PNR 204/PNR204 Exam 2 V3 | Pediatric Nursing
Q&A with Rationale | Fortis College
1. According to Erikson’s stages of psychosocial development, which task is the primary focus
for an infant from birth to 1 year?
A. Autonomy vs. Shame and Doubt
B. Trust vs. Mistrust
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
Explanation: Trust is established when an infant’s basic needs such as feeding and comfort
are met consistently by caregivers. If these needs are not met or are met inconsistently, the
infant develops a sense of mistrust in the world. This stage forms the foundation for all
subsequent psychological development in the child.
2. A nurse is providing discharge teaching for the parents of a 4-year-old child with a newly
diagnosed seizure disorder. Which safety instruction is most important?
A. Ensure the child wears a medical alert bracelet at all times.
B. Supervise the child closely when they are swimming or in the bathtub.
C. Avoid using pillows in the child’s bed to prevent suffocation.
D. Keep a tongue blade nearby to insert during a seizure.
,Correct Answer: B
Explanation: Drowning is a major risk for children with seizure disorders, making
constant supervision during water activities essential. While medical alert bracelets are
helpful for identification, they do not prevent immediate injury during an event. Inserting
objects into the mouth during a seizure is dangerous and contraindicated as it can cause
dental or airway damage.
3. A 3-year-old is admitted with suspected epiglottitis. Which nursing action should be
avoided to prevent sudden airway obstruction?
A. Placing the child in a tripod position.
B. Administering humidified oxygen.
C. Visualizing the throat with a tongue blade.
D. Starting an intravenous line for antibiotics.
Correct Answer: C
Explanation: Attempting to visualize the throat or using a tongue blade in a child with
suspected epiglottitis can trigger a laryngospasm and complete airway obstruction. The
child should be kept as calm as possible to minimize respiratory distress. Examination of
the throat should only be performed in a setting where emergency intubation or
tracheostomy can be performed immediately.
4. Which clinical manifestation is a hallmark sign of a child experiencing Intussusception?
A. Currant jelly-like stools
, B. Projectile vomiting after feedings
C. Ribbon-like, foul-smelling stools
D. Pain in the lower right quadrant
Correct Answer: A
Explanation: Currant jelly stools occur when the intestinal mucosa sloughs and mixes with
blood and mucus due to the telescoping of the bowel. This condition is a pediatric
emergency that requires immediate intervention to prevent bowel necrosis. Diagnostic and
therapeutic management often includes an air or barium enema to reduce the
intussusception.
5. A nurse is caring for an infant with Tetralogy of Fallot who begins to cry and becomes
cyanotic and tachypneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask.
B. Place the infant in the knee-chest position.
C. Prepare for immediate administration of morphine sulfate.
D. Call the physician for an emergency consult.
Correct Answer: B
Explanation: The knee-chest position increases systemic vascular resistance, which
reduces the right-to-left shunt and improves oxygenation during a ‘tet’ spell. This is the
Q&A with Rationale | Fortis College
1. According to Erikson’s stages of psychosocial development, which task is the primary focus
for an infant from birth to 1 year?
A. Autonomy vs. Shame and Doubt
B. Trust vs. Mistrust
C. Initiative vs. Guilt
D. Industry vs. Inferiority
Correct Answer: B
Explanation: Trust is established when an infant’s basic needs such as feeding and comfort
are met consistently by caregivers. If these needs are not met or are met inconsistently, the
infant develops a sense of mistrust in the world. This stage forms the foundation for all
subsequent psychological development in the child.
2. A nurse is providing discharge teaching for the parents of a 4-year-old child with a newly
diagnosed seizure disorder. Which safety instruction is most important?
A. Ensure the child wears a medical alert bracelet at all times.
B. Supervise the child closely when they are swimming or in the bathtub.
C. Avoid using pillows in the child’s bed to prevent suffocation.
D. Keep a tongue blade nearby to insert during a seizure.
,Correct Answer: B
Explanation: Drowning is a major risk for children with seizure disorders, making
constant supervision during water activities essential. While medical alert bracelets are
helpful for identification, they do not prevent immediate injury during an event. Inserting
objects into the mouth during a seizure is dangerous and contraindicated as it can cause
dental or airway damage.
3. A 3-year-old is admitted with suspected epiglottitis. Which nursing action should be
avoided to prevent sudden airway obstruction?
A. Placing the child in a tripod position.
B. Administering humidified oxygen.
C. Visualizing the throat with a tongue blade.
D. Starting an intravenous line for antibiotics.
Correct Answer: C
Explanation: Attempting to visualize the throat or using a tongue blade in a child with
suspected epiglottitis can trigger a laryngospasm and complete airway obstruction. The
child should be kept as calm as possible to minimize respiratory distress. Examination of
the throat should only be performed in a setting where emergency intubation or
tracheostomy can be performed immediately.
4. Which clinical manifestation is a hallmark sign of a child experiencing Intussusception?
A. Currant jelly-like stools
, B. Projectile vomiting after feedings
C. Ribbon-like, foul-smelling stools
D. Pain in the lower right quadrant
Correct Answer: A
Explanation: Currant jelly stools occur when the intestinal mucosa sloughs and mixes with
blood and mucus due to the telescoping of the bowel. This condition is a pediatric
emergency that requires immediate intervention to prevent bowel necrosis. Diagnostic and
therapeutic management often includes an air or barium enema to reduce the
intussusception.
5. A nurse is caring for an infant with Tetralogy of Fallot who begins to cry and becomes
cyanotic and tachypneic. Which action should the nurse take first?
A. Administer 100% oxygen via face mask.
B. Place the infant in the knee-chest position.
C. Prepare for immediate administration of morphine sulfate.
D. Call the physician for an emergency consult.
Correct Answer: B
Explanation: The knee-chest position increases systemic vascular resistance, which
reduces the right-to-left shunt and improves oxygenation during a ‘tet’ spell. This is the
