NR 328 Pediatric Nursing Exam Study Guide, Practice
Questions, Comprehensive Lecture Notes, and ATI-Focused
Review for Pediatric Nursing Concepts, Child Health
Assessment, and NCLEX-Style Preparation for Nursing
Students
Question 1: A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to demonstrate?
A. Walking with assistance
B. Saying two-word phrases
C. Rolling from back to abdomen
D. Building a tower of two blocks
CORRECT ANSWER: C. Rolling from back to abdomen
Rationale: By 6 months of age, most infants can roll from back to abdomen and vice versa.
Walking with assistance typically occurs around 9-12 months, two-word phrases emerge
around 18-24 months, and building blocks is a fine motor skill seen closer to 15-18 months. This
milestone aligns with normal gross motor development per Denver II screening guidelines.
Question 2: A pediatric nurse is preparing to administer an immunization to a 2-month-old
infant. Which vaccine is typically NOT administered at this age according to the CDC
childhood immunization schedule?
A. DTaP (Diphtheria, Tetanus, acellular Pertussis)
B. IPV (Inactivated Poliovirus)
C. MMR (Measles, Mumps, Rubella)
D. PCV13 (Pneumococcal Conjugate)
CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale: The MMR vaccine is first administered at 12-15 months of age. At 2 months, infants
typically receive DTaP, IPV, PCV13, Hib, Rotavirus, and Hepatitis B vaccines. Administering MMR
before 12 months may result in inadequate immune response due to maternal antibody
interference.
Question 3: A nurse is caring for a 4-year-old child diagnosed with acute otitis media. Which
assessment finding is most consistent with this diagnosis?
A. Clear drainage from the ear canal
B. Bulging, erythematous tympanic membrane
C. Pearly gray, translucent tympanic membrane
D. Weber test lateralizing to the unaffected ear
CORRECT ANSWER: B. Bulging, erythematous tympanic membrane
Rationale: Acute otitis media is characterized by inflammation and fluid accumulation behind
the tympanic membrane, causing it to appear bulging and red. Clear drainage suggests otitis
externa or tympanic membrane perforation. A pearly gray membrane is normal. Weber test
findings relate to conductive vs. sensorineural hearing loss, not acute infection diagnosis.
Question 4: A pediatric nurse is calculating the dose of amoxicillin for a child weighing 15 kg.
The prescribed dose is 40 mg/kg/day divided every 8 hours. How many milligrams should the
nurse administer per dose?
,A. 100 mg
B. 200 mg
C. 300 mg
D. 600 mg
CORRECT ANSWER: B. 200 mg
Rationale: Total daily dose = 40 mg/kg × 15 kg = 600 mg/day. Divided every 8 hours means
three doses per day. 600 mg ÷ 3 = 200 mg per dose. Accurate weight-based dosing is critical in
pediatrics to prevent underdosing or toxicity.
Question 5: A nurse is teaching parents about safe sleep practices for their newborn. Which
statement by the parents indicates understanding of SIDS prevention guidelines?
A. "We will place our baby on their side to sleep."
B. "We will use a soft mattress with loose bedding."
C. "We will place our baby on their back on a firm sleep surface."
D. "We will allow our baby to sleep in our bed for easier breastfeeding."
CORRECT ANSWER: C. "We will place our baby on their back on a firm sleep surface."
Rationale: The American Academy of Pediatrics recommends placing infants on their back on a
firm, flat sleep surface without soft bedding, pillows, or toys to reduce SIDS risk. Side sleeping is
unstable and increases risk. Bed-sharing increases suffocation risk. Loose bedding and soft
mattresses are hazardous.
Question 6: A nurse is assessing a 3-year-old child with suspected dehydration. Which clinical
finding is the earliest indicator of mild dehydration in a pediatric patient?
A. Sunken fontanelles
B. Tachycardia
C. Dry mucous membranes
D. Decreased urine output
CORRECT ANSWER: D. Decreased urine output
Rationale: Decreased urine output (fewer than 3 wet diapers in 24 hours) is often the earliest
sign of mild dehydration in children. Dry mucous membranes and tachycardia appear with
moderate dehydration. Sunken fontanelles are late signs seen in severe dehydration,
particularly in infants under 18 months.
Question 7: A pediatric nurse is caring for a child with asthma experiencing an acute
exacerbation. Which medication should the nurse anticipate administering FIRST for
immediate relief?
A. Inhaled corticosteroid
B. Long-acting beta-agonist
C. Short-acting beta-agonist (albuterol)
D. Leukotriene receptor antagonist
CORRECT ANSWER: C. Short-acting beta-agonist (albuterol)
Rationale: Short-acting beta-agonists like albuterol are first-line rescue medications for acute
asthma symptoms due to their rapid bronchodilatory effects within minutes. Inhaled
corticosteroids and leukotriene modifiers are for long-term control. Long-acting beta-agonists
are never used alone for acute relief and require concurrent controller therapy.
,Question 8: A nurse is developing a care plan for a toddler hospitalized for a procedure.
Which intervention best supports family-centered care principles?
A. Limiting parental visitation to reduce infection risk
B. Encouraging parents to participate in comfort measures
C. Performing all care tasks without parental involvement
D. Providing medical updates only to the primary physician
CORRECT ANSWER: B. Encouraging parents to participate in comfort measures
Rationale: Family-centered care recognizes parents as essential partners in a child's care.
Involving parents in comforting their child reduces anxiety, promotes trust, and improves
outcomes. Restricting visitation or excluding parents contradicts this model and may increase
child distress.
Question 9: A nurse is assessing a 9-month-old infant. Which finding would warrant
immediate further evaluation?
A. Unable to stand without support
B. Absent pincer grasp
C. No babbling or consonant sounds
D. Preference for using one hand consistently
CORRECT ANSWER: D. Preference for using one hand consistently
Rationale: Hand preference before 12 months may indicate neurological impairment, such as
cerebral palsy or hemiparesis, as typical development involves bilateral hand use until 18-24
months. Standing without support is not expected until 12 months. Pincer grasp develops
around 9-12 months, and babbling should be present by 7 months.
Question 10: A pediatric nurse is preparing discharge teaching for parents of a child with type
1 diabetes. Which statement by the parents indicates a need for further education?
A. "We will check blood glucose levels before meals and at bedtime."
B. "We can skip insulin doses if our child is not eating well."
C. "We will rotate injection sites to prevent lipohypertrophy."
D. "We will keep fast-acting glucose available for hypoglycemia."
CORRECT ANSWER: B. "We can skip insulin doses if our child is not eating well."
Rationale: Insulin should never be skipped without medical guidance, even with poor oral
intake, as this risks diabetic ketoacidosis. Basal insulin requirements persist regardless of food
intake. Parents should be taught to adjust rapid-acting insulin based on carbohydrate intake
and blood glucose, not omit doses entirely.
Question 11: A nurse is caring for an infant with bronchiolitis. Which intervention is PRIORITY
for this patient?
A. Administering antibiotics prophylactically
B. Maintaining oxygen saturation above 90%
C. Encouraging oral fluids every hour
D. Performing chest physiotherapy routinely
CORRECT ANSWER: B. Maintaining oxygen saturation above 90%
Rationale: Bronchiolitis, typically viral (RSV), causes airway inflammation and hypoxia.
Maintaining adequate oxygenation is the priority intervention. Antibiotics are ineffective
, against viral etiologies. Oral fluids may be difficult due to respiratory distress; IV fluids may be
needed. Chest physiotherapy is not routinely recommended and may increase distress.
Question 12: A pediatric nurse is assessing pain in a nonverbal 2-year-old postoperatively.
Which pain assessment tool is MOST appropriate?
A. Visual Analog Scale (VAS)
B. Numeric Rating Scale (NRS)
C. FLACC Behavioral Pain Scale
D. Wong-Baker FACES Pain Rating Scale
CORRECT ANSWER: C. FLACC Behavioral Pain Scale
Rationale: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is validated for children aged
2 months to 7 years who cannot self-report pain. VAS and NRS require abstract thinking and
numerical comprehension beyond a toddler's capacity. Wong-Baker FACES may be used in
children ≥3 years who can point to faces, but FLACC is more reliable for nonverbal toddlers.
Question 13: A nurse is teaching a school-age child about using a metered-dose inhaler with a
spacer. Which action by the child indicates correct technique?
A. Shaking the inhaler after actuation
B. Inhaling rapidly and deeply immediately after actuation
C. Waiting 1 minute between puffs if two are prescribed
D. Rinsing the mouth with water after administering a corticosteroid inhaler
CORRECT ANSWER: D. Rinsing the mouth with water after administering a corticosteroid
inhaler
Rationale: Rinsing after inhaled corticosteroids reduces the risk of oral candidiasis and
dysphonia. The inhaler should be shaken BEFORE actuation. The child should inhale slowly and
deeply, then hold breath for 5-10 seconds. Waiting 30-60 seconds between puffs is
recommended, but mouth rinsing is critical for steroid safety.
Question 14: A pediatric nurse is caring for a child with celiac disease. Which food should the
nurse ensure is REMOVED from the child's meal tray?
A. Rice cereal
B. Wheat-based pasta
C. Corn tortillas
D. Fresh apples
CORRECT ANSWER: B. Wheat-based pasta
Rationale: Celiac disease requires strict avoidance of gluten-containing grains: wheat, barley,
rye. Wheat-based pasta contains gluten and triggers autoimmune intestinal damage. Rice, corn,
and fruits are naturally gluten-free and safe. Cross-contamination must also be prevented in
food preparation.
Question 15: A nurse is assessing a 5-year-old child with suspected appendicitis. Which
finding is MOST suggestive of this condition?
A. Periumbilical pain that migrates to the right lower quadrant
B. Diffuse abdominal pain with diarrhea
C. Epigastric pain relieved by eating
D. Left lower quadrant tenderness with rebound
Questions, Comprehensive Lecture Notes, and ATI-Focused
Review for Pediatric Nursing Concepts, Child Health
Assessment, and NCLEX-Style Preparation for Nursing
Students
Question 1: A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to demonstrate?
A. Walking with assistance
B. Saying two-word phrases
C. Rolling from back to abdomen
D. Building a tower of two blocks
CORRECT ANSWER: C. Rolling from back to abdomen
Rationale: By 6 months of age, most infants can roll from back to abdomen and vice versa.
Walking with assistance typically occurs around 9-12 months, two-word phrases emerge
around 18-24 months, and building blocks is a fine motor skill seen closer to 15-18 months. This
milestone aligns with normal gross motor development per Denver II screening guidelines.
Question 2: A pediatric nurse is preparing to administer an immunization to a 2-month-old
infant. Which vaccine is typically NOT administered at this age according to the CDC
childhood immunization schedule?
A. DTaP (Diphtheria, Tetanus, acellular Pertussis)
B. IPV (Inactivated Poliovirus)
C. MMR (Measles, Mumps, Rubella)
D. PCV13 (Pneumococcal Conjugate)
CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale: The MMR vaccine is first administered at 12-15 months of age. At 2 months, infants
typically receive DTaP, IPV, PCV13, Hib, Rotavirus, and Hepatitis B vaccines. Administering MMR
before 12 months may result in inadequate immune response due to maternal antibody
interference.
Question 3: A nurse is caring for a 4-year-old child diagnosed with acute otitis media. Which
assessment finding is most consistent with this diagnosis?
A. Clear drainage from the ear canal
B. Bulging, erythematous tympanic membrane
C. Pearly gray, translucent tympanic membrane
D. Weber test lateralizing to the unaffected ear
CORRECT ANSWER: B. Bulging, erythematous tympanic membrane
Rationale: Acute otitis media is characterized by inflammation and fluid accumulation behind
the tympanic membrane, causing it to appear bulging and red. Clear drainage suggests otitis
externa or tympanic membrane perforation. A pearly gray membrane is normal. Weber test
findings relate to conductive vs. sensorineural hearing loss, not acute infection diagnosis.
Question 4: A pediatric nurse is calculating the dose of amoxicillin for a child weighing 15 kg.
The prescribed dose is 40 mg/kg/day divided every 8 hours. How many milligrams should the
nurse administer per dose?
,A. 100 mg
B. 200 mg
C. 300 mg
D. 600 mg
CORRECT ANSWER: B. 200 mg
Rationale: Total daily dose = 40 mg/kg × 15 kg = 600 mg/day. Divided every 8 hours means
three doses per day. 600 mg ÷ 3 = 200 mg per dose. Accurate weight-based dosing is critical in
pediatrics to prevent underdosing or toxicity.
Question 5: A nurse is teaching parents about safe sleep practices for their newborn. Which
statement by the parents indicates understanding of SIDS prevention guidelines?
A. "We will place our baby on their side to sleep."
B. "We will use a soft mattress with loose bedding."
C. "We will place our baby on their back on a firm sleep surface."
D. "We will allow our baby to sleep in our bed for easier breastfeeding."
CORRECT ANSWER: C. "We will place our baby on their back on a firm sleep surface."
Rationale: The American Academy of Pediatrics recommends placing infants on their back on a
firm, flat sleep surface without soft bedding, pillows, or toys to reduce SIDS risk. Side sleeping is
unstable and increases risk. Bed-sharing increases suffocation risk. Loose bedding and soft
mattresses are hazardous.
Question 6: A nurse is assessing a 3-year-old child with suspected dehydration. Which clinical
finding is the earliest indicator of mild dehydration in a pediatric patient?
A. Sunken fontanelles
B. Tachycardia
C. Dry mucous membranes
D. Decreased urine output
CORRECT ANSWER: D. Decreased urine output
Rationale: Decreased urine output (fewer than 3 wet diapers in 24 hours) is often the earliest
sign of mild dehydration in children. Dry mucous membranes and tachycardia appear with
moderate dehydration. Sunken fontanelles are late signs seen in severe dehydration,
particularly in infants under 18 months.
Question 7: A pediatric nurse is caring for a child with asthma experiencing an acute
exacerbation. Which medication should the nurse anticipate administering FIRST for
immediate relief?
A. Inhaled corticosteroid
B. Long-acting beta-agonist
C. Short-acting beta-agonist (albuterol)
D. Leukotriene receptor antagonist
CORRECT ANSWER: C. Short-acting beta-agonist (albuterol)
Rationale: Short-acting beta-agonists like albuterol are first-line rescue medications for acute
asthma symptoms due to their rapid bronchodilatory effects within minutes. Inhaled
corticosteroids and leukotriene modifiers are for long-term control. Long-acting beta-agonists
are never used alone for acute relief and require concurrent controller therapy.
,Question 8: A nurse is developing a care plan for a toddler hospitalized for a procedure.
Which intervention best supports family-centered care principles?
A. Limiting parental visitation to reduce infection risk
B. Encouraging parents to participate in comfort measures
C. Performing all care tasks without parental involvement
D. Providing medical updates only to the primary physician
CORRECT ANSWER: B. Encouraging parents to participate in comfort measures
Rationale: Family-centered care recognizes parents as essential partners in a child's care.
Involving parents in comforting their child reduces anxiety, promotes trust, and improves
outcomes. Restricting visitation or excluding parents contradicts this model and may increase
child distress.
Question 9: A nurse is assessing a 9-month-old infant. Which finding would warrant
immediate further evaluation?
A. Unable to stand without support
B. Absent pincer grasp
C. No babbling or consonant sounds
D. Preference for using one hand consistently
CORRECT ANSWER: D. Preference for using one hand consistently
Rationale: Hand preference before 12 months may indicate neurological impairment, such as
cerebral palsy or hemiparesis, as typical development involves bilateral hand use until 18-24
months. Standing without support is not expected until 12 months. Pincer grasp develops
around 9-12 months, and babbling should be present by 7 months.
Question 10: A pediatric nurse is preparing discharge teaching for parents of a child with type
1 diabetes. Which statement by the parents indicates a need for further education?
A. "We will check blood glucose levels before meals and at bedtime."
B. "We can skip insulin doses if our child is not eating well."
C. "We will rotate injection sites to prevent lipohypertrophy."
D. "We will keep fast-acting glucose available for hypoglycemia."
CORRECT ANSWER: B. "We can skip insulin doses if our child is not eating well."
Rationale: Insulin should never be skipped without medical guidance, even with poor oral
intake, as this risks diabetic ketoacidosis. Basal insulin requirements persist regardless of food
intake. Parents should be taught to adjust rapid-acting insulin based on carbohydrate intake
and blood glucose, not omit doses entirely.
Question 11: A nurse is caring for an infant with bronchiolitis. Which intervention is PRIORITY
for this patient?
A. Administering antibiotics prophylactically
B. Maintaining oxygen saturation above 90%
C. Encouraging oral fluids every hour
D. Performing chest physiotherapy routinely
CORRECT ANSWER: B. Maintaining oxygen saturation above 90%
Rationale: Bronchiolitis, typically viral (RSV), causes airway inflammation and hypoxia.
Maintaining adequate oxygenation is the priority intervention. Antibiotics are ineffective
, against viral etiologies. Oral fluids may be difficult due to respiratory distress; IV fluids may be
needed. Chest physiotherapy is not routinely recommended and may increase distress.
Question 12: A pediatric nurse is assessing pain in a nonverbal 2-year-old postoperatively.
Which pain assessment tool is MOST appropriate?
A. Visual Analog Scale (VAS)
B. Numeric Rating Scale (NRS)
C. FLACC Behavioral Pain Scale
D. Wong-Baker FACES Pain Rating Scale
CORRECT ANSWER: C. FLACC Behavioral Pain Scale
Rationale: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is validated for children aged
2 months to 7 years who cannot self-report pain. VAS and NRS require abstract thinking and
numerical comprehension beyond a toddler's capacity. Wong-Baker FACES may be used in
children ≥3 years who can point to faces, but FLACC is more reliable for nonverbal toddlers.
Question 13: A nurse is teaching a school-age child about using a metered-dose inhaler with a
spacer. Which action by the child indicates correct technique?
A. Shaking the inhaler after actuation
B. Inhaling rapidly and deeply immediately after actuation
C. Waiting 1 minute between puffs if two are prescribed
D. Rinsing the mouth with water after administering a corticosteroid inhaler
CORRECT ANSWER: D. Rinsing the mouth with water after administering a corticosteroid
inhaler
Rationale: Rinsing after inhaled corticosteroids reduces the risk of oral candidiasis and
dysphonia. The inhaler should be shaken BEFORE actuation. The child should inhale slowly and
deeply, then hold breath for 5-10 seconds. Waiting 30-60 seconds between puffs is
recommended, but mouth rinsing is critical for steroid safety.
Question 14: A pediatric nurse is caring for a child with celiac disease. Which food should the
nurse ensure is REMOVED from the child's meal tray?
A. Rice cereal
B. Wheat-based pasta
C. Corn tortillas
D. Fresh apples
CORRECT ANSWER: B. Wheat-based pasta
Rationale: Celiac disease requires strict avoidance of gluten-containing grains: wheat, barley,
rye. Wheat-based pasta contains gluten and triggers autoimmune intestinal damage. Rice, corn,
and fruits are naturally gluten-free and safe. Cross-contamination must also be prevented in
food preparation.
Question 15: A nurse is assessing a 5-year-old child with suspected appendicitis. Which
finding is MOST suggestive of this condition?
A. Periumbilical pain that migrates to the right lower quadrant
B. Diffuse abdominal pain with diarrhea
C. Epigastric pain relieved by eating
D. Left lower quadrant tenderness with rebound
