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WorksheetsPediatric Development and Safety Quiz
Total questions: 74
Worksheet time: 37mins
A nurse observes a 9-month-old sitting unsupported and banging two blocks together. Which milestone is the nurse documenting?
Walks with assistance
Sits without support
Pincer grasp developed
Transfers objects hand to hand
A toddler repeatedly answers “NO” to requests and insists on dressing himself. This behavior most closely reflects which psychosocial task?
Trust vs mistrust
Autonomy vs shame/doubt
Initiative vs guilt
Industry vs inferiority
A preschool child tells the nurse that the toy car is alive because it moved. This demonstrates:
Conservation
Magical thinking
Concrete operational thinking
Hypothetical reasoning
A parent asks when the pincer grasp is expected. The nurse replies:
5 months
7 months
10 months
12 months
Which safety teaching is most important for parents of an infant to prevent aspiration?
Avoid circular foods like grapes and hot dogs
Use baby powder frequently to keep skin dry
Place stuffed animals in crib for comfort
Dress the infant in button-up clothes only
A 3-year-old who used to nap now resists naps and has decreased daytime sleep. This is typical because:
The child is developing a sleep disorder
The child is experiencing normal developmental changes
The child is not getting enough physical activity
The child is showing signs of illness
A parent asks when the baby should be rear-facing in a car seat. The nurse instructs:
Until 12 months
Until 18 months
Until 2 years
Until the child is 3 years old
Which play style would you expect in a 2-year-old?
Cooperative group play with roles
Parallel play — plays alongside another child
Team sports with complex rules
Very abstract creative play
By about what age should a child be able to build a tower of 2 blocks?
6 months
9 months
12 months
18 months
A 6-month-old with a large VSD is admitted. Which sign is most likely?
Cyanosis at rest
Systolic murmur and signs of heart failure
Bounding pulses in lower extremities
Headache and nosebleeds
A 7-year-old has weak femoral pulses and high blood pressure in the arms. Which defect is most likely?
Ventricular septal defect
Coarctation of the aorta
Tetralogy of Fallot
Atrial septal defect
A child with Tetralogy of Fallot has a hypercyanotic (“Tet”) spell. The nurse’s first action is to:
Lay the child flat and elevate feet
Administer oxygen and call the physician
Place the child in a knee-chest position
Start intravenous fluids immediately
Which congenital heart defect causes increased pulmonary blood flow and is acyanotic?
Tetralogy of Fallot
Ventricular septal defect (VSD)
Transposition of the great arteries
Tricuspid atresia
A toddler on furosemide (Lasix) should have which serum monitored regularly?
Calcium
Potassium
Hemoglobin
Glucose
An infant tires while feeding and sweats during feeds. Which intervention is best?
Offer larger, less frequent feeds
Provide small, frequent feedings and allow rest
Withhold feeds until stronger
Feed only with formula concentrated to 36 kcal/oz
Which complication of Kawasaki disease is the most life-threatening and a focus of prevention?
Desquamation of hands and feet
Coronary artery aneurysm
Strawberry tongue
Conjunctivitis without exudate
A toddler’s apical pulse is 70 bpm before a scheduled digoxin dose. The nurse should:
Administer digoxin as ordered
Hold dose and notify the provider (low heart rate for age)
Give half the dose and recheck in 30 minutes
Give a double dose at the next scheduled time
Which parent statement shows correct digoxin teaching?
I’ll give the dose double if I missed one earlier.
I’ll check my child’s pulse before giving the medicine.
If my child vomits after the dose, I’ll give it again.
I can stop digoxin when my child seems better.
After a cardiac catheterization, the nurse notes a cool, pale foot distal to the insertion site and a weak pedal pulse. The nurse should:
Continue to observe; this is expected temporarily
Elevate the affected extremity
Notify the provider immediately
Apply a warm compress to the foot
Which is the most common congenital heart defect?
Atrial septal defect (ASD)
Ventricular septal defect (VSD)
Tetralogy of Fallot
Coarctation of the aorta
A child with an ASD may present with:
Loud harsh murmur and cyanosis at rest
Split second heart sound and systolic murmur
Low blood pressure in the arms only
Progressive hepatomegaly early in life
A child with Tetralogy of Fallot squats during play. This behavior indicates:
A respiratory infection
An attempt to increase systemic vascular resistance to improve pulmonary blood flow
A neurological deficit
An unrelated orthopedic problem
Post–cardiac surgery, a child develops sudden cyanosis and a new cough. This is most concerning for:
Normal post-op pain response
Respiratory infection unrelated to surgery
Decreased oxygenation or complication like pulmonary edema — notify provider
Expected postoperative fatigue
For a child with CHF receiving Lasix, which parent teaching is best?
Avoid potassium-rich foods
Encourage potassium-rich foods like bananas and orange juice
Stop the medicine when edema decreases
Limit protein intake
After IVIG for Kawasaki disease, live vaccines should be postponed for:
1 month
3 months
11 months
24 months
Which diagnostic test gives the best information about valvular regurgitation or structural defects?
Chest x-ray
Electrocardiogram (ECG)
Echocardiogram
Cardiac catheterization
An infant shows poor weight gain, tachypnea, and sweating during feeds. These signs most likely indicate:
Normal newborn adjustment
Heart failure from a congenital defect
Gastrointestinal reflux
Dehydration
Hepatomegaly in a child with congenital heart disease most often reflects:
Left-sided heart failure only
Right-sided heart failure or systemic venous congestion
Improved perfusion
Primary liver disease
Fetal alcohol syndrome increases the risk of which congenital anomaly?
Congenital heart defects
Juvenile diabetes
Neural tube defects only
Cystic fibrosis
The primary purpose of IVIG in Kawasaki disease is to:
Eradicate bacteria causing the illness
Reduce inflammation and prevent coronary aneurysm formation
Increase appetite and weight gain
Cure fever immediately
A parent says, “If my child misses a digoxin dose, I’ll give it twice next time.” The nurse should:
Agree — doubled dose restores level
Explain never to double doses and consult provider for missed doses
Teach to stop medication for a day then resume
Encourage giving the missed dose with meals
Which sign is an early indicator of heart failure in an infant?
Clubbing of fingers
Tachypnea and increased respiratory effort
Hypertension
Cyanosis at rest
A 10-year-old scheduled for cardiac cath has a diaper rash in the groin near the femoral site. The nurse should:
Proceed as scheduled
Notify the provider before the procedure
Apply topical ointment and continue
Cover the rash with a sterile dressing
Which is an early sign of digoxin toxicity in a child?
Weight gain
Nausea and vomiting
High blood pressure
Increased appetite
A toddler with worsening CHF is tachycardic and irritable; the priority nursing intervention is:
Place in semi-Fowler’s position and conserve energy
Offer a new toy to distract the child
Increase oral intake immediately
Encourage active play to strengthen the heart
Which maternal factor is strongly associated with increased risk of congenital heart disease in the infant?
Advanced maternal age only
Fetal alcohol exposure during pregnancy
Low maternal iron stores
Maternal hypothyroidism
A child with a moderate VSD often has which assessment finding?
Cyanosis at rest and clubbing early on
Systolic murmur and signs of heart failure if large
High lower-extremity blood pressure
Crackles in upper lobes only
A child who squats during play is most likely trying to:
Decrease systemic vascular resistance
Increase systemic vascular resistance
Increase venous return to the heart
Reduce intracranial pressure
An infant with CHF should be fed how to reduce oxygen consumption?
Larger volumes less often to minimize handling
Small, frequent feeds with rest periods
Eliminate breast milk and use only formula
Tube feed only and never attempt PO
Which outcome best indicates improvement after CHF treatment?
Increased work of breathing
Decreased heart rate and respiratory rate with improved feeding
New hepatomegaly
Increased peripheral edema
A nurse assesses a small amount of bleeding at the cath site and a weak pedal pulse on the same side. The nurse should:
Apply direct pressure and notify provider immediately
Reassure family this is expected for 24 hours
Remove dressing to inspect more thoroughly and leave site uncovered
Place a splint on the leg and document
During a Tet spell, in addition to knee-chest positioning, which action helps reduce cyanosis?
Give the child a cold drink
Give oxygen and calm the child
Force the child to breathe deeply repeatedly
Encourage the child to stand up
Parents of a child on furosemide should be taught to:
Decrease fruits and vegetables to reduce potassium
Encourage foods high in potassium, monitor for signs of hypokalemia
Avoid all dairy products while on the diuretic
Stop the diuretic when the child feels better
A child with Kawasaki disease has persistent high fever and irritability. The expected treatment includes:
IVIG and high-dose aspirin initially, then low-dose aspirin at discharge
Broad-spectrum IV antibiotics as first line
Immediate packed RBC transfusion
Antiviral therapy
A child has an acquired coarctation repaired surgically. Which finding needs immediate attention?
Warm, well-perfused feet
Sudden onset weak or absent femoral pulses
Mild incision redness without drainage
Age-appropriate activity restrictions
A child with suspected leukemia undergoes bone marrow aspiration. The specimen is usually obtained from the:
Femoral shaft
Posterior iliac crest
Sternum (in small children only)
Tibial plateau
In acute lymphoblastic leukemia (ALL), which laboratory pattern is expected?
Increased RBC, platelets, and neutrophils
Decreased RBC, platelets, and often abnormal WBCs (blasts)
Normal blood counts with increased clotting times only
Increased hemoglobin and hematocrit
A child undergoing chemotherapy develops mucosal ulcerations and refuses to eat. Which nursing action is best?
Offer spicy foods to stimulate appetite
Provide bland, soft, high-calorie foods and pain control measures
Stop all oral intake and place NPO immediately
Encourage hard, crusty breads to increase oral stimulation
The purpose of intrathecal chemotherapy in ALL is to:
Treat or prevent CNS involvement by delivering medication directly to CSF
Reduce systemic side effects of chemotherapy overall
Stimulate bone marrow recovery
Prevent graft-versus-host disease after transplant
Which sign suggests graft-versus-host disease (GVHD) after hematopoietic stem cell transplant?
Dry cough and wheeze only
Maculopapular rash and diarrhea (palms/soles involvement)
Decreased urine output only
Elevated creatinine without skin changes
A child with sickle cell disease presents with sudden severe abdominal pain and marked splenomegaly. The nurse suspects:
Aplastic crisis
Acute splenic sequestration — pooling of blood in spleen
Vaso-occlusive pain crisis only
Hemorrhagic shock unrelated to spleen
To help prevent vaso-occlusive crises in sickle cell disease, the nurse teaches families to:
Encourage dehydration to reduce urine output
Keep the child well hydrated and avoid hypoxia
Limit fluid intake and increase physical activity
Restrict salt and protein in the diet
A child with hemophilia A is bleeding after a tooth extraction. Which treatment is most appropriate?
Apply pressure and ice; administer factor VIII replacement as ordered
Give oral vitamin K only and observe
Start high-dose aspirin for pain control
Apply heat to the area and encourage strenuous activity
Which statement is true about hemophilia inheritance?
It is an autosomal dominant disorder affecting both sexes equally
It is X-linked recessive — mainly males affected, females carriers
It is only passed from fathers to sons
It is acquired from infections
A child with ALL is at greatest immediate risk for which complication due to marrow suppression?
Hypercalcemia
Infection from neutropenia
Excessive clotting
Hyperglycemia
A parent is taught how to give factor VIII at home. Which instruction is most important?
Administer only in clinic settings — never at home
Learn sterile technique, dose calculation, and how to recognize bleeding complications
Store factor VIII at room temperature for months after opening
Delay giving factor until bleeding has significantly worsened
A child with sickle cell disease should receive penicillin prophylaxis as an infant primarily to:
Prevent vaso-occlusive crises
Reduce risk of encapsulated organism sepsis due to functional asplenia
Treat chronic pain long-term
Substitute for routine immunizations
Exchange transfusion (erythrocytapheresis) in sickle cell disease is primarily used to:
Increase iron stores quickly
Replace sickled cells with normal RBCs to reduce viscosity and hypoxia
Treat mild anemia at home
Prevent dehydration only
Which immunization is routinely given at birth?
Hepatitis A
Hepatitis B
Varicella
MMR
For infants, the recommended injection site for most vaccines is:
Deltoid muscle
Vastus lateralis (anterolateral thigh)
Ventrogluteal
Dorsogluteal
Which of the following is a live vaccine?
Hepatitis B
MMR (measles, mumps, rubella)
Tdap (adolescent/adult)
Inactivated influenza injection
After receiving IVIG, a child should avoid live vaccines for approximately how long?
2 weeks
6 weeks
11 months
5 years
A parent asks about normal reactions to vaccines. Which statement indicates correct understanding?
My child may have low-grade fever and soreness for a day or two.
If there is redness after a shot, that means the vaccine is bad.
Muscle aches for several weeks is expected.
Never give fever reducers after vaccinations.
The nurse is preparing to administer the influenza nasal spray vaccine. Which statement is true?
It is a live attenuated vaccine and is given intranasally.
It is an inactivated vaccine given IM.
It is contraindicated in all children under 18.
It is given only to children with severe egg allergy.
Which vaccine can be started as early as age 9 to prevent a common STI?
Rotavirus
HPV (human papillomavirus)
Varicella
MMR
A hospitalized toddler begins to cry inconsolably and clings to a parent after separation. This behavior is characteristic of which stage of separation response?
Protest
Despair
Detachment
Denial
A child in the despair phase of separation may display:
Persistent crying and protest
Cessation of crying, withdrawal, and decreased activity
Increased play and social interaction
Hostile outbursts towards staff only
Which intervention best supports a child's coping during hospitalization?
Avoid parental presence to encourage independence
Use therapeutic play and allow parent involvement when possible
Restrict visiting hours to one short block per day
Withhold toys to prevent injury
Which family reaction is common when a child is hospitalized?
Immediate acceptance and relief
Helplessness and anxiety about the child’s condition
Total denial of the illness with no questions asked
Complete refusal to participate in care
Which measure is recommended to reduce SIDS risk?
Placing infant prone to sleep
Bedsharing with parents at all times
Placing infant supine to sleep
Using soft bedding in the crib
A child life specialist is part of the collaborative team primarily to:
Prescribe medications for anxiety
Provide developmentally appropriate play, preparation, and coping strategies
Perform invasive procedures when parents are absent
Diagnose psychiatric disorders
The case manager’s role in pediatric hospitalization most often includes:
Performing surgery if needed
Coordinating discharge planning, home care referrals, and services
Administering blood products
Prescribing long-term medications
Which intervention is appropriate to help a school-age child cope with chronic illness and maintain industry?
Remove school work until full recovery
Encourage participation in age-appropriate tasks and school reintegration when possible
Prevent peer contact to avoid infection
Avoid discussing illness with the child
When collaborating with parents about a procedure, the nurse should:
Exclude them to minimize stress for the child
Provide age-appropriate explanation and involve them when appropriate
Tell them only after the procedure is completed
Require them to sign a waiver to be present
