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Pediatrics · Pediatric Nursing NCLEX Practice Questions

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Showing all 15 practice questions with expert explanatory rationales.

Question 1 of 15

Case excerpt

During care in a medical unit at 07:20, a 2-year-old with vomiting has dry mucous membranes, no tears, and fewer wet diapers than usual.

Which nursing action is the priority?

A. Permanent tooth eruption
B. Urine output and signs of hydration
C. Pupil color
D. Hair growth
E. Daily shoe size

Expert Explanatory Rationale

Correct Answer: B. Urine output and signs of hydration

Urine output, mucous membranes, tears, capillary refill, and behavior help evaluate pediatric hydration.

Question 2 of 15

Case excerpt

During care in an outpatient clinic at 09:45, a 6-month-old is admitted with bronchiolitis and has nasal congestion that interferes with feeding.

What is the safest response by the nurse?

A. Offer a large bottle rapidly
B. Delay all fluids for 12 hours
C. Give an over-the-counter cough suppressant
D. Place the infant flat
E. Gently clear nasal secretions using the prescribed method

Expert Explanatory Rationale

Correct Answer: E. Gently clear nasal secretions using the prescribed method

Infants are obligate nasal breathers; gentle nasal clearance before feeds can improve breathing and feeding.

Question 3 of 15

Case excerpt

During care in a community health setting at 11:10, a child with a fever has a generalized seizure lasting about one minute and is now drowsy.

Which intervention should the nurse implement first?

A. Place a spoon in the mouth
B. Protect the child from injury and maintain a safe side-lying position
C. Attempt to force the jaw open
D. Restrain the child's arms and legs
E. Offer oral medication during the seizure

Expert Explanatory Rationale

Correct Answer: B. Protect the child from injury and maintain a safe side-lying position

During a seizure, protect from injury, position to support airway drainage, time the event, and do not place objects in the mouth.

Question 4 of 15

Case excerpt

During care in an acute-care unit at 13:35, a school-age child with type 1 diabetes is pale, shaky, and sweaty before lunch and is alert enough to swallow.

How should the nurse respond to this finding?

A. Encourage exercise
B. Administer the scheduled insulin immediately
C. Withhold all carbohydrate
D. Check blood glucose and give rapid-acting carbohydrate if hypoglycemia is confirmed or strongly suspected per protocol
E. Give a long-acting insulin dose

Expert Explanatory Rationale

Correct Answer: D. Check blood glucose and give rapid-acting carbohydrate if hypoglycemia is confirmed or strongly suspected per protocol

Symptoms suggest hypoglycemia. Follow the child's emergency plan, check glucose when feasible, and treat promptly with fast-acting carbohydrate if safe to swallow.

Question 5 of 15

Case excerpt

During care in a rehabilitation unit at 15:50, a 4-year-old is scheduled for an unfamiliar procedure and asks whether it will hurt.

Which action best protects the patient?

A. Give a simple, honest explanation using words the child understands
B. Provide a detailed technical explanation
C. Tell the child to behave or the procedure will be worse
D. Ignore the question
E. Promise that it will not hurt at all

Expert Explanatory Rationale

Correct Answer: A. Give a simple, honest explanation using words the child understands

Preschool children benefit from concrete, honest explanations and preparation close to the procedure.

Question 6 of 15

Case excerpt

During care in a specialty care unit at 18:15, a 3-month-old has a rectal temperature of 38.2°C (100.8°F).

Which nursing action is the priority?

A. Arrange prompt medical evaluation according to the young-infant fever protocol
B. Give aspirin at home
C. Use an ice bath
D. Reassure the caregiver that fever is expected
E. Wait several days before reporting it

Expert Explanatory Rationale

Correct Answer: A. Arrange prompt medical evaluation according to the young-infant fever protocol

Fever in a young infant requires prompt evaluation because serious infection may present with few other signs.

Question 7 of 15

Case excerpt

During care in a medical unit at 21:05, a child with asthma is using accessory muscles and can speak only a few words at a time.

What is the safest response by the nurse?

A. Use a paper bag for breathing
B. Offer a large meal
C. Delay treatment until peak flow is recorded
D. Initiate the prescribed rescue treatment and urgently escalate respiratory distress
E. Encourage the child to lie flat

Expert Explanatory Rationale

Correct Answer: D. Initiate the prescribed rescue treatment and urgently escalate respiratory distress

Severe work of breathing and limited speech signal a potentially severe exacerbation requiring immediate treatment and escalation.

Question 8 of 15

Case excerpt

During care in an outpatient clinic at 07:20, a toddler is admitted with suspected epiglottitis, drooling, and a tripod position.

Which intervention should the nurse implement first?

A. Allowing the child to remain in a position of comfort
B. Keeping emergency airway support available
C. Minimizing agitation
D. Inspecting the throat with a tongue blade
E. Summoning the appropriate airway team

Expert Explanatory Rationale

Correct Answer: D. Inspecting the throat with a tongue blade

Throat inspection can precipitate complete airway obstruction. Keep the child calm and prepare for expert airway management.

Question 9 of 15

Case excerpt

During care in a community health setting at 09:45, a child with acute diarrhea is prescribed oral rehydration solution.

Which nursing actions are appropriate? (Select all that apply)

A. Document objective findings, actions taken, and the patient's response
B. Give a large volume all at once
C. Replace it with undiluted juice
D. Delay follow-up until the end of the shift even if the condition is worsening
E. Reassess the patient after the intervention and compare findings with the baseline
F. Escalate promptly if the patient's condition worsens or remains outside the expected range
G. Offer small, frequent amounts and increase as tolerated

Expert Explanatory Rationale

Correct Answer: A. Document objective findings, actions taken, and the patient's response; E. Reassess the patient after the intervention and compare findings with the baseline; F. Escalate promptly if the patient's condition worsens or remains outside the expected range; G. Offer small, frequent amounts and increase as tolerated

Small frequent amounts of oral rehydration solution are often better tolerated and replace water and electrolytes appropriately. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 10 of 15

Case excerpt

During care in an acute-care unit at 11:10, a 5-year-old is admitted with a suspected fracture and reports increasing pain despite immobilization.

Which nursing actions are appropriate? (Select all that apply)

A. Escalate promptly if the patient's condition worsens or remains outside the expected range
B. Document objective findings, actions taken, and the patient's response
C. Increasing pain with numbness or coolness distal to the injury
D. A request for a favorite toy
E. Reassess the patient after the intervention and compare findings with the baseline
F. Mild anxiety about the cast
G. Delay follow-up until the end of the shift even if the condition is worsening

Expert Explanatory Rationale

Correct Answer: A. Escalate promptly if the patient's condition worsens or remains outside the expected range; B. Document objective findings, actions taken, and the patient's response; C. Increasing pain with numbness or coolness distal to the injury; E. Reassess the patient after the intervention and compare findings with the baseline

Increasing pain, paresthesia, pallor, coolness, or impaired movement may indicate neurovascular compromise or compartment syndrome. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 11 of 15

Case excerpt

During care in a rehabilitation unit at 13:35, a caregiver asks how to reduce the risk of sudden unexpected infant death.

Which nursing actions are appropriate? (Select all that apply)

A. Place the infant prone after every feeding
B. Use pillows to support the infant
C. Place the infant supine on a firm, flat sleep surface without loose bedding
D. Reassess the patient after the intervention and compare findings with the baseline
E. Delay follow-up until the end of the shift even if the condition is worsening
F. Document objective findings, actions taken, and the patient's response
G. Escalate promptly if the patient's condition worsens or remains outside the expected range

Expert Explanatory Rationale

Correct Answer: C. Place the infant supine on a firm, flat sleep surface without loose bedding; D. Reassess the patient after the intervention and compare findings with the baseline; F. Document objective findings, actions taken, and the patient's response; G. Escalate promptly if the patient's condition worsens or remains outside the expected range

A supine position on a firm, flat, separate sleep surface without soft objects reduces sleep-related infant death risk. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 12 of 15

Case excerpt

During care in a specialty care unit at 15:50, a child is prescribed an oral liquid medication. The caregiver plans to use a kitchen teaspoon.

Which nursing actions are appropriate? (Select all that apply)

A. Estimate the dose by bottle level
B. Escalate promptly if the patient's condition worsens or remains outside the expected range
C. Measure the dose with an oral syringe or calibrated medication device
D. Use any household spoon
E. Delay follow-up until the end of the shift even if the condition is worsening
F. Document objective findings, actions taken, and the patient's response
G. Reassess the patient after the intervention and compare findings with the baseline

Expert Explanatory Rationale

Correct Answer: B. Escalate promptly if the patient's condition worsens or remains outside the expected range; C. Measure the dose with an oral syringe or calibrated medication device; F. Document objective findings, actions taken, and the patient's response; G. Reassess the patient after the intervention and compare findings with the baseline

A calibrated oral syringe or medication cup provides more accurate dosing than household spoons. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 13 of 15

Case excerpt

During care in a medical unit at 18:15, a child with a peanut allergy develops hives, wheezing, and lip swelling after eating a snack.

Which nursing actions are appropriate? (Select all that apply)

A. Document objective findings, actions taken, and the patient's response
B. Intramuscular epinephrine
C. Delay follow-up until the end of the shift even if the condition is worsening
D. Oral antihistamine as the only treatment
E. Reassess the patient after the intervention and compare findings with the baseline
F. Escalate promptly if the patient's condition worsens or remains outside the expected range
G. Inhaled saline

Expert Explanatory Rationale

Correct Answer: A. Document objective findings, actions taken, and the patient's response; B. Intramuscular epinephrine; E. Reassess the patient after the intervention and compare findings with the baseline; F. Escalate promptly if the patient's condition worsens or remains outside the expected range

Respiratory symptoms and swelling suggest anaphylaxis. Epinephrine is first-line; activate emergency response and support airway and circulation. Reassessment, accurate documentation, and timely escalation support safe, coordinated care.

Question 14 of 15

Case excerpt

A prescribed IV infusion contains 480 mL and must run evenly over 8 hours. The patient is receiving care related to pediatrics.

What rate should the nurse program in mL/hr? Enter the number only.

Expert Explanatory Rationale

Correct Answer: 60

Calculate volume divided by time: 480 mL ÷ 8 hr = 60 mL/hr. Verify the prescription, pump settings, and patient response.

Question 15 of 15

Case excerpt

The nurse is completing a safe nursing care sequence for a patient receiving pediatrics care.

Place the nursing actions in the safest order.

A. Verify the patient's identity, explain the planned care, and assess current status
B. Gather the required equipment and confirm that it is functioning
C. Perform the intervention using the prescribed procedure and appropriate safety measures
D. Reassess the patient and evaluate the response
E. Document the findings, intervention, and outcome

Expert Explanatory Rationale

Correct Answer: A. Verify the patient's identity, explain the planned care, and assess current status; B. Gather the required equipment and confirm that it is functioning; C. Perform the intervention using the prescribed procedure and appropriate safety measures; D. Reassess the patient and evaluate the response; E. Document the findings, intervention, and outcome

The nurse first verifies identity and assesses the patient, prepares equipment, performs the intervention safely, reassesses the response, and documents the care.

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