Pediatric Nursing Practice Test
These 25 questions test your ability to apply age-specific nursing care — recognising normal vs. abnormal vital signs by age, identifying pediatric emergencies, managing common childhood conditions, and communicating therapeutically with children and families.
Pediatric Nursing Quiz
Prepare for NCLEX with pediatric nursing questions on child development, asthma, RSV, GI disorders, and chronic conditions with explanations.
Question 1: A nurse is assessing a 9-month-old infant. Which finding would require further evaluation?
Answer: B — By 9 months, most infants should be crawling, creeping, or pulling to stand. Absence of these gross motor milestones warrants developmental screening. Not walking independently until 12 to 15 months is normal and would not be a concern at 9 months.
Question 2: A nurse is calculating a medication dose for a 2-year-old weighing 12 kg. The order is for amoxicillin 25 mg/kg/day divided into two doses. What is each individual dose?
Answer: B — Total daily dose: 25 mg/kg x 12 kg = 300 mg/day. Divided into two doses: 300 divided by 2 = 150 mg per dose. Weight-based dosing is standard in pediatrics because children metabolize medications differently than adults and adult doses would be dangerous.
Question 3: A nurse is assessing vital signs on a healthy newborn. Which set of findings is within NORMAL limits?
Answer: C — Normal newborn ranges: heart rate 120-160 bpm, respiratory rate 30-60 breaths/min, temperature 97.7-99.5 F axillary. Option B falls within all normal parameters. A heart rate of 80 or 60 indicates bradycardia in a newborn, which is a medical emergency.
Question 4: A nurse notices that a 4-month-old infant has a closed posterior fontanelle. This finding is:
Answer: B — The posterior fontanelle normally closes by 2 to 3 months of age. A closed posterior fontanelle at 4 months is an expected finding. The anterior fontanelle remains open until 12 to 18 months. A bulging fontanelle suggests increased ICP; a sunken one suggests dehydration.
Question 5: A 5-year-old is brought to the clinic for a well-child visit. According to Erikson, this child is in which psychosocial stage?
Answer: A — Erikson stages: Trust vs. Mistrust (0-1 year), Autonomy vs. Shame and Doubt (1-3 years), Initiative vs. Guilt (3-6 years), Industry vs. Inferiority (6-12 years). A 5-year-old is in Initiative vs. Guilt, characterized by imaginative play and exploring purpose.
Question 6: A nurse is preparing a 10-year-old for a tonsillectomy. The MOST age-appropriate approach for pre-operative teaching is:
Answer: C — School-age children (6-12 years) are concrete thinkers who learn best through hands-on experience and simple, honest explanations. Allowing them to touch equipment reduces fear. Avoiding discussion or using complex medical terms increases anxiety. Children deserve age-appropriate honesty.
Question 7: A 2-year-old presents to the emergency department with a barking cough, inspiratory stridor, and hoarseness. The nurse suspects:
Answer: D — The classic triad of barking (seal-like) cough, inspiratory stridor, and hoarseness in a toddler is croup. It is typically caused by parainfluenza virus and affects the subglottic area. Treatment includes cool mist humidification, racemic epinephrine, and corticosteroids (dexamethasone).
Question 8: A 4-year-old arrives at the ED drooling, sitting upright in a tripod position, with a high fever and muffled voice. The nurse should:
Answer: D — This presentation (drooling, tripod position, high fever, muffled voice) is classic epiglottitis - a life-threatening airway emergency. NEVER examine the throat - this can trigger complete airway obstruction. Keep the child calm, upright, and prepare for emergency airway management.
Question 9: An 8-month-old is admitted with RSV bronchiolitis. The nurse should anticipate which intervention?
Answer: D — RSV is a viral infection - antibiotics are ineffective. Treatment is supportive: supplemental oxygen for hypoxemia, nasal suctioning to clear secretions, IV fluids for hydration (infants often cannot feed well), and monitoring for respiratory distress. Palivizumab is for prevention, not treatment.
Question 10: A toddler is brought to the ED after a witnessed choking event. The child is coughing forcefully. The nurse should:
Answer: C — A forceful cough means the child can still move air - this is the best mechanism to dislodge the object. Only intervene with back blows/chest thrusts (under 1 year) or abdominal thrusts (over 1 year) if the cough becomes ineffective or breathing stops.
Question 11: A child with asthma is using a metered-dose inhaler (MDI). The nurse should teach the child to use which device to improve medication delivery?
Answer: C — A spacer holds the aerosolized medication in a chamber, allowing the child to inhale it more effectively over several breaths. Without a spacer, most medication impacts the back of the throat instead of reaching the lower airways. Spacers significantly improve drug delivery in children.
Question 12: A nurse is teaching the parents of a child diagnosed with asthma. Which instruction is MOST important?
Answer: A — Rescue inhalers (albuterol) are for acute symptom relief. Controller medications (inhaled corticosteroids) are taken daily to reduce inflammation and prevent attacks. Stopping the controller when the child feels well leads to uncontrolled asthma and breakthrough attacks.
Question 13: A 3-week-old infant presents with projectile vomiting after every feeding, visible peristaltic waves across the abdomen, and an olive-shaped mass in the right upper quadrant. The nurse suspects:
Answer: A — This is the classic presentation of pyloric stenosis: projectile (forceful, non-bilious) vomiting in a 2 to 6 week old infant, visible peristaltic waves, and a palpable olive-shaped mass (the hypertrophied pylorus). Treatment is surgical pyloromyotomy. The infant will be dehydrated and alkalotic.
Question 14: A 10-month-old presents with sudden episodes of severe crying, drawing the knees to the chest, and currant jelly stools. The nurse suspects:
Answer: D — The triad of episodic severe crying with knee-to-chest drawing (colic-like), sausage-shaped abdominal mass, and currant jelly stools (blood and mucus) is classic intussusception - telescoping of one bowel segment into another. Treatment is air or barium enema reduction or surgery.
Question 15: A newborn with Hirschsprung disease would MOST likely present with:
Answer: D — Hirschsprung disease (congenital aganglionic megacolon) results from absent nerve cells in the distal bowel, preventing peristalsis. The hallmark sign is failure to pass meconium within 24 to 48 hours. The bowel proximal to the aganglionic segment dilates, causing abdominal distention.
Question 16: A child with appendicitis is awaiting surgery. Which nursing action is CONTRAINDICATED?
Answer: B — NEVER apply heat to the abdomen of a child with suspected appendicitis - heat increases blood flow and can cause the inflamed appendix to rupture, leading to peritonitis. Keep NPO, maintain IV hydration, and position for comfort. Ice is also generally avoided.
Question 17: An infant born with a cleft lip and palate is being prepared for feeding. The nurse should use:
Answer: D — Infants with cleft lip/palate cannot create adequate suction for standard feeding. Use specialized cleft feeders (Haberman, pigeon) or soft bottles that can be gently squeezed to deliver milk. Feed upright to reduce aspiration risk and nasal regurgitation. Burp frequently due to increased air intake.
Question 18: A child with sickle cell disease presents with severe bone pain, fever, and swollen hands and feet. The PRIORITY nursing intervention is:
Answer: C — Sickle cell pain crisis (vaso-occlusive crisis) requires prompt IV hydration (to reduce blood viscosity and improve flow) and opioid pain management. Pain is severe and real - never undertreat. Cold and ice worsen sickling. Restrict activity during crisis to reduce oxygen demand.
Question 19: A nurse is caring for a child with hemophilia who fell and bumped their head. The PRIORITY action is:
Answer: A — Head trauma in a child with hemophilia is a medical emergency because the inability to clot properly creates a high risk for intracranial hemorrhage, which can be fatal. Administer factor replacement immediately and obtain imaging. Never adopt a wait-and-see approach for head injuries in hemophilia.
Question 20: A nurse is teaching the parents of a newly diagnosed child with type 1 diabetes. Which statement by the parent indicates CORRECT understanding?
Answer: A — Type 1 diabetes is an autoimmune destruction of pancreatic beta cells resulting in absolute insulin deficiency. The child will require exogenous insulin for life - it cannot be managed with diet alone or oral hypoglycemics (those work for type 2). Consistent daily insulin is essential for survival.
Question 21: A child with cystic fibrosis is prescribed pancreatic enzyme supplements (pancrelipase). The nurse should teach the parents to administer these:
Answer: C — Cystic fibrosis causes thick mucus to block pancreatic ducts, preventing digestive enzymes from reaching the intestines. Pancrelipase replaces these missing enzymes and must be given with EVERY meal and snack. Do not mix with hot food - heat destroys the enzyme activity.
Question 22: A 4-year-old with nephrotic syndrome has periorbital edema, massive proteinuria, and hypoalbuminemia. The nurse should anticipate which dietary modification?
Answer: B — Nephrotic syndrome causes massive protein loss in urine leading to hypoalbuminemia, decreased oncotic pressure, and fluid shifting into tissues (edema). A normal-protein, low-sodium diet helps reduce edema without worsening kidney stress. Severe fluid restriction is generally not needed unless symptomatic.
Question 23: A nurse suspects child abuse in a 2-year-old who presents with multiple bruises in various stages of healing on the trunk, buttocks, and upper arms. The parent states the child fell off the couch. The nurse should:
Answer: A — Bruises in various healing stages on the trunk, buttocks, and upper arms are inconsistent with a single couch fall. These locations are protected areas unlikely to be injured in typical falls. Nurses are mandated reporters - report suspected abuse immediately without waiting for the child to disclose.
Question 24: A school-age child newly diagnosed with sickle cell disease asks why they cannot play outside on cold days like their friends. The BEST nursing response is:
Answer: A — Cold causes vasoconstriction, which slows blood flow and reduces oxygen delivery to tissues - both triggers for sickling. Age-appropriate education empowers the child to understand their condition and participate in self-management while still enjoying activities with appropriate precautions.
Question 25: A nurse is monitoring a child with acute glomerulonephritis. Which assessment finding is MOST concerning?
Answer: B — Severe hypertension (160/100) with headache and visual changes in a child with glomerulonephritis suggests hypertensive encephalopathy - a medical emergency that can lead to seizures, stroke, and permanent brain damage. This requires immediate antihypertensive treatment and close neurological monitoring.
What your score means
85% or above — Strong pediatric clinical knowledge
You can apply age-specific assessment, recognise pediatric emergencies, and select developmentally appropriate interventions at an exam-ready level.
70–84% — Close. Sharpen your age-specific knowledge.
Most students in this range mix up normal vital sign ranges by age, or confuse similar-presenting pediatric conditions. Use the vital signs spectrum and comparison pairs below.
Below 70% — Work through all three cheat sheet sections.
Pediatric nursing requires knowing how normal ranges shift across age groups and how conditions present differently in children vs. adults. The cheat sheets below are structured around exactly those distinctions.
What’s covered in Pediatric Nursing
Tests your ability to adapt nursing knowledge for children — how presentation, normal values, communication, and interventions differ at each developmental stage from newborn through adolescence.
Growth, Development & Assessment
Age-specific vital signs, weight-based dosing, developmental milestones, and recognising when findings are abnormal for the age.
~6 questionsRespiratory Emergencies
Croup vs. epiglottitis, asthma, RSV, foreign body aspiration, bronchiolitis. Airway management differences in children.
~6 questionsGI & Surgical Conditions
Pyloric stenosis, intussusception, Hirschsprung’s, appendicitis, cleft lip/palate. Age-specific presentation and priority interventions.
~6 questionsChronic & Haematologic Conditions
Sickle cell disease, haemophilia, type 1 diabetes, cystic fibrosis, nephrotic syndrome, child abuse recognition.
~7 questionsAll NCLEX-RN practice topics
How to master Pediatric Nursing
Memorise vital sign ranges by age group, not a single value
A heart rate of 120 bpm is tachycardic in an adult but completely normal in a toddler. A respiratory rate of 40 is alarming in a school-age child but expected in a newborn. The vital signs spectrum below gives you all five parameters across six age groups in one place.
Learn respiratory emergencies through epiglottitis vs. croup
This is the most tested pediatric comparison. Croup: gradual onset, barking cough, low-grade fever. Epiglottitis: sudden onset, drooling, tripod position, high fever, NO throat exam, NO tongue depressor, do NOT lay supine. If you confuse these two, the question will tell you immediately.
Know projectile vomiting conditions by age of presentation
Pyloric stenosis: 2–8 weeks, non-bilious projectile vomiting, olive-shaped mass, metabolic alkalosis. Intussusception: 3 months–3 years, colicky pain with pain-free intervals, current-jelly stool (late sign), sausage-shaped RUQ mass. Age of onset is the fastest differentiator.
Apply Erikson’s stages to every hospitalised child scenario
Toddler (autonomy): offer choices. Preschool (initiative): involve in care. School-age (industry): explain with concrete language. Adolescent (identity): ensure confidentiality and peer connection. Ask yourself: what is the developmental stage, and what does it require from the nurse?
Retake until you score 85%+ consistently
Pediatric questions reward pattern recognition across age groups. Once you can place a child in their developmental stage, apply the correct vital sign ranges, and distinguish similar-presenting conditions, these questions become very predictable.
Quick Reference Cheat Sheets
Three visual formats: age-specific vital signs spectrum, developmental red flags, and condition comparison pairs that look similar but require completely different interventions.
- Social smile to faces
- Lifts head when prone
- Follows objects to midline
- No social smile by 3 months
- No response to loud sounds
- Floppy tone or persistent fisting
- 1–3 meaningful words
- Pulls to stand, pincer grasp
- Points, waves bye-bye
- No babbling → autism screen
- Not standing with support
- No pointing or gesturing
- 50+ words, 2-word phrases
- Runs, kicks a ball
- Parallel play with peers
- Fewer than 50 words
- No 2-word combinations
- Loss of acquired skills
Frequently asked questions
Get your free Pediatric Nursing cheat sheet
Age-specific vital signs reference, developmental red flag guide, and condition comparison pairs — one printable page.
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