NURS240 – Pediatric Nursing | Comprehensive Study
Guide, Practice Exam, Exam Questions & Answers, Exam
Prep Test Bank, Growth & Development, Pediatric
Assessment, Family-Centered Care, Pediatric
Pharmacology, Neonatal Care, Childhood Disorders,
Clinical Judgment, Patient Safety, Detailed Rationales,
Nursing Success Review
Question 1: A 2-year-old child is brought to the emergency department with
inspiratory stridor, a barking cough, and moderate subcostal retractions. The
child is afebrile and has been playful between coughing episodes. Which of the
following is the priority nursing intervention?
A. Prepare for immediate endotracheal intubation
B. Administer a racemic epinephrine nebulizer treatment
C. Obtain a lateral neck radiograph
D. Place the child in a mist tent with cool humidified oxygen
CORRECT ANSWER: B. Administer a racemic epinephrine nebulizer treatment
Rationale: This child's presentation is classic for moderate to severe croup
(laryngotracheobronchitis), characterized by a barking cough, inspiratory stridor, and
retractions. Racemic epinephrine is the first-line pharmacological treatment for
moderate to severe croup to reduce airway mucosal edema. While cool mist can be
soothing, it is not the priority intervention. Intubation is reserved for impending
respiratory failure. A lateral neck film is used to rule out epiglottitis, but this presentation
is more consistent with croup.
Question 2: The parent of a 4-year-old child with a new diagnosis of type 1
diabetes mellitus asks the nurse why the child must take insulin injections
instead of oral medications. Which response by the nurse is most accurate?
A. "The pancreas is producing insulin, but the body's cells are resistant to it."
B. "The immune system has destroyed the cells that produce insulin in the pancreas."
C. "The child's liver is overproducing glucose, and insulin helps to counteract this."
D. "The child's body cannot absorb oral medications due to gastrointestinal immaturity."
CORRECT ANSWER: B. "The immune system has destroyed the cells that
produce insulin in the pancreas."
Rationale: Type 1 diabetes mellitus is an autoimmune condition in which the body's
immune system attacks and destroys the beta cells in the islets of Langerhans of the
pancreas, resulting in an absolute insulin deficiency. Therefore, exogenous insulin must
be administered via injection. Option A describes type 2 diabetes. Option C is incorrect
as the liver does not overproduce glucose in type 1 diabetes. Option D is inaccurate
regarding oral medication absorption.
,Question 3: A school-aged child is prescribed methylphenidate for attention
deficit hyperactivity disorder (ADHD). Which assessment finding is most
important for the nurse to report to the healthcare provider?
A. The child reports a loss of appetite at lunchtime.
B. The child's heart rate is 15 beats per minute above baseline.
C. The child reports difficulty falling asleep at night.
D. The child's weight has decreased by 3 pounds in one month.
CORRECT ANSWER: D. The child's weight has decreased by 3 pounds in one
month.
Rationale: Methylphenidate is a central nervous system stimulant that commonly causes
appetite suppression and weight loss. A weight loss of 3 pounds in one month in a
school-aged child is significant and warrants immediate reporting to the healthcare
provider to prevent growth suppression. While tachycardia, insomnia, and appetite loss
are side effects, a significant weight loss is the most critical finding that requires prompt
intervention, such as adjusting the medication schedule or dosage.
Question 4: A nurse is providing anticipatory guidance to the parents of a 6-
month-old infant. Which statement by the parents indicates a need for further
teaching regarding injury prevention?
A. "We will set our water heater thermostat to 120 degrees Fahrenheit."
B. "We should start child-proofing our cabinets now that our baby is more mobile."
C. "It's safe for our baby to sleep in our bed with us for the first year."
D. "We will place our baby on the back to sleep."
CORRECT ANSWER: C. "It's safe for our baby to sleep in our bed with us for
the first year."
Rationale: Co-sleeping or bed-sharing significantly increases the risk of Sudden Infant
Death Syndrome (SIDS) and accidental suffocation. The American Academy of
Pediatrics recommends that infants sleep in the same room as parents but on a separate
sleep surface, such as a crib or bassinet, for at least the first year of life. Options A, B,
and D are correct anticipatory guidance measures.
Question 5: A 10-year-old child with cystic fibrosis is admitted with a
pulmonary exacerbation. The nurse notes that the child has a frequent,
productive cough with thick, greenish sputum. Which of the following
interventions should the nurse implement first?
A. Administer a prescribed bronchodilator
B. Initiate chest physiotherapy (CPT)
C. Obtain a sputum culture
D. Administer pancreatic enzyme supplements with meals
,CORRECT ANSWER: C. Obtain a sputum culture
Rationale: In a child with cystic fibrosis experiencing a pulmonary exacerbation, the
priority is to obtain a sputum culture before initiating antibiotic therapy to identify the
causative organism and guide appropriate treatment. While bronchodilators and CPT
are important therapies, they should not delay the collection of a culture. Pancreatic
enzymes are for malabsorption issues, not the acute pulmonary exacerbation.
Question 6: The nurse is caring for a 14-year-old adolescent who had a spinal
fusion for scoliosis. Which postoperative assessment finding requires
immediate action by the nurse?
A. Pain rated as 6 on a scale of 0 to 10
B. Capillary refill of 3 seconds in the lower extremities
C. Inability to move the toes bilaterally
D. Mild erythema around the incision site
CORRECT ANSWER: C. Inability to move the toes bilaterally
Rationale: After a spinal fusion, the inability to move the toes is a sign of potential spinal
cord compression or neurological deficit. This is an emergent finding that requires
immediate notification of the surgeon. Pain, prolonged capillary refill, and mild
erythema are concerning but are not as immediately life- or function-threatening as a
potential spinal cord injury.
Question 7: A 16-year-old female reports that she has not had a menstrual
period for the past 4 months. She is not sexually active, has had a normal
growth pattern, and a physical exam is unremarkable. Which of the following
nursing actions is most appropriate?
A. Reassure the mother that this is a normal variation
B. Prepare the adolescent for a pelvic ultrasound
C. Assess the adolescent's dietary intake and exercise habits
D. Administer a pregnancy test as per protocol
CORRECT ANSWER: C. Assess the adolescent's dietary intake and exercise
habits
Rationale: Secondary amenorrhea in an adolescent is often related to lifestyle factors.
The most common causes include excessive exercise, eating disorders (such as anorexia
nervosa), and significant weight loss. While not sexually active, a pregnancy test is
standard but not the first assessment priority. An ultrasound is not a first-line
assessment. Reassurance without investigation is not appropriate in this situation.
, Question 8: The nurse is assessing a newborn infant and notes a high-pitched,
continuous cry, poor feeding, and hypertonicity. Which maternal history
finding is most relevant to these findings?
A. Maternal history of opioid use during pregnancy
B. Maternal history of gestational diabetes
C. Maternal history of preeclampsia
D. Maternal history of alcohol use during pregnancy
CORRECT ANSWER: A. Maternal history of opioid use during pregnancy
Rationale: High-pitched crying, poor feeding, and hypertonicity are classic signs of
neonatal abstinence syndrome (NAS), which results from in-utero exposure to opioids.
These neurological and gastrointestinal symptoms are due to the withdrawal of the
substance after birth. Gestational diabetes, preeclampsia, and alcohol use have different
presentations.
Question 9: A 2-month-old infant is brought to the clinic for a well-child visit.
The nurse notes that the infant is unable to lift his head when placed on his
stomach. Which of the following is the most appropriate nursing action?
A. Document the findings and continue the assessment
B. Refer the infant to a neurologist immediately
C. Instruct the parents on how to perform range-of-motion exercises
D. Ask the parents about the infant's birth history
CORRECT ANSWER: A. Document the findings and continue the assessment
Rationale: At 2 months of age, an infant is expected to be able to lift their head briefly
when in the prone position. The inability to do so is a significant developmental delay
that requires documentation and further assessment, including a complete neurologic
exam and possibly a referral. The first step is to document and continue the assessment.
Instructing parents on exercises is not the priority at this moment.
Question 10: The nurse is preparing to administer immunizations to a 6-
month-old infant. Which of the following vaccines should the nurse plan to
administer at this visit?
A. DTaP, IPV, Hib, PCV, Hepatitis B, and Rotavirus
B. DTaP, IPV, Hib, PCV, and Rotavirus
C. DTaP, IPV, Hib, PCV, and Hepatitis B
D. DTaP, IPV, Hib, and PCV
CORRECT ANSWER: B. DTaP, IPV, Hib, PCV, and Rotavirus
Rationale: At the 6-month well-child visit, the recommended vaccines include DTaP
(diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus
Guide, Practice Exam, Exam Questions & Answers, Exam
Prep Test Bank, Growth & Development, Pediatric
Assessment, Family-Centered Care, Pediatric
Pharmacology, Neonatal Care, Childhood Disorders,
Clinical Judgment, Patient Safety, Detailed Rationales,
Nursing Success Review
Question 1: A 2-year-old child is brought to the emergency department with
inspiratory stridor, a barking cough, and moderate subcostal retractions. The
child is afebrile and has been playful between coughing episodes. Which of the
following is the priority nursing intervention?
A. Prepare for immediate endotracheal intubation
B. Administer a racemic epinephrine nebulizer treatment
C. Obtain a lateral neck radiograph
D. Place the child in a mist tent with cool humidified oxygen
CORRECT ANSWER: B. Administer a racemic epinephrine nebulizer treatment
Rationale: This child's presentation is classic for moderate to severe croup
(laryngotracheobronchitis), characterized by a barking cough, inspiratory stridor, and
retractions. Racemic epinephrine is the first-line pharmacological treatment for
moderate to severe croup to reduce airway mucosal edema. While cool mist can be
soothing, it is not the priority intervention. Intubation is reserved for impending
respiratory failure. A lateral neck film is used to rule out epiglottitis, but this presentation
is more consistent with croup.
Question 2: The parent of a 4-year-old child with a new diagnosis of type 1
diabetes mellitus asks the nurse why the child must take insulin injections
instead of oral medications. Which response by the nurse is most accurate?
A. "The pancreas is producing insulin, but the body's cells are resistant to it."
B. "The immune system has destroyed the cells that produce insulin in the pancreas."
C. "The child's liver is overproducing glucose, and insulin helps to counteract this."
D. "The child's body cannot absorb oral medications due to gastrointestinal immaturity."
CORRECT ANSWER: B. "The immune system has destroyed the cells that
produce insulin in the pancreas."
Rationale: Type 1 diabetes mellitus is an autoimmune condition in which the body's
immune system attacks and destroys the beta cells in the islets of Langerhans of the
pancreas, resulting in an absolute insulin deficiency. Therefore, exogenous insulin must
be administered via injection. Option A describes type 2 diabetes. Option C is incorrect
as the liver does not overproduce glucose in type 1 diabetes. Option D is inaccurate
regarding oral medication absorption.
,Question 3: A school-aged child is prescribed methylphenidate for attention
deficit hyperactivity disorder (ADHD). Which assessment finding is most
important for the nurse to report to the healthcare provider?
A. The child reports a loss of appetite at lunchtime.
B. The child's heart rate is 15 beats per minute above baseline.
C. The child reports difficulty falling asleep at night.
D. The child's weight has decreased by 3 pounds in one month.
CORRECT ANSWER: D. The child's weight has decreased by 3 pounds in one
month.
Rationale: Methylphenidate is a central nervous system stimulant that commonly causes
appetite suppression and weight loss. A weight loss of 3 pounds in one month in a
school-aged child is significant and warrants immediate reporting to the healthcare
provider to prevent growth suppression. While tachycardia, insomnia, and appetite loss
are side effects, a significant weight loss is the most critical finding that requires prompt
intervention, such as adjusting the medication schedule or dosage.
Question 4: A nurse is providing anticipatory guidance to the parents of a 6-
month-old infant. Which statement by the parents indicates a need for further
teaching regarding injury prevention?
A. "We will set our water heater thermostat to 120 degrees Fahrenheit."
B. "We should start child-proofing our cabinets now that our baby is more mobile."
C. "It's safe for our baby to sleep in our bed with us for the first year."
D. "We will place our baby on the back to sleep."
CORRECT ANSWER: C. "It's safe for our baby to sleep in our bed with us for
the first year."
Rationale: Co-sleeping or bed-sharing significantly increases the risk of Sudden Infant
Death Syndrome (SIDS) and accidental suffocation. The American Academy of
Pediatrics recommends that infants sleep in the same room as parents but on a separate
sleep surface, such as a crib or bassinet, for at least the first year of life. Options A, B,
and D are correct anticipatory guidance measures.
Question 5: A 10-year-old child with cystic fibrosis is admitted with a
pulmonary exacerbation. The nurse notes that the child has a frequent,
productive cough with thick, greenish sputum. Which of the following
interventions should the nurse implement first?
A. Administer a prescribed bronchodilator
B. Initiate chest physiotherapy (CPT)
C. Obtain a sputum culture
D. Administer pancreatic enzyme supplements with meals
,CORRECT ANSWER: C. Obtain a sputum culture
Rationale: In a child with cystic fibrosis experiencing a pulmonary exacerbation, the
priority is to obtain a sputum culture before initiating antibiotic therapy to identify the
causative organism and guide appropriate treatment. While bronchodilators and CPT
are important therapies, they should not delay the collection of a culture. Pancreatic
enzymes are for malabsorption issues, not the acute pulmonary exacerbation.
Question 6: The nurse is caring for a 14-year-old adolescent who had a spinal
fusion for scoliosis. Which postoperative assessment finding requires
immediate action by the nurse?
A. Pain rated as 6 on a scale of 0 to 10
B. Capillary refill of 3 seconds in the lower extremities
C. Inability to move the toes bilaterally
D. Mild erythema around the incision site
CORRECT ANSWER: C. Inability to move the toes bilaterally
Rationale: After a spinal fusion, the inability to move the toes is a sign of potential spinal
cord compression or neurological deficit. This is an emergent finding that requires
immediate notification of the surgeon. Pain, prolonged capillary refill, and mild
erythema are concerning but are not as immediately life- or function-threatening as a
potential spinal cord injury.
Question 7: A 16-year-old female reports that she has not had a menstrual
period for the past 4 months. She is not sexually active, has had a normal
growth pattern, and a physical exam is unremarkable. Which of the following
nursing actions is most appropriate?
A. Reassure the mother that this is a normal variation
B. Prepare the adolescent for a pelvic ultrasound
C. Assess the adolescent's dietary intake and exercise habits
D. Administer a pregnancy test as per protocol
CORRECT ANSWER: C. Assess the adolescent's dietary intake and exercise
habits
Rationale: Secondary amenorrhea in an adolescent is often related to lifestyle factors.
The most common causes include excessive exercise, eating disorders (such as anorexia
nervosa), and significant weight loss. While not sexually active, a pregnancy test is
standard but not the first assessment priority. An ultrasound is not a first-line
assessment. Reassurance without investigation is not appropriate in this situation.
, Question 8: The nurse is assessing a newborn infant and notes a high-pitched,
continuous cry, poor feeding, and hypertonicity. Which maternal history
finding is most relevant to these findings?
A. Maternal history of opioid use during pregnancy
B. Maternal history of gestational diabetes
C. Maternal history of preeclampsia
D. Maternal history of alcohol use during pregnancy
CORRECT ANSWER: A. Maternal history of opioid use during pregnancy
Rationale: High-pitched crying, poor feeding, and hypertonicity are classic signs of
neonatal abstinence syndrome (NAS), which results from in-utero exposure to opioids.
These neurological and gastrointestinal symptoms are due to the withdrawal of the
substance after birth. Gestational diabetes, preeclampsia, and alcohol use have different
presentations.
Question 9: A 2-month-old infant is brought to the clinic for a well-child visit.
The nurse notes that the infant is unable to lift his head when placed on his
stomach. Which of the following is the most appropriate nursing action?
A. Document the findings and continue the assessment
B. Refer the infant to a neurologist immediately
C. Instruct the parents on how to perform range-of-motion exercises
D. Ask the parents about the infant's birth history
CORRECT ANSWER: A. Document the findings and continue the assessment
Rationale: At 2 months of age, an infant is expected to be able to lift their head briefly
when in the prone position. The inability to do so is a significant developmental delay
that requires documentation and further assessment, including a complete neurologic
exam and possibly a referral. The first step is to document and continue the assessment.
Instructing parents on exercises is not the priority at this moment.
Question 10: The nurse is preparing to administer immunizations to a 6-
month-old infant. Which of the following vaccines should the nurse plan to
administer at this visit?
A. DTaP, IPV, Hib, PCV, Hepatitis B, and Rotavirus
B. DTaP, IPV, Hib, PCV, and Rotavirus
C. DTaP, IPV, Hib, PCV, and Hepatitis B
D. DTaP, IPV, Hib, and PCV
CORRECT ANSWER: B. DTaP, IPV, Hib, PCV, and Rotavirus
Rationale: At the 6-month well-child visit, the recommended vaccines include DTaP
(diphtheria, tetanus, acellular pertussis), IPV (inactivated poliovirus), Hib (Haemophilus
