Index no: _____________________

DOVECOT COLLEGE OF NURSING

ZAMBIA REGISTERED NURSES

PAEDIATRIC NURSING
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ZRN 28 END OF YEAR EXAMINATIONS
DATE: 6th May, 2024
TIME ALLOWED: 3 HOURS (09:00 – 12:00 HOURS)
INDEX NUMBER_____________________________

INSTRUCTIONS TO CANDIATES:
1. DO NOT open this page until you are told to do so.
2. Write your index numbers on ALL sheets of paper used in the examination.
3. No name of candidates should appear in the examination booklet
4. Answer two essays only, question 1 is compulsory
5. Start each essay on a separate paper.

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SECTION A: MULTIPLE CHOICE QUESTIONS. 50 MARKS

CIRCLE THE MOST APPROPRIATE ANSWER.

1. What is a major cause of Asphyxia Neonatorum?

A. Ineffective communication techniques.
B. Maternal hypoxia.
C. Lack of financial resources in healthcare.
D. Inadequate surgical procedures.

2. What are signs of Asphyxia at birth?

A. High muscle tone and rapid respiration.
B. The baby showing immediate responsiveness.
C. The baby is pale, has reduced muscle tone, and no spontaneous respiration.
D. The baby has a strong and rapid heartbeat.

3. What is the classification of severe Asphyxia based on APGAR scoring?

A. APGAR score of 5-7.
B. APGAR score of 8-10.
C. APGAR score less than 5.
D. APGAR score of 10 only.

4. What is a crucial step in preparing to receive an asphyxiated baby?

A. Ensuring financial support is available.
B. Having resuscitation equipment always available and in working order.
C. Scheduling immediate surgery.
D. Conducting parental interviews.

5. Which drug is used to stimulate breathing in asphyxiated babies?

A. Naloxone Hydrochloride.
B. Aspirin.
C. Paracetamol.
D. Insulin.

6. What is the most commonly fractured bone during labor and delivery?
A. The clavicle.
B. The backbone.
C. The femur.
D. The humerus.

7. Which treatment approach is used for muscle injuries like Torticollis in newborns?
A. Stretching exercises and physiotherapy.
B. Immediate surgical intervention.
C. Financial counselling for parents.
D. Routine administration of vaccinations.

8. What is a key factor in the discharge plan for babies with birth injuries?
A. Assessing economic status.
B. Immediate return to routine.

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C. Fast-tracking vaccination schedules.

D. Providing psychological care to the parents.

9. What is the goal of the Universal Childhood Immunisation (UCI) programme?

A. To increase financial support for healthcare.
B. To provide basic education about immunization.
C. To scale up immunization coverage for children under 12 months.
D. To advance medical technology in vaccine administration.

10. How is a child considered 'fully immunized' under the EPI guidelines?
A. After receiving all financial benefits related to health.
B. Once they complete their basic education.
C. When they have received all vaccinations before their first birthday.
D. After receiving a single dose of each vaccine.

11. What is the DPT-HepB+Hib vaccine also known as?

A. Monovalent vaccine.
B. Dual vaccine.
C. Pentavalent vaccine.
D. Hexavalent vaccine.

12. When should the BCG vaccine be administered?

A. At 6 months of age.
B. Only during measles campaigns.
C. At birth or any time after.
D. Exclusively at 12 months.

13. How is the Inactivated Poliovirus Vaccine (IPV) administered?

A. Orally.
B. Intravenously.
C. Subcutaneously.
D. Intramuscularly.

14. What are the contraindications for the BCG vaccine?

A. History of serious adverse reactions to DPT or pentavalent vaccine.
B. Being a woman of childbearing age.
C. Symptomatic HIV in a baby.
D. Completion of the three DPT vaccinations.

15. Which infants are at higher risk for Neonatal Hypoglycemia?

A. Infants of diabetic mothers.
B. Infants born at full term with no complications.
C. Infants with a history of respiratory issues.
D. Infants born to mothers with no prenatal care.
16. What is a common sign of Hypoglycaemia in neonates?
A. High blood pressure.
B. Cyanosis.
C. Rapid weight gain.
D. Decreased appetite.

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17. What is the primary source of energy for neonates?

A. Protein.
B. Fat.
C. Glucose.
D. Vitamins.

18. What is a key aspect of managing Neonatal Hypoglycaemia?

A. Immediate surgical intervention.
B. Providing psychological care to parents.
C. Administering routine vaccinations.
D. Ensuring adequate nutrition and glucose levels.

19. What is the initial step in the treatment of Neonatal Hypoglycemia?

A. Breastfeeding or providing a formula feed.
B. Immediate psychological assessment.
C. Performing a surgical procedure.
D. Providing assistance to the family.

20. What is the main aim of psychological care for parents of LBW babies?
A. To educate them about financial planning.
B. To reduce parental anxiety and involve them in care.
C. To prepare them for future medical complications.
D. To teach them advanced medical procedures.

21. Why is breastfeeding the first choice of nutrition for LBW babies?
A. To reduce the cost of formula milk.
B. Because it is easier than bottle feeding.
C. It contains maternal antibodies providing immunity.
D. Breastfeeding is more convenient for hospital staff.

22. Which organism is a common causative agent of Neonatal Sepsis?

A. E. coli.
B. Influenza virus.
C. Hepatitis B virus.
D. Rhinovirus.

23. What is a predisposing factor for Neonatal Sepsis?

A. Maternal nutrition.
B. Prolonged rupture of membranes.
C. Advanced medical technology.
D. Financial status of the family.
24. What is a key aim of nursing care in Neonatal Sepsis?
A. Eliminate the infection.
B. Increase the hospital's financial revenue.
C. Reduce the need for parental involvement.
D. Focus on educational outcomes.

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25. What does effective nursing care in Neonatal Sepsis focus on?
A. Reducing hospital stay to lower costs.
B. Avoiding parental involvement in care.
C. Support tissue perfusion or circulatory volume.
D. Limiting the use of antibiotics.

26. What is a predisposing factor for Ophthalmia Neonatorum?

A. Maternal nutrition.
B. Premature rupture of membranes (PROM).
C. Genetic predisposition.
D. Exposure to cold temperatures.

27. How is Ophthalmia Neonatorum managed?

A. Through surgery and laser treatment.
B. Administration of eye drops and systemic antibiotics.
C. Only with warm compresses.
D. Strictly through dietary changes.

28. What is an important prevention strategy for Ophthalmia Neonatorum?

A. Treat all vaginal discharges during pregnancy.
B. Avoiding exposure to sunlight.
C. Using genetic screening techniques.
D. Administering eye drops immediately after birth.

29. What is a key aspect of nursing care for neonates with Ophthalmia Neonatorum?
A. Providing psychological support to the neonate.
B. Performing eye surgeries as a first-line treatment.
C. Laying the baby on the affected eye.
D. Keeping the neonate in a well-lit environment.

30. What is a typical characteristic of asymmetric SGA babies?

A. Disproportionately large head compared to the body.
B. Proportionately small size of all body parts.
C. Above-average length for gestational age.
D. Excessive subcutaneous fat.

31. Which complication is SGA babies at an increased risk for?

A. Polycythaemia.
B. Congenital heart defects.
C. Overheating due to excess subcutaneous fat.
D. Excessive physical activity.
32. What nursing care is essential for an SGA baby?
A. Frequent temperature checks and monitoring of vital signs.
B. Limiting physical contact with parents to reduce infection risk.
C. Keeping the baby in a brightly lit environment.
D. Focusing mainly on increasing the baby’s weight.

33. What is a common characteristic of symmetric SGA babies?

A. Larger head circumference compared to body size.
B. Entire body is proportionately small, including organ size.

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C. Normal length but reduced weight.

D. Increased subcutaneous fat distribution.

34. Which factor significantly influences a child's growth and development?

A. The child's preference for play.
B. Parental occupation.
C. Heredity and environmental factors.
D. The number of siblings.

35. What does 'proximodistal development' refer to?

A. Development from the extremities to the center of the body.
B. Development from the center of the body outward to the extremities.
C. Development starting from the external environment.
D. Development focusing only on cognitive skills.

36. What is a key principle of growth and development in children?

A. Growth and development occur at the same rate for all children.
B. Development is a discontinuous and unpredictable process.
C. Growth and development follow a sequence and individual rates.
D. Growth and development are primarily determined by social factors.

37. What are some important aspects of physical assessment in children?

A. Focusing solely on the child's nutritional intake.
B. Observing the child's general appearance, skin, lymph nodes, and extremities.
C. Limiting the assessment to a child's academic abilities.
D. Concentrating only on the child's height and weight.

38. What is the role of immunizations in child health?

A. To boost intellectual capabilities.
B. Immunizations are not necessary for well children.
C. To protect children from specific infectious diseases.
D. To enhance physical strength and stamina.

39. Why is it important to consider environmental factors in a child's development?

A. They primarily affect the child's financial status.
B. Environmental factors have no significant impact on a child's development.
C. Environmental risks can affect a child's health and development.
D. To ensure the child's adaptation to technological advancements.
40. What is a significant risk factor for delivering a preterm baby?
A. Maternal age over 40 years.
B. Living in a rural area.
C. Multiple pregnancies.
D. High maternal education level.

41. How are nutritional needs of preterm babies typically met?

A. Exclusive breastfeeding from birth.
B. Solid food from the first day.
C. Total parenteral nutrition only.
D. Tube feeding or breastfeeding, as tolerated.

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42. What is a primary management goal for preterm babies?

A. Promoting rapid cognitive development.
B. Ensuring social interaction with other infants.
C. Preventing infections and providing adequate nutrition.
D. Encouraging quick motor skill development.

43. Which complication is a preterm baby at an increased risk for?

A. Hyperglycaemia.
B. Overheating due to excessive brown fat.
C. Excessive physical activity.
D. Hypothermia due to inadequate brown fat.

44. What is essential in the discharge planning for preterm babies?

A. Ensuring that the baby's family has adequate financial resources.
B. The baby demonstrating consistent weight gain.
C. The baby showing advanced developmental milestones.
D. The baby being able to consume solid foods.

45. What challenge do preterm babies often face due to immature liver function?
A. Increased risk of diabetes.
B. High risk of developing hypertension.
C. Prone to developing hyperbilirubinemia.
D. Susceptibility to chronic liver diseases.

46. How is hypothermia managed in preterm infants?

A. Frequent exposure to sunlight.
B. Use of heavy clothing only.
C. Through behavioural therapy techniques.
D. Incubator care or kangaroo care.

47. What is the role of early antenatal care in preventing prematurity?

A. It has no significant impact on the prevention of prematurity.
B. To educate mothers about child psychology.
C. To provide counseling to expecting mothers.
D. Early detection and management of risk factors.

48. What is a significant problem associated with prematurity?

A. Rapid weight gain and obesity.
B. Advanced motor and cognitive skills.
C. Maintaining proper nutrition and preventing hypoglycemia.
D. Overdevelopment of immune responses.

49. Why is infection prevention critical in the care of preterm babies?

A. Their immune systems are usually overactive.
B. To enhance the efficacy of vaccines.
C. Due to their vulnerability to infections from an immature immune system.
D. Infection prevention is not a priority in preterm care.

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50. What is a significant risk factor for delivering a preterm baby?

A. Maternal age over 40 years.
B. Living in a rural area.
C. Multiple pregnancies.
D. High maternal education level.

SECTION B: MATCHING QUESTIONS 20 MARKS

MATCH THE THEORY IN COLUMN I WITH THE APPROPRIATE RESPONSE IN

COLUMN II BY PLACING THE LETTER IN THE SPACES PROVIDED.
A LETTER CAN ONLY BE USED ONCE.

Match the following average age in column I with their motor development in column II
COLUMN I COLUMN II
51. ……0 – 1 month a) child should have a good head control as expected
52. …….3 - 6 months b) Child feeding oneself
53. …….6 – 9 months c) stands unsupported
54. …….9 – 12 months d) child grasps, lift head when in prone position
55. ……..12 – 18 months e) Expected to grasp big things
f) expected to walk and grasps few things with fingers
g) child sits up unsupported
Match the following types of diarrhoea in column a with their description in column II
COLUMN I COLUMN II
56. …..Acute diarrhoea a) an increase in the active secretion, or there is an
inhibition of absorption
57. ….Chronic diarrhoea b) is caused by the rapid movement of food through
the intestines
58. … Secretory diarrhoea c) diarrhoea of sudden onset, often short lived and is
self limiting
59. …..Osmotic diarrhea d) Too much salt is drawn in the gut
60. … Motility related diarrhoea e) diarrhoea lasting more than 2 weeks
f) diarrhoea in which there is blood in stool.
g) occurs when too much water is drawn into the
bowels
Match the following shots for tetanus toxoid in column I with their schedule in column II
COLUMN I COLUMN II
61. …….TT1 a) At least 1 year after TT4 or during subsequent pregnancy
62. ……..TT2 b) At least 10 weeks after TT1
63. ……..TT3 c) At least 1 year after TT3 or during subsequent pregnancy
64. ……..TT4 d) At least 6 months after TT2 or during subsequent
pregnancy
65. ……..TT5 e) At first contact or early during pregnancy during first
trimester
f) At least 6 weeks after TT2

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g) At least 4 weeks after TT1

Match the terminologies in column I with their appropriate responses in column II.
COLUMN I COLUMN II
66. …….Infant a). Is an infant from birth to 28th day of life.
67. …….Neonate b). A baby between 3 – 6 years
68. …….A Child c). A child aged one year to 3 years
69. …….Preschool d). Is child who is 12 months old or less
70. ……Toddler e). An individual between toddling stage
and adolescence.
f). Care of the sick child
g). Is one who grows and develops normally

SECTION C: FILLING IN THE BLANKS QUESTIONS- 20 MARKS

71. _________________________________ is the passing of three or more watery
stools, with or without blood within 24hours.
72. A baby from birth to its 28th day of life is known as an
_________________________________
73. The growth and development in a child that proceeds from the head downwards
through the body and toward the feet is called __________________________.

74. What is the name of the vaccine against pneumococcal infections?

_________________________________
75. The whitish substance present on newborns especially on premature neonates is
known as _________________________________
76. A label containing a heat sensitive material which is placed on the vaccine vial is
called _________________________________
77. The process by which vaccines are managed in terms of transportation, machinery and
personnel from point of manufacture up to point of inoculation is known as
_________________________________.

78. The term used to describe a vaccine containing a weakened live organism is called
_________________________________
79. The vaccine that prevents the child from having severe diarrhoea is
_________________________________
80. The route of administration for measles vaccination is _________________________.

81. The route for administration of vitamin A supplements in children below the age of 5
years is _________________________________.
82. When we suspect freezing of a Pentavalent (DPT Hep B Hib) vaccine had frozen, we
need to perform a _________________________________.
83. A false caput caused by a vacuum cup is known as
_________________________________.
84. A baby born after 42 weeks of gestation calculated from the last menstrual period is
known as _________________________________
85. How many doses of Rota Vaccine should a child receive ………………………….

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86. The target of the Expanded Programme on Immunization is aimed at vaccination of

every child by the age of _________________________________
87. The interval between Td 1 and Td 2 is _________________________________
88. A pathological state resulting from a relative or absolute deficiency or excess of one
or more essential nutrients is called ………………………………………….
89. A child with lungs not fully matured is likely to have RDS because of lack of
………………………………………
90. The reflex elicited by touching the baby’s cheek causing the head to turn to the side
that was touched is called _________________________________.

SECTION D: ESSAY QUESTIONS (100 MARKS)

ANSWER TWO (2) QUESTIONS. QUESTION ONE (1) IS COMPULSORY.
CHOOSE ONE (1) BETWEEN QUESTION TWO (2) AND THREE (3)

QUESTION ONE (1)

Baby Mphatso, a preterm infant, weighing 1.7 kg is delivered from a mother aged 38. At birth
Apgar score was 4/10 and increased to 7/10 after treatment. Within 4 hours, the baby
becomes cyanosed and develops granting respirations. The baby is diagnosed with
Respiratory Distress Syndrome (RDS).

a). Define Respiratory Distress Syndrome (5%)

b). State five (5) signs and symptoms that baby Mphatso will present with (15%)

c). Identify five (5) problems baby Mphatso is likely to have and manage them using a
nursing care plan. (50%).

d). Explain six (6) points you would include in your information, Education and
Communication (IEC) to the mother to baby Mphatso about care of the baby after discharge.
(30%)

QUESTION TWO (2)

Baby Chichi ten (10) days old is admitted to your Neonatal Unit with a diagnosis of neonatal
jaundice.
a). Define the term jaundice. (5%)
b(i). State five (5) causes of neonatal jaundice (10%)
(ii) State five (5) differences between pathological and physiological jaundice
(20%)
c). Describe in detail the management of baby Chichi before, during and after phototherapy.
(50%)

d). State five (5) complications of phototherapy. (15%)

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QUESTION THREE (3)

Baby Kalulu one (1) week old is admitted to your Pediatric Unit with the history of fever,
crying excessively and unable to breast feed. Upon investigations, a diagnosis of neonatal
tetanus is made.

a). Define neonatal tetanus? (5%)

b (i) State five (5) causes of neonatal tetanus. (15%)

(ii) State five (5) characteristic features that baby Kalulu is likely to present with
(15%)

c) Describe in detail the management of baby Kalulu until discharge. (50%)

d) Explain five (5) points you would include in your IEC to the community as
preventive measures of tetanus. (15%)

the end

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