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1. In infants with hydrocephalus, the early

signs of ventricular shunt malfunction are:
a high-pitched cry, colic, and pupillary changes.
a tense fontanelle, vomiting, and irritability.
anorexia, and changes in pulse and respiration.
headaches, lethargy, and a loss of appetite.

2. Infants who are recovering from acute
diarrhea are often fed soy-based formulas
because:
milk-based formulas may cause gastrointestinal
bleeding.
soy protein is fortified with electrolytes.
their intestines are unable to digest normal fats.
their lactase activity is decreased.

3. The pediatric nurse advises a father how to
best convey the circumstances surrounding the
sudden death of his infant son to his four-year-
old daughter. The nurse anticipates that the
daughter:
may feel guilty about her brother's death.
may mistrust her father.
understands the permanence of death.
will role play her brother's death.

4. The physical manifestations of fetal alcohol
syndrome include:
cleft lip and palette.
hepatomegaly, hypotonia, and microphthalmia.
hyperbilirubinemia, jaundice, and failure to thrive.
microcephaly, short philtrum, and prenatal growth
retardation.

5. The laboratory results of a patient with
disseminated intravascular coagulation are
likely to include:
decreased levels of fibrin split products.
increased levels of fibrinogen.
increased platelet counts.
prolonged prothrombin and partial thromboplastin
times.

6. After receiving an immunization for
diphtheria, tetanus, and pertussis, a child
develops swelling and tenderness at the
injection site, a low-grade fever, and malaise.
The pediatric nurse informs the child's parents
that:
the reaction is severe enough that they should
bring the child to an emergency department.
they should delay future immunizations until the
child is seen by an allergist.
this is a mild reaction, and teaches them how to
manage it.
this is an appropriate reaction, and instructs them
to do nothing.

7. A one-month-old female infant, who has
developmental dysplasia of the hip, is placed in
a hip spica cast. The infant's mother expresses
the desire to continue breast-feeding. The
pediatric nurse's best response is:
After breast feeding, hold your baby upright for 45
minutes."
Due to the weight of the cast, breast-feeding is not
encouraged. I recommend that you bottle-feed
expressed breast milk so your baby will get the benefits
of the breast milk."
Feed your baby 2 oz of formula to decrease her
hunger frustration, then place her upright in your lap with
her legs straddling your leg."
To breast-feed, hold your baby under your arm,
with her facing you and her legs extended behind your
back."

8. The pediatric nurse instructs parents who
are concerned about the spread of illness at
their children's daycare centers to inquire about
the facilities':
immunization rates among enrolled children.
infection control practices.
reported cases of diarrhea during the previous
year.
staff-to-child ratios.

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9. A clean-catch urine culture for an eight-year-
old female patient with urinary frequency,
urgency, and dysuria contains over 100,000
colonies of Escherichia coli per mL of urine.
After instructing the family to safely administer
the prescribed antibiotic, the pediatric nurse
recommends having the patient:
empty her bladder at least every six to eight hours.
return for followup care and additional urine
cultures.
wear nylon, in place of cotton, underwear.
wipe the perineum, from back to front, after
urinating.

10. To meet the emotional needs of a 10-year
old child who is dying, the most appropriate
nursing action is to:
answer questions honestly and frankly.
avoid interruptions by coordinating nursing actions.
encourage the child to write in a journal.
4provide opportunities for the child to interact with
children of the same age.

11. A female adolescent, who has pelvic
inflammatory disease (PID), inquires about the
effects of the disease on her ability to bear
children. Which is the pediatric nurse's best
response?
The occurrence of spontaneous abortion during
pregnancy increases with PID."
There is an increased risk for ectopic pregnancy or
infertility."
There is an increased risk of placenta previa."
There should be no problems with your ability to
conceive."

12. In preparing a preschool-aged child for an
injection, the most appropriate nursing
intervention is to:
allow the child to administer an injection to a doll.
coordinate the child watching a peer receive an
injection.
have the parents explain the process to the child.
suggest diversionary activities like singing.

13. An adolescent, with chronic asthma, who
has been hospitalized several times during the
winter with severe asthmatic exacerbations
confides, I wish I could stay here in the
hospital because every time that I go home, I
get sick again! The pediatric nurse's best
response is:
I think that you should consider participating on a
swim team to improve your pulmonary function."
Let's talk about preventing and managing your
asthma on a daily basis at home."
Why don't I speak with your parents about what
they are doing at home to help control your asthma?"
Your insurance company does not pay for any
additional days of hospitalization that are not medically
necessary."

14. The major pharmacologic action of
albuterol (Proventil) is:
decreasing airway reactivity.
decreasing inflammation and airway obstruction.
improving the action of cilia to sweep trapped
mucous upward.
relaxing constricted bronchial smooth muscle.

15. While caring for a Laotian child who is
hospitalized for acute gastroenteritis and
dehydration, the pediatric nurse notes the
parent keeping packets of herbs by the child's
bedside. Suspecting that the parent may be
administering the herbs to the child, the nurse's
first action is to:
ask the parent in a nonjudgmental manner about
the herbs.
coordinate a nursing care conference to discuss
the child's plan of care.
discuss the risks of using alternative therapies with
the parent.
refer the family to a social worker for possible
noncompliance with the health care regimen.

16. A pediatric nurse, who is caring for a 12-
year-old patient with septic shock, perceives a
potential complication of fluid resuscitation
upon noting:
a heart rate of 50 beats/min.
a temperature of 102
o
F (38.8
o
C).
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complaints of leg pain.
rales and rhonchi by auscultation.

17. During the first two years of life, children
with bronchopulmonary dysplasia requiring
rehospitalization are most likely to be
diagnosed with:
electrolyte disturbances.
immune deficiencies.
pulmonary hypertension.
respiratory tract infections.

18. A four-year-old child, whose family follows
a strict vegetarian diet, undergoes a
prekindergarten physical examination. The
pediatric nurse is alert to the child's potential
deficiency of:
niacin.
thiamin.
vitamin B6.
vitamin B12.

19. A pediatric nurse is caring for a patient who
received chemotherapy 10 days ago. Which
laboratory value requires the nurse's
intervention?
A blood urea nitrogen level of 10 mg/dL
A hemoglobin of 8.6 g/dL
A platelet count of 18 x 10
3
/L
A serum glucose of 110 mg/dL

20. According to the Health Insurance
Portability and Accountability Act, a health care
facility may release patient information without
obtaining permission from the patient or family
when there is a request from a:
consulting physician to evaluate the patient.
lawyer regarding a child abuse case.
school nurse to update the school records.
teacher regarding behavioral issues.

21. With gastroesophageal reflux symptoms,
the purpose of esophageal pH monitoring is
evaluating for:
esophagitis from the reflux.
frequency of the reflux.
gastric emptying delays.
possible obstructions.

22. A pediatric nurse formulates the expected
outcomes that a child and family members,
who understand meal planning for type
1diabetes, will demonstrate. Which nursing
intervention assists with meeting the
outcomes?
Avoiding the consumption of foods with sorbitol
Instructing to follow a simple carbohydrate and
protein diet
Monitoring for the signs of hypoglycemia before
meals
Teaching about the basic food groups and
prescribed diet

23. Which initial question directed to the parent
assists the pediatric nurse in obtaining a
patient's health history?
Are your child's immunizations up to date?"
Is your child allergic to anything?"
What brings you here today?"
What is the child's problem?"

24. Which principle does the nurse manager of
a pediatric unit consider when changing staff
nurse-patient assignments?
Change is most effective when recommended by
management.
Change is most productive when responsibilities
are delegated.
Repeatedly seeking all participants' opinions and
suggestions tends to smooth transitions.
Staff investment in the need for change is
essential.

25. When a child participates in a research
study, the pediatric nurse's primary concern is
to ensure that the:
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parent or guardian has given verbal consent for the
child's participation.
quality of care that the child receives will not be
affected if the child chooses to withdraw from the study.
research meets the developmental needs of the
child.
research will directly benefit the child



ANSWER KEY

Question 1
The right answer was a tense
fontanelle, vomiting, and
irritability.
Question 2
The right answer was their lactase
activity is decreased.
Question 3
The right answer was may feel
guilty about her brother's death.
Question 4
The right answer
was microcephaly, short philtrum,
and prenatal growth retardation.
Question 5
The right answer was prolonged
prothrombin and partial
thromboplastin times.
Question 6
The right answer was this is a mild
reaction, and teaches them how to
manage it.
Question 7
The right answer was To breast-
feed, hold your baby under your
arm, with her facing you and her
legs extended behind your back."
Question 8
The right answer was infection
control practices.
Question 9
The right answer was return for
followup care and additional urine
cultures.
Question 10
The right answer was answer
questions honestly and frankly.
Question 11
The right answer was There is an
increased risk for ectopic
pregnancy or infertility."
Question 12
The right answer was allow the
child to administer an injection to a
doll.
Question 13
The right answer was Let's talk
about preventing and managing
your asthma on a daily basis at
home."
Question 14
The right answer was relaxing
constricted bronchial smooth
muscle.
Question 15
The right answer was ask the
parent in a nonjudgmental manner
about the herbs.
Question 16
The right answer was rales and
rhonchi by auscultation.
Question 17
The right answer was respiratory
tract infections.
Question 18
The right answer was vitamin B12.
5

Question 19
The right answer was A platelet
count of 18 x 10
3
/L
Question 20
The right answer was consulting
physician to evaluate the patient.
Question 21
The right answer was frequency of
the reflux.
Question 22
The right answer was Teaching
about the basic food groups and
prescribed diet
Question 23
The right answer was What brings
you here today?"
Question 24
The right answer was Staff
investment in the need for change
is essential.
Question 25
The right answer was quality of
care that the child receives will not
be affected if the child chooses to
withdraw from the study.