I85PREP
⌘ K
CPedN(C) - Pediatric Nursing study materials
CPedN(C) - Pediatric Nursing study resources

CPedN(C) - Pediatric Nursing practice questions

One question at a time. Build your CPedN(C) - Pediatric Nursing understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Growth, Development, and Health Promotion

At which age does a typically developing infant first demonstrate a social smile in response to a caregiver's face?

  1. At birth
  2. Around 6 to 8 weeks of age Correct answer.
  3. Around 6 months of age
  4. Around 9 months of age

Explanation

A responsive social smile usually emerges between 6 and 8 weeks as visual acuity and social awareness mature. Smiling before this time is generally reflexive or related to internal states rather than true social engagement. Recognizing this milestone helps nurses identify delays in social-emotional development.

Question 2Growth, Development, and Health Promotion

A nurse is teaching parents about introducing solid foods to a healthy term infant. Which recommendation is most appropriate?

  1. Start pureed fruits at 2 months to prevent allergies
  2. Introduce finger foods before the extrusion reflex fades
  3. Add whole cow's milk at 4 months as the main drink
  4. Begin iron-fortified cereals around 6 months when head control is good Correct answer.

Explanation

Exclusive milk feeding is recommended for about the first 6 months, after which iron-fortified solids are introduced as iron stores decline and motor skills allow spoon feeding. Readiness signs include good head control and sitting with support. Early solids or cow's milk increase allergy and renal solute risks.

Question 3Growth, Development, and Health Promotion

According to standard growth charts, a newborn's birth weight typically doubles by which age?

  1. About 12 months
  2. About 5 months Correct answer.
  3. About 2 months
  4. About 9 months

Explanation

Birth weight generally doubles by about 4 to 5 months and triples by about 12 months in healthy term infants. Nurses use these benchmarks to screen for feeding adequacy and growth faltering. Deviations warrant assessment of intake, illness, and psychosocial factors.

Question 4Growth, Development, and Health Promotion

A 4-year-old is brought for a well-child visit. Which developmental task is most characteristic of this age?

  1. Using sentences of four or more words and engaging in pretend play Correct answer.
  2. Dressing independently and tying shoelaces
  3. Hopping on one foot and copying a circle
  4. Naming four colors and counting to ten

Explanation

Preschoolers around 4 years use multiword sentences and elaborate pretend play, reflecting rapid language and imaginative development. Gross and fine motor skills also advance but specific tasks differ by age. Matching expectations to age prevents mislabeling normal behavior as delay.

Question 5Growth, Development, and Health Promotion

Which statement best describes the recommended sleep pattern for a healthy 6-month-old infant?

  1. About 14 to 15 hours total per day including 2 to 3 naps Correct answer.
  2. About 18 hours total per day with one long nap
  3. About 20 hours total per day with 5 naps
  4. About 8 hours total per day with no naps

Explanation

Infants around 6 months typically sleep about 14 to 15 hours in a 24-hour period, including two to three naps. Sleep consolidation increases as circadian rhythms mature. Nurses counsel families on safe sleep positioning and consistent routines.

Question 6Growth, Development, and Health Promotion

A parent asks when the anterior fontanel usually closes. What is the best response?

  1. Between 3 and 6 months of age
  2. After 36 months of age
  3. Between 12 and 18 months of age Correct answer.
  4. By 2 months of age

Explanation

The anterior fontanel typically closes between 12 and 18 months, while the posterior fontanel closes by about 2 to 3 months. Closure timing is a marker of skeletal maturation. Early or delayed closure warrants evaluation for endocrine or skeletal disorders.

Question 7Growth, Development, and Health Promotion

A nurse is assessing a 9-month-old. Which finding most suggests the infant is meeting expected gross motor milestones?

  1. Sitting briefly with hand support
  2. Lifting the head when prone
  3. Pulling to stand and cruising along furniture Correct answer.
  4. Rolling from back to front only

Explanation

By about 9 months most infants pull to stand and begin cruising, reflecting increasing strength and balance. Earlier skills such as head lifting and rolling are achieved in the first months. Nurses use sequential milestone checks to detect delay early.

Question 8Growth, Development, and Health Promotion

Which immunization is typically recommended for adolescents at 11 to 12 years of age?

  1. Rotavirus series
  2. Human papillomavirus vaccine series Correct answer.
  3. Hepatitis B birth dose
  4. Measles-mumps-rubella booster

Explanation

The HPV vaccine series is recommended for preteens around 11 to 12 years, along with Tdap and meningococcal vaccines. This timing maximizes antibody response before exposure risk rises. Nurses address vaccine hesitancy with clear, nonjudgmental education.

Question 9Growth, Development, and Health Promotion

A 15-year-old has a body mass index at the 90th percentile for age and sex. How should the nurse interpret this finding?

  1. Obese, requiring immediate pharmacologic therapy
  2. Overweight, warranting counseling on nutrition and activity Correct answer.
  3. Underweight, requiring nutritional supplementation
  4. Healthy weight, needing no further discussion

Explanation

For children and adolescents, BMI between the 85th and 94th percentiles is classified as overweight, while at or above the 95th percentile is obesity. Lifestyle counseling and follow-up are appropriate first steps. Pharmacologic therapy is reserved for selected severe cases.

Question 10Growth, Development, and Health Promotion

Which teaching point is most important when counseling parents about preventing dental caries in a toddler?

  1. Give juice freely throughout the day for hydration
  2. Avoid putting the child to bed with a bottle of milk or juice Correct answer.
  3. Delay the first dental visit until age 6 years
  4. Begin flossing all teeth as soon as the first tooth appears

Explanation

Prolonged exposure to sugary liquids, especially at bedtime, promotes early childhood caries. Parents should offer water and clean teeth daily. Early dental visits and appropriate fluoride use further reduce risk.

Question 11Growth, Development, and Health Promotion

A nurse is preparing a 2-month-old for a well-child visit. Which developmental milestone is expected at this age?

  1. Transferring objects between hands
  2. Sitting without support
  3. Tracking a moving object with the eyes Correct answer.
  4. Using a pincer grasp

Explanation

Visual tracking emerges in the first few months as coordination improves. Transferring objects, pincer grasp, and independent sitting occur later in the first year. Recognizing these sequences guides developmental surveillance.

Question 12Growth, Development, and Health Promotion

A school nurse is planning a health promotion program for 8-year-old children. Which topic best matches this developmental stage?

  1. Prenatal nutrition education
  2. Sudden infant death syndrome prevention
  3. Toilet training readiness
  4. Injury prevention during sports and bicycle riding Correct answer.

Explanation

School-age children engage in organized sports and independent play, raising the risk of injuries that helmets and safety rules can prevent. Health education at this age can use concrete reasoning and peer learning. Topics about infancy or prenatal care are irrelevant to this group.

Question 13Growth, Development, and Health Promotion

A 10-month-old has not yet begun babbling or making repetitive consonant sounds. What is the nurse's best action?

  1. Reassure the parent that speech always begins after 12 months
  2. Recommend eliminating all screen time for one month first
  3. Advise the parent to wait until the 18-month visit
  4. Refer for a hearing and developmental evaluation Correct answer.

Explanation

Babbling with consonants typically appears by 6 to 9 months, so its absence at 10 months suggests possible hearing or developmental delay. Early referral supports timely intervention, which improves outcomes. Watchful waiting risks missing a critical window.

Question 14Growth, Development, and Health Promotion

Which statement about an infant's pincer grasp is most accurate?

  1. It is present at birth as a primitive reflex
  2. It involves thumb and index finger opposition and appears around 9 to 10 months Correct answer.
  3. It involves the whole hand and appears at 4 months
  4. It develops only after the child can walk independently

Explanation

The pincer grasp is a fine motor milestone in which the thumb and index finger oppose to pick up small objects, typically emerging around 9 to 10 months. It reflects cortical maturation and hand-eye coordination. Its appearance supports readiness for finger foods.

Question 15Growth, Development, and Health Promotion

A nurse is teaching a new parent about safe sleep for a 2-month-old. Which instruction is correct?

  1. Let the infant sleep in an adult bed to promote breastfeeding
  2. Use a bumper pad to prevent limb entrapment
  3. Place the infant on the back on a firm surface in the same room as the caregiver Correct answer.
  4. Place the infant on the stomach with a soft blanket for comfort

Explanation

Supine sleep on a firm surface without soft bedding reduces the risk of sudden infant death. Room sharing without bed sharing is recommended for at least the first 6 months. Bumper pads and adult beds increase suffocation risk.

Question 16Growth, Development, and Health Promotion

A 6-year-old is asked to draw a person. Which finding best reflects expected development at this age?

  1. A single circle with dots for facial features
  2. A figure with a head, body, and several limbs Correct answer.
  3. A scribbled mass with no recognizable parts
  4. A detailed figure with clothing and background

Explanation

By about 6 years children draw recognizable human figures with a head, body, and limbs. Scribbling is typical of toddlers, while detailed scenes emerge later in school age. Artwork offers a window into cognitive and fine motor development.

Question 17Growth, Development, and Health Promotion

A nurse is assessing a 3-year-old's language. Which pattern is most consistent with normal development?

  1. Speaking in single words only
  2. Using complex sentences with correct grammar consistently
  3. Using short sentences of three to four words with strangers understanding most speech Correct answer.
  4. Being understood by strangers less than half the time

Explanation

Three-year-olds typically speak in short sentences and are understood by unfamiliar listeners most of the time. Single words alone or poor intelligibility suggest delay. Early recognition supports speech therapy referral.

Question 18Growth, Development, and Health Promotion

Which recommendation about screen time is most appropriate for a 3-year-old?

  1. Allow unlimited screen time to support language learning
  2. Limit high-quality programming to about one hour per day with caregiver co-viewing Correct answer.
  3. Encourage independent screen use in the bedroom at bedtime
  4. Avoid all screens until age 8 years

Explanation

Guidance for preschoolers recommends limiting screen media to about one hour per day of high-quality content, ideally co-viewed with a caregiver. Screens in the bedroom and at bedtime disrupt sleep and reduce interaction. Excessive screen time is linked to language and attention concerns.

Question 19Growth, Development, and Health Promotion

A nurse is reviewing a growth chart for a 2-year-old whose length has fallen from the 50th to the 10th percentile over 6 months. What is the priority action?

  1. Reassure the family that percentile changes are always normal
  2. Recommend a high-calorie supplement without further assessment
  3. Assess dietary intake, chronic illness, and psychosocial stressors Correct answer.
  4. Schedule a follow-up in 12 months

Explanation

Crossing two or more major percentile lines suggests growth faltering and requires evaluation of intake, illness, and social factors. A single percentile is less informative than the trajectory over time. Prompt assessment prevents nutritional and developmental consequences.

Question 20Growth, Development, and Health Promotion

Which developmental change is most characteristic of early adolescence?

  1. Establishment of a stable adult identity
  2. Increased peer influence and desire for independence from parents Correct answer.
  3. Completion of pubertal growth
  4. Onset of stranger anxiety

Explanation

Early adolescence is marked by strong peer orientation and a drive for autonomy while identity is still forming. Pubertal growth continues rather than completes during this period. Stranger anxiety is an infant behavior.

Question 21Growth, Development, and Health Promotion

A parent reports that a 4-month-old can roll from front to back. How should the nurse respond?

  1. This is delayed and requires immediate referral
  2. This is an expected milestone for age 4 months Correct answer.
  3. This skill normally appears after 9 months
  4. This is advanced and suggests hypertonia

Explanation

Rolling from prone to supine typically appears around 4 months as neck and trunk strength increase. It is an expected gross motor milestone for this age. Nurses use such findings to reassure families and continue surveillance.

Question 22Growth, Development, and Health Promotion

A nurse is counseling an adolescent about nutrition. Which recommendation best supports healthy growth?

  1. Rely on energy drinks for daily hydration
  2. Follow a strict low-carbohydrate diet without medical supervision
  3. Eat a balanced diet with adequate calcium and iron and limit sugary drinks Correct answer.
  4. Skip breakfast to control weight

Explanation

Adolescents have high calcium and iron needs during rapid growth, and balanced meals with limited sugary drinks support bone and blood health. Skipping breakfast and unsupervised restrictive diets risk nutrient deficits. Energy drinks are not appropriate for hydration.

Question 23Growth, Development, and Health Promotion

A nurse is assessing a 5-year-old's readiness for school. Which skill is most predictive of a smooth transition?

  1. Tying shoelaces without assistance
  2. Reading simple chapter books independently
  3. Solving basic multiplication problems
  4. Following two- to three-step directions and separating from caregivers Correct answer.

Explanation

School readiness centers on social-emotional skills, language, and the ability to follow directions and separate from caregivers. Academic skills such as reading and multiplication are not expected before school entry. These functional skills predict classroom success better than early academics.

Question 24Growth, Development, and Health Promotion

Which statement about the recommended schedule for well-child visits in the first year is most accurate?

  1. Visits occur at about 1, 2, 4, 6, 9, and 12 months Correct answer.
  2. Visits occur at 3 and 8 months only
  3. Visits occur only at birth and 12 months
  4. Visits occur every week for the first year

Explanation

The standard first-year schedule includes visits at approximately 1, 2, 4, 6, 9, and 12 months to monitor growth, development, and immunizations. Frequent early visits allow early detection of problems. This schedule aligns with immunization timing and developmental surveillance.

Question 25Family-Centered Care and Communication

A 6-year-old child is scheduled for surgery. According to family-centered care principles, which action best supports the child's developmental needs?

  1. Tell the child that nothing painful will happen so the child stays calm
  2. Explain the procedure to the child using simple, honest words and allow choices such as which arm for the ID band Correct answer.
  3. Postpone any teaching until the child is sedated in the operating room
  4. Limit all information to the parents and keep the child unaware until induction

Explanation

School-age children benefit from simple, truthful explanations and small choices, which build a sense of control and reduce anxiety. Family-centered care respects the child as a participant rather than a passive object of care. Deception or withholding information undermines trust.

Question 26Family-Centered Care and Communication

Which statement best describes the core principle of family-centered care in pediatrics?

  1. The family is a constant in the child's life and is recognized as a partner in care planning and delivery Correct answer.
  2. Family involvement is encouraged only during visiting hours set by the unit
  3. Care decisions are made solely by the health care team to avoid conflicting input
  4. Parents are visitors who should step aside so staff can provide care efficiently

Explanation

Family-centered care recognizes the family as the enduring presence in a child's life and treats parents as partners in decision-making and care. It supports collaboration rather than staff-only authority. Policies that treat parents as visitors contradict this philosophy.

Question 27Family-Centered Care and Communication

A nurse is admitting a toddler. Which approach best demonstrates family-centered communication with the parents?

  1. Provide a single written handout and avoid further discussion to save time
  2. Use open-ended questions and actively listen to the parents' concerns and routines Correct answer.
  3. Ask the parents to wait in the hall while the child is examined
  4. Address all questions to the child and refer to parents only for insurance details

Explanation

Open-ended questions and active listening invite parents to share their knowledge of the child and their concerns, which is central to family-centered communication. This builds trust and gathers essential history. Directing all communication away from parents or excluding them from the exam weakens the partnership.

Question 28Family-Centered Care and Communication

Which behavior by a nurse best demonstrates the communication technique of active listening?

  1. Nodding, maintaining eye contact, and reflecting back what the parent said Correct answer.
  2. Documenting on the computer while the parent is speaking
  3. Interrupting to correct a parent's misunderstanding immediately
  4. Changing the subject when the parent becomes emotional

Explanation

Active listening involves full attention, nonverbal cues such as eye contact and nodding, and reflecting or paraphrasing to confirm understanding. It conveys respect and encourages the speaker to continue. Interrupting, distracting behaviors, or avoiding emotion blocks communication.

Question 29Family-Centered Care and Communication

A 4-year-old is crying during a blood draw and the parent looks distressed. Which response best reflects family-centered support?

  1. Proceed quickly without speaking to reduce the total procedure time
  2. Acknowledge the parent's distress and offer comfort techniques such as holding the child's hand Correct answer.
  3. Tell the parent that crying is normal and to ignore it
  4. Ask the parent to leave the room so the child calms faster

Explanation

Acknowledging the parent's feelings and offering a supportive role, such as comforting the child, validates the family and reduces everyone's stress. Family-centered care includes the emotional needs of parents, not only the child. Removing the parent or dismissing distress erodes trust.

Question 30Family-Centered Care and Communication

During a family conference, a parent says, "I don't understand why my child needs this test." What is the nurse's best initial response?

  1. "Tell me what you understand so far so I can explain it clearly." Correct answer.
  2. "It's routine, so you don't need to worry about it."
  3. "You should ask the doctor; that's not my area."
  4. "We can discuss it after you sign the consent form."

Explanation

Asking what the parent already understands allows the nurse to assess knowledge and tailor an explanation, which supports informed consent and shared decision-making. Dismissing concerns or deflecting questions blocks understanding. Consent should follow, not precede, adequate explanation.

Question 31Family-Centered Care and Communication

A nurse must obtain assent from a 10-year-old before a procedure. Which statement best describes the concept of assent in pediatric care?

  1. Assent is the child's developmentally appropriate agreement to participate, obtained alongside parental permission Correct answer.
  2. Assent is a legal signature that replaces parental consent
  3. Assent means the child may refuse any treatment without parental involvement
  4. Assent is only required for children older than 16 years

Explanation

Assent is the child's developmentally appropriate agreement to participate in care, sought together with parental or guardian permission. It is not a legal substitute for consent and does not grant independent refusal rights. Age thresholds vary, but school-age children are typically included.

Question 32Family-Centered Care and Communication

A family speaks primarily Spanish and the nurse does not. Which action best ensures effective communication during discharge teaching?

  1. Use the family's young bilingual child as the interpreter
  2. Ask a Spanish-speaking visitor to translate the discharge instructions
  3. Arrange a professional medical interpreter and document that interpretation was used Correct answer.
  4. Rely on gestures and written materials in English

Explanation

Professional medical interpreters provide accurate, confidential communication and are the standard for limited-English-proficiency families. Using children or untrained bystanders risks errors, breaches confidentiality, and places inappropriate burden on them. Interpretation should be documented.

Question 33Family-Centered Care and Communication

A parent of a hospitalized preschooler is anxious and repeatedly asks the same questions about the plan of care. What is the most therapeutic nursing response?

  1. Document that the parent is noncompliant with teaching
  2. Limit further questions by stating the plan has already been explained
  3. Refer the parent to a social worker and discontinue teaching
  4. Recognize anxiety as a barrier to learning and calmly repeat and clarify information Correct answer.

Explanation

Anxiety interferes with learning and memory, so repeated questions often reflect worry rather than noncompliance. Calm repetition and clarification address the underlying anxiety and build trust. Labeling the parent noncompliant or limiting questions damages the therapeutic relationship.

Question 34Family-Centered Care and Communication

Which nursing action best supports family-centered care during a child's hospitalization?

  1. Restricting parents' presence to set visiting hours to protect unit routines
  2. Encouraging parents to room-in and participate in routine care such as bathing and feeding Correct answer.
  3. Assigning a different nurse each shift to expose the family to varied expertise
  4. Discouraging parents from asking questions to avoid interrupting staff

Explanation

Rooming-in and parent participation in routine care keep the family together and respect parents as caregivers, which is a hallmark of family-centered care. Restricting presence and discouraging questions conflict with this model. Continuity of nursing staff also supports trust.

Question 35Family-Centered Care and Communication

A 7-year-old whose sibling is seriously ill tells the nurse, "My parents love my brother more now." What is the nurse's best response?

  1. "That's not true; your parents love all their children equally."
  2. "You'll understand when you're older."
  3. "It sounds like you feel left out; tell me more about that." Correct answer.
  4. "You shouldn't feel that way; your brother is very sick."

Explanation

Reflecting the child's feeling and inviting further expression validates the emotion and opens communication, which supports the sibling's adjustment. Correcting or shaming the feeling dismisses it and may suppress the child's concerns. Siblings of ill children often need acknowledgement and support.

Question 36Family-Centered Care and Communication

A nurse is preparing a 3-year-old for an injection. Which communication strategy is most developmentally appropriate?

  1. Explain the procedure in detailed medical terms before beginning
  2. Use simple words, a brief explanation right before the procedure, and comfort positioning Correct answer.
  3. Explain the procedure several days in advance so the child can prepare
  4. Avoid explaining and distract the child with no preparation at all

Explanation

Toddlers have limited understanding of time and benefit from simple words and brief, immediate preparation. Comfort positioning and honest, short explanations reduce fear. Detailed terminology or long advance notice is not developmentally useful.

Question 37Family-Centered Care and Communication

During end-of-life care, a family asks about the child's prognosis and wants to be present for all care. Which approach best reflects family-centered care?

  1. Provide honest, compassionate information at the family's pace and accommodate their presence in care Correct answer.
  2. Limit family presence to reduce emotional strain on staff
  3. Make all decisions for the family to avoid conflict
  4. Withhold prognostic information to protect the family from distress

Explanation

Honest, compassionate communication paced to the family's readiness and accommodating their presence supports family-centered end-of-life care. Withholding information or limiting presence denies the family's role and needs. Shared decision-making respects the family's values.

Question 38Family-Centered Care and Communication

A nurse notices that a family's cultural beliefs conflict with a prescribed dietary plan. What is the most appropriate family-centered action?

  1. Insist on the prescribed diet and label the family as nonadherent
  2. Report the family to hospital administration for refusing care
  3. Quietly allow the family to follow their own diet without informing the team
  4. Explore the family's beliefs and collaborate with the team to find an acceptable, safe plan Correct answer.

Explanation

Culturally congruent care requires exploring the family's beliefs and negotiating a plan that is both safe and acceptable to them. Collaboration with the team supports safety while honoring values. Ignoring the conflict or labeling the family does not resolve it.

Question 39Family-Centered Care and Communication

A nurse is teaching a 15-year-old about a new diagnosis while the parent is present. The teen asks to discuss some things privately. What is the best response?

  1. Offer the teen a private conversation while clarifying what will be shared with parents Correct answer.
  2. Discuss only with the parent and let the parent inform the teen
  3. Tell the teen that privacy is not possible until age 18
  4. Refuse, because parents must be present for all discussions of a minor's care

Explanation

Adolescents benefit from a confidential space that supports autonomy, while the nurse clarifies limits of confidentiality and what will be shared with parents. This respects the teen's developing independence and maintains trust. Excluding the teen or denying privacy damages the relationship.

Question 40Family-Centered Care and Communication

Which nurse statement best demonstrates the communication skill of clarification when a parent says, "I think the medicine is making my child worse"?

  1. "Don't worry about that; it's normal."
  2. "You're wrong; the medicine is helping."
  3. "Let me make sure I understand: you feel your child's symptoms got worse after starting the medicine?" Correct answer.
  4. "I'll note it in the chart and we can move on."

Explanation

Clarification restates the parent's message to confirm understanding and invites correction, which prevents miscommunication and shows the concern is taken seriously. Dismissing or contradicting the parent blocks further disclosure and may miss a real adverse effect.

Question 41Assessment and Monitoring of the Pediatric Patient

A 4-year-old child is brought to the clinic for a routine visit. Which finding should the nurse document as a normal expected assessment for this age?

  1. Heart rate of 150 beats per minute
  2. Respiratory rate of 22 breaths per minute Correct answer.
  3. Weight that is triple the birth weight
  4. Blood pressure of 130/85 mmHg

Explanation

A preschool-aged child typically breathes about 20 to 25 times per minute, so a rate of 22 falls within the expected range. Heart rate and blood pressure norms are considerably lower than the values listed, and tripling of birth weight is generally achieved by about one year of age.

Question 42Assessment and Monitoring of the Pediatric Patient

A nurse is preparing to assess an infant's pain level. Which tool is most appropriate for this patient?

  1. Wong-Baker FACES scale
  2. Numeric rating scale
  3. Verbal descriptor scale
  4. FLACC behavioral scale Correct answer.

Explanation

The FLACC scale rates facial expression, leg movement, activity, crying, and consolability, making it suitable for infants and preverbal children who cannot self-report. Self-report tools require a child old enough to understand numbers, faces, or words.

Question 43Assessment and Monitoring of the Pediatric Patient

When weighing a toddler who can stand safely, which action best ensures an accurate measurement?

  1. Weigh the child in underwear or a light diaper Correct answer.
  2. Weigh the child while a parent holds them
  3. Estimate weight from the child's height
  4. Weigh the child fully clothed with shoes on

Explanation

Accurate pediatric weights require removing heavy clothing and shoes so that garments do not add to the measured value. Standing balance scales are appropriate once the child can stand without support.

Question 44Assessment and Monitoring of the Pediatric Patient

A nurse is counting respirations in a sleeping 6-month-old. Which approach yields the most reliable count?

  1. Count for 15 seconds and multiply by four
  2. Count while the infant is crying
  3. Count immediately after a feeding
  4. Count for a full minute while the infant is calm Correct answer.

Explanation

Infant respirations are irregular, so counting for a full minute while the infant is at rest gives the most accurate rate. Crying or feeding alters the pattern and raises the count.

Question 45Assessment and Monitoring of the Pediatric Patient

Which parameter does a pulse oximeter directly estimate in a pediatric patient?

  1. Arterial carbon dioxide tension
  2. Cardiac output
  3. Arterial oxygen saturation Correct answer.
  4. Hemoglobin concentration

Explanation

Pulse oximetry estimates the percentage of hemoglobin binding sites saturated with oxygen by comparing light absorption of oxygenated and deoxygenated blood. It does not measure hemoglobin level, carbon dioxide, or cardiac output.

Question 46Assessment and Monitoring of the Pediatric Patient

A nurse is assessing a 2-year-old's hydration status. Which finding is the most sensitive early indicator of dehydration?

  1. Dry mucous membranes
  2. Prolonged capillary refill
  3. Decreased urine output Correct answer.
  4. Sunken fontanel

Explanation

A decrease in urine output is one of the earliest signs of dehydration because the kidneys conserve water as intravascular volume falls. Other signs such as sunken fontanel and dry mucous membranes tend to appear later or are less specific.

Question 47Assessment and Monitoring of the Pediatric Patient

During auscultation of a 5-year-old's chest, the nurse hears a soft, brief murmur at the upper left sternal border that does not radiate and has no associated symptoms. What is the most appropriate interpretation?

  1. A finding that must be ignored without documentation
  2. An indication of imminent cardiac arrest
  3. A sign of heart failure requiring emergency treatment
  4. A likely innocent murmur requiring no immediate intervention Correct answer.

Explanation

Soft, short murmurs without radiation, thrill, or symptoms are commonly innocent in children and are often related to normal blood flow. They should still be documented and rechecked, but they do not require emergency intervention.

Question 48Assessment and Monitoring of the Pediatric Patient

A nurse is assessing a newborn's gestational age using physical and neuromuscular criteria. Which finding is consistent with a preterm infant?

  1. Abundant breast tissue with a 10 mm nodule
  2. Scarf sign allowing the elbow to cross the midline Correct answer.
  3. Deep creases covering the entire sole
  4. Fully formed ear cartilage with instant recoil

Explanation

The scarf sign assesses passive tone at the shoulder; in preterm infants, reduced tone allows the elbow to pass the midline. Mature infants have more developed sole creases, ear cartilage, and breast tissue.

Question 49Assessment and Monitoring of the Pediatric Patient

A 10-year-old is being evaluated for possible appendicitis. Which assessment finding most strongly supports the diagnosis?

  1. Diffuse cramping relieved by vomiting
  2. Hyperactive bowel sounds in all quadrants
  3. Pain that improves when the right leg is extended
  4. Pain that migrates from the periumbilical area to the right lower quadrant Correct answer.

Explanation

Classic appendicitis pain begins near the umbilicus and then localizes to the right lower quadrant as inflammation reaches the parietal peritoneum. Extension of the right leg typically worsens pain rather than relieving it.

Question 50Assessment and Monitoring of the Pediatric Patient

A nurse is reviewing the immunization record of a 12-month-old. Which vaccine is typically due at this age?

  1. Tetanus booster for adolescents
  2. Inactivated polio booster at 18 months
  3. Hepatitis B birth dose
  4. Measles, mumps, and rubella Correct answer.

Explanation

The first dose of measles, mumps, and rubella vaccine is recommended at 12 to 15 months, when maternal antibody interference has waned. Hepatitis B birth dose occurs at birth, and adolescent tetanus boosters are given later.