NUR 168 Exam 3 Pediatric Nursing | Galen College of Nursing NUR 168 Exam 3 Study
Guide & Exam Prep 2026–2027 | NUR 168 Pediatric Nursing Review | Pediatric Growth
& Development, Developmental Milestones, Pediatric Assessment, Vaccinations,
Family-Centered Care, Play & Play Therapy, Pediatric Pain Management, Pediatric
Cardiac Disorders, Congenital Heart Defects, Increased & Decreased Pulmonary
Blood Flow, Kawasaki Disease, Rheumatic Heart Disease, Congestive Heart Failure,
Pediatric Respiratory Disorders, Croup, Epiglottitis, Bronchiolitis, RSV, Cystic
Fibrosis, Musculoskeletal Disorders, Clubfoot, Scoliosis, Juvenile Rheumatoid
Arthritis, Neurologic Disorders, Hydrocephalus, Cerebral Palsy, Meningitis, Pediatric
Oncology, Gastrointestinal Disorders, Genitourinary Disorders, Nephrotic Syndrome,
Integumentary Disorders, Scabies, Pediculosis, Pediatric Medication Administration,
Clinical Judgment, Prioritization & Nursing Interventions | Practice Questions, Case
Studies & Detailed Rationales
Question 1: A 4-year-old child is admitted with suspected bacterial meningitis.
Which assessment finding should the nurse report immediately to the
healthcare provider?
A. Temperature of 38.3°C (101°F)
B. Positive Brudzinski sign
C. Heart rate of 110 beats per minute
D. Complaint of mild headache
CORRECT ANSWER: B. Positive Brudzinski sign
Rationale: A positive Brudzinski sign is a classic meningeal irritation sign
associated with meningitis and indicates serious central nervous system
involvement requiring immediate medical attention. While fever and headache
are common in meningitis, the positive Brudzinski sign is a more specific and
urgent neurologic finding.
Question 2: The nurse is caring for an infant with hydrocephalus who has a
ventriculoperitoneal shunt. Which finding should the nurse recognize as the
earliest sign of shunt malfunction?
A. Sunken fontanelle
B. Increased blood pressure
C. Vomiting and irritability
D. Decreased head circumference
CORRECT ANSWER: C. Vomiting and irritability
,Rationale: Vomiting and irritability are often the earliest signs of increased
intracranial pressure from shunt malfunction in infants. Sunken fontanelle and
decreased head circumference indicate dehydration or resolution of
hydrocephalus, not malfunction.
Question 3: A child with cerebral palsy is being assessed for feeding difficulties.
Which intervention should the nurse recommend to promote safe oral feeding?
A. Feeding the child in a supine position
B. Using a large-bore nipple for faster feeding
C. Positioning the child upright with head and neck support
D. Offering thin liquids only
CORRECT ANSWER: C. Positioning the child upright with head and neck support
Rationale: Upright positioning with head and neck support reduces the risk of
aspiration and facilitates safer swallowing in children with cerebral palsy. Supine
positioning and large-bore nipples increase aspiration risk, and thin liquids are
more difficult to swallow safely.
Question 4: The nurse is assessing a 6-month-old infant for developmental
dysplasia of the hip (DDH). Which finding is most consistent with this condition?
A. Negative Ortolani sign
B. Asymmetric thigh skin folds
C. Symmetric gluteal folds
D. Full range of motion in both hips
CORRECT ANSWER: B. Asymmetric thigh skin folds
Rationale: Asymmetric thigh skin folds are a classic sign of developmental
dysplasia of the hip due to unequal leg length and hip displacement. Symmetric
folds and full range of motion are expected findings in unaffected infants.
Question 5: A 10-year-old child is diagnosed with scoliosis. Which diagnostic test
is considered the gold standard for measuring the degree of spinal curvature?
A. Magnetic resonance imaging (MRI)
B. Computed tomography (CT) scan
,C. Cobb angle measurement on spinal radiograph
D. Bone scan
CORRECT ANSWER: C. Cobb angle measurement on spinal radiograph
Rationale: The Cobb angle measured on a spinal radiograph is the standard
method for quantifying the severity of scoliosis and guiding treatment decisions.
MRI and CT may be used for underlying causes but do not measure curvature
degree.
Question 6: The nurse is teaching parents about home care for a child with a
spica cast. Which statement by the parent indicates a need for further teaching?
A. "I will check the skin around the cast edges daily."
B. "I will use a hairdryer on the cool setting to relieve itching."
C. "I will place the child in the supine position only."
D. "I will keep the cast dry and clean."
CORRECT ANSWER: C. "I will place the child in the supine position only."
Rationale: Children in spica casts need repositioning and should not remain
supine only, as this can lead to skin breakdown and respiratory complications.
Checking skin, using cool air for itching, and keeping the cast dry are appropriate
care measures.
Question 7: A child is admitted with suspected Reye syndrome. Which history
finding is most closely associated with this condition?
A. Recent antibiotic use
B. Recent aspirin use during a viral illness
C. Recent immunization
D. Recent consumption of unpasteurized milk
CORRECT ANSWER: B. Recent aspirin use during a viral illness
Rationale: Reye syndrome is strongly associated with the use of aspirin
(salicylates) during a viral illness, particularly influenza or varicella. Antibiotics,
immunizations, and unpasteurized milk are not linked to Reye syndrome.
Question 8: The nurse is caring for a child with a traumatic brain injury (TBI).
Which nursing intervention is priority to prevent secondary brain injury?
, A. Maintaining adequate oxygenation and blood pressure
B. Administering hypertonic saline routinely
C. Keeping the head of bed flat at all times
D. Restricting all visitation
CORRECT ANSWER: A. Maintaining adequate oxygenation and blood pressure
Rationale: Preventing hypoxia and hypotension is critical to avoid secondary brain
injury in children with TBI. Routine hypertonic saline, flat positioning, and
visitation restriction are not first-line preventive measures.
Question 9: A 3-year-old child is diagnosed with bacterial conjunctivitis. Which
instruction should the nurse include in parent teaching?
A. Apply warm compresses only
B. Share towels with siblings
C. Administer prescribed antibiotic eye drops and practice good hand hygiene
D. Return to daycare immediately
CORRECT ANSWER: C. Administer prescribed antibiotic eye drops and practice
good hand hygiene
Rationale: Bacterial conjunctivitis requires antibiotic eye drops and strict hand
hygiene to prevent transmission. Warm compresses alone are insufficient, sharing
towels spreads infection, and return to daycare should follow provider guidance.
Question 10: The nurse is assessing a newborn for signs of congenital heart
disease. Which finding is most indicative of a cardiac defect?
A. Heart rate of 140 beats per minute
B. Systolic murmur grade 1/6
C. Cyanosis that worsens with crying
D. Mild acrocyanosis of hands and feet
CORRECT ANSWER: C. Cyanosis that worsens with crying
Rationale: Cyanosis that worsens with crying suggests a right-to-left shunt or
cyanotic congenital heart defect. Mild acrocyanosis and a soft systolic murmur are
common benign newborn findings.
Guide & Exam Prep 2026–2027 | NUR 168 Pediatric Nursing Review | Pediatric Growth
& Development, Developmental Milestones, Pediatric Assessment, Vaccinations,
Family-Centered Care, Play & Play Therapy, Pediatric Pain Management, Pediatric
Cardiac Disorders, Congenital Heart Defects, Increased & Decreased Pulmonary
Blood Flow, Kawasaki Disease, Rheumatic Heart Disease, Congestive Heart Failure,
Pediatric Respiratory Disorders, Croup, Epiglottitis, Bronchiolitis, RSV, Cystic
Fibrosis, Musculoskeletal Disorders, Clubfoot, Scoliosis, Juvenile Rheumatoid
Arthritis, Neurologic Disorders, Hydrocephalus, Cerebral Palsy, Meningitis, Pediatric
Oncology, Gastrointestinal Disorders, Genitourinary Disorders, Nephrotic Syndrome,
Integumentary Disorders, Scabies, Pediculosis, Pediatric Medication Administration,
Clinical Judgment, Prioritization & Nursing Interventions | Practice Questions, Case
Studies & Detailed Rationales
Question 1: A 4-year-old child is admitted with suspected bacterial meningitis.
Which assessment finding should the nurse report immediately to the
healthcare provider?
A. Temperature of 38.3°C (101°F)
B. Positive Brudzinski sign
C. Heart rate of 110 beats per minute
D. Complaint of mild headache
CORRECT ANSWER: B. Positive Brudzinski sign
Rationale: A positive Brudzinski sign is a classic meningeal irritation sign
associated with meningitis and indicates serious central nervous system
involvement requiring immediate medical attention. While fever and headache
are common in meningitis, the positive Brudzinski sign is a more specific and
urgent neurologic finding.
Question 2: The nurse is caring for an infant with hydrocephalus who has a
ventriculoperitoneal shunt. Which finding should the nurse recognize as the
earliest sign of shunt malfunction?
A. Sunken fontanelle
B. Increased blood pressure
C. Vomiting and irritability
D. Decreased head circumference
CORRECT ANSWER: C. Vomiting and irritability
,Rationale: Vomiting and irritability are often the earliest signs of increased
intracranial pressure from shunt malfunction in infants. Sunken fontanelle and
decreased head circumference indicate dehydration or resolution of
hydrocephalus, not malfunction.
Question 3: A child with cerebral palsy is being assessed for feeding difficulties.
Which intervention should the nurse recommend to promote safe oral feeding?
A. Feeding the child in a supine position
B. Using a large-bore nipple for faster feeding
C. Positioning the child upright with head and neck support
D. Offering thin liquids only
CORRECT ANSWER: C. Positioning the child upright with head and neck support
Rationale: Upright positioning with head and neck support reduces the risk of
aspiration and facilitates safer swallowing in children with cerebral palsy. Supine
positioning and large-bore nipples increase aspiration risk, and thin liquids are
more difficult to swallow safely.
Question 4: The nurse is assessing a 6-month-old infant for developmental
dysplasia of the hip (DDH). Which finding is most consistent with this condition?
A. Negative Ortolani sign
B. Asymmetric thigh skin folds
C. Symmetric gluteal folds
D. Full range of motion in both hips
CORRECT ANSWER: B. Asymmetric thigh skin folds
Rationale: Asymmetric thigh skin folds are a classic sign of developmental
dysplasia of the hip due to unequal leg length and hip displacement. Symmetric
folds and full range of motion are expected findings in unaffected infants.
Question 5: A 10-year-old child is diagnosed with scoliosis. Which diagnostic test
is considered the gold standard for measuring the degree of spinal curvature?
A. Magnetic resonance imaging (MRI)
B. Computed tomography (CT) scan
,C. Cobb angle measurement on spinal radiograph
D. Bone scan
CORRECT ANSWER: C. Cobb angle measurement on spinal radiograph
Rationale: The Cobb angle measured on a spinal radiograph is the standard
method for quantifying the severity of scoliosis and guiding treatment decisions.
MRI and CT may be used for underlying causes but do not measure curvature
degree.
Question 6: The nurse is teaching parents about home care for a child with a
spica cast. Which statement by the parent indicates a need for further teaching?
A. "I will check the skin around the cast edges daily."
B. "I will use a hairdryer on the cool setting to relieve itching."
C. "I will place the child in the supine position only."
D. "I will keep the cast dry and clean."
CORRECT ANSWER: C. "I will place the child in the supine position only."
Rationale: Children in spica casts need repositioning and should not remain
supine only, as this can lead to skin breakdown and respiratory complications.
Checking skin, using cool air for itching, and keeping the cast dry are appropriate
care measures.
Question 7: A child is admitted with suspected Reye syndrome. Which history
finding is most closely associated with this condition?
A. Recent antibiotic use
B. Recent aspirin use during a viral illness
C. Recent immunization
D. Recent consumption of unpasteurized milk
CORRECT ANSWER: B. Recent aspirin use during a viral illness
Rationale: Reye syndrome is strongly associated with the use of aspirin
(salicylates) during a viral illness, particularly influenza or varicella. Antibiotics,
immunizations, and unpasteurized milk are not linked to Reye syndrome.
Question 8: The nurse is caring for a child with a traumatic brain injury (TBI).
Which nursing intervention is priority to prevent secondary brain injury?
, A. Maintaining adequate oxygenation and blood pressure
B. Administering hypertonic saline routinely
C. Keeping the head of bed flat at all times
D. Restricting all visitation
CORRECT ANSWER: A. Maintaining adequate oxygenation and blood pressure
Rationale: Preventing hypoxia and hypotension is critical to avoid secondary brain
injury in children with TBI. Routine hypertonic saline, flat positioning, and
visitation restriction are not first-line preventive measures.
Question 9: A 3-year-old child is diagnosed with bacterial conjunctivitis. Which
instruction should the nurse include in parent teaching?
A. Apply warm compresses only
B. Share towels with siblings
C. Administer prescribed antibiotic eye drops and practice good hand hygiene
D. Return to daycare immediately
CORRECT ANSWER: C. Administer prescribed antibiotic eye drops and practice
good hand hygiene
Rationale: Bacterial conjunctivitis requires antibiotic eye drops and strict hand
hygiene to prevent transmission. Warm compresses alone are insufficient, sharing
towels spreads infection, and return to daycare should follow provider guidance.
Question 10: The nurse is assessing a newborn for signs of congenital heart
disease. Which finding is most indicative of a cardiac defect?
A. Heart rate of 140 beats per minute
B. Systolic murmur grade 1/6
C. Cyanosis that worsens with crying
D. Mild acrocyanosis of hands and feet
CORRECT ANSWER: C. Cyanosis that worsens with crying
Rationale: Cyanosis that worsens with crying suggests a right-to-left shunt or
cyanotic congenital heart defect. Mild acrocyanosis and a soft systolic murmur are
common benign newborn findings.
