This domain accounts for 33% of your score, or 50 of the 150 scored items on the test. You must know how to develop care plans, administer treatments, and manage palliative care for pediatric patients. Test your readiness with our 2200+ practice questions.
Question 1
A 10-year-old with a closed head injury exhibits pupillary changes and bradycardia. The provider orders a bolus of 3% hypertonic saline. The nurse understands this intervention reduces intracranial pressure through which primary mechanism?
- A) Decreasing the production of cerebrospinal fluid within the brain ventricles.
- B) Causing profound systemic diuresis to lower total circulating blood volume.
- C) Creating an osmotic gradient to mobilize fluid from brain tissue.✓
- D) Constricting cerebral blood vessels to reduce overall cerebral blood flow.
💡 Key Takeaway
Hypertonic saline reduces intracranial pressure by creating an osmotic gradient that draws water out of edematous brain tissue.
Show rationale
The primary mechanism of hypertonic saline in managing increased ICP is the creation of an osmotic gradient. Because the blood-brain barrier is relatively impermeable to sodium, introducing a high concentration of sodium into the intravascular space pulls excess water out of the brain parenchyma and into the bloodstream, thereby reducing cerebral edema. It does not decrease the production of cerebrospinal fluid (Option A); medications like acetazolamide serve that function. While hypertonic saline expands intravascular volume, it does not cause profound systemic diuresis (Option B) like mannitol does. Finally, it does not primarily constrict cerebral blood vessels (Option D); hyperventilation reduces ICP through vasoconstriction by lowering arterial carbon dioxide levels. Understanding this osmotic mechanism helps you anticipate the need for strict serum sodium and osmolarity monitoring.
Question 2
A 14-year-old with autism is admitted for asthma exacerbation and relies heavily on strict home routines. Which approach should the nurse integrate into the daily care plan to minimize hospital-induced anxiety?
- A) Perform vital sign checks randomly to minimize patient anticipation.
- B) Wake the patient frequently to ensure continuous respiratory monitoring.
- C) Introduce multiple new nursing staff members to build social skills.
- D) Cluster nursing assessments to align with established home daily schedules.✓
💡 Key Takeaway
Incorporating the patient's established home routines into hospital care reduces anxiety and prevents sensory dysregulation.
Show rationale
For a patient who relies heavily on strict home routines, hospitalization can be profoundly disorienting and distressing. Clustering nursing assessments to align with their established daily schedule provides predictability, which drastically reduces anxiety and the potential for sensory or emotional dysregulation. Option A is incorrect because random intervals of care eliminate predictability, keeping the patient in a constant state of heightened anticipation and stress. Option B is suboptimal because while respiratory monitoring is necessary for an asthma exacerbation, waking the patient frequently disrupts restorative sleep and exacerbates sensory irritability. Option C is inappropriate because introducing multiple new staff members increases social and sensory demands, whereas limiting the number of caregivers promotes trust and routine. Maintaining predictable routines is a cornerstone of autism-friendly hospital care.
Question 3
A nurse is monitoring a child receiving a 25% albumin infusion for nephrotic syndrome. Midway through the albumin the child reports a headache and the blood pressure rises significantly above baseline. Which action should the nurse take?
- A) Administer a normal saline bolus to dilute the albumin.
- B) Prepare to administer a rapidly acting oral antihypertensive medication.
- C) Increase the infusion rate to complete the dose quickly.
- D) Pause the infusion and assess for signs of overload.✓
💡 Key Takeaway
Hypertension during albumin administration indicates rapid volume expansion requiring an immediate pause in the infusion.
Show rationale
Albumin acts as a potent volume expander by increasing oncotic pressure and drawing fluid into the bloodstream. A significant rise in blood pressure midway through the infusion strongly suggests the child is experiencing rapid intravascular volume expansion. The safest initial step is to pause the infusion and carefully assess the child for other signs of fluid overload like respiratory distress or a bounding pulse. Administering a normal saline bolus would add more volume and worsen the hypertension. Giving an antihypertensive medication might be required eventually but pausing the infusion is the necessary first step to stop the cause. Increasing the infusion rate would be dangerous and could easily precipitate acute pulmonary edema or heart failure. You must always control the rate of volume expansion to keep the child hemodynamically stable.
Question 4
You need to transfer a 16-year-old weighing 115 kg who has autism spectrum disorder and is exhibiting agitated and unpredictable movements. The patient can occasionally bear weight. Which method is safest?
- A) Apply a bariatric gait belt for a manual transfer.
- B) Utilize a powered stand-assist lift with safety straps.
- C) Employ a bariatric full-body mechanical ceiling lift.✓
- D) Execute a three-person manual pivot transfer technique.
💡 Key Takeaway
Unpredictable or agitated bariatric patients require full-body mechanical lifts to prevent sudden falls and protect staff from injury.
Show rationale
Despite the patient's occasional ability to bear weight, their agitated movements and bariatric weight make any manual transfer (Options A and D) or stand-assist lift (Option B) extremely dangerous. If the patient suddenly drops their weight or thrashes, the staff will be unable to support them, leading to severe injury. A full-body mechanical lift rated for bariatric use ensures maximum safety and containment for both the unpredictable patient and the nursing staff during the transfer.
Question 5
A 12-year-old adolescent arrives at the triage desk reporting a twisted right ankle sustained during a soccer game two hours ago. The patient exhibits mild localized swelling but is able to bear weight with a slight limp.
- A) Designate as emergent for immediate surgical consult.
- B) Designate as urgent for rapid pain management.
- C) Designate as non-urgent for basic x-ray imaging.✓
- D) Designate as critical for advanced trauma support.
💡 Key Takeaway
Isolated minor extremity injuries requiring a single resource are classified as non-urgent triage.
Show rationale
The patient presents with an isolated musculoskeletal injury, stable vital signs, and the ability to bear weight, indicating a low-acuity situation. Option C is correct because this presentation requires only one resource, which aligns perfectly with a non-urgent triage classification. Option A is incorrect because there is no evidence of neurovascular compromise requiring immediate surgical intervention. Option B is incorrect because urgent status implies the need for multiple resources or a risk of rapid deterioration, which is absent here. Option D is incorrect because advanced trauma support is reserved for severe, life-threatening injuries.
Question 6
A 2-year-old presents to the ED with a barking cough and stridor at rest. The nurse administers racemic epinephrine via nebulizer and oral dexamethasone. Thirty minutes later, the child is resting quietly with no audible stridor.
- A) Discharge the patient with strict return precautions now.
- B) Observe the patient for at least two more hours.✓
- C) Administer a second dose of oral dexamethasone immediately.
- D) Prepare the patient for immediate pediatric ICU admission.
💡 Key Takeaway
Patients receiving racemic epinephrine must be observed for 2 to 3 hours due to rebound stridor risk.
Show rationale
Racemic epinephrine provides rapid relief of airway edema, but its effects wear off in 1 to 2 hours, creating a significant risk for rebound stridor. Therefore, observing the patient for at least two more hours is standard practice to ensure respiratory stability before discharge. Discharging immediately (Option A) is unsafe because the child could rapidly deteriorate on the way home. A single dose of dexamethasone is sufficient because of its long half-life, making a second dose (Option C) unnecessary in this timeframe. Routine ICU admission (Option D) is not indicated for a child who responds well to initial therapy and remains stable during the observation period.
Question 7
A nurse preceptor is discussing communication with preschoolers during immunizations and stresses avoiding punitive language. Which statement by the nursing student indicates correct understanding?
- A) I will remind the child that good patients stay still and don't cry.
- B) I will say, 'If you can't hold still, we'll have to use the other arm.'
- C) I will prepare the child by saying, 'The medicine will make your arm feel cold, and then you'll feel a small poke.'✓
- D) I will explain that only babies cry for shots, and the child is a big kid now.
💡 Key Takeaway
Non-punitive language uses sensory-based, honest descriptions without threats, comparisons, or conditions.
Show rationale
The student who selects sensory-based, neutral language demonstrates correct understanding. Option C truthfully describes what the child will feel, using terms like “cold” and “small poke,” which prepares without fear. Option A attaches a moral condition (“good patients”), a punitive implication that shames. Option B is a direct threat that increases anxiety and risks distrust. Option D shames by labeling crying as infantile, which is emotionally punitive. Best practice is to use developmentally appropriate communication that offers honest information and avoids comparison or conditional compliance, exactly as C does.
Question 8
A mother calls the nurse at 2 am reporting that her 8-year-old, who is in home hospice for relapsed neuroblastoma, is experiencing acute severe pain despite receiving scheduled oral morphine. The child is crying and appears frightened. The family has a hospice emergency comfort kit. What should the nurse instruct the mother to do first?
- A) Give an additional dose of the scheduled oral morphine immediately.
- B) Administer the prescribed subcutaneous morphine from the emergency kit.✓
- C) Go to the nearest emergency department for pain control.
- D) Apply cold compresses and use guided imagery until morning.
💡 Key Takeaway
Breakthrough pain in home hospice is managed with parenteral rescue medication from the comfort kit.
Show rationale
In home hospice, a comfort kit contains rapid-acting subcutaneous morphine specifically for severe breakthrough pain that breaks through scheduled oral opioids. Option B is the correct immediate instruction to relieve the child’s distress while honoring the hospice plan to avoid hospital transfers. Option A risks an unsupervised dose increase and potential adverse effects. Option C would involve emergency services and likely unwanted interventions, contradicting hospice goals. Option D is grossly insufficient for severe pain. The nurse’s guidance aligns with standard pediatric hospice protocols that empower families to manage acute symptoms at home using pre-prescribed rescue medications. Timely administration ensures the child remains comfortable in the familiar home environment. Additionally, it avoids the trauma of emergency department visits and maintains the child’s comfort and dignity during the final phase.
Question 9
An 8-year-old child is admitted for a five-day course of intravenous antibiotics and requires a new peripheral intravenous catheter. Which anatomical location provides the most durable and appropriate access for this therapy?
- A) Dorsal venous network of the dominant hand
- B) Volar aspect of the non-dominant inner wrist
- C) Median cubital vein in the antecubital fossa
- D) Cephalic vein on the non-dominant mid-forearm✓
💡 Key Takeaway
For multi-day therapies, select a straight vein on the non-dominant forearm to maximize dwell time and comfort.
Show rationale
The non-dominant mid-forearm is the preferred site for multi-day therapies because it avoids areas of flexion, reducing the risk of mechanical phlebitis and dislodgement. The dominant hand (Option A) should be avoided to preserve the child's ability to play and eat. The inner wrist (Option B) is highly sensitive and carries a risk of nerve injury. The antecubital fossa (Option C) is an area of flexion that frequently leads to premature catheter failure.
Question 10
A caregiver is setting up a play area for a 2-week-old neonate and asks how to best position black-and-white geometric patterns to encourage visual engagement. Which instruction is most appropriate?
- A) Position the patterns twenty inches from the face.
- B) Position the patterns ten inches from the face.✓
- C) Position the patterns thirty inches from the face.
- D) Position the patterns five inches from the face.
💡 Key Takeaway
Neonates have limited visual acuity and focus best on high-contrast objects placed 8 to 12 inches away.
Show rationale
Neonates have immature visual acuity and lack the ability to accommodate effectively. Option B is correct because 10 inches falls perfectly within the optimal focal range of 8 to 12 inches, which is approximately the distance to a caregiver's face during feeding. Options A and C are incorrect because the infant cannot resolve images at 20 or 30 inches, rendering the patterns blurry and ineffective for stimulation. Option D is incorrect because 5 inches is too close for proper convergence, which can cause unnecessary eye strain and prevent clear focus.
Question 11
You are preparing to transfer a 10-year-old patient with osteogenesis imperfecta type III who is entirely non-weight-bearing from the bed to a specialized wheelchair. Which method is the most appropriate for this patient?
- A) Utilize a full-body mechanical sling lift.✓
- B) Apply a gait belt for a pivot transfer.
- C) Perform a two-person manual under-axilla lift.
- D) Use a stand-assist mechanical lift device.
💡 Key Takeaway
Patients with severe bone fragility require full-body mechanical lifts to distribute weight safely and prevent iatrogenic fractures.
Show rationale
Children with osteogenesis imperfecta type III have severe bone fragility, making manual under-axilla lifts (Option C) extremely dangerous as they can easily cause rib or humerus fractures. Because the child is non-weight-bearing, using a gait belt (Option B) or a stand-assist device (Option D) is completely contraindicated. A full-body sling is the safest choice because it evenly distributes the child's weight and minimizes localized pressure on fragile bones during the transfer.
Question 12
A 6-year-old child with cerebral palsy has an existing nasogastric tube. The nurse is preparing to administer scheduled oral medications and draws back 2 mL of clear fluid.
- A) Auscultate over the stomach while injecting a small bolus of room air.
- B) Request a routine abdominal radiograph to verify the current anatomical tube placement.
- C) Test the aspirate pH to confirm a value of 7.0 or greater.
- D) Test the aspirate pH to confirm a value of 5.0 or less.✓
💡 Key Takeaway
Aspirate pH testing of 5.0 or less is the standard bedside verification for gastric tube placement.
Show rationale
Before administering medications, the nurse must verify placement by checking the aspirate pH, which should be 5.0 or less for gastric placement. Auscultation is no longer considered an evidence-based or reliable method. Routine radiographs expose the child to unnecessary radiation and are impractical for daily medication administration. A pH of 7.0 or greater suggests intestinal or respiratory placement.
