NCLEXRN Paediatric Emergencies
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A 4-year-old child arrives in the emergency department with severe
respiratory distress, drooling, a muffled voice, and a tripod position. Which
action should the nurse take first?
A. Inspect the child's throat with a tongue blade
B. Obtain a throat culture
C. Keep the child calm and prepare for emergency airway management
D. Place the child supine
Answer: C. Keep the child calm and prepare for emergency airway
management
Rationale: Epiglottitis can cause sudden, life-threatening airway obstruction.
Agitating the child or attempting to inspect the throat can precipitate
complete airway obstruction.
2. A child with suspected epiglottitis is sitting upright and leaning forward.
Which nursing intervention is appropriate?
A. Force the child to lie down
B. Allow the child to remain in the position of comfort
C. Examine the throat with a tongue blade
D. Give oral fluids
Answer: B. Allow the child to remain in the position of comfort
,Rationale: Children with epiglottitis often maintain an upright, tripod position
to maximize airway patency. Forcing the child to lie down may worsen
obstruction.
3. A 2-year-old with croup has inspiratory stridor at rest, suprasternal
retractions, and increasing respiratory distress. Which treatment should the
nurse anticipate?
A. Oral antibiotics
B. Nebulized epinephrine and corticosteroids
C. Chest physiotherapy
D. Oral antihistamines
Answer: B. Nebulized epinephrine and corticosteroids
Rationale: Moderate to severe croup with stridor at rest may require
nebulized epinephrine for rapid reduction of airway edema and
corticosteroids for sustained improvement.
4. A child with severe asthma suddenly develops markedly decreased breath
sounds and increasing respiratory distress. What should the nurse suspect?
A. Improvement in bronchospasm
B. Pneumonia
C. Impending respiratory failure
D. Anxiety only
Answer: C. Impending respiratory failure
Rationale: A "silent chest" in a child with severe asthma indicates minimal air
movement and can signal life-threatening respiratory failure.
5. A 6-year-old child is having an acute asthma exacerbation. Which medication
is commonly administered first for rapid bronchodilation?
A. Albuterol
B. Montelukast
,C. Fluticasone
D. Cromolyn
Answer: A. Albuterol
Rationale: Short-acting beta₂ agonists such as albuterol provide rapid
bronchodilation during acute asthma exacerbations.
6. A child arrives after swallowing an unknown household cleaning product.
Which action should the nurse take?
A. Induce vomiting immediately
B. Give syrup of ipecac
C. Assess the airway and contact the poison control service
D. Give activated charcoal without further assessment
Answer: C. Assess the airway and contact the poison control service
Rationale: Management depends on the substance involved. Vomiting may
cause additional caustic injury or aspiration. Poison control should guide
treatment.
7. A toddler is suspected of ingesting a caustic substance. Which prescription
should the nurse question?
A. Airway assessment
B. Poison control consultation
C. Oral administration of a neutralizing substance
D. Monitoring for respiratory distress
Answer: C. Oral administration of a neutralizing substance
Rationale: Attempting to neutralize a caustic substance can cause a chemical
reaction and additional tissue injury.
8. A child is brought to the emergency department after a motor vehicle
collision. Which assessment has the highest priority?
, A. Pain rating
B. Airway and cervical spine status
C. Immunization history
D. Last meal
Answer: B. Airway and cervical spine status
Rationale: Pediatric trauma follows the ABCDE approach. Airway protection
with cervical spine stabilization is the first priority.
9. A child involved in a motor vehicle crash has neck pain and decreased
sensation in the extremities. What is the priority intervention?
A. Encourage ambulation
B. Maintain cervical spine immobilization
C. Flex the child's neck
D. Place the child in a sitting position
Answer: B. Maintain cervical spine immobilization
Rationale: Neurologic symptoms after trauma raise concern for spinal cord
injury. The cervical spine must remain stabilized until injury is excluded.
10. A child with a head injury becomes increasingly drowsy and develops
unequal pupils. Which action is most appropriate?
A. Allow the child to sleep
B. Notify the healthcare provider immediately
C. Give oral fluids
D. Reassess in 4 hours
Answer: B. Notify the healthcare provider immediately
Rationale: Altered consciousness and unequal pupils can indicate increased
intracranial pressure or intracranial bleeding and require immediate
evaluation.
Practice Exam 100 Questions And
Correct Answers (Verified Answers)
Plus Rationales 2026
1. A 4-year-old child arrives in the emergency department with severe
respiratory distress, drooling, a muffled voice, and a tripod position. Which
action should the nurse take first?
A. Inspect the child's throat with a tongue blade
B. Obtain a throat culture
C. Keep the child calm and prepare for emergency airway management
D. Place the child supine
Answer: C. Keep the child calm and prepare for emergency airway
management
Rationale: Epiglottitis can cause sudden, life-threatening airway obstruction.
Agitating the child or attempting to inspect the throat can precipitate
complete airway obstruction.
2. A child with suspected epiglottitis is sitting upright and leaning forward.
Which nursing intervention is appropriate?
A. Force the child to lie down
B. Allow the child to remain in the position of comfort
C. Examine the throat with a tongue blade
D. Give oral fluids
Answer: B. Allow the child to remain in the position of comfort
,Rationale: Children with epiglottitis often maintain an upright, tripod position
to maximize airway patency. Forcing the child to lie down may worsen
obstruction.
3. A 2-year-old with croup has inspiratory stridor at rest, suprasternal
retractions, and increasing respiratory distress. Which treatment should the
nurse anticipate?
A. Oral antibiotics
B. Nebulized epinephrine and corticosteroids
C. Chest physiotherapy
D. Oral antihistamines
Answer: B. Nebulized epinephrine and corticosteroids
Rationale: Moderate to severe croup with stridor at rest may require
nebulized epinephrine for rapid reduction of airway edema and
corticosteroids for sustained improvement.
4. A child with severe asthma suddenly develops markedly decreased breath
sounds and increasing respiratory distress. What should the nurse suspect?
A. Improvement in bronchospasm
B. Pneumonia
C. Impending respiratory failure
D. Anxiety only
Answer: C. Impending respiratory failure
Rationale: A "silent chest" in a child with severe asthma indicates minimal air
movement and can signal life-threatening respiratory failure.
5. A 6-year-old child is having an acute asthma exacerbation. Which medication
is commonly administered first for rapid bronchodilation?
A. Albuterol
B. Montelukast
,C. Fluticasone
D. Cromolyn
Answer: A. Albuterol
Rationale: Short-acting beta₂ agonists such as albuterol provide rapid
bronchodilation during acute asthma exacerbations.
6. A child arrives after swallowing an unknown household cleaning product.
Which action should the nurse take?
A. Induce vomiting immediately
B. Give syrup of ipecac
C. Assess the airway and contact the poison control service
D. Give activated charcoal without further assessment
Answer: C. Assess the airway and contact the poison control service
Rationale: Management depends on the substance involved. Vomiting may
cause additional caustic injury or aspiration. Poison control should guide
treatment.
7. A toddler is suspected of ingesting a caustic substance. Which prescription
should the nurse question?
A. Airway assessment
B. Poison control consultation
C. Oral administration of a neutralizing substance
D. Monitoring for respiratory distress
Answer: C. Oral administration of a neutralizing substance
Rationale: Attempting to neutralize a caustic substance can cause a chemical
reaction and additional tissue injury.
8. A child is brought to the emergency department after a motor vehicle
collision. Which assessment has the highest priority?
, A. Pain rating
B. Airway and cervical spine status
C. Immunization history
D. Last meal
Answer: B. Airway and cervical spine status
Rationale: Pediatric trauma follows the ABCDE approach. Airway protection
with cervical spine stabilization is the first priority.
9. A child involved in a motor vehicle crash has neck pain and decreased
sensation in the extremities. What is the priority intervention?
A. Encourage ambulation
B. Maintain cervical spine immobilization
C. Flex the child's neck
D. Place the child in a sitting position
Answer: B. Maintain cervical spine immobilization
Rationale: Neurologic symptoms after trauma raise concern for spinal cord
injury. The cervical spine must remain stabilized until injury is excluded.
10. A child with a head injury becomes increasingly drowsy and develops
unequal pupils. Which action is most appropriate?
A. Allow the child to sleep
B. Notify the healthcare provider immediately
C. Give oral fluids
D. Reassess in 4 hours
Answer: B. Notify the healthcare provider immediately
Rationale: Altered consciousness and unequal pupils can indicate increased
intracranial pressure or intracranial bleeding and require immediate
evaluation.
