NSG 204 — Pediatric Nursing exam
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1. Which finding is considered a normal physiologic characteristic of
a healthy newborn immediately after birth?
A. Heart rate of 80 beats/min
B. Respiratory rate of 10 breaths/min
C. Acrocyanosis of the hands and feet
D. Persistent central cyanosis
Answer: C. Acrocyanosis of the hands and feet
Rationale: Acrocyanosis, or bluish discoloration of the hands and feet,
is common during the first several hours after birth because of
immature peripheral circulation. Central cyanosis involving the lips
and trunk is abnormal and requires evaluation.
, 2. A nurse is assessing a 6-month-old infant. Which developmental
milestone should the nurse expect?
A. Walking independently
B. Sitting with support
C. Using two-word phrases
D. Riding a tricycle
Answer: B. Sitting with support
Rationale: By approximately 6 months, many infants can sit with
support and demonstrate improved head and trunk control.
Independent walking, two-word phrases, and riding a tricycle occur
much later in development.
3. Which assessment finding in an infant is most concerning for
increased intracranial pressure?
A. Flat anterior fontanelle
B. Irritability during feeding
C. Bulging anterior fontanelle
D. Increased interest in surroundings
Answer: C. Bulging anterior fontanelle
,Rationale: A bulging fontanelle, particularly when the infant is calm
and upright, can indicate increased intracranial pressure. A normal
anterior fontanelle should be soft and relatively flat.
4. Which immunization is routinely administered shortly after birth?
A. Measles, mumps, and rubella (MMR)
B. Hepatitis B vaccine
C. Varicella vaccine
D. Human papillomavirus vaccine
Answer: B. Hepatitis B vaccine
Rationale: The hepatitis B vaccine is routinely recommended at birth.
MMR and varicella vaccines are administered later in childhood, while
HPV vaccination is recommended during adolescence.
5. A nurse is teaching parents about preventing sudden infant death
syndrome (SIDS). Which instruction is most appropriate?
A. Place the infant prone for sleep
B. Use soft pillows around the infant
C. Place the infant supine on a firm sleep surface
D. Allow the infant to sleep on an adult mattress
Answer: C. Place the infant supine on a firm sleep surface
, Rationale: Infants should be placed on their backs on a firm, flat sleep
surface without loose bedding, pillows, or soft objects. Supine sleeping
significantly reduces the risk of sleep-related infant death.
6. Which behavior is most characteristic of a toddler experiencing
hospitalization?
A. Complete acceptance of separation
B. Increased independence without distress
C. Separation anxiety
D. Understanding the reason for hospitalization
Answer: C. Separation anxiety
Rationale: Toddlers commonly experience separation anxiety when
hospitalized because they have a strong attachment to their primary
caregivers and limited understanding of time and hospitalization.
Their response may include crying, clinging, or regression.
7. Which intervention is most appropriate when preparing a
preschool-aged child for a procedure?
A. Provide only written instructions
B. Explain the procedure using simple, concrete language
C. Avoid explaining the procedure to prevent anxiety
D. Use complex medical terminology
Questions and Correct Answers (Verified
Answers) Plus Rationale 2027 Q&A|
Instant Download Pdf
1. Which finding is considered a normal physiologic characteristic of
a healthy newborn immediately after birth?
A. Heart rate of 80 beats/min
B. Respiratory rate of 10 breaths/min
C. Acrocyanosis of the hands and feet
D. Persistent central cyanosis
Answer: C. Acrocyanosis of the hands and feet
Rationale: Acrocyanosis, or bluish discoloration of the hands and feet,
is common during the first several hours after birth because of
immature peripheral circulation. Central cyanosis involving the lips
and trunk is abnormal and requires evaluation.
, 2. A nurse is assessing a 6-month-old infant. Which developmental
milestone should the nurse expect?
A. Walking independently
B. Sitting with support
C. Using two-word phrases
D. Riding a tricycle
Answer: B. Sitting with support
Rationale: By approximately 6 months, many infants can sit with
support and demonstrate improved head and trunk control.
Independent walking, two-word phrases, and riding a tricycle occur
much later in development.
3. Which assessment finding in an infant is most concerning for
increased intracranial pressure?
A. Flat anterior fontanelle
B. Irritability during feeding
C. Bulging anterior fontanelle
D. Increased interest in surroundings
Answer: C. Bulging anterior fontanelle
,Rationale: A bulging fontanelle, particularly when the infant is calm
and upright, can indicate increased intracranial pressure. A normal
anterior fontanelle should be soft and relatively flat.
4. Which immunization is routinely administered shortly after birth?
A. Measles, mumps, and rubella (MMR)
B. Hepatitis B vaccine
C. Varicella vaccine
D. Human papillomavirus vaccine
Answer: B. Hepatitis B vaccine
Rationale: The hepatitis B vaccine is routinely recommended at birth.
MMR and varicella vaccines are administered later in childhood, while
HPV vaccination is recommended during adolescence.
5. A nurse is teaching parents about preventing sudden infant death
syndrome (SIDS). Which instruction is most appropriate?
A. Place the infant prone for sleep
B. Use soft pillows around the infant
C. Place the infant supine on a firm sleep surface
D. Allow the infant to sleep on an adult mattress
Answer: C. Place the infant supine on a firm sleep surface
, Rationale: Infants should be placed on their backs on a firm, flat sleep
surface without loose bedding, pillows, or soft objects. Supine sleeping
significantly reduces the risk of sleep-related infant death.
6. Which behavior is most characteristic of a toddler experiencing
hospitalization?
A. Complete acceptance of separation
B. Increased independence without distress
C. Separation anxiety
D. Understanding the reason for hospitalization
Answer: C. Separation anxiety
Rationale: Toddlers commonly experience separation anxiety when
hospitalized because they have a strong attachment to their primary
caregivers and limited understanding of time and hospitalization.
Their response may include crying, clinging, or regression.
7. Which intervention is most appropriate when preparing a
preschool-aged child for a procedure?
A. Provide only written instructions
B. Explain the procedure using simple, concrete language
C. Avoid explaining the procedure to prevent anxiety
D. Use complex medical terminology
