RN Pediatric Nursing 2026 Proctored | Ultimate Study
Guide and Practice Test
800 QUESTIONS WITH ANSWERS
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding should
the nurse recognize as an expected developmental milestone?
A. Walks independently
B. Uses a refined pincer grasp
C. Rolls from abdomen to back
D. Speaks in two-word phrases
Answer: C. Rolls from abdomen to back
Rationale: Rolling from abdomen to back is an expected gross motor milestone around 4-6
months of age. Independent walking typically occurs around 12 months. A refined pincer grasp
develops closer to 9-12 months. Two-word phrases are expected around 18-24 months.
Understanding developmental milestones is essential for identifying delays and providing
anticipatory guidance to parents.
2. A nurse is caring for a child with suspected epiglottitis. Which action is the priority?
A. Obtain a throat culture
B. Keep the child calm and prepare for airway management
C. Inspect the throat with a tongue depressor
D. Encourage the child to drink fluids
Answer: B. Keep the child calm and prepare for airway management
Rationale: Epiglottitis is a life-threatening emergency that can cause rapid, complete airway
obstruction. The priority is to keep the child calm to prevent agitation, which can worsen airway
compromise, and prepare for immediate airway management. Throat inspection with a tongue
depressor can precipitate complete airway obstruction and should be avoided. Obtaining a
throat culture and encouraging fluids are contraindicated until the airway is secured.
, 3. A 2-year-old child is admitted with dehydration from gastroenteritis. Which finding
requires the most immediate intervention?
A. Dry lips
B. Capillary refill of 4 seconds
C. Heart rate of 128/min
D. One wet diaper in 8 hours
Answer: D. One wet diaper in 8 hours
Rationale: Markedly decreased urine output (one wet diaper in 8 hours) indicates significant
dehydration and decreased renal perfusion. This finding requires prompt evaluation and fluid
management. While dry lips, prolonged capillary refill, and tachycardia are concerning signs, the
absence of urine output is a more critical indicator of severe dehydration requiring immediate
intervention.
4. A nurse is preparing to administer digoxin to a 10-month-old infant with congestive
heart failure. Which assessment is most important before administration?
A. Respiratory rate
B. Apical heart rate
C. Blood pressure
D. Temperature
Answer: B. Apical heart rate
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia, especially in
infants and children. The nurse must assess the apical pulse for one full minute before
administration. Pediatric-specific parameters for withholding the medication should be followed
based on the child's age and heart rate. The apical heart rate is the most critical assessment
prior to digoxin administration.
5. A nurse is caring for a child with nephrotic syndrome. Which assessment finding is most
characteristic of this condition?
A. Generalized edema
B. Severe hypertension
C. Hemoptysis
D. Increased urine output
,Answer: A. Generalized edema
Rationale: Nephrotic syndrome causes significant protein loss through the kidneys, resulting in
hypoalbuminemia and decreased plasma oncotic pressure. This leads to generalized edema,
often including periorbital edema, dependent edema, and ascites. Hypertension is more
characteristic of acute glomerulonephritis rather than nephrotic syndrome in the initial
presentation.
6. A child is experiencing an acute asthma exacerbation. Which medication should the
nurse anticipate administering first?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Theophylline
Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta₂ agonist (SABA) used as a rescue medication for acute
bronchospasm. It works rapidly to relax bronchial smooth muscle and relieve airway
obstruction. Inhaled corticosteroids like fluticasone are controller medications for long-term
management, not immediate rescue therapy. Montelukast and theophylline are not first-line
agents for acute exacerbations.
7. A nurse is assessing a child with meningitis. Which finding should the nurse report
immediately to the provider?
A. Photophobia
B. Headache
C. Nuchal rigidity
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: A declining level of consciousness can indicate increased intracranial pressure or
worsening neurologic status in a child with meningitis. This finding requires immediate
intervention as it may precede herniation. While photophobia, headache, and nuchal rigidity
are classic signs of meningitis, changes in consciousness are the most concerning and require
urgent reporting.
, 8. A 4-year-old child presents with a barking cough, inspiratory stridor, and a low-grade
fever. The nurse suspects croup. Which intervention is most appropriate?
A. Keep the child calm and provide humidified oxygen as prescribed
B. Place the child flat in bed
C. Inspect the throat with a tongue blade
D. Encourage vigorous coughing
Answer: A. Keep the child calm and provide humidified oxygen as prescribed
Rationale: Croup (acute laryngotracheobronchitis) causes upper airway inflammation and
edema. Keeping the child calm reduces oxygen demand and prevents further airway
compromise. Humidified oxygen helps soothe the airway and improve oxygenation. Placing the
child flat can worsen respiratory effort; an upright position is preferred. Throat inspection and
vigorous coughing are not appropriate interventions and may worsen the condition.
9. A school-age child is diagnosed with acute otitis media. Which finding is most consistent
with this diagnosis?
A. Clear tympanic membrane with visible landmarks
B. Bulging, red tympanic membrane with decreased mobility
C. Perforated tympanic membrane with purulent drainage
D. Retracted tympanic membrane with visible fluid level
Answer: B. Bulging, red tympanic membrane with decreased mobility
Rationale: Acute otitis media is characterized by inflammation and fluid accumulation in the
middle ear, resulting in a bulging, erythematous tympanic membrane with decreased or absent
mobility on pneumatic otoscopy. This finding indicates acute infection and inflammation. A clear
tympanic membrane is normal. Perforation with drainage suggests rupture, and retraction with
fluid may indicate serous otitis media rather than acute infection.
10. A nurse is teaching the family of a child with a new diagnosis of lactose intolerance.
Which dietary modification should the nurse recommend?
A. Elimination of all dairy products
B. Avoidance of foods containing gluten
C. Limitation of high-fiber foods
D. Restriction of simple carbohydrates
Answer: A. Elimination of all dairy products
Guide and Practice Test
800 QUESTIONS WITH ANSWERS
1. A nurse is assessing a 6-month-old infant during a well-child visit. Which finding should
the nurse recognize as an expected developmental milestone?
A. Walks independently
B. Uses a refined pincer grasp
C. Rolls from abdomen to back
D. Speaks in two-word phrases
Answer: C. Rolls from abdomen to back
Rationale: Rolling from abdomen to back is an expected gross motor milestone around 4-6
months of age. Independent walking typically occurs around 12 months. A refined pincer grasp
develops closer to 9-12 months. Two-word phrases are expected around 18-24 months.
Understanding developmental milestones is essential for identifying delays and providing
anticipatory guidance to parents.
2. A nurse is caring for a child with suspected epiglottitis. Which action is the priority?
A. Obtain a throat culture
B. Keep the child calm and prepare for airway management
C. Inspect the throat with a tongue depressor
D. Encourage the child to drink fluids
Answer: B. Keep the child calm and prepare for airway management
Rationale: Epiglottitis is a life-threatening emergency that can cause rapid, complete airway
obstruction. The priority is to keep the child calm to prevent agitation, which can worsen airway
compromise, and prepare for immediate airway management. Throat inspection with a tongue
depressor can precipitate complete airway obstruction and should be avoided. Obtaining a
throat culture and encouraging fluids are contraindicated until the airway is secured.
, 3. A 2-year-old child is admitted with dehydration from gastroenteritis. Which finding
requires the most immediate intervention?
A. Dry lips
B. Capillary refill of 4 seconds
C. Heart rate of 128/min
D. One wet diaper in 8 hours
Answer: D. One wet diaper in 8 hours
Rationale: Markedly decreased urine output (one wet diaper in 8 hours) indicates significant
dehydration and decreased renal perfusion. This finding requires prompt evaluation and fluid
management. While dry lips, prolonged capillary refill, and tachycardia are concerning signs, the
absence of urine output is a more critical indicator of severe dehydration requiring immediate
intervention.
4. A nurse is preparing to administer digoxin to a 10-month-old infant with congestive
heart failure. Which assessment is most important before administration?
A. Respiratory rate
B. Apical heart rate
C. Blood pressure
D. Temperature
Answer: B. Apical heart rate
Rationale: Digoxin has a narrow therapeutic range and can cause bradycardia, especially in
infants and children. The nurse must assess the apical pulse for one full minute before
administration. Pediatric-specific parameters for withholding the medication should be followed
based on the child's age and heart rate. The apical heart rate is the most critical assessment
prior to digoxin administration.
5. A nurse is caring for a child with nephrotic syndrome. Which assessment finding is most
characteristic of this condition?
A. Generalized edema
B. Severe hypertension
C. Hemoptysis
D. Increased urine output
,Answer: A. Generalized edema
Rationale: Nephrotic syndrome causes significant protein loss through the kidneys, resulting in
hypoalbuminemia and decreased plasma oncotic pressure. This leads to generalized edema,
often including periorbital edema, dependent edema, and ascites. Hypertension is more
characteristic of acute glomerulonephritis rather than nephrotic syndrome in the initial
presentation.
6. A child is experiencing an acute asthma exacerbation. Which medication should the
nurse anticipate administering first?
A. Albuterol
B. Fluticasone
C. Montelukast
D. Theophylline
Answer: A. Albuterol
Rationale: Albuterol is a short-acting beta₂ agonist (SABA) used as a rescue medication for acute
bronchospasm. It works rapidly to relax bronchial smooth muscle and relieve airway
obstruction. Inhaled corticosteroids like fluticasone are controller medications for long-term
management, not immediate rescue therapy. Montelukast and theophylline are not first-line
agents for acute exacerbations.
7. A nurse is assessing a child with meningitis. Which finding should the nurse report
immediately to the provider?
A. Photophobia
B. Headache
C. Nuchal rigidity
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: A declining level of consciousness can indicate increased intracranial pressure or
worsening neurologic status in a child with meningitis. This finding requires immediate
intervention as it may precede herniation. While photophobia, headache, and nuchal rigidity
are classic signs of meningitis, changes in consciousness are the most concerning and require
urgent reporting.
, 8. A 4-year-old child presents with a barking cough, inspiratory stridor, and a low-grade
fever. The nurse suspects croup. Which intervention is most appropriate?
A. Keep the child calm and provide humidified oxygen as prescribed
B. Place the child flat in bed
C. Inspect the throat with a tongue blade
D. Encourage vigorous coughing
Answer: A. Keep the child calm and provide humidified oxygen as prescribed
Rationale: Croup (acute laryngotracheobronchitis) causes upper airway inflammation and
edema. Keeping the child calm reduces oxygen demand and prevents further airway
compromise. Humidified oxygen helps soothe the airway and improve oxygenation. Placing the
child flat can worsen respiratory effort; an upright position is preferred. Throat inspection and
vigorous coughing are not appropriate interventions and may worsen the condition.
9. A school-age child is diagnosed with acute otitis media. Which finding is most consistent
with this diagnosis?
A. Clear tympanic membrane with visible landmarks
B. Bulging, red tympanic membrane with decreased mobility
C. Perforated tympanic membrane with purulent drainage
D. Retracted tympanic membrane with visible fluid level
Answer: B. Bulging, red tympanic membrane with decreased mobility
Rationale: Acute otitis media is characterized by inflammation and fluid accumulation in the
middle ear, resulting in a bulging, erythematous tympanic membrane with decreased or absent
mobility on pneumatic otoscopy. This finding indicates acute infection and inflammation. A clear
tympanic membrane is normal. Perforation with drainage suggests rupture, and retraction with
fluid may indicate serous otitis media rather than acute infection.
10. A nurse is teaching the family of a child with a new diagnosis of lactose intolerance.
Which dietary modification should the nurse recommend?
A. Elimination of all dairy products
B. Avoidance of foods containing gluten
C. Limitation of high-fiber foods
D. Restriction of simple carbohydrates
Answer: A. Elimination of all dairy products
