) Lifting of head and chest when prone
c) A strong parachute reflex
d) Rolling from front to back
7. What should the nurse emphasize when guiding parents about
teething of their 6-month-old infant?
a) Drooling is not normal and indicates that something is
wrong
b) Providing a frozen teething ring helps relieve the
inflammation
c) Most infants will have a high fever and will be irritable and
refuse to eat
d) The use of teething powders and hard candy is
encouraged
8. Infants at 10 months discover object permanence. Which action
would show an infant has developed object permanence?
a) He cores when he is either hungry or lonely

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b) He prefers a large yellow ball to a a small red one

c) He looks for a cheese curl that falls off his high chair tray
d) He smiles when the mobile on his crib jingles
A 15-month old is playing in the playpen. The nurse evaluates
that the child's ability to perform physical tasks is at the agerelated norm when the child is able to:
a) Throw all the toys out of the playpen
b) Stand in the playpen holding onto the sides
c) Build a tower of 6 blocks
d) Walk across the playpen with ease
In which circumstance would a nurse be concerned about
language development of a 3-year-old child?
a) The child uses pronouns and prepositions when talking
b) The child has a vocabulary of about 900 words
c) The child is inquisitive and asks why a majority of the time
d) Conversation with the child is 50% intelligible
How many words does a typical 12-month-old infant use?
a) Two, plus mama and papa
b) About 12 words
c) Twenty or more words
d) About 50 words
An important nursing consideration when performing physical
assessment on a newborn is to:
a) Maintain body temperature
b) Prevent squirming
c) Examine the ears and throat before the eyes and nose
d) Avoid restraints
In doing admission assessment, the nurse should expect to find
which signs of dehydration in an infant?
a) Fever and bradycardia
b) Irritability and sunken eyeballs
c) Dry mucous membranes and bulging anterior fontanel
d) Hypotension and anuria
When preparing to administer the vitamin K to a neonate, the
nurse would select which of the following sites as appropriate for
the injection?
a) Deltoid muscle
b) Anterior femoris muscle
c) Gluteus maximus muscle
d) Vastus lateralis muscle
When assessing the newborn's heart rate, which of the following
ranges would be considered normal if the newborn was
sleeping?
a. 80 bpm
c. 120 bpm
b. 100 bpm
d. 140 bpm
Which of the following groups of newborn reflexes are present at
birth and remain unchanged through adulthood?
a) Blink, cough, rooting and gag
b) Rooting, sneeze, swallowing and cough
c) Blink, cough, sneeze, and gag
d) Stepping, blink, cough, and sneeze
Which of the following may represent an emotional stress from
hospitalization usually experienced by the toddler?
a) Loss of control
b) Fear of bodily injury
c) Separation anxiety
d) Fear of death
During the first 4 hours after a male circumcision, assessing for
which of the following is the priority?
a. Infection
c. Discomfort
b. Hemorrhage
d. Dehydration

19. What is the best way to test Moro reflex?

a) Lift the infant's head while she is supine and allow it to fall
back one inch
b) Observe the infant while she is on her abdomen to see
whether she can turn her head
c) Shake the infant's crib until the infant responds by flailing
her arms
d) Make a sharp noise, such as clapping your hands, to wake
an infant
20. When describing a preterm newborn, the nurse would describe
the newborn as being born at which of the following?
a) Before 25 weeks' gestation
b) After 25 weeks' gestation
c) Before 37 weeks' gestation
d) After 37 weeks' gestation
21. When teaching a mother how to prevent accidents while caring
for her 6-month-old infant, the nurse should emphasize that at
this age, a child can:
a) Roll over
b) Sit up
c) Crawl lengthy distances
d) Stand while holding on to furniture
22. When providing nursing care to a preschooler, the nurse should
remember that a child this age has a fear of:
a) Pain
c. Isolation
b) Death
d. Mutilation
23. A newborn is admitted to the intensive care nursery with the
diagnosis of choanal atresia. The nurse is aware that choanal
atresia is an anomaly located in the:
a) Anal area
c. Intestinal tract
b) Nasopharynx
d. Pharynx and
larynx
24. Which among the following is true about death and dying?
a) The nurse should encourage the parents of a child in the
dying phase to stay close to the room because the child
will not live more that 2 or 3 days
b) Emergency drugs are best delivered intravenously as the
child nears death to promote absorption and improve onset
of drug action
c) At the onset of death, metabolism increases, and the child
may become flushed because cardiac stroke volume
increases
d) The nurse should avoid focusing on self-awareness when
preparing to work with a dying child because the focus
should be on the child and the family.
25. An 11-year-old child is admitted with vaginal bleeding. The
nurse notices that the child and her mother are very nervous but
state that they are sure it's just menstrual blood. The nurse
should initially do which of the following?
a) Accept the fact that the child is probably beginning
menses; don't jump into conclusions
b) Gently examine the child for torn perineal tissue or
lacerations
c) Explain to the child and her mother that menstrual bleeding
does not occur at this early age
d) Insist the child's mother tell if someone is abusing her child
26. Which approach should be included in the plan of care for a 14year-old client who is admitted following a sexual abuse
incident?
a) Encourage communication and listen attentively
b) Medicate the client with lorazepam (Ativan)

c)

Limit communication with the client's parents and reinforce

the secret
d) Encourage the client to immediately engage in normal
routines and social activities
27. When a child begins to use an insulin pump, her parent must
wake at 2:00 am and test her for hypoglycemia. The reason the
blood glucose may drop at this time may be too little:
a. Food
c. Fluid
b. Exercise
d. Sodium
28. On the third day of hospitalization, a 2-year-old child who had
been screaming and crying inconsolably begins to regress and
now is lying quietly in the crib with a blanket. The nurse
recognizes that the child is in the stage of:
a. Denial
c. Mistrust
b. Despair
d. Rejection
29. Which of the following may represent an emotional stress from
hospitalization usually experienced by the toddler?
a) Loss of control
b) Fear of bodily injury
c) Fear of death
d) Separation anxiety
30. An important nursing consideration when performing physical
assessment on a newborn is to:
a) Maintain body temperature
b) Prevent squirming
c) Examine the ears and throat before the eyes and nose
d) Avoid restraints
Situation (31- 35) Ms. Jessica Oliver gave birth to a 7.1 lbs male
infant 20 minutes ago. She had completed 37 weeks of a healthy
pregnancy.
31. The normal vital statistics of newborn includes, EXCEPT:
a. Average length is 45-55 cm
b. Average head circumference is 32 cm
c. Average chest and abdominal circumference is 31-33
d. Average weight lost is 6.7% to 7.8% of total weight
32. Which among these statements about newborn is CORRECT?
a. Bregma closes at 12-18 months, Lambda closes at 2-3
months
b. The eyes of a newborn have conjunctival hemorrhage and
conjunctivitis thats why you are giving erythromycin.
c. Neonate is termed as first 28 days up to 1 year.
d. Newborn are obligatory mouth breathers and needs to
suction first the mouth to prevent aspiration pneumonia.
33. Which among these statements about newborns vital signs is
INCORRECT?
a. HR: 120-160 bpm, irregular, when crying: 180bpm; when
sleeping: 100bpm
b. RR: 30-60 bpm, with a short period of apnea not lasting for
15 secs, irregular
c. Temp: 36.5-37.5, taken temp via axillary immediately at
birth
d. BP: 80/46, routinely on three years old
34. Which among these statements about APGAR SCORE is
CORRECT?
a. The lowest score is 0 and lowest number is 0
b. Reflex irritability is initiated by tangential foot slap only
c. It is measured on the first 1 minute and on the next 15
minutes
d. Acrocyanosis is expected, pink extremities, blue body
35. On the 5th minute, the doctor scored the newborn as 5. What
nursing intervention is the BEST?

a.

Do nothing, because the newborn is good or healthy and

he is adjusting well to extrauterine life
b. Notify the physician immediately because this is life
threatening
c. The newborn is moderately depressed with additional
suctioning needed and O2 administration
d. The newborn is severely depressed and needs NICU
admission and CPR
SituatioN (36- 40) Mrs. Cruz has just given birth to a healthy female
infant an hour ago.
36. What is the most important responsibility of the nurse
immediately after delivery the newborn?
a. Establishment and maintaining effective respiration
b. Establishment of extra uterine circulation
c. Control of body temperature
d. Intake of adequate nourishment
37. Which among these statements about suctioning the mouth is
INCORRECT?
a. Compress the bulb syringe first before inserting in the
mouth to prevent air from forcing mucus back into the
bronchi and alveoli
b. Suction nose first, then the mouth to prevent aspiration of
mucus and amniotic fluid
c. Suction mouth first, then the nose to prevent aspiration of
mucus and amniotic fluid
d. Insert bulb syringe on one side of the mouth so that you will
not simulate gag reflex
38. The following are ABNORMAL cry of newborn, EXCEPT?
a. High pitched cry
b. Weak cry
c. Hoarse cry
d. Loud and Lusty cry
39. Oral mucus may cause the newborn to choke, cough or gag
during the first 12 to 18 hours of life. What is the best position to
place the CS newborn to promote drainage of secretions?
a. Trendelenburg position
b. Supine position
c. Prone position
d. Side lying position
40. Giving oxygen is necessary for a newborn. But giving too much
oxygen is avoided because this can result in what condition?
a. Retrolental fibroplasia
b. Subconjunctival hemorrhage
c. Neisseria Gonorrhea
d. Chlamydia
Situation (41- 45) Different responsibilities of a nurse are very crucial
immediately after birth.
41. What is the rationale why Vit K is given to a newborn
immediately at birth?
a. The newborn is at risk for bleeding
b. The gastrointestinal tract is sterile at birth and unable to
produce vitamin K necessary for blood coagulation
c. Given 0.5 mg for preterm and 1.0 mg for term
d. Given via IM vastus lateralis
42. The following are correct definition of heat loss EXCEPT:
a. Radiation: transfer of body heat to a cooler solid in contact
with the body
b. Convection: flow of heat from the body surface to cooler
surrounding air
c. Conduction: transfer of body heat to a cooler solid object in
contact with the body

d.

Evaporation: loss of heat through conversion of a liquid to a

vapor
43. Which among these are two effects of cold stress or
hypothermia?
a. Hyperglycemia and metabolic acidosis
b. Hypoglycemia and metabolic acidosis
c. Hypoglycemia and respiratory acidosis
d. Hyperglycemia and respiratory acidosis
44. What is the BEST nursing intervention to prevent heat loss?
a. Dry body of amniotic fluid immediately after birth because
conduction of amniotic fluid from babys skin can contribute
to excessive heat loss
b. Wrap the newborn with a dry and alternate it with wet.
c. Give the baby to the mother to hold. The warmth of her
body can be a source of heat for the newborn
d. Cover the head immediately because this is a large surface
area with great amount of heat loss
45. How will the mother initiate breast-feeding?
a. By touching the middle of the lip then the baby will suck
b. When the food touches the posterior portion of the tongue,
the newborn will swallow
c. Stimulate the newborns side of lips or cheeks and the baby
will turn to side of stimulus
d. When the food touches the anterior portion of the tongue,
the baby will spit up
Situation (46- 50) Knowledge regarding newborn is very important
so that the nurse will give a correct health teaching.
46. Which among these reflexes disappeared by 6th month?
i. Palmar
ii. Rooting
iii. Sucking
iv. Moro

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48.

49.

50.

a. I, II, III c. I, III, IV

b. II, III, IV d. None of the above
Which of the following would the nurse identify as a goal of
newborn care in the initial postpartum period?
a. To facilitate development of close parent newborn
relationship
b. To assist parents in developing health attitudes about
childrearing practices
c. To identify actual or potential problems requiring immediate
or emergency attention
d. To provide the parents of the newborn with information
about well-baby programs.
The initial respirations in the newborn are a result of which of
the following?
a. A rise in temperature
b. A change in pressure gradients
c. Increased blood ph
d. Decreased blood CO2 level
Before birth, which of the following structures connects the right
and left atrium of the heart?
a. Umbilical vein
c. Ductus arteriosus
b. Foramen ovale
d. Ductus venosus
Which among these statements regarding circulatory system of
fetus is INCORRECT?
a. 2 Arteries and 1 vein
b. Ductus venosus bypasses the liver and Ductus arteriosus
is the opening between the aorta and pulmonary artery

c.

Foramen Ovale, Ductus arteriosus and Ductus Venosus

starts to close at birth

d. The 2 arteries caries the oxygenated blood from the

placenta and the 1 vein carries the unoxygenated blood
back to the placenta.