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Health Promotion and Maintenance

NCLEX Pediatric Practice Questions

Quick answer

Pediatric questions on the NCLEX check whether you know what is normal for a child at a given age and whether you can tell a sick kid from a very sick kid. They sit mostly inside Health Promotion and Maintenance, which is 6 to 12 percent of the exam, and the well-child topics (vaccines, safety, screening) show up more often than rare diseases.

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Most pediatric items on the exam are not about exotic conditions. They are about a parent in a clinic asking a question, or a child on a unit whose breathing or hydration has changed, and the nurse having to respond with the right teaching or the right next step. You need the immunization schedule, the car seat rules, the choking rules, and a handful of infant red flags cold, because the exam gives you no time to reason them out from scratch. The trap on this topic is treating an infant like a small adult. A temperature of 100.4 degrees Fahrenheit is a shrug in a teenager and an emergency in a six week old. A toddler who is "just sleepy" after a day of vomiting may be badly dehydrated. Age changes the answer, so read the age in the stem before you read anything else.

Practice questions

1

A parent brings a 2 month old infant to the clinic for a well-child visit and asks which vaccines are due today. Which response by the nurse is correct?

  1. A"MMR, varicella, and hepatitis A."
  2. B"DTaP, IPV, Hib, PCV, rotavirus, and the second dose of hepatitis B."
  3. C"Only the influenza vaccine, since the others wait until 6 months."
  4. D"No vaccines are due until the 4 month visit."
Show answer

Answer: B

The 2 month visit includes DTaP, IPV (polio), Hib, pneumococcal conjugate, oral rotavirus, and the second hepatitis B dose (the first is given at birth). Combination products are often used so the infant gets fewer injections, but these are the vaccines covered.

Why the others are wrong

MMR and varicella are live vaccines that are not given until 12 months, and hepatitis A starts at 12 months as well. Influenza vaccine is not given before 6 months of age. Delaying all vaccines to 4 months leaves the infant unprotected against pertussis during the most dangerous months.

2

The nurse is preparing to give the MMR vaccine at a 12 month well-child visit. Which finding in the child's history would lead the nurse to hold the vaccine and notify the provider?

  1. AThe child has a runny nose and a temperature of 99.2 degrees Fahrenheit
  2. BThe child is being treated with high dose oral corticosteroids for a kidney condition
  3. CThe child is allergic to penicillin
  4. DThe child was born three weeks premature
Show answer

Answer: B

MMR is a live attenuated vaccine. A child receiving high dose systemic steroids, chemotherapy, or who has another cause of significant immunosuppression should not get live vaccines, because the weakened virus can cause disease in a body that cannot control it. Pregnancy is the other major contraindication for live vaccines, which is why it comes up with MMR and varicella in adolescent and maternity questions.

Why the others are wrong

A mild illness with a low grade temperature is not a reason to delay vaccination. Penicillin allergy has nothing to do with MMR, which contains neomycin and gelatin, not penicillin. Prematurity is not a contraindication, and premature infants are vaccinated by chronological age.

3

A parent of a 15 month old who weighs 24 pounds asks the nurse about turning the car seat to face forward. Which response is correct?

  1. A"You can turn it forward now since your child is over 1 year old."
  2. B"Keep your child rear facing until they reach the height or weight limit of the seat, which is usually well past age 2."
  3. C"Switch to a booster seat once your child walks steadily."
  4. D"A forward facing seat is safe once your child weighs 20 pounds."
Show answer

Answer: B

Current guidance is to keep children rear facing as long as possible, until they reach the maximum height or weight allowed by the convertible seat. Most children stay rear facing until at least 2 years old, often longer. Rear facing spreads crash forces across the whole back and protects the head and neck.

Why the others are wrong

The old "1 year and 20 pounds" rule is outdated and is a classic wrong answer. Walking has nothing to do with seat choice. Booster seats are for older children who have outgrown a forward facing harness seat, usually around 40 pounds and age 4 or later, and all children ride in the back seat until age 13.

4

The nurse is teaching the parents of an 18 month old about preventing choking. Which statement by a parent shows that the teaching was understood?

  1. A"I will cut grapes and hot dogs into small pieces lengthwise before serving them."
  2. B"Whole peanuts are fine as long as I am watching while she eats."
  3. C"Hard candy is safe because it dissolves in the mouth."
  4. D"She can have popcorn now that she has her molars."
Show answer

Answer: A

Round, firm foods the size of a toddler's airway are the biggest choking risks. Grapes and hot dogs should be cut lengthwise into thin strips, not into round coins, so no piece can plug the trachea. A toddler should also sit down to eat and never eat while running or in a moving car.

Why the others are wrong

Whole nuts, hard candy, and popcorn are all on the do-not-serve list for children under 4 regardless of supervision, because a parent watching cannot stop an aspiration once it starts. Having molars does not mean a toddler can chew these foods safely.

5

A parent calls the clinic about a 6 week old infant who has a rectal temperature of 100.6 degrees Fahrenheit. The infant is feeding a little less than usual but is otherwise acting normally. What is the nurse's best response?

  1. A"Give infant acetaminophen and call back if the fever is still there tomorrow."
  2. B"Sponge the baby with lukewarm water and recheck in an hour."
  3. C"Bring the baby in to be evaluated right away."
  4. D"This is a low fever and is probably from teething."
Show answer

Answer: C

Any rectal temperature of 100.4 degrees Fahrenheit or higher in an infant under 3 months old must be evaluated by a provider the same day, usually in an emergency department. Young infants have immature immune systems and few signs of serious infection, so fever can be the only clue to sepsis, meningitis, or a urinary tract infection, and the workup often includes blood, urine, and spinal fluid cultures.

Why the others are wrong

Treating the number with acetaminophen hides the fever without finding the cause and delays care. Sponging does nothing to rule out a serious infection. Teething does not cause fever, and a 6 week old is far too young to be teething anyway.

6

The nurse is assessing a 7 month old who has had vomiting and diarrhea for two days. Which finding most strongly indicates that the infant is significantly dehydrated?

  1. AThe infant cries when the nurse undresses her for the exam
  2. BThe anterior fontanel is sunken and the parent reports only two wet diapers in the past 24 hours
  3. CThe infant's heart rate is 120 beats per minute while sleeping
  4. DThe infant's stools are loose and yellow
Show answer

Answer: B

A sunken anterior fontanel, fewer than about six wet diapers a day (or none in 6 to 8 hours), absent tears, dry mucous membranes, and poor skin turgor are the classic signs of dehydration in an infant. Two wet diapers in a day plus a sunken soft spot means this infant has lost a lot of fluid and needs rehydration now.

Why the others are wrong

Crying with an exam is normal for a 7 month old, and crying with tears is actually reassuring. A sleeping heart rate of 120 is within the normal range for this age. Loose yellow stools describe the diarrhea itself and do not tell you how much fluid has been lost.

7

A 4 month old is admitted with bronchiolitis caused by RSV. The infant has nasal congestion, a respiratory rate of 58, mild retractions, and an oxygen saturation of 93 percent. Which nursing intervention is the priority?

  1. ASuction the nares with a bulb syringe or saline drops before feedings and sleep
  2. BAdminister a scheduled dose of oral antibiotics
  3. CPlace the infant flat on the back to ease breathing
  4. DOffer a full bottle every two hours to prevent dehydration
Show answer

Answer: A

Infants breathe mostly through their noses, so in bronchiolitis clearing the nasal secretions is the single most useful thing a nurse does. Suction before feeds and before sleep improves oxygenation, lets the infant feed, and often avoids the need for more aggressive support. Care is supportive: suctioning, humidified oxygen if saturation stays below about 90 percent, hydration, and contact plus droplet precautions.

Why the others are wrong

RSV is a virus, so antibiotics do nothing unless there is a secondary bacterial infection. The head of the crib should be raised, not flat, to ease the work of breathing. An infant breathing nearly 60 times a minute can aspirate with large feeds, so small frequent feeds or IV fluids are used instead.

8

A 3 year old arrives in the emergency department sitting upright and leaning forward with the chin out, drooling, and making a high pitched sound on inspiration. The child has a temperature of 103.5 degrees Fahrenheit and looks frightened. Which action should the nurse take first?

  1. AUse a tongue blade to inspect the throat for swelling
  2. BLay the child flat on the stretcher to obtain vital signs
  3. CKeep the child calm in the parent's lap and prepare for emergency airway management
  4. DObtain a throat culture to identify the organism
Show answer

Answer: C

This is epiglottitis until proven otherwise: tripod position, drooling, stridor, high fever, and sudden onset. The swollen epiglottis can close the airway completely at any moment. The nurse keeps the child upright and calm, does not leave the bedside, and gets the provider and intubation equipment ready, with intubation done in a controlled setting such as the operating room.

Why the others are wrong

Never put anything in the mouth of a child with suspected epiglottitis, including a tongue blade or a culture swab, because it can trigger complete airway obstruction. Lying the child flat also closes the airway, and crying from a forced exam makes the swelling worse.

9

The nurse is teaching the parent of a 2 year old who has been diagnosed with acute otitis media. Which statement by the parent indicates a need for further teaching?

  1. A"I will finish the whole course of antibiotics even if he seems better in a few days."
  2. B"I will stop giving him his bottle when he is lying flat in the crib."
  3. C"I will give him acetaminophen for the ear pain."
  4. D"I will put a few drops of warm oil in his ear every night until it clears up."
Show answer

Answer: D

Nothing should be put into the ear canal unless the provider prescribes it, because the eardrum may be perforated and oils or drops can make things worse. Pain control with acetaminophen or ibuprofen, finishing the full antibiotic course, and keeping the child upright for feeds are the right teaching points. Bottle propping, pacifier use past 6 months, and smoke exposure all raise the risk of repeat ear infections.

Why the others are wrong

The other three statements are all correct. Stopping antibiotics early leads to resistant organisms and recurrence. Removing the bottle from the flat crib position stops milk from pooling near the eustachian tube. Analgesics are the main comfort measure in the first days.

10

During a 12 month well-child visit the nurse learns that the family lives in a house built in 1962 and the toddler has started putting everything in his mouth. Which action is most appropriate?

  1. AReassure the parent that lead paint was banned long ago and no testing is needed
  2. BObtain a blood lead level and review how to reduce exposure at home
  3. CTell the parent to bring the child back if he develops stomach pain
  4. DSchedule a hearing test instead, since hearing loss is more common
Show answer

Answer: B

Lead screening is recommended at 12 and 24 months, and a child who lives in a home built before 1978 and who mouths objects has a clear risk. A blood lead level is drawn (a venous sample confirms an elevated capillary result), and the nurse teaches the family to wet mop dust, wash hands and toys often, keep the child away from peeling paint, and offer foods rich in iron and calcium, which reduce lead absorption.

Why the others are wrong

Lead based paint was not banned in US housing until 1978, so a 1962 home is a risk. Lead poisoning is usually silent until the damage to brain development is done, so waiting for symptoms is not screening at all. Hearing is checked at well-child visits too, but it does not replace lead screening when a risk factor is present.

Quick tips

  • Memorize the 2 month vaccine set (DTaP, IPV, Hib, PCV, rotavirus, hepatitis B) and the 12 month set (MMR, varicella, hepatitis A). If the question gives a live vaccine and an immunosuppressed or pregnant client, the answer is hold it.
  • Fever in an infant under 3 months is never a phone-advice problem. Any temperature of 100.4 degrees Fahrenheit rectally or higher gets evaluated the same day.
  • Count wet diapers. Six or more a day is normal for an infant. Fewer than that, a sunken fontanel, no tears, and a dry mouth together mean dehydration.
  • Epiglottitis: the four D's are drooling, dysphagia, dysphonia, and distress. No tongue blade, no throat swab, no lying flat, keep the child in the parent's arms.
  • When a safety question gives you a choice between "supervise closely" and "remove the hazard entirely," the exam almost always wants the hazard removed. Supervision is not a safety plan for a toddler.

Related topics

FAQ

How many pediatric questions are on the NCLEX?

There is no fixed number. Pediatric content is spread across several categories, but most of it lands in Health Promotion and Maintenance, which makes up 6 to 12 percent of the exam. Expect a handful of child-focused items, often about vaccines, safety, and recognizing a sick infant.

Do I need to know the whole immunization schedule for the NCLEX?

You need the big landmarks, not every catch-up rule. Know what is given at birth, 2 months, and 12 months, which vaccines are live (MMR, varicella, rotavirus, nasal flu), and who should not receive live vaccines. Those three things answer nearly every vaccine question.

What is the most commonly tested pediatric emergency?

Epiglottitis shows up constantly because it has a clear "do not do this" rule (never inspect the throat) and a clear picture (tripod, drooling, stridor, high fever). Fever in a young infant and dehydration in a vomiting infant are the other two that appear again and again.

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