**The Pediatric Prioritization: Acute Illness &
Developmental Emergencies**
Question 1
A 4-month-old infant presents with a fever of 39.5°C (103°F), high-pitched cry, and a bulging anterior
fontanel. What is the priority action?
A. Administer acetaminophen
B. Prepare for lumbar puncture
C. Notify the provider
D. Initiate seizure precautions
---
💫RATIONALE✔️✔️: Fever with bulging fontanel suggests meningitis; immediate provider notification and
likely LP are critical to prevent neurologic damage.
💫ANSWER✔️✔️: C. Notify the provider
Question 2
A 2-year-old child with a barking cough, stridor, and retractions is in respiratory distress. Which
intervention should the nurse anticipate first?
A. Intubation
B. Racemic epinephrine nebulizer
C. Chest physiotherapy
D. Oral dexamethasone
---
💫RATIONALE✔️✔️: Moderate to severe croup requires racemic epinephrine for immediate relief of
subglottic edema.
💫ANSWER✔️✔️: B. Racemic epinephrine nebulizer
Question 3
,A nurse is assessing a 6-month-old infant with suspected intussusception. Which finding is most
characteristic?
A. Bilious vomiting and abdominal distention
B. Currant jelly stools and intermittent abdominal pain
C. Projectile vomiting after feeds
D. Watery diarrhea and fever
---
💫RATIONALE✔️✔️: Intussusception classically presents with episodic colicky pain, vomiting, and red,
jelly-like stools from ischemia.
💫ANSWER✔️✔️: B. Currant jelly stools and intermittent abdominal pain
Question 4
A 3-year-old child with respiratory syncytial virus (RSV) has a respiratory rate of 60, nasal flaring, and
SpO2 of 89% on room air. What is the priority action?
A. Administer a bronchodilator neb
B. Apply oxygen via nasal cannula
C. Suction the nares
D. Notify the provider
---
💫RATIONALE✔️✔️: Hypoxemia (SpO2 <90%) requires immediate oxygen administration; suction may be
done after stabilization.
💫ANSWER✔️✔️: B. Apply oxygen via nasal cannula
Question 5
A 10-year-old with type 1 diabetes has a blood glucose of 450 mg/dL, deep rapid breathing, and fruity
breath odor. Which intervention should the nurse implement first?
A. Administer IV regular insulin bolus
B. Start IV fluids
C. Check serum potassium
D. Give oral glucose
,---
💫RATIONALE✔️✔️: Diabetic ketoacidosis requires volume resuscitation first to correct dehydration and
improve perfusion before insulin.
💫ANSWER✔️✔️: B. Start IV fluids
Question 6
A nurse is caring for a 2-month-old with bronchiolitis. Which finding requires immediate intervention?
A. Respiratory rate 55 breaths/min
B. Apnea for 20 seconds
C. Oxygen saturation 91%
D. Mild intercostal retractions
---
💫RATIONALE✔️✔️: Apnea in young infants with RSV indicates severe disease and impending respiratory
failure.
💫ANSWER✔️✔️: B. Apnea for 20 seconds
Question 7
A 4-year-old with a fever of 40°C (104°F) and sore throat refuses to swallow and is drooling. The child
sits upright with the chin thrust forward. What is the priority action?
A. Inspect the throat with a tongue depressor
B. Prepare for immediate intubation in the OR
C. Administer oral antibiotics
D. Obtain a throat culture
---
💫RATIONALE✔️✔️: Drooling, tripod positioning, and muffled voice suggest epiglottitis; manipulation of
the airway can cause complete obstruction.
💫ANSWER✔️✔️: B. Prepare for immediate intubation in the OR
Question 8
, A 5-year-old with a history of asthma has a peak expiratory flow rate of 45% of personal best, and
albuterol has not improved symptoms. Which medication should the nurse prepare next?
A. Oral prednisolone
B. Ipratropium bromide
C. IV magnesium sulfate
D. Inhaled fluticasone
---
💫RATIONALE✔️✔️: Systemic corticosteroids reduce airway inflammation in moderate to severe
exacerbations; give early to prevent deterioration.
💫ANSWER✔️✔️: A. Oral prednisolone
Question 9
A 2-week-old newborn presents with poor feeding, lethargy, and a temperature of 38.5°C (101.3°F).
What is the most appropriate action?
A. Administer acetaminophen
B. Obtain blood, urine, and CSF cultures
C. Encourage oral feeds every 2 hours
D. Discharge home with follow-up
---
💫RATIONALE✔️✔️: Fever in a neonate (<28 days) is a medical emergency requiring full sepsis workup
and empiric antibiotics.
💫ANSWER✔️✔️: B. Obtain blood, urine, and CSF cultures
Question 10
A nurse is assessing a 9-month-old infant for dehydration after 12 hours of vomiting and diarrhea. Which
finding indicates severe dehydration?
A. Sunken fontanel and dry mucous membranes
B. Capillary refill of 2 seconds
C. Urine output of 4 wet diapers in 12 hours
D. Heart rate 120 bpm
Developmental Emergencies**
Question 1
A 4-month-old infant presents with a fever of 39.5°C (103°F), high-pitched cry, and a bulging anterior
fontanel. What is the priority action?
A. Administer acetaminophen
B. Prepare for lumbar puncture
C. Notify the provider
D. Initiate seizure precautions
---
💫RATIONALE✔️✔️: Fever with bulging fontanel suggests meningitis; immediate provider notification and
likely LP are critical to prevent neurologic damage.
💫ANSWER✔️✔️: C. Notify the provider
Question 2
A 2-year-old child with a barking cough, stridor, and retractions is in respiratory distress. Which
intervention should the nurse anticipate first?
A. Intubation
B. Racemic epinephrine nebulizer
C. Chest physiotherapy
D. Oral dexamethasone
---
💫RATIONALE✔️✔️: Moderate to severe croup requires racemic epinephrine for immediate relief of
subglottic edema.
💫ANSWER✔️✔️: B. Racemic epinephrine nebulizer
Question 3
,A nurse is assessing a 6-month-old infant with suspected intussusception. Which finding is most
characteristic?
A. Bilious vomiting and abdominal distention
B. Currant jelly stools and intermittent abdominal pain
C. Projectile vomiting after feeds
D. Watery diarrhea and fever
---
💫RATIONALE✔️✔️: Intussusception classically presents with episodic colicky pain, vomiting, and red,
jelly-like stools from ischemia.
💫ANSWER✔️✔️: B. Currant jelly stools and intermittent abdominal pain
Question 4
A 3-year-old child with respiratory syncytial virus (RSV) has a respiratory rate of 60, nasal flaring, and
SpO2 of 89% on room air. What is the priority action?
A. Administer a bronchodilator neb
B. Apply oxygen via nasal cannula
C. Suction the nares
D. Notify the provider
---
💫RATIONALE✔️✔️: Hypoxemia (SpO2 <90%) requires immediate oxygen administration; suction may be
done after stabilization.
💫ANSWER✔️✔️: B. Apply oxygen via nasal cannula
Question 5
A 10-year-old with type 1 diabetes has a blood glucose of 450 mg/dL, deep rapid breathing, and fruity
breath odor. Which intervention should the nurse implement first?
A. Administer IV regular insulin bolus
B. Start IV fluids
C. Check serum potassium
D. Give oral glucose
,---
💫RATIONALE✔️✔️: Diabetic ketoacidosis requires volume resuscitation first to correct dehydration and
improve perfusion before insulin.
💫ANSWER✔️✔️: B. Start IV fluids
Question 6
A nurse is caring for a 2-month-old with bronchiolitis. Which finding requires immediate intervention?
A. Respiratory rate 55 breaths/min
B. Apnea for 20 seconds
C. Oxygen saturation 91%
D. Mild intercostal retractions
---
💫RATIONALE✔️✔️: Apnea in young infants with RSV indicates severe disease and impending respiratory
failure.
💫ANSWER✔️✔️: B. Apnea for 20 seconds
Question 7
A 4-year-old with a fever of 40°C (104°F) and sore throat refuses to swallow and is drooling. The child
sits upright with the chin thrust forward. What is the priority action?
A. Inspect the throat with a tongue depressor
B. Prepare for immediate intubation in the OR
C. Administer oral antibiotics
D. Obtain a throat culture
---
💫RATIONALE✔️✔️: Drooling, tripod positioning, and muffled voice suggest epiglottitis; manipulation of
the airway can cause complete obstruction.
💫ANSWER✔️✔️: B. Prepare for immediate intubation in the OR
Question 8
, A 5-year-old with a history of asthma has a peak expiratory flow rate of 45% of personal best, and
albuterol has not improved symptoms. Which medication should the nurse prepare next?
A. Oral prednisolone
B. Ipratropium bromide
C. IV magnesium sulfate
D. Inhaled fluticasone
---
💫RATIONALE✔️✔️: Systemic corticosteroids reduce airway inflammation in moderate to severe
exacerbations; give early to prevent deterioration.
💫ANSWER✔️✔️: A. Oral prednisolone
Question 9
A 2-week-old newborn presents with poor feeding, lethargy, and a temperature of 38.5°C (101.3°F).
What is the most appropriate action?
A. Administer acetaminophen
B. Obtain blood, urine, and CSF cultures
C. Encourage oral feeds every 2 hours
D. Discharge home with follow-up
---
💫RATIONALE✔️✔️: Fever in a neonate (<28 days) is a medical emergency requiring full sepsis workup
and empiric antibiotics.
💫ANSWER✔️✔️: B. Obtain blood, urine, and CSF cultures
Question 10
A nurse is assessing a 9-month-old infant for dehydration after 12 hours of vomiting and diarrhea. Which
finding indicates severe dehydration?
A. Sunken fontanel and dry mucous membranes
B. Capillary refill of 2 seconds
C. Urine output of 4 wet diapers in 12 hours
D. Heart rate 120 bpm
