Essentials of Pediatric Nursing Advanced Prep:
Master Pediatric Health Assessment & Nursing
Care Practice Questions
Subject: Essentials of Pediatric Nursing (Kyle & Carman, Chapters 1-29)
Question 1: A 4-year-old child is brought to the clinic for a well-child visit. When assessing the
child’s developmental milestones, which finding would the nurse identify as a potential concern
requiring further evaluation?
A) The child is unable to skip on one foot.
B) The child is unable to copy a square.
C) The child is unable to use a fork consistently.
D) The child is unable to tell a story or remember parts of a story.
Correct Answer: D) The child is unable to tell a story or remember parts of a story.
Explanation: By age 4, children should be able to tell a story and recall parts of a narrative,
reflecting advanced linguistic and cognitive development. Inability to do so may suggest a
developmental delay. Skipping (A) is typically mastered around age 5. Copying a square (B) is a
4-year-old skill, but if the child is exactly 4, this is the limit of their capability, whereas
storytelling is an expected achievement. Fork use (C) can vary based on exposure and fine motor
refinement.
Question 2: Which physiological change should the nurse expect when assessing a 6-month-old
infant born prematurely at 30 weeks gestation, currently being evaluated using "corrected age"?
A) The infant should demonstrate head control similar to a full-term 6-month-old.
B) The infant should demonstrate head control similar to a full-term 3-month-old.
C) The infant's developmental milestones should be assessed based on chronological age.
D) The infant should be expected to sit unsupported.
Correct Answer: B) The infant should demonstrate head control similar to a full-term 3-
month-old.
Explanation: Corrected age (or adjusted age) is calculated by subtracting the number of weeks
born prematurely from the chronological age. This infant is 3 months premature (6 months - 3
,months = 3 months). Expectations for developmental progress should align with the corrected
age of 3 months.
Question 3: A nurse is caring for a 2-year-old child hospitalized for pneumonia. Which behavior
is most characteristic of this developmental stage in the context of hospitalization?
A) Increased cooperation with staff during painful procedures.
B) Showing concern for peer relationships.
C) Manifesting "negativism" and regression in toilet training.
D) Understanding the cause-and-effect relationship of the illness.
Correct Answer: C) Manifesting "negativism" and regression in toilet training.
Explanation: Toddlers (ages 1-3) struggle with autonomy and control. Hospitalization, which
strips them of these, often leads to regressive behaviors like bedwetting or increased defiance
(negativism). They lack the cognitive maturity to understand the pathophysiology of illness.
Question 4: Which assessment finding in an infant with severe dehydration is the most sensitive
indicator of deteriorating cardiovascular status?
A) Capillary refill time of 4 seconds.
B) Sunken fontanel.
C) Decreased tear production.
D) Tachycardia.
Correct Answer: D) Tachycardia.
Explanation: Tachycardia is an early and sensitive compensatory mechanism in pediatric
patients to maintain cardiac output in the face of hypovolemia. While capillary refill (A) is
important, tachycardia often precedes overt changes in perfusion visible via peripheral capillary
refill.
Question 5: A nurse is providing discharge instructions to parents of an infant with a new
diagnosis of Gastroesophageal Reflux (GER). Which instruction is most critical to reducing
aspiration risk?
A) Place the infant in a prone position for all naps.
B) Ensure the infant is fed in a semi-upright position and kept upright for 30 minutes post-
feeding.
,C) Add rice cereal to all bottles to thicken the formula to a heavy consistency.
D) Dilute the formula to decrease the acidity of the stomach contents.
Correct Answer: B) Ensure the infant is fed in a semi-upright position and kept upright for
30 minutes post-feeding.
Explanation: Maintaining an upright position uses gravity to keep stomach contents from
refluxing into the esophagus. Prone positioning (A) is contraindicated due to SIDS risk.
Thickening (C) is a strategy, but must be managed by the provider to avoid airway obstruction,
and dilution (D) is inappropriate as it decreases caloric intake.
Question 6: An adolescent is diagnosed with Idiopathic Scoliosis. The nurse is discussing the
treatment plan, which involves a Boston brace. What is the most crucial aspect of nursing
education regarding this brace?
A) The brace must be worn 23 hours a day to be effective.
B) The brace should be worn only at night while sleeping.
C) The brace is used to cure the spinal curvature.
D) The brace is a temporary measure until surgery is scheduled.
Correct Answer: A) The brace must be worn 23 hours a day to be effective.
Explanation: Bracing is designed to slow the progression of the curve, not cure it (C). To be
effective, high compliance is required, typically 23 hours a day. It is not exclusively for night use
(B), and surgery is usually a last resort if bracing fails (D).
Question 7: A school-age child presents with suspected Nephrotic Syndrome. Which clinical
finding should the nurse prioritize during the assessment?
A) Periorbital edema and proteinuria.
B) Hypertension and hematuria.
C) High fever and flank pain.
D) Decreased urine output and extreme irritability.
Correct Answer: A) Periorbital edema and proteinuria.
Explanation: The hallmark signs of Nephrotic Syndrome are massive proteinuria,
hypoalbuminemia, and resulting edema (often periorbital upon waking). Hypertension and
hematuria (B) are more characteristic of Acute Glomerulonephritis.
, Question 8: A nurse is caring for an infant following a pyloromyotomy for pyloric stenosis. The
infant begins vomiting 4 hours post-operatively. What is the most appropriate action?
A) Call the surgeon immediately, as this indicates a complication.
B) Document the emesis as expected post-operative "spit-up" and continue feeds.
C) Suspend oral feedings and notify the surgical team for assessment of potential obstruction.
D) Change the formula to a hypoallergenic variety.
Correct Answer: C) Suspend oral feedings and notify the surgical team for assessment of
potential obstruction.
Explanation: While some vomiting can occur post-operatively, significant vomiting indicates a
potential complication such as mucosal edema at the surgical site. Suspending feeds is the
priority nursing intervention to prevent aspiration and allow the surgical team to evaluate the
infant.
Question 9: Which developmental milestone is typically achieved by the age of 12 months?
A) Walking without support.
B) Building a tower of 6 blocks.
C) Saying 3 to 5 words with meaning.
D) Drinking from a cup with a lid.
Correct Answer: C) Saying 3 to 5 words with meaning.
Explanation: By 12 months, the average infant says "mama," "dada," and a few other meaningful
words. Walking without support (A) is usually achieved between 12-15 months. Building a tower
of 6 blocks (B) is a toddler skill, and cup drinking with a lid (D) is typically mastered in the
toddler years.
Question 10: The nurse is preparing to administer an intramuscular injection to a 9-month-old
infant. Which site is the safest and most appropriate?
A) Dorsogluteal muscle.
B) Ventrogluteal muscle.
C) Vastus lateralis muscle.
D) Deltoid muscle.
Master Pediatric Health Assessment & Nursing
Care Practice Questions
Subject: Essentials of Pediatric Nursing (Kyle & Carman, Chapters 1-29)
Question 1: A 4-year-old child is brought to the clinic for a well-child visit. When assessing the
child’s developmental milestones, which finding would the nurse identify as a potential concern
requiring further evaluation?
A) The child is unable to skip on one foot.
B) The child is unable to copy a square.
C) The child is unable to use a fork consistently.
D) The child is unable to tell a story or remember parts of a story.
Correct Answer: D) The child is unable to tell a story or remember parts of a story.
Explanation: By age 4, children should be able to tell a story and recall parts of a narrative,
reflecting advanced linguistic and cognitive development. Inability to do so may suggest a
developmental delay. Skipping (A) is typically mastered around age 5. Copying a square (B) is a
4-year-old skill, but if the child is exactly 4, this is the limit of their capability, whereas
storytelling is an expected achievement. Fork use (C) can vary based on exposure and fine motor
refinement.
Question 2: Which physiological change should the nurse expect when assessing a 6-month-old
infant born prematurely at 30 weeks gestation, currently being evaluated using "corrected age"?
A) The infant should demonstrate head control similar to a full-term 6-month-old.
B) The infant should demonstrate head control similar to a full-term 3-month-old.
C) The infant's developmental milestones should be assessed based on chronological age.
D) The infant should be expected to sit unsupported.
Correct Answer: B) The infant should demonstrate head control similar to a full-term 3-
month-old.
Explanation: Corrected age (or adjusted age) is calculated by subtracting the number of weeks
born prematurely from the chronological age. This infant is 3 months premature (6 months - 3
,months = 3 months). Expectations for developmental progress should align with the corrected
age of 3 months.
Question 3: A nurse is caring for a 2-year-old child hospitalized for pneumonia. Which behavior
is most characteristic of this developmental stage in the context of hospitalization?
A) Increased cooperation with staff during painful procedures.
B) Showing concern for peer relationships.
C) Manifesting "negativism" and regression in toilet training.
D) Understanding the cause-and-effect relationship of the illness.
Correct Answer: C) Manifesting "negativism" and regression in toilet training.
Explanation: Toddlers (ages 1-3) struggle with autonomy and control. Hospitalization, which
strips them of these, often leads to regressive behaviors like bedwetting or increased defiance
(negativism). They lack the cognitive maturity to understand the pathophysiology of illness.
Question 4: Which assessment finding in an infant with severe dehydration is the most sensitive
indicator of deteriorating cardiovascular status?
A) Capillary refill time of 4 seconds.
B) Sunken fontanel.
C) Decreased tear production.
D) Tachycardia.
Correct Answer: D) Tachycardia.
Explanation: Tachycardia is an early and sensitive compensatory mechanism in pediatric
patients to maintain cardiac output in the face of hypovolemia. While capillary refill (A) is
important, tachycardia often precedes overt changes in perfusion visible via peripheral capillary
refill.
Question 5: A nurse is providing discharge instructions to parents of an infant with a new
diagnosis of Gastroesophageal Reflux (GER). Which instruction is most critical to reducing
aspiration risk?
A) Place the infant in a prone position for all naps.
B) Ensure the infant is fed in a semi-upright position and kept upright for 30 minutes post-
feeding.
,C) Add rice cereal to all bottles to thicken the formula to a heavy consistency.
D) Dilute the formula to decrease the acidity of the stomach contents.
Correct Answer: B) Ensure the infant is fed in a semi-upright position and kept upright for
30 minutes post-feeding.
Explanation: Maintaining an upright position uses gravity to keep stomach contents from
refluxing into the esophagus. Prone positioning (A) is contraindicated due to SIDS risk.
Thickening (C) is a strategy, but must be managed by the provider to avoid airway obstruction,
and dilution (D) is inappropriate as it decreases caloric intake.
Question 6: An adolescent is diagnosed with Idiopathic Scoliosis. The nurse is discussing the
treatment plan, which involves a Boston brace. What is the most crucial aspect of nursing
education regarding this brace?
A) The brace must be worn 23 hours a day to be effective.
B) The brace should be worn only at night while sleeping.
C) The brace is used to cure the spinal curvature.
D) The brace is a temporary measure until surgery is scheduled.
Correct Answer: A) The brace must be worn 23 hours a day to be effective.
Explanation: Bracing is designed to slow the progression of the curve, not cure it (C). To be
effective, high compliance is required, typically 23 hours a day. It is not exclusively for night use
(B), and surgery is usually a last resort if bracing fails (D).
Question 7: A school-age child presents with suspected Nephrotic Syndrome. Which clinical
finding should the nurse prioritize during the assessment?
A) Periorbital edema and proteinuria.
B) Hypertension and hematuria.
C) High fever and flank pain.
D) Decreased urine output and extreme irritability.
Correct Answer: A) Periorbital edema and proteinuria.
Explanation: The hallmark signs of Nephrotic Syndrome are massive proteinuria,
hypoalbuminemia, and resulting edema (often periorbital upon waking). Hypertension and
hematuria (B) are more characteristic of Acute Glomerulonephritis.
, Question 8: A nurse is caring for an infant following a pyloromyotomy for pyloric stenosis. The
infant begins vomiting 4 hours post-operatively. What is the most appropriate action?
A) Call the surgeon immediately, as this indicates a complication.
B) Document the emesis as expected post-operative "spit-up" and continue feeds.
C) Suspend oral feedings and notify the surgical team for assessment of potential obstruction.
D) Change the formula to a hypoallergenic variety.
Correct Answer: C) Suspend oral feedings and notify the surgical team for assessment of
potential obstruction.
Explanation: While some vomiting can occur post-operatively, significant vomiting indicates a
potential complication such as mucosal edema at the surgical site. Suspending feeds is the
priority nursing intervention to prevent aspiration and allow the surgical team to evaluate the
infant.
Question 9: Which developmental milestone is typically achieved by the age of 12 months?
A) Walking without support.
B) Building a tower of 6 blocks.
C) Saying 3 to 5 words with meaning.
D) Drinking from a cup with a lid.
Correct Answer: C) Saying 3 to 5 words with meaning.
Explanation: By 12 months, the average infant says "mama," "dada," and a few other meaningful
words. Walking without support (A) is usually achieved between 12-15 months. Building a tower
of 6 blocks (B) is a toddler skill, and cup drinking with a lid (D) is typically mastered in the
toddler years.
Question 10: The nurse is preparing to administer an intramuscular injection to a 9-month-old
infant. Which site is the safest and most appropriate?
A) Dorsogluteal muscle.
B) Ventrogluteal muscle.
C) Vastus lateralis muscle.
D) Deltoid muscle.
