RN Pediatric Nursing 2026 Proctored | Ultimate Study
Guide and Practice Test
This comprehensive 800-question examination is designed to prepare nursing students and
practicing registered nurses for the Pediatric Nursing proctored certification examination. The
questions reflect current evidence-based practice guidelines, the latest NCLEX-RN test plan, and
the most recent updates in pediatric nursing care. Each question includes a detailed rationale to
enhance your understanding of the underlying concepts, pathophysiological processes, and
nursing interventions. The exam covers all major content areas including growth and
development, health promotion, acute and chronic illness management, medication
administration, family-centered care, and ethical/legal considerations in pediatric nursing. Use
this study guide to assess your knowledge, identify areas for improvement, and build
confidence for your certification examination.
1. A 2-year-old child is brought to the emergency department with a temperature of 104°F
(40°C), irritability, and nuchal rigidity. The nurse suspects bacterial meningitis. Which
assessment finding would the nurse expect to observe in this child?
A) Positive Brudzinski's sign
B) Negative Kernig's sign
C) Absence of photophobia
D) Decreased intracranial pressure
Answer: A) Positive Brudzinski's sign
Rationale: Brudzinski's sign is a classic meningeal sign characterized by involuntary
flexion of the hips and knees when the neck is flexed. This occurs due to meningeal
irritation and is commonly seen in bacterial meningitis. Kernig's sign (resistance to knee
extension when the hip is flexed) would be positive, not negative. Photophobia is a
common symptom of meningitis. Intracranial pressure typically increases, not decreases,
in bacterial meningitis.
2. The nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to have achieved?
A) Sitting without support
B) Transferring objects from one hand to the other
, C) Pincer grasp
D) Standing while holding onto furniture
Answer: B) Transferring objects from one hand to the other
Rationale: At 6 months of age, infants typically develop the ability to transfer objects
from one hand to the other. Sitting without support usually occurs at 7-8 months. The
pincer grasp typically develops at 9-10 months. Standing while holding onto furniture
(cruising) usually occurs at 9-12 months.
3. A nurse is caring for a child with acute glomerulonephritis. Which assessment finding
requires immediate intervention?
A) Periorbital edema
B) Blood pressure of 150/95 mmHg
C) Tea-colored urine
D) Mild headache
Answer: B) Blood pressure of 150/95 mmHg
Rationale: Hypertension is a serious complication of acute glomerulonephritis that
requires immediate intervention. The nurse should notify the healthcare provider and
prepare to administer antihypertensive medications. Periorbital edema and tea-colored
urine are expected findings in acute glomerulonephritis. A mild headache is common but
should be monitored. Severe hypertension can lead to hypertensive encephalopathy,
seizures, and stroke.
4. The nurse is preparing to administer digoxin to a 4-month-old infant with congenital
heart disease. Prior to administration, the nurse assesses the apical pulse for one full
minute and finds it to be 90 beats per minute. What is the appropriate nursing action?
A) Administer the digoxin as ordered
B) Hold the digoxin and notify the healthcare provider
C) Administer half the ordered dose
D) Administer the digoxin with a full glass of water
Answer: B) Hold the digoxin and notify the healthcare provider
Rationale: The normal resting heart rate for a 4-month-old infant is 100-160 beats per
minute. A heart rate of 90 beats per minute is bradycardic for this age group. Digoxin
should be held if the apical pulse is below 100 beats per minute in infants and below 90
beats per minute in children. The healthcare provider should be notified immediately.
Administering the full or half dose would be unsafe. Digoxin should not be given with a
full glass of water to infants as they cannot consume large volumes.
,5. A 10-year-old child with type 1 diabetes mellitus is experiencing hypoglycemia. The child
is conscious and able to swallow. Which intervention should the nurse implement first?
A) Administer glucagon subcutaneously
B) Give 4 ounces of orange juice
C) Provide a peanut butter sandwich
D) Check blood glucose level
Answer: B) Give 4 ounces of orange juice
Rationale: For a conscious child with hypoglycemia who can swallow, the first
intervention is to give 15 grams of fast-acting carbohydrates, such as 4 ounces of orange
juice or 3-4 glucose tablets. Blood glucose should be checked after 15 minutes. Glucagon
is reserved for severe hypoglycemia when the child is unconscious or unable to swallow.
A peanut butter sandwich contains fat that slows carbohydrate absorption and is not
appropriate for immediate treatment of hypoglycemia.
6. The nurse is assessing a newborn with suspected esophageal atresia and
tracheoesophageal fistula. Which assessment finding is most indicative of this condition?
A) Excessive drooling and frothing at the mouth
B) Bulging fontanels
C) Hyperactive bowel sounds
D) Jaundice within 24 hours of birth
Answer: A) Excessive drooling and frothing at the mouth
Rationale: Excessive drooling and frothing at the mouth are classic signs of esophageal
atresia and tracheoesophageal fistula. The infant cannot swallow saliva, which
accumulates in the mouth and pharynx. Bulging fontanels indicate increased intracranial
pressure. Hyperactive bowel sounds are not specific to this condition. Jaundice within 24
hours of birth is concerning for hemolytic disease or sepsis.
7. A nurse is providing education to parents of a child with newly diagnosed cystic fibrosis.
Which statement by the parents indicates a need for further teaching?
A) "We will give our child pancreatic enzymes with meals and snacks"
B) "We should limit our child's intake of high-fat foods"
C) "We need to perform chest physiotherapy twice daily"
D) "We should encourage our child to drink plenty of fluids"
Answer: B) "We should limit our child's intake of high-fat foods"
Rationale: Children with cystic fibrosis require a high-calorie, high-fat diet to meet their
nutritional needs due to malabsorption. Restricting fat would be detrimental to their
growth and development. Pancreatic enzymes should be given with meals and snacks.
, Chest physiotherapy is essential for airway clearance. Adequate hydration is important
to thin secretions.
8. The nurse is assessing a 3-year-old child with suspected iron deficiency anemia. Which
finding would the nurse expect?
A) Spoon-shaped nails (koilonychia)
B) Angular stomatitis
C) Pallor of the conjunctiva
D) Pica (craving for non-food items)
Answer: C) Pallor of the conjunctiva
Rationale: Pallor of the conjunctiva, nail beds, and skin is a common early sign of iron
deficiency anemia. Spoon-shaped nails (koilonychia), angular stomatitis, and pica are
later manifestations of iron deficiency. Pica is more commonly seen in older children
with prolonged iron deficiency. Pallor is often the first observable sign that prompts
assessment for anemia.
9. A child is admitted to the pediatric unit with a diagnosis of Kawasaki disease. Which
medication would the nurse anticipate administering to prevent coronary artery
aneurysm?
A) Aspirin
B) Acetaminophen
C) Ibuprofen
D) Prednisone
Answer: A) Aspirin
Rationale: High-dose aspirin is the primary treatment for Kawasaki disease to reduce
inflammation and prevent coronary artery aneurysm formation. After the acute phase,
aspirin is continued at a lower dose for its antiplatelet effects. Acetaminophen and
ibuprofen do not have the same anti-inflammatory effects necessary for this condition.
Prednisone may be used in refractory cases but is not the first-line treatment.
10. The nurse is providing discharge teaching to parents of a 6-month-old infant who is
teething. Which recommendation should the nurse include?
A) Apply topical anesthetic gel to the gums before feeding
B) Give the infant a frozen bagel to chew on
C) Provide a chilled teething ring for the infant to chew
D) Administer aspirin for pain relief
Guide and Practice Test
This comprehensive 800-question examination is designed to prepare nursing students and
practicing registered nurses for the Pediatric Nursing proctored certification examination. The
questions reflect current evidence-based practice guidelines, the latest NCLEX-RN test plan, and
the most recent updates in pediatric nursing care. Each question includes a detailed rationale to
enhance your understanding of the underlying concepts, pathophysiological processes, and
nursing interventions. The exam covers all major content areas including growth and
development, health promotion, acute and chronic illness management, medication
administration, family-centered care, and ethical/legal considerations in pediatric nursing. Use
this study guide to assess your knowledge, identify areas for improvement, and build
confidence for your certification examination.
1. A 2-year-old child is brought to the emergency department with a temperature of 104°F
(40°C), irritability, and nuchal rigidity. The nurse suspects bacterial meningitis. Which
assessment finding would the nurse expect to observe in this child?
A) Positive Brudzinski's sign
B) Negative Kernig's sign
C) Absence of photophobia
D) Decreased intracranial pressure
Answer: A) Positive Brudzinski's sign
Rationale: Brudzinski's sign is a classic meningeal sign characterized by involuntary
flexion of the hips and knees when the neck is flexed. This occurs due to meningeal
irritation and is commonly seen in bacterial meningitis. Kernig's sign (resistance to knee
extension when the hip is flexed) would be positive, not negative. Photophobia is a
common symptom of meningitis. Intracranial pressure typically increases, not decreases,
in bacterial meningitis.
2. The nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone should the nurse expect the infant to have achieved?
A) Sitting without support
B) Transferring objects from one hand to the other
, C) Pincer grasp
D) Standing while holding onto furniture
Answer: B) Transferring objects from one hand to the other
Rationale: At 6 months of age, infants typically develop the ability to transfer objects
from one hand to the other. Sitting without support usually occurs at 7-8 months. The
pincer grasp typically develops at 9-10 months. Standing while holding onto furniture
(cruising) usually occurs at 9-12 months.
3. A nurse is caring for a child with acute glomerulonephritis. Which assessment finding
requires immediate intervention?
A) Periorbital edema
B) Blood pressure of 150/95 mmHg
C) Tea-colored urine
D) Mild headache
Answer: B) Blood pressure of 150/95 mmHg
Rationale: Hypertension is a serious complication of acute glomerulonephritis that
requires immediate intervention. The nurse should notify the healthcare provider and
prepare to administer antihypertensive medications. Periorbital edema and tea-colored
urine are expected findings in acute glomerulonephritis. A mild headache is common but
should be monitored. Severe hypertension can lead to hypertensive encephalopathy,
seizures, and stroke.
4. The nurse is preparing to administer digoxin to a 4-month-old infant with congenital
heart disease. Prior to administration, the nurse assesses the apical pulse for one full
minute and finds it to be 90 beats per minute. What is the appropriate nursing action?
A) Administer the digoxin as ordered
B) Hold the digoxin and notify the healthcare provider
C) Administer half the ordered dose
D) Administer the digoxin with a full glass of water
Answer: B) Hold the digoxin and notify the healthcare provider
Rationale: The normal resting heart rate for a 4-month-old infant is 100-160 beats per
minute. A heart rate of 90 beats per minute is bradycardic for this age group. Digoxin
should be held if the apical pulse is below 100 beats per minute in infants and below 90
beats per minute in children. The healthcare provider should be notified immediately.
Administering the full or half dose would be unsafe. Digoxin should not be given with a
full glass of water to infants as they cannot consume large volumes.
,5. A 10-year-old child with type 1 diabetes mellitus is experiencing hypoglycemia. The child
is conscious and able to swallow. Which intervention should the nurse implement first?
A) Administer glucagon subcutaneously
B) Give 4 ounces of orange juice
C) Provide a peanut butter sandwich
D) Check blood glucose level
Answer: B) Give 4 ounces of orange juice
Rationale: For a conscious child with hypoglycemia who can swallow, the first
intervention is to give 15 grams of fast-acting carbohydrates, such as 4 ounces of orange
juice or 3-4 glucose tablets. Blood glucose should be checked after 15 minutes. Glucagon
is reserved for severe hypoglycemia when the child is unconscious or unable to swallow.
A peanut butter sandwich contains fat that slows carbohydrate absorption and is not
appropriate for immediate treatment of hypoglycemia.
6. The nurse is assessing a newborn with suspected esophageal atresia and
tracheoesophageal fistula. Which assessment finding is most indicative of this condition?
A) Excessive drooling and frothing at the mouth
B) Bulging fontanels
C) Hyperactive bowel sounds
D) Jaundice within 24 hours of birth
Answer: A) Excessive drooling and frothing at the mouth
Rationale: Excessive drooling and frothing at the mouth are classic signs of esophageal
atresia and tracheoesophageal fistula. The infant cannot swallow saliva, which
accumulates in the mouth and pharynx. Bulging fontanels indicate increased intracranial
pressure. Hyperactive bowel sounds are not specific to this condition. Jaundice within 24
hours of birth is concerning for hemolytic disease or sepsis.
7. A nurse is providing education to parents of a child with newly diagnosed cystic fibrosis.
Which statement by the parents indicates a need for further teaching?
A) "We will give our child pancreatic enzymes with meals and snacks"
B) "We should limit our child's intake of high-fat foods"
C) "We need to perform chest physiotherapy twice daily"
D) "We should encourage our child to drink plenty of fluids"
Answer: B) "We should limit our child's intake of high-fat foods"
Rationale: Children with cystic fibrosis require a high-calorie, high-fat diet to meet their
nutritional needs due to malabsorption. Restricting fat would be detrimental to their
growth and development. Pancreatic enzymes should be given with meals and snacks.
, Chest physiotherapy is essential for airway clearance. Adequate hydration is important
to thin secretions.
8. The nurse is assessing a 3-year-old child with suspected iron deficiency anemia. Which
finding would the nurse expect?
A) Spoon-shaped nails (koilonychia)
B) Angular stomatitis
C) Pallor of the conjunctiva
D) Pica (craving for non-food items)
Answer: C) Pallor of the conjunctiva
Rationale: Pallor of the conjunctiva, nail beds, and skin is a common early sign of iron
deficiency anemia. Spoon-shaped nails (koilonychia), angular stomatitis, and pica are
later manifestations of iron deficiency. Pica is more commonly seen in older children
with prolonged iron deficiency. Pallor is often the first observable sign that prompts
assessment for anemia.
9. A child is admitted to the pediatric unit with a diagnosis of Kawasaki disease. Which
medication would the nurse anticipate administering to prevent coronary artery
aneurysm?
A) Aspirin
B) Acetaminophen
C) Ibuprofen
D) Prednisone
Answer: A) Aspirin
Rationale: High-dose aspirin is the primary treatment for Kawasaki disease to reduce
inflammation and prevent coronary artery aneurysm formation. After the acute phase,
aspirin is continued at a lower dose for its antiplatelet effects. Acetaminophen and
ibuprofen do not have the same anti-inflammatory effects necessary for this condition.
Prednisone may be used in refractory cases but is not the first-line treatment.
10. The nurse is providing discharge teaching to parents of a 6-month-old infant who is
teething. Which recommendation should the nurse include?
A) Apply topical anesthetic gel to the gums before feeding
B) Give the infant a frozen bagel to chew on
C) Provide a chilled teething ring for the infant to chew
D) Administer aspirin for pain relief
