Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
RN Nursing Care of Children 2025 TESTBANK
Study Guide | Pediatric Exam Scenarios,
Answers & Detailed Rationales
Scenario 1: Respiratory Distress in an Infant (Bronchiolitis)
The Scenario:
A 6-month-old infant is admitted to the pediatric unit with a 2-day history of low-grade fever,
copious clear nasal discharge, and a progressively worsening cough. On assessment, the infant
is irritable, has a respiratory rate of 65 breaths/minute, intercostal and subcostal retractions,
expiratory wheezing, and a capillary refill time of 3 seconds. Auscultation reveals fine crackles
and high-pitched wheezes. The pulse oximetry reading is 90% on room air. The likely diagnosis
is Bronchiolitis caused by Respiratory Syncytial Virus (RSV).
The Question:
What is the priority nursing intervention, and what are the next two most critical
interventions for this infant? Detail the rationale for each intervention.
Intervention Rationale
Priority 1
Intervention 2
Intervention 3
Detailed Rationale and Why it is Frequently Tested
Intervention Rationale
The respiratory rate of 65/min, retractions, and SpO2 of 90%
Priority 1: Maintain a
indicate significant respiratory distress and hypoxia. Maintaining
Patent
adequate oxygenation and ventilation is always the highest priority
,Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
Intervention Rationale
Airway/Administer ($\text{A}irway/\text{B}$reathing). Oxygen should be administered
Supplemental Oxygen. to maintain an SpO2 greater than 92% and to decrease the work of
breathing.
RSV causes copious, thick secretions that obstruct the small nasal
Intervention 2: Suction passages of infants, who are obligate nose-breathers. Removing
Nasopharynx (especially secretions facilitates breathing, improves gas exchange, and is
before feeds/sleep). essential for effective feeding to prevent dehydration and further
respiratory compromise.
The infant is irritable and has signs of possible dehydration
Intervention 3: Initiate (capillary refill >2 seconds) due to increased insensible water loss
IV Fluids/Strict Intake from tachypnea and poor oral intake caused by the effort of
and Output (I&O) breathing. IV fluids prevent dehydration, and I&O is critical to
Monitoring. assess hydration status and prevent fluid overload, especially in the
context of SIADH (a potential complication of RSV).
Why this Question is Frequently Tested:
• Prioritization: It tests the nurse's ability to apply the ABCs (Airway, Breathing,
Circulation) and prioritize interventions in an acutely ill child.
• Disease-Specific Care: Bronchiolitis is the most common reason for hospitalization in
infants. The care is unique (suctioning is key; bronchodilators/steroids are often
ineffective/not indicated), making it a crucial differential from asthma/croup.
• Assessment Skills: The scenario requires recognizing hallmark signs of respiratory
distress in an infant (retractions, wheezing, tachypnea, SpO2).
Scenario 2: Post-Operative Care for a Child with a Ventriculoperitoneal (VP) Shunt
The Scenario:
A 4-year-old child who underwent a revision of a VP shunt 8 hours ago is resting in the
pediatric neurosurgical unit. The nurse notes that the child's pulse rate has dropped from 95 to
60 beats/minute, the blood pressure has increased from 100/60 to 125/80 mmHg, the child is
lethargic, and the anterior fontanel (if still open, or scalp veins in this case) appears full and
tense. The child also reports a headache.
The Question:
Based on the assessment findings, what is the immediate suspected complication, and what
is the nurse's priority action and the rationale?
Suspected Complication Priority Action Rationale
,Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
Export to Sheets
Detailed Rationale and Why it is Frequently Tested
Suspected
Priority Action Rationale
Complication
The signs (bradycardia, widened pulse
pressure → hypertension, and changes in
Increased level of consciousness) represent Cushing's
Elevate the head of the bed
Intracranial Triad, a late and serious sign of significantly
(HOB) to 15∘ to 30∘ and
Pressure (ICP) / increased ICP. A malfunctioning VP shunt
immediately notify the
Shunt prevents the drainage of CSF. Elevating the
Neurosurgeon/HCP
Malfunction HOB uses gravity to promote venous
(Healthcare Provider).
(Obstruction) drainage from the head, helping to
temporarily lower ICP while urgently
awaiting surgical intervention.
Why this Question is Frequently Tested:
• Neurosurgical Emergencies: Shunt malfunction is a life-threatening emergency in
pediatric neurosurgery. Nurses must immediately recognize the signs of increased ICP.
• Cushing's Triad: This classic, critical assessment triad (bradycardia, respiratory
depression/irregularity, and systolic hypertension/widened pulse pressure) is a high-
yield concept that requires immediate intervention and reporting.
• Positioning: It tests knowledge of appropriate positioning post-neurosurgery, as
positioning is essential to manage ICP (avoiding the flat position and extreme neck
flexion).
Scenario 3: Medication Calculation and Safety (Digoxin)
The Scenario:
A 9-month-old infant is prescribed Digoxin 50 μg orally daily for Congestive Heart Failure (CHF)
secondary to a Ventricular Septal Defect (VSD). The available concentration of Digoxin elixir is
0.05 mg/mL.
The Question:
Calculate the amount in milliliters (mL) the nurse should administer per dose. Before
administering, what is the single most critical assessment parameter the nurse must check,
and what is the specific parameter range that requires the nurse to hold the dose and notify
the HCP?
Calculation (mL) Critical Assessment Parameter Parameter Range to Hold Dose
Detailed Rationale and Why it is Frequently Tested
Calculation Critical Assessment
Parameter Range to Hold Dose
(mL) Parameter
Apical Heart Rate for one Apical HR less than 90−110 beats/minute (for
1.0 mL
full minute infants/young children)
, Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
• Calculation:
1. Convert the ordered dose to match the concentration unit: 50 μg ×
1000 μg1 mg = 0.05 mg.
2. Use the concentration to calculate the volume: x mL0.05 mg=1 mL0.05 mg →
x mL=1.0 mL.
• Critical Assessment: Digoxin is a cardiac glycoside that slows the heart rate and
increases contractility. Bradycardia is the first sign of toxicity in children. The Apical HR
(taken at the PMI for a full minute) is the most accurate measure.
• Hold Parameter: In infants and young children, the HCP typically sets a lower limit,
often 90 or 100 beats/minute. A pediatric nurse must know the appropriate lower limit
(<90−110 bpm for infants) to prevent severe bradycardia.
Why this Question is Frequently Tested:
• Medication Safety: Digoxin has a narrow therapeutic window, making safe
administration and recognition of toxicity a critical safety competency. Dosage errors
are often fatal.
• Pediatric Dosage: Pediatric medication calculation (especially mcg to mg conversion) is
essential for exam success.
• Physiological Difference: The required HR limit for infants (90−110 bpm) is much
higher than for adults (<60 bpm), testing the nurse's knowledge of pediatric norms.
1. Respiratory distress in bronchiolitis
Scenario: A 6-month-old infant presents with 3 days of rhinorrhea and cough. On exam the
infant has tachypnea (RR 68), nasal flaring, intercostal retractions and diffuse wheezes. Oxygen
saturation on room air is 89%.
Answer / Key actions:
RN Nursing Care of Children 2025 TESTBANK
Study Guide | Pediatric Exam Scenarios,
Answers & Detailed Rationales
Scenario 1: Respiratory Distress in an Infant (Bronchiolitis)
The Scenario:
A 6-month-old infant is admitted to the pediatric unit with a 2-day history of low-grade fever,
copious clear nasal discharge, and a progressively worsening cough. On assessment, the infant
is irritable, has a respiratory rate of 65 breaths/minute, intercostal and subcostal retractions,
expiratory wheezing, and a capillary refill time of 3 seconds. Auscultation reveals fine crackles
and high-pitched wheezes. The pulse oximetry reading is 90% on room air. The likely diagnosis
is Bronchiolitis caused by Respiratory Syncytial Virus (RSV).
The Question:
What is the priority nursing intervention, and what are the next two most critical
interventions for this infant? Detail the rationale for each intervention.
Intervention Rationale
Priority 1
Intervention 2
Intervention 3
Detailed Rationale and Why it is Frequently Tested
Intervention Rationale
The respiratory rate of 65/min, retractions, and SpO2 of 90%
Priority 1: Maintain a
indicate significant respiratory distress and hypoxia. Maintaining
Patent
adequate oxygenation and ventilation is always the highest priority
,Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
Intervention Rationale
Airway/Administer ($\text{A}irway/\text{B}$reathing). Oxygen should be administered
Supplemental Oxygen. to maintain an SpO2 greater than 92% and to decrease the work of
breathing.
RSV causes copious, thick secretions that obstruct the small nasal
Intervention 2: Suction passages of infants, who are obligate nose-breathers. Removing
Nasopharynx (especially secretions facilitates breathing, improves gas exchange, and is
before feeds/sleep). essential for effective feeding to prevent dehydration and further
respiratory compromise.
The infant is irritable and has signs of possible dehydration
Intervention 3: Initiate (capillary refill >2 seconds) due to increased insensible water loss
IV Fluids/Strict Intake from tachypnea and poor oral intake caused by the effort of
and Output (I&O) breathing. IV fluids prevent dehydration, and I&O is critical to
Monitoring. assess hydration status and prevent fluid overload, especially in the
context of SIADH (a potential complication of RSV).
Why this Question is Frequently Tested:
• Prioritization: It tests the nurse's ability to apply the ABCs (Airway, Breathing,
Circulation) and prioritize interventions in an acutely ill child.
• Disease-Specific Care: Bronchiolitis is the most common reason for hospitalization in
infants. The care is unique (suctioning is key; bronchodilators/steroids are often
ineffective/not indicated), making it a crucial differential from asthma/croup.
• Assessment Skills: The scenario requires recognizing hallmark signs of respiratory
distress in an infant (retractions, wheezing, tachypnea, SpO2).
Scenario 2: Post-Operative Care for a Child with a Ventriculoperitoneal (VP) Shunt
The Scenario:
A 4-year-old child who underwent a revision of a VP shunt 8 hours ago is resting in the
pediatric neurosurgical unit. The nurse notes that the child's pulse rate has dropped from 95 to
60 beats/minute, the blood pressure has increased from 100/60 to 125/80 mmHg, the child is
lethargic, and the anterior fontanel (if still open, or scalp veins in this case) appears full and
tense. The child also reports a headache.
The Question:
Based on the assessment findings, what is the immediate suspected complication, and what
is the nurse's priority action and the rationale?
Suspected Complication Priority Action Rationale
,Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
Export to Sheets
Detailed Rationale and Why it is Frequently Tested
Suspected
Priority Action Rationale
Complication
The signs (bradycardia, widened pulse
pressure → hypertension, and changes in
Increased level of consciousness) represent Cushing's
Elevate the head of the bed
Intracranial Triad, a late and serious sign of significantly
(HOB) to 15∘ to 30∘ and
Pressure (ICP) / increased ICP. A malfunctioning VP shunt
immediately notify the
Shunt prevents the drainage of CSF. Elevating the
Neurosurgeon/HCP
Malfunction HOB uses gravity to promote venous
(Healthcare Provider).
(Obstruction) drainage from the head, helping to
temporarily lower ICP while urgently
awaiting surgical intervention.
Why this Question is Frequently Tested:
• Neurosurgical Emergencies: Shunt malfunction is a life-threatening emergency in
pediatric neurosurgery. Nurses must immediately recognize the signs of increased ICP.
• Cushing's Triad: This classic, critical assessment triad (bradycardia, respiratory
depression/irregularity, and systolic hypertension/widened pulse pressure) is a high-
yield concept that requires immediate intervention and reporting.
• Positioning: It tests knowledge of appropriate positioning post-neurosurgery, as
positioning is essential to manage ICP (avoiding the flat position and extreme neck
flexion).
Scenario 3: Medication Calculation and Safety (Digoxin)
The Scenario:
A 9-month-old infant is prescribed Digoxin 50 μg orally daily for Congestive Heart Failure (CHF)
secondary to a Ventricular Septal Defect (VSD). The available concentration of Digoxin elixir is
0.05 mg/mL.
The Question:
Calculate the amount in milliliters (mL) the nurse should administer per dose. Before
administering, what is the single most critical assessment parameter the nurse must check,
and what is the specific parameter range that requires the nurse to hold the dose and notify
the HCP?
Calculation (mL) Critical Assessment Parameter Parameter Range to Hold Dose
Detailed Rationale and Why it is Frequently Tested
Calculation Critical Assessment
Parameter Range to Hold Dose
(mL) Parameter
Apical Heart Rate for one Apical HR less than 90−110 beats/minute (for
1.0 mL
full minute infants/young children)
, Pediatric 2025 Rn nursing care of children test bank review - Examiner panel review copy
• Calculation:
1. Convert the ordered dose to match the concentration unit: 50 μg ×
1000 μg1 mg = 0.05 mg.
2. Use the concentration to calculate the volume: x mL0.05 mg=1 mL0.05 mg →
x mL=1.0 mL.
• Critical Assessment: Digoxin is a cardiac glycoside that slows the heart rate and
increases contractility. Bradycardia is the first sign of toxicity in children. The Apical HR
(taken at the PMI for a full minute) is the most accurate measure.
• Hold Parameter: In infants and young children, the HCP typically sets a lower limit,
often 90 or 100 beats/minute. A pediatric nurse must know the appropriate lower limit
(<90−110 bpm for infants) to prevent severe bradycardia.
Why this Question is Frequently Tested:
• Medication Safety: Digoxin has a narrow therapeutic window, making safe
administration and recognition of toxicity a critical safety competency. Dosage errors
are often fatal.
• Pediatric Dosage: Pediatric medication calculation (especially mcg to mg conversion) is
essential for exam success.
• Physiological Difference: The required HR limit for infants (90−110 bpm) is much
higher than for adults (<60 bpm), testing the nurse's knowledge of pediatric norms.
1. Respiratory distress in bronchiolitis
Scenario: A 6-month-old infant presents with 3 days of rhinorrhea and cough. On exam the
infant has tachypnea (RR 68), nasal flaring, intercostal retractions and diffuse wheezes. Oxygen
saturation on room air is 89%.
Answer / Key actions:
