PEDIATRIC NURSING

COMMON DISORDERS
POST TEST
Prepared by: Prof. Mike Chavez RN, USRN

1.A child with a myelomeningocele is started on a bowel management plan. The child's mother questions why this is
being done. The nurse's response will be based on the understanding that:
a.Lack of innervation to the colon predisposes the child to diarrhea.
b.Lack of innervation to the anal spinchter predisposes the child to being incontinent.
c.Lack of mobility increases the gastric-colic reflex.
d.Lack of mobility decreases the need for regular bowel movements.

2.The nurse is teaching a class of pregnant women about diet. Which nutrient decreases the incidence if neural tube
defects (NTDs)?
a.Vitamin A c. Vitamin D
b.Vitamin C d. Folic acid

3.Which assessment finding suggests that Rod has spina bifida occulta?
a. Bilateral hip dislocation
b. Bulging anterior fontanel
c. Noticeable dimpling above the separation of the buttocks.
d. No movement in the lower extremities

4. A mother brought a 10-month old boy born with myelomeningocele and underwent surgical repair of
myelomeningocele. Which measure should the nurse use to prevent musculoskeletal deformity in the infant?
a. Placing the feet in flexion. c. Maintaining knees in the neutral position.
b. Allowing the hips to be abducted. d. Placing the legs in adduction.

5. When assessing the infant admitted to the pediatric unit with upper lumbar myelomeningocele, which
characteristic should Nurse Lilibeth anticipate finding?
a. Minimal movement of the lower extremities. c. Urinary bladder prolapsed.
b. Upper extremity paralysis. d. Respiratory problems.

6. When positioning a neonate with unrepaired myelomenigocele, which of the following positions is the most
appropriate?
a. Supine with hips at 90 degrees.
b. Right side lying position with the knees flexed.
c. Prone with hips in abduction.
d. Supine in semi-fowler’s position with chest and abdomen elevated.

7. Which of the following signs and symptoms would the nurse most likely find when assessing an infant with
Arnold-Chiari formation?
a. Flaccidity, lack of sensation in the lower extremities and loss of bowel and bladder control
b. Diminished or absent gag and swallowing reflex, hydrocephalus and respiratory distress
c. Thick mass over the neck muscle, holds the head tilted to the site of the muscle involved
d. The foot cannot be properly aligned, foot turns out

8. What would cause the closure of the Foramen ovale after the baby had been delivered?
a.Decreased blood flow
b.Shifting of pressures from right side to the left side of the heart
c.Increased PO2
d.Increased in oxygen saturation

9. Which of the following are defects associated with Tetralogy of Fallot?

a. Coarctation of the aorta, aortic valve stenosis, mitral valve stenosis, and patent ductus arteriosus
b. Ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy
c. Tricuspid valve atresia, atrial septal defect, ventricular septal defect, and hypoplastic right ventricle
d. Aorta exits from the right ventricle, pulmonary artery exits from the left ventricle, and two noncommunicating
circulations

10. A child diagnosed with Tetralogy of Fallot becomes upset, crying and thrashing around when a blood specimen is
obtained. The child’s color becomes blue and the respiratory rate increases to 44 breaths per minute. Which of
the following actions should Nurse Aubrey do first?
a. Obtain an order for sedation for the child. c. Explain to the child that it will hurt for a short time.
b. Assess for an irregular heart rate and rhythm. d. Place the child in a knee-to-chest position.
 11. When assessing the child with tetralogy of Fallot, which of the following positions would the nurse expect to see as
a compensatory mechanism?
a. Low fowler’s c. Supine
b. Prone d. Squatting

12. When teaching a preschool child how to pet-form coughing and deep-breathing exercises before corrective
surgery of Tetralogy of Fallot, which of the following teaching principles should Nurse Aubrey address first?
a. Organizing information to be taught in a logical manner.
b. Arranging to use actual equipment for demonstrations. -
c. Building the teaching on the child’s current level of knowledge.
d. Presenting the information in order from simplest to most complex.

13. After the surgery to correct Tetralogy of Fallot, the child’s parents express concern to the nurse that their 4-year-
old child wants to be held more frequently than usual. Nurse Aubrey interprets the child’s behavioral response to
stress as:
a. Repression. b. Depression. c. Regression. d. Discomfort.

14. The mother of a hospitalized child diagnosed with TOF tells the nurse that the child’s 3-year-old sibling has
become quiet and shy and demonstrates more than usual amount of sexual curiosity since her other child has
been hospitalized. Nurse Aubrey responds to the mother based on the interpretation that these behaviors reflect:
a. Usual behavior for a 3 year old. c. Exposure to a sexual experience.
b. Need for more attention. d. Indication of depression.

15. The nurse assesses a newborn with absent femoral pulses. This physical finding is associated with which neonatal
problem?
a. PDA b. VSD c. TOF d. COA

16. While assessing a child with coarctation of the aorta, the nurse would expect to find which of the following?
a. Absent of diminished femoral pulses c. Cyanotic (“tet”) episodes
b. Squatting posture d. Severe cyanosis at birth

17. When developing a teaching plan for the parents of a child with pulmonic stenosis, the nurse would keep in mind
that this disorder involves which of the following?
a. Return of blood to the heart without entry into the left atrium
b. Obstruction of blood flow from the right ventricle
c. Obstruction of blood from the left ventricle
d. A single vessel arising from both ventricles

18. Foramen ovale is the opening between two Atria so, if its will not close Atrial Septal defect can occur.
Before birth, which of the following structures connects the right and left auricles of the heart?
a.Umbilical vein
b.Foramen ovale
c.Ductus arteriosus
d.Ductus venosus

19. Failure of the Foramen Ovale to close will cause what Congenital Heart Disease?
a.Total anomalous Pulmunary Artery
b.Atrial Septal defect
c.Transposition of great arteries
d.Pulmunary Stenosis

20. After birth, the newborn’s circulation converts from a fetal to a neonatal circulation. The nurse understands that
the increase in the infant’s PO2 causes which shunt to close?
a.Foramen ovale
b.Ductus arteriosus
c.Ductus venosus
d.Ventricular septum

21. Which of the following represents an effective nursing intervention to reduce cardiac demands and decrease cardiac
workload?
a. Scheduling care to provide for uninterrupted rest periods
b. Developing and implementing a consistent plan of care
c. Feeding the infant over long periods of time
d. Allowing the infant to have her way to avoid conflict
 22. Which of the following nursing interventions would be appropriate to promote optimal nutrition in an infant with
congestive heart failure?
a. Offering formula that is high in sodium and calories
b. Providing large feedings evenly spaced every 4 hours
c. Replacing regular nipples with easy-to-suck ones
d. Allowing the infant to feed for at least 1 hour

23. After teaching the parents of baby Nicole about her anomaly, Nurse Cyrus determines that the teaching was
successful when the father described the condition as:
a. “The muscle below the stomach is too tight, causing the baby to vomit forcefully.”
b. “There is a blind upper pouch and an opening from the esophagus into the airway.”
c. “The lower bowel is lacking certain nerves to allow normal function.”
d. “A pert of the bowel is on the outside without anything covering it.”

24. Nurse Cyrus notices that Baby Nicole, a 1-day old girl, is having increased number of drooling and choking
episodes with excessive amounts of mucus and cyanotic episodes, especially after feeding. The infant is
diagnosed with tracheoesophageal fistula (TEF). Which of the following nursing diagnoses should Nurse Cyrus
identify as a priority for the infant with a TEF?
a. Impaired parenting related to newborns’ illness.
b. Risk for injury related to increased potential for aspiration.
c. Ineffective breathing pattern related to a weak diaphragm.
d. Imbalanced nutrition: less than body requirements related to poor sucking ability. -

25. Baby Nicole has undergone a surgery for the repair of TEF and now receives gastrostomy tube feedings. After
feeding the Infant by this method, Nurse Cyrus cradles and rocks the infant for about 15 minutes, primarily to
help accomplish:
a. Promote intestinal peristalsis c. Relieve pressure on the surgical site
b. Prevent regurgitation of formula d. Associate eating with a pleasurable experience

26. 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 leaning 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

27. Which of the following respiratory conditions is always considered a medical emergency?
a. Laryngotracheobronchitis b. Epiglottitis c. Asthma d. Acute nasopharyngitis

28. Epiglottitis, an inflammation of the epiglottis creates an emergency situation. This is:
a. An autoimmune disorder c. Caused only by bacteria
b. Viral only in nature d. Is bacterial and viral in nature

29. If the child has epiglottitis, the nurse should not attempt to do which of the following before an artificial airway is
established?
a. Give intravenous therapy to maintain hydration c. Visualize the epiglottis using a tongue blade
b. Administer oxygen d. Give moist air to reduce epigiottal inflammation

30. A child in the emergency room is diagnosed with an acute episode of Croup (Acute lanryngothracheobronchitis).
During the initial assessment, which of the following finding would the nurse expect to find?
a. Diffuse expiratory wheezing c. Decreased aeration in lung fields
b. inspiratory stridor with a brassy cough d. Shallow respirations

31. Croup is most likely to be caused by:

a. H. Influenza b. Staphylococcus aureus c. parainfluenza virus d. Streptococcus

32. A 2-year-old child is brought to the emergency department with suspected croup. Which of the following
assessment findings reflects increasing respiratory distress?
a. Intercostals retractions b. Bradycardia c. Decreased level of consciousness d. Flushed skin

33. Which of the following would the nurse keep in mind as a rationale for using a mist tent for the child with acute
laryngotracheobronchitis?
a. Provide 100% oxygen b. Liquefy secretions c. Warm the respiratory tract d. reverse isolation

34. For which of the following reasons would the nurse expect to institute intravenous fluid therapy and nothing by
mouth (NPO) status for an infant with bronchiolitis?
a. Tachypnea b. Fever c. Irritability d. Tachycardia
 35. One of the primary nursing diagnoses for a child with chronic bronchitis is “ineffective airway clearance related to
retained secretions,” plans to decrease retained secretions should include:
a. Administering oxygen as ordered
b. Placing the client in a high-Flower’s position
c. Gargling periodically with warm normal saline
d. Increasing fluid intake to at least 2,000 ml/day

36. Immediately following a tonsillectomy, the child should be placed in which of the following positions?
a. High Fowler’s, head straight c. Side lying
b. Semi-Fowler’s, head to the side d. Prone position, head to the side

37. The child has just returned from the OR following tonsillectomy. The nurse should observe for signs of
hemorrhage which includes:
a. Increasing pulse or respiratory rate. c. Throat clearing and feeling of anxiety
b. Frequent swallowing d. All of the above

38. The mother tells the nurse that her child has nosebleed that does not stop. The nurse should advise the mother
to position the child:
a. Prone with the face on a pillow c. Sitting with the head tilted backward
c. Prone with the head to the side d. Sitting with the head tilted forward

39. A child with cystic fibrosis is hospitalized for a respiratory infection. Which documentation in the chart would
indicate the need for counseling regarding nutrition and gastrointestinal complication?
a. Frothy, foul-smelling stools c. Weight unchanged from yesterday.
b. Consumed 80 percent of breakfast d. Eats three snacks every day.

40. 2 year-old child has just been diagnosed with cystic fibrosis. The child's father asks the nurse "What is our major
concern now, and what will we have to deal with in the future?" Which of the following is the best response?
a. "There is a probability of life-long complications."
b. "Cystic fibrosis results in nutritional concerns that can be dealt with."
c. "Thin, tenacious secretions from the lungs are a constant struggle in cystic fibrosis."
d. "You will work with a team of experts and also have access to a support group that the family can attend."

41. The parent of a child with cystic fibrosis informs the nurse that they will be unable to perform postural drainage
at home because their bed does not recline like the hospital bed. The nurse’s response is based on an
understanding that:
a. Postural drainage is essential to mobilize secretions in the airways so they can be coughed out.
b. Postural drainage is not necessary as long as the child takes his pulmozyme to decrease the viscosity of the mucus.
c. Postural drainage dose not influence the pulmonary status of a child with cystic fibrosis.
d. The parents can be referred to the Cystic Fibrosis Foundation for a flexible bed.

42. The nurse would expect the cystic fibrosis client to receive supplemental pancreatic enzymes along with a diet
a. High in carbohydrates and proteins c. High in carbohydrates, low in proteins
b. Low in carbohydrates and proteins d. Low in carbohydrates, high in proteins

43. An adolescent was diagnosed with cystic fibrosis as an infant. At this time the adolescent will need additional
teaching related to:
a. Obtaining a sweat chloride test c. The effect of pancreatic enzymes on the sex hormones
b. Weight reduction diet d. Reproductive ability

44. Which test result is a key finding in the child with cystic fibrosis?
a. Chest X-ray revealing interstitial fibrosis c. Lateral X-ray revealing an enlarged epiglottis
b. Neck X-ray showing areas of upper airways narrowing d. Positive pilocarpine iontophoresis sweat test

45. Baby Ama, an infant of Chavez couple, who has cleft lip and palate is admitted for surgery. Nurse Maganda
teaches the mother of measures on feeding her infant. Which of the following measures would be most effective
in helping baby Ama to retain oral feedings?
a. Burp the infant at frequent intervals.
b. Feed the infant small amounts at one time.
c. Place the end of the nipple far to the back of the infant’s tongue.
d. Maintain the infant in lying position while feeding.

46. After the teaching, Mrs. Chavez asks Nurse Maganda, “When would be the best time for the repair of my baby’s
cleft palate?” Nurse Maganda responds by stating that the first repair of a cleft palate is usually done at which of
the following times?
a. Before the eruption of teeth. c. Before the development of speech.
b. When the child’s weight is approximately 22 kg. d. After the child learns to drink from a cup.

47. Nurse Maganda is developing a plan of care for baby Ama with clift palate before a surgery is performed. Which
of the following should be a priority in the plan of care?
a. Maintaining skin Integrity in the oral cavity. c. Altering the usual method of feeding.
b. Using techniques to minimize crying. d. Preventing the infant from putting fingers in the mouth.

48. Which of the following measures would be most effective in helping the infant with a cleft lip and palate to retain
oral feedings?
a. Bubble the infant at frequent intervals c. Place the end of the nipple far to the back of the infant’s tongue
b. Feed the infant small amounts at one time d. Maintain the infant in a lying position while feeding

49. Immediately upon return to the nursing unit after the operation of baby Ama’s cleft palate, in which position
should Nurse Maganda place the baby?
a. On the back with the head on the position of comfort c. In low fowler’s with the head turn on the side
b. Lying on the abdomen with the head turn to the side d. In Trendelenburg’s with the head tilted forward.

50. A 2-month-old is brought to the clinic by his mother. His abdomen is distended and he has been vomiting
forcefully and with increasing frequency over the past 2 weeks. On examination, the nurse notes signs of
dehydration and a palpable mass” to the right of the umbilicus. Peristaltic waves are visible, moving from left to
right. The nurse should suspect which of the following conditions?
a. Colic b. Failure to thrive c. Intussusception d. Pyloric stenosis