NACE Care of the Child Real Exam Questions
and Correct Detailed Answers with Rationales
|| 100% Guaranteed Pass!! <Recent Version>
NACE Care of the Child: Practice Questions 1-100
1. A 4-year-old child is brought to the emergency department after ingesting an unknown
amount of their grandparent's warfarin. Which antidote should the nurse prepare to
administer?
A. Naloxone
B. Acetylcysteine
C. Vitamin K
D. Flumazenil
Rationale: Warfarin is an anticoagulant that works by inhibiting vitamin K-dependent clotting
factors. The specific antidote for warfarin overdose is vitamin K, which helps restore the body's
ability to form clots. Naloxone is for opioids, acetylcysteine for acetaminophen, and flumazenil
for benzodiazepines.
2. The nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires
further investigation?
A. The infant has a closed anterior fontanel.
B. The infant does not sit unsupported.
C. The infant exhibits a persistent tonic neck reflex.
D. The infant babbles and coos.
Rationale: The tonic neck reflex (fencing posture) typically disappears between 4-6 months of
age. Its persistence beyond this point can be a sign of neurological impairment and requires
evaluation. A closed anterior fontanel is normal by 18 months. Not sitting unsupported is
expected at 6 months (usually begins around 7-8 months). Babbling is a normal developmental
milestone.
3. A 3-year-old with cystic fibrosis is admitted for a pulmonary exacerbation. Which nursing
intervention is most critical to include in the plan of care?
A. Providing a low-fat, low-protein diet
B. Scheduling postural drainage and percussion before meals
,C. Placing the child in a protective environment
D. Encouraging vigorous play to build endurance
Rationale: Airway clearance techniques (ACTs) like postural drainage and percussion are
fundamental in managing cystic fibrosis to mobilize thick secretions. Performing these before
meals reduces the risk of vomiting and aspiration. Children with CF require a high-calorie, high-
protein, high-fat diet to meet nutritional needs. A protective environment is not standard, and
vigorous play may be too taxing during an exacerbation.
4. A child with suspected rheumatic fever is admitted. Which assessment finding is a major
Jones criterion for this disease?
A. Tachycardia
B. Erythema marginatum
C. History of a sore throat
D. Fatigue
Rationale: The major Jones criteria for rheumatic fever include: carditis, polyarthritis,
Sydenham's chorea, subcutaneous nodules, and erythema marginatum (a distinctive rash).
Tachycardia may be present with carditis but is not a specific criterion. A history of strep
infection is a prerequisite, not a Jones criterion. Fatigue is a nonspecific symptom.
5. The nurse is teaching the parents of a child with a new ventriculoperitoneal (VP) shunt.
Which statement by the parents indicates a correct understanding of a sign of shunt
malfunction?
A. "We will call if our child has a sunken fontanel."
B. "We will call if our child is irritable and vomits repeatedly."
C. "We will call if our child's head seems to be growing slower."
D. "We will call if our child has a fever a week after surgery."
Rationale: Signs of increased intracranial pressure (ICP) from shunt malfunction include
irritability, high-pitched cry, vomiting (often projectile), headache, and a full or bulging fontanel
(not sunken). A sunken fontanel suggests overdrainage. Slow head growth is not an acute sign of
malfunction. A fever could indicate infection, which is a serious complication, but the question
specifically asks about malfunction.
6. A toddler with severe dehydration is receiving IV fluid resuscitation. The nurse should
prioritize assessing for which complication?
A. Hyperkalemia
B. Fluid overload
C. Hypoglycemia
D. Metabolic alkalosis
,Rationale: While all are concerns in a dehydrated child, the most immediate risk during rapid IV
fluid administration is fluid overload, which can lead to pulmonary edema. Careful monitoring
of respiratory status, heart sounds, and weight is essential. Hypokalemia (not hyperkalemia) and
metabolic acidosis (not alkalosis) are more common in dehydration.
7. An adolescent with type 1 diabetes mellitus is experiencing ketonuria, tachypnea, and
drowsiness. Their blood glucose level is 485 mg/dL. Which action should the nurse take first?
A. Administer 5 units of regular insulin subcutaneously.
B. Encourage the adolescent to drink a sugar-free fluid.
C. Obtain an order for and administer IV fluids.
D. Provide a snack of 15g of carbohydrates.
Rationale: The patient is presenting with signs of diabetic ketoacidosis (DKA). The priority in
DKA management is fluid resuscitation to correct dehydration and hypoperfusion. Insulin
administration is critical but is typically initiated after starting IV fluids to prevent a rapid shift of
fluid and electrolytes into cells. Oral intake is not appropriate for a drowsy patient.
8. A preschooler is scheduled for a cardiac catheterization. Which pre-procedure teaching
strategy is most appropriate?
A. Providing a detailed, scientific explanation of the procedure
B. Using a doll to demonstrate the procedure
C. Waiting until the day of the procedure to minimize anxiety
D. Emphasizing the potential risks to ensure informed consent
Rationale: For a preschooler, play therapy (using a doll) is a developmentally appropriate way to
explain procedures and reduce fear and anxiety. Detailed explanations are for older
adolescents/adults. Teaching should be done beforehand to allow processing. Emphasizing risks
is the role of the provider obtaining consent and should be done in a balanced, age-appropriate
manner for the parents.
9. The mother of a 2-month-old infant is concerned because her baby's head is flat on the
back. Which advice from the nurse is best?
A. "This is permanent and may require helmet therapy immediately."
B. "This is common and often resolves with supervised 'tummy time' when awake."
C. "You should use a soft pillow to keep the baby's head turned to the side."
D. "There is nothing you can do; it will round out on its own."
Rationale: Positional plagiocephaly (flat head) is common due to Back to Sleep
recommendations. It is often managed conservatively with repositioning strategies and
encouraging supervised tummy time while the infant is awake to relieve pressure on the back of
, the head. Helmets are not a first-line treatment. Pillows in the crib are a suffocation hazard and
violate safe sleep guidelines.
10. A school-age child with hemophilia A falls and hurts their knee. The knee is swollen and
painful. Which action should the nurse take first?
A. Apply a warm compress to the knee.
B. Elevate the joint and apply ice.
C. Perform passive range of motion to prevent contractures.
D. Massage the knee to relieve muscle spasm.
Rationale: For acute bleeds in hemophilia, the standard first aid is RICE: Rest, Ice, Compression,
and Elevation. Ice causes vasoconstriction and helps control bleeding and swelling. Heat would
increase blood flow and bleeding. Movement or massage could exacerbate the injury and
bleeding.
11. A child with sickle cell anemia is admitted with severe pain in the knees and elbows. The
nurse anticipates which initial priority order from the provider?
A. Broad-spectrum antibiotics
B. IV opioid analgesics
C. High-dose oral ibuprofen
D. Packed red blood cell transfusion
Rationale: The patient is experiencing a vaso-occlusive pain crisis. The paramount priority is
rapid and aggressive pain management, typically with IV opioids. Hydration is also critical.
Antibiotics are for suspected infection. Transfusions are reserved for severe complications like
splenic sequestration or acute chest syndrome, not for an uncomplicated pain crisis.
12. The nurse is reviewing the lab results of a child with nephrotic syndrome. Which finding is
most characteristic of this condition?
A. Hematuria
B. Hypoalbuminemia
C. Elevated serum creatinine
D. Low serum cholesterol
Rationale: The hallmark of nephrotic syndrome is massive proteinuria, which leads to
hypoalbuminemia (low albumin). This causes edema. Hematuria and elevated creatinine are
more characteristic of nephritic syndrome. Hyperlipidemia (high cholesterol), not low
cholesterol, is a key feature.
13. An infant with tetralogy of Fallot becomes acutely cyanotic and dyspneic after crying.
Which action should the nurse take first?
and Correct Detailed Answers with Rationales
|| 100% Guaranteed Pass!! <Recent Version>
NACE Care of the Child: Practice Questions 1-100
1. A 4-year-old child is brought to the emergency department after ingesting an unknown
amount of their grandparent's warfarin. Which antidote should the nurse prepare to
administer?
A. Naloxone
B. Acetylcysteine
C. Vitamin K
D. Flumazenil
Rationale: Warfarin is an anticoagulant that works by inhibiting vitamin K-dependent clotting
factors. The specific antidote for warfarin overdose is vitamin K, which helps restore the body's
ability to form clots. Naloxone is for opioids, acetylcysteine for acetaminophen, and flumazenil
for benzodiazepines.
2. The nurse is assessing a 6-month-old infant during a well-child visit. Which finding requires
further investigation?
A. The infant has a closed anterior fontanel.
B. The infant does not sit unsupported.
C. The infant exhibits a persistent tonic neck reflex.
D. The infant babbles and coos.
Rationale: The tonic neck reflex (fencing posture) typically disappears between 4-6 months of
age. Its persistence beyond this point can be a sign of neurological impairment and requires
evaluation. A closed anterior fontanel is normal by 18 months. Not sitting unsupported is
expected at 6 months (usually begins around 7-8 months). Babbling is a normal developmental
milestone.
3. A 3-year-old with cystic fibrosis is admitted for a pulmonary exacerbation. Which nursing
intervention is most critical to include in the plan of care?
A. Providing a low-fat, low-protein diet
B. Scheduling postural drainage and percussion before meals
,C. Placing the child in a protective environment
D. Encouraging vigorous play to build endurance
Rationale: Airway clearance techniques (ACTs) like postural drainage and percussion are
fundamental in managing cystic fibrosis to mobilize thick secretions. Performing these before
meals reduces the risk of vomiting and aspiration. Children with CF require a high-calorie, high-
protein, high-fat diet to meet nutritional needs. A protective environment is not standard, and
vigorous play may be too taxing during an exacerbation.
4. A child with suspected rheumatic fever is admitted. Which assessment finding is a major
Jones criterion for this disease?
A. Tachycardia
B. Erythema marginatum
C. History of a sore throat
D. Fatigue
Rationale: The major Jones criteria for rheumatic fever include: carditis, polyarthritis,
Sydenham's chorea, subcutaneous nodules, and erythema marginatum (a distinctive rash).
Tachycardia may be present with carditis but is not a specific criterion. A history of strep
infection is a prerequisite, not a Jones criterion. Fatigue is a nonspecific symptom.
5. The nurse is teaching the parents of a child with a new ventriculoperitoneal (VP) shunt.
Which statement by the parents indicates a correct understanding of a sign of shunt
malfunction?
A. "We will call if our child has a sunken fontanel."
B. "We will call if our child is irritable and vomits repeatedly."
C. "We will call if our child's head seems to be growing slower."
D. "We will call if our child has a fever a week after surgery."
Rationale: Signs of increased intracranial pressure (ICP) from shunt malfunction include
irritability, high-pitched cry, vomiting (often projectile), headache, and a full or bulging fontanel
(not sunken). A sunken fontanel suggests overdrainage. Slow head growth is not an acute sign of
malfunction. A fever could indicate infection, which is a serious complication, but the question
specifically asks about malfunction.
6. A toddler with severe dehydration is receiving IV fluid resuscitation. The nurse should
prioritize assessing for which complication?
A. Hyperkalemia
B. Fluid overload
C. Hypoglycemia
D. Metabolic alkalosis
,Rationale: While all are concerns in a dehydrated child, the most immediate risk during rapid IV
fluid administration is fluid overload, which can lead to pulmonary edema. Careful monitoring
of respiratory status, heart sounds, and weight is essential. Hypokalemia (not hyperkalemia) and
metabolic acidosis (not alkalosis) are more common in dehydration.
7. An adolescent with type 1 diabetes mellitus is experiencing ketonuria, tachypnea, and
drowsiness. Their blood glucose level is 485 mg/dL. Which action should the nurse take first?
A. Administer 5 units of regular insulin subcutaneously.
B. Encourage the adolescent to drink a sugar-free fluid.
C. Obtain an order for and administer IV fluids.
D. Provide a snack of 15g of carbohydrates.
Rationale: The patient is presenting with signs of diabetic ketoacidosis (DKA). The priority in
DKA management is fluid resuscitation to correct dehydration and hypoperfusion. Insulin
administration is critical but is typically initiated after starting IV fluids to prevent a rapid shift of
fluid and electrolytes into cells. Oral intake is not appropriate for a drowsy patient.
8. A preschooler is scheduled for a cardiac catheterization. Which pre-procedure teaching
strategy is most appropriate?
A. Providing a detailed, scientific explanation of the procedure
B. Using a doll to demonstrate the procedure
C. Waiting until the day of the procedure to minimize anxiety
D. Emphasizing the potential risks to ensure informed consent
Rationale: For a preschooler, play therapy (using a doll) is a developmentally appropriate way to
explain procedures and reduce fear and anxiety. Detailed explanations are for older
adolescents/adults. Teaching should be done beforehand to allow processing. Emphasizing risks
is the role of the provider obtaining consent and should be done in a balanced, age-appropriate
manner for the parents.
9. The mother of a 2-month-old infant is concerned because her baby's head is flat on the
back. Which advice from the nurse is best?
A. "This is permanent and may require helmet therapy immediately."
B. "This is common and often resolves with supervised 'tummy time' when awake."
C. "You should use a soft pillow to keep the baby's head turned to the side."
D. "There is nothing you can do; it will round out on its own."
Rationale: Positional plagiocephaly (flat head) is common due to Back to Sleep
recommendations. It is often managed conservatively with repositioning strategies and
encouraging supervised tummy time while the infant is awake to relieve pressure on the back of
, the head. Helmets are not a first-line treatment. Pillows in the crib are a suffocation hazard and
violate safe sleep guidelines.
10. A school-age child with hemophilia A falls and hurts their knee. The knee is swollen and
painful. Which action should the nurse take first?
A. Apply a warm compress to the knee.
B. Elevate the joint and apply ice.
C. Perform passive range of motion to prevent contractures.
D. Massage the knee to relieve muscle spasm.
Rationale: For acute bleeds in hemophilia, the standard first aid is RICE: Rest, Ice, Compression,
and Elevation. Ice causes vasoconstriction and helps control bleeding and swelling. Heat would
increase blood flow and bleeding. Movement or massage could exacerbate the injury and
bleeding.
11. A child with sickle cell anemia is admitted with severe pain in the knees and elbows. The
nurse anticipates which initial priority order from the provider?
A. Broad-spectrum antibiotics
B. IV opioid analgesics
C. High-dose oral ibuprofen
D. Packed red blood cell transfusion
Rationale: The patient is experiencing a vaso-occlusive pain crisis. The paramount priority is
rapid and aggressive pain management, typically with IV opioids. Hydration is also critical.
Antibiotics are for suspected infection. Transfusions are reserved for severe complications like
splenic sequestration or acute chest syndrome, not for an uncomplicated pain crisis.
12. The nurse is reviewing the lab results of a child with nephrotic syndrome. Which finding is
most characteristic of this condition?
A. Hematuria
B. Hypoalbuminemia
C. Elevated serum creatinine
D. Low serum cholesterol
Rationale: The hallmark of nephrotic syndrome is massive proteinuria, which leads to
hypoalbuminemia (low albumin). This causes edema. Hematuria and elevated creatinine are
more characteristic of nephritic syndrome. Hyperlipidemia (high cholesterol), not low
cholesterol, is a key feature.
13. An infant with tetralogy of Fallot becomes acutely cyanotic and dyspneic after crying.
Which action should the nurse take first?
