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NCLEX-PN Pediatric Nursing Practice
Questions & Exam 2026–2027 | 100
Advanced Pediatric Nursing Questions
with Answers & Detailed Rationales |
NCLEX-PN Exam Prep
1. A 6-month-old infant is admitted with bronchiolitis and has nasal flaring,
intercostal retractions, and an oxygen saturation of 88% on room air. Which
action should the practical nurse take first?
A. Encourage oral fluids
B. Suction the infant's nose and mouth
C. Administer an antitussive medication
D. Place the infant in a supine position
Answer: B. Suction the infant's nose and mouth
Rationale: Bronchiolitis commonly causes copious secretions and airway
obstruction in infants. Clearing the airway is the priority because the infant is
demonstrating respiratory distress and hypoxemia.
, 2. A 4-year-old child with bacterial meningitis becomes increasingly irritable
and develops projectile vomiting. Which finding requires the most
immediate intervention?
A. Photophobia
B. Neck stiffness
C. Increasing head circumference
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: A declining level of consciousness may indicate increasing
intracranial pressure or neurologic deterioration and requires immediate
intervention.
3. A child with nephrotic syndrome has generalized edema and decreased
urine output. Which assessment finding is most concerning?
A. Mild periorbital edema
B. Urine that appears frothy
C. Blood pressure of 138/92 mm Hg
D. Weight gain of 0.5 kg overnight
Answer: C. Blood pressure of 138/92 mm Hg
Rationale: Significant hypertension in a child with nephrotic syndrome may
indicate worsening renal dysfunction and fluid retention. It requires prompt
evaluation.
4. A 7-year-old child with type 1 diabetes mellitus is lethargic, has deep
respirations, and has a fruity odor to the breath. Which condition should
the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Acute adrenal insufficiency
,Answer: B. Diabetic ketoacidosis
Rationale: Kussmaul respirations, fruity breath, altered mental status, and
hyperglycemia are characteristic of diabetic ketoacidosis.
5. A child with sickle cell disease reports severe generalized pain. Which
intervention is most appropriate?
A. Restrict fluids
B. Apply cold packs to painful joints
C. Encourage hydration and administer prescribed analgesia
D. Encourage vigorous exercise to improve circulation
Answer: C. Encourage hydration and administer prescribed analgesia
Rationale: Hydration helps reduce blood viscosity, while appropriate analgesia
treats vaso-occlusive pain. Cold exposure and dehydration can worsen sickling.
6. A 2-year-old child is hospitalized with severe dehydration from
gastroenteritis. Which finding indicates the greatest degree of
dehydration?
A. Dry lips
B. Capillary refill of 4 seconds
C. Decreased urine output
D. Absence of tears
Answer: B. Capillary refill of 4 seconds
Rationale: Delayed capillary refill is an important sign of poor peripheral
perfusion and significant dehydration.
7. A child receiving chemotherapy develops a temperature of 38.5°C
(101.3°F). The absolute neutrophil count is very low. What is the priority
nursing action?
A. Administer acetaminophen and reassess in 1 hour
B. Place the child in protective isolation and notify the provider immediately
, C. Encourage the child to ambulate
D. Obtain a routine throat culture tomorrow
Answer: B. Place the child in protective isolation and notify the provider
immediately
Rationale: Fever in a severely neutropenic child can indicate life-threatening
infection. Prompt evaluation and empiric antimicrobial therapy may be
required.
8. A 9-year-old child with asthma develops wheezing and difficulty speaking
during an acute exacerbation. Which medication should the nurse expect to
administer first?
A. Montelukast
B. Albuterol
C. Fluticasone
D. Theophylline
Answer: B. Albuterol
Rationale: Short-acting beta2 agonists such as albuterol provide rapid
bronchodilation during an acute asthma exacerbation.
9. A child with tetralogy of Fallot suddenly becomes severely cyanotic and
dyspneic while crying. Which position should the nurse place the child in?
A. Supine with legs extended
B. Trendelenburg
C. Knee-chest position
D. Prone with the head elevated
Answer: C. Knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
helping reduce right-to-left shunting during a hypercyanotic spell.
NCLEX-PN Pediatric Nursing Practice
Questions & Exam 2026–2027 | 100
Advanced Pediatric Nursing Questions
with Answers & Detailed Rationales |
NCLEX-PN Exam Prep
1. A 6-month-old infant is admitted with bronchiolitis and has nasal flaring,
intercostal retractions, and an oxygen saturation of 88% on room air. Which
action should the practical nurse take first?
A. Encourage oral fluids
B. Suction the infant's nose and mouth
C. Administer an antitussive medication
D. Place the infant in a supine position
Answer: B. Suction the infant's nose and mouth
Rationale: Bronchiolitis commonly causes copious secretions and airway
obstruction in infants. Clearing the airway is the priority because the infant is
demonstrating respiratory distress and hypoxemia.
, 2. A 4-year-old child with bacterial meningitis becomes increasingly irritable
and develops projectile vomiting. Which finding requires the most
immediate intervention?
A. Photophobia
B. Neck stiffness
C. Increasing head circumference
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: A declining level of consciousness may indicate increasing
intracranial pressure or neurologic deterioration and requires immediate
intervention.
3. A child with nephrotic syndrome has generalized edema and decreased
urine output. Which assessment finding is most concerning?
A. Mild periorbital edema
B. Urine that appears frothy
C. Blood pressure of 138/92 mm Hg
D. Weight gain of 0.5 kg overnight
Answer: C. Blood pressure of 138/92 mm Hg
Rationale: Significant hypertension in a child with nephrotic syndrome may
indicate worsening renal dysfunction and fluid retention. It requires prompt
evaluation.
4. A 7-year-old child with type 1 diabetes mellitus is lethargic, has deep
respirations, and has a fruity odor to the breath. Which condition should
the nurse suspect?
A. Hypoglycemia
B. Diabetic ketoacidosis
C. Hyperosmolar hyperglycemic state
D. Acute adrenal insufficiency
,Answer: B. Diabetic ketoacidosis
Rationale: Kussmaul respirations, fruity breath, altered mental status, and
hyperglycemia are characteristic of diabetic ketoacidosis.
5. A child with sickle cell disease reports severe generalized pain. Which
intervention is most appropriate?
A. Restrict fluids
B. Apply cold packs to painful joints
C. Encourage hydration and administer prescribed analgesia
D. Encourage vigorous exercise to improve circulation
Answer: C. Encourage hydration and administer prescribed analgesia
Rationale: Hydration helps reduce blood viscosity, while appropriate analgesia
treats vaso-occlusive pain. Cold exposure and dehydration can worsen sickling.
6. A 2-year-old child is hospitalized with severe dehydration from
gastroenteritis. Which finding indicates the greatest degree of
dehydration?
A. Dry lips
B. Capillary refill of 4 seconds
C. Decreased urine output
D. Absence of tears
Answer: B. Capillary refill of 4 seconds
Rationale: Delayed capillary refill is an important sign of poor peripheral
perfusion and significant dehydration.
7. A child receiving chemotherapy develops a temperature of 38.5°C
(101.3°F). The absolute neutrophil count is very low. What is the priority
nursing action?
A. Administer acetaminophen and reassess in 1 hour
B. Place the child in protective isolation and notify the provider immediately
, C. Encourage the child to ambulate
D. Obtain a routine throat culture tomorrow
Answer: B. Place the child in protective isolation and notify the provider
immediately
Rationale: Fever in a severely neutropenic child can indicate life-threatening
infection. Prompt evaluation and empiric antimicrobial therapy may be
required.
8. A 9-year-old child with asthma develops wheezing and difficulty speaking
during an acute exacerbation. Which medication should the nurse expect to
administer first?
A. Montelukast
B. Albuterol
C. Fluticasone
D. Theophylline
Answer: B. Albuterol
Rationale: Short-acting beta2 agonists such as albuterol provide rapid
bronchodilation during an acute asthma exacerbation.
9. A child with tetralogy of Fallot suddenly becomes severely cyanotic and
dyspneic while crying. Which position should the nurse place the child in?
A. Supine with legs extended
B. Trendelenburg
C. Knee-chest position
D. Prone with the head elevated
Answer: C. Knee-chest position
Rationale: The knee-chest position increases systemic vascular resistance,
helping reduce right-to-left shunting during a hypercyanotic spell.
