NCLEX-RN COMPREHENSIVE PRACTICE
EXAM 2026
Pediatric Nursing
Total Questions: 50 | Time Recommended: 75 minutes Includes Select All That
Apply (SATA) questions
SECTION 1: GROWTH & DEVELOPMENT
Question 1
A nurse is assessing a 9-month-old infant during a well-child visit. The mother reports the
infant can sit without support, transfers objects from one hand to the other, and says
"mama" and "dada" nonspecifically. Vitals: HR 128 bpm, RR 30/min, Temp 98.4°F (36.9°C),
SpO2 98%. The nurse notes the infant does not pull to stand or cruise along furniture.
Which response by the nurse is most appropriate?
A) "Your baby is significantly delayed and needs an immediate developmental referral." B)
"These findings are consistent with normal development for a 9-month-old." C) "Your baby
should be walking by now; we need to consult a neurologist." D) "The inability to cruise at
9 months indicates cerebral palsy."
Correct answer: B
Explanation:
At 9 months, expected milestones include sitting without support, transferring
objects hand-to-hand, babbling with "mama/dada" nonspecifically, and stranger
anxiety. Pulling to stand typically emerges around 9–10 months, and cruising at 10–
12 months. This infant is developmentally on track.
(A) There is no evidence of significant delay. All reported milestones are age-
appropriate.
(C) Independent walking is expected at 12–15 months, not 9 months. This represents
a gross misunderstanding of developmental timelines.
(D) The absence of cruising at 9 months is within normal limits and does not suggest
cerebral palsy, which presents with persistent primitive reflexes, spasticity, and
failure to meet multiple milestones.
, NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 2
A pediatric nurse is planning care for a 4-year-old child admitted for an elective
tonsillectomy. The child clings to a stuffed bear and cries when the parent leaves the
room. According to Erikson's psychosocial development theory, which nursing intervention
best supports this child's developmental stage?
A) Establish a strict schedule with no deviations to promote a sense of trust B) Encourage
the child to make simple choices such as which color gown to wear C) Assign all care to
one nurse to establish a sense of industry D) Allow the child unlimited screen time to
promote autonomy
Correct answer: B
Explanation:
A 4-year-old is in Erikson's stage of Initiative vs. Guilt. Children in this stage benefit
from opportunities to make choices, initiate activities, and assert control over their
environment. Offering simple choices fosters initiative without overwhelming the
child.
(A) Rigid scheduling addresses Trust vs. Mistrust (infancy, birth–1 year), not the
preschool stage. Strict routines without flexibility do not promote initiative.
(C) Industry vs. Inferiority applies to school-age children (6–12 years). While
continuity of care is good practice, the rationale does not match the developmental
stage.
(D) Autonomy vs. Shame and Doubt is the toddler stage (1–3 years), and unlimited
screen time is neither developmentally supportive nor evidence-based.
NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 3
A home health nurse is conducting a safety assessment for a family with a 2-year-old
toddler. The home has an unfenced swimming pool, unlocked cabinets containing cleaning
supplies under the kitchen sink, accessible window blind cords in the child's bedroom, and
a toy chest with a heavy hinged lid.
Which hazard poses the greatest risk of mortality for this age group?
A) Unlocked cabinets with cleaning supplies B) Unfenced swimming pool C) Window blind
cords D) Toy chest with heavy hinged lid
Correct answer: B
,Explanation:
Drowning is the leading cause of unintentional injury death in children aged 1–4
years (CDC, 2024). An unfenced pool is the single most dangerous environmental
hazard. Pool fencing with self-latching gates reduces drowning risk by over 50%.
(A) Poisoning is a serious risk and a leading cause of ED visits in toddlers, but fatality
rates from household cleaner ingestion are lower than drowning rates.
(C) Window blind cords pose a strangulation risk, but the incidence of fatality is
significantly lower than drowning.
(D) Heavy toy chest lids can cause head/neck injuries and entrapment, but this is a
less common cause of mortality compared to drowning.
NCLEX Category: Safe and Effective Care Environment — Safety and Infection
Control
Cognitive Level: Analysis
Question 4
A nurse in a well-child clinic is evaluating a 6-month-old infant. The mother is concerned
because the infant has not yet rolled over from back to front. The infant can hold the head
steady when pulled to sit, laughs aloud, reaches for objects, and follows objects 180
degrees with the eyes. Vitals: HR 132 bpm, RR 34/min, Temp 98.6°F (37°C), Weight 7.2 kg
(50th percentile).
What is the nurse's best response?
A) "Rolling from back to front usually develops between 4 and 6 months; we should
monitor closely at the next visit." B) "This is a serious delay and the infant needs a CT
scan of the brain." C) "All infants roll over by 4 months; we should refer to a
developmental specialist immediately." D) "Your infant's other milestones suggest normal
development; back-to-front rolling can occur up to 7 months."
Correct answer: D
Explanation:
While rolling from front to back typically occurs around 4–5 months, rolling from back
to front may not occur until 5–7 months. Given that all other milestones are age-
appropriate (head control, laughing, reaching, visual tracking), this infant is
developing normally. Reassurance with continued monitoring is appropriate.
(A) Although monitoring is appropriate, stating "4 to 6 months" creates unnecessary
concern when the infant is still within the normal range and meeting all other
milestones.
(B) A CT scan is not indicated. There are no red flags such as regression, abnormal
tone, or failure to meet multiple milestones.
(C) This is factually incorrect—not all infants roll by 4 months—and an immediate
specialist referral is unwarranted.
, NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Analysis
Question 5
A school nurse is screening 7-year-old children for developmental progress. According to
Erikson, which behavior indicates successful resolution of the Industry vs. Inferiority
stage?
A) A child who insists on dressing independently every morning B) A child who proudly
shows the nurse a completed science project C) A child who has developed a close best
friendship with one peer D) A child who questions the school's rules and advocates for
changes
Correct answer: B
Explanation:
Industry vs. Inferiority (6–12 years) is characterized by the child's drive to
demonstrate competence and mastery of skills. Proudly displaying a completed
project reflects a sense of accomplishment and productivity—hallmarks of industry.
(A) Insisting on self-dressing reflects Autonomy vs. Shame and Doubt (toddler, 1–3
years).
(C) Forming close, intimate friendships is characteristic of Intimacy vs. Isolation
(young adulthood, 18–40 years), though peer relationships begin earlier.
(D) Questioning rules and advocating for change reflects Identity vs. Role Confusion
(adolescence, 12–18 years).
NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 6
A nurse is caring for a 15-month-old toddler brought to the emergency department after a
fall. The parent reports the child was "walking along the coffee table and fell." The child
weighs 10 kg. Vitals: HR 110 bpm, RR 26/min, Temp 98.2°F (36.8°C), BP 90/56 mmHg,
SpO2 99%. The nurse notes a spiral fracture of the right tibia on X-ray.
Which action should the nurse prioritize?
A) Apply a splint and discharge with follow-up to orthopedics B) Document findings and
notify the healthcare provider of suspected non-accidental trauma C) Accept the parent's
explanation as consistent with a toddler's typical fracture D) Administer acetaminophen
150 mg PO and reassess in 1 hour
Correct answer: B
EXAM 2026
Pediatric Nursing
Total Questions: 50 | Time Recommended: 75 minutes Includes Select All That
Apply (SATA) questions
SECTION 1: GROWTH & DEVELOPMENT
Question 1
A nurse is assessing a 9-month-old infant during a well-child visit. The mother reports the
infant can sit without support, transfers objects from one hand to the other, and says
"mama" and "dada" nonspecifically. Vitals: HR 128 bpm, RR 30/min, Temp 98.4°F (36.9°C),
SpO2 98%. The nurse notes the infant does not pull to stand or cruise along furniture.
Which response by the nurse is most appropriate?
A) "Your baby is significantly delayed and needs an immediate developmental referral." B)
"These findings are consistent with normal development for a 9-month-old." C) "Your baby
should be walking by now; we need to consult a neurologist." D) "The inability to cruise at
9 months indicates cerebral palsy."
Correct answer: B
Explanation:
At 9 months, expected milestones include sitting without support, transferring
objects hand-to-hand, babbling with "mama/dada" nonspecifically, and stranger
anxiety. Pulling to stand typically emerges around 9–10 months, and cruising at 10–
12 months. This infant is developmentally on track.
(A) There is no evidence of significant delay. All reported milestones are age-
appropriate.
(C) Independent walking is expected at 12–15 months, not 9 months. This represents
a gross misunderstanding of developmental timelines.
(D) The absence of cruising at 9 months is within normal limits and does not suggest
cerebral palsy, which presents with persistent primitive reflexes, spasticity, and
failure to meet multiple milestones.
, NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 2
A pediatric nurse is planning care for a 4-year-old child admitted for an elective
tonsillectomy. The child clings to a stuffed bear and cries when the parent leaves the
room. According to Erikson's psychosocial development theory, which nursing intervention
best supports this child's developmental stage?
A) Establish a strict schedule with no deviations to promote a sense of trust B) Encourage
the child to make simple choices such as which color gown to wear C) Assign all care to
one nurse to establish a sense of industry D) Allow the child unlimited screen time to
promote autonomy
Correct answer: B
Explanation:
A 4-year-old is in Erikson's stage of Initiative vs. Guilt. Children in this stage benefit
from opportunities to make choices, initiate activities, and assert control over their
environment. Offering simple choices fosters initiative without overwhelming the
child.
(A) Rigid scheduling addresses Trust vs. Mistrust (infancy, birth–1 year), not the
preschool stage. Strict routines without flexibility do not promote initiative.
(C) Industry vs. Inferiority applies to school-age children (6–12 years). While
continuity of care is good practice, the rationale does not match the developmental
stage.
(D) Autonomy vs. Shame and Doubt is the toddler stage (1–3 years), and unlimited
screen time is neither developmentally supportive nor evidence-based.
NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 3
A home health nurse is conducting a safety assessment for a family with a 2-year-old
toddler. The home has an unfenced swimming pool, unlocked cabinets containing cleaning
supplies under the kitchen sink, accessible window blind cords in the child's bedroom, and
a toy chest with a heavy hinged lid.
Which hazard poses the greatest risk of mortality for this age group?
A) Unlocked cabinets with cleaning supplies B) Unfenced swimming pool C) Window blind
cords D) Toy chest with heavy hinged lid
Correct answer: B
,Explanation:
Drowning is the leading cause of unintentional injury death in children aged 1–4
years (CDC, 2024). An unfenced pool is the single most dangerous environmental
hazard. Pool fencing with self-latching gates reduces drowning risk by over 50%.
(A) Poisoning is a serious risk and a leading cause of ED visits in toddlers, but fatality
rates from household cleaner ingestion are lower than drowning rates.
(C) Window blind cords pose a strangulation risk, but the incidence of fatality is
significantly lower than drowning.
(D) Heavy toy chest lids can cause head/neck injuries and entrapment, but this is a
less common cause of mortality compared to drowning.
NCLEX Category: Safe and Effective Care Environment — Safety and Infection
Control
Cognitive Level: Analysis
Question 4
A nurse in a well-child clinic is evaluating a 6-month-old infant. The mother is concerned
because the infant has not yet rolled over from back to front. The infant can hold the head
steady when pulled to sit, laughs aloud, reaches for objects, and follows objects 180
degrees with the eyes. Vitals: HR 132 bpm, RR 34/min, Temp 98.6°F (37°C), Weight 7.2 kg
(50th percentile).
What is the nurse's best response?
A) "Rolling from back to front usually develops between 4 and 6 months; we should
monitor closely at the next visit." B) "This is a serious delay and the infant needs a CT
scan of the brain." C) "All infants roll over by 4 months; we should refer to a
developmental specialist immediately." D) "Your infant's other milestones suggest normal
development; back-to-front rolling can occur up to 7 months."
Correct answer: D
Explanation:
While rolling from front to back typically occurs around 4–5 months, rolling from back
to front may not occur until 5–7 months. Given that all other milestones are age-
appropriate (head control, laughing, reaching, visual tracking), this infant is
developing normally. Reassurance with continued monitoring is appropriate.
(A) Although monitoring is appropriate, stating "4 to 6 months" creates unnecessary
concern when the infant is still within the normal range and meeting all other
milestones.
(B) A CT scan is not indicated. There are no red flags such as regression, abnormal
tone, or failure to meet multiple milestones.
(C) This is factually incorrect—not all infants roll by 4 months—and an immediate
specialist referral is unwarranted.
, NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Analysis
Question 5
A school nurse is screening 7-year-old children for developmental progress. According to
Erikson, which behavior indicates successful resolution of the Industry vs. Inferiority
stage?
A) A child who insists on dressing independently every morning B) A child who proudly
shows the nurse a completed science project C) A child who has developed a close best
friendship with one peer D) A child who questions the school's rules and advocates for
changes
Correct answer: B
Explanation:
Industry vs. Inferiority (6–12 years) is characterized by the child's drive to
demonstrate competence and mastery of skills. Proudly displaying a completed
project reflects a sense of accomplishment and productivity—hallmarks of industry.
(A) Insisting on self-dressing reflects Autonomy vs. Shame and Doubt (toddler, 1–3
years).
(C) Forming close, intimate friendships is characteristic of Intimacy vs. Isolation
(young adulthood, 18–40 years), though peer relationships begin earlier.
(D) Questioning rules and advocating for change reflects Identity vs. Role Confusion
(adolescence, 12–18 years).
NCLEX Category: Health Promotion and Maintenance
Cognitive Level: Application
Question 6
A nurse is caring for a 15-month-old toddler brought to the emergency department after a
fall. The parent reports the child was "walking along the coffee table and fell." The child
weighs 10 kg. Vitals: HR 110 bpm, RR 26/min, Temp 98.2°F (36.8°C), BP 90/56 mmHg,
SpO2 99%. The nurse notes a spiral fracture of the right tibia on X-ray.
Which action should the nurse prioritize?
A) Apply a splint and discharge with follow-up to orthopedics B) Document findings and
notify the healthcare provider of suspected non-accidental trauma C) Accept the parent's
explanation as consistent with a toddler's typical fracture D) Administer acetaminophen
150 mg PO and reassess in 1 hour
Correct answer: B
