🩺 Introduction
Preparing for the NCLEX-RN or NCLEX-PN exam can be challenging, especially when it comes to Pediatric Nursing, where every question tests your understanding of child growth, disease management, and family-centered care. This complete guide — NCLEX Pediatric Nursing Questions and Answers — brings you 100+ carefully crafted MCQs with detailed rationales to help you master pediatric topics step by step.
Whether you’re a nursing student, a new graduate, or a re-taker, these free NCLEX-style pediatric questions cover real exam scenarios — from growth milestones and immunizations to congenital disorders, infection control, and pharmacology.
🌱 Why Pediatric Nursing Is Important for the NCLEX
Pediatric Nursing represents a significant portion of the NCLEX exam. Questions in this area evaluate your ability to:
- Assess and care for infants, toddlers, school-age children, and adolescents.
- Recognize early signs of distress or developmental delay.
- Educate parents on medication safety, nutrition, and home care.
- Apply therapeutic communication and prioritize safety interventions.
Success in Pediatric Nursing reflects your understanding of holistic care for children and families, which is why mastering these questions can greatly improve your NCLEX score.
🧠 How to Solve Pediatric NCLEX Questions Effectively
Here are a few quick strategies before you begin the quiz:
- Focus on Safety First: Always identify life-threatening symptoms before routine care.
- Think Developmentally: What’s normal for an infant isn’t normal for a toddler.
- Use the ABC Rule (Airway, Breathing, Circulation): Prioritize life-sustaining functions.
- Read Rationales Carefully: Even incorrect answers teach valuable lessons.
- Stay Calm and Systematic: Think like a nurse — apply assessment, diagnosis, planning, implementation, and evaluation.
📘 About This NCLEX Pediatric Nursing Practice Test
Goal: Strengthen your confidence before the real exam
Total Questions: 100
Question Type: Multiple Choice with Rationales
Difficulty: Moderate to Advanced
Source: Based on NCLEX-RN Test Plan
🧸 NCLEX Pediatric Nursing Practice Questions
Question 1:
A 4-year-old is scheduled for a tonsillectomy. Which preoperative instruction is most important for the nurse to give to the parents?
A. Stop giving the child solid food 4 hours before surgery.
B. The child should not eat or drink anything after midnight.
C. Encourage fluids up to 2 hours before the surgery.
D. Provide a light breakfast the morning of the surgery.
✅ Correct Answer: B. The child should not eat or drink anything after midnight.
💡 Rationale:
Children undergoing surgery should have nothing by mouth (NPO) after midnight to prevent aspiration during anesthesia. This is standard preoperative care.
Question 2:
A nurse is assessing a 9-month-old infant. Which developmental milestone is expected at this age?
A. Walks independently.
B. Says two-word sentences.
C. Sits without support.
D. Draws with a crayon.
✅ Correct Answer: C. Sits without support.
💡 Rationale:
By 9 months, most infants can sit independently, demonstrating improved motor control. Walking occurs closer to 12–15 months.
Question 3:
Which vaccine should a 2-month-old infant receive?
A. MMR
B. Varicella
C. DTaP
D. Influenza (live)
✅ Correct Answer: C. DTaP
💡 Rationale:
The DTaP (diphtheria, tetanus, and pertussis) vaccine is given at 2, 4, and 6 months. MMR and varicella are administered after 12 months.
Question 4:
A child with cystic fibrosis is admitted with a productive cough and thick sputum. What is the nurse’s priority intervention?
A. Restrict fluid intake.
B. Administer cough suppressants.
C. Perform chest physiotherapy.
D. Offer a low-sodium diet.
✅ Correct Answer: C. Perform chest physiotherapy.
💡 Rationale:
Chest physiotherapy helps loosen thick mucus and improve airway clearance — a cornerstone in cystic fibrosis management.
Question 5:
A nurse observes a toddler having a temper tantrum. What is the best response?
A. Ignore the behavior if the child is safe.
B. Scold the child immediately.
C. Offer a favorite toy to distract the child.
D. Pick up and comfort the child.
✅ Correct Answer: A. Ignore the behavior if the child is safe.
💡 Rationale:
Ignoring tantrums teaches toddlers that negative behavior doesn’t bring attention, promoting better emotional control.
Question 6:
The parent of a 3-year-old reports the child is fearful of the dark. What should the nurse recommend?
A. Ignore the fear.
B. Leave the lights on all night.
C. Provide a night light in the room.
D. Allow the child to sleep with the parents.
✅ Correct Answer: C. Provide a night light in the room.
💡 Rationale:
Preschoolers have vivid imaginations and often fear the dark; a night light provides reassurance without reinforcing dependency.
Question 7:
An 18-month-old is being evaluated for developmental delay. Which behavior indicates normal development?
A. Uses 4–6 words.
B. Walks up and down stairs alone.
C. Uses a spoon and cup.
D. Copies a triangle.
✅ Correct Answer: C. Uses a spoon and cup.
💡 Rationale:
By 18 months, toddlers typically can use a spoon and drink from a cup with some spilling — a normal fine motor milestone.
Question 8:
A 6-year-old with asthma is having difficulty breathing. Which medication should the nurse administer first?
A. Montelukast
B. Albuterol
C. Fluticasone
D. Prednisone
✅ Correct Answer: B. Albuterol
💡 Rationale:
Albuterol, a short-acting bronchodilator, provides rapid relief during acute asthma attacks. Others are for maintenance therapy.
Question 9:
Which instruction should the nurse give to the parent of a child with iron-deficiency anemia?
A. Give iron with milk.
B. Give iron on an empty stomach with juice.
C. Limit vitamin C intake.
D. Avoid dark stools.
✅ Correct Answer: B. Give iron on an empty stomach with juice.
💡 Rationale:
Iron is best absorbed with vitamin C (like orange juice). Milk interferes with absorption. Dark stools are normal.
Question 10:
A 12-year-old with type 1 diabetes becomes irritable, sweaty, and shaky during class. What should the nurse do first?
A. Administer insulin.
B. Offer a glass of juice.
C. Call the healthcare provider.
D. Have the child lie down.
✅ Correct Answer: B. Offer a glass of juice.
💡 Rationale:
Symptoms indicate hypoglycemia. Rapid-acting carbohydrates like juice should be given immediately.
Question 11:
A child is admitted with dehydration due to gastroenteritis. Which assessment finding requires immediate intervention?
A. Sunken eyes
B. Dry mucous membranes
C. Capillary refill of 5 seconds
D. Mild irritability
✅ Correct Answer: C. Capillary refill of 5 seconds
💡 Rationale:
A capillary refill greater than 3 seconds indicates poor perfusion and possible hypovolemic shock — requiring IV fluids immediately.
(Related: NCLEX MCQs Bank)
Question 12:
The nurse is teaching parents about safety for their 2-year-old. Which statement indicates the need for further teaching?
A. “We will keep medicines locked away.”
B. “We’ll store cleaning supplies on a high shelf.”
C. “We allow our child to play near the street if supervised.”
D. “We will use a car seat in the back seat.”
✅ Correct Answer: C. “We allow our child to play near the street if supervised.”
💡 Rationale:
Toddlers are impulsive and should never play near streets, even with supervision.
(Also read: NCLEX Fundamental of Nursing Questions)
Question 13:
Which toy is most appropriate for a 9-month-old infant?
A. Building blocks
B. Rattle or soft toy
C. Crayons and coloring book
D. Small puzzle pieces
✅ Correct Answer: B. Rattle or soft toy
💡 Rationale:
Infants at this stage enjoy toys that make noise or can be grasped; avoid small objects that could cause choking.
Question 14:
A nurse is caring for a 5-year-old hospitalized for pneumonia. Which activity is most appropriate?
A. Board games
B. Reading adult magazines
C. Watching news channels
D. Quiet rest only
✅ Correct Answer: A. Board games
💡 Rationale:
Preschoolers benefit from interactive and imaginative play such as board games, which aid social development during hospitalization.
Question 15:
A 7-year-old diagnosed with leukemia is receiving chemotherapy. Which finding should the nurse report immediately?
A. Hair loss
B. Nosebleed
C. Fatigue
D. Loss of appetite
✅ Correct Answer: B. Nosebleed
💡 Rationale:
A nosebleed may indicate thrombocytopenia (low platelets), a potentially serious chemotherapy side effect requiring prompt attention.
Question 16:
The nurse observes that a child with Down syndrome has a loud murmur. What should the nurse anticipate?
A. This is a normal finding.
B. It indicates a congenital heart defect.
C. It is caused by respiratory distress.
D. It is due to dehydration.
✅ Correct Answer: B. It indicates a congenital heart defect.
💡 Rationale:
Children with Down syndrome often have cardiac anomalies such as atrioventricular septal defects, which present as murmurs.
Question 17:
Which statement from a parent shows correct understanding of administering antibiotics to a child?
A. “I will stop the medicine when symptoms disappear.”
B. “I’ll give all doses even if my child feels better.”
C. “I’ll double the dose if my child misses one.”
D. “I’ll keep leftover medicine for next time.”
✅ Correct Answer: B. “I’ll give all doses even if my child feels better.”
💡 Rationale:
Finishing the full course prevents antibiotic resistance and recurrence of infection.
Question 18:
A 10-year-old reports feeling lonely after starting insulin therapy. What nursing intervention is best?
A. Discourage discussion of feelings.
B. Arrange a meeting with peers who have diabetes.
C. Increase parental supervision.
D. Reduce insulin dose.
✅ Correct Answer: B. Arrange a meeting with peers who have diabetes.
💡 Rationale:
Peer support helps school-age children accept chronic illness and promotes healthy self-management.
(Also see: NCLEX Diabetes Management Questions)
Question 19:
The nurse is preparing to administer an IM injection to a 3-year-old. Which site is most appropriate?
A. Deltoid
B. Vastus lateralis
C. Gluteus maximus
D. Abdomen
✅ Correct Answer: B. Vastus lateralis
💡 Rationale:
For toddlers, the vastus lateralis (thigh) is safest because it has a large muscle mass and fewer nerves.
Question 20:
A child with sickle cell anemia reports severe leg pain. What should the nurse do first?
A. Apply cold compresses.
B. Administer prescribed opioid.
C. Restrict fluids.
D. Encourage ambulation.
✅ Correct Answer: B. Administer prescribed opioid.
💡 Rationale:
Pain control and hydration are priorities in sickle cell crisis. Opioids are often required for effective relief.
Question 21:
Which symptom is most concerning in a child with acute epiglottitis?
A. Barking cough
B. Drooling and tripod position
C. Runny nose
D. Mild sore throat
✅ Correct Answer: B. Drooling and tripod position
💡 Rationale:
These are signs of airway obstruction—a medical emergency requiring immediate airway support and no throat examination.
Question 22:
A nurse is teaching a mother of a 4-year-old with nephrotic syndrome. Which statement indicates correct understanding?
A. “I should increase my child’s salt intake.”
B. “I will check daily weight and report sudden gain.”
C. “I’ll reduce fluid intake to half.”
D. “Protein foods should be avoided.”
✅ Correct Answer: B. “I will check daily weight and report sudden gain.”
💡 Rationale:
Daily weight helps monitor fluid retention, a key sign of nephrotic syndrome relapse.
Question 23:
A nurse is teaching parents about nutrition for a toddler. Which statement shows correct understanding?
A. “I’ll offer 3 large meals daily.”
B. “I’ll allow my child to feed independently with supervision.”
C. “I’ll punish if the child refuses food.”
D. “Snacks should be avoided.”
✅ Correct Answer: B. “I’ll allow my child to feed independently with supervision.”
💡 Rationale:
Encouraging self-feeding promotes autonomy and fine motor development during toddlerhood.
Question 24:
A nurse is evaluating growth of a 6-month-old. Which finding is normal?
A. Weight has doubled since birth.
B. Weight has tripled since birth.
C. Head circumference equals chest circumference.
D. No teeth have erupted.
✅ Correct Answer: A. Weight has doubled since birth.
💡 Rationale:
By 6 months, infants typically double birth weight and by 12 months, it triples.
Question 25:
The nurse observes a 3-year-old stacking blocks. This activity demonstrates which developmental milestone?
A. Fine motor skills
B. Gross motor skills
C. Cognitive reasoning
D. Social development
✅ Correct Answer: A. Fine motor skills
💡 Rationale:
Stacking blocks shows hand-eye coordination and fine motor control typical for preschoolers.
Question 26:
A nurse is caring for a 2-year-old with a diagnosis of otitis media. Which finding should prompt the nurse to notify the provider immediately?
A. Pulling at the affected ear
B. Crying during feeding
C. Drainage of clear fluid from the ear
D. Mild irritability
✅ Correct Answer: C. Drainage of clear fluid from the ear
💡 Rationale:
Clear or watery drainage may indicate cerebrospinal fluid (CSF) leak, a sign of tympanic membrane rupture—requires immediate medical evaluation.
Question 27:
A nurse provides teaching to parents of a child with asthma. Which statement indicates correct understanding?
A. “We’ll give the bronchodilator after the corticosteroid.”
B. “We’ll use the peak flow meter every morning before medications.”
C. “We’ll limit fluids to prevent mucus.”
D. “We’ll use the rescue inhaler only at bedtime.”
✅ Correct Answer: B. “We’ll use the peak flow meter every morning before medications.”
💡 Rationale:
Peak flow monitoring helps assess airway function before medication, allowing comparison with the child’s personal best.
(Also read: NCLEX endocrine MCQs)
Question 28:
A 4-year-old is admitted with acute lymphocytic leukemia. What is the priority nursing action?
A. Encourage high-protein diet
B. Avoid live vaccines
C. Allow visitors freely
D. Perform daily weight only
✅ Correct Answer: B. Avoid live vaccines
💡 Rationale:
Children on chemotherapy are immunocompromised; live vaccines like MMR and varicella are contraindicated.
Question 29:
A nurse is caring for a child with severe dehydration. Which IV fluid is initially used?
A. 0.9% Normal saline
B. 0.45% saline
C. 5% dextrose in water
D. Lactated Ringer’s with glucose
✅ Correct Answer: A. 0.9% Normal saline
💡 Rationale:
Isotonic fluids (NS) restore circulating volume quickly and are used for initial resuscitation.
(See also: NCLEX Fluid & Electrolytes Questions)
Question 30:
A child with cystic fibrosis is prescribed pancreatic enzymes. When should the nurse administer this medication?
A. Before meals
B. Between meals
C. At bedtime
D. Before physical activity
✅ Correct Answer: A. Before meals
💡 Rationale:
Pancreatic enzymes should be given before or with meals to help digest nutrients and prevent malabsorption.
Question 31:
A nurse assesses a 6-month-old infant. Which finding is most concerning?
A. Weight gain since last visit
B. Soft, flat fontanel
C. Absent Moro reflex
D. Head lag when pulled to sitting position
✅ Correct Answer: D. Head lag when pulled to sitting position
💡 Rationale:
By 6 months, head control should be steady; persistent head lag indicates developmental delay.
Question 32:
The nurse is caring for a child with diabetes insipidus. What is a priority nursing assessment?
A. Assess for bradycardia
B. Check urine specific gravity
C. Monitor blood glucose hourly
D. Evaluate for ketones in urine
✅ Correct Answer: B. Check urine specific gravity
💡 Rationale:
Low specific gravity (<1.005) confirms excessive water loss in diabetes insipidus.
Question 33:
A 3-year-old child refuses to take oral medication. What should the nurse do?
A. Mix the medication with milk or food.
B. Force the medication using a syringe.
C. Offer a choice of juice to mix it with.
D. Hide the medication completely in a meal.
✅ Correct Answer: C. Offer a choice of juice to mix it with.
💡 Rationale:
Giving limited choices gives toddlers a sense of control and reduces resistance.
Question 34:
A nurse is caring for a child with acute glomerulonephritis. Which finding is expected?
A. Hypotension
B. Hematuria
C. Polyuria
D. Weight loss
✅ Correct Answer: B. Hematuria
💡 Rationale:
Glomerulonephritis often presents with tea-colored urine, hypertension, and mild edema due to renal inflammation.
Question 35:
The nurse is teaching parents of a child with epilepsy. Which statement indicates understanding?
A. “We will stop medication if seizures stop for two weeks.”
B. “We will ensure our child wears a helmet during activities.”
C. “We will restrain our child during seizures.”
D. “We’ll skip a dose if our child is sleepy.”
✅ Correct Answer: B. “We will ensure our child wears a helmet during activities.”
💡 Rationale:
Safety is essential. Helmets prevent head injuries during seizures. Medications should never be skipped.
Question 36:
The nurse notes that a child with rheumatic fever has new murmurs. This may indicate:
A. Reversible inflammation
B. Valvular damage
C. Dehydration
D. Fluid overload
✅ Correct Answer: B. Valvular damage
💡 Rationale:
Carditis in rheumatic fever can cause permanent valve damage, leading to murmurs.
Question 37:
Which intervention is essential when caring for a child with nephrotic syndrome on corticosteroids?
A. Encourage high-sodium diet
B. Monitor for infection
C. Limit fluid intake to zero
D. Stop medication abruptly
✅ Correct Answer: B. Monitor for infection
💡 Rationale:
Steroids suppress immunity — infection risk is high. Teach families to avoid crowded places.
Question 38:
A nurse is teaching about iron supplementation for anemia. What should parents know?
A. Give with milk for better absorption.
B. Give on an empty stomach with juice.
C. Store iron in an open cabinet.
D. Expect black tarry stools as a sign of toxicity.
✅ Correct Answer: B. Give on an empty stomach with juice.
💡 Rationale:
Vitamin C (juice) enhances iron absorption. Milk inhibits absorption.
Question 39:
A child with asthma is prescribed albuterol (a bronchodilator). Which side effect is expected?
A. Bradycardia
B. Tremors and tachycardia
C. Drowsiness
D. Hypothermia
✅ Correct Answer: B. Tremors and tachycardia
💡 Rationale:
Albuterol stimulates beta-adrenergic receptors, causing increased heart rate and nervousness.
Question 40:
A 5-year-old is being treated for dehydration. Which parameter best indicates improvement?
A. Skin turgor remains poor
B. Weight gain of 1 kg in 24 hours
C. Capillary refill >3 seconds
D. Decreased urine output
✅ Correct Answer: B. Weight gain of 1 kg in 24 hours
💡 Rationale:
Regaining fluid volume reflects rehydration; 1 kg ≈ 1 liter of fluid gained.
Question 41:
A nurse observes a child with measles sitting alone. The nurse should:
A. Encourage group play
B. Place the child in airborne isolation
C. Remove isolation precautions
D. Allow unrestricted visitation
✅ Correct Answer: B. Place the child in airborne isolation
💡 Rationale:
Measles spreads via airborne transmission; strict isolation prevents outbreaks.
Question 42:
A nurse administers a vaccine to a 12-month-old. Which observation requires attention?
A. Mild redness at site
B. Fever of 38°C (100.4°F)
C. Persistent crying >3 hours
D. Temporary irritability
✅ Correct Answer: C. Persistent crying >3 hours
💡 Rationale:
Prolonged crying may indicate a serious reaction or neurologic irritability — report immediately.
Question 43:
A parent reports their child has been vomiting for 24 hours. The nurse should advise:
A. Give oral rehydration solution frequently
B. Offer soda and chips
C. Stop fluids until vomiting ceases
D. Use antiemetics without prescription
✅ Correct Answer: A. Give oral rehydration solution frequently
💡 Rationale:
Small, frequent amounts of ORS prevent dehydration in pediatric vomiting or diarrhea.
Question 44:
A 13-year-old with type 1 diabetes is found confused and sweating. What is the priority action?
A. Give insulin
B. Give orange juice or glucose
C. Start IV fluids
D. Allow the child to rest
✅ Correct Answer: B. Give orange juice or glucose
💡 Rationale:
Confusion + sweating = hypoglycemia. Immediate glucose prevents seizure or coma.
Question 45:
A nurse is teaching about toilet training for toddlers. Which advice is most appropriate?
A. Begin training at 6 months
B. Begin when the child shows readiness signs
C. Punish for accidents
D. Wake at night for training
✅ Correct Answer: B. Begin when the child shows readiness signs
💡 Rationale:
Children usually show readiness by 18–24 months, such as staying dry for 2 hours or expressing discomfort in wet diapers.
Question 46:
Which toy is most suitable for a hospitalized 10-year-old?
A. Rattle
B. Coloring book
C. Model-building kit
D. Teething ring
✅ Correct Answer: C. Model-building kit
💡 Rationale:
School-age children enjoy projects and problem-solving activities that develop coordination and creativity.
Question 47:
The nurse should suspect lead poisoning in a child with which symptom?
A. Hyperactivity
B. Developmental delay
C. Diarrhea
D. Tachycardia
✅ Correct Answer: B. Developmental delay
💡 Rationale:
Lead toxicity affects the nervous system, leading to learning problems and behavioral changes.
Question 48:
The nurse observes that a 3-year-old with autism avoids eye contact. The best nursing approach is to:
A. Force eye contact for communication.
B. Use brief, consistent, calm interactions.
C. Introduce new caregivers frequently.
D. Speak loudly and rapidly.
✅ Correct Answer: B. Use brief, consistent, calm interactions.
💡 Rationale:
Children with autism respond best to routine, predictability, and minimal sensory stimulation.
Question 49:
Which statement from a parent of a child with febrile seizures requires teaching?
A. “I’ll keep my child safe during a seizure.”
B. “I’ll place my child on the side.”
C. “I’ll give aspirin for fever.”
D. “I’ll monitor temperature regularly.”
✅ Correct Answer: C. “I’ll give aspirin for fever.”
💡 Rationale:
Aspirin is contraindicated in children due to risk of Reye’s syndrome. Use acetaminophen or ibuprofen instead.
Question 50:
A nurse is assessing an infant with respiratory distress syndrome (RDS). Which finding is most concerning?
A. Nasal flaring
B. Grunting
C. Cyanosis
D. Respiratory rate of 40/min
✅ Correct Answer: C. Cyanosis
💡 Rationale:
Cyanosis indicates inadequate oxygenation and possible worsening respiratory failure.
(See also: NCLEX Respiratory System MCQs)
51. A 2-year-old with croup is having inspiratory stridor and retractions. What is the priority nursing action?
A. Encourage oral fluids
B. Administer cough suppressant
C. Sit the child in a high Fowler’s position with humidified oxygen
D. Perform chest physiotherapy
✅ Correct Answer: C
Rationale: Sitting upright with humidified oxygen eases airway obstruction and promotes better breathing. Oral fluids and chest physiotherapy may worsen distress.
52. The nurse observes a child with sickle cell crisis crying in pain. What should be the first nursing action?
A. Offer fluids
B. Administer prescribed opioid analgesic
C. Apply cold compress
D. Restrict movement
✅ Correct Answer: B
Rationale: Pain relief using prescribed opioids is the priority in sickle cell crisis to prevent further hypoxia. Cold compresses can worsen vasoconstriction.
53. The nurse teaches parents about signs of dehydration in infants. Which finding is most concerning?
A. Slightly sunken fontanel
B. Tearless crying
C. Dry lips
D. No urine for 8 hours
✅ Correct Answer: D
Rationale: No urine output for over 6–8 hours indicates severe dehydration needing immediate evaluation.
54. A child with bacterial meningitis is placed on isolation. What type of precautions are required?
A. Contact precautions
B. Airborne precautions
C. Droplet precautions
D. Reverse isolation
✅ Correct Answer: C
Rationale: Meningitis caused by Neisseria meningitidis or Haemophilus influenzae requires droplet precautions to prevent transmission.
55. When giving oral digoxin to a child, the nurse should:
A. Mix it with formula
B. Repeat dose if vomiting occurs
C. Check apical pulse for 1 full minute
D. Give with a meal
✅ Correct Answer: C
Rationale: Always check apical pulse before administering digoxin. Hold the dose if the pulse is below the safe limit.
56. A school-age child with cystic fibrosis needs nutritional advice. Which recommendation is best?
A. Low-fat diet
B. High-calorie, high-protein diet
C. Restrict salt intake
D. Limit fluid intake
✅ Correct Answer: B
Rationale: Children with cystic fibrosis need extra calories and protein due to malabsorption and increased energy demands.
57. A nurse suspects epiglottitis in a 4-year-old. What action is contraindicated?
A. Assessing airway with a tongue depressor
B. Administering humidified oxygen
C. Keeping emergency tracheostomy set nearby
D. Allowing the child to sit in a position of comfort
✅ Correct Answer: A
Rationale: Using a tongue depressor can cause complete airway obstruction in epiglottitis.
58. The best time to administer pancreatic enzymes to a child with cystic fibrosis is:
A. At bedtime
B. Between meals
C. With meals and snacks
D. One hour before eating
✅ Correct Answer: C
Rationale: Enzymes are most effective when taken with meals to aid digestion.
59. Which vaccine should be delayed in a child with a weakened immune system?
A. DTaP
B. Hib
C. MMR
D. IPV
✅ Correct Answer: C
Rationale: MMR is a live vaccine and should be delayed in immunocompromised children.
60. A nurse is caring for a newborn with spina bifida. Which nursing intervention is most important?
A. Keep the infant supine
B. Cover the sac with a moist sterile dressing
C. Clean the area with iodine
D. Apply baby powder around the lesion
✅ Correct Answer: B
Rationale: Covering the sac with a moist sterile dressing prevents infection and keeps the area hydrated.
61. A 5-year-old receiving chemotherapy develops mouth ulcers. The nurse should recommend:
A. Alcohol-based mouthwash
B. Soft toothbrush
C. Lemon swabs
D. Frequent brushing
✅ Correct Answer: B
Rationale: A soft toothbrush reduces trauma to the oral mucosa. Alcohol or lemon-based products can irritate ulcers.
62. The nurse should instruct parents to call the physician immediately if a child with nephrotic syndrome:
A. Has foamy urine
B. Develops fever
C. Has periorbital edema
D. Feels tired
✅ Correct Answer: B
Rationale: Fever may indicate infection, which is a serious complication in nephrotic syndrome.
63. A 7-year-old with ADHD is starting methylphenidate (Ritalin). What should the nurse teach parents?
A. Give at bedtime
B. Skip doses on weekends
C. Monitor for decreased appetite and weight loss
D. Expect increased sleepiness
✅ Correct Answer: C
Rationale: Ritalin may cause appetite suppression; weight and growth should be monitored regularly.
64. A toddler with gastroenteritis is vomiting frequently. What is the best fluid to give at home?
A. Milk
B. Oral rehydration solution
C. Apple juice
D. Plain water
✅ Correct Answer: B
Rationale: ORS replaces lost electrolytes and prevents dehydration more effectively than plain fluids.
65. A nurse observes bruises on different parts of a 3-year-old’s body. The mother says the child “fell often.” What should the nurse do?
A. Document and monitor
B. Report suspicion of abuse immediately
C. Confront the mother directly
D. Ask the child privately
✅ Correct Answer: B
Rationale: Nurses are mandated reporters — they must report any suspicion of abuse to protect the child.
66. What should the nurse do when giving an IM injection to an infant?
A. Inject in the deltoid
B. Use the vastus lateralis muscle
C. Use a 1.5-inch needle
D. Inject rapidly
✅ Correct Answer: B
Rationale: The vastus lateralis is the safest site for IM injections in infants due to adequate muscle mass.
67. The nurse teaches parents about preventing sudden infant death syndrome (SIDS). Which instruction is correct?
A. Place the baby on the stomach to sleep
B. Use soft bedding
C. Keep the baby’s room cool and smoke-free
D. Co-sleep with parents
✅ Correct Answer: C
Rationale: A cool, smoke-free room and supine sleeping position reduce SIDS risk.
68. A child with a ventriculoperitoneal (VP) shunt shows irritability and vomiting. What should the nurse suspect?
A. Dehydration
B. Shunt infection or blockage
C. Normal post-op response
D. Constipation
✅ Correct Answer: B
Rationale: These are signs of increased intracranial pressure, indicating possible shunt malfunction.
69. A nurse is teaching parents of a child with phenylketonuria (PKU). What dietary instruction is most important?
A. Avoid high-fat foods
B. Restrict phenylalanine-rich foods like meat and dairy
C. Encourage nuts and legumes
D. Give regular milk
✅ Correct Answer: B
Rationale: Children with PKU must avoid foods high in phenylalanine to prevent neurological damage.
70. A nurse is giving post-op care to a child after a tonsillectomy. Which action is correct?
A. Offer red-colored fluids
B. Encourage coughing
C. Place the child in prone or side-lying position
D. Use straw for liquids
✅ Correct Answer: C
Rationale: The prone or side-lying position prevents aspiration and helps manage secretions.
71. A 10-year-old with type 1 diabetes is learning self-care. Which statement shows proper understanding?
A. “I will skip insulin if I don’t eat.”
B. “I will rotate injection sites each time.”
C. “I will store insulin in the freezer.”
D. “I will take extra insulin before exercise.”
✅ Correct Answer: B
Rationale: Rotating injection sites prevents lipodystrophy. Insulin should never be frozen or skipped; exercise usually lowers glucose, so extra insulin isn’t needed.
72. The nurse teaches a parent about using a metered-dose inhaler for a child with asthma. Which step is correct?
A. Inhale quickly and forcefully
B. Exhale immediately after puffing
C. Shake inhaler, exhale, then inhale slowly while pressing
D. Use inhaler without a spacer
✅ Correct Answer: C
Rationale: Slow, deep inhalation ensures proper delivery of medication to the lungs. A spacer is recommended for children to improve drug absorption.
73. A 4-year-old with nephrotic syndrome is on corticosteroid therapy. What side effect should parents watch for?
A. Weight loss
B. Increased susceptibility to infection
C. Hair loss
D. Excessive urination
✅ Correct Answer: B
Rationale: Corticosteroids suppress the immune system, increasing infection risk. Parents should report fever or sore throat immediately.
74. Which child should the nurse assess first?
A. A child with mild diarrhea
B. A child with asthma who is wheezing and retracting
C. A child with otitis media complaining of ear pain
D. A child with eczema scratching the skin
✅ Correct Answer: B
Rationale: Airway obstruction due to asthma is a priority. Wheezing and retractions indicate respiratory distress requiring immediate attention.
75. The nurse is providing safety teaching to parents of a 2-year-old. Which statement shows understanding?
A. “I’ll keep small toys within reach.”
B. “I’ll place medications on the top shelf.”
C. “I’ll use baby gates near stairs.”
D. “I’ll allow my child to play near electrical outlets.”
✅ Correct Answer: C
Rationale: Toddler injuries often occur due to falls. Installing baby gates is an effective preventive measure.
76. A 9-year-old receiving chemotherapy has a platelet count of 40,000/mm³. What nursing action is most appropriate?
A. Encourage contact sports
B. Use a soft toothbrush
C. Give intramuscular injections
D. Administer aspirin for pain
✅ Correct Answer: B
Rationale: Low platelets increase bleeding risk. A soft toothbrush minimizes gum injury; aspirin should be avoided as it affects clotting.
77. A nurse is caring for an infant with congenital heart disease. Which finding requires immediate attention?
A. Heart rate of 130 bpm
B. Slight irritability
C. Weight gain of 1 lb in a day
D. Occasional spit-up
✅ Correct Answer: C
Rationale: Rapid weight gain indicates fluid retention and possible heart failure in infants with cardiac conditions.
78. When caring for a child with a tracheostomy, what is the most important nursing priority?
A. Keeping suction equipment available
B. Changing the trach ties every hour
C. Feeding orally
D. Inflating the cuff frequently
✅ Correct Answer: A
Rationale: Suctioning maintains airway patency. Airway management is the top priority in tracheostomy care.
79. The nurse teaches parents about iron supplementation in toddlers. Which instruction is correct?
A. Give iron with milk
B. Administer iron with orange juice
C. Mix iron in cereal
D. Give iron after brushing teeth
✅ Correct Answer: B
Rationale: Vitamin C (orange juice) enhances iron absorption, while milk decreases it.
80. The nurse is caring for a 6-year-old with a new cast on the right arm. Which finding is most concerning?
A. Reports mild itching
B. Fingers are pale and cold
C. Slight swelling near cast edge
D. Reports dull ache
✅ Correct Answer: B
Rationale: Pale, cold fingers indicate circulatory compromise — a possible compartment syndrome — requiring immediate medical attention.
81. A mother asks about toilet training her 18-month-old. The nurse’s best response is:
A. “You can start now; most children are ready at 18 months.”
B. “Wait until your child shows readiness cues like staying dry for 2 hours.”
C. “Toilet training should begin by 1 year of age.”
D. “Use rewards after every attempt, ready or not.”
✅ Correct Answer: B
Rationale: Readiness cues include the ability to stay dry, follow simple directions, and show interest in the toilet. Forcing training early can cause resistance.
82. A 7-year-old with rheumatic fever is prescribed penicillin. What teaching is most important?
A. Stop medication once symptoms improve
B. Continue full course as prescribed
C. Give on an empty stomach only
D. Store in the freezer
✅ Correct Answer: B
Rationale: Completing the full course of antibiotics prevents recurrence of rheumatic fever and heart complications.
83. A child with a ventricular septal defect (VSD) presents with poor feeding and sweating during feeds. What should the nurse suspect?
A. Normal infant behavior
B. Congestive heart failure
C. Gastroesophageal reflux
D. Overfeeding
✅ Correct Answer: B
Rationale: Poor feeding and diaphoresis are signs of heart failure in infants with cardiac defects.
84. The nurse educates parents of a child with lead poisoning. Which food helps reduce lead absorption?
A. Foods rich in iron and calcium
B. High-fat foods
C. Sugary snacks
D. Processed foods
✅ Correct Answer: A
Rationale: Iron and calcium compete with lead for absorption sites in the body, reducing lead toxicity.
85. Which toy is safest for a hospitalized 10-month-old?
A. Small plastic blocks
B. Stuffed animal with buttons
C. Large, soft stacking rings
D. Toy with removable parts
✅ Correct Answer: C
Rationale: Infants need large, non-detachable, soft toys to avoid choking hazards.
86. A 5-year-old with acute lymphocytic leukemia (ALL) is on chemotherapy. Which precaution is most important?
A. Restrict visitors with infections.
B. Encourage outdoor play daily.
C. Use rectal thermometers for accuracy.
D. Provide live vaccines for immunity.
✅ Correct Answer: A
Rationale: Chemotherapy suppresses immunity. Anyone with infections must be restricted to prevent life-threatening illness.
87. The nurse teaches parents of a child with celiac disease. Which food should be avoided?
A. Rice
B. Corn
C. Oatmeal
D. Chicken
✅ Correct Answer: C
Rationale: Oatmeal (and other gluten-containing grains like wheat, barley, rye) should be avoided. Rice and corn are safe alternatives.
88. A 2-year-old is admitted with dehydration due to gastroenteritis. Which assessment finding is most concerning?
A. Sunken fontanel
B. Slightly dry lips
C. Frequent urination
D. Capillary refill <2 seconds
✅ Correct Answer: A
Rationale: A sunken fontanel indicates moderate to severe dehydration, requiring immediate rehydration therapy.
89. A 12-year-old with scoliosis is scheduled for spinal fusion. Postoperatively, which nursing intervention is a priority?
A. Encourage early ambulation.
B. Turn the child using the log-roll technique.
C. Place the child in a prone position.
D. Elevate the head of the bed 60 degrees.
✅ Correct Answer: B
Rationale: The log-roll technique maintains spinal alignment and prevents injury to the surgical site.
90. A 7-year-old with sickle cell crisis complains of severe pain. What is the nurse’s priority action?
A. Apply ice packs.
B. Administer prescribed opioid analgesic.
C. Encourage activity to distract from pain.
D. Restrict fluids.
✅ Correct Answer: B
Rationale: Pain in sickle cell crisis is caused by tissue ischemia; opioids are the treatment of choice, along with hydration and oxygen.
91. A child with epiglottitis is admitted. Which nursing action is most critical?
A. Examine the throat with a tongue depressor.
B. Obtain a throat culture.
C. Keep emergency airway equipment nearby.
D. Give oral fluids.
✅ Correct Answer: C
Rationale: Epiglottitis can cause sudden airway obstruction. Airway management equipment must be readily available at all times.
92. The nurse teaches a parent about preventing otitis media. Which statement shows understanding?
A. “I will bottle-feed my baby lying flat.”
B. “I will keep my baby’s immunizations up to date.”
C. “I will smoke outside the house only.”
D. “I will clean my baby’s ears with cotton swabs.”
✅ Correct Answer: B
Rationale: Immunizations, particularly pneumococcal and influenza vaccines, help prevent ear infections.
93. A 15-year-old reports feeling tired, has pale skin, and bruises easily. What should the nurse suspect?
A. Iron deficiency anemia
B. Acute lymphocytic leukemia
C. Dehydration
D. Hypoglycemia
✅ Correct Answer: B
Rationale: Fatigue, pallor, and bruising are signs of bone marrow suppression seen in leukemia.
94. A child with spina bifida is at high risk for which complication?
A. Respiratory distress
B. Latex allergy
C. Hearing loss
D. Liver enlargement
✅ Correct Answer: B
Rationale: Children with spina bifida often develop latex allergies due to frequent exposure during procedures.
95. The nurse is teaching a parent how to give ear drops to a 3-year-old. The correct method is:
A. Pull the pinna up and back.
B. Pull the pinna down and back.
C. Instill drops directly on the eardrum.
D. Hold the ear straight upward.
✅ Correct Answer: B
Rationale: For children under 3 years old, pull the pinna down and back to straighten the ear canal.
96. A 4-year-old with acute glomerulonephritis has blood pressure of 150/95 mmHg. What is the nurse’s priority?
A. Monitor intake and output.
B. Notify the healthcare provider immediately.
C. Encourage physical activity.
D. Increase fluid intake.
✅ Correct Answer: B
Rationale: Hypertension in glomerulonephritis can lead to seizures or heart failure — requires urgent medical management.
97. Which statement by a parent indicates understanding of care for a child with eczema (atopic dermatitis)?
A. “I’ll bathe my child daily in hot water.”
B. “I’ll apply moisturizer immediately after bathing.”
C. “I’ll use perfumed lotions to soothe the skin.”
D. “I’ll avoid all moisturizers.”
✅ Correct Answer: B
Rationale: Applying moisturizer immediately after bathing locks in moisture, preventing flare-ups. Hot water and perfumed lotions worsen symptoms.
98. A nurse is planning care for a child with Down syndrome. Which goal is most appropriate?
A. Promote independence in self-care.
B. Expect the child to meet all developmental milestones on time.
C. Limit social interactions.
D. Provide minimal stimulation.
✅ Correct Answer: A
Rationale: Children with Down syndrome should be encouraged toward independence within their ability level, promoting confidence and skill-building.
99. A nurse observes a 5-year-old hospitalized for pneumonia playing alone, talking to stuffed animals. Which type of play is this?
A. Parallel play
B. Solitary play
C. Cooperative play
D. Associative play
✅ Correct Answer: D
Rationale: Associative play involves interaction and imagination without rigid rules — typical for preschoolers.
100. A nurse is caring for a 1-month-old with pyloric stenosis. Which finding is most characteristic?
A. Projectile vomiting after feeding
B. Watery diarrhea
C. High-pitched cry
D. Jaundice
✅ Correct Answer: A
Rationale: Pyloric stenosis causes projectile vomiting due to gastric outlet obstruction, often leading to dehydration and weight loss.
🏁 Conclusion: Strengthen Your Pediatric Nursing Knowledge
Mastering pediatric nursing requires understanding growth, safety, and disease management across developmental stages. These 100 NCLEX Pediatric Nursing Questions with answers and rationales help you not only memorize facts but also apply critical thinking in real-world scenarios.
For deeper preparation:
- 🩺 Try our NCLEX Maternity Nursing Practice Test to review maternal and newborn care.
- 💊 Review NCLEX Medication Calculation Questions for dosage and accuracy mastery.
- 🧠 Don’t miss our NCLEX Mental Health Practice Test to strengthen psychiatric nursing understanding.