Pediatric Proctored Exam

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Sample questions from Pediatric Proctored Exam

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.A 4-year-old arrives in the emergency department with sudden fever, severe throat pain, drooling, and inspiratory stridor. The child is sitting upright and leaning forward. Temperature is 39.4 C, heart rate is 148/min, respiratory rate is 36/min, and oxygen saturation is 92% on room air. Which action should the nurse take first?

   • A.Inspect the throat with a tongue depressor to identify swelling
   • B.Keep the child upright with the caregiver and activate the emergency airway team
   • C.Place the child supine and obtain a throat culture
   • D.Offer small sips of cool water to assess swallowing ability

   Rationale: Drooling, tripod positioning, and stridor suggest epiglottitis with impending airway obstruction, requiring minimal agitation and immediate expert airway support. Throat inspection and culture collection can trigger complete obstruction and should not precede controlled airway management. Oral fluids are unsafe because swallowing is impaired and aspiration is possible. The exam takeaway is to protect the airway without provoking distress when epiglottitis is suspected.

2. 2.A 5-month-old hospitalized with bronchiolitis has copious nasal secretions, subcostal retractions, and difficulty taking a bottle. Respiratory rate is 60/min and oxygen saturation is 94% on room air. Which intervention should the nurse perform before attempting a small oral feeding?

   • A.Administer an over-the-counter cough suppressant
   • B.Perform chest percussion for 15 minutes
   • C.Gently suction the nares with saline as needed
   • D.Offer the usual feeding volume through a faster-flow nipple

   Rationale: Gentle nasal suctioning can improve airflow and feeding tolerance in an infant who relies heavily on nasal breathing. Cough suppressants are inappropriate for infants and can cause serious adverse effects. Routine chest percussion does not improve uncomplicated bronchiolitis, and a faster-flow nipple increases aspiration risk during tachypnea. The exam takeaway is to clear the nose, then reassess respiratory effort and feeding safety rather than forcing oral intake.

3. 3.An 8-year-old in the emergency department has received repeated inhaled albuterol for an asthma exacerbation. The child now appears drowsy, speaks only one word at a time, and has markedly diminished bilateral breath sounds. Respiratory rate is 34/min and oxygen saturation is 89% despite supplemental oxygen. Which action is the priority?

   • A.Activate emergency assistance and prepare for ventilatory support
   • B.Coach the child to perform incentive spirometry
   • C.Obtain a peak expiratory flow measurement before further treatment
   • D.Ask the caregiver to review the child's home asthma triggers

   Rationale: Drowsiness, hypoxemia, and a nearly silent chest indicate critically limited airflow and impending respiratory failure. Incentive spirometry will not reverse acute bronchospasm and may exhaust the child. Peak flow measurement and trigger education would delay lifesaving escalation. The exam takeaway is that diminishing wheezing with worsening distress can indicate deterioration rather than improvement.

4. 4.A 10-year-old at an outpatient asthma visit uses inhaled fluticasone twice daily and albuterol as needed. The child has a normal lung examination and oxygen saturation of 99%. Which statement by the child indicates correct medication understanding?

   • A.I will use extra fluticasone instead of albuterol when I suddenly cannot breathe.
   • B.I can stop fluticasone whenever I have gone a week without wheezing.
   • C.I should take albuterol on a fixed schedule even when my action plan does not direct it.
   • D.I will rinse my mouth and spit after using fluticasone.

   Answer and rationale are in the full material.

5. 5.A 2-year-old is observed in the emergency department for a barking cough and inspiratory stridor at rest. After dexamethasone and nebulized epinephrine, the child becomes calm, has no stridor at rest, and has an oxygen saturation of 97% on room air. Which plan is most appropriate?

   • A.Discharge immediately because the stridor has resolved
   • B.Continue observation for recurrence as the epinephrine effect wears off
   • C.Begin routine antibiotics for presumed bacterial tracheitis
   • D.Schedule chest physiotherapy before discharge

   Answer and rationale are in the full material.