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1. A nurse is reviewing the laboratory report of a child with tetralogy of Fallot that indicates an elevated RBC count. What does the nurse identify as the cause of the polycythemia?

• Low blood pressure
• Tissue oxygen needs
• Diminished iron level
• Hypertrophic cardiac muscle

2. A 1-month-old infant is admitted to the pediatric unit with a tentative diagnosis of Hirschsprung disease (congenital aganglionic megacolon). What procedure does the nurse expect to be used to confirm the diagnosis?

• Colonoscopy
• Rectal biopsy
• Multiple saline enemas
• Fiberoptic nasoenteric tube

3. What should nursing care for an infant after the surgical repair of a cleft lip include?

• Preventing crying
• Placing in a semi-Fowler position
• Keeping NPO for 1 day after surgery
• Feeding with a spoon for 2 days after surgery

4. What should a nurse use to feed an infant born with a unilateral cleft lip and palate?

• Plastic spoon
• Cross-cut nipple
• Parenteral infusion
• Rubber-tipped syringe

5. A nurse is caring for an infant with a tentative diagnosis of hypertrophic pyloric stenosis (HPS). What is most important for the nurse to assess?

• Quality of the cry
• Signs of dehydration
• Coughing up of feedings
• Characteristics of the stool

6. A newborn with an anorectal anomaly had an anoplasty performed. At the 2-week follow-up visit, a series of anal dilations are begun. What should the nurse recommend to the parents to help prevent the infant from becoming constipated?

• Use a soy formula.
• Breastfeed if possible.
• Administer a suppository nightly.
• Offer glucose water between feedings.

7. A 3-month-old infant with severe developmental dysplasia of the hip has a hip spica cast applied. What should the nurse teach the parents to prevent a serious complication?

• Change diapers frequently.
• Decrease the number of feedings per day.
• Avoid turning from prone to supine positions.
• Call the health care provider if there is a foul smell.

8. The parents of a newborn with phenylketonuria (PKU) need help and support in adhering to specific dietary restrictions. They ask the nurse, “How long will our child have to be on this diet?” How should the nurse respond?

• “We still are not sure; you should discuss this with yourhealth care provider.”
• “If your baby does well, foods containing protein can gradually be introduced.”
• “Your child needs to be on this diet at least through adolescence and into adulthood.”
• “This is a lifelong problem, and it is recommended that dietary restrictions must be continued.”

9. What is a common finding that the nurse can identify in most children with symptomatic cardiac malformations?

• Mental retardation
• Inherited genetic factors
• Delayed physical growth
• Clubbing of the fingertips

10. A nurse is caring for a 3-month-old infant who is diagnosed with congenital hypothyroidism. What should the parents be told of the probable effect on the infant’s future if treatment is not begun immediately?

• Myxedema
• Thyrotoxicosis
• Spastic paralysis
• Mental retardation

11. An infant with a congenital heart defect is being given gavage feedings. The parents ask the nurse why this is necessary. How should the nurse respond?

• “It limits the chance of vomiting.”
• “It allows the feeding to be administered rapidly.”
• “The energy that would have been expended on sucking is conserved.”
• “The quantity of nutritional liquid can be regulated better than with a bottle.”

12. A parent brings a 2-month-old infant with Down syndrome to the pediatric clinic for a physical and administration of immunizations. The nurse performs an initial physical assessment. Which clinical finding should alert the nurse to perform a further assessment?

• Flat occiput
• Small, low-set ears
• Circumoral cyanosis
• Protruding furrowed tongue

13. After a discussion with the health care provider, the parents of an infant with patent ductus arteriosus (PDA) ask the nurse to explain once again what PDA is. How should the nurse respond?

• The diameter of the aorta is enlarged.
• The wall between the right and left ventricles is open.
• It is a narrowing of the entrance to the pulmonary artery.
• It is a connection between the pulmonary artery and the aorta.

14. At a visit to the well-baby clinic, the parents are upset because their 9-month-old infant has a severe diaper rash; one parent wants to know how to treat it and prevent it from recurring. What cause of diaper dermatitis should the nurse include when answering the parent’s question?

• Use of disposable diapers
• Prolonged contact with an irritant
• Decreased pH of the infant’s urine
• Too early introduction of solid foods

15. What is an essential nursing action when caring for a young child with severe diarrhea

• Maintain the IV.
• Take daily weights
• Replace the lost calories
• Promote perianal skin integrity

16. A young child has coarctation of the aorta. What does the nurse expect to identify when taking the child’s vital signs?

• A weak radial pulse
• An irregular heartbeat
• A bounding femoral pulse
• An elevated radial blood pressure

17. A 5-month-old infant develops severe diarrhea and is given IV fluids. What is the rationale for the nurse to closely monitor the IV flow rate?

• Limiting output
• Replacing lost fluids
• Avoid IV infiltration
• Preventing cardiac overload

18. What clinical manifestation of tetralogy of Fallot should the nurse expect when caring for children with this diagnosis?

• Slow respirations
• Clubbing of fingers
• Decreased RBC counts
• Subcutaneous hemorrhages

19. An infant had corrective surgery for hypertrophic pyloric stenosis (HPS). What should the nurse teach a parent to do immediately after a feeding to limit vomiting?

• Rock the infant.
• Place the infant in an infant seat.
• Place the infant flat on the right side.
• Keep the infant awake with sensory stimulation.

20. When evaluating the laboratory report of a 1-year-old infant’s hematocrit, a nurse compares it with the expected hematocrit range for this age group. What is the hematocrit of a heal thy 12-month-old infant?

• 19% to 32%
• 29% to 41%
• 37% to 47%
• 42% to 69%

21. A nurse plans to discuss childhood nutrition with a group of parents whose children have Down syndrome in an attempt to minimize a common nutritional problem. What problem should be addressed?

• Rickets
• Obesity
• Anemia
• Rumination

22. Surgery to correct hypertrophic pyloric stenosis (HPS) is performed on a 3-week-old infant who had been formula-fed. Which postoperative feeding order is appropriate?

• Thickened formula 24 hours after surgery
• Withholding feedings for the first 24 hours
• Regular formula feeding within 24 hours after surgery
• Additional glucose feedings as desired after first 24 hours

23. What explanation should the nurse give a parent about the purpose of a tetanus toxoid injection for her child?

• Passive immunity is conferred for life.
• Long-lasting active immunity is conferred.
• Lifelong active natural immunity is conferred.
• Passive natural immunity is conferred temporarily.

24. A parent brings a 9-month-old infant to the pediatric clinic and asks about the introduction of new foods. What should the nurse suggest?

• “Mix the pureed food with formula and offer it in a bottle.”
• “Give the entire regular feeding and then introduce the new food.”
• “Offer a new food every day until one is accepted and then offer it again.”
• “Give a small amount of formula and then offer the new food while still hungry.”

25. An infant who had cardiac surgery for a congenital defect is to be discharged. What should the nurse emphasize to the parents when they administer the prescribed antibiotic?

• Give the antibiotic between feedings.
• Ensure that the antibiotic is administered as prescribed.
• Shake the bottle thoroughly before giving the antibiotic.
• Keep the antibiotic in the refrigerator after the bottle has been opened.

26. A 3-year-old child is scheduled for a cardiac catheterization. What is the priority nursing care after this procedure?

• Encouraging early ambulation
• Monitoring the site for bleeding
• Restricting fluids until the blood pressure is stabilized
• Comparing the blood pressure of both lower extremities

27. A nurse who is caring for an infant with a cleft lip is concerned about preventing an infection. Why does the cleft lip predispose the infant to infection?

• Waste products accumulate along the defect.
• There is inadequate circulation in the defective area.
• Nutrition is inadequate because of ineffective feeding.
• Mouth breathing dries the oropharyngeal mucous membranes.

28. A 1-year-old child has a congenital cardiac malformation that causes right-to-left shunting of blood through the heart. What clinical finding should the nurse expect?

• Proteinuria
• Peripheral edema
• Elevated hematocrit
• Absence of pedal pulses

29. A nurse is discussing the care of an infant with colic with the parents. What should the nurse explain is the cause of colicky behavior?

• Inadequate peristalsis
• Paroxysmal abdominal pain
• An allergic response to certain proteins in milk
• A protective mechanism designed to eliminate foreign proteins

30. A child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. What behavior is essential for the nurse to prevent postoperatively?

• Crying
• Coughing
• Straining at stool
• Unnecessary movement

31. What procedure should a nurse use when elevating the head of an infant in a spica cast?

• Change this position after an hour.
• Place pillows under the shoulders.
• Pad the edge of the cast with folded diapers.
• Raise the entire mattress at the head of the crib.

32. A 5-month-old infant is brought to the pediatric clinic for a routine monthly examination. What assessment alerts the nurse to notify the health care provider?

• Temperature of 99.5° F
• Blood pressure of 75/48 mm Hg
• Heart rate of 100 beats per minute
• Respiratory rate of 50 breaths per minute

33. A nurse is administering IV fluids to a dehydrated infant. What intervention is most important at this time?

• Continuing the prescribed flow rate
• Monitoring the intravenous drop rate
• Calculating the total necessary intake
• Maintaining the fluid at body temperature

34. A nurse is caring for an infant whose vomiting is intractable. For what complication is it most important for the nurse to assess?

• Acidosis
• Alkalosis
• Hyperkalemia
• Hypernatremia

35. A health care provider orders a tap water enema for a 6-month-old infant with suspected Hirschsprung disease. What rationale causes the nurse to question the order?

• The result could be loss of necessary nutrients.
• It could cause a fluid and electrolyte imbalance.
• It could increase the fear of intrusive procedures.
• The result could cause shock from a sudden drop in temperature.

36. A 4-month-old infant had a spica cast applied. What should the nurse include in the discharge instructions to the parents?

• Obtain a specially designed car seat.
• Keep diapers on to prevent soiling of the cast.
• Change the infant’s position every eight hours.
• Use the bar between the infant’s legs to change positions.

37. A parent brings a 2-week-old infant to the clinic because the infant continually regurgitates. Chalasia, an incompetent cardiac sphincter, is suspected. What instructions should the nurse give the parent?

• Keep the infant in an upright position after feedings.
• Prevent the infant from crying for prolonged periods.
• Keep the infant in the prone position following feedings.
• Ensure that the infant drinks a full bottle of formula at each feeding.

38. An order is written for an isotonic enema for a 2-year-old child. What is the maximum amount of fluid the nurse should administer without a specific order from the health care provider?

• 100 to 150 mL
• 155 to 250 mL
• 255 to 360 mL
• 365 to 500 mL

39. The nurse observes that an infant has asymmetric gluteal folds. For which disorder should the nurse perform a focused assessment?

• Congenital inguinal hernia
• Central nervous system damage
• Peripheral nervous system damage
• Developmental dysplasia of the hip

40. The parents of a 6-week-old infant who was born without an immune system ask a nurse why their baby is still so healthy. How should the nurse reply?

• Exposure to pathogens during this time can be limited.
• Some antibodies are produced by the infant’s colonic bacteria.
• Antibodies are passively received from the mother through the placenta and breast milk.
• Fewer antibodies are produced by the fetal thymus during the eighth and ninth months of gestation.

41. An infant with hypertrophic pyloric stenosis (HPS) is admitted to the pediatric unit. What does the nurse expect when palpating the infant’s abdomen?

• A distended colon
• Marked tenderness around the umbilicus
• An olive-sized mass in the right upper quadrant
• Rhythmic peristaltic waves in the lower abdomen

42. A nurse is caring for a child with a cardiac malformation associated with left-to-right shunting. What does the nurse consider to be the major characteristic of this type of congenital disorder?

• Elevated hematocrit
• Severe growth retardation
• Clubbing of the fingers and toes
• Increased blood flow to the lungs

43. What should the nurse include in the teaching plan for parents of an infant diagnosed with phenylketonuria (PKU)?

• Mental retardation occurs if PKU is untreated.
• Testing for PKU is done immediately after birth
• Treatment for PKU includes lifelong medications
• PKU is transmitted by an autosomal dominant gene.

44. Which cardiac defects are associated with tetralogy of Fallot?

• Right ventricular hypertrophy, atrial and ventricular defects, and mitral valve stenosis
• Origin of the aorta from the right ventricle and of the pulmonary artery from the left ventricle
• Right ventricular hypertrophy, ventricular septal defect, pulmonic stenosis, and overriding aorta
• Altered connection between the pulmonary artery and the aorta, right ventricular hypertrophy, and an atrial septal defect

45. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after the birth. What should the nurse consider before responding?

• Feeding problems are common in neonates.
• Inadequate sucking is not significant in the absence of cyanosis.
• Ineffective sucking and swallowing may be early indications of a heart defect.
• Many neonates retain mucus, and this may interfere with feeding for several weeks.

46. A nurse is caring for an infant with phenylketonuria (PKU). What diet should the nurse anticipate will be ordered by the health care provider?

• Fat-free
• Protein-enriched
• Phenylalanine-free
• Low-phenylalanine

47. Corrective surgery for hypertrophic pyloric stenosis (HPS) is completed, and the infant is returned to the pediatric unit with an IV infusion in place. What is the priority nursing action?

• Apply adequate restraints.
• Administer a mild sedative.
• Assess the IV site for infiltration.
• Attach the nasogastric tube to wall suction.

48. A nurse is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure. What did the nurse determine is the last sign of heart failure?

• Tachypnea
• Tachycardia
• Peripheral edema
• Periorbital edema

49. The parents of a child who is scheduled for open-heart surgery ask why their child must be subjected to chest tubes after surgery. What should the nurse consider before responding in language the parents will understand?

• They will increase tidal volumes.
• Drainage of air and fluid will be facilitated.
• They will maintain positive intrapleural pressure.
• Pressure on the pericardium and chest wall will be regulated.

50. A parent of an 11-month-old infant who has a cleft palate asks the nurse why it was recommended that closure of the palate should be done before the age of 2. How should the nurse respond?

• “After age 2 surgery is frightening and should be avoided if possible.”
• “Eruption of the 2-year molars often complicates the surgical procedure.”
• “As your child gets older, the palate gets wider and more difficult to repair.”
• “Surgery should be performed before your child starts to use faulty speech patterns.”