Video Library
Final exam pediatrics 2026 proctored exam
Total Questions : 49
Showing 10 questions, Sign in for moreA patient at her 12-week visit, asks the nurse if it is okay to take an over-the-counter pain med during her pregnancy for an occasional headache. What is the nurse's best response?
An ultrasound on a woman who is 32 weeks pregnant reveals the placenta implanted over the entire cervical os. The nurse understands that this condition is known as
The parents of a newborn diagnosed with Down syndrome are preparing for discharge. During the teaching session, the nurse explains that the infant has generalized hypotonia. Which instruction should the nurse provide to help the parents safely care for their newborn at home?
The nurse caring for a preterm observes increased apnea spells, a weak suck, and seizure activity. The nurse notifies the HCP with concerns the infant has developed which complication?
A nurse is caring for a 42-week gestation newborn who is being closely monitored in the nursery. The mother asks, "Why does my baby need so much extra monitoring?"
A new mother asks the nurse what she can do to foster attachment between the newborn and her 5-year-old daughter. Which recommendations will the nurse encourage?
For each recommendation, click to select whether the nurse should encourage or not encourage the action to foster sibling attachment.
Explanation
This question focuses on promoting healthy sibling attachment and family adaptation after the birth of a newborn. Older siblings may experience feelings of jealousy, anxiety, or fear of being replaced when a new baby arrives. Nurses should encourage age-appropriate involvement, supervised interaction, and opportunities for the older child to participate in the infant's care. Interventions should strengthen the sibling bond while maintaining the safety of both children.
• Keep the baby away from the 5-year-old as much as possible: Separating siblings can increase feelings of jealousy, resentment, and exclusion. Older children may interpret the separation as evidence that they are no longer important to their parents. Instead, siblings should be encouraged to interact safely and participate in age-appropriate activities with the newborn. Promoting inclusion supports healthy emotional adjustment.
• Have the 5-year-old feed the newborn a bottle unsupervised: A 5-year-old child lacks the developmental maturity and judgment necessary to safely feed an infant independently. Feeding requires careful positioning, monitoring for choking, and recognition of infant cues. Unsupervised feeding increases the risk of injury or aspiration. If appropriate, the child may assist only with close adult supervision.
• Encourage co-sleeping with the 5-year-old and infant: Co-sleeping is unsafe because it significantly increases the risk of accidental suffocation, entrapment, and sleep-related infant death. Newborns should always sleep on a separate, firm sleep surface according to safe sleep recommendations. Although sibling bonding is important, it should occur during supervised awake periods rather than during sleep.
• Have the 5-year-old visit in the hospital: Allowing the older sibling to visit the newborn helps initiate early bonding and decreases feelings of exclusion. It provides an opportunity for the child to see the baby, ask questions, and feel included in the family transition. Early involvement can reduce jealousy and promote acceptance of the new family member. Hospital visits should be positive, brief, and developmentally appropriate.
• Let the 5-year-old help hold the newborn with adult supervision: Including the older sibling in age-appropriate caregiving activities promotes a sense of responsibility and belonging. Supervised holding helps foster attachment and allows the child to feel important in caring for the baby. Adult supervision ensures the newborn's safety while encouraging positive sibling interactions. This approach also reinforces confidence and family connectedness.
The nurse is providing education to parents of an infant with cleft palate. What will the nurse instruct the parents to report immediately?
A neonatal unit recently completed a quality improvement review after several incidents involving incorrect feeding tube placement. The nurse's safest action to ensure tube placement when preparing to initiate a gavage feeding is to:
The nurse educates prenatal patients about the threat of TORCH infections. These infections include (Select all that apply.)
The nurse is assessing a preterm newborn in the nursery. The infant is noted to have nasal flaring, sternal retractions, and expiratory grunting. The infant's respiratory rate is 72 breaths/minute, and oxygen saturation is 88% on room air
Complete the Bow-Tie by selecting:
1 Potential Condition
2 Nursing Actions
2 Parameters to Monitor
Explanation
This question focuses on recognizing Respiratory Distress Syndrome (RDS) in a preterm newborn. RDS occurs primarily because of insufficient surfactant production in immature lungs, leading to alveolar collapse, impaired gas exchange, and increased work of breathing. Common manifestations include tachypnea, nasal flaring, expiratory grunting, retractions, and hypoxemia. Early identification and prompt respiratory support are essential to prevent respiratory failure and complications.
Rationale for correct choices:
• Respiratory Distress Syndrome (RDS): RDS is the most likely condition because the infant is preterm and exhibits classic manifestations of surfactant deficiency, including nasal flaring, sternal retractions, expiratory grunting, tachypnea (72 breaths/minute), and oxygen saturation of 88% on room air. Surfactant deficiency causes alveolar collapse and impaired oxygen exchange. Preterm infants are particularly vulnerable because surfactant production may be insufficient before full lung maturation.
• Apply supplemental oxygen as prescribed: Supplemental oxygen helps improve oxygenation and reduce hypoxemia while other respiratory interventions are implemented. Maintaining adequate oxygen levels is essential to support tissue perfusion and prevent complications associated with prolonged oxygen deprivation. Oxygen therapy should be administered carefully to achieve target saturation levels while minimizing the risk of oxygen toxicity.
• Monitor respiratory status closely: Frequent respiratory assessment is critical because newborns with RDS can deteriorate rapidly. Monitoring includes observing respiratory effort, breath sounds, respiratory rate, and signs of worsening distress. Early recognition of clinical deterioration allows prompt escalation of care, such as continuous positive airway pressure (CPAP) or mechanical ventilation if necessary.
• Observe for retractions, grunting, and nasal flaring: These are key indicators of increased work of breathing and worsening respiratory compromise. Serial assessments help determine whether the infant is responding to treatment or progressing toward respiratory failure. Improvement in these findings suggests effective therapy, while worsening symptoms require immediate intervention.
• Oxygen saturation: Continuous oxygen saturation monitoring is essential to evaluate gas exchange and the effectiveness of oxygen therapy. Persistent low oxygen saturation indicates inadequate oxygen delivery and may necessitate additional respiratory support. Monitoring also helps avoid excessive oxygen administration, which can lead to complications such as retinopathy of prematurity.
Rationale for incorrect choices:
• Hypoglycemia: Neonatal hypoglycemia commonly presents with jitteriness, lethargy, poor feeding, hypotonia, temperature instability, seizures, or apnea. Although respiratory distress may occasionally occur, it is not the hallmark presentation. The infant's prominent signs of grunting, nasal flaring, retractions, and low oxygen saturation strongly suggest a primary respiratory disorder rather than a glucose imbalance.
• Neonatal Abstinence Syndrome (NAS): NAS occurs when newborns withdraw from substances, most commonly opioids, after birth. Typical manifestations include high-pitched crying, irritability, tremors, poor feeding, diarrhea, sneezing, and increased muscle tone. The infant's presentation is dominated by respiratory distress findings consistent with surfactant deficiency rather than withdrawal symptoms.
• Transient neonatal pustular melanosis: Transient neonatal pustular melanosis is a benign skin condition characterized by superficial pustules that rupture and leave hyperpigmented macules. It does not affect the respiratory system and is not associated with hypoxemia, tachypnea, or increased work of breathing. Therefore, it does not explain the infant's clinical presentation.
• Place the infant in a prone sleeping position: Prone sleeping is not recommended because it increases the risk of sudden infant death syndrome (SIDS). Newborns should be placed on their backs for sleep unless a provider specifically orders an alternative position in a highly monitored setting. Prone positioning is not a first-line intervention for managing RDS.
• Delay interventions to allow the infant to rest: Delaying treatment is unsafe because newborns with respiratory distress can deteriorate rapidly. Immediate intervention is necessary to improve oxygenation and reduce the work of breathing. Waiting could worsen hypoxemia and increase the risk of respiratory failure and other serious complications.
• Presence of Moro reflex: The Moro reflex is a normal newborn neurologic reflex used to assess neurologic integrity. It does not provide information about respiratory function or the severity of RDS. Monitoring respiratory parameters is more clinically relevant in evaluating treatment effectiveness.
• Number of wet diapers: Monitoring wet diapers is useful for assessing hydration and renal function but is not a priority indicator for evaluating respiratory distress. The immediate concern is supporting oxygenation and respiratory status. Urine output may be monitored as part of overall care but is not a primary parameter for RDS progression.
Sign Up or Login to view all the 49 Questions on this Exam
Join over 100,000+ nursing students using Naxlex’s science-backend flashcards, practice tests and expert solutions to improve their grades and reach their goals.
Sign Up Now
