RN Nursing Care of Children 2025 Predictor Exam – exam panel
RN Nursing Care of Children 2025 Predictor Exam | 100
Scenario-Based Pediatric Questions with Rationales &
Examiners’ Notes
RN Nursing Care of Children — Pediatric Study Guide (Scenario-
based)
2025 ACTUAL EXAM PREDICTOR
RN Nursing Care of Children 2025 Predictor Exam — 100
realistic pediatric nursing scenarios with detailed answers,
rationales, and examiner insights designed to mirror actual RN
pediatric exam questions.
1. Respiratory distress in bronchiolitis
Scenario: A 6-month-old infant presents with 3 days of rhinorrhea and cough. On exam the
infant has tachypnea (RR 68), nasal flaring, intercostal retractions and diffuse wheezes. Oxygen
saturation on room air is 89%.
Answer / Key actions:
• Place infant on oxygen to maintain sats ≥ 92% (use blow-by or nasal cannula as
tolerated).
• Suction nasal secretions and position to optimize airway.
• Assess for dehydration and provide small frequent feeds or IV fluids if needed.
• Consider nebulized hypertonic saline or bronchodilator per local protocol and clinical
response; admit for observation if respiratory distress or hypoxia.
,RN Nursing Care of Children 2025 Predictor Exam – exam panel
Detailed rationale:
Bronchiolitis (commonly RSV) causes small-airway inflammation with mucus and airway
edema. Infants are obligate nose breathers — nasal congestion worsens work of breathing and
feeding. Oxygen and suctioning improve oxygenation and reduce work of breathing. IV fluids
are needed if poor intake or exhaustion. Routine antibiotics are not indicated unless bacterial
infection suspected.
Why frequently tested:
Bronchiolitis is a common pediatric diagnosis; nurses must triage hypoxia, support airway, and
prioritize feeding/hydration and respiratory monitoring.
Examiner's note:
Focus on age-specific respiratory rates, signs of increased work of breathing, and stepwise
supportive care (oxygen, suction, fluids).
2. Febrile seizure management
Scenario: A 2-year-old with a 39.5°C (103.1°F) fever has a generalized tonic-clonic seizure
lasting 3 minutes at home. By arrival to ED child is postictal and febrile.
Answer / Key actions:
• Ensure airway patency, breathing and circulation; place in recovery position.
• If seizure ongoing >5 minutes, give benzodiazepine per protocol (e.g., intranasal or IV
midazolam).
• Treat fever with antipyretics and determine source; observe for recurrence and assess
neurological status.
• Educate caregivers that simple febrile seizures are usually benign but require prompt
evaluation.
Detailed rationale:
Most febrile seizures are self-limited (<5 min) and do not cause long-term harm. The
immediate priority is ABCs. Benzodiazepines are reserved for prolonged seizures. Identifying
source of fever and ensuring hydration is important. Distinguish simple vs complex febrile
seizures (duration >15 min, focal features, or recurrence within 24 hours) which require
further workup.
Why frequently tested:
Recognizing seizure management priorities and caregiver education are essential in pediatric
nursing — febrile seizures are common.
Examiner's note:
Be precise with seizure duration thresholds and indications for anticonvulsant administration.
3. Dehydration assessment in gastroenteritis
Scenario: A 14-month-old with 2 days of vomiting and diarrhea. Weight loss of approximately
6% from baseline. Vital signs: HR 150, dry mucous membranes, sunken fontanelle, decreased
urine output.
Answer / Key actions:
,RN Nursing Care of Children 2025 Predictor Exam – exam panel
• Classify dehydration as moderate (~6–9% weight loss). Start oral rehydration therapy
(ORT) if tolerated; otherwise begin IV isotonic fluid bolus (20 mL/kg) and reassess.
• Monitor electrolytes, urine output, and vital signs; gradually reintroduce age-
appropriate feeds.
Detailed rationale:
Assessment includes weight change, mucous membranes, tear production, fontanelle, and
urine output. ORT with balanced solutions (e.g., ORS) is first-line for mild–moderate
dehydration; IV fluids for moderate–severe or if vomiting prevents ORT. Isotonic solutions
restore intravascular volume safely.
Why frequently tested:
Dehydration from gastroenteritis is a leading cause of pediatric visits; precise assessment and
correct rehydration method are essential nursing skills.
Examiner's note:
Include weight-percent loss calculations and clear ORT vs IV indications.
4. Diabetes mellitus type 1 — DKA presentation
Scenario: A 10-year-old with new-onset polyuria, polydipsia, abdominal pain, Kussmaul
respirations and fruity breath. Lab shows hyperglycemia and positive ketones.
Answer / Key actions:
• Recognize diabetic ketoacidosis (DKA). Begin fluid resuscitation (careful bolus per
protocol), obtain labs (electrolytes, venous blood gas), start insulin infusion after initial
fluid resuscitation, and monitor potassium closely.
• Transfer to pediatric ICU if severe.
Detailed rationale:
DKA is life-threatening due to dehydration, metabolic acidosis and electrolyte shifts (notably
potassium). Insulin reduces ketone production but causes potassium to shift intracellularly —
replace potassium when levels low/normal after initial fluids. Rapid correction of
hyperglycemia or sodium can risk cerebral edema; follow protocol.
Why frequently tested:
DKA management involves time-sensitive, protocol-driven nursing interventions and close
monitoring — a high-stakes scenario frequently assessed on exams.
Examiner's note:
Emphasize sequence (fluids → labs → insulin) and potassium monitoring to prevent
complications.
5. Asthma exacerbation and peak flow
Scenario: A 9-year-old with asthma presents with cough, wheeze and difficulty speaking in full
sentences. Initial peak expiratory flow is 45% of personal best.
Answer / Key actions:
• Give short-acting beta-agonist (SABA) via nebulizer or MDI with spacer; oxygen if
hypoxic.
, RN Nursing Care of Children 2025 Predictor Exam – exam panel
• Administer systemic corticosteroid early; consider ipratropium for severe
exacerbation.
• Reassess work of breathing, PEF, and oxygenation; admit if persistent distress or PEF
<50% after treatment.
Detailed rationale:
SABA reverses bronchospasm quickly; systemic steroids reduce airway inflammation but take
hours to act, so give early. Peak flow provides objective measure of airway obstruction.
Treatment aims to relieve bronchospasm, correct hypoxia, and prevent relapse.
Why frequently tested:
Asthma is common; nurses must triage severity objectively and implement stepwise treatment
and monitoring.
Examiner's note:
Know thresholds (PEF % personal best) that guide discharge vs admission decisions.
6. Immunization contraindication
Scenario: A 7-month-old infant is due for routine vaccinations. The caregiver reports the child
had an anaphylactic reaction to neomycin in the past.
Answer / Key actions:
• Review vaccine components. Live vaccines contraindicated for severe allergy to
vaccine component. For most routine vaccines, consult facility policy and
immunization guidelines; avoid vaccines containing neomycin if truly allergic and
consult allergy/immunology.
• Document reaction and provide alternative scheduling or specialist referral.
Detailed rationale:
True severe allergic reactions to vaccine components are rare but are absolute/relative
contraindications depending on the component. Many vaccines contain trace antibiotics;
careful chart review and specialist input are necessary.
Why frequently tested:
Vaccine safety, contraindications, and informed consent are core pediatric nursing
responsibilities.
Examiner's note:
Emphasize verifying documented allergies and consulting guidelines rather than withholding all
vaccines reflexively.
7. Child with suspected appendicitis
Scenario: An 11-year-old with periumbilical pain migrating to the right lower quadrant,
anorexia and low-grade fever. Guarding and rebound tenderness noted.
Answer / Key actions:
• Prepare for urgent surgical evaluation: NPO, IV access, analgesia per protocol, and
imaging (ultrasound or CT as ordered).
RN Nursing Care of Children 2025 Predictor Exam | 100
Scenario-Based Pediatric Questions with Rationales &
Examiners’ Notes
RN Nursing Care of Children — Pediatric Study Guide (Scenario-
based)
2025 ACTUAL EXAM PREDICTOR
RN Nursing Care of Children 2025 Predictor Exam — 100
realistic pediatric nursing scenarios with detailed answers,
rationales, and examiner insights designed to mirror actual RN
pediatric exam questions.
1. Respiratory distress in bronchiolitis
Scenario: A 6-month-old infant presents with 3 days of rhinorrhea and cough. On exam the
infant has tachypnea (RR 68), nasal flaring, intercostal retractions and diffuse wheezes. Oxygen
saturation on room air is 89%.
Answer / Key actions:
• Place infant on oxygen to maintain sats ≥ 92% (use blow-by or nasal cannula as
tolerated).
• Suction nasal secretions and position to optimize airway.
• Assess for dehydration and provide small frequent feeds or IV fluids if needed.
• Consider nebulized hypertonic saline or bronchodilator per local protocol and clinical
response; admit for observation if respiratory distress or hypoxia.
,RN Nursing Care of Children 2025 Predictor Exam – exam panel
Detailed rationale:
Bronchiolitis (commonly RSV) causes small-airway inflammation with mucus and airway
edema. Infants are obligate nose breathers — nasal congestion worsens work of breathing and
feeding. Oxygen and suctioning improve oxygenation and reduce work of breathing. IV fluids
are needed if poor intake or exhaustion. Routine antibiotics are not indicated unless bacterial
infection suspected.
Why frequently tested:
Bronchiolitis is a common pediatric diagnosis; nurses must triage hypoxia, support airway, and
prioritize feeding/hydration and respiratory monitoring.
Examiner's note:
Focus on age-specific respiratory rates, signs of increased work of breathing, and stepwise
supportive care (oxygen, suction, fluids).
2. Febrile seizure management
Scenario: A 2-year-old with a 39.5°C (103.1°F) fever has a generalized tonic-clonic seizure
lasting 3 minutes at home. By arrival to ED child is postictal and febrile.
Answer / Key actions:
• Ensure airway patency, breathing and circulation; place in recovery position.
• If seizure ongoing >5 minutes, give benzodiazepine per protocol (e.g., intranasal or IV
midazolam).
• Treat fever with antipyretics and determine source; observe for recurrence and assess
neurological status.
• Educate caregivers that simple febrile seizures are usually benign but require prompt
evaluation.
Detailed rationale:
Most febrile seizures are self-limited (<5 min) and do not cause long-term harm. The
immediate priority is ABCs. Benzodiazepines are reserved for prolonged seizures. Identifying
source of fever and ensuring hydration is important. Distinguish simple vs complex febrile
seizures (duration >15 min, focal features, or recurrence within 24 hours) which require
further workup.
Why frequently tested:
Recognizing seizure management priorities and caregiver education are essential in pediatric
nursing — febrile seizures are common.
Examiner's note:
Be precise with seizure duration thresholds and indications for anticonvulsant administration.
3. Dehydration assessment in gastroenteritis
Scenario: A 14-month-old with 2 days of vomiting and diarrhea. Weight loss of approximately
6% from baseline. Vital signs: HR 150, dry mucous membranes, sunken fontanelle, decreased
urine output.
Answer / Key actions:
,RN Nursing Care of Children 2025 Predictor Exam – exam panel
• Classify dehydration as moderate (~6–9% weight loss). Start oral rehydration therapy
(ORT) if tolerated; otherwise begin IV isotonic fluid bolus (20 mL/kg) and reassess.
• Monitor electrolytes, urine output, and vital signs; gradually reintroduce age-
appropriate feeds.
Detailed rationale:
Assessment includes weight change, mucous membranes, tear production, fontanelle, and
urine output. ORT with balanced solutions (e.g., ORS) is first-line for mild–moderate
dehydration; IV fluids for moderate–severe or if vomiting prevents ORT. Isotonic solutions
restore intravascular volume safely.
Why frequently tested:
Dehydration from gastroenteritis is a leading cause of pediatric visits; precise assessment and
correct rehydration method are essential nursing skills.
Examiner's note:
Include weight-percent loss calculations and clear ORT vs IV indications.
4. Diabetes mellitus type 1 — DKA presentation
Scenario: A 10-year-old with new-onset polyuria, polydipsia, abdominal pain, Kussmaul
respirations and fruity breath. Lab shows hyperglycemia and positive ketones.
Answer / Key actions:
• Recognize diabetic ketoacidosis (DKA). Begin fluid resuscitation (careful bolus per
protocol), obtain labs (electrolytes, venous blood gas), start insulin infusion after initial
fluid resuscitation, and monitor potassium closely.
• Transfer to pediatric ICU if severe.
Detailed rationale:
DKA is life-threatening due to dehydration, metabolic acidosis and electrolyte shifts (notably
potassium). Insulin reduces ketone production but causes potassium to shift intracellularly —
replace potassium when levels low/normal after initial fluids. Rapid correction of
hyperglycemia or sodium can risk cerebral edema; follow protocol.
Why frequently tested:
DKA management involves time-sensitive, protocol-driven nursing interventions and close
monitoring — a high-stakes scenario frequently assessed on exams.
Examiner's note:
Emphasize sequence (fluids → labs → insulin) and potassium monitoring to prevent
complications.
5. Asthma exacerbation and peak flow
Scenario: A 9-year-old with asthma presents with cough, wheeze and difficulty speaking in full
sentences. Initial peak expiratory flow is 45% of personal best.
Answer / Key actions:
• Give short-acting beta-agonist (SABA) via nebulizer or MDI with spacer; oxygen if
hypoxic.
, RN Nursing Care of Children 2025 Predictor Exam – exam panel
• Administer systemic corticosteroid early; consider ipratropium for severe
exacerbation.
• Reassess work of breathing, PEF, and oxygenation; admit if persistent distress or PEF
<50% after treatment.
Detailed rationale:
SABA reverses bronchospasm quickly; systemic steroids reduce airway inflammation but take
hours to act, so give early. Peak flow provides objective measure of airway obstruction.
Treatment aims to relieve bronchospasm, correct hypoxia, and prevent relapse.
Why frequently tested:
Asthma is common; nurses must triage severity objectively and implement stepwise treatment
and monitoring.
Examiner's note:
Know thresholds (PEF % personal best) that guide discharge vs admission decisions.
6. Immunization contraindication
Scenario: A 7-month-old infant is due for routine vaccinations. The caregiver reports the child
had an anaphylactic reaction to neomycin in the past.
Answer / Key actions:
• Review vaccine components. Live vaccines contraindicated for severe allergy to
vaccine component. For most routine vaccines, consult facility policy and
immunization guidelines; avoid vaccines containing neomycin if truly allergic and
consult allergy/immunology.
• Document reaction and provide alternative scheduling or specialist referral.
Detailed rationale:
True severe allergic reactions to vaccine components are rare but are absolute/relative
contraindications depending on the component. Many vaccines contain trace antibiotics;
careful chart review and specialist input are necessary.
Why frequently tested:
Vaccine safety, contraindications, and informed consent are core pediatric nursing
responsibilities.
Examiner's note:
Emphasize verifying documented allergies and consulting guidelines rather than withholding all
vaccines reflexively.
7. Child with suspected appendicitis
Scenario: An 11-year-old with periumbilical pain migrating to the right lower quadrant,
anorexia and low-grade fever. Guarding and rebound tenderness noted.
Answer / Key actions:
• Prepare for urgent surgical evaluation: NPO, IV access, analgesia per protocol, and
imaging (ultrasound or CT as ordered).
