,NUR 223 Pediatrics Clinical Judgment Exam Questions And Answers
2026/2027 Jersey College
Q1. An infant with bronchiolitis has become increasingly sleepy.
Respiratory rate has fallen from 62/min to 32/min, retractions are
less visible, but oxygen saturation has dropped from 93% to 84%.
How should this trend be interpreted?
A) The infant may be tiring and progressing toward respiratory failure
B) The respiratory illness is resolving
C) The lower respiratory rate confirms adequate oxygenation
D) Reduced retractions indicate successful treatment
Correct Answer: A) The infant may be tiring and progressing toward
respiratory failure
Rationale: Decreasing respiratory effort accompanied by worsening
oxygenation and altered responsiveness can indicate exhaustion rather than
improvement.
Q2. A 3-year-old with vomiting and diarrhea is lethargic, has dry
mucous membranes, heart rate 148/min, capillary refill of 4 seconds,
and minimal urine output. Which problem has the highest priority?
A) Altered nutrition
B) Significant dehydration with impaired perfusion
C) Sleep disturbance
D) Developmental regression
Correct Answer: B) Significant dehydration with impaired perfusion
Rationale: Tachycardia, delayed capillary refill, lethargy, and oliguria
indicate substantial intravascular volume depletion.
Q3. A child with asthma initially had loud wheezing. Two hours later,
wheezing is barely audible, the child is drowsy, and breath sounds
are markedly diminished. Which interpretation is most appropriate?
A) Bronchospasm has resolved
B) The child is entering a normal sleep phase
C) Air movement has become critically limited
D) The medication has produced complete recovery
Correct Answer: C) Air movement has become critically limited
,Rationale: A quiet chest in a deteriorating child with asthma can reflect
severe obstruction and inadequate airflow.
Q4. Which pediatric patient requires assessment first?
A) A school-age child with mild postoperative pain
B) A toddler with a temperature of 38°C and normal activity
C) An adolescent waiting for discharge instructions
D) An infant with grunting, central cyanosis, and decreasing responsiveness
Correct Answer: D) An infant with grunting, central cyanosis, and decreasing
responsiveness
Rationale: Signs of respiratory failure and impaired consciousness represent
an immediate threat to airway and oxygenation.
Q5. A child being treated for dehydration has improved capillary
refill, stronger pulses, increased urine output, and more alert
behavior. What is the best interpretation?
A) Circulating volume and perfusion are improving
B) Fluid replacement should immediately stop
C) Renal function is worsening
D) The child is developing shock
Correct Answer: A) Circulating volume and perfusion are improving
Rationale: Improved perfusion, mental status, and urine output indicate a
positive response to fluid replacement.
Q6. A hospitalized toddler cries whenever the parent leaves, refuses
food, and repeatedly asks for a familiar blanket. Which intervention
best addresses these cues?
A) Limit contact with the parent to encourage independence
B) Promote caregiver presence and preserve familiar routines when possible
C) Remove familiar objects to encourage adaptation
D) Ignore the behavior because it is manipulative
Correct Answer: B) Promote caregiver presence and preserve familiar
routines when possible
Rationale: Young children often experience separation anxiety during
hospitalization, and caregiver presence and familiar routines reduce distress.
, Q7. A preschool child says, “I got sick because I was bad.” Which
response best demonstrates developmentally appropriate clinical
judgment?
A) “You need to behave better when you go home.”
B) “You are too young to understand why you are sick.”
C) “Being sick is not a punishment for anything you did.”
D) “We should ask your parent why this happened.”
Correct Answer: C) “Being sick is not a punishment for anything you did.”
Rationale: Preschool children may use magical thinking and interpret illness
as punishment, so simple reassurance corrects the misconception.
Q8. A child receives an opioid for postoperative pain. Fifteen
minutes later, the child is difficult to arouse and respirations are
8/min. What is the priority action?
A) Document that pain relief was successful
B) Allow the child to sleep undisturbed
C) Offer oral fluids
D) Assess and support airway and breathing while initiating urgent treatment
for opioid-induced respiratory depression
Correct Answer: D) Assess and support airway and breathing while initiating
urgent treatment for opioid-induced respiratory depression
Rationale: Respiratory depression after opioid administration is a potentially
life-threatening adverse effect requiring immediate intervention.
Q9. A child with fever becomes increasingly irritable and difficult to
console. Which assessment should be prioritized when the child also
develops delayed capillary refill and cool extremities?
A) Perfusion and possible progression toward shock
B) School performance
C) Bowel habits
D) Dental development
Correct Answer: A) Perfusion and possible progression toward shock
Rationale: Cool extremities and delayed capillary refill can reflect impaired
circulation and require prompt hemodynamic assessment.
2026/2027 Jersey College
Q1. An infant with bronchiolitis has become increasingly sleepy.
Respiratory rate has fallen from 62/min to 32/min, retractions are
less visible, but oxygen saturation has dropped from 93% to 84%.
How should this trend be interpreted?
A) The infant may be tiring and progressing toward respiratory failure
B) The respiratory illness is resolving
C) The lower respiratory rate confirms adequate oxygenation
D) Reduced retractions indicate successful treatment
Correct Answer: A) The infant may be tiring and progressing toward
respiratory failure
Rationale: Decreasing respiratory effort accompanied by worsening
oxygenation and altered responsiveness can indicate exhaustion rather than
improvement.
Q2. A 3-year-old with vomiting and diarrhea is lethargic, has dry
mucous membranes, heart rate 148/min, capillary refill of 4 seconds,
and minimal urine output. Which problem has the highest priority?
A) Altered nutrition
B) Significant dehydration with impaired perfusion
C) Sleep disturbance
D) Developmental regression
Correct Answer: B) Significant dehydration with impaired perfusion
Rationale: Tachycardia, delayed capillary refill, lethargy, and oliguria
indicate substantial intravascular volume depletion.
Q3. A child with asthma initially had loud wheezing. Two hours later,
wheezing is barely audible, the child is drowsy, and breath sounds
are markedly diminished. Which interpretation is most appropriate?
A) Bronchospasm has resolved
B) The child is entering a normal sleep phase
C) Air movement has become critically limited
D) The medication has produced complete recovery
Correct Answer: C) Air movement has become critically limited
,Rationale: A quiet chest in a deteriorating child with asthma can reflect
severe obstruction and inadequate airflow.
Q4. Which pediatric patient requires assessment first?
A) A school-age child with mild postoperative pain
B) A toddler with a temperature of 38°C and normal activity
C) An adolescent waiting for discharge instructions
D) An infant with grunting, central cyanosis, and decreasing responsiveness
Correct Answer: D) An infant with grunting, central cyanosis, and decreasing
responsiveness
Rationale: Signs of respiratory failure and impaired consciousness represent
an immediate threat to airway and oxygenation.
Q5. A child being treated for dehydration has improved capillary
refill, stronger pulses, increased urine output, and more alert
behavior. What is the best interpretation?
A) Circulating volume and perfusion are improving
B) Fluid replacement should immediately stop
C) Renal function is worsening
D) The child is developing shock
Correct Answer: A) Circulating volume and perfusion are improving
Rationale: Improved perfusion, mental status, and urine output indicate a
positive response to fluid replacement.
Q6. A hospitalized toddler cries whenever the parent leaves, refuses
food, and repeatedly asks for a familiar blanket. Which intervention
best addresses these cues?
A) Limit contact with the parent to encourage independence
B) Promote caregiver presence and preserve familiar routines when possible
C) Remove familiar objects to encourage adaptation
D) Ignore the behavior because it is manipulative
Correct Answer: B) Promote caregiver presence and preserve familiar
routines when possible
Rationale: Young children often experience separation anxiety during
hospitalization, and caregiver presence and familiar routines reduce distress.
, Q7. A preschool child says, “I got sick because I was bad.” Which
response best demonstrates developmentally appropriate clinical
judgment?
A) “You need to behave better when you go home.”
B) “You are too young to understand why you are sick.”
C) “Being sick is not a punishment for anything you did.”
D) “We should ask your parent why this happened.”
Correct Answer: C) “Being sick is not a punishment for anything you did.”
Rationale: Preschool children may use magical thinking and interpret illness
as punishment, so simple reassurance corrects the misconception.
Q8. A child receives an opioid for postoperative pain. Fifteen
minutes later, the child is difficult to arouse and respirations are
8/min. What is the priority action?
A) Document that pain relief was successful
B) Allow the child to sleep undisturbed
C) Offer oral fluids
D) Assess and support airway and breathing while initiating urgent treatment
for opioid-induced respiratory depression
Correct Answer: D) Assess and support airway and breathing while initiating
urgent treatment for opioid-induced respiratory depression
Rationale: Respiratory depression after opioid administration is a potentially
life-threatening adverse effect requiring immediate intervention.
Q9. A child with fever becomes increasingly irritable and difficult to
console. Which assessment should be prioritized when the child also
develops delayed capillary refill and cool extremities?
A) Perfusion and possible progression toward shock
B) School performance
C) Bowel habits
D) Dental development
Correct Answer: A) Perfusion and possible progression toward shock
Rationale: Cool extremities and delayed capillary refill can reflect impaired
circulation and require prompt hemodynamic assessment.
