,NSG 434 – Midterm Exam Questions and
Answers with Rationale 2026/2027
Update
Question 1: Pediatric Assessment & Vital Signs
When assessing the vital signs of a healthy 18-month-old toddler
during a routine well-child visit, which of the following findings
should the nurse expect?
A. Heart rate of 140–160 beats/min and blood pressure of
120/80 mmHg.
B. Heart rate of 80–120 beats/min and respiratory rate of
20–30 breaths/min.
C. Heart rate of 60–100 beats/min and regular adult
breathing patterns.
D. Axillary temperature of 100.5°F as a baseline normal
average.
Correct Answer: B. Heart rate of 80–120 beats/min and
respiratory rate of 20–30 breaths/min.
Expert Rationale: Toddlers have higher baseline metabolic
rates and smaller cardiac reserves compared to adults, resulting
in faster normal resting heart rates (typically 80 to 120
beats/min) and respiratory rates (20 to 30 breaths/min). Blood
pressure is significantly lower than adult values (average
systolic pressure for a toddler is around 90–100 mmHg).
Question 2: Growth and Development Milestones
,During a 9-month-old infant wellness check, which
developmental milestone should the nurse expect the infant to
have achieved?
A. Walking independently across the room without support.
B. Sitting unsupported and demonstrating a crude pincer
grasp.
C. Speaking 5 to 10 distinct words with clear meaning.
D. Building a tower of six small wooden blocks.
Correct Answer: B. Sitting unsupported and demonstrating
a crude pincer grasp.
Expert Rationale: By 9 months of age, a typical infant can sit
steadily without support and uses a crude pincer grasp (using
the index finger and thumb) to pick up small objects.
Independent walking usually emerges around 12 to 15 months,
complex speech develops later in toddlerhood, and building
block towers occurs around age 2.
Question 3: Pediatric Fluid Management & Dehydration
A 10-month-old infant is admitted with acute gastroenteritis and
severe dehydration. The infant weighs 10 kg. Using the standard
Holliday-Segar method, what is the infant's normal 24-hour
maintenance fluid requirement?
A. 500 mL / 24 hours
B. 1,000 mL / 24 hours
C. 1,500 mL / 24 hours
D. 2,000 mL / 24 hours
Correct Answer: B. 1,000 mL / 24 hours
, Expert Rationale: The Holliday-Segar method calculates
maintenance fluid requirements based on body weight:
100 mL/kg for the first 10 kg ($10 \times 100 = 1000$
mL).
50 mL/kg for the second 10 kg.
20 mL/kg for any weight over 20 kg.
For a 10 kg infant, the total requirement is 1,000 mL per 24
hours (or approximately 42 mL/hour).
Question 4: Pediatric Medication Administration
A nurse is calculating a safe pediatric dosage for an antibiotic
syrup. The child weighs 33 lbs. What is the child's weight in
kilograms?
A. 12 kg
B. 15 kg
C. 22 kg
D. 33 kg
Correct Answer: B. 15 kg
Expert Rationale: To convert pounds to kilograms, divide the
weight in pounds by 2.2. Accurate weight conversion is a critical
safety check prior to calculating milligram-per-kilogram
medication doses.
Question 5: Pediatric Respiratory Assessment
A 3-year-old child is brought to the emergency department with
acute respiratory distress, intercostal retractions, nasal flaring,
Answers with Rationale 2026/2027
Update
Question 1: Pediatric Assessment & Vital Signs
When assessing the vital signs of a healthy 18-month-old toddler
during a routine well-child visit, which of the following findings
should the nurse expect?
A. Heart rate of 140–160 beats/min and blood pressure of
120/80 mmHg.
B. Heart rate of 80–120 beats/min and respiratory rate of
20–30 breaths/min.
C. Heart rate of 60–100 beats/min and regular adult
breathing patterns.
D. Axillary temperature of 100.5°F as a baseline normal
average.
Correct Answer: B. Heart rate of 80–120 beats/min and
respiratory rate of 20–30 breaths/min.
Expert Rationale: Toddlers have higher baseline metabolic
rates and smaller cardiac reserves compared to adults, resulting
in faster normal resting heart rates (typically 80 to 120
beats/min) and respiratory rates (20 to 30 breaths/min). Blood
pressure is significantly lower than adult values (average
systolic pressure for a toddler is around 90–100 mmHg).
Question 2: Growth and Development Milestones
,During a 9-month-old infant wellness check, which
developmental milestone should the nurse expect the infant to
have achieved?
A. Walking independently across the room without support.
B. Sitting unsupported and demonstrating a crude pincer
grasp.
C. Speaking 5 to 10 distinct words with clear meaning.
D. Building a tower of six small wooden blocks.
Correct Answer: B. Sitting unsupported and demonstrating
a crude pincer grasp.
Expert Rationale: By 9 months of age, a typical infant can sit
steadily without support and uses a crude pincer grasp (using
the index finger and thumb) to pick up small objects.
Independent walking usually emerges around 12 to 15 months,
complex speech develops later in toddlerhood, and building
block towers occurs around age 2.
Question 3: Pediatric Fluid Management & Dehydration
A 10-month-old infant is admitted with acute gastroenteritis and
severe dehydration. The infant weighs 10 kg. Using the standard
Holliday-Segar method, what is the infant's normal 24-hour
maintenance fluid requirement?
A. 500 mL / 24 hours
B. 1,000 mL / 24 hours
C. 1,500 mL / 24 hours
D. 2,000 mL / 24 hours
Correct Answer: B. 1,000 mL / 24 hours
, Expert Rationale: The Holliday-Segar method calculates
maintenance fluid requirements based on body weight:
100 mL/kg for the first 10 kg ($10 \times 100 = 1000$
mL).
50 mL/kg for the second 10 kg.
20 mL/kg for any weight over 20 kg.
For a 10 kg infant, the total requirement is 1,000 mL per 24
hours (or approximately 42 mL/hour).
Question 4: Pediatric Medication Administration
A nurse is calculating a safe pediatric dosage for an antibiotic
syrup. The child weighs 33 lbs. What is the child's weight in
kilograms?
A. 12 kg
B. 15 kg
C. 22 kg
D. 33 kg
Correct Answer: B. 15 kg
Expert Rationale: To convert pounds to kilograms, divide the
weight in pounds by 2.2. Accurate weight conversion is a critical
safety check prior to calculating milligram-per-kilogram
medication doses.
Question 5: Pediatric Respiratory Assessment
A 3-year-old child is brought to the emergency department with
acute respiratory distress, intercostal retractions, nasal flaring,
