NCLEX Pediatric Questions
POP QUIZ NCLEX Childhood and Adolescent Question
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Question 1
A 6-year-old child is brought to the pediatric clinic by their parent, who reports that the child has had a persistent cough, fever, and wheezing for the past two days. Which of the following actions should the nurse take first? A. Administer a bronchodilator. B. Perform a throat swab. C. Obtain the child’s oxygen saturation. D. Provide a fever-reducing medication. E. Schedule a chest x-ray.
Correct Answer: C. Obtain the child’s oxygen saturation.
Rationale: The first action in assessing a child with respiratory symptoms is to evaluate the severity of the condition and immediate needs. Obtaining the child’s oxygen saturation helps in determining the level of respiratory distress and need for supplemental oxygen, making it a priority over medication administration or diagnostic tests. This assessment guides urgent interventions and is critical for children presenting with wheezing and difficulty breathing, indicating potential hypoxemia. Early detection of oxygenation issues allows for timely management and can prevent further respiratory compromise.
Question 2
A 3-year-old child with type 1 diabetes mellitus comes to the clinic for a routine check-up. The nurse needs to educate the parents about recognizing hypoglycemia. Which of the following symptoms should the nurse include in the teaching? A. Polyuria B. Tachycardia C. Blurred vision D. Deep, rapid breathing E. Increased thirst
Correct Answer: B. Tachycardia.
Rationale: Tachycardia is a common sign of hypoglycemia in children with diabetes, as the body releases adrenaline in response to low blood sugar, which can cause the heart to beat faster. Educating parents on recognizing tachycardia, along with other symptoms of hypoglycemia such as sweating, dizziness, and shakiness, is crucial for early intervention and prevention of serious complications. Polyuria, blurred vision, deep rapid breathing, and increased thirst are more commonly associated with hyperglycemia. Prompt recognition and treatment of hypoglycemia can prevent seizures and unconsciousness.
Question 3
A 2-month-old infant is brought to the emergency department with a high fever, irritability, and poor feeding. Which of the following actions by the nurse is most appropriate? A. Advise the parent to increase fluid intake. B. Prepare to administer acetaminophen. C. Obtain a lumbar puncture order. D. Start an oral antibiotic. E. Perform a urine dipstick test.
Correct Answer: C. Obtain a lumbar puncture order.
Rationale: In infants younger than 3 months with a high fever and signs of serious illness such as irritability and poor feeding, a lumbar puncture is necessary to rule out meningitis, a potentially life-threatening condition. This action is prioritized over symptomatic treatment or non-specific interventions because early diagnosis and treatment of meningitis are critical to prevent serious complications. While increasing fluid intake and administering acetaminophen may be supportive, they do not address the potential cause of the infant’s symptoms. Obtaining a lumbar puncture order allows for definitive diagnosis and appropriate management.
Question 4
A 5-year-old child is diagnosed with asthma and the nurse is providing education on using a metered-dose inhaler (MDI) with a spacer. Which of the following statements by the parent indicates a need for further teaching? A. “I should shake the inhaler well before use.” B. “My child should breathe out fully before using the inhaler.” C. “It’s okay if my child doesn’t hold their breath after inhaling the medication.” D. “We need to wait a minute between puffs if more than one puff is prescribed.” E. “I will clean the spacer at least once a week.”
Correct Answer: C. “It’s okay if my child doesn’t hold their breath after inhaling the medication.”
Rationale: Holding the breath for about 10 seconds after inhaling the medication from an MDI with a spacer allows the medication to deposit in the lungs and be more effective. This statement indicates a misunderstanding of the inhalation technique and the importance of breath-holding for optimal medication delivery. Proper technique is crucial for the effectiveness of asthma management, and not holding the breath can result in inadequate delivery of the medication to the lungs. This misconception should be corrected to ensure the child receives the full benefit of the prescribed medication.
Question 5
A nurse is caring for a 10-year-old child who has just undergone appendectomy. Which of the following pain management strategies should the nurse suggest to the child? A. Use of a pain scale to describe pain intensity. B. Application of a cold pack to the surgical site. C. Deep breathing exercises. D. Limiting fluid intake. E. Ambulating the evening of surgery.
Correct Answer: A. Use of a pain scale to describe pain intensity.
Rationale: Utilizing a pain scale enables the child to accurately communicate the intensity of their pain, facilitating appropriate pain management interventions by the healthcare team. This method is age-appropriate for a 10-year-old and empowers the child to be an active participant in their pain management. Cold packs, while useful for some types of injuries or surgeries, are not a universal recommendation post-appendectomy due to potential impacts on wound healing and circulation. Deep breathing exercises and ambulation are valuable for recovery but are not direct methods for managing acute postoperative pain. Ensuring adequate pain control is essential for promoting comfort, reducing stress, and facilitating recovery after surgery.
A 4-year-old child presents to the pediatric clinic with a barking cough, stridor at rest, and a history of mild fever for the past 24 hours. The nurse recognizes these symptoms as indicative of croup. Which of the following interventions should the nurse prioritize? A. Administering a nebulized epinephrine treatment. B. Encouraging oral fluid intake. C. Initiating corticosteroid therapy. D. Providing supplemental oxygen. E. Recommending over-the-counter cough syrup.
Correct Answer: A. Administering a nebulized epinephrine treatment.
Rationale: In cases of severe croup characterized by stridor at rest, administering nebulized epinephrine is a priority to rapidly reduce airway inflammation and ease breathing. This intervention can provide quick relief of the upper airway obstruction that characterizes croup, particularly in severe cases. While corticosteroid therapy is also a key component of treatment for croup to reduce inflammation, the immediate effect of nebulized epinephrine is crucial for urgent symptom relief. Oral fluids are important for hydration, but they do not address the acute airway obstruction, and over-the-counter cough syrups are generally not recommended for children under 6 years of age due to safety concerns.
Question 7
A pediatric nurse is teaching a group of parents about the prevention of sudden infant death syndrome (SIDS). Which of the following recommendations should the nurse include? A. Place the infant on a soft mattress. B. Keep soft objects and loose bedding out of the crib. C. Position the infant on their stomach to sleep. D. Dress the infant in warm, heavy sleepwear. E. Use a sleep positioner to keep the infant on their back.
Correct Answer: B. Keep soft objects and loose bedding out of the crib.
Rationale: Keeping soft objects and loose bedding out of the crib is a key recommendation to reduce the risk of SIDS. This practice prevents suffocation and provides a safe sleeping environment by eliminating potential hazards that could obstruct the infant’s airway. The recommendation to place infants on their backs to sleep, not on their stomachs, and to use a firm sleep surface further supports SIDS prevention efforts. Heavy sleepwear and the use of sleep positioners are discouraged because they can lead to overheating or pose additional risks. Educating parents on creating a safe sleep environment is crucial in the effort to decrease the incidence of SIDS.
Question 8
A 7-year-old child is admitted to the hospital with suspected rheumatic fever. Which of the following assessments is most important for the nurse to perform initially? A. Checking the child’s throat for redness and swelling. B. Listening for a heart murmur. C. Examining the joints for swelling and pain. D. Measuring the child’s temperature. E. Observing for involuntary jerking movements.
Correct Answer: B. Listening for a heart murmur.
Rationale: Rheumatic fever can lead to rheumatic heart disease, which primarily affects the heart valves, potentially causing a heart murmur. Initial assessment focusing on the heart, especially listening for a murmur, is crucial for early identification and management of cardiac involvement in rheumatic fever. This approach aids in determining the severity of the disease and guiding subsequent treatment plans to prevent long-term heart damage. While other symptoms such as joint swelling, fever, and involuntary movements (Sydenham chorea) are important in the diagnosis of rheumatic fever, the priority is to assess for heart involvement due to its potential for serious and lasting consequences.
Question 9
A nurse is preparing to administer vaccinations to a 2-month-old infant. Which of the following vaccines should the nurse prepare to administer according to the CDC’s immunization schedule? A. Measles, Mumps, and Rubella (MMR) B. Varicella C. Hepatitis B D. Influenza E. Human Papillomavirus (HPV)
Correct Answer: C. Hepatitis B
Rationale: According to the CDC’s immunization schedule, the Hepatitis B vaccine is administered to infants in a series, with the first dose given at birth and subsequent doses typically given at 1-2 months and then at 6-18 months of age. This makes the Hepatitis B vaccine appropriate for a 2-month-old infant. The MMR and Varicella vaccines are usually administered later in childhood, starting around the age of 1 year. The Influenza vaccine is recommended annually for children 6 months and older, and the HPV vaccine is recommended for children starting at ages 11-12 years. The administration of vaccines according to the recommended schedule is critical for protecting infants and children from vaccine-preventable diseases.
Question 10
A nurse is educating parents of a newborn about feeding practices. Which of the following pieces of advice should the nurse include to prevent bottle caries? A. “Clean your baby’s gums with a soft cloth after feedings.” B. “Add a teaspoon of honey to the bottle to soothe the baby.” C. “Let your baby fall asleep with the bottle.” D. “Only fill the bottle with formula or milk, nothing else.” E. “It’s okay to start introducing cow’s milk at 2 months.”
Correct Answer: A. “Clean your baby’s gums with a soft cloth after feedings.”
Rationale: Cleaning the baby’s gums with a soft cloth after feedings helps to remove milk residue and bacteria, which can reduce the risk of bottle caries (tooth decay). This practice should begin even before the baby’s teeth have erupted, as it promotes good oral hygiene from an early age. Adding honey to the bottle is not recommended due to the risk of botulism in infants, and letting a baby fall asleep with a bottle can lead to prolonged exposure to sugars in milk, which contributes to tooth decay. Cow’s milk should not be introduced before the age of 12 months to avoid nutritional deficiencies and allergies. Educating parents on proper oral hygiene practices from infancy is essential for preventing dental problems
Pediatric disorders For NCLEX
Cleft Lip and Cleft Palate
Cleft lip and cleft palate are congenital defects that affect the development of the lip and mouth. The cleft lip may be cosmetic and affect speech and feeding. The cleft palate affects the child’s ability to eat, digest and speak. Both conditions are surgically correctable. This is best corrected before school age because it will affect the child’s interaction with their peers. Sometimes it causes guilt for the parents because cleft lip and cleft palate are congenital. Nursing considerations before surgery are important. The infant will have decreased sucking ability and aspiration is a concern in these children. When feeding the child, ensure that the child is in an upright position. Special nipples may be used. This lessens the risk of aspiration. Suction equipment should be available at beside. Daily weights are done on these children. Carefully assess calorie intact, I’s and O’s, and nutrition status. Postoperative care includes protecting the repair. Some children may be esophageal atresia placed in elbow restraints. Feeding is usually resumed early.
Esophageal Atresia and Tracheoesophageal Fistula
Atresia tells us there is a lack of esophageal continuity. The upper esophagus ends in a blind pouch. When these babies swallow, the food stops here. These babies will have coughing, choking, and cyanosis (turning blue). If the doctor is not able to pass a feeding tube into the stomach, this suggests that the infant has esophageal atresia. When this is combined with a tracheoesophageal fistula there is an abnormal connection between the esophagus and the trachea. Nursing considerations: These babies will have the symptoms above and a round abdomen from swallowed air. The abnormal anatomy will vary. These babies will require surgery. Remember the 3 C’s: coughing, choking, and cyanosis as important signs of EATF.
Gastroesophageal Reflux (GERD)
GERD occurs in infants and may present with coughing, choking, loss of appetite, and recurrent respiratory infections. Initial treatment includes medications, but surgery may be indicated. In these babies the surgery is elective and usually, there is an attempt to treat these infants with medication and diet alteration. Babies are treated with, for example, PPIs and H2 blockers (pediatric dosing). Infants with reflux will require more frequent burping. Not all infants with GERD require surgery.
NCLEX Pediatric Questions, below
Hypertrophic Pyloric Stenosis
The pylorus is the distal opening of the stomach that acts as a sphincter regulating gastric emptying. It allows partially digested food to pass. When the pylorus thickens (hypertrophy) it results in a blockage of the stomach contents moving into the intestine. After the baby is feed, he or she vomits. We describe this as “projectile vomiting”. These babies may have a palpable “olive” in the epigastrium on physical exam.The infants may be dehydrated and have metabolic alkalosis when they are hospitalized.
Lactose Intolerance
Lactose intolerance in newborns means the infant does not tolerate lactose. The babies will have indigestion with lactose products. Symptoms include cramping abdominal pain, colic, and diarrhea. The treatment is to eliminate lactose products from the diet.
Celiac Disease
Patients with celiac disease do not tolerate gluten. When gluten foods are consumed they have abdominal pain, bloating, cramping, anorexia, bloating, and vomiting. Infants may have irritability, weight loss, dehydration from diarrhea, and electrolyte losses if celiac crisis occurs. This is rare. This adolescence can be sick enough that they need to be admitted to the hospital for rehydration. Diagnosis is confirmed with a biopsy of the small intestine. Treatment includes instructing the patient and educating the patient that the child should avoid gluten. Individuals substitute, for example, corn and rice.
Appendicitis
Patient pain starts in the mid-abdomen or periumbilical and then after some time, the pain is reported in the right lower quadrant. These patients may have difficulty walking especially in the pediatric population or pain with heel strike, “Jar sign” or “Markel’s sign”. Fever, anorexia, vomiting, and leukocytosis or elevated white blood cell count may be elevated. Perforation occurs with delays in diagnosis. Nursing considerations include preoperative preparation for surgery.
Hirschsprung’s Disease
Is a condition of the lower gastrointestinal tract or colon. This is due to an aganglionic segment of the colon. The aganglionic segment does not have normal nerve cells. This absence of nerve cells creates a functional obstruction. This section of the distal colon does not have normal bowel motility. The primary symptom is the failure to pass stool (or meconium) by the newborn. These babies have abdominal distension and chronic constipation. The treatment is surgery.
Intussusception
Intussusception is a telescoping of one part of the bowel or intestine into the adjacent part of the bowel. When this occurs, it results in a blockage. It can also affect the blood flow to the region of the affected bowel. When the symptoms occur, the baby will have severe pain often associated with loud crying. The stool may be mixed with blood (currant jelly stool) and the infant may vomit. Treatment may be medical nasogastric tube insertion and an enema to stimulate the bowel movement or surgical. Surgery is typically laparoscopic today.
Abdominal Wall Defects
These are birth defects where the infant is born with an opening in the abdominal wall. The intestines may protrude outside of the abdomen. Large defects may allow other organs, including the liver and stomach, to protrude outside of the abdomen. Omphalocele is similar, except the contents have a thin covering. Infants with omphalocele and gastroschisis require abdominal wall closure. Managing these babies can be challenging and includes stabilizing the respiratory status. The lungs in these babies may be small. As the abdominal contents are replaced in the abdominal, respiratory distress may occur and this must be constantly monitored. Fluid status and the open abdominal wound must be carefully managed.
Inguinal Hernia
Inguinal Hernia occurs when a portion of the intestine protrudes through a weakened area in the abdominal wall or groin. When the blood supply is interrupted, we refer to it as incarcerated. The nursing exam reveals a bulge on the physical exam. The treatment may be surgery and will be determined by the health care provider or pediatric surgeon.
Imperforate Anus
Imperforate anus is a congenital defect where the anus is absent at birth. The nurse will note the absence of an opening that results in the newborn not being able to pass the meconium or first stool. The treatment is surgery to restore the opening.
NCLEX Pediatric Questions
NCLEX QUESTION 1) The nursing student asks the nurse about how to recognize a ruptured appendix in a child with right lower quadrant pain. The nurse correctly answers, (select all that apply)
A. hunger and thirst
B. tachycardia
C. severe abdominal pain
D. somnolence
NCLEX QUESTION 2) The nursing student asks the nurse about how to recognize pyloric stenosis in an infant. The nurse correctly answers, (select all that apply)
A. dehydration
B. projectile vomiting
C. high-pitched cry
NCLEX QUESTION 3) The nurse is taking care of a 16-year-old male admitted with acute appendicitis, the nurse’s examination reveals a low glow-grade temperature, a rigid abdomen with pain and heart rate of 140 beats/minute. What is the next appropriate step?
A. Administer the prescribed pain medication.
B. Call the healthcare provider
C. Cough, deep breathing, and incentive spirometry
D. Administer a Dulcolax suppository
NCLEX QUESTION 4) The nurse is providing discharge instructions for the mother of an infant after pyloromyotomy for pyloric stenosis. What are some important instructions?
A. Keep the patient NPO for the first 5-7 days
B. Show the parents how to inspect the wound dressing and incision
C. Monitor the infant for abdominal distension and pain
D. Monitor the infant’s intake
NCLEX Style Questions, keep up the good work!
NCLEX QUESTION 5) The nurse is preparing a 2-year-old with acute appendicitis preoperatively, what orders does the nurse expect to see documented on the child’s chart? (select all that apply)
A. Normal saline intravenous fluids at 250 cc/hour
B. Aspirin 325 mg p.o. every 6-8 hours PRN for mild to moderate pain
C. NPO
D. Intravenous antibiotics
NCLEX QUESTION 6) The nursing student asks the nurse about signs and symptoms of Hirschsprung’s Disease. The nurse correctly answers, (select all that apply)
A. hunger and thirst
B. bradycardia
C. failure to pass meconium
D. distended abdomen
NCLEX QUESTION 7) The nurse is taking care of a 18-month-old male admitted with intussusception, the nurse’s examination reveals a BP of 81/52 mm Hg, a rigid abdomen and heart rate of 140 beats/minute. What is the next appropriate step?
A. Administer the prescribed pain medication
B. Call the health care provider (HCP)
C. Cough, deep breathing, and incentive spirometry
D. Administer a Dulcolax suppository
NCLEX QUESTION 8) The UAP asks the nurse how to recognize the difference between omphalocele and gastroschisis in an infant. The nurse correctly answers, (select all that apply)
A. Gastroschisis involves herniation of the intestine next to the umbilical ring
B. Projectile vomiting
C. High-pitched cry
D. Omphalocele involves herniation of the intestine through the umbilical ring, usually covered by the peritoneum
NCLEX QUESTION 9) The nurse is taking care of a new mother whose first child is diagnosed with an umbilical hernia. What are the findings that the mother should be told about an incarcerated umbilical hernia should it occur? (select all that apply)
A. tenderness over the site of the hernia
B. hunger and thirst
C. abdominal distension (“swelling”)
D. this represents a medical emergency
NCLEX QUESTION 10) The nurse is providing instructions to a father whose 15- year-old is diagnosed with chronic constipation. What are the recommendations that the nurse should tell the father? (select all that apply)
A. Limit fluid intake to 6 glasses of water per day
B. Enemas may by used for impaction
C. Increase dietary fiber
D. Administer laxatives and stool softeners prescribe
More NCLEX Questions from the question bank
Answers to NCLEX-style Questions
NCLEX Musculoskeletal Questions
1. B,C
Appendicitis is inflammation (“itis”) of the appendix and can occur in any age group. The treatment is surgery and antibiotics. Left untreated rupture and abscess may occur.
2. A,C
Hypertrophic pyloric stenosis occurs when the circular muscles of the pylorus lead to a thickening and narrowing of the opening between the stomach and the duodenum. This obstructs the passage of food and results in projectile vomiting.
3. C
Don’t be fooled by the “low grade temperature”. In this question you are presented with some classic findings of peritonitis or an “acute abdomen”, a surgical emergency.
4. B,C,D
Pyloromyotomy involves making an incision in the pylorus muscle to alleviate the stenosis. It may be performed laparoscopically. Infants usually respond well and recover quickly postoperatively.
5. B,D
Most patients who are preoperatively getting ready for surgery are NPO. Patients with appendicitis are treated with IV antibiotics. Aspirin (ASA) is not appropriate in this age group. In addition, ASA affects platelets and increases the risk of bleeding. NS at 250 cc/hour in this 2-year-old is not appropriate.
6. B,D
Remember that Hirschsprung’s Disease is a commonly tested congenital abnormality due to absence of ganglion cells in areas of the intestine. You should think of it when a newborn fails to pass meconium (the first stool).
7. C
Notice the hypotension and tachycardia in this 18-month-old. (Review our NCLEX video on pediatric vital signs). In this question you are presented with some classic findings of peritonitis or an “acute abdomen”, a surgical/medical emergency. You must recognize this and know when to call the HCP.
8. A,D
Both of these abdominal wall defects are serious in the newborn. The exposed intestines must be protected. Surgery is done to replace the intestines in the abdominal cavity.
9. A,B,D
A hernia is protrusion of an organ or tissue through and abnormal opening. Incarceration is an emergency and should be recognized as soon as possible to prevent strangulation (ischemia) and the death of tissue.
10. B,C,D
Constipation means having difficult bowel movements that occur less frequently than normal. After about three days, the stool becomes hard and may be painful to pass. The initial treatment usually involves patient education.
