NURS 5130 Exam 4 V3 | NURS 5130
Comprehensive Assessment – Pediatric
Assessment Lab | Actual Q&A with
Rationale (NURS5130 Exam 4) | The
University of Texas at Arlington
1. When conducting a physical examination on a 2-year-old child, in what order should the
advanced practice nurse perform the assessment components to maximize cooperation?
A. Head-to-toe, starting with the ears and throat to establish authority.
B. Least invasive areas first, such as heart and lungs, leaving the ears and throat for last.
C. Invasive procedures first followed by auscultation of the heart and lungs.
D. The neurological exam followed by the abdominal palpation and then the ears.
Answer: B
Rationale: Toddlers are often fearful of intrusive procedures and may become
uncooperative after uncomfortable assessments. By starting with auscultation while the
child is quiet, the provider ensures high-quality data collection before the child becomes
distressed. Leaving the throat and ears for the end of the exam is a standard pediatric
clinical strategy to maintain rapport as long as possible.
2. During a well-child check, the provider notes the Moro reflex is still present in a 7-month-
old infant. What is the most appropriate clinical interpretation?
A. This is an abnormal finding that warrants further neurological evaluation.
,B. This is a normal finding until the infant reaches 12 months of age.
C. This suggests the infant is developing ahead of schedule in motor skills.
D. The infant likely has a musculoskeletal injury preventing reflex integration.
Answer: A
Rationale: The Moro reflex, also known as the startle reflex, typically disappears by 4 to 6
months of age in healthy infants. Persistence of primitive reflexes beyond the expected
timeframe can indicate central nervous system dysfunction or developmental delays. The
provider should perform a comprehensive neurodevelopmental assessment and consider a
referral to a specialist.
3. Which physical finding is a hallmark indicator of coarctation of the aorta in a pediatric
patient?
A. A holosystolic murmur at the lower left sternal border without radiation.
B. A continuous machinery-like murmur heard best at the left upper sternal border.
C. Hypercyanotic ‘tet’ spells occurring during periods of crying or feeding.
D. Bounding pulses in the upper extremities with diminished pulses in the lower
extremities.
Answer: D
Rationale: Coarctation of the aorta involves a narrowing of the aortic lumen, which
increases blood pressure proximally and decreases it distally. Consequently, a blood
, pressure gradient is observed where the upper body has higher pressure and stronger
pulses than the lower body. This assessment finding is critical for early diagnosis and
preventing potential heart failure.
4. A 4-year-old child presents with a ‘barking’ cough and inspiratory stridor. Which condition
is the most likely diagnosis based on these clinical manifestations?
A. Laryngotracheobronchitis (Croup)
B. Epiglottitis
C. Bacterial Tracheitis
D. Foreign Body Aspiration
Answer: A
Rationale: Croup is characterized by subglottic inflammation, leading to a classic seal-like
barking cough and stridor. Unlike epiglottitis, which presents with high fever and drooling,
croup typically has a more gradual onset and lower-grade fever. It is most commonly
caused by viral pathogens such as parainfluenza.
5. While assessing a newborn, the provider performs the Ortolani maneuver. What
constitutes a ‘positive’ Ortolani sign?
A. Resistance encountered when attempting to adduct the hips.
B. A ‘clunk’ felt as the femoral head reduces into the acetabulum during abduction.
C. Asymmetry of the gluteal folds when the infant is prone.
Comprehensive Assessment – Pediatric
Assessment Lab | Actual Q&A with
Rationale (NURS5130 Exam 4) | The
University of Texas at Arlington
1. When conducting a physical examination on a 2-year-old child, in what order should the
advanced practice nurse perform the assessment components to maximize cooperation?
A. Head-to-toe, starting with the ears and throat to establish authority.
B. Least invasive areas first, such as heart and lungs, leaving the ears and throat for last.
C. Invasive procedures first followed by auscultation of the heart and lungs.
D. The neurological exam followed by the abdominal palpation and then the ears.
Answer: B
Rationale: Toddlers are often fearful of intrusive procedures and may become
uncooperative after uncomfortable assessments. By starting with auscultation while the
child is quiet, the provider ensures high-quality data collection before the child becomes
distressed. Leaving the throat and ears for the end of the exam is a standard pediatric
clinical strategy to maintain rapport as long as possible.
2. During a well-child check, the provider notes the Moro reflex is still present in a 7-month-
old infant. What is the most appropriate clinical interpretation?
A. This is an abnormal finding that warrants further neurological evaluation.
,B. This is a normal finding until the infant reaches 12 months of age.
C. This suggests the infant is developing ahead of schedule in motor skills.
D. The infant likely has a musculoskeletal injury preventing reflex integration.
Answer: A
Rationale: The Moro reflex, also known as the startle reflex, typically disappears by 4 to 6
months of age in healthy infants. Persistence of primitive reflexes beyond the expected
timeframe can indicate central nervous system dysfunction or developmental delays. The
provider should perform a comprehensive neurodevelopmental assessment and consider a
referral to a specialist.
3. Which physical finding is a hallmark indicator of coarctation of the aorta in a pediatric
patient?
A. A holosystolic murmur at the lower left sternal border without radiation.
B. A continuous machinery-like murmur heard best at the left upper sternal border.
C. Hypercyanotic ‘tet’ spells occurring during periods of crying or feeding.
D. Bounding pulses in the upper extremities with diminished pulses in the lower
extremities.
Answer: D
Rationale: Coarctation of the aorta involves a narrowing of the aortic lumen, which
increases blood pressure proximally and decreases it distally. Consequently, a blood
, pressure gradient is observed where the upper body has higher pressure and stronger
pulses than the lower body. This assessment finding is critical for early diagnosis and
preventing potential heart failure.
4. A 4-year-old child presents with a ‘barking’ cough and inspiratory stridor. Which condition
is the most likely diagnosis based on these clinical manifestations?
A. Laryngotracheobronchitis (Croup)
B. Epiglottitis
C. Bacterial Tracheitis
D. Foreign Body Aspiration
Answer: A
Rationale: Croup is characterized by subglottic inflammation, leading to a classic seal-like
barking cough and stridor. Unlike epiglottitis, which presents with high fever and drooling,
croup typically has a more gradual onset and lower-grade fever. It is most commonly
caused by viral pathogens such as parainfluenza.
5. While assessing a newborn, the provider performs the Ortolani maneuver. What
constitutes a ‘positive’ Ortolani sign?
A. Resistance encountered when attempting to adduct the hips.
B. A ‘clunk’ felt as the femoral head reduces into the acetabulum during abduction.
C. Asymmetry of the gluteal folds when the infant is prone.
