Paediatric Nursing Questions for the Prometric Exam 2026: 20 MCQs with Answers on Growth and Development, Vital Signs, Dehydration, Fever, Respiratory Distress, Immunisation, Medication Doses and Child Safety

Paediatric nursing is 8 to 10% of the registered nurse paper, around 12 to 15 questions, and the Gulf has a young population, so children's wards and emergency departments hire heavily. The questions test whether you know what is normal for an age, can spot the sick child, and can calculate a weight-based dose without error. This set covers what recurs. Newborn care has its own set (maternal and newborn questions).

Growth and development

Question 1

Which developmental finding is expected in a healthy 9-month-old?

1. Walks independently and speaks in two-word phrases
2. Sits without support, transfers objects between hands, has a pincer grasp developing, babbles, and shows stranger anxiety
3. Cannot hold the head up
4. Draws a circle

Answer: B. Red flags include no head control by 4 months, not sitting by 9 months, not walking by 18 months, no single words by 16 to 18 months and loss of previously acquired skills at any age.

Question 2

Which set of vital signs is within normal limits for a 3-year-old at rest?

1. Heart rate 160, respiratory rate 50
2. Heart rate 90 to 140, respiratory rate 20 to 30, systolic blood pressure about 90 to 110 mmHg
3. Heart rate 60, respiratory rate 12
4. Heart rate 200, respiratory rate 60

Answer: B. Ranges fall with age; a rising heart rate is the earliest sign of shock in children, while hypotension is a late sign.

Question 3

A toddler admitted for pneumonia screams when the mother leaves and later becomes withdrawn and quiet. The nurse recognises:

1. Improvement, because the child is quiet
2. Stages of separation anxiety (protest, despair, detachment), and supports parental presence, rooming-in, consistent caregivers and familiar comfort objects
3. Autism
4. Pain requiring opioids

Answer: B. Family-centred care, including culturally appropriate involvement of mothers and extended family, is tested throughout the paediatric domain.

Fluids, doses and dehydration

Question 4

A 15 kg child is prescribed paracetamol 15 mg/kg orally. The syrup contains 250 mg in 5 mL. The volume to give is:

1. 2.5 mL
2. 4.5 mL
3. 9 mL
4. 15 mL

Answer: B. 15 × 15 = 225 mg; 225 ÷ 250 × 5 = 4.5 mL. Maximum daily paracetamol is about 60 mg/kg (not exceeding 4 g); double-checking paediatric doses with a second nurse is standard.

Question 5

Using the Holliday-Segar method, the maintenance fluid requirement for a 22 kg child over 24 hours is:

1. 1,000 mL
2. 1,540 mL (100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 20 mL/kg for each kilogram above 20)
3. 2,200 mL
4. 880 mL

Answer: B. 1,000 + 500 + 40 = 1,540 mL, about 64 mL/h. Isotonic fluids with glucose are now preferred for maintenance because hypotonic fluids cause hyponatraemia.

Question 6

A 2-year-old with gastroenteritis has sunken eyes, dry mucous membranes, reduced skin turgor, capillary refill of 3 seconds and is irritable but drinks eagerly. The assessment and management are:

1. No dehydration; home with no treatment
2. Some (moderate) dehydration; oral rehydration solution about 75 mL/kg over 4 hours in small frequent amounts, continuing breastfeeding, with zinc supplementation and reassessment
3. Severe dehydration; immediate intravenous bolus
4. Anti-diarrhoeal medication

Answer: B. Lethargy, inability to drink, absent pulses or capillary refill over 3 seconds with sunken eyes indicate severe dehydration and intravenous resuscitation. Antimotility drugs are not used in children.

Question 7

A child in hypovolaemic shock weighs 20 kg. The initial intravenous fluid bolus is:

1. 5 mL/kg of 5% dextrose
2. 10 to 20 mL/kg of isotonic crystalloid (200 to 400 mL) given rapidly and repeated after reassessment, with caution in cardiac disease and diabetic ketoacidosis
3. 50 mL/kg of colloid
4. Oral fluids only

Answer: B. Dextrose solutions are never used for boluses; a blood glucose is checked in every sick child.

Fever and infection

Question 8

An 18-month-old has a generalised tonic-clonic seizure lasting 3 minutes with a temperature of 39.5 °C and recovers fully within 15 minutes. The nurse's teaching for the parents includes:

1. The child has epilepsy and needs lifelong medication
2. This is a simple febrile seizure, which is common between 6 months and 5 years, does not cause brain damage, and may recur; place the child on the side during a seizure, do not put anything in the mouth, time the seizure and seek help if it lasts over 5 minutes
3. Give aspirin to lower the fever
4. Bathe the child in cold water

Answer: B. Aspirin is avoided in children because of Reye's syndrome; antipyretics do not prevent febrile seizures. The source of fever still needs assessment.

Question 9

Which finding in a febrile 4-month-old requires immediate medical review?

1. A runny nose
2. A bulging fontanelle, non-blanching rash, high-pitched cry, grunting, mottled skin, reduced consciousness or a temperature of 38 °C or more in an infant under 3 months
3. Mild irritability that settles with feeding
4. A temperature of 37.6 °C

Answer: B. Classic meningism (neck stiffness, Kernig's sign) is often absent in infants; a non-blanching rash is treated as meningococcal sepsis until proven otherwise.

Question 10

A child is admitted with suspected measles. The appropriate isolation is:

1. Standard precautions only
2. Airborne precautions in a negative-pressure room with N95 respirators for staff, and only immune staff caring for the child, for 4 days after rash onset
3. Contact precautions only
4. No isolation after the fever settles

Answer: B. Measles, varicella and tuberculosis need airborne precautions; respiratory syncytial virus needs contact and droplet precautions. The infection control set covers the rest.

Respiratory conditions

Question 11

A 4-month-old has three days of coryza, now with wheeze, fine crackles, a respiratory rate of 60, mild subcostal recession, feeding about two thirds of normal and saturations of 93%. The most likely diagnosis and management are:

1. Asthma; nebulised salbutamol and oral steroids
2. Bronchiolitis (usually RSV); supportive care with oxygen if saturations are persistently below 90 to 92%, nasal suction, smaller frequent feeds or nasogastric feeding, and monitoring for apnoea in young infants; bronchodilators, steroids and antibiotics are not routinely effective
3. Pneumonia; intravenous antibiotics
4. Croup; dexamethasone

Answer: B. Feeding below half of normal, apnoea, severe recession, grunting or saturations below 90% indicate admission or escalation.

Question 12

A 2-year-old has a barking cough, hoarse voice and inspiratory stridor at rest with mild recession. The first-line treatment is:

1. Oral antibiotics
2. A single dose of oral dexamethasone (about 0.15 to 0.6 mg/kg), with nebulised adrenaline for moderate to severe stridor and minimal handling to avoid agitation
3. Throat examination with a tongue depressor
4. Cool mist humidifier only

Answer: B. Croup is viral laryngotracheitis; examining the throat can precipitate obstruction in epiglottitis, which presents with drooling, a toxic appearance and no cough.

Question 13

A 7-year-old with known asthma arrives with a respiratory rate of 40, saturations of 90%, too breathless to speak in sentences, using accessory muscles. The nurse's first actions are:

1. Peak flow measurement, then wait for the doctor
2. High-flow oxygen to target saturations of 94 to 98%, salbutamol via spacer (10 puffs) or nebuliser repeated as needed with ipratropium, oral prednisolone or intravenous hydrocortisone, and urgent medical review, escalating if there is a silent chest, cyanosis, exhaustion or confusion
3. Antibiotics
4. Sedation to calm the child

Answer: B. A silent chest and a normal or rising carbon dioxide indicate life-threatening asthma. Discharge teaching covers spacer technique and a written action plan.

Other common conditions

Question 14

A 10-year-old with type 1 diabetes has vomiting, abdominal pain, deep sighing respirations, a blood glucose of 25 mmol/L and ketones of 5 mmol/L. The nurse anticipates:

1. A rapid insulin bolus before any fluids
2. Fluid resuscitation per the diabetic ketoacidosis protocol, then an insulin infusion at 0.05 to 0.1 units/kg/h starting one to two hours after fluids, hourly glucose and neurological observations, potassium replacement, and watching for cerebral oedema (headache, falling heart rate, rising blood pressure, altered consciousness)
3. Oral fluids only
4. Subcutaneous insulin and discharge

Answer: B. Cerebral oedema is the main cause of death in paediatric DKA; insulin boluses and rapid fluid shifts increase the risk. Type 1 diabetes incidence is high in the Gulf.

Question 15

A 6-year-old with sickle cell disease has severe pain in both legs and a temperature of 38.3 °C. The nurse's priorities are:

1. Reassure and give paracetamol only
2. Rapid pain assessment and analgesia within 30 minutes (opioids for severe pain), hydration, oxygen if hypoxic, blood cultures and antibiotics for fever because of functional asplenia, and monitoring for acute chest syndrome and stroke
3. Cold compresses to the legs
4. Withhold opioids because of addiction risk

Answer: B. Sickle cell disease is common in the eastern Saudi Arabia, Bahrain and Oman; undertreated pain is a recognised failing. Cold worsens vaso-occlusion.

Question 16

Which approach to pain assessment is appropriate for a 4-year-old after an appendicectomy?

1. A numerical 0 to 10 scale
2. A self-report faces scale (such as Wong-Baker FACES) from about age 3 to 4, or a behavioural scale (FLACC) if the child cannot self-report, reassessed after analgesia, with non-pharmacological comfort measures and parental involvement
3. Assume no pain if the child is sleeping
4. Ask the parents only

Answer: B. Neonates use scales such as NIPS or PIPP; children in pain may sleep from exhaustion.

Prevention and safety

Question 17

Under the UAE and Saudi national immunisation schedules, which vaccines are typically due at 2 months of age?

1. Measles, mumps and rubella
2. The first doses of a combined DTaP-IPV-Hib-hepatitis B (hexavalent) vaccine, pneumococcal conjugate and rotavirus vaccines
3. Varicella only
4. No vaccines until 6 months

Answer: B. BCG and hepatitis B are given at birth; MMR and varicella start at about 12 months. Schedules differ slightly between authorities, and the nurse checks the national schedule and the child's record.

Question 18

A 3-year-old is brought in with a spiral fracture of the femur; the parents say the child fell from a sofa, and there are bruises of different ages on the back and buttocks. The nurse should:

1. Accept the explanation
2. Recognise indicators of possible non-accidental injury, ensure the child's immediate safety and treatment, document findings objectively and precisely, and report through the hospital's child protection pathway as required by law
3. Confront the parents
4. Discharge quickly

Answer: B. Gulf child protection laws (for example the UAE's Wadeema law) make reporting mandatory for health professionals.

Question 19

Discharge teaching for the parents of an 18-month-old should include which injury-prevention advice most relevant to the Gulf?

1. Allow the child to play unsupervised near pools
2. Constant supervision near water with pool fencing, a rear-facing then forward-facing car seat on every journey (never on a lap in the front seat), hot-surface and scald prevention, medicines and detergents locked away, and never leaving a child in a parked car in the heat
3. Walkers improve safety
4. Honey for coughs in infants

Answer: B. Drowning, road traffic injury and heat-related illness are leading causes of child death in the region; honey is avoided under 12 months because of botulism.

Question 20

A 5-year-old is to receive an intramuscular injection of 1 mL. The preferred site and technique are:

1. The dorsogluteal site with a 2-inch needle
2. The ventrogluteal or deltoid site (vastus lateralis in infants), with age-appropriate preparation, distraction, a parent holding the child comfortably, and topical anaesthetic or sucrose where appropriate
3. The abdomen
4. Restraint by three staff without explanation

Answer: B. The dorsogluteal site is avoided in children because of sciatic nerve risk; atraumatic care reduces needle fear that persists into adulthood.

How to practise

• Learn the age-based normals: vital signs, milestones, weights and fluid requirements.
• Practise calculations until they are automatic: mg/kg doses, syrup volumes, Holliday-Segar, boluses, ORS volumes.
• Know the sick-child red flags and the condition-specific protocols: bronchiolitis, croup, asthma, DKA, sickle crisis, meningitis.

Paediatric chapters with explanations are in the Registered Nurse bank; related sets are the drug calculation questions, medical-surgical questions and general nursing questions. The domain weighting is in the DHA nursing syllabus.

Frequently asked questions

How many paediatric questions are in the Prometric nursing exam?

About 12 to 15 of 150, within the paediatric domain, with newborn care in the maternal and newborn domain.

Which paediatric topics come up most?

Weight-based calculations, dehydration and fluids, respiratory conditions (bronchiolitis, croup, asthma), fever and meningitis signs, immunisation and safeguarding.

Are drug calculations in the paediatric questions?

Yes. Expect at least two or three weight-based dose or fluid calculations.

Do adult-ward nurses get paediatric questions?

Yes. The registered nurse paper covers the whole blueprint regardless of your specialty.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.