D119 Pediatric Nursing Practice Questions: Scenarios & Answers

D119 Pediatric Nursing Practice Questions: Scenarios & Answers

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Student Name

Western Governors University 

D119 Pediatric Primary Care for the Advanced Practice Nurse

Prof. Name

Date

Pediatric Nursing Practice Questions

Instructions

The following pediatric nursing scenarios are designed to strengthen clinical reasoning, prioritization, and evidence-based decision-making in pediatric care. Each case reflects realistic clinical situations encountered in pediatric settings and is followed by a focused question to guide appropriate nursing interventions. Rationales are grounded in current pediatric nursing standards to support safe, effective, and developmentally appropriate care.

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Question 1: Croup

Scenario

A 2-year-old child presents to the emergency department with a barking cough, hoarseness, and audible stridor at rest.

What should be the nurse’s priority intervention?

Croup is a viral-induced inflammatory condition affecting the upper airway, particularly the larynx and trachea, resulting in edema and narrowing of the airway. The presence of stridor at rest indicates moderate to severe airway obstruction and signals a potential respiratory emergency. The nurse’s highest priority is the administration of nebulized racemic epinephrine. This medication produces rapid vasoconstriction of the airway mucosa, leading to a prompt reduction in edema and improvement in airflow.

Non-priority actions such as encouraging oral fluids, placing the child supine, or delaying treatment for diagnostic testing may increase agitation and worsen airway compromise. Prompt pharmacologic intervention aimed at airway stabilization is essential to prevent progression to respiratory failure and the need for advanced airway management.

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Question 2: Attention-Deficit/Hyperactivity Disorder (ADHD)

Scenario

A 7-year-old boy diagnosed with ADHD is struggling to remain seated during class and has difficulty completing academic tasks.

Which classroom accommodations should the nurse recommend?

Children with ADHD benefit significantly from structured and predictable learning environments that accommodate attentional and behavioral challenges. The most effective classroom intervention is breaking academic tasks into short, manageable segments combined with scheduled breaks. This approach enhances focus, minimizes frustration, and promotes successful task completion.

Strategies such as seating the child away from instructional focus areas, restricting physical activity, or allowing unstructured free time often worsen symptoms. Nurses play a key advocacy role by collaborating with educators to implement evidence-based accommodations that support both learning outcomes and behavioral self-regulation.

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Question 3: Sexually Transmitted Infections (STIs)

Scenario

A 16-year-old female diagnosed with chlamydia asks whether she can avoid informing 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 but can lead to pelvic inflammatory disease, infertility, and ectopic pregnancy if untreated. The nurse must clearly and professionally explain that notifying sexual partners is necessary to ensure they receive appropriate treatment and to prevent reinfection.

Partner notification is a standard component of STI management and a critical public health responsibility. While maintaining a nonjudgmental and supportive approach, the nurse should emphasize that confidentiality does not eliminate the obligation to protect the health of others.

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Question 4: Vulvovaginitis

Scenario

A 5-year-old girl reports itching in the perineal area. Her mother notes poor toileting hygiene and frequent 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 prolonged moisture exposure. Low estrogen levels in young children result in thinner, more sensitive mucosal tissue, making the area more susceptible to irritation and inflammation. Improper wiping techniques, tight-fitting clothing, and remaining in damp garments contribute significantly to symptom development.

Although infections and abuse must always be considered and ruled out, the history and presentation strongly suggest hygiene-related vulvovaginitis as the primary cause.

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Question 5: Stress and Psychosomatic Symptoms

Scenario

A 9-year-old child who recently moved to a new area reports frequent stomachaches before school.

What nursing action best supports the child’s mental well-being?

Children often express psychological 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 expression of emotions and concerns. This approach fosters trust, helps identify anxiety or fear, and supports emotional adjustment.

Dismissing symptoms or focusing solely on physical causes may invalidate the child’s experience and intensify distress. Addressing both emotional and physical aspects promotes holistic care and resilience.

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Question 6: Nursing Prioritization

Scenario

A pediatric nurse receives handoff reports for four patients at the start of a shift.

Which patient should the nurse assess first?

Applying the ABC (Airway, Breathing, Circulation) prioritization framework, the nurse should immediately assess the 2-year-old child with croup exhibiting stridor at rest. Stridor reflects critical airway compromise and poses an imminent threat to life if not rapidly addressed.

While other patients may require timely care, none present with an immediate risk to airway patency. Stabilizing the child with the highest acuity ensures patient safety and aligns with standard prioritization principles.

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Question 7: Postoperative Care After Tonsillectomy

Scenario

A 6-year-old child, two hours post-tonsillectomy, begins swallowing frequently.

What is the nurse’s immediate priority?

Frequent swallowing in the immediate postoperative period following tonsillectomy is a classic and concerning sign of potential oropharyngeal bleeding. Postoperative hemorrhage can rapidly compromise the airway and lead to hypovolemic shock. The nurse must promptly inspect the throat for active bleeding and notify the surgical team as needed.

Interventions such as offering fluids or providing reassurance without assessment may delay recognition of a life-threatening complication. Early identification and response are essential to prevent serious outcomes.

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Question 8: Attachment Disorders

Comparison Between Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)

Early identification of attachment disorders is critical for timely intervention and improved psychosocial outcomes. The table below highlights key distinctions between Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.

Feature	Reactive Attachment Disorder (RAD)	Disinhibited Social Engagement Disorder (DSED)
Core Behavior	Emotional withdrawal and limited responsiveness	Excessive familiarity with unfamiliar adults
Response to Comfort	Actively avoids or resists comfort	Seeks comfort indiscriminately
Social Interaction	Minimal social engagement	Poor social boundaries and over-sociability
Emotional Expression	Flat or restricted affect	Inappropriately friendly or disinhibited affect
Etiology	Severe neglect and lack of consistent caregiving	Severe neglect with disrupted attachment formation

Understanding these contrasting patterns enables nurses to support early referral, caregiver education, and trauma-informed interventions.

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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. CDC.

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.