Which assessment finding would lead the nurse to suspect down syndrome in an infant?

1. While performing physical assessment of a 12 month-old, the nurse notes that the infant’s anterior fontanelle is still slightly open. Which of the following is the nurse’s most appropriate action?
   1. Notify the physician immediately because there is a problem.
   2. Perform an intensive neurologic examination.
   3. Perform an intensive developmental examination.
   4. Do nothing because this is a normal finding for the age.
2. When teaching a mother about introducing solid foods to her child, which of the following indicates the earliest age at which this should be done?
   1. 1 month
   2. 2 months
   3. 3 months
   4. 4 months
3. The infant of a substance-abusing mother is at risk for developing a sense of which of the following?
   1. Mistrust
   2. Shame
   3. Guilt
   4. Inferiority
4. Which of the following toys should the nurse recommend for a 5-month-old?
   1. A big red balloon
   2. A teddy bear with button eyes
   3. A push-pull wooden truck
   4. A colorful busy box
5. The mother of a 2-month-old is concerned that she may be spoiling her baby by picking her up when she cries. Which of the following would be the nurse’s best response?
   1. “ Let her cry for a while before picking her up, so you don’t spoil her”
   2. “Babies need to be held and cuddled; you won’t spoil her this way”
   3. “Crying at this age means the baby is hungry; give her a bottle”
   4. “If you leave her alone she will learn how to cry herself to sleep”
6. When assessing an 18-month-old, the nurse notes a characteristic protruding abdomen. Which of the following would explain the rationale for this finding?
   1. Increased food intake owing to age
   2. Underdeveloped abdominal muscles
   3. Bowlegged posture
   4. Linear growth curve
7. If parents keep a toddler dependent in areas where he is capable of using skills, the toddle will develop a sense of which of the following?
   1. Mistrust
   2. Shame
   3. Guilt
   4. Inferiority
8. Which of the following is an appropriate toy for an 18-month-old?
   1. Multiple-piece puzzle
   2. Miniature cars
   3. Finger paints
   4. Comic book
9. When teaching parents about the child’s readiness for toilet training, which of the following signs should the nurse instruct them to watch for in the toddler?
   1. Demonstrates dryness for 4 hours
   2. Demonstrates ability to sit and walk
   3. Has a new sibling for stimulation
   4. Verbalizes desire to go to the bathroom
10. When teaching parents about typical toddler eating patterns, which of the following should be included?
    1. Food “jags”
    2. Preference to eat alone
    3. Consistent table manners
    4. Increase in appetite
11. Which of the following suggestions should the nurse offer the parents of a 4-year-old boy who resists going to bed at night?
    1. “Allow him to fall asleep in your room, then move him to his own bed.”
    2. “Tell him that you will lock him in his room if he gets out of bed one more time.”
    3. “Encourage active play at bedtime to tire him out so he will fall asleep faster.”
    4. “Read him a story and allow him to play quietly in his bed until he falls asleep.”
12. When providing therapeutic play, which of the following toys would best promote imaginative play in a 4-year-old?
    1. Large blocks
    2. Dress-up clothes
    3. Wooden puzzle
    4. Big wheels
13. Which of the following activities, when voiced by the parents following a teaching session about the characteristics of school-age cognitive development would indicate the need for additional teaching?
    1. Collecting baseball cards and marbles
    2. Ordering dolls according to size
    3. Considering simple problem-solving options
    4. Developing plans for the future
14. A hospitalized schoolager states: “I’m not afraid of this place, I’m not afraid of anything.” This statement is most likely an example of which of the following?
    1. Regression
    2. Repression
    3. Reaction formation
    4. Rationalization
15. After teaching a group of parents about accident prevention for schoolagers, which of the following statements by the group would indicate the need for more teaching?
    1. “Schoolagers are more active and adventurous than are younger children.”
    2. “Schoolagers are more susceptible to home hazards than are younger children.”
    3. “Schoolagers are unable to understand potential dangers around them.”
    4. “Schoolargers are less subject to parental control than are younger children.”
16. Which of the following skills is the most significant one learned during the schoolage period?
    1. Collecting
    2. Ordering
    3. Reading
    4. Sorting
17. A child age 7 was unable to receive the measles, mumps, and rubella (MMR) vaccine at the recommended scheduled time. When would the nurse expect to administer MMR vaccine?
    1. In a month from now
    2. In a year from now
    3. At age 10
    4. At age 13
18. The adolescent’s inability to develop a sense of who he is and what he can become results in a sense of which of the following?
    1. Shame
    2. Guilt
    3. Inferiority
    4. Role diffusion
19. Which of the following would be most appropriate for a nurse to use when describing menarche to a 13-year-old?
    1. A female’s first menstruation or menstrual “periods”
    2. The first year of menstruation or “period”
    3. The entire menstrual cycle or from one “period” to another
    4. The onset of uterine maturation or peak growth
20. A 14-year-old boy has acne and according to his parents, dominates the bathroom by using the mirror all the time. Which of the following remarks by the nurse would be least helpful in talking to the boy and his parents?
    1. “This is probably the only concern he has about his body. So don’t worry about it or the time he spends on it.”
    2. “Teenagers are anxious about how their peers perceive them. So they spend a lot of time grooming.”
    3. “A teen may develop a poor self-image when experiencing acne. Do you feel this way sometimes?”
    4. “You appear to be keeping your face well washed. Would you feel comfortable discussing your cleansing method?”
21. Which of the following should the nurse suspect when noting that a 3-year-old is engaging in explicit sexual behavior during doll play?
    1. The child is exhibiting normal pre-school curiosity
    2. The child is acting out personal experiences
    3. The child does not know how to play with dolls
    4. The child is probably developmentally delayed.
22. Which of the following statements by the parents of a child with school phobia would indicate the need for further teaching?
    1. “We’ll keep him at home until phobia subsides.”
    2. “We’ll work with his teachers and counselors at school.”
    3. “We’ll try to encourage him to talk about his problem.”
    4. “We’ll discuss possible solutions with him and his counselor.”
23. When developing a teaching plan for a group of high school students about teenage pregnancy, the nurse would keep in mind which of the following?
    1. The incidence of teenage pregnancies is increasing.
    2. Most teenage pregnancies are planned.
    3. Denial of the pregnancy is common early on.
    4. The risk for complications during pregnancy is rare.
24. When assessing a child with a cleft palate, the nurse is aware that the child is at risk for more frequent episodes of otitis media due to which of the following?
    1. Lowered resistance from malnutrition
    2. Ineffective functioning of the Eustachian tubes
    3. Plugging of the Eustachian tubes with food particles
    4. Associated congenital defects of the middle ear.
25. While performing a neurodevelopmental assessment on a 3-month-old infant, which of the following characteristics would be expected?
    1. A strong Moro reflex
    2. A strong parachute reflex
    3. Rolling from front to back
    4. Lifting of head and chest when prone
26. By the end of which of the following would the nurse most commonly expect a child’s birth weight to triple?
    1. 4 months
    2. 7 months
    3. 9 months
    4. 12 months
27. Which of the following best describes parallel play between two toddlers?
    1. Sharing crayons to color separate pictures
    2. Playing a board game with a nurse
    3. Sitting near each other while playing with separate dolls
    4. Sharing their dolls with two different nurses
28. Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia?
    1. Instituting infection control precautions
    2. Encouraging adequate intake of iron-rich foods
    3. Assisting with coping with chronic illness
    4. Administering medications via IM injections
29. Which of the following information, when voiced by the mother, would indicate to the nurse that she understands home care instructions following the administration of a diphtheria, tetanus, and pertussis injection?
    1. Measures to reduce fever
    2. Need for dietary restrictions
    3. Reasons for subsequent rash
    4. Measures to control subsequent diarrhea
30. Which of the following actions by a community health nurse is most appropriate when noting multiple bruises and burns on the posterior trunk of an 18-month-old child during a home visit?
    1. Report the child’s condition to Protective Services immediately.
    2. Schedule a follow-up visit to check for more bruises.
    3. Notify the child’s physician immediately.
    4. Don nothing because this is a normal finding in a toddler.
31. Which of the following is being used when the mother of a hospitalized child calls the student nurse and states, “You idiot, you have no idea how to care for my sick child”?
    1. Displacement
    2. Projection
    3. Repression
    4. Psychosis
32. Which of the following should the nurse expect to note as a frequent complication for a child with congenital heart disease?
    1. Susceptibility to respiratory infection
    2. Bleeding tendencies
    3. Frequent vomiting and diarrhea
    4. Seizure disorder
33. Which of the following would the nurse do first for a 3-year-old boy who arrives in the emergency room with a temperature of 105 degrees, inspiratory stridor, and restlessness, who is learning forward and drooling?
    1. Auscultate his lungs and place him in a mist tent.
    2. Have him lie down and rest after encouraging fluids.
    3. Examine his throat and perform a throat culture
    4. Notify the physician immediately and prepare for intubation.
34. Which of the following would the nurse need to keep in mind as a predisposing factor when formulating a teaching plan for child with a urinary tract infection?
    1. A shorter urethra in females
    2. Frequent emptying of the bladder
    3. Increased fluid intake
    4. Ingestion of acidic juices
35. Which of the following should the nurse do first for a 15-year-old boy with a full leg cast who is screaming in unrelenting pain and exhibiting right foot pallor signifying compartment syndrome?
    1. Medicate him with acetaminophen.
    2. Notify the physician immediately
    3. Release the traction
    4. Monitor him every 5 minutes
36. At which of the following ages would the nurse expect to administer the varicella zoster vaccine to child?
    1. At birth
    2. 2 months
    3. 6 months
    4. 12 months
37. When discussing normal infant growth and development with parents, which of the following toys would the nurse suggest as most appropriate for an 8-month-old?
    1. Push-pull toys
    2. Rattle
    3. Large blocks
    4. Mobile
38. Which of the following aspects of psychosocial development is necessary for the nurse to keep in mind when providing care for the preschool child?
    1. The child can use complex reasoning to think out situations.
    2. Fear of body mutilation is a common preschool fear
    3. The child engages in competitive types of play
    4. Immediate gratification is necessary to develop initiative.
39. Which of the following is characteristic of a preschooler with mid mental retardation?
    1. Slow to feed self
    2. Lack of speech
    3. Marked motor delays
    4. Gait disability
40. Which of the following assessment findings would lead the nurse to suspect Down syndrome in an infant?
    1. Small tongue
    2. Transverse palmar crease
    3. Large nose
    4. Restricted joint movement
41. While assessing a newborn with cleft lip, the nurse would be alert that which of the following will most likely be compromised?
    1. Sucking ability
    2. Respiratory status
    3. Locomotion
    4. GI function
42. When providing postoperative care for the child with a cleft palate, the nurse should position the child in which of the following positions?
    1. Supine
    2. Prone
    3. In an infant seat
    4. On the side
43. While assessing a child with pyloric stenosis, the nurse is likely to note which of the following?
    1. Regurgitation
    2. Steatorrhea
    3. Projectile vomiting
    4. “Currant jelly” stools
44. Which of the following nursing diagnoses would be inappropriate for the infant with gastroesophageal reflux (GER)?
    1. Fluid volume deficit
    2. Risk for aspiration
    3. Altered nutrition: less than body requirements
    4. Altered oral mucous membranes
45. Which of the following parameters would the nurse monitor to evaluate the effectiveness of thickened feedings for an infant with gastroesophageal reflux (GER)?
    1. Vomiting
    2. Stools
    3. Uterine
    4. Weight
46. Discharge teaching for a child with celiac disease would include instructions about avoiding which of the following?
    1. Rice
    2. Milk
    3. Wheat
    4. Chicken
47. Which of the following would the nurse expect to assess in a child with celiac disease having a celiac crisis secondary to an upper respiratory infection?
    1. Respiratory distress
    2. Lethargy
    3. Watery diarrhea
    4. Weight gain
48. Which of the following should the nurse do first after noting that a child with Hirschsprung disease has a fever and watery explosive diarrhea?
    1. Notify the physician immediately
    2. Administer antidiarrheal medications
    3. Monitor child ever 30 minutes
    4. Nothing, this is characteristic of Hirschsprung disease
49. A newborn’s failure to pass meconium within the first 24 hours after birth may indicate which of the following?
    1. Hirschsprung disease
    2. Celiac disease
    3. Intussusception
    4. Abdominal wall defect
50. When assessing a child for possible intussusception, which of the following would be least likely to provide valuable information?
    1. Stool inspection
    2. Pain pattern
    3. Family history
    4. Abdominal palpation

Answers and Rationale

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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