RELIAS Competency: PEDIATRIC
Nursing A v1 Exam Questions And Well
Graded Solutions With Rationales
Updated 2026-2027
Pass the Relias Competency: Pediatric Nursing A v1 assessment on your first try.
This high-utility guide features verified multiple-choice questions, accurate
answers, and complete clinical rationales. Covers pediatric pharmacology,
dosage limits, growth milestones, dehydration markers, and acute
respiratory distress signs. Perfect for travel nurses and RNs looking to
validate skills and boost test confidence
1. A 3-month-old infant is admitted with suspected respiratory syncytial virus (RSV).
Which of the following clinical findings should the nurse identify as an early sign of
respiratory distress?
A) Central cyanosis
B) Intercostal retractions
C) Tachypnea
D) Bradycardia
Answer: C) Tachypnea
Rationale: Tachypnea is the earliest compensatory mechanism used by infants to
increase minute ventilation in response to hypoxia. Signs like retractions indicate
increasing work of breathing, while cyanosis and bradycardia are late, ominous signs
of impending respiratory failure.
2. A nurse is preparing to administer an intravenous antibiotic to a 14-year-old
adolescent who weighs 72 kg. The weight-based calculation results in a dose that is
25% higher than the maximum recommended adult dose. Which action should the
nurse take?
A) Administer the weight-based dose as calculated.
B) Administer the standard maximum adult dose.
C) Hold the dose and request a lower weight-based calculation from the pharmacist.
D) Administer half of the calculated weight-based dose.
Answer: B) Administer the standard maximum adult dose.
Rationale: Pediatric and adolescent medication dosing is weight-based but must
never exceed the maximum standard adult dose. If the calculated weight-based dose
surpasses the adult ceiling, the dose must be capped at the adult limit to prevent
toxic overdose.
3. While performing a physical assessment on a healthy 5-month-old infant, the nurse
palpates the skull. Which fontanel finding should the nurse expect?
A) The anterior and posterior fontanels are both open.
1|Page
, B) The anterior and posterior fontanels are both closed.
C) The anterior fontanel is open, and the posterior fontanel is closed.
D) The anterior fontanel is closed, and the posterior fontanel is open.
Answer: C) The anterior fontanel is open, and the posterior fontanel is closed.
Rationale: The posterior fontanel normally closes by 2 months of age. The anterior
fontanel accommodates rapid brain growth during infancy and remains open until
closing between 12 and 18 months of age.
4. A nurse evaluates a 12-month-old infant at a well-child checkup. The infant's birth
weight was 8 pounds. Which current weight indicates normal growth?
A) 16 pounds
B) 24 pounds
C) 32 pounds
D) 40 pounds
Answer: B) 24 pounds
Rationale: A general guideline for infant growth is that birth weight doubles by 6
months of age and triples by 12 months of age. An infant born at 8 pounds should
weigh approximately 24 pounds at one year.
5. A 4-year-old child is brought to the emergency department following an accidental
ingestion of a full bottle of liquid acetaminophen. Which laboratory values are most
critical for the nurse to evaluate?
A) Blood urea nitrogen (BUN) and creatinine
B) Amylase and lipase
C) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
D) Partial thromboplastin time (PTT) and INR
Answer: C) Alanine aminotransferase (ALT) and aspartate aminotransferase
(AST)
Rationale: Acetaminophen toxicity causes severe hepatotoxicity. Toxic levels lead to
hepatic necrosis, making the monitoring of liver transaminases (ALT and AST) the
highest priority to determine the extent of liver damage.
6. A nurse is caring for an infant who is crying persistently. Which characteristic of the
cry should alert the nurse to potential neurological impairment or increased
intracranial pressure?
A) Hoarse, low-pitched cry
B) High-pitched, shrill cry
C) Intermittent, whimpering cry
D) Loud, rhythmic cry
Answer: B) High-pitched, shrill cry
Rationale: A high-pitched, shrill cry is a classic indicator of neurological irritability,
central nervous system anomalies, or increased intracranial pressure in neonates
and infants.
7. A mother asks the nurse when she can safely introduce solid foods to her 5-month-
old breastfed infant. Which recommendation should the nurse provide?
A) Solid foods can be started now, introducing one new food every 2 to 3 weeks.
B) Introduce solid foods individually once a week to identify potential food allergies.
C) Delay all solid foods until 12 months when the GI tract is fully mature.
D) Start solid foods mixed together in a bottle twice daily.
Answer: B) Introduce solid foods individually once a week to identify potential
food allergies.
Rationale: Solid foods are typically introduced between 4 and 6 months of age.
2|Page
, Introducing new foods one at a time, spaced about 5 to 7 days (once a week) apart,
allows parents to isolate and identify specific food allergens if a reaction occurs.
8. A toddler is diagnosed with a severe bacterial infection and is prescribed an
intravenous aminoglycoside antibiotic. Which adverse effect must the nurse monitor
for most closely during therapy?
A) Hepatotoxicity
B) Ototoxicity
C) Cardiotoxicity
D) Pulmonary fibrosis
Answer: B) Ototoxicity
Rationale: Aminoglycosides are notoriously ototoxic and nephrotoxic. The nurse
must monitor for signs of hearing impairment, vestibular dysfunction, and renal
clearance (serum creatinine) during administration.
9. A 9-month-old infant is brought to the emergency department with vomiting and
diarrhea. The nurse notes sunken fontanels, dry mucous membranes, and a capillary
refill of 3 seconds. How should the nurse interpret these findings?
A) Fluid volume overload
B) Standard viral illness without systemic changes
C) Moderate dehydration
D) Severe septic shock
Answer: C) Moderate dehydration
Rationale: Clinical signs such as sunken fontanels, dry mucous membranes, delayed
capillary refill, and decreased tear production are classic signs of moderate fluid
volume deficit (dehydration) in an infant.
10. A nurse is planning care for an 8-year-old child admitted for a surgical procedure.
According to Piaget's stages of cognitive development, the nurse should anticipate
that a child this age is in which stage?
A) Sensorimotor
B) Preoperational
C) Concrete operational
D) Formal operational
Answer: C) Concrete operational
Rationale: Children between the ages of 7 and 11 years are in the concrete
operational stage. They develop logical thinking about concrete events but struggle
with abstract or hypothetical concepts.
11. A 2-year-old toddler is admitted to the pediatric unit. According to Erikson’s
psychosocial theory, which developmental task is this child attempting to master?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: B) Autonomy vs. Shame and Doubt
Rationale: Toddlers aged 1 to 3 years focus on achieving a sense of independence
and autonomy over physical skills. Failure to support their efforts can lead to feelings
of shame and doubt.
12. A nurse is performing an assessment on a 6-month-old infant. Which gross motor
milestone should the nurse expect the infant to have successfully achieved?
A) Sitting independently without support
B) Rolling from abdomen to back
C) Pulling up to a standing position
3|Page
, D) Crawling on hands and knees
Answer: B) Rolling from abdomen to back
Rationale: Infants typically roll from abdomen to back by 4 to 5 months of age, and
back to abdomen by 6 months. Sitting independently without support is expected
around 7 to 8 months.
13. A 6-year-old child presents with a sudden onset of high fever, severe sore throat,
drooling, and an inspiratory stridor. The child is sitting forward in a "tripod" position.
Which action should the nurse avoid?
A) Placing the child on a pulse oximeter
B) Administering humidified oxygen
C) Examining the throat with a tongue depressor
D) Preparing for emergency airway management
Answer: C) Examining the throat with a tongue depressor
Rationale: These symptoms are indicative of acute epiglottitis. Examining the throat
with a tongue depressor or taking a throat culture can trigger a sudden, fatal
laryngospasm and complete airway obstruction.
14. A nurse is reviewing lab results for a child with suspected iron deficiency anemia.
Which laboratory result confirms this diagnosis?
A) Elevated ferritin levels
B) Decreased total iron-binding capacity (TIBC)
C) Decreased hemoglobin and decreased ferritin
D) Elevated mean corpuscular volume (MCV)
Answer: C) Decreased hemoglobin and decreased ferritin
Rationale: Iron deficiency anemia is characterized by a low hemoglobin level and
depleted iron stores, reflected by a low serum ferritin level. TIBC would be elevated,
and MCV would be decreased (microcytic).
15. An infant with tetralogy of Fallot becomes acutely distressed, cyanotic, and
tachypneic during a blood draw. Which immediate action should the nurse
implement?
A) Place the infant in a knee-chest position.
B) Prepare for immediate endotracheal intubation.
C) Administer a rapid fluid bolus of normal saline.
D) Place the child in a prone position.
Answer: A) Place the infant in a knee-chest position.
Rationale: This scenario describes a hypercyanotic spell ("tet spell"). Placing the
infant in a knee-chest position increases systemic vascular resistance, which
reduces the right-to-left shunt across the ventricular septal defect, forcing more blood
into the pulmonary artery to improve oxygenation.
16. A nurse is providing discharge education to the parents of a child diagnosed with
celiac disease. Which food item should the nurse instruct the parents to eliminate
completely from the child’s diet?
A) Corn tortilla chips
B) Oatmeal cookies made with standard wheat flour
C) Steamed white rice
D) Grilled chicken breast
Answer: B) Oatmeal cookies made with standard wheat flour
Rationale: Celiac disease is an autoimmune enteropathy triggered by the ingestion
of gluten, a protein found in wheat, barley, and rye. Standard wheat flour contains
gluten and must be strictly avoided.
4|Page
Nursing A v1 Exam Questions And Well
Graded Solutions With Rationales
Updated 2026-2027
Pass the Relias Competency: Pediatric Nursing A v1 assessment on your first try.
This high-utility guide features verified multiple-choice questions, accurate
answers, and complete clinical rationales. Covers pediatric pharmacology,
dosage limits, growth milestones, dehydration markers, and acute
respiratory distress signs. Perfect for travel nurses and RNs looking to
validate skills and boost test confidence
1. A 3-month-old infant is admitted with suspected respiratory syncytial virus (RSV).
Which of the following clinical findings should the nurse identify as an early sign of
respiratory distress?
A) Central cyanosis
B) Intercostal retractions
C) Tachypnea
D) Bradycardia
Answer: C) Tachypnea
Rationale: Tachypnea is the earliest compensatory mechanism used by infants to
increase minute ventilation in response to hypoxia. Signs like retractions indicate
increasing work of breathing, while cyanosis and bradycardia are late, ominous signs
of impending respiratory failure.
2. A nurse is preparing to administer an intravenous antibiotic to a 14-year-old
adolescent who weighs 72 kg. The weight-based calculation results in a dose that is
25% higher than the maximum recommended adult dose. Which action should the
nurse take?
A) Administer the weight-based dose as calculated.
B) Administer the standard maximum adult dose.
C) Hold the dose and request a lower weight-based calculation from the pharmacist.
D) Administer half of the calculated weight-based dose.
Answer: B) Administer the standard maximum adult dose.
Rationale: Pediatric and adolescent medication dosing is weight-based but must
never exceed the maximum standard adult dose. If the calculated weight-based dose
surpasses the adult ceiling, the dose must be capped at the adult limit to prevent
toxic overdose.
3. While performing a physical assessment on a healthy 5-month-old infant, the nurse
palpates the skull. Which fontanel finding should the nurse expect?
A) The anterior and posterior fontanels are both open.
1|Page
, B) The anterior and posterior fontanels are both closed.
C) The anterior fontanel is open, and the posterior fontanel is closed.
D) The anterior fontanel is closed, and the posterior fontanel is open.
Answer: C) The anterior fontanel is open, and the posterior fontanel is closed.
Rationale: The posterior fontanel normally closes by 2 months of age. The anterior
fontanel accommodates rapid brain growth during infancy and remains open until
closing between 12 and 18 months of age.
4. A nurse evaluates a 12-month-old infant at a well-child checkup. The infant's birth
weight was 8 pounds. Which current weight indicates normal growth?
A) 16 pounds
B) 24 pounds
C) 32 pounds
D) 40 pounds
Answer: B) 24 pounds
Rationale: A general guideline for infant growth is that birth weight doubles by 6
months of age and triples by 12 months of age. An infant born at 8 pounds should
weigh approximately 24 pounds at one year.
5. A 4-year-old child is brought to the emergency department following an accidental
ingestion of a full bottle of liquid acetaminophen. Which laboratory values are most
critical for the nurse to evaluate?
A) Blood urea nitrogen (BUN) and creatinine
B) Amylase and lipase
C) Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
D) Partial thromboplastin time (PTT) and INR
Answer: C) Alanine aminotransferase (ALT) and aspartate aminotransferase
(AST)
Rationale: Acetaminophen toxicity causes severe hepatotoxicity. Toxic levels lead to
hepatic necrosis, making the monitoring of liver transaminases (ALT and AST) the
highest priority to determine the extent of liver damage.
6. A nurse is caring for an infant who is crying persistently. Which characteristic of the
cry should alert the nurse to potential neurological impairment or increased
intracranial pressure?
A) Hoarse, low-pitched cry
B) High-pitched, shrill cry
C) Intermittent, whimpering cry
D) Loud, rhythmic cry
Answer: B) High-pitched, shrill cry
Rationale: A high-pitched, shrill cry is a classic indicator of neurological irritability,
central nervous system anomalies, or increased intracranial pressure in neonates
and infants.
7. A mother asks the nurse when she can safely introduce solid foods to her 5-month-
old breastfed infant. Which recommendation should the nurse provide?
A) Solid foods can be started now, introducing one new food every 2 to 3 weeks.
B) Introduce solid foods individually once a week to identify potential food allergies.
C) Delay all solid foods until 12 months when the GI tract is fully mature.
D) Start solid foods mixed together in a bottle twice daily.
Answer: B) Introduce solid foods individually once a week to identify potential
food allergies.
Rationale: Solid foods are typically introduced between 4 and 6 months of age.
2|Page
, Introducing new foods one at a time, spaced about 5 to 7 days (once a week) apart,
allows parents to isolate and identify specific food allergens if a reaction occurs.
8. A toddler is diagnosed with a severe bacterial infection and is prescribed an
intravenous aminoglycoside antibiotic. Which adverse effect must the nurse monitor
for most closely during therapy?
A) Hepatotoxicity
B) Ototoxicity
C) Cardiotoxicity
D) Pulmonary fibrosis
Answer: B) Ototoxicity
Rationale: Aminoglycosides are notoriously ototoxic and nephrotoxic. The nurse
must monitor for signs of hearing impairment, vestibular dysfunction, and renal
clearance (serum creatinine) during administration.
9. A 9-month-old infant is brought to the emergency department with vomiting and
diarrhea. The nurse notes sunken fontanels, dry mucous membranes, and a capillary
refill of 3 seconds. How should the nurse interpret these findings?
A) Fluid volume overload
B) Standard viral illness without systemic changes
C) Moderate dehydration
D) Severe septic shock
Answer: C) Moderate dehydration
Rationale: Clinical signs such as sunken fontanels, dry mucous membranes, delayed
capillary refill, and decreased tear production are classic signs of moderate fluid
volume deficit (dehydration) in an infant.
10. A nurse is planning care for an 8-year-old child admitted for a surgical procedure.
According to Piaget's stages of cognitive development, the nurse should anticipate
that a child this age is in which stage?
A) Sensorimotor
B) Preoperational
C) Concrete operational
D) Formal operational
Answer: C) Concrete operational
Rationale: Children between the ages of 7 and 11 years are in the concrete
operational stage. They develop logical thinking about concrete events but struggle
with abstract or hypothetical concepts.
11. A 2-year-old toddler is admitted to the pediatric unit. According to Erikson’s
psychosocial theory, which developmental task is this child attempting to master?
A) Trust vs. Mistrust
B) Autonomy vs. Shame and Doubt
C) Initiative vs. Guilt
D) Industry vs. Inferiority
Answer: B) Autonomy vs. Shame and Doubt
Rationale: Toddlers aged 1 to 3 years focus on achieving a sense of independence
and autonomy over physical skills. Failure to support their efforts can lead to feelings
of shame and doubt.
12. A nurse is performing an assessment on a 6-month-old infant. Which gross motor
milestone should the nurse expect the infant to have successfully achieved?
A) Sitting independently without support
B) Rolling from abdomen to back
C) Pulling up to a standing position
3|Page
, D) Crawling on hands and knees
Answer: B) Rolling from abdomen to back
Rationale: Infants typically roll from abdomen to back by 4 to 5 months of age, and
back to abdomen by 6 months. Sitting independently without support is expected
around 7 to 8 months.
13. A 6-year-old child presents with a sudden onset of high fever, severe sore throat,
drooling, and an inspiratory stridor. The child is sitting forward in a "tripod" position.
Which action should the nurse avoid?
A) Placing the child on a pulse oximeter
B) Administering humidified oxygen
C) Examining the throat with a tongue depressor
D) Preparing for emergency airway management
Answer: C) Examining the throat with a tongue depressor
Rationale: These symptoms are indicative of acute epiglottitis. Examining the throat
with a tongue depressor or taking a throat culture can trigger a sudden, fatal
laryngospasm and complete airway obstruction.
14. A nurse is reviewing lab results for a child with suspected iron deficiency anemia.
Which laboratory result confirms this diagnosis?
A) Elevated ferritin levels
B) Decreased total iron-binding capacity (TIBC)
C) Decreased hemoglobin and decreased ferritin
D) Elevated mean corpuscular volume (MCV)
Answer: C) Decreased hemoglobin and decreased ferritin
Rationale: Iron deficiency anemia is characterized by a low hemoglobin level and
depleted iron stores, reflected by a low serum ferritin level. TIBC would be elevated,
and MCV would be decreased (microcytic).
15. An infant with tetralogy of Fallot becomes acutely distressed, cyanotic, and
tachypneic during a blood draw. Which immediate action should the nurse
implement?
A) Place the infant in a knee-chest position.
B) Prepare for immediate endotracheal intubation.
C) Administer a rapid fluid bolus of normal saline.
D) Place the child in a prone position.
Answer: A) Place the infant in a knee-chest position.
Rationale: This scenario describes a hypercyanotic spell ("tet spell"). Placing the
infant in a knee-chest position increases systemic vascular resistance, which
reduces the right-to-left shunt across the ventricular septal defect, forcing more blood
into the pulmonary artery to improve oxygenation.
16. A nurse is providing discharge education to the parents of a child diagnosed with
celiac disease. Which food item should the nurse instruct the parents to eliminate
completely from the child’s diet?
A) Corn tortilla chips
B) Oatmeal cookies made with standard wheat flour
C) Steamed white rice
D) Grilled chicken breast
Answer: B) Oatmeal cookies made with standard wheat flour
Rationale: Celiac disease is an autoimmune enteropathy triggered by the ingestion
of gluten, a protein found in wheat, barley, and rye. Standard wheat flour contains
gluten and must be strictly avoided.
4|Page
