NRSG 4504 -NURSING CARE OF CHILDREN EXAM- BRAND
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LATEST EXAM 2026-2027
1. A 6-month-old infant is brought to the pediatric clinic for a routine well-child visit.
During the assessment, the nurse notes that the infant exhibits head lag when pulled to a
sitting position. Which action by the nurse is most appropriate?
A. Document head lag as a normal expected finding for this age group
B. Notify the pediatric healthcare provider immediately for a neurological workup
C. Recommend immediate physical therapy for generalized hypotonia
D. Schedule an urgent magnetic resonance imaging (MRI) of the brain
Answer: B
Head lag should typically disappear by 4 months of age. Persistent head lag at 6 months is a
red flag indicating potential developmental delay or neuromuscular abnormality, requiring
prompt provider evaluation.
2. The nurse is assessing a 2-year-old toddler in the emergency department who presents
with a sudden onset of barking cough, inspiratory stridor, and low-grade fever that
worsens at night. Which condition does the nurse suspect?
A. Acute laryngotracheobronchitis (croup)
B. Acute epiglottitis
C. Foreign body aspiration
D. Bronchiolitis
Answer: A
Croup is typically caused by a viral infection leading to subglottic edema, classically
presenting with a distinctive barking cough, inspiratory stridor, and low-grade fever, often
worsening at night.
,3. An 8-year-old child with type 1 diabetes mellitus is admitted to the pediatric unit in
diabetic ketoacidosis (DKA). Which intravenous fluid is initiated first for initial volume
resuscitation?
A. 0.9% sodium chloride solution
B. 0.45% sodium chloride solution
C. 5% dextrose in water
D. 3% hypertonic saline solution
Answer: A
Initial fluid resuscitation in pediatric DKA requires rapid expansion of the intravascular space
using an isotonic crystalloid solution, specifically 0.9% sodium chloride, to restore perfusion
before addressing hyperglycemia.
4. The nurse is providing discharge instructions to the parents of a 4-year-old child
following a tonsillectomy. Which finding should the nurse emphasize as requiring
immediate medical notification?
A. Continuous bright red bleeding from the mouth or frequent swallowing
B. Mild throat pain controlled with prescribed liquid analgesics
C. Low-grade temperature of 38.0°C on the first postoperative day
D. Halitosis and thick white coating in the throat area
Answer: A
Frequent swallowing is an early sign of hidden postoperative hemorrhage following a
tonsillectomy, which, along with bright red bleeding, requires immediate intervention to
prevent severe blood loss.
5. A 3-month-old infant is admitted with respiratory syncytial virus (RSV) bronchiolitis.
Which intervention is the highest priority in the nursing care plan?
A. Maintaining adequate hydration and performing frequent suctioning of nasal secretions
B. Administering broad-spectrum prophylactic intravenous antibiotics every six hours
C. Encouraging high-fiber solid foods to prevent gastrointestinal complications
D. Enforcing strict complete bed rest without position changes
,Answer: A
Infants with RSV bronchiolitis are obligatory nose breathers; keeping the upper airway clear
via gentle suctioning and ensuring adequate hydration are essential management priorities.
6. The nurse is preparing to administer an intramuscular immunization to a healthy 12-
month-old infant. Which anatomical site is the preferred injection location?
A. Vastus lateralis muscle
B. Dorsogluteal muscle
C. Deltoid muscle
D. Rectus femoris muscle
Answer: A
The vastus lateralis muscle in the anterolateral thigh is the preferred, safest intramuscular
injection site for infants and toddlers due to its well-developed muscle mass and absence of
major nerves or blood vessels.
7. A school-age child with newly diagnosed nephrotic syndrome is admitted with
generalized edema. Which laboratory finding is characteristic of this condition?
A. Marked proteinuria and hypoalbuminemia
B. Elevated hemoglobin and hematocrit levels
C. Decreased serum cholesterol and triglyceride levels
D. Metabolic respiratory alkalosis
Answer: A
Nephrotic syndrome is characterized by massive glomerular protein loss resulting in severe
proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema.
8. An adolescent with sickle cell anemia is admitted in vaso-occlusive crisis experiencing
severe extremity pain. Which nursing intervention should take priority?
A. Administering prescribed opioid analgesics on a scheduled basis and ensuring aggressive
intravenous hydration
B. Applying cold ice packs directly to painful joints to reduce localized inflammation
, C. Restricting fluid intake to prevent circulatory volume overload
D. Encouraging high-intensity competitive athletic activities to maintain mobility
Answer: A
Vaso-occlusive crisis causes severe ischemic pain due to sickled red blood cells obstructing
microvasculature; primary management centers on pain control and hydration to promote
hemodilution and tissue perfusion.
9. The nurse is assessing a newborn infant delivered 12 hours ago. Which finding requires
immediate reporting to the pediatric healthcare provider?
A. Absence of meconium stool passage since birth
B. Pink-tinged uric acid crystals in the diaper
C. Acrocyanosis of the hands and feet
D. A patent umbilical cord with two arteries and one vein
Answer: A
Failure to pass meconium within the first 24 to 48 hours of life can indicate lower
gastrointestinal anomalies such as Hirschsprung disease, cystic fibrosis (meconium ileus), or
anorectal malformation.
10. A 5-year-old child is diagnosed with acute lymphocytic leukemia (ALL) and is receiving
induction chemotherapy. Which assessment finding is most indicative of a potential
neutropenic infection?
A. An oral temperature of 38.5°C
B. Mild transient fatigue after playing games
C. Ecchymosis on the lower extremities
D. Pale conjunctivae and nail beds
Answer: A
Even a low-grade fever in an immunocompromised neutropenic child is treated as an
oncologic medical emergency requiring immediate blood cultures and broad-spectrum
intravenous antibiotics.
NEW VERSION!!–COMPLETE STUDY GUIDE | PRACTICE
QUESTIONS AND ANSWERS-RATIONALES | EXAM PREP |
DOWNLOAD INSTANT PDF | GUARANTEED PASS ||
LATEST EXAM 2026-2027
1. A 6-month-old infant is brought to the pediatric clinic for a routine well-child visit.
During the assessment, the nurse notes that the infant exhibits head lag when pulled to a
sitting position. Which action by the nurse is most appropriate?
A. Document head lag as a normal expected finding for this age group
B. Notify the pediatric healthcare provider immediately for a neurological workup
C. Recommend immediate physical therapy for generalized hypotonia
D. Schedule an urgent magnetic resonance imaging (MRI) of the brain
Answer: B
Head lag should typically disappear by 4 months of age. Persistent head lag at 6 months is a
red flag indicating potential developmental delay or neuromuscular abnormality, requiring
prompt provider evaluation.
2. The nurse is assessing a 2-year-old toddler in the emergency department who presents
with a sudden onset of barking cough, inspiratory stridor, and low-grade fever that
worsens at night. Which condition does the nurse suspect?
A. Acute laryngotracheobronchitis (croup)
B. Acute epiglottitis
C. Foreign body aspiration
D. Bronchiolitis
Answer: A
Croup is typically caused by a viral infection leading to subglottic edema, classically
presenting with a distinctive barking cough, inspiratory stridor, and low-grade fever, often
worsening at night.
,3. An 8-year-old child with type 1 diabetes mellitus is admitted to the pediatric unit in
diabetic ketoacidosis (DKA). Which intravenous fluid is initiated first for initial volume
resuscitation?
A. 0.9% sodium chloride solution
B. 0.45% sodium chloride solution
C. 5% dextrose in water
D. 3% hypertonic saline solution
Answer: A
Initial fluid resuscitation in pediatric DKA requires rapid expansion of the intravascular space
using an isotonic crystalloid solution, specifically 0.9% sodium chloride, to restore perfusion
before addressing hyperglycemia.
4. The nurse is providing discharge instructions to the parents of a 4-year-old child
following a tonsillectomy. Which finding should the nurse emphasize as requiring
immediate medical notification?
A. Continuous bright red bleeding from the mouth or frequent swallowing
B. Mild throat pain controlled with prescribed liquid analgesics
C. Low-grade temperature of 38.0°C on the first postoperative day
D. Halitosis and thick white coating in the throat area
Answer: A
Frequent swallowing is an early sign of hidden postoperative hemorrhage following a
tonsillectomy, which, along with bright red bleeding, requires immediate intervention to
prevent severe blood loss.
5. A 3-month-old infant is admitted with respiratory syncytial virus (RSV) bronchiolitis.
Which intervention is the highest priority in the nursing care plan?
A. Maintaining adequate hydration and performing frequent suctioning of nasal secretions
B. Administering broad-spectrum prophylactic intravenous antibiotics every six hours
C. Encouraging high-fiber solid foods to prevent gastrointestinal complications
D. Enforcing strict complete bed rest without position changes
,Answer: A
Infants with RSV bronchiolitis are obligatory nose breathers; keeping the upper airway clear
via gentle suctioning and ensuring adequate hydration are essential management priorities.
6. The nurse is preparing to administer an intramuscular immunization to a healthy 12-
month-old infant. Which anatomical site is the preferred injection location?
A. Vastus lateralis muscle
B. Dorsogluteal muscle
C. Deltoid muscle
D. Rectus femoris muscle
Answer: A
The vastus lateralis muscle in the anterolateral thigh is the preferred, safest intramuscular
injection site for infants and toddlers due to its well-developed muscle mass and absence of
major nerves or blood vessels.
7. A school-age child with newly diagnosed nephrotic syndrome is admitted with
generalized edema. Which laboratory finding is characteristic of this condition?
A. Marked proteinuria and hypoalbuminemia
B. Elevated hemoglobin and hematocrit levels
C. Decreased serum cholesterol and triglyceride levels
D. Metabolic respiratory alkalosis
Answer: A
Nephrotic syndrome is characterized by massive glomerular protein loss resulting in severe
proteinuria, hypoalbuminemia, hyperlipidemia, and generalized edema.
8. An adolescent with sickle cell anemia is admitted in vaso-occlusive crisis experiencing
severe extremity pain. Which nursing intervention should take priority?
A. Administering prescribed opioid analgesics on a scheduled basis and ensuring aggressive
intravenous hydration
B. Applying cold ice packs directly to painful joints to reduce localized inflammation
, C. Restricting fluid intake to prevent circulatory volume overload
D. Encouraging high-intensity competitive athletic activities to maintain mobility
Answer: A
Vaso-occlusive crisis causes severe ischemic pain due to sickled red blood cells obstructing
microvasculature; primary management centers on pain control and hydration to promote
hemodilution and tissue perfusion.
9. The nurse is assessing a newborn infant delivered 12 hours ago. Which finding requires
immediate reporting to the pediatric healthcare provider?
A. Absence of meconium stool passage since birth
B. Pink-tinged uric acid crystals in the diaper
C. Acrocyanosis of the hands and feet
D. A patent umbilical cord with two arteries and one vein
Answer: A
Failure to pass meconium within the first 24 to 48 hours of life can indicate lower
gastrointestinal anomalies such as Hirschsprung disease, cystic fibrosis (meconium ileus), or
anorectal malformation.
10. A 5-year-old child is diagnosed with acute lymphocytic leukemia (ALL) and is receiving
induction chemotherapy. Which assessment finding is most indicative of a potential
neutropenic infection?
A. An oral temperature of 38.5°C
B. Mild transient fatigue after playing games
C. Ecchymosis on the lower extremities
D. Pale conjunctivae and nail beds
Answer: A
Even a low-grade fever in an immunocompromised neutropenic child is treated as an
oncologic medical emergency requiring immediate blood cultures and broad-spectrum
intravenous antibiotics.
