NU225
Pediatric Nursing
Midterm Exam Prep
2026
(With Solutions)
Multiple Choice Questions (15)
A 6-year-old child with congenital heart disease presents with cyanosis and clubbing. What is the
most likely underlying pathophysiological cause?
a) Left-to-right shunt
b) Right-to-left shunt
c) Pulmonary hypertension
d) Systemic hypertension
Answer: b) Right-to-left shunt
Rationale: Right-to-left shunts cause deoxygenated blood to bypass the lungs, leading to hypoxia,
cyanosis, and clubbing.
Which medication is the first-line treatment for a pediatric patient experiencing a status asthmaticus
attack in the emergency department?
a) Ipratropium bromide
b) Albuterol (salbutamol) nebulizer
c) Oral corticosteroids
d) Intravenous magnesium sulfate
Answer: b) Albuterol (salbutamol) nebulizer
Rationale: Short-acting beta2 agonists like albuterol are first-line bronchodilators for acute asthma
exacerbations.
In diagnosing acute lymphoblastic leukemia in a child, which laboratory finding is most indicative?
a) Elevated neutrophil count
b) Pancytopenia with blasts on peripheral smear
c) Elevated platelet count
d) Hypercalcemia
Answer: b) Pancytopenia with blasts on peripheral smear
Rationale: ALL presents with immature lymphoblasts in the peripheral blood, often associated with
pancytopenia.
Which vaccine is contraindicated in immunocompromised pediatric patients?
a) Inactivated polio vaccine
b) MMR (measles, mumps, rubella) vaccine
c) Hepatitis B vaccine
d) Pneumococcal conjugate vaccine
Answer: b) MMR vaccine
Rationale: MMR is a live attenuated vaccine and contraindicated in immunocompromised children.
A 2-year-old presents with a barking cough and stridor. What is the first nursing priority?
,a) Administer antipyretics
b) Maintain airway patency
c) Start intravenous antibiotics
d) Perform chest physiotherapy
Answer: b) Maintain airway patency
Rationale: Stridor indicates airway obstruction; airway management to prevent respiratory distress is
critical.
Which clinical sign is most specific for early detection of increased intracranial pressure (ICP) in a
pediatric patient?
a) Bradycardia
b) Projectile vomiting
c) Bulging fontanelle
d) Tachypnea
Answer: c) Bulging fontanelle
Rationale: In infants, a bulging fontanelle is a key early sign of elevated ICP.
In the nutritional management of a child with cystic fibrosis, supplementation of which vitamin is
essential?
a) Vitamin C
b) Vitamin D
c) Vitamin K
d) Vitamin E
Answer: c) Vitamin K
Rationale: Fat-soluble vitamin deficiencies, especially K, occur due to pancreatic insufficiency
affecting clotting.
Which is the most common electrolyte imbalance seen in pediatric diabetic ketoacidosis?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hyponatremia
Answer: a) Hyperkalemia
Rationale: Despite total body potassium depletion, serum potassium is often elevated due to acidosis-
induced potassium shift.
Which nursing intervention is crucial when caring for a neonate undergoing phototherapy for
hyperbilirubinemia?
a) Maintain hydration and monitor for dehydration
b) Use of heavy clothing to prevent hypothermia
c) Frequent application of emollients
d) Avoid covering the eyes with protective shields
Answer: a) Maintain hydration and monitor for dehydration
Rationale: Phototherapy increases insensible water loss; hydration must be maintained.
Which scale is best used to assess postoperative pain in preverbal children?
a) Wong-Baker FACES scale
b) FLACC scale
c) Numeric rating scale
d) Visual analog scale
Answer: b) FLACC scale
Rationale: FLACC (Face, Legs, Activity, Cry, Consolability) is validated for non-verbal/infant pain
assessment.
, In a child with Kawasaki disease, what is the most important long-term complication the nurse should
monitor for?
a) Coronary artery aneurysms
b) Joint contractures
c) Hearing loss
d) Renal failure
Answer: a) Coronary artery aneurysms
Rationale: Kawasaki disease causes inflammation of coronary arteries that may lead to aneurysm
formation.
Which of the following is the best indicator of fluid volume status in infants?
a) Blood pressure
b) Capillary refill time
c) Urine output
d) Heart rate
Answer: c) Urine output
Rationale: Urine output reliably reflects renal perfusion and hydration status.
During a seizure, which intervention is the most appropriate nursing action?
a) Insert a tongue depressor to prevent swallowing of tongue
b) Restrain the child to prevent injury
c) Position the child on the side to maintain airway patency
d) Provide oral fluids to prevent dehydration
Answer: c) Position the child on the side to maintain airway patency
Rationale: Side-lying position prevents aspiration and maintains airway; restraint and oral fluids are
contraindicated.
The main cause of diarrhea in children with malabsorption syndromes is:
a) Excessive bile acid absorption
b) Increased intestinal motility
c) Fat maldigestion
d) Decreased gastric acid secretion
Answer: c) Fat maldigestion
Rationale: Malabsorption of fats leads to steatorrhea and watery diarrhea.
Which lab value would most help differentiate nephrotic syndrome from acute glomerulonephritis in
a child?
a) Urine protein
b) Serum creatinine
c) Serum albumin
d) Urinalysis for blood
Answer: d) Urinalysis for blood
Rationale: Hematuria is common in acute glomerulonephritis but absent or minimal in nephrotic
syndrome.
True or False (10)
True or False: In pediatric septic shock, hypotension is often a late sign.
Answer: True
Rationale: Children compensate by increasing heart rate and systemic vascular resistance;
hypotension occurs late.
True or False: The APGAR score assesses a newborn’s neurological status at 1 and 5 minutes after
Pediatric Nursing
Midterm Exam Prep
2026
(With Solutions)
Multiple Choice Questions (15)
A 6-year-old child with congenital heart disease presents with cyanosis and clubbing. What is the
most likely underlying pathophysiological cause?
a) Left-to-right shunt
b) Right-to-left shunt
c) Pulmonary hypertension
d) Systemic hypertension
Answer: b) Right-to-left shunt
Rationale: Right-to-left shunts cause deoxygenated blood to bypass the lungs, leading to hypoxia,
cyanosis, and clubbing.
Which medication is the first-line treatment for a pediatric patient experiencing a status asthmaticus
attack in the emergency department?
a) Ipratropium bromide
b) Albuterol (salbutamol) nebulizer
c) Oral corticosteroids
d) Intravenous magnesium sulfate
Answer: b) Albuterol (salbutamol) nebulizer
Rationale: Short-acting beta2 agonists like albuterol are first-line bronchodilators for acute asthma
exacerbations.
In diagnosing acute lymphoblastic leukemia in a child, which laboratory finding is most indicative?
a) Elevated neutrophil count
b) Pancytopenia with blasts on peripheral smear
c) Elevated platelet count
d) Hypercalcemia
Answer: b) Pancytopenia with blasts on peripheral smear
Rationale: ALL presents with immature lymphoblasts in the peripheral blood, often associated with
pancytopenia.
Which vaccine is contraindicated in immunocompromised pediatric patients?
a) Inactivated polio vaccine
b) MMR (measles, mumps, rubella) vaccine
c) Hepatitis B vaccine
d) Pneumococcal conjugate vaccine
Answer: b) MMR vaccine
Rationale: MMR is a live attenuated vaccine and contraindicated in immunocompromised children.
A 2-year-old presents with a barking cough and stridor. What is the first nursing priority?
,a) Administer antipyretics
b) Maintain airway patency
c) Start intravenous antibiotics
d) Perform chest physiotherapy
Answer: b) Maintain airway patency
Rationale: Stridor indicates airway obstruction; airway management to prevent respiratory distress is
critical.
Which clinical sign is most specific for early detection of increased intracranial pressure (ICP) in a
pediatric patient?
a) Bradycardia
b) Projectile vomiting
c) Bulging fontanelle
d) Tachypnea
Answer: c) Bulging fontanelle
Rationale: In infants, a bulging fontanelle is a key early sign of elevated ICP.
In the nutritional management of a child with cystic fibrosis, supplementation of which vitamin is
essential?
a) Vitamin C
b) Vitamin D
c) Vitamin K
d) Vitamin E
Answer: c) Vitamin K
Rationale: Fat-soluble vitamin deficiencies, especially K, occur due to pancreatic insufficiency
affecting clotting.
Which is the most common electrolyte imbalance seen in pediatric diabetic ketoacidosis?
a) Hyperkalemia
b) Hypokalemia
c) Hypernatremia
d) Hyponatremia
Answer: a) Hyperkalemia
Rationale: Despite total body potassium depletion, serum potassium is often elevated due to acidosis-
induced potassium shift.
Which nursing intervention is crucial when caring for a neonate undergoing phototherapy for
hyperbilirubinemia?
a) Maintain hydration and monitor for dehydration
b) Use of heavy clothing to prevent hypothermia
c) Frequent application of emollients
d) Avoid covering the eyes with protective shields
Answer: a) Maintain hydration and monitor for dehydration
Rationale: Phototherapy increases insensible water loss; hydration must be maintained.
Which scale is best used to assess postoperative pain in preverbal children?
a) Wong-Baker FACES scale
b) FLACC scale
c) Numeric rating scale
d) Visual analog scale
Answer: b) FLACC scale
Rationale: FLACC (Face, Legs, Activity, Cry, Consolability) is validated for non-verbal/infant pain
assessment.
, In a child with Kawasaki disease, what is the most important long-term complication the nurse should
monitor for?
a) Coronary artery aneurysms
b) Joint contractures
c) Hearing loss
d) Renal failure
Answer: a) Coronary artery aneurysms
Rationale: Kawasaki disease causes inflammation of coronary arteries that may lead to aneurysm
formation.
Which of the following is the best indicator of fluid volume status in infants?
a) Blood pressure
b) Capillary refill time
c) Urine output
d) Heart rate
Answer: c) Urine output
Rationale: Urine output reliably reflects renal perfusion and hydration status.
During a seizure, which intervention is the most appropriate nursing action?
a) Insert a tongue depressor to prevent swallowing of tongue
b) Restrain the child to prevent injury
c) Position the child on the side to maintain airway patency
d) Provide oral fluids to prevent dehydration
Answer: c) Position the child on the side to maintain airway patency
Rationale: Side-lying position prevents aspiration and maintains airway; restraint and oral fluids are
contraindicated.
The main cause of diarrhea in children with malabsorption syndromes is:
a) Excessive bile acid absorption
b) Increased intestinal motility
c) Fat maldigestion
d) Decreased gastric acid secretion
Answer: c) Fat maldigestion
Rationale: Malabsorption of fats leads to steatorrhea and watery diarrhea.
Which lab value would most help differentiate nephrotic syndrome from acute glomerulonephritis in
a child?
a) Urine protein
b) Serum creatinine
c) Serum albumin
d) Urinalysis for blood
Answer: d) Urinalysis for blood
Rationale: Hematuria is common in acute glomerulonephritis but absent or minimal in nephrotic
syndrome.
True or False (10)
True or False: In pediatric septic shock, hypotension is often a late sign.
Answer: True
Rationale: Children compensate by increasing heart rate and systemic vascular resistance;
hypotension occurs late.
True or False: The APGAR score assesses a newborn’s neurological status at 1 and 5 minutes after
