Pediatric Practice Questions
Instructions
The following pediatric nursing scenarios are designed to strengthen clinical reasoning, decision-making, and prioritization skills in pediatric settings. Each case presents a realistic patient situation followed by a guiding clinical question. Nursing interventions are explained using evidence-based rationales to support safe, effective, and developmentally appropriate pediatric care.
Question 1: Croup
Scenario
A 2-year-old child presents to the emergency department with a harsh, barking cough, hoarseness, and audible stridor occurring at rest.
What should be the nurse’s priority intervention?
Croup is an acute upper airway disorder commonly caused by viral pathogens that result in inflammation and edema of the larynx and trachea. The presence of stridor at rest signifies moderate to severe airway obstruction and indicates a potential respiratory emergency. The nurse’s immediate priority is the administration of nebulized racemic epinephrine. This medication produces alpha-adrenergic vasoconstriction, which rapidly decreases mucosal edema and improves airway patency. Prompt intervention is essential to prevent progression to respiratory distress or failure. Supportive measures such as hydration, imaging studies, or positioning the child supine may exacerbate airway compromise and should not delay pharmacologic airway management.
Question 2: Attention-Deficit/Hyperactivity Disorder (ADHD)
Scenario
A 7-year-old boy with a diagnosis of ADHD is experiencing difficulty remaining seated during class activities and struggles to complete academic tasks.
Which classroom accommodations should the nurse recommend?
Children with ADHD demonstrate improved attention and task performance when environmental and instructional strategies are adapted to their cognitive needs. The most appropriate recommendation is to divide academic work into brief, clearly structured segments with scheduled breaks. This approach minimizes cognitive overload, enhances focus, and reduces frustration. Interventions such as restricting recess, seating the child away from instruction, or allowing excessive unstructured time are counterproductive and may worsen behavioral symptoms. The nurse plays a vital advocacy role by promoting individualized educational strategies that support both behavioral regulation and academic success.
Question 3: Sexually Transmitted Infections (STIs)
Scenario
A 16-year-old female diagnosed with chlamydia asks whether she is required to inform her sexual partner about the infection.
What is the nurse’s best response?
Chlamydia is a highly transmissible sexually transmitted infection that frequently remains asymptomatic yet can result in serious reproductive complications if untreated. The nurse must clearly explain that partner notification is essential to ensure timely treatment, prevent reinfection, and reduce community transmission. Partner management is a standard component of STI treatment guidelines and a critical public health responsibility. Providing reassurance without emphasizing the importance of disclosure undermines ethical nursing practice and compromises infection control efforts.
Question 4: Vulvovaginitis
Scenario
A 5-year-old girl reports itching in the perineal area. Her caregiver notes inconsistent wiping techniques and frequent prolonged exposure to wet clothing.
What is the most likely cause of the symptoms?
In prepubertal girls, vulvovaginitis most commonly results from inadequate perineal hygiene and moisture retention. Low estrogen levels lead to thin, sensitive mucosal tissue that is more susceptible to irritation. Poor wiping habits, damp clothing, and tight garments contribute to inflammation and discomfort. Although infection or abuse must always be considered and ruled out, the clinical history strongly suggests hygiene-related vulvovaginitis as the primary cause of the child’s symptoms.
Question 5: Stress and Psychosomatic Symptoms
Scenario
A 9-year-old child who recently moved to a new community reports recurrent abdominal pain prior to attending school.
What nursing action best supports the child’s mental well-being?
Children often manifest emotional stress through somatic complaints, particularly during significant life transitions such as relocation. The most therapeutic nursing intervention is to engage the child using open-ended questions that encourage emotional expression. This approach fosters trust, allows identification of underlying anxiety, and supports emotional coping. Disregarding symptoms or focusing exclusively on physical causes may intensify distress and fail to address the psychological origins of the complaint.
Question 6: Nursing Prioritization
Scenario
A pediatric nurse receives shift handoff for four patients with varying clinical conditions.
Which patient should the nurse assess first?
Applying the ABC (Airway, Breathing, Circulation) prioritization framework, the nurse should first assess the 2-year-old child with croup who exhibits stridor at rest. Stridor indicates compromised airway patency and presents an immediate risk for respiratory failure. While other patients may require timely care, none demonstrate signs of an imminent, life-threatening airway emergency, making the child with croup the highest priority.
Question 7: Postoperative Care after Tonsillectomy
Scenario
A 6-year-old child, two hours post-tonsillectomy, is observed swallowing repeatedly.
What is the nurse’s immediate priority?
Frequent swallowing in the immediate postoperative period following tonsillectomy is a classic warning sign of hemorrhage. Postoperative bleeding can quickly result in airway obstruction or hypovolemic shock. The nurse must immediately inspect the oropharynx for evidence of active bleeding. Interventions such as offering fluids or providing reassurance should not delay assessment, as failure to identify hemorrhage promptly may result in life-threatening complications.
Question 8: Attachment Disorders
Comparison of Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)
| Feature | Reactive Attachment Disorder (RAD) | Disinhibited Social Engagement Disorder (DSED) |
|---|---|---|
| Primary Behavioral Pattern | Emotional withdrawal and limited attachment | Excessive familiarity with unfamiliar adults |
| Response to Comfort | Avoids or resists soothing | Seeks comfort indiscriminately |
| Social Interaction | Minimal engagement | Poor social boundaries |
| Emotional Expression | Flat or restricted affect | Inappropriately friendly behavior |
| Underlying Cause | Severe neglect and lack of consistent caregiving | Severe neglect with disrupted attachment formation |
Recognizing the distinct characteristics of RAD and DSED enables nurses to identify at-risk children, facilitate timely referrals, and educate caregivers. Early intervention improves emotional regulation, attachment development, and 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.
Hockenberry, M. J., & Wilson, D. (2023). Wong’s nursing care of infants and children (12th ed.). Elsevier.
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2022). Maternal child nursing care (7th ed.). Elsevier.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2022). Kaplan & Sadock’s synopsis of psychiatry (12th ed.). Wolters Kluwer.A