PEDIATRIC NURSING

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

1.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

2.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

3. 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.

4. 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.

5. 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.

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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. -
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c. Building the teaching on the child’s current level of knowledge.
d. Presenting the information in order from simplest to most complex.

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. Epiglottitis, an inflammation of the epiglottis creates an emergency situation. This is:
a. An autoimmune disorder c. Caused only by bacteria
b. Viral
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 23. 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

24. 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

25. Croup is most likely to be caused by:

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

26. 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

27. 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

28. 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

29. 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

30. 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.

31. 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."

32. 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.

33. 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

34. 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

35. 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
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 36. 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.

37. 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.

38. 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 sided. In Trendelenburg’s with the head tilted forward.

39. 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

40. The nurse is caring for an infant vomiting secondary to pyloric stenosis. The mother questions why the vomitus of
this child appears different from that of her other children when they have the flu. The nurse would explain that
the emesis of an infant with pyloric stenosis does not contain bile because:
a. The GI system is still immature in newborns and infants c. The obstruction is above the bile duct b. The
emesis is from passive regurgitation d. The bile duct is obstructed

41. A 2-week-old neonate returned 6 hours ago from surgery to correct pyloric stenosis. Which postoperative nursing
interventions are most important?
a. Feeding small amounts frequently, assessing the amount of emesis, and encouraging parental involvement in care
b. Giving the neonate nothing by mouth until the wound heals, and encouraging parental Involvement c. Monitoring
Intake and output, and encouraging parental involvement in care
d. Monitoring hydration status, and encouraging parental involvement

42. Which of the following would be the priority nursing diagnosis for a 4-week-old infant with a diagnosis of pyloric
stenosis?
a. Constipation c. Imbalance nutrition: less than body requirements b. Deficient Fluid Volume d.
Impaired swallowing

43. For the child experiencing excessive vomiting secondary to pyloric stenosis the nurse should assess the child for
which of the following acid-base imbalances?
a. Respiratory alkalosis b. Respiratory acidosis c. Metabolic alkalosis d. Metabolic acidosis

44. The nurse is assessing the child diagnosed with Intussusception. The nurse would expect to find which of the
following?
a. Stool is light yellow, frothy and foul smelling c. Stool is narrow and ribbon-like
b. Stool is currant jelly like d. Green liquid stools

45. The parents of an infant with Hirschsprung’s disease ask the nurse how their baby got the disease. The nurse
would be correct in telling the parents that:
a. Their infant was born with this condition
b. It is the result of the meconium ileus their Infant has experienced as a newborn
c. Their infant spontaneously developed this condition
d. It often occurs following the introduction of solid foods due to a genetically inherited metabolic defect

46. Nurse Lilibeth provided health teachings regarding Hirschsprung’s disease to the infant’s parents. She determined
that no further teaching is required in relation to the diagnosis when the mother said:
a. “There is no rectal opening for stool to pass.”
c. “The nerves at the end of the large colon are missing.”
b. “There is a tube between the trachea and the esophagus.”
d. “The muscle below the stomach is too tight.”
47. The nurse is assessing newborn infants and children during their hospital stay. The nurse will notice which of the
following symptoms as a primary manifestation of Hirschsprung’s disease?
a. Failure to pass meconium during the first 24-48 hours after birth
b. Fine rash over the trunk
c. High-grade
This fever
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d. Skin turns yellow and then brown after 48 hours of life

48. A 2 year old diagnosed with Hirschsprung’s disease is being interviewed by the nurse. During data collection the
parents described the child’s stools as “strange”. Which of the following stool types would most likely fit the
parent’s description?
a. Light yellow, frothy and foul smelling b. Currant jelly-like c. Narrow and ribbon like d. Green liquid

49. During assessment of a 4-month-old infant with Hirschsprung’s disease, Nurse Lilibeth should most likely note:
a. Scaphoid shaped abdomen. c. Cyanosis of the fingers and toes. b. Weight less than expected for height and age. d.
Hyperactive deep tendon reflexes.

50. A 2-year-old male is admitted through the emergency department with a suspected diagnosis of Hirschsprung’s
disease. The child’s mother asks about treatment of the disease. The nurse’s response should be based on which
of the following facts?
a. He’ll have a permanent colostomy; as he matures, he can learn the required care.
b. He’ll have a temporary colostomy; “pull through” surgery will be done in the future
c. He’ll require many reconstructive colostomy surgeries over a lifetime
d. Hell require chemotherapy and radiation to treat his disease

51. A 4-month old infant has been diagnosed with PKU. The child has eczema and sensitivity to the sunlight. The
mother asks the nurse why her child's skin is so sensitive. An appropriate explanation by the nurse would be: a.
"Some children just have sensitive skin, don’t worry about it."
b. "Your child will outgrow his sensitivity when he is 5 years old. Just use sunscreen for now." c. "Your child has a
deficiency in melanin because of decreased tyrosine. You will always have to take special care of his skin."
d. "The phenylketones in your baby's blood concentrates the sun's rays, making burning more likely. Children with PKU
can never be in the sun."

52. Mothers in the waiting room of the endocrine clinic are discussing their children's illnesses. The mothers of
children with phenylketonuria and congenital hypothyroidism recognize there is a common goal in the early
treatment of their children. That goal is the avoidance of:
a. mental retardation b. fever c. obesity d. protein foods

53. The nurse is teaching the parents of a child with celiac disease about the dietary restrictions. The nurse would
explain that the most appropriate diet for their child is:
a. Gluten-free b. Salt-free c. Fat-free d. High-calorie, low fat.

54. The nurse is giving nutritional counseling to the mother of a child with celiac disease. Which statement by the
mother would indicate understanding?
a. “My son can’t eat wheat, rye oats or barley c. “My son must avoid potatoes, rice, flour and cornstarch” b.
“My son needs a diet rich in gluten” d. “My son can safely eat frozen and packaged foods”

55. Nurse Lilibeth is teaching the mother of a child with celiac disease about dietary management. Which of the
following statements by the mother indicates successful teaching?
a. “I will feed my child foods that contain wheat products.”
c. “I will plan to feed my child foods that contain rice.”
b. “I will be sure to give my child lots of milk.”
d. “I will be sure my child gets oatmeal every day.”

56. The mother asks Nurse Lilibeth, “How long must my child stay on this diet?” Which response should Nurse
Lilibeth give?
a. “Until the jejunal biopsy is normal” c. “For the next 6 months.”
b. “Until his stools appear normal” d. “For the rest of his life.”

57. The nurse is caring for a child with celiac disease. How should the nurse evaluate the effectiveness of nutritional
therapy?
a. Monitor vital signs every 4 hours c. Measure BUN and serum creatinine levels b. monitor the appearance, size,
and number of stools d. Measure intake and output

58. Which of the following statements by the mother would suggest that the child has celiac disease?
a. “His urine is so dark.” c. “His belly is so small.”
b. “His stool is large and smelly.” d. “He is so short.”

59. During the assessment of the child with celiac disease, Nurse Lilibeth should most likely note which of the
following physical findings?
a. Enlarged liver. c. Tender inguinal lymph nodes.
b. Protuberant abdomen. d. Periorbital edema.

60. Parents
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 should the nurse refer them?
a. Registered dietitian b. Genetic counselor c. Certified nurse midwife d. Social worker “Many of the great achievements

of the world were accomplished by tired and discouraged men who kept on working.”

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