Galen NSG 3600
Exam 4 – Child Health
Pediatric Nursing Comprehensive Exam Bank
2026/2027 Academic Year
65 NCLEX-Style Practice Questions with Rationales
,Infectious Diseases
20 Questions
1. A 9-month-old infant is brought to the pediatric clinic by a parent who reports the child has had a high
fever of 104°F for the past 3 days but has been playful and drinking well. Today the fever has resolved,
but a pinkish maculopapular rash has appeared on the trunk. The nurse anticipates which diagnosis?
A) Roseola (Roseola infantum, caused by HHV-6)
B) Measles (Rubeola)
C) Rubella (German measles)
D) Fifth disease (Erythema infectiosum)
Rationale: Roseola, caused by human herpesvirus 6 (HHV-6) or HHV-7, classically presents with a sudden high
fever of 103-105°F lasting 3-5 days in an otherwise well-appearing infant or toddler, followed by a
maculopapular rash that appears as the fever subsides. The child's playful behavior despite the high fever is a
hallmark finding. Measles presents with the 3 C's (cough, coryza, conjunctivitis) and Koplik spots before a rash
that spreads from the hairline downward. Rubella presents with lymphadenopathy and a mild rash. Fifth disease
presents with the classic "slapped cheek" appearance.
2. A nurse is providing discharge teaching to the parents of a toddler recovering from roseola. Which
statement by the parent indicates that the teaching has been effective?
A) I should give aspirin to reduce my child's fever because it works faster than acetaminophen.
B) I will need to bring my child back for a course of antibiotics to clear the infection.
C) I understand that the rash is contagious, so my child must stay home until it completely
resolves.
D) I will monitor my child closely during the fever because of the risk of febrile seizures.
Rationale: Febrile seizures are a known complication of the rapid, high fever (103-105°F) seen in roseola, so the
parent's statement about monitoring for febrile seizures indicates effective teaching. Aspirin should never be
given to children due to the risk of Reye syndrome, making option A incorrect. Roseola is caused by HHV-6 or
HHV-7, a viral illness, so antibiotics are not indicated, making option B incorrect. The rash of roseola is NOT
contagious; the child is contagious only during the febrile phase before the rash appears, making option C
incorrect.
3. A school nurse observes a 7-year-old child who presents with a bright red, flushed appearance on both
cheeks, described as a "slapped cheek" look, along with a lacy, reticular rash on the trunk and extremities.
The child has also been complaining of joint pain. Which nursing action is the priority?
A) Place the child on airborne precautions immediately
B) Administer antipyretics and reassess in 1 hour
C) Notify the parents and exclude the child from school, while identifying pregnant staff
members who may have been exposed
D) Prepare the child for a lumbar puncture to rule out meningitis
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, Rationale: The clinical presentation of "slapped cheek" rash with a lacy reticular rash and arthralgias is
characteristic of Fifth disease (Erythema infectiosum), caused by Parvovirus B19. The priority nursing action is
to identify and notify pregnant women who may have been exposed, as Parvovirus B19 infection during
pregnancy can cause hydrops fetalis and fetal death. There is no vaccine available. Airborne precautions are not
indicated for Fifth disease. A lumbar puncture is not necessary for this presentation. Antipyretics are not the
priority over managing the exposure risk.
4. A pregnant school teacher is informed that a student in her class has been diagnosed with Fifth disease
(Parvovirus B19). The teacher is very concerned. Which response by the nurse is most appropriate?
A) You have nothing to worry about because there is a vaccine that can protect you.
B) You should be tested for Parvovirus B19 immunity, and if susceptible, you will be
monitored closely for signs of fetal anemia.
C) Since you have already been exposed, there is nothing that can be done at this point.
D) You should immediately start antiviral medication to prevent transmission to the fetus.
Rationale: There is no vaccine for Parvovirus B19 and no specific antiviral treatment. The most appropriate
response is to test the pregnant woman for Parvovirus B19 IgG and IgM antibodies to determine immunity
status. If she is IgG-positive, she has prior immunity and is not at risk. If she is susceptible (IgG-negative), serial
ultrasounds should be performed to monitor for hydrops fetalis, which can occur due to fetal hemolytic anemia
caused by the virus. IVIG may be considered in severe cases. Telling her there is nothing to be done or that a
vaccine exists would be inaccurate.
5. A pediatric nurse is caring for a 4-year-old child admitted with suspected measles. Which assessment
finding would the nurse expect to observe that is pathognomonic for measles?
A) Small white lesions with a bluish-white center on the buccal mucosa (Koplik spots)
B) Vesicular lesions in various stages on the trunk and face
C) A sandpaper-like rash with Pastia lines in the flexor creases
D) A desquamating rash on the palms and soles of the feet
Rationale: Koplik spots are small, irregular, bluish-white lesions on a red base found on the buccal mucosa
opposite the lower molars, and they are pathognomonic for measles (Rubeola). They appear 1-2 days before the
characteristic maculopapular rash, which spreads from the hairline downward to the extremities. Vesicular
lesions in various stages are characteristic of varicella. A sandpaper-like rash with Pastia lines is seen in scarlet
fever. Desquamation on palms and soles is associated with conditions like Kawasaki disease or late-stage scarlet
fever, not measles.
6. A 6-year-old child is admitted to the pediatric unit with a confirmed diagnosis of measles. Which
transmission-based precaution should the nurse implement?
A) Droplet precautions with a surgical mask for anyone entering the room
B) Airborne precautions in a negative-pressure room with an N95 respirator
C) Contact precautions with gown and gloves for all caregivers
D) Standard precautions only, as measles is not highly contagious
Rationale: Measles is one of the most contagious airborne diseases, transmitted via small particle aerosols that
remain suspended in the air. Airborne precautions require a negative-pressure isolation room and the use of an
N95 respirator (or PAPR) by healthcare providers. Droplet precautions are insufficient because the particles can
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Exam 4 – Child Health
Pediatric Nursing Comprehensive Exam Bank
2026/2027 Academic Year
65 NCLEX-Style Practice Questions with Rationales
,Infectious Diseases
20 Questions
1. A 9-month-old infant is brought to the pediatric clinic by a parent who reports the child has had a high
fever of 104°F for the past 3 days but has been playful and drinking well. Today the fever has resolved,
but a pinkish maculopapular rash has appeared on the trunk. The nurse anticipates which diagnosis?
A) Roseola (Roseola infantum, caused by HHV-6)
B) Measles (Rubeola)
C) Rubella (German measles)
D) Fifth disease (Erythema infectiosum)
Rationale: Roseola, caused by human herpesvirus 6 (HHV-6) or HHV-7, classically presents with a sudden high
fever of 103-105°F lasting 3-5 days in an otherwise well-appearing infant or toddler, followed by a
maculopapular rash that appears as the fever subsides. The child's playful behavior despite the high fever is a
hallmark finding. Measles presents with the 3 C's (cough, coryza, conjunctivitis) and Koplik spots before a rash
that spreads from the hairline downward. Rubella presents with lymphadenopathy and a mild rash. Fifth disease
presents with the classic "slapped cheek" appearance.
2. A nurse is providing discharge teaching to the parents of a toddler recovering from roseola. Which
statement by the parent indicates that the teaching has been effective?
A) I should give aspirin to reduce my child's fever because it works faster than acetaminophen.
B) I will need to bring my child back for a course of antibiotics to clear the infection.
C) I understand that the rash is contagious, so my child must stay home until it completely
resolves.
D) I will monitor my child closely during the fever because of the risk of febrile seizures.
Rationale: Febrile seizures are a known complication of the rapid, high fever (103-105°F) seen in roseola, so the
parent's statement about monitoring for febrile seizures indicates effective teaching. Aspirin should never be
given to children due to the risk of Reye syndrome, making option A incorrect. Roseola is caused by HHV-6 or
HHV-7, a viral illness, so antibiotics are not indicated, making option B incorrect. The rash of roseola is NOT
contagious; the child is contagious only during the febrile phase before the rash appears, making option C
incorrect.
3. A school nurse observes a 7-year-old child who presents with a bright red, flushed appearance on both
cheeks, described as a "slapped cheek" look, along with a lacy, reticular rash on the trunk and extremities.
The child has also been complaining of joint pain. Which nursing action is the priority?
A) Place the child on airborne precautions immediately
B) Administer antipyretics and reassess in 1 hour
C) Notify the parents and exclude the child from school, while identifying pregnant staff
members who may have been exposed
D) Prepare the child for a lumbar puncture to rule out meningitis
Page PAGE
, Rationale: The clinical presentation of "slapped cheek" rash with a lacy reticular rash and arthralgias is
characteristic of Fifth disease (Erythema infectiosum), caused by Parvovirus B19. The priority nursing action is
to identify and notify pregnant women who may have been exposed, as Parvovirus B19 infection during
pregnancy can cause hydrops fetalis and fetal death. There is no vaccine available. Airborne precautions are not
indicated for Fifth disease. A lumbar puncture is not necessary for this presentation. Antipyretics are not the
priority over managing the exposure risk.
4. A pregnant school teacher is informed that a student in her class has been diagnosed with Fifth disease
(Parvovirus B19). The teacher is very concerned. Which response by the nurse is most appropriate?
A) You have nothing to worry about because there is a vaccine that can protect you.
B) You should be tested for Parvovirus B19 immunity, and if susceptible, you will be
monitored closely for signs of fetal anemia.
C) Since you have already been exposed, there is nothing that can be done at this point.
D) You should immediately start antiviral medication to prevent transmission to the fetus.
Rationale: There is no vaccine for Parvovirus B19 and no specific antiviral treatment. The most appropriate
response is to test the pregnant woman for Parvovirus B19 IgG and IgM antibodies to determine immunity
status. If she is IgG-positive, she has prior immunity and is not at risk. If she is susceptible (IgG-negative), serial
ultrasounds should be performed to monitor for hydrops fetalis, which can occur due to fetal hemolytic anemia
caused by the virus. IVIG may be considered in severe cases. Telling her there is nothing to be done or that a
vaccine exists would be inaccurate.
5. A pediatric nurse is caring for a 4-year-old child admitted with suspected measles. Which assessment
finding would the nurse expect to observe that is pathognomonic for measles?
A) Small white lesions with a bluish-white center on the buccal mucosa (Koplik spots)
B) Vesicular lesions in various stages on the trunk and face
C) A sandpaper-like rash with Pastia lines in the flexor creases
D) A desquamating rash on the palms and soles of the feet
Rationale: Koplik spots are small, irregular, bluish-white lesions on a red base found on the buccal mucosa
opposite the lower molars, and they are pathognomonic for measles (Rubeola). They appear 1-2 days before the
characteristic maculopapular rash, which spreads from the hairline downward to the extremities. Vesicular
lesions in various stages are characteristic of varicella. A sandpaper-like rash with Pastia lines is seen in scarlet
fever. Desquamation on palms and soles is associated with conditions like Kawasaki disease or late-stage scarlet
fever, not measles.
6. A 6-year-old child is admitted to the pediatric unit with a confirmed diagnosis of measles. Which
transmission-based precaution should the nurse implement?
A) Droplet precautions with a surgical mask for anyone entering the room
B) Airborne precautions in a negative-pressure room with an N95 respirator
C) Contact precautions with gown and gloves for all caregivers
D) Standard precautions only, as measles is not highly contagious
Rationale: Measles is one of the most contagious airborne diseases, transmitted via small particle aerosols that
remain suspended in the air. Airborne precautions require a negative-pressure isolation room and the use of an
N95 respirator (or PAPR) by healthcare providers. Droplet precautions are insufficient because the particles can
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