Pediatric Nursing Exam Prep – Real Practice Questions, Answers &
Detailed Rationales (Updated 2026) | Growth & Development Milestones,
Pediatric Assessment & Vital Signs, Childhood Diseases & Infections,
Pediatric Pharmacology, Respiratory & Cardiac Disorders, Family-
Centered Care, Immunizations & Safety, NCLEX-Style Clinical Judgment &
Pediatric Nursing Review
Question 1: Which of the following is the most appropriate initial action when
assessing a febrile infant under 3 months of age?
A. Administer antipyretics immediately
B. Perform a full sepsis workup including blood, urine, and CSF cultures
C. Recommend home care with hydration and monitoring
D. Prescribe oral antibiotics empirically
CORRECT ANSWER: B. Perform a full sepsis workup including blood, urine, and CSF
cultures
Rationale: Infants under 3 months of age with fever are at high risk for serious bacterial
infections due to immature immune systems. Current pediatric guidelines recommend
a comprehensive sepsis evaluation, including lumbar puncture, blood culture, and
urinalysis with culture, before initiating empiric antibiotics.
Question 2: What is the primary reason for using a bulb syringe before feeding in a
newborn with nasal congestion?
A. To stimulate the gag reflex
B. To prevent aspiration during feeding
C. To assess for nasal patency
D. To reduce oxygen demand
CORRECT ANSWER: B. To prevent aspiration during feeding
Rationale: Nasal congestion can interfere with an infant’s ability to breathe while
feeding, increasing the risk of choking or aspiration. Clearing the nasal passages with a
bulb syringe helps maintain a patent airway and supports safe oral intake.
Question 3: Which developmental milestone is typically expected in a 6-month-old
infant?
A. Walking independently
B. Speaking two-word sentences
C. Rolling from back to front
D. Building a tower of three blocks
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months of age, most infants can roll from their back to their stomach
and vice versa. Independent walking usually occurs around 12–15 months, two-word
sentences emerge near 18–24 months, and stacking blocks develops after 12 months.
,Question 4: In managing a child with croup, which intervention is considered first-
line therapy for moderate to severe symptoms?
A. Oral antihistamines
B. Nebulized epinephrine
C. Intravenous corticosteroids
D. Humidified oxygen alone
CORRECT ANSWER: B. Nebulized epinephrine
Rationale: Nebulized epinephrine provides rapid relief of upper airway edema in
moderate to severe croup by causing vasoconstriction and reducing swelling.
Corticosteroids (e.g., dexamethasone) are also standard but act more slowly;
epinephrine is used acutely for significant stridor at rest.
Question 5: Which vaccine is contraindicated in a child with a history of
anaphylaxis to eggs?
A. Hepatitis B vaccine
B. Inactivated polio vaccine (IPV)
C. Measles, mumps, rubella (MMR) vaccine
D. None of the above
CORRECT ANSWER: D. None of the above
Rationale: Current formulations of MMR and influenza vaccines (which historically
raised egg concerns) are safe even in children with severe egg allergies. The CDC states
that no special precautions are needed, and egg allergy is not a contraindication to any
routine childhood vaccine.
Question 6: What is the most common cause of acute gastroenteritis in children
under 5 years old worldwide?
A. Escherichia coli
B. Salmonella
C. Rotavirus
D. Norovirus
CORRECT ANSWER: D. Norovirus
Rationale: While rotavirus was historically the leading cause, widespread vaccination
has significantly reduced its incidence. Norovirus is now the most common cause of
acute viral gastroenteritis in young children globally, characterized by vomiting, watery
diarrhea, and low-grade fever.
Question 7: Which sign is most indicative of increased intracranial pressure (ICP) in
an infant?
A. Sunken fontanelle
B. Bulging anterior fontanelle
, C. Tachycardia
D. Hypertension
CORRECT ANSWER: B. Bulging anterior fontanelle
Rationale: In infants with open fontanelles, a bulging anterior fontanelle is a classic sign
of elevated ICP. Other signs include vomiting, altered mental status, and abnormal eye
movements. A sunken fontanelle suggests dehydration, not increased ICP.
Question 8: When calculating maintenance fluid requirements for a 15 kg child
using the 100/50/20 rule, what is the total daily fluid volume?
A. 1,000 mL
B. 1,250 mL
C. 1,500 mL
D. 1,750 mL
CORRECT ANSWER: B. 1,250 mL
Rationale: Using the 100/50/20 rule: First 10 kg = 100 mL/kg/day → 1,000 mL; next 5 kg =
50 mL/kg/day → 250 mL. Total = 1,000 + 250 = 1,250 mL/day.
Question 9: Which finding is most consistent with Kawasaki disease in a 2-year-
old?
A. Petechial rash and neck stiffness
B. Conjunctival injection without exudate, strawberry tongue, and cervical
lymphadenopathy
C. Vesicular rash on hands and feet
D. Purpuric lesions on buttocks
CORRECT ANSWER: B. Conjunctival injection without exudate, strawberry tongue,
and cervical lymphadenopathy
Rationale: Kawasaki disease is a vasculitis of unknown etiology characterized by fever
≥5 days plus four of five criteria: bilateral nonexudative conjunctivitis, oral changes
(strawberry tongue, cracked lips), polymorphous rash, extremity changes, and cervical
lymphadenopathy >1.5 cm.
Question 10: What is the priority nursing intervention for a child experiencing an
asthma exacerbation with wheezing and prolonged expiration?
A. Administer oral corticosteroids
B. Provide humidified oxygen via nasal cannula
C. Initiate nebulized short-acting beta-agonists (e.g., albuterol)
D. Encourage deep breathing exercises
CORRECT ANSWER: C. Initiate nebulized short-acting beta-agonists (e.g., albuterol)
Detailed Rationales (Updated 2026) | Growth & Development Milestones,
Pediatric Assessment & Vital Signs, Childhood Diseases & Infections,
Pediatric Pharmacology, Respiratory & Cardiac Disorders, Family-
Centered Care, Immunizations & Safety, NCLEX-Style Clinical Judgment &
Pediatric Nursing Review
Question 1: Which of the following is the most appropriate initial action when
assessing a febrile infant under 3 months of age?
A. Administer antipyretics immediately
B. Perform a full sepsis workup including blood, urine, and CSF cultures
C. Recommend home care with hydration and monitoring
D. Prescribe oral antibiotics empirically
CORRECT ANSWER: B. Perform a full sepsis workup including blood, urine, and CSF
cultures
Rationale: Infants under 3 months of age with fever are at high risk for serious bacterial
infections due to immature immune systems. Current pediatric guidelines recommend
a comprehensive sepsis evaluation, including lumbar puncture, blood culture, and
urinalysis with culture, before initiating empiric antibiotics.
Question 2: What is the primary reason for using a bulb syringe before feeding in a
newborn with nasal congestion?
A. To stimulate the gag reflex
B. To prevent aspiration during feeding
C. To assess for nasal patency
D. To reduce oxygen demand
CORRECT ANSWER: B. To prevent aspiration during feeding
Rationale: Nasal congestion can interfere with an infant’s ability to breathe while
feeding, increasing the risk of choking or aspiration. Clearing the nasal passages with a
bulb syringe helps maintain a patent airway and supports safe oral intake.
Question 3: Which developmental milestone is typically expected in a 6-month-old
infant?
A. Walking independently
B. Speaking two-word sentences
C. Rolling from back to front
D. Building a tower of three blocks
CORRECT ANSWER: C. Rolling from back to front
Rationale: By 6 months of age, most infants can roll from their back to their stomach
and vice versa. Independent walking usually occurs around 12–15 months, two-word
sentences emerge near 18–24 months, and stacking blocks develops after 12 months.
,Question 4: In managing a child with croup, which intervention is considered first-
line therapy for moderate to severe symptoms?
A. Oral antihistamines
B. Nebulized epinephrine
C. Intravenous corticosteroids
D. Humidified oxygen alone
CORRECT ANSWER: B. Nebulized epinephrine
Rationale: Nebulized epinephrine provides rapid relief of upper airway edema in
moderate to severe croup by causing vasoconstriction and reducing swelling.
Corticosteroids (e.g., dexamethasone) are also standard but act more slowly;
epinephrine is used acutely for significant stridor at rest.
Question 5: Which vaccine is contraindicated in a child with a history of
anaphylaxis to eggs?
A. Hepatitis B vaccine
B. Inactivated polio vaccine (IPV)
C. Measles, mumps, rubella (MMR) vaccine
D. None of the above
CORRECT ANSWER: D. None of the above
Rationale: Current formulations of MMR and influenza vaccines (which historically
raised egg concerns) are safe even in children with severe egg allergies. The CDC states
that no special precautions are needed, and egg allergy is not a contraindication to any
routine childhood vaccine.
Question 6: What is the most common cause of acute gastroenteritis in children
under 5 years old worldwide?
A. Escherichia coli
B. Salmonella
C. Rotavirus
D. Norovirus
CORRECT ANSWER: D. Norovirus
Rationale: While rotavirus was historically the leading cause, widespread vaccination
has significantly reduced its incidence. Norovirus is now the most common cause of
acute viral gastroenteritis in young children globally, characterized by vomiting, watery
diarrhea, and low-grade fever.
Question 7: Which sign is most indicative of increased intracranial pressure (ICP) in
an infant?
A. Sunken fontanelle
B. Bulging anterior fontanelle
, C. Tachycardia
D. Hypertension
CORRECT ANSWER: B. Bulging anterior fontanelle
Rationale: In infants with open fontanelles, a bulging anterior fontanelle is a classic sign
of elevated ICP. Other signs include vomiting, altered mental status, and abnormal eye
movements. A sunken fontanelle suggests dehydration, not increased ICP.
Question 8: When calculating maintenance fluid requirements for a 15 kg child
using the 100/50/20 rule, what is the total daily fluid volume?
A. 1,000 mL
B. 1,250 mL
C. 1,500 mL
D. 1,750 mL
CORRECT ANSWER: B. 1,250 mL
Rationale: Using the 100/50/20 rule: First 10 kg = 100 mL/kg/day → 1,000 mL; next 5 kg =
50 mL/kg/day → 250 mL. Total = 1,000 + 250 = 1,250 mL/day.
Question 9: Which finding is most consistent with Kawasaki disease in a 2-year-
old?
A. Petechial rash and neck stiffness
B. Conjunctival injection without exudate, strawberry tongue, and cervical
lymphadenopathy
C. Vesicular rash on hands and feet
D. Purpuric lesions on buttocks
CORRECT ANSWER: B. Conjunctival injection without exudate, strawberry tongue,
and cervical lymphadenopathy
Rationale: Kawasaki disease is a vasculitis of unknown etiology characterized by fever
≥5 days plus four of five criteria: bilateral nonexudative conjunctivitis, oral changes
(strawberry tongue, cracked lips), polymorphous rash, extremity changes, and cervical
lymphadenopathy >1.5 cm.
Question 10: What is the priority nursing intervention for a child experiencing an
asthma exacerbation with wheezing and prolonged expiration?
A. Administer oral corticosteroids
B. Provide humidified oxygen via nasal cannula
C. Initiate nebulized short-acting beta-agonists (e.g., albuterol)
D. Encourage deep breathing exercises
CORRECT ANSWER: C. Initiate nebulized short-acting beta-agonists (e.g., albuterol)
