Four children with asthma arrive in the emergency department at the same time. Which child should the nurse assess first?

A 9-year-old who is too breathless to talk, with a quiet chest and SpO2 89%

A 12-year-old with a cough at night and a peak flow at 75% of best

A 5-year-old with mild wheeze who is playing, SpO2 96% in room air

A 7-year-old with loud expiratory wheeze, speaking in short phrases, SpO2 93%

On day 14 of Kawasaki disease the child's fever has settled, the skin of the fingertips is peeling and the platelet count is 820 x 10^9/L (reference 150-400). Which statement about this phase is correct?

It is the subacute phase, with the highest risk of coronary thrombosis

It is the convalescent phase, and aspirin can now be stopped

It is a sign of IVIG reaction, and the infusion should be reported

It is the acute phase, and a second dose of IVIG is due

Common paediatric illnesses and emergencies

58 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Common paediatric illnesses and emergencies, part of Paediatric Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
Viral croup (laryngotracheobronchitis) in toddlers is most often caused by:
1. AParainfluenza virus
2. BHaemophilus influenzae type b
3. CEpstein-Barr virus
4. DRespiratory syncytial virus
Show answerHide answer
Answer: A · Parainfluenza virus
Parainfluenza viruses cause most cases of croup, which affects children from about 6 months to 3 years. Swelling below the vocal cords gives a barking, seal-like cough, a hoarse voice and inspiratory stridor, often worse at night. Most cases are mild and settle in a few days. Fever is usually low grade, unlike epiglottitis.
- B: Hib causes epiglottitis, not viral croup.
- C: Epstein-Barr virus causes infectious mononucleosis.
- D: RSV mainly causes bronchiolitis in infants.
Question 2 · Hard
Four children with asthma arrive in the emergency department at the same time. Which child should the nurse assess first?
1. AA 12-year-old with a cough at night and a peak flow at 75% of best
2. BA 5-year-old with mild wheeze who is playing, SpO2 96% in room air
3. CA 7-year-old with loud expiratory wheeze, speaking in short phrases, SpO2 93%
4. DA 9-year-old who is too breathless to talk, with a quiet chest and SpO2 89%
Show answerHide answer
Answer: D · A 9-year-old who is too breathless to talk, with a quiet chest and SpO2 89%
A child who cannot speak, with a quiet (silent) chest and SpO2 below 92%, has life-threatening asthma. Air movement is so poor that the wheeze disappears, and respiratory arrest may follow. Loud wheeze with phrases and SpO2 93% is moderate to severe but still moving air. Night cough and mild wheeze in a playing child are less urgent.
- A: A peak flow of 75% of best indicates mild symptoms.
- B: A playing child with normal saturations is the most stable.
- C: Loud wheeze shows air is still moving, so this child is less critical.
Question 3 · Hard
An 18-kg child with an asthma attack is prescribed oral prednisolone 1 mg/kg once daily. The pharmacy supplies prednisolone oral solution 15 mg/5 mL. How much should the nurse give?
1. A6 mL
2. B1.2 mL
3. C12 mL
4. D54 mL
Show answerHide answer
Answer: A · 6 mL
The dose is 1 mg/kg x 18 kg = 18 mg. The solution contains 15 mg in 5 mL, which is 3 mg per mL. The volume is 18 mg / 3 mg/mL = 6 mL. Short oral courses of prednisolone reduce relapse after an acute attack.
- B: 1.2 mL comes from treating the solution as 15 mg per mL.
- C: 12 mL would be a 2 mg/kg dose, double the order.
- D: 54 mL comes from multiplying the dose by 3 instead of dividing.
Question 4 · Hard
On day 14 of Kawasaki disease the child's fever has settled, the skin of the fingertips is peeling and the platelet count is 820 x 10^9/L (reference 150-400). Which statement about this phase is correct?
1. AIt is the convalescent phase, and aspirin can now be stopped
2. BIt is the subacute phase, with the highest risk of coronary thrombosis
3. CIt is a sign of IVIG reaction, and the infusion should be reported
4. DIt is the acute phase, and a second dose of IVIG is due
Show answerHide answer
Answer: B · It is the subacute phase, with the highest risk of coronary thrombosis
The subacute phase runs roughly from the end of the fever to about day 25 and is marked by peeling of the fingers and toes and a rising platelet count. Coronary aneurysms form or enlarge, and with thrombocytosis the risk of thrombosis and sudden death is greatest. Low-dose aspirin continues for its antiplatelet effect, and irritability and chest pain are reported at once. The convalescent phase starts when the signs and laboratory values return to normal.
- A: The convalescent phase starts when signs and platelets return to normal, and aspirin is not yet stopped.
- C: Peeling and thrombocytosis are part of the disease, not an IVIG reaction.
- D: The acute phase is the febrile first 10 days; the fever has settled here.
Question 5 · Easy
Which injury in an infant is most specific for non-accidental (inflicted) injury?
1. AA graze on the forehead
2. BA clavicle fracture at birth
3. CPosterior rib fractures
4. DA bruise on the shin
Show answerHide answer
Answer: C · Posterior rib fractures
Posterior rib fractures occur when an infant's chest is squeezed hard by an adult's hands, and they rarely result from falls or normal handling. They are often found only on a skeletal survey because they are not visible. Bruises on shins and grazes on the forehead are common in mobile children. Clavicle fractures can occur during a difficult birth.
- A: Forehead grazes are typical of accidental falls in toddlers.
- B: A clavicle fracture can be a recognised birth injury.
- D: Shin bruises are common in children who walk and play.
Question 6 · Hard
A 4-month-old is brought to the emergency department with a swollen thigh. The father says the baby rolled off the bed yesterday. X-ray shows a spiral fracture of the femur. Which feature of this case is most concerning for abuse?
1. AThe injury does not fit the infant's developmental stage
2. BThe father brought the infant in instead of the mother
3. CThe parents ask for pain relief for the infant
4. DThe infant is crying and resists moving the leg
Answer and explanation in LearnFree account
Question 7 · Hard
At 30 hours of age, a well-looking newborn has critical congenital heart disease screening by pulse oximetry: right hand 96%, foot 88%. What is the correct interpretation and action?
1. AA passed screen, as the right-hand reading is above 95%
2. BA failed screen; inform the doctor for urgent echocardiography
3. CA borderline screen; repeat the test in 24 hours
4. DA normal transitional finding; recheck before discharge
Answer and explanation in LearnFree account
Question 8 · Hard
A 4-year-old boy has pallor, jaundice and cola-coloured urine two days after a family meal. Hb 64 g/L (reference 110-140), reticulocytes 9%, unconjugated bilirubin raised, blood film shows bite cells and Heinz bodies, direct antiglobulin test negative. The most likely cause is:
1. AHaemolytic uraemic syndrome
2. BIron-deficiency anaemia
3. CAutoimmune haemolytic anaemia
4. DAcute haemolysis from G6PD deficiency
Answer and explanation in LearnFree account
Question 9 · Medium
An 8-year-old with thalassaemia had a splenectomy last year. His mother phones because he has a temperature of 38.8 °C and feels unwell. The nurse advises:
1. AGive paracetamol and review him in 48 hours
2. BIncrease his fluids and keep him home from school
3. CWait to see whether a rash appears tomorrow
4. DBring him to hospital now for urgent assessment
Answer and explanation in LearnFree account
Question 10 · Hard
A 4-year-old has periorbital swelling for 5 days. BP 98/60 mmHg. Urine: protein 4+, no blood. Serum albumin 17 g/L (reference 35-50), cholesterol 9.8 mmol/L (380 mg/dL), creatinine normal, complement C3 normal. The most likely diagnosis is:
1. AMinimal change nephrotic syndrome
2. BPost-streptococcal glomerulonephritis
3. CAcute pyelonephritis
4. DIgA nephropathy
Answer and explanation in LearnFree account
Question 11 · Medium
Before giving an infant the oral rotavirus vaccine, the nurse asks the parents about a past history of:
1. AIntussusception
2. BEgg allergy
3. CNeonatal jaundice
4. DFebrile seizures
Answer and explanation in LearnFree account
Question 12 · Easy
Routine pulse oximetry screening of a well newborn for critical congenital heart disease is done after 24 hours of age. Where are the readings taken?
1. ABoth hands
2. BRight ear lobe and forehead
3. CLeft hand and left foot
4. DRight hand and either foot
Answer and explanation in LearnFree account
Question 13 · Medium
A child with Kawasaki disease received IV immunoglobulin last week. When teaching the parents about the measles, mumps and rubella vaccine due soon, the nurse advises that it should be:
1. AGiven on schedule without any change
2. BGiven early, within the next two weeks
3. CReplaced by a single dose of immunoglobulin
4. DDelayed for about 11 months after the immunoglobulin
Answer and explanation in LearnFree account
Question 14 · Easy
Parents of a boy with G6PD deficiency are taught that he must avoid eating:
1. AFava (broad) beans
2. BWheat bread
3. CPeanuts
4. DCow's milk
Answer and explanation in LearnFree account
Question 15 · Easy
A child with beta-thalassaemia major receives an iron chelator by slow subcutaneous infusion over 8-12 hours on most nights. The drug is:
1. ADeferasirox
2. BFolic acid
3. CDesferrioxamine
4. DFerrous sulphate
Answer and explanation in LearnFree account
Question 16 · Hard
An unvaccinated 4-year-old arrives with a temperature of 39.8 °C, drooling, a muffled voice and sits leaning forward on her mother's lap. What is the nurse's priority action?
1. ALay her flat to examine the throat with a tongue depressor
2. BInsert an IV cannula first so antibiotics can begin
3. CTake a throat swab before antibiotics are started
4. DKeep her upright with her mother and call the airway team
Answer and explanation in LearnFree account
Question 17 · Easy
A 3-year-old with asthma is prescribed salbutamol by metered-dose inhaler. The best way to give it is:
1. AThrough a spacer with a tight-fitting face mask
2. BThrough a spacer with a mouthpiece, holding the breath
3. CDirectly into the mouth while the child inhales
4. DAs a dry-powder inhaler with a fast deep breath
Answer and explanation in LearnFree account
Question 18 · Easy
Under WHO guidance, a child over 6 months with acute diarrhoea receives zinc 20 mg daily for:
1. A4 weeks
2. B10-14 days
3. C3 days
4. DOnly until the diarrhoea stops
Answer and explanation in LearnFree account
Question 19 · Hard
A 9-month-old with diarrhoea has doughy skin, marked irritability and a serum sodium of 163 mmol/L. Ten hours after IV rehydration began, the sodium is 149 mmol/L and the infant has a generalised seizure. The most likely cause of the seizure is:
1. ACerebral venous thrombosis from the original dehydration
2. BA simple febrile seizure triggered by the gastroenteritis
3. CHypocalcaemia caused by the diarrhoeal stool losses
4. DCerebral oedema from lowering the sodium too quickly
Answer and explanation in LearnFree account
Question 20 · Easy
A 30-week preterm infant with chronic lung disease is prescribed palivizumab by monthly intramuscular injection during the winter season. The purpose of this drug is to prevent:
1. AInvasive Haemophilus influenzae type b disease
2. BRotavirus gastroenteritis
3. CSevere respiratory syncytial virus infection
4. DWhooping cough
Answer and explanation in LearnFree account
Question 21 · Medium
A child on low-dose aspirin after Kawasaki disease has been in contact with a cousin who has chickenpox. Why should the parents inform the doctor promptly?
1. AAspirin makes the chickenpox rash more likely to bleed heavily
2. BVaricella can reactivate the Kawasaki vasculitis in the coronaries
3. CVaricella during aspirin treatment raises the risk of Reye syndrome
4. DAspirin blocks the immune response to the varicella virus
Answer and explanation in LearnFree account
Question 22 · Medium
A 5-year-old in a relapse of nephrotic syndrome, with marked oedema and ascites, develops fever, abdominal pain and tenderness. The nurse should suspect:
1. ASide effects of high-dose prednisolone
2. BSpontaneous bacterial peritonitis
3. CAcute appendicitis from constipation
4. DNormal discomfort from tense ascites
Answer and explanation in LearnFree account
Question 23 · Hard
A 10-kg infant with gastroenteritis is judged 5% dehydrated and has no further losses. The plan is to replace the deficit evenly over 24 hours on top of maintenance fluid of 100 mL/kg/day. What total volume should run over the 24 hours?
1. A500 mL
2. B1,000 mL
3. C1,500 mL
4. D1,050 mL
Answer and explanation in LearnFree account
Question 24 · Hard
A 15-kg child has been convulsing for 6 minutes and has an IV line. Lorazepam 0.1 mg/kg IV is ordered; the vial contains 2 mg/mL. What volume should the nurse draw up?
1. A1.5 mL
2. B0.75 mL
3. C3 mL
4. D0.38 mL
Answer and explanation in LearnFree account
Question 25 · Medium
When teaching a 10-year-old to measure peak expiratory flow at home, the nurse tells him to:
1. ABlow three times and record the highest reading
2. BBlow three times and record the average reading
3. CBlow once slowly and record that single reading
4. DBlow three times and record the lowest reading
Answer and explanation in LearnFree account

33 more Common paediatric illnesses and emergencies questions

Answer them one by one, keep your score and see your weak topics in Learn. Signed-out visitors try 25 per exam; sign in with Google to see them all.

Study Paediatric Nursing

Common paediatric illnesses and emergencies

Viral croup (laryngotracheobronchitis) in toddlers is most often caused by:

Four children with asthma arrive in the emergency department at the same time. Which child should the nurse assess first?

An 18-kg child with an asthma attack is prescribed oral prednisolone 1 mg/kg once daily. The pharmacy supplies prednisolone oral solution 15 mg/5 mL. How much should the nurse give?

On day 14 of Kawasaki disease the child's fever has settled, the skin of the fingertips is peeling and the platelet count is 820 x 10^9/L (reference 150-400). Which statement about this phase is correct?

Which injury in an infant is most specific for non-accidental (inflicted) injury?

A 4-month-old is brought to the emergency department with a swollen thigh. The father says the baby rolled off the bed yesterday. X-ray shows a spiral fracture of the femur. Which feature of this case is most concerning for abuse?

At 30 hours of age, a well-looking newborn has critical congenital heart disease screening by pulse oximetry: right hand 96%, foot 88%. What is the correct interpretation and action?

A 4-year-old boy has pallor, jaundice and cola-coloured urine two days after a family meal. Hb 64 g/L (reference 110-140), reticulocytes 9%, unconjugated bilirubin raised, blood film shows bite cells and Heinz bodies, direct antiglobulin test negative. The most likely cause is:

An 8-year-old with thalassaemia had a splenectomy last year. His mother phones because he has a temperature of 38.8 °C and feels unwell. The nurse advises:

A 4-year-old has periorbital swelling for 5 days. BP 98/60 mmHg. Urine: protein 4+, no blood. Serum albumin 17 g/L (reference 35-50), cholesterol 9.8 mmol/L (380 mg/dL), creatinine normal, complement C3 normal. The most likely diagnosis is:

Before giving an infant the oral rotavirus vaccine, the nurse asks the parents about a past history of:

Routine pulse oximetry screening of a well newborn for critical congenital heart disease is done after 24 hours of age. Where are the readings taken?

A child with Kawasaki disease received IV immunoglobulin last week. When teaching the parents about the measles, mumps and rubella vaccine due soon, the nurse advises that it should be:

Parents of a boy with G6PD deficiency are taught that he must avoid eating:

A child with beta-thalassaemia major receives an iron chelator by slow subcutaneous infusion over 8-12 hours on most nights. The drug is:

An unvaccinated 4-year-old arrives with a temperature of 39.8 °C, drooling, a muffled voice and sits leaning forward on her mother's lap. What is the nurse's priority action?

A 3-year-old with asthma is prescribed salbutamol by metered-dose inhaler. The best way to give it is:

Under WHO guidance, a child over 6 months with acute diarrhoea receives zinc 20 mg daily for:

A 9-month-old with diarrhoea has doughy skin, marked irritability and a serum sodium of 163 mmol/L. Ten hours after IV rehydration began, the sodium is 149 mmol/L and the infant has a generalised seizure. The most likely cause of the seizure is:

A 30-week preterm infant with chronic lung disease is prescribed palivizumab by monthly intramuscular injection during the winter season. The purpose of this drug is to prevent:

A child on low-dose aspirin after Kawasaki disease has been in contact with a cousin who has chickenpox. Why should the parents inform the doctor promptly?

A 5-year-old in a relapse of nephrotic syndrome, with marked oedema and ascites, develops fever, abdominal pain and tenderness. The nurse should suspect:

A 10-kg infant with gastroenteritis is judged 5% dehydrated and has no further losses. The plan is to replace the deficit evenly over 24 hours on top of maintenance fluid of 100 mL/kg/day. What total volume should run over the 24 hours?

A 15-kg child has been convulsing for 6 minutes and has an IV line. Lorazepam 0.1 mg/kg IV is ordered; the vial contains 2 mg/mL. What volume should the nurse draw up?

When teaching a 10-year-old to measure peak expiratory flow at home, the nurse tells him to: