PEDS NURSING EXAM 2025 QUESTIONS
AND ANSWERS
A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a
blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44
bpm. Which of the following actions would the nurse do first?
a) obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
d) place the child in knee-to-chest position - ANS Answer: D.
the child is experiencing a "tet spell" or hypoxic episode. Therefore the nurse should place the
child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower
extremities and reduces the volume of blood being shunted through the interventricular septal
defect and the overriding aorta in the child with tetralogy of fallot. As a result, the blood then
entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing
the legs also increases vascular resistance and pressure in the left ventricle. An infant often
assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child
may need sedative. Once the child is in this position, the nurse may assess for an irregular heart
rate and rhythm. Explaining tho the child that it will only hurt for a short time does nothing to
alleviate hypoxia.
The mother of a child with tetralogy of Fallot asks the nurse why her child has clubbed fingers.
The nurse bases the response on the understanding that clubbing is due to which of the
following?
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,a) Anemia.
b) Peripheral hypoxia.
c) Delayed physical growth.
d) Destruction of bone marrow. - ANS Answer: B
Clubbing of the fingers is one common finding in the child with persistent hypoxia leading to
tissue changes in the body because of the low oxygen content of the blood (hypoxemia). It
apparently results from tissue fibrosis and hypertrophy from the hypoxemia and from an
increase in capillaries in the area, which occur as the body attempts to improve blood supply.
Clubbing of the fingers is associated with polycythemia, not anemia. Polycythemia results from
the body's attempt to increase oxygen levels in the tissues. The child may be small for his or her
chronological age, but clubbing does not result from slow physical growth. Destruction of the
bone marrow is not related to this congenital heart malformation. Instead, bone marrow is
actively producing erythrocytes to compensate for the chronic hypoxia.
A chest x-ray examination is ordered for a child with suspected cardiac problems. The child's
parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should
be based on knowledge that the x-ray film will do which of the following?
a. Show bones of chest but not the heart
b. Evaluate the vascular anatomy outside of the heart
c. Show a graphic measure of electrical activity of the heart
d. Provide information on heart size and pulmonary blood flow patterns - ANS ANS: D
Chest x-ray films provide information on the size of the heart and pulmonary blood flow
patterns. The bones of the chest are visible on the chest x-ray film, but the heart and blood
vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for
evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of
the heart is provided by electrocardiography.
John is a 6-year-old child scheduled for a cardiac catheterization. Preoperative teaching should
be which of the following?
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,a. Directed at his parents because he is too young to understand
b. Adapted to his level of development so that he can understand
c. Done several days before the procedure so he will be prepared
d. Provide details about the actual procedures so he will know what to expect - ANS ANS: B
Preoperative teaching should always be directed to the child's stage of development. The
caregivers also benefit from these explanations. The parents may ask additional questions,
which should be answered, but the child needs to receive the information based on
developmental level. This age-group will not understand in-depth descriptions. School-age
children should be prepared close to the time of the cardiac catheterization.
A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki
disease. On assessment of the child, the nurse expects to note which clinical manifestation of
the acute stage of the disease?
a) cracked lips
b) a normal appearance
c) conjunctival hyperemia
d) desquamation of the skin - ANS Answer: C
In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands,
rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and
fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac
manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal,
but signs of inflammation may be present.
After returning from cardiac catheterization, the nurse determines that the pulse distal to the
catheter insertion site is weaker. The nurse should do which of the following?
a. Elevate affected extremity.
b. Notify practitioner of the observation.
c. Record data on assessment flow record.
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 3
, d. Apply warm compresses to insertion site. - ANS ANS: C
The pulse distal to the catheterization site may be weaker for the first few hours after
catheterization, but should gradually increase in strength. Documentation of the finding
provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected
change. The pulse is monitored. If there are neurovascular changes in the extremity, the
practitioner is notified. The site is kept dry. Warm compresses are not indicated.
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells
the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with
blood. The most appropriate initial nursing action is which of the following?
a. Notify the physician.
b. Place child in Trendelenburg position.
c. Apply a new bandage with more pressure.
d. Apply direct pressure above catheterization site. - ANS ANS: D
When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the
percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified
and a new bandage with more pressure can be applied after pressure is applied. The nurse can
have someone else notify the physician while the pressure is being maintained. Trendelenburg
position would not be a helpful intervention. It would increase the drainage from the lower
extremities.
The nurse should recognize that congestive heart failure (CHF) is which of the following?
a. Disease related to cardiac defects
b. Consequence of an underlying cardiac defect
c. Inherited disorder associated with a variety of defects
d. Result of diminished workload imposed on an abnormal myocardium - ANS ANS: B
CHF is the inability of the heart to pump an adequate amount of blood to the systemic
circulation at normal filling pressures to meet the body's metabolic demands. CHF is not a
disease but rather a result of the inability of the heart to pump efficiently. CHF is not inherited.
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 4
AND ANSWERS
A child diagnosed with tetralogy of fallot becomes upset, crying and thrashing around when a
blood specimen is obtained. The child's color becomes blue and respiratory rate increases to 44
bpm. Which of the following actions would the nurse do first?
a) obtain an order for sedation for the child
b) assess for an irregular heart rate and rhythm
c) explain to the child that it will only hurt for a short time
d) place the child in knee-to-chest position - ANS Answer: D.
the child is experiencing a "tet spell" or hypoxic episode. Therefore the nurse should place the
child in a knee-to-chest position. Flexing the legs reduces venous flow of blood from lower
extremities and reduces the volume of blood being shunted through the interventricular septal
defect and the overriding aorta in the child with tetralogy of fallot. As a result, the blood then
entering the systemic circulation has higher oxygen content, and dyspnea is reduced. Flexing
the legs also increases vascular resistance and pressure in the left ventricle. An infant often
assumes a knee-to-chest position to relieve dyspnea. If this position is ineffective, then the child
may need sedative. Once the child is in this position, the nurse may assess for an irregular heart
rate and rhythm. Explaining tho the child that it will only hurt for a short time does nothing to
alleviate hypoxia.
The mother of a child with tetralogy of Fallot asks the nurse why her child has clubbed fingers.
The nurse bases the response on the understanding that clubbing is due to which of the
following?
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 1
,a) Anemia.
b) Peripheral hypoxia.
c) Delayed physical growth.
d) Destruction of bone marrow. - ANS Answer: B
Clubbing of the fingers is one common finding in the child with persistent hypoxia leading to
tissue changes in the body because of the low oxygen content of the blood (hypoxemia). It
apparently results from tissue fibrosis and hypertrophy from the hypoxemia and from an
increase in capillaries in the area, which occur as the body attempts to improve blood supply.
Clubbing of the fingers is associated with polycythemia, not anemia. Polycythemia results from
the body's attempt to increase oxygen levels in the tissues. The child may be small for his or her
chronological age, but clubbing does not result from slow physical growth. Destruction of the
bone marrow is not related to this congenital heart malformation. Instead, bone marrow is
actively producing erythrocytes to compensate for the chronic hypoxia.
A chest x-ray examination is ordered for a child with suspected cardiac problems. The child's
parent asks the nurse, "What will the x-ray show about the heart?" The nurse's response should
be based on knowledge that the x-ray film will do which of the following?
a. Show bones of chest but not the heart
b. Evaluate the vascular anatomy outside of the heart
c. Show a graphic measure of electrical activity of the heart
d. Provide information on heart size and pulmonary blood flow patterns - ANS ANS: D
Chest x-ray films provide information on the size of the heart and pulmonary blood flow
patterns. The bones of the chest are visible on the chest x-ray film, but the heart and blood
vessels are also seen. Magnetic resonance imaging is a noninvasive technique that allows for
evaluation of vascular anatomy outside of the heart. A graphic measure of electrical activity of
the heart is provided by electrocardiography.
John is a 6-year-old child scheduled for a cardiac catheterization. Preoperative teaching should
be which of the following?
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 2
,a. Directed at his parents because he is too young to understand
b. Adapted to his level of development so that he can understand
c. Done several days before the procedure so he will be prepared
d. Provide details about the actual procedures so he will know what to expect - ANS ANS: B
Preoperative teaching should always be directed to the child's stage of development. The
caregivers also benefit from these explanations. The parents may ask additional questions,
which should be answered, but the child needs to receive the information based on
developmental level. This age-group will not understand in-depth descriptions. School-age
children should be prepared close to the time of the cardiac catheterization.
A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki
disease. On assessment of the child, the nurse expects to note which clinical manifestation of
the acute stage of the disease?
a) cracked lips
b) a normal appearance
c) conjunctival hyperemia
d) desquamation of the skin - ANS Answer: C
In the acute stage, the child has a fever, conjunctival hyperemia, red throat, swollen hands,
rash, and enlargement of the cervical lymph nodes. In the subacute stage, cracking lips and
fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac
manifestations, and thrombocytosis occur. In the convalescent stage, the child appears normal,
but signs of inflammation may be present.
After returning from cardiac catheterization, the nurse determines that the pulse distal to the
catheter insertion site is weaker. The nurse should do which of the following?
a. Elevate affected extremity.
b. Notify practitioner of the observation.
c. Record data on assessment flow record.
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 3
, d. Apply warm compresses to insertion site. - ANS ANS: C
The pulse distal to the catheterization site may be weaker for the first few hours after
catheterization, but should gradually increase in strength. Documentation of the finding
provides a baseline. The extremity is maintained straight for 4 to 6 hours. This is an expected
change. The pulse is monitored. If there are neurovascular changes in the extremity, the
practitioner is notified. The site is kept dry. Warm compresses are not indicated.
The nurse is caring for a school-age girl who has had a cardiac catheterization. The child tells
the nurse that her bandage is "too wet." The nurse finds the bandage and bed soaked with
blood. The most appropriate initial nursing action is which of the following?
a. Notify the physician.
b. Place child in Trendelenburg position.
c. Apply a new bandage with more pressure.
d. Apply direct pressure above catheterization site. - ANS ANS: D
When bleeding occurs, direct continuous pressure is applied 2.5 cm (1 inch) above the
percutaneous skin site to localize pressure on the vessel puncture. The physician can be notified
and a new bandage with more pressure can be applied after pressure is applied. The nurse can
have someone else notify the physician while the pressure is being maintained. Trendelenburg
position would not be a helpful intervention. It would increase the drainage from the lower
extremities.
The nurse should recognize that congestive heart failure (CHF) is which of the following?
a. Disease related to cardiac defects
b. Consequence of an underlying cardiac defect
c. Inherited disorder associated with a variety of defects
d. Result of diminished workload imposed on an abnormal myocardium - ANS ANS: B
CHF is the inability of the heart to pump an adequate amount of blood to the systemic
circulation at normal filling pressures to meet the body's metabolic demands. CHF is not a
disease but rather a result of the inability of the heart to pump efficiently. CHF is not inherited.
Copyright ©2025 BRIGHTSTARS ALL RIGHTS RESERVED 4
