D119 Pediatric Nursing Practice Questions: Scenarios & Answers

Grace J.
January 3, 2026January 3, 2026
D119, MSN, Western Governors University

Student Name

Western Governors University

D119 Pediatric Primary Care for the Advanced Practice Nurse

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Date

Pediatric Practice Questions

Instructions
The following pediatric nursing scenarios aim to enhance clinical judgment and prioritization skills. Each scenario presents a real-life patient case, followed by a focused question to guide nursing interventions. Evidence-based nursing practices and rationales are integrated throughout to facilitate effective learning and application in pediatric care.

Question 1: Croup

Scenario
A 2-year-old child arrives at the emergency department exhibiting a barking cough, hoarseness, and stridor heard at rest.

What should be the nurse’s priority intervention?
Croup is an inflammatory condition of the upper airway involving the larynx, typically caused by viral infection, leading to swelling and airway obstruction. Stridor present at rest indicates a moderate to severe level of airway compromise, which requires urgent intervention. The nurse’s foremost action is to administer nebulized racemic epinephrine. This medication works by causing vasoconstriction, thereby rapidly reducing airway edema and improving airflow, which is crucial to prevent respiratory failure. Other interventions such as encouraging oral intake, diagnostic imaging, or laying the child flat may worsen airway obstruction and distress. Therefore, immediate pharmacological management of the airway is essential in this situation.

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

Scenario
A 7-year-old boy diagnosed with ADHD is having difficulty staying seated in class and completing assignments.

Which classroom accommodations should the nurse recommend?
Children with ADHD benefit from structured, supportive environments tailored to their needs. The most effective recommendation involves breaking tasks into short, structured segments with frequent breaks. This method promotes engagement, reduces frustration, and improves task completion. Seating the child at the back of the classroom or limiting recess can exacerbate symptoms, while providing excessive free time may lead to loss of focus. Nurses play a crucial role in advocating for evidence-based educational strategies that promote both academic achievement and behavioral regulation.

Question 3: Sexually Transmitted Infections (STIs)

Scenario
A 16-year-old female diagnosed with chlamydia asks whether she can avoid telling her sexual partner about the infection.

What is the nurse’s best response?
Chlamydia is a common, easily transmissible STI that often presents without symptoms but can lead to severe reproductive complications if untreated. The nurse must explain clearly that informing the sexual partner is necessary to ensure they receive treatment and to prevent reinfection. Partner notification is a critical public health measure and a standard part of STI management. Offering reassurance without emphasizing partner notification compromises ethical nursing practice and public health safety.

Question 4: Vulvovaginitis

Scenario
A 5-year-old girl complains of itching in the perineal area. Her mother observes that the child has poor wiping habits and frequently stays in wet clothing.

What is the most likely cause of the symptoms?
In prepubertal girls, vulvovaginitis commonly results from poor perineal hygiene and prolonged exposure to moisture. The lack of estrogen causes mucosal tissues to be thinner and more vulnerable to irritation. Improper wiping techniques, tight or damp clothing contribute significantly to local inflammation. Although sexual abuse and infections must be ruled out, the clinical history suggests that hygiene-related vulvovaginitis is the primary cause.

Question 5: Stress and Psychosomatic Symptoms

Scenario
A 9-year-old child who recently relocated complains of frequent stomachaches before going to school.

What nursing action best supports the child’s mental well-being?
Children frequently express emotional stress through physical symptoms, especially during major life changes like moving. The most supportive nursing approach is to engage the child with open-ended questions to encourage expression of feelings. This builds trust, helps uncover underlying anxiety, and facilitates emotional processing. Ignoring the symptoms or punitive measures may increase the child’s distress, while focusing only on physical symptoms overlooks the psychological origin of complaints.

Question 6: Nursing Prioritization

Scenario
A pediatric nurse receives handoff information regarding four patients.

Which patient should the nurse assess first?
Using the ABC (Airway, Breathing, Circulation) prioritization framework, the nurse should first assess the 2-year-old child presenting with croup and stridor at rest. Stridor signals an immediate risk of airway obstruction, which can lead to respiratory failure if not promptly managed. Other patients, though requiring attention, do not exhibit signs of life-threatening airway compromise and can be attended to after stabilizing the highest-risk patient.

Question 7: Postoperative Care after Tonsillectomy

Scenario
A 6-year-old child two hours after tonsillectomy begins to swallow frequently.

What is the nurse’s immediate priority?
Frequent swallowing in the early postoperative period after tonsillectomy is a classic indicator of potential hemorrhage, a dangerous complication that can rapidly cause airway obstruction or hypovolemic shock. The nurse must immediately examine the throat for active bleeding. Delaying assessment by offering fluids or providing reassurance could result in missing this life-threatening event.

Question 8: Attachment Disorders

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

Feature	Reactive Attachment Disorder (RAD)	Disinhibited Social Engagement Disorder (DSED)
Primary Behavior	Emotional withdrawal and detachment	Overly familiar behavior with strangers
Response to Comfort	Avoids or resists comfort	Seeks comfort indiscriminately
Social Boundaries	Limited social engagement	Poor social boundaries and excessive sociability
Emotional Expression	Flat or limited affect	Inappropriate friendliness
Etiology	Severe neglect or lack of attachment	Severe neglect with disrupted attachments

Understanding these distinct presentations enables nurses to identify, refer, and educate families appropriately, improving psychosocial outcomes in affected children.

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.