Name
Purdue University Globle
NU580 FNP II – Primary Care of Children and Adolescents’ Health
Prof. Name
Date
Pediatric nursing practice questions and answers help nursing students, pediatric nurse practitioners, and healthcare professionals review essential concepts related to child health, common pediatric conditions, nursing interventions, pain management, immunizations, and developmental milestones. This NU580 Midterm Study Guide presents practice questions with explanations to support exam preparation and strengthen understanding of pediatric primary care.
Question: Which statement about cyclic vomiting syndrome is correct?
A. Episodes may last for days.
B. SSRIs are required to stop symptoms.
C. Headaches are not always associated with the condition.
D. Pain medication and Zofran are required in every case.
Correct Answer: C. Headaches are not always associated with the condition.
Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent episodes of intense nausea and vomiting separated by periods of relative wellness. It is often associated with migraine disorders, but a headache does not have to occur during every episode.
Episodes may last several hours to multiple days. Management depends on the child’s symptoms, severity, hydration status, and individualized treatment plan.
Important clinical considerations include:
Recurrent vomiting with symptom-free intervals.
Possible association with migraine.
Assessment for dehydration and electrolyte abnormalities.
Supportive care and treatment directed at preventing or managing episodes.
Question: A 5-day-old infant presents with jaundice, decreased wet diapers, breastfeeding difficulties, and a bilirubin level of 18 mg/dL. Which nursing interventions are appropriate?
A. Initiate phototherapy.
B. Provide breastfeeding support and education.
C. Closely monitor intake and output.
D. All of the above.
Correct Answer: D. All of the above.
A newborn with jaundice, poor feeding, and decreased urine output requires prompt assessment. Inadequate milk intake can contribute to dehydration and increased bilirubin levels. A bilirubin value of 18 mg/dL must be interpreted according to the infant’s age in hours, gestational age, and other risk factors. Phototherapy is not automatically indicated solely because the bilirubin is 18 mg/dL.
Appropriate nursing care includes:
Assessing hydration status and urine output.
Supporting effective breastfeeding and milk transfer.
Monitoring weight and feeding frequency.
Evaluating bilirubin levels and the need for phototherapy according to current neonatal guidelines.
Teaching caregivers about adequate feeding and warning signs of dehydration.
Question: An infant weighing 6 kg is admitted with dehydration. Which urine output is generally considered adequate for an infant?
A. 0.5 mL/kg/hr
B. 0.5–2.5 mL/kg/hr
C. 1–3 mL/kg/hr
D. Wet diapers alone are sufficient to assess hydration.
Correct Answer: C. 1–3 mL/kg/hr.
Urine output is an important indicator of hydration and kidney perfusion in infants. A commonly used clinical target is approximately 1–2 mL/kg/hr, although expected output may vary according to age, clinical condition, and institutional protocols.
For a 6-kg infant, urine output of 1–3 mL/kg/hr corresponds to approximately 6–18 mL/hr. Nurses should interpret urine output alongside other findings, including mucous membranes, capillary refill, weight, heart rate, and response to fluid therapy.
Question: What is the most important education point for a child prescribed oral corticosteroids and a short-acting beta agonist inhaler?
A. Provide a written asthma action plan.
B. Explain medication side effects.
C. Provide spirometry information.
D. Explain medication use at school.
Correct Answer: A. Provide a written asthma action plan.
A written asthma action plan helps children and caregivers recognize symptoms, follow prescribed treatment, and respond appropriately when asthma worsens. It should be individualized to the child’s needs and reviewed regularly.
An effective asthma action plan includes:
Daily controller medication instructions, when prescribed.
Rescue inhaler use and dosing instructions.
Signs of worsening asthma.
Guidance on when to contact the healthcare provider.
Emergency instructions for severe symptoms.
School-related medication and emergency care information when applicable.
Question: What is an important role of a pediatric pulmonologist when a child has severe asthma that remains uncontrolled despite standard treatment?
A. Confirm the diagnosis.
B. Recommend alternative disease management strategies.
C. Focus only on medication adherence.
D. Assume responsibility for all chronic disease management.
Correct Answer: B. Recommend alternative disease management strategies.
A pediatric pulmonologist evaluates children with difficult-to-control asthma and helps identify factors contributing to poor symptom control. The specialist may reassess the diagnosis, review inhaler technique, evaluate adherence, identify environmental triggers, and consider advanced treatment options.
Specialist management may include:
Additional diagnostic testing.
Assessment for alternative or coexisting conditions.
Environmental trigger evaluation.
Optimization of existing therapy.
Consideration of advanced asthma treatments.
Question: An 18-month-old child has a rectal temperature of 100.4°F (38°C), is playful, and is drinking fluids. What is the most appropriate recommendation?
A. Give antipyretics immediately.
B. Visit the clinic immediately.
C. Encourage fluids and monitor symptoms.
D. Order laboratory tests.
Correct Answer: C. Encourage fluids and monitor symptoms.
A well-appearing toddler who is drinking fluids and behaving normally may be managed with supportive care and observation, provided there are no concerning symptoms or risk factors. Fever treatment should focus on the child’s comfort rather than temperature reduction alone.
Caregivers should monitor for:
Changes in activity or responsiveness.
Poor fluid intake.
Reduced urine output.
Breathing difficulties.
Persistent vomiting.
Worsening symptoms or signs of serious illness.
Question: A 10-year-old child describes shooting, tingling, and burning pain in both legs. Which type of pain is suspected?
A. Chronic pain.
B. Neuropathic pain.
C. Somatic pain.
D. Visceral pain.
Correct Answer: B. Neuropathic pain.
Neuropathic pain results from injury or dysfunction involving the somatosensory nervous system. Children may describe this pain as burning, tingling, shooting, or electric shock-like discomfort.
Common features include:
Burning sensations.
Tingling or pins-and-needles feelings.
Shooting or electric shock-like pain.
Numbness or altered sensation.
The nurse should assess the pain pattern, associated neurologic symptoms, functional impact, and possible underlying causes.
Pain assessment tools should be selected according to the child’s developmental level, cognitive abilities, and communication skills.
Examples include:
Preschool children: Behavioral assessment tools or simple age-appropriate descriptive scales.
School-age children: Faces pain scales, such as the Faces Pain Scale–Revised.
Nonverbal or cognitively impaired children: Behavioral tools such as FLACC or the Non-Communicating Children’s Pain Checklist–Revised (NCCPC-R), when appropriate.
Question: Which pain assessment tool is designed to help assess pain in cognitively impaired children who cannot communicate verbally?
A. COMFORT Scale.
B. FLACC Scale.
C. Non-Communicating Children’s Pain Checklist–Revised (NCCPC-R).
D. Nonverbal observations only.
Correct Answer: C. Non-Communicating Children’s Pain Checklist–Revised (NCCPC-R).
The NCCPC-R is a behavioral pain assessment tool used for children who have severe cognitive impairment and cannot reliably communicate their pain. It helps clinicians identify possible pain through changes in behavior and other observable indicators.
Assessment may include:
Facial expressions.
Vocalizations.
Body movements.
Changes in activity.
Alterations in eating, sleeping, or usual behavior.
The tool should be used according to its intended population and clinical instructions.
Question: Which intervention can provide additional analgesic effects during painful procedures in infants?
A. Toys.
B. Music.
C. Oral sucrose solution.
D. Swaddling.
Correct Answer: C. Oral sucrose solution.
Oral sucrose is commonly used as a nonpharmacologic adjunct for reducing procedural pain in newborns and young infants. It is particularly useful during brief procedures such as heel sticks or venipuncture.
Pain management may also include:
Swaddling.
Non-nutritive sucking.
Breastfeeding when appropriate.
Skin-to-skin contact.
Comforting and positioning techniques.
Sucrose should be administered according to clinical protocols and does not replace appropriate analgesia for more painful procedures.
Question: Which medication regimen is listed as an option for adolescents with moderate dysmenorrhea?
A. Increase ibuprofen dosage.
B. Acetaminophen 1,000 mg every 4–6 hours.
C. Naproxen 500 mg initially, followed by 250 mg every 6–8 hours.
D. Extended-release naproxen.
Correct Answer: C. Naproxen 500 mg initially, followed by 250 mg every 6–8 hours.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as first-line treatment for primary dysmenorrhea. They reduce prostaglandin production, which helps relieve menstrual cramps.
Treatment education should include:
Taking medication according to the prescribed regimen.
Starting NSAIDs early when appropriate.
Reviewing contraindications and adverse effects.
Avoiding duplicate NSAID products.
Seeking medical evaluation if pain is severe, persistent, or does not respond to treatment.
Medication safety note: The regimen listed in the original practice question should not be treated as a universal pediatric prescription. Naproxen dosing and maximum daily limits depend on age, weight, formulation, and clinical guidance. Acetaminophen dosing must also account for the child’s weight and total daily intake.
Question: What should healthcare providers know about transient tachypnea of the newborn (TTN)?
A. Antibiotics are routinely required.
B. Home oxygen is always necessary.
C. Recovery is usually complete with supportive care.
D. Mechanical ventilation is required.
Correct Answer: C. Recovery is usually complete with supportive care.
Transient tachypnea of the newborn is a respiratory condition caused by delayed clearance of fetal lung fluid. It commonly presents shortly after birth with rapid breathing and may be associated with mild respiratory distress.
Management typically involves supportive care and monitoring. Some infants require supplemental oxygen or additional respiratory support.
Key points include:
Respiratory rate and oxygen saturation monitoring.
Assessment for signs of respiratory distress.
Evaluation for other causes of newborn respiratory difficulty.
Supportive treatment based on clinical needs.
Observation for improvement over the first several days.
Most infants recover without long-term complications, although severe or persistent symptoms require further evaluation.
Question: What is the best initial response when parents express concerns about childhood vaccines?
A. Discuss vaccine ingredients immediately.
B. Provide Vaccine Information Statements only.
C. Ask about their concerns.
D. Discuss exposure risks only.
Correct Answer: C. Ask about their concerns.
A respectful conversation begins by understanding the caregiver’s questions, experiences, and concerns. Listening helps healthcare providers address specific misconceptions and provide relevant, evidence-based information.
Effective vaccine counseling includes:
Asking open-ended questions.
Listening without judgment.
Explaining vaccine benefits and potential adverse effects.
Addressing concerns with reliable information.
Reviewing the child’s recommended immunization schedule.
Encouraging caregivers to ask questions.
Question: What should be done if an infant receives the MMR vaccine before 12 months of age?
A. Administer a reduced dose.
B. Obtain antibody titers.
C. Wait until school age.
D. Repeat the vaccine according to the routine schedule.
Correct Answer: D. Repeat the vaccine according to the routine schedule.
The routine first dose of measles, mumps, and rubella (MMR) vaccine is generally administered at 12–15 months of age. An MMR dose given before the first birthday generally does not count toward the routine two-dose series because of possible interference from maternal antibodies.
When an early dose is given, the child should receive the routine doses at the recommended ages, following current immunization guidance.
Important: MMR vaccination before 12 months may be recommended in specific circumstances, such as international travel or an outbreak. The schedule for subsequent doses should be confirmed with the child’s healthcare provider and current CDC recommendations.
Question: What is thelarche?
A. Development of pubic hair.
B. Breast development.
C. First menstrual period.
D. All of the above.
Correct Answer: B. Breast development.
Thelarche refers to the onset of breast development during puberty. It is commonly the first visible sign of puberty in females, although the sequence can vary.
Other important puberty terms include:
Pubarche: Appearance of pubic hair.
Menarche: Onset of menstruation.
Adrenarche: Maturation of adrenal androgen production, which contributes to body odor and pubic or axillary hair development.
Question: How often should thyroid studies generally be performed after the initial newborn screening in children with Down syndrome?
A. Every 2 months.
B. Monthly.
C. Every 6 months.
D. Yearly.
Correct Answer: D. Yearly.
Children with Down syndrome have an increased risk of thyroid dysfunction, particularly hypothyroidism. Lifelong surveillance is recommended to support early identification and treatment.
Thyroid screening is generally performed:
At birth through routine newborn screening.
At approximately 6 months.
At 12 months.
Annually thereafter, according to applicable clinical guidelines.
Additional testing may be necessary when symptoms or abnormal results are present.
Question: Which malignancy is more common among children with Down syndrome?
A. Colon cancer.
B. Leukemia.
C. Pancreatic cancer.
D. Bladder cancer.
Correct Answer: B. Leukemia.
Children with Down syndrome have an increased risk of certain hematologic malignancies, particularly acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
Related conditions include:
Acute lymphoblastic leukemia (ALL).
Acute myeloid leukemia (AML).
Transient abnormal myelopoiesis, a condition associated with Down syndrome that may resolve but requires appropriate evaluation and monitoring.
Nurses should recognize concerning findings such as unexplained bruising, pallor, persistent fever, fatigue, and recurrent infections.
Question: What is an appropriate management option for an 18-month-old child with mild acute otitis media?
A. High-dose amoxicillin.
B. Analgesics and watchful waiting.
C. Ceftriaxone.
D. Antibiotic ear drops.
Correct Answer: B. Analgesics and watchful waiting.
For selected children with mild acute otitis media, observation with appropriate pain management may be considered. The decision depends on age, symptom severity, laterality, fever, otorrhea, and the ability to ensure follow-up.
Children with more severe symptoms or specific clinical findings may require antibiotic treatment.
Nursing management includes:
Assessing pain and providing appropriate analgesia.
Monitoring temperature and symptoms.
Educating caregivers about the expected course.
Explaining when to seek additional medical care.
Ensuring follow-up when observation is selected.
Children with persistent or recurrent otitis media may require additional evaluation. Possible interventions include:
Referral to an otolaryngologist.
Hearing assessment.
Evaluation for tympanostomy tubes when criteria are met.
Assessment for persistent middle-ear effusion.
Further diagnostic testing based on symptoms.
Otitis externa, commonly known as swimmer’s ear, involves inflammation of the external ear canal. Preventive measures focus on reducing moisture and trauma.
Recommended practices include:
Drying the ears after swimming.
Avoiding cotton swabs and other objects inside the ear canal.
Avoiding excessive ear cleaning.
Following medical advice regarding ear drops for prevention.
Question: A child presents with vertigo, purulent ear drainage, and a pearly white lesion on the tympanic membrane. Which condition is suspected?
A. Cholesteatoma.
B. Mastoiditis.
C. Otitis externa.
D. Otitis media with effusion.
Correct Answer: A. Cholesteatoma.
A cholesteatoma is an abnormal collection of keratinizing squamous epithelium in the middle ear or related spaces. It can cause chronic drainage, hearing loss, and other complications if left untreated.
Potential signs include:
Persistent or foul-smelling ear drainage.
Conductive hearing loss.
A pearly white mass or lesion.
Recurrent ear infections.
Dizziness or balance problems in some cases.
Children with suspected cholesteatoma require medical evaluation and referral to an otolaryngologist.
The following concepts are useful to review before the NU580 midterm:
Assess hydration using intake and output, urine output, weight, and physical examination findings.
Select pain assessment tools according to developmental and communication abilities.
Provide families with individualized written asthma action plans.
Promote effective breastfeeding to reduce the risk of newborn dehydration.
Use supportive and evidence-based pain management strategies.
Communicate respectfully with caregivers about childhood immunizations.
Monitor children with Down syndrome for thyroid disorders and leukemia.
Recognize common signs of pediatric ear disorders.
Review medication dosing, contraindications, and safety precautions.
Use current pediatric clinical guidelines when evaluating treatment decisions.
American Academy of Pediatrics. (2021). Clinical practice guideline for the diagnosis and management of acute otitis media. Pediatrics. https://publications.aap.org/pediatrics
American Academy of Pediatrics. (2023). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (5th ed.). https://www.aap.org/brightfutures
Centers for Disease Control and Prevention. (2024). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/
National Institute of Neurological Disorders and Stroke. (2024). Pain information and management. https://www.ninds.nih.gov
World Health Organization. (2023). Immunization coverage and vaccine safety information. https://www.who.int/health-topics/vaccines-and-immunization
Centers for Disease Control and Prevention. (n.d.). Child and adolescent immunization schedule by age. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Global Initiative for Asthma. (2024). Global strategy for asthma management and prevention. https://ginasthma.org/
American Academy of Pediatrics. (2022). Health supervision for children and adolescents with Down syndrome. Pediatrics. https://publications.aap.org/pediatrics
