Certified pediatric nurse exam questions with verified
answers with Rationales graded A+ 2025/2026
A child is complaining of abdominal and shoulder pain after an all-terrain vehicle crash.
He is pale and tachycardic. These symptoms are suggestive of
A. dislocated shoulder.
B. splenic injury.
C. cardiac contusion.
D. clavicle fracture. - correct answer B. The child presenting appearing pale and
tachycardia suggests the child is internally bleeding. These signs, accompanied by
abdominal pain and shoulder pain (Kehr's sign), make the diagnosis of splenic injury the
most likely.
An adolescent presents with severe eye pain, stating "there is something stuck in my
eye." The globe is intact. Which of the following is the PRIORITY intervention?
A. Patch both eyes.
B. Instill fluorescein stain.
C.Administer topical analgesics.
D. Irrigate eye with saline - correct answer C. Eye drops and ophthalmic ointments are
used to decrease pain. Patching is not supported any longer by evidence. Both irrigation
and fluoroscein will happen but after pain control.
Which of the following patients requires the MOST emergent intervention?
A. a crying child with delayed capillary refill
B. an anxious child with decreased breath sounds
C. an alert infant with a bulging fontanel
D. an obtunded child who is vomiting - correct answer D. The Patient Assessment
Triangle (PAT) is an "across the room" visual assessment. An obtunded child is the most
concerning as a sign of decreased mentation.
A 5-day-old neonate is diagnosed with hyperbilirubinemia. If left untreated, the infant
may have long-term issues with
,A. bleeding disorders.
B. intellectual deficits.
C. dehydration.
D. change in skin color. - correct answer B. As production of bilirubin exceeds the
newborn capacity to conjugate and plasma levels begin to rise rapidly, free bilirubin can
migrate into the brain cells via the blood-brain barrier and cause kernicterus.
Kernicterus is acute bilirubin encephalopathy. Characteristics of fully developed
encephalopathy may not be clearly evident for several years and can include intellectual
deficits.
A child presents with fever, malaise, and generalized flat, red rash for 24 hours. The
caregiver notes white spots inside the mouth. The nurse should suspect
A. measles.
B. scarlet fever.
C. varicella.
D. viral exanthema. - correct answer A. Koplicks spots in the mouth are diagnostic of
measles.
In addition to airway, breathing, and circulation, which of the following assessments is
MOST critical when assessing a 2-year-old with a temperature of 101.3° F (38.5° C)?
A. past medical history
B. Glasgow Coma Scale score
C. medication given
D. history of current illness - correct answer B. Once airway, breathing, and circulation
have been stabilized, disability/neuro-assessment is the next component of the primary
survey. The other options are elements of the secondary survey.
A 14-year-old male presents with the caregiver. He recently experienced the loss of a
classmate. The caregiver reports recent poor attendance at school accompanied by
weight loss, hypersomnia, limited interaction with the caregiver and a desire to be with
the deceased classmate.
Prior to discharge and away from the patient, what is the PRIORITY question to ask the
caregiver?
,A. "Is he on any medications?"
B. "Are there any guns in the house?"
C. "What other behavior have you witnessed?"
D. "Are there any illegal drugs being used?" - correct answer B. The patient is at risk
for suicide due to the recent loss of a classmate. While the other questions are
important, the risk for suicide is elevated.
A 12-month-old presents with a 2-day history of nausea and vomiting. Vital signs
include: BP 80/60 HR 56 RR 12
The child is limp and ashen. Which of the following is the PRIORITY intervention?
A. complete history from the parent
B. venous access and fluid bolus
C. manual ventilations
D. humidified oxygen - correct answer C. Normal respiration rate should be 30-60
breaths/min for this age group. A respiratory rate of 12 breaths/min requires positive
pressure ventilation. Assisting ventilation is expected to increase the heart rate.
HYPOVENTILATION IS THE LEADING CAUSE OF BRADYCARDIA.
Which of the following is a component of the Pediatric Assessment Triangle (PAT)?
A. vital signs
B. circulation
C. Glasgow Coma Scale
D. history - correct answer B. The components of the Pediatric Assessment Triangle
are appearance, breathing, and circulation.
A child presents with lethargy and bilateral ptosis after eating home canned vegetables.
Which of the following additional findings would the nurse expect?
A. excessive salivation
B. Leg weakness
C. constricted pupils
, D. elevated temperature - correct answer B. Botulism is a neurotoxin that is acquired
by eating canned goods that are not properly prepared. Symptoms include ptosis, dry
mouth, and muscle flaccid muscles leading to paralysis
A nurse is caring for a 3-year-old that has a decrease in hearing and pain to right ear.
Upon exam, the nurse notes impacted cerumen. The nurse should question an order for
irrigation if the caregiver mentions a history of
A. gingivitis.
B. tympanic membrane rupture
C. nasal septum deviation.
D. a fever greater than 39.4 (103˚F). - correct answer B. If the patient has a tympanic
membrane rupture, the warm irrigation solution could become trapped and provide an
environment that could produce bacterial or fungal growth. While a fever may be
present due to an ear infection, it should not prevent the use of irrigation. Gingivitis and
a nasal septum deviation do not prevent the use of irrigation.
A 2-year-old presents with a left thigh deformity after tripping over a toy. Further
assessment and diagnostic studies show a left femur fracture, multiple healed fractures
to bilateral legs, and blue-tinted sclera. The nurse is suspicious for
A. child maltreatment.
B. medical child abuse.
C. osteogenesis imperfecta.
D. juvenile arthritis. - correct answer C. Osteogenesis imperfecta is a connective tissue
disorder that causes osteoporosis in children. Clinical features include varying degrees
of bone fragility, deformity, fracture, blue sclerae, hearing loss, and discolored teeth. It is
an inherited autosomal dominant gene.
What is a PRIORITY treatment for Ludwig's angina?
A. administrating analgesics as ordered
B. administrating antibiotics as ordered
C. preparing the patient for a CT scan
D. preparing the patient for placement of a central line - correct answer B. Ludwig's
angina a rapidly progressive gangrenous cellulitis of the soft tissues of the neck and
answers with Rationales graded A+ 2025/2026
A child is complaining of abdominal and shoulder pain after an all-terrain vehicle crash.
He is pale and tachycardic. These symptoms are suggestive of
A. dislocated shoulder.
B. splenic injury.
C. cardiac contusion.
D. clavicle fracture. - correct answer B. The child presenting appearing pale and
tachycardia suggests the child is internally bleeding. These signs, accompanied by
abdominal pain and shoulder pain (Kehr's sign), make the diagnosis of splenic injury the
most likely.
An adolescent presents with severe eye pain, stating "there is something stuck in my
eye." The globe is intact. Which of the following is the PRIORITY intervention?
A. Patch both eyes.
B. Instill fluorescein stain.
C.Administer topical analgesics.
D. Irrigate eye with saline - correct answer C. Eye drops and ophthalmic ointments are
used to decrease pain. Patching is not supported any longer by evidence. Both irrigation
and fluoroscein will happen but after pain control.
Which of the following patients requires the MOST emergent intervention?
A. a crying child with delayed capillary refill
B. an anxious child with decreased breath sounds
C. an alert infant with a bulging fontanel
D. an obtunded child who is vomiting - correct answer D. The Patient Assessment
Triangle (PAT) is an "across the room" visual assessment. An obtunded child is the most
concerning as a sign of decreased mentation.
A 5-day-old neonate is diagnosed with hyperbilirubinemia. If left untreated, the infant
may have long-term issues with
,A. bleeding disorders.
B. intellectual deficits.
C. dehydration.
D. change in skin color. - correct answer B. As production of bilirubin exceeds the
newborn capacity to conjugate and plasma levels begin to rise rapidly, free bilirubin can
migrate into the brain cells via the blood-brain barrier and cause kernicterus.
Kernicterus is acute bilirubin encephalopathy. Characteristics of fully developed
encephalopathy may not be clearly evident for several years and can include intellectual
deficits.
A child presents with fever, malaise, and generalized flat, red rash for 24 hours. The
caregiver notes white spots inside the mouth. The nurse should suspect
A. measles.
B. scarlet fever.
C. varicella.
D. viral exanthema. - correct answer A. Koplicks spots in the mouth are diagnostic of
measles.
In addition to airway, breathing, and circulation, which of the following assessments is
MOST critical when assessing a 2-year-old with a temperature of 101.3° F (38.5° C)?
A. past medical history
B. Glasgow Coma Scale score
C. medication given
D. history of current illness - correct answer B. Once airway, breathing, and circulation
have been stabilized, disability/neuro-assessment is the next component of the primary
survey. The other options are elements of the secondary survey.
A 14-year-old male presents with the caregiver. He recently experienced the loss of a
classmate. The caregiver reports recent poor attendance at school accompanied by
weight loss, hypersomnia, limited interaction with the caregiver and a desire to be with
the deceased classmate.
Prior to discharge and away from the patient, what is the PRIORITY question to ask the
caregiver?
,A. "Is he on any medications?"
B. "Are there any guns in the house?"
C. "What other behavior have you witnessed?"
D. "Are there any illegal drugs being used?" - correct answer B. The patient is at risk
for suicide due to the recent loss of a classmate. While the other questions are
important, the risk for suicide is elevated.
A 12-month-old presents with a 2-day history of nausea and vomiting. Vital signs
include: BP 80/60 HR 56 RR 12
The child is limp and ashen. Which of the following is the PRIORITY intervention?
A. complete history from the parent
B. venous access and fluid bolus
C. manual ventilations
D. humidified oxygen - correct answer C. Normal respiration rate should be 30-60
breaths/min for this age group. A respiratory rate of 12 breaths/min requires positive
pressure ventilation. Assisting ventilation is expected to increase the heart rate.
HYPOVENTILATION IS THE LEADING CAUSE OF BRADYCARDIA.
Which of the following is a component of the Pediatric Assessment Triangle (PAT)?
A. vital signs
B. circulation
C. Glasgow Coma Scale
D. history - correct answer B. The components of the Pediatric Assessment Triangle
are appearance, breathing, and circulation.
A child presents with lethargy and bilateral ptosis after eating home canned vegetables.
Which of the following additional findings would the nurse expect?
A. excessive salivation
B. Leg weakness
C. constricted pupils
, D. elevated temperature - correct answer B. Botulism is a neurotoxin that is acquired
by eating canned goods that are not properly prepared. Symptoms include ptosis, dry
mouth, and muscle flaccid muscles leading to paralysis
A nurse is caring for a 3-year-old that has a decrease in hearing and pain to right ear.
Upon exam, the nurse notes impacted cerumen. The nurse should question an order for
irrigation if the caregiver mentions a history of
A. gingivitis.
B. tympanic membrane rupture
C. nasal septum deviation.
D. a fever greater than 39.4 (103˚F). - correct answer B. If the patient has a tympanic
membrane rupture, the warm irrigation solution could become trapped and provide an
environment that could produce bacterial or fungal growth. While a fever may be
present due to an ear infection, it should not prevent the use of irrigation. Gingivitis and
a nasal septum deviation do not prevent the use of irrigation.
A 2-year-old presents with a left thigh deformity after tripping over a toy. Further
assessment and diagnostic studies show a left femur fracture, multiple healed fractures
to bilateral legs, and blue-tinted sclera. The nurse is suspicious for
A. child maltreatment.
B. medical child abuse.
C. osteogenesis imperfecta.
D. juvenile arthritis. - correct answer C. Osteogenesis imperfecta is a connective tissue
disorder that causes osteoporosis in children. Clinical features include varying degrees
of bone fragility, deformity, fracture, blue sclerae, hearing loss, and discolored teeth. It is
an inherited autosomal dominant gene.
What is a PRIORITY treatment for Ludwig's angina?
A. administrating analgesics as ordered
B. administrating antibiotics as ordered
C. preparing the patient for a CT scan
D. preparing the patient for placement of a central line - correct answer B. Ludwig's
angina a rapidly progressive gangrenous cellulitis of the soft tissues of the neck and
