Vital Signs Assessment in Pediatric Nursing: Master the Basics

Question 1

Which type of thermometer is commonly used to obtain axillary temperature in children?

Accepted Answer

Digital probe thermometer

Answer

Tympanic thermometer

Answer

Rectal thermometer

Answer

Forehead thermometer

Question 2

Which of the following is NOT a potential sign of respiratory distress in a child?

Accepted Answer

Bradycardia

Answer

Cyanosis

Answer

Tachypnea

Answer

Grunting

Question 3

What is the most common cause of fever in children?

Accepted Answer

Viral infection

Answer

Bacterial infection

Answer

Overheating

Answer

Dehydration

Question 4

A child's pulse is measured at 150 beats per minute. What is the most likely interpretation of this finding?

Accepted Answer

Tachycardia

Answer

Bradycardia

Answer

Normal sinus rhythm

Answer

Ventricular tachycardia

Question 5

When taking the radial pulse of an infant, which technique is appropriate?

Accepted Answer

Use two fingertips.

Answer

Use the back of your hand.

Answer

Use a stethoscope.

Answer

Use three fingertips.

Question 6

When measuring blood pressure in children, which cuff size is recommended?

Accepted Answer

At least 2/3 the length of the upper arm.

Answer

Half the length of the upper arm.

Answer

The same size as the child's wrist.

Answer

Large enough to cover the entire upper arm.

Question 7

Which is a sign of dehydration in children?

Accepted Answer

Sunken eyes

Answer

Increased urination

Answer

Rapid breathing

Answer

Cool, moist skin

Question 8

When assessing vital signs in a restless child, what is the most important step?

Accepted Answer

Try to calm the child first.

Answer

Ignore the child's behavior and take the measurements anyway.

Answer

Ask the parents or guardians to assist.

Answer

Wait until the child is sleeping to take the measurements.

Question 9

Which sound during auscultation of a child's breath sounds indicates wheezing?

Accepted Answer

A high-pitched whistling sound during expiration.

Answer

A low-pitched rumbling sound during inspiration.

Answer

A crackling sound during inspiration.

Answer

A rattling sound during expiration.

Question 10

When measuring temperature in infants, which method provides the most accurate results?

Accepted Answer

Rectal

Answer

Axillary

Answer

Forehead scan

Answer

Tympanic

Question 11

Which pulse rate range is considered normal for a pediatric patient aged 1-3 years?

Accepted Answer

1-3 years

Answer

0-3 months

Answer

3-5 months

Answer

5-1 year

Question 12

Which condition is a contraindication for using a blood pressure cuff on a child?

Accepted Answer

Limb injury

Answer

Skin irritation

Answer

Hypertension

Answer

Fever

Question 13

When measuring blood pressure in a toddler, which position is appropriate?

Accepted Answer

Sitting upright

Answer

Lying down

Answer

Standing

Answer

Kneeling

Question 14

During a vital signs assessment, which situation requires the nurse to consider an ethical concern related to child protection?

Accepted Answer

Observing a suspicious bruise on the child's arm

Answer

Measuring a child's blood pressure with the parent present

Answer

Providing comfort and reassurance to the child during the assessment

Answer

Explaining the procedure to the parent and obtaining consent

Question 15

When auscultating a child's blood pressure, where should the bell of the stethoscope be placed?

Accepted Answer

Brachial artery

Answer

Femoral artery

Answer

Popliteal artery

Answer

Dorsalis pedis artery

Question 16

What is the typical systolic blood pressure range for a healthy child between 4-8 years of age?

Accepted Answer

90 - 110 mmHg

Answer

80 - 100 mmHg

Answer

100 - 120 mmHg

Answer

110 - 130 mmHg

Question 17

Which is the most common underlying cause of fever in children?

Accepted Answer

Infection

Answer

Dehydration

Answer

Inflammatory conditions

Answer

Unknown cause

Question 18

In children over 1 year of age, where is the recommended site to measure blood pressure?

Accepted Answer

Upper arm

Answer

Forearm

Answer

Thigh

Answer

Calf

Question 19

Which of these body sites is the most accurate for obtaining a temperature in children?

Accepted Answer

Rectum

Answer

Axilla

Answer

Groin

Answer

Oral

Question 20

Which factor should not be considered when interpreting a child's respiratory rate?

Accepted Answer

BMI

Answer

Age

Answer

Activity level

Answer

Sleep state

Question 21

When measuring blood pressure in a child, which cuff size should be used for an arm circumference of 18 cm?

Accepted Answer

Pediatric cuff

Answer

Small adult cuff

Answer

Medium adult cuff

Answer

Large adult cuff

Question 22

Which respiratory rate range is outside the normal limits for a resting 5-year-old child?

Accepted Answer

35-40 breaths per minute

Answer

15-25 breaths per minute

Answer

20-30 breaths per minute

Answer

25-35 breaths per minute

Question 23

When using a tympanic thermometer on a child, where should the probe be inserted?

Accepted Answer

Into the auditory canal

Answer

Into the external ear

Answer

In front of the earlobe

Answer

Behind the earlobe

Question 24

Which pulse irregularity could indicate an underlying heart condition?

Accepted Answer

Premature ventricular contractions

Answer

Sinus bradycardia

Answer

Sinus tachycardia

Answer

Regular sinus rhythm

Question 25

When palpating a child's pulse, how should your fingertips be placed?

Accepted Answer

Lightly on the skin

Answer

Firmly on the skin

Answer

Over a bone

Answer

Over a muscle

Question 26

When measuring a child's pulse, the appropriate site for palpation is:

Accepted Answer

Radial artery

Answer

Brachial artery

Answer

Femoral artery

Answer

Popliteal artery

Question 27

For a child with a mid-arm circumference of 18 cm, what blood pressure cuff size is recommended?

Accepted Answer

Large child cuff (15-18 cm)

Answer

Small child cuff (8-12 cm)

Answer

Medium child cuff (12-15 cm)

Answer

Adult cuff (>18 cm)

Question 28

When assessing a child's vital signs, how do healthcare professionals work together to provide the best care?

Accepted Answer

Nurses, doctors, respiratory therapists, and other healthcare professionals work as a team to check vital signs and make decisions about the child's care.

Answer

Nurses check vital signs alone and tell the doctor only if there's a problem.

Answer

Doctors are the only ones who check vital signs and then tell the nurses what to do.

Answer

Only unlicensed assistants, supervised by nurses, are responsible for checking vital signs.

Question 29

In pediatric nursing, why is it essential to use age-specific vital sign ranges? How do these ranges differ from adult ranges?

Accepted Answer

Age-specific ranges consider children's unique physiology, including size, metabolism, and organ development.

Answer

Adult ranges are not suitable for children of any age.

Answer

Age-specific ranges apply only to newborns and infants.

Answer

Age-specific and adult ranges are virtually identical.

Question 30

A 3-year-old child has a pulse rate of 110 beats per minute (bpm). How should the nurse interpret this finding?

Accepted Answer

Normal

Answer

Apnea

Answer

Bradycardia

Answer

Tachycardia

Question 31

Which of the following is an indicator of respiratory distress in an infant?

Accepted Answer

Subcostal retractions

Answer

Cheyne-Stokes respirations

Answer

Hyperventilation

Answer

Orthopnea

Question 32

A 5-year-old child has a blood pressure reading of 100/60 mmHg. How would the nurse classify this measurement?

Accepted Answer

Normal

Answer

Hypotension

Answer

Hypertension

Answer

Prehypertension

Question 33

When selecting a blood pressure cuff for a child, what is the most crucial consideration?

Accepted Answer

Appropriate cuff size

Answer

Cuff brand

Answer

Cuff color

Answer

Cuff material

Question 34

What is the typical respiratory rate range for a 1-year-old child?

Accepted Answer

20-30 breaths per minute

Answer

10-15 breaths per minute

Answer

30-40 breaths per minute

Answer

40-50 breaths per minute

Question 35

What is the recommended method for assessing capillary refill in a child?

Accepted Answer

Press on the nail bed for 5 seconds and observe the time it takes to return to its original color

Answer

Pinch the skin on the back of the hand

Answer

Apply pressure to the forehead

Question 36

Which of the following is a clinical sign of dehydration in a child?

Accepted Answer

Dry mucous membranes

Answer

Edema

Answer

Increased urine output

Answer

Rapid pulse

Question 37

When assessing a child's respirations, the nurse should count the number of breaths per:

Accepted Answer

Minute

Answer

10 seconds

Answer

30 seconds

Answer

Hour

Question 38

What is a normal blood pressure range for a 5-year-old child?

Accepted Answer

90-110/50-70 mm Hg

Answer

100-120/60-80 mm Hg

Answer

80-100/45-65 mm Hg

Answer

110-130/70-90 mm Hg

Question 39

A child is crying while the nurse is preparing to assess their vital signs. What is the nurse's BEST action?

Accepted Answer

Calm the child before taking measurements

Answer

Take the measurements immediately due to the child's distress

Answer

Ask the parents to hold the child still during measurements

Answer

Record the vital signs as "unable to obtain" due to crying

Question 40

When auscultating a child's apical pulse, the nurse should listen for:

Accepted Answer

Apical heart sounds

Answer

Korotkoff sounds

Answer

Respiratory sounds

Answer

Bowel sounds

Question 41

Which technique should a nurse use when assessing a child's respirations?

Accepted Answer

Look, listen, and feel

Answer

Palpation only

Answer

Auscultation only

Answer

Observation only

Question 42

Which temperature-taking method is generally considered the **least** accurate in young children?

Accepted Answer

Axillary

Answer

Tympanic

Answer

Oral

Answer

Rectal

Question 43

A 3-year-old child has a pulse rate of 120 beats per minute. This is considered:

Accepted Answer

Normal

Answer

Bradycardia

Answer

Tachycardia

Question 44

A child's temperature is 101.2°F (38.4°C). This reading would be classified as:

Accepted Answer

Low-grade fever

Answer

High fever

Answer

Normal

Answer

Critical

Question 45

During vital sign assessment, which parameter does **not** directly reflect a child's overall health status?

Accepted Answer

Weight

Answer

Temperature

Answer

Pulse

Answer

Respirations

Question 46

When measuring a child's blood pressure, an inaccurate reading is most likely to occur when:

Accepted Answer

An inappropriately sized cuff is used

Answer

The measurement is not repeated

Answer

The child is not positioned comfortably

Answer

The child is moving or crying

Question 47

For a 5-year-old child, which cuff size is appropriate for blood pressure measurement?

Accepted Answer

A cuff that covers two-thirds of the upper arm

Answer

A cuff that covers the entire upper arm

Answer

Any cuff will suffice

Answer

The smallest cuff available

Question 48

When assessing vital signs on a 2-year-old child, what is the correct order of measurement?

Accepted Answer

Respirations, pulse, temperature, blood pressure

Answer

Temperature, pulse, respirations, blood pressure

Answer

Pulse, respirations, temperature, blood pressure

Answer

Blood pressure, temperature, pulse, respirations

Question 49

A child's temperature is 100.4°F (38°C). What is the appropriate nursing intervention?

Accepted Answer

Monitor the child for other signs and symptoms

Answer

Do nothing, as the temperature is within normal limits

Answer

Call the doctor immediately

Answer

Administer antipyretic medication

Question 50

Which of the following factors can influence a child's blood pressure?

Accepted Answer

All of the above

Answer

Age

Answer

Ethnicity

Answer

Gender

Question 51

You are assessing a 6-month-old infant's vital signs. Which of the following is the most reliable method for obtaining a respiratory rate?

Accepted Answer

Observe abdominal rise and fall

Answer

Place a hand on the chest

Answer

Count chest movements

Answer

Use a stethoscope