PEDIATRICS NURSING FINAL EXAM QUESTIONS AND
ANSWERS WITH RATIONALE GRADED A+
The nurse is planning postoperative care for an infant after a cleft-lip repair. Which nursing intervention
is most appropriate for this infant?
1. Prone positioning
2. Suctioning with a Yankauer device
3. Supine or side-lying positioning
4. Avoidance of soft elbow restraints
Answer: 3
Rationale : Integrity of the suture line is essential for postoperative care of cleft-lip repair. The infant
should be placed in a supine or side-lying position to avoid rubbing the suture line on the bedding. The
prone position should be avoided. A Yankauer suction device is made of hard plastic and, if used, could
cause trauma to the suture line. Suctioning should be done with a small, soft suction catheter. Soft
elbow restraints may be used to prevent the infant from touching the incisional area.
An infant is born with an esophageal atresia and tracheoesophageal fistula. Which preoperative nursing
diagnosis is the priority for this infant?
1. Risk for Aspiration Related to Regurgitation
2. Acute Pain Related to Esophageal Defect
3. Ineffective Infant Feeding Pattern Related to Uncoordinated Suck and Swallow
4. Ineffective Tissue Perfusion: Gastrointestinal, Related to Decreased Circulation
Answer: 1
,Rationale : With the most common type of esophageal atresia and tracheoesophageal fistula, the upper
segment of the esophagus ends in a blind pouch and a fistula connects the lower segment to the
trachea. Preoperatively, there is a risk of aspiration of gastric secretions from the stomach into the
trachea because of the fistula that connects the lower segment of the esophagus to the trachea. Pain is
not usually experienced preoperatively with this condition. The infant is always kept NPO (nothing by
mouth) preoperatively, so ineffective feeding pattern would not apply. Tissue perfusion is not a problem
with this condition.
The nurse is evaluating an infant's tolerance of feedings after a pyloromyotomy. Which finding indicates
that the infant is not tolerating the feeding?
1. Need for frequent burping
2. Irritability during feeding
3. The passing of gas
4. Emesis after two feedings
Answer: 4
Rationale : An infant is not tolerating feedings after a pyloromyotomy if emesis is present. Frequent
burping, irritability, and the passing of gas would be expected findings following a pyloromyotomy and
would indicate tolerance of the feeding.
An infant born with an omphalocele defect is admitted to the intensive-care nursery. Which instruction
from the nurse manager to the unlicensed assistive personnel is most appropriate?
1. Prepare a warmer.
2. Prepare a crib.
3. Prepare a feeding of formula.
4. Prepare the bilirubin light.
,Answer: 1
Rationale : Omphalocele is a congenital malformation in which intra-abdominal contents herniate
through the umbilical cord. The infant many lose heat through the viscera; a warmer is indicated to
prevent hypothermia. The crib would not provide adequate maintenance of temperature control. The
infant is NPO (nothing by mouth) preoperatively and may or may not need a bilirubin light before
surgery.
The nurse is providing instruction to the parents of an infant with a colostomy. Which statement by the
parents indicates appropriate understanding of the teaching session?
1. "We will change the colostomy bag with each wet diaper."
2. "We will use adhesive enhancers when we change the bag."
3. "We will watch for skin irritation around the stoma."
4. "We will expect a moderate amount of bleeding after cleansing the area around the stoma."
Answer: 3
Rationale : Skin irritation around the stoma should be assessed; it may indicate leakage. Physical or
chemical skin irritation may occur if the appliance is changed too frequently or with each wet diaper.
Adhesive enhancers should be avoided on the skin of newborns. Their skin layers are thin, and removal
of the appliance can strip off the skin. Also, adhesive contains latex, and its constant use is not advised
due to risk of latex allergy development. Bleeding is usually attributable to excessive cleaning.
A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which
equipment does the nurse ensure is prepared at the bedside?
1. Intubation setup
2. Appropriate bag and mask
3. Sterile gauze and saline
, 4. Soft arm restraints
Answer: 1
Rationale : A diaphragmatic hernia (protrusion of abdominal contents into the chest cavity through a
defect in the diaphragm) is a life-threatening condition. Intubation is required immediately so the
newborn's respiratory status can be stabilized. A bag and mask will not be adequate to ventilate a
newborn with this condition. The defect is not external, so sterile gauze and saline are not needed. Soft
arm restraints are not immediately necessary.
The nurse is administering several medications to an infant with neurologic impairment and delay.
Which medication is a proton pump inhibitor that is administered for gastroesophageal reflux?
1. Omeprazole
2. Ranitidine
3. Phenytoin
4. Glycopyrrolate
Answer: 1
Rationale : Omeprazole is the proton pump inhibitor that blocks the action of acid-producing cells and is
used to treat gastroesophageal reflux. Ranitidine causes the stomach to produce less acid and may be
used to treat gastroesophageal reflux, but it is a histamine-2 receptor blocker. Phenytoin is an
anticonvulsant used to treat seizures, and glycopyrrolate is an anticholinergic agent used to inhibit
excessive salivation.
A newborn is diagnosed with Hirschsprung disease. Which clinical manifestations found on assessment
support this newborn's diagnosis?
1. Acute diarrhea; dehydration
ANSWERS WITH RATIONALE GRADED A+
The nurse is planning postoperative care for an infant after a cleft-lip repair. Which nursing intervention
is most appropriate for this infant?
1. Prone positioning
2. Suctioning with a Yankauer device
3. Supine or side-lying positioning
4. Avoidance of soft elbow restraints
Answer: 3
Rationale : Integrity of the suture line is essential for postoperative care of cleft-lip repair. The infant
should be placed in a supine or side-lying position to avoid rubbing the suture line on the bedding. The
prone position should be avoided. A Yankauer suction device is made of hard plastic and, if used, could
cause trauma to the suture line. Suctioning should be done with a small, soft suction catheter. Soft
elbow restraints may be used to prevent the infant from touching the incisional area.
An infant is born with an esophageal atresia and tracheoesophageal fistula. Which preoperative nursing
diagnosis is the priority for this infant?
1. Risk for Aspiration Related to Regurgitation
2. Acute Pain Related to Esophageal Defect
3. Ineffective Infant Feeding Pattern Related to Uncoordinated Suck and Swallow
4. Ineffective Tissue Perfusion: Gastrointestinal, Related to Decreased Circulation
Answer: 1
,Rationale : With the most common type of esophageal atresia and tracheoesophageal fistula, the upper
segment of the esophagus ends in a blind pouch and a fistula connects the lower segment to the
trachea. Preoperatively, there is a risk of aspiration of gastric secretions from the stomach into the
trachea because of the fistula that connects the lower segment of the esophagus to the trachea. Pain is
not usually experienced preoperatively with this condition. The infant is always kept NPO (nothing by
mouth) preoperatively, so ineffective feeding pattern would not apply. Tissue perfusion is not a problem
with this condition.
The nurse is evaluating an infant's tolerance of feedings after a pyloromyotomy. Which finding indicates
that the infant is not tolerating the feeding?
1. Need for frequent burping
2. Irritability during feeding
3. The passing of gas
4. Emesis after two feedings
Answer: 4
Rationale : An infant is not tolerating feedings after a pyloromyotomy if emesis is present. Frequent
burping, irritability, and the passing of gas would be expected findings following a pyloromyotomy and
would indicate tolerance of the feeding.
An infant born with an omphalocele defect is admitted to the intensive-care nursery. Which instruction
from the nurse manager to the unlicensed assistive personnel is most appropriate?
1. Prepare a warmer.
2. Prepare a crib.
3. Prepare a feeding of formula.
4. Prepare the bilirubin light.
,Answer: 1
Rationale : Omphalocele is a congenital malformation in which intra-abdominal contents herniate
through the umbilical cord. The infant many lose heat through the viscera; a warmer is indicated to
prevent hypothermia. The crib would not provide adequate maintenance of temperature control. The
infant is NPO (nothing by mouth) preoperatively and may or may not need a bilirubin light before
surgery.
The nurse is providing instruction to the parents of an infant with a colostomy. Which statement by the
parents indicates appropriate understanding of the teaching session?
1. "We will change the colostomy bag with each wet diaper."
2. "We will use adhesive enhancers when we change the bag."
3. "We will watch for skin irritation around the stoma."
4. "We will expect a moderate amount of bleeding after cleansing the area around the stoma."
Answer: 3
Rationale : Skin irritation around the stoma should be assessed; it may indicate leakage. Physical or
chemical skin irritation may occur if the appliance is changed too frequently or with each wet diaper.
Adhesive enhancers should be avoided on the skin of newborns. Their skin layers are thin, and removal
of the appliance can strip off the skin. Also, adhesive contains latex, and its constant use is not advised
due to risk of latex allergy development. Bleeding is usually attributable to excessive cleaning.
A nurse is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which
equipment does the nurse ensure is prepared at the bedside?
1. Intubation setup
2. Appropriate bag and mask
3. Sterile gauze and saline
, 4. Soft arm restraints
Answer: 1
Rationale : A diaphragmatic hernia (protrusion of abdominal contents into the chest cavity through a
defect in the diaphragm) is a life-threatening condition. Intubation is required immediately so the
newborn's respiratory status can be stabilized. A bag and mask will not be adequate to ventilate a
newborn with this condition. The defect is not external, so sterile gauze and saline are not needed. Soft
arm restraints are not immediately necessary.
The nurse is administering several medications to an infant with neurologic impairment and delay.
Which medication is a proton pump inhibitor that is administered for gastroesophageal reflux?
1. Omeprazole
2. Ranitidine
3. Phenytoin
4. Glycopyrrolate
Answer: 1
Rationale : Omeprazole is the proton pump inhibitor that blocks the action of acid-producing cells and is
used to treat gastroesophageal reflux. Ranitidine causes the stomach to produce less acid and may be
used to treat gastroesophageal reflux, but it is a histamine-2 receptor blocker. Phenytoin is an
anticonvulsant used to treat seizures, and glycopyrrolate is an anticholinergic agent used to inhibit
excessive salivation.
A newborn is diagnosed with Hirschsprung disease. Which clinical manifestations found on assessment
support this newborn's diagnosis?
1. Acute diarrhea; dehydration
