Pediatrics NCLEX-Style Practice Exam
Review
Comprehensive Pediatric Nursing Practice
Examination
1. A 2-year-old child is admitted with dehydration secondary to gastroenteritis. Which assessment
finding indicates severe dehydration?
A) Slightly dry mucous membranes
B) Capillary refill of 2 seconds
C) Sunken fontanelles and eyes
D) Heart rate of 110 bpm
Answer: C) Sunken fontanelles and eyes
Rationale: Sunken fontanelles and eyes are classic signs of severe dehydration in children. Mild
dehydration presents with slightly dry mucous membranes, while moderate dehydration shows capillary
refill >2 seconds and tachycardia. Severe dehydration is characterized by sunken fontanelles, eyes,
lethargy, and decreased urine output.
2. A nurse is caring for a 6-month-old infant with bronchiolitis caused by RSV. Which intervention
should be prioritized?
A) Administer antibiotics as prescribed
B) Maintain strict isolation precautions
C) Suction the nares before feedings
D) Encourage oral fluids frequently
Answer: C) Suction the nares before feedings
Rationale: RSV causes inflammation and mucus production in the small airways. Infants are obligate
nose breathers, and nasal congestion significantly interferes with feeding and breathing. Suctioning
before feedings is the priority intervention to maintain airway patency and prevent aspiration. RSV is
viral, so antibiotics are not indicated unless a secondary bacterial infection develops.
3. A 4-year-old child is being evaluated for possible intussusception. Which clinical manifestation is
most characteristic of this condition?
,A) "Currant jelly" stools
B) Projectile vomiting
C) Olive-shaped abdominal mass
D) Bilious emesis
Answer: A) "Currant jelly" stools
Rationale: Intussusception occurs when one segment of bowel telescopes into another, causing
obstruction and ischemia. The classic manifestation is "currant jelly" stools (stool mixed with blood and
mucus), which indicates mucosal sloughing and bleeding. Projectile vomiting is more characteristic of
pyloric stenosis, and an olive-shaped mass is associated with pyloric stenosis, not intussusception.
4. The nurse is assessing a newborn with suspected congenital hypothyroidism. Which finding
supports this diagnosis?
A) Hyperactivity and irritability
B) Prolonged jaundice and constipation
C) Tachycardia and hypertension
D) Excessive weight loss and diarrhea
Answer: B) Prolonged jaundice and constipation
Rationale: Congenital hypothyroidism presents with signs of decreased metabolism including prolonged
jaundice, constipation, lethargy, poor feeding, and hypotonia. Hyperactivity, tachycardia, and
hypertension are signs of hyperthyroidism, not hypothyroidism. The newborn screen helps detect this
condition early to prevent developmental delays.
5. A school-age child with asthma is prescribed an albuterol inhaler. What instruction should the nurse
include regarding use of this medication?
A) "Use the inhaler only when you are short of breath"
B) "Rinse your mouth immediately after using the inhaler"
C) "Wait 5 minutes between puffs if using two puffs"
D) "Hold your breath for 10 seconds after inhaling"
Answer: D) "Hold your breath for 10 seconds after inhaling"
Rationale: Holding the breath for 10 seconds after inhalation allows maximum medication deposition in
the airways. Albuterol should be used as prescribed, not only during acute episodes. Rinsing the mouth is
more important with corticosteroid inhalers to prevent oral thrush, and 1 minute should pass between
puffs, not 5 minutes.
6. An 8-month-old infant presents with failure to thrive, vomiting, and seizures. Laboratory findings
reveal metabolic acidosis and hyperammonemia. Which condition should the nurse suspect?
,A) Pyloric stenosis
B) GERD
C) Inborn error of metabolism
D) Intussusception
Answer: C) Inborn error of metabolism
Rationale: Inborn errors of metabolism present with failure to thrive, vomiting, seizures, and metabolic
abnormalities including acidosis and hyperammonemia. Pyloric stenosis presents with projectile vomiting
but no metabolic abnormalities. GERD presents with regurgitation but not seizures or hyperammonemia.
7. A 10-year-old child is diagnosed with acute glomerulonephritis. Which finding requires immediate
intervention?
A) Periorbital edema
B) Blood pressure of 150/95 mmHg
C) Urine output of 20 mL/hour
D) Temperature of 37.8°C
Answer: C) Urine output of 20 mL/hour
Rationale: In acute glomerulonephritis, urine output of 20 mL/hour is dangerously low for a 10-year-old
child (normal output is >1 mL/kg/hour). This suggests acute kidney injury and requires immediate
intervention to prevent fluid overload and electrolyte imbalances. While hypertension is concerning, the
low urine output is the more critical finding requiring immediate action.
8. The nurse is teaching parents about home care for a child with impetigo. Which instruction is most
important?
A) "Apply antibiotic ointment three times daily"
B) "Keep the lesions covered with gauze"
C) "Wash linens and towels in hot water daily"
D) "Avoid sharing personal items with siblings"
Answer: C) "Wash linens and towels in hot water daily"
Rationale: Impetigo is highly contagious and can spread through contact with contaminated linens,
towels, and clothing. Washing linens in hot water daily is crucial to prevent transmission to other family
members. While all interventions are appropriate, infection control measures are the priority, making
linen hygiene most important.
9. A 2-week-old infant is brought to the clinic with projectile vomiting after feedings. The nurse notes
poor weight gain and visible gastric peristalsis. Which intervention should the nurse anticipate?
, A) NPO status and IV fluids
B) Feeding with small, frequent meals
C) Antibiotic therapy
D) Immediate surgery
Answer: A) NPO status and IV fluids
Rationale: These signs suggest pyloric stenosis, which causes gastric outlet obstruction from hypertrophy
of the pyloric sphincter. Initial management includes NPO status and IV fluid resuscitation to correct
dehydration and electrolyte imbalances (especially hypochloremic metabolic alkalosis) before surgical
intervention (pyloromyotomy).
10. An adolescent client with type 1 diabetes is experiencing diabetic ketoacidosis (DKA). Which
finding indicates that treatment is effective?
A) Blood glucose decreased from 350 to 250 mg/dL
B) Serum potassium increased from 3.0 to 3.5 mEq/L
C) Anion gap decreased from 18 to 12 mEq/L
D) Urine output increased to 50 mL/hour
Answer: C) Anion gap decreased from 18 to 12 mEq/L
Rationale: A decreasing anion gap indicates resolution of metabolic acidosis, which is a key sign of
effective DKA treatment. While decreasing blood glucose, rising potassium, and increasing urine output
are expected, they can occur with fluid and electrolyte management alone. The anion gap directly
reflects acid-base status.
11. A child with sickle cell anemia presents with fever, chest pain, and respiratory distress. The nurse
should suspect which complication?
A) Acute chest syndrome
B) Sequestration crisis
C) Aplastic crisis
D) Vaso-occlusive crisis
Answer: A) Acute chest syndrome
Rationale: Acute chest syndrome is characterized by fever, chest pain, and respiratory distress in patients
with sickle cell disease. It is a leading cause of death in these patients and requires immediate
intervention. Sequestration crisis involves pooling of blood in the spleen causing hypovolemia. Aplastic
crisis results from bone marrow suppression.
12. A 3-year-old child is receiving chemotherapy for leukemia. The nurse should implement which
intervention to manage the risk of tumor lysis syndrome?
Review
Comprehensive Pediatric Nursing Practice
Examination
1. A 2-year-old child is admitted with dehydration secondary to gastroenteritis. Which assessment
finding indicates severe dehydration?
A) Slightly dry mucous membranes
B) Capillary refill of 2 seconds
C) Sunken fontanelles and eyes
D) Heart rate of 110 bpm
Answer: C) Sunken fontanelles and eyes
Rationale: Sunken fontanelles and eyes are classic signs of severe dehydration in children. Mild
dehydration presents with slightly dry mucous membranes, while moderate dehydration shows capillary
refill >2 seconds and tachycardia. Severe dehydration is characterized by sunken fontanelles, eyes,
lethargy, and decreased urine output.
2. A nurse is caring for a 6-month-old infant with bronchiolitis caused by RSV. Which intervention
should be prioritized?
A) Administer antibiotics as prescribed
B) Maintain strict isolation precautions
C) Suction the nares before feedings
D) Encourage oral fluids frequently
Answer: C) Suction the nares before feedings
Rationale: RSV causes inflammation and mucus production in the small airways. Infants are obligate
nose breathers, and nasal congestion significantly interferes with feeding and breathing. Suctioning
before feedings is the priority intervention to maintain airway patency and prevent aspiration. RSV is
viral, so antibiotics are not indicated unless a secondary bacterial infection develops.
3. A 4-year-old child is being evaluated for possible intussusception. Which clinical manifestation is
most characteristic of this condition?
,A) "Currant jelly" stools
B) Projectile vomiting
C) Olive-shaped abdominal mass
D) Bilious emesis
Answer: A) "Currant jelly" stools
Rationale: Intussusception occurs when one segment of bowel telescopes into another, causing
obstruction and ischemia. The classic manifestation is "currant jelly" stools (stool mixed with blood and
mucus), which indicates mucosal sloughing and bleeding. Projectile vomiting is more characteristic of
pyloric stenosis, and an olive-shaped mass is associated with pyloric stenosis, not intussusception.
4. The nurse is assessing a newborn with suspected congenital hypothyroidism. Which finding
supports this diagnosis?
A) Hyperactivity and irritability
B) Prolonged jaundice and constipation
C) Tachycardia and hypertension
D) Excessive weight loss and diarrhea
Answer: B) Prolonged jaundice and constipation
Rationale: Congenital hypothyroidism presents with signs of decreased metabolism including prolonged
jaundice, constipation, lethargy, poor feeding, and hypotonia. Hyperactivity, tachycardia, and
hypertension are signs of hyperthyroidism, not hypothyroidism. The newborn screen helps detect this
condition early to prevent developmental delays.
5. A school-age child with asthma is prescribed an albuterol inhaler. What instruction should the nurse
include regarding use of this medication?
A) "Use the inhaler only when you are short of breath"
B) "Rinse your mouth immediately after using the inhaler"
C) "Wait 5 minutes between puffs if using two puffs"
D) "Hold your breath for 10 seconds after inhaling"
Answer: D) "Hold your breath for 10 seconds after inhaling"
Rationale: Holding the breath for 10 seconds after inhalation allows maximum medication deposition in
the airways. Albuterol should be used as prescribed, not only during acute episodes. Rinsing the mouth is
more important with corticosteroid inhalers to prevent oral thrush, and 1 minute should pass between
puffs, not 5 minutes.
6. An 8-month-old infant presents with failure to thrive, vomiting, and seizures. Laboratory findings
reveal metabolic acidosis and hyperammonemia. Which condition should the nurse suspect?
,A) Pyloric stenosis
B) GERD
C) Inborn error of metabolism
D) Intussusception
Answer: C) Inborn error of metabolism
Rationale: Inborn errors of metabolism present with failure to thrive, vomiting, seizures, and metabolic
abnormalities including acidosis and hyperammonemia. Pyloric stenosis presents with projectile vomiting
but no metabolic abnormalities. GERD presents with regurgitation but not seizures or hyperammonemia.
7. A 10-year-old child is diagnosed with acute glomerulonephritis. Which finding requires immediate
intervention?
A) Periorbital edema
B) Blood pressure of 150/95 mmHg
C) Urine output of 20 mL/hour
D) Temperature of 37.8°C
Answer: C) Urine output of 20 mL/hour
Rationale: In acute glomerulonephritis, urine output of 20 mL/hour is dangerously low for a 10-year-old
child (normal output is >1 mL/kg/hour). This suggests acute kidney injury and requires immediate
intervention to prevent fluid overload and electrolyte imbalances. While hypertension is concerning, the
low urine output is the more critical finding requiring immediate action.
8. The nurse is teaching parents about home care for a child with impetigo. Which instruction is most
important?
A) "Apply antibiotic ointment three times daily"
B) "Keep the lesions covered with gauze"
C) "Wash linens and towels in hot water daily"
D) "Avoid sharing personal items with siblings"
Answer: C) "Wash linens and towels in hot water daily"
Rationale: Impetigo is highly contagious and can spread through contact with contaminated linens,
towels, and clothing. Washing linens in hot water daily is crucial to prevent transmission to other family
members. While all interventions are appropriate, infection control measures are the priority, making
linen hygiene most important.
9. A 2-week-old infant is brought to the clinic with projectile vomiting after feedings. The nurse notes
poor weight gain and visible gastric peristalsis. Which intervention should the nurse anticipate?
, A) NPO status and IV fluids
B) Feeding with small, frequent meals
C) Antibiotic therapy
D) Immediate surgery
Answer: A) NPO status and IV fluids
Rationale: These signs suggest pyloric stenosis, which causes gastric outlet obstruction from hypertrophy
of the pyloric sphincter. Initial management includes NPO status and IV fluid resuscitation to correct
dehydration and electrolyte imbalances (especially hypochloremic metabolic alkalosis) before surgical
intervention (pyloromyotomy).
10. An adolescent client with type 1 diabetes is experiencing diabetic ketoacidosis (DKA). Which
finding indicates that treatment is effective?
A) Blood glucose decreased from 350 to 250 mg/dL
B) Serum potassium increased from 3.0 to 3.5 mEq/L
C) Anion gap decreased from 18 to 12 mEq/L
D) Urine output increased to 50 mL/hour
Answer: C) Anion gap decreased from 18 to 12 mEq/L
Rationale: A decreasing anion gap indicates resolution of metabolic acidosis, which is a key sign of
effective DKA treatment. While decreasing blood glucose, rising potassium, and increasing urine output
are expected, they can occur with fluid and electrolyte management alone. The anion gap directly
reflects acid-base status.
11. A child with sickle cell anemia presents with fever, chest pain, and respiratory distress. The nurse
should suspect which complication?
A) Acute chest syndrome
B) Sequestration crisis
C) Aplastic crisis
D) Vaso-occlusive crisis
Answer: A) Acute chest syndrome
Rationale: Acute chest syndrome is characterized by fever, chest pain, and respiratory distress in patients
with sickle cell disease. It is a leading cause of death in these patients and requires immediate
intervention. Sequestration crisis involves pooling of blood in the spleen causing hypovolemia. Aplastic
crisis results from bone marrow suppression.
12. A 3-year-old child is receiving chemotherapy for leukemia. The nurse should implement which
intervention to manage the risk of tumor lysis syndrome?
