PNLE PRACTICE QUESTIONS: Rationale:

PEDIATRIC NURSING From birth to 6 months, the infant grows 1 inch (2.5 cm) per month.
From 6 to 12 months, the infant grows ½ inch (1.25 cm) per month.
1. The infant with Down Syndrome should go through which of the Erickson’s
developmental stages first? 7. Alice, 10 years old was brought to the ER because of Asthma. She was
A. Initiative vs. Self-doubt immediately put under aerosol administration of Terbutaline. After
B. Industry vs. Inferiority sometime, you observe that the child does not show any relief from the
C. Autonomy vs. Shame and doubt treatment given. Upon assessment, you noticed that both the heart and
D. Trust vs. Mistrust respiratory rate as still elevated and the child shows difficulty of exhaling. You
suspect:
Rationale: A. Bronchiectasis
The child with Down Syndrome will go through the same first stage, trust vs. B. Atelectasis
mistrust, only at a slow rate. Therefore, the nurse should concentrate on C. Epiglottitis
developing on bond between the primary caregiver and the child. D. Status Asthmaticus

2. The child with phenylketonuria (PKU) must maintain a low phenylalanine Rationale:
diet to prevent which of the following complications? Status Asthmaticus leads to respiratory distress and bronchospasm despite of
A. Irreversible brain damage treatment and interventions. Mechanical ventilation maybe needed due to
B. Kidney failure respiratory failure.
C. Blindness
D. Neutropenia 8. Nurse Jonas assesses a 2-year-old boy with a tentative diagnosis of
nephroblastoma. Symptoms the nurse observes that suggest this problem
Rationale: include:
The child with PKU must maintain a strict low phenylalanine diet to prevent A. Lymphedema and nerve palsy
central nervous system damage, seizures, and eventual death. B. Hearing loss and ataxia
C. Headaches and vomiting
3. Which age group is with imaginative minds and creates imaginary friends? D. Abdominal mass and weakness
A. Toddler
B. Preschool Rationale:
C. School Nephroblastoma or Wilm’s tumor is caused by chromosomal abnormalities,
D. Adolescence most common kidney cancer among children characterized by abdominal
mass, hematuria, hypertension, and fever.
Rationale:
During preschool, this is the stage when children do imitative play, 9. Nurse Jacob is assessing a 15-month-old child with acute otitis media.
imaginative play – the occurrence of imaginative playmates, dramatic play Which of the following symptoms would the nurse anticipate finding?
where children like to act, dance, and sing. A. Periorbital edema, absent light reflex, and translucent tympanic membrane
B. Irritability, purulent drainage in middle ear, nasal congestion and cough
4. Which of the following situations would alert you to a potentially C. Diarrhea, retracted tympanic membrane and enlarged parotid gland
developmental problem with a child? D. Vomiting, pulling at ears and pearly white tympanic membrane
A. Pointing to body parts at 15 months of age.
B. Using gesture to communicate at 18 months. Rationale:
C. Cooing at 3 months Irritability, purulent drainage in middle ear, nasal congestion and cough, fever,
D. Saying “mama” or “dada” for the first time at 18 months of age. loss of appetite, vomiting and diarrhea are clinical manifestations of otitis
media. Acute otitis media is common in children 6 months to 3 years old and
Rationale: 8 years old and above. Breast fed infants have higher resistance due to
A child should say “mama” or “dada” during 10 to 12 months of age. Choices protection of Eustachian tubes and middle ear from breast milk.
A, B, and C are all normal assessments of language development of a child.
10. The parent of a client with albinism would need to be taught which
5. Isabelle, a 2-year-old girl loves to move around and often times manifests preventive healthcare measure by the nurse:
negativism and temper tantrums. What is the best way to deal with her A. Ulcerative colitis diet
behavior? B. Use of a high SPF sunblock
A. Tell her that she would not be loved by others if she behaves that way. C. Hair loss monitoring
B. Withholding giving her toys until she behaves properly. D. Monitor for growth retardation
C. Ignore her behavior as long as she does not hurt herself and others.
D. Ask her what she wants and give it to pacify her. Rationale:
Without melanin production, the child with albinism is at risk for severe
Rationale: sunburns. Maximum sun protection should be taken, including use of hats,
If a child is trying to get attention or trying to get something through long sleeves, minimal time in the sun and high-SPF sunblock, to prevent any
tantrums – ignore his/her behavior. problems.

6. Baby boy Villanueva, a 4-month-old, was seen at the pediatric clinic for his 11. Billy is a 4-year-old boy who has an IQ of 140 which means:
scheduled checkup. By this period, baby Villanueva has already increased his A. average normal
height by how many inches? B. very superior
A. 3 inches C. above average
B. 4 inches D. genius
C. 5 inches
D. 6 inches Rationale:
IQ = mental age/chronological age x 100
Mental age refers to the typical intelligence level found for people at a given Rationale:
chronological age. IQ of 140 and above is considered genius. The client with cystic fibrosis absorbs fat poorly because of the thick
secretions blocking the pancreatic duct. The lack of natural pancreatic
12. A priority nursing intervention for the infant with cleft lip is which of the enzyme leads to poor absorption of predominantly fats in the duodenum,
following: foul-smelling, frothy stool is termed steatorrhea.
A. Monitoring for adequate nutritional intake
B. Teaching high-risk newborn care 17. Which of the following would be a disadvantage of breast feeding?
C. Assessing for respiratory distress A. Involution occurs rapidly
D. Preventing injury B. The incidence of allergies increases due to maternal antibodies
C. The father may resent the infant’s demands on the mother’s body
Rationale: D. There is a greater chance of error during preparation
The infant with cleft lip is unable to create an adequate seal for sucking. The
child is at risk for inadequate nutritional intake as well as aspiration. Rationale:
With breast feeding, the father’s body is not capable of providing the milk for
13. Nurse Jacob is assessing a 12-year-old who has hemophilia A. Which of the newborn, providing fewer chances for bonding, or he may be jealous of
the following assessment findings would the nurse anticipate? the infant’s demands on his wife’s time and body. Breast feeding is
A. an excess RBC advantageous because uterine involution occurs more rapidly, thus
B. an excess of WBC minimizing blood loss. The presence of maternal antibodies in breast milk
C. a deficiency of clotting factor VIII helps decrease the incidence of allergies in the newborn. A greater chance for
d. a deficiency of clotting factor IX error is associated with bottle feeding. No preparation required for breast
feeding.
Rationale:
Hemophilia A (classic hemophilia) is a deficiency in factor VIII (an alpha 18. A client is noted to have lymphedema, webbed neck, and low posterior
globulin that stabilized fibrin clots) hairline. Which of the following diagnosis is most appropriate?
A. Turner’s syndrome
14. Celine, a mother of a 2-year-old tells the nurse that her child “cries and B. Down syndrome
has a fit when I have to leave him with a sitter or someone else”. Which of C. Marfan’s syndrome
the following statements would be the nurse’s most accurate analysis of the D. Klinefelter’s syndrome
mother’s comment?
A. The child has not experienced limit-setting or structure. Rationale:
B. The child is expressing a physical need, such as hunger Lymphedema, webbed neck, and low posterior hairline, these are the 3 key
C. The mother has nurtured overdependence in the child assessment features in Turner’s Syndrome. If the child is diagnosed early in
D. The mother is describing her child’s separation anxiety age, proper treatment can be offered to the family. All newborns should be
screened for possible congenital defects.
Rationale:
Before coming to any conclusion, the nurse should ask the mother focused 19. A 4-year-old boy most likely perceives death in which way:
questions; however, based on initial information, the analysis of separation A. An insignificant event unless taught otherwise
anxiety would be most valid. Separation anxiety is a normal toddler response. B. Punishment for something the individual did
When the child senses he is being sent away from those who most provide C. Something that just happens to older people
him with love and security. Crying is one way a child expresses a physical D. Temporary separation from the loved one
need; however, the nurse would be hasty in drawing this at first conclusion
based on what the mother has said. Nurturing overdependence or not Rationale:
providing structure for the toddler are inaccurate conclusions based on the The predominant perception of death by preschool age children is that death
information provided. is temporary separation. Because the child is losing someone significant and
will not see that person again, it’s inaccurate to infer death is insignificant,
15. Mylene Lopez, a 16-year-old girl with scoliosis has recently received an regardless of the child’s response.
invitation to a pool party. She asks the nurse how she can disguise her
impairment when dressed in a bathing suit. Which nursing diagnosis can be 20. Catherine Diaz is a 14-year-old patient on a hematology unit who is being
justified by Mylene’s statement? treated for sickle cell crisis. During a crisis such as that seen in sickle cell
A. Anxiety anemia, aldosterone release is stimulated. In what way might this influence
B. Body image disturbance Catherine’s fluid and electrolyte balance?
C. Ineffective individual coping A. Sodium loss, water loss, and potassium retention
D. Social isolation B. Sodium loss, water loss, and potassium loss
C. Sodium retention, water loss, and potassium retention
Rationale: D. Sodium retention, water retention, and potassium loss
Mylene is experiencing uneasiness about the curvative of her spine, which
will be more evident when she wears a bathing suit. This data suggests a Rationale:
body image disturbance. There is no evidence of anxiety or ineffective coping. Stress stimulates the adrenal cortex to increase the release of aldosterone.
The fact that Mylene is planning to attend a pool party dispels a diagnosis of Aldosterone promotes the resorption of sodium, the retention of water, and
social isolation. the loss of potassium.

16. The foul-smelling frothy characteristic of the stool in cystic fibrosis results
from the presence of large amounts of which of the following:
A. sodium and chloride
B. undigested fats
C. semi-digested carbohydrates
D. lipase, trypsin, and amylase