VIRGINIA PEDIATRIC EMERGENCY NURSE EXAM: 200 PRACTICE
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES (2027
LATEST UPDATE)
Question 1
A 4-year-old child is brought to the emergency department with severe
respiratory distress. The child is sitting upright, has nasal flaring,
intercostal retractions, and an oxygen saturation of 84% on room air.
Which action should the pediatric emergency nurse take first?
A. Obtain a detailed medical history
B. Apply high-flow oxygen and rapidly assess airway and breathing
C. Establish two peripheral IV lines
D. Obtain a chest radiograph
Answer: B. Apply high-flow oxygen and rapidly assess airway and
breathing
Rationale: In a critically ill child, airway and breathing are immediate
priorities. Severe hypoxemia and respiratory distress require prompt
oxygen administration and rapid assessment for impending respiratory
failure. Diagnostic testing and IV access should not delay stabilization.
Question 2
A 2-year-old child presents with a barking cough, hoarse voice, and
inspiratory stridor that worsens when crying. The child is afebrile and
has no drooling. Which condition should the nurse suspect?
A. Epiglottitis
B. Croup
,C. Foreign body aspiration
D. Bronchiolitis
Answer: B. Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a
barking cough, hoarseness, and inspiratory stridor, often following a
viral upper respiratory infection. Epiglottitis presents with drooling, high
fever, and tripod positioning. Foreign body aspiration typically has
sudden onset without fever. Bronchiolitis presents with wheezing and
crackles.
Question 3
A 6-month-old infant is brought to the emergency department with a 2-
day history of poor feeding, lethargy, and a temperature of 38.9°C
(102°F). The infant has a bulging anterior fontanel. Which action should
the nurse anticipate first?
A. Administer oral acetaminophen
B. Obtain a blood culture
C. Prepare for a lumbar puncture
D. Initiate intravenous antibiotics
Answer: D. Initiate intravenous antibiotics
Rationale: The infant presents with signs of bacterial meningitis (fever,
lethargy, bulging fontanel). Empiric intravenous antibiotics should be
initiated immediately after blood cultures are drawn, but before lumbar
puncture if the infant is unstable or has signs of increased intracranial
pressure. Antibiotics should not be delayed.
Question 4
A 10-year-old child with a known peanut allergy is brought in with
urticaria, wheezing, and hypotension after accidental ingestion. Which
,medication should the nurse prepare to administer first?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It
reverses airway edema, bronchospasm, and hypotension.
Antihistamines and corticosteroids are adjuncts but do not reverse life-
threatening symptoms.
Question 5
A 3-year-old child is admitted with a suspected foreign body aspiration.
The child is coughing forcefully and has audible wheezing. Which action
should the nurse take?
A. Perform abdominal thrusts
B. Encourage the child to continue coughing
C. Perform a blind finger sweep
D. Administer a bronchodilator
Answer: B. Encourage the child to continue coughing
Rationale: If the child is coughing forcefully, the airway is partially
obstructed, and the cough is the most effective mechanism to expel the
foreign body. Abdominal thrusts are indicated for complete obstruction
in conscious children. Blind finger sweeps are contraindicated.
Question 6
A 5-year-old child presents with a fever of 39.5°C (103.1°F), irritability,
and a petechial rash. The child is hypotensive and has a capillary refill of
4 seconds. Which condition should the nurse suspect?
, A. Kawasaki disease
B. Meningococcemia
C. Scarlet fever
D. Rocky Mountain spotted fever
Answer: B. Meningococcemia
Rationale: Meningococcemia presents with fever, petechial/purpuric
rash, and signs of septic shock (hypotension, delayed capillary refill).
Kawasaki disease has a longer fever duration and mucocutaneous
findings. Scarlet fever has a sandpaper-like rash. Rocky Mountain
spotted fever has a petechial rash that starts on the wrists and ankles.
Question 7
A 7-year-old child is brought in after a motor vehicle collision. The child
has a Glasgow Coma Scale score of 8. Which action should the nurse
prioritize?
A. Obtain a CT scan of the head
B. Prepare for intubation
C. Administer a bolus of normal saline
D. Apply a cervical collar
Answer: B. Prepare for intubation
Rationale: A GCS of 8 or less indicates severe neurological impairment
and the need for airway protection. Intubation should be performed to
secure the airway and prevent aspiration. CT scan and IV fluids are
important but do not take precedence over airway management.
Question 8
A 12-year-old child with type 1 diabetes presents with fruity breath,
Kussmaul respirations, and blood glucose of 450 mg/dL. Which action
should the nurse take first?
QUESTIONS & VERIFIED ANSWERS WITH RATIONALES (2027
LATEST UPDATE)
Question 1
A 4-year-old child is brought to the emergency department with severe
respiratory distress. The child is sitting upright, has nasal flaring,
intercostal retractions, and an oxygen saturation of 84% on room air.
Which action should the pediatric emergency nurse take first?
A. Obtain a detailed medical history
B. Apply high-flow oxygen and rapidly assess airway and breathing
C. Establish two peripheral IV lines
D. Obtain a chest radiograph
Answer: B. Apply high-flow oxygen and rapidly assess airway and
breathing
Rationale: In a critically ill child, airway and breathing are immediate
priorities. Severe hypoxemia and respiratory distress require prompt
oxygen administration and rapid assessment for impending respiratory
failure. Diagnostic testing and IV access should not delay stabilization.
Question 2
A 2-year-old child presents with a barking cough, hoarse voice, and
inspiratory stridor that worsens when crying. The child is afebrile and
has no drooling. Which condition should the nurse suspect?
A. Epiglottitis
B. Croup
,C. Foreign body aspiration
D. Bronchiolitis
Answer: B. Croup
Rationale: Croup (laryngotracheobronchitis) is characterized by a
barking cough, hoarseness, and inspiratory stridor, often following a
viral upper respiratory infection. Epiglottitis presents with drooling, high
fever, and tripod positioning. Foreign body aspiration typically has
sudden onset without fever. Bronchiolitis presents with wheezing and
crackles.
Question 3
A 6-month-old infant is brought to the emergency department with a 2-
day history of poor feeding, lethargy, and a temperature of 38.9°C
(102°F). The infant has a bulging anterior fontanel. Which action should
the nurse anticipate first?
A. Administer oral acetaminophen
B. Obtain a blood culture
C. Prepare for a lumbar puncture
D. Initiate intravenous antibiotics
Answer: D. Initiate intravenous antibiotics
Rationale: The infant presents with signs of bacterial meningitis (fever,
lethargy, bulging fontanel). Empiric intravenous antibiotics should be
initiated immediately after blood cultures are drawn, but before lumbar
puncture if the infant is unstable or has signs of increased intracranial
pressure. Antibiotics should not be delayed.
Question 4
A 10-year-old child with a known peanut allergy is brought in with
urticaria, wheezing, and hypotension after accidental ingestion. Which
,medication should the nurse prepare to administer first?
A. Diphenhydramine
B. Epinephrine
C. Methylprednisolone
D. Albuterol
Answer: B. Epinephrine
Rationale: Epinephrine is the first-line treatment for anaphylaxis. It
reverses airway edema, bronchospasm, and hypotension.
Antihistamines and corticosteroids are adjuncts but do not reverse life-
threatening symptoms.
Question 5
A 3-year-old child is admitted with a suspected foreign body aspiration.
The child is coughing forcefully and has audible wheezing. Which action
should the nurse take?
A. Perform abdominal thrusts
B. Encourage the child to continue coughing
C. Perform a blind finger sweep
D. Administer a bronchodilator
Answer: B. Encourage the child to continue coughing
Rationale: If the child is coughing forcefully, the airway is partially
obstructed, and the cough is the most effective mechanism to expel the
foreign body. Abdominal thrusts are indicated for complete obstruction
in conscious children. Blind finger sweeps are contraindicated.
Question 6
A 5-year-old child presents with a fever of 39.5°C (103.1°F), irritability,
and a petechial rash. The child is hypotensive and has a capillary refill of
4 seconds. Which condition should the nurse suspect?
, A. Kawasaki disease
B. Meningococcemia
C. Scarlet fever
D. Rocky Mountain spotted fever
Answer: B. Meningococcemia
Rationale: Meningococcemia presents with fever, petechial/purpuric
rash, and signs of septic shock (hypotension, delayed capillary refill).
Kawasaki disease has a longer fever duration and mucocutaneous
findings. Scarlet fever has a sandpaper-like rash. Rocky Mountain
spotted fever has a petechial rash that starts on the wrists and ankles.
Question 7
A 7-year-old child is brought in after a motor vehicle collision. The child
has a Glasgow Coma Scale score of 8. Which action should the nurse
prioritize?
A. Obtain a CT scan of the head
B. Prepare for intubation
C. Administer a bolus of normal saline
D. Apply a cervical collar
Answer: B. Prepare for intubation
Rationale: A GCS of 8 or less indicates severe neurological impairment
and the need for airway protection. Intubation should be performed to
secure the airway and prevent aspiration. CT scan and IV fluids are
important but do not take precedence over airway management.
Question 8
A 12-year-old child with type 1 diabetes presents with fruity breath,
Kussmaul respirations, and blood glucose of 450 mg/dL. Which action
should the nurse take first?
