Paediatric questions appear in every major nursing exam, and they often catch candidates out because children aren’t small adults. Their vital signs, fluid needs, drug doses and warning signs are different. Here are 30 practice questions with answers and rationales.
These are revision questions written for practice, not real exam items. Follow local and national guidelines in practice.
Growth and development
1. At what age do most infants double their birth weight?
- 2 months
- About 5–6 months
- 12 months
- 18 months
Answer: b. Birth weight usually doubles by about 5–6 months and triples by about 12 months.
2. The anterior fontanelle usually closes by:
- 2 months
- 6 months
- 12–18 months
- 3 years
Answer: c. The posterior fontanelle closes much earlier, by about 2 months.
3. A 9-month-old can’t sit without support. What should the nurse do?
- Reassure the parents that this is normal
- Refer for developmental assessment
- Wait until 18 months
- Advise more tummy time only
Answer: b. Most infants sit unsupported by 6–8 months. Failure to do so by 9 months warrants assessment.
4. Which toy is most appropriate for a 2-year-old in hospital?
- A small bead set
- Large building blocks or a push-along toy
- A board game with rules
- A video game
Answer: b. Toddlers enjoy gross motor play. Small objects are a choking risk.
Vital signs
5. What’s a normal resting heart rate for a newborn?
- 60–80 beats/min
- 80–100 beats/min
- About 110–160 beats/min
- 180–200 beats/min
Answer: c.
6. What’s a normal respiratory rate for a 1-year-old?
- 12–16/min
- About 25–40/min
- 50–60/min
- 8–12/min
Answer: b. Ranges vary slightly between charts. Use your local paediatric early warning score (PEWS).
7. Which sign is a late and serious sign of deterioration in a child?
- Tachycardia
- Tachypnoea
- Hypotension
- Irritability
Answer: c. Children compensate well, so low blood pressure appears late and indicates decompensated shock.
Respiratory
8. A 4-month-old has a runny nose, cough, wheeze and difficulty feeding in winter. What’s the likely diagnosis?
- Asthma
- Bronchiolitis
- Croup
- Pneumonia
Answer: b. Usually caused by RSV. Care is mainly supportive: oxygen if needed, nasal suction and feeding support.
9. A child with suspected epiglottitis is drooling and sitting forward. What should the nurse avoid?
- Keeping the child calm with a parent
- Examining the throat with a tongue depressor
- Calling for senior help
- Giving oxygen without distressing the child
Answer: b. This can cause complete airway obstruction.
10. Which finding suggests a life-threatening asthma attack in a child?
- Audible wheeze
- Silent chest, cyanosis and exhaustion
- Cough at night
- Respiratory rate slightly raised
Answer: b.
11. According to WHO’s IMCI approach, which sign indicates pneumonia in a 2-year-old with a cough?
- Respiratory rate 30/min
- Fast breathing (40 or more breaths/min) or chest indrawing
- Runny nose
- Mild fever
Answer: b. For children aged 12 months to 5 years, fast breathing is 40 or more breaths per minute.
Fluids and gastrointestinal
12. A child has diarrhoea with some dehydration. What’s the first-line treatment?
- IV fluids immediately
- Oral rehydration solution (ORS) and zinc
- Antibiotics
- Stop all feeds
Answer: b. WHO recommends low-osmolarity ORS and zinc supplements. Continue breastfeeding.
13. Which is a sign of severe dehydration in a child?
- Thirsty and drinking eagerly
- Lethargic, sunken eyes, skin pinch goes back very slowly, unable to drink
- Restless and irritable only
- Moist mucous membranes
Answer: b.
14. What’s the maintenance fluid requirement for a 15 kg child per 24 hours (Holliday-Segar method)?
- 1,000 mL
- 1,250 mL
- 1,500 mL
- 2,000 mL
Answer: b. 100 mL/kg for the first 10 kg (1,000 mL) plus 50 mL/kg for the next 5 kg (250 mL) = 1,250 mL.
15. A 6-week-old has projectile non-bilious vomiting after feeds and is hungry. What’s suspected?
- Gastro-oesophageal reflux
- Pyloric stenosis
- Intussusception
- Gastroenteritis
Answer: b.
16. A 9-month-old has intermittent screaming, drawing up the legs and “redcurrant jelly” stools. What’s suspected?
- Constipation
- Intussusception
- Colic
- Appendicitis
Answer: b. This is a surgical emergency.
Neonatal
17. What’s the Apgar score of a baby with HR 110, weak cry, some flexion, grimace and blue extremities?
- 4
- 6
- 7
- 9
Answer: b. HR above 100 = 2, weak cry = 1, some flexion = 1, grimace = 1, blue extremities = 1. Total 6.
18. Which is the best way to prevent hypothermia in a newborn immediately after birth?
- Bath the baby straight away
- Dry thoroughly and place skin-to-skin with the mother
- Leave the baby uncovered under a light
- Put the baby in a cot alone
Answer: b. Delay bathing for at least 24 hours where possible, as WHO recommends.
19. Why is vitamin K given to newborns?
- To prevent jaundice
- To prevent vitamin K deficiency bleeding
- To boost immunity
- To prevent infection
Answer: b.
20. What’s the recommended care for the umbilical cord in most settings?
- Apply hot water compresses
- Keep clean and dry; chlorhexidine may be recommended in high-mortality settings
- Apply herbal pastes
- Cover tightly with a bandage
Answer: b.
Immunisation
21. Which vaccine is typically given at birth in many African immunisation schedules?
- Measles
- BCG, oral polio (OPV0) and hepatitis B birth dose
- Yellow fever
- MMR
Answer: b. Follow your national schedule.
22. A child has a mild cold and a temperature of 37.6°C. Should routine vaccines be given?
- No, postpone for a month
- Yes, minor illness isn’t a contraindication
- Only if the parent insists
- Only half doses
Answer: b.
Common conditions
23. A child is having a febrile convulsion. What’s the first nursing action?
- Put something in the child’s mouth
- Protect from injury, place in recovery position after the seizure, time it, and call for help if it lasts more than 5 minutes
- Restrain the child
- Give a cold bath
Answer: b.
24. A child with sickle cell disease presents with fever of 38.5°C. What’s the priority?
- Give paracetamol and send home
- Urgent assessment and antibiotics because of high infection risk
- Wait 24 hours
- Encourage exercise
Answer: b. Functional asplenia puts these children at risk of overwhelming infection.
25. A child with nephrotic syndrome typically presents with:
- Haematuria and hypertension
- Periorbital oedema, heavy proteinuria and low albumin
- Dehydration
- Jaundice
Answer: b.
Medication safety
26. Why are paediatric drug calculations high risk?
- Children metabolise drugs exactly like adults
- Doses are weight-based, and a decimal error can cause a ten-fold overdose
- Children rarely need medicines
- Liquid medicines are always safe
Answer: b. Always double-check, especially with high-risk drugs.
27. Which medicine should not be given to children under 16 in most countries because of the risk of Reye’s syndrome?
- Paracetamol
- Aspirin
- Amoxicillin
- Ibuprofen
Answer: b. Except under specialist advice, for example in Kawasaki disease.
Safeguarding and family care
28. Which injury pattern should raise concern for non-accidental injury?
- Bruise on the shin of an active toddler
- Bruises on a non-mobile baby, or bruising in unusual places such as ears or torso
- Grazed knees
- A bump on the forehead after a witnessed fall
Answer: b. “Those who don’t cruise rarely bruise.” Follow safeguarding procedures.
29. A 5-year-old needs a cannula and is frightened. What’s the best approach?
- Do it quickly without explanation
- Explain simply, use topical anaesthetic, involve the parent and use distraction
- Ask the parent to leave
- Tell the child it won’t hurt
Answer: b. Honesty builds trust.
30. What’s family-centred care?
- Excluding parents from care decisions
- Recognising the family as central to the child’s care and involving them in decisions
- Only nurses making decisions
- Restricting visiting
Answer: b.