1. Which statement indicates nutrition A.

“Now that our child is 4 years old, weighs 40

counseling has been effective for the mother of pounds, and is 42 inches tall, we can move to a
a 6-month-old infant? forward-facing booster seat.”

A. “I will start my infant on rice cereal since it is B. “Now that our child is 4 years old, she can sit
iron fortified and has little chance of causing in the regular car seat and use the seat belt and
allergy.” shoulder belt like adults.”

B. “I will start my infant on egg whites since they C. “Now that our child is 4 years old, she can sit
are high in iron and protein and have little in her booster seat in the front seat.”
chance of causing allergy.”
D. “Our 4-year-old must stay in her
C. “I will start feeding fruits and vegetables and forward-facing car seat until she is 6 years old.”
progress to whole grain cereals as tolerated.”

D. “I know that I can start feeding my baby

strained meats for the iron and protein and 4. Which is the best advice the nurse can give to
progress to the more irritating fruits and parents asking for help in handling their
vegetables.” toddler’s temper tantrums?

A. “I think you should start using time-outs

when he throws a temper tantrum.”
2. Which observation during a healthcare visit
alerts the nurse to the need for further B. “Reward him for good behavior and the
developmental assessment in an infant? temper tantrums will decrease.”

A. A four-month-old has just started to roll from C. “There is nothing to be done. They are a
front to back. symptom of emotional instability.”

B. A nine-month-old now stands while holding D. “Temper tantrums will increase in number
on the furniture. through the preschool years.”

C. A nine-month-old is able to sit with support

from pillows on each side.
5. The high school principal asks the school
D. A 12-month-old says two words, “dog” and nurse to provide injury prevention information
“bottle.” to the students. What does the nurse identify as
priority for the majority of students?

A. Driving and substance abuse

3. The nurse knows that teaching about car seat
safety to the parents of a 4-year-old child has B. CPR and emergency care
been effective when which statement is made?
C. Sports injuries

D. Driving patterns
6. The nurse is preparing a disaster education 9. A nurse obtains a history from a
plan for school-age children to discuss fire breastfeeding mother with a small 3-month-old
prevention and fire evacuation planning. What infant who has been vomiting. Which would
information is priority in the plan? give the nurse an indication this infant has
severe dehydration?
A. It is essential for the child to stay with the
family at the time of the fire. A. The infant is having a seizure

B. The child and family need to have a definite B. The pulse rate is slightly elevated
evacuation plan in place.
C. Skin turgor is normal
C. The child should stay indoors in the event of a
fire. D. Mucous membranes are dry

D. It is important the child remember to drink

more water than usual after a fire.
10. The nurse notes changes in a toddler with
heart failure since the shift yesterday. Which
finding is the most significant for extracellular
7. A school nurse is packing a portable fluid volume overload?
emergency bag for a potential disaster. Which
indicates the need for further education in A. Jugular venous distention
disaster preparedness?
B. Weight gain of 0.8 kg
A. A list of staff and students and their location
C. Weak pulse
B. A blueprint of the school and its grounds
D. Presence of lung crackles
C. Handheld portable radios with batteries
11. The parents of a child who had a
D. A portable automatic external defibrillator tonsillectomy 3 days ago call about concerns
with symptoms they are seeing. Which
symptom would alert the nurse that the child
may be having a postoperative problem?
8. Which is the correct developmental stage at
which a child begins to have a more realistic A. The child has white crusts on the back of the
understanding of death? throat

A. Preschooler B. The child is having increased swallowing.

B. Adolescent C. The child will only eat Popsicles.

C. School age D. The child complains of throat pain.

D. Preteen 12. A child is brought to the emergency

department with an abrupt onset of decreased
appetite, stridor, high fever, and agitation. What pediatric floor. Who is the most appropriate
information is needed to determine the nurse’s roommate for this child?
priority intervention?
A. A 2-year-old female recovering from varicella
A. Determine if the child has been drooling.
B. A 4-year-old female with a fractured femur
B. Ask if the child will lie down.
C. A 6-year-old male postoperative
C. Ask if the child has been around anyone sick. appendectomy

D. Auscultate the child’s breath sounds. D. A 3-year-old female with cystic fibrosis

13. A child is being treated with dexamethasone 16. When a child with type 1 diabetes is sick,
in conjunction with other chemotherapy for which is the most appropriate
treatment of leukemia. On a follow-up visit, the recommendation?
pediatric oncology clinic nurse expects which as
a side effect? A. The usual dose of insulin may need to be
decreased or omitted.
A. Weight gain
B. Test blood glucose if the urine ketones are
B. Decreased blood pressure positive.

C. Anorexia C. Urine ketones are tested when the glucose

level is greater than 200 mg/dL.
D. Improved mood
D. Maintain fluid intake, avoiding fluids that
contain carbohydrates.
14. A child with leukemia has a white blood cell
count of 10,000, a red blood cell count of 5, and
platelets of 20,000. The child is also fairly active, 17. Identify the priority nursing diagnosis for an
visiting the playroom twice a day. When adolescent with hyperthyroidism?
planning this child’s care, which risk should the
nurse consider most significant? A. Disturbed Body Image related to changes in
appearance caused by process of metabolic
A. Infection disorder.

B. Anemia B. Imbalanced Nutrition: More than Body

Requirements related to decreased metabolic
C. Hemorrhage needs.
D. Pain C. Risk for Decreased Fluid Volume related to
excess salt excretion.
15. A 3-year-old female with nephrotic
syndrome is being admitted to the general
D. Constipation related to thyroid medication screaming and kicking. What is the best action
side effects. by the nurse?

A. Inform the child that cooperation is necessary

for proper healing and will shorten the hospital
18. The parent of a child recently diagnosed stay.
with viral meningitis is concerned about
permanent effects from the disease. Her B. Allow the parents to change the dressings
neighbor’s child had viral encephalitis with with coaching from the nurse.
learning and mobility sequelae as a result. How
should the nurse respond to her concerns? C. Allow the child to participate in the dressing
change process as much as possible.
A. “Let’s wait and see if this disease becomes
viral encephalitis.” D. Inform the child that restraints will be used if
there is no cooperation.
B. “Have they been playing together?”

C. “Most children with viral meningitis have

future learning problems. You’ll need to make 21. A nurse is preparing a plan of care for a
plans for a special school.” newborn with fetal alcohol syndrome. The nurse
should include which priority intervention in the
D. “Children who have viral meningitis usually plan of care?
have a complete recovery without permanent
effects.” A. Allow the newborn to establish own
sleep-rest pattern

B. Maintain the newborn in a brightly lighted

19. An infant is brought to the emergency area of the nursery
department with assessment findings of failure
to thrive, vomiting, and a decreased level of C. Encourage frequent handling of the newborn
consciousness. Which should the nurse suspect? by staff and parents

A. Influenza D. Monitor the newborn’s response to feedings

and weight gain pattern
B. Reaction to the dTaP immunization

C. Shaken baby syndrome

22. A clinic nurse reads the results of a Mantoux
D. A malabsorption syndrome test on a 3 year old child. The results indicate an
area of induration measuring 10mm. The nurse
would interpret these results as:
20. A 6-year-old child is having burn care A. Positive
following premedication for pain. The child is
not cooperative for dressing changes and begins B. Negative

C. Inconclusive
D. Definitive and requiring a repeat test D. The child does not respond when spoken to

23. A nurse is planning care for a child with 26. A nurse is reviewing the laboratory results
acute bacterial meningitis. Based on the mode for a child scheduled for tonsillectomy. The
of transmission of this infection which of the nurse determines that which laboratory value is
following should be included in the plan of most significant to review
care?
A. Creatinine level
A. Maintain enteric precautions
B. Prothrombin time
B. Maintain neutropenic precautions
C. Sedimentation rate
C. No precautions are required as long as
antibiotics have been started D. Blood urea nitrogen level

D. Maintain respiratory isolation precautions

for at least 24 hours after the initiation of
27. A nurse is preparing to care for a child after
antibiotics
a tonsillectomy. The nurse documents on the
plan of care to place the child in which
appropriate position?
24. After a tonsillectomy, a child begins to vomit
bright red blood. The initial nursing action is to: A. Supine

A. Notify the physician B. Side-lying

B. Maintain NPO status C. High Fowler’s

C. Turn the child to the side D. Tredelenburg’s

D. Administer the prescribed antiemetic

28 . After tonsillectomy, a nurse reviews the
physician’s postoperative prescriptions. Which
25. A day care nurse is observing a 2 year old of the following physician’s prescriptions does
child and suspects that the child may have the nurse question?
strabismus. Which observation made by the
nurse might indicate this condition? A. Monitor for bleeding

A. The child has difficulty hearing B. Suction every 2 hours

B. The child consistently tilts the head to see C. Give no milk or milk products

C. The child consistently turns the head to see D. Give clear, cool liquids when awake and alert
29. A nurse is providing home care instructions 32. A nurse has provided home care instructions
to the mother of a 10 year old child with to the mother of a child who is being discharged
hemophilia. Which of the following activities after cardiac surgery. Which statement made by
should the nurse suggest that the child could the mother indicates a need for further
participate in safety with peers? instructions?

A. Soccer A. ” A balance of rest and exercise is important”

B. Basketball B. “I can apply lotion or powder to the incision

if it is itchy”
C. Swimming
C. “Activities in which my child could fall need to
D. Field hockery be avoided for 2 to 4 weeks”

D. “Large crowds of people need to be avoided

for at least 2 weeks after surgery
30 A 10-year-old child with Hemophilia A has
slipped on the ice and bumped his knees. The
nurse should prepare to administer an:
33. A nurse receives a telephone call from the
A. Injection of factor X admitting office and is told that a child with
rheumatic fever will be arriving in the nursing
B. Intravenous infusion of iron
unit for admission. On admission, the nurse
C. Intravenous infusion of factor VII prepares to ask the mother which question to
elicit assessment information specific to the
D. Intramuscular injection of iron using the development of rheumatic fever?
Z-tract method
A. “Has the child complained of back pain?”

B. “Has the child complained of headaches?”

31. An infant with congestive heart failure is
receiving diuretic therapy and a nurse is closely C. “Has the child had any nausea or vomiting?”
monitoring the intake and output. The nurse
D. “Did the child have a sore throat or fever
uses which most appropriate method to assess
within the last 2 months?”
the urine output?

A. Weighing the diapers

34. A nurse is preparing to care for a child with a
B. Inserting a Foley Catheter
diagnosis of intussusception. The nurse reviews
C. Comparing intake with output the child’s record and expects to note which
symptom of this disorder documented?
D. Measuring the amount of water added to
formula A. Watery diarrhea

B. Ribbon like stools

C. Profuse projectile vomiting right side. The nurse places the infant in which
best position at this time?
D. Bright red blood and mucus in the stools
A. Prone position

B. On the stomach
35. A clinic nurse reviews the record of an infant
and notes that the physician has documented a C. Left lateral position
diagnosis of suspected Hirschsprung’s disease.
The nurse reviews the assessment findings D. Right lateral position
documented in the record, knowing that which
symptom most likely led the mother to seek
health care for the infant? 38. A nurse reviews the record of a newborn
infant and notes that a diagnosis of esophageal
A. Diarrhea
atresia with tracheoesophageal fistula is
B. Projectile vomiting suspected. The nurse expects to note which
most likely sign of this condition documented in
C. Regurgitation of feedings the record?

D. Foul smelling ribbon like stools A. Incessant crying

B. Coughing at nighttime

36. A 17 – year – old cliet with a perforated C. Choking with feedings

gastric ulcer is scheduled for surgery. The client
cannot sign the operative consent form because D. Severe projectile vomiting
of sedation from opioid analgesics that have
been administered. The nurse should take which
appropriate action in the care of this client? 39. A child is hospitalized because of persistent
vomiting. The nurse monitors the child closely
A. Obtain a court order for the surgery
for:
B. Send the client to surgery without the
A. Diarrhea
consent form being signed
B. Metabolic acidosis
C. Have the hospital chaplain sign the informed
consent immediately C. Metabolic alkalosis

D. Obtain telephone consent from a family D. Hyperactive bowel sounds

member, following agency policy

40. A nurse is caring for a newborn infant with a

37. An infant has just returned to the nursing suspected diagnosis of imperforate anus. The
unit after a surgical repair of a cleft lip on the nurse monitors the infant, knowing that which
of the following is a clinical manifestation 43. An infant of a mother infected with HIV is
associated with this disorder? seen in the clinic each month and is being
monitored for symptoms indicative of human
A. Bile stained fecal emesis immunodeficiency virus infection. The nurse
assesses the infant, knowing that the most
B. The passage of currant jelly-like stools
common opportunistic infection of children
C. Failure to pass meconium stool in the first 24 infected with HIV is:
hours after birth
A. Meningitis
D. Sausage-shaped mass palpated in the upper
B. Gastroenteritis
right abdominal quadrant
C. Cytomegalovirus infection

D. Pneumocystis jiroveci pneumonia

41. A nurse admits a child to the hospital with a
diagnosis of pyloric stenosis. On admission
assessment, which data would the nurse expect
to obtain when asking the mother about the 44. A physician prescribes laboratory studies for
child’s symptoms? an infant of a woman positive for human
deficiency virus to determine the presence of
A. Watery diarrhea HIV antigen in the infant. The nurse anticipates
that which laboratory study will be prescribed
B. Projectile vomiting
for the infant?
C. Increased urine output
A. Chest x-ray
D. Vomiting large amounts of bile
B. Western blot

C. CD4 cell count

42. A nurse has just reassessed the condition of
D. p24 antigen assay
a postoperative client who was admitted 1 hour
ago to the surgical unit. The nurse plans to
monitor which of the following parameters
most carefully during the next hour? 45. A clinic nurse is instructions the mother of a
child with human immunodeficiency virus
A. Urinary output of 20ml/hr infection regarding immunizations. The nurse
tells the mother that
B. Temperature of 37.6°C
A. Then hepatitis B vaccine will not be given to
C. Blood pressure of 100/70 mm Hg
the child
D. Serous drainage on the surgical dressing
B. The inactivated influenza vaccine will be
given yearly
C. The varicella vaccine will be given before 6 48. A preoperative 17 – year – old expresses
months of age anxiety to a nurse about upcoming surgery.
Which response by the nurse is most likely to
D. A western blot test needs to be performed stimulate further discussion between the client
and the results evaluated before immunizations and the nurse?

A. ” If it’s any help, everyone is nervous before

surgery”
46. A nurse is caring for a 4 year old child virus
with human immunodeficiency virus infection. B. “I will be happy to explain the entire surgical
In planning care to address the child’s produce to you”
psychosocial needs, the nurse expects that this
child? C. “Can you share with me what you’ve been
told about your surgery”
A. Will express fear, withdrawal and denial
D. “Let me tell you about the care you’ll receive
B. Begins to understand that something is after surgery and the amount of pain you can
wrong anticipate”
C. Is unable to grasp the concept of illness and
death
49. A 6 month old infant receives a diptheria,
D. Begins to conceptualize the death process as tetanus, and acellular pertussis, immunization
involving physical harm at a well baby clinic. The mother returns home
and calls the clinic to report that the infant has
developed swelling and redness at the site of
47. A nurse is developing a plan of care for a injection. A nurse tells the mother to
child scheduled for surgery. The nurse should
A. Monitor the infant for a fever
include which activity in the nursing care plan
for the child on the day of surgery? B. Bring the infant back to the clinic
A. Have the client void immediately before C. Apply a hot pack to the injection site
going into surgery
D. Apply an ice pack to the injection site
B. Avoid oral hygiene and rinsing with
mouthwash

C. Verify that the client has not eaten for the 50. A child with rubeola is being admitted to the
last 24 hours hospital. In preparing for the admission of the
child, a nurse plans to place the child on which
D. Report immediately any slight increase in precautions?
blood pressure or pulse
A. Neutropenic

B. Enteric
C. Airborne B. Ensure that the weights are resting lightly on
the floor
D. Protective
C. Restrict diversional and play activities until
the child is out of traction
51. A 10 year old child with asthma is treated D. Check the physician’s prescriptions for the
for acute exacerbation in the emergency amount of weight to be applied
department. A nurse caring for the child
monitors for which of the following, knowing
that it indicates a worsening of the condition?
54. A home care nurse is instructing the parents
A. Warm, dry skin of child with iron deficiency anemia regarding
the administration of a liquid oral iron
B. Decreased wheezing supplement. The nurse tells the mother to
C. Pulse rate of 90 beats/min A. Administer the iron at mealtimes
D. Respirations of 18 breaths/min B. Administer the iron through a straw

C. Mix the iron with cereal to administer

52. A child has a right femur fracture caused by D. Add the iron formula to easy administration
a motor vehicle accident and is placed in skin
traction temporarily until surgery can be
performed. During assessment the nurse notes
that the dorsalis pedal pulse is absent on the 55. A nurse analyzes the laboratory results of a
right foot. What action should the nurse take? child with hemophilia. The nurse understands
that which of the following would most likely be
A. Notify the physician abnormal in this child? *

B. Administer an analgesic A. Platelet count

C. Release the skin traction B. Hematocrit level

D. Apply ice to the extremity C. Hemoglobin level

D. Partial thromboplastin time

53. A child is placed in skeletal traction for

treatment of a fractured femur. The nurse
develops a plan of care for the child and 56. A nurse caring for an infant with congenital
includes which intervention in the plan? heart failure (CHF) is monitoring the infant
closely for signs of congestive heart failure. The
A. Ensure that all ropes are outside the pulleys nurse assesses the infant for which early signs
of CHF?
A. Pallor made by the parent indicates the need for
further instructions?
B. Cough
A. “I will not mix the medication with food”
C. Tachycardia
B. If more than one dose is missed, I will call the
D. Slow and shallow breathing physician”

C. “I will take the child’s pulse before

administering the medication”
57. A nurse is caring for a child with a suspected
diagnosis of rheumatic fever. The nurse reviews D. “If the child vomits after medication
the laboratory results, knowing that which administration, I will repeat the dose”
laboratory study would assist in confirming the
diagnosis?

A. Immunoglobulin 60. A physician has prescribed oxygen as

needed for an infant with congestive heart
B. Red blood count failure. In which situation should the nurse
administer the oxygen to the infant?
C. White blood cell count
A. During sleep
D. Antistreptolysin O titer
B. When changing the infant’s diapers

C. When the mother is holding the infant

58. A nurse is preparing for the admission of a
child with a diagnosis of acute-stage Kawasaki D. When drawing blood for electrolyte level
disease. On assessment of the child, the nurse testing
expects to note which clinical manifestation of
the acute stage of the disease?

A. Cracked lips 61. A clinic nurse reviews the record of a child

just seen by a physician and diagnosed with
B. Normal appearance suspected aortic stenosis. The nurse expects to
note documentation of which clinical
C. Conjunctival hyperemia
manifestation specifically found in this disorder?
D. Desquamation of the skin
A. Pallor

B. Hyperactivity
59. A nurse provides home care instructions to
C. Exercise intolerance
the parents of a child with congestive heart
failure regarding the procedure for D. Gastrointestinal disturbances
administration of digoxin. Which statement
62. The nurse is caring for an adolescent who is B. The nurse’s failure to further question the
receiving frequent visits from peer group physician placed the child at risk
members. The nurse understands that groups
are important in the emotional development of C. High fevers are common in children;
an individual because they: therefore presents little cause for concern

A. Always protect their members D. The physician is totally responsible for the
client’s health history and treatment regimen
B. Are easily identified by their members

C. Go through the same developmental phase

65. A 3-year-old boy with eczema of the face
D. Identify acceptable behavior for their and arms has disregarded the nurse’s warnings
members to “stop scratching—or else!” The nurse finds
the toddler scratching so intensely that his arms
are bleeding. With great flurry, the nurse ties
the toddler’s arms to the crib sides, saying “I’m
63. To help parents cope with the behavior of
going to teach you one way or another.” In this
young school-age children, the nurse suggests
situation, the nurse:
that it would help if they:
A. Has used actions that can be interpreted as
A. Avoid asking specific questions
assault and battery
B. Give children a list of expectations
B. Has responded to the problem with
C. Be consistent about established rules considerable accountability

D. Allow the children to set up their own C. Had to protect the toddler’s skin and acted
routines the same as any reasonably prudent nurse

D. Had tried to explain to the toddler and

expected the toddler to understand and
64. A 2-year-old child is admitted with a cooperate
diagnosis of pneumonia and is given antibiotics,
fluids and oxygen. The child’s temperature rises
until it reaches 103°F. The nurse calls the
66. A toddler screams and cries noisily after
physician at the mother’s request, but the
parental visits, disturbing all the other children.
physician sees no need to change treatment,
When the crying is particularly loud and
even though the child has a history of febrile
prolonged, the nurse puts the crib in a separate
seizures. Although concerned, the nurse takes
room and closes the door. The toddler is left
no further action. Later, the child has a seizure
there until the crying ceases, a matter of 30 to
that results in neurologic impairment. Legally,
45 minutes. Legally,
A. The physician’s decision takes precedence
A. The child needed to have limits set to control
over the nurse’s concern
the crying
B. The child had a right to remain in the room C. Emphasize that she does have two children
with the other children already

C. The segregation of the child for more than 30 D. Ensure that all treatment options have been
minutes was too long explored

D. The other children had to be considered, so

the child needed to be removed
69. Twenty-four hours after a cesarean birth, a
client elects to sign herself and her baby out of
the hospital because of difficulty at home with
67. A client is admitted with the diagnosis of her 2-year-old son. Staff members are unable to
possible placenta previa. The nurse begins IV contact her physician. The client arrives at the
fluids, administer oxygen, and draws blood for nursery dressed and ready to leave and asks
laboratory tests as ordered. The client’s that her infant be given to her dress and take
apprehension is increasing, and she asks the home. What is the most appropriate nursing
nurse what is happening. The nurse tells her not action?
to worry, that she is going to be alright, and that
everything is under control. What is the best A. Explain to the client that her infant must
description of the nurse’s statement? remain in the hospital until signed out by the
physician
A. Adequate, because the preparations are
routine and need no explanation B. Give the infant to the client to take home,
making sure that she receives information
B. Incorrect, because only the physician should regarding care of a 2-day-old infant
explain why treatments are being done
C. Allow the child time with the baby before she
C. Proper, because the client’s anxieties would leaves, but emphasize that the baby is a minor
be increased if she knew the dangers and legally must remain until orders are
received.
D. Questionable, because the client has the
right to know what treatment is being given D. Tell the client that under the circumstances,
and why hospital policies prevents the staff from
releasing the infant into her care, but shewill be
informed when the infant is discharged.
68. A client has been told she needs a
hysterectomy for cervical cancer is upset being
unable to have more children. What should the 70. A new mother expresses concern to a nurse
nurse should do? regarding sudden infant death syndrome (SIDS)
she asks the nurse how to position her new
A. Evaluate her willingness to pursue adoption
infant for sleep. The nurse appropriately tells
B. Encourage her to focus on her own recovery the mother that the infant should be placed in
the:
A. Side or prone b. Exploratory searching when a cuddly toy is
hidden from view
B. Back or prone
c. simultaneously kicking the legs and batting
C. Stomach with the face turned the hands in the air
D. Back rather than on the stomach d. waving and clenching fits and dropping toys
placed in the hands

71. Negativism demonstrated by toddlers is

frequently an expression of 74. the nurse is aware that the theorist behind
psychosocial theory is which of the following?
a. A quest for autonomy
a. Freud
b. Hyperactivity
b. Erikson
c. Separation anxiety
c. Piaget
d. Sibling rivalry
d. Kohlberg

72. The nurse explained to the mother that

according to Erikson’s framework of 75. The adolescent’s inability to develop a sense
psychosocial development, play as a vehicle of of who he is and what he can become results in
development can help the school-age develop a a sense of which of the following?
sense of
a. Shame
a. Initiative
b. Guilt
b. Industry
c. Inferiority
c. Identity
d. Role confusion
d. Intimacy

76. In terms of preventive teaching for the

73. The nurse is aware that the play of a 5 parents of a 1 year old, the nurse should speak
month-old infant Is in the oral stage. The nurse to them about:
knows that this behavior most likely to consist
of: a. Aspiration

a. picking up a rattle or toy and putting it into b. Toilet training

the mouth
c. Adequate nutrition
d. Sexual development d. Head circumference 32 cm; chest
circumference 30 cm

77. The nurse is aware that an appropriate toy

for a 3 month old infant during hospitalization 80. A 6 month old infant is admitted with a
would be: diagnosis of failure to thrive. The birth weight
was 7 pounds. Based on growth and
a. Rattles development chart, the nurse should expect an
infant at 6 months to weigh approximately:
b. Tricycle
a. 10 pounds
c. Ten piece puzzle
b. 14 pounds
d. Wagon
c. 18 pounds

d. 21 pounds
78. A term neonate weighs 7 ½ pounds at birth.
When he’s 1 year old, approximately how much
should he weigh?
81. Popcorn and nuts should not be given to a
a. 36 lb toddler primarily because they
b. 22 lb a. Will spoil the child’s appetite
c. 28 lb b. Are easily aspirates
d. 32 lb c. Have very little food value

d. Can cause tooth decay

79. During physical assessment of a newborn,
which of the following comparative
measurements would necessitate additional 82. Besides adolescents, children in which of the
investigation? following age groups experience the most rapid
growth?
a. Head circumference 34 cm; chest
circumference 31 cm a. Infancy

b. Head circumference 31 cm; chest b. Toddler stage

circumference 33 cm
c. Preschool age
c. Head circumference 34.5 cm; chest
circumference 32 cm d. School age
83. A mother tells the nurse that each morning c. When the child begins to lose deciduous
she offers her 24 month old son juice and he teeth
always shakes his head and says, “No.” She asks
the nurse what to do, because she knows the d. The next time another family member goes to
child needs fluids. The nurse suggests that the the dentist
mother:

a. Distract him with some food

86. When ordering a regular diet for a young
b. Be firm and hand him the glass toddler the nurse should choose foods such as:

c. Let him see that he is making her angry a. Spaghetti and bread

d. Offer him a choice of two things to drink b. Corn dog and French fries

c. Hamburger with bun and grapes

84. A 2 year old boy, is admitted to the hospital d. Hot dog with bun and potato chips
for further evaluation, is standing in his crib
crying. The child refuses to be comforted and
calls for his mother. As the nurse approaches 87. The nurse plans to talk to a mother about
the crib to provide morning care the child toilet training a toddler, knowing that the most
screams louder. The nurse, recognizing that the important factor in the process of toilet training
behavior is typical of the stage of protest, is the:
decides to:
a. Child’s desire to be dry
a. Pick him up and carry him around the room
b. Ability of the child to sit still
b. Fill the basin with water and proceed to
bathe him c. Child’s willingness to work at it

c. Sit by his crib and bathe him later when his d. Approach and attitude of the parent
anxiety decreases

d. Skip the bath because the child is upset and

88. A mother tells the nurse that her 22 –
does not really need a bath
month old child says “no” to everything. When
scolded, the toddler becomes angry and starts
crying loudly but then immediately wants to be
85. A mother asks when to take her 2 year old held. What is the best interpretation of this
to the dentist. For dental prophylaxis, the nurse behavior?
encourages her to take the child:
a. The toddler isn’t effectively coping with the
a. Before starting school stress

b. Between 2 to 3 years old

b. The toddler’s need for attention isn’t being b. 6 to 12 years
met
c. Birth to 1 year
c. This is a normal behavior for a 2 – year old
child d. 3 to 5 ½ years

d. This behavior suggests a need for counseling 92. During the oedipal stage of growth and
development, the child:

a. Loves and hates both parents

89. When asked about spanking as a disciplinary
technique, the nurse’s best response would be: b. Loves the parent of the same sex and the
parent of the opposite sex
a. “It really depends on the child’s age.”
c. Loves the parent of the opposite sex and
b. “It is strongly suggestive of negative role hates the parent of the same sex
modeling.”
d. Loves the parent of the same sex and hates
c. “This may be the only option when no other the parent of the opposite sex
technique works.”

d. “Research studies have shown it to be an

effective disciplinary technique.” 93. When teaching a parents’ class, the nurse
explains that medication and household
cleaning products should be kept out of the
reach of the pre - school because:
90. Preschool children role play. This is an
important part of socialization because it: a. They have high level of curiosity

a. Encourages expression b. Their sense of taste is developing at this time

b. Help children think about careers c. Their appetite is greater to support rapid
growth
c. Teaches children about stereotypes
d. They rebel against parental authority during
d. Provides guidelines for adult behavior this phase

91. The nurse is aware that Freud’s phallic stage 94. A 5-year-old boy believes that there are
of psychosexual development, which compares “bogeymen and monsters” in his bedroom at
with Erikson’s psychosocial phase of initiative vs. night. What advice can the nurse give to Eric’s
guilt, is best seen at: parent to help Eric cope with his fears?
a. Adolescent a. Let Eric sleep with his parent
b. Tell Eric that bogeymen and monster do not b. School-age children are more susceptible to
exist hazards in the home environment

c. Keep a night-light on in Eric’s room c. School-age children are the age group
commonly aspirated
d. Tell Eric that no one else sees any monsters,
so he must not see them either d. School-age children are less subject to
parental control over their behavior

95. A 6 year old is brought to the pediatric clinic

for a routine visit. When assessing the child’s 98. Practices common to school-age children
relationship with other children, the nurse include all the following except:
would expect to observe:
a. Talking in code
a. Solitary play
b. Starting collections
b. Parallel play
c. Telling jokes
c. Initiative play
d. Participating mostly in activities with both
d. Cooperative play boys and girls

96. The mother of a 5 year old asks, “When do 99. An adolescent client has just had surgery
the deciduous teeth usually begin to fall out?” and has a dressing on the abdomen. Which of
Which of the following is the nurse’s most the following questions would the nurse expect
appropriate response? the client to ask initially?

a. Age 5 years a. “Did the surgery go okay?”

b. Age 6 years b. “Will I have a large scar?”

c. Age 7 years c. “What complication can I expect?”

d. Age 8 years d. “When can I return to school?”

97. Which of the following statements about 100. On average, the adolescent growth spurt
causes of accidents during the school-age years begins
is inaccurate?
a. Earlier for boys than for girls
a. School-age children are more active and
become more adventurous and daring b. Earlier for girls than for boys
c. At approximately the same time for both c. “Meals and snacks must be eaten at the same
sexes time each day.”

d. Between the seventh and eighth years d. “Cola may be exchanged for fruit juice.”

101. A child with leukemia complains of fatigue. 104. The mother of a newly diagnosed diabetic
The nurse assesses the skin color as pallor. asks why insulin needs to be injected. The nurse
Considering the child’s diagnosis, which of the responds that the child cannot take oral insulin
following data explain these findings? because it

a. Cerebrospinal fluid with elevated white cells a. Is not tolerated well in oral form by children

b. Hemoglabin of 8 g/dl b. Is not available in pill form

c. Platelete count of 150,000/mm3 c. Is destroyed by digestive enzymes

d. Sodium level of 130 d. Will cause gastric ulcers

102. A 7-year-old child complains of shakiness, 105. A 9-year-old girl has been brought to the
hunger, and headache. Based on these findings, emergency department following an
the school nurse should suspect the student has automobile accident and is diagnosed with
which of these conditions? femoral fracture. Which of these goals should
receive priority in the child’s care?
a. Diabetic ketoacidosis
a. Adequate nutrition will be maintained
b. Hyperglycemia
b. Infection will be prevented
c. Hypoglycemia
c. Disturbance in body image will be reduced
d. Polyphagia
d. Pain will be reduced

103. A mother of newly diagnosed diabetic is

receiving nutritional counseling. Which of these 106. Which of these assessments of a child with
statements by the mother indicates the need for a cast for correction of a clubfoot needs to be
further teaching? reported?

a. “Calories and nutrient proportions have to be a. Cast has not dried in 2 hours
consistent on a daily basis.”
b. Color change and cool skin proximal
b. “Chocolate milk with meals is accepted.”
c. Moves toes and capillary refill is <3 seconds
d. Rough edges on the cast bulging anterior fontanel and increased head
size. Based on these findings the nurse knows
the infant is at imminent risk for developing.
107. A child diagnosed with rheumatic fever is a. Encephalitis
prescribed aspirin. The purpose of this
medication is to b. Hydrocephalus

a. Decrease fever c. Meningitis

b. Prevent headache d. Fluid overload

c. Promote relaxation

d. Reduce inflammation 111. A child has diagnosed with a urinary tract

infection. Which statement about appropriate
dietary choices should be given to the parents?
108. Following surgical correction for Tetralogy a. The child should drink adequate amounts of
of Fallot, which of these goals should receive water and juices
priority in a child’s care?
b. Carbonated and caffeinated beverages are
a. Adequate sleep and rest periods provided recommended
b. Adequate nutrition c. Citrus juices are highly effective in eliminating
urinary tract infection
c. Pain management
d. No special recommendations should be made
d. Prevention of vascular complications

112. When performing a physical assessment on

109. An infant is experiencing uncontrolled
an infant with hyospadias with chordee, the
vomiting. Based on this finding, the nurse would
nurse should expect which of the following
expect which acid-base imbalance?
findings?
a. Metabolic alkalosis
a. Bladder exposed with visible urethral opening
b. Metabolic acidosis
b. Bulge in the scrotal sac
c. Respiratory alkalosis
c. Urethra opens on the dorsal aspect of the
d. Respiratory acidosis penis

d. Urethra opens on the ventral side of the

penis
110. When performing a postoperative
assessment on an infant with surgical correction
of a myelomeningocele, the nurse observes
113. Before assessing an infant for undescended
testes, the nurse should plan to
116. A preschooler is admitted to the hospital
a. Allow the child to defecate with moderate burns sustained in a house fire.
He has sustained partial-thickness burns over
b. Assess vital signs 20% of his body surface area, including his
hands and feet. Because of the client’s
c. Palpate the inguinal canals
condition, which of these nursing diagnoses
d. Warm her hands and the room should receive priority on admission to the
hospital unit?

a. Altered parenting
114. Following a tonsillectomy, a child grows
increasingly restless. The nurse assesses the b. Fluid volume deficit
child to find a pulse rate of 120 and frequent
c. Knowledge deficit
swallowing. Based o n this findings, the nurse
should suspect the client has which of these d. Self-esteem disturbance
conditions?

a. Airway obstruction
117. A preschool who has been burned exhibits
b. Hemorrhage a decreased interest in eating. Which of the
following measures should the nurse take to
c. Infection
increase the child’s intake?
d. Usual signs following this surgery
a. Ask the mother to feed the child

b. Eliminate the snacks

115. Which of the following statements is
c. Offer smaller and more frequent feedings
accurate regarding the mode of transmission for
autosomal recessive disorders such as cystic d. Withhold dessert until the meal is eaten
fibrosis (CF)?

a. Both parents must have the disease to have a

child with CF 118. An intravenous infusion is started on a
child with severe burns. The nurse should assess
b. There is a 75% chance with each pregnancy for signs of fluid overload, which include
that the child will have CF
a. Depressed anterior fontanel
c. Both parents must be carriers of the trait in
order for the child to have the disease b. Increased abdominal circumference

d. There is a 50% chance with each pregnancy c. Moist rales in lung fields
that the child will not have CF
d. Tea-colored urine
 c. Supine with the head turned to the side.

119. Which statement best describes the d. Trendelberg’s position to facilitate drainage
problem of regulation of body temperature in a
3-pound premature infant?

a. The surface area of the premature infant is 122. An infant born at 28 weeks’ gestation
relatively smaller than that of a healthy term weighs 4 lb 3 oz. What does the initial nursing
infant. care of this infant include?

b. There is a lack of subcutaneous fat, which a. Place the infant in protective isolation
furnishes insulation. because of the underdeveloped immune system

c. There are frequent episodes of diaphoresis b. Feed him a low phenylalanine formula to
causing loss of body heat. increase digestion and utilization of calories.

d. There is limited ability to produce body c. Provide gavage feedings every 2 hours
proteins. because of an inadequate sucking and swallow
reflex.

d. Place the infant in a regulatory heater to

120. The nurse would identify which situation as maintain regulation of body temperature.
an indication for the administration of
RhoGAM?

a. A woman who has been Rh-sensitized in the 123. The clinical nurse observes that a 3-day-old
past two pregnancies. baby girl is jaundiced. A bilirubin level is
determined, and it is 11.4 mg/dl. What cause
b. An infant with increased hemolysis of red the bilirubin level?
blood cells because of ABO incompatability
a. Physiological jaundice
c. An infant with an increase in serum bilirubin
levels as a result of the presence of Rh factor b. Hemolytic disease
antibopdies.
c. Erythroblastosis fetalis.
d. A primigravida who is Rh negative is
d. Sepsis.
pregnant with an infant who is Rh positive.

124. The nurse assigned to the nursery

121. While in the recovery room, the best
understands the importance of keeping the
immediate postoperative position for an infant
newborn swaddled in a warm blanket to
who has had a cleft lip repair is:
prevent heat loss because:
a. Prone with the head turned to one side.
a. Chilling leads to increased heat production
b. Left Sims’ position and greater oxygen needs.
b. The newborn’s metabolic rate is decreased 127. A 10-pound newborn of a diabetic mother
is admitted to the intensive care unit because of
c. Evaporation will affect the newborn’s ability the hypoglycemia. His mother is concerned that
to feed he will diabetes. The most appropriate response
by the nurse is that the baby will:
d. The newborn will sleep more comfortably.
a. Not have any long-term consequences
because of his mother’s diabetes.
125. The newborn’s mother is concerned about
b. Not be at risk for diabetes until he reaches
the shape of the baby’s head after delivery. She
puberty.
states that it looks like a “cone head.” The most
appropriate response by the nurse is: c. Have to follow a diabetic diet to avoid
complications
a. “You don’t need to worry about it. It is
perfectly normal after birth.” d. Need to be monitored closely during his
childhood years.
b. “It is molding caused by the pressure during
birth and will disappear in a few days.”

c. “I will report it to the physician, and he will 128. The nurse is providing discharge teaching a
order a diagnostic scan.” 20-year-old who has had her first male child.
Which statement by the mother demonstrates
d. “It is a collection of blood related to the
that she understands the discharge teaching
trauma of delivery and will absorb in a few
regarding his circumcision?
weeks.”
a. “I will observe the whitish-yellow drainage
on his penis but I will not remove it.”
126. The nurse is responsible for documenting
b. “I will bring him back to the clinic in 3 days to
the first meconium stool the newborn passes. If
have the drainage removed.”
the newborn does not have stool in the first 24
to 48 hours of life, the nurse should first: c. “I will use antibiotic ointment on his penis
with every diaper change.”
a. Insert a rectal thermometer to facilitate the
process d. “I will rub the area briskly with a washcloth to
remove the discharge.”
b. Inspect the anal area for an opening

c. Monitor the vital signs for a rise in

temperature 129. A 12-year-old hemophiliac client has been
admitted to the medical center for an acute
d. Increase oral feeding to stimulate passage of
episode of hemarthrosis. Which of these
stool
expected outcomes should receive priority in
the client’s care?
a. Family will receive genetic counseling 132. A parent has understood the teaching for
introducing solid foods to her child if she states:
b. Maximum function of the joint will be
restored A. “I can start to feed rice cereal at 2 months of
age.”
c. Child and family will seek support from
National Hemophilia Foundation B. “I will begin with cereal, then introduce
meats next.”
d. Child will participate in appropriate activities
for present condition C. “I will introduce one new food at a time.”

D. “I will begin to wean my baby from the bottle

after I start rice cereal, at 6 months of age.”
130. Sally, age 12 months, weighs 21 pounds.
The nurse reviews the child’s record and finds
out that her birth weight was 7 pounds. In
planning care, the nurse knows that the child: 133. The nurse is preparing to assess an infant
under the age of 6 months. The infant is quiet
A. Has not gained the expected weight related and awake, sucking on a pacifier. The nurse
to the birth weight. should start with:

B. Must not be eating enough. A. An otoscopic exam.

C. Should be referred to Protective Services B. A lung, heart, and abdomen exam.

immediately for being severely underweight.
C. An oral exam.
D. Falls within normal weight gain related to
the birth weight. D. An exam for hip dysplasia

131. A preschool-age client needs a central line 134. The nurse palpates the anterior fontanel of
dressing change. The most appropriate a 12-month-old infant. Identify the area where
technique to use to explain this procedure is to: the nurse is palpating.

A. show a picture of the procedure in a book A. Anterior fontanel

B. explain the procedure with few words B. Posterior fontanel

C. let the child perform a dressing change on a C. Suture lines

doll
D. Lambdoid Suture
D. explain the procedure to the child’s mother
as the child listens
135. The nursing assessment of a 4-year-old
child reveals a rounded chest, with the anterior
diameter approximately equal to the lateral
diameter. The most appropriate interpretation D. Place a hand on the newborn’s back and
of this finding is: count for 30 seconds.

A. Abnormal, and could indicate a chronic

obstructive lung condition.
138. During a routine developmental screening,
B. Abnormal, and pectus carinatum might be the nurse is concerned about the development
present. of a 5-year-old. Which of the following would be
recommended?
C. Normal, and no cause for concern.
A. Refer the child to a social worker.
D. Abnormal, and pectus excavatum could be
present. B. Tell the parent to take the child to a physical
therapist.

C. Refer the child to a trained specialist to

136. The nurse reviews the assessment of a administer developmental testing.
10-year-old child and notes that the child has an
abnormal Romberg’s sign. What is the most D. Tell the mother that the child should be
appropriate nursing action based on this retested in a year.
abnormal assessment finding? *

A. Instruct the child to get help when getting

out of bed 139. Which of the following assessment
questions and instructions used by the nurse
B. Speak when entering the room. would give information regarding relationship
issues of the child?
C. Explain the placement of food on the child’s
plate. A. “Describe your infant’s temperament to me.”

D. Place the child in restraints B. “What does your toddler like to do at

school?”

C. “Tell me about your child’s after school

137. A nurse is assessing a newborn. What is the activities.”
most accurate way for the nurse to assess the
newborn’s respiratory rate? D. “How does your infant comfort himself?”

A. Place a hand on the newborn’s chest and

count the rate for 30 seconds.
140. The nurse is assessing a newborn, and
B. Use the stethoscope and count the rate for notes all of the findings. Which of the following
15 seconds. nursing assessments would cause the nurse to
be concerned?
C. Use the stethoscope or place a hand on the
newborn’s abdomen, and count the rate for A. Baby enjoys sucking on a pacifier and sleeps
one minute. 16 hours a day.
B. Baby is nursing every 2–2½ hours and has 2 D. “At 9 months, she is too young to learn to
stools daily. calm herself. Wait until she is 2 years old before
letting her cry longer.”
C. Birth weight is 6 pounds, 10 ounces. Present
weight is 5 pounds, 4 ounces.

D. Baby is sleeping in between feedings and is 143. The nurse inquires about the activity level
not babbling. of a 3-year-old. The mother states that the child
loves to play at the park, and that they go there
as much as possible. The nurse encourages the
mother to continue to take the child to the park
141. A new mother asks the nurse whether
for play. What important principle is guiding the
breastfeeding is better than formula for her
nurse’s response?
newborn. Which response by the nurse is most
appropriate? A. Socialization with other toddlers helps
develop communication skills.
A. “It often is easier to breastfeed, because you
do not have to prepare bottles.” B. Allowing the toddler to walk, run, and hop
enhances the child’s kinaesthesia.
B. “Breastfeeding is best for your baby; of
course you should choose this.” C. Maternal bonding is enhanced through play.
C. “There are no advantages to breastfeeding. D. Only an emotionally happy child can enjoy
You should do what is best for you.” the park.
D. “There are many benefits to breastfeeding;
let me tell you more about it.”
144. 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:
142. The father of a 9-month-old infant tells the
nurse that his wife picks up the baby A. “Your child has only baby teeth; they will
immediately whenever she begins to cry. The eventually fall out, and so there is no need to
most appropriate response by the nurse is: worry.”
A. “It is important for the child to learn to B. “Make sure your child’s diet is nutritious,
comfort herself. Does the baby try to calm and limit snacks high in sugar.”
herself by sucking her thumb?”
C. “Take the child to the dentist to see if he has
B. “It is OK to pick her up often; eventually, she any cavities.”
will stop crying.”
D. “Let the child watch you brush your teeth so
C. “Most infants do not know how to calm that he can learn how to do it himself.”
themselves. It is important to be responsive
when they cry.”
145. The nurse needs to obtain the height of a 148. A 7-year-old sibling of a child with special
3-year-old as part of routine health screening. needs is acting out in school. This behavior has
To obtain an accurate measurement, the child been attributed to jealousy over the attention
will: the special needs child receives. The school
nurse should suggest to the parents that the
A. Be measured in a recumbent position. sibling should:
B. Remove his shoes and stand upright, with A. Have a special time or activity with each
head level. parent alone.
C. Stand with his feet wide apart. B. Be dealt with using behavior modifications.
D. Face the wall as he is measured. C. Be asked to participate in the care of the
special needs child to understand why the child
needs more attention.
146. Mother of a 3-year-old tells the nurse that
D. Be evaluated by a psychologist to rule out any
her child has frequent nightmares. The
mental illness.
statement by the mother that indicates the
need for more teaching is:

A. “I usually talk quietly and rub her back to 149. A 2-year-old with epilepsy is showing signs
reassure her.” of developmental delay. The nurse has been
working with the family to support
B. “I read her a story until she calms down.”
development. The response from the parents
C. “I take her to my bed so she will calm that indicates the need for further teaching is:
down.”
A. “He has a schedule by which we abide at all
D. “I stay with her awhile to reassure her.” times.”

B. “We make sure he is always in a playpen or

enclosed area when he plays.”
147. Most schools include curricula regarding
human sexuality. What is the most appropriate C. “He has temper tantrums all the time. We
age group for the nurse to include in her stay near, but don’t give in to what he gets mad
instruction? about.”

A. 12-year-olds D. “He gets his Depakote every day at the same

time. He hasn’t shown signs of a seizure since
B. 9-year-olds he was 6 months old.”

C. 11-year-olds

D. 15-year-olds 150. The mother of a trainable adolescent with

Down syndrome states to the school nurse, “I
don’t know what’s going to happen to my child
when I die. How will he take care of himself?”
What is the nurse’s best response?

A. “There will always be somebody to take care

of him. Don’t worry, everything will be okay.”

B. “Is there a relative who can take care of him if

something happens? You need to develop a
plan for the future.”

C. “I am sure there is something we can do. Let

me look into alternative care and see what kind
of insurance you have.”

D. “We do have a program that will assist with

vocational learning. I need to get your consent
first; then, we can look at alternatives.”