NCLEX pediatrics practice questions
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Children compensate until they do not, which is why paediatric items reward you for noticing tachycardia rather than waiting for a blood pressure to fall. Ten questions on developmental milestones, immunisations, weight-based dosing, respiratory illness, dehydration, and the congenital conditions the exam repeats.
Written and reviewed by Dana Whitfield, RN, MSN · Updated August 2026
Health promotion and maintenance
The pediatrics set, all 10 free
Answer, check, and read why each of the four options wins or loses.
Pediatrics
Question 1 of 10
A 3-year-old arrives in the emergency department sitting forward in a tripod position, drooling, with a muffled voice, inspiratory stridor, and a temperature of 39.4 C (102.9 F). Which action should the nurse take first?
Not quite — the answer is B
Why each option is right or wrong
A. Use a tongue blade to visualize the posterior pharynx
Depressing the tongue in suspected epiglottitis can provoke laryngospasm and complete airway obstruction, so this action is contraindicated.
B. Keep the child upright in the parent's arms and notify the provider immediately while preparing for emergency airway management
Keeping the child calm and upright preserves the marginal airway while skilled personnel prepare for emergency intubation, addressing airway first.
C. Obtain a throat culture and send it to the laboratory
A throat culture requires pharyngeal manipulation and delays airway management; cultures are obtained only after the airway is secured.
D. Place the child supine and start a peripheral IV for antibiotics
Supine positioning lets the swollen epiglottis occlude the airway, and an IV start increases crying and obstruction before the airway is protected.
Key takeaway
Drooling, muffled voice, stridor, and tripod positioning suggest epiglottitis, a true airway emergency; keeping the child calm and upright prevents complete obstruction while skilled airway support is mobilized (ABCs). Inspecting the pharynx with a tongue blade or forcing the child supine can trigger laryngospasm and total occlusion, so those actions are contraindicated.
A 4-month-old with respiratory syncytial virus bronchiolitis has a respiratory rate of 68/min, nasal flaring, thick nasal secretions, and an oxygen saturation of 88% on room air. Which action should the nurse take first?
Not quite — the answer is C
Why each option is right or wrong
A. Offer the ordered oral fluids to help thin secretions
Oral fluids in an infant breathing 68 times per minute risk aspiration and do nothing for the current hypoxemia.
B. Place the infant prone to improve oxygenation
Prone positioning is not an established bronchiolitis intervention, raises sudden death risk in infants, and leaves the obstructed nares uncleared.
C. Suction the nares with a bulb syringe and apply supplemental oxygen
Infants are obligate nose breathers, so bulb suctioning plus supplemental oxygen relieves the obstruction and corrects the 88% saturation immediately.
D. Obtain a nasopharyngeal swab for RSV testing
An RSV swab confirms the diagnosis but is diagnostic rather than therapeutic, and collecting it leaves the hypoxemia untreated.
Key takeaway
Infants are obligate nose breathers, so clearing the nares and correcting hypoxemia addresses airway and breathing first under the ABC framework. Offering oral fluids to a tachypneic infant with a rate of 68/min risks aspiration and does nothing for the immediate hypoxemia.
A parent whose 18-month-old had a first simple febrile seizure is being discharged. Which statement by the parent indicates that teaching has been effective?
Not quite — the answer is A
Why each option is right or wrong
A. If another seizure occurs, I will turn my child on his side and time how long it lasts.
Side-lying protects the airway from aspiration during a seizure, and timing the event guides decisions about emergency treatment.
B. I will place a padded tongue blade in his mouth to protect his tongue.
Nothing should be placed in the mouth during a seizure; a tongue blade can break teeth, lacerate tissue, or obstruct the airway.
C. Giving ibuprofen at the first sign of fever will prevent all future seizures.
Antipyretics improve comfort but have never been shown to prevent recurrence of febrile seizures, so this statement is factually inaccurate.
D. My child will need to take antiseizure medication every day for life.
Simple febrile seizures are benign and self-limited, so daily lifelong antiseizure medication is not indicated and reflects a misunderstanding.
Key takeaway
Side-lying positioning protects the airway from aspiration and timing the event guides treatment decisions, which is the core of safe home seizure management. Placing anything in the mouth is unsafe and can cause oral trauma or obstruction, and antipyretics have not been shown to prevent recurrent febrile seizures.
A 12-month-old is scheduled for MMR and varicella vaccines at a well-child visit. The child has clear rhinorrhea, an occasional cough, and a temperature of 37.6 C (99.7 F). Which action should the nurse take?
Not quite — the answer is D
Why each option is right or wrong
A. Withhold both vaccines until the child has been symptom free for 2 weeks
No two-week symptom-free rule exists, and this delay would create repeated missed opportunities to immunize this child.
B. Administer the varicella vaccine only
Splitting the visit is unnecessary because neither live vaccine is contraindicated by clear rhinorrhea and a temperature of 37.6 C.
C. Notify the provider to obtain an order deferring immunizations for 1 month
Deferring a month delays protection without benefit, and no provider order is needed because mild illness is not a contraindication.
D. Administer both vaccines as scheduled, because a mild upper respiratory infection is not a contraindication
Mild upper respiratory illness with low-grade fever is not a contraindication, so both live vaccines are given as scheduled.
Key takeaway
Mild illness with or without low-grade fever is not a contraindication to immunization, and deferring doses creates missed opportunities for protection. Withholding the vaccines would delay immunity unnecessarily; only moderate to severe acute illness or a true anaphylactic reaction to a component warrants postponement.
The nurse is teaching the parents of a 4-year-old with cystic fibrosis about pancreatic enzyme replacement. Which instruction should the nurse include?
Not quite — the answer is C
Why each option is right or wrong
A. Give the enzymes once daily at bedtime
Once-daily bedtime dosing leaves every meal uncovered, so fat and protein pass unabsorbed and steatorrhea and poor growth continue.
B. Mix the enzyme beads in hot milk so they dissolve completely
Heat destroys the enteric coating on the enzyme beads and milk is alkaline; beads belong on a small amount of acidic food.
C. Give the enzyme capsules with every meal and snack, sprinkling the beads on applesauce if the child cannot swallow the capsule
Enzymes must accompany every meal and snack, and the beads may be sprinkled on applesauce when the child cannot swallow capsules.
D. Hold the enzymes on days the child has loose stools
Loose fatty stools usually indicate too little enzyme rather than too much, so holding doses worsens malabsorption and weight loss.
Key takeaway
Enzymes must be given with all meals and snacks to allow fat and protein absorption, and the beads may be sprinkled on a small amount of an acidic food such as applesauce. Holding enzymes when stools are loose worsens steatorrhea and malabsorption, since loose fatty stools usually signal an inadequate rather than an excessive enzyme dose.
A 4-year-old with Kawasaki disease is receiving IV immunoglobulin and high-dose aspirin. Which assessment finding requires immediate follow-up by the nurse?
Not quite — the answer is A
Why each option is right or wrong
A. Bilateral basilar crackles and a new S3 gallop
Crackles with a new S3 gallop suggest myocarditis or IVIG-related fluid overload, a cardiovascular emergency under the ABC framework.
B. Red, cracked lips and a strawberry tongue
Red cracked lips and strawberry tongue are classic expected findings in Kawasaki disease and call for comfort measures, not urgent intervention.
C. Peeling skin on the palms and soles
Desquamation of the palms and soles is an expected subacute-phase feature of Kawasaki disease rather than an emergency.
D. Irritability and bilateral conjunctival redness without drainage
Irritability and nonexudative conjunctival redness are hallmark Kawasaki findings; they are distressing but not immediately dangerous.
Key takeaway
Crackles with a new gallop suggest myocarditis or fluid overload from the IVIG infusion and represent a cardiovascular emergency requiring immediate intervention (ABCs). Cracked lips, strawberry tongue, desquamation, irritability, and nonexudative conjunctivitis are all expected features of Kawasaki disease and do not require urgent action.
During a 9-month well-child visit, which finding should the nurse report to the provider for further developmental evaluation?
Not quite — the answer is D
Why each option is right or wrong
A. The infant cries when the parent leaves the examination room
Separation anxiety peaks near 9 months, so crying when the parent leaves reflects normal attachment rather than a developmental delay.
B. The infant bangs two blocks together
Banging two blocks together is an age-appropriate fine motor milestone for a 9-month-old and needs no referral.
C. The infant says mama without referring to a specific person
Nonspecific babbling of mama is normal at 9 months; specific use of the word is not expected until closer to 12 months.
D. The infant is unable to sit without support
Independent sitting is expected by about 8 months, so its absence at 9 months is a gross motor red flag requiring evaluation.
Key takeaway
Independent sitting is expected by about 8 months, so its absence at 9 months is a gross motor red flag warranting evaluation. Separation anxiety, banging objects together, and nonspecific babbling of mama are all normal 9-month findings and require only reassurance.
A 6-month-old with tetralogy of Fallot suddenly becomes deeply cyanotic and irritable while crying during a diaper change. Which action should the nurse take first?
Not quite — the answer is B
Why each option is right or wrong
A. Administer oxygen by face mask and start an IV line
Oxygen and IV access are appropriate but come after positioning; starting an IV first prolongs crying and worsens the right-to-left shunt.
B. Place the infant in a knee-chest position
The knee-chest position raises systemic vascular resistance, decreasing right-to-left shunting and relieving the hypercyanotic tet spell immediately.
C. Give the scheduled dose of digoxin
Digoxin does not relieve the infundibular spasm of a tet spell, and giving a scheduled dose delays the positioning the infant needs.
D. Lay the infant flat and stimulate crying to expand the lungs
Lying flat lowers systemic vascular resistance and stimulating crying increases the shunt, deepening the cyanosis rather than relieving it.
Key takeaway
The knee-chest position increases systemic vascular resistance and decreases right-to-left shunting, which is the immediate treatment for a hypercyanotic tet spell and can be done instantly at the bedside. Oxygen and IV access follow, but starting an IV first prolongs crying and worsens the shunt.
The nurse reviews home safety with the parent of a 2-year-old. Which statement by the parent requires further teaching?
Not quite — the answer is C
Why each option is right or wrong
A. I keep all cleaning products in a locked cabinet.
Locking cleaning products away is correct poison prevention for a toddler and shows appropriate understanding.
B. My toddler rides in a rear-facing car seat in the back seat.
Rear-facing restraint in the back seat is the recommended standard for a 2-year-old, so no further teaching is needed.
C. I let my 2-year-old eat popcorn and whole grapes while watching television.
Popcorn and whole grapes are leading choking hazards under age 4, and eating while distracted by television increases aspiration risk.
D. I set the water heater temperature at 49 C (120 F).
A water heater set at 49 C (120 F) prevents scald burns and reflects correct home safety practice.
Key takeaway
Popcorn and whole grapes are leading choking hazards for children under 4, and eating while distracted increases aspiration risk, so this statement shows a knowledge deficit. Locked chemicals, rear-facing restraint, and a water heater at 49 C (120 F) are all correct toddler safety measures.
An 18 kg child is prescribed amoxicillin 45 mg/kg/day divided every 12 hours. The pharmacy sends a labeled syringe containing 500 mg for the next dose. Which action should the nurse take?
Not quite — the answer is A
Why each option is right or wrong
A. Hold the dose and clarify the order with the provider, because the calculated safe dose is 405 mg every 12 hours
45 mg/kg x 18 kg equals 810 mg daily, or 405 mg every 12 hours, so the 500 mg syringe exceeds the order.
B. Give the 500 mg dose because it is within 20% of the calculated dose
No twenty percent tolerance rule exists in safe medication administration; a dose that does not match the order must be verified, not rationalized.
C. Administer half of the 500 mg dose and document the change
Splitting the syringe to 250 mg underdoses the child, and independently altering a prescribed dose exceeds the nurse's scope.
D. Administer the dose as sent and monitor the child for adverse effects
Knowingly giving a discrepant dose and watching for adverse effects exposes the child to harm instead of preventing it.
Key takeaway
45 mg/kg x 18 kg = 810 mg/day, divided by 2 doses = 405 mg per dose, so the 500 mg syringe exceeds the prescribed dose and must be clarified before administration. Adjusting or splitting the dose independently is outside the nurse's scope and giving an unverified dose violates safe medication administration.
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