NURS240 – Pediatric Nursing | Comprehensive
Study Guide, Practice Exam, Exam Questions &
Answers, Exam Prep Test Bank, Growth &
Development, Pediatric Assessment, Family-
Centered Care, Neonatal Nursing, Pediatric
Pharmacology, Childhood Disorders,
Immunizations, Medication Administration,
Clinical Judgment, Detailed Rationales, Nursing
Success Review
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of a barking cough, hoarseness, and inspiratory stridor. Which of
the following is the priority nursing intervention?
A. Prepare for immediate endotracheal intubation.
B. Administer a nebulized racemic epinephrine treatment.
C. Obtain a throat culture to rule out bacterial epiglottitis.
D. Place the child in a position of comfort and administer cool mist.
CORRECT ANSWER: D. Place the child in a position of comfort and administer
cool mist.
Rationale:The child's symptoms are classic for croup (laryngotracheobronchitis), a viral
illness causing subglottic swelling. The priority is to reduce anxiety and work of
breathing. Placing the child in a position of comfort (often sitting upright) and providing
cool mist helps decrease airway edema and stridor. While racemic epinephrine is a
treatment for moderate to severe croup, the initial non-invasive intervention is
positioning and mist. Immediate intubation is reserved for impending respiratory failure,
and a throat culture is not the priority and may distress the child, worsening the
obstruction.
Question 2: The mother of a 2-month-old infant reports that the infant has
been crying for 3 hours, drawing knees to the chest, and has passed a "currant
jelly" stool. What is the most appropriate initial nursing action?
A. Administer a dose of simethicone drops.
B. Prepare the infant for a barium enema.
C. Offer the infant a glucose water feeding.
D. Apply a warm compress to the infant's abdomen.
CORRECT ANSWER: B. Prepare the infant for a barium enema.
Rationale:The presentation of inconsolable crying, drawing knees to chest, and "currant
jelly" stools is highly indicative of intussusception, where one segment of bowel
telescopes into another. A barium enema is both diagnostic and often therapeutic as the
,hydrostatic pressure can reduce the intussusception. Simethicone is for gas pain, glucose
water is not a treatment, and a warm compress is not appropriate for this life-threatening
condition, which requires immediate medical intervention.
Question 3: When performing a developmental assessment on a 12-month-old
infant, which of the following fine motor skills would the nurse expect to
observe?
A. Grasping a rattle voluntarily.
B. Building a tower of three blocks.
C. Holding a crayon with a mature tripod grip.
D. Using a neat pincer grasp to pick up a small pellet.
CORRECT ANSWER: D. Using a neat pincer grasp to pick up a small pellet.
Rationale:By 12 months of age, an infant typically develops the ability to use a neat
pincer grasp, picking up small objects with the tips of the thumb and forefinger.
Voluntary grasping of a rattle occurs around 4-5 months. Building a tower of three
blocks is a skill of an 18-24 month old, and a mature tripod grip is not expected until
preschool age (4-5 years).
Question 4: An infant with bronchiolitis is receiving oxygen via a nasal
cannula. Which assessment finding indicates an improvement in the infant's
respiratory status?
A. Respiratory rate has decreased from 50 to 30 breaths per minute.
B. The infant's anterior fontanel is bulging.
C. The infant is using accessory muscles to breathe.
D. Heart rate has increased from 120 to 150 beats per minute.
CORRECT ANSWER: A. Respiratory rate has decreased from 50 to 30 breaths
per minute.
Rationale:A normal respiratory rate for an infant is typically 20-30 breaths per minute.
A decrease in respiratory rate from a tachypneic state towards the normal range
indicates that the infant is compensating effectively and the respiratory distress is
resolving. A bulging fontanel is a sign of increased intracranial pressure. Accessory
muscle use and tachycardia are signs of worsening respiratory distress and hypoxia.
Question 5: A child with type 1 diabetes mellitus is experiencing symptoms of
hypoglycemia. The child is alert and able to swallow. Which of the following
should the nurse administer first?
A. 10 units of regular insulin subcutaneously.
B. 4 ounces of orange juice.
,C. 1 mg of glucagon intramuscularly.
D. 50 ml of 50% dextrose intravenously.
CORRECT ANSWER: B. 4 ounces of orange juice.
Rationale:The "Rule of 15" for treating mild to moderate hypoglycemia in a conscious,
cooperative child is to administer a quick-acting source of glucose such as 4-6 ounces of
orange juice or milk. Glucagon and IV dextrose are reserved for unconscious patients or
those unable to swallow, and insulin would further lower blood glucose.
Question 6: The nurse is caring for a 6-month-old infant hospitalized with RSV
bronchiolitis. Which positioning technique is most appropriate to facilitate
drainage of respiratory secretions?
A. Trendelenburg position.
B. Supine position with the head of the bed flat.
C. Side-lying position.
D. Prone position.
CORRECT ANSWER: C. Side-lying position.
Rationale:For infants with respiratory illnesses, the side-lying position promotes
drainage of oral and nasal secretions by allowing them to pool at the side of the cheek,
preventing aspiration and facilitating suctioning. The Trendelenburg position is
contraindicated in respiratory distress as it pushes abdominal contents against the
diaphragm. The supine flat position can increase the risk of aspiration, and the prone
position is not recommended due to the risk of SIDS and does not facilitate drainage as
effectively.
Question 7: A nurse is educating a family about home care for their child who
has just been diagnosed with cystic fibrosis. Which statement by the parent
indicates a need for further teaching regarding pancreatic enzyme
administration?
A. "I will mix the enzyme beads in a small amount of applesauce."
B. "I should give the enzymes at the beginning of each meal or snack."
C. "If my child does not eat all of the meal, I will still give the full dose of enzymes."
D. "The capsule can be opened and sprinkled on the food if my child cannot swallow it."
CORRECT ANSWER: C. "If my child does not eat all of the meal, I will still give
the full dose of enzymes."
Rationale:Pancreatic enzyme dosage should be based on the amount of fat consumed.
If a child does not finish a meal, the dose should be adjusted (less enzyme given) to
match the intake to prevent hyperdose-related complications like fibrosing colonopathy.
The other statements are correct regarding administration.
, Question 8: Which of the following laboratory findings is most characteristic of
a child with acute post-streptococcal glomerulonephritis (APSGN)?
A. Elevated serum complement C3 levels.
B. Hypokalemia.
C. Hematuria and proteinuria.
D. Positive blood culture.
CORRECT ANSWER: C. Hematuria and proteinuria.
Rationale:APSGN is characterized by immune-complex deposition in the glomeruli,
leading to inflammation. This results in red blood cells leaking into the urine
(hematuria), which gives the urine a smoky or cola-colored appearance, and protein
leaking into the urine (proteinuria). Complement C3 levels are typically decreased in the
acute phase, not elevated. Potassium is usually normal or slightly elevated, and blood
cultures are negative because it is a post-infectious, not a septic, process.
Question 9: The nurse is caring for a child in sickle cell crisis who is
complaining of severe joint pain. Which of the following nursing interventions
is a priority?
A. Apply cold compresses to the affected joints.
B. Administer prescribed opioid analgesics as scheduled and PRN.
C. Restrict oral fluid intake to decrease joint swelling.
D. Maintain the affected joint in a dependent position.
CORRECT ANSWER: B. Administer prescribed opioid analgesics as scheduled
and PRN.
Rationale:Pain in sickle cell crisis is caused by vaso-occlusion and ischemia, which is
often severe and requires aggressive pain management. Opioid analgesics are the
mainstay of treatment. Cold compresses can cause vasoconstriction and worsen the
crisis. Hydration is crucial to reduce blood viscosity, so fluids should be encouraged, not
restricted. The joint should be elevated and kept in a position of comfort.
Question 10: A 15-year-old patient diagnosed with scoliosis is prescribed a
brace. Which statement by the adolescent indicates an understanding of the
treatment plan?
A. "I can take my brace off for up to 2 hours each day for bathing and skin care."
B. "I will wear my brace only at night while sleeping."
C. "I should wear the brace over a thin t-shirt to protect my skin."
D. "I will stop wearing the brace once my pain is gone."
Study Guide, Practice Exam, Exam Questions &
Answers, Exam Prep Test Bank, Growth &
Development, Pediatric Assessment, Family-
Centered Care, Neonatal Nursing, Pediatric
Pharmacology, Childhood Disorders,
Immunizations, Medication Administration,
Clinical Judgment, Detailed Rationales, Nursing
Success Review
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of a barking cough, hoarseness, and inspiratory stridor. Which of
the following is the priority nursing intervention?
A. Prepare for immediate endotracheal intubation.
B. Administer a nebulized racemic epinephrine treatment.
C. Obtain a throat culture to rule out bacterial epiglottitis.
D. Place the child in a position of comfort and administer cool mist.
CORRECT ANSWER: D. Place the child in a position of comfort and administer
cool mist.
Rationale:The child's symptoms are classic for croup (laryngotracheobronchitis), a viral
illness causing subglottic swelling. The priority is to reduce anxiety and work of
breathing. Placing the child in a position of comfort (often sitting upright) and providing
cool mist helps decrease airway edema and stridor. While racemic epinephrine is a
treatment for moderate to severe croup, the initial non-invasive intervention is
positioning and mist. Immediate intubation is reserved for impending respiratory failure,
and a throat culture is not the priority and may distress the child, worsening the
obstruction.
Question 2: The mother of a 2-month-old infant reports that the infant has
been crying for 3 hours, drawing knees to the chest, and has passed a "currant
jelly" stool. What is the most appropriate initial nursing action?
A. Administer a dose of simethicone drops.
B. Prepare the infant for a barium enema.
C. Offer the infant a glucose water feeding.
D. Apply a warm compress to the infant's abdomen.
CORRECT ANSWER: B. Prepare the infant for a barium enema.
Rationale:The presentation of inconsolable crying, drawing knees to chest, and "currant
jelly" stools is highly indicative of intussusception, where one segment of bowel
telescopes into another. A barium enema is both diagnostic and often therapeutic as the
,hydrostatic pressure can reduce the intussusception. Simethicone is for gas pain, glucose
water is not a treatment, and a warm compress is not appropriate for this life-threatening
condition, which requires immediate medical intervention.
Question 3: When performing a developmental assessment on a 12-month-old
infant, which of the following fine motor skills would the nurse expect to
observe?
A. Grasping a rattle voluntarily.
B. Building a tower of three blocks.
C. Holding a crayon with a mature tripod grip.
D. Using a neat pincer grasp to pick up a small pellet.
CORRECT ANSWER: D. Using a neat pincer grasp to pick up a small pellet.
Rationale:By 12 months of age, an infant typically develops the ability to use a neat
pincer grasp, picking up small objects with the tips of the thumb and forefinger.
Voluntary grasping of a rattle occurs around 4-5 months. Building a tower of three
blocks is a skill of an 18-24 month old, and a mature tripod grip is not expected until
preschool age (4-5 years).
Question 4: An infant with bronchiolitis is receiving oxygen via a nasal
cannula. Which assessment finding indicates an improvement in the infant's
respiratory status?
A. Respiratory rate has decreased from 50 to 30 breaths per minute.
B. The infant's anterior fontanel is bulging.
C. The infant is using accessory muscles to breathe.
D. Heart rate has increased from 120 to 150 beats per minute.
CORRECT ANSWER: A. Respiratory rate has decreased from 50 to 30 breaths
per minute.
Rationale:A normal respiratory rate for an infant is typically 20-30 breaths per minute.
A decrease in respiratory rate from a tachypneic state towards the normal range
indicates that the infant is compensating effectively and the respiratory distress is
resolving. A bulging fontanel is a sign of increased intracranial pressure. Accessory
muscle use and tachycardia are signs of worsening respiratory distress and hypoxia.
Question 5: A child with type 1 diabetes mellitus is experiencing symptoms of
hypoglycemia. The child is alert and able to swallow. Which of the following
should the nurse administer first?
A. 10 units of regular insulin subcutaneously.
B. 4 ounces of orange juice.
,C. 1 mg of glucagon intramuscularly.
D. 50 ml of 50% dextrose intravenously.
CORRECT ANSWER: B. 4 ounces of orange juice.
Rationale:The "Rule of 15" for treating mild to moderate hypoglycemia in a conscious,
cooperative child is to administer a quick-acting source of glucose such as 4-6 ounces of
orange juice or milk. Glucagon and IV dextrose are reserved for unconscious patients or
those unable to swallow, and insulin would further lower blood glucose.
Question 6: The nurse is caring for a 6-month-old infant hospitalized with RSV
bronchiolitis. Which positioning technique is most appropriate to facilitate
drainage of respiratory secretions?
A. Trendelenburg position.
B. Supine position with the head of the bed flat.
C. Side-lying position.
D. Prone position.
CORRECT ANSWER: C. Side-lying position.
Rationale:For infants with respiratory illnesses, the side-lying position promotes
drainage of oral and nasal secretions by allowing them to pool at the side of the cheek,
preventing aspiration and facilitating suctioning. The Trendelenburg position is
contraindicated in respiratory distress as it pushes abdominal contents against the
diaphragm. The supine flat position can increase the risk of aspiration, and the prone
position is not recommended due to the risk of SIDS and does not facilitate drainage as
effectively.
Question 7: A nurse is educating a family about home care for their child who
has just been diagnosed with cystic fibrosis. Which statement by the parent
indicates a need for further teaching regarding pancreatic enzyme
administration?
A. "I will mix the enzyme beads in a small amount of applesauce."
B. "I should give the enzymes at the beginning of each meal or snack."
C. "If my child does not eat all of the meal, I will still give the full dose of enzymes."
D. "The capsule can be opened and sprinkled on the food if my child cannot swallow it."
CORRECT ANSWER: C. "If my child does not eat all of the meal, I will still give
the full dose of enzymes."
Rationale:Pancreatic enzyme dosage should be based on the amount of fat consumed.
If a child does not finish a meal, the dose should be adjusted (less enzyme given) to
match the intake to prevent hyperdose-related complications like fibrosing colonopathy.
The other statements are correct regarding administration.
, Question 8: Which of the following laboratory findings is most characteristic of
a child with acute post-streptococcal glomerulonephritis (APSGN)?
A. Elevated serum complement C3 levels.
B. Hypokalemia.
C. Hematuria and proteinuria.
D. Positive blood culture.
CORRECT ANSWER: C. Hematuria and proteinuria.
Rationale:APSGN is characterized by immune-complex deposition in the glomeruli,
leading to inflammation. This results in red blood cells leaking into the urine
(hematuria), which gives the urine a smoky or cola-colored appearance, and protein
leaking into the urine (proteinuria). Complement C3 levels are typically decreased in the
acute phase, not elevated. Potassium is usually normal or slightly elevated, and blood
cultures are negative because it is a post-infectious, not a septic, process.
Question 9: The nurse is caring for a child in sickle cell crisis who is
complaining of severe joint pain. Which of the following nursing interventions
is a priority?
A. Apply cold compresses to the affected joints.
B. Administer prescribed opioid analgesics as scheduled and PRN.
C. Restrict oral fluid intake to decrease joint swelling.
D. Maintain the affected joint in a dependent position.
CORRECT ANSWER: B. Administer prescribed opioid analgesics as scheduled
and PRN.
Rationale:Pain in sickle cell crisis is caused by vaso-occlusion and ischemia, which is
often severe and requires aggressive pain management. Opioid analgesics are the
mainstay of treatment. Cold compresses can cause vasoconstriction and worsen the
crisis. Hydration is crucial to reduce blood viscosity, so fluids should be encouraged, not
restricted. The joint should be elevated and kept in a position of comfort.
Question 10: A 15-year-old patient diagnosed with scoliosis is prescribed a
brace. Which statement by the adolescent indicates an understanding of the
treatment plan?
A. "I can take my brace off for up to 2 hours each day for bathing and skin care."
B. "I will wear my brace only at night while sleeping."
C. "I should wear the brace over a thin t-shirt to protect my skin."
D. "I will stop wearing the brace once my pain is gone."
