A 3-year-old with sickle cell disease has functional asplenia. Besides the routine schedule, which immunisation protection is most important for this child?

Extra pneumococcal and meningococcal vaccines

Monthly injections of normal immunoglobulin

A repeat dose of BCG vaccine every 5 years

A booster dose of rotavirus vaccine

A 12-month-old at a well-child visit pulls to stand, walks holding furniture, uses a neat pincer grasp and says 'mama' to his mother. His father says he does not turn when his name is called, though he startles at loud noises. Which finding needs referral?

Walking only while holding furniture

A 25-year-old nurse at a pre-employment health check is not immune to rubella. Which situation would rule out giving her MMR vaccine?

A current course of antibiotics

A 3-year-old with a known egg allergy that causes hives is due for influenza vaccine. Under current CDC (ACIP) guidance, the nurse should:

Give an age-appropriate influenza vaccine as usual

Withhold all influenza vaccines from this child

Give half the dose and observe for 30 minutes

Give the vaccine only after allergy skin testing

Growth, development and immunisation

36 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Growth, development and immunisation, 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 · Medium
A 3-year-old with sickle cell disease has functional asplenia. Besides the routine schedule, which immunisation protection is most important for this child?
1. AMonthly injections of normal immunoglobulin
2. BA repeat dose of BCG vaccine every 5 years
3. CA booster dose of rotavirus vaccine
4. DExtra pneumococcal and meningococcal vaccines
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Answer: D · Extra pneumococcal and meningococcal vaccines
Children with sickle cell disease lose splenic function early in life, so they are at high risk of overwhelming infection with encapsulated bacteria such as Streptococcus pneumoniae and Neisseria meningitidis. They need extra pneumococcal and meningococcal vaccines, yearly influenza vaccine and usually penicillin prophylaxis. Parents must also be taught to seek care at once for any fever of 38.5°C or more. Sickle cell disease is common in the Gulf region.
- A: Routine immunoglobulin injections are not part of sickle cell care.
- B: BCG is not repeated and does not protect against encapsulated bacteria.
- C: Rotavirus vaccine is not given as a booster and does not prevent bacterial sepsis.
Question 2 · Hard
A 12-month-old at a well-child visit pulls to stand, walks holding furniture, uses a neat pincer grasp and says 'mama' to his mother. His father says he does not turn when his name is called, though he startles at loud noises. Which finding needs referral?
1. AWalking only while holding furniture
2. BSaying only one specific word
3. CNot responding to his name
4. DNot yet walking on his own
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Answer: C · Not responding to his name
Most findings are normal for 12 months: cruising, a neat pincer grasp and one or two words with meaning, while independent walking may come up to about 15-18 months. Failure to respond to his name by 12 months is a red flag for autism spectrum disorder. The startle to loud noises suggests he can hear, but formal hearing testing should still be done. He should be referred for developmental and autism assessment.
- A: Cruising is the expected gross motor stage at 12 months.
- B: One or two words with meaning are normal at 12 months.
- D: Many healthy children walk alone only at 13-15 months.
Question 3 · Easy
A 25-year-old nurse at a pre-employment health check is not immune to rubella. Which situation would rule out giving her MMR vaccine?
1. AA current course of antibiotics
2. BEgg allergy
3. CPregnancy
4. DA mild cold without fever
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Answer: C · Pregnancy
MMR is a live attenuated vaccine, so it is contraindicated in pregnancy and in severe immunodeficiency because of a theoretical risk to the fetus or a vaccine-strain infection. Women are advised to avoid pregnancy for 4 weeks after the dose. Egg allergy, mild illness and antibiotics are not reasons to withhold it. Wrongly treating these as contraindications leaves people unprotected.
- A: Antibiotics do not affect the response to MMR vaccine.
- B: MMR may be given safely to people with egg allergy; the vaccine contains very little egg protein.
- D: A mild illness without significant fever is not a reason to delay vaccination.
Question 4 · Medium
A 3-year-old with a known egg allergy that causes hives is due for influenza vaccine. Under current CDC (ACIP) guidance, the nurse should:
1. AGive an age-appropriate influenza vaccine as usual
2. BWithhold all influenza vaccines from this child
3. CGive half the dose and observe for 30 minutes
4. DGive the vaccine only after allergy skin testing
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Answer: A · Give an age-appropriate influenza vaccine as usual
ACIP guidance states that people with egg allergy of any severity may receive any age-appropriate influenza vaccine. No extra precautions are needed beyond those taken for every vaccination, such as staff trained and equipped to manage anaphylaxis. Skin testing and split dosing are not recommended. Withholding the vaccine leaves the child at risk of influenza.
- B: Egg allergy is no longer a reason to withhold influenza vaccine.
- C: Split or reduced doses are not recommended and may give poorer protection.
- D: Skin testing with the vaccine is not needed before giving it to an egg-allergic child.
Question 5 · Easy
Rotavirus vaccine is given to infants by which route?
1. AOral
2. BSubcutaneous
3. CIntradermal
4. DIntramuscular
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Answer: A · Oral
Rotavirus vaccine is a live oral vaccine given as drops into the infant's mouth. It must be started early in infancy because the maximum age for the first dose is limited. If the infant spits out or vomits the dose, it is usually not repeated. A history of intussusception or severe combined immunodeficiency is a contraindication.
- B: MMR and varicella are the live vaccines given subcutaneously, not rotavirus.
- C: BCG is the vaccine given intradermally, not rotavirus.
- D: Rotavirus vaccine is not made for injection into muscle.
Question 6 · Medium
Six weeks after BCG vaccine, a mother shows the nurse a small, moist ulcer at the injection site on her baby's left upper arm. The baby is well. What should the nurse advise?
1. ABring the baby back for a repeat dose of BCG
2. BApply an antibiotic ointment and a tight dressing
3. CKeep the site clean and dry, without ointment or dressing
4. DTake the baby for incision and drainage of the site
Answer and explanation in LearnFree account
Question 7 · Easy
While examining a newborn, the nurse feels a small triangular soft spot at the back of the skull. The mother should be told that this spot closes by about:
1. A12 to 18 months of age
2. B24 to 30 months of age
3. C6 to 8 months of age
4. D6 to 8 weeks of age
Answer and explanation in LearnFree account
Question 8 · Medium
A 15-month-old who has just started walking is admitted for observation. Which toy is most suitable for this child?
1. AA board game with simple rules
2. BA push-pull toy on wheels
3. CA set of small plastic beads
4. DA jigsaw puzzle of 50 pieces
Answer and explanation in LearnFree account
Question 9 · Medium
A grandmother wants to rub honey on a 5-month-old's pacifier to calm him. The nurse explains that honey should not be given before 12 months because of the risk of:
1. AInfant botulism
2. BNeonatal jaundice
3. CLactose intolerance
4. DIron deficiency anaemia
Answer and explanation in LearnFree account
Question 10 · Medium
In the playroom, three 4-year-olds paint at one table, share brushes and talk about their pictures, but there is no group goal or assigned roles. This type of play is:
1. ACooperative play
2. BSolitary play
3. CParallel play
4. DAssociative play
Answer and explanation in LearnFree account
Question 11 · Medium
A mother asks how she can make her 4-month-old's injections less painful. Which advice is most effective?
1. AGive paracetamol 1 hour before the injections
2. BRub the injection site firmly for 2 minutes first
3. CHold the baby lying flat on the examination couch
4. DBreastfeed the baby during and just after the injections
Answer and explanation in LearnFree account
Question 12 · Medium
At a 2-year check, a mother says her son used about ten words at 18 months but now says none and no longer waves bye-bye. What is the most appropriate nursing action?
1. ARefer him for a prompt developmental assessment
2. BAdvise her to speak to him more often at home
3. CRecheck his speech at the next routine visit
4. DReassure her that boys often talk later than girls
Answer and explanation in LearnFree account
Question 13 · Medium
Under the CDC schedule, how many doses of HPV vaccine does a healthy 12-year-old girl need?
1. ATwo doses, 4 weeks apart
2. BOne dose only, with no booster
3. CThree doses over 6 months
4. DTwo doses, 6 to 12 months apart
Answer and explanation in LearnFree account
Question 14 · Easy
A mother of a newborn weighing 3.3 kg asks when her baby should weigh about 6.6 kg. The nurse answers that this is usually reached by:
1. A4 to 6 months
2. B9 to 10 months
3. C12 to 15 months
4. D2 to 3 months
Answer and explanation in LearnFree account
Question 15 · Hard
A 2-year-old has been in hospital for 10 days without a parent. At first he cried constantly for his mother. Now he plays with the nurses and barely looks up when his mother visits. Which stage of separation does this show?
1. ADetachment
2. BDespair
3. CAdjustment to the ward
4. DProtest
Answer and explanation in LearnFree account
Question 16 · Medium
A 13-month-old received varicella vaccine 2 weeks ago at another clinic. She now attends for her MMR vaccine. What should the nurse do?
1. ADelay MMR until the child is 18 months of age
2. BGive MMR at least 4 weeks after the varicella dose
3. CGive MMR today, as the vaccines do not interfere
4. DRepeat the varicella dose together with MMR today
Answer and explanation in LearnFree account
Question 17 · Medium
A mother of a 2-week-old exclusively breastfed baby asks about vitamins. Which supplement is recommended?
1. AVitamin A 100,000 IU once
2. BVitamin K 1 mg orally daily
3. CVitamin D 400 IU daily
4. DIron drops 10 mg daily
Answer and explanation in LearnFree account
Question 18 · Hard
An unvaccinated baby girl aged 17 weeks comes for her first immunisation visit. Following the CDC (ACIP) schedule, how should the nurse handle rotavirus vaccine?
1. ALeave it out, as dose 1 must be given before 15 weeks of age
2. BGive dose 1 today and the other doses 4 weeks apart
3. CHold it until her first DTaP dose has been given
4. DGive one catch-up dose today in place of the full series
Answer and explanation in LearnFree account
Question 19 · Medium
A 4-year-old with nephrotic syndrome has taken prednisolone 2 mg/kg daily for 6 weeks and is now due a live vaccine. When can the live vaccine be given?
1. AToday, because steroids do not affect live vaccines
2. BAt least 1 month after the steroid is stopped
3. COne day after the last dose of steroid is taken
4. DOnly after the child reaches 10 years of age
Answer and explanation in LearnFree account
Question 20 · Easy
To reduce the risk of sudden infant death, a healthy infant should be put to sleep:
1. AOn the back with a soft pillow under the head
2. BOn the side, propped with a rolled blanket
3. COn the tummy with the head turned to one side
4. DOn the back on a firm, flat mattress
Answer and explanation in LearnFree account
Question 21 · Medium
A nurse pours the same amount of juice into a short, wide cup and a tall, thin cup. A 5-year-old insists the tall cup holds more. This shows that the child:
1. AIs thinking in formal operations
2. BHas a delay in cognitive development
3. CHas not yet mastered conservation
4. DHas not yet achieved object permanence
Answer and explanation in LearnFree account
Question 22 · Medium
An 18-month-old is pale and tired. Her mother says she drinks about 1.5 L of cow's milk a day and eats little else. Which advice should the nurse give?
1. AIncrease milk intake further for extra protein and energy
2. BLimit milk to about 500 mL a day and offer iron-rich foods
3. CGive milk only at night so she eats more in the day
4. DChange her to goat's milk at the same daily volume
Answer and explanation in LearnFree account
Question 23 · Medium
A 20-month-old admitted with pneumonia screams, clings to his mother and pushes the nurse away whenever the mother leaves the room. Which nursing action best reduces this distress?
1. AGive him toys and ask the mother to visit only at meal times
2. BEncourage the mother to stay with him and help with his care
3. CAdvise the mother to slip out quietly while he is distracted
4. DLimit visits so that he settles into the ward routine faster
Answer and explanation in LearnFree account
Question 24 · Hard
A 12 kg child has a fever of 38.6°C the day after vaccines and is miserable. The order is paracetamol 15 mg/kg orally. The suspension contains 120 mg in 5 mL. What volume should the nurse give?
1. A15 mL
2. B3.75 mL
3. C7.5 mL
4. D5 mL
Answer and explanation in LearnFree account
Question 25 · Easy
A 15-year-old on the ward spends hours chatting with friends and trying out new styles and opinions. In Erikson's terms, he is working on:
1. AIdentity versus role confusion
2. BIntimacy versus isolation
3. CIndustry versus inferiority
4. DInitiative versus guilt
Answer and explanation in LearnFree account

11 more Growth, development and immunisation questions

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Study Paediatric Nursing

Growth, development and immunisation

A 3-year-old with sickle cell disease has functional asplenia. Besides the routine schedule, which immunisation protection is most important for this child?

A 12-month-old at a well-child visit pulls to stand, walks holding furniture, uses a neat pincer grasp and says 'mama' to his mother. His father says he does not turn when his name is called, though he startles at loud noises. Which finding needs referral?

A 25-year-old nurse at a pre-employment health check is not immune to rubella. Which situation would rule out giving her MMR vaccine?

A 3-year-old with a known egg allergy that causes hives is due for influenza vaccine. Under current CDC (ACIP) guidance, the nurse should:

Rotavirus vaccine is given to infants by which route?

Six weeks after BCG vaccine, a mother shows the nurse a small, moist ulcer at the injection site on her baby's left upper arm. The baby is well. What should the nurse advise?

While examining a newborn, the nurse feels a small triangular soft spot at the back of the skull. The mother should be told that this spot closes by about:

A 15-month-old who has just started walking is admitted for observation. Which toy is most suitable for this child?

A grandmother wants to rub honey on a 5-month-old's pacifier to calm him. The nurse explains that honey should not be given before 12 months because of the risk of:

In the playroom, three 4-year-olds paint at one table, share brushes and talk about their pictures, but there is no group goal or assigned roles. This type of play is:

A mother asks how she can make her 4-month-old's injections less painful. Which advice is most effective?

At a 2-year check, a mother says her son used about ten words at 18 months but now says none and no longer waves bye-bye. What is the most appropriate nursing action?

Under the CDC schedule, how many doses of HPV vaccine does a healthy 12-year-old girl need?

A mother of a newborn weighing 3.3 kg asks when her baby should weigh about 6.6 kg. The nurse answers that this is usually reached by:

A 2-year-old has been in hospital for 10 days without a parent. At first he cried constantly for his mother. Now he plays with the nurses and barely looks up when his mother visits. Which stage of separation does this show?

A 13-month-old received varicella vaccine 2 weeks ago at another clinic. She now attends for her MMR vaccine. What should the nurse do?

A mother of a 2-week-old exclusively breastfed baby asks about vitamins. Which supplement is recommended?

An unvaccinated baby girl aged 17 weeks comes for her first immunisation visit. Following the CDC (ACIP) schedule, how should the nurse handle rotavirus vaccine?

A 4-year-old with nephrotic syndrome has taken prednisolone 2 mg/kg daily for 6 weeks and is now due a live vaccine. When can the live vaccine be given?

To reduce the risk of sudden infant death, a healthy infant should be put to sleep:

A nurse pours the same amount of juice into a short, wide cup and a tall, thin cup. A 5-year-old insists the tall cup holds more. This shows that the child:

An 18-month-old is pale and tired. Her mother says she drinks about 1.5 L of cow's milk a day and eats little else. Which advice should the nurse give?

A 20-month-old admitted with pneumonia screams, clings to his mother and pushes the nurse away whenever the mother leaves the room. Which nursing action best reduces this distress?

A 12 kg child has a fever of 38.6°C the day after vaccines and is miserable. The order is paracetamol 15 mg/kg orally. The suspension contains 120 mg in 5 mL. What volume should the nurse give?

A 15-year-old on the ward spends hours chatting with friends and trying out new styles and opinions. In Erikson's terms, he is working on: