1. COMPETENCY APPRAISAL 2
Drill 7
TEST I. MULTIPLE CHOICE: Encircle the letter of the correct answer.
1.A mother who brings her 4rth month old infant to the clinic for a regular check-up is checked concerned
that her infant is not developing appropriately. When the infant, which of the following would the nurse to
expect?
A. ability to seat upon bed with support 6mos
B. fine motor finger to thumb grasp 9mos
C. ability to reach for a toy
D. ability to say mama or dada 9mos
1. A mother of 1 month old infant states that she is curious as to whether the infant is developing
normally. Which of the following developmental milestone would the nurse expect the infant to perform?
A. smiling and laughing 2-3 months
B. rolling from back to side 4months
C. holding a rattle briefly 4mons
D. turning the head from side to side
2. A mother thinks that she thinks her 9month old is developing slowly. When assessing the infant’s
development, the nurse is also concerned because the infant should be demonstrating which of the
following?
A. vocalizing single syllables
B. standing alone
C. building a tower of two cubes
D. drinking from a cup with little spilling
3. When assessing for pain in a toddler, which of the following methods would be the most appropriate?
A. ask the child about the pain
B. observe the child for restlessness
C. use a numeric pain scale
D. assess for changes in vital signs
4. After surgical repair of a myelomeningocele, which of the following would the nurse use to prevent
musculoskeletal deformity in infant?
A. placing the feet in flexion
B. allowing to be abducted
C. maintaining knees in the neutral position
D. placing the legs in adduction
5. Which of the following would alert the nurse initially to suspect hydrocephalus in an infant who has
undergone surgical repair of myelomeningocele?
A. seizures and vomiting
B. frontal bossing and sunset eyes
C. increased head circumference and bulging fontanel
D. irritability and shrill cry
6. The parents of a child with occasional generalized seizures want to send the child to summer camp.
The parents contact the nurse for advice on planning for a camping experience . Which of the following
activities would the nurse and family decide is most important for the child to avoid?
A .rock climbing
B. hiking
C. swimming
D. tennis
7. When interviewing a child, a history of which of the following illness would lead the nurse to suspect
pneumococcal meningitis?
A. Bladder infection
B. Middle ear infection
C. Fractured clavicle
D. Septic arthritis
8. A hospitalized pre- schooler with meningitis with meningitis who is to be discharged becomes angry
when the dischragre is delayed. Which of the following play activities would be most appropriate at this
time?
A. Rendering a child a story
B. Painting with water colors
C. Pounding on a pegboard
D. Stacking a toweroflocks

2. 9. A school aged child is admitted to the hospital with a diagnosis of probable infratentorial brain tumor.
During the child’s admission to the pediatric unit, which of the following would the nurse anticipate doing?
A. eliminating the child’s anxiety
B. implementing seizure precaution
C. introducing the child to other client’s of the same age
D. preparing the parents and child for diagnostic procedure
10. After the child undergoes craniectomy for an infratentorial brain tumor, the nurse position the child in
which of the following positions to prevent strain on the suture?
A. prone
B. semi-fowler’s
C. side-lying
D. trendelenburg
11. Which of the following would the nurse do first when noting clear drainage on the child’s dressing
and bed linen after craniotomy for brain tumor?
A. Changes the dressing
B. Elevate the head of the bed’
C. Test the fluid for glucose
D. Notify the physician
12. When assessing the development of a 15 month old child with cerebral palsy, which of the following
milestones would the nurse expect a toddler of this age to have achieved?
A. walking up steps
B. using spoon
C. copying a circle
D. putting a block in a cup
14. While performing physical assessment of a 12 month-old, the nurse notes that the infant’s anterior
fontanel is still slightly open. Which of the following is the nurse’s most appropriate action?
A. Notify the physician immediately because there is a problem.
B. Perform an intensive neurological examination.
C. Perform an intensive developmental examination.
D. Do nothing because this is a normal finding for the age.
15. When teaching a mother about introducing solid foods to her child, which of the following indicates the
earliest age at which this should be done?
A. 1 month
B. 2 months
C. 3 months
D. 4 months
16.The infant of a substance-abusing mother is at risk for developing a sense of which of the following?
A. Mistrust
B. Shame
C. Guilt
D. Inferiority
17. Which of the following toys should the nurse recommend for a 5-month-old?
A. A big red balloon
B. A teddy bear with button eyes
C. A push-pull wooden truck
D. A colorful busy box
18. The mother of a 2-month-old is concerned that she may be spoiling her baby by picking her up when
she cries. Which of the following would be the nurse’s best response?
A. “ Let her cry for a while before picking her up, so you don’t spoil her”
B. “Babies need to be held and cuddled; you won’t spoil her this way”
C. “Crying at this age means the baby is hungry; give her a bottle”
D. “If you leave her alone she will learn how to cry herself to sleep”
19. When assessing an 18-month-old, the nurse notes a characteristic protruding abdomen. Which of the
following would explain the rationale for this finding?
A. Increased food intake owing to age
B. Underdeveloped abdominal muscles
C. Bowlegged posture
D. Linear growth curve
20. If parents keep a toddler dependent in areas where he is capable of using skills, the toddle will
develop a sense of which of the following?

3. A. Mistrust
B. Shame
C. Guilt
D. Inferiority
21. Which of the following is an appropriate toy for an 18-month-old?
A. Multiple-piece puzzle
B. Miniature cars
C. Finger paints
D. Comic book
22. When teaching parents about the child’s readiness for toilet training, which of the following signs
should the nurse instruct them to watch for in the toddler?
A. Demonstrates dryness for 4 hours
B. Demonstrates ability to sit and walk
C. Has a new sibling for stimulation
D. Verbalizes desire to go to the bathroom
23. When teaching parents about typical toddler eating patterns, which of the following should be
included?
A .Food “jags” when a child will eat one food meal after meal
B. Preference to eat alone
C. Consistent table manners
D. Increase in appetite
24. Which of the following suggestions should the nurse offer the parents of a 4-year-old boy who resists
going to bed at night?
A. “Allow him to fall asleep in your room, then move him to his own bed.”
B. “Tell him that you will lock him in his room if he gets out of bed one more time.”
C. “Encourage active play at bedtime to tire him out so he will fall asleep faster.”
D. “Read him a story and allow him to play quietly in his bed until he falls asleep.”
25. When providing therapeutic play, which of the following toys would best promote imaginative play in a
4-year-old?
A. Large blocks
B. Dress-up clothes
C. Wooden puzzle
D. Big wheels
26. Which of the following activities, when voiced by the parents following a teaching session about the
characteristics of school-age cognitive development would indicate the need for additional teaching?
A. Collecting baseball cards and marbles
B. Ordering dolls according to size
C. Considering simple problem-solving options
D. Developing plans for the future
27. A hospitalized school- ager states: “I’m not afraid of this place, I’m not afraid of anything.” This
statement is most likely an example of which of the following?
A. Regression
B. Repression
C. Reaction formation
D. Rationalization
28. After teaching a group of parents about accident prevention for schoolagers, which of the following
statements by the group would indicate the need for more teaching?
A. “Schoola-gers are more active and adventurous than are younger children.”
B. “School-agers are more susceptible to home hazards than are younger children.”
C. “Schoola-gers are unable to understand potential dangers around them.”
D. “Schoolar-gers are less subject to parental control than are younger children.”
29. Which of the following skills is the most significant one learned during the school-age period?
A. Collecting
B. Ordering
C. Reading
D. Sorting
30. A child age 7 was unable to receive the measles, mumps, and rubella (MMR) vaccine at the
recommended scheduled time. When would the nurse expect to administer MMR vaccine?
A. In a month from now
B. In a year from now
C. At age 10
D. At age 13

4. 31. The adolescent’s inability to develop a sense of who he is and what he can become results in a sense
of which of the following?
A. Shame
B. Guilt
C. Inferiority
D. Role diffusion
32. Which of the following would be most appropriate for a nurse to use when describing menarche to a
13-year-old?
A. A female’s first menstruation or menstrual “periods”
B. The first year of menstruation or “period”
C. The entire menstrual cycle or from one “period” to another
D. The onset of uterine maturation or peak growth
33. A 14-year-old boy has acne and according to his parents, dominates the bathroom by using the mirror
all the time.
Which of the following remarks by the nurse would be least helpful in talking to the boy and his parents?
A. “This is probably the only concern he has about his body. So don’t worry about it or the time he spends
on it.”
B. “Teenagers are anxious about how their peers perceive them. So they spend a lot of time grooming.”
C. “A teen may develop a poor self-image when experiencing acne. Do you feel this way sometimes?”
D. “You appear to be keeping your face well washed. Would you feel comfortable discussing your
cleansing method?”
34. Which of the following should the nurse suspect when noting that a 3-year-old is engaging in explicit
sexual behavior during doll play?
A. The child is exhibiting normal pre-school curiosity
B. The child is acting out personal experiences
C. The child does not know how to play with dolls
D. The child is probably developmentally delayed.
35. Which of the following statements by the parents of a child with school phobia would indicate the need
for further teaching?
A. “We’ll keep him at home until phobia subsides.”
B. “We’ll work with his teachers and counselors at school.”
C. “We’ll try to encourage him to talk about his problem.”
D. “We’ll discuss possible solutions with him and his counselor.”
36. When developing a teaching plan for a group of high school students about teenage pregnancy, the
nurse would keep in mind which of the following?
A. The incidence of teenage pregnancies is increasing.
B. Most teenage pregnancies are planned.
C. Denial of the pregnancy is common early on.
D. The risk for complications during pregnancy is rare.
37. By the end of which of the following would the nurse most commonly expect a child’s birth weight to
triple?
A. 4 months
B. 7 months
C. 9 months
D. 12 months
38. Which of the following best describes parallel play between two toddlers?
A. Sharing crayons to color separate pictures
B. Playing a board game with a nurse
C. Sitting near each other while playing with separate dolls
D. Sharing their dolls with two different nurses
39. Which of the following information, when voiced by the mother, would indicate to the nurse that she
understands home care instructions following the administration of a diphtheria, tetanus, and pertussis
injection?
A. Measures to reduce fever
B. Need for dietary restrictions
C. Reasons for subsequent rash
D. Measures to control subsequent diarrhea
40. Which of the following actions by a community health nurse is most appropriate when noting multiple
bruises and burns on the posterior trunk of an 18-month-old child during a home visit?
A. Report the child’s condition to Protective Services immediately.
B. Schedule a follow-up visit to check for more bruises.

5. C. Notify the child’s physician immediately.
D. Don nothing because this is a normal finding in a toddler.
41. Which of the following is being used when the mother of a hospitalized child calls the student nurse
and states, “You idiot, you have no idea how to care for my sick child”?
A. Displacement
B. Projection
C. Repression
D. Psychosis
42. Which of the following should the nurse expect to note as a frequent complication for a child with
congenital heart disease?
A. Susceptibility to respiratory infection
B. Bleeding tendencies
C. Frequent vomiting and diarrhea
D. Seizure disorder
43. Which of the following would the nurse do first for a 3-year-old boy who arrives in the emergency
room with a temperature of 105 degrees, inspiratory stridor, and restlessness, who is learning forward
and drooling?
A. Auscultate his lungs and place him in a mist tent.
B. Have him lie down and rest after encouraging fluids.
C. Examine his throat and perform a throat culture
D. Notify the physician immediately and prepare for intubation.
44. When discussing normal infant growth and development with parents, which of the following toys
would the nurse suggest as most appropriate for an 8-month-old?
A. Push-pull toys
B. Rattle
C. Large blocks
D. Mobile
45. Which of the following aspects of psychosocial development is necessary for the nurse to keep in
mind when providing care for the preschool child?
A. The child can use complex reasoning to think out situations.
B. Fear of body mutilation is a common preschool fear
C. The child engages in competitive types of play
D. Immediate gratification is necessary to develop initiative.
46. Which of the following is characteristic of a preschooler with mid mental retardation?
A. Slow to feed self
B. Lack of speech
C. Marked motor delays
D. Gait disability
47. Which of the following assessment findings would lead the nurse to suspect Down syndrome in an
infant?
A. Small tongue
B. Transverse palmar crease
C. Large nose
D. Restricted joint movement
48. An infant, 6 weeks old, is brought to the clinic for a well-baby visit. To assess the fontanels, how
should nurse Oliver position the infant?
a. Supine
b. Prone
c. In the left lateral position
d. Seated upright
49. An infant, age 8 months, has a tentative diagnosis of congenital heart disease. During physical
assessment, nurse Jasmine measures a heart rate of 170 beats/minute and a respiratory rate of 70
breaths/minute. How should the nurse position the infant?
a. Lying on the back
b. Lying on the abdomen
c. Sitting in an infant seat
d. Sitting in high Fowler’s position
50. How should nurse Amy position an infant when administering an oral medication?
a. Seated in a high chair
b. Restrained flat in the crib
c. Held on the nurse’s lap

6. d. Held in the bottle-feeding position
51. An infant undergoes surgery to remove a myelomeningocele. To detect increased intracranial
pressure (ICP) as early as possible, nurse Amanda should stay alert for which postoperative finding?
a. Decreased urine output
b. Increased heart rate
c. Bulging fontanels
d. Sunken eyeballs
7. Answer: C. Because an infant’s fontanels remain open, the skull may expand in response to
increased ICP. Therefore, bulging fontanels are a cardinal sign of increased ICP in an infant.
Decreased urine output and sunken eyeballs indicate dehydration, not increased ICP. With
increased ICP, the heart rate decreases.
52. When performing cardiopulmonary resuscitation on a 7-month-old, which location would nurse Sally
use to evaluate the presence of a pulse?
a. Carotid artery
b. Femoral artery
c. Brachial artery
d. Radial artery
8. Answer: C. The brachial artery is the best location for evaluating the pulse of an infant
younger than age 1. A child of this age has a very short and often fat neck, so the carotid artery is
inaccessible. The femoral artery is usually inaccessible because of clothing and diapers. The
radial artery may not be palpable if cardiac output is low, even if there is a heart beat.
53. Nurse Ted is administering I.V. fluids to an infant. Infants receiving I.V. therapy are particularly
vulnerable to:
a. Hypotension
b. fluid overload
c. cardiac arrhythmias
d. pulmonary emboli
9. Answer: B. Infants, small children, and children with compromised cardiopulmonary status
receiving I.V. therapy are particularly vulnerable to fluid overload. To prevent fluid overload, the
nurse should use a volume-control set and an infusion pump or syringe and place no more than 2
hours’ worth of I.V. fluid in the volume-control set at a time. Hypotension, cardiac arrhythmias,
and pulmonary emboli aren’t problems associated with I.V. therapy in infants.
54. Nurse Lei is aware that one of the following is an early sign of heart failure in an infant with a
congenital heart defect?
a. Tachypnea
b. Tachycardia
c. Poor weight gain
d. Pulmonary edema
24.Answer: B. The earliest sign of heart failure in infants is tachycardia (sleeping heart rate
greater than 160 beats/minute) as a direct result of sympathetic stimulation. Tachypnea
(respiratory rate greater than 60 breaths/minute in infants) occurs in response to decreased lung
compliance. Poor weight gain is a result of the increased energy demands to the heart and
breathing efforts. Pulmonary edema occurs as the left ventricle fails and blood volume and
pressure increase in the left atrium, pulmonary veins, and lungs.
55. An 8-month-old is admitted to the pediatric unit following a fall from his high chair. The child is
awake, alert, and crying. Nurse Fatima should know that a brain injury is more severe in children because
of:
a. increased myelination
b. intracranial hypotension
c. cerebral hyperemia
d. a slightly thicker cranium
25.Answer: C. Cerebral hyperemia (excess blood in the brain) causes an initial increase in
intracranial pressure in the head of an injured child. The brain is less myelinated in a child and
more easily injured than an adult brain. Intracranial hypertension — not hypotension — places
the child at greater risk for secondary brain injury. A child’s cranium is thinner and more pliable,
causing the child to receive a more severe injury.

7. 56. A parent brings a toddler, age 19 months, to the clinic for a regular check-up. When palpating the
toddler’s fontanels, what should the nurse expects to find?
a. Closed anterior fontanel and open posterior fontanel
b. Open anterior and fontanel and closed posterior fontanel
c. Closed anterior and posterior fontanels
d. Open anterior and posterior fontanels
57. Patrick, a healthy adolescent has meningitis and is receiving I.V. and oral fluids. The nurse should
monitor this client’s fluid intake because fluid overload may cause:
a. Cerebral edema
b. Dehydration
c. Heart failure
d. Hypovolemic shock
58. A 4-month-old with meningococcal meningitis has just been admitted to the pediatric unit. Which
nursing intervention has the highest priority?
a. Instituting droplet precautions
b. Administering acetaminophen (Tylenol)
c. Obtaining history information from the parents
d. Orienting the parents to the pediatric unit
59. Sheena, tells the nurse that she wants to begin toilet training her 22-month-old child. The most
important factor for the nurse to stress to the mother is:
a. Developmental readiness of the child
b. Consistency in approach
c. The mother’s positive attitude
d. Developmental level of the child’s peers
60. Play during infancy is:
a. initiated by the child
b. a way of teaching hoe to share
c. more important than in later years
d. mostly used for physical development
61. When performing a physical exam of a newborn with down syndrome the nurse should carefully
evaluate the infants:
A. hearthsounds
b. anterior fonatanel
c. papillary reaction
d. lower extremities
62.When planning a long term care for a child with cerebral palsy it is important to recognize that:
a. illness is not progressively degenerative
b. child has some degree of mental retardation
c. effects of cerebral palsy are unstable and un predictable
d. child should have a genetic counseling before planning a family
63. Baby girl Aiza has myelomeningocele. The best position the delivery room nurse should place her in?
a. prone
b. supine
c. side lying
d. trendelenburg
64. The nurse in the nursery should plan any intervention with baby Aiza based on the knowledge that the
major short term complication she is most likely to suffer?
a. hydrocephalus
b. meningitis
c. side lying
d. paraplegia
65. the doctor attempts to shine light through baby Aiza’s sac and notes no transllumination. The nurse
should interpret the finding that the sac:
a. can be easily repaired
b. cannot be evaluated via this technique
c. contains meninges and cerebrospinalfluid
d. contains meninges, CSF, and spinal cord