D119 Pediatric Nursing Practice Questions: Scenarios & Answers

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Western Governors University

D119 Pediatric Primary Care for the Advanced Practice Nurse

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Pediatric Practice Questions

Instructions

The following pediatric nursing scenarios are designed to strengthen clinical judgment and prioritization skills. Each case presents a realistic patient situation followed by a focused question. Evidence-based nursing interventions and rationales are incorporated directly into the discussion to support learning and application in pediatric practice.

Question 1: Croup

Scenario

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

What is the nurse’s priority intervention?

Croup is an upper airway condition characterized by laryngeal inflammation and edema, commonly caused by viral infection. The presence of stridor at rest indicates moderate to severe airway obstruction and signals an urgent clinical situation. The nurse’s immediate priority is to administer nebulized racemic epinephrine, as this medication rapidly reduces airway swelling through vasoconstriction, improving airflow and preventing respiratory failure. Interventions such as oral intake, diagnostic imaging, or positioning the child flat may worsen distress and airway compromise. Therefore, prompt pharmacologic airway management is critical in this scenario.

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

Scenario

A 7-year-old boy diagnosed with ADHD is struggling to remain seated in class and has difficulty completing assignments.

What classroom accommodation should the nurse recommend?

Children with ADHD benefit most from structured environments that accommodate their limited attention span and high activity level. The most appropriate recommendation is to provide short, structured tasks with frequent breaks. This approach enhances task completion, reduces frustration, and supports sustained engagement. Seating the child in the back or restricting recess may worsen symptoms, while excessive free time lacks the structure needed for success. Nursing advocacy for evidence-based educational strategies plays a vital role in promoting academic and behavioral outcomes.

Question 3: Sexually Transmitted Infections (STIs)

Scenario

A 16-year-old female diagnosed with chlamydia asks whether she can avoid informing her sexual partner.

What is the nurse’s best response?

Chlamydia is a highly transmissible infection that often remains asymptomatic but can cause serious reproductive complications if untreated. The nurse should clearly explain that the partner must be informed so they can receive treatment and prevent reinfection. Partner notification is a public health responsibility and a key component of STI management. Providing inaccurate reassurance or suggesting confidentiality at the expense of safety violates ethical and professional nursing standards.

Question 4: Vulvovaginitis

Scenario

A 5-year-old girl reports perineal itching. Her mother notes poor wiping technique and that the child often remains in wet clothing.

What is the most likely cause?

In prepubertal children, vulvovaginitis is commonly caused by poor perineal hygiene and prolonged moisture exposure. The lack of estrogen results in thinner mucosal tissue, making young girls more susceptible to irritation. Improper wiping, tight clothing, and damp conditions contribute to inflammation. While sexual abuse and infections must always be considered, the clinical history strongly supports hygiene-related vulvovaginitis as the most likely cause.

Question 5: Stress and Psychosomatic Symptoms

Scenario

A 9-year-old child who recently moved to a new area complains of frequent stomachaches before school.

What nursing action best supports the child’s mental health?

Children often express emotional distress through physical symptoms, particularly during periods of transition. The most therapeutic nursing action is to ask open-ended questions that allow the child to express feelings. This approach fosters trust, uncovers underlying anxiety, and supports emotional processing. Ignoring symptoms or disciplining the child may exacerbate stress, while focusing solely on physical assessment fails to address the root cause.

Question 6: Nursing Prioritization

Scenario

A pediatric nurse receives handoff information on four patients.

Who should the nurse assess first?

Using the ABC (Airway, Breathing, Circulation) framework, the nurse should immediately assess the 2-year-old with croup and stridor at rest. Stridor indicates compromised airway patency and potential respiratory failure, making this condition life-threatening. Other patients, while requiring care, do not present with immediate airway compromise and can be safely addressed after stabilization of the highest-risk patient.

Question 7: Tonsillectomy Postoperative Care

Scenario

A 6-year-old child is two hours postoperative following a tonsillectomy and begins swallowing frequently.

What is the nurse’s priority action?

Frequent swallowing after tonsillectomy is a classic early sign of postoperative hemorrhage, a serious complication that can rapidly lead to airway obstruction or hypovolemic shock. The nurse must immediately inspect the throat for signs of bleeding. Offering fluids or providing reassurance without assessment delays identification of a potentially life-threatening condition.

Question 8: Attachment Disorders

Comparison of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)

Both disorders result from early childhood neglect or inconsistent caregiving; however, they present with contrasting behavioral patterns.

Feature	Reactive Attachment Disorder (RAD)	Disinhibited Social Engagement Disorder (DSED)
Primary Behavior	Emotional withdrawal and detachment	Overly familiar behavior with strangers
Response to Comfort	Avoids or resists comfort	Seeks comfort indiscriminately
Social Boundaries	Limited social engagement	Poor boundaries and excessive sociability
Emotional Expression	Flat or limited affect	Inappropriate friendliness
Etiology	Severe neglect or lack of attachment	Severe neglect with disrupted attachments

Understanding these distinctions enables nurses to support early identification, referral, and family education, which are essential for improving long-term psychosocial outcomes.

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.