**The Pediatric Nursing Precision Exam: Acute and
Chronic Care Management for Infants, Children, and
Adolescents**
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires further
evaluation?
A. The infant's birth weight has doubled.
B. The infant can roll from back to abdomen.
C. The infant has a positive Babinski reflex.
D. The infant cannot sit without support.
💫RATIONALE✔️✔️: The Babinski reflex (toes fanning) should disappear by 12 months. Its persistence
beyond this age is normal; at 6 months it is still present. The finding that requires evaluation is inability
to sit without support by 8 months. However, the question asks at 6 months. All options are normal
except a persistent palmar grasp. Re-evaluating: A positive Babinski is normal up to 12 months. The
answer is actually that all are normal, but the need for further evaluation would be if the infant cannot
sit without support by 9 months. The option "cannot sit without support" is normal at 6 months. There is
no correct abnormal. I will adjust.
💫RATIONALE✔️✔️: (Adjusted) A 6-month-old should be able to sit with support but not independently.
The concerning finding would be not sitting with support. Among these options, none are clearly
abnormal. However, if the infant cannot roll over by 6 months, that is a delay. The question has "can
roll" which is correct. I will change the option to a delay.
💫ANSWER✔️✔️: C. The infant has a positive Babinski reflex. (This is normal, so actually no correct
answer. Let me rewrite correctly.)
*Corrected #1:*
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires further
evaluation?
A. The infant's birth weight has doubled.
B. The infant can roll from back to abdomen.
C. The infant has a persistent palmar grasp reflex.
, D. The infant babbles single syllables.
💫RATIONALE✔️✔️: The palmar grasp reflex should disappear by 3-4 months of age. Persistence at 6
months indicates potential neurologic impairment and requires further evaluation.
💫ANSWER✔️✔️: C. The infant has a persistent palmar grasp reflex.
---
2. A nurse is caring for a child with suspected epiglottitis. Which finding is most concerning?
A. The child is sitting upright with the chin thrust forward.
B. The child has a high fever and drooling.
C. The child has a hoarse voice and stridor.
D. The child is calm and lying flat.
💫RATIONALE✔️✔️: Epiglottitis is a medical emergency. A child who is calm and lying flat may be
exhausted and approaching respiratory arrest. The tripod position indicates airway effort; lying flat is
ominous.
💫ANSWER✔️✔️: D. The child is calm and lying flat.
---
3. A nurse is providing education to the parents of a child with a new diagnosis of type 1 diabetes. Which
statement indicates understanding?
A. "We will give insulin only when our child's blood sugar is high."
B. "We will rotate injection sites to prevent lipohypertrophy."
C. "Our child cannot participate in sports or physical activity."
D. "We will stop insulin if our child is sick and not eating."
💫RATIONALE✔️✔️: Rotating injection sites prevents lipohypertrophy (lumps of fatty tissue) which can
impair insulin absorption.
💫ANSWER✔️✔️: B. "We will rotate injection sites to prevent lipohypertrophy."
---
4. A nurse is assessing a toddler for potential dehydration. Which finding indicates severe dehydration?
A. Dry mucous membranes.
, B. Tachycardia.
C. Sunken fontanel.
D. Delayed capillary refill >4 seconds.
💫RATIONALE✔️✔️: Capillary refill >4 seconds, along with poor skin turgor, sunken eyes, and absent
tears, indicates severe dehydration (10-15% fluid loss) requiring IV repletion.
💫ANSWER✔️✔️: D. Delayed capillary refill >4 seconds.
---
5. A nurse is caring for a child with acute lymphoblastic leukemia (ALL) who is receiving chemotherapy.
Which finding requires immediate intervention?
A. Absolute neutrophil count (ANC) 300/mm3.
B. Hemoglobin 8.5 g/dL.
C. Platelet count 50,000/mm3.
D. Temperature 38.5°C (101.3°F).
💫RATIONALE✔️✔️: Fever in a neutropenic child (ANC <500) is a medical emergency due to risk of
sepsis. The child requires immediate blood cultures and broad-spectrum antibiotics.
💫ANSWER✔️✔️: D. Temperature 38.5°C (101.3°F).
---
6. A nurse is providing education about sudden infant death syndrome (SIDS) prevention to a new
parent. Which statement indicates a need for further teaching?
A. "I will place my baby on the back to sleep."
B. "I will keep soft toys and pillows out of the crib."
C. "I will use a firm mattress with a tight-fitted sheet."
D. "I will place my baby on the side to sleep to prevent reflux."
💫RATIONALE✔️✔️: The supine (back) position is the only safe sleep position. Side sleeping is not
recommended as infants can roll to prone position, increasing SIDS risk.
💫ANSWER✔️✔️: D. "I will place my baby on the side to sleep to prevent reflux."
---
, 7. A nurse is assessing a child with suspected appendicitis. Which finding is most indicative?
A. Left lower quadrant pain relieved by passing flatus.
B. Periumbilical pain that migrates to the right lower quadrant.
C. Generalized abdominal pain with guarding and rigidity.
D. Sharp epigastric pain that radiates to the back.
💫RATIONALE✔️✔️: Appendicitis typically starts as vague periumbilical pain, then localizes to
McBurney's point (right lower quadrant) as inflammation progresses.
💫ANSWER✔️✔️: B. Periumbilical pain that migrates to the right lower quadrant.
---
8. A nurse is caring for a child with croup (laryngotracheobronchitis). Which finding requires immediate
action?
A. Barking cough.
B. Hoarse voice.
C. Stridor at rest.
D. Low-grade fever.
💫RATIONALE✔️✔️: Stridor at rest indicates significant upper airway obstruction and impending
respiratory failure. This child requires immediate evaluation and treatment (racemic epinephrine,
corticosteroids).
💫ANSWER✔️✔️: C. Stridor at rest.
---
9. A nurse is providing education to the parents of a child with a new prescription for an epinephrine
auto-injector (EpiPen) due to peanut allergy. Which statement indicates understanding?
A. "I will give the EpiPen after calling 911."
B. "I will inject the EpiPen into the child's deltoid muscle."
C. "I will hold the child's leg still and inject into the outer thigh."
D. "I will observe the child for 10 minutes before giving a second dose."
💫RATIONALE✔️✔️: The EpiPen is injected into the outer mid-thigh (vastus lateralis). It should be given
immediately at the first sign of anaphylaxis, before calling 911.
Chronic Care Management for Infants, Children, and
Adolescents**
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires further
evaluation?
A. The infant's birth weight has doubled.
B. The infant can roll from back to abdomen.
C. The infant has a positive Babinski reflex.
D. The infant cannot sit without support.
💫RATIONALE✔️✔️: The Babinski reflex (toes fanning) should disappear by 12 months. Its persistence
beyond this age is normal; at 6 months it is still present. The finding that requires evaluation is inability
to sit without support by 8 months. However, the question asks at 6 months. All options are normal
except a persistent palmar grasp. Re-evaluating: A positive Babinski is normal up to 12 months. The
answer is actually that all are normal, but the need for further evaluation would be if the infant cannot
sit without support by 9 months. The option "cannot sit without support" is normal at 6 months. There is
no correct abnormal. I will adjust.
💫RATIONALE✔️✔️: (Adjusted) A 6-month-old should be able to sit with support but not independently.
The concerning finding would be not sitting with support. Among these options, none are clearly
abnormal. However, if the infant cannot roll over by 6 months, that is a delay. The question has "can
roll" which is correct. I will change the option to a delay.
💫ANSWER✔️✔️: C. The infant has a positive Babinski reflex. (This is normal, so actually no correct
answer. Let me rewrite correctly.)
*Corrected #1:*
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires further
evaluation?
A. The infant's birth weight has doubled.
B. The infant can roll from back to abdomen.
C. The infant has a persistent palmar grasp reflex.
, D. The infant babbles single syllables.
💫RATIONALE✔️✔️: The palmar grasp reflex should disappear by 3-4 months of age. Persistence at 6
months indicates potential neurologic impairment and requires further evaluation.
💫ANSWER✔️✔️: C. The infant has a persistent palmar grasp reflex.
---
2. A nurse is caring for a child with suspected epiglottitis. Which finding is most concerning?
A. The child is sitting upright with the chin thrust forward.
B. The child has a high fever and drooling.
C. The child has a hoarse voice and stridor.
D. The child is calm and lying flat.
💫RATIONALE✔️✔️: Epiglottitis is a medical emergency. A child who is calm and lying flat may be
exhausted and approaching respiratory arrest. The tripod position indicates airway effort; lying flat is
ominous.
💫ANSWER✔️✔️: D. The child is calm and lying flat.
---
3. A nurse is providing education to the parents of a child with a new diagnosis of type 1 diabetes. Which
statement indicates understanding?
A. "We will give insulin only when our child's blood sugar is high."
B. "We will rotate injection sites to prevent lipohypertrophy."
C. "Our child cannot participate in sports or physical activity."
D. "We will stop insulin if our child is sick and not eating."
💫RATIONALE✔️✔️: Rotating injection sites prevents lipohypertrophy (lumps of fatty tissue) which can
impair insulin absorption.
💫ANSWER✔️✔️: B. "We will rotate injection sites to prevent lipohypertrophy."
---
4. A nurse is assessing a toddler for potential dehydration. Which finding indicates severe dehydration?
A. Dry mucous membranes.
, B. Tachycardia.
C. Sunken fontanel.
D. Delayed capillary refill >4 seconds.
💫RATIONALE✔️✔️: Capillary refill >4 seconds, along with poor skin turgor, sunken eyes, and absent
tears, indicates severe dehydration (10-15% fluid loss) requiring IV repletion.
💫ANSWER✔️✔️: D. Delayed capillary refill >4 seconds.
---
5. A nurse is caring for a child with acute lymphoblastic leukemia (ALL) who is receiving chemotherapy.
Which finding requires immediate intervention?
A. Absolute neutrophil count (ANC) 300/mm3.
B. Hemoglobin 8.5 g/dL.
C. Platelet count 50,000/mm3.
D. Temperature 38.5°C (101.3°F).
💫RATIONALE✔️✔️: Fever in a neutropenic child (ANC <500) is a medical emergency due to risk of
sepsis. The child requires immediate blood cultures and broad-spectrum antibiotics.
💫ANSWER✔️✔️: D. Temperature 38.5°C (101.3°F).
---
6. A nurse is providing education about sudden infant death syndrome (SIDS) prevention to a new
parent. Which statement indicates a need for further teaching?
A. "I will place my baby on the back to sleep."
B. "I will keep soft toys and pillows out of the crib."
C. "I will use a firm mattress with a tight-fitted sheet."
D. "I will place my baby on the side to sleep to prevent reflux."
💫RATIONALE✔️✔️: The supine (back) position is the only safe sleep position. Side sleeping is not
recommended as infants can roll to prone position, increasing SIDS risk.
💫ANSWER✔️✔️: D. "I will place my baby on the side to sleep to prevent reflux."
---
, 7. A nurse is assessing a child with suspected appendicitis. Which finding is most indicative?
A. Left lower quadrant pain relieved by passing flatus.
B. Periumbilical pain that migrates to the right lower quadrant.
C. Generalized abdominal pain with guarding and rigidity.
D. Sharp epigastric pain that radiates to the back.
💫RATIONALE✔️✔️: Appendicitis typically starts as vague periumbilical pain, then localizes to
McBurney's point (right lower quadrant) as inflammation progresses.
💫ANSWER✔️✔️: B. Periumbilical pain that migrates to the right lower quadrant.
---
8. A nurse is caring for a child with croup (laryngotracheobronchitis). Which finding requires immediate
action?
A. Barking cough.
B. Hoarse voice.
C. Stridor at rest.
D. Low-grade fever.
💫RATIONALE✔️✔️: Stridor at rest indicates significant upper airway obstruction and impending
respiratory failure. This child requires immediate evaluation and treatment (racemic epinephrine,
corticosteroids).
💫ANSWER✔️✔️: C. Stridor at rest.
---
9. A nurse is providing education to the parents of a child with a new prescription for an epinephrine
auto-injector (EpiPen) due to peanut allergy. Which statement indicates understanding?
A. "I will give the EpiPen after calling 911."
B. "I will inject the EpiPen into the child's deltoid muscle."
C. "I will hold the child's leg still and inject into the outer thigh."
D. "I will observe the child for 10 minutes before giving a second dose."
💫RATIONALE✔️✔️: The EpiPen is injected into the outer mid-thigh (vastus lateralis). It should be given
immediately at the first sign of anaphylaxis, before calling 911.
