NURS250 Pediatric Nursing Updated 2026 |
Comprehensive Study Guide, Practice Exam Questions
and Answers, Exam Prep Test Bank, Pediatric Growth
and Development Milestones, Child Health Assessment,
Common Childhood Disorders and Diseases, Pediatric
Pharmacology and Medication Safety, Family-Centered
Nursing Care, Immunization Schedules, Health
Promotion Strategies, Clinical Judgment Skills, and
Detailed Rationales for Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
barking cough, stridor, and moderate subcostal retractions. The nurse notes the
child is anxious and prefers to sit upright. Which of the following is the priority
nursing intervention?
A. Administer a nebulized bronchodilator treatment
B. Prepare the child for an immediate tracheostomy
C. Obtain a throat culture to rule out bacterial epiglottitis
D. Administer racemic epinephrine via nebulizer and prepare for possible corticosteroid
administration
CORRECT ANSWER: D. Administer racemic epinephrine via nebulizer and prepare
for possible corticosteroid administration
Rationale: The child's presentation of a barking cough, stridor, and retractions is classic
for croup (laryngotracheobronchitis), which causes subglottic swelling. The priority
intervention for moderate to severe croup is the administration of racemic epinephrine
to rapidly reduce mucosal edema, along with corticosteroids to decrease inflammation.
While the child is in respiratory distress, a tracheostomy is a last resort and not the
immediate priority. A throat culture is contraindicated due to the risk of triggering
complete airway obstruction. Nebulized bronchodilators are not the primary treatment
for croup.
Question 2: A 6-month-old infant is diagnosed with bronchiolitis caused by
Respiratory Syncytial Virus (RSV). The nurse is providing supportive care. Which
assessment finding would indicate that the infant's condition is deteriorating and
requires immediate intervention?
A. Respiratory rate of 40 breaths per minute
B. Heart rate of 130 beats per minute
C. Prolonged capillary refill time of 4 seconds
D. Mild intercostal retractions
CORRECT ANSWER: C. Prolonged capillary refill time of 4 seconds
Rationale: A prolonged capillary refill time of greater than 3 seconds is a sign of poor
perfusion and impending shock or severe dehydration, indicating a significant
,deterioration in the infant's condition. A respiratory rate of 40, a heart rate of 130, and
mild intercostal retractions are all expected findings in an infant with bronchiolitis and,
while they require monitoring, do not signal an immediate, life-threatening deterioration
compared to the circulatory compromise indicated by poor perfusion.
Question 3: The nurse is caring for a child with a diagnosis of acute
glomerulonephritis. Which of the following assessment findings would the nurse
expect to observe?
A. Hypotension and bradycardia
B. Periorbital edema and tea-colored urine
C. Polyuria and clear urine
D. Hyperglycemia and glycosuria
CORRECT ANSWER: B. Periorbital edema and tea-colored urine
Rationale: Acute post-streptococcal glomerulonephritis typically presents with
periorbital edema (due to fluid retention and decreased glomerular filtration) and
hematuria, which gives the urine a smoky, cola, or tea-colored appearance.
Hypertension, not hypotension, is common due to fluid volume overload. Polyuria and
hyperglycemia are not characteristics of this condition.
Question 4: A school-age child with type 1 diabetes mellitus is experiencing a
"honeymoon period." What is the most appropriate explanation the nurse should
provide to the parents regarding this phase?
A. The child's diabetes is cured and insulin will no longer be needed.
B. The child's pancreas is temporarily producing more insulin, leading to a reduced
need for exogenous insulin.
C. The child's blood glucose levels will be unstable and require frequent hospitalization.
D. The child is developing insulin resistance and will require a higher dose of insulin.
CORRECT ANSWER: B. The child's pancreas is temporarily producing more insulin,
leading to a reduced need for exogenous insulin.
Rationale: The "honeymoon period" occurs shortly after the diagnosis of type 1
diabetes when some beta-cell function returns, and the pancreas temporarily produces
a small amount of insulin. This results in a decreased need for exogenous insulin. It is a
temporary phase, not a cure, and the child will eventually require full insulin
replacement therapy.
Question 5: The nurse is preparing to administer digoxin to a 2-year-old child with a
diagnosis of heart failure. Before administering the medication, which assessment
is most critical for the nurse to perform?
A. Measure the child's blood pressure
B. Assess the child's respiratory rate
C. Count the child's apical pulse for a full 60 seconds
D. Check the child's serum potassium level from the last lab draw
,CORRECT ANSWER: C. Count the child's apical pulse for a full 60 seconds
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia and
dysrhythmias. The most critical assessment before administration is to count the apical
pulse for a full minute. The standard practice is to hold the dose and notify the physician
if the pulse is below 60 beats per minute in an older child or below 90-100 beats per
minute in an infant. While potassium levels and blood pressure are important, the pulse
rate is the primary safety check for digoxin toxicity.
Question 6: A 10-year-old child is admitted with a sickle cell crisis. Which of the
following nursing interventions is of highest priority to manage the child's pain and
prevent complications?
A. Restrict oral fluids to prevent fluid overload
B. Administer meperidine (Demerol) intramuscularly for severe pain
C. Apply cold compresses to the affected joints
D. Administer intravenous fluids and opioids as prescribed
CORRECT ANSWER: D. Administer intravenous fluids and opioids as prescribed
Rationale: The priority for managing a sickle cell crisis is pain management and
hydration. Intravenous fluids help hydrate the child and decrease blood viscosity, which
can help halt the sickling process. Opioids are the mainstay for severe pain and should
be administered on a scheduled basis, not PRN. Meperidine is generally avoided due to
the risk of seizures with repeated use. Cold compresses can cause vasoconstriction
and worsen sickling; warm compresses are often preferred for comfort.
Question 7: The nurse is teaching the parents of an infant with a cleft palate about
feeding techniques. Which of the following instructions is most appropriate?
A. Feed the infant in a supine position
B. Use a regular bottle nipple with a large hole
C. Burp the infant frequently during feedings
D. Apply gentle pressure to the infant's chin to help with sucking
CORRECT ANSWER: C. Burp the infant frequently during feedings
Rationale: Infants with a cleft palate have difficulty creating suction and swallow
excessive amounts of air due to the communication between the oral and nasal
cavities. Therefore, they need to be burped frequently (every 1-2 ounces) to prevent
abdominal distension, vomiting, and aspiration. A specialized feeding device (like a
Mead-Johnson or Haberman feeder) is preferred, not a regular nipple. The infant should
be held in an upright position to facilitate swallowing and prevent aspiration.
Question 8: A 3-year-old child is brought to the clinic with a fever, irritability, and a
characteristic rash. The rash consists of vesicular lesions on an erythematous
base, described as "dewdrops on a rose petal." The lesions are most abundant on
the trunk. Which of the following infectious diseases is the child most likely
experiencing?
, A. Rubeola (measles)
B. Varicella (chickenpox)
C. Rubella (German measles)
D. Fifth disease (erythema infectiosum)
CORRECT ANSWER: B. Varicella (chickenpox)
Rationale: The description of vesicular lesions on an erythematous base ("dewdrops on
a rose petal") is the classic description of the varicella (chickenpox) rash. The rash
begins on the trunk and spreads to the face and extremities. Rubeola has a
maculopapular rash that starts on the face and spreads downward. Rubella has a fine,
pink maculopapular rash. Fifth disease presents with a "slapped cheek" appearance
followed by a lacy reticular rash on the trunk and extremities.
Question 9: The nurse is caring for a 6-week-old infant who is irritable, feeding
poorly, and has a high-pitched cry. The mother reports the infant has had projectile
vomiting after feedings. A diagnosis of pyloric stenosis is suspected. Which of the
following metabolic imbalances would the nurse anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Metabolic alkalosis
Rationale: Pyloric stenosis causes a functional gastric outlet obstruction, leading to
persistent projectile vomiting. The vomiting results in the loss of hydrochloric acid and
gastric contents, which are rich in hydrogen and chloride ions. This leads to a
hypochloremic metabolic alkalosis. The infant also loses potassium and sodium,
leading to hypokalemia and hyponatremia.
Question 10: A 14-year-old adolescent is admitted with anorexia nervosa. The nurse
is developing a plan of care. Which of the following is the primary short-term goal
for this patient?
A. The patient will gain 1 to 2 pounds per week.
B. The patient will identify three negative body image perceptions.
C. The patient will verbalize an understanding of the importance of nutrition.
D. The patient will establish a therapeutic relationship with the staff.
CORRECT ANSWER: A. The patient will gain 1 to 2 pounds per week.
Rationale: The immediate, life-threatening risk for a patient with anorexia nervosa is
severe malnutrition and weight loss. The primary short-term goal for medical
stabilization is weight restoration. A safe rate of weight gain is generally 1 to 2 pounds
per week. While psychological goals (identifying negative perceptions, understanding
nutrition, and building a therapeutic relationship) are all important components of the
overall treatment plan, they are long-term goals and not the immediate medical priority.
Comprehensive Study Guide, Practice Exam Questions
and Answers, Exam Prep Test Bank, Pediatric Growth
and Development Milestones, Child Health Assessment,
Common Childhood Disorders and Diseases, Pediatric
Pharmacology and Medication Safety, Family-Centered
Nursing Care, Immunization Schedules, Health
Promotion Strategies, Clinical Judgment Skills, and
Detailed Rationales for Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
barking cough, stridor, and moderate subcostal retractions. The nurse notes the
child is anxious and prefers to sit upright. Which of the following is the priority
nursing intervention?
A. Administer a nebulized bronchodilator treatment
B. Prepare the child for an immediate tracheostomy
C. Obtain a throat culture to rule out bacterial epiglottitis
D. Administer racemic epinephrine via nebulizer and prepare for possible corticosteroid
administration
CORRECT ANSWER: D. Administer racemic epinephrine via nebulizer and prepare
for possible corticosteroid administration
Rationale: The child's presentation of a barking cough, stridor, and retractions is classic
for croup (laryngotracheobronchitis), which causes subglottic swelling. The priority
intervention for moderate to severe croup is the administration of racemic epinephrine
to rapidly reduce mucosal edema, along with corticosteroids to decrease inflammation.
While the child is in respiratory distress, a tracheostomy is a last resort and not the
immediate priority. A throat culture is contraindicated due to the risk of triggering
complete airway obstruction. Nebulized bronchodilators are not the primary treatment
for croup.
Question 2: A 6-month-old infant is diagnosed with bronchiolitis caused by
Respiratory Syncytial Virus (RSV). The nurse is providing supportive care. Which
assessment finding would indicate that the infant's condition is deteriorating and
requires immediate intervention?
A. Respiratory rate of 40 breaths per minute
B. Heart rate of 130 beats per minute
C. Prolonged capillary refill time of 4 seconds
D. Mild intercostal retractions
CORRECT ANSWER: C. Prolonged capillary refill time of 4 seconds
Rationale: A prolonged capillary refill time of greater than 3 seconds is a sign of poor
perfusion and impending shock or severe dehydration, indicating a significant
,deterioration in the infant's condition. A respiratory rate of 40, a heart rate of 130, and
mild intercostal retractions are all expected findings in an infant with bronchiolitis and,
while they require monitoring, do not signal an immediate, life-threatening deterioration
compared to the circulatory compromise indicated by poor perfusion.
Question 3: The nurse is caring for a child with a diagnosis of acute
glomerulonephritis. Which of the following assessment findings would the nurse
expect to observe?
A. Hypotension and bradycardia
B. Periorbital edema and tea-colored urine
C. Polyuria and clear urine
D. Hyperglycemia and glycosuria
CORRECT ANSWER: B. Periorbital edema and tea-colored urine
Rationale: Acute post-streptococcal glomerulonephritis typically presents with
periorbital edema (due to fluid retention and decreased glomerular filtration) and
hematuria, which gives the urine a smoky, cola, or tea-colored appearance.
Hypertension, not hypotension, is common due to fluid volume overload. Polyuria and
hyperglycemia are not characteristics of this condition.
Question 4: A school-age child with type 1 diabetes mellitus is experiencing a
"honeymoon period." What is the most appropriate explanation the nurse should
provide to the parents regarding this phase?
A. The child's diabetes is cured and insulin will no longer be needed.
B. The child's pancreas is temporarily producing more insulin, leading to a reduced
need for exogenous insulin.
C. The child's blood glucose levels will be unstable and require frequent hospitalization.
D. The child is developing insulin resistance and will require a higher dose of insulin.
CORRECT ANSWER: B. The child's pancreas is temporarily producing more insulin,
leading to a reduced need for exogenous insulin.
Rationale: The "honeymoon period" occurs shortly after the diagnosis of type 1
diabetes when some beta-cell function returns, and the pancreas temporarily produces
a small amount of insulin. This results in a decreased need for exogenous insulin. It is a
temporary phase, not a cure, and the child will eventually require full insulin
replacement therapy.
Question 5: The nurse is preparing to administer digoxin to a 2-year-old child with a
diagnosis of heart failure. Before administering the medication, which assessment
is most critical for the nurse to perform?
A. Measure the child's blood pressure
B. Assess the child's respiratory rate
C. Count the child's apical pulse for a full 60 seconds
D. Check the child's serum potassium level from the last lab draw
,CORRECT ANSWER: C. Count the child's apical pulse for a full 60 seconds
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia and
dysrhythmias. The most critical assessment before administration is to count the apical
pulse for a full minute. The standard practice is to hold the dose and notify the physician
if the pulse is below 60 beats per minute in an older child or below 90-100 beats per
minute in an infant. While potassium levels and blood pressure are important, the pulse
rate is the primary safety check for digoxin toxicity.
Question 6: A 10-year-old child is admitted with a sickle cell crisis. Which of the
following nursing interventions is of highest priority to manage the child's pain and
prevent complications?
A. Restrict oral fluids to prevent fluid overload
B. Administer meperidine (Demerol) intramuscularly for severe pain
C. Apply cold compresses to the affected joints
D. Administer intravenous fluids and opioids as prescribed
CORRECT ANSWER: D. Administer intravenous fluids and opioids as prescribed
Rationale: The priority for managing a sickle cell crisis is pain management and
hydration. Intravenous fluids help hydrate the child and decrease blood viscosity, which
can help halt the sickling process. Opioids are the mainstay for severe pain and should
be administered on a scheduled basis, not PRN. Meperidine is generally avoided due to
the risk of seizures with repeated use. Cold compresses can cause vasoconstriction
and worsen sickling; warm compresses are often preferred for comfort.
Question 7: The nurse is teaching the parents of an infant with a cleft palate about
feeding techniques. Which of the following instructions is most appropriate?
A. Feed the infant in a supine position
B. Use a regular bottle nipple with a large hole
C. Burp the infant frequently during feedings
D. Apply gentle pressure to the infant's chin to help with sucking
CORRECT ANSWER: C. Burp the infant frequently during feedings
Rationale: Infants with a cleft palate have difficulty creating suction and swallow
excessive amounts of air due to the communication between the oral and nasal
cavities. Therefore, they need to be burped frequently (every 1-2 ounces) to prevent
abdominal distension, vomiting, and aspiration. A specialized feeding device (like a
Mead-Johnson or Haberman feeder) is preferred, not a regular nipple. The infant should
be held in an upright position to facilitate swallowing and prevent aspiration.
Question 8: A 3-year-old child is brought to the clinic with a fever, irritability, and a
characteristic rash. The rash consists of vesicular lesions on an erythematous
base, described as "dewdrops on a rose petal." The lesions are most abundant on
the trunk. Which of the following infectious diseases is the child most likely
experiencing?
, A. Rubeola (measles)
B. Varicella (chickenpox)
C. Rubella (German measles)
D. Fifth disease (erythema infectiosum)
CORRECT ANSWER: B. Varicella (chickenpox)
Rationale: The description of vesicular lesions on an erythematous base ("dewdrops on
a rose petal") is the classic description of the varicella (chickenpox) rash. The rash
begins on the trunk and spreads to the face and extremities. Rubeola has a
maculopapular rash that starts on the face and spreads downward. Rubella has a fine,
pink maculopapular rash. Fifth disease presents with a "slapped cheek" appearance
followed by a lacy reticular rash on the trunk and extremities.
Question 9: The nurse is caring for a 6-week-old infant who is irritable, feeding
poorly, and has a high-pitched cry. The mother reports the infant has had projectile
vomiting after feedings. A diagnosis of pyloric stenosis is suspected. Which of the
following metabolic imbalances would the nurse anticipate?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
CORRECT ANSWER: B. Metabolic alkalosis
Rationale: Pyloric stenosis causes a functional gastric outlet obstruction, leading to
persistent projectile vomiting. The vomiting results in the loss of hydrochloric acid and
gastric contents, which are rich in hydrogen and chloride ions. This leads to a
hypochloremic metabolic alkalosis. The infant also loses potassium and sodium,
leading to hypokalemia and hyponatremia.
Question 10: A 14-year-old adolescent is admitted with anorexia nervosa. The nurse
is developing a plan of care. Which of the following is the primary short-term goal
for this patient?
A. The patient will gain 1 to 2 pounds per week.
B. The patient will identify three negative body image perceptions.
C. The patient will verbalize an understanding of the importance of nutrition.
D. The patient will establish a therapeutic relationship with the staff.
CORRECT ANSWER: A. The patient will gain 1 to 2 pounds per week.
Rationale: The immediate, life-threatening risk for a patient with anorexia nervosa is
severe malnutrition and weight loss. The primary short-term goal for medical
stabilization is weight restoration. A safe rate of weight gain is generally 1 to 2 pounds
per week. While psychological goals (identifying negative perceptions, understanding
nutrition, and building a therapeutic relationship) are all important components of the
overall treatment plan, they are long-term goals and not the immediate medical priority.
