Q.1 What is the first action a nurse should take when a child presents with respiratory distress?
Administer a bronchodilator
Assess airway, breathing, and circulation
Obtain a full medical history
Start IV fluids
Explanation - In pediatric emergencies, the primary survey (Airway, Breathing, Circulation) is the first step to ensure the child’s vital functions are maintained.
Correct answer is: Assess airway, breathing, and circulation
Q.2 A 4-year-old child presents with sudden onset of high fever and a bulging fontanel. Which complication should the nurse suspect?
Dehydration
Meningitis
Seizure disorder
Otitis media
Explanation - A bulging fontanel in a young child with fever is a hallmark sign of increased intracranial pressure, often due to meningitis.
Correct answer is: Meningitis
Q.3 Which of the following is the most appropriate intervention for a child with anaphylaxis?
Administer epinephrine immediately
Give oral antihistamines
Apply cold compress
Monitor vital signs every 30 minutes
Explanation - Epinephrine is the first-line treatment for anaphylaxis to prevent airway compromise and cardiovascular collapse.
Correct answer is: Administer epinephrine immediately
Q.4 A nurse is caring for a child post-cardiac surgery. Which assessment finding is most concerning?
Mild incisional pain
Peripheral edema
Decreased urine output
Slight tachycardia
Explanation - Decreased urine output post-cardiac surgery may indicate poor perfusion or acute kidney injury and requires immediate intervention.
Correct answer is: Decreased urine output
Q.5 Which is the most accurate method to assess hydration status in an infant?
Skin turgor over the arm
Mucous membrane assessment
Capillary refill time
Daily weight
Explanation - Daily weight is the most sensitive and objective indicator of hydration in infants, as small fluid losses reflect in weight changes.
Correct answer is: Daily weight
Q.6 A child with a head injury becomes progressively drowsy and irritable. What is the nurse's priority action?
Administer analgesics
Call the physician immediately
Document the behavior
Place the child in a supine position
Explanation - Progressive drowsiness and irritability indicate increasing intracranial pressure; urgent medical evaluation is needed.
Correct answer is: Call the physician immediately
Q.7 Which electrolyte imbalance is most common in a child with severe diarrhea?
Hypernatremia
Hyponatremia
Hyperkalemia
Hypocalcemia
Explanation - Severe diarrhea leads to sodium loss, which can result in hyponatremia, especially in infants and young children.
Correct answer is: Hyponatremia
Q.8 A child in shock presents with rapid, weak pulse and cool extremities. What type of shock is most likely?
Cardiogenic
Hypovolemic
Distributive
Obstructive
Explanation - Hypovolemic shock due to fluid loss causes tachycardia and peripheral vasoconstriction, resulting in weak pulses and cool extremities.
Correct answer is: Hypovolemic
Q.9 Which is the primary goal of nursing care in a child with status epilepticus?
Preventing further seizures and ensuring airway safety
Administering antipyretics
Recording seizure frequency
Encouraging rest after seizure
Explanation - In status epilepticus, protecting the airway, maintaining oxygenation, and stopping the seizure are top priorities.
Correct answer is: Preventing further seizures and ensuring airway safety
Q.10 A 2-year-old child with burns is at risk for which immediate complication?
Hyperthermia
Hypovolemic shock
Infection after 1 week
Chronic pain
Explanation - Severe burns cause fluid loss through damaged skin, leading to hypovolemic shock, especially in young children.
Correct answer is: Hypovolemic shock
Q.11 Which nursing intervention is essential for a child with a tracheostomy in the ICU?
Frequent suctioning as needed
Administering oral antibiotics
Changing tracheostomy ties once a week
Placing the child in supine position only
Explanation - Maintaining airway patency is critical in children with tracheostomy; suctioning prevents obstruction and respiratory compromise.
Correct answer is: Frequent suctioning as needed
Q.12 Which vital sign change is most concerning in a child recovering from sepsis?
Mild tachycardia
Decreasing blood pressure
Slight fever
Normal respiratory rate
Explanation - Hypotension in a child recovering from sepsis is a late sign of shock and indicates deterioration; immediate intervention is needed.
Correct answer is: Decreasing blood pressure
Q.13 Which is the most effective method to prevent ventilator-associated pneumonia (VAP) in pediatric ICU patients?
Daily oral care and suctioning
Administering prophylactic antibiotics
Keeping head flat in bed
Limiting sedation
Explanation - Oral hygiene and suctioning reduce bacterial colonization in ventilated patients and lower the risk of VAP.
Correct answer is: Daily oral care and suctioning
Q.14 A child with diabetic ketoacidosis (DKA) presents with rapid deep breathing. What is this called?
Cheyne-Stokes respirations
Kussmaul respirations
Apneustic breathing
Biot's respirations
Explanation - Kussmaul respirations are deep, rapid breathing seen in metabolic acidosis, such as DKA, to blow off CO2 and compensate.
Correct answer is: Kussmaul respirations
Q.15 Which action is essential when a child is admitted with suspected septic shock?
Start IV antibiotics immediately
Monitor vital signs every 6 hours
Give oral fluids
Schedule a chest X-ray
Explanation - Early administration of IV antibiotics is crucial in septic shock to treat infection and prevent organ failure.
Correct answer is: Start IV antibiotics immediately
Q.16 Which sign indicates increased intracranial pressure in a 6-year-old child?
Persistent vomiting
Slow capillary refill
Hyperactive bowel sounds
Dry mucous membranes
Explanation - Persistent vomiting is an early sign of increased intracranial pressure in children, often accompanied by headache and altered consciousness.
Correct answer is: Persistent vomiting
Q.17 Which is the priority nursing action for a child with aspiration pneumonia?
Administer antibiotics
Position upright and maintain airway
Provide high-calorie diet
Encourage coughing exercises later
Explanation - Airway management and proper positioning prevent further aspiration and respiratory compromise.
Correct answer is: Position upright and maintain airway
Q.18 Which of the following interventions reduces stress in critically ill children in ICU?
Limiting family visits
Providing consistent care routines
Using physical restraints frequently
Exposing the child to multiple staff
Explanation - Consistent care routines create a sense of security and reduce anxiety in critically ill children.
Correct answer is: Providing consistent care routines
Q.19 Which IV fluid is preferred initially in a child with hypovolemic shock?
0.9% normal saline bolus
Dextrose 5% in water
Ringer’s lactate slowly
Half-normal saline
Explanation - Isotonic fluids like 0.9% NS are used to rapidly restore circulating volume in hypovolemic shock.
Correct answer is: 0.9% normal saline bolus
Q.20 A child with severe asthma is wheezing and has difficulty speaking. Which is the nurse's immediate action?
Call rapid response and administer nebulized bronchodilator
Start oral antibiotics
Assess blood glucose
Prepare for chest physiotherapy
Explanation - Severe asthma with impaired speech is life-threatening; rapid response and immediate bronchodilator therapy are critical.
Correct answer is: Call rapid response and administer nebulized bronchodilator
Q.21 Which is the most accurate method to monitor fluid balance in critically ill children?
Weighing diapers and documenting intake/output
Checking skin turgor
Observing thirst
Measuring blood pressure only
Explanation - Accurate monitoring of fluid intake and output, including diaper weight, is essential in pediatric ICU patients.
Correct answer is: Weighing diapers and documenting intake/output
Q.22 Which complication is most likely in a child with prolonged mechanical ventilation?
Ventilator-associated pneumonia
Hyperactivity
Hypotension from fluids
Urinary tract infection only
Explanation - Prolonged ventilation increases risk of VAP due to bacterial colonization and impaired airway clearance.
Correct answer is: Ventilator-associated pneumonia
Q.23 Which sign indicates hypoglycemia in a critically ill infant?
Irritability, jitteriness, and lethargy
Fever and rash
Excessive crying only
Tachypnea and cough
Explanation - Neurological signs like irritability, jitteriness, and lethargy are early indicators of hypoglycemia in infants.
Correct answer is: Irritability, jitteriness, and lethargy
Q.24 In pediatric trauma, which injury is considered a hidden life threat?
Internal bleeding
Superficial laceration
Sprained wrist
Minor contusion
Explanation - Internal bleeding may not be visible externally but can rapidly become life-threatening, requiring urgent intervention.
Correct answer is: Internal bleeding