Certified Pediatric Nurse (CPN) Exam — Questions and Answers

Question 1: At what age should a child receive the first dose of the MMR (measles, mumps, rubella) vaccine according to the CDC schedule?

24 months
18 months
12–15 months (Correct answer)
6 months

Correct answer: 12–15 months

The first MMR dose is recommended at 12–15 months of age, with a second dose at 4–6 years.

Question 2: Which is the BEST indicator of a child's overall growth and nutritional status over time?

Body mass index (BMI)
Height for age (Correct answer)
Head circumference
Weight for age

Correct answer: Height for age

Height (length) for age is the best long-term indicator of nutritional status, as linear growth is most sensitive to chronic malnutrition.

Question 3: When administering digoxin to a pediatric patient, the nurse should withhold the dose and notify the provider if the apical pulse is:

Less than 100 bpm in an infant (Correct answer)
Greater than 120 bpm in a toddler
Less than 60 bpm in an adolescent
Less than 70 bpm in a school-age child

Correct answer: Less than 100 bpm in an infant

In infants, digoxin should be held if the apical pulse is below 100 bpm due to the higher baseline heart rate and risk of bradycardia.

Question 4: A nurse is educating a family about the importance of immunizations. The parents express concern about a link between vaccines and autism. What is the BEST response?

Give the vaccines without discussing the concern
Respect their concern and allow them to skip vaccines
Acknowledge their concern and explain that large-scale studies have found no link between vaccines and autism (Correct answer)
Report the parents for medical neglect

Correct answer: Acknowledge their concern and explain that large-scale studies have found no link between vaccines and autism

Motivational interviewing techniques involve acknowledging concerns respectfully while providing accurate, evidence-based information.

Question 5: A nurse is preparing to discharge a 6-year-old after treatment for mild asthma exacerbation. Which teaching point is MOST important for the family?

Use rescue inhaler (albuterol) BEFORE controller medication during attacks
Discontinue all controller medications once symptoms resolve
Identify and avoid asthma triggers and know when to return to ED (Correct answer)
Avoid all exercise permanently to prevent future exacerbations

Correct answer: Identify and avoid asthma triggers and know when to return to ED

Teaching trigger avoidance and clear return-to-ED criteria (worsening dyspnea, no response to albuterol) is the most essential discharge education for asthma families.

Question 6: Which language milestone is typical for a 2-year-old?

Names all colors
Tells simple stories
Speaks in 5-word sentences
Uses 50+ words and 2-word phrases (Correct answer)

Correct answer: Uses 50+ words and 2-word phrases

By age 2, children typically have a vocabulary of 50+ words and begin combining two words into phrases.

Question 7: A nurse assesses a 6-month-old and notes the infant turns toward a sound. Which sensory milestone does this reflect?

Depth perception
Visual acuity at 20/20
Localization of sound (Correct answer)
Binocular vision

Correct answer: Localization of sound

Localization of sound (turning toward a noise) is a normal auditory milestone by 4–6 months of age.

Question 8: A 5-year-old seizing child has had continuous tonic-clonic activity for 8 minutes. IV access is unavailable. Which benzodiazepine route is most appropriate?

Sublingual diazepam
Intramuscular haloperidol
Oral lorazepam
Intranasal midazolam (Correct answer)

Correct answer: Intranasal midazolam

Intranasal midazolam is the preferred alternative route when IV access is unavailable because it achieves rapid drug delivery through nasal mucosa.

Question 9: A nurse is teaching parents about fever management in a 2-year-old. Which statement by a parent indicates CORRECT understanding?

'I will place my child in an ice bath to bring the fever down quickly.'
'I will use acetaminophen or ibuprofen based on my child's weight.' (Correct answer)
'I will give aspirin for fevers above 101°F.'
'I will alternate acetaminophen and ibuprofen every hour to control fever.'

Correct answer: 'I will use acetaminophen or ibuprofen based on my child's weight.'

Weight-based dosing of acetaminophen or ibuprofen is the correct approach; aspirin is contraindicated in children due to Reye syndrome risk.

Question 10: An infant demonstrates object permanence. What is the earliest age this concept typically emerges?

4 months
2 months
8 months (Correct answer)
12 months

Correct answer: 8 months

Object permanence begins to emerge around 8–9 months, when infants understand that objects still exist when out of sight.

Question 11: Which finding on a newborn physical examination requires the nurse to notify the provider immediately?

Mongolian spot on the sacral area
Epstein pearls on the palate
Caput succedaneum
Absent red reflex in one eye (Correct answer)

Correct answer: Absent red reflex in one eye

An absent red reflex can indicate congenital cataracts, retinoblastoma, or other serious ocular conditions requiring urgent evaluation.

Question 12: Which statement by a parent of a child with asthma indicates a need for further education?

'I will monitor peak flow readings daily.'
'I will give the rescue inhaler when he starts wheezing.'
'I will use the spacer with every inhaler treatment.'
'I should give the controller inhaler only when symptoms appear.' (Correct answer)

Correct answer: 'I should give the controller inhaler only when symptoms appear.'

Controller inhalers must be used daily as prescribed regardless of symptoms; they are not rescue medications.

Question 13: A 5-year-old is brought to the emergency department after a bee sting. The child is anxious, with widespread urticaria, inspiratory stridor, and diffuse wheezing. Vital signs are: HR 140, RR 32, BP 70/40 mmHg, SpO2 92%. What is the priority medication to administer?

Albuterol via nebulizer
Diphenhydramine IV
Epinephrine IM (Correct answer)
Methylprednisolone IV

Correct answer: Epinephrine IM

The child is exhibiting signs of anaphylaxis, a life-threatening multi-system allergic reaction characterized by respiratory compromise (stridor, wheezing) and hypotension. Intramuscular (IM) epinephrine is the first-line, priority treatment for anaphylaxis. It rapidly reverses bronchoconstriction, vasoconstricts peripheral blood vessels to improve blood pressure, and reduces edema. While albuterol, diphenhydramine, and corticosteroids are often used as adjunctive therapies, they do not act as quickly or broadly as epinephrine and should never be used as a substitute for it in an acute life-threatening reaction.

Question 14: Which protective factor should a nurse reinforce to reduce the risk of sudden infant death syndrome (SIDS)?

Using soft bedding and bumper pads for comfort
Placing the infant prone to prevent aspiration
Keeping the room temperature above 75°F
Breastfeeding for at least the first 6 months (Correct answer)

Correct answer: Breastfeeding for at least the first 6 months

Breastfeeding is associated with a reduced risk of SIDS and is recommended as a protective strategy by the AAP.

Question 15: A 12-year-old discloses sexual abuse by a family member. After ensuring safety, the nurse's next action is:

Advise the child not to discuss it further to preserve evidence
Reassure the child that adults will handle everything without their involvement
Notify child protective services and document the disclosure accurately (Correct answer)
Interview the alleged perpetrator to gather facts

Correct answer: Notify child protective services and document the disclosure accurately

Mandatory reporting to CPS with accurate documentation is the nurse's legal and ethical obligation following a child's abuse disclosure.

Question 16: A nurse is providing anticipatory guidance to the parents of a 15-month-old. Which injury prevention topic is MOST important at this developmental stage?

Trampoline safety
Drowning prevention and pool fencing (Correct answer)
Teen driver safety
Firearm safety in the home

Correct answer: Drowning prevention and pool fencing

Drowning is a leading cause of unintentional injury death in children ages 1–4, making water safety and pool fencing critical anticipatory guidance topics at this age.

Question 17: A 15-month-old uses 3–5 words and walks independently. Which additional milestone would be expected at this age?

Uses a spoon alone
Says 'mama' and 'dada' specifically (Correct answer)
Runs well
Climbs stairs alternating feet

Correct answer: Says 'mama' and 'dada' specifically

By 12–15 months, infants typically say 'mama' and 'dada' with meaning in addition to a few other words.

Question 18: Which ethical principle is most directly violated when a nurse shares a pediatric patient's HIV status with the child's school without consent?

Justice
Beneficence
Nonmaleficence
Confidentiality (Correct answer)

Correct answer: Confidentiality

Disclosing a patient's HIV status without consent violates confidentiality, a cornerstone of the nurse-patient relationship and HIPAA.

Question 19: A nurse is conducting a well-child visit for a 16-year-old female. The nurse notes a BMI of 16.5, fine lanugo hair on the back and arms, and reports of feeling cold frequently. The adolescent denies any problems and states she is 'just trying to be healthy.' Which of the following conditions should the nurse be most concerned about?

Avoidant/Restrictive Food Intake Disorder (ARFID)
Anorexia nervosa (Correct answer)
Bulimia nervosa
Binge eating disorder

Correct answer: Anorexia nervosa

The combination of significantly low body weight (indicated by the low BMI), physiological signs of malnutrition like lanugo and feeling cold (due to loss of insulating body fat), and a distorted body image or denial of the seriousness of low weight are classic signs of anorexia nervosa.

Question 20: A 4-year-old child presents with a 24-hour history of vomiting, watery diarrhea, and a low-grade fever. The nurse assesses the child and notes dry mucous membranes, decreased skin turgor, and a capillary refill time of 3 seconds. The child is awake and alert but irritable. Which of the following is the most appropriate initial management strategy?

Administer an IV bolus of 0.9% normal saline.
Provide clear liquids such as water and apple juice as tolerated.
Initiate oral rehydration solution (ORS) in small, frequent amounts. (Correct answer)
Administer an anti-diarrheal medication as prescribed.

Correct answer: Initiate oral rehydration solution (ORS) in small, frequent amounts.

The child is exhibiting signs of mild to moderate dehydration. For children who are awake and alert, oral rehydration therapy with an ORS is the first-line treatment. ORS contains the appropriate balance of electrolytes and glucose to promote absorption. Small, frequent amounts help prevent vomiting. An IV bolus is typically reserved for severe dehydration or when oral rehydration fails. Clear liquids like apple juice can worsen diarrhea due to high sugar content, and water alone does not replace electrolytes. Anti-diarrheal medications are generally not recommended in children.

Question 21: Which rash pattern is characteristic of Lyme disease?

Erythema migrans — an expanding bull's-eye rash at the tick bite site (Correct answer)
Maculopapular rash beginning on the face and spreading downward
Petechial rash concentrated on the trunk
Vesicular rash on the palms and soles

Correct answer: Erythema migrans — an expanding bull's-eye rash at the tick bite site

Erythema migrans, an expanding circular rash with central clearing resembling a bull's-eye, is pathognomonic for Lyme disease caused by Borrelia burgdorferi.

Question 22: A 4-year-old with suspected foreign body aspiration has unilateral decreased breath sounds on the right. What is the nurse's priority action?

Place the child in left lateral decubitus position
Administer albuterol nebulization as first treatment
Perform abdominal thrusts immediately
Maintain airway patency and prepare for bronchoscopy (Correct answer)

Correct answer: Maintain airway patency and prepare for bronchoscopy

A child with suspected bronchial foreign body who is not in complete obstruction should be kept calm and prepared for rigid bronchoscopy for safe removal.

Question 23: A nurse is educating the parents of a toddler about poisoning prevention. Which instruction is MOST important?

Post the Poison Control number only in the kitchen
Store all medications and cleaning products in locked, child-resistant containers (Correct answer)
Rely on child-resistant caps alone to prevent accidental ingestion
Keep vitamins in a reachable place so the child learns independence

Correct answer: Store all medications and cleaning products in locked, child-resistant containers

Locked storage is the most effective prevention strategy because child-resistant caps alone do not reliably prevent access.

Question 24: A pediatric nurse is teaching parents about car seat safety. Which guideline reflects current American Academy of Pediatrics (AAP) recommendations?

Booster seats can be discontinued at age 6
Children should remain rear-facing as long as possible up to the seat's height/weight limit (Correct answer)
Forward-facing seats should be used from birth
Children may use a seatbelt alone once they reach 40 pounds

Correct answer: Children should remain rear-facing as long as possible up to the seat's height/weight limit

The AAP recommends keeping children rear-facing as long as possible until they reach the maximum height or weight allowed by the car seat manufacturer.

Question 25: Which weight milestone is expected for a full-term infant by 6 months of age?

Gains 1 pound per month
Triples birth weight
Doubles birth weight (Correct answer)
Reaches 10 kg

Correct answer: Doubles birth weight

Infants are expected to double their birth weight by approximately 4–6 months of age.

Question 26: A nurse administers the correct medication but via the wrong route, causing patient harm. This is an example of:

Medication error and potential negligence (Correct answer)
Assault
Intentional tort
Battery

Correct answer: Medication error and potential negligence

Administering a medication via an incorrect route that results in harm constitutes a medication error and may meet the legal threshold for negligence.

Question 27: A premature neonate is diagnosed with a patent ductus arteriosus (PDA) causing significant left-to-right shunting. Which pharmacological agent promotes ductal closure?

Prostaglandin E1, which relaxes ductal smooth muscle
Indomethacin, a prostaglandin synthesis inhibitor (Correct answer)
Furosemide, which reduces pulmonary fluid overload
Atropine, which increases heart rate and cardiac output

Correct answer: Indomethacin, a prostaglandin synthesis inhibitor

Indomethacin, an NSAID, inhibits prostaglandin synthesis and thereby removes the stimulus that keeps the ductus arteriosus open, promoting spontaneous closure in premature neonates.

Question 28: Which finding is considered a normal expected variation during a newborn physical assessment?

No meconium passage for 72 hours
Heart rate of 90 bpm while sleeping
Physiological weight loss of 5–10% in the first week of life (Correct answer)
Weight gain of 10% within the first 24 hours

Correct answer: Physiological weight loss of 5–10% in the first week of life

A 5–10% weight loss in the first week is normal due to fluid shifts and is regained by 10–14 days of life.

Question 29: At which well-child visit should universal autism spectrum disorder (ASD) screening using a validated tool such as the M-CHAT-R/F be performed?

18-month and 24-month visits (Correct answer)
9-month and 12-month visits
15-month and 24-month visits
30-month and 36-month visits

Correct answer: 18-month and 24-month visits

The AAP recommends standardized ASD-specific screening with the M-CHAT-R/F at the 18-month and 24-month well-child visits.

Question 30: A 4-year-old presents with sudden high fever, toxic appearance, and a stiff neck. Blood cultures are drawn. While awaiting results, which intervention takes priority?

Administer empiric IV antibiotics immediately (Correct answer)
Wait for culture sensitivity results before antibiotics
Perform lumbar puncture before any treatment
Administer antipyretics only and observe for 2 hours

Correct answer: Administer empiric IV antibiotics immediately

Empiric antibiotics must be started immediately in suspected bacterial meningitis; treatment should not be delayed for culture results.

Question 31: Which element is NOT required for valid informed consent in pediatric care?

Verification that the parent comprehends the information
Disclosure of risks and benefits
Agreement from both biological parents in all circumstances (Correct answer)
The parent's voluntary agreement

Correct answer: Agreement from both biological parents in all circumstances

Informed consent requires disclosure, comprehension, and voluntary agreement; consent from both parents is not always legally required, especially when one parent has sole custody.

Question 32: A 12-year-old presents with altered mental status, diaphoresis, and a blood glucose of 38 mg/dL. The child is unconscious and cannot swallow. What is the appropriate glucose correction?

Oral glucose gel administered buccally
IV dextrose 10% (D10W) at 2 mL/kg (Correct answer)
IV dextrose 50% (D50W) at 1 mL/kg
Subcutaneous regular insulin to stabilize glucose

Correct answer: IV dextrose 10% (D10W) at 2 mL/kg

For severe hypoglycemia in children, IV dextrose 10% at 2 mL/kg (0.2 g/kg) is preferred over D50W because the hyperosmolar solution can cause vein damage and rebound hypoglycemia.

Question 33: When using therapeutic play with a 6-year-old prior to a painful procedure, the primary goal is to:

Entertain the child to improve cooperation
Distract the child until the procedure is complete
Assess the child's cognitive developmental level
Reduce anxiety by giving the child a sense of control and understanding (Correct answer)

Correct answer: Reduce anxiety by giving the child a sense of control and understanding

Therapeutic play reduces anxiety and helps children process experiences by providing age-appropriate control and understanding.

Question 34: Which scenario represents a violation of HIPAA in the pediatric setting?

Documenting care in the facility's electronic health record
Discussing a child's care with the child's legal guardian in a private room
Sharing a patient's diagnosis with the school principal to arrange accommodations without parental consent (Correct answer)
Consulting with a specialist about a patient's complex condition

Correct answer: Sharing a patient's diagnosis with the school principal to arrange accommodations without parental consent

Disclosing a minor's diagnosis to a school official without parental authorization violates HIPAA's privacy protections for protected health information.

Question 35: A nurse notes that a 9-month-old has not begun to babble and does not turn toward sounds. Which referral is MOST appropriate?

Speech therapy only, no further workup needed
Audiology (Correct answer)
Neurology for MRI
Ophthalmology

Correct answer: Audiology

Absence of babbling and response to sound by 9 months warrants immediate audiology evaluation to rule out hearing impairment.

Question 36: A nurse is assessing a 5-year-old with congenital heart disease who has a history of tetralogy of Fallot repair. The child suddenly squats during play. What does this behavior indicate?

Hypoglycemia from exertion
A hypercyanotic (Tet) spell requiring immediate intervention (Correct answer)
Normal fatigue from physical activity
Joint pain related to activity

Correct answer: A hypercyanotic (Tet) spell requiring immediate intervention

Squatting during a hypercyanotic spell increases systemic vascular resistance, reducing right-to-left shunting; it signals a Tet spell requiring immediate oxygen and knee-chest positioning.

Question 37: Which of the following is the correct route for administering surfactant (beractant) to a premature neonate?

Intratracheal instillation (Correct answer)
Subcutaneous injection
Nebulized inhalation
Intravenous infusion

Correct answer: Intratracheal instillation

Surfactant is administered directly into the trachea via an endotracheal tube to treat respiratory distress syndrome in premature infants.

Question 38: When documenting in a pediatric patient's electronic health record (EHR), which principle is most critical for legal protection?

Using common abbreviations to save time and space.
Documenting assessments, interventions, and patient responses factually and contemporaneously. (Correct answer)
Charting only at the end of the shift to ensure a complete summary.
Copying and pasting a previous note for a patient with a stable chronic condition.

Correct answer: Documenting assessments, interventions, and patient responses factually and contemporaneously.

For legal purposes, documentation must be accurate, objective, and timely (contemporaneous). Factual charting of what was assessed, what was done, and the patient's response provides the clearest and most defensible legal record. Delaying charting, using unapproved abbreviations, and copying previous notes can lead to inaccuracies, omissions, and legal vulnerabilities.

Question 39: A 7-year-old with nephrotic syndrome is admitted with severe edema and ascites. Which dietary instruction is most important?

Fluid restriction below 200 mL per day
Low-sodium diet with adequate protein intake (Correct answer)
High-fat diet to replace urinary losses
High-protein, high-sodium diet

Correct answer: Low-sodium diet with adequate protein intake

Sodium restriction reduces fluid retention while adequate protein intake helps replace urinary protein losses in nephrotic syndrome.

Question 40: A 4-week-old presents with projectile vomiting after every feeding and a palpable olive-shaped mass in the epigastric region. The nurse suspects:

Duodenal atresia
Intussusception
Pyloric stenosis (Correct answer)
Hirschsprung disease

Correct answer: Pyloric stenosis

Pyloric stenosis causes progressive projectile non-bilious vomiting and a palpable pyloric 'olive' in young infants around 2–6 weeks of age.

Question 41: Which of the following social-emotional milestones is most characteristic of a school-aged child (6-12 years old)?

Exhibits significant separation anxiety when away from parents.
Develops a strong attachment to a transitional object.
Engages primarily in parallel play.
Forms strong peer relationships and has a 'best friend'. (Correct answer)

Correct answer: Forms strong peer relationships and has a 'best friend'.

During the school-age years, peer relationships become increasingly important, and children often identify a 'best friend'. They enjoy group activities and competition. Parallel play is typical of toddlers. Attachment to transitional objects is common in toddlers and preschoolers. Significant separation anxiety is more characteristic of younger children.

Question 42: A child is prescribed codeine for pain management after tonsillectomy. Which concern has led major health organizations to advise against this practice?

Children eliminate codeine too quickly for it to provide adequate analgesia
Codeine is ineffective for post-operative pain in children under 12
Codeine causes prolonged sedation lasting more than 24 hours in all pediatric patients
Ultra-rapid metabolizers of CYP2D6 can convert codeine to dangerously high morphine levels causing respiratory depression (Correct answer)

Correct answer: Ultra-rapid metabolizers of CYP2D6 can convert codeine to dangerously high morphine levels causing respiratory depression

Ultra-rapid CYP2D6 metabolizers convert codeine to toxic morphine levels, causing fatal respiratory depression, especially in post-tonsillectomy patients.

Question 43: Which of the following is a key feature that helps a nurse differentiate a manic episode in pediatric bipolar disorder from the typical presentation of ADHD?

The child's difficulty with peer relationships.
The episodic nature of the mood changes. (Correct answer)
The presence of hyperactivity and impulsivity.
The chronic and persistent nature of the symptoms.

Correct answer: The episodic nature of the mood changes.

The primary distinguishing feature between pediatric bipolar disorder and ADHD is the pattern of symptoms. In bipolar disorder, symptoms like irritability, high energy, and poor judgment occur in distinct episodes (mania or hypomania) that are a change from the child's usual baseline. In contrast, the symptoms of ADHD, such as hyperactivity and inattention, are chronic and persistent across various settings and do not typically cycle in discrete episodes.

Question 44: A 16-year-old athlete collapses during practice with a suspected heat stroke (core temp 41°C). The nurse's FIRST action is:

Perform a 12-lead ECG
Administer antipyretic medication
Begin rapid external cooling with ice packs to groin and axilla (Correct answer)
Obtain IV access and start fluids

Correct answer: Begin rapid external cooling with ice packs to groin and axilla

Heat stroke is a life-threatening emergency; immediate external cooling to reduce core temperature is the first priority intervention.

Question 45: Which of the following tasks falls outside the generally accepted scope of practice for a registered nurse (RN) on a pediatric floor and is typically reserved for an Advanced Practice Registered Nurse (APRN)?

Providing education to a family about a new medication's side effects.
Performing a comprehensive developmental screening using a standardized tool.
Formulating a medical diagnosis of asthma and prescribing an initial treatment plan. (Correct answer)
Administering a prescribed PRN dose of intravenous morphine for post-operative pain.

Correct answer: Formulating a medical diagnosis of asthma and prescribing an initial treatment plan.

Formulating a medical diagnosis and prescribing medications are advanced practice functions that fall within the scope of an APRN (such as a Pediatric Nurse Practitioner) or a physician. While a registered nurse is skilled in assessment, data collection, administering prescribed treatments, and patient education, they do not independently diagnose medical conditions or prescribe therapies.

Question 46: A 6-week-old infant is brought in with projectile vomiting after every feeding. The infant appears hungry and is losing weight. What condition does the nurse suspect?

Pyloric stenosis (Correct answer)
Hirschsprung disease
Gastroesophageal reflux
Intussusception

Correct answer: Pyloric stenosis

Pyloric stenosis classically presents at 2–8 weeks with projectile, non-bilious vomiting and a constantly hungry infant who is losing weight.

Question 47: Which nursing intervention is MOST appropriate for a child with selective mutism during a clinic visit?

Speak only to the parent to avoid triggering the child's anxiety
Insist the child answer questions verbally to build confidence
Allow alternative communication methods such as writing or pointing (Correct answer)
Refer immediately to a speech-language pathologist for articulation therapy

Correct answer: Allow alternative communication methods such as writing or pointing

Allowing non-verbal communication reduces performance pressure and anxiety without reinforcing avoidance of the clinical setting.

Question 48: A nurse is counseling a family about fluoride supplementation. At what age should supplementation be considered for a child drinking non-fluoridated water?

12 months
24 months
Birth
6 months (Correct answer)

Correct answer: 6 months

The AAP recommends fluoride supplementation starting at 6 months for infants who drink non-fluoridated water.

Question 49: At the 2-month well-child visit, which vaccines are routinely administered according to the CDC immunization schedule?

DTaP and IPV only
MMR and varicella only
DTaP, IPV, Hib, PCV13, rotavirus, and HepB (Correct answer)
Influenza and hepatitis A only

Correct answer: DTaP, IPV, Hib, PCV13, rotavirus, and HepB

The 2-month visit includes DTaP, IPV, Hib, PCV13, rotavirus (RV), and the second dose of hepatitis B, making it one of the most vaccine-intensive visits.

Question 50: A 7-year-old child is admitted with a suspected diagnosis of acute appendicitis. Which of the following clinical findings would most strongly support this diagnosis?

Diffuse abdominal pain with a history of chronic constipation.
Periumbilical pain that migrates to the right lower quadrant. (Correct answer)
High-grade fever and profuse, watery diarrhea.
Abdominal cramping that is relieved by having a bowel movement.

Correct answer: Periumbilical pain that migrates to the right lower quadrant.

The classic presentation of appendicitis involves vague, periumbilical pain that, over several hours, migrates and localizes to the right lower quadrant (McBurney's point). This pain pattern is a key diagnostic indicator. While fever and vomiting may be present, a high-grade fever is more indicative of perforation. Diarrhea can occur but is not the primary symptom and can lead to misdiagnosis. Diffuse pain and pain relieved by defecation are more characteristic of gastroenteritis or constipation.

Question 51: Which urine output is considered adequate for an infant weighing 8 kg?

8 mL/hr
4 mL/hr (Correct answer)
0.5 mL/hr
16 mL/hr

Correct answer: 4 mL/hr

Adequate urine output for infants is 1–2 mL/kg/hr, so 8 kg × 0.5 mL/kg/hr minimum = 4 mL/hr minimum.

Question 52: A nurse is teaching parents of a newly diagnosed diabetic child about insulin administration. Which learning principle should guide the teaching session?

Teach only the parent who will be the primary caregiver
Use teach-back method to confirm parental understanding (Correct answer)
Provide all information in a single session to minimize disruption
Avoid written materials as they may overwhelm parents

Correct answer: Use teach-back method to confirm parental understanding

The teach-back method requires parents to repeat instructions in their own words, confirming comprehension and identifying gaps.

Question 53: The nurse is looking for evidence of improvement in a female youngster who has acute post-streptococcal glomerulonephritis. Which observation often represents the first indication of progress?

Decreased diarrhea
Increased urine output (Correct answer)
Increased energy level
Increased appetite

Correct answer: Increased urine output

Acute post-streptococcal glomerulonephritis (APSGN) often presents with oliguria (decreased urine output) due to impaired kidney function. An increase in urine output is a primary and early indicator that the kidneys are beginning to recover and effectively excrete excess fluid and waste products. This observation signifies a crucial step towards improvement in the child's condition.

Question 54: A 5-year-old with leukemia develops a temperature of 38.5°C with an ANC of 400 cells/mm³. The nurse anticipates:

Isolation and watchful waiting for 24 hours
Antifungal therapy alone
Oral antibiotics and discharge with close follow-up
Broad-spectrum IV antibiotics after blood cultures are drawn (Correct answer)

Correct answer: Broad-spectrum IV antibiotics after blood cultures are drawn

Febrile neutropenia (ANC <500) is an oncologic emergency requiring immediate blood cultures and broad-spectrum IV antibiotics.

Question 55: A nurse is evaluating sibling adjustment after a brother's leukemia diagnosis. Which observation suggests a sibling is coping poorly?

Declining school attendance and social withdrawal (Correct answer)
Expressing anger occasionally about missed family events
Spending extra time with parents at the hospital
Asking questions about the brother's treatment

Correct answer: Declining school attendance and social withdrawal

Social withdrawal and school avoidance are red flags indicating that a sibling is not adjusting well and may need psychosocial support.

Question 56: What is the priority nursing intervention for a newborn with confirmed hypoglycemia and a blood glucose of 38 mg/dL?

Place under a radiant warmer and recheck in 1 hour
Initiate early feeding or administer oral glucose gel (Correct answer)
Obtain a blood culture before treating
Immediately insert a peripheral IV for dextrose

Correct answer: Initiate early feeding or administer oral glucose gel

Early feeding or oral dextrose gel is the first-line treatment for mild neonatal hypoglycemia before escalating to IV dextrose.

Question 57: A nurse is asked to witness a parent signing an informed consent form. This means the nurse is attesting that:

The parent's signature is authentic and appears voluntary (Correct answer)
The nurse agrees with the planned procedure
The parent has full medical knowledge of the procedure
The nurse explained all risks and alternatives to the parent

Correct answer: The parent's signature is authentic and appears voluntary

Witnessing a signature attests that the signer appears to be acting voluntarily and that the signature is genuine, not that the nurse provided the informed consent education.

Question 58: A 2-month-old presents with paroxysmal coughing episodes followed by an inspiratory 'whoop.' Which pathogen is responsible?

Streptococcus pneumoniae
Haemophilus influenzae type b
Respiratory syncytial virus
Bordetella pertussis (Correct answer)

Correct answer: Bordetella pertussis

The classic whooping cough with post-tussive vomiting in infants is caused by Bordetella pertussis, targeted by the 'P' component of DTaP.

Question 59: A nurse is assessing a family's readiness to learn after their child's new diagnosis. Which factor MOST negatively affects readiness to learn?

Parent has a college education
Teaching is scheduled for the morning hours
Child is present during the teaching session
Family is in acute grief and emotional shock (Correct answer)

Correct answer: Family is in acute grief and emotional shock

Acute grief and emotional distress significantly impair information retention and readiness to learn.

Question 60: A child presents with fever, severe headache, photophobia, and nuchal rigidity. What is the nurse's priority action?

Perform a bedside lumbar puncture
Administer acetaminophen and reassess in 30 minutes
Implement droplet precautions and notify the provider immediately (Correct answer)
Position supine without a pillow and monitor vitals hourly

Correct answer: Implement droplet precautions and notify the provider immediately

Signs of meningitis require urgent provider notification and isolation due to the risk of rapid neurological deterioration and infectious transmission.

Question 61: Which finding requires the nurse to withhold digoxin in a pediatric patient before administration?

Blood pressure 100/60 mmHg
Temperature 37.8°C
Respiratory rate 30 breaths/min
Apical pulse below 90 bpm in an infant (Correct answer)

Correct answer: Apical pulse below 90 bpm in an infant

Digoxin should be withheld and the provider notified if the apical pulse is below 90-110 bpm in infants (or below 70 bpm in older children).

Question 62: A 4-year-old presents with sudden onset stridor, drooling, and a muffled voice. The child prefers to sit upright and looks toxic. What is the most likely diagnosis?

Epiglottitis (Correct answer)
Foreign body aspiration
Croup
Bacterial tracheitis

Correct answer: Epiglottitis

Epiglottitis presents with the classic triad of drooling, dysphagia, and distress along with a toxic appearance and preference for the tripod position.

Question 63: According to Piaget, what cognitive stage is a 7-year-old child in?

Preoperational
Formal operational
Sensorimotor
Concrete operational (Correct answer)

Correct answer: Concrete operational

Children ages 7–11 are in Piaget's concrete operational stage, during which they develop logical thinking about concrete objects.

Question 64: A nurse is teaching a family about sickle cell crisis triggers. Which environmental factor should be emphasized as a primary prevention measure?

Moderate exercise and balanced nutrition
Sunlight exposure and vitamin D supplementation
High altitude and extreme cold or heat exposure (Correct answer)
Stress management only

Correct answer: High altitude and extreme cold or heat exposure

High altitude, extreme temperatures, and dehydration are key environmental triggers for vaso-occlusive sickle cell crises.

Question 65: Which document designates a healthcare proxy for a pediatric patient who reaches adulthood during a prolonged illness?

Do-not-resuscitate order
Durable power of attorney for healthcare (Correct answer)
POLST form
Living will

Correct answer: Durable power of attorney for healthcare

A durable power of attorney for healthcare allows an adult patient to designate another person to make medical decisions if they become incapacitated.

Question 66: A 6-year-old can print their name, tie their shoes, and count to 100. Which developmental domain does shoe-tying primarily reflect?

Gross motor
Language
Fine motor (Correct answer)
Cognitive

Correct answer: Fine motor

Tying shoelaces is a fine motor skill requiring dexterity and hand-eye coordination typically mastered around age 5–6.

Question 67: A nurse is reviewing the care plan for a 3-year-old with biliary atresia post-Kasai procedure. Which nutritional intervention is most important for long-term outcomes?

Protein restriction to prevent hepatic encephalopathy
Fat-soluble vitamin supplementation (A, D, E, K) (Correct answer)
Standard infant formula without supplementation
High-sodium diet to support liver function

Correct answer: Fat-soluble vitamin supplementation (A, D, E, K)

Biliary atresia impairs bile excretion, leading to fat-soluble vitamin malabsorption; supplementation of vitamins A, D, E, and K is critical for preventing deficiency-related complications.

Question 68: A 10-year-old with appendicitis develops sudden relief of abdominal pain followed by diffuse rigidity and high fever. The nurse should recognize this as a sign of:

Resolving appendicitis
Mesenteric lymphadenitis
Intussusception
Perforated appendix with peritonitis (Correct answer)

Correct answer: Perforated appendix with peritonitis

Sudden pain relief followed by diffuse rigidity and fever suggests appendiceal perforation and peritonitis, a surgical emergency.

Question 69: A nurse is assessing a 14-month-old with suspected intussusception. Which stool description is most characteristic?

Currant jelly stools (blood and mucus) (Correct answer)
Clay-colored stools
Fatty, foul-smelling stools
Watery green diarrhea

Correct answer: Currant jelly stools (blood and mucus)

Currant jelly stools containing blood and mucus are the classic late finding of intussusception due to intestinal ischemia.

Question 70: A nurse accidentally administers double the ordered dose of acetaminophen to a toddler. After assessing the patient, the first priority is to:

Ask a colleague to cover the error in documentation
Notify the charge nurse and physician immediately (Correct answer)
Document the error and hope it goes unnoticed
Wait to see if symptoms develop before reporting

Correct answer: Notify the charge nurse and physician immediately

Immediate notification of the charge nurse and physician after a medication error allows for prompt patient assessment and intervention to minimize harm.

Question 71: A 15-year-old presents to the ER requesting treatment for a sexually transmitted infection without parental notification. Which action is most appropriate?

Require written parental consent before any treatment
Contact child protective services before treating
Provide treatment, as most states allow minors to consent to STI treatment (Correct answer)
Refuse treatment until a parent is contacted

Correct answer: Provide treatment, as most states allow minors to consent to STI treatment

Most U.S. states have minor consent laws that allow adolescents to seek and receive treatment for STIs without parental involvement.

Question 72: A 4-year-old is admitted with epiglottitis. Which intervention is the PRIORITY?

Obtain a throat culture
Administer nebulized albuterol
Insert a nasogastric tube
Keep the child calm and upright (Correct answer)

Correct answer: Keep the child calm and upright

Keeping the child calm and upright minimizes airway obstruction; any agitation or throat examination can cause complete obstruction.

Question 73: A 10-year-old with type 1 diabetes presents with blood glucose of 350 mg/dL, fruity breath, and Kussmaul respirations. Which intervention is the priority?

Provide a high-carbohydrate snack
Administer oral glucose gel
Give subcutaneous regular insulin immediately
Establish IV access and begin fluid resuscitation (Correct answer)

Correct answer: Establish IV access and begin fluid resuscitation

Diabetic ketoacidosis requires IV fluid resuscitation as the first priority to correct dehydration and electrolyte imbalances before insulin administration.

Question 74: The parent of a 4-year-old tells the nurse they are concerned about their child's fine motor skills. Which of the following is an age-appropriate fine motor skill for a 4-year-old?

Printing some capital letters. (Correct answer)
Tying shoelaces.
Zipping up their own jacket.
Using a pincer grasp to pick up small objects.

Correct answer: Printing some capital letters.

A 4-year-old should be able to copy shapes like a square and print some capital letters. Tying shoelaces is a more advanced skill, usually mastered around age 5 or 6. The pincer grasp develops much earlier, around 9-12 months. While a 4-year-old can often zip a jacket once it's started, fully managing the zipper mechanism is a later skill.

Question 75: A 4-month-old infant is unable to hold their head steady when pulled to sitting. What is the nurse's priority action?

Schedule a recheck at 6 months
Reassure the parents
Notify the provider and document the finding (Correct answer)
Document as a normal finding

Correct answer: Notify the provider and document the finding

Head control when pulled to sitting should be present by 4 months; absence suggests a developmental delay requiring provider notification.

Question 76: What is the primary purpose of administering exogenous surfactant to a premature neonate?

Increase absorption of fetal lung fluid
Stimulate the central respiratory drive
Reduce alveolar surface tension to prevent collapse (Correct answer)
Prevent pneumonia from aspiration

Correct answer: Reduce alveolar surface tension to prevent collapse

Exogenous surfactant reduces surface tension within the alveoli, preventing atelectasis in premature lungs that cannot produce adequate natural surfactant.

Question 77: When providing anticipatory guidance to the parents of a school-age child (7 years old), which topic should the nurse prioritize to promote emotional well-being?

Discussing the physical and emotional changes of puberty.
Reviewing the risks of social media and setting screen time limits.
Encouraging structured after-school activities and friendships. (Correct answer)
Teaching about stranger danger and personal safety rules.

Correct answer: Encouraging structured after-school activities and friendships.

For school-age children, developing a positive sense of self, competence, and healthy peer relationships is a key developmental task. Encouraging participation in group activities like sports, clubs, or lessons helps foster friendships, build new skills, and enhance self-esteem, which are crucial components of emotional well-being at this age.

Question 78: An 8-month-old infant is brought to the ED with a history of sudden, intermittent episodes of inconsolable crying and drawing his knees to his chest. The parent reports one diaper with bloody, mucus-like stool. Between episodes, the infant is lethargic. Which condition should the nurse suspect?

Pyloric Stenosis
Intussusception (Correct answer)
Appendicitis
Gastroenteritis

Correct answer: Intussusception

This clinical presentation is classic for intussusception, where one segment of the intestine telescopes into another. The key features are intermittent, severe, colicky abdominal pain; lethargy between episodes; and the passage of 'currant jelly' stool (a mixture of blood and mucus). Gastroenteritis typically presents with watery diarrhea. Pyloric stenosis involves projectile, non-bilious vomiting and is more common in younger infants. Appendicitis is rare in infants and presents with more constant, localizing pain.

Question 79: A 4-year-old child can hop on one foot, dress independently, and draw a person with 4 parts. Which developmental theorist would classify this child as being in the 'initiative vs. guilt' stage?

Kohlberg
Piaget
Erikson (Correct answer)
Freud

Correct answer: Erikson

Erikson described the preschool stage (ages 3–6) as 'initiative vs. guilt,' during which children assert control and initiative.

Question 80: When using the SALAD (Sound-Alike, Look-Alike Drugs) safety strategy in pediatric settings, which pair represents a commonly confused medication set?

Prednisone and prednisolone
Amoxicillin and amphotericin B (Correct answer)
Ibuprofen and acetaminophen
Hydroxyzine and hydralazine

Correct answer: Amoxicillin and amphotericin B

Amoxicillin and amphotericin B are a classic high-risk SALAD pair; amphotericin B has a much narrower safety margin and potentially fatal if given in place of amoxicillin.

Question 81: When teaching a parent about administering oral iron supplements to a toddler, the nurse should include:

Expect stools to turn yellow
Give between meals for better absorption and with dairy
Administer through a straw to protect tooth enamel (Correct answer)
Give with milk to reduce GI upset

Correct answer: Administer through a straw to protect tooth enamel

Iron can stain teeth, so using a straw or dropper placed toward the back of the mouth protects enamel.

Question 82: A newborn at 36 hours of life develops jaundice, poor feeding, and high-pitched cry. Total serum bilirubin is at the exchange transfusion threshold. What is the immediate priority?

Start phototherapy and recheck bilirubin in 6 hours
Begin IV immunoglobulin (IVIG) therapy and phototherapy
Prepare for emergency exchange transfusion (Correct answer)
Discharge with follow-up in 48 hours

Correct answer: Prepare for emergency exchange transfusion

Bilirubin at the exchange transfusion threshold with neurological signs requires emergency exchange transfusion to prevent permanent kernicterus.

Question 83: Which gross motor skill is typically achieved first?

Standing alone briefly
Walking alone
Cruising along furniture (Correct answer)
Running

Correct answer: Cruising along furniture

Cruising (walking while holding onto furniture) develops around 9–10 months, before standing alone and walking independently.

Question 84: A 4-year-old presents with a temperature of 41.2°C, seizure activity, and altered mental status. The parents report the child has not had any vaccines. A lumbar puncture reveals cloudy CSF with neutrophils, low glucose, and high protein. Which organism is most likely responsible?

Enterovirus
Herpes simplex virus
Cryptococcus neoformans
Streptococcus pneumoniae (Correct answer)

Correct answer: Streptococcus pneumoniae

Streptococcus pneumoniae is the most common cause of bacterial meningitis in unvaccinated children over 1 month of age, producing the classic CSF profile described.

Question 85: A 3-year-old ingested acetaminophen 3 hours ago. The dose is calculated at 200 mg/kg. Which intervention is most critical?

Give syrup of ipecac to induce vomiting
Observe and monitor liver enzymes at 24 hours only
Administer N-acetylcysteine (NAC) promptly (Correct answer)
Administer activated charcoal only and no antidote

Correct answer: Administer N-acetylcysteine (NAC) promptly

N-acetylcysteine is the specific antidote for acetaminophen overdose and is most effective when given within 8 hours of ingestion.

Question 86: Parents call the pediatric clinic after their 18-month-old child experienced a generalized seizure lasting 2 minutes during a febrile illness (temperature 103°F/39.4°C). The child is now postictal but easily arousable. Which of the following pieces of advice is most appropriate for the nurse to provide?

"Administer a dose of aspirin now and another in 4 hours to prevent another seizure."
"Give the child a cool water bath immediately to lower the temperature quickly."
"This is likely a simple febrile seizure. Focus on comfort measures and fever control with antipyretics." (Correct answer)
"Bring the child to the emergency department immediately for a full neurologic workup."

Correct answer: "This is likely a simple febrile seizure. Focus on comfort measures and fever control with antipyretics."

This scenario describes a simple febrile seizure, which is common and typically benign in children aged 6 months to 5 years. The primary management involves parental education, reassurance, and symptomatic treatment of the fever with antipyretics like acetaminophen or ibuprofen for comfort. Antipyretics do not prevent the recurrence of febrile seizures but can improve the child's comfort. An ED visit is not typically necessary for a simple febrile seizure if the child has returned to baseline. Aspirin is contraindicated in children due to the risk of Reye's syndrome. Cool water baths are not recommended as they can cause shivering, which may increase the core body temperature.

Question 87: A 3-year-old female presents with fever, vomiting, and foul-smelling urine. A clean-catch urine sample is obtained. Which of the following urinalysis results would be most indicative of a urinary tract infection (UTI)?

Specific gravity of 1.030 and amber color.
Positive for leukocyte esterase and nitrites. (Correct answer)
Negative for nitrites and positive for 1-2 WBCs/hpf.
Positive for ketones and trace protein.

Correct answer: Positive for leukocyte esterase and nitrites.

The presence of both leukocyte esterase (an enzyme released by white blood cells) and nitrites (which are formed when bacteria convert nitrates to nitrites) in urine is highly suggestive of a UTI. While a high number of WBCs would also be indicative, the combination of positive leukocyte esterase and nitrites is a strong predictor. Ketones can be present with dehydration from vomiting. A high specific gravity indicates concentrated urine, which can also be a sign of dehydration.

Question 88: A 15-year-old is brought to the clinic by a parent who is concerned about their recent behavior, including a persistent irritable mood, loss of interest in soccer, significant weight loss, and difficulty concentrating on schoolwork for the past month. The nurse should anticipate screening the adolescent for which of the following conditions first?

Generalized anxiety disorder
Attention-deficit/hyperactivity disorder (ADHD)
Anorexia nervosa
Major depressive disorder (Correct answer)

Correct answer: Major depressive disorder

The constellation of symptoms including persistent irritable mood, anhedonia (loss of interest), significant weight change, and diminished ability to concentrate, lasting for at least two weeks, are hallmark signs of major depressive disorder in adolescents. While symptoms may overlap with other conditions, the combination and duration strongly point towards depression as the primary concern to screen for.

Question 89: A parent reports their 5-year-old has an imaginary friend. What is the most appropriate nursing response?

Recommend social skills therapy
Refer the child for psychological evaluation
Advise the parent this is normal for preschoolers (Correct answer)
Suggest limiting creative play

Correct answer: Advise the parent this is normal for preschoolers

Imaginary friends are a normal part of preschool development reflecting fantasy play and creativity.

Question 90: Which immunization is recommended for ALL adolescents at the 11–12 year well visit regardless of sex?

HPV vaccine (Correct answer)
Hepatitis A vaccine
Varicella booster
Rotavirus vaccine

Correct answer: HPV vaccine

The HPV vaccine is universally recommended at age 11–12 years for all adolescents to protect against HPV-related cancers.

Question 91: Which best describes the nurse's role in research involving pediatric patients?

Nurses are not responsible for informed consent in research settings
Parental consent alone is always sufficient for pediatric research participation
Nurses must ensure both parental consent and child assent (when appropriate) are obtained (Correct answer)
Nurses may enroll patients in studies without IRB approval in emergencies

Correct answer: Nurses must ensure both parental consent and child assent (when appropriate) are obtained

Federal regulations and ethical standards require both parental permission and the child's assent (for those capable) before enrolling a minor in research.

Question 92: During a well-child visit for a 2-year-old, the nurse assesses the child's language development. Which finding would be considered a typical milestone for this age?

Has a vocabulary of approximately 50 words and uses two-word phrases. (Correct answer)
Speaks in 4-5 word sentences.
Follows a series of three commands.
Can clearly state their first and last name.

Correct answer: Has a vocabulary of approximately 50 words and uses two-word phrases.

A 2-year-old typically has a vocabulary of around 50 words and begins combining them into two-word phrases like 'more juice' or 'mama go'. Speaking in 4-5 word sentences is expected closer to age 3-4. Stating a full name and following a series of three commands are milestones for older preschool-aged children.

Question 93: Which action by a nurse demonstrates BEST practice when a parent declines a recommended blood transfusion for their child on religious grounds?

Document the refusal and proceed with other supportive care while notifying the medical team and ethics committee (Correct answer)
Immediately obtain a court order to override the parents' decision
Give the transfusion without consent to save the child's life
Discharge the child immediately since the parents are refusing care

Correct answer: Document the refusal and proceed with other supportive care while notifying the medical team and ethics committee

The nurse must document the refusal, continue other aspects of care, and escalate to the medical team and ethics committee for guidance.

Question 94: A nurse is preparing to administer an intramuscular (IM) injection to a 9-month-old infant. Which site is the most appropriate and safest for this age group?

Deltoid
Dorsogluteal
Ventrogluteal
Vastus lateralis (Correct answer)

Correct answer: Vastus lateralis

The vastus lateralis muscle, located in the anterolateral thigh, is the preferred and safest site for IM injections in infants under 12 months of age. This muscle is well-developed in infants and is free from major nerves and blood vessels. The deltoid muscle is not sufficiently developed, the ventrogluteal site can be difficult to locate correctly in infants, and the dorsogluteal site should never be used due to the risk of sciatic nerve damage.

Question 95: Which component of the Apgar score assesses heart rate?

Pulse (Correct answer)
Grimace
Appearance
Activity

Correct answer: Pulse

The 'P' in the Apgar acronym stands for Pulse, which evaluates the newborn's heart rate at 1 and 5 minutes after birth.

Question 96: A 6-year-old with diabetic ketoacidosis (DKA) receives IV fluid resuscitation. The nurse notes the child becomes confused and complains of headache. What complication should be suspected?

Hypokalemia
Cerebral edema (Correct answer)
Hypoglycemia
Hypernatremia

Correct answer: Cerebral edema

Cerebral edema is a life-threatening complication of DKA treatment, presenting with headache, altered mental status, and deteriorating neurological status.

Question 97: A child with chronic kidney disease (CKD) stage 4 is on a renal diet. Which lab value is the most immediate concern requiring dietary adjustment?

BUN of 35 mg/dL
Serum potassium of 6.2 mEq/L (Correct answer)
Serum sodium of 138 mEq/L
Serum phosphorus of 5.0 mg/dL

Correct answer: Serum potassium of 6.2 mEq/L

A serum potassium of 6.2 mEq/L is dangerously elevated hyperkalemia in CKD, posing an immediate risk of life-threatening cardiac dysrhythmias requiring urgent dietary restriction and intervention.

Question 98: A 10-month-old is brought in with decreased level of consciousness, retinal hemorrhages, and a bulging fontanelle. Radiographs reveal multiple subdural hematomas in different stages. The history is inconsistent. What is the most likely diagnosis?

Accidental head trauma
Abusive head trauma (shaken baby syndrome) (Correct answer)
Normal variant in infants
Glutaric aciduria type I

Correct answer: Abusive head trauma (shaken baby syndrome)

The triad of subdural hematomas, retinal hemorrhages, and encephalopathy with an inconsistent history is the hallmark presentation of abusive head trauma.

Question 99: Jaundice appearing within the first 24 hours of life is most commonly caused by which condition?

Neonatal sepsis
Breast milk jaundice
Physiological jaundice
Hemolytic disease due to ABO or Rh incompatibility (Correct answer)

Correct answer: Hemolytic disease due to ABO or Rh incompatibility

Jaundice within 24 hours is always pathological; hemolytic disease from blood group incompatibility is the most common cause.

Question 100: An infant with bronchopulmonary dysplasia (BPD) is being discharged home on supplemental oxygen. What is the most critical teaching for the parents?

Monitor the infant's respiratory rate and skin color, and keep all scheduled follow-up appointments (Correct answer)
Oxygen is only needed during sleep; remove it during waking hours
Permanently restrict all physical activity to prevent desaturation episodes
Discontinue the oxygen once the infant appears comfortable and pink

Correct answer: Monitor the infant's respiratory rate and skin color, and keep all scheduled follow-up appointments

Parents of infants with BPD must vigilantly monitor respiratory rate, color, and work of breathing, and maintain close follow-up because the condition requires ongoing assessment and management adjustments.

Question 101: A mother of a 14-year-old boy expresses concern that he has not yet received the HPV vaccine series. What is the most appropriate guidance for the nurse to provide regarding the vaccination schedule for him?

"He will require a two-dose series, with the second dose given 6 to 12 months after the first."
"He will require a three-dose series, typically given at 0, 1-2, and 6 months." (Correct answer)
"He can receive a single dose now, which will provide adequate protection."
"It is too late for him to receive the vaccine as it is only recommended for preteens."

Correct answer: "He will require a three-dose series, typically given at 0, 1-2, and 6 months."

According to CDC recommendations, individuals who initiate the HPV vaccine series at age 15 or older require three doses to be fully protected. The standard three-dose schedule is administered at 0, 1-2, and 6 months. The two-dose series is only for those who start the vaccine before their 15th birthday.

Question 102: A 3-month-old infant with confirmed RSV bronchiolitis is admitted with wheezing, tachypnea, and poor feeding. What is the priority nursing intervention?

Administer ribavirin antiviral therapy
Maintain airway patency and closely monitor respiratory status (Correct answer)
Begin broad-spectrum antibiotics immediately
Perform vigorous chest physiotherapy every 2 hours

Correct answer: Maintain airway patency and closely monitor respiratory status

RSV bronchiolitis management is primarily supportive; ensuring airway patency and monitoring respiratory status are the highest priorities as infants can deteriorate rapidly.

Question 103: A child with hemophilia A requires emergency dental surgery. Which factor replacement should the nurse anticipate administering?

Factor IX concentrate
Fresh frozen plasma only
Vitamin K
Factor VIII concentrate (Correct answer)

Correct answer: Factor VIII concentrate

Hemophilia A is a deficiency of factor VIII, so factor VIII concentrate is required before and after surgical procedures.

Question 104: A child is prescribed phenobarbital for seizures. Which side effect requires immediate nursing intervention?

Nausea
Hyperactivity
Mild sedation
Respiratory depression (Correct answer)

Correct answer: Respiratory depression

Respiratory depression is a life-threatening adverse effect of phenobarbital requiring immediate intervention.

Question 105: A 6-year-old who was struck by a car presents with hypotension, tachycardia, and abdominal rigidity. Hematocrit is 22%. During massive blood transfusion, what ratio of products should the nurse anticipate?

1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets (Correct answer)
Colloid solution before any blood products
Packed red blood cells only until hemoglobin exceeds 10 g/dL
10 units packed red blood cells: 1 unit FFP

Correct answer: 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets

Massive transfusion protocol in pediatric trauma uses a balanced 1:1:1 ratio of pRBC, FFP, and platelets to mimic whole blood and prevent coagulopathy.

Question 106: A nurse is providing care for a 7-year-old child recently diagnosed with ADHD, inpatient for a femur fracture. Which nursing intervention is most appropriate to include in the child's plan of care to address their psychosocial needs related to ADHD?

Providing long, detailed explanations of procedures to ensure understanding.
Implementing a structured daily routine with frequent, short breaks during activities. (Correct answer)
Minimizing all forms of stimulation in the room to prevent hyperactivity.
Maintaining a highly flexible schedule to accommodate the child's impulses.

Correct answer: Implementing a structured daily routine with frequent, short breaks during activities.

Children with ADHD thrive on predictability and structure. A consistent daily routine helps manage expectations and reduce anxiety. Incorporating frequent, short breaks can help maintain focus and prevent the child from becoming overwhelmed or overly fatigued during tasks, which is a key strategy for managing ADHD behaviors in various settings, including a hospital.

Question 107: A child with Duchenne muscular dystrophy (DMD) develops dysphagia. Which dietary modification is the priority nursing recommendation?

Restrict protein intake to reduce muscle workload
Encourage carbonated beverages to ease swallowing
Switch to a low-calorie diet to prevent obesity
Introduce thickened liquids and soft, moist foods (Correct answer)

Correct answer: Introduce thickened liquids and soft, moist foods

Thickened liquids and soft, moist foods reduce aspiration risk in DMD-related dysphagia while maintaining adequate nutritional intake.

Question 108: Which sign is most indicative of coarctation of the aorta in a newborn?

Peripheral edema of the lower limbs only
Bradycardia and hypotension in all extremities
Diminished or absent femoral pulses with bounding brachial pulses (Correct answer)
Central cyanosis of the face and trunk

Correct answer: Diminished or absent femoral pulses with bounding brachial pulses

Coarctation of the aorta reduces blood flow to the lower body, producing weak or absent femoral pulses while upper extremity pulses remain strong.

Question 109: A 5-year-old with suspected septic shock has a heart rate of 168, capillary refill of 4 seconds, and mottled skin. After two 20 mL/kg NS boluses, the child remains hypotensive. What is the next priority?

Switch to oral rehydration therapy
Perform immediate lumbar puncture
Administer a third 20 mL/kg fluid bolus only
Begin vasoactive medications (dopamine or epinephrine) (Correct answer)

Correct answer: Begin vasoactive medications (dopamine or epinephrine)

Fluid-refractory septic shock requires initiation of vasoactive agents to restore perfusion pressure after adequate fluid resuscitation.

Question 110: A child diagnosed with coarctation of the aorta would most likely demonstrate which blood pressure finding on assessment?

Lower blood pressure in the upper extremities than the lower extremities
Equal blood pressures in all four extremities
Higher blood pressure in the upper extremities than the lower extremities (Correct answer)
Bounding, equal pulses throughout all extremities

Correct answer: Higher blood pressure in the upper extremities than the lower extremities

Coarctation of the aorta creates a mechanical obstruction that causes hypertension proximal to the narrowing (upper extremities) and hypotension or diminished pulses distal to it (lower extremities).

Question 111: Which action best exemplifies the nurse's role as a child advocate in the inpatient setting?

Deferring all ethical dilemmas to hospital administration
Following all physician orders without question
Ensuring the child's voice and preferences are communicated to the care team (Correct answer)
Limiting family visitation to reduce patient stimulation

Correct answer: Ensuring the child's voice and preferences are communicated to the care team

Child advocacy involves amplifying the patient's voice, preferences, and needs within the healthcare team to ensure patient-centered care.

Question 112: A nurse in a pediatric clinic suspects a child is being physically abused. The parents deny any abuse. What is the nurse's legal obligation?

Document suspicions and wait for more evidence
Consult with colleagues to confirm suspicion before reporting
Discuss findings only with the attending physician
Report the suspicion to child protective services immediately (Correct answer)

Correct answer: Report the suspicion to child protective services immediately

Nurses are mandated reporters and are legally required to report reasonable suspicion of child abuse to child protective services without delay.

Question 113: A 3-month-old is brought to the ER with a bulging fontanelle, high-pitched cry, and fever. The nurse prepares for which PRIORITY intervention?

Lumbar puncture preparation (Correct answer)
Place in Trendelenburg position
Administer acetaminophen and discharge
Apply a cooling blanket immediately

Correct answer: Lumbar puncture preparation

Signs of bacterial meningitis require immediate lumbar puncture preparation for diagnosis and prompt antibiotic administration.

Question 114: Which screening is recommended by the AAP at the 9-month, 18-month, and 30-month well-child visits?

Developmental/behavioral surveillance and screening (Correct answer)
Hearing screening
Vision screening
Autism-specific screening

Correct answer: Developmental/behavioral surveillance and screening

Developmental and behavioral surveillance is recommended at every well-child visit, with standardized screening at 9, 18, and 30 months.

Question 115: A nurse is discharging a 15-year-old after a psychiatric hospitalization for self-harm. Which element is MOST critical in the safety plan?

Means restriction and identified crisis contacts (Correct answer)
A schedule of outpatient therapy appointments
Documentation of the teen's academic goals
A list of activities the teen enjoys

Correct answer: Means restriction and identified crisis contacts

Lethal means restriction combined with clear crisis contacts are the most evidence-based components of safety planning for self-harm.

Question 116: What is the normal respiratory rate for a newborn?

12–20 breaths per minute
60–80 breaths per minute
30–60 breaths per minute (Correct answer)
20–30 breaths per minute

Correct answer: 30–60 breaths per minute

A normal newborn respiratory rate is 30–60 breaths per minute, which is higher than the adult range.

Question 117: A 7-year-old child has a BMI at the 97th percentile. The nurse should initially recommend which intervention?

Increased physical activity and reduced intake of sugar-sweetened beverages (Correct answer)
Prescription weight-loss medication
Bariatric surgery referral
A very low-calorie diet to achieve rapid weight loss

Correct answer: Increased physical activity and reduced intake of sugar-sweetened beverages

First-line management of childhood obesity includes lifestyle interventions such as increased physical activity and reduced consumption of sugar-sweetened beverages.

Question 118: A parent asks when to schedule their child's first dental visit. The nurse's best response is:

Within 6 months of the first tooth eruption or by age 1 (Correct answer)
When the child loses the first baby tooth
By age 3 when most teeth have erupted
At age 5 before starting school

Correct answer: Within 6 months of the first tooth eruption or by age 1

The American Academy of Pediatric Dentistry recommends the first dental visit within 6 months after the first tooth appears or by age 1.

Question 119: Which statement by a parent indicates understanding of safe sleep practices for their 2-month-old?

'My baby sleeps in our bed so I can feed them more easily at night.'
'I keep my baby warm at night by adding a loose blanket in the crib.'
'I put my baby on their side so they won't choke if they spit up.'
'I place my baby alone, on their back, in their own crib with a firm mattress.' (Correct answer)

Correct answer: 'I place my baby alone, on their back, in their own crib with a firm mattress.'

Placing an infant alone, on their back, on a firm surface in their own sleep space follows AAP Safe Sleep guidelines to reduce SIDS risk.

Question 120: Which fine motor milestone is expected of a 9-month-old infant?

Pincer grasp
Builds a tower of 2 cubes
Transfers objects hand to hand (Correct answer)
Scribbles spontaneously

Correct answer: Transfers objects hand to hand

Transferring objects from hand to hand is a fine motor milestone typically achieved around 7–9 months.

Question 121: A 5-year-old with cystic fibrosis is prescribed pancreatic enzyme replacement therapy (PERT). When should enzymes be administered?

Once daily in the morning before breakfast
With every meal and snack containing fat (Correct answer)
Only with high-fat meals such as dinner
Two hours after each main meal

Correct answer: With every meal and snack containing fat

Pancreatic enzymes must be taken with every meal and fat-containing snack to facilitate proper digestion and nutrient absorption in CF.

Question 122: A nurse is about to administer digoxin to a 2-year-old child with heart failure. The child's apical heart rate is 82 beats per minute. What is the correct action?

Administer half the dose and reassess in 30 minutes
Administer the dose as ordered, since 82 bpm is within the normal range
Hold the dose and notify the prescriber, as the rate is below the threshold for this age group (Correct answer)
Increase the dose slightly to improve cardiac contractility

Correct answer: Hold the dose and notify the prescriber, as the rate is below the threshold for this age group

Digoxin should be held and the prescriber notified if the apical pulse is below 90-100 bpm in young children (1-5 years), as bradycardia may indicate digoxin toxicity.

Question 123: When using a pain scale for a 5-year-old, which tool is developmentally MOST appropriate?

Wong-Baker FACES Pain Rating Scale (Correct answer)
McGill Pain Questionnaire
Numeric rating scale (0–10)
Visual analog scale

Correct answer: Wong-Baker FACES Pain Rating Scale

The Wong-Baker FACES scale uses facial expressions that preschool and early school-age children can reliably identify.

Question 124: A child presents to the ED with a barking cough and mild inspiratory stridor at rest, consistent with mild-to-moderate croup. Which intervention is first-line?

Nebulized racemic epinephrine and 2-4 hours of observation
Immediate endotracheal intubation for airway protection
Heliox therapy via face mask
A single dose of oral or IM dexamethasone (Correct answer)

Correct answer: A single dose of oral or IM dexamethasone

Dexamethasone is the first-line treatment for mild-to-moderate croup because it reduces subglottic edema through its anti-inflammatory effect and has a prolonged duration of action.

Question 125: A nurse is teaching parents about safe sleep practices for their newborn. Which instruction is CORRECT?

Co-sleeping with a parent promotes bonding and is safe
Place the infant on their stomach to reduce aspiration risk
Use a firm, flat sleep surface with no soft bedding in the crib (Correct answer)
A small pillow can be used once the infant is 3 months old

Correct answer: Use a firm, flat sleep surface with no soft bedding in the crib

AAP safe sleep guidelines recommend a firm, flat surface free of soft objects to reduce the risk of SIDS and suffocation.

Question 126: A newborn has not passed meconium within 48 hours of birth. Which condition should the nurse suspect?

Pyloric stenosis
Hirschsprung disease (Correct answer)
Intussusception
Gastroesophageal reflux disease

Correct answer: Hirschsprung disease

Failure to pass meconium within 24–48 hours is a classic sign of Hirschsprung disease, caused by absence of ganglion cells in the colon.

Question 127: A 17-year-old who is legally emancipated is admitted for appendicitis. Who provides consent for surgery?

The patient's parents
The hospital administrator
The attending surgeon
The patient himself (Correct answer)

Correct answer: The patient himself

An emancipated minor has full legal authority to make their own medical decisions, including consenting to surgery.

Question 128: A nurse is assessing a 5-year-old for pain. Which scale is MOST appropriate?

FLACC scale
Numeric Rating Scale (0–10)
CRIES scale
Wong-Baker FACES scale (Correct answer)

Correct answer: Wong-Baker FACES scale

The Wong-Baker FACES scale is validated for children ages 3–7 who can self-report pain using facial expressions.

Question 129: Which of the following is improper when giving chemotherapy to a young patient?

Observing the child for 10 minutes to note for signs of anaphylaxis (Correct answer)
Administering medication through a free-flowing intravenous line
Monitoring the child for both general and specific adverse effects
Assessing for signs of infusion infiltration and irritation

Correct answer: Observing the child for 10 minutes to note for signs of anaphylaxis

Anaphylactic reactions to chemotherapy can be severe and rapid, requiring prompt recognition and intervention. Observing a child for only 10 minutes after chemotherapy administration is insufficient to detect all potential acute adverse reactions, including delayed or evolving signs of anaphylaxis. Patients should be monitored for a longer, protocol-specified period (e.g., 30-60 minutes) to ensure safety.

Question 130: A 10-year-old with HIV on antiretroviral therapy (ART) has an undetectable viral load and CD4 count of 750 cells/mm³. The school nurse asks what activities the child can participate in. What is the best response?

Swimming should be avoided due to infection risk from pool water
The child should be restricted from contact sports to protect classmates
Only non-contact activities are permitted to prevent injury-related blood exposure
The child can participate in all school activities without restriction (Correct answer)

Correct answer: The child can participate in all school activities without restriction

A child with well-controlled HIV (undetectable viral load, normal CD4) poses no transmission risk and can participate fully in all school activities without restriction.

Question 131: A child with status epilepticus is given rectal diazepam. Which action is the priority after administration?

Check blood glucose immediately
Place child in prone position
Monitor respiratory rate and oxygen saturation (Correct answer)
Obtain IV access for next dose

Correct answer: Monitor respiratory rate and oxygen saturation

Benzodiazepines can cause respiratory depression, so monitoring airway and oxygenation is the immediate priority.

Question 132: According to Kohlberg, a school-age child who follows rules to gain approval from peers is in which moral stage?

Law and order orientation
Punishment-obedience orientation
Good boy/good girl orientation (Correct answer)
Instrumental purpose orientation

Correct answer: Good boy/good girl orientation

The 'good boy/good girl' orientation (Stage 3) involves conforming to rules to gain social approval, typical of school-age children.

Question 133: A 4-year-old refuses to eat vegetables and only wants a few preferred foods. The nurse's best guidance to the parents is:

Use the division of responsibility: parents decide what is offered, child decides whether to eat (Correct answer)
Allow the child to eat only preferred foods to prevent mealtime conflict
Offer rewards such as dessert in exchange for eating vegetables
Force the child to eat at least one vegetable at every meal

Correct answer: Use the division of responsibility: parents decide what is offered, child decides whether to eat

Ellyn Satter's Division of Responsibility in Feeding is evidence-based: parents are responsible for what, when, and where; children decide whether and how much to eat.

Question 134: A 10-year-old with sickle cell disease presents with sudden severe headache and left-sided weakness. The nurse suspects:

Vaso-occlusive pain crisis
Splenic sequestration
Acute chest syndrome
Stroke (Correct answer)

Correct answer: Stroke

Sudden neurological deficits such as severe headache and focal weakness indicate stroke, a known complication of sickle cell disease.

Question 135: Which of the following vaccines is classified as a live attenuated vaccine?

Varicella (chickenpox) vaccine (Correct answer)
Inactivated poliovirus vaccine (IPV)
Hib conjugate vaccine
Hepatitis B vaccine

Correct answer: Varicella (chickenpox) vaccine

The varicella vaccine contains a live but weakened form of varicella-zoster virus and is contraindicated in severely immunocompromised patients.

Question 136: A nurse is caring for a hospitalized 8-year-old child. The child's parent has been staying at the bedside. Which nursing action best promotes the parent's participation in their child's care?

Providing the parent with a schedule of when nursing tasks will be completed throughout the day.
Asking the parent which aspects of daily care, like bathing or meal setup, they feel comfortable performing. (Correct answer)
Performing all care, such as bathing and dressing changes, efficiently while the parent observes.
Encouraging the parent to take frequent breaks away from the hospital to rest and recharge.

Correct answer: Asking the parent which aspects of daily care, like bathing or meal setup, they feel comfortable performing.

The principle of participation involves actively inviting and enabling families to take part in their child's care at a level with which they are comfortable. By asking the parent what they would like to do, the nurse respects their autonomy, acknowledges their role as the primary caregiver, and supports their desire to be involved.

Question 137: A 10-year-old diabetic child presents with fruity breath, Kussmaul respirations, and a blood glucose of 520 mg/dL. Which electrolyte abnormality is of greatest concern during insulin therapy?

Hypocalcemia
Hypernatremia
Hyperphosphatemia
Hypokalemia (Correct answer)

Correct answer: Hypokalemia

Insulin drives potassium into cells, causing potentially fatal hypokalemia during DKA treatment; potassium must be monitored closely.

Question 138: A young patient is receiving medication intraosseously from Nurse Pressy. When a child is: Intraosseous medication delivery is frequently utilized when:

Critically ill and under age 3 (Correct answer)
Under age 3
Over age 3
Critically ill and over age 3

Correct answer: Critically ill and under age 3

Intraosseous (IO) access is a critical emergency procedure for administering fluids and medications when intravenous access is difficult or impossible to obtain. It is particularly effective in critically ill infants and young children, typically under the age of 6 (often emphasized for those under 3), because their bone marrow cavities are more accessible and provide a rapid, non-collapsible route to the central circulation.

Question 139: A nurse is assessing a newborn for gestational age using the Ballard score. Which physical finding would suggest a post-term infant?

Absent lanugo, leathery skin, and long nails (Correct answer)
Ear cartilage that folds easily and stays folded
Gelatinous, transparent skin
Abundant lanugo covering the body

Correct answer: Absent lanugo, leathery skin, and long nails

Post-term infants show signs of skin maturity including loss of lanugo, dry or peeling leathery skin, and long nails due to prolonged gestation.

Question 140: A metabolic flaw that is inherited that causes RBC to be destroyed too soon?

G6PD (Correct answer)
Hemocystinuria
Celiac Disease
Phenylketonuria

Correct answer: G6PD

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited metabolic disorder where the body lacks or has insufficient G6PD, an enzyme vital for red blood cell protection against oxidative stress. Without adequate G6PD, red blood cells become vulnerable to premature destruction (hemolysis) when exposed to certain triggers like specific medications, foods, or infections.

Question 141: Which nursing intervention is most important for a hospitalized child with cystic fibrosis (CF) to prevent pulmonary complications?

Restrict fluid intake to reduce secretion volume
Administer inhaled corticosteroids twice daily as prescribed
Perform chest physiotherapy and airway clearance techniques regularly (Correct answer)
Limit all physical activity to prevent bronchospasm

Correct answer: Perform chest physiotherapy and airway clearance techniques regularly

Chest physiotherapy and airway clearance techniques mobilize the thick, viscous mucus characteristic of CF, reducing the risk of infection, atelectasis, and progressive lung damage.

Question 142: A 14-year-old is started on isotretinoin for severe acne. Which monitoring requirement is unique to this medication?

Baseline and monthly pulmonary function tests
Weekly CBC and renal function panels
Daily blood pressure monitoring
Monthly pregnancy tests and enrollment in the iPLEDGE program (Correct answer)

Correct answer: Monthly pregnancy tests and enrollment in the iPLEDGE program

Isotretinoin is highly teratogenic; all patients must be enrolled in the iPLEDGE REMS program, which requires monthly pregnancy testing for those who can become pregnant.

Question 143: Which behavior is characteristic of adolescent cognitive development according to Piaget?

Symbolic play
Object permanence
Abstract reasoning and hypothetical thinking (Correct answer)
Conservation of mass

Correct answer: Abstract reasoning and hypothetical thinking

Adolescents in the formal operational stage can engage in abstract thinking, hypothetical reasoning, and systematic problem solving.

Question 144: A 4-year-old weighing 18 kg is prescribed amoxicillin 40 mg/kg/day divided every 8 hours. How many mg should be given per dose?

180 mg
360 mg
240 mg (Correct answer)
720 mg

Correct answer: 240 mg

40 mg/kg/day × 18 kg = 720 mg/day ÷ 3 doses = 240 mg per dose.

Question 145: A nurse is providing nutritional counseling for the parents of a toddler newly diagnosed with cystic fibrosis. Which statement by the parents indicates a correct understanding of the dietary management?

"Our child needs a high-calorie, high-protein diet, and we must give pancreatic enzymes with all meals and snacks." (Correct answer)
"We need to make sure our child follows a low-fat, low-calorie diet to prevent stomach upset."
"We will give the pancreatic enzymes mixed in with a full glass of milk or in warm foods like soup."
"A gluten-free diet is the most important part of managing the digestive issues."

Correct answer: "Our child needs a high-calorie, high-protein diet, and we must give pancreatic enzymes with all meals and snacks."

The cornerstone of nutritional management in cystic fibrosis is a high-calorie, high-protein, high-fat diet to meet increased energy needs and support growth. [3, 10] Due to pancreatic insufficiency, exogenous pancreatic enzymes must be administered with every meal and snack to facilitate the digestion and absorption of nutrients, particularly fats and proteins. [3, 10] Enzymes should not be mixed with hot foods or milk products as this can inactivate them.

Question 146: A 7-year-old is scheduled for a tonsillectomy. When should preoperative teaching ideally begin?

One to two days before the procedure (Correct answer)
Only after the child asks questions about the surgery
The morning of surgery to reduce anxiety from waiting
Immediately upon arrival to the preop area

Correct answer: One to two days before the procedure

Teaching 1–2 days before surgery allows adequate time for the child to process information and ask questions without last-minute overwhelm.

Question 147: The nurse in charge notices an infant's unusually low-set ears during a physical examination. This discovery is related to:

Renal anomalies (Correct answer)
Congenital heart defects
Otogenous tetanus
Tracheoesophageal fistula

Correct answer: Renal anomalies

Unusually low-set ears are a dysmorphic feature often associated with various genetic syndromes and congenital anomalies, particularly those affecting the kidneys and urinary tract. During embryonic development, the ears and kidneys develop concurrently, meaning that malformations in one organ system can frequently indicate potential issues or anomalies in the other.

Question 148: When Doris takes her infant in for a well-baby checkup, she asks the nurse when she should start feeding him solid meals. Which solid food should be introduced initially, per the nurse's instructions?

Applesauce
Egg whites
Rice cereal (Correct answer)
Yogurt

Correct answer: Rice cereal

Single-grain, iron-fortified rice cereal is traditionally recommended as the first solid food for infants, typically introduced around 4-6 months of age. It is easily digestible, has a low allergenic potential, and provides essential iron, which breastfed infants may begin to deplete around this developmental stage. Other foods are introduced gradually after the infant tolerates rice cereal.

Question 149: During phototherapy for neonatal hyperbilirubinemia, which nursing action is most important?

Apply moisturizing lotion to exposed skin
Limit feedings to reduce bilirubin production
Keep the newborn fully clothed to prevent hypothermia
Apply eye shields to protect the retinas (Correct answer)

Correct answer: Apply eye shields to protect the retinas

Eye shields must be applied during phototherapy to protect the newborn's retinas from the intense light used to break down bilirubin.

Question 150: A 3-year-old swallowed a coin 20 minutes ago and is drooling and refusing to swallow. The coin is most likely located in the:

Trachea
Duodenum
Esophagus (Correct answer)
Stomach

Correct answer: Esophagus

Drooling and dysphagia indicate the coin is lodged in the esophagus; tracheal foreign bodies cause respiratory symptoms instead.

Question 151: A 2-year-old is prescribed oral metronidazole for a Clostridium difficile infection. Which food should the parents be counseled to avoid during treatment?

Citrus fruits
High-fiber foods
Dairy products
Foods containing alcohol or alcohol-based sauces (Correct answer)

Correct answer: Foods containing alcohol or alcohol-based sauces

Metronidazole causes a disulfiram-like reaction when combined with alcohol, resulting in nausea, vomiting, and flushing.

Question 152: During a well-child visit, a mother reports her 18-month-old still has not said any recognizable words. The nurse's best response is:

Reassure the mother that boys often talk later
Advise the mother to read to the child more often
Schedule a recheck in six months before acting
Refer the child for a comprehensive hearing and developmental evaluation (Correct answer)

Correct answer: Refer the child for a comprehensive hearing and developmental evaluation

Absence of any words by 18 months warrants immediate evaluation for hearing loss and developmental delay rather than watchful waiting.

Question 153: A 7-year-old with poorly controlled asthma is assessed. The nurse notes the child uses a long-acting beta-agonist (LABA) without inhaled corticosteroids (ICS). What action should the nurse take?

Notify the provider, as LABA monotherapy is contraindicated in children (Correct answer)
Teach the child to use LABA as a rescue inhaler during acute attacks
Add an oral leukotriene modifier alongside the LABA
Reassure the family that LABA alone is appropriate for the child's age

Correct answer: Notify the provider, as LABA monotherapy is contraindicated in children

LABA monotherapy without ICS is contraindicated in pediatric asthma due to increased risk of severe asthma exacerbations and death; the provider must be notified.

Question 154: Palivizumab (Synagis) is administered monthly during RSV season to provide prophylaxis against which pathogen?

Bordetella pertussis
Rotavirus
Influenza virus
Respiratory syncytial virus (RSV) (Correct answer)

Correct answer: Respiratory syncytial virus (RSV)

Palivizumab is a monoclonal antibody targeting RSV, given monthly in fall/winter to high-risk infants such as those born prematurely or with congenital heart disease.

Question 155: A parent asks how to respond when their 4-year-old has a temper tantrum in public. The best nurse guidance is:

Remove the child from the situation and stay calm without giving in (Correct answer)
Ignore the child completely regardless of safety
Threaten consequences to gain immediate compliance
Give the child what they want to stop the behavior quickly

Correct answer: Remove the child from the situation and stay calm without giving in

Calmly removing the child and remaining consistent without yielding to demands is the most effective evidence-based approach to tantrums.

Question 156: A 15-year-old presents with a first-time generalized tonic-clonic seizure that self-terminated in 90 seconds. The child is now post-ictal and afebrile. Which assessment finding would most immediately require further emergency workup?

Focal neurological deficit persisting more than 30 minutes (Correct answer)
Tongue laceration sustained during seizure
Mild headache after the seizure
Transient confusion lasting 10 minutes after the event

Correct answer: Focal neurological deficit persisting more than 30 minutes

A persistent focal neurological deficit (Todd's paralysis lasting >30 minutes) may indicate an underlying structural lesion such as a tumor or hemorrhage requiring urgent neuroimaging.

Question 157: A school-age child with sickle cell disease develops acute chest syndrome. Which intervention is MOST important?

Administer supplemental oxygen and IV hydration (Correct answer)
Hold all analgesics to avoid respiratory depression
Restrict oral fluids to prevent pulmonary edema
Apply cold compresses to the chest

Correct answer: Administer supplemental oxygen and IV hydration

Supplemental oxygen to maintain oxygenation and IV hydration to promote sickling reversal are cornerstones of acute chest syndrome management.

Question 158: A nurse is assessing a 7-year-old child who sustained a head injury after falling from a bicycle. Which of the following is considered an early sign of increased intracranial pressure (ICP) in a conscious child?

Fixed and dilated pupils
Decorticate posturing
Headache and vomiting (Correct answer)
Bradycardia

Correct answer: Headache and vomiting

Headache and vomiting (often forceful and without nausea) are classic early signs of increased intracranial pressure in a verbal child. These symptoms result from pressure on the brainstem and stretching of the meninges. Bradycardia, along with hypertension and irregular respirations (Cushing's triad), is a late and ominous sign. Fixed and dilated pupils and abnormal posturing are also late findings indicating significant brainstem compression and herniation.

Question 159: A 15-year-old female patient asks a clinic nurse for information about obtaining contraception. She explicitly asks that her parents not be informed. Which statement best guides the nurse's response?

The nurse is legally required to inform the parents of any medical services provided.
The nurse can provide the information but must obtain parental consent before a prescription is written.
The nurse should refuse to discuss contraception without a parent present to avoid legal issues.
The nurse must first determine the specific laws regarding minor consent and confidentiality in their state. (Correct answer)

Correct answer: The nurse must first determine the specific laws regarding minor consent and confidentiality in their state.

Laws regarding a minor's right to consent to healthcare and confidentiality, particularly for sensitive services like contraception, vary significantly from state to state. Some states allow minors to consent to contraceptive services without parental notification, while others have specific age or circumstantial requirements. Therefore, the nurse's first and most critical step is to be knowledgeable about and act in accordance with the laws of the state in which they practice.

Question 160: A nurse is caring for a child post-tonsillectomy. Which finding requires IMMEDIATE intervention?

Preference for cold liquids
Low-grade fever of 37.8°C
Mild sore throat
Frequent swallowing and restlessness (Correct answer)

Correct answer: Frequent swallowing and restlessness

Frequent swallowing in a post-tonsillectomy patient is a sign of hemorrhage, as the child may be swallowing blood.

Question 161: Twelve-year-old Erithel is seven months pregnant. Which teaching method is least effective when teaching parenting skills to an adolescent, according to the nurse?

Using audiovisual aids that show discussions of feelings and skills
Initiating a teenage parent support group with first and second-time mothers
Providing age-appropriate reading materials (Correct answer)
Providing a one-on-one demonstration and requesting a return demonstration, using a live infant model

Correct answer: Providing age-appropriate reading materials

Adolescents, especially those facing the complexities of pregnancy and parenting, often learn best through active, hands-on, and interactive methods. While reading materials can supplement learning, they are generally less effective as a primary teaching method for developing practical parenting skills compared to demonstrations, return demonstrations, and peer support groups, which offer experiential learning and social support.

Question 162: Due to a tumble off his bike, the 12-year-old child shattered his arm. The nurse is aware that once the injury has been cast, it is crucial to carry out all of the following assessments on the area nearby the injury, with the exception of:

capillary refill.
skin integrity (Correct answer)
radial and ulnar pulse.
finger movement

Correct answer: skin integrity

After a cast is applied, the most critical assessments are for neurovascular compromise, often referred to as the '5 Ps': pain, pallor, pulselessness, paresthesia, and paralysis (movement). Radial/ulnar pulse, capillary refill, and finger movement directly assess circulation and nerve function, which are paramount for preventing severe complications like compartment syndrome. While skin integrity around the cast edges is important to prevent pressure sores or irritation, it is generally less immediately critical than assessing for acute neurovascular impairment.

Question 163: A 5-year-old is in respiratory arrest following a submersion injury. Rescuers have been performing CPR for 10 minutes. Water temperature was 4°C. What resuscitation principle is most applicable?

Defibrillate immediately regardless of rhythm
Administer epinephrine only if the water was fresh, not salt
Cease resuscitation because prognosis is uniformly poor after 10 minutes
Continue aggressive resuscitation because hypothermic drowning can have favorable outcomes (Correct answer)

Correct answer: Continue aggressive resuscitation because hypothermic drowning can have favorable outcomes

Cold-water submersion can provide cerebral protection through hypothermia; the principle 'not dead until warm and dead' guides prolonged resuscitation efforts.

Question 164: When planning discharge for a child with a new colostomy, which educational need should the nurse address FIRST?

Hands-on pouch change demonstration and return demonstration by the caregiver (Correct answer)
Community support group contacts for families with ostomies
Long-term dietary modifications for optimal colostomy function
Plans for eventual surgical reversal of the colostomy

Correct answer: Hands-on pouch change demonstration and return demonstration by the caregiver

Return demonstration of pouch changes is the highest priority because the caregiver must be competent in this essential skill before discharge.

Question 165: A pediatric nurse is providing education to the parents of a child diagnosed with Autism Spectrum Disorder (ASD). Which statement by the parents indicates an effective understanding of nursing guidance?

"We will try to make our child look us in the eye whenever we speak to them."
"Maintaining a predictable schedule and using visual aids can help reduce our child's anxiety." (Correct answer)
"We should avoid all routines to help our child become more flexible."
"It's best to use long sentences and metaphors to expand their language."

Correct answer: "Maintaining a predictable schedule and using visual aids can help reduce our child's anxiety."

Individuals with ASD often experience significant anxiety with changes and transitions. Providing a structured, predictable environment and using visual supports (like picture schedules) are evidence-based strategies that enhance communication, reduce challenging behaviors, and promote a sense of security.

Question 166: What is the nurse's primary responsibility when a physician's order appears potentially harmful to a pediatric patient?

Refuse the order without further communication
Carry out the order and document concerns afterward
Question the order and clarify with the prescribing physician before administration (Correct answer)
Administer the medication and notify the charge nurse post-administration

Correct answer: Question the order and clarify with the prescribing physician before administration

Nurses have both a professional and legal duty to clarify questionable orders with the prescribing provider before carrying them out.

Question 167: Which activity best promotes cognitive development in toddlers (ages 1–3 years)?

Engaging in parallel play with minimal adult interaction
Allowing unlimited screen time for educational videos
Providing structured academic worksheets
Reading aloud and interactive storytelling (Correct answer)

Correct answer: Reading aloud and interactive storytelling

Reading aloud and interactive storytelling build vocabulary, language, and cognitive skills essential during toddlerhood.

Question 168: A premature infant born at 32 weeks gestation is at greatest risk for which condition?

Appendicitis
Pyloric stenosis
Respiratory distress syndrome (RDS) (Correct answer)
Type 1 diabetes mellitus

Correct answer: Respiratory distress syndrome (RDS)

RDS is the most common serious complication in premature infants due to insufficient surfactant production before 34–36 weeks gestation.

Question 169: A 16-year-old presents after a motor vehicle accident with absent breath sounds on the left, tracheal deviation to the right, and hypotension. What emergency condition does the nurse suspect?

Flail chest
Cardiac tamponade
Tension pneumothorax (Correct answer)
Hemothorax

Correct answer: Tension pneumothorax

Tension pneumothorax causes absent breath sounds, tracheal deviation away from the affected side, and obstructive shock requiring immediate needle decompression.

Question 170: A child is admitted with suspected bacterial meningitis. What type of transmission-based precautions should the nurse implement?

Airborne precautions
Droplet precautions for at least 24 hours after starting antibiotics (Correct answer)
Contact precautions only
No isolation is required

Correct answer: Droplet precautions for at least 24 hours after starting antibiotics

Neisseria meningitidis spreads via respiratory droplets, requiring droplet precautions until 24 hours of effective antibiotic therapy has been completed.

Question 171: At what age does the CDC immunization schedule recommend the first dose of the MMR vaccine?

6 months
2 months
9 months
12–15 months (Correct answer)

Correct answer: 12–15 months

The first MMR dose is given at 12–15 months, after maternal antibody protection has waned, with the second dose at 4–6 years.

Question 172: A nurse is using the SBAR format to hand off care of a 6-year-old with asthma. Which component represents the 'R' in SBAR?

The background of events leading to this admission
A concise summary of the child's medical history
The nurse's specific request or recommendation for the receiving provider (Correct answer)
The child's current respiratory rate and oxygen saturation

Correct answer: The nurse's specific request or recommendation for the receiving provider

The 'R' in SBAR stands for Recommendation, where the nurse proposes a specific action or request to the receiving provider.

Question 173: A nurse is screening a 5-year-old using the Pediatric Symptom Checklist (PSC). This tool is designed to:

Measure medication effectiveness in children with ADHD
Assess developmental milestones in early childhood
Diagnose specific psychiatric disorders in children
Identify children at risk for psychosocial problems for further evaluation (Correct answer)

Correct answer: Identify children at risk for psychosocial problems for further evaluation

The PSC is a validated psychosocial screening tool that flags children who may need further mental health evaluation, not a diagnostic instrument.

Question 174: A nurse is counseling a parent about introducing peanut-containing foods to a 4-month-old with severe eczema and egg allergy. The correct guidance is:

Wait until 12 months then introduce under physician supervision
Refer to an allergist for evaluation before peanut introduction (Correct answer)
Avoid all peanut products until age 5 to prevent allergy
Introduce peanut products at home without prior testing

Correct answer: Refer to an allergist for evaluation before peanut introduction

For infants with severe eczema and/or egg allergy, NIAID guidelines recommend evaluation by an allergist before introducing peanut-containing foods.

Question 175: A nurse is educating parents about media use. According to the AAP, what is the screen time recommendation for children ages 2–5 years?

Less than 1 hour per day of high-quality programming (Correct answer)
Screen time is not regulated for this age group
Up to 2 hours per day
No screen time is allowed

Correct answer: Less than 1 hour per day of high-quality programming

The AAP recommends limiting screen time to less than 1 hour per day of high-quality programs for children ages 2–5, with co-viewing encouraged.

Question 176: A neonate is receiving continuous positive airway pressure (CPAP) for RDS. Which assessment finding requires immediate intervention?

Mild nasal flaring during feedings
Respiratory rate of 55 breaths per minute
Oxygen saturation of 95%
Abdominal distension with decreased bowel sounds (Correct answer)

Correct answer: Abdominal distension with decreased bowel sounds

Abdominal distension with decreased bowel sounds during CPAP may indicate necrotizing enterocolitis (NEC) or bowel perforation requiring urgent evaluation.

Question 177: A child with a large, longstanding unrepaired VSD develops increasing cyanosis, decreased exercise tolerance, and reversal of blood flow through the defect. The nurse recognizes this as:

Coarctation syndrome with progressive aortic narrowing
Pulmonary stenosis with compensatory right ventricular hypertrophy
Eisenmenger syndrome, where pulmonary hypertension reverses the shunt (Correct answer)
Tetralogy of Fallot developing after an acyanotic defect

Correct answer: Eisenmenger syndrome, where pulmonary hypertension reverses the shunt

Eisenmenger syndrome occurs when longstanding left-to-right shunting causes irreversible pulmonary hypertension, eventually exceeding systemic pressure and reversing the shunt to right-to-left, causing cyanosis.

Certified Pediatric Nurse (CPN) Exam

The CPN exam, administered by the Pediatric Nursing Certification Board (PNCB), validates a nurse's specialized knowledge and skills in providing comprehensive care to pediatric patients from infancy through young adulthood. It covers health promotion, patient assessment, care planning and management, and professional responsibilities.

175

Questions

180 min

Time Limit

70%

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