Writing a paediatric nursing care plan and answering child health multiple-choice questions (MCQs) requires a different mental model than adult nursing. Children are not miniature adults. Their anatomical proportions, physiological reserves, and developmental stages fundamentally alter how clinical problems present and how interventions must be ordered. Try free NMCN past/practice question.
When preparing for qualifying examinations under the Nursing and Midwifery Council of Nigeria (NMCN), candidates must demonstrate competence in managing both acute conditions and developmental considerations. While broad exam strategies are outlined in general study overviews—such as our general NMCN preparation guides—this guide focuses specifically on structuring paediatric care plans and dissecting paediatric multiple-choice questions.
Key Differences in Paediatric Care Plans
A care plan written for an adult focuses heavily on individual autonomy, patient education, and self-management. In paediatric nursing, three unique dimensions shift the entire framework:
- Family-centred care: Interventions must account for the primary caregiver. The child cannot be isolated from the parent or guardian, who provides historical data, comfort, and direct bedside support.
- Developmental assessment: Expected outcomes must align with the child's age group—neonate, infant, toddler, preschooler, school-aged child, or adolescent. An outcome that is normal for an eight-year-old might represent severe delay or crisis in an eighteen-month-old.
- Atraumatic care: Interventions must minimise physical distress and psychological trauma. This includes using treatment rooms rather than the child's hospital bed for painful procedures, and employing age-appropriate distraction.
The Five-Column Structure for Paediatric Care
Most nursing programmes in Nigeria require a standard five-phase format: Assessment, Nursing Diagnosis, Planning (Goals/Expected Outcomes), Implementation (Nursing Interventions), and Evaluation. Here is how each stage should be framed specifically for paediatric cases.
1. Assessment
Paediatric assessment combines subjective reporting from the caregiver with objective observations from the nurse. Because young children may not verbalise their pain or nausea, your objective assessment takes centre stage:
- Subjective data: Caregiver reports regarding appetite, fluid intake, changes in play behaviour, wet diapers per day, and sleeping patterns.
- Objective data: Age-specific vital signs, hydration indicators (fontanelle tension, skin turgor, mucous membranes, presence of tears), respiratory effort (nasal flaring, chest indrawing, grunting), and validated paediatric pain scores (such as the FLACC scale for non-verbal children or the Wong-Baker FACES scale for verbal young children).
2. Nursing Diagnosis
Diagnoses should follow standard nursing taxonomy (such as NANDA-I formulations), pairing the human response with an identifiable etiology and supporting symptoms. Common paediatric diagnoses include:
- Deficient Fluid Volume related to active fluid loss via diarrhoea and vomiting, as evidenced by sunken anterior fontanelle, delayed capillary refill, and dry oral mucosa.
- Ineffective Airway Clearance related to excessive, tenacious bronchial secretions and bronchospasm, as evidenced by wheezing, tachypnoea, and intercostal retractions.
- Hyperthermia related to viral or bacterial infection, as evidenced by elevated core temperature, flushed skin, and tachycardia.
3. Planning and Expected Outcomes
Outcomes must be measurable, realistic, and time-bound. Avoid vague statements like "the child will feel better." Instead, specify measurable physiological indicators:
- "The infant will produce at least 1 to 2 mL/kg/hour of urine within 12 hours of rehydration therapy."
- "The child's respiratory rate will return to baseline range (30 to 40 breaths per minute) within 4 hours following nebulisation and oxygen delivery."
4. Implementation
Interventions must clearly explain the nursing action, the frequency, and the rationale. Never write "administer prescribed medications" without specifying the nursing safeguards around paediatric delivery. Interventions should reflect weight-based considerations, position of comfort (often on the caregiver's lap), and atraumatic techniques.
5. Evaluation
Evaluation assesses whether the measurable outcome was met, partially met, or not met, followed by the next clinical decision. For example: "Outcome met: Infant's skin turgor is elastic, anterior fontanelle is flat and soft, and urine output reached 1.5 mL/kg/hour over the last 8 hours. Continue maintenance fluids as charted."
Sample Clinical Scenarios and Care Plan Frameworks
In hospital wards and practical assessments, certain paediatric presentations recur consistently. The table below outlines core interventions for four conditions frequently encountered in clinical rotations and exams.
| Condition | Priority Nursing Problem | Key Nursing Interventions |
|---|---|---|
| Acute Gastroenteritis | Fluid and electrolyte deficit | Assess hydration status; administer oral rehydration salts (ORS) slowly via spoon or syringe; maintain strict intake and output chart; weigh daily on the same scales. |
| Bronchopneumonia | Impaired gas exchange / Ineffective airway clearance | Place child in semi-Fowler's position or on parent's chest; administer humidified oxygen as ordered; perform gentle suctioning if secretions block nares; monitor oxygen saturation continuously. |
| Severe Malaria with Febrile Convulsion | Risk for trauma / Hyperthermia | Maintain clear airway; turn child to lateral position; do not force objects into mouth; expose clothing and tepid sponge with room-temperature water; monitor seizure duration. |
| Severe Acute Malnutrition (SAM) | Imbalanced nutrition / Risk for hypothermia | Prevent hypothermia by keeping warm; introduce low-osmolarity feeds slowly to avoid refeeding syndrome; monitor for oedema and hypoglycemia; support breastfeeding where applicable. |
Mastering Paediatric MCQs
Multiple-choice questions in child health nursing evaluate critical thinking rather than simple recall. Exam questions published by professional bodies like the NMCN frequently use case vignettes that require you to identify the priority action among four plausible options.
The Rule of Paediatric Airway and Dehydration
When assessing MCQ options, keep two physiological principles at the front of your mind:
- Airway compromise develops rapidly: A child's airway is narrower, the tongue is proportionately larger, and the trachea is more compliant than an adult's. Signs of respiratory distress (such as stridor or subcostal recession) almost always take priority over routine tasks.
- Fluid loss is critical: Children have a higher percentage of extracellular fluid and a higher metabolic rate than adults. A child with severe diarrhoea can progress to hypovolaemic shock far faster than an adult with the same fluid output.
Representative Practice Questions and Rationales
The following questions represent standard revision concepts used to test clinical judgment. Note that these are educational practice items designed to illustrate test-taking principles, not actual or leaked examination papers.
Practice Question 1:
A 9-month-old infant is brought to the emergency paediatric unit with a 2-day history of watery diarrhoea. On assessment, the infant has sunken eyes, a deeply sunken anterior fontanelle, skin pinch that retracts very slowly (greater than 2 seconds), and is lethargic. Which nursing action is the immediate priority?
- A. Offer 100 mL of Oral Rehydration Solution via cup and spoon.
- B. Secure intravenous access and initiate rapid fluid resuscitation as prescribed.
- C. Check the infant's stool for blood and parasitic ova.
- D. Educate the mother on hygienic preparation of complementary feeds.
Correct Answer: B. Lethargy, deeply sunken eyes, and very slow skin pinch indicate severe dehydration according to standard clinical classifications. In severe dehydration, the patient requires immediate intravenous fluids to prevent hypovolaemic shock. Oral rehydration (A) is appropriate for mild to moderate dehydration, while diagnostic tests (C) and parental education (D) are non-urgent steps to take once perfusion is restored.
Practice Question 2:
A 3-year-old child admitted with severe pneumonia becomes restless and irritable. The pulse rate is 148 beats per minute, respiratory rate is 58 breaths per minute, and mild intercostal retractions are visible. What is the most accurate clinical interpretation of this change?
- A. The child is exhibiting normal separation anxiety from the parents.
- B. The child is showing early signs of hypoxaemia and respiratory fatigue.
- C. The child's fever is resolving, leading to increased physical activity.
- D. The child is experiencing a paradoxical reaction to prescribed antibiotics.
Correct Answer: B. In paediatric patients, restlessness, irritability, tachycardia, and tachypnoea are classic early signs of inadequate tissue oxygenation. Waiting for cyanosis or lethargy means waiting for late, decompensated respiratory failure. An experienced nurse recognises behavioural agitation as a sign of physiological stress.
Practice Question 3:
When assessing pain in an 11-month-old infant after surgical repair of an umbilical hernia, which tool is most appropriate for the nurse to use?
- A. Numerical Rating Scale (0 to 10)
- B. FLACC Scale (Face, Legs, Activity, Cry, Consolability)
- C. Visual Analogue Scale
- D. Wong-Baker FACES Scale
Correct Answer: B. The FLACC scale is an observational tool validated for infants and young children who cannot self-report pain. The Numerical Rating Scale (A) and Visual Analogue Scale (C) require abstract numerical reasoning found in older children and adults. The Wong-Baker FACES scale (D) requires the child to understand and choose a face depicting their emotional state, which is suitable for children aged 3 years and above.
Common Mistakes to Avoid in Exams
Examiners routinely report specific pitfalls when grading paediatric papers. Keeping these errors in mind will strengthen both your written plans and your MCQ choices:
- Applying adult normal ranges: Stating that a respiratory rate of 35 breaths per minute in a six-month-old is "tachypnoea" is incorrect. Always review and memorize age-specific baseline vitals.
- Treating the child in isolation: Forgetting to document parental presence, caregiver teaching, or maternal emotional support in the care plan loses marks in professional examinations.
- Choosing passive over active options: In MCQs, when an assessment indicates acute compromise, choosing an answer that says "document findings and re-evaluate in 2 hours" is almost always incorrect. Immediate clinical interventions or rapid escalation are required.
- Misidentifying dehydration categories: Distinguish clearly between "some dehydration" (manageable with oral solutions under observation) and "severe dehydration" (requiring urgent intravenous lines and shock management).
Frequently Asked Questions
Are NANDA diagnoses strictly required in paediatric care plans?
This depends on your specific training institution and the exam guidelines issued by the regulatory body. Most Nigerian nursing faculties and hospital schools require standard nursing diagnoses that follow an approved taxonomy. Always confirm your institution's approved care plan format prior to your examination.
How should developmental milestones be incorporated into care plans?
Developmental stages should influence your expected outcomes and interventions. For instance, when caring for an immobilized toddler, your care plan should include interventions that prevent developmental regression, such as providing toys suited for gross or fine motor play that can be safely used in bed.
What is the best way to revise paediatric drug dosages alongside care plans?
Paediatric interventions frequently involve medications calculated by body weight (mg/kg) or body surface area. Review paediatric pharmacology as an integrated component of care planning rather than a separate subject, ensuring you double-check calculation safe ranges before drafting medication interventions.
To deepen your revision across other clinical areas, consult your school's curriculum materials, review past marking schemes, and reference the official guidelines provided by the Nursing and Midwifery Council of Nigeria.