NUR203
Pediatric Nursing
Midterm Exam Review
2026
Multiple Choice Questions (MCQs)
A 2-year-old with bronchiolitis is admitted with increased work of breathing and hypoxia. Which
intervention is the priority?
a) Administer oral corticosteroids
b) Provide continuous supplemental oxygen
c) Encourage increased oral fluids
d) Start broad-spectrum antibiotics
Answer: b) Provide continuous supplemental oxygen
Rationale: Hypoxia and respiratory distress require immediate oxygen supplementation to maintain
adequate oxygenation and prevent respiratory failure.
In a 6-month-old infant with severe dehydration secondary to gastroenteritis, which fluid is most
appropriate initially?
a) 5% dextrose in water
b) Isotonic saline (0.9% NaCl)
c) Half-normal saline (0.45% NaCl)
d) Dextrose saline (5% dextrose in 0.45% NaCl)
Answer: b) Isotonic saline (0.9% NaCl)
Rationale: Isotonic fluids restore circulatory volume effectively in severe dehydration before maintenance
fluids are started.
A 10-year-old with type 1 diabetes develops nausea, abdominal pain, and Kussmaul respirations. This clinical
picture is most consistent with:
a) Hypoglycemia
b) Diabetic ketoacidosis
c) Hyperosmolar hyperglycemic state
d) Insulin overdose
Answer: b) Diabetic ketoacidosis
Rationale: Kussmaul breathing and abdominal pain with hyperglycemia indicate metabolic acidosis typical in
,diabetic ketoacidosis.
The best pain assessment tool for a preverbal toddler is:
a) Numeric rating scale
b) Wong-Baker FACES scale
c) FLACC scale
d) Visual analogue scale
Answer: c) FLACC scale
Rationale: FLACC (Face, Legs, Activity, Cry, Consolability) is validated for assessing pain in children who
cannot self-report.
Which vaccine is contraindicated in a child undergoing chemotherapy for leukemia?
a) Influenza (inactivated)
b) MMR (measles, mumps, rubella)
c) Hepatitis B
d) DTaP
Answer: b) MMR (measles, mumps, rubella)
Rationale: Live attenuated vaccines like MMR are contraindicated during immunosuppression from
chemotherapy.
True/False Questions
The Apgar score at 5 minutes is more predictive of long-term neurological outcome than the 1-minute score.
True
Rationale: The 5-minute Apgar reflects the infant’s adaptation and predicts neurological prognosis better
than the 1-minute score.
In children, the presence of sinus arrhythmia is always indicative of cardiac pathology.
False
Rationale: Sinus arrhythmia is common and normal in pediatric patients, reflecting vagal tone variations.
The Glasgow Coma Scale can be used as-is for infants under 2 years old.
False
Rationale: The pediatric version of the Glasgow Coma Scale modifies verbal responses appropriate for age.
An elevated lead level in a child is best managed first by chelation therapy regardless of symptom severity.
False
Rationale: Chelation depends on blood lead levels and symptoms; supportive care and environmental
intervention precede chelation in mild cases.
,Kawasaki disease is characterized by mucocutaneous lymph node syndrome and requires treatment with
intravenous immunoglobulin (IVIG).
True
Rationale: Timely IVIG reduces coronary artery complications in Kawasaki disease.
Short Answer Questions
List three clinical signs suggestive of increased intracranial pressure in a pediatric patient.
Answer: Bulging fontanel, irritability or lethargy, vomiting, bradycardia, widened pulse pressure
Rationale: These signs indicate altered brain compliance and require urgent management.
Explain why children are more prone to hypothermia compared to adults.
Answer: Children have a larger surface area to body mass ratio and less subcutaneous fat, leading to more
rapid heat loss.
Rationale: Thermoregulation is less efficient in pediatrics due to physiological differences.
Describe the nursing priority in managing a child with a newly placed tracheostomy.
Answer: Maintaining airway patency through suctioning, monitoring respiratory status closely, and
preventing infection.
Rationale: Airway obstruction risk is high post-tracheostomy, so vigilance is critical.
What is the pathophysiological basis of iron-deficiency anemia in toddlers?
Answer: Insufficient dietary iron intake or poor absorption causes decreased hemoglobin synthesis leading
to microcytic hypochromic anemia.
Rationale: Iron is essential for hemoglobin production, and deficiency impairs oxygen transport.
Identify two routes by which pediatric patients can be administered rapid fluid resuscitation during shock.
Answer: Peripheral intravenous lines, intraosseous access
Rationale: IO access is critical when peripheral IV access is difficult in emergencies.
Matching Questions
16-20. Match the pediatric condition with its typical clinical feature.
Condition Clinical Feature
a) Cystic fibrosis 1) Meconium ileus at birth
b) Intussusception 2) Currant jelly stools
c) Epiglottitis 3) Drooling and muffled voice
d) Congenital heart defect (VSD) 4) Holosystolic murmur
e) Duchenne muscular dystrophy 5) Gower’s sign
Answers:
, a-1, b-2, c-3, d-4, e-5
Rationale: Each feature is a hallmark of the respective pediatric disease.
Fill in the Blank
The hallmark laboratory finding in hemolytic uremic syndrome is __________.
Answer: microangiopathic hemolytic anemia
Rationale: HUS causes red cell fragmentation leading to anemia.
The standard initial treatment for severe asthma exacerbation in children is administration of __________.
Answer: inhaled beta-2 agonists (e.g., albuterol)
Rationale: Beta-2 agonists relieve bronchospasm rapidly.
The pediatric early warning score (PEWS) primarily assists in identifying __________.
Answer: clinical deterioration
Rationale: PEWS triggers timely intervention in worsening patients.
An important nursing consideration when administering digoxin to infants is to check the __________
before dosing.
Answer: heart rate
Rationale: Bradycardia is a contraindication for digoxin administration.
The primary cause of bronchiolitis in infants is infection with __________ virus.
Answer: Respiratory syncytial virus (RSV)
Rationale: RSV is the most common etiologic agent.
Multiple Choice Questions (continued)
Which electrolyte imbalance is a common complication during initiation of parenteral nutrition in
malnourished pediatric patients?
a) Hyperkalemia
b) Hypophosphatemia
c) Hypermagnesemia
d) Hyponatremia
Answer: b) Hypophosphatemia
Rationale: Refeeding syndrome causes intracellular phosphate shift leading to hypophosphatemia.
A 3-year-old child with dehydration is refusing oral fluids. What is the recommended nursing action?
a) Force oral fluids to prevent IV therapy
Pediatric Nursing
Midterm Exam Review
2026
Multiple Choice Questions (MCQs)
A 2-year-old with bronchiolitis is admitted with increased work of breathing and hypoxia. Which
intervention is the priority?
a) Administer oral corticosteroids
b) Provide continuous supplemental oxygen
c) Encourage increased oral fluids
d) Start broad-spectrum antibiotics
Answer: b) Provide continuous supplemental oxygen
Rationale: Hypoxia and respiratory distress require immediate oxygen supplementation to maintain
adequate oxygenation and prevent respiratory failure.
In a 6-month-old infant with severe dehydration secondary to gastroenteritis, which fluid is most
appropriate initially?
a) 5% dextrose in water
b) Isotonic saline (0.9% NaCl)
c) Half-normal saline (0.45% NaCl)
d) Dextrose saline (5% dextrose in 0.45% NaCl)
Answer: b) Isotonic saline (0.9% NaCl)
Rationale: Isotonic fluids restore circulatory volume effectively in severe dehydration before maintenance
fluids are started.
A 10-year-old with type 1 diabetes develops nausea, abdominal pain, and Kussmaul respirations. This clinical
picture is most consistent with:
a) Hypoglycemia
b) Diabetic ketoacidosis
c) Hyperosmolar hyperglycemic state
d) Insulin overdose
Answer: b) Diabetic ketoacidosis
Rationale: Kussmaul breathing and abdominal pain with hyperglycemia indicate metabolic acidosis typical in
,diabetic ketoacidosis.
The best pain assessment tool for a preverbal toddler is:
a) Numeric rating scale
b) Wong-Baker FACES scale
c) FLACC scale
d) Visual analogue scale
Answer: c) FLACC scale
Rationale: FLACC (Face, Legs, Activity, Cry, Consolability) is validated for assessing pain in children who
cannot self-report.
Which vaccine is contraindicated in a child undergoing chemotherapy for leukemia?
a) Influenza (inactivated)
b) MMR (measles, mumps, rubella)
c) Hepatitis B
d) DTaP
Answer: b) MMR (measles, mumps, rubella)
Rationale: Live attenuated vaccines like MMR are contraindicated during immunosuppression from
chemotherapy.
True/False Questions
The Apgar score at 5 minutes is more predictive of long-term neurological outcome than the 1-minute score.
True
Rationale: The 5-minute Apgar reflects the infant’s adaptation and predicts neurological prognosis better
than the 1-minute score.
In children, the presence of sinus arrhythmia is always indicative of cardiac pathology.
False
Rationale: Sinus arrhythmia is common and normal in pediatric patients, reflecting vagal tone variations.
The Glasgow Coma Scale can be used as-is for infants under 2 years old.
False
Rationale: The pediatric version of the Glasgow Coma Scale modifies verbal responses appropriate for age.
An elevated lead level in a child is best managed first by chelation therapy regardless of symptom severity.
False
Rationale: Chelation depends on blood lead levels and symptoms; supportive care and environmental
intervention precede chelation in mild cases.
,Kawasaki disease is characterized by mucocutaneous lymph node syndrome and requires treatment with
intravenous immunoglobulin (IVIG).
True
Rationale: Timely IVIG reduces coronary artery complications in Kawasaki disease.
Short Answer Questions
List three clinical signs suggestive of increased intracranial pressure in a pediatric patient.
Answer: Bulging fontanel, irritability or lethargy, vomiting, bradycardia, widened pulse pressure
Rationale: These signs indicate altered brain compliance and require urgent management.
Explain why children are more prone to hypothermia compared to adults.
Answer: Children have a larger surface area to body mass ratio and less subcutaneous fat, leading to more
rapid heat loss.
Rationale: Thermoregulation is less efficient in pediatrics due to physiological differences.
Describe the nursing priority in managing a child with a newly placed tracheostomy.
Answer: Maintaining airway patency through suctioning, monitoring respiratory status closely, and
preventing infection.
Rationale: Airway obstruction risk is high post-tracheostomy, so vigilance is critical.
What is the pathophysiological basis of iron-deficiency anemia in toddlers?
Answer: Insufficient dietary iron intake or poor absorption causes decreased hemoglobin synthesis leading
to microcytic hypochromic anemia.
Rationale: Iron is essential for hemoglobin production, and deficiency impairs oxygen transport.
Identify two routes by which pediatric patients can be administered rapid fluid resuscitation during shock.
Answer: Peripheral intravenous lines, intraosseous access
Rationale: IO access is critical when peripheral IV access is difficult in emergencies.
Matching Questions
16-20. Match the pediatric condition with its typical clinical feature.
Condition Clinical Feature
a) Cystic fibrosis 1) Meconium ileus at birth
b) Intussusception 2) Currant jelly stools
c) Epiglottitis 3) Drooling and muffled voice
d) Congenital heart defect (VSD) 4) Holosystolic murmur
e) Duchenne muscular dystrophy 5) Gower’s sign
Answers:
, a-1, b-2, c-3, d-4, e-5
Rationale: Each feature is a hallmark of the respective pediatric disease.
Fill in the Blank
The hallmark laboratory finding in hemolytic uremic syndrome is __________.
Answer: microangiopathic hemolytic anemia
Rationale: HUS causes red cell fragmentation leading to anemia.
The standard initial treatment for severe asthma exacerbation in children is administration of __________.
Answer: inhaled beta-2 agonists (e.g., albuterol)
Rationale: Beta-2 agonists relieve bronchospasm rapidly.
The pediatric early warning score (PEWS) primarily assists in identifying __________.
Answer: clinical deterioration
Rationale: PEWS triggers timely intervention in worsening patients.
An important nursing consideration when administering digoxin to infants is to check the __________
before dosing.
Answer: heart rate
Rationale: Bradycardia is a contraindication for digoxin administration.
The primary cause of bronchiolitis in infants is infection with __________ virus.
Answer: Respiratory syncytial virus (RSV)
Rationale: RSV is the most common etiologic agent.
Multiple Choice Questions (continued)
Which electrolyte imbalance is a common complication during initiation of parenteral nutrition in
malnourished pediatric patients?
a) Hyperkalemia
b) Hypophosphatemia
c) Hypermagnesemia
d) Hyponatremia
Answer: b) Hypophosphatemia
Rationale: Refeeding syndrome causes intracellular phosphate shift leading to hypophosphatemia.
A 3-year-old child with dehydration is refusing oral fluids. What is the recommended nursing action?
a) Force oral fluids to prevent IV therapy
