2026 PED-BC Exam Prep: Pediatric Nursing
Practice Questions, Answer Rationales,
Growth & Development, Child Assessment,
Pediatric Conditions, Pharmacology &
Clinical Care Study Guide
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1–42)
Question 1
A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone is most appropriate for this age?
A) Walking independently
B) Using two-word phrases
C) Sitting without support
D) Drawing a circle
Rationale: At 6 months, infants typically achieve sitting without support (6–8
months), demonstrating developing truncal control and gross motor progression.
Developmental milestones follow predictable patterns: head control (2–4 months),
rolling (4–6 months), sitting (6–8 months), crawling (8–10 months), walking (12–
15 months). Independent walking emerges at 12–15 months. Two-word phrases
develop at 18–24 months. Drawing shapes emerges in preschool years (3–5 years).
Question 2
During assessment of a 2-year-old toddler, which behavior is expected based on
Erikson's psychosocial development theory?
A) Engaging in parallel play and asserting independence ("no")
B) Demonstrating cooperative play and school readiness
C) Developing intimate relationships and identity exploration
D) Showing trust versus mistrust resolution
,Rationale: Erikson's toddler stage (autonomy vs. shame and doubt, 1–3 years)
features asserting independence, negativism ("no"), parallel play (playing beside
but not with peers), and developing self-control. Cooperative play and school
readiness characterize the preschool stage (initiative vs. guilt, 3–6 years). Intimacy
and identity exploration characterize adolescence. Trust vs. mistrust is the infant
stage (0–1 year).
Question 3
A nurse is assessing a 5-year-old child admitted with suspected appendicitis.
Which pain assessment tool is most appropriate?
A) Visual Analog Scale (VAS)
B) Numeric Rating Scale (NRS)
C) FACES Pain Scale-Revised
D) CRIES scale
Rationale: The FACES Pain Scale-Revised (FPS-R) is validated for children ages
3–18 years, using six cartoon faces with neutral to crying expressions. Children
point to the face matching their pain. It combines developmental appropriateness
(visual) with self-report (gold standard when possible). VAS requires abstract
thinking and sustained attention, difficult for preschoolers. NRS requires numerical
understanding, typically used for ages 8+. CRIES is used for neonatal pain
assessment.
Question 4
Which growth chart is most appropriate for plotting the weight of a 2-year-old
male?
A) WHO growth standards for birth to 24 months
B) CDC growth charts for children ages 2–20 years
C) WHO growth standards for children ages 2–5 years
D) CDC growth charts for infants birth to 24 months
Rationale: The CDC growth charts are used for children ≥2 years; WHO standards
apply only up to 24 months. The transition from WHO to CDC charts at age 2
reflects the change from length to height measurement and the use of a nationally
representative reference population.
,Question 5
A 6-month-old presents with a cough, wheeze, and fever. Which diagnostic test is
most likely to confirm bronchiolitis?
A) Chest X-ray
B) Viral PCR panel of nasopharyngeal secretions
C) Serum procalcitonin level
D) Complete blood count
Rationale: Bronchiolitis is most commonly caused by RSV; a viral PCR of
nasopharyngeal secretions identifies the pathogen. Chest X-ray may show
hyperinflation but is not diagnostic. Procalcitonin is a marker of bacterial infection.
CBC is nonspecific.
Question 6
When assessing pain in a non-verbal 3-year-old, which tool is most appropriate?
A) Numeric Rating Scale (0–10)
B) Visual Analog Scale
C) FLACC scale
D) Wong-Baker FACES scale
Rationale: The FLACC (Face, Legs, Activity, Cry, Consolability) scale is
validated for non-verbal or young children who cannot self-report pain. The NRS
and VAS require verbal and abstract cognitive abilities. The Wong-Baker FACES
scale requires the child to be able to point to a face, which may be difficult for a
non-verbal 3-year-old.
Question 7
Which of the following is a sign of impending respiratory failure in a child with
asthma?
A) Use of accessory muscles
B) Mild wheezing on expiration only
C) Normal oxygen saturation on pulse oximetry
D) Decreased respiratory rate below 12 breaths/min
, Rationale: Use of accessory muscles indicates increased work of breathing and
possible failure. Mild expiratory wheezing suggests mild obstruction. Normal
oxygen saturation may be misleading in early failure. A decreased respiratory rate
in a previously tachypneic child is a late and ominous sign.
Question 8
Which electrolyte abnormality is most commonly associated with prolonged
vomiting in a pediatric patient?
A) Hyperkalemia
B) Hyponatremia
C) Metabolic alkalosis with hypochloremia
D) Metabolic acidosis with hyperchloremia
Rationale: Prolonged vomiting causes loss of gastric hydrochloric acid, leading to
hypochloremic metabolic alkalosis. Potassium is also lost, causing hypokalemia.
Hyperkalemia and metabolic acidosis are associated with diarrhea, not vomiting.
Question 9
A 4-month-old infant is brought to the clinic for a well-child visit. Which
developmental milestone should the nurse expect to observe?
A) Rolling from front to back
B) Sitting without support
C) Pincer grasp
D) Walking with assistance
Rationale: At 4 months, infants typically can roll from front to back. Sitting
without support is expected at 8 months. Pincer grasp develops at 9–10 months.
Walking with assistance is expected at 12 months.
Question 10
A nurse is assessing a 9-month-old infant. Which injury risk best fits this
developmental stage?
A) Crawling and putting small items in the mouth
B) Falling from a changing table
Practice Questions, Answer Rationales,
Growth & Development, Child Assessment,
Pediatric Conditions, Pharmacology &
Clinical Care Study Guide
SECTION 1: ASSESSMENT AND DIAGNOSIS (Questions 1–42)
Question 1
A nurse is assessing a 6-month-old infant during a well-child visit. Which
developmental milestone is most appropriate for this age?
A) Walking independently
B) Using two-word phrases
C) Sitting without support
D) Drawing a circle
Rationale: At 6 months, infants typically achieve sitting without support (6–8
months), demonstrating developing truncal control and gross motor progression.
Developmental milestones follow predictable patterns: head control (2–4 months),
rolling (4–6 months), sitting (6–8 months), crawling (8–10 months), walking (12–
15 months). Independent walking emerges at 12–15 months. Two-word phrases
develop at 18–24 months. Drawing shapes emerges in preschool years (3–5 years).
Question 2
During assessment of a 2-year-old toddler, which behavior is expected based on
Erikson's psychosocial development theory?
A) Engaging in parallel play and asserting independence ("no")
B) Demonstrating cooperative play and school readiness
C) Developing intimate relationships and identity exploration
D) Showing trust versus mistrust resolution
,Rationale: Erikson's toddler stage (autonomy vs. shame and doubt, 1–3 years)
features asserting independence, negativism ("no"), parallel play (playing beside
but not with peers), and developing self-control. Cooperative play and school
readiness characterize the preschool stage (initiative vs. guilt, 3–6 years). Intimacy
and identity exploration characterize adolescence. Trust vs. mistrust is the infant
stage (0–1 year).
Question 3
A nurse is assessing a 5-year-old child admitted with suspected appendicitis.
Which pain assessment tool is most appropriate?
A) Visual Analog Scale (VAS)
B) Numeric Rating Scale (NRS)
C) FACES Pain Scale-Revised
D) CRIES scale
Rationale: The FACES Pain Scale-Revised (FPS-R) is validated for children ages
3–18 years, using six cartoon faces with neutral to crying expressions. Children
point to the face matching their pain. It combines developmental appropriateness
(visual) with self-report (gold standard when possible). VAS requires abstract
thinking and sustained attention, difficult for preschoolers. NRS requires numerical
understanding, typically used for ages 8+. CRIES is used for neonatal pain
assessment.
Question 4
Which growth chart is most appropriate for plotting the weight of a 2-year-old
male?
A) WHO growth standards for birth to 24 months
B) CDC growth charts for children ages 2–20 years
C) WHO growth standards for children ages 2–5 years
D) CDC growth charts for infants birth to 24 months
Rationale: The CDC growth charts are used for children ≥2 years; WHO standards
apply only up to 24 months. The transition from WHO to CDC charts at age 2
reflects the change from length to height measurement and the use of a nationally
representative reference population.
,Question 5
A 6-month-old presents with a cough, wheeze, and fever. Which diagnostic test is
most likely to confirm bronchiolitis?
A) Chest X-ray
B) Viral PCR panel of nasopharyngeal secretions
C) Serum procalcitonin level
D) Complete blood count
Rationale: Bronchiolitis is most commonly caused by RSV; a viral PCR of
nasopharyngeal secretions identifies the pathogen. Chest X-ray may show
hyperinflation but is not diagnostic. Procalcitonin is a marker of bacterial infection.
CBC is nonspecific.
Question 6
When assessing pain in a non-verbal 3-year-old, which tool is most appropriate?
A) Numeric Rating Scale (0–10)
B) Visual Analog Scale
C) FLACC scale
D) Wong-Baker FACES scale
Rationale: The FLACC (Face, Legs, Activity, Cry, Consolability) scale is
validated for non-verbal or young children who cannot self-report pain. The NRS
and VAS require verbal and abstract cognitive abilities. The Wong-Baker FACES
scale requires the child to be able to point to a face, which may be difficult for a
non-verbal 3-year-old.
Question 7
Which of the following is a sign of impending respiratory failure in a child with
asthma?
A) Use of accessory muscles
B) Mild wheezing on expiration only
C) Normal oxygen saturation on pulse oximetry
D) Decreased respiratory rate below 12 breaths/min
, Rationale: Use of accessory muscles indicates increased work of breathing and
possible failure. Mild expiratory wheezing suggests mild obstruction. Normal
oxygen saturation may be misleading in early failure. A decreased respiratory rate
in a previously tachypneic child is a late and ominous sign.
Question 8
Which electrolyte abnormality is most commonly associated with prolonged
vomiting in a pediatric patient?
A) Hyperkalemia
B) Hyponatremia
C) Metabolic alkalosis with hypochloremia
D) Metabolic acidosis with hyperchloremia
Rationale: Prolonged vomiting causes loss of gastric hydrochloric acid, leading to
hypochloremic metabolic alkalosis. Potassium is also lost, causing hypokalemia.
Hyperkalemia and metabolic acidosis are associated with diarrhea, not vomiting.
Question 9
A 4-month-old infant is brought to the clinic for a well-child visit. Which
developmental milestone should the nurse expect to observe?
A) Rolling from front to back
B) Sitting without support
C) Pincer grasp
D) Walking with assistance
Rationale: At 4 months, infants typically can roll from front to back. Sitting
without support is expected at 8 months. Pincer grasp develops at 9–10 months.
Walking with assistance is expected at 12 months.
Question 10
A nurse is assessing a 9-month-old infant. Which injury risk best fits this
developmental stage?
A) Crawling and putting small items in the mouth
B) Falling from a changing table
