Virginia Pediatric Emergency Nurse Exam
Practice Questions & [Verified Answers],
Plus Explained Rationales|2027 Latest
Update| Instant Download PDF
Question 1
A 4-year-old child is brought to the emergency department with severe
respiratory distress. The child is sitting upright, has nasal flaring,
intercostal retractions, and an oxygen saturation of 84% on room air.
Which action should the pediatric emergency nurse take first?
A. Obtain a detailed medical history
B. Apply high-flow oxygen and rapidly assess airway and breathing
C. Establish two peripheral IV lines
D. Obtain a chest radiograph
Answer: B. Apply high-flow oxygen and rapidly assess airway and
breathing
Rationale: In a critically ill child, airway and breathing are immediate
priorities. Severe hypoxemia and respiratory distress require prompt
oxygen administration and rapid assessment for impending
respiratory failure. Diagnostic testing and IV access should not delay
stabilization.
Question 2
1|Page
,A 7-year-old child presents after falling from a bicycle. The child is
awake but has neck pain and midline cervical tenderness. Which
nursing intervention is most appropriate?
A. Encourage the child to rotate the neck slowly
B. Place the child in a sitting position
C. Maintain cervical spine immobilization
D. Apply a warm compress to the neck
Answer: C. Maintain cervical spine immobilization
Rationale: Midline cervical tenderness after trauma raises concern for
cervical spine injury. The nurse should maintain spinal precautions
until an appropriate evaluation has excluded significant injury.
Question 3
A 2-year-old child with suspected bacterial meningitis is admitted to the
emergency department. Which infection-control intervention is most
appropriate initially?
A. Standard precautions only
B. Airborne precautions
C. Droplet precautions in addition to standard precautions
D. Protective isolation
Answer: C. Droplet precautions in addition to standard precautions
Rationale: Suspected meningococcal meningitis requires droplet
precautions because respiratory secretions can transmit Neisseria
meningitidis. Droplet precautions are maintained according to
applicable infection-control guidance until the child has received
appropriate antimicrobial therapy for the required period.
2|Page
,Question 4
A 3-year-old child arrives with severe dehydration after several days of
vomiting and diarrhea. Which finding is most concerning?
A. Dry lips
B. Decreased urine output
C. Capillary refill of 5 seconds with altered mental status
D. Thirst
Answer: C. Capillary refill of 5 seconds with altered mental status
Rationale: Prolonged capillary refill combined with altered mental
status suggests poor perfusion and potentially decompensated shock.
This requires immediate intervention and reassessment of airway,
breathing, circulation, and neurologic status.
Question 5
A 6-year-old child with an acute asthma exacerbation has severe
wheezing, tachypnea, and increasing fatigue. Which finding indicates
possible impending respiratory failure?
A. Mild expiratory wheezing
B. Ability to speak in complete sentences
C. Decreasing level of consciousness and diminished air movement
D. Mild tachycardia
Answer: C. Decreasing level of consciousness and diminished air
movement
Rationale: A child who becomes fatigued, has altered consciousness,
and develops markedly decreased air movement may be experiencing
respiratory muscle exhaustion and impending respiratory failure. A
3|Page
, “quiet chest” in a severely ill asthmatic child can indicate critically
reduced airflow rather than improvement.
Question 6
A 5-year-old child is suspected of having epiglottitis. Which nursing
action should be avoided?
A. Keeping the child calm
B. Providing supplemental oxygen as tolerated
C. Allowing the child to remain in a position of comfort
D. Inspecting the throat with a tongue depressor
Answer: D. Inspecting the throat with a tongue depressor
Rationale: Manipulation of the airway in a child with suspected
epiglottitis can precipitate sudden airway obstruction. The child
should be kept calm, unnecessary procedures avoided, and personnel
capable of securing the airway should be involved promptly.
Question 7
A 9-month-old infant is brought to the emergency department after
choking on food. The infant is conscious but cannot cry, cough
effectively, or breathe. What should the nurse do?
A. Perform blind finger sweeps
B. Give abdominal thrusts
C. Alternate 5 back slaps with 5 chest thrusts
D. Begin mouth-to-mouth ventilation immediately
Answer: C. Alternate 5 back slaps with 5 chest thrusts
4|Page
Practice Questions & [Verified Answers],
Plus Explained Rationales|2027 Latest
Update| Instant Download PDF
Question 1
A 4-year-old child is brought to the emergency department with severe
respiratory distress. The child is sitting upright, has nasal flaring,
intercostal retractions, and an oxygen saturation of 84% on room air.
Which action should the pediatric emergency nurse take first?
A. Obtain a detailed medical history
B. Apply high-flow oxygen and rapidly assess airway and breathing
C. Establish two peripheral IV lines
D. Obtain a chest radiograph
Answer: B. Apply high-flow oxygen and rapidly assess airway and
breathing
Rationale: In a critically ill child, airway and breathing are immediate
priorities. Severe hypoxemia and respiratory distress require prompt
oxygen administration and rapid assessment for impending
respiratory failure. Diagnostic testing and IV access should not delay
stabilization.
Question 2
1|Page
,A 7-year-old child presents after falling from a bicycle. The child is
awake but has neck pain and midline cervical tenderness. Which
nursing intervention is most appropriate?
A. Encourage the child to rotate the neck slowly
B. Place the child in a sitting position
C. Maintain cervical spine immobilization
D. Apply a warm compress to the neck
Answer: C. Maintain cervical spine immobilization
Rationale: Midline cervical tenderness after trauma raises concern for
cervical spine injury. The nurse should maintain spinal precautions
until an appropriate evaluation has excluded significant injury.
Question 3
A 2-year-old child with suspected bacterial meningitis is admitted to the
emergency department. Which infection-control intervention is most
appropriate initially?
A. Standard precautions only
B. Airborne precautions
C. Droplet precautions in addition to standard precautions
D. Protective isolation
Answer: C. Droplet precautions in addition to standard precautions
Rationale: Suspected meningococcal meningitis requires droplet
precautions because respiratory secretions can transmit Neisseria
meningitidis. Droplet precautions are maintained according to
applicable infection-control guidance until the child has received
appropriate antimicrobial therapy for the required period.
2|Page
,Question 4
A 3-year-old child arrives with severe dehydration after several days of
vomiting and diarrhea. Which finding is most concerning?
A. Dry lips
B. Decreased urine output
C. Capillary refill of 5 seconds with altered mental status
D. Thirst
Answer: C. Capillary refill of 5 seconds with altered mental status
Rationale: Prolonged capillary refill combined with altered mental
status suggests poor perfusion and potentially decompensated shock.
This requires immediate intervention and reassessment of airway,
breathing, circulation, and neurologic status.
Question 5
A 6-year-old child with an acute asthma exacerbation has severe
wheezing, tachypnea, and increasing fatigue. Which finding indicates
possible impending respiratory failure?
A. Mild expiratory wheezing
B. Ability to speak in complete sentences
C. Decreasing level of consciousness and diminished air movement
D. Mild tachycardia
Answer: C. Decreasing level of consciousness and diminished air
movement
Rationale: A child who becomes fatigued, has altered consciousness,
and develops markedly decreased air movement may be experiencing
respiratory muscle exhaustion and impending respiratory failure. A
3|Page
, “quiet chest” in a severely ill asthmatic child can indicate critically
reduced airflow rather than improvement.
Question 6
A 5-year-old child is suspected of having epiglottitis. Which nursing
action should be avoided?
A. Keeping the child calm
B. Providing supplemental oxygen as tolerated
C. Allowing the child to remain in a position of comfort
D. Inspecting the throat with a tongue depressor
Answer: D. Inspecting the throat with a tongue depressor
Rationale: Manipulation of the airway in a child with suspected
epiglottitis can precipitate sudden airway obstruction. The child
should be kept calm, unnecessary procedures avoided, and personnel
capable of securing the airway should be involved promptly.
Question 7
A 9-month-old infant is brought to the emergency department after
choking on food. The infant is conscious but cannot cry, cough
effectively, or breathe. What should the nurse do?
A. Perform blind finger sweeps
B. Give abdominal thrusts
C. Alternate 5 back slaps with 5 chest thrusts
D. Begin mouth-to-mouth ventilation immediately
Answer: C. Alternate 5 back slaps with 5 chest thrusts
4|Page
