PEDS NURSING EXAMINATION MANUAL 2025/2026
QUESTIONS WITH ANSWERS MARKED A+
✔✔The primary nursing intervention to prevent bacterial endocarditis is which of the
following?
a. Counsel parents of high-risk children.
b. Institute measures to prevent dental procedures.
c. Encourage restricted mobility in susceptible children.
d. Observe children for complications, such as embolism and heart failure. - ✔✔ANS: A
The objective of nursing care is to counsel the parents of high-risk children about the
need for both prophylactic antibiotics for dental procedures and maintaining excellent
oral health. The child's dentist should be aware of the child's cardiac condition. Dental
procedures should be done to maintain a high level of oral health. Restricted mobility in
susceptible children is not indicated. Parents are taught to observe for unexplained
fever, weight loss, or change in behavior.
✔✔When caring for the child with Kawasaki disease, the nurse should know which of
the following?
a. Aspirin is contraindicated.
b. Principal area of involvement is the joints.
c. Child's fever is usually responsive to antibiotics within 48 hours.
d. Therapeutic management includes administration of gamma globulin and salicylates.
- ✔✔ANS: D
High-dose intravenous gamma globulin and salicylate therapy is indicated to reduce the
incidence of coronary artery abnormalities when given within the first 10 days of the
illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the
extremities, and cardiac involvement are seen. The fever of Kawasaki disease is
unresponsive to antibiotics. It is responsive to antiinflammatory doses of aspirin and
antipyretics.
✔✔Nursing care of the child with Kawasaki disease is challenging because of:
a. the child's irritability.
b. predictable disease course.
c. complex antibiotic therapy.
d. the child's ongoing requests for food. - ✔✔ANS: A
Patient irritability is a hallmark of Kawasaki disease and the most challenging problem.
A quiet environment is necessary to promote rest. The diagnosis is often difficult to
make, and the course of the disease can be unpredictable. Intravenous gamma globulin
and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to
eat. Soft foods and fluids should be offered to prevent dehydration.
,✔✔SELECT ALL THAT APPLY.
The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the
following clinical manifestations would the nurse expect to observe?
a. Osler nodes
b. Cervical lymphadenopathy
c. Strawberry tongue
d. Chorea
e. Erythematous palms
f. Polyarthritis - ✔✔ANS: B, C, E
Clinical manifestations of Kawasaki disease in the acute phase include cervical
lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a
clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic
fever.
✔✔The regulation of red blood cell (RBC) production is thought to be controlled by:
a. hemoglobin.
b. tissue hypoxia.
c. reticulocyte count.
d. number of RBCs. - ✔✔ANS: B
Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin
to adequately oxygenate the tissue, then erythropoietin may be released. When tissue
hypoxia occurs, the kidneys release erythropoietin into the bloodstream. This stimulates
the marrow to produce new RBCs. Reticulocytes are immature RBCs. The "retic" count
can be used to monitor hematopoiesis. The number of RBCs does not directly control
production. In congenital cardiac disorders with mixed blood flow or decreased
pulmonary blood flow, RBC production continues secondary to tissue hypoxia.
✔✔A mother states that she brought her child to the clinic because the 3-year-old girl
was not keeping up with her siblings. During physical assessment, the nurse notes that
the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on
admission is 6.4 g/dl. After notifying the practitioner of the results, the nurse's priority
intervention is to:
a. reduce environmental stimulation to prevent seizures.
b. have the laboratory repeat the analysis with a new specimen.
c. minimize energy expenditure to decrease cardiac workload.
d. administer intravenous fluids to correct the dehydration. - ✔✔ANS: C
The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl.
When the oxygen-carrying capacity of the blood decreases slowly, the child is able to
compensate by increasing cardiac output. With the increasing workload of the heart,
additional stress can lead to cardiac failure. Reduction of environmental stimulation can
, help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin
analysis is not necessary. The child does not have evidence of dehydration. If
intravenous fluids are given, they can further dilute the circulating blood volume and
increase the strain on the heart.
✔✔A child with severe anemia requires a unit of red blood cells (RBCs). The nurse
explains to the child that the transfusion is necessary to:
a. allow her parents to come visit her.
b. fight the infection that she now has.
c. increase her energy so she will not be so tired.
d. help her body stop bleeding by forming a clot (scab). - ✔✔ANS: C
The indication for RBC transfusion is risk of cardiac decompensation. When the number
of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is
improved, and the child will have more energy. Parental visiting is not dependent on
transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is
no evidence that the child is currently infected. Forming a clot is the function of platelets.
✔✔An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has
developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry
cough. These manifestations are most suggestive of which of the following
complications?
a. Air embolism
b. Allergic reaction
c. Hemolytic reaction
d. Circulatory overload - ✔✔ANS: D
The signs of circulatory overload include distended neck veins, hypertension, crackles,
dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty
breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing,
asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions.
Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site,
nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive
signs of shock and renal failure.
✔✔Which of the following explains why iron deficiency anemia is common during
infancy?
a. Cow's milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by 1 month of age.
d. Dietary iron cannot be started until 12 months of age. - ✔✔ANS: A
Children between the ages of 12 and 36 months are at risk for anemia, since cow's milk
is a major component of their diet and it is a poor source of iron. Iron is stored during
fetal development, but the amount stored depends on maternal iron stores. Fetal iron
QUESTIONS WITH ANSWERS MARKED A+
✔✔The primary nursing intervention to prevent bacterial endocarditis is which of the
following?
a. Counsel parents of high-risk children.
b. Institute measures to prevent dental procedures.
c. Encourage restricted mobility in susceptible children.
d. Observe children for complications, such as embolism and heart failure. - ✔✔ANS: A
The objective of nursing care is to counsel the parents of high-risk children about the
need for both prophylactic antibiotics for dental procedures and maintaining excellent
oral health. The child's dentist should be aware of the child's cardiac condition. Dental
procedures should be done to maintain a high level of oral health. Restricted mobility in
susceptible children is not indicated. Parents are taught to observe for unexplained
fever, weight loss, or change in behavior.
✔✔When caring for the child with Kawasaki disease, the nurse should know which of
the following?
a. Aspirin is contraindicated.
b. Principal area of involvement is the joints.
c. Child's fever is usually responsive to antibiotics within 48 hours.
d. Therapeutic management includes administration of gamma globulin and salicylates.
- ✔✔ANS: D
High-dose intravenous gamma globulin and salicylate therapy is indicated to reduce the
incidence of coronary artery abnormalities when given within the first 10 days of the
illness. Aspirin is part of the therapy. Mucous membranes, conjunctiva, changes in the
extremities, and cardiac involvement are seen. The fever of Kawasaki disease is
unresponsive to antibiotics. It is responsive to antiinflammatory doses of aspirin and
antipyretics.
✔✔Nursing care of the child with Kawasaki disease is challenging because of:
a. the child's irritability.
b. predictable disease course.
c. complex antibiotic therapy.
d. the child's ongoing requests for food. - ✔✔ANS: A
Patient irritability is a hallmark of Kawasaki disease and the most challenging problem.
A quiet environment is necessary to promote rest. The diagnosis is often difficult to
make, and the course of the disease can be unpredictable. Intravenous gamma globulin
and salicylates are the therapy of choice, not antibiotics. The child often is reluctant to
eat. Soft foods and fluids should be offered to prevent dehydration.
,✔✔SELECT ALL THAT APPLY.
The nurse is caring for a child with Kawasaki disease in the acute phase. Which of the
following clinical manifestations would the nurse expect to observe?
a. Osler nodes
b. Cervical lymphadenopathy
c. Strawberry tongue
d. Chorea
e. Erythematous palms
f. Polyarthritis - ✔✔ANS: B, C, E
Clinical manifestations of Kawasaki disease in the acute phase include cervical
lymphadenopathy, a strawberry tongue, and erythematous palms. Osler nodes are a
clinical manifestation of endocarditis. Chorea and polyarthritis are seen in rheumatic
fever.
✔✔The regulation of red blood cell (RBC) production is thought to be controlled by:
a. hemoglobin.
b. tissue hypoxia.
c. reticulocyte count.
d. number of RBCs. - ✔✔ANS: B
Hemoglobin does not directly control RBC production. If there is insufficient hemoglobin
to adequately oxygenate the tissue, then erythropoietin may be released. When tissue
hypoxia occurs, the kidneys release erythropoietin into the bloodstream. This stimulates
the marrow to produce new RBCs. Reticulocytes are immature RBCs. The "retic" count
can be used to monitor hematopoiesis. The number of RBCs does not directly control
production. In congenital cardiac disorders with mixed blood flow or decreased
pulmonary blood flow, RBC production continues secondary to tissue hypoxia.
✔✔A mother states that she brought her child to the clinic because the 3-year-old girl
was not keeping up with her siblings. During physical assessment, the nurse notes that
the child has pale skin and conjunctiva and has muscle weakness. The hemoglobin on
admission is 6.4 g/dl. After notifying the practitioner of the results, the nurse's priority
intervention is to:
a. reduce environmental stimulation to prevent seizures.
b. have the laboratory repeat the analysis with a new specimen.
c. minimize energy expenditure to decrease cardiac workload.
d. administer intravenous fluids to correct the dehydration. - ✔✔ANS: C
The child has a critically low hemoglobin value. The expected range is 11.5 to 15.5 g/dl.
When the oxygen-carrying capacity of the blood decreases slowly, the child is able to
compensate by increasing cardiac output. With the increasing workload of the heart,
additional stress can lead to cardiac failure. Reduction of environmental stimulation can
, help minimize energy expenditure, but seizures are not a risk. A repeat hemoglobin
analysis is not necessary. The child does not have evidence of dehydration. If
intravenous fluids are given, they can further dilute the circulating blood volume and
increase the strain on the heart.
✔✔A child with severe anemia requires a unit of red blood cells (RBCs). The nurse
explains to the child that the transfusion is necessary to:
a. allow her parents to come visit her.
b. fight the infection that she now has.
c. increase her energy so she will not be so tired.
d. help her body stop bleeding by forming a clot (scab). - ✔✔ANS: C
The indication for RBC transfusion is risk of cardiac decompensation. When the number
of circulating RBCs is increased, tissue hypoxia decreases, cardiac function is
improved, and the child will have more energy. Parental visiting is not dependent on
transfusion. The decrease in tissue hypoxia will minimize the risk of infection. There is
no evidence that the child is currently infected. Forming a clot is the function of platelets.
✔✔An 8-year-old girl is receiving a blood transfusion when the nurse notes that she has
developed precordial pain, dyspnea, distended neck veins, slight cyanosis, and a dry
cough. These manifestations are most suggestive of which of the following
complications?
a. Air embolism
b. Allergic reaction
c. Hemolytic reaction
d. Circulatory overload - ✔✔ANS: D
The signs of circulatory overload include distended neck veins, hypertension, crackles,
dry cough, cyanosis, and precordial pain. Signs of air embolism are sudden difficulty
breathing, sharp pain in the chest, and apprehension. Urticaria, pruritus, flushing,
asthmatic wheezing, and laryngeal edema are signs and symptoms of allergic reactions.
Hemolytic reactions are characterized by chills, shaking, fever, pain at infusion site,
nausea, vomiting, tightness in chest, flank pain, red or black urine, and progressive
signs of shock and renal failure.
✔✔Which of the following explains why iron deficiency anemia is common during
infancy?
a. Cow's milk is a poor source of iron.
b. Iron cannot be stored during fetal development.
c. Fetal iron stores are depleted by 1 month of age.
d. Dietary iron cannot be started until 12 months of age. - ✔✔ANS: A
Children between the ages of 12 and 36 months are at risk for anemia, since cow's milk
is a major component of their diet and it is a poor source of iron. Iron is stored during
fetal development, but the amount stored depends on maternal iron stores. Fetal iron
