RN Pediatric Nursing Competency Exam
— Code: RN-PEDS-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A 4-year-old child with bacterial meningitis develops a temperature of 39.6°C
(103.3°F), irritability, and a rapidly increasing heart rate. Which nursing action is
the priority?
A. Apply a cooling blanket
B. Administer the prescribed antipyretic
C. Reduce environmental stimulation
D. Initiate seizure precautions
Answer: B. Administer the prescribed antipyretic
Rationale: Fever increases metabolic and oxygen demands and can worsen
neurologic stress in a child with meningitis. Prompt antipyretic therapy, along
,with treatment of the underlying infection, is appropriate. Seizure precautions
and environmental control are also important but do not address the immediate
physiologic stress of the high fever.
2.
A child with Tetralogy of Fallot suddenly becomes cyanotic and dyspneic while
crying. Which intervention should the nurse implement first?
A. Place the child supine
B. Administer a rapid IV fluid bolus
C. Place the child in the knee-chest position
D. Encourage vigorous coughing
Answer: C. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow during a
hypercyanotic spell. Oxygen and prescribed medications may also be required.
3.
A 6-month-old with bronchiolitis has nasal flaring, intercostal retractions, and
oxygen saturation of 88%. Which action should the nurse take first?
A. Begin oral feeding
B. Suction the airway
C. Administer an antitussive
D. Place the infant flat in the crib
Answer: B. Suction the airway
Rationale: Infants are primarily nasal breathers, and airway secretions can
significantly increase respiratory compromise. Suctioning can rapidly improve
airway patency and oxygenation.
4.
,A 7-year-old receiving chemotherapy has an absolute neutrophil count of
400/mm³. Which finding requires immediate intervention?
A. Mild fatigue
B. Temperature of 38.3°C (100.9°F)
C. Decreased appetite
D. Alopecia
Answer: B. Temperature of 38.3°C (100.9°F)
Rationale: Severe neutropenia places the child at high risk for life-threatening
infection. Fever in a neutropenic child is an emergency requiring prompt
evaluation and antimicrobial therapy according to protocol.
5.
A child with nephrotic syndrome has generalized edema and ascites. Which
assessment finding best indicates worsening fluid retention?
A. Weight loss
B. Increased urine output
C. Increasing abdominal girth
D. Decreased blood pressure with dry mucous membranes
Answer: C. Increasing abdominal girth
Rationale: Increasing abdominal girth reflects worsening ascites and fluid
accumulation. Daily weight, abdominal measurements, intake/output, and
edema assessment are important indicators of fluid status.
6.
A 10-year-old with type 1 diabetes mellitus is vomiting and has deep, rapid
respirations. Which finding is most concerning?
A. Blood glucose of 210 mg/dL
B. Respiratory rate of 32/min with deep respirations
, C. Mild thirst
D. Heart rate of 88/min
Answer: B. Respiratory rate of 32/min with deep respirations
Rationale: Deep, rapid respirations are consistent with Kussmaul respirations, a
compensatory response to metabolic acidosis associated with diabetic
ketoacidosis (DKA). DKA requires urgent fluid, electrolyte, and insulin
management.
7.
A child with suspected epiglottitis is drooling and sitting upright with the neck
extended. Which nursing action is contraindicated?
A. Administering oxygen as tolerated
B. Keeping the child calm
C. Inspecting the throat with a tongue blade
D. Preparing for possible airway management
Answer: C. Inspecting the throat with a tongue blade
Rationale: Manipulation of the throat can precipitate sudden airway obstruction
in epiglottitis. The child should remain calm, and emergency airway equipment
and personnel should be readily available.
8.
A 2-year-old is admitted after ingestion of an unknown household chemical.
Which prescription should the nurse question?
A. Obtain poison-control guidance
B. Assess airway and respiratory status
C. Induce vomiting
D. Identify the substance if possible
Answer: C. Induce vomiting
— Code: RN-PEDS-COMP | 100-
Question Advanced Practice Exam 2026
| Questions & Answers with Detailed
Rationales | Complete Exam Prep &
Study Guide
1.
A 4-year-old child with bacterial meningitis develops a temperature of 39.6°C
(103.3°F), irritability, and a rapidly increasing heart rate. Which nursing action is
the priority?
A. Apply a cooling blanket
B. Administer the prescribed antipyretic
C. Reduce environmental stimulation
D. Initiate seizure precautions
Answer: B. Administer the prescribed antipyretic
Rationale: Fever increases metabolic and oxygen demands and can worsen
neurologic stress in a child with meningitis. Prompt antipyretic therapy, along
,with treatment of the underlying infection, is appropriate. Seizure precautions
and environmental control are also important but do not address the immediate
physiologic stress of the high fever.
2.
A child with Tetralogy of Fallot suddenly becomes cyanotic and dyspneic while
crying. Which intervention should the nurse implement first?
A. Place the child supine
B. Administer a rapid IV fluid bolus
C. Place the child in the knee-chest position
D. Encourage vigorous coughing
Answer: C. Place the child in the knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
reducing right-to-left shunting and improving pulmonary blood flow during a
hypercyanotic spell. Oxygen and prescribed medications may also be required.
3.
A 6-month-old with bronchiolitis has nasal flaring, intercostal retractions, and
oxygen saturation of 88%. Which action should the nurse take first?
A. Begin oral feeding
B. Suction the airway
C. Administer an antitussive
D. Place the infant flat in the crib
Answer: B. Suction the airway
Rationale: Infants are primarily nasal breathers, and airway secretions can
significantly increase respiratory compromise. Suctioning can rapidly improve
airway patency and oxygenation.
4.
,A 7-year-old receiving chemotherapy has an absolute neutrophil count of
400/mm³. Which finding requires immediate intervention?
A. Mild fatigue
B. Temperature of 38.3°C (100.9°F)
C. Decreased appetite
D. Alopecia
Answer: B. Temperature of 38.3°C (100.9°F)
Rationale: Severe neutropenia places the child at high risk for life-threatening
infection. Fever in a neutropenic child is an emergency requiring prompt
evaluation and antimicrobial therapy according to protocol.
5.
A child with nephrotic syndrome has generalized edema and ascites. Which
assessment finding best indicates worsening fluid retention?
A. Weight loss
B. Increased urine output
C. Increasing abdominal girth
D. Decreased blood pressure with dry mucous membranes
Answer: C. Increasing abdominal girth
Rationale: Increasing abdominal girth reflects worsening ascites and fluid
accumulation. Daily weight, abdominal measurements, intake/output, and
edema assessment are important indicators of fluid status.
6.
A 10-year-old with type 1 diabetes mellitus is vomiting and has deep, rapid
respirations. Which finding is most concerning?
A. Blood glucose of 210 mg/dL
B. Respiratory rate of 32/min with deep respirations
, C. Mild thirst
D. Heart rate of 88/min
Answer: B. Respiratory rate of 32/min with deep respirations
Rationale: Deep, rapid respirations are consistent with Kussmaul respirations, a
compensatory response to metabolic acidosis associated with diabetic
ketoacidosis (DKA). DKA requires urgent fluid, electrolyte, and insulin
management.
7.
A child with suspected epiglottitis is drooling and sitting upright with the neck
extended. Which nursing action is contraindicated?
A. Administering oxygen as tolerated
B. Keeping the child calm
C. Inspecting the throat with a tongue blade
D. Preparing for possible airway management
Answer: C. Inspecting the throat with a tongue blade
Rationale: Manipulation of the throat can precipitate sudden airway obstruction
in epiglottitis. The child should remain calm, and emergency airway equipment
and personnel should be readily available.
8.
A 2-year-old is admitted after ingestion of an unknown household chemical.
Which prescription should the nurse question?
A. Obtain poison-control guidance
B. Assess airway and respiratory status
C. Induce vomiting
D. Identify the substance if possible
Answer: C. Induce vomiting
