11 original SNLE questions on pediatric medical, each with an explanation for all four options. Part of Maternal-Child Nursing, worth 30% of the Saudi Nursing Licensure Examination.
Q01 / 10medium0 correct
Maternal-Child Nursingmediumq011
A nurse is teaching parents of a healthy 2-month-old infant about safe sleep. Which statement by a parent indicates that teaching has been effective?
All 11 questions
Every question below, with the reasoning for all four options. Try to answer before you open one.
Pediatric medical · medium
A nurse is teaching parents of a healthy 2-month-old infant about safe sleep. Which statement by a parent indicates that teaching has been effective?
AI will put my baby to sleep on his side so he does not choke if he spits up
BI will use a soft quilt and a wedge to keep my baby comfortable and in position
CI will place my baby on his back on a firm flat surface with no pillows or bumpers
DI will let my baby sleep in our bed so I can feed him more easily at night
Show the answer and why the others fail
Answer: C. I will place my baby on his back on a firm flat surface with no pillows or bumpers
A
Side sleeping is unstable and increases the risk of rolling prone. Healthy infants have intact airway protective reflexes when supine and do not have increased aspiration risk.
B
Soft bedding and positioning devices are associated with suffocation and are specifically advised against.
C — correct
Supine positioning on a firm, flat, separate sleep surface free of soft bedding is the evidence-based recommendation to reduce sudden infant death syndrome risk.
D
Bed-sharing increases risk of suffocation and sudden infant death. Room-sharing on a separate sleep surface is the recommended alternative.
TakeawaySafe infant sleep: supine, firm flat separate surface, nothing soft in the sleep space, room-share but do not bed-share.
Pediatric medical · hard
A 4-year-old is admitted with epiglottitis. The child is sitting upright, leaning forward, drooling, and has inspiratory stridor. Which action must the nurse avoid?
AAdministering humidified oxygen without upsetting the child
BEnsuring emergency airway equipment is immediately available at the bedside
CKeeping the child in the position of comfort on the parent's lap
DInspecting the throat with a tongue depressor to visualize the epiglottis
Show the answer and why the others fail
Answer: D. Inspecting the throat with a tongue depressor to visualize the epiglottis
A
This is appropriate supportive care, provided it does not agitate the child.
B
This is essential preparation, since these children can obstruct abruptly.
C
This is correct care — the upright tripod position maximizes airway patency, and keeping the child calm with a parent prevents agitation-induced obstruction.
D — correct
Examining the pharynx in suspected epiglottitis can trigger laryngospasm and complete airway obstruction. Direct visualization is performed only by skilled personnel in a setting prepared for immediate intubation.
TakeawayNever inspect the throat or place anything in the mouth of a child with suspected epiglottitis — keep them calm, upright, and near airway equipment.
Pediatric medical · medium
A 6-year-old child with a history of asthma is brought to the emergency department with increased work of breathing. The nurse assesses the child. Which finding indicates the child is in the early stage of respiratory distress?
ADecreased breath sounds and silent chest
BBradycardia and hypotension
CCyanosis of the lips and nail beds
DTachypnea and wheezing without retractions
Show the answer and why the others fail
Answer: D. Tachypnea and wheezing without retractions
A
Decreased breath sounds and silent chest are late signs indicating severe airway obstruction and impending respiratory failure.
B
Bradycardia and hypotension are late, pre-arrest signs; early respiratory distress typically presents with tachycardia due to sympathetic stimulation.
C
Cyanosis is a late sign of hypoxemia and indicates severe respiratory compromise.
D — correct
Tachypnea and wheezing without accessory muscle use are early signs of mild respiratory distress, reflecting increased work of breathing to overcome airway resistance and maintain ventilation.
TakeawayEarly signs of respiratory distress in children include tachypnea and wheezing; retractions, nasal flaring, and grunting indicate moderate distress, while cyanosis, decreased breath sounds, and bradycardia are late signs.
Pediatric medical · medium
A 6-month-old infant is admitted with bronchiolitis. The nurse notes nasal flaring, intercostal retractions, and an oxygen saturation of 92% on room air. Which intervention should the nurse perform first?
AApply oxygen via nasal cannula.
BSuction the nasopharynx.
CAdminister a bronchodilator via nebulizer.
DInitiate chest physiotherapy.
Show the answer and why the others fail
Answer: B. Suction the nasopharynx.
A
Supplemental oxygen is indicated for saturations persistently below 90%. At 92%, the priority is to clear secretions that may be causing increased work of breathing; suctioning addresses the underlying obstruction and may improve oxygenation without the need for supplemental oxygen.
B — correct
Infants are obligate nasal breathers, and in bronchiolitis, mucus and edema obstruct the nasal passages. Suctioning clears the airway, reduces work of breathing, and may improve oxygenation, making it the priority intervention among the listed options.
C
Bronchodilators are not routinely recommended for bronchiolitis as they have not been shown to improve outcomes in most infants and are not the first-line intervention for respiratory distress in this condition.
D
Chest physiotherapy is not recommended for bronchiolitis as it does not improve clinical outcomes and may cause unnecessary distress to the infant.
TakeawayIn infants with bronchiolitis, nasopharyngeal suctioning is a priority intervention to clear secretions and relieve airway obstruction, as infants are obligate nasal breathers. Oxygen is reserved for saturations persistently below 90%.
Pediatric medical · medium
A 7-year-old child with a history of asthma presents to the emergency department with audible wheezing, tachypnea, and intercostal retractions. The child is able to speak in short phrases. Oxygen saturation is 93% on room air. Which intervention should the nurse implement first?
AAdminister oral prednisolone as prescribed.
BObtain a peak expiratory flow rate measurement.
CAdminister supplemental oxygen via nasal cannula.
DAdminister inhaled albuterol via metered-dose inhaler with spacer.
Show the answer and why the others fail
Answer: D. Administer inhaled albuterol via metered-dose inhaler with spacer.
A
Systemic corticosteroids are recommended for moderate to severe asthma exacerbations but have a delayed onset of action (hours). They are not the first-line intervention for immediate bronchodilation.
B
Peak flow measurement is useful for assessing severity and monitoring response to treatment, but it should not delay the administration of bronchodilator therapy in a symptomatic child.
C
Supplemental oxygen is indicated for hypoxemia (SpO2 < 90%). With an oxygen saturation of 93%, oxygen is not the immediate priority; bronchodilator therapy takes precedence.
D — correct
Inhaled short-acting beta-agonists (e.g., albuterol) are the first-line treatment for acute asthma exacerbations to achieve rapid bronchodilation. The child's presentation indicates moderate distress, and prompt bronchodilator therapy is the priority.
TakeawayIn acute asthma exacerbations, inhaled short-acting beta-agonists are the first-line intervention for rapid bronchodilation. Supplemental oxygen is reserved for SpO2 < 90%.
Pediatric medical · medium
A 4-year-old child is admitted with periorbital and peripheral edema. Laboratory results show urine protein 4+ on dipstick and serum albumin 1.8 g/dL (normal 3.5–5.0 g/dL). Which additional finding should the nurse anticipate?
AElevated blood pressure
BHyperlipidemia
CIncreased serum creatinine
DGross hematuria
Show the answer and why the others fail
Answer: B. Hyperlipidemia
A
Elevated blood pressure is not a typical finding in nephrotic syndrome; blood pressure is usually normal. Hypertension is more characteristic of nephritic syndrome.
B — correct
Hyperlipidemia is a common associated finding in nephrotic syndrome, resulting from both increased hepatic lipoprotein synthesis and decreased lipid clearance due to urinary loss of regulatory proteins.
C
Serum creatinine is usually normal in uncomplicated nephrotic syndrome. An elevation would suggest acute kidney injury, which is not a primary feature of this condition.
D
Gross hematuria is a hallmark of nephritic syndrome. In nephrotic syndrome, urine may appear frothy from high protein content but is typically normal in color.
TakeawayNephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, and edema. Hyperlipidemia is a common associated finding due to altered lipid metabolism. Blood pressure is typically normal, and urine is frothy but not grossly bloody.
Pediatric medical · medium
A 9-month-old infant is brought to the emergency department with a 12-hour history of sudden, intermittent episodes of crying and drawing up the knees. The mother reports two episodes of vomiting and a stool mixed with blood and mucus. On examination, the infant is lethargic and a sausage-shaped mass is palpated in the right upper quadrant. Which of the following is the most likely diagnosis?
AMeckel's diverticulum
BPyloric stenosis
CIntussusception
DAppendicitis
Show the answer and why the others fail
Answer: C. Intussusception
A
Meckel's diverticulum usually presents with painless rectal bleeding in children under 2 years, without the colicky pain, vomiting, or palpable abdominal mass described here.
B
Pyloric stenosis typically presents in infants 2–8 weeks old with projectile non-bilious vomiting, visible gastric peristalsis, and an olive-shaped mass in the epigastrium, not with colicky pain, currant jelly stools, or a right upper quadrant mass.
C — correct
Intussusception is the most common cause of intestinal obstruction in infants and toddlers aged 6 months to 3 years. The classic triad includes intermittent colicky abdominal pain, currant jelly stools (blood and mucus), and a sausage-shaped mass in the right upper quadrant, matching this presentation.
D
Appendicitis is rare in infants and typically presents with fever, anorexia, and localized right lower quadrant pain with guarding, not with currant jelly stools or a palpable mass in the right upper quadrant.
TakeawayIntussusception is the most common cause of intestinal obstruction in infants and toddlers aged 6 months to 3 years, presenting with intermittent colicky pain, currant jelly stools, and a sausage-shaped mass.
Pediatric medical · medium
A 2-year-old child is brought to the emergency department with a barking cough and inspiratory stridor that is present only when the child is agitated. The child is alert, has a temperature of 38°C (100.4°F), and mild suprasternal retractions. What is the priority nursing intervention?
APrepare for endotracheal intubation
BAdminister a single dose of oral dexamethasone
CAdminister nebulized racemic epinephrine
DProvide cool mist therapy to the child
Show the answer and why the others fail
Answer: B. Administer a single dose of oral dexamethasone
A
Intubation is reserved for severe croup with impending respiratory failure, not for a child with mild retractions and alertness.
B — correct
Corticosteroids are the first-line treatment for croup of any severity, reducing airway edema and symptom severity.
C
Nebulized epinephrine is reserved for moderate-to-severe croup with stridor at rest; it is not indicated for mild croup where stridor occurs only with agitation.
D
Current evidence shows no significant benefit of cool mist therapy over placebo, and it is not routinely recommended.
TakeawayFor mild croup (stridor only with agitation), the priority intervention is a single dose of oral dexamethasone to reduce airway edema and prevent progression.
Pediatric medical · medium
A 15-month-old child is brought to the clinic with a 2-day history of pulling at the right ear and a low-grade fever of 38.2°C (100.8°F). The child is active, eating well, and has no history of recurrent ear infections. On examination, the right tympanic membrane is erythematous and bulging with decreased mobility; the left ear is normal. The parents are reliable and express a strong preference to avoid antibiotics if it is safe to do so. What is the most appropriate nursing action?
AEducate the parents about watchful waiting with pain management and arrange follow-up in 48–72 hours.
BInstruct the parents to start the child on oral amoxicillin as initial therapy.
CRefer the child to an otolaryngologist for immediate tympanostomy tube placement.
DRecommend the parents apply topical antibiotic ear drops to the affected ear for 7 days.
Show the answer and why the others fail
Answer: A. Educate the parents about watchful waiting with pain management and arrange follow-up in 48–72 hours.
A — correct
Current guidelines support observation with pain control for children 6–23 months with unilateral, non-severe AOM when parents are reliable and prefer to avoid antibiotics. The nurse's role is to provide education and ensure timely re-evaluation.
B
Antibiotics are not routinely indicated for unilateral, non-severe AOM in children over 6 months when watchful waiting is an option. Additionally, the nurse cannot independently initiate antibiotic therapy without a provider order.
C
Tympanostomy tubes are reserved for recurrent AOM or persistent effusion with hearing loss, not a first episode. Immediate referral is not indicated and is not an appropriate initial nursing action.
D
Topical antibiotic drops are ineffective for AOM with an intact tympanic membrane and are not a recommended nursing intervention; they are used for otitis externa or tympanostomy tube otorrhea.
TakeawayFor children 6–23 months with unilateral, non-severe AOM and reliable parents who prefer to avoid antibiotics, the nurse's role is to educate about watchful waiting with pain management and ensure close follow-up, supporting antimicrobial stewardship and shared decision-making.
Pediatric medical · medium
A 2-year-old child is brought to the clinic with a 2-day history of watery diarrhea and occasional vomiting. The child is alert, has moist mucous membranes, and is tolerating small sips of oral rehydration solution. The mother asks when she can resume the child's normal diet. Which response by the nurse is most appropriate?
AGive diluted formula for the next 24 hours, then return to full-strength formula.
BStart with the BRAT diet (bananas, rice, applesauce, toast) for the next 48 hours before resuming regular foods.
CResume the child's usual age-appropriate diet as soon as rehydration is completed.
DContinue clear liquids for 24 hours after vomiting stops, then gradually reintroduce solid foods.
Show the answer and why the others fail
Answer: C. Resume the child's usual age-appropriate diet as soon as rehydration is completed.
A
Diluting formula provides inadequate nutrition and can prolong diarrhea. Full-strength formula should be resumed as soon as rehydration is achieved.
B
The BRAT diet is restrictive and lacks adequate protein, fat, and calories. It is no longer recommended for management of acute gastroenteritis.
C — correct
Current evidence supports early refeeding with a normal diet to promote gut healing and provide necessary nutrients. This approach reduces the duration and severity of diarrhea.
D
Prolonged clear liquids delay nutritional recovery and are not recommended. Once rehydration is achieved, an age-appropriate diet should be resumed promptly.
TakeawayAfter rehydration in acute gastroenteritis, resume an age-appropriate unrestricted diet immediately to promote gut recovery and prevent malnutrition.
Pediatric medical · easy
A 2-year-old child is brought to the emergency department after experiencing a 2-minute generalized tonic-clonic seizure at home. The parent reports the child had a fever of 39°C (102.2°F) before the seizure. The child is now alert and playful. The parent asks what to do if another seizure occurs. Which instruction should the nurse provide?
ARestrain the child's arms and legs to prevent injury.
BPlace the child on their side and ensure the area is safe.
CInsert a padded tongue depressor between the teeth to prevent tongue biting.
DAdminister ibuprofen immediately to lower the fever.
Show the answer and why the others fail
Answer: B. Place the child on their side and ensure the area is safe.
A
Restraining the child during a seizure can cause injury and does not stop the seizure activity. The child should be allowed to move freely while being protected from environmental hazards.
B — correct
During a seizure, the priority is to maintain a patent airway and prevent injury. Placing the child on their side helps prevent aspiration, and clearing the area of dangerous objects reduces injury risk.
C
Inserting any object into the mouth during a seizure can cause dental injury, airway obstruction, or soft tissue damage, and does not effectively prevent tongue biting. The priority is to protect the child from environmental hazards without interfering with the seizure.
D
Antipyretics are not given during a seizure because the child cannot safely swallow, and they do not stop an ongoing seizure. Fever management is appropriate after the seizure ends.
TakeawayDuring a febrile seizure, place the child on their side, clear the area of dangerous objects, and do not restrain or put anything in the mouth.