D119 Pediatric Nursing Practice Questions: Scenarios & Answers

D119 Pediatric Nursing Practice Questions: Scenarios & Answers

Name

 Western Governors University

D119 Pediatric Primary Care for the Advanced Practice Nurse

Prof. Name

Date

Pediatric Practice Questions

Instructions

The following pediatric nursing practice questions are designed to strengthen clinical reasoning, prioritization, and decision-making skills essential for pediatric nursing practice. Each scenario reflects a realistic clinical situation encountered in pediatric settings and is followed by a guiding question embedded within the narrative. Evidence-based rationales are incorporated to support safe, effective, and developmentally appropriate nursing interventions. The goal is to promote critical thinking and application of best practices in pediatric care.

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Question 1: Croup

Scenario and Nursing Priority

A 2-year-old child presents to the emergency department with a harsh, barking cough, hoarseness, and audible stridor at rest.

What should be the nurse’s priority intervention?

Croup is a viral-induced inflammatory condition affecting the upper airway, particularly the larynx and trachea. Edema in this region can rapidly compromise airflow in young children due to their narrow airways. The presence of stridor at rest indicates moderate to severe airway obstruction and signals an urgent situation requiring immediate intervention.

The nurse’s highest priority is the administration of nebulized racemic epinephrine. This medication produces localized vasoconstriction, which reduces mucosal edema and improves airway patency within minutes. Prompt pharmacologic intervention is essential to prevent progression to respiratory failure. Non-urgent actions, such as imaging studies, oral hydration, or positioning the child supine, may worsen distress and should be deferred until the airway is stabilized. Early recognition and treatment are critical components of pediatric airway management.

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Question 2: Attention-Deficit/Hyperactivity Disorder (ADHD)

Scenario and Educational Support

A 7-year-old boy with a diagnosis of ADHD is struggling to remain seated and complete classroom tasks.

Which classroom accommodations should the nurse recommend?

Children with ADHD demonstrate improved academic performance and behavioral control when placed in structured, predictable environments. The most effective classroom strategy is dividing assignments into short, manageable segments with scheduled breaks. This approach aligns with the child’s attention span, reduces cognitive overload, and promotes task completion.

Interventions such as removing recess, seating the child in isolated areas, or allowing unrestricted free time may exacerbate inattentiveness and hyperactivity. Pediatric nurses serve as advocates by collaborating with educators to ensure that evidence-based accommodations are implemented to support both learning and psychosocial development.

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Question 3: Sexually Transmitted Infections (STIs)

Scenario and Ethical Nursing Response

A 16-year-old adolescent diagnosed with chlamydia asks whether it is possible to avoid informing her sexual partner about the infection.

What is the nurse’s best response?

Chlamydia is a highly transmissible sexually transmitted infection that often remains asymptomatic yet poses serious long-term reproductive risks if untreated. The nurse must clearly explain that notifying sexual partners is essential to ensure they receive appropriate treatment and to prevent reinfection.

Partner notification is a fundamental component of STI management and a public health responsibility. Nurses must provide factual, nonjudgmental education while reinforcing confidentiality protections and available support resources. Avoiding discussion of partner treatment undermines ethical practice and increases the risk of ongoing transmission.

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Question 4: Vulvovaginitis

Scenario and Etiology

A 5-year-old girl experiences perineal itching, and her mother reports inadequate wiping habits and frequent exposure to wet clothing.

What is the most likely cause of the symptoms?

In prepubertal girls, vulvovaginitis commonly results from hygiene-related irritation rather than infection. Low estrogen levels in this age group lead to thinner, more sensitive vaginal mucosa, making it susceptible to inflammation. Poor perineal hygiene, improper wiping techniques, and prolonged moisture exposure are significant contributing factors.

While infection and abuse must always be considered and ruled out, the child’s history strongly supports irritant-induced vulvovaginitis. Nursing education should focus on proper hygiene practices, breathable clothing, and prompt changing out of wet garments to prevent recurrence.

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Question 5: Stress and Psychosomatic Symptoms

Scenario and Psychosocial Nursing Care

A 9-year-old child who recently moved to a new community reports frequent stomachaches before school.

What nursing action best supports the child’s mental well-being?

Children often express psychological distress through physical symptoms, particularly during periods of transition or stress. The most therapeutic nursing intervention is to engage the child using open-ended questions that encourage discussion of emotions and concerns. This approach fosters trust, validates the child’s experience, and helps identify underlying anxiety related to the recent relocation.

Focusing exclusively on physical symptoms or minimizing the child’s complaints may increase distress and delay appropriate support. Pediatric nurses play a critical role in recognizing psychosomatic presentations and facilitating emotional expression and coping strategies.

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Question 6: Nursing Prioritization

Scenario and Clinical Judgment

A pediatric nurse receives handoff information for four assigned patients at the start of a shift.

Which patient should the nurse assess first?

Using the ABC (Airway, Breathing, Circulation) framework, the nurse should prioritize assessment of the 2-year-old child with croup exhibiting stridor at rest. Stridor reflects significant airway compromise and presents an immediate threat to life if not addressed promptly.

Although other patients may require timely care, none demonstrate the same level of acute risk. Effective prioritization ensures that life-threatening conditions are stabilized before attending to less urgent needs.

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Question 7: Postoperative Care after Tonsillectomy

Scenario and Immediate Nursing Action

A 6-year-old child, two hours post-tonsillectomy, is observed swallowing repeatedly.

What is the nurse’s immediate priority?

Frequent swallowing following tonsillectomy is a classic sign of postoperative hemorrhage, a potentially fatal complication. Blood may trickle down the throat, prompting swallowing even in the absence of visible bleeding.

The nurse’s immediate priority is to inspect the oropharynx for signs of active bleeding and notify the surgical team as needed. Delaying assessment by offering fluids or reassurance may result in rapid deterioration, including airway obstruction or hypovolemic shock.

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Question 8: Attachment Disorders

Comparison of Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

Understanding the differences between attachment disorders enables early identification, appropriate referral, and effective family education.

Feature	Reactive Attachment Disorder (RAD)	Disinhibited Social Engagement Disorder (DSED)
Core Behavior	Emotional withdrawal and detachment	Excessive familiarity with unfamiliar adults
Response to Comfort	Avoids or resists comfort	Seeks comfort indiscriminately
Social Interaction	Limited or absent engagement	Poor boundaries and overly sociable behavior
Emotional Expression	Flat or restricted affect	Inappropriately friendly demeanor
Underlying Cause	Severe neglect and lack of stable attachment	Severe neglect with disrupted attachments

Early recognition by nurses is critical, as timely intervention can significantly improve long-term emotional and social outcomes for affected children.

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References

American Academy of Pediatrics. (2023). Red book: 2023–2026 report of the Committee on Infectious Diseases. American Academy of Pediatrics.

Centers for Disease Control and Prevention. (2024). Sexually transmitted infections treatment guidelines. CDC.

Hockenberry, M. J., & Wilson, D. (2023). Wong’s nursing care of infants and children (12th ed.). Elsevier.

D119 Pediatric Nursing Practice Questions: Scenarios & Answers

Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2022). Maternal child nursing care (7th ed.). Elsevier.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.

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