1.

On examination, a nurse hears a murmur at the left sternal border (LSB) in a child with
diarrhea and fever. The parent asks why the health-care provider never said anything about the
murmur. The nurse explains:
A. “The health-care provider is not a cardiologist.”
B. “Murmurs are difficult to detect, especially in children.”
C. “The fever increased the intensity of the murmur.”
D. “We need to refer the child to an interventional cardiologist.”

2. While assessing a newborn with respiratory distress, the nurse auscultates a machine-like
heart murmur. Other findings are a wide pulse pressure, periods of apnea, increased Pa CO2,
and decreased PO
2. The nurse suspects that the newborn has:
A. Pulmonary hypertension.
B. Patent ductus arteriosus (PDA).
C. Ventricular septal defect (VSD).
D. Bronchopulmonary dysplasia.

3. The following are the most serious complications for a child with Kawasaki disease (KD)
except?
A. Coronary thrombosis.
B. Coronary stenosis.
C. Coronary artery aneurysm.
D. Hypocoagulability.

4. The nurse is caring for a child with Kawasaki disease (KD). A student nurse who is on the unit
asks if there are medications to treat this disease. The nurse’ s response to the student nurse is:
A. Immunoglobulin G and aspirin.
B. Immunoglobulin G and ACE inhibitors.
C. Immunoglobulin E and heparin.
D. Immunoglobulin E and ibuprofen (Motrin).

5. Congenital heart defects (CHDs) are classified by the following except?

A. Cyanotic and acyanotic defects.
B. Mixed defects
C. Defects with increased pulmonary blood flow.
D. Defects with decreased pulmonary blood flow.

6. During a well-child checkup for an infant with tetralogy of Fallot (TOF), the child develops
severe respiratory distress and becomes cyanotic. The nurse’ s first action should be to:
A. Lay the child flat to promote hemostasis.
B. Lay the child flat with legs elevated to increase blood flow to the heart.
C. Sit the child on the parent’s lap, with legs dangling, to promote venous pooling.
D. Hold the child in knee-chest position to decrease venous blood return.
7. Hypoxic spells in the infant with a congenital heart defect (CHD) can cause the following
except?
A. Polycythemia.
B. Blood clots.
C. Cerebrovascular accident (CVA).
D. Developmental delays.
E. Viral pericarditis.
F. Brain damage.

8. A toddler who has been hospitalized for vomiting because of gastroenteritis is sleeping and
difficult to wake up. Assessment reveals vital signs of a regular HR of 220 beats per minute,
respiratory rate of 30 per minute, BP of 84/52, and capillary refill of 3 seconds. Which
dysrhythmia does the nurse suspect in this child?
A. Rapid pulmonary flutter.
B. Sinus bradycardia.
C. Rapid atrial fibrillation.
D. Supraventricular tachycardia.

9. BP screenings to detect end-organ damage should be done routinely beginning at what age?
A. Birth.
B. 3 years.
C. 8 years.
D. 13 years.

10. What associated manifestation might the nurse occasionally find in a child diagnosed with
Wilms tumor?
A. Atrial fibrillation.
B. Hypertension.
C. Endocarditis.
D. Hyperlipidemia.

11. Which drug should not be used to control secondary hypertension in a sexually active
adolescent female who uses intermittent birth control?
A. Beta blockers.
B. Calcium channel blockers.
C. ACE inhibitors.
D. Diuretics.

12. A 16-year-old being treated for hypertension has a history of asthma. Which drug class
should be avoided in treating this client's hypertension?
A. Beta blockers.
B. Calcium channel blockers.
C. ACE inhibitors.
D. Diuretics.
13. While looking through the chart of an infant with a congenital heart defect (CHD) of
decreased pulmonary blood flow, the nurse would expect which laboratory finding?
A. Decreased platelet count.
B. Polycythemia.
C. Decreased ferritin level.
D. Shift to the left.

14. The following are examples of acquired heart disease except?

A. infective endocarditis.
B. Transposition of the great vessels.
C. Rheumatic fever (RF).
D. Cardiomyopathy.
E. Kawasaki disease (KD).

15. A child diagnosed with congestive heart failure (CHF) is receiving maintenance doses of
digoxin (Lanoxin) and furosemide (Lasix). She is rubbing her eyes when she is looking at the
lights in the room, and her HR is 70 beats per minute. The nurse expects which laboratory
finding?
A. Hypokalemia.
B. Hypomagnesemia.
C. Hypocalcemia.
D. Hypophosphatemia.

16. Which plan would be appropriate in helping to control congestive heart failure (CHF) in an
infant?
A. Promoting fluid restriction.
B. Feeding a low-salt formula.
C. Feeding in semi-Fowler position.
D. Encouraging breast milk.

17. in which congenital heart defect (CHD) would the nurse need to take upper and lower
extremity BPs?
A. Transposition of the great vessels.
B. Aortic stenosis (AS).
C. Coarctation of the aorta (COA).
D. Tetralogy of Fallot (TOF).

18. A 10-year-old has undergone a cardiac catheterization. At the end of the procedure, the
nurse should first assess:
A. Pain.
B. Pulses.
C. Hemoglobin and hematocrit levels.
D. Catheterization report.
19. Which statement by the mother of a child with rheumatic fever (RF) shows she has good
understanding of the care of her child?
A. “I will apply heat to his swollen joints to promote circulation.”
B. “I will have him do gentle stretching exercises to prevent contractures.”
C. “I will give him his ordered anti-inflammatory medication for pain and inflammation.”
D. “I will apply cold packs to his swollen joints to reduce pain.”

20. A child has been diagnosed with valvular disease following rheumatic fever (RF). During
patient teaching, the nurse discusses the child's long-term prophylactic therapy with antibiotics
for dental procedures, surgery, and childbirth. The parents indicate they understand when they
say:
A. “She will need to take the antibiotics until she is 18 years old.”
B. “She will need to take the antibiotics for 5 years after the last attack.”
C. “She will need to take the antibiotics for 10 years after the last attack.”
D. “She will need to take the antibiotics for the rest of her life.”

21. A child born with Down syndrome should be evaluated for which associated cardiac
manifestation?
A. Congenital heart defect (CHD).
B. Systemic hypertension.
C. Hyperlipidemia.
D. Cardiomyopathy.

22. The Norwood procedure is used to correct:

A. Transposition of the great vessels.
B. Hypoplastic left heart syndrome.
C. Tetralogy of Fallot (TOF).
D. Patent ductus arteriosus (PDA).

23. A child has a Glasgow Coma Scale of 3, HR of 88 beats per minute and regular, respiratory
rate of 22, BP of 78/52, and blood sugar of 35 mg/dL. The nurse asks the caregiver about
accidental ingestion of which drug?
A. Calcium channel blocker.
B. Beta blocker.
C. ACE inhibiter.
D. ARB.

24. Exposure to which illness should be a cause to discontinue therapy and substitute
dipyridamole (Persantine) in a child receiving aspirin therapy for Kawasaki disease (KD)?
A. Chickenpox or influenza.
B. E. coli or Staphylococcus.
C. Candida or Streptococcus A.
D. Streptococcus A or staphylococcus.
25. The nurse is caring for an 8-year-old girl whose parents indicate she has developed spastic
movements of her extremities and trunk, facial grimace, and speech disturbances. They state it
seems worse when she is anxious and does not occur while sleeping. The nurse questions the
parents about which recent illness?
A. Kawasaki disease (KD).
B. Rheumatic fever (RF).
C. Malignant hypertension.
D. Atrial fibrillation.

26. The most common cardiac dysrhythmia in the pediatric population is:
A. Ventricular tachycardia.
B. Sinus bradycardia.
C. Supraventricular tachycardia.
D. First-degree heart block.

27. A nursing action that promotes ideal nutrition in an infant with congestive heart failure (CHF)
is:
A. Feeding formula that is supplemented with additional calories.
B. Allowing the infant to nurse at each breast for 20 minutes.
C. Providing large feedings every 5 hours.
D. Using firm nipples with small openings to slow feedings.

28. An 18-month-old with a myelomeningocele is undergoing a cardiac catheterization. The

mother expresses concern about the use of dye in the procedure. The child does not have any
allergies. in addition to the concern for an iodine allergy, what other allergy should the nurse
bring to the attention of the catheterization staff?
A. Soy.
B. Latex.
C. Penicillin.
D. Dairy.

29. Treatment for congestive heart failure (CHF) in an infant began 3 days ago and has included
digoxin (Lanoxin) and furosemide (Lasix). The child no longer has retractions, lungs are clear,
and HR is 96 beats per minute while the child sleeps. The nurse is confident that the child has
diuresed successfully and has good renal perfusion when the nurse notes the child's urine
output is:
A. 0.5 cc/kg/hr.
B. 1 cc/kg/hr.
C. 30 cc/hr.
D. 1 oz/hr.

30. The parents of a 3-month-old ask why their baby will not have an operation to correct a
ventricular septal defect (VSD). The nurse's best response is:
A. “It is always helpful to get a second opinion about any serious condition like this.”
B. “Your baby ’s defect is small and will likely close on its own by 1 year of age.”
C. “It is common for health-care providers to wait until an infant develops respiratory distress
before they do the surgery.”
D. “With a small defect like this, they wait until the child is 10 years old to do the surgery.”

31. A child has been seen by the school nurse for dizziness since the start of the school term. It
happens when standing in line for recess and homeroom. The child now reports that she would
rather sit and watch her friends play hopscotch because she cannot count out loud and jump at
the same time. When the nurse asks her if her chest ever hurts, she says yes. Based on this
history, the nurse suspects that she has:
A. Ventricular septal defect (VSD).
B. Aortic stenosis (AS).
C. Mitral valve prolapse.
D. Tricuspid atresia.

32. The school nurse has been following a child who comes to the office frequently for vague
complaints of dizziness and headache. Today, she is brought in after fainting in the cafeteria
following a nosebleed. Her BP is 122/85, and her radial pulses are bounding. The nurse
suspects she has:
A. Transposition of the great vessels.
B. Coarctation of the aorta (COA).
C. Aortic stenosis (AS).
D. Pulmonic stenosis (PS).

33. Which medication should the nurse give to an infant diagnosed with transposition of the
great vessels?
A. Ibuprofen (Motrin).
B. Betamethasone.
C. Prostaglandin E.
D. indomethacin (indocin).

34. Which statement by the mother of a child with rheumatic fever (RF) shows an understanding
of prevention for her other children?
A. “Whenever one of them gets a sore throat, I will give that child an antibiotic.”
B. “There is no treatment. It must run its course.”
C. “If their culture is positive for group A Streptococcus, I will give them their antibiotic.”
D. “If their culture is positive for Staphylococcus A, I will give them their antibiotic.”

35. Which client could require feeding by gavage?

A. infant with congestive heart failure (CHF).
B. School-age child with rheumatic fever (RF) and chorea. br>C. Toddler with repair of
transposition of the great vessels.
D. Toddler with Kawasaki disease (KD) in the acute phase.
36. Which physiological changes occur as a result of hypoxemia in congestive heart failure
(CHF)?
A. Polycythemia and clubbing.
B. Anemia and barrel chest.
C. increased white blood cells and low platelets.
D. Elevated erythrocyte sedimentation rate and peripheral edema.

37. Aspirin has been ordered for the child with rheumatic fever (RF) in order to:
A. Keep the patent ductus arteriosus (PDA) open.
B. Reduce joint inflammation.
C. Decrease swelling of strawberry tongue.
D. Treat ventricular hypertrophy of endocarditis.

38. Which vaccines must be delayed for 11 months after the administration of gamma globulin?
A. Diphtheria, tetanus, and pertussis.
B. Hepatitis B.
C. inactivated polio virus.
D. Measles, mumps, and rubella.

39. The mother of a toddler reports that the child's father has just had a myocardial infarction
(MI). Because of this information, the nurse recommends the child have a(n):
A. Electrocardiogram.
B. Lipid profile.
C. Echocardiogram.
D. Cardiac catheterization.

40. During play, a toddler with a history of tetralogy of Fallot (TOF) might assume which
position?
A. Sitting.
B. Supine.
C. Squatting.
D. Standing.

41. A heart transplant may be indicated for a child with severe heart failure and:
A. Patent ductus arteriosus (PDA).
B. Ventricular septal defect (VSD).
C. Hypoplastic left heart syndrome.
D. Pulmonic stenosis (PS).

42. Family discharge teaching has been effective when the parent of a toddler diagnosed with
Kawasaki disease (KD) states:
A. “The arthritis in her knees is permanent. She will need knee replacements.”
B. “I will give her diphenhydramine (Benadryl) for her peeling palms and soles of her feet.”
C. “I know she will be irritable for 2 months after her symptoms started.”
D. “I will continue with high doses of Tylenol for her inflammation.”

43. Which assessments indicate that the parent of a 7-year-old is following the prescribed
treatment for congestive heart failure (CHF)? Select all that apply.
A. HR of 56 beats per minute.
B. Elevated red blood cell count.
C. Playing basketball with other children his age.
D. Urine output of 0.5 cc/kg/hr.

44. A three-year-old girl is brought to the physician’s office with persistent otitis media. in order
to assess factors which may be contributing to the unresolved illness, the nurse should ask the
parents which question?
A. “Is anyone smoking around the child?”
B. “Is the child playing with other children with otitis media?”
C. “Does the child get water is her ears during the bath?”
D. “Has the child had a fever recently?”

45. An 18-month-old girl is admitted for a surgical repair of the cleft palate. She returns from the
operating room, supine, with an IV, and a mist tent on room air. Which is the priority nursing
action?
A. medicate for pain
B. check the IV for signs of infiltration
C. turn the child on her side
D. review the postoperative orders

46. A one-year-old boy is brought to the physician’s office with fever, irritability, and loss of
appetite. A diagnosis of otitis media is made, and the child is placed on amoxicillin (Augmentin)
150 mg p.o TID for 10 days. Which nursing instructions must be includes in the child’s plan of
care?
A. “Drink clear fluids while in the medication.”
B. “Take an extra nap, since amoxicillin may cause drowsiness.”
C. “Stay indoors until the medication is finished.”
D. “Take the medication for the full length of time.”

47. A three-year-old boy is admitted with laryngotracheobronchitis. His parents seem extremely
anxious and the child is crying. Which nursing diagnosis has the highest priority?
A. potential infection
B. ineffective airway clearance
C. altered parenting
D. impaired tissue perfusion
48. A four-month-old infant is admitted with a ventricular septal defect, and undergoes a cardiac
catheterization. Post-catheterization, which sign would alert the nurse to a potential
complication?
A. pedal pulses palpable bilaterally
B. apical pulse 140 beats/minute
C. blood pressure 96/40
D. groin dressing intact with small amount of blood noted

49. A 12-year-old with a myelomeningocele at L2 is being seen at the clinic. Which statement by
the child would indicate the need for more client teaching?
A. “I always drink three extra glasses of water every day.”
B. “My teacher says I need remedial reading.”
C. “I only need to catheterize myself twice a day now.”
D. “I do wheelchair exercises while watching TV.”

50. in planning care for a newborn with a surgical repair of a myelomeningocele, the nurse
should be aware that this child is prone to develop which of the following?
A. osteomyelitis
B. decubitis
C. otitis media
D. hydrocephalus

51. The nurse is preparing to assess an infant under the age of 6 months. The infant is quiet
and awake, sucking on a pacifier. The nurse should start with:
A. An otoscopic exam.
B. A lung, heart, and abdomen exam.
C. An oral exam.
D. An exam for hip dysplasia.

52. A three-month-old client is being admitted with pyloric stenosis. She has an IV of D50.2 N/S
at 22 cc/h. She is NPO awaiting surgery. Which nursing assessment takes priority?
A. Urine output 30 cc/2h
B. IV site red
C. Skin turgor elastic
D. Baby acts slightly irritable

53. An ASO titer is drawn on an 11-year-old in the hospital with acute glomerulonephritis. The
mother asks the nurse why the titer was drawn. Which response by the nurse is most justifiable?
A. “This will tell us if he’s ever had the measles.”
B. “This will tell us if he’s had a recent strep infection.”
C. “This lab work is done routinely on all patients.”
D. “This is done to determine the level of antibiotic is his blood.”
54. A four-year-old who had hydrocephalus as an infant is admitted with a malfunctioning
ventriculoperitoneal shunt. Following new shunt placement, the nurse conducts a postoperative
check. Which of the following would demand an immediate response from the nurse?
A. sleepy, very difficult to arouse
B. pupils equal and reactive to light
C. B/P 100/60, apical pulse of 90
D. urine output 33 cc in 2 hours

55. A complete blood count is ordered on a two-month-old child with cyanotic heart disease.
The results are a hemoglobin of 18 g/dl and a hematocrit of 51%. Which of the following
statements reflects the most appropriate interpretation of this information?
A. the body is compensating for tissue hypoxia by increasing RBC production
B. the child may be anemic. This is a low hemoglobin for a two-month-old child and the
hematocrit is within normal limits
C. the child is severely dehydrated, and the loss of vascular fluid has elevated the hematocrit.
The hemoglobin is within normal limits
D. This laboratory data would be considered within normal limits for a two-month-old child

56. A two-year-old is admitted to the hospital with vomiting and possible dehydration. Which of
the following findings would most concern the nurse?
A. potassium 2.5 mEq/L
B. blood glucose 150 mg/dl
C. weight loss 10 grams
D. urine specific gravity 1.020

57. A 12-year-old girl had a ventro-peritoneal shunt placed to treat hydrocephalus in infancy. in
counseling the child about health management of the ventro-peritoneal shunt, the nurse would
consider the teaching effective if the child states:
A. “I should drink plenty of fluids and stay rested.”
B. “I may need to wear glasses as a teenager.”
C. “I can take prochlorperazine (Compazine) for vomiting.”
D. “If I get a really hard headache, I should call the doctor.”

58. A mother brings her 18-month-old to the pediatric emergency room. The child has sustained
a fractured left femur. Which statement by the mother might make the nurse suspect a problem
of child abuse?
A. “She is so active and gets into everything.”
B. “She was riding her bicycle and her foot got caught in the spoke.”
C. “My daughter slipped out of her high chair because the strap was too loose.”
D. “My daughter climbed up on a chair and fell down.”

59. The nurse who is assigned to care for a child with cerebral palsy should obtain information
concerning his abilities, limitations, interest, and habits, because the aim of therapy is to:
A. assess the child’s assets and potentialities and capitalize on these in the habilitative process,
while ignoring limitations
B. reverse abnormal functioning and restore brain damage through rehabilitation
C. provide a therapeutic program that avoids subjecting the child to frustrating experiences that
decrease his achievement
D. develop an individualized therapeutic program that utilizes the child’s assets and abilities to
provide experiences that permit him to achieve success as well as help to cope with frustration
and failure

60. A nurse is assessing a 2-year-old boy with the following vital signs: temperature 97.8°F
axillary, apical pulse 100, respirations 28 breaths per minute, blood pressure 125/
80. Which action by the nurse would be most appropriate?
A. Reevaluate the child's temperature in 1 hour
B. Report the blood pressure to the physician
C. Assess for additional signs of respiratory distress in the child
D. Determine why the child has tachycardia

61. A 2-year-old with epilepsy is showing signs of developmental delay. The nurse has been
working with the family to support development. The response from the parents that indicates
the need for further teaching is:
A. “He has a schedule by which we abide at all times.”
B. “We make sure he is always in a playpen or enclosed area when he plays.”
C. “He has temper tantrums all the time. We stay near, but don’t give in to what he gets mad
about.”
D. “He gets his Depakote every day at the same time. He hasn’t shown signs of a seizure since
he was 6 months old.”

62. The father of a 2½ - year-old asks the nurse how to prevent early-childhood dental cavities.
The best response by the nurse would be:
A. "Your child has only baby teeth; they will eventually fall out, and so there is no need to worry."
B. "Make sure your child's diet is nutritious, and limit snacks high in sugar."
C. "Take the child to the dentist to see if he has any cavities."
D. "Let the child watch you brush your teeth so that he can learn how to do it himself."

63. The nurse needs to obtain the height of a 3-year-old as part of routine health screening. To
obtain an accurate measurement, the child will:
A. Be measured in a recumbent position.
B. Remove his shoes and stand upright, with head level.
C. Stand with his feet wide apart.
D. Face the wall as he is measured.

64. Which of the following would the nurse identify as the initial priority for a child with acute
lymphocytic leukemia?
A. instituting infection control precautions
B. Encouraging adequate intake of iron-rich foods
C. Assisting with coping with chronic illness
D. Administering medications via IM injections

65. A neonate undergoing phototherapy treatment needs to monitored for which adverse effect?
A. hyperglycemia
B. increased insensible water loss
C. severe decrease in platelet count
D. increased GI transit time

66. Which immunoglobulin (Ig) provides immunity against bacterial and viral pathogens through
passive immunity?
A. IgA
B. IgE
C. IgG
D. IgM

67. Which of the following should the nurse expect to note as a frequent complication for a child
with congenital heart disease?
A. Susceptibility to respiratory infection
B. Bleeding tendencies
C. Frequent vomiting and diarrhea
D. Seizure disorder

68. Which of the following would the nurse do first for a 3-year-old boy who arrives in the
emergency room with a temperature of 105 degrees, inspiratory stridor, and restlessness, who
is learning forward and drooling?
A. Auscultate his lungs and place him in a mist tent.
B. Have him lie down and rest after encouraging fluids.
C. Examine his throat and perform a throat culture
D. notify the physician immediately and prepare for intubation.

69. Which of the following would the nurse need to keep in mind as a predisposing factor when
formulating a teaching plan for child with a urinary tract infection?
A. A shorter urethra in females
B. Frequent emptying of the bladder
C. increased fluid intake
D. ingestion of acidic juices

70. Which of the following should the nurse do first for a 15-year-old boy with a full leg cast who
is screaming in unrelenting pain and exhibiting right foot pallor signifying compartment
syndrome?
A. Medicate him with acetaminophen.
B. notify the physician immediately
C. Release the traction
D. Monitor him every 5 minutes

71. Which of the following assessment findings would lead the nurse to suspect Down
syndrome in an infant?
A. Small tongue
B. Transverse palmar crease
C. Large nose
D. Restricted joint movement

72. While assessing a newborn with cleft lip, the nurse would be alert that which of the following
will most likely be compromised?
A. Sucking ability
B. Respiratory status
C. Locomotion
D. GI function

73. When providing postoperative care for the child with a cleft palate, the nurse should position
the child in which of the following positions?
A. Supine
B. Prone
C. in an infant seat
D. On the side

74. While assessing a child with pyloric stenosis, the nurse is likely to note which of the
following?
A. Regurgitation
B. Steatorrhea
C. Projectile vomiting
D. "Currant jelly" stools

75. Which of the following nursing diagnoses would be inappropriate for the infant with
gastroesophageal reflux (GER)?
A. Fluid volume deficit
B. Risk for aspiration
C. Altered nutrition: less than body requirements
D. Altered oral mucous membranes

76. Which of the following parameters would the nurse monitor to evaluate the effectiveness of
thickened feedings for an infant with gastroesophageal reflux (GER)?
A. Vomiting
B. Stools
C. Uterine
D. Weight
77. Discharge teaching for a child with celiac disease would include instructions about avoiding
which of the following?
A. Rice
B. Milk
C. Wheat
D. Chicken

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

79. Which of the following should the nurse do first after noting that a child with Hirschsprung
disease has a fever and watery explosive diarrhea?
A. notify the physician immediately
B. Administer antidiarrheal medications
C. Monitor child ever 30 minutes
D. nothing, this is characteristic of Hirschsprung disease

80. A newborn's failure to pass meconium within the first 24 hours after birth may indicate which
of the following?
A. Hirschsprung disease
B. Celiac disease
C. intussusception
D. Abdominal wall defect

81. When assessing a child for possible intussusception, which of the following would be least
likely to provide valuable information?
A. Stool inspection
B. Pain pattern
C. Family history
D. Abdominal palpation

82. The nurse assessing newborn babies and infants during their hospital stay after birth will
notice which of the following symptoms as a primary manifestation of Hirschsprung's disease?
A. A fine rash over the trunk
B. Failure to pass meconium during the first 24 to 48 hours after birth
C. The skin turns yellow and then brown over the first 48 hours of life
D. High-grade fever
83. The nurse is caring for a 2- week- old baby who is showing clinical manifestations of heart
murmur, widened pulse pressure, cardiomegaly, bounding pulses, and tachycardia. The
assessment finding indicates that which of the following shunt systems from fetal circulation has
failed to close?
A. Ductus venosus
B. Ductus arteriosus
C. Ligamentum arteriosum
D. Foramen ovale.

84. The nurse has been discussing promotion of growth and development with a family whose
15-month old son has a cyanotic heart defect. Which statement by the father indicates a need
for further teaching?
A. ''I need to feed him slowly and allow frequent rest periods.''
B. ''I need to play quiet games and activities with my son.''
C. ''I need to provide highly nutritious foods.''
D. ''I need to limit my son's interactions with other children.''

85. The nurse is playing with a 2 year-old child with tetralogy of Fallot, who suddenly squats on
the floor. What is the best initial nursing action?
A. Return the child to bed immediately.
B. Allow the child to remain in that position.
C. Place the child in a chair.
D. Call the physician immediately.

86. A 2-year old is admitted to the hospital with meningitis. What is the highest priority?
A. inform the parents of the child’s condition.
B. Maintain a quiet environment.
C. Monitoring for changes in intracranial pressure.
D. Maintain bed rest.

87. A young child with bronchial asthma is admitted for the second time in 1 month. Cystic
fibrosis is suspected. Which physiological assessment is most likely to be seen in the child with
cystic fibrosis?
A. Expectoration of large amounts of thin, frothy mucus with coughing, and bubbling ronchi for
lung sounds.
B. High serum sodium chloride levels and low sodium chloride levels in the sweat.
C. Large, loose, foul smelling tools with normal frequency or a chronic diarrhea of unformed
stools.
D. Obesity from malabsorption of fats and polycythemia from poor oxygenation of tissues.

88. An infant is born with a bilateral cleft palate and right cleft lip. Plans are made to begin
reconstruction immediately. Nursing intervention to promote parent-infant bonding should
include:
A. Demonstrating a positive acceptance of the infant.
B. Placing the baby in a nursery away from view of the general public.
C. Explaining to the parents that the infant will look normal after the surgery.
D. Encouraging the parents to limit contact with the infant until after surgery.

89. Baby Tina, a 3-month-old infant, just had a cleft lip and palate repair. What should the nurse
do to prevent trauma to the operative site?
A. Avoid touching the suture line, even when cleaning.
B. Place the baby in a prone position.
C. Give the baby a pacifier.
D. Place the infant's arms in soft elbow restraints.

90. How does breast milk help prevent infection in a newborn?

A. it is rich in fatty acid, so bacteria are destroyed by it.
B. It is always flowing forward in the breast, so it is not static.
C. it contains maternal antibodies and viral binding factors.
D. It is low in lactose, so it becomes a poor culture medium.

91. Baby Atkins 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. Sodium chloride
B. Morphine sulphate
C. Penicillin G
D. Naloxone (narcan)

92. Why are small for gestational age newborns are at risk for difficulty maintaining body
temperature?
A. They are preterm so are born relatively in small size.
B. They are more active than usual so throw off covers.
C. They do not have as many fat stores as other infants.
D. Their skin is more susceptible to conduction of cold.

93. Baby Atkins has surfactant administered at birth. The purpose of surfactant is to:
A. Help raise lung secretions by relaxing the airway.
B. Prevent alveoli from collapsing on expiration.
C. paralyze respiratory muscles to synchronize breathing.
D. reduce gastric secretions by action on the pancreas.

94. Baby Atkins develops hyperbilirubinemia. What is a method use to treat hyperbilirubinemia
ina newborn?
A. Keeping infants in a warm and dark environment.
B. Early feeding to speed passage of meconium.
C. gentle exercise to stop muscle breakdown.
D. Administration of a cardiovascular stimulant.
95. You typically gag children to inspect the back of their throat. When is it important not to elicit
a gag reflex?
A. When children are under 5 years of age
B. When a child has symptoms of epiglottitis
C. When a boy has a possible inguinal hernia
D. When a girl has a geographic tongue

96. Keoto has sinus arrhythmia. This refers to:

A. A wide spaced rib cage
B. Faint, barely audible heart sounds
C. increased heart rate on inspiration
D. An abnormal heart rate in a child

97. Young children are more at risk for dehydration with vomiting than adults are. This is
because;
A. They have a smaller stomach and intestines than adults
B. They have proportionally more extracellular water than adults.
C. Children metabolize fluid more slowly than do most adults
D. They maintain more fluid inside body cells than do adults.

98. Which is an important nursing measure for a newborn with diaphragmatic hernia?
A. Feed the infant immediately to decrease air in the intestine.
B. Keep the infant positioned head down so the intestine can expand.
C. Wrap the infant’s abdomen tightly to better contain intestine.
D. Position the infant in an infant chair to contain intestine in abdomen.

99. Baby Sparrow may be developing increased intracranial pressure. What vital sign changes
occur with this?
A. Decreased temperature; increased blood pressure
B. increased respirations; decreased pulse rates
C. increased temperature; decreased pulse rate
D. Decreased blood pressure; increased temperature

100. Which is an important care measure to teach parents of a child with torticollis?
A. Encourage the infant to turn his head to stretch the neck.
B. Wrap the infant’s neck in a warm towel twice daily
C. Massage the infants shoulders and torso at bed time
D. Administer 1 grain of aspirin with each bottle feeding

101. What is a typical description of an infant with Down syndrome?

A. Holds arms stiff and pronated.
B. Muscle are hypotonic or flaccid
C. Head is larger than other infants
D. Skin is ruddy and vein streaked.