Current paediatric guidance recommends that maintenance IV fluid for most hospitalised children aged 28 days to 18 years be:

Isotonic, such as 0.9% saline with 5% dextrose

Hypertonic, such as 3% saline at a low rate

Electrolyte-free, such as 5% dextrose in water

Hypotonic, such as 0.18% saline with 4% dextrose

An 18 kg child with gastroenteritis has passed 54 mL of urine in the last 6 hours. The expected minimum output is 1 mL/kg/h. The nurse's best interpretation is that output is:

0.5 mL/kg/h, low and to be reported

9 mL/kg/h, a sign of fluid overload

3 mL/kg/h, adequate for this child

1 mL/kg/h, at the minimum for age

In a child with shock, the onset of low blood pressure is best regarded as:

A late sign that compensation is failing

An early sign of mild fluid loss

A reliable sign of normal recovery

The first sign the nurse should look for

Paediatric medication, fluids and procedures

26 Gulf Prometric RN (DHA, DOH, MOH, SCFHS) practice questions on Paediatric medication, fluids and procedures, 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
Current paediatric guidance recommends that maintenance IV fluid for most hospitalised children aged 28 days to 18 years be:
1. AIsotonic, such as 0.9% saline with 5% dextrose
2. BHypertonic, such as 3% saline at a low rate
3. CElectrolyte-free, such as 5% dextrose in water
4. DHypotonic, such as 0.18% saline with 4% dextrose
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Answer: A · Isotonic, such as 0.9% saline with 5% dextrose
Ill children often secrete extra ADH from pain, nausea, surgery or lung and brain disease, so free water from hypotonic fluids is retained and sodium falls. The AAP 2018 guideline, like NICE, recommends isotonic maintenance fluid with potassium chloride and dextrose to prevent hospital-acquired hyponatraemia. Serum sodium and glucose are monitored at least daily. Neonates, and children with heart, kidney or liver failure, may need different fluids.
- B: 3% saline treats symptomatic hyponatraemia; it is not maintenance fluid.
- C: 5% dextrose alone becomes free water once the glucose is used.
- D: 0.18% saline is hypotonic and has caused fatal hyponatraemia.
Question 2 · Hard
An 18 kg child with gastroenteritis has passed 54 mL of urine in the last 6 hours. The expected minimum output is 1 mL/kg/h. The nurse's best interpretation is that output is:
1. A0.5 mL/kg/h, low and to be reported
2. B9 mL/kg/h, a sign of fluid overload
3. C3 mL/kg/h, adequate for this child
4. D1 mL/kg/h, at the minimum for age
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Answer: A · 0.5 mL/kg/h, low and to be reported
The hourly output is 54 mL / 6 h = 9 mL/h, and 9 mL/h / 18 kg = 0.5 mL/kg/h. This is half the expected minimum of 1 mL/kg/h for a child, pointing to poor renal perfusion from dehydration. The nurse reports it, checks other signs of perfusion and reviews fluid intake. Accurate intake and output, with weighed nappies where needed, guides rehydration.
- B: 9 mL/kg/h confuses the hourly volume with a weight-based rate.
- C: 3 mL/kg/h divides 54 by 18 without accounting for the 6 hours.
- D: 1 mL/kg/h would need 108 mL over 6 hours.
Question 3 · Easy
For a child aged 1 to 10 years, PALS defines hypotension as a systolic blood pressure below:
1. A70 mmHg + (2 x age in years)
2. B80 mmHg + (5 x age in years)
3. C60 mmHg + (age in years)
4. D90 mmHg + (2 x age in years)
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Answer: A · 70 mmHg + (2 x age in years)
PALS sets the lower limit of systolic pressure for children aged 1 to 10 years at 70 + (2 x age in years) mmHg; for example, a 5-year-old is hypotensive below 80 mmHg. The limits are 60 mmHg for term neonates, 70 mmHg for infants and 90 mmHg above 10 years. Hypotension in a child means compensation is failing and needs immediate action.
- B: This is not a PALS formula and overestimates the limit.
- C: 60 mmHg is the neonatal limit and is not adjusted by age this way.
- D: 90 + 2 x age is a common estimate of the median systolic pressure, not the lower limit.
Question 4 · Hard
A 14 kg child with severe gastroenteritis has signs of shock. The prescriber orders a bolus of isotonic crystalloid at 20 mL/kg. What volume should the nurse prepare?
1. A28 mL
2. B140 mL
3. C700 mL
4. D280 mL
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Answer: D · 280 mL
The bolus is 20 mL/kg x 14 kg = 280 mL of 0.9% saline or a balanced crystalloid. It is given rapidly, usually over 5 to 20 minutes, by syringe push or pressure bag rather than a gravity drip. The nurse reassesses heart rate, capillary refill, conscious level, blood pressure and liver size after each bolus, and stops if crackles or hepatomegaly appear. Further boluses depend on the response.
- A: 28 mL misplaces the decimal point.
- B: 140 mL is the 10 mL/kg volume, half the order.
- C: 700 mL multiplies 14 kg by 50 mL/kg, not 20.
Question 5 · Medium
In a child with shock, the onset of low blood pressure is best regarded as:
1. AAn early sign of mild fluid loss
2. BA late sign that compensation is failing
3. CA reliable sign of normal recovery
4. DThe first sign the nurse should look for
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Answer: B · A late sign that compensation is failing
Children keep their blood pressure normal for a long time by raising heart rate and systemic vascular resistance. Early signs of shock are tachycardia, delayed capillary refill, cool skin and weak peripheral pulses. Hypotension appears only when these mechanisms fail and cardiac arrest may be near. The nurse must recognise shock before the blood pressure falls.
- A: Mild fluid loss is offset by tachycardia and vasoconstriction.
- C: Falling pressure signals deterioration, not recovery.
- D: Tachycardia and poor perfusion appear well before hypotension.
Question 6 · Easy
A core principle of family-centred care for a hospitalised child is that:
1. AParents should leave during nursing procedures
2. BDecisions are made by staff, then explained
3. CVisiting is limited to set hours for rest
4. DParents are partners in planning and giving care
Answer and explanation in LearnFree account
Question 7 · Medium
A 5-year-old on the ward needs a cannula inserted. Where should the nurse perform the procedure?
1. AIn the playroom, where the child feels safe
2. BIn the child's own bed, with curtains drawn
3. CIn the treatment room, away from the bed
4. DAt the nurses' station, for good lighting
Answer and explanation in LearnFree account
Question 8 · Medium
EMLA cream is ordered before venepuncture in a 6-year-old. For full effect, it should be applied under an occlusive dressing at least:
1. A5 minutes before the procedure
2. B15 minutes before the procedure
3. C4 hours before the procedure
4. D60 minutes before the procedure
Answer and explanation in LearnFree account
Question 9 · Easy
The safest way to give an oral liquid medicine to a 6-month-old infant is to:
1. AMix it into a full bottle of the infant's formula
2. BGive it quickly from a syringe to the back of the throat
3. CSquirt it slowly from an oral syringe into the cheek
4. DPour it from a medicine cup with the infant lying flat
Answer and explanation in LearnFree account
Question 10 · Easy
At rest, a healthy term newborn usually breathes how many times a minute?
1. A20 to 30 breaths per minute
2. B30 to 60 breaths per minute
3. C12 to 20 breaths per minute
4. D60 to 80 breaths per minute
Answer and explanation in LearnFree account
Question 11 · Hard
Using the Holliday-Segar formula, the daily maintenance fluid for a fasting school-age girl weighing 32 kg is:
1. A2100 mL
2. B3200 mL
3. C1500 mL
4. D1740 mL
Answer and explanation in LearnFree account
Question 12 · Easy
The FLACC behavioural pain scale is intended mainly for which group of children?
1. APreverbal children aged about 2 months to 7 years
2. BSchool-age children who can rate pain with numbers
3. CAdolescents recovering from day-case surgery
4. DNeonates under 32 weeks of gestation in NICU
Answer and explanation in LearnFree account
Question 13 · Medium
A nurse is to measure the vital signs of a quietly sleeping 8-month-old. Which should be measured first?
1. AOxygen saturation
2. BRespiratory rate
3. CBlood pressure
4. DAxillary temperature
Answer and explanation in LearnFree account
Question 14 · Medium
In a Gulf hospital, the mother of a 3-year-old admitted with pneumonia asks to stay overnight and to bathe and feed her son herself. The nurse should:
1. AArrange for her to stay and share in his care
2. BSuggest that the father stay at night instead
3. CExplain that nurses must give all care on the ward
4. DAllow her to stay only until visiting time ends
Answer and explanation in LearnFree account
Question 15 · Hard
Four children are assigned to a nurse at the start of a shift. Which child should the nurse assess first?
1. A4-year-old: crying with ear pain, HR 128, FLACC score 4
2. B2-year-old: HR 172, capillary refill 4 s, cool hands, BP 94/60
3. C6-month-old: asleep, RR 34, HR 122, pink and warm
4. D9-year-old: BP 100/64, HR 86, awaiting discharge
Answer and explanation in LearnFree account
Question 16 · Medium
A 4-year-old asks for a cartoon plaster on his injection site, although it is not bleeding. The best response is to:
1. AShow him that the puncture has closed
2. BExplain that the site needs no covering
3. CPut on the plaster, as it reassures him
4. DAsk his mother to decide about the plaster
Answer and explanation in LearnFree account
Question 17 · Medium
A 10-year-old girl after appendicectomy can count and understands the idea of ranking. The most suitable tool to assess her pain is:
1. AThe FLACC behavioural scale
2. BObservation of her heart rate
3. CA 0 to 10 numeric rating scale
4. DThe parents' estimate of pain
Answer and explanation in LearnFree account
Question 18 · Medium
After hernia repair, a 2-year-old has an occasional grimace, is restless with tense legs and is squirming. He whimpers now and then and settles with touch and a hug. What is his FLACC score?
1. A3
2. B5
3. C6
4. D4
Answer and explanation in LearnFree account
Question 19 · Medium
The mother of a hospitalised 3-year-old reports that he has started wetting the bed again, although he was toilet trained 6 months ago. The nurse should explain that:
1. AHe should wear nappies at all times from now on
2. BThis points to a urinary infection needing tests
3. CRegression is common in illness and usually passes
4. DHe needs firm correction to break the habit
Answer and explanation in LearnFree account
Question 20 · Hard
A 14 kg child with fever is prescribed oral ibuprofen 200 mg every 6 hours. The usual dose is 5-10 mg/kg per dose, maximum 40 mg/kg/day. What should the nurse do?
1. AGive half the dose and record the change
2. BHold the dose and contact the prescriber
3. CGive the dose as prescribed, every 6 hours
4. DGive 200 mg but extend it to every 8 hours
Answer and explanation in LearnFree account
Question 21 · Easy
In acute dehydration in a child, each 1 kg of sudden weight loss corresponds to about:
1. A100 mL of fluid lost
2. B1000 mL of fluid lost
3. C2000 mL of fluid lost
4. D500 mL of fluid lost
Answer and explanation in LearnFree account
Question 22 · Medium
In which child is the Wong-Baker FACES scale the most suitable pain tool?
1. AA sedated, ventilated 2-year-old in PICU
2. BA 4-year-old who can point to a face
3. CAn 18-month-old who has just had a fall
4. DA 9-month-old crying after a vaccination
Answer and explanation in LearnFree account
Question 23 · Medium
A 6-year-old on day 1 after surgery receives 0.18% saline with 4% dextrose at full maintenance rate. He develops headache, vomiting and drowsiness. Serum sodium is 126 mmol/L (135-145). These findings most likely result from:
1. AHyponatraemia caused by hypotonic IV fluid
2. BOpioid side effects after the operation
3. CDehydration from inadequate fluid intake
4. DHypoglycaemia from the fasting period
Answer and explanation in LearnFree account
Question 24 · Easy
To reduce weight-based dosing errors, a child's weight should be measured and recorded:
1. AIn kilograms only
2. BIn grams for all ages
3. CIn kilograms and pounds
4. DIn pounds and ounces
Answer and explanation in LearnFree account
Question 25 · Hard
Morphine 0.1 mg/kg IV is ordered for post-operative pain in a boy weighing 25 kg, and ampoules hold 10 mg in 1 mL. How much should be drawn up before dilution?
1. A2.5 mL
2. B0.4 mL
3. C0.25 mL
4. D0.025 mL
Answer and explanation in LearnFree account

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Paediatric medication, fluids and procedures

Current paediatric guidance recommends that maintenance IV fluid for most hospitalised children aged 28 days to 18 years be:

An 18 kg child with gastroenteritis has passed 54 mL of urine in the last 6 hours. The expected minimum output is 1 mL/kg/h. The nurse's best interpretation is that output is:

For a child aged 1 to 10 years, PALS defines hypotension as a systolic blood pressure below:

A 14 kg child with severe gastroenteritis has signs of shock. The prescriber orders a bolus of isotonic crystalloid at 20 mL/kg. What volume should the nurse prepare?

In a child with shock, the onset of low blood pressure is best regarded as:

A core principle of family-centred care for a hospitalised child is that:

A 5-year-old on the ward needs a cannula inserted. Where should the nurse perform the procedure?

EMLA cream is ordered before venepuncture in a 6-year-old. For full effect, it should be applied under an occlusive dressing at least:

The safest way to give an oral liquid medicine to a 6-month-old infant is to:

At rest, a healthy term newborn usually breathes how many times a minute?

Using the Holliday-Segar formula, the daily maintenance fluid for a fasting school-age girl weighing 32 kg is:

The FLACC behavioural pain scale is intended mainly for which group of children?

A nurse is to measure the vital signs of a quietly sleeping 8-month-old. Which should be measured first?

In a Gulf hospital, the mother of a 3-year-old admitted with pneumonia asks to stay overnight and to bathe and feed her son herself. The nurse should:

Four children are assigned to a nurse at the start of a shift. Which child should the nurse assess first?

A 4-year-old asks for a cartoon plaster on his injection site, although it is not bleeding. The best response is to:

A 10-year-old girl after appendicectomy can count and understands the idea of ranking. The most suitable tool to assess her pain is:

After hernia repair, a 2-year-old has an occasional grimace, is restless with tense legs and is squirming. He whimpers now and then and settles with touch and a hug. What is his FLACC score?

The mother of a hospitalised 3-year-old reports that he has started wetting the bed again, although he was toilet trained 6 months ago. The nurse should explain that:

A 14 kg child with fever is prescribed oral ibuprofen 200 mg every 6 hours. The usual dose is 5-10 mg/kg per dose, maximum 40 mg/kg/day. What should the nurse do?

In acute dehydration in a child, each 1 kg of sudden weight loss corresponds to about:

In which child is the Wong-Baker FACES scale the most suitable pain tool?

A 6-year-old on day 1 after surgery receives 0.18% saline with 4% dextrose at full maintenance rate. He develops headache, vomiting and drowsiness. Serum sodium is 126 mmol/L (135-145). These findings most likely result from:

To reduce weight-based dosing errors, a child's weight should be measured and recorded:

Morphine 0.1 mg/kg IV is ordered for post-operative pain in a boy weighing 25 kg, and ampoules hold 10 mg in 1 mL. How much should be drawn up before dilution?