**The PEDS Edge: Pediatric Nursing
Mastery Certification**
1. A 6-month-old infant is brought to the emergency department with stridor, barking cough, and
respiratory distress that worsens at night. The child is afebrile. What is the priority intervention?
A) Administer racemic epinephrine nebulizer
B) Obtain a lateral neck x-ray
C) Prepare for intubation
D) Give dexamethasone 0.6 mg/kg PO
💫RATIONALE✔️✔️: This presentation is croup (laryngotracheobronchitis). Racemic epinephrine reduces
airway edema rapidly for moderate to severe stridor at rest. Dexamethasone is also given but
epinephrine is first for acute distress.
💫ANSWER✔️✔️: A) Administer racemic epinephrine nebulizer
---
2. A 2-year-old with a history of febrile seizures presents with a temperature of 40°C (104°F) and a
generalized tonic-clonic seizure lasting 4 minutes. The seizure stops spontaneously. What is the priority
action?
A) Administer rectal diazepam 0.5 mg/kg
B) Obtain a stat CT scan of the head
C) Assess airway, breathing, and circulation
D) Give acetaminophen 15 mg/kg PR
💫RATIONALE✔️✔️: After a febrile seizure that has stopped, the priority is post-ictal assessment of
airway, breathing, and oxygenation. Antipyretics do not prevent recurrence. Further workup depends on
clinical picture.
💫ANSWER✔️✔️: C) Assess airway, breathing, and circulation
---
,3. A 4-year-old with acute lymphoblastic leukemia (ALL) has a platelet count of 10,000/mm³. The child is
active and playing. Which activity should the nurse prohibit?
A) Playing with building blocks
B) Riding a tricycle
C) Drawing with crayons
D) Looking at picture books
💫RATIONALE✔️✔️: With severe thrombocytopenia (<20,000), the child is at risk for bleeding from
trauma. Riding a tricycle poses fall risk. Low-risk activities (blocks, drawing, books) are safe.
💫ANSWER✔️✔️: B) Riding a tricycle
---
4. A 3-month-old infant with a fever of 38.5°C (101.3°F) is brought to the clinic. The infant is irritable but
consolable. Immunizations are up to date. What is the most appropriate management?
A) Admit for sepsis workup
B) Obtain blood, urine, and CSF cultures
C) Reassure parents and treat fever with acetaminophen
D) Prescribe oral antibiotics and discharge
💫RATIONALE✔️✔️: A 3-month-old with fever without source requires full sepsis evaluation (blood, urine,
CSF) and admission for empiric antibiotics due to risk of serious bacterial infection. Age <3 months is
high risk.
💫ANSWER✔️✔️: B) Obtain blood, urine, and CSF cultures
---
5. A 7-year-old with status asthmaticus is on continuous albuterol nebulizers. The child develops a heart
rate of 160 bpm and a fine tremor. What is the priority action?
A) Stop the albuterol immediately
B) Switch to levalbuterol
C) Continue albuterol; these are expected side effects
D) Administer propranolol 0.5 mg/kg
💫RATIONALE✔️✔️: Tachycardia and tremor are common beta-agonist side effects. In status asthmaticus,
they are not an indication to stop therapy. Continue and monitor.
,💫ANSWER✔️✔️: C) Continue albuterol; these are expected side effects
---
6. A newborn is 12 hours old and has jaundice visible on the face and chest. The bilirubin level is 12
mg/dL. The newborn is breastfed and otherwise healthy. What is the priority action?
A) Initiate phototherapy
B) Obtain a direct Coombs test
C) Encourage frequent breastfeeding
D) Prepare for exchange transfusion
💫RATIONALE✔️✔️: Physiologic jaundice in a term newborn at 12 hours with level 12 is within expected
range (peak at 72 hours). Encourage frequent feeding to promote excretion. Phototherapy threshold for
12 hours is higher (>15-18 depending on risk).
💫ANSWER✔️✔️: C) Encourage frequent breastfeeding
---
7. A 10-year-old with type 1 diabetes is brought to the school nurse with nausea, abdominal pain, and
fruity breath. The blood glucose is 450 mg/dL. What is the priority action?
A) Give 10 units of rapid-acting insulin
B) Check urine ketones
C) Send the child to the emergency department
D) Give 15 g of carbohydrates
💫RATIONALE✔️✔️: Fruity breath, hyperglycemia, nausea indicate diabetic ketoacidosis (DKA). This is a
medical emergency requiring hospital management (IV fluids, insulin drip). Do not give subcutaneous
insulin in DKA (risk of cerebral edema). Send to ED.
💫ANSWER✔️✔️: C) Send the child to the emergency department
---
8. A 2-month-old infant is scheduled for the first set of immunizations (DTaP, IPV, Hib, PCV13, RV).
Which finding is a contraindication to vaccination?
A) Temperature of 38°C (100.4°F) from a cold
B) History of a seizure after a previous DTaP
, C) Mild upper respiratory infection with runny nose
D) Current antibiotic therapy for otitis media
💫RATIONALE✔️✔️: A true contraindication to DTaP is encephalopathy or seizure within 7 days of a
previous dose. Minor illness with low-grade fever is not a contraindication.
💫ANSWER✔️✔️: B) History of a seizure after a previous DTaP
---
9. A 5-year-old is admitted with nephrotic syndrome. The nurse notes generalized edema, periorbital
swelling, and ascites. Which laboratory finding is expected?
A) Serum albumin 2.0 g/dL (normal 3.5-5.5)
B) Hemoglobin 15 g/dL
C) Serum sodium 150 mEq/L
D) Blood urea nitrogen 5 mg/dL
💫RATIONALE✔️✔️: Nephrotic syndrome causes massive proteinuria leading to hypoalbuminemia
(albumin <2.5). Edema results from decreased oncotic pressure. Hemoglobin may be elevated due to
hemoconcentration, but hypoalbuminemia is diagnostic.
💫ANSWER✔️✔️: A) Serum albumin 2.0 g/dL
---
10. A 3-year-old with respiratory syncytial virus (RSV) bronchiolitis has an oxygen saturation of 88% on
room air, nasal flaring, and grunting. What is the priority intervention?
A) Administer a bronchodilator neb
B) Suction the nares with bulb suction
C) Apply oxygen via nasal cannula at 2 L/min
D) Position the child supine for a chest x-ray
💫RATIONALE✔️✔️: Hypoxia (SpO2 <90%) with retractions and grunting requires supplemental oxygen.
Nasal suctioning may help but oxygen is priority. Bronchodilators are not routinely effective in RSV
bronchiolitis.
💫ANSWER✔️✔️: C) Apply oxygen via nasal cannula at 2 L/min
---
Mastery Certification**
1. A 6-month-old infant is brought to the emergency department with stridor, barking cough, and
respiratory distress that worsens at night. The child is afebrile. What is the priority intervention?
A) Administer racemic epinephrine nebulizer
B) Obtain a lateral neck x-ray
C) Prepare for intubation
D) Give dexamethasone 0.6 mg/kg PO
💫RATIONALE✔️✔️: This presentation is croup (laryngotracheobronchitis). Racemic epinephrine reduces
airway edema rapidly for moderate to severe stridor at rest. Dexamethasone is also given but
epinephrine is first for acute distress.
💫ANSWER✔️✔️: A) Administer racemic epinephrine nebulizer
---
2. A 2-year-old with a history of febrile seizures presents with a temperature of 40°C (104°F) and a
generalized tonic-clonic seizure lasting 4 minutes. The seizure stops spontaneously. What is the priority
action?
A) Administer rectal diazepam 0.5 mg/kg
B) Obtain a stat CT scan of the head
C) Assess airway, breathing, and circulation
D) Give acetaminophen 15 mg/kg PR
💫RATIONALE✔️✔️: After a febrile seizure that has stopped, the priority is post-ictal assessment of
airway, breathing, and oxygenation. Antipyretics do not prevent recurrence. Further workup depends on
clinical picture.
💫ANSWER✔️✔️: C) Assess airway, breathing, and circulation
---
,3. A 4-year-old with acute lymphoblastic leukemia (ALL) has a platelet count of 10,000/mm³. The child is
active and playing. Which activity should the nurse prohibit?
A) Playing with building blocks
B) Riding a tricycle
C) Drawing with crayons
D) Looking at picture books
💫RATIONALE✔️✔️: With severe thrombocytopenia (<20,000), the child is at risk for bleeding from
trauma. Riding a tricycle poses fall risk. Low-risk activities (blocks, drawing, books) are safe.
💫ANSWER✔️✔️: B) Riding a tricycle
---
4. A 3-month-old infant with a fever of 38.5°C (101.3°F) is brought to the clinic. The infant is irritable but
consolable. Immunizations are up to date. What is the most appropriate management?
A) Admit for sepsis workup
B) Obtain blood, urine, and CSF cultures
C) Reassure parents and treat fever with acetaminophen
D) Prescribe oral antibiotics and discharge
💫RATIONALE✔️✔️: A 3-month-old with fever without source requires full sepsis evaluation (blood, urine,
CSF) and admission for empiric antibiotics due to risk of serious bacterial infection. Age <3 months is
high risk.
💫ANSWER✔️✔️: B) Obtain blood, urine, and CSF cultures
---
5. A 7-year-old with status asthmaticus is on continuous albuterol nebulizers. The child develops a heart
rate of 160 bpm and a fine tremor. What is the priority action?
A) Stop the albuterol immediately
B) Switch to levalbuterol
C) Continue albuterol; these are expected side effects
D) Administer propranolol 0.5 mg/kg
💫RATIONALE✔️✔️: Tachycardia and tremor are common beta-agonist side effects. In status asthmaticus,
they are not an indication to stop therapy. Continue and monitor.
,💫ANSWER✔️✔️: C) Continue albuterol; these are expected side effects
---
6. A newborn is 12 hours old and has jaundice visible on the face and chest. The bilirubin level is 12
mg/dL. The newborn is breastfed and otherwise healthy. What is the priority action?
A) Initiate phototherapy
B) Obtain a direct Coombs test
C) Encourage frequent breastfeeding
D) Prepare for exchange transfusion
💫RATIONALE✔️✔️: Physiologic jaundice in a term newborn at 12 hours with level 12 is within expected
range (peak at 72 hours). Encourage frequent feeding to promote excretion. Phototherapy threshold for
12 hours is higher (>15-18 depending on risk).
💫ANSWER✔️✔️: C) Encourage frequent breastfeeding
---
7. A 10-year-old with type 1 diabetes is brought to the school nurse with nausea, abdominal pain, and
fruity breath. The blood glucose is 450 mg/dL. What is the priority action?
A) Give 10 units of rapid-acting insulin
B) Check urine ketones
C) Send the child to the emergency department
D) Give 15 g of carbohydrates
💫RATIONALE✔️✔️: Fruity breath, hyperglycemia, nausea indicate diabetic ketoacidosis (DKA). This is a
medical emergency requiring hospital management (IV fluids, insulin drip). Do not give subcutaneous
insulin in DKA (risk of cerebral edema). Send to ED.
💫ANSWER✔️✔️: C) Send the child to the emergency department
---
8. A 2-month-old infant is scheduled for the first set of immunizations (DTaP, IPV, Hib, PCV13, RV).
Which finding is a contraindication to vaccination?
A) Temperature of 38°C (100.4°F) from a cold
B) History of a seizure after a previous DTaP
, C) Mild upper respiratory infection with runny nose
D) Current antibiotic therapy for otitis media
💫RATIONALE✔️✔️: A true contraindication to DTaP is encephalopathy or seizure within 7 days of a
previous dose. Minor illness with low-grade fever is not a contraindication.
💫ANSWER✔️✔️: B) History of a seizure after a previous DTaP
---
9. A 5-year-old is admitted with nephrotic syndrome. The nurse notes generalized edema, periorbital
swelling, and ascites. Which laboratory finding is expected?
A) Serum albumin 2.0 g/dL (normal 3.5-5.5)
B) Hemoglobin 15 g/dL
C) Serum sodium 150 mEq/L
D) Blood urea nitrogen 5 mg/dL
💫RATIONALE✔️✔️: Nephrotic syndrome causes massive proteinuria leading to hypoalbuminemia
(albumin <2.5). Edema results from decreased oncotic pressure. Hemoglobin may be elevated due to
hemoconcentration, but hypoalbuminemia is diagnostic.
💫ANSWER✔️✔️: A) Serum albumin 2.0 g/dL
---
10. A 3-year-old with respiratory syncytial virus (RSV) bronchiolitis has an oxygen saturation of 88% on
room air, nasal flaring, and grunting. What is the priority intervention?
A) Administer a bronchodilator neb
B) Suction the nares with bulb suction
C) Apply oxygen via nasal cannula at 2 L/min
D) Position the child supine for a chest x-ray
💫RATIONALE✔️✔️: Hypoxia (SpO2 <90%) with retractions and grunting requires supplemental oxygen.
Nasal suctioning may help but oxygen is priority. Bronchodilators are not routinely effective in RSV
bronchiolitis.
💫ANSWER✔️✔️: C) Apply oxygen via nasal cannula at 2 L/min
---
