Pediatric Nursing Midterm Exam Test
Bank 2026/2027 | Verified Questions and
Detailed Answers with Rationales
1. A 3-year-old child is brought to the emergency department with a sudden onset of high
fever, stridor, drooling, and anxious restlessness. The nurse suspects acute epiglottitis.
Which immediate nursing intervention is most appropriate?
A. Examine the throat with a tongue blade to visualize membrane formation
B. Obtain a stat throat culture to identify the causative organism
C. Keep the child calm and avoid invasive procedures while preparing emergency airway
equipment
D. Place the child in a supine position and administer humidified oxygen
Correct Answer: C
Rationale: Acute epiglottitis is a medical emergency. Any inspection of the throat or invasive
procedure (like using a tongue blade or taking a throat swab) can trigger laryngospasm and
complete airway obstruction. The nurse must keep the child calm in a position of comfort
(usually sitting upright) and prepare for emergency endotracheal intubation.
2. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic during a
blood draw ("tet" spell). Which action should the nurse perform first?
A. Administer IV morphine sulfate
B. Place the infant in the knee-chest position
C. Apply 100% oxygen via non-rebreather mask
D. Start an intravenous fluid bolus of normal saline
Correct Answer: B
Rationale: Placing the infant in the knee-chest position increases systemic vascular
resistance (SVR), which decreases the right-to-left shunting across the ventricular septal
defect and improves pulmonary blood flow. Oxygen and morphine are subsequent
interventions.
3. A nurse is caring for an 18-month-old admitted with severe dehydration secondary to
gastroenteritis. Which clinical assessment finding indicates the most critical impairment
of tissue perfusion?
A. Capillary refill time of 4 seconds
B. Sunken anterior fontanelle
C. Dry mucous membranes and absent tears
D. Weight decrease of 8% from baseline
, Correct Answer: A
Rationale: A prolonged capillary refill time (>3–4 seconds), cool extremities, mottled skin,
and tachycardia are direct indicators of impaired peripheral vascular perfusion and worsening
cardiovascular collapse due to hypovolemic shock.
4. A 6-year-old child with asthma is brought to the clinic. The nurse reviews peak
expiratory flow rate (PEFR) monitoring. The child's PEFR reading is in the yellow zone
(65% of personal best). How should the nurse interpret this finding?
A. Asthma is well controlled; continue routine maintenance therapy
B. Medical emergency; administer quick-relief inhaled bronchodilator and seek immediate
care
C. Airway narrowing may be occurring; administer short-acting beta2-agonist as
prescribed
D. Permanent lung remodeling is occurring; request a corticosteroids dosage decrease
Correct Answer: C
Rationale: The yellow zone (50% to 79% of personal best) signals caution and indicates
acute airway narrowing. The patient's action plan typically dictates taking a short-acting
beta2-agonist (like albuterol) and rechecking PEFR.
5. A child with nephrotic syndrome is receiving oral prednisone therapy. Which
instruction should the nurse include in the discharge teaching for the parents?
A. Discontinue the medication immediately once proteinuria resolves
B. Administer the medication on an empty stomach first thing in the morning
C. Avoid live virus vaccines while the child is on immunosuppressive therapy
D. Restrict fluid intake to 500 mL per day for the entire course of therapy
Correct Answer: C
Rationale: Corticosteroids like prednisone induce immunosuppression, placing the child at
high risk for severe complications if given live attenuated vaccines (e.g., MMR, varicella).
Steroids should never be stopped abruptly due to risk of adrenal crisis.
6. A 4-year-old child is admitted with suspected acute glomerulonephritis (AGN). Which
historical finding is most relevant to this diagnosis?
A. Recent streptococcal pharyngitis infection 2 weeks ago
B. History of chronic urinary tract infections
C. Frequent episodes of high-grade fever and joint pain
D. Unintentional weight loss over the past 3 months
Correct Answer: A
Rationale: Post-streptococcal glomerulonephritis (APSGN) typically develops 1 to 3 weeks
after a group A beta-hemolytic streptococcal infection of the throat or skin (impetigo).
, 7. A 2-year-old child is evaluated for developmental milestones. Which motor skill should
the nurse expect a typically developing 24-month-old child to demonstrate?
A. Riding a trike using pedals
B. Kicking a ball forward without falling
C. Hopping on one foot for three consecutive hops
D. Tying shoelaces into a knot
Correct Answer: B
Rationale: By 24 months (2 years), a toddler can kick a ball forward, run, and walk up and
down stairs two feet per step. Riding a tricycle and hopping on one foot are 3-to-4-year-old
gross motor achievements.
8. A infant with pyloric stenosis is admitted for surgical correction. Which classic clinical
manifestation should the nurse anticipate observing during physical assessment?
A. Biliary non-projectile vomiting after every feeding
B. Currant jelly stools mixed with blood and mucus
C. Olive-shaped mass in the right upper quadrant of the abdomen
D. Sausage-shaped mass in the right lower quadrant
Correct Answer: C
Rationale: Hypertrophic pyloric stenosis presents with non-bilious projectile vomiting, visible
gastric peristaltic waves, and a palpable olive-shaped mass in the epigastrium or right upper
quadrant.
9. A nurse is caring for a 10-month-old infant with intussusception. Which triad of clinical
features is hallmark for this condition?
A. Colicky abdominal pain, sausage-shaped abdominal mass, and currant jelly stools
B. Painless rectal bleeding, failure to thrive, and abdominal distension
C. High fever, projectile vomiting, and diarrhea containing bright red blood
D. Rigid abdomen, constant dull aching pain, and rebound tenderness
Correct Answer: A
Rationale: Intussusception classic presentation includes intermittent severe colicky pain, a
sausage-shaped mass in the right upper quadrant, and red "currant jelly" stools containing
blood and mucus.
10. A 5-year-old child with sickle cell anemia is admitted in vaso-occlusive crisis. What is
the priority nursing intervention?
A. Applying cold compresses to swollen joints to relieve pain
B. Administering intravenous fluids and pain management
C. Enforcing strict bed rest without turning to prevent thrombosis
D. Administering rapid-acting packed red blood cell transfusions immediately
Correct Answer: B
Bank 2026/2027 | Verified Questions and
Detailed Answers with Rationales
1. A 3-year-old child is brought to the emergency department with a sudden onset of high
fever, stridor, drooling, and anxious restlessness. The nurse suspects acute epiglottitis.
Which immediate nursing intervention is most appropriate?
A. Examine the throat with a tongue blade to visualize membrane formation
B. Obtain a stat throat culture to identify the causative organism
C. Keep the child calm and avoid invasive procedures while preparing emergency airway
equipment
D. Place the child in a supine position and administer humidified oxygen
Correct Answer: C
Rationale: Acute epiglottitis is a medical emergency. Any inspection of the throat or invasive
procedure (like using a tongue blade or taking a throat swab) can trigger laryngospasm and
complete airway obstruction. The nurse must keep the child calm in a position of comfort
(usually sitting upright) and prepare for emergency endotracheal intubation.
2. An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic during a
blood draw ("tet" spell). Which action should the nurse perform first?
A. Administer IV morphine sulfate
B. Place the infant in the knee-chest position
C. Apply 100% oxygen via non-rebreather mask
D. Start an intravenous fluid bolus of normal saline
Correct Answer: B
Rationale: Placing the infant in the knee-chest position increases systemic vascular
resistance (SVR), which decreases the right-to-left shunting across the ventricular septal
defect and improves pulmonary blood flow. Oxygen and morphine are subsequent
interventions.
3. A nurse is caring for an 18-month-old admitted with severe dehydration secondary to
gastroenteritis. Which clinical assessment finding indicates the most critical impairment
of tissue perfusion?
A. Capillary refill time of 4 seconds
B. Sunken anterior fontanelle
C. Dry mucous membranes and absent tears
D. Weight decrease of 8% from baseline
, Correct Answer: A
Rationale: A prolonged capillary refill time (>3–4 seconds), cool extremities, mottled skin,
and tachycardia are direct indicators of impaired peripheral vascular perfusion and worsening
cardiovascular collapse due to hypovolemic shock.
4. A 6-year-old child with asthma is brought to the clinic. The nurse reviews peak
expiratory flow rate (PEFR) monitoring. The child's PEFR reading is in the yellow zone
(65% of personal best). How should the nurse interpret this finding?
A. Asthma is well controlled; continue routine maintenance therapy
B. Medical emergency; administer quick-relief inhaled bronchodilator and seek immediate
care
C. Airway narrowing may be occurring; administer short-acting beta2-agonist as
prescribed
D. Permanent lung remodeling is occurring; request a corticosteroids dosage decrease
Correct Answer: C
Rationale: The yellow zone (50% to 79% of personal best) signals caution and indicates
acute airway narrowing. The patient's action plan typically dictates taking a short-acting
beta2-agonist (like albuterol) and rechecking PEFR.
5. A child with nephrotic syndrome is receiving oral prednisone therapy. Which
instruction should the nurse include in the discharge teaching for the parents?
A. Discontinue the medication immediately once proteinuria resolves
B. Administer the medication on an empty stomach first thing in the morning
C. Avoid live virus vaccines while the child is on immunosuppressive therapy
D. Restrict fluid intake to 500 mL per day for the entire course of therapy
Correct Answer: C
Rationale: Corticosteroids like prednisone induce immunosuppression, placing the child at
high risk for severe complications if given live attenuated vaccines (e.g., MMR, varicella).
Steroids should never be stopped abruptly due to risk of adrenal crisis.
6. A 4-year-old child is admitted with suspected acute glomerulonephritis (AGN). Which
historical finding is most relevant to this diagnosis?
A. Recent streptococcal pharyngitis infection 2 weeks ago
B. History of chronic urinary tract infections
C. Frequent episodes of high-grade fever and joint pain
D. Unintentional weight loss over the past 3 months
Correct Answer: A
Rationale: Post-streptococcal glomerulonephritis (APSGN) typically develops 1 to 3 weeks
after a group A beta-hemolytic streptococcal infection of the throat or skin (impetigo).
, 7. A 2-year-old child is evaluated for developmental milestones. Which motor skill should
the nurse expect a typically developing 24-month-old child to demonstrate?
A. Riding a trike using pedals
B. Kicking a ball forward without falling
C. Hopping on one foot for three consecutive hops
D. Tying shoelaces into a knot
Correct Answer: B
Rationale: By 24 months (2 years), a toddler can kick a ball forward, run, and walk up and
down stairs two feet per step. Riding a tricycle and hopping on one foot are 3-to-4-year-old
gross motor achievements.
8. A infant with pyloric stenosis is admitted for surgical correction. Which classic clinical
manifestation should the nurse anticipate observing during physical assessment?
A. Biliary non-projectile vomiting after every feeding
B. Currant jelly stools mixed with blood and mucus
C. Olive-shaped mass in the right upper quadrant of the abdomen
D. Sausage-shaped mass in the right lower quadrant
Correct Answer: C
Rationale: Hypertrophic pyloric stenosis presents with non-bilious projectile vomiting, visible
gastric peristaltic waves, and a palpable olive-shaped mass in the epigastrium or right upper
quadrant.
9. A nurse is caring for a 10-month-old infant with intussusception. Which triad of clinical
features is hallmark for this condition?
A. Colicky abdominal pain, sausage-shaped abdominal mass, and currant jelly stools
B. Painless rectal bleeding, failure to thrive, and abdominal distension
C. High fever, projectile vomiting, and diarrhea containing bright red blood
D. Rigid abdomen, constant dull aching pain, and rebound tenderness
Correct Answer: A
Rationale: Intussusception classic presentation includes intermittent severe colicky pain, a
sausage-shaped mass in the right upper quadrant, and red "currant jelly" stools containing
blood and mucus.
10. A 5-year-old child with sickle cell anemia is admitted in vaso-occlusive crisis. What is
the priority nursing intervention?
A. Applying cold compresses to swollen joints to relieve pain
B. Administering intravenous fluids and pain management
C. Enforcing strict bed rest without turning to prevent thrombosis
D. Administering rapid-acting packed red blood cell transfusions immediately
Correct Answer: B
