Review Paediatric Exam (Regular)

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Paediatric Exam (Regular)

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Total Questions : 45

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Question 1:

The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply.

A. The trachea and chest wall are less compliant. B. The tongue is smaller. C. The nasal passages are narrower. D. The larynx is more funnel shaped. E. The bronchi and bronchioles are shorter and wider. F. There are significantly fewer alveoli.

Answer and Explanation

Choice A:

Incorrect: The trachea and chest wall are actually more compliant in newborns due to immature cartilage and musculature, making them more prone to airway collapse.

Choice B:

Incorrect: The tongue is larger, not smaller, in proportion to the mouth, increasing the risk of airway obstruction.

Choice C:

Correct: Newborns have narrower nasal passages, making them more prone to obstruction, especially since they are obligate nose breathers.

Choice D:

Correct: The larynx is more funnel-shaped, which can contribute to airway narrowing and increased risk of aspiration.

Choice E:

Incorrect: The bronchi and bronchioles are shorter and narrower, not wider, increasing the risk of obstruction and infection spread.

Choice F:

Correct: Newborns have significantly fewer alveoli, reducing their surface area for gas exchange and making them more vulnerable to hypoxia.

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Question 2:

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation?

A. "This is normal behavior for infants unless the stool passed is black or green." B. "This indicates a blockage in the intestine and must be reported to the health care provider." C. "This is normal behavior for infants unless the stool passed is hard and dry." D. "This is normal behavior for infants due to the immaturity of the gastrointestinal system."

Answer and Explanation

Choice A:

Incorrect: Black or green stool can indicate other issues, but the presence of grunting does not necessarily relate to stool color.

Choice B:

Incorrect: Grunting alone does not indicate an intestinal blockage; other signs like vomiting and abdominal distension would be present.

Choice C:

Correct: It is normal for infants to grunt and strain while passing stool, as their abdominal muscles are immature. However, concern arises if the stool is hard and dry, which may indicate constipation.

Choice D:

Incorrect: While the gastrointestinal system is immature, this response does not directly address the mother’s concern about stool consistency.

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Question 3:

The neonatal nurse assesses newborns for iron deficiency anemia. Which newborn is at highest risk for this disorder?

A. A term newborn with jaundice B. A premature newborn C. A newborn born to a diabetic mother D. A postterm newborn

Answer and Explanation

Choice A:

Incorrect: Jaundice is not directly linked to iron deficiency anemia; it is more related to bilirubin metabolism.

Choice B:

Correct: Premature newborns are at highest risk because iron stores accumulate during the last trimester. Since preterm infants miss this crucial period, they have lower iron reserves.

Choice C:

Incorrect: Infants born to diabetic mothers are at risk for hypoglycemia and macrosomia, but not iron deficiency anemia.

Choice D:

Incorrect: Postterm infants typically have adequate iron stores due to prolonged gestation.

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Question 4:

The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem?

A. The child does not say dada or mama. B. The chilfloes! does not vocally respond to voices. C. The child does not babble. D. The child never squeals or yells.

Answer and Explanation

Choice A:

Incorrect: Saying "mama" or "dada" is expected around 7-9 months, not at 4 months.

Choice B:

Incorrect: At 4 months, babies do not necessarily respond vocally to every voice, though they may turn toward sounds.

Choice C:

Correct: Lack of babbling at 4 months may indicate a delay in language development, as infants should be cooing and babbling by this age.

Choice D:

Incorrect: Infants may not yet yell or squeal frequently at 4 months, but they should be making other vocalizations.

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Question 5:

The nurse observes an infant interacting with his parents. What are normal social behavioral developments for this age group? Select all that apply.

A. Around 3 months, the infant will mimic the parent's facial movements, such as sticking out the tongue. B. Around 2 months, the infant exhibits a first real smile. C. Around 3 to 6 months of age, the infant may enjoy socially interactive games D. such as patty-cake and peek-a-boo. E. Around 3 months the infant smiles widely and gurgles when interacting with the caregiver F. Around 5 months, the infant may develop stranger anxiety. G. Separation anxiety may also start in the last few months of infancy

Answer and Explanation

Choice A:

Correct: Around 3 months, infants begin to mimic facial expressions, such as sticking out their tongue.

Choice B:

Correct: The first real social smile typically emerges around 2 months of age.

Choice C:

Correct: By 3-6 months, babies enjoy interactive games like patty-cake and peek-a-boo.

Choice D:

Incorrect: Games like patty-cake and peek-a-boo typically begin after 6 months, not at 3-6 months.

Choice E:

Correct: Around 3 months, infants begin to smile widely and coo/gurgle when interacting with caregivers.

Choice F:

Incorrect: Stranger anxiety typically begins closer to 6-8 months, not at 5 months.

Choice G:

Correct: Separation anxiety starts in late infancy (around 9 months) as babies develop object permanence.

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Question 6:

The nurse is performing a health assessment of a 3-month-old African-American boy. For what condition should this infant be monitored based on his race?

A. Gastroesophageal reflux disease (GERD) B. Iron deficiency C. Jaundice D. Lactose intolerance

Answer and Explanation

Choice A:

Incorrect: GERD is common in infants but is not specifically associated with race.

Choice B:

Correct: African-American infants are at a higher risk for iron deficiency anemia, particularly if they are born prematurely or have low birth weight. Lower iron stores at birth and dietary differences contribute to this risk.

Choice C:

Incorrect: While jaundice can occur in any newborn, there is no specific racial predisposition for African-American infants.

Choice D:

Incorrect: Lactose intolerance is less common in infants because they naturally produce lactase at birth. It is more likely to develop later in childhood or adulthood.

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Question 7:

The nurse is promoting a healthy diet to guide a mother when feeding her 2-week- old girl. Which is the most effective anticipatory guidance?

A. Substituting cow's milk if breast milk is not available B. Advocating iron supplements with bottle-feeding C. Advising fluid intake per feeding of 5 or 6 ounces D. Discouraging the addition of fruit juice to the diet

Answer and Explanation

Choice A:

Incorrect: Cow’s milk should never be given to infants under 1 year because it lacks essential nutrients like iron and can lead to gastrointestinal bleeding.

Choice B:

Incorrect: Iron supplementation is not necessary unless the infant is premature or formula-fed with low-iron formula. Standard iron-fortified formula is usually sufficient.

Choice C:

Incorrect: A 2-week-old should typically consume 1.5 to 3 ounces per feeding, increasing gradually. 5-6 ounces per feeding is excessive at this age.

Choice D:

Correct: Fruit juice should be discouraged before 12 months of age as it provides unnecessary sugars, increases the risk of obesity, and may contribute to dental caries.

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Question 8:

The nurse is caring for a 7-month-old girl during a well-child visit. Which intervention is most appropriate for this child?

A. Advising about increased caloric needs B. Discussing the type of sippy cup to use C. Describing the tongue extrusion reflex D. Explaining how to prepare table meats

Answer and Explanation

Choice A:

Incorrect: Increased caloric needs become more relevant in adolescence or in children with higher energy demands, not at 7 months.

Choice B:

Correct: Around 6-9 months, infants begin transitioning from bottles to sippy cups. Guidance on selecting the right type helps promote oral motor development and reduce the risk of bottle dependence.

Choice C:

Incorrect: The tongue extrusion reflex disappears around 4-6 months, allowing solid food introduction. By 7 months, it should have already diminished.

Choice D:

Incorrect: Table meats are typically introduced around 9-12 months, when infants can better handle textures.

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Question 9:

The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. What is the priority intervention?

A. Performing a developmental evaluation of the child B. Asking the mother if the child uses Spanish words C. Referring the child to a developmental specialist D. Encouraging the parents to speak English to the child

Answer and Explanation

Choice A:

Incorrect: A developmental evaluation is not the first step. Bilingual children may develop speech slightly later, so other assessments should be made first.

Choice B:

Correct: It is essential to ask if the child uses words in either language. Bilingual children often mix or delay language acquisition slightly but usually catch up.

Choice C:

Incorrect: Referral to a specialist is premature without first assessing for bilingual speech patterns.

Choice D:

Incorrect: Encouraging only English could negatively impact language development, as bilingualism does not cause speech delays.

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Question 10:

At which age would the nurse expect to find the beginning of object permanence?

A. 1 month B. 9 months C. 12 months D. 6 months

Answer and Explanation

Choice A:

Incorrect: At 1 month, newborns do not have object permanence; they only react to immediate stimuli.

Choice B:

Incorrect: While object permanence is more developed at 9 months, it begins earlier.

Choice C:

Incorrect: By 12 months, object permanence should already be well-established.

Choice D:

Correct: Object permanence begins around 6 months, when infants start recognizing that objects still exist even when out of sight.

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Total Questions : 45

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Paediatric Exam (Regular)

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