PEDIATRIC NURSING NORMALS

REINFORCEMENT EXAM
1. The terms growth and development are often used interchangeably. Which of the following does development
refer to?
a. A boy grows taller all through early childhood
b. A boy learns to throw a ball overhead
c. A boy triples his weight on his third year
d. A boy increases his brain size until school age
Answer: B Development is a skill so throwing a ball is a true example (fine motor skill) all of the other options
pertains more to growth. Growth is an increase in physical size or quantitative change. Development is an
increase in skill or ability to function or qualititive change.(www.nursetest.com.ph)
2. Which of the following statements reflect Kohlbergs theory of moral development of the pre-school-age
child?
a. Obeying adults is seen as correct behavior
b. Showing respect for parents is seen as important.
c. Pleasing others is viewed as good behavior.
d. Behavior is determined by consequences.
Answer: D. According to Kohlberg, in the preconventional stage of development, the behavior of the preschool
child is determined by the consequences of the behavior. Stage 1 (2-3 yrs old) Punishment/ obedience oriented
(heteronymous morality) child does right cause a parent tells him or her to and to avoid punishment. Stage 2 (4-7
yrs. Old) Individualism. Instrumental purpose and exch. Carries out action to satisfy own needs rather than
society.-Will do something for another if that person does something for the child.
Reference: Pillitteri 3rd Edition
3. When developing a play program for a group of school aged children by integrating Eriksons framework of
psychosocial development, the nurse would incorporate play activities to aid in developing the childs sense
of which of the following?
a. Identity
c. Industry
b. Intimacy
d. Initiative
Answer: C. According to Erikson, industry versus inferiority is the theme of psychosocial development during
middle and late childhood. The challenge is mastering skills to create and complete projects; this is often done
through play. Identity vs. Role confusion (adolescent). Intimacy vs. Isolation (Young adulthood). Initiative vs.
Guilt (pre-schooler) (Lippincotts 3rd edition)
4. You are a pediatric nurse. By the knowledge of growth and development, gross motor coordination is
demonstrated by:
a. A toddler running in the playground
b. A pre-schooler tying is shoe laces
c. A school aged child writing in his notebook
d. An adolescent sewing a school project in her arts and craft class
Answer: A. Large muscle groups of the legs demonstrated in running is an example of gross coordination. Option
B, C, and D are demonstration of fine coordination skills making use of small muscle groups and refined types of
movement(www.nursetest.com.ph)
5. A clinic is preparing to discuss the concepts of moral development with a mother. The nurse understand that
according to Kohlbergs theory of moral development, in the preconventional level, moral development is
thought to be motivated by which of the following?
a. The parents behavior
c. Social pressure
b. Peer pressure
d. Punishment and reward
Answer: D In the preconventional stage, morals are thought to be motivated by punishment and reward. If the
child is obedient and is not punished, then the child is being moral. The child sees actions as good or bad. If the
childs actions are good, the child is praised. If the childs actions are bad, the child is punished.(Pilliteri 5 th
edition)
6. A 2 year old male child who has fallen from a tree tells his parents, bad, bad tree. The nurse recognizes
that the child is within the cognitive developmental norm of Piagets:
a. concrete operations
b. concept of reversibility
c. preconceptual operations
d. sensorimotor development
Answer: C. In the toddler, two-and three-word phrases are used with an increased
vocabulary, attributing lifelike qualities to inanimate objects (animism) is also associated with preconceptual
thought.A. This is related to school-age childrenB. This is a phase of concrete operations seen in school-age
childrenD. This is related to infants(Pilliteri 5 th edition)

7. Which of the following principles of development is being addressed when new parents are taught that infants
are able to lift their heads before their trunks?
a. Cephalocaudal
c. Simple to the complex
b. Proximodistal direction
d. General to specific
Answer: A- Cephalo means head and caudal pertains to tail or feet which is a predictable pattern of growth and
development. Proximodistal direction means parts proximal to the body develop first than that of the distal one
(ie. A newborn makes litle use of the arms and hands, at 3 to 4 months the infant has enough arm control to
support the upper body weight on the forearms) Simple to complex means child learns form simple operations
before complex function of move from a broad general pattern of behavior.(www.nursetest.com.ph)
8. The mother tells the nurse that her preschool-age child doesnt seem to know the difference between right
and wrong. In assessing this child, the nurse would explain to the mother that this is typical of which level of
moral development as described by Kohlberg?
a. Autonomous.
c. Preconventional.
b. Conventional.
d. Principles
Answer: C The preconventional level of Kohlbergs stages of moral development is typical of the preschool-age
child. Stage I behaviors of this preconventional level
have a punishmentobedience orientation. Conventional morality pertains to children age 7 to 12. Autonomous
and principles are not stages of moral development as described by Kohlberg. (A, T, H)(Pilliteri 5 th edition)
9. In assessing a pediatric patients growth and development, the nurse is guided by principles of growth and
development. Which is not included in these principles?
a. Rate and pattern of growth can be modified
b. Different parts of the body grows at different rate
c. All individual follow predictable growth rate
d. All individuals follow head to foot and central to distal patterns
Answer: A. Growth and development occurs in cephalo-caudal meaning development occurs through out the
bodys axis. Proximo-distal is development that progresses from center of the body to the extremities. Different
parts of the body grows at different range because some body tissue mature faster than the other such as the
neurologic tissues peaks its growth during the first years of life while the genital tissue doesnt till puberty. Also
G&D is predictable in the sequence which a child normally precedes such as motor skills and behavior. Lastly
G&D can never be modified.(Pilliteri 5th edition)
10. Growth and development in a child progresses in different patterns. The given patterns include the following
EXCEPT:
a. From cognitive to psychosexual
b. From trunk to the tip of the extremities
c. From head to toe
d. From broad to specific
Answer: A. Growth and development occurs in cephalo-caudal (head to toe), proximodistal (trunk to tips of the
extremities and general to specific, but it doesnt occur in cognitive to psychosexual because they can develop at
the same time.(www.nursetest.com.ph)
11. Which of the following characterizes the rate of growth during preschool?
a. most rapid period of growth
c. growth spurt
b. slowed growth
d. rapid growth
Answer: B. During the Preschooler stage growth is very minimal. Weight gain is only 4.5lbs (2kgs) per year and
Height is 3.5in (6-8cm) per year.Review: Most rapid growth and development- Infancy, Slow growth- Toddler
hood and Preschooler, Slower growth- School age, Rapid growth- Adolescence(Pilliteri 5 th edition)
12. The father of a newborn observes that neonates big toe dorsiflexes and the other toes fan when the nurse
gently strokes the sole of the foot. The nurse should interpret this positive finding of which of the following?
a.
Babinski sign
c.
Stepping reflex
b.
Palmar grasp
d.
Landau reflex
Answer: A. A positive babinski sign involves dorsiflexion of the big toe and fanning of the other toes. Although
normal in infants, this response is abnormal after about age 1 year or when walking begins.Plantar grasp,
newborn grasp an object placed in their palm by closing their fingers on it. Steeping reflex, newborn who are held
in a vertical position with their feet touching a hadr surface will take a few quick, alternating steps. Landau reflex,
A newborn who is held in a prone position with a hand underneath, supporting the trunk, should demonstrate
some muscle tone. (Lippincotts 3rd edition)
13. Vitamin K is administered to the newborn shortly after birth for which of the following reasons?
a. To stop hemorrhage
c.
To replace electrolytes
b. To treat infection
d.
To facilitate clotting

Answer: D. Vitamin K is given after delivery because the newborns intestinal tract is sterile and lacks vitamin K
needed for clotting. Vitamin K is used to prevent and treat hemorrhagic disease in newborns. It is a necessary
component for the production of certain coagulation factors (II, Vii, IX, and X) and is produced by
microorganisms in the intestinal tract. Dosage of .5 1.5 ml IM, vastus lateral or lateral ant thigh, 5 ml in preterm
babyReference: Pillitteri 3rd Edition
14. The nurse is responsible for performing a neonatal assessment on a full-term infant. At 1 minute , the nurse
could expect to find:
a. An apical pulse of 100
c. Cyanosis of the feet and hands
b. An absence of tonus
d. Jaundice of the skin and sclera
Answer: C. Cyanosis of the feet and hands is acrocyanosis. This is a normal finding 1 minute after birth. An
apical pulse should be 120-160, and the baby should have muscle tone, making answers A and B incorrect.
Jaundice immediately after birth is pathological jaundice and is abnormal, so answer D is incorrect.
Reference: Pillitteri 3rd Edition
15. The nurse is caring for a new mother. The mother asks why her baby has lost weight since he was born. The
best explanation of the weight loss is:
a. The baby sis dehydrated
b. The baby is hypoglycemic
c. The baby is allergic to the formula the mother is giving him
d. A loss of 10% is normal in first week due to meconium stools.
Answer: D. A loss of 5 to 10% is normal due to meconium stool and water loss. There is no evidence to indicate
dehydration, hypoglycemia, or allergy to the infant formula.Reference: Pillitteri 3 rd Edition
16. A parent seemed concerned about the fact that the infants soft spot is still open. Which of the following
would the nurse include when explaining about the usual age for closure of the soft spot near the front of the
infants head?
a. 2-4 months
c. 9-11 months
b. 5-8 months
d. 12-18 months
Answer: D. The anterior fontanel, the soft spot near the front of infants head, usually closes between age 12 and
18 months. The small anterior fontanel usually closes by 6-8 weeks. The porterior fontanels closes at 2-3 months.
Reference: Pillitteri 3rd Edition
17. The nurse is assessing a recently admitted newborn. Which finding should be reported to the physician?
a. The umbilical cord contains three vessels.
b. The newborn has a temperature of 98 degree F.
c. The feet and hands are bluish in color.
d. A large, soft swelling crosses the suture line.
Answer: D. The large soft swelling that crosses the suture line indicates that the newborn has a caput
succedaneum. This finding should be reported to the physician. Option A is incorrect because the umbilical cord
normally contains three vessels (two arteries and one vein). Option B is incorrect because the temperature is
normal for the newborn. Option C refers to acrocyanosis, which is normal in the newborn.Reference: Pillitteri 3 rd
Edition
18. When examining the umbilical cord of a newborn, the nurse would expect to observe which of the following
as normal?
a. One vein and two arteries
c. Two veins and one artery
b. One artery and one vein
d. Two veins and two arteries
Answer: A. The normal umbilical cord consists of three vessels, one vein and two arteries. Any abnormalities
usually iindicate cardiac abnormalies.Reference: Pillitteri 3 rd Edition
19. An infants Apgar score is 9 at 5 minutes. The nurse aware that the most likely cause for the deduction of one
point is:
a. The baby is cold.
c. The babys hands and feet are blue.
b. The baby is experiencing bradycardia.
d. The baby is lethargic.
Answer: C. Infants with an Apgar of 9 at 5 minutes most likely have acrocyanosis, a normal physiologic
adaptation to birth. It is not related to the infant be in cold, experiencing bradycardia, or being lethargic.
0
1
2
HR
-absent
<100
>100
Resp effort
-absent
- slow, irreg, weak -good strong cry
Muscle tone
- flaccid extremities - some flexion
- well flexed
Reflex irritability
Catheter
- no response
- grimace
- cough, sneeze

Tangential Footslap
Color

- NR
- blue/pale

- grimace
- acrocyanosis
(body- pink
extremities-blue)

- cry
- pinkish

APGAR result
0 3 = severely depressed, need CPR, admission NICU
4 6 = moderately depressed, needs addl suctioning & O2
7 - 10 =good/ healthy
Reference: Pillitteri 3rd Edition
20. The nurse is teaching basic infant care to a group first time parents. The nurse should explain that a sponge
bath is recommended for the first two weeks of life because:
a. New parents need time to learn how to hold the baby.
b. The umbilical cord needs time to separate.
c. Newborn skin is easily traumatize by washing
d. The chance of chilling the baby is lower compared to tub bath.
Answer: B. The umbilical cord needs time to dry and fall off before putting the infant in the tub. Although option
A, C, and D might be important, they are not the primary answer to the question.Reference: Pillitteri 3 rd Edition
21. The nurse is teaching circumcision care to the mother of a newborn. Which statement indicates that the
mother needs further teaching?
a. I will apply petroleum gauze to the area with each diaper change.
b. I clean the area carefully with each diaper change.
c. I can place a heat lamp to the area to speed up the healing process.
d. I should carefully observe the area for signs of infection.
Answer: C. The mother does not need to place an external heat source near the infant. It will not promote healing,
and there is a chance that the newborn could be burned, so the mother needs further teaching. Applying petroleum
gauze prevents the circumcised area from sticking to the diaper and to prevent trauma to the wound. Cleaning the
area carefully is essential as well as observing for signs of infection like fever, abnormal discharges and
irritability.Reference: Pillitteri 3 rd Edition
22. Upon arrival in the nursery, Erythromycin eyedrops are applied to the newborns eyes. The nurse understands
that the medication will:
a. Make the eyes less sensitive to light.
c. Strengthen the muscles of the eyes.
b. Help prevent neonatal blindness.
d. Improve accommodation to near objects.
Answer: B. The purpose of applying Erythromycin eye drops to the newborns eyes is to prevent neonatal
blindness or opthalmia neonatorium that can result from contamination with Neisseria gonorrhoeae. The other
options are not the purpose of credes prophylaxis.Reference: Pillitteri 3 rd Edition
23. Which of the following responses would be most appropriate when a breastfeeding mother asks the nurse
How will I know if my baby is getting enough milk?
a. Youll see that my baby wont cry between the feedings.
b. The baby will sleep a minimum of four hours after each feeding.
c. The baby should have 6 or more wet diapers per day.
d. The baby will have a large, soft, unformed stool with each feeding.
Answer: C. Frequent voiding indicates a well hydrated newborn with appropriate fluid intake. An infant who is
receiving only breast milk and is well hydrated is receiving adequate nourishment. The infant should also be
weighed frequently to determine nutritional status. Defecating after every feeding indicates adequate gastrocolic
reflex.Reference: Pillitteri 3rd Edition
24. The nurse records on the teaching sheet that a client understands the primary advantage of breastfeeding when
she hears the client tell her husband which of the following?
a. A breastfed infant sleeps for longer periods of time.
b. He will gain much faster than when on formula.
c. We will not need to use contraception while I am nursing.
d. The baby will get antibodies to protect him from infections.
Answer: D. The primary advantage of breastfeeding is the immunoglobulins A received by the infant from the
mother which can help the infant fight infections.(Pilliteri 5 th edition)
25. The obstetrician hands the neonate to the nurse after delivery. The nurses first action should be to:
a. Dry and place the infant in a warm environment
b. Cut the umbilical cord and attach a Hesseltine umbiliclip
c. Administer oxygen by face until cyanosis clears
d. Perform an abbreviated systematic physical assessment

Answer: A. Preventing heat loss conserves the infants oxygen and glycogen reserves, and this is a first priority.
This will also prevent the occurrence of hypothermia which can place the baby in danger. The other options can
be performed after.(Pilliteri 5th edition)
26. A nurse is preparing to assess the apical heart rate of a newborn infant in the newborn nursery. The nurse
performs the procedure and notes that the heart rate is normal if which of the following is noted?
a. heart rate of 90 beats/min
c. A heart rate of 180 beats/min
b. A heart rate of 140 beats/min
d. A heart rate of 190 beats/min
Answer: B. The normal heart rate in a newborn infant is 120 to 160 beats/min. Options A, C and D are incorrect.
Option A indicates bradycardia and options C and D indicate tachycardia.(Pilliteri 5 th edition)
27. Which pulse is best to assess in a neonate?
a. Apical
c. Carotid
b. Brachial
d. Pedal
Answer: A. Auscultating the apical area is the most accurate way to determine the rate & quality (rhythm,
strength & sound) of a neonates pulse. The apical pulse w/c should be assessed for 1 min when the neonate is
quiet, normally ranges from 110-160 bpm. Auscultating any of the other sites would yield imprecise results; a
neonate has small arteries & a rapid pulse rate, w/c makes palpation of the pulse difficult. (Pilliteri 5 th edition)
28. A nurse is preparing to assess the respirations of a newborn infant just admitted to the nursery. The nurse
performs the procedure and determines that the respiratory rate is normal if which of the following are noted?
a. A respiratory rate of 20 breaths/min
b. A respiratory rate of 40 breaths/min
c. A respiratory rate of 90 breaths/min
d. A respiratory rate of 100 breaths/min
Answer: B. Normal respiratory rate varies from 30 to 60 breaths/min when the infant is not crying. Respirations
should be counted for 1 full minute to ensure an accurate measurement because the newborn infant is a periodic
breather. Observing and palpating respirations while the infant is quiet promotes accurate assessment. Palpation
aids observation in determining the respiratory rate. Option A indicates bradypnea, and options C and D indicate
tachypnea. (Pilliteri 5th edition)
29. The client asks the nurse what surfactant is. Which of the following functions best explains the main role of
surfactant in the neonate?
a. Assist the ciliary body maturation in the upper airways
b. Helps maintain a rhythmic breathing patterns
c. Promotes cleansing mucus from the respiratory tract
d. Helps the lung remain expanded after the initiation of breathing
Answer: D. Surfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain
slightly expanded, decreasing the amount or work required for inspiration. Surfactant hasnt been shown to
influence ciliary body maturation, clearing to the respiratory tract, or regulation of the neonates breathing
pattern. (Pilliteri 5th edition)
30. The nurse teaches a postpartum client that her neonates first stool will be meconium, which consist intestinal
secretions and cells. Which of the following colors and consistencies best describe the typical appearance of
meconium?
a. Soft, pale yellow
c. Sticky green, black
b. Hard, pale brown
d. Loose, golden yellow
Answer: C. Meconium collects in the GI tract during gestation and is initially sterile. Meconium is greenish black
because of occult blood and is viscous. The stools of breast-fed neonates are loose greenish yellow after the
transition to extrauterine life. The stools of formula babies are typically soft and pale yellow after feeding is well
established.(Pilliteri 5th edition)
31. A neonate demonstrates the tonic neck reflex by:
a. Extending the leg on the same side to which his head is turned
b. Flexing the leg on the same side to which his head is turned
c. Extending the leg on the opposite side to which his head is turned
d. Abducting the leg on the opposite side to which his head is turned
Answer: A. The tonic neck reflex is demonstrated by extension of the arm and leg on the same side to which the
neonates head is turned & by flexion of the contralateral arm & leg (asymmetrical positioning). This reflex
typically disappears by age 3 or 4 months, when symmetrical positioning (movt of the limbs in unison) occurs.
(Pilliteri 5th edition)
32. A nurse in the newborn nursery is caring for a premature infant. The best way to assist the parents to develop
attachment behaviors is to:
a. Encourage the parents to touch and speak to their infant

b. Place family pictures in the infants view

c. Report only positive qualities and progress to the parents
d. Provide information on infant development and stimulation
Answer: A. Parents involvement through touch and voice establishes and initiates the bonding process in the
parent-infant relationship. Their active participation builds their confidence and supports the parenting role.
Providing information and emphasizing only positives are not incorrect, but do not relate to the attachment
process. Family pictures are ineffective for an infant.(Pilliteri 5 th edition)
33. When inspecting her newborn after delivery, a mother asks the nurse whether her newborn has flat feet. The
nurse recalls that:
a. Flat feet are common in children and infants
b. This is difficult to assess because the feet are so small
c. Flat feet are associated with major deformities of the bones of the feet such as clubfoot
d. The arch of the newborns foot is covered with a fat pad giving the appearance of being flat
Answer: D. The fat pad is present in newborns and infants; the arch develops when the child begins to walk. Flat
feet are normal assessment in ifants who are stiil unable to walk.(Pilliteri 5 th edition)
34. Which one of the following infants will require a further assessment of growth?
a. 4-month-old birth weight 7lb, 6oz; current weight 14lb, 4oz
b. 2-week-old; birth weight 6lb, 10oz, current weight 6lb, 12 oz
c. 6-month-old birth weight 8lb, 8oz; current weight 15lb
d. 2-month-old: birth weight 7lb, 2oz; current weight 9lb, 6oz
Answer: B. The infant is not gaining weight as he should. Further assessment of feeding patterns as well as
organic causes for growth failure should be investigated. The normal weight at birth 2.5 kg or 5.5 lbs. A newboen
loses 5 to 10% of birth weight during the first few days after birth. After this initial loss of weight, a newborn has
1 day of stable weight, then begins to gain weight about 2lbs per month (6 to 8oz per week) for the firs 6 months
of life.Reference: Pillitteri 3rd Edition
35. An infant weighs 7 pounds (3.18kg.) at birth. The expected weight by 1 year should be:
a. 10 pounds (4.55 kg.)
c. 18 pounds (8.18 kg.)
b. 12 pounds (5.45 kg.)
d. 21 pounds (9.55 kg)
Answer: D. A birth weight of 7 pounds would indicate 21 pounds in a year, or triple his birth weight.
Reference: Pillitteri 3rd Edition
36. A new born weighed 7 pounds at birth. At 6 months of age, the infant could be expected to weigh:
a. 14 pounds
a. 25 pounds
b. 18 pounds
b. 30 pounds
Answer: A. The infants birth weight should double by 6 months of age. Option B, C, and D are incorrect because
they are greater than the expected weight gain by 6 months of age.Reference: Pillitteri 3 rd Edition
37. A mother asks the nurse when she should wean her 4 month old infant from breast feeding and begin using a
cup. Which of the following would the nurse explain as the best indication of the infants readiness to be
weaned?
a. Shortening the nursing time
c. Taking solid foods well
b. Sleeping through the night
d. Eating on a regular schedule
Answer: A. Readiness for weaning is an individual matter but is usually indicated when an infant begins to
decrease the time spent in nursing. The infant is then showing independence and will soon be ready to take a cup
and learn a new skill. Women breast-feed for varying lengths of time. Some do it for 1, 2, or 3 months, then wean
their children from breast to bottle. Others continue until their children are 6 to 12 months of age and then wean
direstly to small cup or glass. Infants are capable of approximating their lips to a cup so they can drink effectively
from on to 9 months of age. The sucking reflex begins to diminish in intensity between ages 6 and 9 months,
which makes this the time to consider weaning/ (www.nursetest.com.ph)
38. Which of the following should the nurse do next after noting that an 8 month old childs posterior fontanel is
slightly open?
a. Schedule an x-ray of the childs head
b. Question the mother about the childs delivery
c. Document this as a normal finding
d. Check the childs head circumference
Answer: D. The posterior fontanel usually closes at 2-3 months. Therefore, the nurse should measure the head
circumference to determine if the childs head is larger than the established norms because hydrocephalus can
cause separation of the cranium sutures. X-ray is not indicated because it may expose to unnecessary radiation.
The type of delivery is not associated with the closure of the fontanels.(Pilliteri 5 th edition)
39. Which of the following combination of foods is appropriate for a 6 month old?

a. Cocoa-flavored cereal, orange juice, and strained meat.

b. Graham crackers, strained prunes, and pudding.
c. Rice cereal, bananas, and strained carrots
d. Mashed potatoes, strained beets, and boiled egg.
Answer: C. Rice cereal, bananas, and strained carrots are appropriate foods for a 6 month infant. Option ACocoa-flavored cereal contains chocolate and sugar, orange juice is too acidic for the infant, and strained meat is
difficult to digest. Option B- graham crackers contains wheat flour and sugar. Pudding contains sugar and
additives unsuitable for the 6 month old. Option D- the white of the egg contains albumin, which can cause
allergic reaction.Reference: Pillitteri 3 rd Edition
40. The grandmother of a 7-month-old brings the infant to the clinic because she thinks the child is slow. Which
of the following developmental milestones would the nurse normally expect to assess in an infant of this
stage?
a. Playing a pat a cake.
c. Saying two words.
b. Sitting alone.
d. Waving bye-bye.
Answer: B. The majority of infants (90%) can sit without support by 7 months of age. Approximately 75% of
infants at 10 months of age are able to play pat-a-cake. The ability to say two words occur in 90% of children by
16 months. A child typically can wave bye-bye at about 14 months of age.Reference: Pillitteri 3 rd Edition
41. The nurse is ready to begin an exam on a 9-month-old infant. The child is sitting in his mothers lap. Which
should the nurse do first?
a. Check the babinski reflex
b. Listen to the heart and lung sounds
c. Palpate the abdomen
d. Check tympanic membranes
Answer: B. The first action that the nurse should take when beginning to examine the infant is to listen to the
heart and lungs. If the nurse elicits the Babinski, palpates abdomen, or looks in the childs ear first, the child will
begin to cry and it will be difficult to obtain an objective finding while listening to the heart and lungs.
Reference: Pillitteri 3rd Edition
42. During a home visit, the nurse notices that a 1-month-old infant has esotropia. The nurse would advise the
parent to do which of the following?
a. Call the babys health care provider immediately.
b. Mention his findings at the babys 6-month check-up.
c. Do nothing, because this condition is normal for the infants age.
d. Call the clinic for a referral to an optometrist.
Answer C. The nurse should advise the parents to do nothing, because esotropia, inward turning of the eyes, is a
normal finding in infants of this age. If the condition continues past the age of 4 months, more aggressive
treatment will be advised. Waiting until the infants 6-month checkup to mention the finding is inappropriate.
Reference: Pillitteri 3rd Edition
43. The nurse judges that the mother has understood the teaching about care of an infant with colic when the
nurse observes the mother doing which of the following?
a. Holding the infant prone while feeding.
b. Holding the infant in her lap to burp.
c. Placing the infant prone after the feeding.
d. Burping the infant during and after the feeding.
Answer D. Infants with colic should be burped frequently during and after the feeding. Much of the discomfort of
colic appears to be associated with the presence of air in the stomach and intestines. Frequent burping helps to
relieve the air. Infants with colic should be held fairly upright while being fed, to help air rise. The preferred
position for burping the infant with colic is to hold the infant at the mothers shoulder so that the infants
abdomen lies on the shoulder. This position cause more pressure to be exerted on the infants abdomen, leading to
a more forceful burp. The child should be placed in an infant seat after feedings.Reference: Pillitteri 3 rd Edition
44. When developing the teaching plan for the mother of an infant about introducing solid foods into the diet,
which of the following would the nurse expect to include in the plan as a measure to help prevent obesity?
a. Decreasing the amount of formula or breast milk intake as solid food intake increases
b. Introducing the infant to the taste of vegetables by mixing then with formula or breast milk.
c. Mixing cereal and fruit in the bottle when offering solid food for the first few times
d. Using a large bowled spoon for feeding solid foods during the first several months.
Answer A. Decreasing the amount of formula given as the infant begins to take solids helps prevents excess
caloric intake. Because the infant is receiving calories from the solid foods, the formula no longer needs to
provide the infants total caloric requirements. Mixing vegetables with formula or breast milk does not allow the
child to become accustomed to new textures and tastes. Solid food should be given with spoon, not in the bottle.
Using a bottle with food allows the infant to ingest more food than is needed. Also, the infant needs to learn to eat

from the spoon. A small-bowled spoon is recommended for infants because infants have tendency to push food
out with the tongue. The small bowled spoon helps in placing the food in the back of the infants tongue when
feeding.Reference: Pillitteri 3rd Edition
45. What information should the nurse give a new mother regarding the introduction of solids foods for her
infant?
a. Solids foods should not be given until the extrusion reflex disappears at 8 to 10 months of age.
b. Solids foods should be introduced one at a time, with 4 to 7 day intervals.
c. Solids foods can mixed in a bottle or infant feeder, to make feeding easier
d. Solids foods should begin with fruits and vegetables.
Answer: B. Solid foods should be added to the diet one at a time, with intervals of 4 to 7 days between new foods.
The extrusion reflex fades at 3 to 4 months of age; Therefore, option A is incorrect. Option C-solids should not be
added to the bottle and the use of infant is discouraged. Option D- the first food added to the infants diet is rice
cereal.Reference: Pillitteri 3rd Edition
46. Which development milestone puts the 4-month-old infant at greatest risk for injury?
a. Switching objects from one hand to another.
c. Standing
b. Crawling
d. Rolling over
Answer: D. At 4 months of age the infant can roll over, which makes it vulnerable to falls from dressing tables or
beds without rails. Option A-does not prove at threat to safety. Option B and C- the 4 month old is usually not
capable of crawling or standing.Reference: Pillitteri 3 rd Edition
47. A six-month old is brought to the clinic for a well-baby check-up. During the exam, the nurse should expect
to assess which of the following?
a. A pincer grasp
b. Sitting with support
c. Tripling of the birth weight
d. Presence of the posterior fontanel
Answer: B. A six-month-old is capable to sit with support. Pincer grasp is accomplished at 10 months.
Birthweight triples at 1 year. The posterior fontanel closes at 2 to 3 months.(Pilliteri 5 th edition)
48. The birth length of a baby was 50 cms. Which of the following at 12 months would be his expected heightt?
a. 65 cms
c. 85 cms.
b. 75 cms.
d. 100 cms.
Answer: B. An infants birth length is expected to increase by 50% at 12 months. 50% of 50 is 25, so 35 is added
to 50 cms.(Pilliteri 5th edition)
49. Which of the following statements best describes the infants physical development?
a. Anterior fontanel closes by age 6 to 10 months
b. Dentition begins on the fourth month
c. Birth weight doubles by age 6 months and triples by age 1 year
d. Maternal iron stores persist during the first 12 months of life
Answer: C. This is the expected growth trend in all children. Anterior fontanel closes between 12 th and the 18th
month, while dentition begins on the 6 th month. Maternal iron stores persist only for 6 months after birth.(Pilliteri
5th edition)
50. A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her
newborn infant needs the injection. The best response by the nurse would be:
a. Your infant needs vitamin K to develop immunity
b. The vitamin K will protect your infant from being jaundiced
c. Newborn infants are deficient in vitamin K and this injection prevents your infant from bleeding
d. Newborn infants have sterile bowels, and vitamin K promotes the growth of bacteria in the bowel
Answer: C. Neonates have sterile bowels thus they cannot synthesize their own vitamin K which is needed to
prevent bleeding among neonates. Vitamin K is not needed for development of immunity. Babies normally turned
jaundiced days after birth. Vitamin K does not promote growth of bacteria in the bowels. (Pilliteri 5 th edition)
51. A new mother asks the nurse how diaper rash can be prevented? The nurse recommends:
a. Wash with soap and water then apply powder every time diaper is change
b. Wash with mild soap and water and dry thoroughly whenever the baby defecates
c. Wash with soap before applying a thin layer of oil
d. Wash with oil then powder the creases
Answer: B. After cleaning the perineal area with mild soap and water to remove the chemical irritation which the
urine and stool could cause, it should be dried thoroughly and preferable be allowed to be exposed to air for a
while. Powder and oil should not be applied on the diaper area as they can cause more irritating effect.(Pilliteri 5 th
edition)

52. The universal language of all children

a. Play
c. Three wishes
b. Rating game
d. Cry
Answer: A. What the child cannot clearly express in words, he can express it when he plays. The most
spontaneous expression of his emotions is witnessed in his reactions during playing. The other options as
incorrect.(Pilliteri 5th edition)
53. An infant will develop a sense of mistrust if she is:
a. Adopted
c. Hospitalized after birth
b. Consistently ignored
d. Cared for by a grandmother
Answer: B. Trust develops when the babys needs are met. Crying indicates presence of a need which should not
be ignored. Adopted children will also develop trust as long as his needs are met. Hospitalization will not cause
mistrust as long as care even if in the hospital is consistent.Any significant other who became the primary care
giver can help the child develop trust.(Pilliteri 5 th edition)
54. A 2 year old child and his 2 month old sibling are brought to the clinic by their father, who explains that the
older child says no whenever asked to do something. The nurse would explain that the negativism
demonstrated by toddlers is frequently an expression of which of the following?
a. Separation anxiety
c. Need to expend excess energy
b. Pursuit of autonomy
d. Sibling rivalry
Answer: B. According to Erikson, the developmental task of toddlerhood is acquiring a sense of autonomy while
overcoming a sense of doubt and shame. Characteristics of negativism and ritualism are typical behaviors in this
quest of autonomy. The toodler often does the opposite of what others request. The other 3 remaining options are
not associated with negativism.(Pilliteri 5 th edition)
55. In terms of cognitive development, a 2 year old would be expected to:
a. Think abstractly
c. Understand conversation of matter
b. Use magical thinking
d. See things from the perspective of others
Answer: B. A 2 year old is expected only to use magical thinking, such as believing that a toy bear is a real bear.
Answers A, C, and D are not expected until the child is much older. Abstract thinking, conservation of matter and
the ability to look at things from the perspective of others are not skills for small children.Reference: Pillitteri 3 rd
Edition
56. The mother of a 6 month old asks when her child will have all his baby teeth. The nurse knows that most
children have all their primary teeth by age:
a. 1 year
c. 2 years
b. 1 years
d. 3 years
Answer: D. All 20 primary or deciduous teeth should be present by age 3 years.Reference: Pillitteri 3 rd Edition
57. Which of the following examples represent parallel play?
a. Jenny and Tommy share their toys
b. Jimmy plays with his car beside Mary, who is playing with her doll.
c. Kevin plas a game of scrabble with Kathy and Sue.
d. Mary plays with a handled game while sitting in her.
Answer: B. Parallel play is play that is demonstrated by two children playing side by side but not together. The
play in Answers A and C is participative play (play for pre-schooler) because the children are playing together.
The play in answer D is solitary play (infants play) because the mother is not playing with Mary.
Reference: Pillitteri 3rd Edition
58. A parent asks the nurse about the nutritional needs of her toddler. Which of the following responses by the
nurse would be most appropriate?
a. Toddlers usually do not have a good appetite.
b. Toddlers have definite food preferences.
c. Toddlers usually consume large quantities of milk.
d. Toddlers are inquisitive, willing to try new foods.
Answer: B. Toddlers have definite food preferences, typically wanting the same food item for several days in a
row (food jags). Because toddlers experience a slow and a steady growth rate, they usually have a good appetite.
Toddlers should consume 2 to 3 cups of milk per day. The majority of their nutrients should come from table
foods. Toddlers typically are not interested in trying new foods.Reference: Pillitteri 3 rd Edition
59. The nurse in a homeless clinic has an opportunity to teach the parents of toddlers. Which of the following
would be most important to include when teaching the parents how to promote overall toddler development?
a. Language is the most important achievement.
b. Discipline is critical to appropriate development.

c. Safety is a priority concern for this age group.

d. Eating habits that follow into adulthood begin now.
Answer: C Because of toddlers high energy and poor impulse control, safety is a priority concern for this age
group. Additionally, the familys homeless situation further underscores the need for safety because the family has
less control over the environment.Reference: Pillitteri 3 rd Edition
60. At the day care center, one of the toddlers bites another child. Which of the following actions by the teacher
would be most appropriate?
a. Bite the child who did the biting.
b. Place the child who did the biting in time out.
c. Spank the child who did the biting.
d. Call the parents to pick up the child who did the biting.
Answer: B. Biting is an unacceptable aggressive behavior that should not be allowed. Placing the child who did
the biting in time out is the most appropriate because it removes the child from the situation and the other
children and also teaches the child that the behavior is inappropriate. When a child bites another, the child who
did the biting should never be bitten. Doing so teaches the child that biting is an acceptable behavior. Spanking
the child is inappropriate because doing so reinforces the hitting behavior as appropriate. Calling the parents to
pick up the child is inappropriate because the teacher should be able to handle this situation properly. However,
the parents should be informed of the incident. (Pilliteri 3 rd edition)
61. When teaching a mother about measures to prevent lead poisoning in her children, which of the following
would the nurse include as the most effective preventive measure?
a. Condemning of old housing developments.
b. Educating the public on common sources of lead.
c. Educating the public on the importance of good nutrition.
d. Keeping pregnant women out of old homes that are being remodeled.
Answer: B. Public education about the sources of lead that could cause poisoning has been found to be the most
effective measure to prevent lead poisoning. This includes recent efforts to alert the public to lead in certain types
of window blinds. Condemning old housing developments has been ineffective because lead paint still exists in
many other dwellings. Providing education about good nutrition, although important, is not an effective
preventive measure. Pregnant women and children should not remain in an older home that is being remodeled
because they may breathe in lead in the dust, but this is not the most effective preventive measure.
Reference: Pillitteri 3rd Edition
62. A 2 1/2 year-old brought to the clinic by her parents is uncooperative when the nurse tries to look in her ears.
Which of the following would the nurse try first?
a. Ask another nurse to assist
c. Wait until the child calms down.
b. Allow a parent to assist.
d. Restrain the childs arms.
Answer: B. Parents can be asked to assist when their child becomes uncooperative during a procedure. Most
commonly, the childs difficulty in cooperating is caused by fear. In most situations, the child feel more secure
with a parent present. Other methods may be necessary, but obtaining a parents assistance is the recommended
first action. Restraints should be used only as a last resort, after all other attempts have been made to encourage
cooperation. Reference: Pillitteri 3 rd Edition
63. When assessing for pain in a toddler, which of the following methods would be the most appropriate?
a. Ask the child about the pain.
c. Use a numeric pain scale.
b. Observe the child for restlessness.
d. Assess for changes in vital signs.
Answer:B. Toddlers usually express pain through such behaviors as restlessness, facial grimaces, irritability and
crying. It is not particularly helpful to ask toddlers about pain. In most instances, they would be unable to
understand or describe the nature and location of their pain because of their lack of verbal and cognitive skills.
However pre-school and older children have the verbal and cognitive skills to be able to respond appropriately.
Numeric pain scales are more appropriate for children who are of school age or older. Changes in vital signs do
occur as a result of pain, but behavioral changes are usually noticed first Reference: Pillitteri 3 rd Edition
64. A mother tells the nurse that her 22 month old child says no to everything. When scolded, the toddler
becomes angry and starts crying loudly, but then immediately wants to be held. What is the best interpretation
of this behavior?
a. The toddler is not effectively coping with stress
b. The toddlers need for affection is not being met
c. This is normal behavior for a 2 year old child
d. This behavior suggests the need
Answer: C. Rationale: Because toddlers are confronted with the conflict of achieving autonomy, yet
relinguishing the much-enjoyed dependence on and affection of others, their negativism is a necessary
assertion of self-control. Therefore, this behavior is a normal part of the childs growth and development. Nothing

about this behavior indicates that the child is undevelopment. Nothing about this behavior indicates that the child
is under stress, is not receiving sufficient affection, or requires counseling. (Growth and Development)
65. Lawrence is placed in a room with 2-year-old Andrew. The nurse observes that each is actively engaged in his
own play. The nurse realizes that this is a characteristic of this age-group and it is called:
a. Parallel play
c. Cooperative play
b. Group play
d. Dramatic play
Answer: A. Rationale: Toddlers play individually, although side-by-side (parallel play). Group play and
Cooperative is characterized by pre-schooler. Dramatic play or acting is characteristic of older children; they
assume and act out roles. (Toddler: Developmental Milestones: Emotional Development: Play behavior)
66. In evaluating the skills of a 4 year-old that would be beyond the ability of a toddler, the nurse would expect
the child to:
a. Give own first name and age
c. Give own address and phone number
b. Have a vocabulary of 1500 words
d. Use just three or four-word sentence
Answer: B. Rationale: Because of expanded experiences and developing cognitive ability, the 4-year-old should
have a vocabulary of approximately 1500 words. Option A and D are achieved at age 3. Option C is usually
accomplishes at age 5.(Pilliteri 3 rd edition)
67. Two years old holds his breath until he passes out when he wants something his mother does not want him to
have. You would base your evaluation of whether these temper tantrums are a form of a seizure on the basis
that:
a. Seizures are not provoked, temper tantrums are
b. Seizures rarely occurs in toddlers
c. Seizures always occur with fever, temper tantrums do not
d. With seizures, cyanosis never develops
Ans. A-Temper tantrums are provoked by frustration. Since the toddler cannot express themselves verbally yet,
their expressions become physical like the outburst they have. Seizures can occur in any age group and may
happen even if the child is afebrile. Seizure is usually accompanied by cyanosis.(Pilliteri 3 rd edition)
68. The psychosocial developmental tasks of toddlers include which of the following?
a. Development of a conscience
c. Ability to get along with age males
b. Recognition of sex differences
d. Ability to withstand delayed gratification
Ans. D-The toddler is in the stage of reality principle, the common sense (ego). They have to learn to accept that
not all that they are asking for will be given to them. They have to learn to accept the difference between needs
and wants. Small doses of frustration will help them to accept reality. All the other options are psychosocial
developmental tasks of preschoolers.(Pilliteri 3 rd edition)
69. Which of the following aspects of psychosocial development is necessary for the nurse to keep in mind when
providing care for the preschool child?
a. Immediate gratification is necessary to develop autonomy
b. The child can use complex reasoning to think out situations
c. Fear of body mutilation is a common preschool fear
d. The child engages in competitive types of play
Answer: C. During the preschool period, the child has mastered a sense of autonomy and goes on to master a
sense of initiative. During this period, the child commonly experiences more fears than any other time. One
common fear is body mutilation especially associated with painful experiences.School-aged children engage in
competitive play.(Pilliteri 3rd edition)
70. Assuming that all have achieved normal cognitive and emotional development, which of the following
children is at greatest risk for accidental poisoning?
a. A 6-month-old
c. A 12-year-old
b. A 4-year-old
d. A 13-year-old
Answer: B. The 4-year-old is more prone to accidental poisoning because children at this age are much more
mobile. Answer A, C, and D are incorrect because the 6-month-old is still too small to be extremely mobile, the
12-year-old has begun to understand the risk, and the 13-year-old is also aware that injuries can occur and is less
likely to become injured than a 4-year-old.Reference: Pillitteri 3 rd Edition
71. Which of the following responses by the nurse would be most appropriate by the mother of a 4-year-old son
who voices concern about her childs stuttering?
a. This behavior is normal and the child would probably stop soon.
b. The child needs a speech therapist before the school starts.
c. The majority of children do this until they are about 6 years of age.
d. You need to help the child complete the words giving him problem.

Answer: A. Stuttering is considered a normal behavior during preschool years. Children know what they want to
say but hesitate or repeat sounds as they search for the correct words. The child would not need to se a speech
therapist unless the stuttering continues beyond the preschool years. The parent is advised never to help a child by
finishing a word for him. Rather, the child needs plenty of time to finish.Reference: Pillitteri 3 rd Edition
72. The mother of a 4-year-old is concerned about her childs masturbating. When responding to use mother,
which of the following would the nurse need to keep in mind?
a. The child needs counseling for the abnormal behavior.
b. Masturbation is normal in children of this age.
c. The child is expressing some unmet needs.
d. Masturbation at this age provides sexual release.
Answer: B. Most boys and girls masturbate, most commonly at about 4 years of age and then again during
adolescence. It is not considered abnormal behavior. Masturbation at this age is part of sexual exploration and
curiosity; it does not express unmet needs or release sexual tension. Parents need to ensure privacy for the child.
(Pilliteri 3rd edition)
73. When developing the teaching plan for the mother of a preschooler about illness, which of the following
would the nurse expect to include about how a preschooler perceives illness?
a. Necessary part of life.
c. Punishment of wrongdoing.
b. Test of self-worth.
d. The will of God.
Answer: C. Preschool-aged children may view illness as punishment for their wrong doing. At this age children
do not have the cognitive ability to separate fantasies from reality and may expect to be punished for their evil
thoughts. Viewing illness as a necessary part of life requires a higher level of cognition than preschoolers
possess. This view is seen in children of middle school age and older. Perceiving illness as a test of self-worth or
as will of God is more characteristic of adults. Reference: Pillitteri 3 rd Edition
74. The mother of a 4 year old expresses concern that her child may be hyperactive. She describes the child as
always in motion, constantly dropping and spilling things. Which of the following actions would be most
appropriate at this time?
a. Determine whether there have been any changes at home.
b. Explain that this is not unusual behavior.
c. Explore the possibility that the child is being abused.
d. Suggest that the child be seen by a pediatric neurologist.
Answer: B. Preschool-aged children have been described as powerhouses of gross motor activity who seem to
have endless energy. A limitation of their motor ability is that in moving as quickly as they do. They are not
always able to judge distances, nor are they able to estimate the amount of strength and balance needed for
activities. As a result, they have frequent mishaps. This level of activity typically is not associated with changes at
home. However, if the behavior intensifies, a referral to a pediatric neurologist would be appropriate. Children
who have been abused usually demonstrate with drawn behaviors, not endless energy.
Reference: Pillitteri 3rd Edition
75. The nurse should expect a 3 year old child to be able to perform which action?
a. Ride a tricycle
c. Roller-skate
b. Tie shoelaces
d. Jump rope
Answer: A.Rationale: At age 3, gross motor development and refinement and eye-hand coordination enable a
child to ride a tricycle. The fine motor skills required to tie shoelaces and the gross motor skills required for
roller-skating and jumping rope develop around age 5. (Growth and Development)
76. The school nurse observes a group of preschooler children in the playroom. The nurse recognizes which of
the following activities as appropriate behavior for as five year-old boy?
a. The boy plays with a large truck beside another child playing with his own toy
b. The boy talks on a toy telephone and imitates his father
c. The boy works on a puzzle with several other children
d. The boy holds and cuddles a large stuffed animal
Answer: B. Imitative behavior is seen at pre-school age. Option A demonstrate parallel play.(Pilliteri 3 rd edition)
77. The parents of a four-year-old child tell the nurse that the child has an invisible friend named Felix. The
child blames Felix for any misbehavior and is often heard scolding Felix, calling him a bad boy. The
nurse understands that the best interpretation of behavior is which of the following?
a. A delay in moral development
b. Impaired parent-child relationship
c. A way for the child to assume control
d. Inconsistent parental discipline strategies
Answer: C. Imaginary friends are normal part of development for many preschooler children. These imaginary
friends often have many faults. The child plays the role of the parent with the imaginary friend. This becomes a

way of assuming control and authority in a safe situation. This is expected moral development for this age group.
There are no data to support that there is an alternation in the parent-child relationship. There are also no data to
support that the parents are inconsistent in discipline strategies or have unrealistic behavioral expectations of this
four-year-old child. (Pilliteri 3rd edition)
78. Which comment by a 7 year old boy to his friend best typifies his developmental stage?
a. Girls are so yucky
b. My mommy and I are always together
c. I cant decide if I like Amy or Alex better
d. I can turn into Batman when I come out of my closet
Answer: A. During the school-age years, the most important social interactions typically are with peers. These
interactions lead to the formation of intimate friendships between same-sex children. However, friendships with
opposite-sex children are uncommon. At this age, children socialize more frequently with friends than with
parents. Interest in peers of the opposite sex does not begin until age 10 to 12. Magical thinking and fantasy play
are more characteristic during the preschool years. (Pilliteri 3 rd edition)
79. Jovie age 3 years is being admitted for about 1 week of hospitalization. Her parents tell the nurse that they are
going to buy her a lot of new toys, because she will be in the hospital. The nurses reply should be based on
an understanding of which of the following?
a. New toys make hospitalization easier
b. New toys are usually better than older ones for children at this age
c. At this age, children often need the comfort and reassurance of familiar toys from home
d. Buying new toys for a hospitalized child is a maladaptive way to cope with parental guilt.
Answer: C. Separation anxiety during hospitalization is among the foremost fear of a hospitalized 3 year old. A
familiar object from home gives the child the feeling of security, rather than new toys.(Pilliteri 3 rd edition)
80. Which of the following is descriptive of the preschoolers understanding of time?
a. Has no understanding of time
b. Associates time with events
c. Can tell time on clock
d. Uses terms like yesterday appropriately
Answer: B. Because time is still incompletely understood, the preschooler interprets it according to his own frame
or reference like in relationship to an event. They cannot tell time yet using the clock, something that is still to be
learned in school. Use of adverb of time like yesterday, tomorrow is not yet understood by children
.(Pilliteri 3rd edition)
81. When giving IM injection to a preschooler, the most important responsibility of the nurse is:
a. Cover injection site with band aid afterwards
b. Give it only on the safe muscles of the thigh
c. Use the smallest gauge needle all the time
d. Insert needle slowly to lessen pain
Answer: A. Injections and wounds are examples of what represents the worst fear of a preschooler which is body
mutilation. Afraid that their body content would leak out of the opening in their skin, the nurse must cover the
area with band-aid to cover the hole. Safe muscles for IM in preschooler may include others like gluteal and
deltoid. Size of needle depends upon viscosity of drug and size of the child. Needles are best inserted quickly
with dart like action.(Pilliteri 3 rd edition)
82. Which of the following statements would the nurse expects a 5-year-old boy to say whose pet rabbit just died
a. Papa Jesus already got him in heaven
b. I think hes just a little dead
c. Ill be a good boy from now on so I wont die like my rabbit
d. I think my pets just joking around and lying down closing his eyes
Answer: B. A-5 y/o views death in certain degrees. So the child most likely will say that he is just a bit dead.
Personification of death occurs in ages 7 to 9 as well as denying death can if they will be good. Denying death
using jokes and attributing life qualities to death occurs during age 3-5.(Pilliteri 3 rd edition)
83. Preparation for surgery on a 4 year old must include consideration of the childs age-related fear of:
a. Strangers
c. Disruption of routines
b. Intrusive/ invasive procedures
d. Loss of time to play
Answer: B. Intrusive procedures threaten the developing body image of the preschooler. The preschooler is more
tolerant of strangers than is a younger child. The preschooler has the fear of three things- dark, mutilation,
separation and abandonment. The peak of fear of stangers anxiety is at 8 months.(Pilliteri 3 rd edition)
84. The parents of a hospitalized 4 year-old boy express concern because their son is wetting the bed. What
should the nurse tell her?

a. Its common for a child to exhibit regressive behavior when anxious or stressed.
b. Your child is probably angry about being hospitalized. This is his way of acting out.
c. Dont worry. Its common for a 4 year-old child not to be fully toilet trained.
d. The nurses probably havent been answering the call button soon enough. They will try to respond
more quickly.
Answer: A. Young children commonly demonstrate regressive behavior when anxious, under stress, or in a
strange environment. While the child could be deliberately wetting the bed out of anger, her behavior most likely
isnt under voluntary control. Its appropriate to expect a 4 year-old child to be toilet trained, but it isnt
appropriate to expect the child to be able to utilize a call button to summon the nurse. (Pilliteri 3 rd edition)
85. A mother of a 4-year-old expresses concern because her child has been thumb sucking after being
hospitalized. The mother states that this behavior began two days after admission to the hospital. The appropriate
nursing response is which of the following?
a. It is best to ignore the behavior.
b. Your child is acting like a baby.
c. The doctor will need to be notified.
d. A 4 year-old is too old for this type of behavior.
Answer: A. In the hospitalized preschooler, the best option is too accept regression if it occurs. Regression is most
often a result of the stress of the hospitalization. Parents may be overly concerned about regression and should be
told that their child may continue the behavior at home. When regression does occur, the best approach is to
ignore it while praising existing patterns of appropriate behavior. Calling the physician is not necessary. Option 2
and 4 are inappropriate. (Pilliteri 3 rd edition)
86. When teaching a group of parents of school-aged children about growth and development, which of the
following characteristics would the nurse include about children of this age?
a. Desire to carry a task to completion.
b. Ability to imagine possibilities.
c. Feeling that others are focused on them.
d. Ability to consider hypothetical risks and benefits.
Answer: A. School-aged children typically desire to carry a task to completion to achieve a sense of personal
accomplishment. Adolescents have more abstract thought, including the ability to imagine possibilities or
consider hypothetical risks and benefits, and also feelings that others focused on them
.Reference: Pillitteri 3rd Edition
87. The mother of a 7-year-old child comes to the clinic very upset, having just learned that her child has
stolen a computer game from a store. The nurse expects to respond to the mother based on understanding
of which of the following?
a. The child needs to receive serious punishment for the stealing behavior.
b. The child needs to apologize and return the game to the store.
c. The mother needs to have along talk with the child to explain why the behavior is wrong.
d. This is indication of something is seriously wrong with the child.
Answer: B. In most situations, children 5 to 8 years of age have not yet developed respect for others property.
They may take something such as money or a game because they are attached to it. This usually is not an
indication of a serious problem in the child. Serious punishment is inappropriate. A long talk is not warranted in
this situation because the child is unable to maintain attention for a long period.Reference: Pillitteri 3 rd Edition
88. The following are characteristic traits of a school-aged child except:
a. Curious about gender difference
b. Likes to prove themselves to friends
c. Wants to excel in school
d. Attempts to show athletic interest
Answer: A. Being curious about gender difference is a characteristic of preschooler, not a school-aged. Schoolaged are in the achievement oriented stage which justifies why the other options are appropriate descriptions of
school-aged.(Pilliteri 3rd edition)
89. School-aged child engages in this kind of games:
a. Parallel
c. Solitary
b. Cooperative
d. Competitive
Answer: D. being in the stage of achievement oriented years, schoolers like to compete and prove themselves to
others. Parallel would be for toddlers, cooperative fo preschoolers and solitary would be for infants.
(Pilliteri 3rd edition)
90. A more complex form of play that evolves from the need for peer interaction is the team games and sports
that are part of the early school years. What stage is this?
a. School age
b. Preschool age

c. Infancy
d. Toddler
Answer: A. They begin to develop a sense of belonging to a team or club. More so, school-age children love
competitive gamesRef. Essentials of Pediatric Nursing by Wong, pp. 428-429
91. Which of the following is true about personal-social relationship among 9-year old boys?
a. The family has little impact on the childs personal-social development
b. Boys prefer playing with other boys their own age
c. Although 9 year old boys play mostly with other boys the same age, they are interested in boy- girl
relations
d. Boys have an interest in girls and demonstrate affection for them
Answer: B. The school years, especially the 9 th year is the stage of normal homosexual. Children prefers to
associate with other kids with the same gender. The childs ability to relate with others is highly influenced by his
family relationship. (Pilliteri 3rd edition)
92. You care for a 7 year old. One reason why this is often called the eraser years is that children on this
year:
a. Wants to perform well
c. Tends to erase their misdeeds or lies
b. Learns to write during this year
d. Believes in magical thinking
Answer: A. School-age children are achievement oriented. They want to show their best especially in school.
Learning to write is something a child learned several years back. Misdeeds cannot be erased Preschoolers are
magical thinkers not school-aged children. (Pilliteri 3 rd edition)
93. A school-age boy cries out loud during an IV insertion. Which of the following response of the nurse is
therapeutic?
a. You will feel more pain if you cry
b. Next time we wont let your mother stay with you if you cry
c. Big boys dont cry
d. I know it hurts so its okay to cry
Answer: D. This option allows the child to express his feelings which is most therapeutic. Pain is felt less when
allowed to express. Options A, B and C are not therapeutic.(Pilliteri 3 rd edition)
94. Which of the following techniques would be inappropriate when interviewing adolescents?
a. Frequent use of validation
c. Closed ended questions primarily
b. Confidentiality
d. Concern for teens perspective
Answer: C. Should be open ended questions to allow own perspective. The nurse should frequently validate
understanding of what the adolescent is verbalizing, and that the adolescent understands what the nurse is
verbalizing. The nurse is legally and ethically obligated to use confidentiality when interviewing adolescents.
The nurse should have concern for all clients perspectives, regardless of age.
.Source: Lippincott's Review Series 3rd Ed
95. An adolescent has just had surgery and has a dressing on the abdomen. Which question would the nurse
expect the adolescent to ask?
a. "Did the surgery go OK?"
c. "What complications can I expect?"
b. "Will I have a large scar?"
d. "When can I return to school?"
Answer: B. Adolescents are deeply concerned about their body image and how they appear to others. How the
surgery went and complicatios are not the focus of adolescents. Option D is usually asked by a school-age.
Source: Brunner and Suddarth's 9th Ed.
96. The nurse is assessing the sexual development of a pre teenage girl. What is the first sign of sexual
maturation in females?
a. Onset of menstruation
c. Appearance of pubic hair
b. Breast development
d. Appearance of axillary hair
Answer: B. The first sign of sexual maturation in females is the development of breast buds (elevation of the
nipples and areolae). Then sexual development progresses, causing the appearance of pubic hair , the onset of
menstruation and appearance of axillary hair.Source: Brunner and Suddarth's 9th Ed.
97. Which of the following observations signals the onset of puberty in male adolescents?
a. Appearance of pubic hair
c. Testicular enlargement
b. Appearance of axillary hair
d. Nocturnal emissions
Answer: C. Testicular enlargement signifies the onset of puberty in the male adolescent. Then sexual development
progresses, causing the appearance of pubic hair and axillary hair and the onset of nocturnal emissions.Source:
Brunner and Suddarth's 9th Ed.
98. The nurse is caring for an adolescent client who underwent surgery for a perforated appendix. When
caring for this client, the nurse should keep in mind that the main life-stage task for an adolescent is to:

a. Resolve conflict with parents.

b. Develop an identity and independence.
c. Develop trust.
d. Plan for the future.
Answer: B. The adolescent strives for a sense of independence and identity. During this time, conflicts are
heightened, not resolved. Trust begins to develop during infancy and matures along with development.
Adolescents rarely finalize plans for the future; this usually happens later in adulthood.
Source: Brunner and Suddarth's 9th Ed.
99. The mother of a 16-year-old tells a nurse that she is concerned because the child sleeps about 8 hours
every night and until noontime every weekend. The most appropriate nursing response is which of the
following?
a. The child probably is anemic and should eat more foods containing iron
b. Adolescent need that amount of sleep every night
c. The child should not be staying up so late at night
d. If the child eats properly, that should not be happening
Answer: B. The adolescent needs about 8 hours of sleeo per night. During this age, with an increase in social
activities, school commitments, and possibly work activities, it is important that the adolescent receive enough
sleep at night. Options A, C and D are inaccurate and inappropriate nursing responses.(Pilliteri 3 rd edition)
100. A 16-year-old is admitted to the hospital for acute appendicitis, and an appendectomy is performed. Which
of the following nursing interventions is most appropriate to facilitate normal growth and development?
a. Allow the family to bring in the childs favorite computer games
b. Encourage the parents to room-in with the child
c. Encourage the child to rest and read
d. Allow the child to participate in activities with other individuals in the same age group, when the condition
permits.
Answer: D. Adolescents often are not sure whether they want their parents with them when they are hospitalized.
Because of the importance of the peer group, separation from friends is a source of anxiety. Ideally, the members
of the peer group will support their ill friend. Option A, B and C isolate the child from the peer group.
(Pilliteri 3rd edition)