NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
GALEN NUR 168
Pediatric Clinical Judgment Workbook
Pediatric Prioritization - Medications - Family Teaching - Emergency
Scenarios
2026/2027 Study Edition
NUR 168 - Integrated Concepts of Registered Nursing
Course
Practice
Focus Pediatric clinical judgment and child-caring family concepts
High-yield review + 32 original clinical scenarios + detailed
Workbook Format
rationales
Current 2026 Galen catalog scope + publicly available
Alignment
detailed pediatric unit blueprint
Important use note
This is an independent study workbook. It is not an official Galen College exam, answer key, or course document. The
scenarios are original and are designed to practice clinical judgment, prioritization, medication safety, family teaching, and
emergency recognition. Course schedules and instructor emphasis may vary by campus and term.
Independent educational resource | Original practice scenarios
Page 1
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
1. Alignment and Workbook Goals
The July-December 2026 Galen College catalog describes NUR 168 as a transition-to-RN course that includes
care of the childbearing and child-caring family. A detailed publicly available NUR 168 syllabus from 2024/2025
organizes the pediatric theory portion into three major clusters: pediatric overview with cardiac and respiratory
disorders; musculoskeletal, neurologic, and oncologic disorders; and gastrointestinal, genitourinary, and
integumentary disorders. This workbook uses those clusters as a study framework while keeping all scenarios
original.
Workbook Domain Primary Skills Practiced Representative Topics
Respiratory distress, dehydration,
Recognize cues, set urgency, choose first
Pediatric prioritization congenital heart disease, meningitis,
nursing action, reassess
renal disorders, oncology precautions
Bronchodilators, corticosteroids, digoxin,
kg-based dosing, maximum-dose checks,
Medication safety diuretics, antibiotics, anticonvulsants,
monitoring, adverse-effect recognition
analgesics
Asthma, cystic fibrosis, scoliosis,
Developmentally appropriate education,
Family teaching hydrocephalus shunt care, UTI
discharge safety, teach-back
prevention, skin care
Airway-first thinking, escalation, Anaphylaxis, status asthmaticus,
Emergency scenarios emergency medication and team epiglottitis, seizures, shock, cyanotic
response spells, burns
Clinical judgment lens used throughout
Recognize cues -> Analyze cues -> Prioritize hypotheses -> Generate solutions -> Take action -> Evaluate outcomes. In
pediatric questions, always combine physiologic urgency with age, developmental stage, weight-based medication safety,
family involvement, and the child's baseline behavior.
2. Pediatric Clinical Judgment Foundations
2.1 Priority hierarchy for pediatric questions
1. Airway and breathing threats usually come first. Look for stridor, retractions, grunting, cyanosis, altered mental
status, silent chest, or rapidly increasing work of breathing.
2. Circulation follows closely. Poor perfusion may appear as delayed capillary refill, weak pulses, cool extremities,
tachycardia, decreased urine output, or worsening lethargy.
3. Neurologic deterioration is urgent. New seizure activity, declining level of consciousness, unequal pupils, or
signs of increased intracranial pressure require rapid escalation.
4. Safety hazards can outrank routine care. Examples include suspected epiglottitis, anaphylaxis, severe
dehydration, septic appearance, chemotherapy-related neutropenic fever, or a cyanotic spell.
5. After stabilization, address pain, hydration, nutrition, development, family teaching, and psychosocial needs.
2.2 Age-appropriate communication and family-centered care
Age group Communication approach Helpful nursing strategy
Use soothing voice, touch, caregiver Assess behavior, feeding, consolability,
Infant
presence, and predictable routines. work of breathing, and caregiver report.
Use simple concrete words and limited Let the child handle safe equipment; keep
Toddler
choices. parent nearby; use play for preparation.
Explain immediately before procedures; Use dolls, pictures, and play; clarify that
Preschool
avoid abstract explanations. illness is not punishment.
School-age Give clear step-by-step explanations and Offer realistic choices and preserve
Independent educational resource | Original practice scenarios
Page 2
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
Age group Communication approach Helpful nursing strategy
allow participation. modesty; explain cause and effect.
Respect privacy and growing autonomy Speak directly to the adolescent; explain
Adolescent
while involving family appropriately. confidentiality limits and invite questions.
2.3 Pediatric assessment cues that change urgency
Cue Why it matters Clinical judgment implication
Keep the child calm, avoid unnecessary
Stridor at rest Suggests upper-airway narrowing.
agitation, escalate airway evaluation.
Assess oxygenation, respiratory fatigue, and
Retractions/grunting/nasal flaring Signals increased work of breathing.
need for escalation.
Can be an early marker of dehydration or Trend intake/output and perfusion; assess
Poor feeding or fewer wet diapers
illness in infants. for dehydration.
May signal hypoxia, shock, infection, or Treat as a high-priority change from
Lethargy or decreased interaction
neurologic compromise. baseline.
Reassess circulation, hydration, and
Delayed capillary refill/cool extremities May reflect poor perfusion.
hemodynamic status.
Use urgent infection/sepsis precautions and
Nonblanching petechiae with fever Can occur with invasive infection.
rapid escalation.
Sudden severe abdominal pain with episodic Can suggest an obstructive process such as Keep NPO, assess perfusion, prepare for
drawing up of legs intussusception. urgent evaluation.
3. Pediatric Medication Safety and Calculation Essentials
Medication safety rule
Use kilograms for pediatric medication calculations. Verify the child's weight, ordered dose, safe mg/kg range, route,
concentration, and maximum dose when one applies. For high-alert or emergency medications, follow current institutional
policy and approved references.
Step Question to ask
Is the documented weight in kilograms and current enough for
1. Convert/verify weight
the clinical situation?
2. Calculate ordered dose Ordered mg/kg/dose x weight (kg) = dose in mg.
Does the result fall within the stated safe mg/kg range and
3. Compare with safe range
maximum dose?
4. Convert to volume Required mg / concentration (mg per mL) = mL to administer.
What effect, adverse reaction, or laboratory value must be
5. Reassess
monitored?
3.1 Calculation drills
# Practice prompt Solution
Child weighs 18 kg. Order: acetaminophen 270 mg; 8.4 mL (rounded to nearest tenth if
1
15 mg/kg PO once. Available: 160 mg/5 mL. policy permits).
Child weighs 24 kg. Order: amoxicillin 25
2 mg/kg PO every 12 hr. Available: 400 mg/5 600 mg per dose; 7.5 mL per dose.
mL.
Independent educational resource | Original practice scenarios
Page 3
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
# Practice prompt Solution
Infant weighs 8.2 kg. Order: medication 0.1
3 0.82 mg; 0.82 mL.
mg/kg IV. Available: 1 mg/mL.
Child weighs 30 kg. Order: 10 mg/kg. Calculated dose 300 mg, but maximum is
4
Maximum single dose: 250 mg. 250 mg; clarify/obey max-dose guidance.
Child weighs 16 kg. Safe range: 20-40 Daily range 320-640 mg/day; each q8h dose
5
mg/kg/day divided q8h. range about 107-213 mg.
Child weighs 22 lb. Convert to kilograms
6 .2 = 10 kg.
before calculating a dose.
4. High-Yield Pediatric Review by NUR 168 Unit Cluster
4.1 Unit 7 cluster: Pediatric overview, cardiac and respiratory disorders
Topic Recognize Prioritize / Nursing focus Family teaching anchor
Keep calm; assess stridor at rest
Barking cough, hoarseness, Seek urgent care for stridor at rest,
and work of breathing; support
Croup inspiratory stridor; symptoms often cyanosis, severe retractions,
humidified oxygen/medications as
worse at night. drooling, or exhaustion.
ordered.
Toxic appearance, high fever, Do not force throat inspection;
Airway emergency; rapid
Epiglottitis drooling, dysphagia, tripod keep child upright/calm; prepare
professional evaluation is required.
posture, muffled voice. for controlled airway management.
Tachypnea, wheeze/crackles,
Nasal suction, hydration
copious secretions, feeding Small frequent feeds if safe; watch
Bronchiolitis/RSV assessment, oxygen/supportive
difficulty, apnea risk in young breathing effort and wet diapers.
care based on severity.
infants.
Wheeze, cough, prolonged Short-acting bronchodilator;
Controller adherence, trigger plan,
Asthma expiration; severe attack may have oxygen/adjuncts as ordered;
spacer technique, action plan.
poor air movement or silent chest. reassess response quickly.
Thick secretions, recurrent Airway clearance, nutrition, Enzymes with meals/snacks when
Cystic fibrosis respiratory infection, pancreatic enzyme support, prescribed; high-calorie nutrition;
malabsorption/poor growth. infection prevention. airway-clearance routine.
Knee-chest position, Recognize increasing cyanosis,
Cyanosis; hypercyanotic spell may
Tetralogy of Fallot oxygen/supportive emergency syncope, poor feeding, or reduced
follow crying/feeding.
management, reduce agitation. activity.
Tachycardia, tachypnea, Reduce oxygen demand, support Report feeding intolerance, rapid
Pediatric heart failure diaphoresis with feeds, poor nutrition, monitor perfusion and breathing, edema, or fewer wet
weight gain, hepatomegaly. medication effects. diapers.
Keep follow-up
Persistent fever with Administer prescribed IVIG/anti-
echocardiography/cardiology
Kawasaki disease mucocutaneous findings; coronary inflammatory therapy; monitor
appointments; report recurrent
complications are a concern. cardiac status.
fever.
4.2 Unit 8 cluster: Musculoskeletal, neurologic and oncologic disorders
Topic Recognize Priority focus Teaching / safety
Foot fixed in abnormal position at Early treatment and neurovascular Cast care; keep follow-up; check
Clubfoot
birth. checks with casting/bracing. toes for color, warmth, swelling.
Lateral spinal curvature; Assess progression, respiratory
Brace schedule and skin care;
Scoliosis asymmetry may be noted on impact in severe disease, brace
maintain activity as advised.
screening. adherence.
Balance pain control, activity, Medication adherence,
Joint pain, swelling, stiffness,
Juvenile idiopathic arthritis range of motion, fatigue and exercise/therapy, eye screening
reduced mobility.
growth. when indicated.
Hydrocephalus Increasing head circumference in Watch for increased ICP and Report vomiting, headache,
Independent educational resource | Original practice scenarios
Page 4
GALEN NUR 168
Pediatric Clinical Judgment Workbook
Pediatric Prioritization - Medications - Family Teaching - Emergency
Scenarios
2026/2027 Study Edition
NUR 168 - Integrated Concepts of Registered Nursing
Course
Practice
Focus Pediatric clinical judgment and child-caring family concepts
High-yield review + 32 original clinical scenarios + detailed
Workbook Format
rationales
Current 2026 Galen catalog scope + publicly available
Alignment
detailed pediatric unit blueprint
Important use note
This is an independent study workbook. It is not an official Galen College exam, answer key, or course document. The
scenarios are original and are designed to practice clinical judgment, prioritization, medication safety, family teaching, and
emergency recognition. Course schedules and instructor emphasis may vary by campus and term.
Independent educational resource | Original practice scenarios
Page 1
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
1. Alignment and Workbook Goals
The July-December 2026 Galen College catalog describes NUR 168 as a transition-to-RN course that includes
care of the childbearing and child-caring family. A detailed publicly available NUR 168 syllabus from 2024/2025
organizes the pediatric theory portion into three major clusters: pediatric overview with cardiac and respiratory
disorders; musculoskeletal, neurologic, and oncologic disorders; and gastrointestinal, genitourinary, and
integumentary disorders. This workbook uses those clusters as a study framework while keeping all scenarios
original.
Workbook Domain Primary Skills Practiced Representative Topics
Respiratory distress, dehydration,
Recognize cues, set urgency, choose first
Pediatric prioritization congenital heart disease, meningitis,
nursing action, reassess
renal disorders, oncology precautions
Bronchodilators, corticosteroids, digoxin,
kg-based dosing, maximum-dose checks,
Medication safety diuretics, antibiotics, anticonvulsants,
monitoring, adverse-effect recognition
analgesics
Asthma, cystic fibrosis, scoliosis,
Developmentally appropriate education,
Family teaching hydrocephalus shunt care, UTI
discharge safety, teach-back
prevention, skin care
Airway-first thinking, escalation, Anaphylaxis, status asthmaticus,
Emergency scenarios emergency medication and team epiglottitis, seizures, shock, cyanotic
response spells, burns
Clinical judgment lens used throughout
Recognize cues -> Analyze cues -> Prioritize hypotheses -> Generate solutions -> Take action -> Evaluate outcomes. In
pediatric questions, always combine physiologic urgency with age, developmental stage, weight-based medication safety,
family involvement, and the child's baseline behavior.
2. Pediatric Clinical Judgment Foundations
2.1 Priority hierarchy for pediatric questions
1. Airway and breathing threats usually come first. Look for stridor, retractions, grunting, cyanosis, altered mental
status, silent chest, or rapidly increasing work of breathing.
2. Circulation follows closely. Poor perfusion may appear as delayed capillary refill, weak pulses, cool extremities,
tachycardia, decreased urine output, or worsening lethargy.
3. Neurologic deterioration is urgent. New seizure activity, declining level of consciousness, unequal pupils, or
signs of increased intracranial pressure require rapid escalation.
4. Safety hazards can outrank routine care. Examples include suspected epiglottitis, anaphylaxis, severe
dehydration, septic appearance, chemotherapy-related neutropenic fever, or a cyanotic spell.
5. After stabilization, address pain, hydration, nutrition, development, family teaching, and psychosocial needs.
2.2 Age-appropriate communication and family-centered care
Age group Communication approach Helpful nursing strategy
Use soothing voice, touch, caregiver Assess behavior, feeding, consolability,
Infant
presence, and predictable routines. work of breathing, and caregiver report.
Use simple concrete words and limited Let the child handle safe equipment; keep
Toddler
choices. parent nearby; use play for preparation.
Explain immediately before procedures; Use dolls, pictures, and play; clarify that
Preschool
avoid abstract explanations. illness is not punishment.
School-age Give clear step-by-step explanations and Offer realistic choices and preserve
Independent educational resource | Original practice scenarios
Page 2
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
Age group Communication approach Helpful nursing strategy
allow participation. modesty; explain cause and effect.
Respect privacy and growing autonomy Speak directly to the adolescent; explain
Adolescent
while involving family appropriately. confidentiality limits and invite questions.
2.3 Pediatric assessment cues that change urgency
Cue Why it matters Clinical judgment implication
Keep the child calm, avoid unnecessary
Stridor at rest Suggests upper-airway narrowing.
agitation, escalate airway evaluation.
Assess oxygenation, respiratory fatigue, and
Retractions/grunting/nasal flaring Signals increased work of breathing.
need for escalation.
Can be an early marker of dehydration or Trend intake/output and perfusion; assess
Poor feeding or fewer wet diapers
illness in infants. for dehydration.
May signal hypoxia, shock, infection, or Treat as a high-priority change from
Lethargy or decreased interaction
neurologic compromise. baseline.
Reassess circulation, hydration, and
Delayed capillary refill/cool extremities May reflect poor perfusion.
hemodynamic status.
Use urgent infection/sepsis precautions and
Nonblanching petechiae with fever Can occur with invasive infection.
rapid escalation.
Sudden severe abdominal pain with episodic Can suggest an obstructive process such as Keep NPO, assess perfusion, prepare for
drawing up of legs intussusception. urgent evaluation.
3. Pediatric Medication Safety and Calculation Essentials
Medication safety rule
Use kilograms for pediatric medication calculations. Verify the child's weight, ordered dose, safe mg/kg range, route,
concentration, and maximum dose when one applies. For high-alert or emergency medications, follow current institutional
policy and approved references.
Step Question to ask
Is the documented weight in kilograms and current enough for
1. Convert/verify weight
the clinical situation?
2. Calculate ordered dose Ordered mg/kg/dose x weight (kg) = dose in mg.
Does the result fall within the stated safe mg/kg range and
3. Compare with safe range
maximum dose?
4. Convert to volume Required mg / concentration (mg per mL) = mL to administer.
What effect, adverse reaction, or laboratory value must be
5. Reassess
monitored?
3.1 Calculation drills
# Practice prompt Solution
Child weighs 18 kg. Order: acetaminophen 270 mg; 8.4 mL (rounded to nearest tenth if
1
15 mg/kg PO once. Available: 160 mg/5 mL. policy permits).
Child weighs 24 kg. Order: amoxicillin 25
2 mg/kg PO every 12 hr. Available: 400 mg/5 600 mg per dose; 7.5 mL per dose.
mL.
Independent educational resource | Original practice scenarios
Page 3
, NUR 168 Pediatric Clinical Judgment Workbook | 2026/2027
# Practice prompt Solution
Infant weighs 8.2 kg. Order: medication 0.1
3 0.82 mg; 0.82 mL.
mg/kg IV. Available: 1 mg/mL.
Child weighs 30 kg. Order: 10 mg/kg. Calculated dose 300 mg, but maximum is
4
Maximum single dose: 250 mg. 250 mg; clarify/obey max-dose guidance.
Child weighs 16 kg. Safe range: 20-40 Daily range 320-640 mg/day; each q8h dose
5
mg/kg/day divided q8h. range about 107-213 mg.
Child weighs 22 lb. Convert to kilograms
6 .2 = 10 kg.
before calculating a dose.
4. High-Yield Pediatric Review by NUR 168 Unit Cluster
4.1 Unit 7 cluster: Pediatric overview, cardiac and respiratory disorders
Topic Recognize Prioritize / Nursing focus Family teaching anchor
Keep calm; assess stridor at rest
Barking cough, hoarseness, Seek urgent care for stridor at rest,
and work of breathing; support
Croup inspiratory stridor; symptoms often cyanosis, severe retractions,
humidified oxygen/medications as
worse at night. drooling, or exhaustion.
ordered.
Toxic appearance, high fever, Do not force throat inspection;
Airway emergency; rapid
Epiglottitis drooling, dysphagia, tripod keep child upright/calm; prepare
professional evaluation is required.
posture, muffled voice. for controlled airway management.
Tachypnea, wheeze/crackles,
Nasal suction, hydration
copious secretions, feeding Small frequent feeds if safe; watch
Bronchiolitis/RSV assessment, oxygen/supportive
difficulty, apnea risk in young breathing effort and wet diapers.
care based on severity.
infants.
Wheeze, cough, prolonged Short-acting bronchodilator;
Controller adherence, trigger plan,
Asthma expiration; severe attack may have oxygen/adjuncts as ordered;
spacer technique, action plan.
poor air movement or silent chest. reassess response quickly.
Thick secretions, recurrent Airway clearance, nutrition, Enzymes with meals/snacks when
Cystic fibrosis respiratory infection, pancreatic enzyme support, prescribed; high-calorie nutrition;
malabsorption/poor growth. infection prevention. airway-clearance routine.
Knee-chest position, Recognize increasing cyanosis,
Cyanosis; hypercyanotic spell may
Tetralogy of Fallot oxygen/supportive emergency syncope, poor feeding, or reduced
follow crying/feeding.
management, reduce agitation. activity.
Tachycardia, tachypnea, Reduce oxygen demand, support Report feeding intolerance, rapid
Pediatric heart failure diaphoresis with feeds, poor nutrition, monitor perfusion and breathing, edema, or fewer wet
weight gain, hepatomegaly. medication effects. diapers.
Keep follow-up
Persistent fever with Administer prescribed IVIG/anti-
echocardiography/cardiology
Kawasaki disease mucocutaneous findings; coronary inflammatory therapy; monitor
appointments; report recurrent
complications are a concern. cardiac status.
fever.
4.2 Unit 8 cluster: Musculoskeletal, neurologic and oncologic disorders
Topic Recognize Priority focus Teaching / safety
Foot fixed in abnormal position at Early treatment and neurovascular Cast care; keep follow-up; check
Clubfoot
birth. checks with casting/bracing. toes for color, warmth, swelling.
Lateral spinal curvature; Assess progression, respiratory
Brace schedule and skin care;
Scoliosis asymmetry may be noted on impact in severe disease, brace
maintain activity as advised.
screening. adherence.
Balance pain control, activity, Medication adherence,
Joint pain, swelling, stiffness,
Juvenile idiopathic arthritis range of motion, fatigue and exercise/therapy, eye screening
reduced mobility.
growth. when indicated.
Hydrocephalus Increasing head circumference in Watch for increased ICP and Report vomiting, headache,
Independent educational resource | Original practice scenarios
Page 4
