RELIAS LEARNING
RELIAS Pediatric A v1
2026/2027 Edition
54 Questions & Answers
Official Practice Exam -- 2026/2027 Edition
54 Questions 90 Minutes 80% Passing Score Annual Recertification
Table of Contents
Section 1: Pediatric Assessment and Growth/Development (14 Questions)
Section 2: Pediatric Respiratory and Cardiovascular (14 Questions)
Section 3: Pediatric GI, Renal, and Endocrine (13 Questions)
Section 4: Pediatric Emergency and Special Populations (13 Questions)
Answer Key
Instructions
This practice exam contains 54 multiple-choice questions divided into 4 sections. Each question has four answer
choices (A, B, C, D). Select the one best answer for each question. You have 90 minutes to complete the exam. A
passing score of 80% (43 out of 54 correct) is required. Read each question carefully. The correct answer and
rationale are provided immediately after each question for study purposes. This exam is based on the 2026/2027
RELIAS Pediatric A v1 blueprint.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 1 of 0
,Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q1 Question 1 of 54
A 6-month-old infant presents for a well-child visit. The mother reports the infant can roll
from front to back, sits with support, babbles, and reaches for objects. The infant's weight
is at the 50th percentile, length at the 75th percentile, and head circumference at the 50th
percentile. Are these developmental milestones appropriate for this age?
A. Yes, these milestones are consistent with a typically developing 6-month-old infant
B. No, the infant should be walking independently by this age
C. No, the infant should be speaking in two-word phrases by this age
D. No, rolling from front to back is not expected until 12 months of age
Correct Answer: A
Rationale:
Rolling front to back by 6 months, sitting with support, babbling, and reaching for objects are all
age-appropriate milestones for a 6-month-old infant. Independent walking typically occurs around 12
months, not 6 months. Two-word phrases are expected around 24 months. Rolling typically emerges
between 4-6 months, so it is not delayed at this age.
Q2 Question 2 of 54
A 2-year-old toddler is brought to the clinic by his grandmother who is concerned about his
language development. The child says approximately 10 words and does not combine
words into phrases. He follows simple one-step commands and points to objects he wants.
What is the most appropriate assessment of this child's language development?
A. The child's language development is within normal limits for a 2-year-old
B. The child has a speech and language delay and should be referred for evaluation
C. The child's language is advanced because he follows one-step commands
D. The child is demonstrating selective mutism and needs behavioral therapy
Correct Answer: B
Rationale:
By 24 months, a child should have a vocabulary of approximately 50 words and should be combining
words into two-word phrases. A vocabulary of only 10 words without word combinations at age 2
represents a significant speech and language delay warranting further evaluation. Following
commands indicates receptive language ability, but the expressive language is delayed. Selective
mutism is not applicable at this age and does not present with limited vocabulary development.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 2 of 0
,Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q3 Question 3 of 54
A nurse is performing a growth assessment on a 4-year-old girl. Her height is 101 cm (40th
percentile) and her weight is 19 kg (95th percentile). Her BMI is at the 97th percentile for
age. The mother reports the child drinks approximately 24 ounces of juice daily and snacks
frequently on chips and cookies. What is the most appropriate initial intervention?
A. Refer the child to a pediatric endocrinologist for evaluation of hormonal causes of obesity
B. Place the child on a strict calorie-restricted diet to achieve rapid weight loss
C. Counsel the family on reducing juice intake to 4 ounces daily, replacing snacks with
fruits and vegetables, and increasing physical activity
D. Prescribe orlistat to reduce fat absorption and promote weight loss
Correct Answer: C
Rationale:
Excessive juice consumption (24 ounces daily far exceeds the recommended 4 ounces) and poor
snack choices are modifiable dietary factors contributing to this child's elevated BMI. Counseling on
nutrition and activity is the first-line intervention for childhood obesity. Endocrinology referral is
reserved for cases where lifestyle modification fails or there are signs of comorbidities. Strict calorie
restriction is not recommended in young children as it may impair growth. Orlistat is not approved for
children this young.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 3 of 0
, Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q4 Question 4 of 54
A newborn infant is noted to have a yellowish tint to the skin and sclera at 36 hours of life.
The total bilirubin is 14 mg/dL. The infant was born at 39 weeks gestation, is breastfeeding
well, and has a normal physical exam otherwise. The mother's blood type is O positive and
the infant's blood type is A positive. What is the most likely diagnosis?
A. Breast milk jaundice which typically presents within the first 24 hours of life
B. Crigler-Najjar syndrome requiring immediate liver transplantation
C. Biliary atresia causing direct hyperbilirubinemia from birth
D. Physiologic jaundice influenced by ABO incompatibility requiring phototherapy
evaluation
Correct Answer: D
Rationale:
Jaundice at 36 hours with an elevated bilirubin of 14 mg/dL in the setting of maternal blood type O and
infant blood type A is most consistent with physiologic jaundice exacerbated by ABO incompatibility.
Breast milk jaundice typically presents after day 5-7, not at 36 hours. Biliary atresia presents with
direct (conjugated) hyperbilirubinemia and pale stools, not indirect hyperbilirubinemia. Crigler-Najjar is
a rare enzyme deficiency that presents with severe unconjugated hyperbilirubinemia within the first
days of life but is far less common than ABO incompatibility.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 4 of 0
RELIAS Pediatric A v1
2026/2027 Edition
54 Questions & Answers
Official Practice Exam -- 2026/2027 Edition
54 Questions 90 Minutes 80% Passing Score Annual Recertification
Table of Contents
Section 1: Pediatric Assessment and Growth/Development (14 Questions)
Section 2: Pediatric Respiratory and Cardiovascular (14 Questions)
Section 3: Pediatric GI, Renal, and Endocrine (13 Questions)
Section 4: Pediatric Emergency and Special Populations (13 Questions)
Answer Key
Instructions
This practice exam contains 54 multiple-choice questions divided into 4 sections. Each question has four answer
choices (A, B, C, D). Select the one best answer for each question. You have 90 minutes to complete the exam. A
passing score of 80% (43 out of 54 correct) is required. Read each question carefully. The correct answer and
rationale are provided immediately after each question for study purposes. This exam is based on the 2026/2027
RELIAS Pediatric A v1 blueprint.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 1 of 0
,Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q1 Question 1 of 54
A 6-month-old infant presents for a well-child visit. The mother reports the infant can roll
from front to back, sits with support, babbles, and reaches for objects. The infant's weight
is at the 50th percentile, length at the 75th percentile, and head circumference at the 50th
percentile. Are these developmental milestones appropriate for this age?
A. Yes, these milestones are consistent with a typically developing 6-month-old infant
B. No, the infant should be walking independently by this age
C. No, the infant should be speaking in two-word phrases by this age
D. No, rolling from front to back is not expected until 12 months of age
Correct Answer: A
Rationale:
Rolling front to back by 6 months, sitting with support, babbling, and reaching for objects are all
age-appropriate milestones for a 6-month-old infant. Independent walking typically occurs around 12
months, not 6 months. Two-word phrases are expected around 24 months. Rolling typically emerges
between 4-6 months, so it is not delayed at this age.
Q2 Question 2 of 54
A 2-year-old toddler is brought to the clinic by his grandmother who is concerned about his
language development. The child says approximately 10 words and does not combine
words into phrases. He follows simple one-step commands and points to objects he wants.
What is the most appropriate assessment of this child's language development?
A. The child's language development is within normal limits for a 2-year-old
B. The child has a speech and language delay and should be referred for evaluation
C. The child's language is advanced because he follows one-step commands
D. The child is demonstrating selective mutism and needs behavioral therapy
Correct Answer: B
Rationale:
By 24 months, a child should have a vocabulary of approximately 50 words and should be combining
words into two-word phrases. A vocabulary of only 10 words without word combinations at age 2
represents a significant speech and language delay warranting further evaluation. Following
commands indicates receptive language ability, but the expressive language is delayed. Selective
mutism is not applicable at this age and does not present with limited vocabulary development.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 2 of 0
,Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q3 Question 3 of 54
A nurse is performing a growth assessment on a 4-year-old girl. Her height is 101 cm (40th
percentile) and her weight is 19 kg (95th percentile). Her BMI is at the 97th percentile for
age. The mother reports the child drinks approximately 24 ounces of juice daily and snacks
frequently on chips and cookies. What is the most appropriate initial intervention?
A. Refer the child to a pediatric endocrinologist for evaluation of hormonal causes of obesity
B. Place the child on a strict calorie-restricted diet to achieve rapid weight loss
C. Counsel the family on reducing juice intake to 4 ounces daily, replacing snacks with
fruits and vegetables, and increasing physical activity
D. Prescribe orlistat to reduce fat absorption and promote weight loss
Correct Answer: C
Rationale:
Excessive juice consumption (24 ounces daily far exceeds the recommended 4 ounces) and poor
snack choices are modifiable dietary factors contributing to this child's elevated BMI. Counseling on
nutrition and activity is the first-line intervention for childhood obesity. Endocrinology referral is
reserved for cases where lifestyle modification fails or there are signs of comorbidities. Strict calorie
restriction is not recommended in young children as it may impair growth. Orlistat is not approved for
children this young.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 3 of 0
, Section 1: Pediatric Assessment and Growth/Development -- 2026/2027
Q4 Question 4 of 54
A newborn infant is noted to have a yellowish tint to the skin and sclera at 36 hours of life.
The total bilirubin is 14 mg/dL. The infant was born at 39 weeks gestation, is breastfeeding
well, and has a normal physical exam otherwise. The mother's blood type is O positive and
the infant's blood type is A positive. What is the most likely diagnosis?
A. Breast milk jaundice which typically presents within the first 24 hours of life
B. Crigler-Najjar syndrome requiring immediate liver transplantation
C. Biliary atresia causing direct hyperbilirubinemia from birth
D. Physiologic jaundice influenced by ABO incompatibility requiring phototherapy
evaluation
Correct Answer: D
Rationale:
Jaundice at 36 hours with an elevated bilirubin of 14 mg/dL in the setting of maternal blood type O and
infant blood type A is most consistent with physiologic jaundice exacerbated by ABO incompatibility.
Breast milk jaundice typically presents after day 5-7, not at 36 hours. Biliary atresia presents with
direct (conjugated) hyperbilirubinemia and pale stools, not indirect hyperbilirubinemia. Crigler-Najjar is
a rare enzyme deficiency that presents with severe unconjugated hyperbilirubinemia within the first
days of life but is far less common than ABO incompatibility.
RELIAS Pediatric A -- 2026/2027 | Passing Score: 80% | Page 4 of 0
