Pediatric Nursing Practice Questions and Answers Updated 2026 |
Complete Child Health Nursing Study Guide with Verified Questions,
Detailed Rationales, Growth & Development, Pediatric Respiratory
Disorders, Infectious Diseases, Congenital Conditions, Fluid & Electrolyte
Balance, Medication Safety, Immunizations, Family-Centered Care &
NCLEX-RN/PN Exam Prep
Question 1: Which immunization is typically administered to a newborn within the
first 24 hours of life?
A. Hepatitis B
B. DPT
C. MMR
D. Polio
CORRECT ANSWER: A. Hepatitis B
Rationale: The first dose of the Hepatitis B vaccine is recommended within 24 hours of
birth for all medically stable infants weighing at least 2,000 grams, born to HBsAg-
positive mothers or when maternal status is unknown.
Question 2: A 6-month-old infant is brought to the clinic. Which developmental
milestone should the nurse expect?
A. Walking independently
B. Sitting without support
C. Saying "mama" with meaning
D. Using a pincer grasp
CORRECT ANSWER: B. Sitting without support
Rationale: By 6 months of age, most infants can sit without support. Walking typically
occurs around 12 months, "mama" with meaning around 10-12 months, and pincer
grasp around 9-10 months.
Question 3: Which assessment finding in a neonate requires immediate
intervention?
A. Acrocyanosis
B. Respiratory rate of 50 breaths/min
C. Central cyanosis
D. Heart rate of 130 bpm
CORRECT ANSWER: C. Central cyanosis
Rationale: Central cyanosis (bluish discoloration of the lips, tongue, and trunk)
indicates hypoxemia and requires immediate intervention. Acrocyanosis (bluish hands
and feet) is normal in the first 24-48 hours.
Question 4: A child with tetralogy of Fallot assumes a squatting position during a
crying episode. What is the primary physiological benefit?
,A. Decreases venous return
B. Increases systemic vascular resistance
C. Decreases pulmonary blood flow
D. Increases heart rate
CORRECT ANSWER: B. Increases systemic vascular resistance
Rationale: Squatting kinks the femoral arteries, increasing systemic vascular
resistance, which reduces the right-to-left shunt and improves pulmonary blood flow
and oxygenation during a "tet spell."
Question 5: Which finding is most consistent with pyloric stenosis in an infant?
A. Bilious vomiting
B. Projectile non-bilious vomiting
C. Currant jelly stools
D. Ribbon-like stools
CORRECT ANSWER: B. Projectile non-bilious vomiting
Rationale: Pyloric stenosis classically presents with projectile, non-bilious vomiting
after feeding, typically appearing between 2-8 weeks of age. An olive-shaped mass may
be palpable in the epigastrium.
Question 6: What is the recommended fluid maintenance rate for a 10 kg child
using the Holliday-Segar method?
A. 500 mL/day
B. 1000 mL/day
C. 1500 mL/day
D. 2000 mL/day
CORRECT ANSWER: B. 1000 mL/day
Rationale: Using the 4-2-1 rule: 100 mL/kg for the first 10 kg = 1000 mL/day. For 11-20 kg,
add 50 mL/kg; above 20 kg, add 20 mL/kg.
Question 7: A toddler is diagnosed with croup (laryngotracheobronchitis). Which
clinical manifestation is most characteristic?
A. Drooling and dysphagia
B. Barking cough and stridor
C. High fever and sore throat
D. Wheezing and prolonged expiration
CORRECT ANSWER: B. Barking cough and stridor
Rationale: Croup is characterized by a barking or seal-like cough, inspiratory stridor, and
hoarseness, typically worse at night. Drooling suggests epiglottitis.
Question 8: Which immunization is given at 12 months of age?
,A. Hepatitis B
B. MMR
C. DTaP
D. IPV
CORRECT ANSWER: B. MMR
Rationale: The first dose of MMR (measles, mumps, rubella) vaccine is administered at
12-15 months of age.
Question 9: A child with nephrotic syndrome is most likely to exhibit which primary
symptom?
A. Hematuria
B. Massive proteinuria and edema
C. Hypertension
D. Oliguria
CORRECT ANSWER: B. Massive proteinuria and edema
Rationale: Nephrotic syndrome is characterized by massive proteinuria (>40 mg/m²/hr),
hypoalbuminemia, hyperlipidemia, and generalized edema.
Question 10: Which position is most appropriate for an infant with
gastroesophageal reflux?
A. Supine with flat head
B. Prone with head elevated 30 degrees
C. Left lateral decubitus
D. Trendelenburg
CORRECT ANSWER: B. Prone with head elevated 30 degrees
Rationale: For infants with GERD, positioning prone with the head of the bed elevated 30
degrees helps reduce reflux episodes. Note: Back-to-sleep is recommended for SIDS
prevention in healthy infants.
Question 11: What is the most common cause of acute otitis media in children?
A. Moraxella catarrhalis
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Staphylococcus aureus
CORRECT ANSWER: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common bacterial pathogen in acute
otitis media, followed by non-typable H. influenzae and M. catarrhalis.
Question 12: A 4-year-old child has a body surface area burn of 18%. According to
the Parkland formula, what is the priority in the first 24 hours?
, A. Administer colloids immediately
B. Administer lactated Ringer's solution
C. Administer 5% dextrose in water
D. Withhold fluids until urine output is measured
CORRECT ANSWER: B. Administer lactated Ringer's solution
Rationale: The Parkland formula recommends lactated Ringer's solution at 4 mL × kg ×
%TBSA, with half given in the first 8 hours and the remainder over the next 16 hours.
Question 13: Which finding is a late sign of increased intracranial pressure in an
infant?
A. Bulging fontanel
B. High-pitched cry
C. Bradycardia with hypertension
D. Irritability
CORRECT ANSWER: C. Bradycardia with hypertension
Rationale: Cushing's triad (bradycardia, hypertension, irregular respirations) is a late
sign of increased ICP. Bulging fontanel, high-pitched cry, and irritability are earlier signs.
Question 14: A child with type 1 diabetes presents with Kussmaul respirations,
fruity breath odor, and blood glucose of 450 mg/dL. What is the priority nursing
action?
A. Administer regular insulin IV
B. Administer subcutaneous NPH insulin
C. Give oral glucose
D. Restrict fluids
CORRECT ANSWER: A. Administer regular insulin IV
Rationale: These are classic signs of diabetic ketoacidosis (DKA). Priority treatment
includes IV regular insulin, fluid resuscitation, and electrolyte management.
Question 15: Which immunization is contraindicated in a child with a severe egg
allergy?
A. DTaP
B. Influenza vaccine
C. Hepatitis B
D. IPV
CORRECT ANSWER: B. Influenza vaccine
Rationale: Some influenza vaccines are grown in eggs and may contain egg protein.
Children with severe egg allergy should receive the vaccine in a supervised setting or
use egg-free alternatives.
Complete Child Health Nursing Study Guide with Verified Questions,
Detailed Rationales, Growth & Development, Pediatric Respiratory
Disorders, Infectious Diseases, Congenital Conditions, Fluid & Electrolyte
Balance, Medication Safety, Immunizations, Family-Centered Care &
NCLEX-RN/PN Exam Prep
Question 1: Which immunization is typically administered to a newborn within the
first 24 hours of life?
A. Hepatitis B
B. DPT
C. MMR
D. Polio
CORRECT ANSWER: A. Hepatitis B
Rationale: The first dose of the Hepatitis B vaccine is recommended within 24 hours of
birth for all medically stable infants weighing at least 2,000 grams, born to HBsAg-
positive mothers or when maternal status is unknown.
Question 2: A 6-month-old infant is brought to the clinic. Which developmental
milestone should the nurse expect?
A. Walking independently
B. Sitting without support
C. Saying "mama" with meaning
D. Using a pincer grasp
CORRECT ANSWER: B. Sitting without support
Rationale: By 6 months of age, most infants can sit without support. Walking typically
occurs around 12 months, "mama" with meaning around 10-12 months, and pincer
grasp around 9-10 months.
Question 3: Which assessment finding in a neonate requires immediate
intervention?
A. Acrocyanosis
B. Respiratory rate of 50 breaths/min
C. Central cyanosis
D. Heart rate of 130 bpm
CORRECT ANSWER: C. Central cyanosis
Rationale: Central cyanosis (bluish discoloration of the lips, tongue, and trunk)
indicates hypoxemia and requires immediate intervention. Acrocyanosis (bluish hands
and feet) is normal in the first 24-48 hours.
Question 4: A child with tetralogy of Fallot assumes a squatting position during a
crying episode. What is the primary physiological benefit?
,A. Decreases venous return
B. Increases systemic vascular resistance
C. Decreases pulmonary blood flow
D. Increases heart rate
CORRECT ANSWER: B. Increases systemic vascular resistance
Rationale: Squatting kinks the femoral arteries, increasing systemic vascular
resistance, which reduces the right-to-left shunt and improves pulmonary blood flow
and oxygenation during a "tet spell."
Question 5: Which finding is most consistent with pyloric stenosis in an infant?
A. Bilious vomiting
B. Projectile non-bilious vomiting
C. Currant jelly stools
D. Ribbon-like stools
CORRECT ANSWER: B. Projectile non-bilious vomiting
Rationale: Pyloric stenosis classically presents with projectile, non-bilious vomiting
after feeding, typically appearing between 2-8 weeks of age. An olive-shaped mass may
be palpable in the epigastrium.
Question 6: What is the recommended fluid maintenance rate for a 10 kg child
using the Holliday-Segar method?
A. 500 mL/day
B. 1000 mL/day
C. 1500 mL/day
D. 2000 mL/day
CORRECT ANSWER: B. 1000 mL/day
Rationale: Using the 4-2-1 rule: 100 mL/kg for the first 10 kg = 1000 mL/day. For 11-20 kg,
add 50 mL/kg; above 20 kg, add 20 mL/kg.
Question 7: A toddler is diagnosed with croup (laryngotracheobronchitis). Which
clinical manifestation is most characteristic?
A. Drooling and dysphagia
B. Barking cough and stridor
C. High fever and sore throat
D. Wheezing and prolonged expiration
CORRECT ANSWER: B. Barking cough and stridor
Rationale: Croup is characterized by a barking or seal-like cough, inspiratory stridor, and
hoarseness, typically worse at night. Drooling suggests epiglottitis.
Question 8: Which immunization is given at 12 months of age?
,A. Hepatitis B
B. MMR
C. DTaP
D. IPV
CORRECT ANSWER: B. MMR
Rationale: The first dose of MMR (measles, mumps, rubella) vaccine is administered at
12-15 months of age.
Question 9: A child with nephrotic syndrome is most likely to exhibit which primary
symptom?
A. Hematuria
B. Massive proteinuria and edema
C. Hypertension
D. Oliguria
CORRECT ANSWER: B. Massive proteinuria and edema
Rationale: Nephrotic syndrome is characterized by massive proteinuria (>40 mg/m²/hr),
hypoalbuminemia, hyperlipidemia, and generalized edema.
Question 10: Which position is most appropriate for an infant with
gastroesophageal reflux?
A. Supine with flat head
B. Prone with head elevated 30 degrees
C. Left lateral decubitus
D. Trendelenburg
CORRECT ANSWER: B. Prone with head elevated 30 degrees
Rationale: For infants with GERD, positioning prone with the head of the bed elevated 30
degrees helps reduce reflux episodes. Note: Back-to-sleep is recommended for SIDS
prevention in healthy infants.
Question 11: What is the most common cause of acute otitis media in children?
A. Moraxella catarrhalis
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Staphylococcus aureus
CORRECT ANSWER: B. Streptococcus pneumoniae
Rationale: Streptococcus pneumoniae is the most common bacterial pathogen in acute
otitis media, followed by non-typable H. influenzae and M. catarrhalis.
Question 12: A 4-year-old child has a body surface area burn of 18%. According to
the Parkland formula, what is the priority in the first 24 hours?
, A. Administer colloids immediately
B. Administer lactated Ringer's solution
C. Administer 5% dextrose in water
D. Withhold fluids until urine output is measured
CORRECT ANSWER: B. Administer lactated Ringer's solution
Rationale: The Parkland formula recommends lactated Ringer's solution at 4 mL × kg ×
%TBSA, with half given in the first 8 hours and the remainder over the next 16 hours.
Question 13: Which finding is a late sign of increased intracranial pressure in an
infant?
A. Bulging fontanel
B. High-pitched cry
C. Bradycardia with hypertension
D. Irritability
CORRECT ANSWER: C. Bradycardia with hypertension
Rationale: Cushing's triad (bradycardia, hypertension, irregular respirations) is a late
sign of increased ICP. Bulging fontanel, high-pitched cry, and irritability are earlier signs.
Question 14: A child with type 1 diabetes presents with Kussmaul respirations,
fruity breath odor, and blood glucose of 450 mg/dL. What is the priority nursing
action?
A. Administer regular insulin IV
B. Administer subcutaneous NPH insulin
C. Give oral glucose
D. Restrict fluids
CORRECT ANSWER: A. Administer regular insulin IV
Rationale: These are classic signs of diabetic ketoacidosis (DKA). Priority treatment
includes IV regular insulin, fluid resuscitation, and electrolyte management.
Question 15: Which immunization is contraindicated in a child with a severe egg
allergy?
A. DTaP
B. Influenza vaccine
C. Hepatitis B
D. IPV
CORRECT ANSWER: B. Influenza vaccine
Rationale: Some influenza vaccines are grown in eggs and may contain egg protein.
Children with severe egg allergy should receive the vaccine in a supervised setting or
use egg-free alternatives.
