ATI RN PEDIATRIC EXAM QUESTIONS
WITH ANSWERS AND EXPLANATIONS
1. The diagnosis is Expected development at 6 months. Which intervention or plan should the nurse expect
to be prioritized?
A. Encourage supervised floor play, responsive talking and reading, safe introduction of complementary foods,
and continued breast milk or iron-fortified formula
B. Use topical or local analgesia when appropriate, age-appropriate preparation, caregiver presence, comfort
positioning, distraction, and the least restrictive approach
C. Use simple literal language, correct misconceptions, explain what the child will see and feel, and protect body
privacy and integrity
D. Use the FLACC score with physiologic and caregiver information, treat pain, and reassess the child's response
Correct Answer: A. Encourage supervised floor play, responsive talking and reading, safe introduction of
complementary foods, and continued breast milk or iron-fortified formula
Explanation: Encourage supervised floor play, responsive talking and reading, safe introduction of
complementary foods, and continued breast milk or iron-fortified formula is the most appropriate strategy for
Expected development at 6 months. It addresses the principal clinical mechanism or risk rather than only a
nonspecific symptom. Ongoing care should also watch for Persistent head lag, loss of milestones, poor visual
engagement, marked asymmetry, or inability to bear weight with support warrants developmental evaluation.
2. Viral croup is suspected. Which diagnostic or assessment plan should the nurse anticipate?
A. Make a clinical airway emergency diagnosis and avoid agitating throat examination outside a controlled
airway setting
B. Assess work of breathing, oxygen saturation, air movement, ability to speak or feed, and response to rapid
bronchodilator therapy
C. Make the diagnosis clinically and assess oxygenation, hydration, apnea risk, and work of breathing rather than
ordering routine chest radiography
D. Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation
Correct Answer: D. Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation
Explanation: Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation is the most
appropriate evaluation for suspected Viral croup. It directly addresses the expected presentation and helps
separate this condition from important alternatives. Testing should remain clinically targeted.
3. Which statement about Atraumatic procedural care is most accurate for pediatric nursing care?
A. Toddler development includes increasing autonomy and joint attention; regression at any age is abnormal
B. Preschoolers often use magical thinking and interpret explanations literally, so concrete reassurance is more
effective than abstract reasoning
C. At about 6 months, purposeful reaching, rolling, social interaction, and emerging supported sitting are
expected while independent walking is not
D. Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather than simply
completing the procedure quickly
Correct Answer: D. Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather
than simply completing the procedure quickly
Explanation: Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather than
simply completing the procedure quickly is the most useful distinguishing statement for Atraumatic procedural
care. It connects the clinical pattern with the disorder and helps separate it from a common mimic. The
alternatives describe findings or strategies that fit other conditions in the same clinical domain.
4. A child with Post-tonsillectomy hemorrhage is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates significant
hemorrhage
B. Increasing stridor at rest, fatigue, cyanosis, decreased air movement, or altered consciousness indicates
impending respiratory failure
C. Declining lung function, poor growth, recurrent exacerbations, hemoptysis, or cystic-fibrosis-related diabetes
requires specialist reassessment
,D. Sudden increased distress, cyanosis, decreased air movement, or altered consciousness can precede complete
airway obstruction
Correct Answer: A. Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates
significant hemorrhage
Explanation: Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates significant
hemorrhage is an important warning sign in Post-tonsillectomy hemorrhage and can represent progression or a
serious complication. This finding warrants prompt reassessment rather than routine follow-up alone.
5. Expected development at 18 months is suspected. Which diagnostic or assessment plan should the nurse
anticipate?
A. Assess the child's understanding of illness, fears about bodily harm, and ability to use concrete explanations
B. Assess developmental level, prior experiences, pain, anxiety, and coping strategies before the procedure
C. Assess gross motor, fine motor, language, social skills, feeding readiness, vision, hearing, and growth at the
health visit
D. Use standardized developmental and autism screening while reviewing language, motor, social, hearing, and
family concerns
Correct Answer: D. Use standardized developmental and autism screening while reviewing language, motor,
social, hearing, and family concerns
Explanation: Use standardized developmental and autism screening while reviewing language, motor, social,
hearing, and family concerns is the most appropriate evaluation for suspected Expected development at 18
months. It directly addresses the expected presentation and helps separate this condition from important
alternatives. Testing should remain clinically targeted.
6. At a pediatric urgent-care visit, a child has chronic productive cough, recurrent sinopulmonary
infection, poor weight gain, and greasy stools. Which condition should the nurse recognize as most
consistent with these findings?
A. Acute pediatric asthma exacerbation
B. Post-tonsillectomy hemorrhage
C. Cystic fibrosis
D. Epiglottitis
Correct Answer: C. Cystic fibrosis
Explanation: The findings are most consistent with Cystic fibrosis. The discriminating point is Cystic fibrosis
combines chronic airway disease with exocrine pancreatic insufficiency in many affected children. That feature
makes the alternative diagnoses less consistent with the overall pattern.
7. A child with Family-centered pediatric care is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Withdrawal from peers, persistent school refusal, declining self-esteem, or inability to resume age-appropriate
roles requires follow-up
B. Persistent severe distress or uncontrolled pain after the procedure requires reassessment and additional
analgesia or coping support
C. Persistent extreme fear, regression, or misconceptions that interfere with necessary care require additional
child-life or behavioral support
D. Escalating caregiver distress, misunderstanding, or inability to participate safely requires additional support
and communication
Correct Answer: D. Escalating caregiver distress, misunderstanding, or inability to participate safely requires
additional support and communication
Explanation: Escalating caregiver distress, misunderstanding, or inability to participate safely requires additional
support and communication is an important warning sign in Family-centered pediatric care and can represent
progression or a serious complication. This finding warrants prompt reassessment rather than routine follow-up
alone.
8. The diagnosis is Viral croup. Which intervention or plan should the nurse expect to be prioritized?
A. Provide nasal suctioning, hydration support, and oxygen when hypoxemic; use escalation of respiratory
support according to severity
B. Notify the surgeon immediately, maintain a safe side-lying or upright position as appropriate, keep suction
available, and prepare for operative control if bleeding is confirmed
,C. Provide airway-clearance therapy, pancreatic enzymes when insufficient, high-calorie nutrition, fat-soluble
vitamins, and genotype-appropriate modulator therapy
D. Give dexamethasone and add nebulized epinephrine for moderate or severe croup with observation for
recurrent symptoms
Correct Answer: D. Give dexamethasone and add nebulized epinephrine for moderate or severe croup with
observation for recurrent symptoms
Explanation: Give dexamethasone and add nebulized epinephrine for moderate or severe croup with observation
for recurrent symptoms is the most appropriate strategy for Viral croup. It addresses the principal clinical
mechanism or risk rather than only a nonspecific symptom. Ongoing care should also watch for Increasing stridor
at rest, fatigue, cyanosis, decreased air movement, or altered consciousness indicates impending respiratory
failure.
9. During a pediatric assessment, a toddler is found beside an open household chemical container with
possible ingestion but no reliable dose estimate. Which condition should the nurse recognize as most
consistent with these findings?
A. Physical child abuse concern
B. Accidental household poisoning
C. Measles
D. Live vaccine in severe immunodeficiency
Correct Answer: B. Accidental household poisoning
Explanation: The findings are most consistent with Accidental household poisoning. The discriminating point is
Routine induction of emesis with syrup of ipecac is not recommended for childhood poisoning. That feature
makes the alternative diagnoses less consistent with the overall pattern.
10. Which statement about Intussusception is most accurate for pediatric nursing care?
A. Pyloric obstruction produces nonbilious projectile vomiting because the obstruction lies proximal to the
duodenum
B. Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in intussusception
C. Removing gluten before testing can normalize serology and make confirmation more difficult
D. Hirschsprung disease results from distal aganglionosis causing functional obstruction rather than a mechanical
meconium plug alone
Correct Answer: B. Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in
intussusception
Explanation: Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in
intussusception is the most useful distinguishing statement for Intussusception. It connects the clinical pattern
with the disorder and helps separate it from a common mimic. The alternatives describe findings or strategies that
fit other conditions in the same clinical domain.
11. At a pediatric urgent-care visit, a preschool child believes illness occurred because of a bad thought and
becomes distressed before a procedure. Which condition should the nurse recognize as most consistent with
these findings?
A. Preschool magical thinking and body integrity
B. Adolescent confidentiality and private interview
C. Expected development at 18 months
D. Expected development at 6 months
Correct Answer: A. Preschool magical thinking and body integrity
Explanation: The findings are most consistent with Preschool magical thinking and body integrity. The
discriminating point is Preschoolers often use magical thinking and interpret explanations literally, so concrete
reassurance is more effective than abstract reasoning. That feature makes the alternative diagnoses less consistent
with the overall pattern.
12. Which statement best differentiates Cystic fibrosis from a common pediatric mimic?
A. Drooling and tripod positioning without a barking cough should raise concern for epiglottitis rather than croup
B. Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in many affected
children
C. Croup usually causes a barking cough and stridor, whereas epiglottitis is more likely to cause drooling, toxic
appearance, and tripod posture
, D. Typical bronchiolitis is managed supportively; routine antibiotics and bronchodilators are not indicated for
most infants
Correct Answer: B. Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in
many affected children
Explanation: Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in many
affected children is the most useful distinguishing statement for Cystic fibrosis. It connects the clinical pattern
with the disorder and helps separate it from a common mimic. The alternatives describe findings or strategies that
fit other conditions in the same clinical domain.
13. A child with Physical child abuse concern is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Respiratory distress, altered consciousness, seizures, persistent vomiting, caustic exposure, or cardiovascular
instability requires emergency care
B. Respiratory symptoms, cerebellar findings, severe skin infection, or immunocompromise increases
complication risk
C. Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate danger requires
emergency evaluation
D. Immune recovery or medication reduction can change future vaccine eligibility and should be reassessed
Correct Answer: C. Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate
danger requires emergency evaluation
Explanation: Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate danger
requires emergency evaluation is an important warning sign in Physical child abuse concern and can represent
progression or a serious complication. This finding warrants prompt reassessment rather than routine follow-up
alone.
14. The diagnosis is Expected development at 18 months. Which intervention or plan should the nurse
expect to be prioritized?
A. Provide achievable tasks, schoolwork and peer contact when possible, praise effort, and involve the child in
care choices
B. Partner with the child and family in planning, provide clear information, preserve routines when possible, and
support shared decision-making
C. Use simple literal language, correct misconceptions, explain what the child will see and feel, and protect body
privacy and integrity
D. Offer simple choices, maintain routines and limits, read and talk frequently, and promote safe exploration
Correct Answer: D. Offer simple choices, maintain routines and limits, read and talk frequently, and promote
safe exploration
Explanation: Offer simple choices, maintain routines and limits, read and talk frequently, and promote safe
exploration is the most appropriate strategy for Expected development at 18 months. It addresses the principal
clinical mechanism or risk rather than only a nonspecific symptom. Ongoing care should also watch for No
independent walking, no meaningful words or gestures, poor social reciprocity, or loss of skills warrants prompt
evaluation.
15. The clinical picture suggests Hirschsprung disease: A newborn has delayed passage of meconium,
abdominal distention, bilious vomiting, or explosive stool after rectal examination. The next step should
confirm or support the diagnosis without adding low-yield testing. Which diagnostic or assessment plan
should the nurse anticipate?
A. Measure tissue-transglutaminase IgA and total IgA while the child is still eating gluten, followed by specialist
confirmation
B. Estimate dehydration clinically using weight change when known, perfusion, mental status, mucosa, tears, and
urine output
C. Rectal suction biopsy demonstrating absence of ganglion cells
D. Abdominal ultrasonography and serum electrolytes to assess the expected hypochloremic metabolic alkalosis
Correct Answer: C. Rectal suction biopsy demonstrating absence of ganglion cells
Explanation: Rectal suction biopsy demonstrating absence of ganglion cells is the most appropriate evaluation
for suspected Hirschsprung disease. It directly addresses the expected presentation and helps separate this
condition from important alternatives. Testing should remain clinically targeted.
WITH ANSWERS AND EXPLANATIONS
1. The diagnosis is Expected development at 6 months. Which intervention or plan should the nurse expect
to be prioritized?
A. Encourage supervised floor play, responsive talking and reading, safe introduction of complementary foods,
and continued breast milk or iron-fortified formula
B. Use topical or local analgesia when appropriate, age-appropriate preparation, caregiver presence, comfort
positioning, distraction, and the least restrictive approach
C. Use simple literal language, correct misconceptions, explain what the child will see and feel, and protect body
privacy and integrity
D. Use the FLACC score with physiologic and caregiver information, treat pain, and reassess the child's response
Correct Answer: A. Encourage supervised floor play, responsive talking and reading, safe introduction of
complementary foods, and continued breast milk or iron-fortified formula
Explanation: Encourage supervised floor play, responsive talking and reading, safe introduction of
complementary foods, and continued breast milk or iron-fortified formula is the most appropriate strategy for
Expected development at 6 months. It addresses the principal clinical mechanism or risk rather than only a
nonspecific symptom. Ongoing care should also watch for Persistent head lag, loss of milestones, poor visual
engagement, marked asymmetry, or inability to bear weight with support warrants developmental evaluation.
2. Viral croup is suspected. Which diagnostic or assessment plan should the nurse anticipate?
A. Make a clinical airway emergency diagnosis and avoid agitating throat examination outside a controlled
airway setting
B. Assess work of breathing, oxygen saturation, air movement, ability to speak or feed, and response to rapid
bronchodilator therapy
C. Make the diagnosis clinically and assess oxygenation, hydration, apnea risk, and work of breathing rather than
ordering routine chest radiography
D. Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation
Correct Answer: D. Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation
Explanation: Clinical assessment of stridor at rest, retractions, air entry, agitation, and oxygenation is the most
appropriate evaluation for suspected Viral croup. It directly addresses the expected presentation and helps
separate this condition from important alternatives. Testing should remain clinically targeted.
3. Which statement about Atraumatic procedural care is most accurate for pediatric nursing care?
A. Toddler development includes increasing autonomy and joint attention; regression at any age is abnormal
B. Preschoolers often use magical thinking and interpret explanations literally, so concrete reassurance is more
effective than abstract reasoning
C. At about 6 months, purposeful reaching, rolling, social interaction, and emerging supported sitting are
expected while independent walking is not
D. Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather than simply
completing the procedure quickly
Correct Answer: D. Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather
than simply completing the procedure quickly
Explanation: Atraumatic care aims to minimize physical pain, fear, separation, and loss of control rather than
simply completing the procedure quickly is the most useful distinguishing statement for Atraumatic procedural
care. It connects the clinical pattern with the disorder and helps separate it from a common mimic. The
alternatives describe findings or strategies that fit other conditions in the same clinical domain.
4. A child with Post-tonsillectomy hemorrhage is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates significant
hemorrhage
B. Increasing stridor at rest, fatigue, cyanosis, decreased air movement, or altered consciousness indicates
impending respiratory failure
C. Declining lung function, poor growth, recurrent exacerbations, hemoptysis, or cystic-fibrosis-related diabetes
requires specialist reassessment
,D. Sudden increased distress, cyanosis, decreased air movement, or altered consciousness can precede complete
airway obstruction
Correct Answer: A. Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates
significant hemorrhage
Explanation: Bright-red emesis, tachycardia, pallor, hypotension, or continuous swallowing indicates significant
hemorrhage is an important warning sign in Post-tonsillectomy hemorrhage and can represent progression or a
serious complication. This finding warrants prompt reassessment rather than routine follow-up alone.
5. Expected development at 18 months is suspected. Which diagnostic or assessment plan should the nurse
anticipate?
A. Assess the child's understanding of illness, fears about bodily harm, and ability to use concrete explanations
B. Assess developmental level, prior experiences, pain, anxiety, and coping strategies before the procedure
C. Assess gross motor, fine motor, language, social skills, feeding readiness, vision, hearing, and growth at the
health visit
D. Use standardized developmental and autism screening while reviewing language, motor, social, hearing, and
family concerns
Correct Answer: D. Use standardized developmental and autism screening while reviewing language, motor,
social, hearing, and family concerns
Explanation: Use standardized developmental and autism screening while reviewing language, motor, social,
hearing, and family concerns is the most appropriate evaluation for suspected Expected development at 18
months. It directly addresses the expected presentation and helps separate this condition from important
alternatives. Testing should remain clinically targeted.
6. At a pediatric urgent-care visit, a child has chronic productive cough, recurrent sinopulmonary
infection, poor weight gain, and greasy stools. Which condition should the nurse recognize as most
consistent with these findings?
A. Acute pediatric asthma exacerbation
B. Post-tonsillectomy hemorrhage
C. Cystic fibrosis
D. Epiglottitis
Correct Answer: C. Cystic fibrosis
Explanation: The findings are most consistent with Cystic fibrosis. The discriminating point is Cystic fibrosis
combines chronic airway disease with exocrine pancreatic insufficiency in many affected children. That feature
makes the alternative diagnoses less consistent with the overall pattern.
7. A child with Family-centered pediatric care is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Withdrawal from peers, persistent school refusal, declining self-esteem, or inability to resume age-appropriate
roles requires follow-up
B. Persistent severe distress or uncontrolled pain after the procedure requires reassessment and additional
analgesia or coping support
C. Persistent extreme fear, regression, or misconceptions that interfere with necessary care require additional
child-life or behavioral support
D. Escalating caregiver distress, misunderstanding, or inability to participate safely requires additional support
and communication
Correct Answer: D. Escalating caregiver distress, misunderstanding, or inability to participate safely requires
additional support and communication
Explanation: Escalating caregiver distress, misunderstanding, or inability to participate safely requires additional
support and communication is an important warning sign in Family-centered pediatric care and can represent
progression or a serious complication. This finding warrants prompt reassessment rather than routine follow-up
alone.
8. The diagnosis is Viral croup. Which intervention or plan should the nurse expect to be prioritized?
A. Provide nasal suctioning, hydration support, and oxygen when hypoxemic; use escalation of respiratory
support according to severity
B. Notify the surgeon immediately, maintain a safe side-lying or upright position as appropriate, keep suction
available, and prepare for operative control if bleeding is confirmed
,C. Provide airway-clearance therapy, pancreatic enzymes when insufficient, high-calorie nutrition, fat-soluble
vitamins, and genotype-appropriate modulator therapy
D. Give dexamethasone and add nebulized epinephrine for moderate or severe croup with observation for
recurrent symptoms
Correct Answer: D. Give dexamethasone and add nebulized epinephrine for moderate or severe croup with
observation for recurrent symptoms
Explanation: Give dexamethasone and add nebulized epinephrine for moderate or severe croup with observation
for recurrent symptoms is the most appropriate strategy for Viral croup. It addresses the principal clinical
mechanism or risk rather than only a nonspecific symptom. Ongoing care should also watch for Increasing stridor
at rest, fatigue, cyanosis, decreased air movement, or altered consciousness indicates impending respiratory
failure.
9. During a pediatric assessment, a toddler is found beside an open household chemical container with
possible ingestion but no reliable dose estimate. Which condition should the nurse recognize as most
consistent with these findings?
A. Physical child abuse concern
B. Accidental household poisoning
C. Measles
D. Live vaccine in severe immunodeficiency
Correct Answer: B. Accidental household poisoning
Explanation: The findings are most consistent with Accidental household poisoning. The discriminating point is
Routine induction of emesis with syrup of ipecac is not recommended for childhood poisoning. That feature
makes the alternative diagnoses less consistent with the overall pattern.
10. Which statement about Intussusception is most accurate for pediatric nursing care?
A. Pyloric obstruction produces nonbilious projectile vomiting because the obstruction lies proximal to the
duodenum
B. Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in intussusception
C. Removing gluten before testing can normalize serology and make confirmation more difficult
D. Hirschsprung disease results from distal aganglionosis causing functional obstruction rather than a mechanical
meconium plug alone
Correct Answer: B. Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in
intussusception
Explanation: Currant-jelly stool is a later finding; episodic pain and lethargy often appear earlier in
intussusception is the most useful distinguishing statement for Intussusception. It connects the clinical pattern
with the disorder and helps separate it from a common mimic. The alternatives describe findings or strategies that
fit other conditions in the same clinical domain.
11. At a pediatric urgent-care visit, a preschool child believes illness occurred because of a bad thought and
becomes distressed before a procedure. Which condition should the nurse recognize as most consistent with
these findings?
A. Preschool magical thinking and body integrity
B. Adolescent confidentiality and private interview
C. Expected development at 18 months
D. Expected development at 6 months
Correct Answer: A. Preschool magical thinking and body integrity
Explanation: The findings are most consistent with Preschool magical thinking and body integrity. The
discriminating point is Preschoolers often use magical thinking and interpret explanations literally, so concrete
reassurance is more effective than abstract reasoning. That feature makes the alternative diagnoses less consistent
with the overall pattern.
12. Which statement best differentiates Cystic fibrosis from a common pediatric mimic?
A. Drooling and tripod positioning without a barking cough should raise concern for epiglottitis rather than croup
B. Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in many affected
children
C. Croup usually causes a barking cough and stridor, whereas epiglottitis is more likely to cause drooling, toxic
appearance, and tripod posture
, D. Typical bronchiolitis is managed supportively; routine antibiotics and bronchodilators are not indicated for
most infants
Correct Answer: B. Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in
many affected children
Explanation: Cystic fibrosis combines chronic airway disease with exocrine pancreatic insufficiency in many
affected children is the most useful distinguishing statement for Cystic fibrosis. It connects the clinical pattern
with the disorder and helps separate it from a common mimic. The alternatives describe findings or strategies that
fit other conditions in the same clinical domain.
13. A child with Physical child abuse concern is being monitored. Which finding requires the nurse to
notify the provider or escalate care most urgently?
A. Respiratory distress, altered consciousness, seizures, persistent vomiting, caustic exposure, or cardiovascular
instability requires emergency care
B. Respiratory symptoms, cerebellar findings, severe skin infection, or immunocompromise increases
complication risk
C. Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate danger requires
emergency evaluation
D. Immune recovery or medication reduction can change future vaccine eligibility and should be reassessed
Correct Answer: C. Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate
danger requires emergency evaluation
Explanation: Any concern for intracranial injury, abdominal injury, fracture, strangulation, or immediate danger
requires emergency evaluation is an important warning sign in Physical child abuse concern and can represent
progression or a serious complication. This finding warrants prompt reassessment rather than routine follow-up
alone.
14. The diagnosis is Expected development at 18 months. Which intervention or plan should the nurse
expect to be prioritized?
A. Provide achievable tasks, schoolwork and peer contact when possible, praise effort, and involve the child in
care choices
B. Partner with the child and family in planning, provide clear information, preserve routines when possible, and
support shared decision-making
C. Use simple literal language, correct misconceptions, explain what the child will see and feel, and protect body
privacy and integrity
D. Offer simple choices, maintain routines and limits, read and talk frequently, and promote safe exploration
Correct Answer: D. Offer simple choices, maintain routines and limits, read and talk frequently, and promote
safe exploration
Explanation: Offer simple choices, maintain routines and limits, read and talk frequently, and promote safe
exploration is the most appropriate strategy for Expected development at 18 months. It addresses the principal
clinical mechanism or risk rather than only a nonspecific symptom. Ongoing care should also watch for No
independent walking, no meaningful words or gestures, poor social reciprocity, or loss of skills warrants prompt
evaluation.
15. The clinical picture suggests Hirschsprung disease: A newborn has delayed passage of meconium,
abdominal distention, bilious vomiting, or explosive stool after rectal examination. The next step should
confirm or support the diagnosis without adding low-yield testing. Which diagnostic or assessment plan
should the nurse anticipate?
A. Measure tissue-transglutaminase IgA and total IgA while the child is still eating gluten, followed by specialist
confirmation
B. Estimate dehydration clinically using weight change when known, perfusion, mental status, mucosa, tears, and
urine output
C. Rectal suction biopsy demonstrating absence of ganglion cells
D. Abdominal ultrasonography and serum electrolytes to assess the expected hypochloremic metabolic alkalosis
Correct Answer: C. Rectal suction biopsy demonstrating absence of ganglion cells
Explanation: Rectal suction biopsy demonstrating absence of ganglion cells is the most appropriate evaluation
for suspected Hirschsprung disease. It directly addresses the expected presentation and helps separate this
condition from important alternatives. Testing should remain clinically targeted.
