Pediatric Nursing Case Study-Based Questions Practice and Answers
Updated 2026 | Complete Pediatric Nursing Study Guide with Verified
Case Scenarios, Detailed Rationales, Growth & Development Milestones,
Pediatric Respiratory Disorders, Infectious Diseases, Congenital
Conditions, Fluid & Electrolyte Balance, Medication Safety, Immunizations,
Family-Centered Care & NGN NCLEX Exam Prep
Question 1: A 6-month-old presents with a barking cough and inspiratory stridor.
What is the priority medication?
A. Albuterol
B. Racemic epinephrine
C. Ipratropium
D. Fluticasone
CORRECT ANSWER: B. Racemic epinephrine
Rationale: Racemic epinephrine is the priority to reduce subglottic airway edema in
croup.
Question 2: A 2-year-old with a history of asthma presents with wheezing and
retractions. What is the first-line rescue medication?
A. Salmeterol
B. Albuterol
C. Montelukast
D. Fluticasone
CORRECT ANSWER: B. Albuterol
Rationale: Albuterol is a short-acting beta-agonist used as a first-line rescue medication
for acute asthma exacerbations.
Question 3: A 4-month-old infant with RSV bronchiolitis develops apnea. What is
the priority nursing intervention?
A. Administer antibiotics
B. Provide chest physiotherapy
C. Stimulate and provide oxygen
D. Administer bronchodilators
CORRECT ANSWER: C. Stimulate and provide oxygen
Rationale: Apnea in bronchiolitis requires immediate stimulation and oxygenation to
maintain airway patency.
Question 4: An 8-year-old with cystic fibrosis presents with steatorrhea and poor
weight gain. What medication should the nurse administer with meals?
A. Pancreatic enzymes
B. Fat-soluble vitamins
,C. H2 receptor antagonists
D. Ursodeoxycholic acid
CORRECT ANSWER: A. Pancreatic enzymes
Rationale: Pancreatic enzyme replacement is essential for digestion and absorption of
nutrients in cystic fibrosis.
Question 5: A 5-year-old with pneumonia has crackles and decreased oxygen
saturation. What is the best positioning?
A. Supine with head flat
B. Prone
C. Upright or semi-Fowler
D. Trendelenburg
CORRECT ANSWER: C. Upright or semi-Fowler
Rationale: Upright positioning promotes lung expansion and improves oxygenation in
pneumonia.
Question 6: A 10-year-old presents with severe epistaxis. What is the correct first
aid?
A. Lean back and pinch nares
B. Lean forward and pinch nares
C. Apply ice to the forehead
D. Insert nasal packing immediately
CORRECT ANSWER: B. Lean forward and pinch nares
Rationale: Leaning forward prevents blood aspiration, and pinching the nares applies
direct pressure to stop bleeding.
Question 7: A 3-year-old aspirated a foreign body and has severe stridor. What is
the next step?
A. Back blows
B. Abdominal thrusts
C. Rigid bronchoscopy
D. Chest physiotherapy
CORRECT ANSWER: C. Rigid bronchoscopy
Rationale: Rigid bronchoscopy is the definitive treatment for foreign body aspiration in
the lower airway.
Question 8: A 1-month-old presents with a staccato cough and no fever. Suspected
chlamydial pneumonia. What is the treatment?
A. Amoxicillin
B. Ceftriaxone
,C. Azithromycin
D. Ciprofloxacin
CORRECT ANSWER: C. Azithromycin
Rationale: Macrolides like azithromycin are the treatment of choice for chlamydial
pneumonia in infants.
Question 9: A 6-year-old with asthma has a peak expiratory flow rate in the yellow
zone. What is the action?
A. Go to the emergency room
B. Use a short-acting beta-agonist
C. Continue current medications
D. Administer oral corticosteroids immediately
CORRECT ANSWER: B. Use a short-acting beta-agonist
Rationale: The yellow zone indicates caution; a short-acting beta-agonist should be
used as directed in the asthma action plan.
Question 10: A 12-year-old with a pneumothorax has absent breath sounds on the
right. What is the expected treatment?
A. Needle decompression
B. Chest tube insertion
C. Intubation
D. Oxygen therapy only
CORRECT ANSWER: B. Chest tube insertion
Rationale: A chest tube is required to re-expand the lung in a significant pneumothorax.
Question 11: A 2-month-old has tachypnea and diaphoresis during feeds, indicating
heart failure. What medication is priority?
A. Furosemide
B. Digoxin
C. Captopril
D. Prostaglandin E1
CORRECT ANSWER: B. Digoxin
Rationale: Digoxin increases myocardial contractility and is a primary medication for
pediatric heart failure.
Question 12: A 4-year-old with Kawasaki disease has a high fever and strawberry
tongue. What is the priority treatment?
A. IVIG and aspirin
B. Antibiotics
, C. Corticosteroids
D. Antivirals
CORRECT ANSWER: A. IVIG and aspirin
Rationale: IVIG and high-dose aspirin are the standard treatment to reduce
inflammation and prevent coronary artery aneurysms.
Question 13: An 8-year-old with rheumatic fever develops Sydenham chorea. What
is the nursing care priority?
A. Strict bed rest
B. Safety and quiet environment
C. High-calorie diet
D. Fluid restriction
CORRECT ANSWER: B. Safety and quiet environment
Rationale: Chorea causes involuntary movements; a quiet environment minimizes
stimuli and ensures safety.
Question 14: A 5-year-old with Tetralogy of Fallot experiences a "tet spell." What is
the immediate nursing action?
A. Administer oxygen
B. Place in knee-chest position
C. Administer morphine
D. Call the provider
CORRECT ANSWER: B. Place in knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance, reducing
right-to-left shunting.
Question 15: A 3-month-old with coarctation of the aorta has weak femoral pulses.
What blood pressure difference is expected?
A. Higher in legs than arms
B. Equal in arms and legs
C. Higher in arms than legs
D. Unobtainable in arms
CORRECT ANSWER: C. Higher in arms than legs
Rationale: Coarctation causes hypertension in the upper extremities and hypotension in
the lower extremities.
Question 16: A 6-year-old with a ventricular septal defect has a loud holosystolic
murmur. What is the major complication?
A. Cyanosis
B. Heart failure
Updated 2026 | Complete Pediatric Nursing Study Guide with Verified
Case Scenarios, Detailed Rationales, Growth & Development Milestones,
Pediatric Respiratory Disorders, Infectious Diseases, Congenital
Conditions, Fluid & Electrolyte Balance, Medication Safety, Immunizations,
Family-Centered Care & NGN NCLEX Exam Prep
Question 1: A 6-month-old presents with a barking cough and inspiratory stridor.
What is the priority medication?
A. Albuterol
B. Racemic epinephrine
C. Ipratropium
D. Fluticasone
CORRECT ANSWER: B. Racemic epinephrine
Rationale: Racemic epinephrine is the priority to reduce subglottic airway edema in
croup.
Question 2: A 2-year-old with a history of asthma presents with wheezing and
retractions. What is the first-line rescue medication?
A. Salmeterol
B. Albuterol
C. Montelukast
D. Fluticasone
CORRECT ANSWER: B. Albuterol
Rationale: Albuterol is a short-acting beta-agonist used as a first-line rescue medication
for acute asthma exacerbations.
Question 3: A 4-month-old infant with RSV bronchiolitis develops apnea. What is
the priority nursing intervention?
A. Administer antibiotics
B. Provide chest physiotherapy
C. Stimulate and provide oxygen
D. Administer bronchodilators
CORRECT ANSWER: C. Stimulate and provide oxygen
Rationale: Apnea in bronchiolitis requires immediate stimulation and oxygenation to
maintain airway patency.
Question 4: An 8-year-old with cystic fibrosis presents with steatorrhea and poor
weight gain. What medication should the nurse administer with meals?
A. Pancreatic enzymes
B. Fat-soluble vitamins
,C. H2 receptor antagonists
D. Ursodeoxycholic acid
CORRECT ANSWER: A. Pancreatic enzymes
Rationale: Pancreatic enzyme replacement is essential for digestion and absorption of
nutrients in cystic fibrosis.
Question 5: A 5-year-old with pneumonia has crackles and decreased oxygen
saturation. What is the best positioning?
A. Supine with head flat
B. Prone
C. Upright or semi-Fowler
D. Trendelenburg
CORRECT ANSWER: C. Upright or semi-Fowler
Rationale: Upright positioning promotes lung expansion and improves oxygenation in
pneumonia.
Question 6: A 10-year-old presents with severe epistaxis. What is the correct first
aid?
A. Lean back and pinch nares
B. Lean forward and pinch nares
C. Apply ice to the forehead
D. Insert nasal packing immediately
CORRECT ANSWER: B. Lean forward and pinch nares
Rationale: Leaning forward prevents blood aspiration, and pinching the nares applies
direct pressure to stop bleeding.
Question 7: A 3-year-old aspirated a foreign body and has severe stridor. What is
the next step?
A. Back blows
B. Abdominal thrusts
C. Rigid bronchoscopy
D. Chest physiotherapy
CORRECT ANSWER: C. Rigid bronchoscopy
Rationale: Rigid bronchoscopy is the definitive treatment for foreign body aspiration in
the lower airway.
Question 8: A 1-month-old presents with a staccato cough and no fever. Suspected
chlamydial pneumonia. What is the treatment?
A. Amoxicillin
B. Ceftriaxone
,C. Azithromycin
D. Ciprofloxacin
CORRECT ANSWER: C. Azithromycin
Rationale: Macrolides like azithromycin are the treatment of choice for chlamydial
pneumonia in infants.
Question 9: A 6-year-old with asthma has a peak expiratory flow rate in the yellow
zone. What is the action?
A. Go to the emergency room
B. Use a short-acting beta-agonist
C. Continue current medications
D. Administer oral corticosteroids immediately
CORRECT ANSWER: B. Use a short-acting beta-agonist
Rationale: The yellow zone indicates caution; a short-acting beta-agonist should be
used as directed in the asthma action plan.
Question 10: A 12-year-old with a pneumothorax has absent breath sounds on the
right. What is the expected treatment?
A. Needle decompression
B. Chest tube insertion
C. Intubation
D. Oxygen therapy only
CORRECT ANSWER: B. Chest tube insertion
Rationale: A chest tube is required to re-expand the lung in a significant pneumothorax.
Question 11: A 2-month-old has tachypnea and diaphoresis during feeds, indicating
heart failure. What medication is priority?
A. Furosemide
B. Digoxin
C. Captopril
D. Prostaglandin E1
CORRECT ANSWER: B. Digoxin
Rationale: Digoxin increases myocardial contractility and is a primary medication for
pediatric heart failure.
Question 12: A 4-year-old with Kawasaki disease has a high fever and strawberry
tongue. What is the priority treatment?
A. IVIG and aspirin
B. Antibiotics
, C. Corticosteroids
D. Antivirals
CORRECT ANSWER: A. IVIG and aspirin
Rationale: IVIG and high-dose aspirin are the standard treatment to reduce
inflammation and prevent coronary artery aneurysms.
Question 13: An 8-year-old with rheumatic fever develops Sydenham chorea. What
is the nursing care priority?
A. Strict bed rest
B. Safety and quiet environment
C. High-calorie diet
D. Fluid restriction
CORRECT ANSWER: B. Safety and quiet environment
Rationale: Chorea causes involuntary movements; a quiet environment minimizes
stimuli and ensures safety.
Question 14: A 5-year-old with Tetralogy of Fallot experiences a "tet spell." What is
the immediate nursing action?
A. Administer oxygen
B. Place in knee-chest position
C. Administer morphine
D. Call the provider
CORRECT ANSWER: B. Place in knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance, reducing
right-to-left shunting.
Question 15: A 3-month-old with coarctation of the aorta has weak femoral pulses.
What blood pressure difference is expected?
A. Higher in legs than arms
B. Equal in arms and legs
C. Higher in arms than legs
D. Unobtainable in arms
CORRECT ANSWER: C. Higher in arms than legs
Rationale: Coarctation causes hypertension in the upper extremities and hypotension in
the lower extremities.
Question 16: A 6-year-old with a ventricular septal defect has a loud holosystolic
murmur. What is the major complication?
A. Cyanosis
B. Heart failure
