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 Techniques, Common Childhood
Disorders and Diseases, Pediatric Pharmacology and Medication Administration,
Family-Centered Nursing Care, Immunization Schedules and Preventive Health,
Pediatric Clinical Judgment, and Detailed Rationales for Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of a barking cough, hoarseness, and inspiratory stridor that is worse
at night. Which of the following is the priority nursing intervention for this child?
A. Prepare for immediate endotracheal intubation
B. Administer a prescribed nebulized racemic epinephrine treatment
C. Obtain a throat culture to rule out bacterial epiglottitis
D. Place the child in a supine position for airway assessment
CORRECT ANSWER: B. Administer a prescribed nebulized racemic epinephrine
treatment
Rationale: The child's symptoms are classic for moderate to severe croup
(laryngotracheobronchitis). Nebulized racemic epinephrine is the treatment of choice
for acute management of moderate to severe croup because it acts as a mucosal
vasoconstrictor, reducing subglottic edema and relieving airway obstruction. Intubation
is a last resort for impending respiratory failure, throat cultures are not immediately
indicated, and supine positioning would worsen stridor; the child should be kept
comfortable, often in an upright position.
Question 2: A 2-day-old newborn is noted to have a high-pitched, continuous,
machine-like murmur that is loudest at the left upper sternal border. Bounding
peripheral pulses and a widened pulse pressure are also noted. What congenital
heart defect is most consistent with these findings?
A. Ventricular septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Tetralogy of Fallot
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur at the left upper sternal border, along
with bounding pulses and a widened pulse pressure, is the classic presentation of a
hemodynamically significant patent ductus arteriosus (PDA). This occurs because the
ductus arteriosus fails to close after birth, allowing continuous shunting of blood from
the aorta to the pulmonary artery. VSD typically presents with a harsh holosystolic
murmur at the lower left sternal border, while coarctation presents with diminished
femoral pulses. Tetralogy of Fallot presents with cyanosis and a systolic ejection
murmur.
,Question 3: A 6-year-old child with a history of asthma is brought to the clinic. The
parents report that their child has been using their rescue inhaler (albuterol) three
to four times per week for the past month. According to the National Asthma
Education and Prevention Program (NAEPP) guidelines, which of the following is the
most appropriate next step in managing this child's asthma?
A. Reassure the parents that this is within normal limits for a child with asthma
B. Prescribe a low-dose inhaled corticosteroid (ICS) for daily use
C. Increase the dose of the rescue inhaler
D. Schedule a pulmonary function test before making any changes
CORRECT ANSWER: B. Prescribe a low-dose inhaled corticosteroid (ICS) for daily
use
Rationale: The NAEPP guidelines recommend that for children with persistent asthma
(symptoms >2 days per week or >2 nights per month), a low-dose inhaled corticosteroid
should be initiated as a daily controller medication. Using a rescue inhaler 3-4 times per
week indicates that the child's asthma is not well-controlled and requires preventive
therapy. Increasing the rescue inhaler does not address the underlying inflammation,
and PFTs are not always immediately required for this clinical decision in school-aged
children.
Question 4: A 10-month-old infant is admitted with dehydration secondary to acute
gastroenteritis. The child is receiving IV fluids. Which assessment finding would be
the earliest indicator of fluid overload in this infant?
A. Pitting edema in the lower extremities
B. A sudden increase in blood pressure
C. A rapid, bounding pulse and a weight gain of 1 kg in 24 hours
D. Crackles heard on auscultation of the lung bases
CORRECT ANSWER: C. A rapid, bounding pulse and a weight gain of 1 kg in 24 hours
Rationale: A weight gain of 1 kg in 24 hours indicates a fluid retention of 1 liter, which is
a sensitive and early indicator of fluid overload in an infant. A rapid, bounding pulse is
another early cardiovascular sign. Crackles and pitting edema are late signs of fluid
overload and heart failure. A sudden increase in blood pressure can be a sign, but
weight gain is the most reliable early indicator.
Question 5: A 15-year-old male presents to the school nurse with severe, unilateral
testicular pain that began abruptly two hours ago during a basketball game. He
reports nausea and vomiting. The nurse notes that the testicle is swollen, tender,
and elevated. Which of the following is the priority nursing action?
,A. Administer over-the-counter pain medication and send the student home to rest
B. Apply an ice pack to the scrotum and instruct the student to keep the area elevated
C. Notify the parents immediately and arrange for emergency transport to the
emergency department
D. Perform a urinalysis to check for a urinary tract infection
CORRECT ANSWER: C. Notify the parents immediately and arrange for emergency
transport to the emergency department
Rationale: The student's presentation is classic for testicular torsion, a urologic
emergency. The sudden onset of severe, unilateral pain, nausea, vomiting, and an
elevated, tender testicle are hallmark signs. Testicular torsion requires immediate
surgical intervention to untwist the spermatic cord and restore blood flow; irreversible
ischemia can occur within 4-6 hours. Pain management and comfort measures are not
sufficient; this is a medical emergency requiring rapid transport.
Question 6: A 4-month-old infant is brought to the clinic for a well-child visit. The
mother asks the nurse about introducing solid foods. According to the American
Academy of Pediatrics, which of the following guidelines should the nurse provide?
A. Introduce single-ingredient infant cereals and pureed fruits or vegetables starting at 4
months of age
B. Introduce solid foods when the infant can sit with minimal support and has good
head control, which is typically around 6 months
C. Start with meats and high-protein foods to ensure adequate iron intake
D. Mix solid foods with honey to make them more palatable for the infant
CORRECT ANSWER: B. Introduce solid foods when the infant can sit with minimal
support and has good head control, which is typically around 6 months
Rationale: The AAP recommends introducing solid foods around 6 months of age, when
the infant demonstrates readiness cues, including sitting with minimal support, good
head control, loss of the tongue-thrust reflex, and showing interest in food. Starting
earlier than 6 months is not necessary and may increase the risk of choking or
overfeeding. Honey is contraindicated in infants under 12 months due to the risk of
botulism.
Question 7: The nurse is caring for a child with acute glomerulonephritis. Which of
the following assessment findings would be most concerning and require
immediate intervention?
A. Gross hematuria and mild periorbital edema
B. A blood pressure of 145/95 mmHg and a headache
C. Urine output of 1 mL/kg/hour and a specific gravity of 1.020
D. Serum potassium of 5.0 mEq/L
, CORRECT ANSWER: B. A blood pressure of 145/95 mmHg and a headache
Rationale: In a child with acute glomerulonephritis, hypertension is a common
complication, and the presence of a headache in conjunction with elevated blood
pressure could be an early sign of hypertensive encephalopathy. This is a life-
threatening emergency that requires immediate intervention to lower blood pressure
and prevent seizures or stroke. Hematuria and periorbital edema are expected findings.
A urine output of 1 mL/kg/hour is adequate, and a K+ of 5.0 is slightly elevated but not
immediately emergent in this context.
Question 8: A 7-year-old child with type 1 diabetes mellitus is feeling shaky, hungry,
and has a headache. The child's blood glucose level is 65 mg/dL. Which of the
following is the most appropriate nursing action?
A. Administer a bolus dose of rapid-acting insulin per sliding scale
B. Give the child 4 ounces (120 mL) of orange juice or a glucose tablet
C. Administer 1 mg of glucagon intramuscularly
D. Withhold the child's next meal to prevent further hyperglycemia
CORRECT ANSWER: B. Give the child 4 ounces (120 mL) of orange juice or a glucose
tablet
Rationale: A blood glucose of 65 mg/dL indicates hypoglycemia. The "Rule of 15"
should be implemented: give 15 grams of simple, fast-acting carbohydrate (e.g., 4 oz of
fruit juice, 3-4 glucose tablets) and recheck blood glucose in 15 minutes. Insulin would
be contraindicated as it would lower the glucose further. Glucagon is reserved for
severe hypoglycemia where the child is unconscious or unable to swallow. Withholding
a meal is inappropriate.
Question 9: The nurse is assessing a 2-week-old infant during a home visit. The
mother states that the infant cries excessively and is difficult to console, especially
after feedings. The infant draws the knees to the chest and passes gas frequently.
What is the most likely cause of this infant's distress?
A. Colic
B. Gastroesophageal reflux disease (GERD)
C. Pyloric stenosis
D. Cow's milk protein allergy
CORRECT ANSWER: A. Colic
Rationale: The classic presentation of colic is paroxysmal, excessive, and inconsolable
crying in an otherwise healthy infant, typically starting around 2-3 weeks of age and
peaking at 6 weeks. The drawing of knees to the chest and passing gas are common
accompanying features. GERD usually presents with frequent spit-up and arching of the
Exam Questions and Answers, Exam Prep Test Bank, Pediatric Growth and
Development Milestones, Child Health Assessment Techniques, Common Childhood
Disorders and Diseases, Pediatric Pharmacology and Medication Administration,
Family-Centered Nursing Care, Immunization Schedules and Preventive Health,
Pediatric Clinical Judgment, and Detailed Rationales for Nursing Exam Success
Question 1: A 4-year-old child is brought to the emergency department with a
sudden onset of a barking cough, hoarseness, and inspiratory stridor that is worse
at night. Which of the following is the priority nursing intervention for this child?
A. Prepare for immediate endotracheal intubation
B. Administer a prescribed nebulized racemic epinephrine treatment
C. Obtain a throat culture to rule out bacterial epiglottitis
D. Place the child in a supine position for airway assessment
CORRECT ANSWER: B. Administer a prescribed nebulized racemic epinephrine
treatment
Rationale: The child's symptoms are classic for moderate to severe croup
(laryngotracheobronchitis). Nebulized racemic epinephrine is the treatment of choice
for acute management of moderate to severe croup because it acts as a mucosal
vasoconstrictor, reducing subglottic edema and relieving airway obstruction. Intubation
is a last resort for impending respiratory failure, throat cultures are not immediately
indicated, and supine positioning would worsen stridor; the child should be kept
comfortable, often in an upright position.
Question 2: A 2-day-old newborn is noted to have a high-pitched, continuous,
machine-like murmur that is loudest at the left upper sternal border. Bounding
peripheral pulses and a widened pulse pressure are also noted. What congenital
heart defect is most consistent with these findings?
A. Ventricular septal defect
B. Coarctation of the aorta
C. Patent ductus arteriosus
D. Tetralogy of Fallot
CORRECT ANSWER: C. Patent ductus arteriosus
Rationale: A continuous, "machine-like" murmur at the left upper sternal border, along
with bounding pulses and a widened pulse pressure, is the classic presentation of a
hemodynamically significant patent ductus arteriosus (PDA). This occurs because the
ductus arteriosus fails to close after birth, allowing continuous shunting of blood from
the aorta to the pulmonary artery. VSD typically presents with a harsh holosystolic
murmur at the lower left sternal border, while coarctation presents with diminished
femoral pulses. Tetralogy of Fallot presents with cyanosis and a systolic ejection
murmur.
,Question 3: A 6-year-old child with a history of asthma is brought to the clinic. The
parents report that their child has been using their rescue inhaler (albuterol) three
to four times per week for the past month. According to the National Asthma
Education and Prevention Program (NAEPP) guidelines, which of the following is the
most appropriate next step in managing this child's asthma?
A. Reassure the parents that this is within normal limits for a child with asthma
B. Prescribe a low-dose inhaled corticosteroid (ICS) for daily use
C. Increase the dose of the rescue inhaler
D. Schedule a pulmonary function test before making any changes
CORRECT ANSWER: B. Prescribe a low-dose inhaled corticosteroid (ICS) for daily
use
Rationale: The NAEPP guidelines recommend that for children with persistent asthma
(symptoms >2 days per week or >2 nights per month), a low-dose inhaled corticosteroid
should be initiated as a daily controller medication. Using a rescue inhaler 3-4 times per
week indicates that the child's asthma is not well-controlled and requires preventive
therapy. Increasing the rescue inhaler does not address the underlying inflammation,
and PFTs are not always immediately required for this clinical decision in school-aged
children.
Question 4: A 10-month-old infant is admitted with dehydration secondary to acute
gastroenteritis. The child is receiving IV fluids. Which assessment finding would be
the earliest indicator of fluid overload in this infant?
A. Pitting edema in the lower extremities
B. A sudden increase in blood pressure
C. A rapid, bounding pulse and a weight gain of 1 kg in 24 hours
D. Crackles heard on auscultation of the lung bases
CORRECT ANSWER: C. A rapid, bounding pulse and a weight gain of 1 kg in 24 hours
Rationale: A weight gain of 1 kg in 24 hours indicates a fluid retention of 1 liter, which is
a sensitive and early indicator of fluid overload in an infant. A rapid, bounding pulse is
another early cardiovascular sign. Crackles and pitting edema are late signs of fluid
overload and heart failure. A sudden increase in blood pressure can be a sign, but
weight gain is the most reliable early indicator.
Question 5: A 15-year-old male presents to the school nurse with severe, unilateral
testicular pain that began abruptly two hours ago during a basketball game. He
reports nausea and vomiting. The nurse notes that the testicle is swollen, tender,
and elevated. Which of the following is the priority nursing action?
,A. Administer over-the-counter pain medication and send the student home to rest
B. Apply an ice pack to the scrotum and instruct the student to keep the area elevated
C. Notify the parents immediately and arrange for emergency transport to the
emergency department
D. Perform a urinalysis to check for a urinary tract infection
CORRECT ANSWER: C. Notify the parents immediately and arrange for emergency
transport to the emergency department
Rationale: The student's presentation is classic for testicular torsion, a urologic
emergency. The sudden onset of severe, unilateral pain, nausea, vomiting, and an
elevated, tender testicle are hallmark signs. Testicular torsion requires immediate
surgical intervention to untwist the spermatic cord and restore blood flow; irreversible
ischemia can occur within 4-6 hours. Pain management and comfort measures are not
sufficient; this is a medical emergency requiring rapid transport.
Question 6: A 4-month-old infant is brought to the clinic for a well-child visit. The
mother asks the nurse about introducing solid foods. According to the American
Academy of Pediatrics, which of the following guidelines should the nurse provide?
A. Introduce single-ingredient infant cereals and pureed fruits or vegetables starting at 4
months of age
B. Introduce solid foods when the infant can sit with minimal support and has good
head control, which is typically around 6 months
C. Start with meats and high-protein foods to ensure adequate iron intake
D. Mix solid foods with honey to make them more palatable for the infant
CORRECT ANSWER: B. Introduce solid foods when the infant can sit with minimal
support and has good head control, which is typically around 6 months
Rationale: The AAP recommends introducing solid foods around 6 months of age, when
the infant demonstrates readiness cues, including sitting with minimal support, good
head control, loss of the tongue-thrust reflex, and showing interest in food. Starting
earlier than 6 months is not necessary and may increase the risk of choking or
overfeeding. Honey is contraindicated in infants under 12 months due to the risk of
botulism.
Question 7: The nurse is caring for a child with acute glomerulonephritis. Which of
the following assessment findings would be most concerning and require
immediate intervention?
A. Gross hematuria and mild periorbital edema
B. A blood pressure of 145/95 mmHg and a headache
C. Urine output of 1 mL/kg/hour and a specific gravity of 1.020
D. Serum potassium of 5.0 mEq/L
, CORRECT ANSWER: B. A blood pressure of 145/95 mmHg and a headache
Rationale: In a child with acute glomerulonephritis, hypertension is a common
complication, and the presence of a headache in conjunction with elevated blood
pressure could be an early sign of hypertensive encephalopathy. This is a life-
threatening emergency that requires immediate intervention to lower blood pressure
and prevent seizures or stroke. Hematuria and periorbital edema are expected findings.
A urine output of 1 mL/kg/hour is adequate, and a K+ of 5.0 is slightly elevated but not
immediately emergent in this context.
Question 8: A 7-year-old child with type 1 diabetes mellitus is feeling shaky, hungry,
and has a headache. The child's blood glucose level is 65 mg/dL. Which of the
following is the most appropriate nursing action?
A. Administer a bolus dose of rapid-acting insulin per sliding scale
B. Give the child 4 ounces (120 mL) of orange juice or a glucose tablet
C. Administer 1 mg of glucagon intramuscularly
D. Withhold the child's next meal to prevent further hyperglycemia
CORRECT ANSWER: B. Give the child 4 ounces (120 mL) of orange juice or a glucose
tablet
Rationale: A blood glucose of 65 mg/dL indicates hypoglycemia. The "Rule of 15"
should be implemented: give 15 grams of simple, fast-acting carbohydrate (e.g., 4 oz of
fruit juice, 3-4 glucose tablets) and recheck blood glucose in 15 minutes. Insulin would
be contraindicated as it would lower the glucose further. Glucagon is reserved for
severe hypoglycemia where the child is unconscious or unable to swallow. Withholding
a meal is inappropriate.
Question 9: The nurse is assessing a 2-week-old infant during a home visit. The
mother states that the infant cries excessively and is difficult to console, especially
after feedings. The infant draws the knees to the chest and passes gas frequently.
What is the most likely cause of this infant's distress?
A. Colic
B. Gastroesophageal reflux disease (GERD)
C. Pyloric stenosis
D. Cow's milk protein allergy
CORRECT ANSWER: A. Colic
Rationale: The classic presentation of colic is paroxysmal, excessive, and inconsolable
crying in an otherwise healthy infant, typically starting around 2-3 weeks of age and
peaking at 6 weeks. The drawing of knees to the chest and passing gas are common
accompanying features. GERD usually presents with frequent spit-up and arching of the
