NURS240 – Pediatric Nursing | Comprehensive
Study Guide, Practice Exam, Exam Questions &
Answers, Exam Prep Test Bank, Pediatric
Assessment, Growth & Development, Family-
Centered Care, Neonatal Nursing, Pediatric
Pharmacology, Childhood Diseases,
Immunizations, Medication Safety, Clinical
Judgment, Detailed Rationales, Nursing Exam
Success
Question 1: A 4-year-old child is brought to the emergency department with a
severe, barking cough, stridor at rest, and a fever of 102.2°F. The nurse notes a
"steeple sign" on the neck X-ray. Which of the following is the priority nursing
intervention?
A. Prepare the child for a tracheostomy
B. Administer a nebulized racemic epinephrine treatment
C. Prepare for immediate intubation
D. Administer an oral antibiotic
CORRECT ANSWER: B. Administer a nebulized racemic epinephrine treatment
Rationale:The presentation of a barking cough, stridor at rest, and a steeple sign on X-
ray is classic for moderate to severe croup (laryngotracheobronchitis). The priority
intervention for significant stridor at rest is the administration of nebulized racemic
epinephrine to rapidly reduce airway edema. Corticosteroids (e.g., dexamethasone) are
also indicated to reduce inflammation. Intubation and tracheostomy are reserved for
impending respiratory failure.
Question 2: The parents of a 6-month-old infant with bronchiolitis inquire
about the use of cough syrup. What is the most appropriate response by the
nurse?
A. "Cough syrup is safe as long as it contains guaifenesin."
B. "We can administer a small dose to help them sleep better."
C. "Over-the-counter cough and cold medications should not be used in children under
4 years old due to the risk of adverse effects."
D. "We will prescribe a low-dose codeine syrup to help with the cough."
CORRECT ANSWER: C. "Over-the-counter cough and cold medications should
not be used in children under 4 years old due to the risk of adverse effects."
Rationale:The American Academy of Pediatrics strongly advises against the use of
over-the-counter cough and cold products in children under 4 years of age due to a lack
of efficacy and a significant risk of serious side effects, including respiratory depression,
,tachycardia, and even death. Codeine is also contraindicated in children due to the risk
of fatal respiratory depression.
Question 3: A school-age child with a history of asthma arrives at the clinic
with a peak expiratory flow rate (PEFR) that is 60% of their personal best. The
child is coughing and has mild wheezing. According to the asthma action plan,
this reading corresponds to which zone, and what is the initial action?
A. Green zone; continue current maintenance medications
B. Yellow zone; administer a rescue bronchodilator (SABA)
C. Red zone; administer a rescue bronchodilator and call 911
D. Yellow zone; administer oral corticosteroids
CORRECT ANSWER: B. Yellow zone; administer a rescue bronchodilator
(SABA)
Rationale:A PEFR between 50% and 80% of a patient's personal best indicates the
"Yellow Zone," which signifies caution and worsening asthma control. The first action is
to administer a short-acting beta-agonist (SABA) such as albuterol to relieve
bronchospasm.
Question 4: The nurse is assessing a newborn with a diaphragmatic hernia
immediately after birth. Which of the following physical assessment findings
would the nurse anticipate observing?
A. Symmetrical chest wall movement and audible bowel sounds in the chest
B. A scaphoid abdomen and severe respiratory distress
C. Distended abdomen and hyperresonance on percussion
D. Absent breath sounds on the right side and a prominent precordial bulge
CORRECT ANSWER: B. A scaphoid abdomen and severe respiratory distress
Rationale:In congenital diaphragmatic hernia (CDH), abdominal organs herniate into
the thoracic cavity through a defect in the diaphragm. This compresses the lungs and
prevents abdominal organ development in utero, resulting in a scaphoid (concave)
abdomen and immediate, profound respiratory distress due to pulmonary hypoplasia.
Question 5: The nurse is preparing to administer a vaccination to a 2-month-
old infant. Which of the following immunizations is NOT typically
recommended for administration at this age?
A. DTaP (Diphtheria, Tetanus, Pertussis)
B. Rotavirus (RV)
C. MMR (Measles, Mumps, Rubella)
D. PCV13 (Pneumococcal conjugate vaccine)
,CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale:The MMR vaccine is a live-attenuated vaccine and is contraindicated in
infants under 12 months of age due to the presence of maternal antibodies that can
neutralize the vaccine virus, rendering it ineffective. It is routinely administered at 12-15
months and again at 4-6 years.
Question 6: A 15-year-old patient with type 1 diabetes is brought to the clinic
for a routine visit. The nurse notices the patient has been skipping insulin
doses to lose weight. Which nursing diagnosis takes the highest priority?
A. Noncompliance related to denial of illness
B. Risk for injury related to hyperglycemic episodes
C. Deficient knowledge related to disease management
D. Disturbed body image related to insulin therapy
CORRECT ANSWER: D. Disturbed body image related to insulin therapy
Rationale:While all options are valid concerns, the underlying root cause of the
patient's behavior is likely a disturbed body image and a fear of weight gain associated
with insulin therapy. This is a common issue among adolescents with type 1 diabetes.
Addressing the disturbed body image is a priority to help the patient adhere to their
treatment regimen and prevent life-threatening complications like diabetic ketoacidosis.
Question 7: A 5-year-old child is admitted with nephrotic syndrome. The nurse
notes significant periorbital and peripheral edema. Which nursing intervention
is most appropriate to monitor the effectiveness of therapy?
A. Strict intake and output monitoring
B. Daily weights at the same time each day
C. Assessment of urine specific gravity
D. Monitoring serum albumin levels
CORRECT ANSWER: B. Daily weights at the same time each day
Rationale:Edema is the hallmark of nephrotic syndrome, caused by massive proteinuria
leading to hypoalbuminemia and decreased oncotic pressure. While all options are part
of the plan, daily weights are the most sensitive and accurate indicator of fluid status
and the effectiveness of diuretic therapy and dietary restrictions. A weight loss of 0.5-1
kg/day indicates a positive response to treatment.
Question 8: The nurse is providing discharge teaching to the parents of a child
diagnosed with acute otitis media. Which statement indicates the parent needs
further teaching?
, A. "I will continue to give the full course of antibiotics as prescribed."
B. "I will give acetaminophen for my child's ear pain and fever."
C. "I should position my child on the affected ear to help with drainage."
D. "I will stop the antibiotics once the fever is gone to prevent resistance."
CORRECT ANSWER: D. "I will stop the antibiotics once the fever is gone to
prevent resistance."
Rationale:Antibiotics must be taken for the entire prescribed course to ensure all
bacteria are eradicated and to prevent the development of antibiotic-resistant strains.
Stopping early can lead to a relapse of the infection.
Question 9: A 3-year-old child is prescribed amoxicillin for acute otitis media.
The medication is available as a 250 mg/5 mL suspension. The prescription
states: 125 mg PO TID. How many mL should the nurse administer per dose?
A. 1 mL
B. 2.5 mL
C. 5 mL
D. 10 mL
CORRECT ANSWER: B. 2.5 mL
Rationale:The drug concentration is 250 mg/5 mL, which means each 1 mL contains
50 mg. To give 125 mg: 125 mg / 50 mg/mL = 2.5 mL.
Question 10: An adolescent is brought to the emergency department with
suspected appendicitis. The nurse assesses for the classic sign of rebound
tenderness. Which intervention best prevents transmission of infection from
this patient?
A. Wearing gloves during any contact with the patient
B. Placing the patient in a private room with standard precautions
C. Ensuring the patient's wound is covered with a sterile dressing
D. Placing the patient in negative pressure isolation
CORRECT ANSWER: B. Placing the patient in a private room with standard
precautions
Rationale:Appendicitis is not a communicable disease transmitted via airborne or
droplet routes. Standard precautions, which include hand hygiene and the use of gloves
when anticipating contact with body fluids, are sufficient. A private room is not required
unless the patient is immunocompromised or has a secondary infection.
Study Guide, Practice Exam, Exam Questions &
Answers, Exam Prep Test Bank, Pediatric
Assessment, Growth & Development, Family-
Centered Care, Neonatal Nursing, Pediatric
Pharmacology, Childhood Diseases,
Immunizations, Medication Safety, Clinical
Judgment, Detailed Rationales, Nursing Exam
Success
Question 1: A 4-year-old child is brought to the emergency department with a
severe, barking cough, stridor at rest, and a fever of 102.2°F. The nurse notes a
"steeple sign" on the neck X-ray. Which of the following is the priority nursing
intervention?
A. Prepare the child for a tracheostomy
B. Administer a nebulized racemic epinephrine treatment
C. Prepare for immediate intubation
D. Administer an oral antibiotic
CORRECT ANSWER: B. Administer a nebulized racemic epinephrine treatment
Rationale:The presentation of a barking cough, stridor at rest, and a steeple sign on X-
ray is classic for moderate to severe croup (laryngotracheobronchitis). The priority
intervention for significant stridor at rest is the administration of nebulized racemic
epinephrine to rapidly reduce airway edema. Corticosteroids (e.g., dexamethasone) are
also indicated to reduce inflammation. Intubation and tracheostomy are reserved for
impending respiratory failure.
Question 2: The parents of a 6-month-old infant with bronchiolitis inquire
about the use of cough syrup. What is the most appropriate response by the
nurse?
A. "Cough syrup is safe as long as it contains guaifenesin."
B. "We can administer a small dose to help them sleep better."
C. "Over-the-counter cough and cold medications should not be used in children under
4 years old due to the risk of adverse effects."
D. "We will prescribe a low-dose codeine syrup to help with the cough."
CORRECT ANSWER: C. "Over-the-counter cough and cold medications should
not be used in children under 4 years old due to the risk of adverse effects."
Rationale:The American Academy of Pediatrics strongly advises against the use of
over-the-counter cough and cold products in children under 4 years of age due to a lack
of efficacy and a significant risk of serious side effects, including respiratory depression,
,tachycardia, and even death. Codeine is also contraindicated in children due to the risk
of fatal respiratory depression.
Question 3: A school-age child with a history of asthma arrives at the clinic
with a peak expiratory flow rate (PEFR) that is 60% of their personal best. The
child is coughing and has mild wheezing. According to the asthma action plan,
this reading corresponds to which zone, and what is the initial action?
A. Green zone; continue current maintenance medications
B. Yellow zone; administer a rescue bronchodilator (SABA)
C. Red zone; administer a rescue bronchodilator and call 911
D. Yellow zone; administer oral corticosteroids
CORRECT ANSWER: B. Yellow zone; administer a rescue bronchodilator
(SABA)
Rationale:A PEFR between 50% and 80% of a patient's personal best indicates the
"Yellow Zone," which signifies caution and worsening asthma control. The first action is
to administer a short-acting beta-agonist (SABA) such as albuterol to relieve
bronchospasm.
Question 4: The nurse is assessing a newborn with a diaphragmatic hernia
immediately after birth. Which of the following physical assessment findings
would the nurse anticipate observing?
A. Symmetrical chest wall movement and audible bowel sounds in the chest
B. A scaphoid abdomen and severe respiratory distress
C. Distended abdomen and hyperresonance on percussion
D. Absent breath sounds on the right side and a prominent precordial bulge
CORRECT ANSWER: B. A scaphoid abdomen and severe respiratory distress
Rationale:In congenital diaphragmatic hernia (CDH), abdominal organs herniate into
the thoracic cavity through a defect in the diaphragm. This compresses the lungs and
prevents abdominal organ development in utero, resulting in a scaphoid (concave)
abdomen and immediate, profound respiratory distress due to pulmonary hypoplasia.
Question 5: The nurse is preparing to administer a vaccination to a 2-month-
old infant. Which of the following immunizations is NOT typically
recommended for administration at this age?
A. DTaP (Diphtheria, Tetanus, Pertussis)
B. Rotavirus (RV)
C. MMR (Measles, Mumps, Rubella)
D. PCV13 (Pneumococcal conjugate vaccine)
,CORRECT ANSWER: C. MMR (Measles, Mumps, Rubella)
Rationale:The MMR vaccine is a live-attenuated vaccine and is contraindicated in
infants under 12 months of age due to the presence of maternal antibodies that can
neutralize the vaccine virus, rendering it ineffective. It is routinely administered at 12-15
months and again at 4-6 years.
Question 6: A 15-year-old patient with type 1 diabetes is brought to the clinic
for a routine visit. The nurse notices the patient has been skipping insulin
doses to lose weight. Which nursing diagnosis takes the highest priority?
A. Noncompliance related to denial of illness
B. Risk for injury related to hyperglycemic episodes
C. Deficient knowledge related to disease management
D. Disturbed body image related to insulin therapy
CORRECT ANSWER: D. Disturbed body image related to insulin therapy
Rationale:While all options are valid concerns, the underlying root cause of the
patient's behavior is likely a disturbed body image and a fear of weight gain associated
with insulin therapy. This is a common issue among adolescents with type 1 diabetes.
Addressing the disturbed body image is a priority to help the patient adhere to their
treatment regimen and prevent life-threatening complications like diabetic ketoacidosis.
Question 7: A 5-year-old child is admitted with nephrotic syndrome. The nurse
notes significant periorbital and peripheral edema. Which nursing intervention
is most appropriate to monitor the effectiveness of therapy?
A. Strict intake and output monitoring
B. Daily weights at the same time each day
C. Assessment of urine specific gravity
D. Monitoring serum albumin levels
CORRECT ANSWER: B. Daily weights at the same time each day
Rationale:Edema is the hallmark of nephrotic syndrome, caused by massive proteinuria
leading to hypoalbuminemia and decreased oncotic pressure. While all options are part
of the plan, daily weights are the most sensitive and accurate indicator of fluid status
and the effectiveness of diuretic therapy and dietary restrictions. A weight loss of 0.5-1
kg/day indicates a positive response to treatment.
Question 8: The nurse is providing discharge teaching to the parents of a child
diagnosed with acute otitis media. Which statement indicates the parent needs
further teaching?
, A. "I will continue to give the full course of antibiotics as prescribed."
B. "I will give acetaminophen for my child's ear pain and fever."
C. "I should position my child on the affected ear to help with drainage."
D. "I will stop the antibiotics once the fever is gone to prevent resistance."
CORRECT ANSWER: D. "I will stop the antibiotics once the fever is gone to
prevent resistance."
Rationale:Antibiotics must be taken for the entire prescribed course to ensure all
bacteria are eradicated and to prevent the development of antibiotic-resistant strains.
Stopping early can lead to a relapse of the infection.
Question 9: A 3-year-old child is prescribed amoxicillin for acute otitis media.
The medication is available as a 250 mg/5 mL suspension. The prescription
states: 125 mg PO TID. How many mL should the nurse administer per dose?
A. 1 mL
B. 2.5 mL
C. 5 mL
D. 10 mL
CORRECT ANSWER: B. 2.5 mL
Rationale:The drug concentration is 250 mg/5 mL, which means each 1 mL contains
50 mg. To give 125 mg: 125 mg / 50 mg/mL = 2.5 mL.
Question 10: An adolescent is brought to the emergency department with
suspected appendicitis. The nurse assesses for the classic sign of rebound
tenderness. Which intervention best prevents transmission of infection from
this patient?
A. Wearing gloves during any contact with the patient
B. Placing the patient in a private room with standard precautions
C. Ensuring the patient's wound is covered with a sterile dressing
D. Placing the patient in negative pressure isolation
CORRECT ANSWER: B. Placing the patient in a private room with standard
precautions
Rationale:Appendicitis is not a communicable disease transmitted via airborne or
droplet routes. Standard precautions, which include hand hygiene and the use of gloves
when anticipating contact with body fluids, are sufficient. A private room is not required
unless the patient is immunocompromised or has a secondary infection.
