NURS240 Pediatric Nursing Updated 2026 | Comprehensive Study Guide,
Practice Exam Questions and Answers, Exam Prep Test Bank, Growth and
Development Milestones, Pediatric Health Assessment, Childhood
Disorders and Diseases, Family-Centered Nursing Care, Pediatric
Pharmacology, Health Promotion and Safety, and Detailed Rationales for
Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of stridor, barking cough, and hoarseness. The child is afebrile and
has no drooling. What is the most appropriate initial management for this child?
A. Immediate intubation in the operating room
B. Administration of racemic epinephrine via nebulizer
C. A complete blood count and blood cultures
D. Lateral neck radiographs to rule out epiglottitis
CORRECT ANSWER: B. Administration of racemic epinephrine via nebulizer
Rationale: The child's symptoms of stridor, barking cough, and hoarseness without fever
or drooling are classic for croup (laryngotracheobronchitis). The mainstay of treatment
for moderate to severe croup is nebulized racemic epinephrine, which reduces airway
edema through vasoconstriction. Intubation is reserved for impending respiratory
failure; epiglottitis is less likely given the absence of fever and drooling, and radiographs
are not the first step in management.
Question 2: A 6-month-old infant is diagnosed with iron-deficiency anemia. Which
finding would the nurse expect to observe in this infant?
A. Hyperactivity and irritability
B. Pale conjunctiva and lethargy
C. Jaundiced skin and sclera
D. Petechiae and bruising
CORRECT ANSWER: B. Pale conjunctiva and lethargy
Rationale: Iron-deficiency anemia leads to reduced hemoglobin, resulting in pallor,
fatigue, and lethargy. Hyperactivity is not typical; jaundice suggests hemolysis or liver
disease; and petechiae/bruising are more associated with platelet disorders.
Question 3: The nurse is caring for a 10-year-old child with acute
glomerulonephritis. Which assessment finding is most consistent with this
diagnosis?
A. Hypotension and bradycardia
B. Periorbital edema and tea-colored urine
,C. Polyuria and nocturia
D. Clear, amber-colored urine and weight loss
CORRECT ANSWER: B. Periorbital edema and tea-colored urine
Rationale: Acute glomerulonephritis typically presents with periorbital edema,
hypertension, hematuria (tea-colored urine), and oliguria. Hypotension and polyuria are
not characteristic.
Question 4: A newborn is receiving phototherapy for hyperbilirubinemia. Which
intervention is essential for the nurse to perform?
A. Cover the newborn's eyes with opaque patches
B. Position the newborn prone for maximum exposure
C. Administer supplemental iron drops
D. Increase the room temperature to 80°F
CORRECT ANSWER: A. Cover the newborn's eyes with opaque patches
Rationale: Phototherapy emits high-intensity light that can damage the retina; therefore,
the infant's eyes must be covered. Prone positioning is not recommended due to SIDS
risk; iron is not related to bilirubin; and room temperature should be regulated but not
excessively high.
Question 5: The nurse is assessing a 2-year-old child with suspected autism
spectrum disorder. Which behavioral manifestation is a key early indicator?
A. Strong attachment to a single, specific toy
B. Lack of response to their name being called
C. Frequent temper tantrums when transitioning
D. Advanced vocabulary for their age
CORRECT ANSWER: B. Lack of response to their name being called
Rationale: Failure to respond to one's name by 12–18 months is a red flag for autism.
While attachment to toys and tantrums can occur, they are not as specific. Advanced
vocabulary is not typical; language delay is more common.
Question 6: A 14-year-old adolescent is newly diagnosed with type 1 diabetes. The
nurse is teaching the family about insulin administration. Which site has the
fastest absorption rate for subcutaneous insulin?
A. Abdomen
B. Thigh
,C. Buttocks
D. Upper arm
CORRECT ANSWER: A. Abdomen
Rationale: The abdomen has the most consistent and fastest absorption rate due to
increased vascularity. The thigh, buttocks, and upper arm have slower and more
variable absorption.
Question 7: The nurse is preparing a 5-year-old child for a scheduled tonsillectomy.
Which postoperative intervention is most important to prevent hemorrhage?
A. Encouraging the child to cough frequently
B. Offering red-colored liquids to soothe the throat
C. Monitoring for frequent swallowing or clearing of the throat
D. Placing the child in a supine position
CORRECT ANSWER: C. Monitoring for frequent swallowing or clearing of the throat
Rationale: Frequent swallowing or throat clearing after tonsillectomy can indicate
bleeding. Coughing should be avoided; red liquids can mask bleeding; and the supine
position does not prevent hemorrhage.
Question 8: A 3-month-old infant is admitted with bronchiolitis caused by
respiratory syncytial virus (RSV). Which nursing intervention is the priority?
A. Administering broad-spectrum antibiotics
B. Maintaining adequate hydration and oxygenation
C. Placing the infant in an isolation room with negative pressure
D. Providing chest physiotherapy every 4 hours
CORRECT ANSWER: B. Maintaining adequate hydration and oxygenation
Rationale: Bronchiolitis management is supportive, focusing on hydration and
oxygenation. Antibiotics are not effective against RSV; contact precautions (not negative
pressure) are used; and chest physiotherapy is not routinely recommended.
Question 9: A school-age child with nephrotic syndrome has been receiving
corticosteroid therapy. Which finding would indicate a positive response to
treatment?
A. Decreased urinary protein excretion
B. Increased serum creatinine level
C. Weight gain of 2 kg in 24 hours
D. Elevated blood pressure
, CORRECT ANSWER: A. Decreased urinary protein excretion
Rationale: Corticosteroids reduce glomerular protein permeability, leading to
decreased proteinuria. Increased creatinine, weight gain (edema), and hypertension
indicate poor response or complications.
Question 10: The nurse is caring for a child with a ventriculoperitoneal shunt.
Which sign indicates a possible shunt malfunction?
A. Sunken fontanels
B. Irritability and vomiting upon waking
C. Decreased head circumference
D. Increased urine output
CORRECT ANSWER: B. Irritability and vomiting upon waking
Rationale: Irritability and vomiting, especially in the morning, are signs of increased
intracranial pressure due to shunt malfunction. Sunken fontanels and decreased head
circumference are not indicative; increased urine output is unrelated.
Question 11: A 7-year-old child with asthma is prescribed a metered-dose inhaler
with a spacer. What is the primary purpose of the spacer?
A. To increase the force of the medication delivery
B. To allow for deeper inhalation of the medication
C. To reduce the risk of oral fungal infections
D. To increase the deposition of medication in the lungs
CORRECT ANSWER: D. To increase the deposition of medication in the lungs
Rationale: A spacer increases the deposition of medication in the lungs by allowing the
aerosol to disperse and slowing the velocity of particles, reducing oropharyngeal
deposition. It does not increase force, prevent fungal infections directly, or ensure
deeper inhalation without proper technique.
Question 12: The nurse is assessing a 9-month-old infant with developmental
dysplasia of the hip (DDH). Which finding is a classic sign of this condition?
A. Symmetric gluteal folds
B. Positive Ortolani maneuver
C. Full range of motion in both hips
D. Negative Barlow test
CORRECT ANSWER: B. Positive Ortolani maneuver
Practice Exam Questions and Answers, Exam Prep Test Bank, Growth and
Development Milestones, Pediatric Health Assessment, Childhood
Disorders and Diseases, Family-Centered Nursing Care, Pediatric
Pharmacology, Health Promotion and Safety, and Detailed Rationales for
Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of stridor, barking cough, and hoarseness. The child is afebrile and
has no drooling. What is the most appropriate initial management for this child?
A. Immediate intubation in the operating room
B. Administration of racemic epinephrine via nebulizer
C. A complete blood count and blood cultures
D. Lateral neck radiographs to rule out epiglottitis
CORRECT ANSWER: B. Administration of racemic epinephrine via nebulizer
Rationale: The child's symptoms of stridor, barking cough, and hoarseness without fever
or drooling are classic for croup (laryngotracheobronchitis). The mainstay of treatment
for moderate to severe croup is nebulized racemic epinephrine, which reduces airway
edema through vasoconstriction. Intubation is reserved for impending respiratory
failure; epiglottitis is less likely given the absence of fever and drooling, and radiographs
are not the first step in management.
Question 2: A 6-month-old infant is diagnosed with iron-deficiency anemia. Which
finding would the nurse expect to observe in this infant?
A. Hyperactivity and irritability
B. Pale conjunctiva and lethargy
C. Jaundiced skin and sclera
D. Petechiae and bruising
CORRECT ANSWER: B. Pale conjunctiva and lethargy
Rationale: Iron-deficiency anemia leads to reduced hemoglobin, resulting in pallor,
fatigue, and lethargy. Hyperactivity is not typical; jaundice suggests hemolysis or liver
disease; and petechiae/bruising are more associated with platelet disorders.
Question 3: The nurse is caring for a 10-year-old child with acute
glomerulonephritis. Which assessment finding is most consistent with this
diagnosis?
A. Hypotension and bradycardia
B. Periorbital edema and tea-colored urine
,C. Polyuria and nocturia
D. Clear, amber-colored urine and weight loss
CORRECT ANSWER: B. Periorbital edema and tea-colored urine
Rationale: Acute glomerulonephritis typically presents with periorbital edema,
hypertension, hematuria (tea-colored urine), and oliguria. Hypotension and polyuria are
not characteristic.
Question 4: A newborn is receiving phototherapy for hyperbilirubinemia. Which
intervention is essential for the nurse to perform?
A. Cover the newborn's eyes with opaque patches
B. Position the newborn prone for maximum exposure
C. Administer supplemental iron drops
D. Increase the room temperature to 80°F
CORRECT ANSWER: A. Cover the newborn's eyes with opaque patches
Rationale: Phototherapy emits high-intensity light that can damage the retina; therefore,
the infant's eyes must be covered. Prone positioning is not recommended due to SIDS
risk; iron is not related to bilirubin; and room temperature should be regulated but not
excessively high.
Question 5: The nurse is assessing a 2-year-old child with suspected autism
spectrum disorder. Which behavioral manifestation is a key early indicator?
A. Strong attachment to a single, specific toy
B. Lack of response to their name being called
C. Frequent temper tantrums when transitioning
D. Advanced vocabulary for their age
CORRECT ANSWER: B. Lack of response to their name being called
Rationale: Failure to respond to one's name by 12–18 months is a red flag for autism.
While attachment to toys and tantrums can occur, they are not as specific. Advanced
vocabulary is not typical; language delay is more common.
Question 6: A 14-year-old adolescent is newly diagnosed with type 1 diabetes. The
nurse is teaching the family about insulin administration. Which site has the
fastest absorption rate for subcutaneous insulin?
A. Abdomen
B. Thigh
,C. Buttocks
D. Upper arm
CORRECT ANSWER: A. Abdomen
Rationale: The abdomen has the most consistent and fastest absorption rate due to
increased vascularity. The thigh, buttocks, and upper arm have slower and more
variable absorption.
Question 7: The nurse is preparing a 5-year-old child for a scheduled tonsillectomy.
Which postoperative intervention is most important to prevent hemorrhage?
A. Encouraging the child to cough frequently
B. Offering red-colored liquids to soothe the throat
C. Monitoring for frequent swallowing or clearing of the throat
D. Placing the child in a supine position
CORRECT ANSWER: C. Monitoring for frequent swallowing or clearing of the throat
Rationale: Frequent swallowing or throat clearing after tonsillectomy can indicate
bleeding. Coughing should be avoided; red liquids can mask bleeding; and the supine
position does not prevent hemorrhage.
Question 8: A 3-month-old infant is admitted with bronchiolitis caused by
respiratory syncytial virus (RSV). Which nursing intervention is the priority?
A. Administering broad-spectrum antibiotics
B. Maintaining adequate hydration and oxygenation
C. Placing the infant in an isolation room with negative pressure
D. Providing chest physiotherapy every 4 hours
CORRECT ANSWER: B. Maintaining adequate hydration and oxygenation
Rationale: Bronchiolitis management is supportive, focusing on hydration and
oxygenation. Antibiotics are not effective against RSV; contact precautions (not negative
pressure) are used; and chest physiotherapy is not routinely recommended.
Question 9: A school-age child with nephrotic syndrome has been receiving
corticosteroid therapy. Which finding would indicate a positive response to
treatment?
A. Decreased urinary protein excretion
B. Increased serum creatinine level
C. Weight gain of 2 kg in 24 hours
D. Elevated blood pressure
, CORRECT ANSWER: A. Decreased urinary protein excretion
Rationale: Corticosteroids reduce glomerular protein permeability, leading to
decreased proteinuria. Increased creatinine, weight gain (edema), and hypertension
indicate poor response or complications.
Question 10: The nurse is caring for a child with a ventriculoperitoneal shunt.
Which sign indicates a possible shunt malfunction?
A. Sunken fontanels
B. Irritability and vomiting upon waking
C. Decreased head circumference
D. Increased urine output
CORRECT ANSWER: B. Irritability and vomiting upon waking
Rationale: Irritability and vomiting, especially in the morning, are signs of increased
intracranial pressure due to shunt malfunction. Sunken fontanels and decreased head
circumference are not indicative; increased urine output is unrelated.
Question 11: A 7-year-old child with asthma is prescribed a metered-dose inhaler
with a spacer. What is the primary purpose of the spacer?
A. To increase the force of the medication delivery
B. To allow for deeper inhalation of the medication
C. To reduce the risk of oral fungal infections
D. To increase the deposition of medication in the lungs
CORRECT ANSWER: D. To increase the deposition of medication in the lungs
Rationale: A spacer increases the deposition of medication in the lungs by allowing the
aerosol to disperse and slowing the velocity of particles, reducing oropharyngeal
deposition. It does not increase force, prevent fungal infections directly, or ensure
deeper inhalation without proper technique.
Question 12: The nurse is assessing a 9-month-old infant with developmental
dysplasia of the hip (DDH). Which finding is a classic sign of this condition?
A. Symmetric gluteal folds
B. Positive Ortolani maneuver
C. Full range of motion in both hips
D. Negative Barlow test
CORRECT ANSWER: B. Positive Ortolani maneuver
