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Pediatrics NCLEX practice questions
Pediatric questions mix growth and development, immunizations and emergencies where children decompensate fast. Practice spotting the red flag.
Question 1 · Physiological Adaptation
A 4-year-old is brought to the emergency department with a fever of 104°F (40°C), drooling, and sitting upright leaning forward with the chin thrust out (tripod position). The nurse suspects epiglottitis. Which action should the nurse avoid?
Show answer and rationale
Answer: A. Inspecting the throat or using a tongue depressor in a child with suspected epiglottitis can trigger laryngospasm and complete airway obstruction, so this must never be done outside a controlled setting with airway equipment ready. Administering oxygen, preparing for intubation, and keeping the child calm with the caregiver are all appropriate because agitation and crying can worsen airway swelling and oxygen demand. Epiglottitis is a life-threatening airway emergency caused by swelling of the epiglottis, often from Haemophilus influenzae type b in unvaccinated children. The priority is to avoid anything that increases anxiety or directly stimulates the airway.
Checked against: OpenStax Nutrition for Nurses, 4.2
Question 2 · Pharmacological and Parenteral Therapies
A pediatric nurse is preparing to administer a medication to a 15-kg child based on a weight-based dosing protocol. Which action is most important before administering the medication?
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Answer: D. Pediatric medications are calculated based on the child's weight in kilograms, and the nurse must always verify that the ordered dose is within the safe range and double-check the math before administration, since pediatric patients have a narrow margin for error. Relying solely on pharmacy verification does not replace the nurse's independent responsibility to verify safe dosing. Rounding weight for simplicity can introduce dosing errors and is not an acceptable shortcut in pediatric dosing. Administering an adult standard dose is inappropriate and dangerous, as pediatric dosing must always be individualized based on weight, not a fixed threshold.
Checked against: OpenStax Clinical Nursing Skills, 11.2; OpenStax Pharmacology for Nurses, 2.4
Question 3 · Pharmacological and Parenteral Therapies
A nurse is preparing to administer vaccines scheduled for a 2-month well-child visit. Which vaccines should the nurse expect to give at this visit? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: A, C, D, E. The 2-month well-child visit begins the primary immunization series, which includes DTaP, IPV, Hib, and PCV. MMR and varicella are live-virus vaccines that are not given until 12 to 15 months of age, so they are not part of the 2-month schedule.
Checked against: OpenStax Pharmacology for Nurses, 6.2; OpenStax Maternal-Newborn Nursing, 24.1
Question 4 · Physiological Adaptation
The nurse assesses a 7-month-old infant during a well-child visit. Which finding is the priority to report to the healthcare provider?
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Answer: A. A bulging fontanel with a high-pitched cry and irritability suggests increased intracranial pressure, which is a neurologic emergency requiring immediate provider notification and further evaluation, such as neuroimaging. A sunken fontanel with dry mucous membranes suggests dehydration, which is concerning but generally more manageable with fluid replacement and less immediately life-threatening than rising intracranial pressure. A flat anterior fontanel is a normal, reassuring finding in an infant of this age. Mild diarrhea for one day without other systemic symptoms is a common, lower-priority finding that warrants monitoring rather than urgent reporting.
Checked against: openstax.org; ncbi.nlm.nih.gov
Question 5 · Physiological Adaptation
The nurse is assessing a child with suspected bacterial meningitis. Which findings support this diagnosis? Select all that apply.
Select all that apply.
Show answer and rationale
Answer: B, C, D, E. Nuchal rigidity, photophobia, positive Kernig and Brudzinski signs, and a non-blanching petechial rash are all classic findings of bacterial meningitis, and the petechial rash in particular signals a medical emergency requiring rapid intervention. Currant-jelly stools are associated with intussusception, a gastrointestinal emergency unrelated to meningitis. A barky, seal-like cough is characteristic of croup, a viral respiratory illness, and is not a meningitis finding. Recognizing this cluster of neurologic signs allows the nurse to advocate for prompt diagnostic testing and treatment.
Checked against: OpenStax Clinical Nursing Skills, 26.3; OpenStax Medical-Surgical Nursing, 17.2
Question 6 · Physiological Adaptation
A nurse is caring for a 6-month-old infant who has fewer wet diapers than usual, a sunken fontanel, and no tears with crying. Which action should the nurse take first?
Show answer and rationale
Answer: C. These findings are signs of dehydration in an infant, and the nurse should further assess perfusion status by checking capillary refill and notify the provider promptly for further evaluation and treatment. Waiting 24 hours to reassess delays needed intervention for a potentially worsening condition. Offering only water is inappropriate for infant rehydration, as it can cause electrolyte imbalances; oral rehydration solutions are preferred. Applying a warm compress to the fontanel has no therapeutic benefit and does not address the underlying dehydration.
Checked against: OpenStax Fundamentals of Nursing, 20.1; OpenStax Clinical Nursing Skills, 19.1
Question 7 · Physiological Adaptation
A mother brings her 9-month-old infant to the clinic reporting episodes of the infant drawing the legs up to the abdomen and crying, followed by periods of lethargy. The infant passed a stool described as red, mucous-like, and resembling jelly. Which condition does the nurse suspect?
Show answer and rationale
Answer: D. Intussusception occurs when part of the bowel telescopes into another section, classically causing 'currant jelly' stools, a palpable sausage-shaped abdominal mass, and episodes of the infant drawing the legs up due to abdominal pain. Pyloric stenosis presents with projectile vomiting and an olive-shaped mass rather than bloody stools. Kawasaki disease presents with prolonged fever, strawberry tongue, and red palms, not abdominal symptoms like these. A febrile seizure is a neurological event related to rapid fever rise and does not involve gastrointestinal symptoms.
Checked against: pmc.ncbi.nlm.nih.gov
Question 8 · Physiological Adaptation
A 2-year-old is brought to the emergency department after having a seizure at home during a rapid rise in temperature to 103°F (39.4°C). The seizure lasted less than a minute, and the child is now alert and back to baseline. The parents are extremely anxious. Which response by the nurse is most appropriate?
Show answer and rationale
Answer: D. Febrile seizures are caused by a rapid rise in fever and are usually benign, occurring most commonly between 6 months and 5 years of age; reassurance is an appropriate nursing action for anxious parents. Febrile seizures do not typically lead to epilepsy and are not associated with a serious underlying neurological disorder in most cases. Daily anticonvulsant therapy is not standard management for a simple febrile seizure. Providing inaccurate, alarming information would increase parental anxiety unnecessarily and is not supported by the benign nature of this condition.
Checked against: ninds.nih.gov; pmc.ncbi.nlm.nih.gov
Question 9 · Physiological Adaptation
The nurse is assessing a 4-month-old admitted with bronchiolitis (RSV). Which finding requires the most immediate notification of the healthcare provider?
Show answer and rationale
Answer: D. An apnea spell in an infant with bronchiolitis is a red flag that indicates the infant may be decompensating and at risk for respiratory failure, requiring immediate provider notification and close monitoring. A respiratory rate of 55 breaths/min, while elevated, is less urgent than an apnea episode and may be monitored as part of ongoing assessment. Mild nasal congestion and an occasional dry cough are common, expected findings in bronchiolitis and do not indicate an emergency. Recognizing apnea as a life-threatening cue reflects the clinical judgment skill of prioritizing the most urgent finding.
Checked against: OpenStax Maternal-Newborn Nursing, 24.2
Question 10 · Physiological Adaptation
A 4-year-old child is brought to the emergency department drooling, sitting in a tripod position, and refusing to lie down. The parent reports the child has had no cough. Which action should the nurse take first?
Show answer and rationale
Answer: B. These findings (drooling, tripod positioning and no cough) are classic for epiglottitis, a life-threatening airway emergency; the nurse should avoid inspecting the throat and prepare for emergency airway management. Using a tongue blade or otherwise manipulating the throat can trigger complete airway obstruction and must never be done. Placing the child supine can worsen airway obstruction, as these children instinctively position themselves to maximize airway patency. Cool mist and delayed reassessment may be used for mild croup, not for this life-threatening presentation.
Checked against: OpenStax Nutrition for Nurses, 4.2
Question 11 · Physiological Adaptation
A 2-year-old with a barky cough and stridor at rest is brought to the emergency department. The parent reports the child's breathing improved after exposure to cool night air on the way to the hospital. This response is most consistent with which condition?
Show answer and rationale
Answer: C. Croup is a viral illness that classically improves with cool mist or cool air exposure, which helps reduce airway swelling and stridor. Epiglottitis does not typically improve with cool air and instead requires urgent airway management, as it is a rapidly progressing bacterial infection. Bacterial tracheitis presents with a toxic appearance and does not reliably improve with cool air. Foreign body aspiration presents with sudden onset of choking or respiratory distress unrelated to temperature exposure, not a barky cough that improves with cool air.
Checked against: medlineplus.gov; ncbi.nlm.nih.gov
Question 12 · Health Promotion and Maintenance
A nurse is assessing developmental milestones during a well-child visit. At which age would the nurse expect an infant to first demonstrate a social smile in response to a caregiver's face?
Show answer and rationale
Answer: B. The social smile is an early social development milestone that typically emerges around 2 months of age as the infant begins to respond to caregivers' faces and voices. A 2-week-old is too young; smiling that early is usually reflexive, not a true social response. By 6 months the infant is achieving gross motor skills like sitting with support, and by 9 months other milestones such as stranger anxiety and object permanence have already emerged, so the social smile would already be established rather than newly appearing.
Checked against: OpenStax Fundamentals of Nursing, 39.1
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Every question on this page was approved by a licensed RN, and its answer was checked against open nursing references (mostly OpenStax nursing textbooks) before publishing. They are NCLEX-style practice, not real NCLEX items. NurseLingo is not affiliated with NCSBN. Spot a problem? Tell us.